HOW DOES PSYCHOTHERAPY WORK?
Learn about my approach
Psychotherapy works by literally, physically, changing your brain. Thoughts and emotional reactions are not simply abstract phenomena occurring somewhere in space. Instead, thoughts and emotions are actual physical events that take place amongst the billions of neurons within your brain. What this means is that past events and interactions with others, and our thoughts and emotions about these events, have left their mark in our brains. When you engage in psychotherapy, you are addressing the impact, on your brain, of certain aspects of your life, in a very specific, intentional, and physical way.
In the following paragraphs, I will attempt to offer a general introductory account of how psychological difficulties develop and how psychotherapy works. This description is based heavily on the Control-Mastery Theory of psychotherapy, initially developed by Joseph Weiss and Harold Sampson, and expanded upon by the San Francisco Psychotherapy Research Group (Formerly the Mount Zion Research Group. It is by no means intended to be an exhaustive or complete account of psychotherapy. My hope is that by providing this general description, the reader will gain some general understanding of how psychotherapy works and how I work as a therapist.
At the most basic level, we want psychotherapy to work on our “psychopathology”, which is just another way of saying that we want psychotherapy to work on the things that bother us psychologically. Psychopathology does not mean “crazy” or “insane.” Everybody has some degree of psychopathology at different times because everybody has things about themselves, the way they think, feel, and behave, that bothers them or creates problems for them. Furthermore, mental health is not static (unchanging), but instead fluctuates across the lifespan depending upon what is happening in our lives at any given time.
Psychological difficulties or "psychopathology" arise out of an interaction between our own personal genetic predispositions and our environment. By “personal genetic predispositions” I mean simply that some people are born a little more anxious than others, some are born more extroverted, some a little more reserved, etc. This is just their particular temperament. When I talk about “environment” I am simply acknowledging that humans undergo a learning process with regards to how the world works and how we should behave in it. Who we “become” is the result of our genetics interacting with our environment. This interaction between genetics and environment continues throughout our lifetime, but it is our earliest experiences of these interactions that lay the foundation for who we are, how we think and how we behave as adults. In summary, our early experiences combine with our genetics to co-create a structure, or template, for how we process information and how we respond to this information.
Starting with infancy, we are engaged in a social environment populated with parents, caretakers, siblings, etc. As infants and children, we are highly motivated to connect with, and to maintain our relationships with our caregivers. The consequences of failing to maintain these relationships as an infant and even as a young child would be catastrophic, and ultimately fatal. Gradually, through repeated interactions with caregivers, we learn how “to be” and how to behave. The cumulative result of these interactions is the development of foundational, firmly held beliefs about others, the world, and ourselves.
When interactions with caregivers are consistently predictable and nurturing, we learn that we can count on others to be there for us, to protect us, and that we have value as a person. We learn that there is some order in the world and that we have at least some control and power over what happens to us. However, when our interactions with caregivers are consistently negative, critical, abusive and traumatic, if we are regularly forgotten and neglected, we may develop a very different set of grim, negative beliefs about ourselves and the world. We may develop the belief that we cannot count on anyone to be there for us, that the world is a dangerous, unpredictable place. We may learn that we are of little value, and have little or no control or power in this world. Some of these beliefs may be conscious, but often they are unconscious.
In psychotherapy, we refer to these grim, trauma-based beliefs as Pathogenic Beliefs. What is important to recognize is that our beliefs, whether they are the more positive beliefs, or the more grim pathogenic beliefs, are “accurate” or “true” for the child who develops them. The nurtured child really does live in a predictable world where she is protected, has value, and some degree of control. The consistently criticized, abused, or neglected child really does live in a world that is unpredictable, chaotic, dangerous, and where she has little value. Whereas the nurtured child comes to expect respect, the abused child comes to expect disrespect.