As a psychotherapist, I am often asked, “What exactly is therapy?”, “How do I know if I have found the right therapist?”, “What types of therapies exist?” These questions are important. Each question indicates that we live in a world that is primed to shatter the stereotypes and stigmas surrounding the concept of therapy. We are at the precipice of change, change that could lead to more robust mental health policy, better insurance systems that could allow greater access to psychological services, and deeper knowledge of the hows and whats of therapy itself.
So, what is therapy? Therapy is ultimately about embracing vulnerability. It helps us remove the mask we often present in public, shed that extra layer of skin, and explore our authentic self in a space that is meant to be safe. Therapy is about analysing emotions, thoughts and behaviours, and learning how to distinguish between each of these core human characteristics. From a clinical standpoint, therapy is a form of treatment that could help alleviate the symptoms of a wide variety of mental health conditions. According to the American Psychiatric Association, therapy also helps identify the “psychological root causes” of these conditions. Therefore, it helps a person live a better life.
A critical aspect of therapy - no matter what approach the therapist uses - is the therapeutic alliance. This is the relationship that the client and therapist develop over a period of time, a bond that is both deeply personal while remaining professionally bound. In many ways, it is this dichotomy that makes the therapeutic alliance so unique. It is at once empathetic, wholesome, and hopefully, deeply genuine, while also being one-sided and occasionally formal. It is a partnership based on mutual respect and collaboration, but only one party is meant to divulge personal information.
Contending with the dichotomies of this relationship, getting used to having someone in your life who knows so much about you while you know so little about them, is difficult. It takes time to thrive. Yet, in its best form, the therapeutic alliance is the transformative core of therapy.
Another key part of most therapeutic approaches is goal-setting. Therapeutic goals are tailored to what you, the client, are trying to address. They could include regulating emotions, reducing symptoms of a mental health condition, managing interpersonal relationships, dealing with professional stress, among many other possible goals. The process of setting goals may take a few sessions, as formulating them also depends on how situated you feel within the therapeutic relationship. For instance, you may be more comfortable explaining that your goal is to tackle your anxiety after you know your therapist a bit.
While the therapeutic alliance and goal-setting are key to most therapeutic approaches, each approach does have a unique premise, and employs nuanced techniques. Of the many existing approaches, the language of cognitive behavioural therapy, psychodynamic therapy, and person-centred therapy have found their way into mainstream lingo.
Cognitive behavioural therapy (CBT), an evidence-based approach, stipulates that our emotions, thoughts and behaviours are intricately linked. A CBT therapist will likely be quite structured; first, they will help you identify your negative thought patterns or “cognitive distortions” such as black-and-white thinking (i.e. thinking in extremes), catastrophising (assuming the worst will happen), personalization (blaming yourself disproportionately), etc. Then, they will help challenge or restructure these thought patterns by asking you to test the accuracy or validity of the thought itself. For instance, what if you constantly tell yourself that your body is not what it is “supposed” to look like, and assume that other people also think about you this way?
A CBT therapist would first help you notice that you are body-shaming yourself. They would then challenge the assumptions you’ve made about what people think of you, and then help you reframe your idea of bodily aesthetics. A CBT therapist would also help you notice how these negative thoughts about your body alter your behaviours. For instance, perhaps you socialize less because you do not want people to see what you look like. This behaviour has its own set of consequences, and could lead to different mental and emotional distress (such as loneliness, for instance).
If CBT pertains to the here and now, psychodynamic therapy is more focused on the past. Derived from Sigmund Freud’s psychoanalysis, a psychodynamic therapist might ask you more about your childhood, your interpersonal relationships, your dreams, and the mechanisms you use to protect yourself emotionally. A psychodynamic therapist will explore your latent thoughts embedded within your unconscious mind. Engaging in such exploration requires time, and is a longer process than, for example, CBT.
In pop psychology, psychodynamic therapy occasionally gets a bad rep because of the stigma associated with Freud’s more controversial theories (such as the Oedipal Complex). It is important to note that psychodynamic therapy is distinct from psychoanalysis, but retains some of its most powerful elements–the examination of the unconscious mind, the emphasis on how childhood patterns persist in adulthood, and exploration of emotional defences. Such self-examination is critical.
Finally, a person-centred approach, one I employ often, views the client as the expert in the therapy room. Developed by Carl Rogers, this humanistic approach emphasises three key elements: unconditional positive regard for the client, genuineness (or congruence) and empathy. If the therapist can facilitate the presence of these three elements within the therapeutic space, the therapeutic alliance is considered strong. Therapists often integrate the values of person-centred therapy into other approaches because of how wholesome the approach can be.
Ultimately, figuring out which therapeutic approach works best for you requires time and exploration. Ask your therapist what approach they use. Read about the various approaches. While the process requires some effort, I promise that once you find the right therapist with an approach that appeals to you, the journey of getting there will be worth it.
Malika Noor Mehta is a psychotherapist and mental health advocate who runs her own private practice in Mumbai.
Therapy Deconstructed is a monthly column that aims to demystify all aspects of therapy.