Starting psychotherapy for the first time usually stirs up a sea of questions: how do I begin? What exactly happens in the sessions? How long will it last?
To answer this, we must first understand that psychotherapy has certain particularities that distinguish it from other disciplines in the vast field of health.
Starting a therapeutic process is far from going to the doctor to ask for a prescription so that symptoms ease soon; it is different from visiting the physiotherapist to rehabilitate a sprain, or going to the dentist who will use specific techniques to extract a troublesome molar.
In traditional medicine, the role of the person consulting is usually more passive. In psychotherapy, the rules of the game change.
The active role: beyond the word “patient”
To be honest, many psychotherapists are a little uncomfortable with the word “patient”, which refers to “the one who suffers” or “the one who passively endures pain”.
It is a term inherited from medicine that does not fit well with our field, since doing psychotherapy is not about “receiving” a treatment passively; on the contrary, it is sustained by subjective work that requires the absolutely active position of the person who participates seeking a solution to their discomfort.
What does this work consist of? It is a labour based on speaking, associating, reflecting, analysing, recognising and asking about one's own inner world. As such, it implies first of all a choice, followed by effort and a sustained commitment; indispensable elements to cause and open the way to a possible therapeutic process.
Possible paths at the start: openness and resistance
Each person goes through this journey at their own pace. Some quickly get to work — or rather, put words into the space — and begin to reconstruct their story, to think about themselves and those around them, to question their choices and identify patterns. They open their way with a certain naturalness in this space they make their own.
Other people, by contrast, present greater initial resistance. It is common for them to ask the therapist to question them, to guide them or to tell them exactly what to do to be cured of what brings them to consultation. This demand is understandable and expected, even more so in those taking their first steps in therapy.
For this reason, the first therapeutic work to be done together will be to cause an opening; an interest in putting words into play; a desire to know about oneself, in order to gradually answer the questions: what is happening to me and why?
There will be some who, faced with resistance, perhaps think that therapy “is not for them”. However, those who bet on and believe in this subjective work manage, over time, to let their thoughts run and discover that what seemed meaningless is sustained by a singular logic. They begin to follow traces that, although they were always there, needed to be dusted off.
The therapist's role: respecting and causing
This journey will be difficult to make without the help of a therapist who respects each person's timing, without forcing or rushing. The professional's function will be to host, holding the firm belief that the person consulting has something to say.
As therapists, we listen attentively to every word and every phrase, every story, every memory, every symptom, and every conflict in the bond with others.
We listen and give it value, so that later it is the patient themselves who values their own word and story. So that they can fish out that there is a hidden knowledge, that they did not know they knew, and that it will be the starting point to invent a new position before life, different from the suffering position with which they arrived.
The work “between” sessions: the echo of words
Moreover, therapeutic work goes beyond what happens only inside the consulting room. The real work is not limited to the minutes of a session, but finds a place in the time “between” appointments.
In the best case, what unfolds in a session will remain resonating in the following days like an echo, and the challenge for the person consulting will be to know how to listen to it, give it room and continue elaborating and working the path in their daily life.
The big question: how long will it last?
Another crucial difference with medicine is the dimension of time. In the medical model, time is exact, defined and limited: “take one tablet a day for a week”, “the surgery will last two hours and recovery three days” or “the pain will ease two hours after taking this pill”.
In psychotherapy, time is more complex and uncertain, which does not mean it is eternal or that rapid therapeutic effects are not perceived. To address this concern, I find it interesting to transform the question: it is not so much “how long will the treatment last?”, but rather “how much of the path do I want to travel?”. Here too, the decision and the commitment to sustain the process fall on the side of the subject.
Our responsibility as psychotherapists
The therapist is not a spiritual guide or a counsellor who directs people's lives. On the contrary, therapy should bet on the patient themselves finding their answers.
Not without forgetting that our work as professionals is fundamental and is divided into three pillars:
- To cause the desire to begin travelling this journey and historical process together.
- To sustain the path through attentive listening, clinical pointing and the precise question that orients and mobilises speech.
- To agree on the exit ethically when the therapeutic work has been exhausted or when the patient decides to stop.