On Therapy
Therapy involves a professional relationship that helps people to understand and work through problems in their lives. People seek support for a wide range of reasons, and there are many perspectives on how challenges develop and how meaningful change can occur. There are many therapeutic approaches therapists, which reflect different theories of how suffering impacts us and how we can grow or heal. My view is that effective therapies, and effective therapists, work by helping people to learn about themselves. This kind of learning requires a safe connection - also called a secure attachment - with the therapist, in which the person feels understood. Below, I have outlined what I see as a few key areas of therapy that I think about.
Trauma
Many people experience incredible difficulty in their lives due to traumatic experiences. Some aspects of trauma are captured by the diagnosis, Posttraumatic Stress Disorder, or PTSD. Following an overwhelming or life-threatening event, people can have flashbacks/intrusive memories, dissociation, nightmares, hypervigilance for threats, and avoidance of reminders of the event. They may have "hyperarousal," or a persistent sense of being on edge. A crucial aspect of trauma is negative (or non-existent) responses from others following an overwhelming event. This relates to complex or developmental trauma, which involves repeated experiences of interpersonal neglect/abuse, typically but not always in childhood.
We can think about a traumatic experience as being afraid and alone, that is, bearing the burden of overwhelming and frightening feelings without anyone holding us in mind. Trauma treatment involves establishing safety and stabilisation, working through the trauma in an intentional and coherent way, and mourning or reconnecting to parts of one's life one has lost. In my view, it is important to learn how to think and feel through traumatic experiences with a safe, skilful, and compassionate other, to learn how to do this for ourselves.
Attachment
Humans are social. Our survival, sense of self, richness or problems in relationships, and how we relate to and express our culture, values, and meaning in life, involves other people - one way or another. Attachment is our drive to connect to others to regulate ourselves. It is present from infancy on. Our temperaments, environments, caregivers, and social world, all play a part in how attachment develops for us. Some of us establish connection more easily than others. Naturally, how we attach affects the quality of our sense of self and our relationships, and so is an important area to look at in therapy. As a therapist, I am interested in what skills and strengths do people have in connecting with others, working out conflict, in knowing others and in letting themselves be known. And, in what ways can attachment go wrong for someone? One reason attachment is important to think about is that it is through attuned and responsive care (not perfect, but good enough) from caregivers that we are able to develop a sense of self, explore the world around us, and connect with others confidently. When there is a mismatch between caregivers and children, or when caregivers are absent or abusive, this can make it incredibly painful or confusing to be aware of ourselves or to trust others. A positive therapeutic relationship is one way people can begin to learn about how they relate to themselves and others, and to relate differently in more fulfilling, expansive ways.
Mindfulness
Mindfulness has become a very popular practice to help with a range of problems and aspirations. Mindfulness has been shown to be effective for helping people with anxiety, depression, addiction, chronic pain, fatigue, stress, insomnia, and emotion dysregulation. Dr. Jon Kabat-Zinn defines mindfulness as the awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally. It is easy for our minds to become over-involved and or under-involved in much of our experience. On one side, we can ruminate or spiral with worries about the past or the future, about ourselves or others. On the other side, we may have very little idea of what's going on within or around us, as if we're on autopilot. Being mindful, however, can let us fully and deeply experience our bodies and thoughts and feelings, while being flexible in our attention and not getting stuck. In therapy, I believe mindfulness plays a key role in helping people to pay caring attention, "feel clearly," and enrich their self-awareness. The psychologist Jon G. Allen has pointed out that mindfulness has its roots in Buddhism: it was cultivated originally to liberate not just individuals within their own lives but society as a whole. With that in mind, mindfulness can help us not only come to greater awareness of ourselves, but also can help us make valuable choices and stronger connections to others, and so nourish our communities overall.
Mentalising
Mentalising is the ability to make sense of ourselves and others according to mental states - like thoughts, emotions, goals, desires, memories, dreams, and so forth. We use mentalising all the time to try to understand, for example, why we feel the way we do, or why others have acted the way they have. Mentalising is often described as "holding the mind in mind." It is something we can improve at, and it is fundamental to how we navigate our lives, both in view of how we see and make sense of ourselves, and how we make sense of and interact with others. We can all lose mentalising when we're distressed or upset: we may quickly jump to highly critical conclusions about others if we're furious with them; we may be sure others are judging us if we feel very anxious; we may feel an immovable self-loathing in some varieties of depression. Mentalising can be implicit or explicit, meaning we can interpret ourselves and others more automatically (implicit) or more deliberately (explicit). In general, therapy is an exercise in explicit mentalising, as the therapist and patient/client work together to clarify, elaborate, and explore the experience of the patient/client. In some ways, mentalising is a skill involved in any kind of therapy. Mentalisation Based Therapy (MBT) is a therapy that explicitly aims to stimulate and enhance mentalising. Anthony Bateman and Peter Fonagy initially created (MBT) to help people with borderline personality disorder, though it has been shown to help people with a variety of problems and aims in therapy.
Choosing a Therapist or Therapy
I hope the ideas above have given you some sense of what I pay attention to and think is important in therapy, and how I tend to approach therapy. I like using MBT because it incorporates attachment, mindfulness, and of course mentalising, and gives a sensible and helpful account of how trauma and other emotional/psychological problems emerge and how they can be treated. This said, both therapists and patients/clients can get stuck about what kinds of therapy work best for what kinds of problems. We do have many different therapies that have been shown to be effective for many kinds of problems, but most researched therapies are about as effective as one another. Researchers suggest instead that the individual personality factors or characteristics in both the therapist and the patient/client, and the relationship factors - the fit between the therapist and patient/client - affect the outcomes of therapy more than the specific therapy used.