ווי קען אַ קליענט פֿאַרשטיין אַז זיין אַרבעט מיט אַ סייקאָוטעראַפּיסט איז עפעקטיוו?

«clear» therapy

In situations where a client comes in with a specific request—for example, to help resolve a conflict or make a responsible choice—it’s fairly easy to evaluate performance. The conflict is resolved, the choice is made, which means that the task is solved. Here is a typical situation.

A woman comes to me who has problems with her husband: they can’t agree on anything, they quarrel. She worries that love, it seems, is gone, and perhaps it’s time to get divorced. But still wants to try to mend the relationship. At the first meetings, we study their style of interaction. He works hard, and in rare free hours he meets with friends. She is bored, trying to drag him somewhere, he refuses, citing fatigue. She is offended, makes claims, he gets angry in response and even less wants to spend time with her.

A vicious circle, recognizable, I think, by many. And so we sort out quarrel after quarrel with her, try to change the reaction, behavior, find a different approach, in some situation go towards her husband, thank him for something, discuss something with him … The husband notices the changes and also takes steps towards . Gradually, relations become warmer and less conflicting. With the fact that it is still impossible to change, she resigns herself and learns to manage constructively, but otherwise, she considers her request satisfied by sixty percent and completes therapy.

When it’s not clear…

It is a completely different story if a client comes with deep personal problems, when something needs to be seriously changed in himself. It is not easy to determine the effectiveness of the work here. Therefore, it is useful for the client to know the main stages of deep psychotherapeutic work.

Usually the first 10-15 meetings are perceived as very effective. Beginning to realize how the problem that prevents him from living is arranged, a person often feels relieved and enthusiastic.

Suppose a man contacts me with complaints of burnout at work, fatigue and unwillingness to live. During the first few meetings, it turns out that he is not at all able to defend and promote his needs, that he lives by serving others — both at work and in his personal life. And specifically — he goes to meet everyone, agrees with everything, does not know how to say “no” and insist on his own. Obviously, if you do not take care of yourself at all, exhaustion sets in.

And so, when the client understands the reasons for what is happening to him, sees the general picture of his actions and their consequences, he experiences an insight — so here it is! It remains to take a couple of steps, and the problem will be solved. Unfortunately, this is an illusion.

Main illusion

Understanding is not the same as decision. Because it takes time and effort to master any new skill. It seems to the client that he can easily say “No, sorry, I can’t do it / But I want it like this!”, because he understands why and how to say it! A says, as usual: “Yes, dear / Of course, I will do everything!” — and is insanely angry with himself for this, and then, for example, suddenly breaks down on a partner … But there is really nothing to be angry about!

People often don’t realize that learning a new way of behaving is just as easy as learning to drive a car, for example. Theoretically, you can know everything, but get behind the wheel and pull the lever in the wrong direction, and then you do not fit into the parking lot! It takes a long practice to learn how to coordinate your actions in a new way and bring them to such automaticity when driving stops being stressful and turns into pleasure, and at the same time it is safe enough for you and those around you. It’s the same with psychic skills!

The most difficult

Therefore, in therapy, there necessarily comes a stage that we call a “plateau”. It’s like that desert where you have to walk for forty years, winding circles and at times losing faith in achieving the original goal. And it is sometimes unbearably difficult. Because a person already sees everything, understands “as it should be”, but what he tries to do results in either the smallest thing, or an action that is too strong (and therefore ineffective), or something generally opposite to what is desired comes out — and from this the client gets worse.

He no longer wants to and cannot live in the old way, but he still does not know how to live in a new way. And people around react to changes not always in a pleasant way. Here was a helpful man, he always helped everyone, rescued him, he was loved. But as soon as he begins to defend his needs and boundaries, this causes dissatisfaction: “You have completely deteriorated”, “It is now impossible to communicate with you”, “Psychology will not bring to good.”

This is a very difficult period: the enthusiasm has passed, the difficulties are obvious, their “jambs” are visible at a glance, and the positive result is still invisible or unstable. There are many doubts: can I change? Maybe we really are doing nonsense? Sometimes you want to quit everything and get out of therapy.

וואָס העלפט?

Passing through this plateau is easier for those who have experience of close trusting relationships. Such a person knows how to rely on another. And in therapy, he trusts the specialist more, relies on his support, openly discusses his doubts and fears with him. But for a person who does not trust people and himself, it is much more difficult. Then additional time and effort is also required to build a working client-therapeutic alliance.

It is also very important that not only the client himself be set up for hard work, but also his relatives understand: it will be hard for him for some time, you need to be patient and support. Therefore, we definitely discuss how and what to inform them about, what kind of support to ask for. The less dissatisfaction and more support there is in the environment, the easier it is for the client to survive this stage.

move gradually

The client often wants to get a great result immediately and forever. Slow progress he may not even notice. This is largely the support of a psychologist — to show that there is a dynamic for the better, and today a person manages to do what he was not capable of yesterday.

Progress can be partial — a step forward, a step back, a step sideways, but we definitely celebrate it and try to appreciate it. It is important for the client to learn to forgive himself for failures, to look for support in himself, to set more achievable goals, to lower the high bar of expectations.

How long can this period last? I have heard the opinion that deep therapy requires about a year of therapy for every 10 years of a client’s life. That is, a 30-year-old person needs about three years of therapy, a 50-year-old — about five years. Of course, this is all very approximate. So, the plateau of these conditional three years can be two or two and a half years.

Thus, for the first 10-15 meetings there is a fairly strong progress, and then most of the therapy takes place in a plateau mode with a very leisurely rise. And only when all the necessary skills are gradually worked out, consolidated and assembled into a new holistic way of living, a qualitative leap occurs.

What does completion look like?

The client is increasingly talking not about problems, but about his successes and achievements. He himself notices difficult points and himself finds ways to overcome them, understands how to protect himself, knows how to take care of himself, not forgetting about others. That is, he begins to cope with his daily life and critical circumstances at a new level. He increasingly feels that he is satisfied with the way his life is now arranged.

We begin to meet less often, rather for safety net. And then, at some point, we hold a final meeting, recalling with warmth and joy the path we have traveled together and identifying the main guidelines for the client’s independent work in the future. Approximately this is the natural course of long-term therapy.