How Does Therapy Work? Pt. 2

Aaron has already provided an excellent summary of why therapy works, but it’s interesting to ponder exactly what makes the clinical setting of a trained therapist and an anonymous client so special. Don’t empathetic friends, wise parents or experienced clergy provide the same sort of services for free? Why insist that the therapist and client not share relationship outside the counseling office if all people need is a healing relationship? Is there something about this more formal setting that does what other healthy relationships can’t do?

These are good questions, because they notice something absolutely essential to mental and emotional healing – namely empathetic relationships. But they also reveal that there must be something about the clinical setting that accomplishes what these other relationships can’t. And I would suggest that this element goes beyond the expertise of the therapist, though that too is a factor.

The clinical relationship is characterized by what some psychologists call “containment.” Containment is a way of describing a sort of psychological laboratory set apart from every other relationship and obligation in your life. It is the creation of a relational space capable of holding all of your thoughts, feelings and judgments without overwhelming the “other” in the room. In that space you are free to work out an understanding of yourself and your life without the relational consequences that take place in every other sphere of your life. But this is not just about “venting” – it’s about the ways that you replay and re-enact aspects of significant relationships outside the counseling room in the process of relating to your therapist (a dynamic known as “transference”). You reveal wounds, insecurities, patterns of thinking and acting that have taken place across your lifespan. By becoming curious about these aspects of yourself and examining them with your therapist, you open the opportunity for healing by receiving the empathy that you needed in those moments. It opens the possibility of carrying the insight you possess now back into those moments where you could have used them. By working through these things with your therapist, you construct the insight and experience of these new patterns of thinking, feeling and relating and take them back into your life with you.

Of course not all therapy is as involved as the emotional and relational repair described above. Sometimes the issues that you bring into the counseling room requires help that’s less emotional and more practical. But even in those cases, the freedom to experiment, try and fail, reevaluate and try again is protected by the containment of a clinical space. It’s intentionally separated from all the other spheres of your life, where people’s advice tends to be tied up in their own stories, so that your therapist can help draw your own desires, goals, strengths and wisdom out of you.

The clinical relationship is a real relationship. It’s an empathetic relationship, even a kind of intimate one. But it is unlike the other relationships in your life because of this containment – and for that reason it carries a unique power to heal.

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