What’s the Bit of Therapy That Heals You?

It’s widely assumed that there is something about psychotherapy that has the power to heal. But exactly what this might be is not always necessarily very clear.

A standard view is that what makes us mentally unwell is something in our pasts which we have forgotten or repressed: it might have been a humiliation, a period of neglect, a moment of cruelty or a pattern of abuse. We’ve become ill because somewhere in our histories, a sombre secret is being held in our unconscious and from there rattles our whole lives. The point of therapy then resembles some kind of detective story in which the therapist accompanies us on a quest to find the buried trauma and thereby brings us relief. Key to this is the hope that the moment the buried trauma is found, we will be well – just as the unveiling of the murder weapon signals the end of a detective’s work. We’ll understand, for example, that our father was belittling or our mother depressed over the loss of a sibling and then – at last, in a relatively short time – we’ll be free. 

The difficulty with this account is that it’s extremely close to being very accurate. And yet it misses out something crucial – on which a proper understanding of the beneficial effects of psychotherapy rests.

What heals people isn’t simply to know what made them unwell; it is to experience, across many hours in the company of a therapist, the kind of relationship with another person which the traumatic dynamics of the past means they will have missed out on.

No one gets better simply by knowing – and then holding firmly in their hands – a piece of information about the sorrows of their early years. Knowledge alone doesn’t heal us from being taunted or ignored, bullied or abused. What makes us better is if we can have an opportunity to correct the impact of difficult incidents in the presence of someone who can offer us everything that our original caregivers may not have been able to. We correct the fear, loneliness, panic, paranoia and shame we once knew by spending sufficient time with someone who is present, kind, thoughtful, encouraging and sane. 

The therapist’s role isn’t – therefore – just to uncover missing painful memories (though they should do this too where relevant), it’s to be able to fill in for the emotional gap which past pains created; to provide an experience coloured by the sensitivity, sympathy, generosity, patience and sheer kindness of which we may have been deprived.

Unfortunately, this approach makes psychotherapy far more difficult than we might have imagined. Success requires an intense and deeply authentic chemistry between client and therapist. Matters will automatically fail if the therapist is frightening, defensive, obtuse, cold, judgemental or hierarchical – the sort of problems that people in our pasts might have suffered from and that too many therapists are not necessarily free of, the world being what it is and therapeutic training courses typically failing to teach with sufficient depth how one might evolve as a human so as to be able to provide a warm-hearted bond with a client. This isn’t medicine, where one can hate one’s doctor and yet still derive all the benefits of the treatments they prescribe. One has to have an active sense of the therapist’s goodness, maturity and kindness – which is an extremely tall order, about as rare as landing on a great friend (which tends to happen, if one is lucky, two or three times in an entire life).

The other issue with this view is that it makes therapy far more expensive and long-term than anyone would like. So long as therapy is seen merely as a detective story, then we have the option to get better rather quickly, as soon as the murder weapon is found. But if we see it as a process that relies on a reparative relationship, then one might need to be showing up once a week, maybe more, for a year or two or three. And therefore one can see exactly why insurance companies, corporations and anyone with an even modestly busy life has huge incentives to try to sidestep the idea.

But if we do, the danger is that we end up in a half-way house; wanting therapy to relieve us of our pains by uncovering a trauma, probably in five sessions or so with the first therapist one lands on, but then lacking the patience or the clarity to see that we need a therapist who can also, as it were, play some of the role of an ideal parent. We’ll be doing therapy and ourselves proper justice when we can exchange the therapist-as-detective concept for that of the therapist-as-reparenter – and then hope that we will, one day, have the privilege and good fortune to find a therapeutic solution that properly repays our trust and investment.