How does psychotherapy help?

I flinched a little at the word 'patients,' because 'patient' immediately associates me with hospitals and a subordinate position. But all right, I swallowed it and responded calmly: "We talk. There is no template, I don't give homework or special exercises. We solve emotional problems exclusively through conversation."

He nodded as if to confirm he heard me, then asked: "And how does a person change just by talking?"

This isn't the first time someone has asked me this question. Others have similar dilemmas:

• How does psychotherapy help?
• How does a person mentally and emotionally recover just by talking?
• Why psychotherapy, when a good friend can listen to you?
• What do you talk about in there?

Questions like these always catch me off guard...

We're not sure how change happens, but we know that it does. We have research and statistical evidence that repeatedly confirms the effectiveness of psychotherapy. We have various testimonials ranging from Hollywood stars to people in our own circle. This will be an attempt to explain how that change happens.

A New Relationship

"Childhood is the parent of man's personality." — Sigmund Freud

Relationships with parents are the pillar of healthy psychological and emotional development. If our early relationships were unhealthy (toxic, manipulative, dependent) while we were growing up, it's certain that our emotional life with others won't be promising either, because we haven't learned anything better, and we unconsciously repeat the same patterns of behavior and action.

When we start psychotherapy, a relationship is built between us and the therapist. In the microcosm of the therapist's office, we gradually build a "relationship" with the therapist that is the same as the relationships we build in the outside world. The therapist, over time, becomes a mother, or a father, or a brother/sister, and other close relationships from the outside world.

The difference is that the relationships we have built so far are toxic, and this is the first healthy relationship. I know I sound arrogant, but that's exactly why when you choose a therapist, you should choose them based on your personal feeling, and include their expertise. But above all, a psychotherapist must be a good person. With a therapist, we can be free to express our emotions, fantasies, desires... We can be heartbroken, vulnerable, angry. To feel free to show everything we haven't dared to with other important people in our lives until now.

A new atmosphere and a different model of a relationship change the dynamics of our inner world. In our eyes, the therapist becomes a 'good parent,' someone with whom we recreate the relationship from childhood. Only this time with a better outcome.

This 'good relationship' becomes a model for all other relationships that are created outside the psychotherapy office. The psychotherapist's voice is internalized and becomes a new, good experience. We adopt it and carry it through life, just as we did in childhood when learning from our parents. We set clearer boundaries, live more enthusiastically and meaningfully, build self-confidence, understand others better...

People, freed from their previous destructive relationships, go into the world creating closer and more authentic relationships.

Making the Unconscious Conscious

"Unexpressed emotions will never die. They are buried alive and will come forth later in uglier ways." — Sigmund Freud

Freud's concept of the unconscious still holds great significance. He says that emotions we couldn't recognize and process during our upbringing will appear in the form of various symptoms—panic, depression, anxiety...

We cannot clearly see ourselves—what we do when someone gets close to us, what we are like in intimate relationships, how we react in certain situations, and why we react the way we do. When a relationship develops between a client and a therapist, repressed emotions and behavioral patterns begin to surface from the unconscious and show themselves right in the therapy session.

The therapist is a trained professional who recognizes these self-sabotaging unconscious patterns. Their task is to make them conscious together with the client, to confront them, and to put them in their place. With the help of the therapist, we become aware of the mechanisms by which we create barriers to our development.

Transference

As I have already mentioned, in psychotherapy, a strong emotional relationship is created between the client and the therapist, which is professionally called transference.

It can be positive or negative, depending on which unconscious functions are operating at a given moment. For example, a positive one can be a crush, admiration, or enchantment with the therapist, while a negative one can be resentment, hatred, or rebellion against them... But transference doesn't only happen in psychotherapy. It also occurs in all other relationships we build with people in the outside world.

The point is that the client begins to act towards the therapist as they act towards others outside. The only difference is that the therapeutic office allows the transference to be isolated (recognized as a separate, repeating phenomenon) and defined (made conscious, explaining how it originated and how it works). The cause, structure, and consequences of transference are sought.

For example: A client who comes from a family with very critical parents may get the impression that the therapist is strict, overly demanding, and critical, and that they should expect reproach or punishment for every possible mistake, and therefore should remain closed to communication. This kind of transference would be attempted to be defined by asking the client to describe their upbringing and what they see in the therapist that is a replica of their parents.

Or for example, a client who had to cheer up their depressed parent will also try to entertain and cheer up the therapist, and the therapist may seem absent, deadened, and uninterested in their story.

Transference will manifest in all our relationships until it is recognized and resolved. It haunts us because it is unconscious. The task of the therapist and the client is to recognize the transference and work through it until the client becomes aware of it and is free from it.

Conclusion

Although they are not the only ones, these three factors are among the most significant that influence psychotherapeutic change. Change depends on many other things, including the therapist's expertise and goodness, and the individual who decided to start therapy...

The devil can dance, but if a person is not interested in (or ready for) change, change is not possible.

Author: Nemanja Kurlagić – psychotherapist using the O.L.I. psychodynamic method