• natashaknoff

WHAT MAKES THERAPY WORK?


The common way clients find a therapist is by using Google’s search engine. They type in keywords like “therapy for anxiety”, “couples counseling”, or “therapist near me”. Using a therapist directory is also common. Multiple filters and search options help clients narrow down the database to an ideal list. They can usually find several professionals who fit important criteria like treatment method, area of speciality, location, and insurance plan.


But what about everything that comes after that? After you make an appointment, and a few weeks ago by…How do you know therapy is “working”?


I’ll answer this question in my favorite way: with a story and a lesson.

It’s wonderful when you get along with your therapist. You look forward to each session, and you have moments where you say to yourself, “Oh, I really need to bring this up in therapy!” Your therapist welcomes your feelings, questions, and observations with warmth and curiosity. They praise your efforts, and celebrate your success. They troubleshoot, and offer feedback that is gentle but direct.


Sessions weave together to tell the story of your life in all its complexity. You talk about the good, the bad, and the existential. You hear your story reflected back to you, and new insights emerge.

Sometimes, a goal is set or you try a new way of solving an old problem. Other times, the undertaking is less about fixing or doing and more about being held by the mysteries of existence. Either way, the direction forward makes sense and your therapist is a trustworthy partner in charting the course of your unique path.


Soon, you will notice that therapy feels like a helpful part of a weekly routine. Your relationship with your therapist feels secure, relaxed and meaningful. The content of your sessions flow naturally from one to the next.


At some point, your therapist asks for feedback about various aspects of the process. You reflect on your gains, and pinpoint the goals that need more attention. The work continues right on track.

If your therapist misunderstands you, it feels safe to bring this up. You share freely, and expect your therapist to respond with acceptance and compassion.


Finally, it’s time to reduce the frequency of meetings to prepare for termination. It’s bittersweet to reach your intended goals because it signals the necessary end of this supportive working relationship. At the same time you celebrate success, you say goodbye.


If I could give this story a title, it might be “The Relationship is the Cure”. My reasoning behind this title is both artistic and academic. This story is about a very important therapy-specific concept called “therapeutic alliance”.


The American Psychological Association defines therapeutic alliance as “a cooperative working relationship between client and therapist, considered by many to be an essential aspect of successful therapy.”


Basically, the relationship between you and your therapist is a vital component to effective, successful therapy. In fact, it might be the #1 aspect of the process that makes it work!

Research tells us that obvious factors like years of experience, specific interventions, and level of expertise only influence the outcome of therapy to a small degree. For clients, the high quality of the connection to their therapist is what adds up to therapy that is effective, helpful, and ‘works’.

The working relationship has 3 components - bonds, goals, tasks.


Bonds are the ways in which client and therapist relate to one another.

The client has a positive attitude toward the therapist, and is open to suggestions, feedback, and direction. The therapist is warm, encouraging, and accepting of the client’s story. They ask questions and inquire with intention.


Goals are the endpoints that the work of therapy is moving toward.

The client and therapist mutually understand and agree upon the goals of therapy. The process is undertaken with a clear intention to resolve specific stuck-points, and access a previously unattainable state.


Tasks are the methods used to achieve the goals.

The client and therapist both take action within their roles. The therapist aids the client in reflection, and introduces new ideas. They encourage the client to move past long-held thresholds. The client responds with courage, and asks for assistance when needed. Both review points of progress, celebrate success, and determine when the process is complete.

So, the next time you Google “therapist near me” consider the therapeutic alliance. From the first phone call, to the first session, to the end of treatment - the relationship is the primary way change happens.

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