Lessons from the couch, about the couch: What is therapy really and how does it work?

This is a piece for the uninformed yet potential therapy user that I hope will be equally esteemed by therapists themselves. In an effort to demystify the process of healing and change that we call psychotherapy, I decided to put pen to paper with the hope that the more one knows about a thing, the less anxious one will be about trying that thing. So I’m going to offer my thoughts on what I have learned from being a practicing psychotherapist and working with people from all walks of life dealing all types of issues, using all types of psychotherapies. This is what I have learned, so far:

  1. Therapy is a journey:  From the very first session, you start out on a quest together — doctor and patient. As the pilot, the therapist is keenly aware of where you the patient needs to go (at least most of the time).  And much of the the therapist knows where you have to travel to get there. But oh, the places we’ll go! It’s the twists and turns that you can never predict and that you don’t quite expect that make the journey. It’s the loopdey loops and the slow ascensions followed by the steep drops that leave you, the therapist, sometimes breathless. Thoughtless. Speechless. And truth be told, sometimes very frustrated. And many times scratching your head in sheer confusion. The therapeutic journey is real. And sometimes it’s a real trip! Sometimes it feels like a trip on the highest, fastest rollercoaster ever built. But I’ve learned that there is magic in the journey. And that is what makes the journey worth it.
  2. Therapy, like life, is about relationships: The therapeutic relationship — that between patient and doctor, is indeed, a rare one.  In fact, I am going to go so far as to say that I don’t know of any other relationship quite like it. It’s a special bond forged by mutual trust, honesty, compassion and vulnerability.  But unlike other relationships with a similar foundation, rarely is there ever the type of implicit trust that this relationship packs. As the patient you’ve given your therapist carte blanche to give you his or her honest interpretations and clinical opinions of you and your thoughts. And your behavior. And your decisions. No matter how HARD it is to hear. And you have made the explicit decision that since this therapist is an expert in human behavior; he or she must know what the heck she is talking about. So you trust what they say. Most times. And you keep coming back. Most times. Because you feel that this doctor cares in a way that no one else has or can. And you trust that if you keep coming back, and listen to the recommendations, and do the work then change will come at some point.
  3. The therapist is a tool (it’s not what you think)! I’ve been practicing professional psychology for exactly two decades. I was 24 when I saw my very first therapy client in graduate school. Not only was I green to therapy, but for real, I was green to life! And while I had a few tools in my toolbox and a bit of skills, I had no wisdom. Like Zorro with the proverbial sword, I didn’t know how to use the sword. I had no context to marry the skills with. While many of my colleagues may disagree, here is what I know for certain: I know that I have become a thousand times more comfortable in this role over time and with  experience: life experience. I’ve become more genuine with those on the couch the more I came into my own being and my own acceptance of me. Of what I know, and more importantly, of what I don’t know. The more life I had lived, and the more experiences that I had (both good and bad), the more I understood life. These are the experiences that I rely upon in my sessions. They have given me street creds. They are my bona fides. They are the passport that gets me into a foreign land (the minds of my patients). And so because I have lived some life, I have some wisdom about some things. There are just some things you know because you have lived enough life to have seen them over and over again. I know that trouble doesn’t last always. I know that emotional pain isn’t permanent. I understand that there are hills and valleys in life. So with that said, I am a tool in therapy. And my near 50 years of life are the scrapes and scratches and marks that have well seasoned me to be of good use: to drill down to the issues and get to the depths of the pain. And to facilitate the journey.
  4. Therapy is part art & all science lightly sprinkled with a pinch of miracle dust: Though it may seem so, therapy is not hocus-pocus conjury. On the contrary, psychotherapy is based on hard science. Its foundation is built on the integration of various schools of psychological thought and a century of research in human behavior, with a smattering of miracle dust and a sprinkling of Wonka juice. I jest, of course, but sometimes that’s what it feels like. Though there is no proverbial waving of a wand by the therapist, something magical happens in therapy. At the end of the journey, if the therapist is truthful with herself, she acknowledges that it was very little of her own skills or talent. And maybe it wasn’t even much of the science implemented or the techniques recommended. Rather it was a great deal of trust, courage, consistency, and difficult individual reflection done in the comfort of the patient’s home. Outside of the therapist’s office.
  5. Therapist As Superhero: In the end, we are not superheroes. We are mere mortals with the same emotions, issues, and insecurities as our patients. We aspire to be just a bit more authentic, self-aware, real, and emotionally healthy as our clients do. But the truth is, we are not superheroes, or even super human. Truth is, this is hard, emotionally taxing, and really heavy work. It weighs on us. And we hurt sometimes because of it. There is no cape we wear; no red cape to hide the wounds. No suit that gives us special strength, no wand we wave. There is no magic in us, yet I am clear that very magical things sometimes happens through us.

The therapist is simply a mirror. We simply show you…YOU in a realistic way. The way the world sees you. Like the queen in the fairy tale, you must have the courage to ask the mirror (metaphorically speaking), what it sees and even more courage to accept the response. That right there; that’s the magic. And when therapy is done right, you get to see the you that you are and begin moving towards becoming the you that you were destined to be. It will be a journey. I don’t guarantee much, but I can guarantee that. But in the end you’ll say it was the greatest ride ever.

So, consider therapy. Find a good therapist. It can and will change your life!

Be well,

The good Dr. Nik


Dr. Nik is a DMV-based Clinical Psychologist, prolific blogger, speaker, media commentator and compassionate activist. For more information about her services, go to http://www.TheGoodDrNik.Com, and follow her @theGoodDrNik on FB, Twitter, and Instagram.

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