How does counselling or psychotherapy work?

I have written in depth about the differences in counselling and psychotherapy – the work and the training of the clinician.  So, for the sake of this blog, I will treat the terms as interchangeable, even though they employ vastly differing depths of work and skill.

How does counselling work? This question often comes up when we are contacted by people who know they need some help, but are unclear how “talking to a stranger” can help them.

Irrespective of a therapist’s modality of training (how a therapist works) – fundamentally, the success of the work is dependent on the quality of the therapeutic relationship and on how the therapist works within this relationship. The latter is extremely important and is often overlooked by less qualified therapists. More on this shortly.

What is the Therapeutic Relationship?

A relationship with your counsellor or psychotherapist is a unique relationship. In the early stages, it may feel a little odd. It is a relationship based on clear boundaries. You know when and where you will meet. You know where you will be sitting. You know that you will not go for a coffee with your therapist after the session. It is also a very intimate relationship where you will, in time, risk sharing thoughts, feelings and memories that are painful and difficult. You might not have shared these thoughts with anyone else before. Paradoxically, it is the boundaried nature of the therapeutic relationship that makes intimacy safe and possible, at least, with time.

So talking with a counsellor or psychotherapist is safe?

Yes and no. Safety in the shape of boundaries is important, indeed, it is vital. However, therapy should not be too safe.  For therapy to be effective, it needs to feel safe enough (which is part of building that therapeutic relationship), meaning that the therapist’s role is to  challenge appropriately from within the relationship.

Is it Simply Talking?

It may look like that at first glance, but significantly more is going on.  Therapists listen to the content of what the client brings, but perhaps more importantly they listen for the feelings behind the content. This is what makes therapy an intimate process, as we allow our vulnerability to be seen by another and validated.

Grieving

Talking is a way of giving shape, form and understanding to experiences. Through language, previous unprocessed experiences can be processed. I often think of the example of Eskimos and their 50 words for snow.  Leaving aside whether this is completely accurate, the principle stands; the Inuit people of North America have far more words for the different types of snow than the average British person. These differentiations in the types of snow enable the Inuit people to make sense of their surroundings and navigate safely.

By giving shape and form to our losses through language, we can start to process them and grieve.

Working in the Relationship

Returning to the concept of working in the relationship, this is where the skill of a good counsellor or psychotherapist comes into its own.  It means to form an authentic relationship with the client; to experience our own emotions in relation to the client and pick through what is theirs, what they are evoking in us and what is simply ours.  This is often summed up as working in the transference (see blog on transference).  It is a subtle, complex and ultimately transformative way of working whereby the therapist helps the client give shape, form and language to their losses which are played out in the relationship between the therapist and client: what remains unresolved in us is destined to be repeated.

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

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