What Makes Therapy Work?

To start writing a blog about, “What Makes Therapy Work” by describing one’s friends may seem strange, but bear with me.

I have approximately 20 friends, 4-5 really close friends……. and I additionally have 3 best friends. First, in alphabetical order by first name, comes Eve. Eve lives in San Diego. She moved there about 6 years ago and I still mourn her departure. She is a self-proclaimed writer/nerd/geek who lives with her nerd/geek husband and son, John and Julian respectively. During the time they lived in Boston, they were my second family, the place that I turned to for comfort, love and Sunday mornings bagels, coffee and lox. Secondly, my longest term best friend, Jane – artist and cartoon animator with a women-only animation collective in Leeds, West Yorkshire, UK. We rarely talk, our lives have gone in different directions, and with vastly different interests. But when we see each other and spend time together (times which are all too infrequent) the connection returns quickly. Last, but by no means least, my dear friend, Dr. Kathy McMahon - sex therapist and clinical psychologist, mentor, stellar Professor, envelope pusher par excellence, thinker and all round wonderful human being, who lives in Western Massachusetts. I visit her as much as is humanly possible, usually for long weekends. I never tire of talking with her, her wonderfully beautiful, sardonic and sarcastic daughter Sarah, or her too-smart-for-his-own-good husband, Daniel. Kathy pushes me to be honest, demands that I go past my comfort zone and hangs in there with me as long as it takes.

And then, in a class of her own, there’s Kelly. Kelly is beyond a best friend. Kelly is a mystic, a metaphysical scholar, a self-described “brain on legs” who only lives to learn, to read, to study. An auto-didactic scholar, she is constantly cruising the internet, while listening to a police scanner, reading a book and watching the History Channel on cable TV. Kelly’s the kind of friend that you have and will never lose, no matter how much you may screw up, mess up with each other, or anger and annoy each other. You fight. You disappoint each other, get your feelings hurt, apologize and then move on. Sometimes this means taking a break, only to come back together and just resume where you left off, only without the “sucky” feelings. Kelly reads this blog avidly, not just because I’m her friend, but because she loves ideas and learning, and therapy is about learning and incorporating new ideas. So this morning she was asking me (via instant messaging online) things she didn’t know about being a psychotherapist and we ended up talking about what makes therapy work. Kelly said, “I'd love to hear about your inner efforts to like a client. Or what gets tripped up inside you about their stuff. That would be a great read. Also what has gotten more healed in you as you be their therapist. Have you ever sent a client away because you just couldn't like them?” I realized that this would be a challenging blog to write, for these are tough questions to ponder and answer.

The truth is that in the early days of being a therapist, there were several occasions whenI was tempted to refer clients out to another therapist, because I was struggling to like them. However, when I stopped to think and was honest with myself, I realized that part of the problem was that I couldn’t figure out how to help them. Coming face to face with your own fallibility is a humbling experience. But the only way for me to grow as a therapist, to become more helpful to clients is to look truthfully at my own shortcomings, to look inside at my own struggles, not to blame it on clients as their fault for being “difficult” or “resistant.” There were a few occasions when a couple of clients I was finding it difficult to “like” (i.e. help) stopped coming. In retrospect, I see that not as their failure, but as mine. I think they knew that I was stuck as a therapist. It made sense for them to move on. They didn't like themselves and I believe that witnessing that self-dislike was painful and made it hard for me to figure out how to like them too. What I learned, the knowledge that enabled me to grow as a therapist and heal more as a human being, is that I need to be honest with myself and my clients at all times. No short measures. Avoiding confrontations because I or my clients may feel something uncomfortable is not a place in which I can feel self-respecting.

So, my job is to figure out what is likeable about people, to understand their strengths and not be drawn in to obsess (like these clients themselves are often compelled to do) on their shortcomings and deficits. My job is not to be their worst nightmare, the proof that they are unlovable, that they don't deserve respect. People need to be able to tell that their therapist will go to the mat for them, will figure out how to find their loveable qualities and not be scared off by the ‘baggage.’ People coming to therapy need somebody to reflect back to them what is loveable in a way that they can internalize, and assist them in making that sense of lovability knowable and useable to them.

So, the sixty-four thousand dollar question, “What Makes Therapy Work? Research shows that when therapy works, it does so because the client can tell that they are genuinely liked and respected by the therapist. Fancy interventions are a little helpful, intelligence definitely factors in…but you just gotta like folks. It doesn’t meant that I’m not tough on people who come to see me; it doesn’t mean that I don’t push them to look at places that hurt, that I don’t challenge them and occasionally ask them to skate on therapeutic thin ice. But they comply, they take risks, they are willing to put on their skates and pirouette because they are deeply respected and deeply and warmly liked.

Which brings me back to my friends.

The only reason that I am willing to tackle challenges, show my vulnerabilities, take risks and get real with the friends I’ve talked about is because I know deep down in my bones that these people love me unconditionally. Having Kelly in my life helped me learn to be honest because there seems to be nothing I can do that would cause her to reject me. I was accepted into Eve's family wholeheartedly, entrusted with loving their dearly beloved son, blessed by their care and respect and had the experience of choosing family, of feeling chosen and feeling wanted. Being best friends with Kathy has taught me that I am worthy of effort, that I see myself reflected back through her eyes as interesting, intelligent, funny and smart and I can internalize that as real for myself. I am willing to make changes in my life, listen to hard truths about myself that may be painful to hear and why? Because my friends gosh-darn love me and respect me. Therapy and therapeutic relationships may be governed by different rules, but you have to know that somebody has your best interests at heart. Without unconditional love and acceptance neither deep abiding friendships, nor caring, effective therapeutic relationships would work. Through the experience of being cared about and accepted by my friends, I learn more about how much my clients need that, though in a different form, from me.

So, that’s why therapy works. I’ll bet my life on it.