There are many approaches to psychotherapy (e.g., cognitive-behavioral, humanistic, existential) and in reality, many clinicians integrate multiple theories into their practice. I myself practice from a primarily psychodynamic or psychoanalytic perspective, while integrating aspects of Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), Narrative Practice, and Affective Neuroscience. So what does that look like?
First, I seek to establish a therapeutic frame. That is to say, I seek to clearly define for both my client and myself several details about how our work will occur. Logistics are a big part of this: when/how often to meet, how long to meet, how much sessions will cost. Another major part of the therapeutic frame is what we actually do in sessions.
During sessions, I invite my client to speak as openly and freely as possible, particularly about what is bringing them to psychotherapy, any major events occurring in the their life, and what their here-and-now experience of therapy with me is like. This is an unstructured process for the most part, and I leave a lot of room for my client to drive the session. Speaking in such an unstructured manner can be uncomfortable and it is not always easy to do. However, it is one of the most powerful tools I have in getting to know my clients on a deeper level. Even those things which get in the way of their free and open communication are incredibly helpful as I come to understand their internal world.
My role in therapy is to listen attentively, with a carefully trained ear, and to share my reactions to what my client is sharing. I take a warm, empathic stance where I seek to meet the client where they are at. At the same time, I also consider my client from a broader perspective, outside of the both of us. In doing so, I hope to provide opportunities for my client to learn more about themself and their internal world. I also hope to foster an environment where my client feels accepted and supported, perhaps in ways that they have not felt before.
This is a glimpse into how I work. It is also worth sharing how I do not work. I do not generally offer a ton of advice or coaching. At times I may, and it can be incredibly helpful. But I find that what happens relationally between myself and my client when I hold back on offering advice can often be even more powerful. I also may not share a ton about myself or my background. I certainly seek to be a real, authentic person in the room. However, therapy can be expensive and I want the majority of the time spent to be focused on the client. Outside of therapy, it is often the case that we are left unseen or unheard by people who are more focused on themselves than on us. That is not something I want to replicate in therapy. It may be uncomfortable for a client to not know everything about me, but even those feelings are valuable to share and discuss.
And in many was, that is one of the core values of the work I do. I seek to create a space where clients can make speakable that which has not previously been speakable. To put into words those things which escaped language, or even awareness, for so long. It is precisely through that work that true healing and change can happen.