Why Therapy Is Often Measured by the Wrong Things
I came across an image recently that contrasted two different ways of talking about therapy. On one side were phrases therapists are rather fond of using: emotional regulation, boundaries, reducing anxiety, processing grief and building self-confidence. On the other were things that feel altogether more familiar: having fewer arguments, starting to date again, being able to say no, attending social events and remembering the good times.
It made me smile.
Not because the image was wrong, quite the opposite, but because it reminded me of something I have noticed countless times over the years. Therapists and clients are often talking about exactly the same thing, only in entirely different languages.
Clients almost never walk into my counselling room and announce, “Kevin, I’d really like to develop healthier affect regulation and improve my capacity for emotional containment.”
If they did, I suspect I’d wonder whether they had accidentally wandered into a psychology conference instead.
Instead, people tell me they want to stop snapping at their children. They’d like to walk into work without feeling sick. They’d quite enjoy going to Sainsburys without rehearsing conversations with strangers in aisle four. They miss laughing. They want to stop apologising for existing. They’d like to enjoy a Sunday afternoon without an inexplicable sense of dread arriving just after lunch.
Those are the conversations I recognise.
They’re also, I think, where the real value of therapy quietly lives.
Perhaps this is one of the reasons I’ve always found psychodynamic therapy so compelling. It has never seemed particularly interested in polishing psychological terminology. Instead, it asks what lies beneath the everyday struggles we bring into the room. Why this anxiety? Why this relationship? Why this loneliness? Why now?
Oddly enough, the answers rarely remain confined to anxiety, relationships or loneliness for very long.
Therapy Doesn’t Usually Announce Itself
People often imagine that therapy changes lives through dramatic moments.
There is something rather appealing about this fantasy. We picture one profound session where everything suddenly clicks into place. The music swells. The therapist says something impossibly wise. The client leaves transformed and immediately begins living their best emotionally integrated life.
I hate to disappoint anyone hoping for that experience, but therapy is usually much less theatrical.
Its greatest achievements often arrive with remarkable subtlety.
A client might walk into a session looking slightly puzzled and say, “Something strange happened this week.”
As therapists, we tend to become rather interested when clients begin sentences like that.
“I said no to someone at work… and then I didn’t spend the rest of the day feeling guilty.”
Or…
“My mum criticised me, and I realised afterwards that I wasn’t actually upset.”
Or…
“My partner and I had an argument, but I didn’t automatically assume we were going to split up.”
There is often a pause after these moments.
Almost as though the person is waiting for me to explain why something so apparently ordinary feels so significant.
The truth is that these are the moments I enjoy most.
Not because they are dramatic, but because they tell me something fundamental has shifted beneath the surface. The person hasn’t simply learned a new technique or remembered to breathe differently. Their internal world has become organised in a different way.
Life outside begins reflecting life inside.
Psychodynamic therapists become quietly excited by that sort of thing.
We’re an odd bunch.
The Quiet Ways We Learn to Survive
One of the ideas I return to repeatedly with clients is that every behaviour makes sense once we understand the circumstances in which it first developed.
That people-pleasing tendency that now leaves you exhausted may once have been an ingenious way of keeping peace in a chaotic household.
The anxiety that seems irrational today may have been entirely rational for a child who never quite knew what mood awaited them after school.
Perfectionism may have begun life as a desperate attempt to earn love rather than an ambitious personality trait.
Even emotional distance, so often criticised, may once have been a remarkably intelligent adaptation to an environment where feelings were unwelcome.
We are extraordinarily inventive as children.
The difficulty is that our most successful childhood survival strategies often become rather inconvenient adult companions.
Therapy isn’t about criticising those adaptations. In many ways they deserve our gratitude. They helped us survive circumstances that perhaps should never have required such ingenuity in the first place.
The problem comes when we continue living as though those circumstances still exist.
Sometimes I find myself wondering whether adulthood is largely the gradual process of discovering which parts of ourselves are still responding to yesterday.
Why Life Begins to Feel Different
People often assume that therapy changes thoughts.
I think it changes relationships.
Not simply romantic relationships, although those often improve too, but our relationship with almost everything.
With ourselves.
With uncertainty.
With conflict.
With success.
With disappointment.
With the parts of ourselves we’ve spent years trying not to notice.
It is remarkable how many clients begin therapy believing their problem is anxiety, only to discover that anxiety has been acting as a kind of emotional security guard. It has been trying, rather clumsily perhaps, to prevent them from experiencing rejection, vulnerability, grief or disappointment.
Once that begins making sense, the anxiety often softens.
Not because we’ve fought it.
Because we’ve finally listened to it.
This is perhaps where psychodynamic therapy differs from approaches that focus solely on symptom reduction. Symptoms matter, of course they do. Nobody enjoys feeling anxious, depressed or overwhelmed.
But symptoms are also storytellers.
Silencing them without understanding what they have been trying to say can sometimes feel rather like disconnecting a smoke alarm without wondering why it was ringing.
The Ordinary Moments That Tell Me Therapy Is Working
If someone asked me what successful therapy looks like after all these years, I don’t think I’d mention insight first.
Or emotional regulation.
Or healthier attachment patterns.
Useful though all of those things undoubtedly are.
Instead, I’d probably tell them about the client who realised they had spent an entire weekend relaxing without feeling they should have been doing something more productive.
Or the woman who answered a phone call from her father and noticed she no longer felt like a frightened fourteen-year-old.
Or the man who cancelled plans because he was genuinely tired rather than inventing an elaborate excuse to avoid disappointing someone.
I think about the client who said, “I’ve started buying clothes because I like them.”
Such a simple sentence.
Such a profound psychological shift.
Because somewhere along the way that person had begun believing their own preferences mattered.
No therapist could have written that goal into a treatment plan.
Yet there it was.
Perhaps this is why I sometimes smile when people ask whether therapy is worth the investment.
I understand the question.
It’s an important one.
But I wonder whether we occasionally ask the wrong version of it.
Rather than asking whether therapy is worth paying for, perhaps we might ask what it costs to spend another ten years living exactly as we are now.
That tends to be a rather more uncomfortable calculation.
You Are Not Simply Learning Skills
There is a temptation in modern life to treat everything as a skill.
Learn resilience.
Practise mindfulness.
Improve communication.
Optimise wellbeing.
There is nothing inherently wrong with any of these ideas, but I sometimes wonder whether they unintentionally encourage us to believe that emotional life is something to master.
Psychodynamic therapy has always felt rather more humble than that.
It assumes that before we can change ourselves, we have to meet ourselves.
Properly.
Not the polished version we present to colleagues.
Not the capable version who insists they’re fine.
Not the endlessly accommodating version who never wants to inconvenience anyone.
The whole person.
The frightened child.
The hopeful teenager.
The exhausted adult.
The angry part.
The lonely part.
The joyful part that perhaps hasn’t had much opportunity to appear recently.
When all of those parts are finally welcomed into the same room, something quietly remarkable begins happening.
People stop fighting themselves quite so much.
And it turns out that living without an internal civil war is surprisingly liberating.
Therapy Gives You Your Life Back, One Ordinary Day at a Time
Perhaps that is the greatest misconception about therapy.
People imagine it changes lives through extraordinary breakthroughs.
I think it changes lives through ordinary mornings.
You wake up without that familiar knot in your stomach.
You notice you are looking forward to seeing a friend rather than finding reasons to cancel.
You laugh before remembering you had been trying to feel happier.
You disagree with someone and discover the relationship survives.
You remember good times without immediately feeling guilty for enjoying the memory.
None of these moments would ever make newspaper headlines.
Yet together they form something infinitely more valuable.
A life that gradually feels like your own again.
Not perfect.
Not free from sadness.
Not magically uncomplicated.
Simply lived with a greater sense of freedom, curiosity and compassion than before.
For me, that has always been the real value of therapy.
Not that it teaches us how to become someone new.
But that, little by little, it introduces us to the person we have been trying to find beneath years of coping.
Reaching Out for Support
If you’ve been wondering whether therapy might help, perhaps you don’t need to have all the answers before making contact. Most people arrive with questions rather than certainty. They know something doesn’t feel quite right, or that life has become harder than it needs to be, but they can’t always explain why. That is more than enough. Therapy isn’t about arriving with a neatly organised story; it’s about making sense of one together.
At Serenity of Mind Therapy, I can offer psychodynamic therapy both online and in-person at my therapy rooms in Haywards Heath, West Sussex, and Crowborough, East Sussex. We can become curious about the patterns that have shaped your life, your relationships and your sense of yourself. Often the changes that emerge are quieter than people expect, but they are also deeper and longer-lasting. One day you may simply notice that life feels less like something you’re enduring and more like something you’re living.
If any part of this blog has resonated with you, I’d be delighted to hear from you, get in touch and contact me here.