In my private practice, I meet clients who have previous therapy experience. They often have had 1-4 previous therapy contacts. Some contacts have been shorter, and some have been longer. The reasons for starting therapy differ, but their previous experience is the same. There was no desired change.
What makes one therapy work and not another? The reason may be that the psychologist and the client have been focusing on understanding to a large extent. They have put the problems into words, explained the background, and formulated what change they can see for the client in the future, i.e., a positive development. But it is all on an intellectual level.
Why the therapy has stalled is that the psychologist and client have had intimate conversations that the conversations were more intellectual than emotional. I can recognize having done the same mistake earlier in my career. Important things were discussed, there was a sense of direction, and both psychologist and client understood the background, current problems, and wishes for the future. Nevertheless, the desired change could be small.
For therapy to be transformative, the psychologist and the client need to be able to articulate the problem, of course, and they need to connect their understanding to emotional experiences. In that way, emotions as a motivation is activated and change comes more naturally and with less effort.
It can be pretty quick to recognize the problem, but staying close to what you want to change can be difficult - in both words and feelings. It is one thing to be able to think and talk about what you know and another thing to feel what you know. It is a kind of emotional certainty, not just an intellectual certainty.
If both client and psychologist distance themselves from what is challenging emotionally for the client, there is a risk that the therapy will not lead to change. The conversation may become superficial, but you can feel a strong presence in sharing something intimate and vulnerable.
Now, I hope that the people reading this will not be stressed and feel that they need to come more prepared for therapy. Finding out what a therapy should focus on in broad terms can be quite sufficient when they seek a psychologist. You may need a more open approach, and I, as the psychologist, do not try to narrow it down.
This is one perspective on the therapeutic conversation, and I am aware that therapeutic conversations have several ingredients.
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