What is psychotherapy?

The other day, I saw a social media post that said, “You can get therapy during your nail appointment but you can’t get your nails done during therapy”. Whilst I had to immediately grapple with my anger that it implied therapy was something anybody can do with no training, I knew that the post wasn’t really meant to diminish therapists, but rather to increase attendance at nail salons.

However, it does contribute to the myth that psychotherapy and counselling is merely one person talking and the other listening and nodding. Sometimes it really can look like that from the outside, and even from the client’s perspective, but that is only because no-one can see the therapist’s internal brain processes as the client is talking. (It reminds me of a friend who was surprised I’d had an ADHD diagnosis - but probably wouldn’t be if I verbalised every thought I have, at the speed I have them, and the frequency with which they repeat themselves). In reality, the psychotherapist is using everything the client is saying, how they are saying it, how they are using their face and body as they are saying it, their own internal response to what the client is bringing, linking it to things the therapist knows about the client already, linking it to things the client has said before, in order to decide on the most important thing to ask next and to “diagnose” where the work is.

It reminds me of the watchmaker argument for the existence of God. (I’m not saying therapists are God). We don’t see a watch at face value; we assume that what we can see - the hands moving round the clock face - is only part of the whole and that in fact, there are cogs or electronics behind the face making something happen on the surface. And so it is with psychotherapy: What goes on inside the therapist’s head will inform what you can see happening, and this is precisely why high-level psychotherapy study demands hundreds of hours of training, client sessions, supervision and personal therapy. Just like the existence of God, psychotherapy does, I think in the beginning at least, require faith - for it to work, there needs to be some sessions where the therapist simply gathers information about the client, so it can possibly feel like nothing is happening. “Trust the process” is not just a cheap social media saying - you really do need to trust that the psychotherapist knows what they are doing and that if you commit, both in and out of the therapy room, you will see change. (Of course, this does not mean you should have blind faith in just anyone who calls themselves a counsellor or psychotherapist - still check out their qualifications, professional memberships, level of training and the vibe they give off - but once you are sure you have chosen the therapist for you, settle in and allow them to do what their training has prepared them for.)

Psychotherapy with me tends to follow a pattern, particularly if a client is coming to see me for support in processing trauma. The first part is where we build our relationship, usually by you telling me your life story, during which time I will be using my years of study to build a picture of who you are and where specifically the work might be. During this time you will also tell me your goals for therapy, before we move on to addressing them in detail. In this second phase, I will teach you concepts from Transactional Analysis psychotherapy that you can apply to your own life, and we may do exercises that help you move closer to your goals. It is around this time that an internal shift can happen, where the client truly understands that the way they have been living their life so far doesn’t have to determine their future. It is at this point we enter the third phase, where the client consciously makes decisions outside of the therapy room that support their new life choices. When this phase is complete and the client is living life in the way they’d only previously dreamed of, it is time for therapy to end, or for the client to request to work towards new goals. This process can take months, or it can take years - it’s down to the individual client.

So you can see that psychotherapy is an intentional process, with deep work, deep thought and deep feeling. It is a process and a journey, and it takes time. It is important, therefore, to differentiate between what is ‘therapy’ and what is ‘therapeutic’. Talking to your nail technician at the salon can be therapeutic (and it happens to be an hour in my monthly routine that I love - shout out to Amber!), but therapy it isn’t. A walk in nature, meditation, yoga, going to a restaurant with friends, swimming, watching trash TV - all those things can be therapeutic, but they are not psychotherapy. Whilst we must not underestimate the therapeutic benefit of someone listening to us talking about our problems, counsellors and psychotherapists are doing much more than that.

Still need convincing? This is why I offer the first hour, the ‘Connection Before Counselling’ hour, free of charge. It is a space where you can tell me what brings you here and experience the interventions for yourself. Whether you are looking for support with grief and bereavement, workload stress, neurodivergence, relationship issues, gender and sexual identity issues, family problems, parenting support or simply anything which is getting in the way of you leading the life you want, make an enquiry about my latest availability. In the meantime, keep listening to those who seek your support and keep talking to your nail tech - these things are really important for our wellbeing too.