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  • When one is in a bad place in one's head, the modern world offers three main sources

  • of help: psychiatric medication, CBT and psychotherapy. Each has its own advantages

  • and drawbacks. Medication can be exemplary in a crisis, at points when the mind is so

  • under siege from fear, anxiety or despair that thinking things through cannot be an

  • option. Correctly administered, without requiring any conscious cooperation from us, pills play

  • around with our brain chemistry in a way that helps us get through to the next dayand

  • the one after. We may get very sleepy, a bit nauseous or rather foggy in the process, but

  • at least we're still aroundand functioning, more or less. Then there is Cognitive Behavioural

  • Therapy (CBT), normally administered by psychologists and psychiatrists in six to ten hour-long

  • sessions which teach us techniques for arguing rationally with, and with any luck at points

  • controlling, the ghoulish certainties thrown up by our internal persecutors: paranoia,

  • low self-esteem, shame and panic. Lastly there is psychotherapy, which from a distance looks

  • like it has only drawbacks. Psychotherapy has a very hard time showing its efficacy in scientific

  • trialsand has to plead that its results are too singular neatly to fit the models

  • offered by statisticians. Also, It takes up a large amount of time, demanding perhaps two sessions

  • a week for a couple of yearsand is therefore by far the most expensive option on the menu.

  • Finally, psychotherapy requires active engagement from its patients and sustained emotional effort;

  • one can't simply allow chemistry to do the work. And yet, psychotherapy is, in certain

  • cases, a hugely effective choice, which properly alleviates pain not by magic or chance , but

  • for three solidly-founded reasons: – Firstly, our unconscious feelings become conscious. A founding

  • idea of psychotherapy is that we get mentally unwell, have a breakdown or develop phobias

  • because we are not sufficiently aware of the difficulties we have been through. Somewhere

  • in the past, we have endured certain situations that were so troubling or sad, they outstripped

  • our rational faculties and had to be pushed out of day-to-day awareness. For example,

  • we can't remember the real dynamics of our relationship with a parent; we can't see

  • what we do every time someone tries to get close to us, nor trace the origins of our

  • self-sabotage or panic around sex. Victims of our unconscious, we can't grasp what

  • we long for or are terrified by. In such cases, we can't not be healed simply through rational

  • discussion, as proponents of CBT implicitly propose, because we can't fathom what is

  • powering our distress in the first place. Psychotherapy is a tool for correcting our self-ignorance

  • in the most profound ways. It provides us with a space in which we can, in safety, say

  • whatever comes into our heads. The therapist won't be disgusted or surprised or bored.

  • They have seen everything already. In their company, we can feel acceptable and our secrets

  • sympathetically unpacked. As a result, crucial ideas and feelings bubble up from the unconscious

  • and are healed through exposure, interpretation and contextualisation.

  • We cry about incidents we didn't even know, before the session started that we'd been through or felt so strongly

  • about. The ghosts of the past are seen in daylight and are laid to rest. There is a

  • second reason why psychotherapy can work so well: Transference: Transference is a technical

  • term that describes the way, once therapy develops, a patient will start to behave towards

  • the therapist in ways that echo aspects of their most important and most traumatic past

  • relationships. A patient with a punitive parent mightfor exampledevelop a strong

  • feeling that the therapist must find them revolting, or boring. Or a patient who needed

  • to keep a depressed parent cheerful when they were small might feel compelled to put up

  • a jokey facade whenever dangerously sad topics come into view. We transfer like this outside

  • therapy all the time, but there, what we're doing doesn't get noticed or properly dealt

  • with. However, psychotherapy is a controlled experiment that can teach us to observe what we're

  • up to, understand where our impulses come fromand then adjust our behaviour in

  • less unfortunate directions. The therapist might gently ask the patient why they're

  • so convinced they must be disgusting. Or they might lead them to see how their use of jokey

  • sarcasm is covering up underlining sadness and terror. The patient thereby starts to spot the distortions

  • in their expectations set up by their historyand develops less self-defeating ways

  • of interacting with people in their lives going forward. Then the third reason why psychotherapy works. It is the first good relationship

  • We are, many of us, critically damaged by the legacy of past bad relationships. When

  • we were defenceless and small, we did not have the luxury of experiencing people who

  • were reliable, who listened to us, who set the right boundaries and helped us to feel

  • legitimate and worthy. However, when things go well, the therapist

  • is experienced as the first truly supportive and reliable person we've yet encountered.

  • They become the good parent we so needed and maybe never had. In their company, we can regress

  • to stages of development that went wrong and relive them with a better ending. Now we can

  • express need, we can be properly angry and entirely devastated and they will take it

  • thereby making good years of pain. One good relationship becomes the model for

  • relationships outside the therapy room. The therapist's moderate, intelligent voice

  • becomes part of our own inner dialogue. We are cured through continuous, repeated exposure

  • to sanity and kindness. Psychotherapy won't work for everyone; one has to be in

  • the right place in one's mind, one has to stumble on a good therapist and be in a position

  • to give the process due time and care. But all that said, with a fair wind, psychotherapy

  • also has the chance to be the best thing we ever get around to doing.

  • If you are interested in trying psychotherapy, The School of Life offers a service in person in London,

  • or by Skype around the world. Click on the link for further details.

When one is in a bad place in one's head, the modern world offers three main sources

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How Psychotherapy Works

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    Evangeline posted on 2018/07/06
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