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What is therapy?

What is therapy?

On this page are ideas about what therapy is and how it works. Dr. Simpson has gleaned these ideas over the years from the pages of books, magazines, journals, and newspapers.

For example, the therapist M. Guy Thompson said that therapy is "a relationship between two people united in common cause: to figure out what is going on." He wrote that on page 80 of his book, The Truth About Freud's Technique.

Here are some more thoughts on the art, or science, or inner functioning of psychotherapy. Dr. Simpson will be adding to this list from time to time. 

The elegant and quietly revisionist German-American psychoanalyst and theorist Hans Loewald wrote, "Psychoanalysis requires an objectivity and neutrality, the essence of which is love and respect for the individual and for individual development" (International Journal of Psychoanalysis, vol.41, p. 229).

Stanley Stern

Stanley Stern (1933-2022) was a psychoanalyst in Phoenix, Arizona. Part of becoming an analyst is to undergo analytic training with a practicing expert. He was assigned to Hans Loewald (1906-1993) in the late 1960s and writes about the experience in the essay, "My Experience of Analysis With Loewald" (2009) published in The Psychoanalytic Quarterly, vol. 78(4). The essay provides many insights into what therapy is, such as: "The analyst functions at a higher level of organization than the patient, making the analytic relationship analogous to that between an ideal parent and a child" (p. 1025). 

At the end of his essay, Stern wrote, "The analytic atmosphere of acceptance, compassion, and analytic love has allowed me to more 'freely associate,' to increasingly trust my thoughts and feelings, and to find my own voice" (p. 1029).

Hans Loewald

More about the work of Hans Loewald: In a paper called "Analytic Theory and the Analytic Process" published in the 2000 book The Essential Loewald: Collected Papers and Monographs, edited by Jonathan Lear, Loewald is quoted as writing, "In psychoanalysis it becomes increasingly clear that interactional processes—those that are intra-psychic and inter-psychic ones, and these two in their interacions—are the material of investigation, epitomized and highlighted in the psychoanalytic process" (p.xli).

And then, "Scientific detachment in its genuine form, far from excluding love, is based on it. . . . In our best moments of dispassionate and objective analyzing we love our object, the patient, more than at any other time and are compassionate with his whole being" (p. 297). 

Gerald Fogel

In 1996, Gerald Fogel and four other psychoanalysts wrote a paper for the Journal of the American Psychoanalytic Association, vol.44, called "A Classic Revisited: Loewald on the Therapeutic Action of Psychoanalysis."

On page 898, Fogel was quoted as wondering whether Loewald's conception of analytic love might be "a quality of acceptance and attunement that contains and facilitates, a quality that more or less transcends love or hate in the ordinary sense."

Harry Guntrip

British psychoanalyst Harry Guntrip (1901-1975) has been described as one of "the psychoanalytic immortals." In writing about his own training analysis, Guntrip said it was "a process of interaction, a function of two variables, the personalities of two people working together towards free spontaneous growth." This is on page 155 of his article "My Experience of Analysis With Fairbairn and Winnicott" published in the 1975 issue of the International Review of Psychoanalysis, vol.2.

"Unlike with a medical doctor, in therapy it is less the therapist that does the operation and more the soul that does the operation and healing. As a therapist I try to find a way to notice what the psyche wants. It starts with deep listening to the story the patient shares. Out of that, often the psyche of the patient starts generating its own direction that it wants to move in. It knows so much better where to go and what to do than I." Machiel Klerk, PhD, from his social media post: “Misconceptions About Therapy: Thinking That the Therapist Knows What Is Good for the Patient” (2023).

On the blog "thistherapylife.tumblr.com" in 2018 spreezpz wrote:
"Therapists are just..... Common sense filters
     [for example ... ]
Me: yeah so I just don't have the energy to get up and make myself a sandwich or wait for something to cook so I just. Don't

Her: why don't you just eat the sandwch components without putting them together

Me:

Her: you can just eat a handful of cheese and some sandwich meat. You don't have to make a sandwich.

Me:

Her: what "

Jane Hall

Jane Hall, a retired psychoanalyst, devotes her blog (janehallpsychotherapy.com), called "opening doors....," to explaining the question of "What is therapy?"

In one entry, she wrote, "Almost everyone who crosses the therapist’s threshold is looking for a second chance — a shot at living a richer, less restricted life.

In psychoanalytic work, understanding how echoes of the past resonate with and shape the present provides opportunities to resolve crippling conflicts and make new choices. Such insights also produce a sense of mastery. We all want to be masters of our own fate." She told me she practices what she likes to call "benevolent curiosity."

Gabor Maté

Gabor Maté wrote in Scattered (1988), his book on Attention Deficit Disorder, that "the purpose of psychotherapy and counseling is not that the therapist either heals the patient or advises him what to do with his life. The goal is to mature and to individuate—to become a self-respecting person in his own right. In other words, the goal is not to be cured, but to develop.

The role of the therapist is, in part, that of a talking mirror in which the individual can see himself more clearly reflected, helping him to reflect on himself. Until he acquires the necessary skills, without a mirror he can no more see his psyche than his own eyes. The therapist must be able to extend to the client the attitude Carl Rogers called 'unconditional positive regard'” (Part VI: Chapter 28).

A small, local group of Ithaca therapists came up with a mission statement a few years ago. It inluded three ideas: "Therapy is the development of a language; it is not a hierarchy; and it is healing into a new way of life."

Mark Epstein

Mark Epstein, in his 2018 book The Zen of Therapy, said, "Therapy is like a koan. It changes minds by bringing forth unfamiliar qualities that are nevertheless intrinsic to our natures." [Koans are riddles for which there are no rational answers.] I found this and the following answers in an audio book. That's why I can't provide page numbers. Sorry.

Epstein said a lot in answer to my question, What is therapy?, such as, "Kindness is the thread that runs through the work of Winnicott, Cage, and the Buddha, each of whom discovered that non-interfering attentiveness in a mother, an artist, a meditator, or a therapist is by its very nature transformative."

And, "disorienting systems is something both Buddhism and therapy can agree on. Things that feel fixed, set, permanent, unchanging—like one’s self-righteous anger—are never as real as they seem. Problems are not hard and fast, selves are not static and motionless, even memory is nothing we can be certain about. The Zen of therapy wants to get things moving again. It wants to open things up, make people less sure of themselves, and in the process release some of the energy that has become stuck in the mud. Rational explanations have their place, but irrational breakthroughs, like those that come out of koan practice, are invigorating because they alert us to capacities we do not know we have." 

And, "when enough trust has built up in the therapeutic relationship, there is a chance to release and be released from a self-preoccupation that is no longer serving a reasonable purpose."

And, "therapy can bring out the hidden intimacy that gives meaning to life." 

“You know what makes Buddhism and therapy similar?” [Michael Vincent Miller] asked me [Epstein]. I waited for him to tell me. “They both aim for the restoration of innocence after experience.” 

And finally from Epstein, "A good therapy, like an inspired koan, finds ways to get us around ourselves; not to fall into an abyss of self-doubt, but to uncover and sustain an intelligence and creativity that feeds who we each are uniquely capable of being."

Anthony Storr

In his book Solitude (1988), psychiatrist and psychoanalyst Anthony Storr wrote, “When a person is encouraged to get in touch with and express his deepest feelings in the secure knowledge that he will not be rejected, criticized, nor expected to be different, some kind of rearrangement, or sorting-out process often occurs within the mind, which brings with it a sense of peace, a sense that the depths of the well of truth have really been reached” (p. 22).

Amanda Palmer

In Amanda Palmer's The Art of Asking (2014), she recounted some of her best friend and mentor's stories. Her mentor was C. Anthony Martignetti, a Boston psychotherapist. This is one of his stories: "There were professional sin-eaters in England.

A guy, for money, would come around and eat bread over the corpse of a dead family member to purge the body of sin before it went to heaven. It's also the magic and mystery of what we do—when we nail it—in psychotherapy. We take on the suffering of others, digest it, transform it. . . . Yeah, good artists do it, too" (p. 106). 

David Brooks

David Brooks wrote an opinion piece for The New York Times (April 15, 2021) called "Wisdom Isn't What You Think It Is." In it, he described the process of therapy: "People only change after they’ve felt understood. The really good confidants — the people we go to for wisdom — are more like story editors than sages.

They take in your story, accept it, but prod you to reconsider it so you can change your relationship to your past and future. They ask you to clarify what it is you really want, or what baggage you left out of your clean tale. They ask you to probe for the deep problem that underlies the convenient surface problem you’ve come to them with. 

Being seen in this way has a tendency to turn down the pressure, offering you some distance from your situation, offering hope. It is this skillful, patient process of walking people to their own conclusions that feels like wisdom; maybe that’s why Aristotle called ethics a 'social practice.' ”

Irvin Yalom, CJ Jung and Mary Pipher

Irvin Yalom (1989) believes that “a therapist helps a patient not by sifting through the past but by being lovingly present with that person; by being trustworthy, interested; and by believing that their joint activity will ultimately be redemptive and healing.” From Love’s Executioner, p. 227.

C. G. Jung felt acceptance was the ultimate purpose of therapy. He said acceptance was “an affirmation of things as they are: an unconditional ‘yes’ to that which is, without subjective protests—acceptance of the conditions of existence as I see them and understand them, acceptance of my own nature, as I happen to be.” From Memories, Dreams, Reflections (1989/1961), p. 297.

Mary Pipher believes "therapists encourage people to go on a voyage of discovery. With likable, authoritative guides, people will travel anywhere. . . . With therapists, it’s a question of building a relationship grounded in respect, steadfastness, and common sense.” This is from her article "Fostering Moral Imagination" in the January/February 2007 issue of Psychotherapy Networker on p. 51.

“If we look squarely at the fundamentals, it becomes apparent that therapy is neither science nor art—it’s conversation. Conversation is at once the most subtle and complex of all human activities, and our most important problem-solving tool.” Jay Efran with Michael Lukens and Mitchell Greene wrote this in their article "Defining Psychotherapy" in the March/April 2007 issue of Psychotherapy Networker on p. 54.

George Kelly, Alice Miller and Others

[Therapist George Kelly] “spoke only about helping clients resolve their pressing life concerns. Kelly believed that when clients attempted to solve their problems themselves, they’d keep rattling around in the same unproductive slots—they needed help reformulating their questions so that they could find better answers.” This is from the article by Jay Efran with Michael Lukens and Mitchell Greene, "Defining Psychotherapy" in the March/April 2007 issue of Psychotherapy Networker on p. 55.

According to Alice Miller, “when the patient has truly emotionally worked through the history of his childhood and thus regained his sense of being alive—then the goal of the analysis has been reached.” This idea can be found on pp. 111-112 in her 1981 book, The Drama of the Gifted Child: The search for the True Self [Prisoners of Childhood].

A therapy session is “a protected laboratory where hypotheses can be formulated, test-tube sized experiments can be performed, field trials planned, and outcomes evaluate,” according to Jay Efran with Michael Lukens and Mitchell Greene in their article "Defining Psychotherapy" in the March/April 2007 issue of Psychotherapy Networker on p. 55.

“Clinical psychoanalysis inevitably deals with individuals whose past experience has left them vulnerable to current stress and the repetition of adverse early experiences. The treatment imposes a nonpragmatic, elaborative, mentalistic stance. This enhances the development of reflective self-function and may, in the long run, enhance the psychic resilience of individuals in a generic way and provide them with improved control over their system or representation of relationships. The development of this function equips them with a kind of self-righting capacity.” So said Fonagy, Steele, Steele, Leigh, Kennedy, Mattoon, and Target in their 1995 article "Attachment, the Reflective Self, and Borderline States," which can be found in Goldberg, Muir, and Kerr's book, Attachment Theory: Social, Developmental, and Clinical Perspectives on p. 267.

In 2010, Daphne Merkin wrote an article on counseling for The New York Times in which she described therapy as "a habit of mind that enabled me to look at myself with a third eye and take some distance on my own repetitive patterns and compulsions” (August 8, 2010, p. MM28).

Therapy involves “telling our story to someone who appreciates life’s complexities,” according to Jay Efran with Michael Lukens and Mitchell Greene in their article "Defining Psychotherapy" in the March/April 2007 issue of Psychotherapy Networker on p. 55.

"Therapy is at its core an intimate relationship that explores some of the most profound questions we have to encounter as human beings. The issues of how one can trust, how disappointment tears the psyche, how love and hate are related, what sexuality means to the individual, how betrayal closes us off to other people and how we can dare to open ourselves again are all dramatized within the therapeutic relationship.

"Therapy addresses these crucial issues in two ways. First, as one might expect, it examines how particular themes unfold in a patient’s life. Second, it explores how the issues of trust, betrayal, diappointment, love, hate, sexuality and so on occur in and shape the relationship between therapist and patient. The relationship in the consulting room becomes a witness to, a stage for, as well as a participant in a unique form of human drama." From Susie Orbach’s The Impossibility of Sex (2000), pp. 11-12.

We, as therapists, “are trying to introduce [our patient] to a character which we think it would be worth his while to respect, namely, himself: either himself as he was once, or to introduce what he was once to himself as he is today. These two people dislike each other and do not want to be introduced. Not only do they hate each other, but they hate this psycho-analyst who is trying to introduce them” (p. 90). From Wilfred R. Bion’s Brazilian Lectures (1990).

“Psychotherapy, by definition, [is] a revolutionary endeavor, a revolution in self-awareness. It was such a revolutionary project that it had to invent its own language. . . . [If psychotherapy] were starting now instead of a century ago, in the context of Screenworld [our present-day world of virtual technology], it would still be nothing less than revolutionary, because of its quiet, its intimacy, its demand for face-to-face frankness, its worldview, and its purpose—not information, but meaning; not entertainment, but understanding; not passivity, but engagement” (p. 33). Michael Ventura. "Screenworld" (2009, January/February). Psychotherapy Networker, 33(1), 28-33, 64.

Nancy McWilliams, Roy Clymer and Richard Handler

Nancy McWilliams is a psychoanalyst who believes “psychotherapy is a healing relationship in which you might use several different kinds of techniques . . . [and where] the healing relationship is the definitional part of it. . . . [It’s point is to increase] the meaningfulness of life or the satisfactions of life.” This is on p. 3 of An Interview with Nancy McWilliams, PhD, by Louis Roussel (2010), which can be found at http://www.psychotherapy.net/interview/psychoanalytic

“I believe all therapy is a dialogue between two people trying to determine what works and what doesn’t as we try to live the best lives we can” (p. 33). Roy Clymer said this in his article, “The Puzzle of PTSD” (2010, November/December), in Psychotherapy Networker, 34(6), 26-33, 60.

Psychotherapy “is at bottom a dialectical relationship between doctor and patient. It is an encounter, a discussion between two psychic wholes, in which knowledge is used only as a tool. The goal is transformation” (p. 554). Carl Jung (1939). “Foreword” to Suzuki’s Introduction to Zen Buddhism in The Collected Works of C. G. Jung (Vol. 11, pp. 538-557).

“In the end, [therapy] means ‘Be true to your responsibilities, delay immediate gratification, and settle into a longer view’.” This is Richard Handler quotingJonathan Engel,on page 68 ofPsychotherapy Networker(2009, May/June), in his review of Engel's book:American Therapy: The rise of psychotherapy in the United States].

On page 68 of Handler's review of Jonathan Engel's American Therapy: The rise of psychotherapy in the United States, Handler wrote: “For Engel, therapy is ultimately an exercise in learning and gradual self-improvement. He tells us that ‘psychotherapy works best when it leverages a patient’s desire to participate more productively in the world around him, when the patient is genuinely committed to the difficult process of acquiring new, healthy skills.’ He even paraphrases Viktor Frankl, the psychiatrist and concentration-camp survivor who said, according to Engel, that the ‘common trait of all emotionally healthy people is a desire to get to work’.”

Again, from page 68 of Handler's review of Jonathan Engel's American Therapy: The rise of psychotherapy in the United States: “The central question that underlies Engel’s book is a basic one: what, after all, is therapy? Observers have wrestled with this question for decades. The original Freudians viewed therapy as an excursion in an alternative reality of the inner psyche. Like submariners looking for the sunken Titanic, they saw themselves exploring the murk of the unconscious. Their mission was to excavate truths that, once faced and addressed, could transform lives and reduce suffering. Cognitive behavioral therapists—roll-up-your-sleeves pragmatists, to whom Engel is partial—abandoned this obsession with mysteries of the mind. They favor tinkering with patterns of thought that lie closer to the surface of everyday awareness. Clearly influenced by the cognitive perspective, Engel believes that therapy is fundamentally an educational enterprise: it operates by ‘fixing broken bonds’ and readjusting ‘people to normal social intercourse,’ and works by ‘education rather than analyzing'."

“Clients come in for tutoring when their own inquiry process bogs down, when they weren’t finding the answers they needed within the limited framework they were using. As therapist-educators, we teach, lead, explore, and influence. We help in the formulation of better questions that lead toward more productive and interesting answers. Good questions are those that generate additional options for living.” Jay Efran, Michael Lukens, & Robert Lukens wrote this on page 181 of their book Language Structure and Change: Frameworks of Meaning in Psychotherapy (1990).

“Instead of tinkering with thoughts as if they were discrete, easily interchanged entities, the therapist ‘embraces’ the thinker, creating a space in which that person can allow his or her own pattern of thinking and planning to unfold and be observed. The emphasis is not on directly changing those thoughts or plans but on permitting them to be viewed against the wider background the client-therapist nexus provides. Under those circumstances, thoughts and plans change by themselves.” Jay Efran, Michael Lukens, & Robert Lukens wrote this on page 159 of their book Language Structure and Change: Frameworks of Meaning in Psychotherapy (1990).

"We rely upon the hope that analyst and patient together will become enmeshed in complicated reenactments of early, unformulated experiences with significant others that can shed light upon the patient’s current interpersonal and intrapsychic difficulties by reopening in the analytic relationship prematurely foreclosed areas of experience.” Jody Davies wrote this on page 156 of her article "Love In the Afternoon" in the journal Psychoanalytic Dialogues (1994).

Therapy means "Be true to your responsibilities, delay immediate gratification, and settle into a longer view." Richard Handler (2009), from p. 68 of "Bookmarks" in the magazinePsychotherapy Networker.

Therapy allows one to (a) be open to internal recollections, (b) practice attuned communication and contingent joining, (c) allow self-reflection and deepen self-understanding of leftover issues, (d) change emotionally disconnected patterns, and (e) resolve trauma and loss. This is paraphrased from pages 12-13 of Daniel J. Siegel's 2003 article, "Attachment and Self-Understanding: Parenting with the Brain in Mind," which can be found at <<www.attach.org/AttachmentandSelf- understanding1.pdf>>

“Patients seek the truth of their lives, new ways to explain themselves to themselves that will enliven them to their future ” (p. 237). Cathie Simpson (2005). Remembering Infancy, unpublished dissertation for Pacifica Graduate Institute, Carpinteria, CA.

“Psychotherapy is about meaning—which, in the end, the human animal cannot live without. Psychotherapy is two flesh-and-blood, breathing, speaking, silent, smiling, frowning, sometimes crying, sometimes laughing, sometimes yelling humans, present to each other." Michael Ventura wrote that in 2009 on page 64 of the article, "Screenworld," in the magazine Psychotherapy Networker.

Edgar Levenson and Polly Young-Eisendrath

The goal of therapy is not the restoration of the self, but the enrichment of the self, the person becoming more present, more defined, closer to an aware personality; that is, the self comes to approximate the personality. To put it somewhat aphoristically, the patient becomes what he or she really is, not what he or she should be, or would like to be. All neuroses are failures of presence, warts and all." Edgar Levenson wrote this in 1989 on page 550 of his article, "Whatever Happened to the Cat?: Interpersonal Perspectives on the Self," in the journal, Contemporary Psychoanalysis.

In therapy, "one comes to witness and accept a range of subjective states without blame and with a certain playfulness or lightness of being. The usual outcome of this process is greater courage, insight, empathy, and creativity—means for uniting the opposites, as Jung would say.” Polly Young-Eisendrath said this on page 233 of The Cambridge Companion to Jung (1997).

Therapy is "restoring a patient to a previous level of functioning that has been compromised by a crisis." Glen Gabbard said this on pages 92-93 of his book,Psychodynamic Psychiatry in Clinical Practice(1994).

“Therapy thrives on breaking up patterns that are encouraged elsewhere. Therefore, it doesn’t go well if it consists of allowing the client to continue to do the two things he or she does best—complain and make New Year’s resolutions.” From page 76 of Jay Efran, Michael Lukens, and Robert Lukens' book, Language Structure and Change: Frameworks of Meaning in Psychotherapy (1990).

“Clients and therapists—or members of self-help groups—converse in ways that help people generate options they were unable to realize by themselves or in other settings.” Jay Efran, Michael Lukens, and Robert Lukens (1990), Language Structure and Change: Frameworks of Meaning in Psychotherapy, p. 60.

“In therapy, two or more individuals meet and form a novel coupling that enables them to carve out new distinctions. In the process, they breathe life into alternatives that had no previous existence. At its best, psychotherapy begins with a particular ‘glitch’ in a client’s life and moves toward redefining and expanding the possibilities of living. That’s what can make it an exciting and enriching endeavor for clients and therapists alike.” Jay Efran, Michael Lukens, and Robert Lukens (1990), Language Structure and Change: Frameworks of Meaning in Psychotherapy, p. 197.

“The task of treatment is to help the patient see what his assumptions are.” Michael Franz Basch (1980), Doing Psychotherapy, p. 36.

“If we look squarely at the fundamentals, it becomes apparent that therapy is neither science nor art—it’s conversation. Conversation is at once the most subtle and complex of all human activities, and our most important problem-solving tool.” Jay Efran, with Michael Lukens and Mitchell Greene, wrote this on page 54 of their article, "Defining Psychotherapy" (2007, March/April) inPsychotherapy Networker.

“This is the core of depth work: to listen to the forces inside us, to pay heed, and to acknowledge them so that we can prevent continuous suffering." This is on page 36 of Machiel Klerk's dissertation for clinical psychology,The Birth of Compassion and the Experience of the Divine, 2008. Pacifica Graduate Institute. See <<http://www.machielklerk.com>>

“What, then, is this wholeness that is the aim of psychological work? It is the fullest possible consciousness of all that comprises one’s own personality, and it is approached in the steady, honest, and demanding self-discipline that Jung calls the process of individuation. Since, as we have implied, whatever is unconscious within us is first encountered in projection, the process involves the withdrawal of projection and the assimilation of its content into that conscious being where it belongs—our own. It involves the ever-growing admission of who we really are,” said David L. Hart on page 92 of The Cambridge Companion to Jung (1997).

Therapy takes a “look at the BIG questions: Who am I? What is my purpose? Is my story yours? Is your story mine? Is it true? Is it real? What’s real anyway? And, what on earth is a Self on earth?” leeny sack, performance artist, Ithaca, NY.

When you counsel someone, you should appear to be reminding him of something he had forgotten, not of the light he was unable to see. -Baltasar Gracian, writer and philosopher (8 Jan 1601-1658)