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How Does Therapy Work? Eco-Systems of Mental Health

IMG_0458As a psychotherapist I am often asked the question, “How does therapy work?” There is no quick and easy answer to this question. Every modality of therapy is different and each therapist works differently within these modalities. Even my own approach will be different from client to client depending on the individual needs and personality of each person I see.

Every human being is involved in a complex interplay between their subjective inner experience and the outer world around them. It is as though we are each ensconced in our own eco-system comprised of our individual selves and the environment with which we interact. Each person’s eco-system is unique, though we share and connect with others as part of larger eco-systems such as families, communities and ultimately, nature and the world. Whether or not we experience mental health often depends on whether we have access to the elements we need in order for our particular eco-systems to thrive.

Basic needs such as food, shelter, safety, good enough health, human interaction and more specific desires such as meaningful work, loving relationships, pleasurable enjoyments, spiritual connection and a sense of belonging to a community are some of the elements that most of us look to in order to sustain our eco-systems. These elements are more external, coming to us from outside ourselves but they are still experienced subjectively and interact with our more internal elements such as feelings of self worth, empowerment, hope and a sense of possibility. All these qualities and circumstances constantly interact with one another to form our experience of ourselves in the world.

Another aspect of our eco-system that plays a part in our experience is our belief systems, learned in our formative years, which act as a blueprint for what we tend to expect from life. The influence of these early experiences cannot be underestimated. Once we have reached a certain age we are able to look at our experiences with some objectivity but in early childhood we swallow our experiences whole as it were. Without objectivity we cannot say, “My mother is anxious or depressed”. We are more likely to react to these situations by feeling in some inexpressible way that the world is scary or lacking in vitality. It is hard to shake these early impressions of the world as they form the unconscious foundations of our experience.

In cases where there is a trauma of some kind in the family, a child is likely to blame herself for the situation and feel “bad” or guilty into adulthood without understanding why. Children tend to do this because feeling responsible is less frightening than accepting how helpless they are in the face of the trauma. People who have experienced early trauma will likely have a much more difficult time navigating the vicissitudes of life. Their eco-systems can have fragile areas that unexpectedly surface in times of stress, causing them great anxiety and lack of confidence in themselves and the world around them.

Fragility in the psyche is not always a result of a major trauma. In a sensitive child it can result simply from a mis-attunement in the relationship between parent and child. A parent who is overly preoccupied with her own concerns or difficulties, who is locked in a rigid or limited eco-system of her own, will not be able to provide certain children with the feelings of safety and self-worth they need to navigate life’s more difficult passages.

Therapy helps us to understand our own unique eco-system. We do not all need or desire the same type of experiences nor do we all have the same fragilities and gifts. Our culture allows for a certain amount of diversity but it also is an eco-system in itself and it subtly pressures us to conform to “social norms”. This is problematic when a person assumes they ought to behave in a certain way and then suffers tremendous anxiety or depression when they attempt to do so.

For instance, our particular culture rewards extroversion, assertiveness and resilience. The introvert who feels anxious at parties is led to believe that he is mentally ill when in fact he is just not well suited to that type of interaction. People with more delicate constitutions become ill and depressed when they try to keep pace with those of more robust physical makeup. Creative people in repetitive jobs feel tremendous anxiety and wonder what is wrong with them. We all need to fit into our culture to some degree. In therapy we explore our values and potentials in depth and detail, often finding ways to live in our culture in a manner that is more compatible with our true selves.

Understanding which situations are difficult for us does not mean we should rigidly avoid all situations that make us anxious. Therapy helps us to expand our comfort zone and become more flexible in what we can tolerate. It also helps us to truly understand that it is completely unprofitable to compare ourselves to others. The more we accept ourselves with our gifts and limitations the better we are able to place our own eco-system in a larger eco-system that will nurture us. Some of us need more nurturing and more specific life situations than others. Just as some animals seem to be able to survive anywhere, others need specific conditions in order to thrive. This doesn’t mean that the adaptable coyote is a more worthwhile animal than the endangered tiger. Unlike the animals, we as humans have the ability to choose and manipulate our environments. Therapy can teach us to understand how to do this.

As a therapy progresses the therapist becomes a part of the personal eco-system of the person in therapy. This is an important aspect of the therapeutic process. Therapy, instead of being experienced as a rare form of interaction outside of the regular day-to-day ways of being in the world, evolves into a way of relating that can be used outside of the therapist-client relationship. The person in a sense internalizes the therapist and is able to respond to situations outside of therapy in ways that better reflect a more integrated sense of self. This change in our personal eco-system, this inner attunement to a relationship in which no concern of ours is too menial to be given attention, no feeling is bad or wrong and the central purpose is our own well being, can bring profound changes to the way we experience life.

As with any eco-system, changes do not generally happen overnight. The more organic and natural the process of change feels the more sustainable it is likely to be. It is difficult to dissect the experience of therapy to pin point when and how the changes have taken place. We can watch time-lapse photography of flowers blooming, we know about the influence of sunshine, soil and water but we still do not really understand what compels the flower to bloom. It is similar in therapy. I can be with a person in ways that I hope will facilitate positive change but a person’s eco-system is complex and subtle. It encompasses everything from the unconscious depths of the psyche, to the more conscious, day-to-day experiences, to the wide world we live in. For this reason I am continually surprised by the courageous and creative choices my clients make in order to better their lives.

Ultimately the answer I would give to the question “How does therapy work” is that it is impossible to generalize. Therapy, like life, is a unique subjective experience. As a therapist I have the privilege of being invited into the subjective world of my clients as much as they allow me and as far as I am able. Together we work to create conditions in which this unique individual will thrive.