At a friend’s birthday party in third grade, I saw the animated movie Cinderella. I sobbed through the entire film, terrified that the evil cat would devour the mice. When the credits rolled and the beloved rodents triumphed, I was vastly relieved — but also confused. Cinderella’s happily-ever-after finale made no sense. She lost both parents. She suffered emotional abuse and neglect. She survived extreme isolation and had no human friends. Cinderella couldn’t possibly erase her traumatic past with a hasty marriage to a man, flashing epaulettes, who knew her shoe size before her name. Cinderella didn’t need a prince; she needed a therapist.
Fast-forward twenty years.
I completed a doctoral program in mental health and began a career that lasted more than two decades. Along the way, I’ve been asked several times to explain how therapy works, how words can become catalysts for emotional change. I’ve fielded this question at dinner parties, teaching classes, in sessions with clients, supervising trainees. It’s a worthy question, superficially simple, deceptively complex.
I was always annoyed when therapists spoke Jargon rather than English. When I was in grad school, training to work with patients, my role-model mentors conveyed ideas with an artistic simplicity. They helped their patients explore the depths of their emotional worlds, speaking with clarity and heart, in no way sacrificing scientific knowledge or human intricacies. They chose clear words, to show their patients how unresolved issues from the past became superimposed on the present, derailing the ability to make healthy choices. Simple language is our telegraph line into the tangled, layered, lush emotional life we all hold deep within.
Some adults survive backgrounds that match Cinderella’s early trauma, and resist the emotional pathology that seems inevitable. Some of these children (like Cinderella) look unbreakable, immune, invulnerable — which of course isn’t true. In our offices, our patients show us that their survival has rested in part on their ability to manage potentially incapacitating feelings of vulnerability, a vulnerability which often surfaces in the safety of therapy, as a part of healing. These children carry bruises, even scars into adulthood, but they survived because they were, in many ways, healthy. Like Cinderella with her animal friends, these folks figured out ways to interact with the situation at hand, allowing their own psychological development to continue a forward motion.
But what happens to forward motion when that child stumbles over a roadblock? What happens when that young emotional core needs bolstering from a more mature emotional core? And what if that more mature helper is not available? Then, in the service of forward motion, the child skips over that building block in development. It’s those potential but not yet solidified building blocks that our patients present to us, sometimes in the moment, sometimes decades later.
Into adulthood, people can create lifestyles that accommodate those not-yet solidified building blocks. But if life throws them a curve ball, or if their own emotional needs call for these building books to be cemented into place, then these people bring to us their pain, bewilderment, vulnerability, both past and present. They begin to examine their own youthful coping strategy, a strategy that was beyond their own years at the time, and to initiate the process of psychologically catching up to themselves.
Each person is an emotional tapestry — interwoven threads of strength, weakness, illness, health. The unique blend in each individual forms an emotional fingerprint of textures, colors, patterns. As clinicians, we strive to understand each thread, and how it intertwines with all the others. Therapy helps patients explore their own internal tapestry, and move from images centered around illness and trauma to norms allowing for a more healthy range. In other words, in the course of treatment, patients shed the constraints that, by necessity, they themselves created in order to grow up.
So how does therapy work? Together, the therapist and patient create a safe place to feel vulnerable, which allows the patient to take charge of that vulnerability. The hunger in each patient becomes a measure not only of need, but also of capacity. If both health and illness are vital to this picture, then the patient’s own strength can be enlisted to engage the patient’s potential to heal, which empowers the patient (instead of the therapist) to become the primary agent of change.
Throughout treatment, the therapeutic relationship is essential. Every word, every nuance, every gesture is an opportunity for the therapist to communicate an optimism of repair — an optimism which no amount of drugs, predictable program regimens or technology can replace. (To be clear, meds, programs and technology can be extremely helpful, but not as a replacement for talking-therapy.) Whenever a sign of health emerges, the therapist can reach for it, weaving it into the tapestry of the therapeutic relationship, and into the patient’s core tapestry as well.
If Cinderella, grown up, had entered my office for treatment, I would have listened carefully to the words she chose to tell her story. Together, we would have developed a language to understand her emotional landscape. I would have helped her own the importance of her relationships with the animals — their warmth, their love, their limitations. Layer by layer, we’d walk through her losses, anger, fear — interwoven with her perseverance, tenacity, resiliency. Inevitably, at some point, she’d become upset with me — possibly she’d experience me as mean (like her step-mom); possibly she’d become terrified that I was about to die (like her Dad); I’d point out that her past was shaping her present world view, causing her to relate to me as a stand-in for someone who had hurt her. When the moment was right, I’d comment on her stunningly graceful movements and her unusual gift relating to animals. I’d wonder — did she hold any interest in dance? In veterinary medicine? I’d ask if she liked her glass slippers, or if she preferred Birkenstocks. I’d guide her to redefine her existence as more than an exercise in endurance, her goals as more than escaping from pain. We’d find words to expand her emotional repertoire, as she discovered new frontiers of empowerment. I’d help her become the person who, by her own definition, she was meant to be.
That’s how therapy works. Just that simple. Just that complex.