MIND MOVES: The experience of psychotherapy is a deeply personal one for both the client and the practitioner.
Two strangers meet by arrangement. Their purpose: to wrestle with life itself; their goal: to recapture for one of them a meaning and a sense of being alive that has been lost, to shake loose the chains of depression and fear, some deadness that has taken hold on the soul and frozen over the energy for living.
There are risks involved; the risk of trusting another human being, perhaps for the very first time, and exposing yourself to dreaded judgment and shame; the likelihood that one or both of you will encounter memories and previously untold stories filled with intense pain and loneliness.
The outcome is unknown, the path of recovery often marred by setbacks and reversals. The only certainty is that by persisting with the struggle to forge trust and to explore where life's energy has become tangled and stuck, both client and therapist will be changed in the process.
The hope is that the client can become disentangled and lay claim to a greater sense of freedom and self-dignity. To rewrite a sad and tired old script and discover possibilities for a more vibrant and self-determined existence.
Psychotherapy offers a range of interventions, not least the experience of the relationship with the therapist, that are designed to empower the client to understand, transform and cope with the specific vulnerabilities and problems that give rise to their mental health difficulties.
Different terms are used to label therapy, including counselling, psychotherapy and psychoanalysis. These terms generally imply different timeframes within which the work of healing is carried out.
Counselling is often the preferred term for a brief intervention with an individual who presents in a crisis, usually precipitated by some specific challenging event in their life, eg a career disappointment, a bereavement, a medical illness. The opportunity to talk to someone in confidence can support them through the crisis and show them how they can resource themselves in the face of it.
Psychotherapy refers to a wide range of interventions and programmes that target difficulties which by their nature tend to be more complex and recurrent, eg anxiety disorders, depression, low self-esteem, post-traumatic stress disorder. These problems often reflect developmental difficulties, painful childhood experiences, which continue to exert a negative impact on relationships with self and others.
Psychotherapy may be structured or unstructured, and may be time-limited or extended over a number of years; it can take place in a one-to-one, family or group context, and relies most importantly for its effectiveness on the quality of the relationship that evolves between the therapist and the client.
Psychodynamic and psychoanalytic therapies are concerned with conflicts that underlie recurrent mental health problems. These underlying psychic knots can require time to access and resolve. More often, they are isolated and identified through watching the way they are re-enacted in a person's relationships over and over again.
An extended timeframe, and a particular focus on the way the client-therapist relationship structures itself, characterise the many diverse approaches that are included in this category.
Matching someone with a particular therapist and the particular approach that will most likely benefit them can be difficult. People differ in their preferences: some may opt for someone who is interactive and structured in their approach, others favour a practitioner whose style is unstructured and who may prefer silent facilitation. People also differ in their readiness - and need - to engage in deep exploration of their problems as opposed to focusing on some specific difficulty and learning how to cope with it. The profession of psychotherapy is marked by debate between different schools who claim superior outcome for their particular approach.
Research has repeatedly identified the following elements as the most critical factors that predict a successful outcome in psychotherapy: the resources of the client and the quality of their relationship with the therapist. Specific therapeutic techniques can be very helpful to the process but they are of limited value if they are not attuned to the client's need and readiness to engage with them.
If you're about to engage in psychotherapy, it's important that you know you have every right to ask a psychotherapist about how they work and what they believe to be most important in facilitating change in a person's emotional life. Seasoned therapists are generally open to discussing with you what approach may be best suited to your needs. Key questions you should ask yourself so you can be sure you're in the right place include: "Is this someone I feel I can be completely honest and real with?"; "Do I experience warmth from this person, do I feel accepted by them?"; "Do I feel this person understands the problems I can put into words and the problems I can't seem to find words for?"
If the answer to these questions is yes, you may well be in safe hands. If the answer is no, listen to your own intuitions and discuss with the therapist the wisdom of continuing with them. It's your life after all, and your commitment to a course of psychotherapy may, and should be, a life-changing experience.
Tony Bates is clinical principal psychologist at St James's Hospital, Dublin.
