I have been in both chairs.
Some hours I have spent in the client’s chair… and many more in the psychologist’s chair. In the client’s chair, I vividly remember wondering about the “behind the scenes” workings of my therapy and my therapist. What was he actually thinking? Was he working with a plan? Was there a solid underlying philosophy to his work with me? What did he write in his notes after the session? Did he really hear what I was trying to say? Did he diagnose me with something or the other? Did I play the client part right? Is this really working?
These questions often loom large in the minds of clients. Especially when they are new to the therapy process, this can be quite anxiety-provoking. Going to a first therapy session – taking a leap into the unknown (and into the office of a complete stranger!) – is therefore one of the bravest things anyone can do.
I have often had clients ask me about the “inner workings” of my job. Sometimes, I think, they will feel safer if they know a bit more, other times they are simply really curious about a profession which has been somewhat shrouded in mystery over the years. This blog will be my attempt to shed some light on a few of the “behind the scenes” workings of the practice of psychotherapy. (Quick disclaimer: the “voice” in the writings will be purely my own. I cannot speak for psychologists in general, as clinicians are so different in terms of their backgrounds and personal styles.)
For many people who have spent some time in the client’s chair, the tricky bit comes in when trying to understand what makes Psychology the same as but different from other “medical” professions. When I have a wonky ankle I might be referred to a physiotherapist for muscle rehab: I go for my sessions, they progress according to a plan (probably fairly similar to the plans for other people with wonky ankles), they are very predictable, and once the outcome is reached, I’m done. Goodbye, dear physio! Ankle fixed! Problem solved! The same goes for speech therapy and for occupational therapy, for example. If a child struggles with making the “s” sound, the speech therapist has a reasonably standard plan to help ease out the lisp. If a youngster presents with low muscle tone, there is a list of exercises the OT will prescribe. Is it the same when you come for psychotherapy though?
Psychology is both similar to and different from other health care professions. Yes – there is a plan! Yes – there is a method! Yes – therapists come from a background of proper training! Yes – there is some predictability! But… even if someone shows up with something as “common” as anxiety or depression, that anxiety or depression is different and looks different, and feels different, for every single person I have met as a client. Their stories are different. The setting, the characters, the plot… everything is different. And therefore every therapy is different. Yes, there will be overlap, and yes, therapists will draw on similar techniques, questions and intervention strategies for all their clients. But – unlike when going to the physio or dentist – the client and practitioner “write the therapy story” together. The therapist brings her engagement, her building of a safe space and all her therapeutic knowledge and skills to the table. The client decides how open to be, how trusting to be, what problems to voice, how to describe things, whether to try out or to ignore some things discussed in therapy, how deeply to look inside him- or herself – and this a far cry from being a passive recipient of a health care service!
Psychotherapy is often predictable in the sense that it has a beginning, middle and end, and people generally know that the basic idea is that they are to talk about things that are hard for them. They usually expect some sort of intervention strategy, and come with the expectation that things will get better as a result of therapy. This is all fairly straightforward and “according to plan”, and things often progress in exactly this fashion. Yet therapy can also be full of surprises! The upwards path can be a bit crooked, there may be more downs before there are ups, there may be highways and byways and little side road journeys, and sometimes the healing can come in unexpected ways. There may be a lot of tears in a session, but also a lot of laughter (I am a big fan of both!).
In short: therapy could be Eastlink (a nice straight highway) but more often it presents as a twisty road with only a sketchy map, with neither client nor therapist exactly sure what will happen in each session. How exhilarating and wonderful! How creative! Yet… let me tell you a true story to explain the slight hesitation in my heart about the joy and surprises of the windy, creative road described above.
When I was in my final year of my internship in 2002 in South Africa I had to deliver a talk in front of many people on the treatment I have done with 2 young children during my child psychology rotation. I gave it a good shot, but my presentation was a bit wishy-washy to say the least. (In my defence – I was actually very ill with the flu and bronchitis at the time, but too proud and too young and too keen to do the presentation to stay at home like a wise girl would have!). After my dodgy attempt at looking the part of the creative, innovative young therapist (and in the process omitting much fact and research and background information) I got the following public reprimand from a rather annoyed senior child psychiatrist: “Psychology, my dear, is not only an art! It is also a science! This you still have to learn! ”
These words made my cheeks burn with shame then… but they were words that turned out to be hugely powerful in how I view and do therapy now.
Psychology is indeed a science. The twisty road with the sketchy map needs some proper illumination and some driver skill! Therefore, psychologists learn all about stats, about research methods, about underlying philosophies and theories, about assessment and psychopathology and diagnosis, about developmental stages, about attachment, about family dynamics, about nature and nurture. We learn about warmth, empathy, confidentiality, ethics, and about creating welcoming, safe spaces. We learn about figuring out best treatment plans, implementing different interventions, changing thought processes, changing behaviour, reframing and tracking progress. We learn to let acronyms and abbreviations fly off our tongues (I’ll tell you all about CBT, ACT, PCT, IPT, etc later!). We even learn about keeping an eye on the clock to orchestrate a well-contained and meaningful “50-minute-hour”! We learn a lot. There is a lot of science in our training.
And then we use all that science to turn therapy into an art.
Into something that is dynamic, creative, co-written, full of surprises and indeed, different for every single client.
Felix & Sage Psychology