From the outside, therapy is a room, two chairs, and conversations. What's not mystical about that? This essay explores my understanding of what actually happens in therapy and how healing unfolds.

I have been practising as a psychotherapist for a little more than 6 years, and I still feel challenged to adequately answer this simple but heavy question – ‘What is Therapy or What happens in Therapy?’

In this article I will try to make the glass less foggy, and offer a clearer understanding from my own perspective and journey as a therapist and a client.

(Please note - I will be writing from the context of individual adult therapy in this essay; therapy for children, couples, families, or in group setup differ.)

So, What is Therapy?

For most individuals, therapy feels like a strange, abstract, unfamiliar space.

Which it is.

But therapy, in the simplest terms, is a space where you can unravel yourself, your inhibitions, and your narrative of the universe that you live in.

In more maybe complex terms, it is a space where you can cognitively, emotionally, and somatically pause - to reflect, understand, and experience elements in your life that feel most important to you, however scary they may appear. And it is in this process where you ideally connect to your inner most voice to meet your needs, wants, dreams and wishes in life by addressing the barriers that are on your path.

One might arrive at the doorstep of this room, cause life feels too much or they may arrive because they notice some patterns in themselves that they want to work on. Whether it is to ease your pain, feel less lonely, or finds ways to grow, therapy is a space that can be used by all at any point in their life.

What happens in Therapy?

For simplification - think of therapy as being layered like a cake, it is not only a physical space of a safe room (The first layer), it is also the safe and secure relational space between you and the therapist (The second Layer), and the verbal & non-verbal dialogue or process within which healing can occur (The third layer). A combination of all these layers make up what happens in therapy.

THE FIRST LAYER - A Physical Space.

Think of this layer not only as a physical room which essentially could feel calm, and support you by offering you tissues, water, or even a warm cup of tea, but it is also the structural ethical boundaries that therapy functions within.

This includes the therapists’ clear communication of their availability, session duration, extra time rules, booking process, payment process, cancellation process, late arrival process, confidentiality terms, termination terms, norms of how & when you can reach them between sessions. These aren’t random rules, the purpose of each of these norms is to create a sense of reliability, routine, and predictability for the client and the therapist, so the focus of the sessions can be on the deeper work.

For instance, if a client arrives late every session, then it is important to explore with gentle curiosity what could be the reason behind this, maybe it is an expression of avoidance or maybe it is an expression of their undiagnosed Attention Deficit Disorder, or something else entirely but it is crucial to explore this for the process of therapy to be fruitful. Another instance could be, addressing the therapists’ late coming or sudden cancellations, and together processing the reasoning behind that.

This ethical contractual structure, offers the protected space for a client to receive consistent treatment, and for the therapist it offers a framework to stay in touch with what is happening in therapy with a client.

This is an important layer to make therapy feel stable and effective for a client.

THE SECOND LAYER - The Facilitative Other.

Therapy is not an individualistic process where you meet a professional who just listens to you where you can just vent about your life and walk away, but it is (ideally) where you meet an Other who works toward providing you with their human company by learning to attune to you, understand you, extend their organic compassion, care, & empathy toward you.

A space where the Other learns and puts the efforts to create the environment, relationship, company, conditions that help you feel seen and heard and then also supports you to hear your innermost self clearly & safely.

Safety here doesn’t only mean the absence of physical harm but in this context relational safety means sharing your internal thoughts & emotions without the cost of feeling unheard, overlooked, dismissed, reduced, rejected, judged, or punished by another for what you express.

Authentic relational safety is one where I can be Me and you can be You with no fears of hurt, rejection or abandonment, but with the trust that repair can occur even if hurt, rejection or a sense of abandonment get triggered.

You as a client must ideally feel that they are received with presence, curiosity & acceptance.

THE THIRD LAYER - A process where healing can occur.

When we encounter an Other who meets us with this kind of presence and safety, something shifts internally. We find ourselves more willing and sometimes more able to explore and speak about the parts of our experiences that we have kept contained.

We finally naturally arrive at the shore of wanting to share, explore, experience all that we have kept contained or carried alone for far too long.

The efforts of the client of - being open to share their feedback & experience and that of the therapist - of learning the client’s language of them feeling and receiving a therapists’ comfort and care play a crucial role for processing and healing work to unfold in therapy.

Because this unfolding is not a moment we arrive at, it is an ever-evolving continuous process and it does not dramatically happen or appear in ones life. It is something that slowly takes shape over time when the all these layers are repeatedly worked on by the therapist and the client - this is the Third Layer - Process and Processing.

This Third Layer in simplest terms has two hero ingredients -

• One is the Process of always striving towards establishing safety between the client and therapist throughout the duration of the existence of the therapeutic contract.
• The second ingredient is the “processing part” - the pockets where dialogue around pain & healing occurs in a more traditional sense. (Although learning to establish connection and safety through exploration and repair between a client and therapist also have an healing effect).

This second ingredient is about continuous reflective experiencing - So what does this actually look like in therapy? It is when a therapist asks -

‘And how does that make you feel?’ (too cliché I know.)

‘What happened inside you when this event occurred?’

‘Keeping everything aside, what did you really need in that moment from the other person?’

‘As you are talking about that experience do you sense a physical/emotional/cognitive reaction to it right now?’

The idea is can we get to the core emotional experience in relation to what you’ve just shared with them right now.

Let’s say I share a memory from my childhood, some areas that a therapist might explore with me could be - do I experience something as a reaction to it right now? what kind of imprint does it have on me? what did it make me feel back then? what it tell me about myself, others, or how the world functions? did it lead to the development of any beliefs about who I am or should be? what can I expect or not expect from others? - to name a few examples.

These are all actually really uncomfortable & challenging questions to answer.

But it is within this uncomfortable yet safe process that something deeper begins to emerge.

Through this gentle curiosity that we extend to ourselves, we find our inner wisdom, our wants, our needs – things that are buried and hidden under layers and layers of the million things that make us who we are and who we think we must be/become.

In much simpler terms, therapy is what occurs in all these layers and ingredients but also when all these layers and ingredients come together to provide you with the pleasure of eating this cake by helping us bravely witness not only our suffering and pain but to find our voice, and ourselves in process.

There is something so quietly powerful about expressing our most authentic, uninhibited perceptions however scary or ugly they might feel with an attentive, empathic, warm, receptive, and attuned Other, and to most importantly then learn ways to act and be different from what you now know about yourself and your life.

It is through this expression that we reach the core of our experience and in experiencing that core we access our inner wisdom or true self. This is healing, and therapy becomes the vehicle through which we try to reach these moments again and again till you feel we’ve reached a safe landing, a peak or skyline where you would like to stay for a bit.

Therapy is thus for me is a process, a relationship and a space, and what happens in therapy occurs within these dimensions.