What Is Psychotherapy?

“No one would ever say that someone with a broken arm or a broken leg is less than a whole person, but people say that or imply that all the time about people with mental illness.” - Elyn R. Saks
As a therapist, it is sometimes disheartening to hear others outside the profession discuss psychotherapy. There’s an air of fear and mistrust that surrounds therapy, as if one must be broken or weak to seek help. When asked what I do for a living, my answer is often met with unease. The person becomes clammy, guarded and responds with an uncomfortable laugh and request not to be psychoanalyzed. A part of me feels embarrassed and another part, concerned.
I find their response terribly ironic since one of the foundations of psychotherapy is confidentiality. Our role is to be confided in, though apparently only when necessary. Psychotherapy is a last resort for many, often when there is no one to listen or when we no longer feel we are able to go it alone. Many clients have shared, with tears in their eyes, the shame they feel having to come to therapy. While they find it helpful, their friends and family often scoff at their supposed weakness. I could not count the times I have heard a client lament over their loved ones telling them to “just get over it” or that their feelings are “just a phase.” It is difficult to imagine someone with cancer or Lupus receiving the same advice.
What is it about “mental illness” and psychotherapy that is so offputting and why is the suffering of others written off as a ruse?
A Conflict of Interests
The specific meaning of psychotherapy is difficult to pinpoint, and as this is a blog not a scholarly paper, I am not here to make definitive statements. Psychotherapy for me is a very personal exchange and takes on a meaning that cannot be quantified in a textbook. I imagine each client has a different understanding of exactly what goes on within the office walls of their therapist, each with its own validity. I find the existence of this profession both a blessing and a misfortune. It is a blessing in the sense that many are able to share their most painful experiences with another and feel listened to and understood. At the same time, it is a shame we cannot do this with our loved ones or within society in general.
This is the conflict I feel when met by an uncomfortable, clammy response after stating my profession. How can a profession supposedly built on empathy be interpreted as a profession of judgement? To be psychoanalyzed has become synonymous, in a way, with violation. I understand this to a point, we work within the realm of uncomfortable truths. Part of psychotherapy is the uncovering of hidden meanings, themes and experiences that cause us pain. We cover these up to avoid the pain, and the possibility that the sheet may be pulled away can be a frightening prospect.
Similar to how we avoid doctor’s appointments out of fear of finding something wrong with us, psychotherapy may raise our awareness of a problem we had not considered.  Awareness of something often requires change and change is difficult. This makes sense. However, doctors are often met with high regard for their work, rather than suspicion. One is not seen as weak for having cancer or a broken leg, but vulnerable and in need of help. However, depression, since we cannot see it or because of its limitation to the individual’s subjective experience, is treated as an attitude rather than a malady. Therefore, therapists are seen as those who adjust bad attitudes rather than heal suffering.
The Power of Empathy
Part of the reason psychotherapy is often misunderstood is because of it’s limbo between medicine and the humanities. While much of psychology is backed by science and takes place in hospitals and clinics, psychotherapy bears little resemblance to medical intervention. Infections are not cured by a doctor discussing the suffering it causes, but rather through antibiotics. However, grief, anxiety and depression can be relieved by talking through one’s experiences, emotions and thoughts in a caring and open environment. Yet, this seems closer to the spiritual counsel of a priest/rabbi/imam/etc. or the warmth of a close friend than a medical procedure.
Furthermore, it is the empathic relationship between the client and therapist that accounts for most of psychological improvement rather than any specific intervention. While medications help relieve symptoms, psychotherapy has been shown to be effective for 75-80% of participants*. Oddly enough, it is empathy and the helping relationship that accounts for most of the change seen in psychotherapy, or rather, kindness and personability. Yet, if you ask most people, I would assume it is the psychoanalyzing, assessment, medication, diagnosing and other cold, clinical interventions that are cited as descriptions of a therapist’s work. From the outside, therapists are seen as prodding rather than caring.
I have witnessed the impact of this perception on loved ones along with the prolonged suffering it causes. Rather than seeking a therapist to help ease the pain of a loss, strain of a transition or the disabling fear of anxiety, we attempt to forget them. This is like ignoring a toothache with the hope it will heal itself. To some, a therapist’s voice can be as unsettling as a dentist’s drill. However, psychotherapy is more like the cleansing waters of a bath.**
An effective therapist will help support, encourage, validate and listen to you.
Caring vs. Curing
My hope in writing this is to bring awareness to the misguided perception of our field and psychological suffering on whole. I fear the medicalized model of treatment that currently dominates the way we interpret, fund and treat the life problems of our clients infringes on our ability to aid them in the greatest capacity possible. The same philosophical assumptions that bring our field validity, objectivity and prestige in the culture are also infringing on the very purpose of its existence; to alleviate the suffering of others. Somehow therapist are understood as diagnosers over healers and judgers over listeners, which I do not believe is the intent of its practitioners.
I do not believe I am alone in these conflicts and experiences. Whether you are reading this as a therapist, social worker, patient, doctor or salesman, it is important to take away the importance of empathy and understanding in your life. Psychotherapy, in many ways, fills the need for acceptance and compassion in our culture. Hopefully, seeing a therapist will one day be understood as a way of caring for rather than curing ourselves.

*Check out  NREPP’s website for more information of importance of the therapeutic relationship.

**I apologize for picking on dentists here, you also provide a much needed and valued service!

Photo by Mikael Altamark