The Elements of Good Therapy
There are many models, or types of therapy, to choose from. We believe there are a handful of common denominators present in all forms of healthy, ethical therapy. These elements are described here:
Viewing a person as greater than his or her problems is the hallmark of nonpathologizing therapy. It does not mean problems do not exist; rather, it means one does NOT view the problems as the whole person. Working nonpathologically requires a shift in both the understanding and the approach to pathology.
Here is the understanding: Most of the issues people go to therapy for are not organic disorders—they are not hardware problems, they are software problems. These issues are the result of the person’s psyche doing the best it can to deal with life experiences—to adapt, survive, and prevent the person from ever getting hurt again. Certainly, there are some “disorders” that are purely organic in etiology (meaning a hardware problem that is genetic, biochemical, or neurological), such as some forms and instances of psychotic and mood disorders, but these are the minority. However, the nonorganic problems people bring to therapy, which are often labeled as disorders, are actually very organized, orderly, and systemic psychological reactions. Thus, the word disorder is simply inadequate and misleading. Adding insult to injury, being labeled with a disorder can provoke shame and inadequacy and often make people feel worse. Read more about the GoodTherapy.org position on the concept of disorder.
Here is the approach: Treatment of a software problem requires curiosity and compassion in order to undo the orderly and organized response to suffering. Treatment of a software problem does NOT warrant psychological amputation—this is what the medical model does to pathology. When a therapist joins a client in getting rid of a symptom instead of exploring its depths, the therapist is overlooking the client’s opportunity to heal. We do justice to a person's true nature when we remember that behind the layers of protection, no matter how self-destructive or hurtful to others an individual has been, there is a loveable and vulnerable person at the very core. What about sociopathy?
Therapists who empower their clients maintain the belief that people have the capacity for change and are equipped with the inner resources to do so, even if they never do change. Therapy is based on the belief that people can heal if they want to and if they are able to contribute to their own growth what is sufficient and necessary. Unfortunately, there is a tendency, especially in medical model treatment environments, to view people as fundamentally flawed. When a therapist views a person as flawed or incapable of change, the person is more likely to feel and become flawed. When the therapist is able to see beyond a person's wounds and defenses, the client is more likely to discover his or her true nature. Some people may not be able to overcome their obstacles and heal in this lifetime, but the therapist should not become an additional barrier.
The spirit of collaborative therapy is summarized in the words of Albert Schweitzer who wrote, "Each patient carries his own doctor inside him.... We are at our best when we give the doctor who resides within each patient a chance to go to work." Collaborative therapy can be established when a therapist encourages a client to become the co-therapist. Therapists who work collaboratively trust people to know themselves (or have the potential to know themselves) better than anyone else, to access their own wisdom, and to attend to their wounds. This orientation puts the client in the driver's seat of therapy. Collaboration is not directionless, nor does it put the client at risk of further trauma.
Therapists generally love working with people and tend to be empathic and big-hearted. There is no doubt that providing psychotherapy is gratifying and rewarding for most therapists. Although therapists witness the damage caused by the worst life has to offer – emotional abuse, trauma, violence – they can be rewarded by being present with people during some of their greatest aha-moments, unburdenings, and transformations. Indeed, therapists get some emotional needs met as a part of the therapy process, sometimes even experiencing secondary healing. However, there are some therapists who unintentionally use the therapy process and their clients to soothe their own psychological wounds. These needs vary, but come from the same issues that many of us, therapist or not, have struggled with: to feel powerful, smart, appreciated, good, loved, seen, in control, etc. When a therapist's psychological needs are met in therapy at the expense of a client, it damages the therapy process and has a high potential to hurt the client. Those therapists who have done their own therapy, have identified their psychological reasons for entering the helping profession, and are aware of, have tended to, and continue to tend to their own wounds and needs outside of their therapy practice, are less likely to depend on their clients to feel good about themselves and are less likely to cause harm. Addressing the client's needs--not the therapist's--is the focus of good therapy.
Self is a state of being that a therapist can embody when with his or her clients. It's defined by Richard Schwartz, PhD, as a state of calm, curiosity, compassion, creativity, confidence, courage, connectedness, and clarity. Self is considered a requisite of good therapy because it is this state that allows a therapist to work collaboratively without pushing, without pathologizing, and without retraumatizing.
Beyond technique and theory is the realm of the relationship: the ongoing human-to-human connection that provides the foundation for change. The relationship is the safe container that allows one to more fully and completely feel the presence of Self while in the presence of another. A therapist who embodies Self and feels unconditional positive regard in the face of whatever the client may be experiencing nurtures the therapeutic relationship. Without a therapeutic relationship, there is no therapy.
Therapy often times needs to go deep. There seems to be a split in the mental health field between types of therapy that emphasize cognitive solutions and those that emphasize emotional or body-oriented healing. Both are important. Healing takes more than just insight about a problem, cognitive countering, and surface behavior change. To heal, we must explore the depth of the wounds that fuel extreme beliefs, feelings, and behaviors rather than turn away from, counter, or compensate for our suffering. When we counter and turn away from our deeper suffering, we experience "more of the same," which often leads to more suffering. Also, healing requires feeling. As it is said, "If we can feel it, we can heal it." Many of our extreme beliefs, feelings, and behaviors are maintained because we have, in an effort to survive, avoided the painful wounds and burdens that lurk beneath. Good therapy helps people to process and complete whatever hidden and unhidden wounds they have harbored. Treating a client without going deep can be like stitching up a wound without taking the bullet out; the wound is more likely to remain sore, become infected, and require ongoing attention.
"Enlightenment consists not merely in the seeing of luminous shapes and visions, but in making the darkness visible. The latter procedure is more difficult and therefore, unpopular." ~ Carl Jung
Good Therapy Is Imperfect
The phrase "good therapy" encourages a misconception: the idea that there is such a thing as pure good therapy, a process exempt of any problems or issues. In the same way that a good marriage is not one without problems, but rather one that works through problems, good therapy will not always be free of difficulties. No therapist is perfect, and no therapy can be provided perfectly, no matter how ideal a therapy may be in theory. Even those therapists who do the best they can to be conscious of their inner world and attuned to the therapeutic process have aspects of themselves that they are unaware of, pieces of themselves that are unhealed, and mistakes they make. Good therapy is the sum of all the experiences, internal and external, occurring as a result of the imperfect psychotherapy process; it leads toward self-awareness, growth, and the release of extreme feelings, energies, and beliefs. And what a blessing it is that even the best therapy can be lined with areas of unawareness, mistakes, and challenges to the therapeutic relationship and yet still turn out good…like a marriage. Think of the beautiful repairs you and your life partner may have made, the important problems you've worked out with friends, and the repairs you may have made in therapy with the people you work with. A solid repair improves the connection and deepens the trust. So, cheers to road bumps in therapy, within all relationships, and within ourselves! Read More about "Good Therapy, Bad Therapy, and Everything in Between."
Sometimes We Can't Help
As therapists, we are limited. We greet our clients with great hope. We have spent countless hours studying our trade, doing our own inner work, mastering our technique, and learning to "be" with our clients. We have parts of ourselves that want to do good work. We are compelled to help others release burdens and cope with suffering because we know how good it feels to do so. Yet, there are times we can't help. We believe a good therapist never gives up hope that a person can heal in this lifetime, but we also recognize that he or she may not be the one to help, that the time may not be right, or that this person may not be ready and, for whatever reason, may never do the work we envision them doing. Good therapy means letting go of expectations and outcomes for ourselves and our clients without giving up hope.
If there is a principle of "good" therapy that you'd like to suggest, please feel free to share your ideas with us.
Last Update: 03-04-2012