What is Psychotherapy?

“Think…of the world you carry within you, and call this thinking whatever you want to: a remembering of your own childhood or a yearning toward a future of your own – only be attentive to what is arising within you, and place that above everything you perceive around you. What is happening in your innermost self is worthy of your entire love; somehow you must find a way to work at it...”

Rainer Maria Rilke (1929). “Letters to a Young Poet”


What is Psychotherapy?

Perhaps a bit surprisingly, the answer to that question depends on who you ask, as there is no one set definition of “therapy” given the vast application (and possible appropriation) of that term across several distinct professional and paraprofessional disciplines. Those practicing “psychotherapy” or “therapy” or “counseling” will have different levels of training from different types of training programs specific to different areas of academic study. For example, “therapists” graduate from the following fields/programs: clinical psychology (psychology department), counseling psychology, counseling (often within the education department), marriage and family therapy, addiction counseling, social work, school counseling, pastoral counseling, and so forth. Such training programs, then, will differ on instructional models of practice and technique, theoretical orientation, clinical research, supervision experience, case conference opportunities, practicum and internship opportunities, and face-to-face direct clinical hours (prior to graduation as well as post-graduation). Therapists may hold a master’s degree (generally a 2 year degree) or a doctoral degree (generally a 5+ year degree) with distinct degree requirements as well as post-degree requirements, such as supervision, license examination (note: exams vary depending on field of study), and clinical hours required for full licensure within the respective field.

Generally speaking, most therapists agree that “therapy” is organized around relational variables, such as the establishment of rapport as well as the commitment to safety while developing some degree and type of therapeutic relationship. The significance and/or utilization of this therapeutic relationship within the treatment itself varies across therapists and respective therapeutic modalities. However, with the advent of AI and some app-based companies commodifying and/or co-opting therapy as a commercial product or subscription-type service, it remains to be seen how the “therapeutic relationship” will function or be re-defined by non-human AI operations and non-face to face interactions. In short, and from my professional purview, successful and meaningful psychotherapy is predicated upon the development, maintenance, and utilization of a safe and co-negotiated therapeutic relationship on which the therapeutic process unfolds across time.

Without getting caught in the weeds of too many distinctions, it is important to note the difference in therapies that focus on symptom reduction and management versus those centering on understanding and reworking underlying mechanisms that give rise to symptoms and difficulties. I feel it imperative to not reduce a person’s symptoms or suffering to surface level measurements or oversimplified metrics (which might look great on paper, so to speak, but do little to foster lasting, meaningful change within the mind and life of an individual). Trees, for instance, have a life-dependent root system beneath their surface; any scientist interested in the study of trees would be interested in the parts visible as well as invisible (with such richly interconnected life underground, that interestingly enough, resembles the intricate neuro-connections of the human brain). Naturally, human beings have our own conscious or subjective phenomenological experience of ourselves, but deeper questions often remain, such as: Who are we really? Why do we do the things we do? What are we all about? What makes us tick? How did we get this way? Why do we find ourselves repeating the same maladaptive patterns again and again? Why do we feel or think this way? Why are we doing this to ourselves or others? Questions abound - but therapies that seek to explore, formulate, process, and rework the depths and complexities of the human experience answer these types of important questions.

As such, relational aspects of human development and experience must not be reduced or removed from the therapeutic process, for personality organization, character formation, and our overall “sense of self” all originate from formative relational experiences during our developmental years. We come to know ourselves (what we feel we are worth, what we feel we deserve or don’t deserve, what we feel is right or wrong with us, what we feel we must do to be wanted or tolerated, what we feel we can get away with, etc.) through our interactions with the important people in our lives who tell/show us about ourselves in a variety of ways. It is through these formative, seminal relational interactions that we develop our own distinctive ways of relating to and being with ourselves and others. Such ways of relating can be likened to the nuanced uniqueness of fingerprint patterns or DNA structures, metaphorically speaking, in that no two people will have exactly the same relational blueprint or template. In short, these relational blueprints become the foundation or underlayment on which our psychological and interpersonal lives are built and experienced across the lifespan.

Symptoms and struggles often have a relational origin. Take, for example, a person who continues to be taken advantage of because they feel they must give and give in order to be valued and loved. Like all of us, this person was not born with a built-in, ready to go sense of worth and security; it had to be developed over a period of time and was based upon interactions with significant others. When symptoms can be understood in the context of such relational matrices (that is, when they can be understood from within specific relational configurations of self and others) meaningful psychotherapy has begun!

With all this in mind, I have come to define psychotherapy as a process by which the development of a meaningful therapeutic relationship makes it possible to build or expand upon the kind of relational spaces (in one’s mind and interpersonal life) needed to safely experience, formulate, understand, and rework dynamics that afford new ways of being, thinking, feeling, acting, and relating. It is from within this ongoing unfolding of moment-to-moment nuanced interactions (between therapist and patient) that the richest form of potential exists with regard to the change and healing process.

To put more specifically, this means that the way we (therapist and patient) come to experience, formulate, and understand our interactions provides an essential catalyst for change and growth, as new or alternative ways of experiencing and relating (to oneself and others) become possible and attainable. In other words, by understanding what goes on between us (therapist and patient) and within us (our internal experiences while working together), we invite healing and growth to occur on a deeply moving, deeply experiential level that leads to lasting change and relief.

A Special Message for Trauma Survivors

Psychotherapy works best when the therapeutic relationship creates a kind of space that specifically allows for the safe negotiation and management of all aspects and experiences of trauma. It should include the ongoing and nuanced co-negotiation, co-creation, and co-regulation of therapeutic safety and consent, the former being requisite for the latter. It should respect the pace that feels both safe and manageable, rather than one that is forced or rushed. In fact, therapy should be patient in the way that trauma never was or will be. Trauma did not wait for consent; therapy must.

Feel free to read my other writings on trauma, located on this website, for more in-depth information about my therapeutic approach to, and understanding of, trauma.


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