How does therapy work?

The end of the academic year, and that means marking time. Marking student work used to be one of my least favourite tasks when I worked in sport science: thankfully as a researcher I didn’t have to do much teaching nor marking…but it was enough to set up a resistance and dislike. However, since changing career and taking up a new teaching role in counselling and psychotherapy I’ve found the opportunity to engage with the student’s ideas through their assignments is a part of the job I am coming to appreciate…and (dare I say) enjoy.

self otherAs a lecturer on two programmes – the Post-Graduate diploma in humanistic counselling and the MSc in psychotherapy – I am marking a variety of assignments: including write-ups of case studies and critical evaluations of recorded interactions with clients. They are fascinating to read, and I enjoy seeing how the students are considering what is happening in the room (between them and their clients) and bringing the appropriate psychotherapeutic theory to help them understand. The best pieces of work are those that consider what is going on for them, what is going on for the client, and what kind of relationship that develops in to. In other words, what we the teaching team are looking for is consideration as to ‘self’, ‘other’ and the in-between. For the students on the PGDip, their final assignment for their qualification was to describe their conceptualisation of counselling – how they think therapy works. This is an assignment that I completed when I trained at Brighton, so each year I get to re-evaluate how I have shifted, and how my practice has evolved. I thought in my blog this week I would share some ideas.


The above opening to the blog this week may have already given a sense of my first point – the humanistic approach is first and foremost a relational therapy. This is not to say that we are “relationship” therapists, but rather that we place the relationship between client and therapist at the forefront of how we work: in our way of seeing things, people’s distress and therefore its alleviation, happen in relationship. The humanistic tradition of therapy stands upon existential ideas, and an important one here is to consider how as human beings we are not in this world in isolation, we are as a product of our birth thrown in to a world of “being-with-others”. Even if we choose to live our adult lives on our own, we cannot escape our heritage, our development from babies to children to adults. The human species is pretty unique compared to the rest of the animal kingdom: we are born under-developed, an unfinished job. It is our early environment that completes that project – how our brain (and therefore our intellectual, physical, emotional and social networks) grow depends on how we are cared for in the first few years of life. As long as we receive ‘good enough’ parenting, we are going to be generally okay; in other words, as long as we have caregivers that see our needs and validate our lived-experience, we will generate the capacity as little human beings to find our environment safe and stimulating for growth. Absence of our needs being seen or met will cause issues later in life – the same issues that often arrive in therapy to be addressed. In the words of John Welwood, a Buddhist psychotherapist with whom I have studied:

“We are created through relationship; we are wounded in relationship. It therefore makes sense that we can be healed in relationship”.

The second point I wanted to share was how I see distress being set-up in people’s lives; and I started to address this a little in the first point above. Essentially, childhood experiences mean that we enter adulthood with a history of mis-attunement. For those of us fortunate to have been on the receiving end of ‘good enough’ caregiving, those mis-attunements will have been fairly small, and will have been repaired by attentive caregivers who noticed the moment of rupture. For many of my clients, this hasn’t happened: they tell me of how their parents ‘missed’ them, never saw them, never heard them; I think of one client who shared with me that her emotional experience was never validated. If she felt sad, her Mum would talk it away with “we have to keep smiling”, or “never mind, life carries on”. With that background sensitivity, it is no wonder her partner’s positive attitude has left her feeling similarly unmet. Mis-attunements lead to ingenious strategies in children – we find a way to survive, or even thrive, in childhood by taking on ‘scripts’. My own was to ‘be perfect’, and to ensure that I stayed on a road of serial accomplishment: in sport, in academia. Essentially I confused, as many of my clients do, accomplishment and praise with receiving love. As a therapist, my role is to be curious as to how I am attuned to my clients when we are together. I attend to my clients words, their tone, their body posture, their gestures and see how I impact them when in relationship together. How do I miss my clients? How do I not hear them? And when these mis-attunements happen, how do I notice and find out how I triggered an experience of not being seen, heard or understood? And then, how do we make sense of that together? Again, coming back to the existential roots of the humanistic approach, making meaning of experience is very important.

Its worth pointing out that mis-attunement happens on many levels – as well as the experiences of not being seen or heard, many clients have more major stories of neglect or abuse. Traumatic experiences can require an upscaling of attunement, perhaps a greater emphasis on helping a client ‘regulate’. Through my presence, I can offer a safe environment, a safe neural pathway if you like, to which they can attach and learn to regulate distressing emotional and physical affect.

In outlining those first two aspects, you can probably get a sense of how important present moment working is to me. Gestalt psychotherapy is centred on the ‘here and now’. Whilst clients might want and need to bring their stories to me and our sessions, listening to the content is less of an important focus than listening to HOW they are telling me. Essentially, I invite a curiosity as to how we are relating, what the process is perhaps telling us. It might be that our relational dynamic feels familiar. This is often very new to clients, and at first many people find it hard to locate what they are experiencing in the room with me. Fritz Perls, the founder of Gestalt therapy, is quoted as saying “lose your mind and come to your senses”: we can get bogged down with our thinking, the internal scripts, the shoulds, the critical voices, planning and controlling, problem solving – and we lose contact with how we feel, our emotional and sense world. I help clients become aware of what is going on for them in each moment: moving from the predominant thinking to integrate the feeling mind. And this is a two-way interaction: I am also using my experience of being with them, and I use that to help the client’s understanding – what are they like to be in relationship with?

This contact with experience as it is happening is essentially helping raise a client’s awareness. As well as being in relationship together, we can build their capacity to notice what it is like to be in relationship. Raising awareness is, in my experience, most of the work a client needs in their healing process. Becoming aware of who and how we are AND an acceptance of who and how we are is often enough – because from that awareness we begin to see our choices: a gap opens up so rather than reacting we can respond. Freedom to chose, and the responsibility of choice again are important existential components of the humanistic approach to therapy. It isn’t always a comfortable awakening though. Even after a client sees how they are contributing to a relational pattern they can often deny there is choice. “I can’t tell my husband that, he would go mad” as an example. The client and I would discuss and explore that statement – perhaps it is less that they “can’t” and more that they “can” but the consequences feel enormous. Denying their own wishes to and not revealing themselves to their husband is a lifelong script which denies their freedom but stops them receiving the anger of others. How can we help them face and digest other’s anger?

silhouette dancers

Since completing my counselling and therapy training, I have become more and more influenced by ideas of our existence in relationship withothers (our caregivers as children, and with colleagues, friends, family and lovers as adults) as the management of being-alone and being-with: to be separate, to be together; to be removed, to be in contact. This isn’t just a question of whether we are introverted or extraverted, this is about a dance of intimacy as we try to meet our needs for space and for company. The metaphor of dance is a beautiful and powerful way to consider this and I often use this in my teaching work. When we meet a new client, what dance do we observe them in? How do they invite me to dance? Do I feel them push me away, or do I feel them pull me in? How do I respond? Do I go along with their dance steps, or do I say what I see and feel and ask if they want to try something different? After all, as Einstein reminds us:

“If you always do what you’ve always done, you will always get what you’ve always got”.

I was trained in the Humanistic approach, and then refined my ideas and working practices as I deepened my understanding of the Gestalt frame. The here and now working of Gestalt, its focus on raising awareness and the relational and phenomenological methods it brings to that pursuit haven’t once let me down in my therapeutic work. I love and appreciate that way of working. It also makes sense to me as a Buddhist: and with a deepening of that aspect in my life has come a more natural integration of Buddhist psychology and practices in to my work. Buddhism has helped my deepen my connection to the existential givens of life: an understanding that painful things will always happen: its how we react and respond. Resist the givens (the traditional four are birth, old age, sickness and death) and we increase our likelihood of suffering. We need to meet that suffering with acceptance yet also with compassion – just because its a given, doesn’t mean we ignore it, “not grumble and carry on” but feel that pain and give space for it. My work with clients who are grieving underlines this quality of practice. Yet in order to give our feeling world space, we have to learn to sit with, be with our experience. The Buddhist view and practices have opened this up to me more and more: firstly the ability for me to offer a healing presence to my clients and to know my own experience more deeply and use that in the work; and secondly to help clients sit with their own inner world and gain a curiosity as to what has been covered over for many years (a lifetime in some cases).

I don’t think this view of how I conceptualise counselling and psychotherapy has changed that much since I too wrote that essay back in my training days. If anything, my resolve and belief in the existential and phenomenological principles has simply deepened. I am less likely to let my fear get in the way: I am braver and take more risks, trusting the approaches I have learnt. And where that fear of being more congruent, more open, takes place I simply use that as information as to what is happening in the room.

Leave a Comment

Your email address will not be published. Required fields are marked *