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Behind the Scenes of What Happens in Therapy and How it Works

Updated: Feb 15


Did you know that 1 in every 5 adults in America suffers from mental illness? The stats in India are not as precise but it is estimated that around 20 percent of Indians are suffering from mental illnesses. 20 percent of the Indian population translates to several millions of people. And that’s a whole lot isn’t it?


What these stats imply is that at some point you are going to have to interact with people who aren’t doing too well. It can be a friend, a neighbour, a teacher, a co-worker, a boss, a spouse, a child, a sibling, a relative, a friendly face, or...you. It doesn’t matter who they are, but chances are that they aren’t feeling okay and if that goes on for long enough, they’ll believe that there is no way out of the misery and will either accept living that way as the new norm or take drastic measures to end their pain.


If you broke your arm you’d go to the doctor. If your tooth hurt, you’d grumble and eventually go to a dentist. When you are in physical pain, you know to get help. But what happens when you emotionally hurt? Just because the pain isn’t visible or the problem might not show up on scans, we dismiss the issue as something that can’t really be helped by a professional. But it is showing up in places you aren’t looking – your mood, your appetite, your sleep, your ability to do day-to-day tasks, your quality of life.


When you hurt emotionally, you go to a mental health professional.


What Happens in Therapy?


Therapy is grounded in conversations between the mental health professional and the client. The first session is to gauge what problem the client is struggling with currently. A qualified mental health professional is trained to make the client feel comfortable with opening up without the fear of being judged. However, some people might still feel uncomfortable in the beginning as they are confiding in a complete stranger. So, it’s perfectly normal to feel a little apprehensive about it. What’s important to know is that

confidentiality is a strict rule of therapy and your therapist is legally bound to abide by it unless you are a threat to yourself or others. The first session will focus on what problems the client is facing and how much these problems are affecting their life.


The initial sessions are structured in a way that the therapist gets to know more about the client’s life with regard to the problems they are facing, tracing back to when the client first recalls the problem began and how it has grown since. Getting more information about the client’s life helps the therapist learn how the clients deal with stress, what is their coping style, what are their thinking patterns, what they are insecure about, what are the resources that are available to them, to what extent they are utilizing these resources, etc.

Apart from this, the client and the therapist collaborate to set goals for therapy which directs the issues that are discussed in the sessions. Setting goals informs the client and the therapist where they are currently and where they need to arrive at for therapy to wind up.

During the sessions, the therapist will guide the conversation by asking questions that will make the client reflect on how they feel and what they think about things/people/incidents. Verbalizing their feelings and thoughts is usually an enlightening process for the clients because they learn more about themselves and when the therapist points out behaviour and thought patterns that are repeated across several incidents, it helps the client understand why they do things the way they do or why they feel a certain way.

This knowledge enables them to identify these patterns as they happen in their life in between the sessions. Once they are able to recognize the unhealthy patterns, the therapist works with the client to find alternative healthy ways to handle situations and helps them to practice these instead. When the client is successfully able to do this without requiring the assistance of the therapist any longer, and all the goals have been achieved or addressed, and the client reports that they are feeling better, then therapy can be terminated.


Why Therapy Works?

A qualitative research in 2007 on people who have been to therapy aimed to explore what changed for them during therapy. And although the participants couldn’t clearly define the change, their responses broadly fell under these six themes:

1. Motivation and Readiness: Therapy helped motivate them to feel better, be better, and do better.

2. Tools and Strategies: They learned to change their problematic behaviours by identifying the inevitable consequences of their previous behavioural choices.

3. Learning: They were being informed about what they are struggling with, where it stemmed from, and what to do to overcome these problems.


4. Interaction with Therapist:

The relationship between them and the therapist was a space for healing because they felt safe to confide and open up to someone without being judged.


5. Perceived Aspects of Self:

They learnt more about who they are when the therapist, who is an objective person, pointed out things that are easily overlooked and knowing these things positively contributed to their self-image.


6. Relief of talking:

The act of expressing whatever they think or feel without having to hold back in any way, without worrying about what the other person will say, is a very liberating or cathartic experience.


Do You Know about the Plasticity of the Brain?





Brain plasticity means that the brain is capable of changing, reorganizing, and growing. This amazing quality of the brain is something that instills hope no matter how bad something looks. People with traumatic brain injuries have miraculously recovered to near normal functioning because of the plasticity of the brain. It is for this very reason that therapy works. Because it means that your brain is capable of learning to recognize old and unhelpful patterns of thought and behaviour and break them and introduce new and

healthy, helpful patterns instead.


Over 20 studies since 1992 have researched on whether psychotherapy can change how the brain functions and their results show that therapy is equal or in some cases more effective than certain medications in treating mental illnesses. So, apart from the behavioural changes you can observe in day-to-day life, psychotherapy also affects how your brain functions by stimulating certain parts of the brain that are associated with higher order thinking, motivation, and mood.


Therapy has risen as a discipline because of the increasing demand for it. There is a demand for it because people are recognizing that living in misery shouldn’t be the only option. Just like you would seek a doctor when you are in physical pain, you need to consult with a mental health practitioner to alleviate emotional pain that you are not able to come to terms with. The process of change might seem daunting, but is it more daunting than continuing to feel the way you do?


Change can seem painful and scary because it’s unfamiliar. We can be set in our ways of avoiding, denying, and distracting ourselves from things that bother us. But these approaches aren’t getting us anywhere in life. You can keep running from it but then you will also keep running into it. Instead, facing the pain head on and staying with the discomfort it brings for some time while reflecting on your experiences will have so much to tell you about yourself that you might even be grateful for it. The famous poet Robert Frost put it best when he said “The best way out is always through”.

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