“What is therapy?”

Have you attempted to answer this inquiry? After working in the field for more than 15 years, I’ve discovered how some clients walk into my office with a mixture of beliefs regarding therapy. It’s possible that you, too, might need to clarify for your clients accurate versus distorted facts about therapy.

Let’s settle the record.

Psychotherapy is a professional, yet personal, relationship which offers necessary help for the client.

When it comes to doing therapy, an impressive grasp of psychological concepts alone is insufficient. The same goes for tremendous clinical skills. Unless you understand the nature of psychotherapy, it would be difficult for you to explain it to someone else. So, let’s unpack this brief definition.

Therapy Is Professional

For starters, zero in on the first part of the definition: psychotherapy is a professional service. The professional part of therapy distinguishes this activity from similar services. The set of laws and ethical codes which govern our field ensures only the qualified are allowed to provide psychotherapy.

Psychological treatment, including therapy, is the product of years of higher education and post-graduate training—in psychological science, theories, techniques, treatment delivery, as well as law and ethics, to name a few.

Therapy’s professional nature also creates a safe space for clients to share their most intimate secrets with their therapists. Confidentiality and privacy are twin hallmarks of psychotherapy, protecting not only our clients’ identities, but also the content of their sessions.

Therapy Is Personal

How about the next key word—personal? Therapy is personal in that we, as therapists, bring in our entire personhood to the counseling hour. The personality you own, the way in which your mind works, as well as your life experiences, all enrich the therapy you provide.

My first job in the field of psychology was for a psychoanalyst in a prosperous private practice. I’ll never forget him for a variety of reasons, including because he embraced the risk inherent in hiring a green grad student to be his psychological assistant.

This seasoned analyst imparted invaluable lessons about how to be a therapist. One gem in particular fits our topic, but let me first share the backstory. This perceptive man noticed the tension I carried whenever I walked into the office. As a newbie, I strove to eliminate mistakes while simultaneously fighting off feelings of inadequacy. This internal war only made me appear uptight to clients.

The doctor then juxtaposed how cold I appeared when carrying out my professional role with the warmth he encountered when he and I interacted in a personal capacity. Even more importantly, he gave me permission to allow my natural personality to seep into my work.

The more in touch we are with ourselves, the more at ease our clients will become. This is why therapy is so personal.

Therapy Is A Relationship

Whether you’re a diligent student of a particular modality, such as cognitive-behavioral therapy emotion-focused therapy, or whether there isn’t yet a theory you feel at home with, research is unambiguous: the strength of our relationship with our clients predicts the success of their therapy outcomes [1].

That’s because therapy works based on our relationship with our clients. This means you’d be hard-pressed to continue providing therapy for anyone you can barely tolerate. Remember my first boss, the psychoanalyst? He taught me the importance of finding ways to regard my clients in a positive light. Unless this happened, he warned, I wouldn’t be able to retain that client.

I’ve since learned that there is a myriad of reasons why clients would stop working with us. (Some of these factors might have very little to do with the therapist. For instance, clients who are most likely to terminate prematurely tend to be in their 20s, seeking therapy for personality disorders, or for eating disorders [2]). However, I’ve also seen his clinical wisdom in action, over and over again.

Nurturing a solid relationship with clients is at the heart of therapy.

Therapy Provides Necessary Help

What type of help do psychotherapists offer? Specific answers vary, depending on the therapist you ask. However, most therapists would agree that the nature of help covers mental and/or emotional realm. This includes symptoms of clinical impairment like depression, anxiety, or any mental disorder within the DSM-5, as well as stressful life circumstances without a formal diagnosis—like life after loss, how to raise a strong-willed tween, or coping with unwanted singleness.

Notice that we can only help our clients when two conditions are met: first, when the help they need is something we can give, and second, when the help we offer is something they consent to receive. Because of these principles, for instance, giving spiritual counsel falls outside the proper boundaries of psychotherapy. I have had to refer clients to clergy because the only topics they wanted to cover were religious in nature.

Likewise, we don’t have the right to offer our clients unsolicited help. If a client feels resentful because her narcissistic partner keeps overlooking her needs, but says nothing about leaving the relationship, we have no basis to prescribe such a move.

Therapy Is For the Client

The client of the hour deserves our focus. Unceasingly and unwaveringly. That is, we owe the client we’re sitting with our entire attention, from the start of session to its finish, every time we meet. Always.

Notice the phrase in the previous paragraph—“the client of the hour.” No matter how many clients we see on any given day, we have to laser-focus our attention on the client sitting across the room from us.

This specific aim also means no client ever has to see pictures of our cute poodle or hear about how devastated we were when someone in our life dies. First off, certain theoretical orientations — such as those under the psychodynamic umbrella — may frown on disclosing facts about ourselves. But even if your favorite theory (or supervisor) permits self-disclosure, it’s important to ponder the purpose of sharing any personal detail about yourself. If it doesn’t further your treatment plan, it doesn’t deserve air time.

The opposite scenario also holds true. Because therapy is for the client, he or she has no obligations to reciprocate the amount of attention we lavish on them by checking in with us about our weekend or to hand us any gift for any reason.

I got the chance to practice the last part when, at the end of a session, a client pitched me a question. Did I want anything from Hawaii, where he was headed for work? I smiled and said no. Refusing to back down, however, the client upped the ante by mentioning macadamia nuts, which he claimed “everyone” seemed to favor.

Giving in would’ve been a breeze. How could surrendering to small sugary snacks hurt anything? Then again, why accept the gift and shift the nature of our relationship to where my client weren’t the only beneficiary?

Because we’re therapists, our job is to be there for our clients. Exclusively. No client is under the obligation to take turns and care for us or our sweet tooth. Ever.

Thinking about what therapy meant caused me to, once again, smile and decline his offer.

References

[1] Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training, 38(4), 357–361.

[2] Chamberlin, J. (2015). Are your clients leaving too soon? APA Monitor, 46 (4), 60.

Interested in more writing from Dr. Davidheiser? Check out 6 Ways to Build a Strong Professional Foundation as a Therapist in Training.