So, how does thearpy work?

I don’t usually get a lot of questions about the nuts and bolts of how therapy works. Occasionally another dad at a kid’s birthday party, or a new acquaintance making small talk will ask “so how does what you do actually work”. I’m happy to indulge those questions when they come up, but when I’m talking with a prospective client for the first time they mostly just want to know if I can help them with their unique set of circumstances. I want to be respectful of their time and give them an answer to help them decide if me and my style are the best fit for them. Waxing poetic on the jargon laden, inner workings of contextual behavioral science accomplishes neither of those goals. Still, I often hear on an initial phone call “I’ve never seen a therapist before, I really don’t know how any of this works”.

I could drone on and on here about the intricacies of psychotherapy, but that probably wouldn’t make for a very fun read. It would probably leave you with a list of topics to go research and only slightly closer to how all of this actually works. I like to use metaphors and analogies in therapy and one of my favorites for what therapy looks like is the image of two mountain climbers.

There are many versions out there and I’m not entirely sure who gets credit for the original. The earliest I can find is a treatment manual for OCD by Michael Twohig (1). What follows is an elaboration and amalgamation of what is floating out there.

Start by imagining two separate mountains within view of each other. You and I are both climbing these mountains. You on yours and me on mine. As it would be working your way up any mountain the terrain is variable. There are parts that are easy and you can breeze through effortlessly, and there are parts that are treacherous and perhaps seem insurmountable. Being on the mountain there is only so much you can see about how to keep moving towards the top. You do the best you can with what you can see, but it seems like you just can’t get past some of those more treacherous areas.

Meanwhile, I’m over on my mountain with a different view of how things look over on yours. I’m human with all of my own shit too; this doesn’t mean I’m comfortably resting on the top of my mountain, looking down on you and your struggles. I’m climbing my mountain the best I can like anyone else, but I’ve got a unique perspective that can help you navigate those difficult spots on your mountain. I can see where you might get hung up, see what you may want to avoid, see if there is an easier path you might want to try. I have a vantage point to see where you have tried a certain route over and over, but keep winding up in the same place.

While I can see a lot from where I sit, what I don’t know is what it is really like to be over on your mountain. I don’t know what it feels like trying to climb up it. I don’t know what the rocks feel like when you lay your hands on them. That’s information I need from you. Easy for me to call out what looks like an easy path, but it’s a moot direction if your body isn’t up to taking it.

There’s an element of teamwork that is crucial. I can help you avoid old unhelpful routes and try to find a more workable path upwards, but the more of your experience taking that path you relate back the more progress we make. When we get that back and forth right, you get unstuck from wherever you have been on that mountain and into new territory. No more of the old, unhelpful paths and onto new stuff.

Don’t mistake the end goal for reaching the top of the mountain. I’ve never been mountaineering, but as I understand it the accomplishment doesn’t merely exist in reaching the summit. The accomplishment lies in the experience of having navigated the mountain. In actual mountaineering there is always another summit to tackle. When we summit a peak in therapy life is sure to keep happening.

This doesn’t mean that therapy becomes an endless endeavor. As much as I enjoy the clients I work with it is never my goal for them to be in therapy forever. I want to get them where they want to go, and then we part ways. The end goal of the therapy mountain is knowing enough about what you are climbing to be able to navigate whatever it throws at you on your own. I want you to learn and experience enough of the mountain so that you are in a position where you no longer need my perspective. Instead you are knowledgeable enough without me to navigate new hazards, and weather new storms skillfully on your own.

Hopefully this demystified the therapy process a bit, or gave some useful, jargon-free, perspective on how it works. If you have any interest in conquering your own mountain let me know and I’d be happy to get to work.

Refrences:

(1) Twohig, M. (2004). ACT for OCD: Abbreviated Treatment Manual