What is the purpose of counselling or psychotherapy?

Were you to ask a group of clinicians (counsellors or psychotherapists) to define the purpose of therapy , you will likely get a set of quite different answers based in a large part on the lens (modality) through which each clinician views mental health and their approach.  One would hope to find some degree of similarity between them, but ultimately, there seems to be no agreed upon objective apart from somehow ‘helping’ the client to feel better.  I see this as profoundly problematic.

It is a question that in my view is enormously ethical as surely, as psychotherapists, we have a duty to firstly do no harm, and secondly, to be of service to our patients?  If so, then what is the purpose of psychotherapy?

As psychotherapists, I would suggest we have to walk a line between holding a clinical diagnosis and being present with the patient’s experience; too much of a shift in either direction, and the ability to hold both the individual and their underlying psychic structure becomes lost.  We therefore need to have a clinical understanding of what is happening in the mind of the patient and to be able to work with this, whilst also remaining present with the patient’s moment-to-moment experience in the room – no mean feat!

Like any other clinician, I have my own lens – broadly psychoanalytic – through which I think about a patient’s mental state.  I am trained to work with the unconscious and thus believe in how past experiences and relational patterns repeat in the client’s experience of their lived experience in the present. Secondly, I believe that what has been damaged in relationship, can only be healed in relationship.

I am also heavily influenced by object relations theory, meaning the study of how a patient has internalised the relationship(s) with their primary caregiver(s) and then how this manifests in their relationship to themselves and their significant others.  However, not all clinicians believe in the unconscious (notably person-centred therapists) and not all work relationally.

Too much time and energy is taken up with the ongoing debate and argument about which approach and method is best.  Approaches to understanding a patient’s internal world are like languages – they often say something similar and in some cases can be literally translated but nonetheless, they also contain with them ‘cultural’ expressions and understandings that simply cannot be translated.  And where these cultural expressions form the bedrock of an approach, they can end up diverging significantly.  However, at their core they all seek to help patients make sense of their experience and aim to ‘help’, so where is the commonality?

I believe that perhaps it can at least in part be encapsulated by the following bullet points:

• To assist patients in becoming aware of their emotional state, so they can know when they are experiencing emotions;
• To assist patients in learning to express their emotions safely (to themselves and to others) using language (feelings), so they can become aware of and protect their personal boundaries;
• To work with patients in separating the past from the present on an emotional level, so that they can experience their emotional response to the world based on their present needs, rather than on past trauma being re-triggered and replayed;
• To teach patients to address their present and genuine needs – which will involve in turn them feeling satisfaction; frustration; and negotiating – as opposed to repressing –  their needs to protect an attachment.

Whilst I technically work within the realm of mental health, very little of my work is genuinely about any sort of psychiatric disorder; most of my patients are stuck in some way and have no learnt through adequate parenting how to feel, consider, contain and express their emotions in a healthy way.

Successful talking therapy depends on the patient-therapist relationship.  Relational trauma and damage occurred in their relationship(s) in early life and so it is only through relationship that this can be worked through.  The function of the relationship with our primary caregiver is firstly, once we step beyond the obvious physical needs, one in which we learn how to feel and navigate our emotions, and secondly, one in which we become aware of the emotions and mind of another – relationship.

Counseling and Therapy Help People Feel and Understand Themselves

Unless people are able to navigate their emotions, establishing any kind of genuine relationship that is stable and fulfilling becomes nigh on impossible.  The role of the therapist and thus therapy is, therefore, to help the patient become aware of what they are feeling, help them to differentiate between the past and the present (on an emotional/affect level) and to pendulate through their states of arousal without becoming overwhelmed.

Creating a Relationship the Patient Never Had

So perhaps ultimately the purpose of cpsychotherapy does go back to creating a relationship with the patient that they never had, so that through the therapeutic relationship they can learn to regulate their emotions in healthy ways.  From the therapist’s perspective, this is contingent on a careful and precise attunement to the patient’s emotional and nervous system, teaching them to know themselves first, so that it then becomes safe and thus possible to know themselves and the other in the capacity of a relationship.

Mark Vahrmeyer

Image credit: Sam Jahara