What Makes Therapy Work?

Have you ever wondered what makes therapy work? It can sometimes feel like a mysterious process. We talk, we explore, maybe we cry, and somehow, things can start to shift. But how? While every therapy journey is unique, decades of thinking and practice, including insights from Transactional Analysis, point to some key ingredients that help create lasting change. It turns out, a lot of it has to do with relationships – the ones from our past, the one we build with our therapist, and the one we have with ourselves.

It Starts with Connection: The Therapeutic Relationship

At its heart, therapy is a relationship. That connection you build with your therapist isn't just background noise; it's often the main stage where change happens. Therapists talk about "transference" and "countertransference" – which sounds complex, but simply means that the patterns and feelings from our past relationships inevitably show up in the therapy room.

You might find yourself reacting to your therapist in ways that feel familiar, perhaps reminding you of a parent or another important figure. At the same time, the therapist offers something new – a different way of responding. Navigating this mix of the "old" and the "new" within the safety of the therapeutic relationship is a powerful catalyst for growth. It's like revisiting old scenes but with the chance to write a different ending.

Understanding Our Inner World: Scripts and Parts of Self

We all have different parts to ourselves. Transactional Analysis calls these "ego states" – like an inner Child (holding our childhood experiences, feelings, and needs), an inner Parent (internalized messages and behaviors from parents or authority figures), and an inner Adult (our present-day, rational self). Often, these parts formed relationships within us, based on our early experiences. For example, an internal critical Parent part might constantly influence a vulnerable Child part.

Based on these early experiences and the relationships between our inner parts, we create unconscious "life plans" or "scripts". Think of these as the stories we tell ourselves about who we are, how others are, and how the world works. These scripts act like blueprints, guiding our choices, feelings, and how we relate to others, often without us even realizing it. Developing these life plans is a normal part of how we make sense of the world as children – like little scientists forming theories based on their experiments. Therapy helps bring these scripts into the light so we can examine and update them.

Why Change Can Be Hard: Resistance, Shame, and Defenses

If our scripts or old patterns aren't serving us well, why is it sometimes so hard to change? Often, there's a part of us that resists letting go of familiar, even if painful, ways of being. We might have an unconscious loyalty to those old internal relationships or patterns, fearing what might happen if we challenge them. It can feel like betraying someone important, even if that "someone" is an internalized part of ourselves.

Shame is another major roadblock. It often stems from past experiences where we felt criticized, humiliated, ridiculed, or simply not accepted for who we were. Shame tells us "Something is wrong with me". It can make us hide parts of ourselves, disconnect from our feelings (like anger at being mistreated, or sadness and fear about losing connection), and feel unworthy of relationship. Sometimes, puffing ourselves up with self-righteousness can be a way to cover up that underlying shame. These defenses protected us once, but now they might be keeping us stuck.

How Transformation Happens: Relationship, Meaning, and New Experiences

So, how does therapy help us overcome these hurdles? It comes back to the power of the relationship and the process of learning and integration.   

  1. The Healing Relationship: A therapist who is attuned, empathic, and consistently present offers a corrective emotional experience. Feeling truly seen, heard, and accepted, perhaps for the first time, allows those hidden, shame-bound parts of ourselves to emerge safely. The therapist takes responsibility for maintaining the connection, especially when misunderstandings or ruptures happen, modelling a different way of handling relationship difficulties.   
  2. Making New Meaning: Therapy is a space to explore your inner world and your life script. By understanding whyyou developed certain patterns or beliefs (often as clever survival strategies in the past), you can begin to deconstruct them. It involves telling your story, perhaps seeing it from new angles, and ultimately, creating a new, more flexible narrative for yourself.   
  3. Integrating Old and New: We don't just erase the past. Instead, therapy helps us integrate it. We revisit old patterns (therapists might call this assimilation – fitting experiences into our existing script) but within a relationship that responds differently. This allows for accommodation – changing our old script or internal schemas to incorporate the new, healthier experiences. The "new emerges out of the old". This happens through emotional experiencing, not just intellectual understanding. Sometimes, this involves working through "enactments," those moments where old dynamics get unconsciously played out between client and therapist, offering rich opportunities for insight and change when processed together.   

The Journey of Change

Change in psychotherapy isn't usually a single lightning bolt moment. It's a process, grounded in a safe and attuned relationship, that allows us to understand our inner world, gently challenge old defenses like shame, update the life scripts that no longer fit, and integrate new, healthier ways of being and relating. It's about finding the freedom to write the next chapter of your story.  

 References