Does Therapy Actually Work?
Therapy Actually Works
I remember seeing a therapist for anxiety during a particularly difficult period of my life. After several sessions when I still wasn’t feeling any relief from my anxiety, I asked the counselor “what percentage of your clients improve their anxiety through therapy?”
I didn’t realize it at the moment, but, of course the question behind the question was - what are the odds that I personally will improve my anxiety?
Without even a split second of hesitation she smiled and said “oh, a hundred percent! Basically a hundred percent of my clients improve!”
Now, as the guy in the counselor’s chair instead of sitting on the couch as a client, I can also say that I see change in my clients every single day.
Our relationship towards ourselves and others, our understanding of our parts, emotions, and the physical sensations in our bodies really can change in big ways over time.
Therapy really does work.
But, what does therapy working even look like?
3 Ways Therapy Works
There are a lot of ways of thinking about what therapy “working” means. Each person comes to therapy with a unique story and circumstances, and unique desires and goals for themselves that they hope to achieve. There are all kinds of beneficial changes that can happen to a person in the counseling process.
(I talk specifically about my own understanding of what therapy entails in the About section of my website if you’re interested)
But, if I had to try to nail it down and describe what therapy “working” really means, I think these three categories describe a lot of what “working” means for counseling:
Experiencing the Therapeutic Relationship
Increased Self-Understanding, Self-Awareness, and Self-Compassion
A Changed Relationship to Your Body
Here’s each one of the above broken down a little further:
The Therapeutic Relationship
If you’ve never been to therapy before, you might be thinking something along the lines of, “I have a couple friends or family members I can talk to…how is a therapist any different?”
And the truth is, the relationship you develop with a therapist is actually very different from any other relationship, anywhere else in your life.
Here are a couple unique factors in the relationship between client and therapist that simply don’t occur anywhere else in society:
The focus is entirely on you
There’s probably no other relationship you have in your life where the focus is entirely on you. With friends and family members and in natural conversation there is an ebb and flow - we focus sometimes on ourselves, and sometimes on the other person in the conversation, there’s a kind of give and take, a dance between both people. And that’s how those relationships should be! If your relationships with your family or friends are just about you, or just about the other person…that’s probably a sign something is up.
The therapeutic relationship is a space where it really is JUST ABOUT YOU.
That experience of having regular focused attention just on what’s happening in your life and what you’re going through simply doesn’t happen in other relationships, and is a really unique and beautiful space to have in your life.
2. The relationship is entirely confidential
Almost every day someone shares something with me that they admit they have never told another person in their entire life.
The special confidentiality of the therapist relationship creates a safe container for you to share parts of yourself and dive into things that you just wouldn’t feel comfortable sharing and exploring with anyone else.
This confidentiality is taken so seriously that counselors are trained to not even acknowledge one of their clients if they see them in public, unless the client acknowledges them first. We want the confidentiality of the relationship to remain in place. (If you do come say hi to us, we’re happy to say hi back - but - it’s essential that it’s your choice whether to have that interaction or not).
Some therapists believe that this kind of confidentiality extends even after a client's death and will not attend a funeral of a client that they have worked with intimately for years because they do not want to accidentally disclose through their presence to others that the client was in therapy. Clients can tell therapists about crimes they have committed in the past, and counselors will not break their confidentiality.
We take this confidentiality stuff seriously.
3. You experience “unconditional positive regard”
Unfortunately, so many of our relationships are fraught with complicated feelings of insecurity, guilt, or shame. In our relationships we often wonder, “if I share this, what will they think of me? Will they judge me for that?”
Therapists are trained to show clients “unconditional positive regard”, meaning that we show complete support and acceptance of our clients. We don’t just “show” it either…we really feel that way!
Sometimes this kind of support is so different from the relationships people have experienced in the past that they can’t believe it’s real! Over time though, as the relationship and trust depends, people learn that they can accept and embrace this kind of support from their therapist, but also from others, and from themselves as well.
The special relationship between client and their therapist is for many people - priceless.
There are all kinds of theories and methods and tips and tricks and hacks that therapists learn, but, most agree that the particularity of the relationship plays a major, if not the major factor in change in the client’s life.
I regularly have people at the end of the very first session say something like, “wow, this was really nice to just get to talk to someone about what I’m going through - and I feel like you really listened to me”…
That’s before we’ve even gotten to a second session or started “working” on anything…the act of simply having time and space to share what’s inside of you with someone who accepts you and you can trust is “therapy working”.
Again, even before we dive into questions about whether you’ll no longer be anxious, or depressed, or angry, or no longer secretly hate yourself…experiencing the intimacy, vulnerability, and authenticity of the therapeutic relationship is a huge part of therapy “working”, and actually helps lead to all other changes taking place as well.
A 2021 Client Satisfaction Survey at Sanctuary Counseling Group, the practice I’m a part of, indicated that 97% of clients trusted their therapists.
Experiencing a relationship of trust is therapy “working”.
2. Increased Self-Understanding, Self-Awareness, and Self-Compassion
Increasing self-understanding, self-awareness, self-knowledge, is a second part of what therapy “working” is all about.
Sometimes clients arrive just really confused and they don’t know why they’re doing the things they’re doing. And that makes sense - when things are off in our lives, it can be really baffling!
Sometimes clients show up with a story already in hand about how and why things work with them the way they do. And, this really makes sense too - we are story-creating beings…we’re always trying to write and understand our own story, so, it makes sense that we would construct our own stories about our mental health.
A lot of these stories explain why a particular symptom is happening that clients don’t like, commonly tracing it back to something that happened in their past.
Clients will say things like,
“I secretly hate that I’m so self-critical of myself, but I do it because my mother was always critical of me from an early age”.
“I secretly hate myself and find myself disgusting because I experienced childhood sexual abuse early in life, and I’ve always blamed myself for what happened”.
“I secretly hate how angry I get sometimes. I get so angry with my bosses because I grew up without a father, and I think I just react against any authority figure I have out of anger I feel towards the dad I never had”.
“I secretly hate how anxious I am all the time. My parents were anxious and I inherited it from them”.
Wherever you’re at in your story-making process, therapy can help bring additional self-understanding and self-awareness pieces that can help you more fully understand what’s going on inside you, and ultimately hopefully help you develop self-compassion for those parts about yourself you secretly hate.
Imagine going from feeling completely confused and baffled at what’s going on inside you, or feeling trapped secretly hating parts that you feel someone else was responsible for creating inside you - to understanding, and having compassion, for the parts you previously secretly hated.
Understanding yourself on a new level - that’s therapy “working”.
In the theory I utilize, once we are able to have compassion and understanding for the parts about ourselves we secretly hate, they relax and become less rigid and start to work with us.
Furthermore, I’ll just say that an increase in some kind of self-understanding can happen pretty quickly. I honestly think that for most people within 2-3 sessions clients will already be beginning to gain wisdom about themselves they didn’t previously possess.
It could be increased self-understanding about how they tend to operate, what some of the different parts within them are, or how their nervous system tends to function. Therapy is definitely not going to be done in 2-3 sessions, but you’ll probably start gaining pieces of self-understanding that quickly.
Clients begin to notice things, and understand things about themselves that they simply did not have the training or guidance to notice or understand before…and that’s therapy “working”.
3. A Changed Relationship to Your Body
Okay - this is admittedly a weird way of describing this…so hang in there and I’ll explain more.
There’s a physical element to a lot of the things client’s enter therapy to work on.
Take anxiety for example. Clients hate that feeling they get in the pit of their stomach, the way their breath gets shallow and quick, the way they have trouble breathing and feel light headed…these are all undesired physical sensations that happen in your body.
It’s not just anxiety either…depression has physical sensations, PTSD definitely has physical sensations, anger has physical sensations…often trauma that happened earlier in life can be locked away in our bodies and we can find ourselves (understandably!) afraid to feel anything in our bodies at all because it would mean encountering all those bad memories and sensations all over again.
When therapy “works” in these situations usually one or both of the following happens:
There is a decrease in the undesired physical sensations clients are feeling (or an increase in the ability to safely feel in our bodies if we’re afraid of feeling anything)
And / Or
A person’s relationship to the undesired physical sensation changes and their bodies changes as well
What do I mean by that second part?
Imagine this situation - you’re driving your car when someone cuts you off and slams on their breaks. In an instant you feel a surge of energy and chemicals in your body, your breath changes and your heart starts racing. In a split second, you swerve lanes and avoid a collision. For the next few minutes your heart keeps beating strongly, your breath is still short, but,you honestly don’t think much of it because it all makes sense to you: you thought you were going to get in a wreck, so your body clicked into high gear, and you changed lanes, and now your body is coming down from that surge of energy.
But - we find ourselves in counseling because the unpleasant physical sensations don’t make sense to us, and we feel negatively about them being there.
A panic attack, for example, is the exact same physical sensation as being cut off in traffic - shortness of breath, pounding heart, a surge of chemicals in us, the feeling in the pit of your stomach…but…it feels much worse because it doesn’t make sense to us.
Therapy can help change the relationship to unpleasant physical sensations so that even if you experience those physical sensations, you will feel an understanding about what’s happening with you as in the first example when you got cut off in traffic.
I know people who used to have very bad panic attacks, who now occasionally have moments where they feel those physical sensations starting to happen, but now they feel as calm as they would at any other moment of the day…the physical sensation just kind of passes through them…they just notice it, say high to it, great it, and let it go right on by.
Or I know other people who used to live in their heads because they were afraid that if they felt anything - it meant they would have to feel everything. Over time they learned that it was safe to connect to their body, and they could experience life in a calm and connected way.
Maybe that sounds impossible from where you’re at reading this, but, those are examples of therapy “working”, and it really does happen.
Another part of a changed relationship with our body can be gaining an understanding of how our body can be a part of our healing process as well. We spend so much time in our heads, but our bodies also do have truths to share with us, if we are able to listen that can lead to our healing.
Those kinds of changes take time, but they definitely are possible.
Does Therapy Actually Work?
As I mentioned in the story at the opening of this post, I once asked my own therapist if her clients with anxiety improved because I wanted to know if I myself would get better.
If therapy worked for them…maybe it could work for me too, I wondered.
My hunch is, if you’ve read to the bottom of this article here, there’s a part of you that maybe is thinking something similar as well…
It sounds like therapy does work for other people, but, will it work for me?
If that’s you - when you’re ready - feel free to reach out and book a free 20 minute video consultation. I’m happy to honestly answer any questions you may have about counseling, to help you understand what therapy working for you looks like, and to see if we might be a good fit for each other.
Are you ready for the next step???
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