Is psychotherapy “just talking?” Part II.

Since a short blog post cannot possibly, not even closely, encompass all the fascinating stuff running in the background in one’s mind as psychotherapy takes place, here are just a few examples of mind processes that are underway as therapy unfolds.

Often what happens in psychotherapy is a sort of “slowing down” of the usual way of thinking and perceiving things. Slowing waaaaay down. I don’t mean speaking slowly or thinking slowly, I mean taking the time to pay attention to things we often do not have or do not make time to pay attention to in our daily routines: fears, hopes, emotions, expectations, goals, assumptions…all of that good stuff that is usually “running in the background” of our day and affecting every big and small decision we make, from what part of the toothpaste tube we squeeze to get the toothpaste out to whom we choose as our significant others. Yet, it also tends to be the stuff that the modern lifestyle leaves little room to think, talk about, or explore.

What does slowing down enable you to accomplish in psychotherapy? Think of it this way: we constantly have to adapt to new situations, solve new problems, deal with new pains or disappointments, or adjust our goals for circumstances we did not expect. Most of the time we do this on autopilot. Why? Well, it’s not very efficient to sit down with your morning coffee every day and re-construct how you think of the entire universe every morning, is it? “Hmm let’s see, well, shall we start with, who am I? What makes me a person? What are my values? What motivates me? Come to think of it, what do I think is right and wrong in the world and how does that influence my decisions about where I buy my coffee?” Not very efficient at all to do this every day. That would take most of your morning and leave little room for living by taking too much room for thinking.

While our autopilot is great for efficiency, it can be not-so-great for adjustment and adaptation. Autopilot keeps the same course, but sometimes the course needs to be adjusted. So in psychotherapy we turn the autopilot off for a while. We pay attention, in a specific way, on purpose, to all the important “background program” stuff that our computer [mind] is running: patterns from past experiences, tendencies to make specific choices, complexities of emotions and thoughts, and tendencies to protect ourselves or to cope in specific ways. You may have heard this process labelled with many different words; “mindfulness’ is one way this process can be described.

Psychotherapy can act like a mirror – a mirror that in daily living we see only a part of, through a tube, thus only seeing a small part of the mirror, a small part of ourselves. Through therapy, what we “see,” what we know about ourselves expands. Through that process, people often find out things about themselves that they like and things they don’t like. You’d think that latter would deter anyone from going to psychotherapy, but the reality is – gaining awareness about some behaviour, expectation, or way of approaching things that I don’t particularly like in myself can create motivation for change, motivation to adapt more effectively to whatever situation is happening.

So one of the most fundamental ‘unseen’ processes that is happening as psychotherapy unfolds is creation of new knowledge and increase in self-awareness. This knowledge often has to do with better understanding the range of human emotions, or how patterns unfold in romantic relationships, or the masks that grief can wear. Often, this knowledge is very personal, such as learning more about your own internal reactions and feelings, but it can be general knowledge, too – such as knowledge about effective coping strategies for when those intense emotions hit or knowledge of the connection between stress, emotional health, and physical health. I don’t usually resort to clichés, but when I do, they are particularly cheesy. So here is one. Knowledge is power. And it is especially true when it comes to knowledge of yourself.

As a psychotherapist who is influenced by existentialist philosophy, I literally cannot help but point that new knowledge creates new options. When you understand yourself better and see that you are not a one-dimensional robot with a range of three emotions (hungry, angry, and tired – oh and only one of these is an emotion), new possibilities for action are created in the mind. The person can see new options for how to approach a problem or a new choice that they didn’t realize was available to them before. As an existentialist, I can’t help but be tickled pink by the realization that greater self-knowledge creates greater freedom.

Processing of emotions is another common thing that is ‘under the hood’ of therapy. Not all psychotherapies use an approach that focuses on emotions in depth, but most major approaches to psychotherapy will work with emotions at least to some extent. Some studies have suggested that psychotherapy tends to work best when the client feels emotionally connected to and engaged with the process, and able to share how they feel in therapy. “Processing emotions” “simply” refers to a very complicated process:

• Being able to recognize and identify emotions; less of a sense of feeling swept up in wave of confusing emotions, overwhelmed by something that feels unknowable;
• Identifying how one emotion – such as anger – can actually be a bit of an emotion “onion,” linked to hurt, sadness, loss;
• Acknowledging emotions – a task that can be very challenging for many people, especially if they have been taught to not show, express, or honour their emotional responses;
• Understand the functions of different emotions – e.g., anger can be self-protective, but is the behaviour of acting out in anger really meeting your goal of self-protection? In another example, sadness can often have the function of reminding us of our values or cherished relationships;
• Be able to understand that different emotions signal different things – sadness may signal that there has been a loss, frustration may signal that an important goal is being blocked. It is important to learn to pay attention to these signals BUT not be controlled by them;
• Be able to regulate emotions without relying on a black-or-white strategy of either suppressing them with a Xengis Han-like brutality or allowing them to run completely wild and free, leading to impulsivity and acting rashly.

I can really go on forever about other parts of “just” the “processing emotions” part. Literally, I can keep going. But I’ve rambled on it too long already. You get the idea. Lots is happening.

When some of these processes are underway, there are changes happening in both the brain, the physical organ, and the mind, the perceptual manifestation of your identity, personality, and self-perception.

You might call it “untangling” and “re-aligning.” Imagine a giant network of a bubbles of different colours, shapes, and sizes. Imagine them in a tangled, messy ball of chaos. In that ball, sadness might be tangled up with anger, dashed hopes might be intertwined with pessimism and worry about the future, all mixed in with memories of what you had been meaning to do but haven’t got to. This kind of “tangled” experience is common – people can carry it inside them with little time spared to untangle the variety of thoughts, emotions, memories, and intentions. There might be some accidental untangling or re-aligning of things that happens when you confide in a friend or a treasured family member, when you take the time to talk about your own experiences and all the flavours that our internal experiences comes in. That is one way we might feel relieved or unburdened after talking about our difficulties or feelings with a friend.

However, in psychotherapy, this untangling is not accidental. It is intentional. When the therapist is facilitating the therapy process, they might lead you on a careful untangling process, helping to sort through – which parts of your experiences are emotions? Which parts are thoughts? How do they influence one another? How does the past experience influence the present? How do you respond to new situations that you haven’t experienced before? What are you go-to responses? And so on. This untangling helps to bring clarity, helps to group emotions with emotions and thoughts with thoughts, helps to separate past from the present and from the future. On a basic science level, when the person engages in this kind of process, new connections between neurons can be formed and strengthened; perhaps where there was only a connection to fear, a connection to the feeling of hope or safety can be created.

As a psychologist, I can only speak to my profession’s and my training of psychotherapy. To me, what is very important about being able to conduct psychotherapy effectively is to make sure that my internal experiences do not get ‘tangled’ up with my client’s. Otherwise, I might lead them astray unknowingly. To avoid this, psychologists who specialize in psychotherapy undergo years of closely supervised training, which often includes (but varies from one training program to another) a significant component of increasing the psychologist’s self-awareness of the very same thing that we encourage our clients to be aware of: emotions, thoughts, go-to response options. I believe a high level of self-awareness to be imperative to the therapist being able to focus with clarity on the client and not to unknowingly influence the therapy with the own issues that the therapist is not aware of. I can say with a sense of gratitude that I feel my training as a psychologist has prepared me well for this, and has also prepared me well to practice what I preach, so to speak. This reflects the importance of authenticity in psychotherapy, of being willing to yourself do what one might be asking of the client (e.g., ask yourself difficult questions, look at your own patterns in feelings and relationships, etc.).

How do we know that this is what happens in psychotherapy? Well, while there is a lot we don’t know about the human mind, there are many studies from disciplines like psychology, neuroscience, and public health that show us evidence of these processes. It’s not just psychologists tooting their own horn. This stuff actually works. This is why I love engaging my clients in the process of psychotherapy.

So. Conclusions. A psychotherapist and a client are sitting in a room together, talking in quiet voices. Neither is very animated. Everything looks serene and cerebral, maybe even boring to an onlooker. It’s like the night sky – you can see some of the stars, but there is so much more happening that what can be seen by the unaided human eye. But if you know what’s going on, you know that what looks like “just talking” is a clever cover for amazing mind activity that is happening under the surface: new knowledge created; new connections drawn; unhelpful patterns discovered and adjusted; emotions clarified; intentions set; and so the self grows more aware, stronger, and wiser.

About Armin Mortazavi, the illustrator of this blog post::

Armin is a science cartoonist living in Vancouver. You can check out his latest project here: http://adventuresofpatoo.herokuapp.com/

To connect with Armin:

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