How Does Therapy Help?

SHARING IS CARING

We live in a world where oversharing our personal information is a daily occurrence. Whether it’s sharing opinions on Facebook or photos of our latest vacation on Instagram, we are a species quick to offer up our most personal insights to anyone who will listen.  

How, then does therapy differ?  Are we not doing the same thing but in a room for an hour? 

Well, yes, but also no. The most obvious answer is that therapy provides a space where we are able to safely delve into our psyches with the aid and support of a trained professional.  But how and why does a relationship like this lead to self-growth and change where other relationships don’t?

THE FIRST RELATIONSHIP

Our first answer comes from the world of attachment theory, created by John Bowlby and Mary Ainsworth. These two developmental psychologists concluded some profound insights into the world of how infants form attachments with their caregivers and why that first relationship is paramount in developing our sense of self, identity, and self-esteem.

Our first relationship with our parents essentially sets the foundation for how we, as future adults, relate to ourselves, our partners, and our internal working model we have of the world.  

When a child is in her infancy, she literally cannot survive without the aid of her caregiver.  Unlike other ground-dwelling mammals, humans are essentially dependent on their caregivers well into their teenage years.  Until a certain point, we depend on our caregivers to respond to our distress, to help us when we make a mistake, give us shelter, and to keep us safe.  

Children with secure attachment, learn that mom (dad, grandma, or any other caregiver) will respond to their needs, respect their boundaries, and show genuine interest in them.  They also learn that their caregiver is a safe person to rely on and is available upon request. 

Children with avoidant attachment learn that crying, screaming, or asking for aid will be met with resistance, withdrawal, or neglect and quickly learn that their cries for help are fruitless. These children appear calm, but research has shown that underneath their calm demeanor they are experiencing heightened anxiety (Wallin).  Often these children learn to mute their feelings and appear to have flat and neutral facial expressions.

The last is ambivalent attachment, which is when children have a hard time being reassured or consoled by their caregivers.  These children will cry, kick, or push away their caregiver’s attempt at reunion or reconnection.  Generally, this occurs when a caregiver is unpredictably available or unavailable.  These children are preoccupied with the whereabouts of their caregivers and don’t like being left alone. 

THE INTERNAL PARENT

Our early relationships help us establish “internal working models” (Bowlby) of how we relate to ourselves and our surroundings. For instance, if a client grew up securely attached they would learn, through their parent’s responses, how to attend to themselves, make sense of scary situations, and essentially “internalize” their parents so that when they become adults, they have a healthy “internal” parent that can help them respond to their feelings and experiences. 

When children are very young, they don’t know how to make sense of their emotional reactions and often times need a parent or caregiver to help them put the pieces together.  When the parent or caregiver is abusive, neglectful, or withdrawn, the child doesn’t learn how to make sense of what they’re experiencing.  They may interpret feeling sad with extreme discomfort, fear, and confusion and eventually attempt to suppress that feeling when it comes up in the future.  

A responsive and attuned parent, would see that their child is sad, put the pieces together for them, saying something like, “you’re feeling sad because we have to go home and you want to stay and play”, and the child would have an understanding of why this powerful feeling just came on.

If a client grew up with parents who did not respond to him when he was distressed and who expressed annoyance at his feelings, he would learn ways to censor his fear, anger, or sadness as a means of maintaining proximity to his caregivers.  The problem, however, is that when this client becomes an adult, he still relies on the same self-protective strategies that were necessary in childhood, but now hurt him in his intimate relationships. This may show up as passive aggressiveness when he feels anger toward his partner, and his partner may interpret his passivity as a signal that he doesn’t care, when in fact he cares tremendously but cannot show it adaptively.  

THE SECURE BASE

A therapy relationship resembles our first relationships.  It represents the “secure base” (Ainsworth) that we can return to in order to make sense of our internal experiences. Through this relationship, we seek support, reassurance, and guidance so that we can start putting the pieces of our emotional experiences together.  

When we go to a therapist, we often project past relational experiences onto them.  This could be perceiving the therapist as the authoritative figure telling us “what to do”, the benevolent savior who will protect us always, the friend who you “pay to talk to”, or the person “telling me what I want to hear”.  Sometimes, we even place our will onto the therapist, assuming that they want us to do x, when it’s actually we who want to do x. 

A therapist who practices from an attachment perspective, will identify their client’s attachment style and work to give them a “corrective emotional experience”.  Essentially, this is when the therapist acts as the “good enough” mother who is attuned and responsive to the emotional reactions of her client.  This is not an act, rather it’s a way of responding to the client so that the client learns how to respond to their overwhelming emotions, bodily reactions, and thoughts differently.

As people, we’re very similar to library’s.  We all have stories that could fit into hundreds of books. As a way of making sense of our stories, we try to organize them and shelve them in their respective categories.  If I learned that relationships were shoddy at best and left me feeling empty, I would start to categorize any relationship that I had under that description: “Relationships Hurt Me”. I would then learn that if I wanted to know more about relationships, I’d fall back on previous experiences and use that as my internal working model of how people relate to and treat me. 

As an alternative example, if I never had a caregiver or parent help me make sense of my experiences at a young age, I would have nowhere to place those experiences and all of those stories would be scattered, lost in a pile somewhere, or completely out of order.  Going to therapy is the equivalent of having my stories, experiences, and memories put back together, giving them caring attention, and helping me understand why I felt the way I did.  

WHY DO I FEEL THIS WAY?

Feeling chronically overwhelmed, stressed, emotion-avoidant, and depressed floods the system and fatigues us. When we don’t understand what is causing us pain or making our brains fixate on thoughts or memories, we inevitably try to avoid, suppress, or repress whatever is plaguing us.  The problem is that we never get the chance to understand, accept, and move forward from those issues.  Having an attuned and responsive therapist will help us safely navigate the waters of our emotional ocean and give us the chance to find safe harbor when things get rough. 

Therapy is not a cure-all. It is an ongoing process that requires both parties participate.  The most satisfying client-therapist relationships are the ones in which a strong working alliance is struck, mutual respect and trust is given, and open communication takes place.  This also means allowing ourselves, as clients, to experience any and all emotions that come up toward our therapist.  And yes, that means anger.  The more we can identify and express what we feel toward our therapist, the more they can help us make sense of those feelings. 

If you’re seeking out therapy, I highly encourage you to find one who has expertise and knowledge on attachment theory.  It’s not an absolute requirement, but having that insight will help tremendously in the therapy relationship.