How Therapy Works

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Example: Unlocking Your Mind

Mary offered, “I just need to learn to say No.”  She felt that she was too often taken advantage of, and subsequently decided it was time to learn to be more assertive.  Easy, just learn to say No. 

Except there was an obvious contradiction.  Mary was intelligent, communicative and said No plenty of times in her life.  She sure didn’t need a doctor to tell her something she already knew; she even knew when she should say No, but she couldn’t, or worse, wouldn’t.  The real problem was that Mary was terrified of conflict. But Why?



Generally speaking we all want to feel great and fulfilled in life, not troubled by worries, insecurities, fears or depression. We know this, and even strive to be positive and moving forward. Yet curiously, a host of factors—both in our minds and from the outside world—create obstructions to our feeling great.


“I can’t,”
“Oh, I’m not like that,”
“But you don’t understand, that will make matters worse”
Denying the severity of problems, minimizing their impact, or even blaming others can make it seem like problems are immoveable.

It starts with, as you might imagine, talking about your problems. Talking with your psychologist is much different than simply talking with a friend, in ways that are described as you read on. “I don’t see how just talking about my problems is going to help?” is not an uncommon statement for a doctor to hear. In part it is true! Talking will ultimately not be enough. Embedded in this question is the idea that therapy or “talking cures” lack the ability to help people make changes.

The act of talking to a psychologist can work in different ways. Typically, talking with the doctor starts by creating an incisive clarity about one’s problems. For example, an issue with anxiety may seem to be about personal or professional problems, like a bad relationship or being unappreciated at work. However, the real problem may be that you are extremely self-critical. Privately and even without conscious awareness you blame yourself, question your worth, or fear you don’t deserve better and thus wont make a necessary move or change. You may even make your personal standards unreachable—this apparent tool for motivation and improvement (I could’ve done better) is actually a form of self-punishment to make you constantly feel worried, inadequate, selfish or even lazy!

An issue with over-eating may actually be about the inability to manage feelings well—thus, food (like alcohol or drugs) is being used to manage feelings but never actually solves the problem. So what is the problem?

Talking helps to identify the Real problem.  And despite what many (friends, family, loved ones) think, the real problem is at times, actually difficulty to identify without unbiased professional help.


When a problem exists and causes emotional discomfort, it is because our minds have made a poor compromise between what is wanted and how we feel about that want, including judgments, conflicts, and values.  Here are some common examples of psychological defenses that keep people stuck:

“I know there is nothing to be afraid of, but I get panic attacks in the car.” (metaphor for, I’m terrified of facing uncontrollable aspects of my life). “If I put myself first that would be selfish, and I am not like that.” (metaphor for, I am better than other people, this makes me more moral and special).  “I like being alone, it has nothing to do with that.” (metaphor for, I fear I am not wanted by a partner, or I am an unattractive person).

You will inevitably need to make decisions to do things differently; by understanding and identifying the problem through talking with your doctor, you will learn about how and why you sabotage your own efforts to be happy—even when you can legitimately blame others, you may still be burdened with the responsibility of making choices.

We work so hard to avoid the truth, that avoidance typically becomes more painful than the real fear, i.e., part of me is selfish, I do feel angry and judge others, I feel insecure.


Next, the Real problem or problems must be dealt with—effectively. When issues and problems are not truly resolved, they re-emerge and take shape again.

A psychologist through training, education and supervised experience can help you 1) identify the real problem, 2) make choices, and 3) make lasting changes to resolve the problem for good.

The following is an example of the complexity, but ultimate liberation and success that can be experienced through therapy.

Here is an example:  Micah came to see me for problems with sleep, relationship difficulties, and occasional panic attacks. After 4 visits Micah questioned my intelligence as I was unable to solve his problems, which would be unacceptable in medicine. Micah was in medical school earning almost perfect marks but rarely studied. Talking about his studies, Micah was quite convinced that he was one of the most intelligent in his classes—in fact he talked about this often. So what was it that was causing Micah’s panic attacks and problems—he didn’t know. I proposed that Micah didn’t study because when he occasionally earned a lower grade, he had an obvious excuse; he didn’t study. Maybe he wasn’t so smart. It turns out that Micah was terrified that he was not intelligent. When he faced this fear he ascertained that he was indeed smart, but objectively not as bright as others. In truth, Micah accepted that he was not as intelligent as some of his peers and certainly could not match his genius father (famous attorney). It was very hurtful. But his panic attacks vanished and he slept through the night. We continued to work on how he hid problems from himself. Hiding them made them worse. Facing problems sometimes hurt, but he made lasting improvements that changed his life forever.      


Your therapist should tell you how long it could take; sometimes it is as short as 10 sessions, other times it is longer to achieve the change you want. Who wants to spend their life in therapy when they could be living instead. And therapy can be expensive. But remember, you have been alive growing, cultivating, and gathering experiences for years and years. Your doctor glimpses 45-50 minutes of the tip of the iceberg in which to understand, solve, and fix your problems and send you on your way—if it were really that easy you would have done it yourself. Be respectful of yourself and the time it can take to make changes.

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