How does psychotherapy work?
In short there is a wealth of evidence that therapy works, but no concrete understanding of its precise mechanisms. At last count there were approximately 480 schools or modalities. The ‘Dodo bird effect’ states that although there is evidence of benefit, there is no proof that one modality is more beneficial than another. Research published suggesting that one modality is superior to another has been shown to be suffering from researcher bias.
Current thinking suggests that it is empathically attuned human relationship that heals. Conversely deficits in early relationships cause psychological trauma. In early years when our needs are not met, we are programmed with the expectation that this will continue to be the case. We then push these needs out of awareness and create a self-fulfilling prophecy.
In short there is a wealth of evidence that therapy works, but no concrete understanding of its precise mechanisms. At last count there were approximately 480 schools or modalities. The ‘Dodo bird effect’ states that although there is evidence of benefit, there is no proof that one modality is more beneficial than another. Research published suggesting that one modality is superior to another has been shown to be suffering from researcher bias.
Current thinking suggests that it is the empathically attuned human relationship that heals. Conversely deficits in early relationships cause psychological trauma. In early years when our needs are not met, we are programmed with the expectation that this will continue to be the case. We then push these needs out of awareness and create a self-fulfilling prophecy.
Winnicott said that a child growing up with “inadequate relationships, with insufficient contact, cannot develop an adequate sense of self”
Children who do not have their emotional needs met will split off from feelings they cannot tolerate. Primitive attempts to self-stabilize and self-regulate result in the attachment patterns that stay with us for life.
The acknowledgement and validation of emotional needs can be healing. Therapists can use their own experiences to understand the client's pain on a deeply personal level and communicate that knowing back though tone of voice, facial expression, and body language.
It is thought that several common factors are involved in the healing process. These have been described as hope, corrective emotional experiences, a treatment rational, positive expectations, catharsis, therapist warmth, learning, changes in expectation, a healing ritual, and the therapeutic relationship.
Beissers paradoxical theory of change suggests that if you try and change someone they will automatically push back and that the best way to encourage growth is to fully accept who they are.
Once trust between the client and the therapist has been established, subconscious right-brain to right-brain communication is established allowing previous negative relational experiences to be overwritten. The new relationship promotes neuroplasticity and the growing new neural connections in a part of the brain called the orbitofrontal cortex. This area of the brain is responsible for defining our personality and its development allows us better socially relate and emotionally regulate.
If strong links between the prefrontal cortex and the amygdala are not formed early on, they may get pruned away leaving a connection too weak to inhibit a fear response leading to anxiety in later life. Almost all psychiatric problems result from right brain under development and emotional dysregulation.
Integration in psychotherapy can mean the integration of both the theory and the client. It is the integration of knowledge to bring about both integration of the self and the brain. Psychological integration will result in neurological integration.
Though it is an over simplification we can think about the integration of the emotional, creative, imaginative, globally aware right brain with the locally focused, logical, verbal, analytical left brain. Therapeutically the act of putting feelings into words and creating an emotional narrative of our lives can improve the integration between left and right hemispheres.
We can also consider the triune brain and the structural integration of the brain stem limbic system and human neocortex. We need a bottom-up approach in psychotherapy that integrates somatic sensations and emotions which underlie our thoughts and behaviours.
The therapist works with implicit procedural memory and allows the client to reflect and express experience verbally in a safer, more tolerant and accepting relationship.
How to find a therapist
One of the uncomfortable ironies of life is that the more we might need a therapist the less able we are to jump through the hoops it may take to find one. If we are in a crisis, we might be stuck in a fight flight response with our prefrontal cortex offline and unable to make choices.
There are many ways one could go about finding a suitable counsellor or Psychotherapist. If we are in a bad place, we may ask a friend or relative if they have someone they have had a good experience with. This strategy can work, but just because one person gets on with a particular therapist does not necessarily mean that you will.
One of the uncomfortable ironies of life is that the more we might need a therapist the less able we are to jump through the hoops it may take to find one. If we are in a crisis, we might be stuck in a fight flight response with our prefrontal cortex offline and unable to make choices.
There are many ways one could go about finding a suitable counsellor or Psychotherapist. If we are in a bad place, we may ask a friend or relative if they have someone they have had a good experience with. This strategy can work, but just because one person gets on with a particular therapist does not necessarily mean that you will.
Another choice is to search the various directories out there such as:
These directories allow you to search by location and modality or presenting issue. You can often filter by whether you require short- or long-term work and whether you prefer to work online or in person.
It can be useful to consider your budget and how willing you are prepared to travel. Is the race or gender of the therapist important to you? You might look at how much experience a particular therapist has, what level they are qualified to and whether that are part of a professional body.
Having a therapist belong to a professional body is useful in that they will have signed up to follow a particular code of ethics and it gives you someone to complain to if you have a grievance.
Often, we will want to see a photo of the therapist to try and get a sense of whether we feel this is someone we can trust. Perhaps the therapist has a website, blog, or YouTube channel we can use to get a sense of them.
How important is the type of therapy they deliver? There are many different types of therapy including Person centred, Psychodynamic, Cognitive Behavioural therapy, Gestalt, Transactional Analysis and Integrative. Before knowing what sort of therapy works for you, you may need to give it a go and find out.
If you do try a style of therapy and it does not work for you take some time to reflect on what did not work. The knowledge you gain of knowing what does not work for you can be invaluable second time around.
It might be useful to consider what it is about yourself that you need help with and find a therapist that specialises in that area. Are you having a problem with thoughts, feelings, sensations, or behaviour? Different modalities may focus more heavily on one area over another.
It might be that you have something specific you want to work on such as anxiety around public speaking or exam stress or it might be that something is not quite right and you want help finding out what that might be.
Whatever the issue it is likely that there will be someone out there with experience in that area. The important thing is to find a place where you feel safe and a person you feel you can trust. Once you have found some one you can try them out.
Once you have an established relationship its worth giving it a fair go before leaving or moving on to something else. Therapy can often be a bit of a bumpy ride. Sometimes when things get a bit uncomfortable it could be a sign that things are working.