What does a Psychotherapist actually do?
You might have seen some caricature or perhaps a scene in a comedy show portraying
a therapy session as this: a patient lying on the couch talking and talking, and a
psychotherapist or psychoanalyst sitting behind either sleeping, or doodling on a
notebook, or doing something else besides listening to what the poor patient was
saying. I even saw one cartoon where there was a skeleton instead of the therapist sat
behind the patient, as if the analyst had long died whilst the patient was still talking.
Well, although it is a funny anecdote (if you’re not the neglected patient, that is), it
hardly represents the truth. And it shouldn’t, because it’s an anecdote and it’s meant to
be funny. Right, but what exactly does a psychotherapist do? How does therapy work?
How can talking therapy help?
In this little article I’ll try to address some of these questions as clearly and accessibly
as a can, so you can understand a bit about what a therapist does and how
Firstly I should say that there are many different types of talking therapies, and many
different approaches and theories to base them. Besides that, every therapist has
his/her own way of working, a ‘personal touch’, which is nothing more than a style of
conducting the sessions. Although the theories and techniques in each approach in
psychotherapy are solid and should be applied to any therapy, each psychotherapist will
inevitably bring his/her own way of working with these. Most importantly, every client is
unique, and therefore each therapy will inevitably become unique and specific.
Just so you can get the picture: there are some important general guidelines to be
followed in psychotherapy and counselling, but they are experienced differently both by
the therapist and the client as they work together. Because therapy takes place in the
meeting of two minds, it is expected that this encounter will produce something unique.
And this is the beauty of psychotherapy: it represents diversity and flexibility.
As I am a psychotherapist in London EC1, I’ll keep the explanations in relation to how
psychotherapy works and what the therapist does within my experience and knowledge
framework. So here are a few general considerations on what psychoanalytic
1- Talking helps: there is something very therapeutic in talking. When something
happens in our life, good or bad, it’s always good to talk about it. Some of us feel
more inclined to do so, whilst others tend to keep things more to themselves. But
telling something to someone else allow us to revisit what happened, to think and
to elaborate more on what is being recounted. As we do so it helps us gain new
perspectives. Something liberating and releasing happens when we talk. So in
psychotherapy you will feel this very desirable effect. But it doesn’t stop there,
otherwise our friends or family would do the job. A psychotherapist is trained to
listen in a non-judgmental and confidential way. He/she will help you find new
ways of thinking about what is being talked about, pointing to aspects that
perhaps were not as evident and clear at the time. A psychoanalytic
psychotherapist will also pay attention to what the client communicates in an
unconscious level, the hidden meanings beyond and underneath the words, or to
patterns that the patients perhaps is not so much aware of. These will bring
about important realisations, which can lead to awareness and change.
2- Neutrality: as you talk to your therapist, you might observe that he/she does not
react or respond in the same was as other people. They might seem less
affected by what may be very painful to you. This doesn’t mean that the therapist
doesn’t feel anything, or that he/she is cold and dismissive. The psychotherapist
is in fact allowing you and him/her some internal space for thinking. This will give
the patient freedom to express anything without worrying too much about
horrifying the therapist, as well as provide the therapist with an internal breathing
space to formulate interventions and interpretations. Believe me, although you
may wish so, you don’t need for the therapist to be your friend. You need him to
point out the truth, which will help you develop and change.
3- Interpretations: as the psychotherapist listens to you, he/she will be formulating
in the mind some interventions, trying to uncover the meaning of what you may
communicating, be it in a conscious or unconscious level. When a therapist
shares an interpretation, he/she may be trying to disrupt unhealthy defensive
measures, calling out unconscious feelings, challenging contradicting thoughts
and helping the patient to face pain and difficulty. This can feel very painful at
times, but it is absolutely necessary for the psychotherapy work to take place. It
will eventually help the patient to acquire the tools necessary to carry on knowing
themselves better, so that they are not caught up in unhealthy patterns or left
overwhelmed with disconnected feelings.
4- Building links: interpretations have also the function of linking up scattered
elements in the mind that may be repressed, projected onto others, converted
into symptoms (e.g OCD, depression, stress, anxiety). This is also therapeutic.
5- Identifying patterns: the psychotherapist will help the patient to identify patterns
of behaviour, feelings or relationship that may be affecting their life. This is
important as it will allow the patient to reacquire the chance to change such
patterns, by becoming aware of them.
6- Finding meaning: there is meaning underneath every word, feeling, thought or
behaviour, and the psychotherapist is there to help you find this meaning.
7- Thinking instead of acting: sitting down with a psychotherapist and talking
about your problems gives the patient a chance to develop the ability to think
instead of act on every impulse that kicks in. The psychotherapist will help the
patient to find an internal breathing space, so when situation rise he or she will
be able to carefully think before making any decision.
As a psychotherapist in London EC1, I could spend ages listing every aspect of what
a psychotherapy does and how psychotherapy works. As this is not possible, I hope this
little article has captured some of the essence of what psychotherapy entails. But
instead of just trying to learn from a blog post, why not experience for yourself?