Why go to therapy?

Therapy, or more accurately, psychotherapy, is a form of psychological intervention, often conducted by a psychologist or trained counsellor that typically explores our emotions, behaviours, and thoughts. But why go and is it right for you?

There are clearly a myriad of reasons why people may choose to engage in psychotherapy but I’m going to do that terrible thing and overly simplify it into two broad categories. I find people come because there is something wrong or because there is something missing.


For some, the purpose of psychotherapy is to right a wrong; to create function out of dysfunction; to dial down our mental or physical suffering and increase vitality. The“wrongness” can be as varied as “I’ve never felt this low and empty for so long”, or “I just don’t want sex anymore”, “I want to connect more but it feels too overwhelming”, “we’re going to split if I don’t change soon”, and “I hate myself”. Many of these people may be experiencing a diagnosable mental health condition such as Major DepressiveDisorder, Social Anxiety, Borderline Personality Disorder, or Post-TraumaticStress Disorder. However, many others may also be experiencing distress that does not meet an arbitrary diagnosis yet still need treatment.

For many who have the experience that something is wrong, there is the hope or desire that there is a“thing” that can treat them. They will often come to therapy asking for a toolor technique to stop their version of pain and allow them to get over it or move on with their life. In asking for the tool or technique to tame anger, subdue anxiety, or quell their depression is often the whisper of a wish for hope that this “wrongness” is fixable, and the fixing can be achieved with what mental energy they have left.

While there are many reasons we should feel sceptical that there is a simple technique or two to control our suffering, there are several ways that meaningful psychotherapy can successfully treat many versions of “wrongness”. Ideally, we should look for clinicians trained in “evidence-based therapies” that have been created and tested for these problems such as Cognitive Behavioural Therapy (CBT),Acceptance and Commitment Therapy (ACT), Schema Therapy, Psychodynamic Therapy, and Interpersonal Therapy (IPT) to name a few. Many of these therapies have some over-lapping elements and can each be useful modalities to help treat many conditions.  


For others, the purpose of psychotherapy is to explore the depth and breadth of their experience and life to understand their specific constellation of defences that may limit their capacity to flourish. For these people, nothing may be quite wrong, yet something may not quite be right either. Perhaps in perusing their life the dream they were sold has not come to fruition and they want to figure out why or how. Is it that there is, in fact, something wrong in which they are blind to? Is it that things are just…fine? Which is to say, mediocre or kind of“meh”? The checklist of the good life is supposedly full including work, family, friends, yet this does not fulfil in the way they thought it would.

At times this“missingness” can be a puzzle that feels easier left unthought and unfocused on. Yet, this is perhaps the beginning to understanding the problem. Our un-thoughts and un-focus have a way to infiltrate into our experience, welcomed or not. Perhaps thoughts such as, “what really is a good life”, or, “amI flourishing”, “how am I currently creating and perpetuating my own problems”, “what way has life not prepared me to suffer”, and “is this it?” are places to start when contemplating our “missingness”.

I believe that this experience requires specific type of therapies; ideally those that focus on the process of living in the world or has some focus on values. Something such as Psychodynamic Therapy, Acceptance and Commitment Therapy, or SchemaTherapy (although I see schema therapy most often applied to clinical issues).Typically, a part of dynamic therapies may explore characterological structure/organisation (i.e., the typical way we exist and see the world) which include the typical ways we defend against “threat” (I’m using “threat” very broadly here and don’t mean literal physical threat), including defending against certain emotions. Often dynamic therapies will use the relationship made with the therapist as an in-vivo, live example of how one relates to others. ACT has a lot of focus on a value-driven life and value-exploration is an important part of it. It also focuses on a number of other processes that help live “a good life” and not merely reduce a symptom. ACT has been extensively applied to non-clinical/mental-health contexts such as work performance, elite sports performance, and other coaching environments.

As promised, this describes two broad ways of defining the experience that some people have before entering psychotherapy. Even if it doesn’t quite match your own experience, if there is a sense that you want a space to explore and understand yourself more fully, perhaps reach out to a trained clinician and discuss with them the way in which they may be able to help you.

Dr Daniel Brown

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