How does therapy work?
Interestingly, this question can be answered with the answer to a different question. Which type of therapy is best? Back in the 70s they wanted to answer this question. They did their research and ended up with a surprising result: no therapy seemed to be more effective than another. This was referred to as the Dodo Bird Verdict (like in Alice in Wonderland): “Everybody has won and all must have prizes”. The results of this research helped us to understand the common factors that made therapy effective. The three keys to therapy are “Accurate Empathy, Genuineness, and Unconditional Positive Regard”. These are the attributes a therapist must have to cause change in their clients. You have to know and feel that your therapist cares about you, that they truly hear you, and that they are not judging you. If these conditions are met, then change can happen. There are barriers to this as well, but good therapy will overcome them in time by accurately identifying the client’s difficulties with vulnerability and authenticity in the present moment. A research article that I have been unable to relocate, sadly, referred to therapy as a “social healing ritual”. I think that this is a perfect description of what is happening in therapy.
Therapy happens in 3 phases according to Sue Johnson, a renowned therapist and the creator of Emotionally Focused Therapy. They are Stabilization, Restructuring, and Consolidation. Like any other linear system in psychology, they do not always happen sequentially. Stabilization may be needed at many different points throughout the process of therapy, as new material or reprocessing efforts can be fairly destabilizing at times.
What is stabilization? This is best defined as the process of becoming regulated enough through learning to trust the therapist as well as practicing some of the coping skills that are learned in therapy. That’s right, deep breathing! Everyone’s favorite… All jokes aside, regulation/coping skills need to be practiced regularly and they are a lot of work to practice. It might feel like having a part time job you never asked for. Oh, and you don’t get paid! Easy to see why few clients practice them outside of therapy. The less you practice, the longer therapy is going to take. And no, it is not your therapist’s lack of ability to magically heal you. If you became frustrated that physical therapy was not working and you never did your prescribed exercises, that would just be silly. This process is no different.
Restructuring is when the therapy is actually happening. You sit in your emotions and your discomfort as your therapist facilitates the process to keep you in your window of tolerance so that the therapy remains effective. Facilitating the process can look like many things and EMDR is a clear and effective example. You create traumatic “targets” together and through a structured ongoing assessment you work through them using bilateral stimulation which causes a new calm experience and a positive mindset when faced with the trauma. This is a brief summary of EMDR and not at all exhaustive of how it works. The restructuring of traumatic material is the goal.
Consolidation is simply bringing the therapy to the rest of your life. Can you maintain the changes you worked on in therapy so that you now have the life that you want? This is where we all hope to get to and with enough work it becomes a reality.
Hopefully this is helpful and gives some substance if therapy was thought to be too nebulous. While this lends the process of therapy some structure, it does not give a fair estimate of how long therapy will take. It is going to be different for every person. The client and therapist should check in around every 3 months to reassess progress and a proposed length of continued therapy.
