What is the purpose of counselling or psychotherapy?

Ask 100 counsellors and psychotherapists what the purpose is of therapy and you will likely get 100 different answers.  One would hope there was some similarity between them, but ultimately, there seems to be no agreed upon objective apart from somehow ‘helping’ the client to feel better.

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

As psychotherapists, I would suggest we have to walk a line between clinical diagnosis and being present with the client’s experience; too much of a shift in either direction, and the ability to both hold the individual and their underlying psychic structure becomes lost.  However this still does not provide an effective roadmap for treatment.

Recently I was re-reading ‘When The Body Says No, Exploring the Stress-Disease Connection’ by Gabor Mate, which appeals to me greatly as a clinician who works with terminal patients and their relatives within a palliative care context.  Like me, Dr. Mate sees most psychological conditions arising from trauma and stress and that these symptoms manifest in the body when the client or patient is unable to access their emotions – either because they don’t know how or because they believe that to do so is wrong or dangerous.

This brought me back to the question of the ultimate purpose of therapy and I believe that perhaps it can in part be encapsulated by the following bulletpoints adapted from Dr. Mate’s book:

• To assist clients in becoming aware of their emotional state, so they can know when they are experiencing stress;

• To assist clients in learning to express their emotions safely (to themselves and to others), so they can become aware of and protect their personal boundaries;

• To work with clients 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 clients 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.

Dr Mate suggests that in the absence of an ability to flow with our emotional state in the ‘here-and-now’ we experience emotional stress, which can in turn leaves us stuck.  I tend to agree with him.  And the effects can be physically devastating as well as emotionally crippling.

Successful talking therapy (and I would suggest somatic therapy too) relies on the client – therapist relationship.  However, unless the client is able to navigate their emotions, establishing any kind of genuine relationship becomes nigh on impossible.  Quite simply, unless the client is aware of what they are feeling, able to detach the past from the present and pendulate through their states of arousal, therapy will not work, as their social engagement system cannot be activated – they are in fight, flight or freeze mode (quite often freeze).  And for the client to do this, their therapist needs to be able to do so first!

So, perhaps the purpose of therapy does go back to creating the relationship with the client that they never had.  However, how this is done relies on a careful and precise attunement to the client’s emotional and nervous system, teaching them to know themselves first, so that it then becomes safe and thus possible to know themselves in the capacity of a relationship and then finally to know the other.  Good mental health relies on good emotional health and these correlate with good physical health.

Our next blog will focus on therapist self-care, which I would argue is any counsellor or psychotherapist’s fundamental responsibility if they are to teach clients to listen to their own emotions.

Mark Vahrmeyer

Image credit: Sam Jahara