Reflecting on... What I do

I am often asked what I do when I ‘do’ psychotherapy. Depending on who’s asking; a student, parent, potential client or service provider, my response varies. I don’t have any stock answers, in my experience, they don’t really wash. And anyway, non-psychotherapeutic people have watched ‘The Sopranos’ and ‘In Treatment’ and think they know what therapy is about. So what is therapy about? 

In theoretical terms, psychotherapy is about helping patients to think about, reflect upon and come to terms with what’s going on, or has gone on, in their lives. So far, so comprehensible. It gets complicated when I add that much of these ‘goings on’ are beyond conscious awareness. At this point the questioner does one of three things: 1. Glazes over, none-the-wiser, 2. Assumes I’m talking about Freud and all that [I quote] ‘wanting-to-shag-your-mother stuff’, or 3. Remains interested enough to want to know more; then repeats ‘but what do you actually do?’

If I’m feeling playful, which I often am, I might wonder what it is they think I do. Answering a question with a question is the stuff of therapy, right? This may sound glib, but there’s truth in it too, because wondering back, when a patient asks a question encourages joint exploration and demonstrates that I, the therapist, don’t have all the answers (and even if I did, I wouldn’t deliver them readily).

Patients frequently use metaphor to describe what therapists do. I hear about the ‘wounds’ that brought them into therapy, which has been described as ‘picking at’ or ‘uncovering’ something difficult. It sounds painful, and of course psychotherapy often is, as the defense mechanisms/plasters/scabs are gradually removed to reveal the unconscious trauma/wound beneath the surface. Only then can healing begin, and this can take a long time. As one patient who wasn’t ready to end treatment told me, ‘if I leave now, it will just scab over again but the badness will fester away inside me’.

So when people ask me what I do when I do psychotherapy, they are usually asking what I can do for them/their child, and that depends on what they are ready, willing and able to do for themselves. If the time is right for them to start treatment, I will respect the defences that have served them well-enough for long-enough and be alongside them as they start to slowly remove the plaster and reveal the wounds beneath. We will examine those wounds together and try to make sense of them, and finally, with patience and compassion, we will embark on the healing process together. Because that is what I do. 

Published in BACP Children & Young People June 2013