By what mechanism is talk therapy supposed to be effective?
May 17, 2014 7:32 PM Subscribe
I have a fair bit of experience with getting talk therapy of the open-ended type, sometimes for long periods. It doesn't seem to ever have resulted in any change in my attitudes or behavior patterns. What's more, I don't understand how it theoretically could
result in this, either generally or with a specific issue I've been dealing with (procrastination/self-discipline). Explain/exemplify?
posted by zeri to Grab Bag (24 answers total) 21 users marked this as a favorite
Over the years I've seen a number of therapists for various reasons -- six altogether, if I'm counting right, for periods ranging from a few weeks to over a year. It's always been talk therapy of the unstructured type (rather than practical/goal-oriented modalities like CBT). My therapists have generally been highly intelligent, well-respected professionals. I keep going because I like having someone to talk to regularly in this way, but I've never felt that I've changed in any way as a result of therapy, and I'm not sure by what mechanism this is supposed to happen.
The idea seems to be largely to acquire insight into the underlying causes of one's difficulties. But I'm a very introspective, analytical person, and I'm always thinking about these questions as it is, so nothing a therapist has said has ever been major news to me; and even if it was, so what? How is insight supposed to translate into changed behavior?
For example, take one of the main things I'm struggling with right now, which is a difficulty with persevering on self-directed projects (both practical things like academic writing and hobbies like music). I could expatiate at length about the psychological and historical reasons for this (e.g. fear of criticism rooted in childhood relationships, etc.); it's something I've thought about a lot. When I talk about it with my current therapist (and it's been basically the same with past therapists), I feel like she more or less says back to me the same things I've been saying to her, just in different vocabulary. Sure, there have been one or two sessions that I've come out thinking "Oh yeah, she's right: I hadn't thought of the connection between current behavior X and childhood caregiver interaction Y", or "Hmm, word X is a slightly better way to think about this issue than word Y which I've been using", or things like that. But those are just more "insights" to add to my analytical dossier, and meanwhile I keep acting in the same ineffective ways I've always acted.
I know a lot of people who swear by talk therapy, and I don't think they're all self-deluding. So I'm thinking that maybe this type of therapy is just not suited for my particular issues, or else not suited to my particular personality (or else that I just haven't found the right therapist, but this strikes me as less likely given that I've seen half a dozen who have all been pretty different form each other in personality and general approach). But I don't have a good sense of how this process is theoretically supposed to work. If you understand this, please explain? And especially, if you've had experience with talk therapy that actually led to a change in rooted behavior patterns, please describe how this happened?
(Just to anticipate some possible replies: I've brought up this question with my current therapist and some previous ones, but I've never gotten a satisfactory response. I know that there are other modalities like CBT which might be more effective for things like procrastination, but I'm not asking for alternative suggestions, and I don't want to focus on that particular issue -- it's just an example.)