How Therapy Works

In the long run we only hit what we aim at.

— Thoreau

Therapy is an intentional process

Psychotherapy is communication between a patient and therapist that is intended to relieve emotional distress, seek solutions to problems or modify ways of thinking or acting that are impairing work or relationships.

The following factors make the process of therapy predictable and effective:


The person seeking therapy may come to the first session with a clear goal in mind or they may work with the therapist to determine a goal. A good way of determining a practical goal is to ask, “If this therapy were useful to me, how would I know it was ‘working’?”

A plan

It usually takes a few sessions for the therapist to become familiar with the circumstances of the client’s life and then the therapist and client can work together to determine a course of treatment. The treatment plan may be quite simple or more involved depending on the issues. Part of the planning will involve the therapist and the client discussing the therapist’s recommendation of how often the client should attend therapy.


The client and the therapist have an important and very unique relationship. Rapport and trust provide the foundation of the relationship that will be the basis of successful work. If the person seeking therapy is not comfortable with the therapist, it is important that this be openly communicated. Therapists know that as with all relationships, sometimes the chemistry isn’t a fit. A good therapist doesn’t take this personally and wants to know if the client isn’t comfortable moving forward. The therapist can then make a referral to another therapist that may be a better fit.


Much work takes place during sessions in the therapist’s office. Often the therapist takes notes (with the permission of the client) as a way of remembering and organizing information that the client shares. The therapist takes responsibility for tracking the time and brings the session to a stopping point.


An important part of the therapeutic process is the action that takes place outside of session. The therapist may assign homework to facilitate progress towards meeting treatment goals. The therapist and client may agree on experiments that the client will conduct outside of sessions in order to provide needed information. When practicing new habits, the therapist may ask that the client to track (on paper or smart phone) the frequency of certain behaviors that occur between sessions.


Generally speaking, the client is sort of “driving the car” in terms of what is discussed during sessions. The therapist is “in the passenger seat” occasionally providing information or asking questions to enable the client to better understand his situation. Sometimes the therapist shares a perspective that offers up a new way of seeing a situation. The therapist is not committed to giving advice but to assisting the client in determining his or her own course of action.

The Frame

The therapeutic frame refers to the boundaries or rules that keep the therapeutic process on track. These boundaries make the process predictable and safe for both the client and the therapist. Boundaries concerning the location of sessions, fees and payment, cancellation policy, late arrival, session length, communication outside of session times and confidentiality are discussed so that both parties have similar expectations.