What is Psychotherapy?

You’ll get an endless array of answers to this question depending on where you go looking. I struggle with it myself still. What I’ll offer here is my best attempt at answering an impossible question — my humble perspective based on my education, my own experience in therapy, my personal experience as a fellow human being, and my combined clinical experience over the last 10 years.

Consider the following allegory. Based on the work of people much smarter than me, we know that humans have been on earth in our current anatomical form for something like 300,000 years. So, imagine you were 13 years old roughly 100,000 years ago. It will be another 90 thousand years or so before humans start writing things down and keeping what we now describe as a historical record. Nobody will remember your name or who you were in the future, but you take up life and solve the problems of being human like everyone before… and as everyone after you must. Survive, belong, thrive… to name a few.

You live in a tribe that hunts and gathers. You’ve trained with a spear, and you’re about to go on your first hunt. Your father is the village chief and a prolific hunter who is almost solely responsible for the recent success and growth of your tribe. He is a master of using the spear, and a pioneer in a new hunting method. He leads and teaches. He commands respect. He provides. And so, he’s raised you in his likeness. He’s drilled you harder than every other child in the tribe. It’s overwhelming, but you keep showing up. Today is your first hunt.

You head out. There isn’t a name or a word for “anxiety” — but something in you screams: “What if I miss?” You have a chance genetic mutation that predisposes you to higher stress hormone release — something modern science will still struggle to understand and explain even today. Your opportunity arrives, and the unthinkable happens. Your father’s face is unmistakable — profound disappointment, anger and frustration. The village goes hungry. The little children wail loudly in their hunger. The feeling is unbearable. Your father can barely look at you — and in that moment, you tell yourself a story, in a language long forgotten, that fundamentally changes your experience and how you see yourself: “I’m a failure.”

The anxiety, still very real and very present, is now accompanied by something much worse. You’re slower to pick up your spear. Afraid to go on the next hunt. You’ve lost your faith in yourself. You start to imagine that the village would be better off without you. Your father is struggling with his own feelings. He remembers the time before he became the chief — when the hunters struggled to provide. He remembers hunger, he remembers friends and family dying. He is marked by suffering that you don’t know — he’s struggling with something we describe as PTSD. And so, he’s no help to you. You have a mother with younger siblings who she must attend to. She sees you suffering but doesn’t know how to help and doesn’t have time. You are profoundly alone in your own head and heart — and profoundly isolated in your suffering. The other kids snicker at you quietly. It’s unbearable. You put on a brave stoic face, long before Greek philosophers “invented” stoicism. You consider leaving the village to fend for yourself, which will mean almost certain death. You’ve seen others thrown out for different reasons, and so a noxious belief emerges in your mind: “that’s what I deserve…”

But something happens that you didn’t see coming — there’s another person who sees you. Your father’s best friend and longtime confidant sees your suffering. He throws his arm around your neck at the moment you most needed it, and in that same forgotten language tells you: “I won’t quit on you if you won’t. I know you can do this. Let’s figure this out.” It’s shocking at first: “How did you know?” You don’t quite trust it, but he sounds like he means it. And instead of drilling with your father, you start to drill with him. Like your father, he wants you to succeed and is just as firm and unforgiving, but the relationship is different somehow. He’s different — strangely patient and kind with every mistake you make. There’s little or no judgement in his feedback. There’s no anger in his voice. There’s no disapproving look when your hands shake, when you make a mistake, or when you miss. He simply lifts your chin up, looks you in the eye, and says firmly: “Again.” Over time, you realize slowly that your hands don’t shake as much. The anxiety is still there, but you feel accustomed to it — something is different. You get better with every throw. A quiet confidence grows and emerges in you.

With your mentor standing by you, you swallow your pride, tolerate the sneers and japes of your friends, and you tell your father you want another shot. In his woundedness, he looks down at you with that same disapproving look and skepticism, but it’s different. The look doesn’t hold the same power — you tolerate it in a way that surprises you. And, he’s still a father deep down. His heart scores a rare win in the battle against his cold and stern mind — and he allows it. With your companion at your side quietly cheering you on, you score your first kill.

Thus, psychotherapy was born… long before humans tried to name it or create a discipline out of it. Today, people in the mental health world quibble endlessly and religiously about which approach is the “correct” or most “evidence based” approach. This is often accompanied by an air of authority and substantiated by some rather insipid statistical chicanery. This isn’t inherently bad, but it can be, from my perspective, potentially misleading. Sometimes I worry that it’s more harmful than helpful — see my section on diagnosis. But if you’ve ever had a relationship with a coach, a teacher, a pastor, or a mentor who chose to believe in you when you were struggling to — and maybe when you most needed it — you have an idea of what psychotherapy is and what it’s not. Every helping profession, by every name, has been an imperfect and very human attempt to create a professional discipline dedicated to capturing and cultivating the experience described above. This is what I hope to hold and cultivate for anyone I keep company.