How does Psychotherapy work? - My personal model

I. Psychotherapy Model.

In the next lines I’ll share the insights of a psychotherapy process, disclosing what I do and how I help people to improve their mental health.

This information is concluded as part of my own experience doing psychotherapy for the last 10 years, and integrates practices from multiple psychotherapeutic models.

In summary, Psychotherapy should look like something like this:

1st Stage: Bonding and Problem Analysis.

I usually use a cognitive model to frame the client’s problem, complementing with other theories when necessary, according to the client's resources and the nature of the problem.

In short, most psychological problems are related to the client’s perception of a threat, which activates defense mechanisms that paradoxically end up impairing the client’s wellbeing.

This usually looks like a struggle with a particular situation “A”, that I would like it to be different (“B”), because situation "A" situation is extremely dangerous/uncomfortable to the client’s eyes.

A concrete example could be:

Peter is experiencing problems sleeping and socializing. He can’t find a job since he graduated, and has been trying his best to get a job without any success (situation "A"). He would like to find a well payed job soon and easier (situation "B"), because studying again doesn't appeal to him and he worked very hard to graduate. Thefore, situation A triggers anxiety and insecurity, because of the expectation of situation B to come true to bring safety and selfworth.

Situation A is interpreted by Peter as a personal failure: “I’m not good enough and I’m not need it”. He is aware that he should not define his value through his job situation, but he can’t stop thinking that others are more competitive than him.

This particular case, assuming that there are not other factors like neurodiversity, mistreatment in childhood, or traumatic experiences , could be framed in a cognitive model as:

Peter perceives his jobless situation as a threat to his identity and self-value. He probably has a core belief stating something like: “Jobless people are not acceptable; I’m a flaw and useless if I can’t work on my field of education”.

To cope against this belief, he would like his life to be different, and struggle accepting his reality. Cognitive Therapy would help Peter, through a reflective process, to update his system of beliefs and re-define himself.

In the first stage of the therapy it is very important to build the therapeutic alliance, which is the bonding and collaborating relationship between client and therapist. If as a client, you manage to trust your therapist, your mind could challenge your system of beliefs easier. However, this could bevery challenging when client’s have experienced betrayal and mistrust by significant people in their life, which turn psychotherapy into a very challenging practice that may take longer to build trust in the client-therapist relationship.

A good therapeutic alliance ensures that clients will take an active role assisting the psychotherapeutic process, doing their homework, showing up on time, or doing their best attempt to participate in the process.

2nd Stage: Designing an Intervention Plan.

Through homework and a few sessions, I usually have a better understanding of client’s strategies to cope with life.

Trying to keep it simple to readers without deep knowledge in psychology, let’s assume that most psychological problems are connected to maladaptive reactions to perceived threats.

For example, in phobia to spiders, the threat are the spiders and the maladaptive defensive reaction could be a list of rigid conditions to avoid encountering spiders, like never leave the house, keep windows and doors always close, put dangerous poison around the corner of the house, screen every room for spiders everyday.

People develop different defense mechanisms to cope with threats. In cognitive therapy, they are usually known as cognitive distortions or cognitive schemas, that we use frequently to cope with problems. When individuals perceive a threat, they will react with a defense mechanism. I borrow this model from the stress response theory in neuroscience and Schema Therapy, where the author argues that we seek to compensate, avoid, or surrender to cope with threats as a natural response.

The analysis of these defenses bring clients awareness and a deeper understanding of themselves. This process of insight is key to developing a system to change a client's reactions and bring new meaning to their interpretation of reality, which most of the time does not require more “thinking”, but more acting in new ways.

If you can’t sleep early, and you perceive this as a threat. You may want to compensate it by reading about insomnia, taking pills, exhausting yourself to your limit, or any other strategy to change this situation. Paradoxically, fighting a threat releases a significant amount of adrenaline and anxiety, which will make sleep even more difficult. Therefore, the defense mechanism of compensating or fighting is not a good strategy to cope with insomnia.

Designing an intervention plan requires to comprehend how clients deal with threats, and invite them to try new strategies to react differently. Sometimes, even to not react and just accept the situation as it is.

Having a clear understanding of a client's defense mechanism, cognitive distortions, core beliefs, and emotional activation, allows them to develop new strategies to cope with threats.

3rd stage. Executing the intervention plan.

After trying a few changes and perceptions of the client’s problem. Client and therapist would have an idea of what is important and meaningful for the client.

Usually, after understanding ourselves from a psychological perspective, we start perceiving our life differently, thus, the world changes. Discovering what is important and meaningful for clients is a powerful tool to endure the unavoidable suffering in life. There will always be threats, and finding a powerful meaning to endure these threats or painful experiences, can help people to get through incredible challenging situations.

I usually suggest my clients the best seller book “Man’s search for meaning” from Victor Frankl, which introduces his thoughts and experiences using meaning to survive his painful experiences in a concentration camp.

Once this goal/meaning in life is defined, we proceed to create rituals, habits, promises, and reflections to keep moving into our desired direction and learn to cope with our suffering, defenses, and wounds. This process is a mix of acceptance of our limitations, and development of new skills to regulate our emotions and behaviors around our goals.

4th Stage. Maintenance and update

The last phase is to review and update the current routines and strategies to achieve the desired goals and overcome new problematic defense mechanisms. This process should become autonomous for each client, so we can learn to review, update, and become their own therapist to cope with their psychological defenses and triggers.

This final stage is also used to prevent relapses and forecast future problems. Life will always bring rewarding and challenging moments, and counting with clear methods to face these challenges and enjoy the good moments, brings peace and hope to most clients.

A follow- up process is also common, which helps me to learn about psychotherapeutic outcomes over time, and clients to add some new feedback into their lives.

Finally, just to add that this is the first draft of my methods to practice tele-psychotherapy. I have different ones to write for every specific condition or problem, so if you have questions or comments, please feel free to write them.

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