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People come to therapy for a myriad of different reasons. Some are looking for short term solutions to current issues in their lives, while others are seeking to uproot repetitive patterns within themselves that they find distressing. Still others are seeking to have a long term therapeutic relationship that is a consistent presence over many years that helps to create meaning and insight in their life no matter what they are going through. A metaphor I like to use in orientating to people’s needs is to think of psychotherapy as a home renovation. Some people want to shift some pictures around and find that is sufficient for bringing about satisfaction. In therapy, this translates to those who come to therapy with a specific problem they want to solve. They may wonder if something they’ve been thinking is unreasonable and want to work through sound thinking. This client may want to learn about stress reduction tools or to get back on track with self care. Sometimes people just need a reset and a check in about some part of their lives that feels “off”.
In keeping with the home renovation metaphor, others may want to change paint colours, throw out old items or move some furniture. This type of therapy looks at beliefs and habits that may impede a persons ability to make choices that enhance their lives. The basic structure of a person remains intact but there is some “fine tuning” of their ways of being in the world. This would include examining and challenging beliefs and schemas, adding or removing certain habits in their lives and processing the challenge of doing so in session. We may look at motivation for change, imagining a different “configuration” of their world or some aspect of their world. Learning to put up boundaries, deal with a tricky coworker or deal with phase of life issues like middle age or transitioning out of marriage may be examples of this.
The next level is where there are structural changes made to the inner “house”. This means looking at trauma, lifelong conditioning and childhood messaging. This includes challenging cultural influence and socialization, deprogramming ourselves from the expectations set out by others that keep us trapped. We may look at what it means to be in the roles we are in as workers, parents and partners and how past messaging may influence us in ways that are contradictory to our nature and values. At this level we are identifying and rearranging deep values and seeking ways to align with what we feel to be more truthful and authentic ways of living with ourselves and others. Cognitive and body based therapies, to name a few, can be helpful here.
Finally there is the level at which we look at our “foundations” this is how we find or give meaning to human existence and ask questions like “what is life all about?”, “how do I want to be alive in the world?” or as the wonderful Mary Oliver said “what will I do with my one wild and precious life?”. This includes experiencing life’s awe and wonderment as well as suffering, darkness and death. It is the type of therapy that helps truth seekers question and ponder the fact of our miraculous existence through dialogue with the therapist. As the Oracle of Delphi said: “Know thyself, through dialogue with self and other”. At this level, people live between sessions wondering about big questions, bringing their questioning to session to enhance understanding of their lives and to give meaning to existence. In this way we are not only unearthing the foundation of a person’s life but building it with every session.
As a therapist, I believe it is important to converse with clients about what they are expecting from therapy. Sessions can ebb and flow between levels of work and an attuned therapist will be able to track this. We may start with hammering in a few new pictures and find a wall crumbling down around us! Being responsive and conversant about whatever is afoot in session is the key to fruitful therapy and essential to a clients journey through their lives in a increasingly conscious way.
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