Therapy: Part 1
Why in the world is therapy effective?
Over the years I have heard many people ponder, sometimes just to themselves, about how therapy works. I too have wondered this, and I am an actual therapist.
It really is a seemingly mystical process: you go to into an office with someone you have just met, and you tell them about your struggles with the hope that they will somehow be lessened.
There is a South Park episode in which Underpants Gnomes travel the world stealing underpants. When asked why they are stealing underpants, they unveil a diabolical plan that looks like this:
Phase 1: Collect Underpants
Phase 2: ?
Phase 3: PROFIT
To me, therapy seems a lot like this plan, with a glaring question mark in the middle.
Phase 1: Tell a stranger about my problems
Phase 2: ?
Phase 3: Healing/change/growth and ultimately feeling better occurs
So what happens in Phase 2? Well, that depends on several factors. Therapy is one of the least-uniform processes out there. In the medical field, there are protocols for most procedures and operations. Medical professionals are trained to follow step by step processes and adhere to the plan. In the field of therapy, it's quite the opposite. We do NOT have step by step plans (or at least, not in my experience). Most therapists can agree that the patient should have a goal or two toward which they are working, such as "reduce my anxiety" or "experience relief from depression." But once again-- how does that happen? Well, it may sound overly simple but the first factor is basic trust. The person has to actually trust the therapist.
Okay, so...How does trust happen? One of the first things we learned in graduate school about counseling and therapy is how to be a safe presence. On the most basic level, try to sit in a way that's somewhat inviting (open body language). Like, don't have your arms folded and your legs crossed with a frown on your face. Okay, that part was fine. And the next part sounds simple enough: Shut the hell up and listen with openness to what the person is really saying. Just listen and don't jump in. Sounds easy peasy, right?
WRONG. It was extremely challenging at first. We've all lost count of how many times in life we have been talking to a friend or relative and before we've even finished a sentence they've JUMPED in with life advice, suggestions, or the phrase, "Well at least..." or "Well the thing is..." or "Look at it this way..." In our world, or at least maybe in our culture, truly listening to even our friends and loved ones is not something we really learned how to do. We feel a pressure to contribute somehow, to fix it, or make the other person feel better or see it differently, rather than just shutting up and LISTENING.
One unexpected challenge of learning to truly listen was what to do about the dreaded SILENCE in the conversation. It's really not natural. Like, taking a moment BEFORE responding to see if the person wants to elaborate. We would have video tapes of ourselves as baby therapists and our professors would rewind the tape and say, "See there? You cut him off!" or "Stop! She was about to tell you something!" It was so incredibly evident on tape (and yes, I was always sweating profusely during these viewings) that new therapists are overly eager to jump in and are WAY too uncomfortable with silence.
Example: The patient says, "I have been having some trouble at home. It's my wife, she has seemed distant, and the kids are acting up, and I feel overwhelmed."
SILENCE. Maybe a nod. That's IT. Meanwhile, as a graduate student, I'm sitting there wondering all sorts of things, like "Should I ask why? Omg, it's hot in here. Is he going to want me to fix it? OH GOD, I HAVE NO IDEA HOW TO FIX IT. Why is it SO hot in here?"
Eventually, silence stops being bothersome. And then baby therapists learn another skill: Paraphrasing. Again, it's a simple enough concept: Repeat back to the patient a VERY basic summary of what you just heard. Don't put any bells and whistles on it. Just say back what you heard.
Example: The patient says, "I was at work today and my boss stormed in and said I am behind on my reports, and when I left to go home my check engine light was on, and there was traffic, and I'm feeling so flustered with everything!"
Paraphrase: "Wow, it sounds like a few stressful things happened today."
THEN...SHUT UP. Listen. The patient will continue, and you do the same thing again.
Patient: Yes! It was super stressful! And then I was mad because I just got my car serviced over the weekend, and they said nothing was wrong with it. It seems like everything is going wrong lately, and I feel like I can't do anything right.
Paraphrase: "So you've had a lot of discouragement lately."
THEN...SHUT UP. AGAIN. It works!
In conclusion to Therapy: Part One, I dare you to experiment with people you know with open body language, listening, and yes, even paraphrasing. They will be delighted that you are letting them speak.
Think about the last time you spoke with someone who actually listened to you- they didn't make it about themselves, they didn't change the subject, they didn't offer advice or try to fix it. They were present for you, and maybe even clarified to make sure they understood what you were saying. Can you even remember the last time that happened? It's a pretty amazing experience. And I bet you felt safe.
Over the years I have heard many people ponder, sometimes just to themselves, about how therapy works. I too have wondered this, and I am an actual therapist.
It really is a seemingly mystical process: you go to into an office with someone you have just met, and you tell them about your struggles with the hope that they will somehow be lessened.
There is a South Park episode in which Underpants Gnomes travel the world stealing underpants. When asked why they are stealing underpants, they unveil a diabolical plan that looks like this:
Phase 1: Collect Underpants
Phase 2: ?
Phase 3: PROFIT
To me, therapy seems a lot like this plan, with a glaring question mark in the middle.
Phase 1: Tell a stranger about my problems
Phase 2: ?
Phase 3: Healing/change/growth and ultimately feeling better occurs
So what happens in Phase 2? Well, that depends on several factors. Therapy is one of the least-uniform processes out there. In the medical field, there are protocols for most procedures and operations. Medical professionals are trained to follow step by step processes and adhere to the plan. In the field of therapy, it's quite the opposite. We do NOT have step by step plans (or at least, not in my experience). Most therapists can agree that the patient should have a goal or two toward which they are working, such as "reduce my anxiety" or "experience relief from depression." But once again-- how does that happen? Well, it may sound overly simple but the first factor is basic trust. The person has to actually trust the therapist.
Okay, so...How does trust happen? One of the first things we learned in graduate school about counseling and therapy is how to be a safe presence. On the most basic level, try to sit in a way that's somewhat inviting (open body language). Like, don't have your arms folded and your legs crossed with a frown on your face. Okay, that part was fine. And the next part sounds simple enough: Shut the hell up and listen with openness to what the person is really saying. Just listen and don't jump in. Sounds easy peasy, right?
WRONG. It was extremely challenging at first. We've all lost count of how many times in life we have been talking to a friend or relative and before we've even finished a sentence they've JUMPED in with life advice, suggestions, or the phrase, "Well at least..." or "Well the thing is..." or "Look at it this way..." In our world, or at least maybe in our culture, truly listening to even our friends and loved ones is not something we really learned how to do. We feel a pressure to contribute somehow, to fix it, or make the other person feel better or see it differently, rather than just shutting up and LISTENING.
One unexpected challenge of learning to truly listen was what to do about the dreaded SILENCE in the conversation. It's really not natural. Like, taking a moment BEFORE responding to see if the person wants to elaborate. We would have video tapes of ourselves as baby therapists and our professors would rewind the tape and say, "See there? You cut him off!" or "Stop! She was about to tell you something!" It was so incredibly evident on tape (and yes, I was always sweating profusely during these viewings) that new therapists are overly eager to jump in and are WAY too uncomfortable with silence.
Example: The patient says, "I have been having some trouble at home. It's my wife, she has seemed distant, and the kids are acting up, and I feel overwhelmed."
SILENCE. Maybe a nod. That's IT. Meanwhile, as a graduate student, I'm sitting there wondering all sorts of things, like "Should I ask why? Omg, it's hot in here. Is he going to want me to fix it? OH GOD, I HAVE NO IDEA HOW TO FIX IT. Why is it SO hot in here?"
Eventually, silence stops being bothersome. And then baby therapists learn another skill: Paraphrasing. Again, it's a simple enough concept: Repeat back to the patient a VERY basic summary of what you just heard. Don't put any bells and whistles on it. Just say back what you heard.
Example: The patient says, "I was at work today and my boss stormed in and said I am behind on my reports, and when I left to go home my check engine light was on, and there was traffic, and I'm feeling so flustered with everything!"
Paraphrase: "Wow, it sounds like a few stressful things happened today."
THEN...SHUT UP. Listen. The patient will continue, and you do the same thing again.
Patient: Yes! It was super stressful! And then I was mad because I just got my car serviced over the weekend, and they said nothing was wrong with it. It seems like everything is going wrong lately, and I feel like I can't do anything right.
Paraphrase: "So you've had a lot of discouragement lately."
THEN...SHUT UP. AGAIN. It works!
In conclusion to Therapy: Part One, I dare you to experiment with people you know with open body language, listening, and yes, even paraphrasing. They will be delighted that you are letting them speak.
Think about the last time you spoke with someone who actually listened to you- they didn't make it about themselves, they didn't change the subject, they didn't offer advice or try to fix it. They were present for you, and maybe even clarified to make sure they understood what you were saying. Can you even remember the last time that happened? It's a pretty amazing experience. And I bet you felt safe.
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