How Therapy Works: 3 Key Ingredients

3 Key Ingredients in Effective Therapy

As a therapist, one of the most frequent questions I’m asked is, “How does therapy work?”

No doubt, therapy is an incredibly complex endeavor. But it is often seen as mysterious.

Here, I hope to demystify some of the process. 

Therapy is unique to every individual, every therapist, and every session. However, there are factors that many therapists believe are essential ingredients in the process.

You’ve seen psychotherapists in the movies. Movie therapists are often depicted as cold and robotic. You see the (usually male) therapist sit back in their mid-century modern lounge chair and eye his patient in silence. There is a vague, knowing look in the eye of the therapist that seems to throw the patient into some sort of frenzy. The client begins to feel flustered and then defensive. The patient begins rambling, arguing with the therapist, or just sits in uncomfortable silence.

Therapists are often depicted as cold, robotic, on some sort of power trip, and pretty old school. The aforementioned therapist is likely a good fit for some people, but definitely not for everyone.

While I’ve certainly met these therapists, we’re not all like that. In fact, many are warm, engaging, and have a modern approach to therapy. 

To benefit the most from therapy, it’s imperative that you find a therapist you click with.

This brings us to the first and most critical aspect of therapy:

1. The Therapeutic Relationship

Research shows the relationship between a therapist and their client is, in and of itself, the most important factor in therapy.

Why the therapeutic relationship matters:

Many individuals who seek therapy do so because of issues that have been created from unhealthy relationship dynamics from their past. Problematic relationship dynamics may have included:

• rejection
• unrealistic expectations
• emotional or physical neglect
• emotional or physical abuse 
• blurred boundaries and roles 
• overbearing or unreliable caretakers, and so on.

The therapist, however, engages the client in a new, healthy relationship. 

In therapy, the client is welcomed and encouraged to express themselves authentically, to show their true feelings, and explore their truest thoughts – fears, desires, and pain- out loud. The client can show their best selves and their worst selves. They can share their struggles or what they perceive to be “failures,” and they can freely  “brag” or acknowledge their wins.

And in doing so, find that they are met with understanding and acceptance.

A good therapeutic relationship should provide all of this.

How the therapeutic relationship heals:

Regular exposure to acceptance, understanding, and genuine care is healing. Unhealthy relationships often taint the narrative we have of ourselves and others. We begin to perceive ourselves and the world around us in a subjective way that doesn’t reflect objective reality.

A healthy therapeutic relationship then becomes a means by which we shift our problematic thoughts about ourselves and behaviors in our relationships. The therapeutic relationship serves as a  model to base other healthy relationships on the outside of the therapy room.

Interestingly, many individuals who experience problematic relationship patterns do so in a subconscious attempt to heal past wounds. Because the therapeutic relationship is healthy, it can disrupt the unhealthy pattern.

Boundaries are another important aspect in the therapeutic relationship. The therapist’s job is to set and model good boundaries. Therapist boundaries include, but are not limited to:

• Touch
• Transference
• Dual relationships
• Conflicts of interest
• Practice policies
• Privacy & confidentiality
• Contact outside of the office
• Time limits for therapy sessions
• Avoiding social media interaction with clients

Therapists also “hold space” and provide support for their clients, which are powerful healing factors in therapy. There is enormous power in holding space for a person to process through their pain without rushing them through it or trying to fix it for them. Therapists are trained in effective ways to hold space and support clients.

If your therapist does not provide this kind of relationship or if they do not practice good boundaries, it may be best to find a better fit.

2. Insight & awareness

In The Role of Insight in Psychotherapy, Dr. Reid and Dr. Finesinger (source) write, “Our hindsight is proverbial better than our foresight, but our insight is no doubt worse than either.” 

Insight and awareness in therapy includes obtaining an understanding of the self, the contextual factors, the situation, the problem and goals. It is to have objective knowledge of your personhood and your problems.

The process of gaining insight and awareness begins in the first session of therapy and continues throughout.

Why insight matters:

It has been argued that there is no change without insight or self-awareness. You need to see the problem before you can change the problem.

Awareness of the self and insight into the problem are important in therapy as it allows the client to present their thoughts, feelings, and biases to the therapist. The therapist can then assist the client by reflecting, questioning, challenging, or guiding them in the direction they seek to grow.  

How insight leads to change:

Sometimes clients begin therapy before they have much self-awareness or insight. They just know that they are hurting and that their relationships could be better. 

And that is ok. 

Therapists aim to meet their clients where they are and work with what they bring to therapy. It’s quite common to start with little insight or awareness of the person or the problem. Even if this is the case, great progress can still be made. 

The more awareness one has into themselves, their problems, and the related factors, the more they begin to understand their lives and can make a more informed decision as to how to progress forward. 

As a client increases in introspection and insight, they develop the skill of self-observation. With the ability to observe the self, is the freedom to choose one’s actions.

3. Interventions

Therapists are trained to provide tailored interventions that you cannot get from a book, an article, or a podcast. While these resources can be incredibly valuable, they are generally offered to a wide audience. Individual therapy is tailored just for you. You are a unique individual and your therapist should tailor treatment that honors your uniqueness.

Licensed therapists have received many years of higher education and have been supervised through thousands of hours of practice. They are required to obtain continuing education, and they have been trained in evidence-based treatment approaches. 

These approaches include various interventions. Therapeutic interventions include the model or method of treatment and the assumptions behind it.

The interventions your therapist will use varies according to different factors. These factors include the therapist’s theory of change, therapeutic modality, and assessment of your needs.

Common interventions in therapy include making reflections, asking questions, challenging problematic thoughts, facilitating processing, modeling, and skills training. 

TLDR

3 key ingredients for effective therapy include the therapeutic relationship, insight, and interventions. There are many other factors that may contribute to effective therapy, however, the single most important is that you find a therapist you click with.

To find a therapist you click with, it is important to schedule a free consult before your first session. You’ll want to get an idea of what it feels like to work with the therapist and hear about their approach to therapy. If you’re in the Frisco Tx area or anywhere throughout Texas and would like to work together, you can schedule a free consultation here.