How does therapy actually work?

Whether or not you’ve had experience in therapy before, it often can be hard to know what to expect when you start with a new therapist.

Is talking about my problems for an hour a week really going to be enough?

In fact, there’s a lot more going on than usually meets the eye.

While we never know exactly what our sessions will hold when a new client walks through our door, there are several key principles that guide the way we approach our own work that can help explain how and why therapy works.

Therapy addresses our core circuitry

Clients usually understand the expectation that we’ll be exploring some of their past in therapy, including but not limited to their with their relationship with their parents and their childhood. Some laugh at the cliché, but others sometimes counter with some resistance - “my childhood was fine,”“the past is past” or “it just doesn’t matter anymore.”

Yet when it comes to unconscious thoughts and behaviors, more often than not the past is actually still quite present. This is because we know from neurobiology and developmental psychology that the brain is extremely malleable and plastic when we’re young. Its job is to take in experience and to build neural connections for future reference, and so the whole nervous system becomes organized and evolves around your experiences over time.

So while it might sound simple, we can start to see how even years later, when we can recognize that what we learned early in life was not right or necessarily true, we still often find ourselves run by these deep-seated systems that can be hard to knock.

Therapy provides new experiences, which is a powerful agent in re-learning

Therapy works because not only does it helps us become more aware of and begin to separate from these unconsciousness parts and processes, but the kind of deep and intentional work we do in therapy can actually provides new experiences (and affiliated neural connections) required to “rewire” them.

Oftentimes simply talking - as in traditional talk therapy - can still allow great progress here. From a place of compassion and curiosity we begin to question early narratives, connect new dots, ad create new beliefs.

But have you ever found yourself saying you can understand something “logically,” but you still can’t seem to “feel” a certain way? That’s because it can also be extra helpful in therapy to work at the emotional and somatic (physical) level. Just like our mind and nervous system was originally built through experience, “rewiring” our brain also requires new experiences to form and strengthen different neural connections.

Consider working through trauma. While some clients can talk about their experiences in a detached and clinical way, while others avoid remembering it all together, when we hold onto a trauma without fully digesting the pain or letting others hold it with us, feelings can become almost “stuck.” Working through with a caring professional can can both release bottled-up emotions as well as create a new experience of safety and connection a survivor never had before. Moreover, when we revisit past memories, research now shows that they, too, become malleable, and we have the opportunity to actually reprocess traumatic memories them with a new experience and meaning.

Other opportunities to create new experiences in session might look like a subtle focus on your process - like noticing your tone of voice or body language when talking about something. Sometimes we’ll get into a state of mindfulness. This can strengthen the “muscles” that allow you to ground and regulate, but it can also provide an opportunity to try on new, more healing experiences through somatic-based experiments, like having you give voice to and dialogue with different internal “parts,” or stay with and fully processing an emotion.

All of these things allow us an opportunity to continue to create and strengthen new neural connections in both the mind and body, thus integrating learning across left and right brain.

The relationship in therapy alone can be healing, because we’re wired relationally

Finally, research shows that the number one predictor of therapeutic success is the relationship you have with your therapist. In many ways, it’s important to work with a therapist you feel safe enough to venture into some of your most vulnerable places with, as well as someone you trust enough to be fully honest with. A sense of comfort and safety while addressing hard subjects helps them to not feel so overwhelming while we find a way to work through.

But healing with another person is also so powerful because we are, by nature, social animals. In fact, most of the significant wounds we work with in therapy are relational in nature - be it from a parent, a teacher, or a romantic relationship. Even wounds from the larger culture or society often stem most greatly from things like loss of connection or belonging.

In therapy, we create space for clients to be vulnerable, but to still be held and accepted at their most vulnerable. We allow space for them to mess up, but still know they are loved and ok when they mess up.

This can be a particularly powerful form of experiential healing, given the many negative, critical and judgmental voices we tend to have in our heads. Having someone who really sees and accepts us un for who we are, as we are, is a deep need that is rarely met enough. However, through the experience of the therapeutic relationship itself, we continue to build and more greatly internalize this sense of self-acceptance and self-love.

Putting it all together

There are so many additional tools and approaches our therapists integrate into their sessions from schools and approaches across the board, but most ultimately work in the same fundamental way. Week after week, little by little, you’ll take something at the tip of the iceberg - the fight you bring in with your partner, the frustration with work or a colleague, the panic attack from over the weekend - and we use it as a window into the patterns that often find a small way to manifest into each, as well as an opportunity to shift and experience something even just 5-10% differently. This is why therapy often evolves into a long and beautiful relationship, yet you can also blink and it sort of feels like magic - you know you’ve changed, but you can’t quite put your finger on exactly how.

Our lives are built on everyday experiences. Together, we work by undoing and redoing it the exact same way—50 minutes at a time.