What is Happening in the Therapy Room?

What is Happening in the Therapy Room?

Photo by Finn on Unsplash

I've noticed a trend in the type of therapy inquiries I've been getting. While the presenting issues may be same as they ever were, I'm finding more and more people saying they're looking for a more relational approach or they're ready to dig deeper than they've been able to with other therapists. Search "bad therapy" on tiktok and get ready to hear hundreds if not thousands of disappointing stories about dismissive mental health "professionals." I'm not sure if that's an indication of how bad the training programs are these days or if maybe most therapists never actually get good therapy themselves, which is what I think is a huge component of being a good therapist.  

Time and time again, I'm hearing clients say that a therapist terminated with them because the therapist thinks the client "seems fine." That is like going into a doctor's office with a list of complaints you don't understand and the doctor saying "well, you look healthy." If a person continues to show up in my office, despite whatever my projections are about their situation, I generally assume that there's a reason they continue to be there. If I'm truly stumped on that reason, I address it, and make sure they are getting something out of the process, and re-evaluate the treatment goals.

Sometimes, the "therapy" is actually quite simple. Sometimes it's really just that the person is creating this space for themselves once a week and they are getting comfortable bringing their full selves to that hour. Sometimes the "therapy" is simply talking to another human being. Sometimes it's the client showing up in ways they never have, and sometimes it's simply the relationship we have with each other in that room. If we get too hung up on what should happen in the treatment room, we might miss the progress that is actually happening.

Therapists should be able to sit with the ambivalence people have about change, with enough curiosity to get past the defenses people have that are masquerading the real reason they are there (which sometimes takes a while to figure out). As Jonathan Shedler put it "Patients do not come to therapy to change. They may say and think they want to change. It soon becomes evident they want to continue being exactly the person they have been and living life in the same self-limiting ways, but feel better doing it." Shedler posits that real therapy may begin with the disappointment that no one else can give patients the feeling they're looking for and that they must become different, which is a hard reality, but one that needs to be accepted in order to develop a sense of realistic hope for the therapy process.

I think a lot of therapy stalls out because too many therapists collude with the magic bullet thinking. Even therapists can fall prey to the illusion that if you just follow a protocol of a few well kept secret steps, you'll be better. I find that infantilizing. Mental health is not about following a certain set of steps that you can easily google. It's about developing insight into your specific situation that allows you to understand your heart and your mind in ways that might awaken you to new thoughts, behaviors, and actions that better serve you.