• In our ever-more 'quick-fix' culture, psychotherapist Sylwia Kowalska-Lewis explores the benefits, and realities, of more in-depth therapy

  • Do we have realistic expectations of what it takes to overcome deep-rooted difficulties?

  • If you are ready to take the plunge, we have therapists available here

One of my patients reported feeling very frustrated after seeing an advert of a well-known online therapy provider promising the viewer a virtually instant return to health at no personal cost. She burst out: "this is not how therapy actually feels!" She was not wrong, or at least not entirely. 

Distorted image of therapy

The discourse around therapy tends to focus on its benefits and the practicalities such as what happens in the first session. Rarely do we read about what therapy feels like when we have decided to take the plunge.

I don’t think this is an accidental omission. Many of the readily available articles pitch therapy as a 'problem-solving workshop', where the emphasis is on thinking and behaviour, not on feeling. 

Some therapies are like this...

Such problem-solving approaches sit at the core of short-term, solution-focused therapies like cognitive behavioural therapy (CBT) or dialectical behavioural therapy (DBT). They can be as rapid as six sessions, but even those therapies don’t guarantee an easy experience. And whilst they are useful for issues such as obsessive-compulsive behaviour or post-traumatic stress, they are not a panacea for all psychological distress. 

Unfortunately, in a financially depleted national health service, that’s the prevailing model, often to the detriment of long-term or more relevant therapies for certain problems.

Other therapies are like that...

My patient is in a psychodynamic psychotherapy orientated towards a Jungian idea of self-actualisation. Therapies that work with the unconscious (psychodynamic, psychoanalytic and Jungian) postulate that change occurs by bringing to consciousness unresolved conflicts through intense emotional experiences and linking them with current symptoms or interpersonal problems. 

Another way to think about the aim of such work is to bring a balance and instigate collaboration between conscious and unconscious aspects of the psyche for a more harmonious life.

I have a worry

Unfortunately, depth therapies are systematically undermined and dismissed as irrelevant, non-evidence based, too long and too expensive. In fact, there is a wealth of evidence supporting their effectiveness (F. Leichsenring and S. Rabung; M. Nordmo, N. M. Sonderland, O. E. Havik to name just a couple of the studies). Sure, to address a problem at its roots, particularly when it’s chronic, which is often the case with one of the most common complaints such as depression, takes time. That said, there are hidden costs of going through the revolving door of symptom management.

In addition, what is omitted from the discourse is that in the UK there isn’t a culture of paying for therapy as there is, for example, in Argentina where accessing therapy is deemed to be a priority for everyone, as important as paying for weekly groceries. This means less awareness and knowledge about the approaches that have the potential to bring healing to the whole personality. This is because depth therapy is hardly ever offered on the NHS and when it is, there is always a long waiting list. Those less affected must jump through the hoops of solution-focused approaches before they are offered another alternative, whether they like it or not.

What about those intense emotional experiences?

Solution-focused therapy is not devoid of feeling and feeling is not all that happens in depth therapy. I think we owe it to our patients who enter into therapy, particularly the modalities that work with the unconscious, to be prepared for what’s coming, just like we may like to be prepared for any other challenging experience, whether a marathon or the news of a terminal illness of a loved one. The upshot to this is that with proper preparation we stand a chance of finishing a marathon or saying ‘goodbye’ to someone we might otherwise lose without the experience of closure.

When problems interfere with our capacity to function or to enjoy life, therapy can help. However, a lot depends on our attitude and expectations. If we just want to feel better and hope for some magical cure, it won’t work. Confrontation with one’s shadow, limitations, rejections, disappointments is hard and so we must be willing to endure pain. Sometimes therapy sessions can bring up feelings that are difficult to cope with, and we might feel nervous about going back, or even want to quit. Feelings such as resentment, envy or shame are particularly difficult to explore.

Psychotherapy takes courage and a real desire to change. Our thoughts and feelings about ourselves, our beliefs and views about the world and our place in it make up who we are. We have to be ready to leave it behind in favour of more realistic perceptions. This is why it hurts, we can’t change our lives without changing ourselves. Someone once said that when we think about personal change, we think it is like getting a new car. We can trade in the old one with all its dents and scratches and drive out of the garage anew. Truth is, we can’t remain exactly the person we currently are and change at the same time.

The success of therapy depends on many reasons. We tend to get out of it what we put in. No matter how competent and compassionate the therapist is, they can’t do the work for you. But if you dare to try, as a therapist, I know this can take time and endurance. But as a patient, I also know there is no better investment that you can make in yourself. 

Sylwia Kowalska-Lewis is a verified Welldoing psychotherapist in South East London and online

Further reading

In therapy: why you might feel worse before you feel better

Watch our videos about different types of therapy

Which type of therapy is right for me?

Deciding on therapy: A leap of faith?