When people ask the question—“Why does therapy help?”—the answer usually has something to do with self-awareness, or self-knowledge. The idea is that the better you know yourself, the more you can control. It is narrative that permeates all levels of mental health, from people who have never gone to therapy to those who deliver it.
However, in my experience I have found that self-knowledge is not the end all, be all of therapy. It can help, of course, for the simple reason that knowing something about oneself brings that thing into consciousness. If you know yourself as an introvert, then you can understand why you need to be alone sometimes. Without this understanding, a variety of assumptions or explanations can take its place. There is something wrong with me. I don’t like these people. I must be in a mood today. Knowing you are an introvert helps you predict, assess, and in some cases accept the results.
Yet this knowledge does not always change you. There is an old joke in the field about a person who goes to see an analyst because he’s wetting the bed. After thirty years of analysis he still wets the bed—but now he knows why. In order to move our conceptualization of human behavior past the fairly stale “know thyself,” we must understand that therapy can be more of an emotional and experiential activity, as opposed to an intellectual one. Joan Didion writes that there are “certain irreducible ambiguities” in fiction; the same is true for the artistic experience of therapy. The act of talking to a trusted person promotes change in an oblique way. I understand that people want direct and straightforward answers for their paid services, but for better or worse, the process of therapy is not subject to those kinds of demands.
The intellectual stuff—recognizing a problem and planning for it and executing that plan, all based on self-knowledge—sounds nice, doesn’t it? It’s an approach that calms people, coming across as logical, scientific, foolproof. Like you’re going to the doctor’s office, but for your mind. People do not want to hear that the “activity itself promotes change” or that “the relationship is the most important factor.” What the hell do those things even mean? And yet these two things—the activity itself, and the relationship that develops between you and your therapist—are indeed the two most important components of change, in my experience and according to the research.
More on that research later.