Change in psychotherapy

There are many ways to come to therapy, which can be summarised by “something is wrong, and something must change”.

Often, we don’t fully know what is wrong, or why we feel wrong when we know we “should” be happy.

We might know that we hurt, or we might feel nothing at all and be so cut-off that we wish for anything to happen instead of that nothingness.

Rarely, but it happens, we feel ok but everybody around us seem to agree that we’re not.

Coming to therapy is an act of hope.

Bringing ourselves through that door is a way to ask “can it be different?”, to want to try and shine a new light on what we are going through, find a way out.

Sometimes that hope is faint, or it can be frightening in its urgency, sometimes it seems to exist out of mere hopelessness, as a necessary contrast to the darkness.

Our work as therapists is to welcome this hope with our hope, nourish it and hold it, and progressively work out what is in the way of being fully alive for our clients.

But how do we know something is wrong? What is psychological suffering?

To understand why people come in the first place has been the essence of the work of psychotherapy since its beginnings.

That said, often what strikes us as “the problem” is the residue of a way to creatively respond to a painful situation which we have subjectively experienced as a terrible threat to our sense of identity, our understanding of the world and of others. All of a sudden the ways we make sense of our experience didn’t work anymore and we have been hurt deeply in places we didn’t know even existed.

I would like to note here that I might seem to talk about particularly damaging traumatic events - but I’m not necessarily. The very nature of some of the hurt we carry might be in how mundane it seems to others but has been so damaging to us, and that misunderstanding might be a constant reminder of our sense of inadequacy.

Sometimes what is wrong is something that never happened, but that we needed to come.

So we’ve been hurt badly, and we had then found a way to manoeuvre around the danger, by running away, shutting ourselves out, building strong shields of meaning between the threat and our fragile selves. It might have worked in offering us the protection of certainty, but it is preventing us from seeing what’s in front of us, and we cannot be reassured that the danger is over. We never let go of the shield of meanings we’ve raised and used so efficiently. We don’t dare to peak out to check if the coast is clear, taking the time to look within ourselves where we’ve been hurt and how badly. We hear others questioning why we’re so defended and why we can’t just enjoy the sunshine, saying that everything is ok, that we have nothing to worry about. Part of us wants to believe them, but we feel that this is just another trick of our old enemy, trying to catch us off guard and strike, so we recoil even more, and hate their carelessness.

We don’t realise that we’re limping. That the weight of that shield is making our arms shake, that our back bends and our head hurt for trying to hide behind it as it wears and tears, as we’re trying to get on and pretend that everything is well. We’re not letting anyone in to help with the wounds we are hiding but are getting infected, with the additional soreness of having to channel all our energy into our lonely fight, with the fatigue and the fear of not being able to protect ourselves when we’re threatened again because we feel so weak right now, and everything is so heavy.

In short: Symptoms are coping mechanisms gone wrong, that were once helpful but have stopped helping. And instead of letting them go, we cling to them even more, as we don’t know what is happening and why, and we feel totally exposed without them.

So what is therapy in this picture? What can it change?

Clearly, we cannot change the hurt that has happened. And it doesn’t help to add to the choir saying that everything is fine, that you should just relax, have you tried meditation?

But a therapist is trying to be a different voice, one that says:

” hey, you look like you’re struggling here, and you’ve come a long way to where you are today. I can’t see what you are afraid of but I respect your fear, and I know you might feel afraid of me, and I promise that I won’t get mad at you or laugh at you for this.

I know that what you are carrying feels heavy but it makes you feel safe, and you cannot let it go yet. You have your reasons even if you don’t know them, and I’m here if you want to try together and understand why you feel you need to protect yourself so much, what hurt you so much, so you can start to heal.

I’m sorry that sometimes it will feel as if I’m the one who is making you hurt, I promise that I will never do so deliberately, and that I will listen if you tell me how it feels to you so we can back off a bit.

The process of therapy can be a painful one, as we will be touching on inflamed areas of your mind and soul. We are going to look after old wounds that haven’t been tended to and have become infected: when our bodies are trying to fight an injury, it swells, becomes hot and painful, and you cannot take your mind off it. If it doesn’t fully work, you learn to live with the pain, and you protect your wound by never letting anyone approach you. It’s the same with the mind. But to really heal, we will have to learn to differentiate different types of pain: the pain from the injury, and the pain that is part of our fighting response. We have to reopen the old wounds, clean them out, dig a bit deeper to get rid of the gravel that kept moving in there. Then we can start to heal, it will take time, but ultimately it will scar and we’ll be able to use those parts of our bodies, of our minds, that we ended up wishing would disappear. We might start to feel other pains that had been silenced by the urgency of that deep hurt. We’ll need to tend to those, too. But we know we’re not alone anymore.”

That different voice comes through when we’re tired enough to be looking for it, when we start to feel the air coming through the holes in our protection and that the cold makes us shake, and the sun burns. When our shields don’t hide anything anymore but we still can’t let go of their handles because our hands have seized around them.

And so, tentatively, we build a relationship that feels different and new. By trying to understand together how we feel like now, and what happened back then, we thread connections that support their own weight. With that pressure easing off, we discover the parts of ourselves that have helped us continue to live, that have been preserved and can be strong enough to carry us now, while we recover.

A therapist is someone who takes responsibility for what they intend to bring in the relationship, and who pays particular attention to how it can go wrong for us sometimes, when our fear comes back and we kick out, without hitting back at us. This helps us realise that others have their shields too, and that perhaps the very thing that hurt us in the first place was someone else defending themselves blindly and mistaking us for their personal enemy, because they never saw us in the first place. This hurts too, but differently.

When we get to feel composed and familiar enough with ourselves, we can become more creative. We develop the ability to observe what happens and how we feel in response, and to choose how we will act rather than re-act.

Therapy is an act of courage: to face our fears, our demons, our vulnerabilities, our hurt, our unrequited loves, our broken dreams, our loneliness. But when we face them, we can relate to them from a different place, rather than being possessed by them.

What we discover in therapy, through the process of therapy and within the therapeutic relationship, is a way to stand in the world unashamedly, to say:

“this is I, scars and all, I have hurt and I’ve survived”, and feel that we deserve to be loved, that we can protect ourselves, that we can trust others - who are struggling like we are along the way.

Therapy helps us paradoxically let go of the urge to change, to “better ourselves”, to grow into what the world tells us to be in order to “fit”.

It helps us develop tender loving care towards the parts of us that have been hurt and cast away in the shadows, both to hide them from view and protect them from further harm.

We get to gently bring them into the light, and help them feel welcome to the party.

We let them feel that they belong, that we belong, to ourselves and to each other.

We get to feel that we can still be hurt, but that we’ll take the risk, because we know we can heal. That life comes with bumps and hurdles, but that we have time to learn how to negotiate them.

We learn that it’s fine to take it slow. To take the time to sit down and pause to admire the view: to look at all the way we’ve come and how strong we are for being here, rather than stay fixated on a way to escape where we are at all costs, wherever we are, because it is Us that we’re trying to escape.

It is to find that sometimes the hardest thing to do is to be still and let the current carry us toward something new and unexpected and feel that we’ll be able to manage that.

It is also to find the courage to make decisions that speak of us, feel how hard it is, and being kind to ourselves when we are afraid.

So what changes is not necessarily anything obvious, anything we can point out or quantify. It is the stance in the relationship we hold toward ourselves, our past, our emotions, our bodies: it is the restoration of respect for ourselves, for the dignity of our emotions, it is finding amazement at the way our minds work, curiosity for the world, faith in humanity, trust in resilience, gratitude for being alive, to find the courage of existing before we die.

This will look different for everyone of course, as none of us will hold the same truth, but we can share our need to live truly and we can recognise it in each other.

To conclude on this idea of change in therapy, and about the importance of accepting that we might not need to change what happened to feel that change has happened, I would like to share the beacon guiding my work ever since a client mentioned this idea to me. Some might be aware of the concept of Kintsugi, the Japanese art of mending damaged pottery with gold which highlights its history instead of hiding it or discarding the object.

In therapy, it could translate to:

However broken and shattered we arrive, and feeling useless to ourselves and the world,

With patient care and attention we can start putting the pieces back together, and our shared emotions will hold them,

To make us

a beautiful mess

of a human.

© 2019 Marion Zalay

Marion presented this paper as part of the Cambridge Festival of Ideas on 19th October 2019.

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