How does psychotherapy work ?

I went to see a psychotherapist once it was clear I was not going to make it on my own. And by “make it”, what I really mean is being able to live my life. I waited until I had no other option partly because I did not know how it would work.

Giving access to my inner world to someone else, without understanding what would happen, was terrifying.

I had found my therapist in the phone book, which is admittedly not the best way to do it. At the time the main trend in my country was the psychoanalytical theory. So what I imagined was lying on a couch with a therapist sitting behind me, who would not say a word while I would be going on and on about my past.

Understandably, the idea made me want to run away. I was so relieved when I saw there was no couch and my therapist did not particularly expect me to talk about the past.

Apart from that, she did not have a clue as how to help me, and the therapy went nowhere. Honestly, no benefit at all. After a couple of months of me being mostly confused, she moved to another country and let me in the care of a male, more experienced therapist.

I was petrified at the idea of spending an hour a week alone with this unknown guy, but I gave it a try because it was still my last hope. I think he also did not know how to help a child sexual abuse survivor, but still, with time he managed to reconcile me with the male half of humankind. He also got me to a perfectible but better relationship with myself. All in all, no small result.

Since then, I’ve been through a few years of talk therapy, with the help of another therapist who I can’t help calling Yoda. I benefited immensely from it. I am not scared of psychotherapy anymore, because I know how it works, and I’ve seen the benefits. Done well, therapy is a powerful healing opportunity.

Here is my take on how it works. It’s an insider perspective, with the benefit of hindsight. If I can help one person to take the decision to try, then what I am doing here is worthwhile.

So let’s have a look at what good talk therapy looks like.

You do the talking

I had psychoanalysis in mind, with a therapist never saying a word. Conversely, others thought they would talk about their difficulties, and the therapist would offer insight, pieces of advice as to how to solve the situation, or even instructions. You know, a bit like a financial advisor: this is what you need to do, and here is how you need to do it.

In reality, none of this happens. We do 95% of the talking. A very natural question then is why paying someone to mostly shut up ? Surely, our best friend can do this for a fraction the price ?

Sadly, no. We need a therapist. Even worse, we need a good therapist. The quality of the few sentences we will hear and non verbal communication we will see will make a huge difference.

You are met with attention and acceptance

First of all, his or her attention is important. How often does it happen in normal life that someones really listens to you for an hour, without interjecting with their own stuff ? It does not. It takes an unusually empathetic friend or significant other to really listen to us for more than a few minutes, without bringing their own emotions or experiences in the mix. And it is to be expected. A normal relationship is not one sided, both parties should have space. What you are hiring with a therapist is a one sided relationship for your own benefit. Here, everything is about you.

It feels good to be really listened to. For some of us, it’s the first time in our life. That was the case for me: I was coming from a place where people were absolutely not willing or able to really listen to me and know what my internal world looked like. Once adult, I had internalized I should not share who I really was. I was convinced people would run away, bored to death or freaked out. Of course it was part of my problem: this belief ensured that no matter what, I would stay lonely.

But attention is no use without acceptance. Acceptance does not mean our therapist should always agree with what we are saying. It means that they respect what we are saying, believe that we are sharing our reality, and understand that our reality is what it is for very good reasons (especially if it seems weird even to ourselves). If they are experienced, they may even understand or guess where we are coming from, even if we don’t.

I remember a session when I shared my desire for a man. At the time I was not single, and besides, the man in question was my boss. This was innapropriate and I was feeling terribly ashamed. My therapist deflated the whole thing with a few words. The idea was that it was completely normal to be attracted to someone, even if not single, and even for my boss. That it was also very common. I calmed down, came out of shame, and recognized that desiring someone is part of the human experience. For some of us, it goes without saying. Not for me. I needed help to get there.

At the time I was full of shame. For everything. Sharing my reality, being listened to with attention and gently contradicted on what I thought was my uniquely defective character (but in reality, was just me being normal) was a tremendous relief. It was a corrective experience that I really needed to feel good about myself.

You are guided into rewriting your history

Like most trauma survivors, I was also carrying an extraordinary burden of shame about my past. With time, my therapists drove home that my shame was misplaced. It did not belong to me. All of us know this intellectually, but we may still be in denial about how badly we were treated, especially if we were abused by people we loved. We think what happened is somehow related to the way we behaved or who we were.

I’m very careful in this blog about not being triggering, so I’ll give a relatively mundane example here. I once explained that for a few years when I was little, my birthday and Christmas presents were pieces of furniture for my bedroom. For Christmas my bed, for my birthday my desk, then my bedside table, etc.

When talking about this, I was not feeling or thinking anything in particular. But my therapist reacted : “your mother used your birthdays and Christmas to furnish her house”.

I was stunned. I realized he was right, even though I had never thought about it that way. Nice furniture was not what I wanted. I wanted toys. I had very few even though my parents had no financial problem. But my mother wanted nice furniture in her daughters bedrooms, and in essence she used my birthdays and christmases to buy herself presents.

Nothing earth shattering of course, but it was very telling of narcissistic parents who could not tolerate the idea that their children had needs – and even worse, that they were in charge of meeting them. How inconvenient.

With countless memories like this, some considerably darker than this one, the picture of my childhood and of myself changed. I started therapy with a very low self esteem, thinking that I was guilty, fragile, incompetent. I finished understanding there were indeed guilty, fragile, and incompetent people in my story, but that I was not part of the lot. Given my circumstances, I came to see myself as competent, resilient, and kind. And I have stopped feeling ashamed. It has improved my quality of life tremendously.

You process stuff

Sometimes I read trauma survivors need to process their trauma in therapy, meaning we need to remember sexual abuse events and share what happened then. I did not.

Maybe it’s because it’s advanced therapy and I never got there. Maybe it’s because it’s not necessary, or even useful. Maybe it’s not even possible: sexual violence is written all over my life, and my family’s history, but I have no real narrative memories of the trauma to share. My memories are confused and scattered (There are biological reasons for this, I know).

Anyway, not talking directly about the sexual violence events did not prevent me from feeling better than I possibly imagined.

I still did process stuff, though, in particular emotions about what happened to me. I talked about shame earlier, but there were other emotions to be felt and shared, in particular sadness. Therapy involves grieving for what happened, for what did not happen, for the opportunities we missed, sometimes for the things we did. A lot of grieving.

As Carl Jung once famously said, “neurosis is always a substitute for legitimate suffering”. How profoundly true. Expect sadness, but know that it is liberating.

Another crucial emotion to be felt is anger – or should I say rage. Young adult, I used to view myself as unable to feel anger. Even when treated badly, I could not for the life of me feel angry. As a resut, I had tremendous difficulties maintaining my boundaries. It did not help my relationships, and my self esteem.

But after a few months of good therapy, I started to feel obsessively angry at my therapist. It was weird: the guy was kind, empathetic, and skilled. There was no real reason to be angry. Yet, I was furious with him every day, the whole day, for months.

What was happening was that all my repressed rage was coming out and projected on him, because he was a man, because I was feeling safe, and because he was my therapist. I’m not sure this phase was particularly enjoyable for both of us, but it proved very useful. This anger carried red hot healing energy.

What processing means is feeling and expressing your emotions. About your current life. About your past. A good therapist will allow you to feel them , and will hear them with understanding and empathy. Sometimes, it also happens that you perceive their emotional reaction to what you are saying, like anger about what happened to you. I’m not sure it’s part of their training- it was definitely not part of mine – but this kind of emotional validation is also powerful medicine.

All the while, you stay in control

While in therapy I felt at times mistreated by the process. I believe most of us do. But the truth is we are in control the whole time. We are the ones chosing the therapist. We are the ones booking the appointments, and deciding to come (or not). We are the ones deciding what we want to talk about and what we should reveal, and when. And we are the one deciding when to end therapy.

This control of the relationship is reassuring, especially for someone like me who was traumatized in a close relationship. There is no need to be afraid of therapy. It’s not he only healing opportunity there is, but it is a great one.