(Especially when it looks like he or she is just sitting there listening to you)

A counsellor or psychotherapist is someone who makes the attempt to be present with you, and to listen to you. Perhaps this doesn’t sound like much?  In some ways it is a bit like asking what a mother or an artist is doing, when they appear to be doing nothing in particular, maybe just washing some dishes or gazing into space.  The lines of this timeless poem by WB Yeats come to mind:  

There on the scaffolding reclines Michael Angelo.

With no more sound than the mice make

His hand moves to and fro.

Like a long-legged fly upon the stream

His mind moves upon silence.

(WB Yeats, Last Poems. 1939)

When a psychotherapist is sitting with you, listening to you, talking with you, she is doing her utmost to stay present and attentive.  She pays attention to the deeper currents that flow beneath, through and beyond the words you share together.    

So what does a therapist do?

A psychotherapist holds a space for you that has special qualities.  The idea of holding space is like she puts a frame around the two of you in the room together, and actively cares for this space, that includes physical, emotional and mental elements.  This is a unique conversation very different to any other you may have experienced.   Unlike in normal conversation, the psychotherapist herself is not trying to fill up the space,  and so moments of silence may occur.  She is trying to read what is occurring between the two of you as a unique relational field.  This field is full of information that she needs to perceive, understand and make good use of, in order to assist you, the client, to achieve your stated goals. So most of all, a psychotherapist attempts to be present, to pay attention, and to observe with a neutral but benevolent attitude.   Thus the virtues of a psychotherapist include patience, the ability to hold steady attention, fluid thinking, skill in timing, and the ability to bring her observations into ordinary language that can inform, encourage or challenge you – at the right time.    She is both scientist – carefully observing the data  – and artist – putting her hard-won observations together in new ways so you learn new things about yourself you would never have thought of.

Ten Things a Psychotherapist will actually be doing when she is working with you

We offer a combination of nurturing and deep support combined with challenge.  The balance of these qualities will vary from client to client and from day to day.

  1. We are present and attentive.  Presence and attention are qualities we all desire to experience from others, from our earliest days.  Humans seek recognition, affirmation, validation and respect from others, as this tells us that we are ok and that we belong and are accepted and loved.  Your own childhood experience, such as whether you received plenty of benevolent attention, or whether it was in short supply, or whether the attention you received was  domineering or intrusive, will affect how you experience this attention from your psychotherapist – for example you might initially feel self conscious.
  2. We listen and observe carefully, and we prefer not to come to conclusions too quickly.   We prefer to take our time before coming to conclusions or giving you advice,  if this is possible.  We have an unusual tolerance for not knowing, and for living in uncertainty.  This is partly due to the fact that people undergo personal and spiritual growth and make effective changes when they feel furthest from equilibrium. When you need to make important changes, it is helpful that your equilibrium has been challenged, and so we don’t want to move back to homeostasis too soon. The ability to tolerate some uncertainty has also been correlated with maturity and peace of mind.  You will find that most psychotherapists are not in a hurry to give you a diagnosis, but nonetheless they will pay close attention to potential diagnostic factors.
  3. We take careful note of things you say, and think about them, sometimes for a long time.  We are reflective learners.  We will also be thinking about how to apply the best concepts and theories in your situation – but before we do this, we will translate it into plain English.  So if we are a bit quiet, this just means we are working internally, not that we are waiting for you to say something.
  4. We care about you. We allow you to genuinely matter to us; this is never just a job, although we will always hold the professional boundaries. We place emphasis on the relationship we develop with you, as we allow our experience of relating with you to teach us about you and how to respond to you. We accept your individuality and do not try to change this. We are interested, too, in all we can learn from you.
  5. We hold the boundaries of the therapeutic frame. We are firm and clear when holding the agreed agenda for our work, and with maintaining professional boundaries. We maintain strict confidentiality so that you have a safe place to discuss and explore. This is why we tend not to engage in social chat, for example when you first arrive.
  6. We support you to make realistic and effective goals and to keep them, and we keep you on track.  We need your help however, as we can’t help you work towards your goals if you don’t focus on them yourself!  We try to tie the themes of our work together, so that each time you leave with a clear focus.
  7. We ask you about how you feel more often than about what you think. This I because we understand feelings to be closer to your authentic self than thoughts.  We are empathic and accepting of your feelings, but it’s possible we may challenge the way you think.  In our model of change, we have to work at the level of feeling to accomplish real and lasting personal growth.
  8. We give you feedback.   We help you see yourself more clearly by providing you with a mirror.  We identify your personal strengths and we name them. We are observant of the way you interact with others, and what you communicate through your body, speech, mind and behaviour. We work very hard to understand your feelings, and then work to help you understand and make sense of them too. If you do not understand the feelings of others, we will point this out. We fiercely support and believe in you and validate your self worth. We help you get through life issues much more quickly than you could ever do alone.
  9. We are however honest with you if we feel you are  being self-defeating, limiting or harming yourself or others, and we can often detect if you are not giving us the whole picture. A therapist will not agree with you all of the time, and will challenge you if we feel it is necessary. We may challenge you if you are acting in a way that goes against your values, or if you make choices that have a negative impact. However, we try to do this skilfully and not in a way that could make you feel criticised.
  10. We manage and monitor our own responses to you. We try to be conscious of our own assumptions, judgements and preferences and to accept and learn from people who are different to ourselves.  There are also subtle clues that we notice in our own responses to you, in how we feel differently in the room with you than with someone else, and in how being in your presence subtly affects us.  It takes us time to mine this valuable information accurately.
  11. We work through the relationship. We see you through the lens of your relationship to yourself, to others, your family, social and other contexts, and also in how you relate to us. We open up our awareness to take in and process many different layers of information from you. This includes allowing you to use us as a mirror of aspects of your past relationships  which in fact say more about you than they do about us.

Some things that therapists will not do

Engage in social conversation with you

Feel embarrassed, afraid or worried if you feel emotional, tearful, scared, resistant, angry, furious, heartbroken, despairing,  confused, or even joyful

Make judgements about you or your situation

Take it personally when you are upset with us, or when you withdraw or get defensive or stuck.  We don’t retaliate, get defensive or critical, or blame you if you get into a difficult situation

A therapist will not think that your concerns are silly, unimportant or less worthy

We do not experience working with you as a burden, boring, or judge you for who you are.