To therapy, or not therapy? Is psychotherapy “right” for me?

“Psychotherapy is a sanctuary; a battleground; it is a place I have been psychotic, neurotic, elated, confused, and despairing beyond belief”
- Kay Redfield Jamison

Client: “I really don’t know if therapy is actually “right” for me, or if I just need life coaching”
Me: “What makes you think you are not “right” for therapy?”
Client: “Well, I guess because I don’t know how talking about things will actually help”
Me: *smiles*

The above encounter is something I often experience with clients entering the therapeutic process for the first time, or even a re-attempt at therapy. Arguably, the main reason for this is the ill-perceived conceptualisation of therapy as being a process where the client “just talks about things” and where the psychotherapist “just sits and listens”. Sadly, I feel that the meaning encapsulated by true psychotherapy is ever so rapidly withering away in the hands of untrained professionals, and even some trained professionals. The mechanisms that underlie therapeutic change have long fascinated scholars, practitioners, and researchers alike. This is mainly because of the perplexing, yet magical and nuanced nature of psychotherapy. Trying to pinpoint exactly how therapy “works” remains a mystery. However, one thing that is not a mystery, and which research continues to evidence, is that the relational aspect of therapy plays a fundamental role in the change process.

Scientific Scrutiny

Unfortunately, psychotherapy and, in fact, the entire field of psychology, has long been scrutinised for its lack of scientific rigour, largely because it gets compared to the medical disease model — which conceptualises diseases as discrete entities with identifiable causes, symptoms, and treatments, often emphasizing biological factors. However, trying to apply the same model to conceptualise psychopathologies or any other psychological phenomena is not only ill-fitting but also unjustified given the complexity of the human psyche. With medical diseases, researchers are able to accurately pinpoint etiologies and measure the cause and effect of specific treatments. Additionally, they can study the biological mechanisms with great accuracy as the thing that they are studying actually exists! For example, you can dissect a heart, you can study little microbes under a microscope, you can even study neuronal activity using today’s technological advancements. However, psychological phenomena do not physically exist, and therefore, need to be estimated using psychological data — which is obtained using psychological assessment measures. As such, there is no direct way to measure the cause and effect of psychological phenomena. For example, you cannot physically make changes to a person’s extraversion in real-time and see how it affects their self-esteem. As such, the actual change mechanisms of psychotherapy cannot be accurately pinpointed; because the vast variability that arises in-between and within people is just too nuanced. Therefore, any attempts at trying to distil a complex human into some categorical diagnostic code would not only be impossible but also entirely undesirable. By doing so, it eliminates the essence of what makes any psychotherapeutic process effective — the uniqueness of the individual.

A Behaviourist’s Playground

Now, several psychologists may argue that behavioural interventions (e.g., CBT, DBT, SFT, ACT, BAT) are more effective for change than talk therapy because of their “evidence-based” nature (*rolls eyes*). I do not believe this to be true, as this would position the psychotherapist as the “holder of knowledge” — the teacher — and the client as the “receiver of knowledge” — the student. Psychotherapy is, at its core, grounded in the belief that the client and the therapist form equal parts in the exploration of the self. As Irvin Yahlom would call it, “fellow travellers”.

Don’t get me wrong, behavioural interventions can play an invaluable role when forming part of the therapeutic process. I often make use of these myself! However, I would argue that when these behavioural interventions represent the entire therapeutic process, then you are no longer doing psychotherapy. If all there were to psychotherapy was behavioural tools, then surely you can go read a book on cognitive behavioural therapy (CBT) and just implement these methods yourself? Why then go to therapist? The main role of the therapist is to help bring to light those parts of your true self that may be hidden from you. It is also the ethical duty of the psychotherapist to use their own discretion as to which behavioural intervention(s) may be relevant and beneficial to the client. More importantly, it also rests on the psychotherapist to ensure that he/she is competent and trained in the modality or intervention used. Unfortunately, with all the TikTokkers and Instagrammers, people have come to associate therapy with “5 steps on how to heal your trauma” or “CBT to heal your BPD”. What the actual?! (*Deep breaths*)

Collaborative Creative Creation

The best way I can explain the process of true psychotherapy is by comparing it to a collaborative, creative construction project, where the therapist and client work together to build a stronger, more stable and resilient structure — the client’s sense of self — using building blocks. At the beginning of therapy, the client’s self-concept may resemble a haphazard stack of blocks, with some blocks worn and cracked from past experiences, and others missing altogether. The therapist joins the client as a skilled architect, equipped with the tools and expertise required to help rebuild and reinforce this structure.

The task of the therapist is to assist the client in deconstructing the existing structure, and carefully examining each block to understand its origin and significance. Through open dialogue, exploration, and self-inquiry, the therapist encourages the client to articulate their thoughts, emotions, experiences, and beliefs — each revelation serving as a new block in the rebuilding process.

As the therapy progresses, the client gains greater insight into their inner architecture, identifying weak spots and reinforcing blocks of strength. With the therapist’s guidance, they begin to select new blocks — healthier beliefs, coping mechanisms, and self-beliefs — to replace old, worn-out blocks. The client’s self-articulation serves as the key assembly tool during the construction process, placing each block intentionally so that all the blocks fit together to form a structure that more accurately reflects the client’s true self. Through reflection and introspection, the client discovers hidden connections between blocks, uncovering patterns and meanings that were previously obscured. With each session, the construction project progresses, inching closer to completion. Ultimately, the therapeutic journey is a shared endeavour of building and rebuilding, deconstructing and reconstructing, as therapist and client work hand in hand to construct a stronger, more authentic sense of self.

Is Therapy “Right” For Me?

Whether therapy is “right” for you will largely depend on your views, beliefs, intentions, motivation, expectations, and readiness for psychotherapy. For some clients, psychotherapy can be a deeply unsettling encounter. However, from my own experience, it is exactly these clients who benefit the most from the process when they choose to push through the discomfort, commit, show up and trust the process.

Generally, people who previously grew up in households where they had very little autonomy and sense of agency may be drawn to therapy but find the process particularly difficult and possibly even “off-putting” or “not working”. The reason for this is because these individuals are so used to others telling them what to do, where they should go next, what career they should pursue, which person they should date, etc. As such, they will enter therapy with the same expectation — for the therapist to tell them how to fix their problem. However, as mentioned before, therapy is by nature is spontaneous and uncertain. It requires trust, authenticity, congruence, patience, and a willingness to embrace the discomfort of navigating the unknown and delve into those unexplored parts of the self. Knowing that there is no “right” or “wrong” way.

However, for those who crave control and certainty — as it provides them with the illusion of safety and security — they want to know if they are “doing” therapy right or wrong, what they should be doing outside of therapy, and how long will therapy take. Given the deep-rooted need for certainty, as the therapeutic process starts to unfold, these individuals may start to find therapy anxiety-provoking, awkward, and uncomfortable. It is generally at this stage that they will start to miss or cancel sessions, decrease session frequency, or invariably talk themselves out of needing therapy altogether.

Conversely, there are also those individuals who are inherently very wilful by nature, some may even describe themselves as being rebellious. For these individuals, the therapeutic process can be quite comforting as they take the reins in therapy, guiding the process, and speaking their minds. However, the process of therapy can become deeply uncomfortable for these individuals when the therapist starts to bring to light those parts of themselves they’ve been hiding from the world — the parts that generate feelings of shame, humiliation, and pain. The parts of themselves they have rebelled against for so long. If the therapist pushes too hard, they lean into their rebellion — as their adopted coping mechanism — and push against the therapeutic process. Invariably this keeps their maladaptive beliefs intact of “No one understands me”, “I am broken”, “No one can help me”, and “I am different”. By abandoning the therapeutic process, they are unconsciously (or even consciously) pushing away the self-reflective mirror held up by the therapist.

Taken together, the process of psychotherapy is not for everyone — and that is ok! Embarking on a journey towards self-discovery and a re-organisation of the self requires trust, commitment, persistence, tolerance, grit, openness to change, and a David Goggins bag of courage. And, as with anything in life that is worth mastering, it takes time, repetition, consistency, and practice — you can actually become “good” at therapy ya’ know. So, instead of asking yourself, is therapy right for me? Perhaps the question should be, am I ready for therapy?

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