Content vs.

Process

When meeting new clients (and others), I encounter a variety of comments that reflect
common misconceptions about psychotherapy. One is that the focus of therapy is for me to
evaluate the client and tell them what to do. Many people start their therapy a bit defensive
because they are fearful of my judgment or correction. Some people have mocked the process of
therapy by saying that therapists never tell you what to do and only “Listen”. Others have said to
me, “Why am I paying you to listen to me when I could just be talking to a friend or family
member?” The difficulty with all of these assessments is that they assume over-activity or
inactivity on the part of therapist. With the distortions of the therapeutic process portrayed in
film and television, I cannot really blame people for these misconceptions. Unfortunately, there
are also a number of people in the world practicing some type of counseling who contribute to
these stereotypes by their methods of practice. The very terms we use for this type of care are
also confusing – counseling, therapy, psychotherapy, psychoanalysis, etc. In a previouspost, I
commented on the technical differences in these various terms. However, what makes the
process of psychotherapy different from talking with a friend or other type of helper is the
attention to the process of therapy. Because this part of the relationship is often managed in
subtle ways, people often perceive that the therapist is not doing much, but the reality that is that
the process is rich with reflection.
Fundamentally, what makes any type of counseling or psychotherapy beneficial is the
quality of the established relationship. However, in the process of psychoanalysis,
psychotherapy, and Pastoral Psychotherapy, the therapist is mindful of the dynamics of the
relationship, monitors these things, and uses them (hopefully) for the client’s benefit. These
types of dynamics can exist in other relationships with friends, etc, but it is rare. Psychotherapy
is, by definition, a relationship between two (or more in the case of couple or family therapy)
people for the benefit of one of them. Everything the therapist does or says should be for the
benefit of the client. In order to do this, the therapist must be aware of many dynamics that are
simultaneously at work in the counseling office.
When a person comes to therapy, the issues they wish to discuss and the struggles they
have with these issues constitute the “content” of the session. However, the forces that motivate
a person’s behavior are also important. The therapist should be reflecting on the selection of
material presented and the content of the material. After a particularly painful session of dealing
with something like grief, a client may come in the next session and talk about more mundane or
superficial issues. The therapist’s job is to note the shift in tone and help bring to awareness the
change. When a client presents a memory of events, the therapist is focusing on how the person
was affected and how they behaved in the events presented, but he or she is also focused on how
the person seems to be feeling as they are presenting the material. The therapist should not make
assumptions about what the client felt, how they are feeling, or why they behaved in a certain
way. The job of therapist is to note that such feelings and motivations exist and to ask questions
to raise the client’s awareness. This is why it has become cliché for a therapist to ask questions
like “How did you feel when that happened?”
Completely out of the awareness of the client (at least it should be) is the therapists’
reflections on another set of dynamics in the room – his or her own. As the client is sharing, the
therapist is also monitoring his or her own feelings about what is being shared. He or she is
monitoring the experience of the person and noting what they observe and hear. The therapist is
monitoring how his or her own story is connected to the client’s story. The goal for the therapist
is to be able to separate his or her own experiences from the experiences of the client. In order to
this effectively, the therapist should have done sufficient therapy for their own personal issues
and to receive adequate supervision and/or consultation on their work. The therapist becomes
less effective when he or she assumes what the client will or should feel instead of allowing the
client to discover what they actually feel.
While the therapist may provide some education on common dynamics of interaction or
personal development, their primary goal is to allow the client to discover how he or she plays
out these dynamics in their own life. Any intervention or action on the part of the therapist
should be in the service of this self-discovery or to help provide an environment that contrasts
the clients’ previous hurtful experiences. By observing the clients actions, monitoring feelings,
and dealing with the dynamics of the client’s relationship with the therapist, the therapist creates
the opportunity for growth and healing. The client’s experience of the resulting relationship
between therapist and client can then grow beyond the walls of the therapy office to the other
parts of the client’s life. The goal for the therapist is to create independence for the client and
not to foster dependence. Advice-giving and such activities, while helpful, only keep the client
dependent on the counselor. When the therapist helps the client discover his or her own ways of
dealing with things, then they are able to apply that understanding to novel situations. The
experience of this growth within a therapeutic relationship is generally experienced by client and
therapist as deeply meaningful. In pastoral psychotherapy, this growth and self-reflection will
often include reflections on faith, God, and spiritual development and the process of the therapy
itself can be experienced as quite spiritual or holy.
So, far from doing nothing or doing everything for a client, the therapist works with the
content of the client’s issues while monitoring the internal and relational process of therapy. The
therapist should maintain a calm exterior, but should always be actively reflecting internally. I
have found this process personally, professionally, and spiritually enriching. I know that the
quality of a good friendship can accomplish similar purposes, but for me, there is no substitute
for a meaningful therapeutic relationship.