What, Specifically, Has 'Therapy' Done For You?

I don’t understand the whole concept behind ‘therapy’. What I would like to know is how do the people who go through this process derive actual benefits from it. Does the psychologist or psychiatrist give you specific directions on how to live your life? If not, how does it all work??

And how exactly does ‘talking things over’ yield benefits? If experiencing some type of trauma is initially bad for you psychologically, then how is it that it becomes psychologically good for you to relive it in the therapist’s office??

I’ve asked someone who has been through this, but all she gave me was some very vague details like ‘I learned some things about myself’ and that type of stuff. Well, what did you learn about yourself that you didn’t already know? I’m looking for definitive examples here.


Well, the benifit I am seeing is that my therapist helps persuade me to do the things that will get me out and about socially. I have depression and social anxiety, it is useful for me to have some one to talk to who persuades me to get out at weekends, to get fit again, to talk to the women that I find attractive. Without this possitive reinforcement I would probably believe it wasn’t worth the hassle to do things. Even though I know that when I get out I have a good time, I always find it difficult to do.
Hope this is not to whishy-washy.
Cheers, Bippy

Therapy in and of itself hasn’t done a whole whole lot for me except for one thing: gotten me on Celexa. That has done wonders for me. It’s nice to have someone to talk things over with, but I can’t say I’ve gotten any great insights from the process.

Speaking from my own experience, I never found the year I spent in therapy even remotely helpful. However, my problems (OCD and bipolar disorder) are pretty clearly chemical, as they responded fabulously to medication. This being the case, it shouldn’t come as a big surprise that I didn’t get much help from chatting about them.

That’s not to say that someone in a different situation wouldn’t benefit from talk therapy. People often have trouble understanding or recognizing their own feelings and their own motivations, and it can make a big difference to have an objective listener offer some guidance. Therapy is also an opportunity to release pent-up frustrations and emotions that one might not feel comfortable discussion with anyone else, and to do so in a non-judgemental environment. This can be pretty important, as anyone knows who has ranted and raved for a few minutes, and then felt better for it afterwords.

Hmm. I don’t know if I’m making a lot of sense, here. I’m betting someone else can explain this better than I; probably someone who’s had successful psychotherapy. I yield the floor…

Re: talking things over

It helps you organize your thinking about events, feelings, etc. It allows you to feel as though another human being is connected to you in the process (very important). The annonymous quote goes: “I learn what I think as I hear myself talk.”

What a therapist does:

A therapist is like a mirror for your personality. Sometimes we just don’t see things about ourselves so we don’t get why things cause us friction in our lives.
Think about it this way, it’s like having bad breath. You don’t really know why people don’t want to be close to you, and no one is willing to tell you about it.

At very least, going to a therapist provides the time, place, and most importantly the expectation that you will work on yourself.

At very most, a therapist is insightful, educated about human behavior, and able to make suggestions about behavior changes.

Alot depends on the orientation of the therapist. A behaviorist will look at your behavior, and usually suggest very concrete changes to make (like the guy that goes to the doctor and says “doc, it hurts when I do this…” and the doc responds “well don’t do that”) cognitive and behavioral psychology are pretty much fused at this point, so thinking errors usually come into play. For example, a therapist might be able to notice by your description of events that you look at them in a way that’s harmful, and thus react as such.

A family therapist will work with members of the family to suggest changes in patterns of interaction that are detrimental to the family functioning (way oversimplifying here).

A psychiatrist will often prescribe medication to treat disorders (therapists and psychiatrists often work in tandem; I personally don’t know any psychiatrists who do psychotherapy nor do I know anyone who could afford it.)

You seemed particularly interested in trauma and how talking about it helps.
If a person suffering from acute stress or PTSD is able to relive the event in a place that is safe, it becomes more and more ok for them to relive the event (which they’re doing anyway, it’s not like if you never talk about watching your mother get shot you simply won’t remember it and live as if it never happened).

so, tell me about your mother…

I’ve been in therapy for about 15 months now, and it’s helped tremendously. I was sexually abused from the time I was about 8 til I was about 14. To add insult to injury, so to speak, my mother and father both knew about the abuse, and had the power to put an end to it, but didn’t do so. As a result of this trauma, I’ve been very sketchy on many details of my childhood. Therapy has helped me to: recover some childhood memories; acknowledge that anger can be a positive emotion when used correctly; acknowledge that my father was as wrong in the situation as my mother was (for many years, I blamed her almost solely); realize that much of my way of thinking about the situation was flawed.

My reason for seeking therapy was my inability to remember. As an analogy, let’s say you’ve got a lot of crap in your attic, and you want to clean it out. Well, in order to decide what to trash, and what to keep, you have to know what’s there. I have to uncover these memories so that I can make a conscious decision to deal with them.

I think a situation like mine is almost an ideal case for talk therapy. I’m certainly glad I decided to do it!

I used to have a major problem with depression. It was so bad, I didn’t even recognize that it was a problem. I just thought everyone felt like this–not the deep pits of despair, mind you, just a low level, constant depression. Well, I went for about a year and it did nothing for me. I thought, “I can rant to my friends for free so why am I paying for this?”

A couple of years after that, I was part of a mental health research study and I asked the therapist interviewing me how I would know if therapy was working. She said that it should feel uncomfortable and challenging. It’s not easy to finally face the things you’ve been trying to back-burner for years so the process of confronting and dealing is not an easy one. Ultimately, you should feel a sense of accomplishment at facing and overcoming these problems.

So, a couple of years ago I decided to give it another shot and it was the best decision I’ve ever made. There’s something about talking to this person who’s not emotionally involved in your life so is not going to tell you what you want to hear and is not just being nice because he/she’s your friend that makes the experience more validating.

I worked through my depression and self image problems. My therapist encouraged me and helped me to confront my fears and insecurities. He was able to show me another way of looking at my problems that I couldn’t see because I was sitting too close. It was an incredibly rewarding experience for me.

This is pretty much why I go. I don’t need someone to tell me if I’m right or wrong. I don’t need their opinion. I just need to talk about these feelings that are so bottled up inside of me that it’s difficult to even form words about them.
I started going because I didn’t know what else to do. I was so miserable that one evening I was getting ready for bed and all of a sudden, I couldn’t breath. I mean, I’m sure I was breathing, but it felt like I couldn’t breath. Like I wanted to just lay down and stop moving, stop thinking, stop breathing and it scared the fuck out of me. The next day I went to the University Counseling Center to get help because I just didn’t know what else to do.

I read an article by Dr. Allan Schore a while ago (that I have never been able to find again, darn it!) that suggested that the normal reflective process in therapy (sympathetic look, sympathetic voice, reflective body positioning) was one of the reasons talking therapy works.

Very briefly:

In infancy, we are unable to fully process emotional content. Instead of doing it ‘ourselves’, our caregivers help out. They serve as functional extensions of our brains, by their response. An in-tune, reflected response stops the stress cycle. For example, baby is scared by a new event. Stress hormones circulate as baby startles or starts to cry. Parent (in tune) makes reassuring noises, which generally mirror the affect of the infant, facially, gesture-wise, and in voice tone, BUT moderate the response toward a more positive affect (that is, not as scared/sad/angry as the infant, but relevant to it). The infant responds on a neurological level, stress hormones drop (though some of the ‘upset’ behaviors may remain, depending on the situation - such as crying from pain will remain, but the distress portion of it drops out of the system). Same process for happy events - caregivers constantly moderate affect ‘upwards’, giving cues to the baby about how to respond to different events. By being in tune, the infant learns that this feeling of ‘sad’ matches that feeling expressed by the parent. It is the basis of understanding, in the fundamental sense - children whose caregivers do not function normally in their responses have difficulty identifying even ‘universal’ expressions of emotions.

So, how does this relate to therapy?

You’ve got a stress, related to an event. The stress is in some cases chemically interfering with your function (triggering dissociation, overwhelming anger or fear, etc.). Too high a cortisol level, and all sorts of normal brain function start getting messed with, including formation/storage of memory (hence memory mishaps from abusive childhoods). By bringing up the stressor in a ‘safe’ environment, you have the opportunity to have someone serve as a controll portion of your brain, resetting your stress response by responding in a moderating fashion to your stress.

For example, you talk about an upsetting event where you were afraid. The therapist makes comforting sounds, in tune with your response but not as severe (that is, upwards affect, but related/reflected). Their body posture, facial expression, etc., also line up with what your brain, in a neurobiological sense, requires in order to re-set the stress reaction to a lower level. You may also talk about ways to recognize your own feelings, the feelings of others, and manage similar events in better ways. Those are structural/behavioral benefits beyond the neurological one.

For me, just the talking was the biggest thing. All my therapy involved me leading, me teaching myself, me noticing what I was doing and coming up with solutions myself 90% of the time. But I needed that reflection of another face/body/voice to release the chemical stress reaction to the event.

Therapy helped me LOADS. The hardest part for me was locating the actual source of the stress, so that I could release that portion of it.

For more about how the basic function works in infancy, try here, Normal Attachment and Mental Health - it is dense, and hard to slog through all the jargon, but it is really fascinating. There’s a second page (linked at the bottom) that deals with the implications of abnormal attachment process and subsequent mental health. There is another, more readable (and more condensed) version of the same info here. Unfortunately, I have never again found the article with the comment on how this relates to therapy. But it does make a huge amount of sense (even if a lot of therapists might be somewhat offended at the implications).

I’m not the type who likes to burden people with my problems, and up until last year I scoffed at people who had to run to a therapist to try to fix themselves. Then I found out the hard way that I needed fixing myself, and probably have since childhood.

My therapist gives me goals, positive reinforcement, and allows me to get some issues off my chest—the types of things I would never tell friends or family.

Plus, therapists are required to counsel each other. Being sieves for other people’s anxieties is bound to affect their psyches as well.

I got a long way to go, but at least I finally started doing something about it.

I’ve gone to therapy in the past and will start up again in a few weeks after a year’s hiatus.

At first I went because I was depressed. It was all very non-specific at this point. As I started learning how to access my emotions and how to deal with them, I saw that anxiety was a big problem for me. So, I did an intensive anxiety workshop. It was really helpful for me – I figured out how to better handle the anxiety in my life.

For me, there are two things about therapy that help. First, I like a particular approach called cognitive behavioral therapy – it emphasizes teaching you how to first recognize and then change your assumptions & thought patterns, among other things. Second, I’m not sure why, but I have trouble figuring out how to help myself. It’s almost like I have some sort of learning disability: If you give me a problem, I can find a solution. I’m a researcher – finding solutions is no problem! If you expect me to figure out how to implement the solution in an orderly way and apply it to my life, well…watch out. At that point I get overwhelmed, frustrated & am liable to chuck the whole thing. So, I tell the therapist that I need help breaking things into managable pieces, and we sit there and figure out how to implement the solution I’ve developed. Plus, working with a therapist helps me keep my goals realistic – due to whatever that problem is I just described, I don’t always make my goals reachable, which is a good way to cultivate failure.

That’s why I’m starting up again. I have a bunch of impluse control issues, like over-spending, procrastination and binge-eating. I want to get these behaviors under control because I covet balance in my life. I can identify the goals I want to achieve in this area…and I need someone’s help to get me from where I’m at now to where I want to be.

Ultimately, I hope that working with a therapist on specific issues when I need to will, in the future, help me figure out better how to help myself. It’s not like I want to be paying these bills forever!

i’m the sort of person who bottles things up.
not only that, but i actively push things to the back of my mind.

the problem is, that some thoughts act like they are on a piece of elastic, and the more you push them away, the more they intrude into your normal thought processes.

so, for me, talking to someone gives me a chance to air these things, give them some attention, AND THEN LEAVE THEM THERE.

that is, once you’ve talked about how you feel, and why you feel that way, you can literally push the event back into it’s box and leave it there.

by doing the talking in a controlled and guided way to someone you don’t have to see everyday, it’s easier to leave the unpleasantness in the therapy room.

also, some things don’t become clear until they are vocalised.

having someone say,
“now, that isn’t making sense to me, WHY EXACTLY do you feel like that?”
or “OK, i can see why you might feel like that, but do you think that that really applies in this situation?”

is actually very effective.

because often they are the sort of questions you DON’T ask yourself, but need to.

I don’t have an ongoing regular therapy session; I use counseling services in crisis situations as needed. I’ll echo this tidbit.

I find that the directed-discussion process tends to short-circuit my own habits of thought and see things more clearly. In other words, by talking about everything, and getting it all out on the table, patterns and problems become clearer and easier to see. Normally we don’t think about our lives in any kind of organized or objective fashion; inside our heads, we tend to assign blame, defend ourselves, and obsess about minutiae. But when you have to explain everything out loud, it’s amazing how this huge problem suddenly seems insignificant in context, and in fact seems to be connected to that other thing over there I had convinced myself not to think about.

In short, this stuff has hugely improved my marriage, my relationship with my family, and my outlook on life. The skepticism of the OP strikes me as nervous defensiveness, IMO.

Spent a couple of years in therapy a long time ago.

It helped me to understand my disorder and gave me tools to cope on a daily basis. Benefits I could not have received except from a psychiatrist, IMHO. I had a great shrink - his goal was to have me get to the point where I no longer needed him. It worked.

My therapist has helped me to recognize that there are certain beliefs I hold about how my life and the world works that are 1) not rational and 2) causing me heartache and holding me back. (Example: I am almost pathologically reluctant to take up any new hobby that requires interacting with a group because of my perfectionistic tendencies. This is one of many things that has helped to keep me isolated from others.) I honestly never realized this before. She didn’t say to me, “Oh, Q.N., this is how it is.” She asked the right questions and kept prodding until things like this came out.

My complaint: “I don’t know anyone in this city. It’s hard to make friends.”
Her: “Well, why do you think that is?”
Me: “I don’t want to socialize with people I work with, and I don’t go to church, and I don’t have ‘connections’, so it’s hard.”
Her: “Have you thought about joining a church? Volunteer group? Taking a class?”
Me: “Hem haw yes but here’s why I don’t…”

And in a later session:
Me: “My work stresses me out.”
Her: “Do you have any hobbies that relax you?”
Me: “Yes. Cooking, reading, working on the table I’m refinishing.”
Her: “Those are all pretty solitary hobbies. Maybe that’s part of why you have trouble meeting people. Have you ever been interested in something more social? Like, taking a writing class. You like to write.”
Me: “Yes, but I’m no good at writing fiction, and I wouldn’t want to share the fiction I write with others.”
Her: “Why?”
Me: “It’s embarrassing. It’s very personal.”
Her: “Have you ever thought about taking up a musical instrument?”
Me: “I played the piano when I was a kid but I was no good so I quit.”
Her: “Do you have to be good at a hobby to enjoy it?”
Me: (thinks about it and laughs) “Well, yes. My dad always used to rant and rave at us about our hobbies and extracurriculars, that if we were going to do something, we should practice and give it 110% and that if we weren’t very talented, we shouldn’t bother. So I guess I don’t even think about it. It’s just not really an option I consider.”
Her: “Do you think it might be a good idea to rethink that view?”
Me: “Yeah. Wow. Never really thought about it that way. There are about 6 things I can think of that I would like to try doing, but I avoid them because I feel stupid or I know I don’t have much talent. And most of those things are more social than my current hobbies.”

And so it goes. There are a couple of other things like this that have come up in the last 6 weeks. I’m generally pretty self-aware, but most people have blind spots they don’t recognize. I’m finding it helpful to identify and correct them. We are working out a treatment plan with goals: things I am not happy about, things I want to change, my ideas for changing them, steps along the way to a goal.

I’ve had crummy therapists that never did anything like this at all. I am very lucky to see the person I am with now. If your therapist just wants you to dump out your complaints, cry, and go home, they’re not very good, IMHO.