How Psychotherapy Works

Many people contact me wanting to know just what is psychotherapy and how does it work to help people change? This is a question that many people have asked over many years about all forms of psychotherapy. In fact, scholars have studied this question extensively, and although there are no definitive answers, they have found that there is one factor that seems to be present in all forms of psychotherapy, no matter what modality (individual or couple) or orientation (Freudian, Jungian, behavioral, cognitive, etc.) and that is the therapeutic relationship (also known as the alliance). According to Dr. Lester Luborsky of the Penn Psychotherapy Project the therapeutic alliance may be defined as "…that point in the therapeutic relationship when the client on one hand elevates the therapist to a position of authority, but on the other hand believes that this power and authority is shared between them, that there is a deep sense of collaboration and participation in the process. In this way a positive attachment develops between the client and the therapist."

In the beginning of therapy the therapeutic alliance is based on the client experiencing the therapist as supportive and helpful. In the later phases of treatment, the alliance is experienced as a joint struggle against what is impeding the client, a shared responsibility for working out treatment goals, and a sense of we-ness.

Psychotherapy from an attachment theory perspective (how I practice) also includes other important elements. Johm Bowlby, the psychiatrist who first wrote about attachment theory, explicitly saw the therapist as a surrogate parent-figure who encouraged the client to explore their inner world (mind, psychological self) from a secure base the therapeutic alliance. In the context of therapeutic work with individuals, Bowlby defined five tasks:

1. Create a safe place, or Secure Base, for client to explore thoughts, feelings and experiences regarding self and attachment figures;
2. Explore current relationships with attachment figures;
3. Explore relationship with psychotherapist as an attachment figure;
4. Explore the relationship between early childhood attachment experiences and current relationships; and
5. Find new ways of regulating attachment anxiety (i.e., emotional regulation)

Recent advances in neurobiology suggest, that psychotherapy changes the brain, in that repeated positive interpersonal experiences may be stored in the form of memory (positive mental models about self and others) which are then carried into other relationships making them more enriching, positive experiences.

In addition, when people have experienced unhealthy parenting as children, neuroscience has shown that some people may not have developed certain capacities because their parents may not have had these abilities themselves. The part of the brain just behind the eyes is called the prefrontal orbital cortext. This is a very important part of the brain because it regulates functions that have to do with interpersonal relationships. When we are born, this part of the brain is not completely developed and therefore environmental experiences will determine how it evolves. Therefore, psychotherapy may include working on any one or a number of these skillls. These capacities include:

1. Autonoetic consciousness: Knowing oneself over time.
2. Social cognition: Empathy and the ability to look into the minds of others.
3. Self reflection: Ability to look into your own mind.
4. Emotion regulation: Ability to soothe oneself and be soothed by others
5. Response flexibility: Weigh options before acting.

A wonderful characteristic of our brain is that it is always changing and receptive to experience. That's why they say, psychotherapy can change the brain!

Ultimately how you change will be unique to you, the specific nature of your difficulties, the interventions and the therapeutic relationship. Feel free to ask about the change process in your sessions at any time.