In previous months I have written about many challenges a person might face and how those challenges can impact a person’s life. I have always written how therapy could be helpful and why a person might seek out therapy for support. I thought this month it would be helpful, (pun intended), to write about what exactly is helpful in therapy. I have written in this column a number of times that research into psychotherapy and counselling finds the relationship between the therapist and client is key to effective therapy. Yet, there are more factors to consider that can be useful in seeking out therapy that supports a person during challenging times.
If a person searches the term ‘therapy’ on the internet, the first result is often a HSE website page, which shows a list of different types of ‘talking therapies’. Wisely enough, the page also reads “For some problems, one type of talking therapy may be better suited than others. You can decide which one works best for you”. I was glad to read this, yet, through working with clients over the past years, I have heard anecdotally that the HSE apparently does not often offer much of a choice of the type of therapy a person receives, even after they endure long waiting lists to access the services available, which is unfortunate if true.
Research has found that few psychotherapeutic approaches show an evidence-base as being the one and only type of therapy that works for all people all of the time. Researchers are yet to find a therapeutic silver bullet so to speak, I found this very thing in my own research too, which I went on to publish in 2024. This fact has been referred to as ‘the Dodo Bird verdict’ and indicates that even if one specific therapeutic method is shown as slightly more effective than another, it does not mean that it will be effective for every client all of the time.
So, what is actually helpful in therapy and how does it work? An effective therapist is a person who practices ethically, has trained to recognised standards and is capable of building a trusting, safe and supportive relationship with a client. A client would usually experience this from the get-go; it translates into feeling seen, heard, welcomed and understood. Furthermore, a client would usually experience a strong therapeutic relationship as a feeling of being able to ‘say the un-sayable’ without any sense of judgement from the therapist. Therapy sessions may be experienced as challenging and difficult, they are certainly not the best craic going, but they should also feel helpful and supportive! Also, at some point, helpful therapy would usually involve a client feeling a gentle challenge from their therapist as opposed to a nodding dog agreeing with everything the client might say or share.
There are some unethical things in therapy that a therapist should not offer a client such as touching a client or having a relationship (friendship or romantic) outside of the therapy room. It would be unhelpful if a therapist overly discloses their personal information to the client and/or uses the client’s therapy session to talk about themselves or their own challenges in depth and excessively. Conversely, in helpful therapy, a therapist might, at the right time and with therapeutic intention, disclose something of their own experience to their client. Different approaches to therapy take different stances on the use of therapist self-disclosure, an effective and ethical therapist should be able to explain why they do or do not self-disclose if a client asks.
If there is a strong therapeutic relationship in place then a client should have a sense that their therapist can accept constructive criticism or that the therapist explicitly invites this. Therapy is a relationship, which means the therapist is an active participant in the therapy session and should be able to lean into exploring where things might be not so helpful. As all therapists are also humans, a therapist can sometimes say something that unintentionally causes a rupture in the relationship built with their client. In this regard, helpful therapy would include the therapist having the ability to address any rupture and turn it into an opportunity to repair the relationship. This could be experienced by a client as challenging communication as it pertains to a collaborative discussion around what has happened or is happening in the therapy relationship. Often times, unhelpful patterns in relationships or early childhood experiences can recreate themselves in a therapy session and supportive therapy will usually address these.
Helpful therapy would usually be undertaken by a therapist that can discuss what the process will be like and what kind of progress can reasonably be expected. The therapist would be experienced as non-judgmental or critical of the client’s choices or life, not seem bored during sessions and not treat a client as emotionally or intellectually inferior. Importantly, helpful therapy would present a client with a therapist who does not seem easily overwhelmed or upset by information the client discloses. I often work with suicidal clients, clients who experienced childhood sexual abuse and clients who have experienced trauma. The therapeutic endeavour is one which, when helpful, should present a space and time for a person to explore the depths of their experiences and feel securely held in that exploration.
Therapy is often referred to as ‘talk therapy’ and therefore it can be assumed that therapy entails a lot of talking. This is a fact, however, if the therapist is the one doing the majority of the talking in every session then that would be a good indicator of unhelpful therapy. Some approaches to therapy, such as psychodynamic therapy, mean the therapist talks to a minimal degree. Others, such as cognitive behavioural therapy or acceptance and commitment therapy, involve the therapist being more active and talking more. None would usually result in the therapist talking the most.
I always try my best as a therapist to offer the people who choose to work with me a safe, non-judgemental, supportive and collaborative therapeutic relationship. I am trained in many approaches to therapy, including the ones mentioned in this column, yet I always explore with each person what they themselves might find useful. Whether that be one specific approach or a mixture. I believe each person is an expert in their own life, having lived it, so they are uniquely placed to know what is best for them. If that in itself seems challenging then there is helpful therapy in exploring that alone. Some people, due to their experiences, might find it hard to say what they want or like/dislike and exploring that can be quite the useful experience too.
With all of that said, therapy is very much two human beings sitting together in the hope that change is possible and that people can break free from the chains, which life and others may have put upon them. Dinae Ackerman, an American writer, says in her book ‘A natural history of love’ that psychotherapy is “…a profession whose mainspring is love. Nearly everyone who visits a therapist has a love disorder, and each has a story to tell – of love lost or denied, love twisted or betrayed, love perverted or shackled to violence.” As a result of this, although we share humanity in common, each individual’s uniqueness would usually inform and shape therapy. Psychotherapy and counselling is not something that is done to one person by another person. Rather, helpful therapy is a space in which a person can experience the conditions to explore, grow and choose personal freedom while being met in their humanity with kindness. It could even be called a beautiful thing.
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