Understanding the Benefits of Psychotherapy with Dr. Albert Soto

Let's start off with the first big issue in therapy and work from there. The big issue is that for many, therapy simply is not effective. The most frequently reported number of times a person will use therapy is once, that means that for many people, they come in once and never come back. There's a lot of reasons for this, including low quality clinical training, therapists who lack skillsets needed to effectively help (different than just empathizing or listening), and finally that many therapists cannot adapt therapy to patients (e.g., can't work with personality disorders, race/ethnicity, gender identity, political ideology, spirituality etc.). In order to remedy this, we have to understand what exactly is the therapeutic relationship and also what patient experiences matter?

You will be hard-pressed to find a therapist who isn't "relational" or who doesn't talk about relationships. Yet, the question is "why do relationships matter and what is the therapeutic relationship?" In essence, it's the idea that you have to be able to be able to work with your therapist effectively and collaboratively together. It's a bit different from liking your therapist. It's almost closer to the idea that "I have to like/trust/respect/appreciate etc. my therapist... just enough to work with them." A therapist isn't a friend, but you do have to be able to collaborate and work to come to an agreement. Whether that is related to "should we be working on this thing instead of looking at my marriage?" or whether it is "Does working on breathing exercises make sense when I stated that I want to improve my self-confidence?". There are many approaches to figuring out and solving your problems, but how you get there is through a relationship. Having someone you trust, can help you, and will guide you through the process. So yes, the relationship matters, but it's more what you do with the relationship, than it is whether you simply like your therapist or not.

Finally, we get to the idea of what patient experiences matter in therapy. To some extent many therapists will start off with a simple "Tell me how your week was...". This suggests the idea that patients know where to go and that it's a free flowing conversation. To some extent that is true, but the bigger issue is that sometimes we are so lost in our experiences that we can spend a whole hour trying to gain traction. Effective therapists develop skillful rabbit ears, they listen for underlying meanings, patterns, emotions etc. and they subtly focus the session. So while the conflict with a co-worker at your workplace might indeed be very distressing, it might be that a question of "I'm curious, does this feel most distressing because of this individual, the emotion, or because it reminds you of something similar you've experienced?" that helps you get to figuring out what matters. A patient is the expert of their experience, but the therapist should help be your guide to identifying what matters and why it matters to you.

In short, although finding a good fit is very difficult and many types of therapy can be ineffective, there is a lot of evidence to suggest that therapy can be effective when done in a skillful manner. In order to do that the therapist has to be able to collaborate with you and understand what truly matters. This differs from just empathizing and nodding along, it involves guiding and being curious.