How Does Psychotherapy Work and What Leads to Lasting Change?

From time to time the question will arise, how does psychotherapy work, or, how is therapy going to help me? The goal of this brief commentary is to look at two quotes that nicely capture, in my opinion, that which leads to symptom improvement. I will attempt to integrate these two quotes into my way of thinking about the mutative process.

In part, that which is curative in a treatment depends on a number of factors, all of which are unique to each individual patient.  What works with one anxious or depressed patient is not necessarily going to be helpful with another patient who presents with similar problems. There are several different types of anxiety and depression, (click here for different types of depression) each of which requires a different treatment approach. In my practice, to design effective treatment techniques, I first need to assess and understand, for instance, how one functions in different areas of life, the nature of and satisfaction or dissatisfaction in interpersonal relations, the capacity to tolerate frustration and delay gratification of destructive pleasures and gratifications, weaknesses in the sense of self, what did the early upbringing look like with significant caregivers, was there love, how much trauma was present, and were there supportive or damaging care takers in the individual’s formative years.

I have recently been impressed with a few non-psychoanalytic authors who described the therapeutic process in a way that is quite similar to the way I think and work in my practice. Here is what one of them had to say:

“If a new result is to have any value, it must unite elements long since known, but till then scattered and seemingly foreign to each other, and suddenly introduce order where the appearance of disorder reigned .. not only is the new fact valuable on its own account, but it alone gives a value to the old facts it unites..” (H. Poicare)

  1. Poicare is describing, what in my mind, would be known as “insight.” In my practice, with certain patients, I help them acquire insight into their problems, or stated more concisely, into that which is driving their problems and keeping the symptoms of depression and anxiety alive. This insight brings order into what previously was too complex to understand, and this is one of the factors that leads to lasting change.

One’s early upbringing, in my opinion, shapes, for better or worse, who we are today. While what is happening in the present is incredibly valuable, and occupies a large part of the space and the process in psychotherapy treatment, there is also value, George Orwell tells us, in giving voice to and thinking about past events and relationships. George Orwell makes this clear in his novel, “1984.”

“Who controls the past controls the future; who controls the present controls the past”

When the past is not peacefully put to rest, we are prisoners of our early, and oftentimes, conflictual early relationships. The goal is to bring the past to light, put words to and develop a capacity to think about early traumatic events that remain undigested and poorly metabolized. Success in therapy includes an increased capacity to both control the present (emotions), look back and think about one’s history, and finally to understand it in a meaningful and new way.  The goal is to put you in control of the past, as Orwell tells us, so you can control the future!

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