What Should A Good Therapist Do For Us?

We hear a lot of background noise about the benefits of psychotherapy. But it can be hard to get a clear sense of how therapy actually works and what we would ideally gain from it. It doesn’t help that there is a huge amount of debate among psychotherapists themselves about what they are up to – and that the way a number of training courses are run leaves certain key questions unanswered. The idea here is therefore to try to get a bit clearer about what a good therapist should be doing, so that we might get a better idea about what we’re after and have some measures by which to judge any therapist we happen to be seeing.

We propose that a good therapist should do the following:  

1. Reveal our Maladaptations

Far more than we ordinarily imagine, small children are at the mercy of their caregivers. They can’t – at a young age – mount a patient complaint against them and, if it isn’t heard, move elsewhere. They can’t as infants call in the authorities, they have no power to reason or negotiate with the big people around them. They just have one central priority to which they devote all their might from an innate instinct for survival: to secure their caregivers’ love – as much of it as they can – in order to make it through to adulthood and freedom.

This is not straightforward. All families have ‘conditions of love’: implicit requirements as to what their offspring need to do in order to be granted the love they need. As a general rule, the healthier the family, the less is asked of the child that runs contrary to who they are: someone is on hand to adapt to them and make sense of their appetites and longings. And the more damaging the family, the more a child has to bend in unhelpful and crippling ways to meet the peculiar and often inhumane demands of their wounded ‘carers’. 

We have all adapted in such a natural way to these conditions of love that we tend – nowadays  – to have no sense that we ever did so. Doing so was akin to having learnt to speak: the process was automatic and complex and now very hard to unpack or alter. And yet what we call our adult personalities are to a large extent the legacies of the many adaptations that we had to perform in order to survive our environments of birth. 

A central task of any therapist is therefore – with huge tact – to guide their clients to see what their adaptations are – and the cost that these may be imposing on them in the here and now. What did we need to do to make it through to today? It might be that we had to become extremely meek. Or that we had to be very careful not to seem too boisterous or ‘dirty.’ Or that we had to fail. Or to succeed. Or to worry inordinately about money. There might have been a father who forced us to remain childlike and dependent – or a mother who couldn’t bear to see us happier than she was.

A good therapist encourages the client to perceive what was clever and ingenious about their maladaptations. How smart, in a way, to learn never to feel – if feeling might have forced one to deal with the agony of a parent’s suicide. How sensible to learn to disassociate if presence would have meant perceiving the full horror of parental abuse. How wise to be extremely vigilant if there was someone nearby who could never be trusted. How understandable that one might never stop working for an instant if a parent seemed to suggest that outer achievement was the sole route to their meagre attention.

2. Saying goodbye to maladaptations

But with our maladaptations in view, a good therapist will also guide us to see how unnecessary they are to what remains of our adult lives.

Once it might have been important to fail; now by continuing to do so we are betraying our talent and energy. Once we needed to appease an angry parent; now we can afford to raise our voice and be noticed. Once we had to adapt to the sporadic love of a distracted parent; now we can allow ourselves to find a reliable partner who cherishes us.

In other words, a good therapist helps us both to see the maladaptive patterns we are engaged in and then to say goodbye to it. We aren’t mad or bad for having the maladaptations we have. We can even admire our younger selves for the way they worked out a way to get through things. It’s just that we can now, at last, discard the old defences and look forward to another way of being.

3. Making the Unconscious Conscious

In all this, good therapists understand the extent to which most of our behaviour is unconscious. We simply can’t ‘see’ what we are up to. We may be brilliantly intelligent in many areas, but this is not a matter of standard intelligence. Our emotional adaptations occur without our awareness – just as we learn to speak without any active grasp of how the pluperfect or subjunctive might work.

The good therapist shines a light very delicately on our behaviour. They hint at the connection between how distant we are in our present relationships and the wariness we needed to develop around our early caregivers. Or what the connection might be between our terror of being happy and the jealousy of an embittered parent. For a good therapist, the issues will come into view fairly quickly, perhaps by the third session. The real talent lies in unpacking things at a pace that the client can bear.

4. Reducing Imperatives

We tend to wind up in therapy because we are living under certain punishing necessities and can’t understand why: why can’t we stop working? Why are we always drawn to bullying lovers? Why are we permanently physically unwell? Why can’t we be potent? The good therapist takes stock of these necessities and, with one eye on their role in our early adaptive strategies, helps us to question them and imagine something else:

Once you needed to worry all the time – do you still now?

Once you had to learn to put up with a constant sense of insecurity in love – do you still now?

Once it mattered that you were never seen as ‘cocky’ or ‘too big for your boots’ – do these ideas make any sense today?

We may have locked ourselves into straight jackets: I have to feel guilty, I need to be alone, I have to think ill of myself and well of those who mess me around, I have to keep making jokes, I need to help everyone at my own expense… 

We can realise, with assistance that these were conclusions drawn by a child’s mind and that they don’t in any way stand up to adult scrutiny.

5. Adjusting our Self-Conception

Who we think we are, how well or badly we esteem ourselves, is the legacy of how others close to us viewed us in the early years.

Without knowing that we have done so, we may have absorbed some deeply unhelpful views of who we might be:

– I have nothing to say for myself

– I am too greedy

– I am ugly 

– My physical needs are repulsive

No parent needs to have said any of this directly (it might have enabled us to be clearer about things if they had), but certain conclusions will be naturally inferred from their behaviour. How valuable can we have been if we were repeatedly belittled? Or if a parent chose to spend all their time out of the house? Or played only with our sibling?

The therapist brings a kindly, compassionate outside eye to this sense of self and hopes to broaden the picture: are you really much of what you assume? Are you so ugly? Do you repulse people? A hugely unfamiliar feeling may dawn: we realise that there might be one or two reasons to like ourselves and to feel extremely sorry for what we went through.

6. Reducing Loneliness

Because no one understood certain key things in the past, we will have grown up assuming that no one ever could today.

How could anyone stand to witness our reality? How could they bear to know what we want, what we dream about, what we crave or what makes us furious?

Our relationships may have ended up as shallower than they needed to be because we have kept so much of ourselves at bay – as we once had to.

But after a therapist has been kind and trustworthy and curious enough to follow us into some dark and tender places, we may be readier to let more of ourselves into the interpersonal realm. There can be more of us to love and to get interested in – and for others to notice and engage with. 

7. Exploring more rooms in our minds

Why do we need another person for therapy? Why couldn’t we just do it on our own? The questions are understandable given the cost and time required.

But we often need the curiosity of another person to lend us the courage to explore more of ourselves. It’s their interest that reassures us when we are faltering and ready to give up because it is all too peculiar and sombre. ‘Go on…’ the therapist will say in a soft and warm voice, ‘I wonder why you feel that…’ And because they wonder, and it’s quiet and we can’t pick our phone, and it’s just us and the ceiling or a view out onto a courtyard, we will keep going – and may make some central discoveries as we do so. 

And then because they understood that bit, because they got the thing about our aunt or sister or what happened during the holidays when we were seven, we can bear to go a little further – and a little further still – until, over time, we notice acres of our minds that used to be under water and across which we can now wander with ease.

8. An experience of Rupture and Repair

If we’re really lucky, the good therapist will get something wrong. They’ll annoy us, they’ll misunderstand. They’ll say something out of place. But – if we’re luckier still – when we dare to point it out, they won’t get angry, flare up or (as Freudian analysts used to in Manhattan in the 1950s) tell us we’re ‘in denial’ or ‘resisting’. Instead, they’ll be mature and well-schooled enough to say, ‘How interesting, tell me more, I want to learn. You’re the expert on you, I was simply giving it a shot, I can sense that I’ve frustrated you and I apologise.’

And from this, we’ll get a taste of something we may have been severely deprived of: an experience of someone authoritative taking us seriously and saying ‘sorry’; someone not getting defensive, and instead hearing us out – and adjusting as we always hoped that they might. We get an experience of what is technically known as rupture and repair. And this can embolden us to see that this is how all adult relationships should function. We don’t have to just shut up and feel sad. We can grow more hopeful about human beings – and more decisive in moving away from certain unduly perplexing types around us. 

Given these goals, we can see just how many qualities the good therapist will need to have:

– They’ll need a very kind, soft, sympathetic manner that gives us a genuine sense that they are interested in us and that our pains register in their hearts. That requires therapists who are happy enough in themselves.

– They’ll need to be free of any urge to moralise. We have to feel that they are extremely broad-minded and unshockable. It can be only too easy for the badly trained therapist to take fright at certain maladaptive behaviours that they stumble on in their clients. Deep inside themselves, they may be thinking: ‘but it’s not good to tell lies all the time…’ Or: ‘but it’s not nice to look at pornography all day…’ Or: ‘how silly to worry so much about your appearance…’ But if there are any such attitudes anywhere in them, the result will spell disaster for the therapy. We pick up at once if someone is judging us and, for sound reasons, clam up. A well-trained therapist will have overcome their urge to moralise because they will have understood that everything a human being does or wants is ultimately a legacy of an adaptation to an unhealthy early environment, not evidence of a moral failing. Our ‘sins’ all simply stem from the way we had to learn to cope with dreadful things. 

– A good therapist has to be a rare mixture of extremely kindly and caring and, in another part of their mind, very intellectually vigorous. They aren’t just there to sympathise with our sorrows, they need to be able to fit our sorrows into an interpretative model. They have to be able to see how x relates to y: how something we’re doing now relates to something we faced then – and how what we said four Tuesdays ago is connected up to what we revealed about our mother in passing at the end of the session today. It’s delicate work indeed.

– Finally, a good therapist needs an excellent sense of timing. It isn’t enough just to have a picture of what is up with a client; one needs to be able to be serene enough to wait for the moment when the client will be able to bear to hear certain seismic truths about themselves. Like the proverbial jazz musician, a good therapist has to know when to come in and when to hang back, when to pick up on a note, and when to let it go. 

No wonder, given all this, that there are very few excellent therapists and very few entirely successful therapies. But the hurdles shouldn’t put us off. Indeed, once we know what the whole thing is for, we should – as clients – only get more determined in our search for the kind of liberating and life-enhancing therapy that we long for and deserve.