What happens in therapy?

For many of us, there’s still a lot of mystery about what actually happens in therapy. We can thank movies and TV shows for their unfair, and honestly, unrealistic portrayal of therapy … You know what I mean; the scary, white clinical room with a box of tissues, talking about your childhood. Bleak. 

The truth is there are a number of things a therapist can help you with, ranging from milder to more serious issues. Depending on what type of therapist you see, they may be able to help you with different things. 

For example, a psychologist can treat clinically diagnosed conditions such as depression and anxiety, whereas a counsellor can help you work through thought patterns and emotional issues. 

It’s important to remember that every therapist is different, not only in their personality (they are human after all, right?!), but also in the approach that they use. You might not know this, but there are hundreds of different therapy approaches, all with their own goals and sets of techniques. I’ll walk you through some of the more common ones.

Introducing: Cognitive Behaviour Therapy

This is probably one of the most widely researched psychological therapies. 

CBT operates on the premise that the way we think (our cognition) affects the way we feel, and the way that we feel affects our behaviour. 

Negative and persistent thoughts and self-talk are likely to prompt an individual to engage in unhelpful, undesirable, or even in some cases, destructive behaviour.

Therefore, if we can find a way to challenge and reconstruct our thoughts, we can actually change the consequential feelings and behaviours. 

A key strategy that therapists implement is doing what I like to call ‘putting the thought up on trial’. So they’d take a person’s negative or unhelpful thought (such as “I’m not good enough”) and work with the person to identify what evidence there is to prove that thought to be true, and perhaps what evidence actually contradicts that thought. 

Meet: Acceptance and Commitment Therapy

This is one of my favourite therapies out there, which I have personally experienced both as a client and also as a counsellor. 

ACT is a mindfulness-based behaviour therapy, operating on the premise of accepting what is beyond our control, committing to actions that align with our core values, and improving and enriching our quality of life. 

ACT is unique in that the focus of this therapy isn’t actually symptom reduction, which may sound counterintuitive, however, the view of ACT is that by focusing solely and intently on getting rid of symptoms, we can actually worsen the symptoms and lead a less fulfilling life. 

Say hello to: Dialectical Behavioural Therapy 

This is a type of cognitive behaviour therapy that works to teach people to live in the moment, find adaptive ways to cope with stress, better regulate emotions, and improve relationships. 

Initially, DBT was intended to treat Borderline Personality Disorder (a more complex type of mental illness), but has since been adapted for a number of mental health conditions, including depression. 

Some of the really useful techniques that DBT offers includes mindfulness, distress tolerance (self-soothing is a part of this), and distractions. The really interesting part of DBT for me is the emphasis on doing the opposite action.

So, for example, if you’re feeling down and your instinct is to withdraw from family and friends, an opposite action under DBT would include organising a catch up with a friend.

This is by no means an exhaustive list of therapies, just three commonly used approaches.

From my personal experience with counselling, what tends to happen is I’ll tell my therapist about something that happened and my reaction to it. She will then help me understand that reaction, particularly if it was a negative or unhelpful one. We explore it from different angles - did it upset me because it reminded me of something from my past? Did I get angry in that situation because it clashed with a core value of mine? Did I feel detached because I felt betrayed? 

These kinds of questions have been so pivotal for me to better understand why I react the way I do, and have helped me learn new ways to deal with situations instead.

Understanding our subconscious thoughts, emotions, and reactions is such a superpower and is often the first step we need to take in order to be able to change our behaviour.

Do you want to know more about different kinds of therapies and how they work? You can download any one of my mini-courses; all of them explain the most common therapies for the different mental health conditions!