The below essential elements of effective therapy are deeply rooted within my approach to therapy with my clients…
Although an unconventional word, non-pathologizing (therapy) views a person as greater than his or her problems. It does not mean problems do not exist; rather, it means one does NOT view the problems as the whole person. Working from the non-pathological perspective requires a shift in both the understanding and the approach to pathology.
Many of the issues people come to therapy for are not organic disorders—they are not hardware problems, they are software problems. These issues are the result of the person’s psyche doing the best it can to deal with life experiences—to adapt, survive, and prevent the person from future pain. Certainly, there are some “disorders” that are purely organic in etiology (meaning a hardware problem that is genetic, biochemical, or neurological), such as some forms and instances of psychotic and mood disorders, but these are the minority. However, the nonorganic problems people bring to therapy, which are often labeled as disorders, are actually very organized, normal, and systemic psychological reactions. Thus, the word ‘disorder’ is simply inadequate.
Therapists empower their clients and maintain the belief that people have the capacity for change and are equipped with the inner resources to do so. Therapy is based on the belief that people can heal if they want to and that they are able to contribute to their own growth. Unfortunately, there is a tendency, especially in medical model treatment environments, to view people as fundamentally flawed. When the therapist is able to see beyond a person's wounds and defenses, the client is more likely to discover his or her true nature.
The spirit of collaborative therapy is summarized in the words of Albert Schweitzer who wrote, "Each patient carries his own doctor inside him.... We are at our best when we give the doctor who resides within each patient a chance to go to work." Collaborative therapy is established when a therapist encourages a client to become the co-therapist. Therapists who work collaboratively trust people to know themselves (or have the potential to know themselves) better than anyone else, to access their own wisdom, and to attend to their wounds. This orientation puts the client in the driver's seat of therapy. Collaboration is not directionless, without expertise, nor does it put the client at risk of further trauma.
Self of the Therapist
Self is a state of being that a therapist can embody when with his or her clients. It is defined by Richard Schwartz, PhD, as a “state of calm, curiosity, compassion, creativity, confidence, courage, connectedness, and clarity.” Self is considered a requisite of an effective therapist because it is this state that allows him or her to work collaboratively without pushing, without pathologizing, without projecting and without re-traumatizing.
Beyond technique and theory is the realm of the therapist/client relationship: the ongoing human-to-human connection that provides the foundation for change. The relationship is the safe container that allows one to more fully and completely feel safe, to learn to trust and begin the process of change. Without a therapeutic relationship, there is no therapy.
Therapy often times needs to go deep. There seems to be a split in the mental health field between types of therapy that emphasize cognitive solutions and those that emphasize emotional healing. Both are important. Healing takes more than just insight about a problem, cognitive countering, and surface behavior change. To heal, we must explore the depth of the wounds that fuel false beliefs, feelings, and behaviors rather than turn away from, counter, or compensate for our suffering. When we turn away from our deeper wounds, we experience "more of the same," which often leads to more suffering. Also, healing requires feeling. As it is said, "If we can feel it, we can heal it." Many of our extreme beliefs, feelings, and behaviors are maintained because we have, in an effort to survive, avoided the painful wounds that lurk beneath. Effective therapy helps people to process and heal the deepest of wounds. Treating a client without going deep can be like stitching up a wound without taking the bullet out; the wound is more likely to remain sore, become infected, and require ongoing attention.
Understanding that even the process of therapy can be imperfect is useful when embarking on the journey of healing. No therapist is perfect, and no therapy can be provided perfectly, no matter how ideal a therapy may be in theory. And what a blessing it is that even the best therapy can be lined with areas of mistakes and challenges to the therapeutic relationship and yet still turn out good…like the saying goes “it’s not what happens TO you, it’s HOW you deal with it.” Imperfection is part of our daily lives, so the occurrence within the therapeutic process simply enriches the experience.
When we can’t help
As therapists, we are limited. We greet our clients with great hope. We have spent countless hours studying our trade, doing our own inner work, mastering our technique, and learning to "be" with our clients. We are compelled to help others release burdens and cope with suffering because we know how good it feels to do so. Yet, there are times we can't help. We believe a good therapist never gives up hope that a person can heal in this lifetime, but we also recognize that he or she may not be the one to help, that the time may not be right, or that this particular client may not be ready. It is our honor (and duty), however, to walk side by side with the client in order to find a more suited professional, create a space to explore the roadblocks together and/or to keep the door open and welcome the client back when he or she is ready.
Content adapted from Noah Rubinstein, LMFT