Why doesn’t the therapist give guarantees?

“If I come to you, you can’t guarantee that my problem will be solved and life will get better?” one of the listeners at an open lecture asked me angrily.

“I can’t, you’re right. But together we can try to figure out what is wrong with your life and what can really change for the better in it, ”I answered.

For him, however, the lack of guarantees meant that psychotherapy was a quackery. In my opinion, just the opposite is true: if you are confidently promised a solution to problems within a specific time frame, this is a reason to suspect fraud. For clarity, I will draw an analogy with medicine. Let’s say you go to the doctor: “Doctor, my stomach hurts. Are you sure you can heal me? For what period? Do not know? I’m going to find a real doctor!»

Doesn’t that sound weird? No doctor will say anything definite until you do tests and other necessary diagnostics. Then the doctor will prescribe treatment. And according to how much it will work, he will correct it or refer you for an additional examination.

If the case is complex, the diagnosis and prognosis may vary. The patient has his own area of ​​responsibility. Is he doing the right tests? Are all doctor’s recommendations followed? This significantly affects the course of treatment.

Psychotherapy works in a similar way. The initial request of the client is just an occasion to discuss the initial strategy of collaboration and a very approximate duration of therapy.

I use the «at least» formula: at least 10 meetings, at least a year. The first few sessions will be spent on “analyzes” — collecting and systematizing information about the client, his life, about what can be changed and what can not. At the same time, we will try some steps and see what helps him and what does not.

It happens that a client makes some kind of local request — for example, he does not know how to ask his boss for a salary increase or how to resolve a conflict, he cannot make some important choice. And in the process of work, circumstances are suddenly revealed that significantly change the picture, which he forgot about or did not consider them to be related to his problem.

One day a woman came to me asking me to help her decide whether to stay with her husband or go to another man. It happens that the answer to such requests can be found already in 7-10 meetings. But in this case, it turned out along the way that she had in her luggage a difficult childhood experience in relations with her father, rape in her youth, depression and a complete lack of friends.

I honestly told her that, in my opinion, she is not able to make a “good” choice from such a present, because she hates herself, which means she does not know her needs well, reads people distortedly through the prism of her past grievances and obsessive suspicions. To return to the medical analogy, we can say that she wanted to change her diet, but it turned out that she had an intestinal tumor.

I explained how her past connected to her problems, and suggested that she change her request to a deeper one — deal with past traumas, learn to better understand and support herself, build close relationships, and only then decide what kind of man she wants.

This task cannot be solved in a short time, it requires at least two years of work. She did not agree and, I think, went to look for a specialist who would solve her problem quickly …

She was not satisfied with the results of our work, and I, within the limits of my responsibility, believed that I had done everything I could.

Why is the result not guaranteed?

The psychotherapist helps the client to change himself and his life, but not all of the desired can be achieved:

1. there are laws of life — no one is able to avoid the blows of fate, their limitations, mistakes and helplessness at some moments;

2. not everything depends only on us: a client can learn to understand his needs and ask others for something or negotiate with them, but if his relatives do not want or do not know how, for example, to meet halfway and build warm relations, this is nothing you can do it. It is necessary to accept this and find people with whom such relationships are possible;

3. everything has its price: you may want something, for example, to find a life partner, but in reality you will not be ready to make efforts, take risks, take concrete steps.

As a result of joint work, we will find the reasons that hinder your actions. But this does not mean that you will definitely overcome them. To go along some road or not to go is always the choice of the client, since he, and not the therapist, puts energy into the changes.

My responsibility as a therapist is to use my professional knowledge and skills to investigate what is happening with the client and honestly present my observations, opinions, hypotheses, suggestions. Maintain and develop your professional competence, but at the same time understand its limits. If this client had stayed with me in therapy, I would definitely refer her to a psychiatrist for depression.

The client is responsible for his conclusions, decisions, actions and changes in his life. The Gestalt therapist, like therapists in other non-directive psychotherapies, does not push him to this or that decision and does not take on the role of an expert in the client’s life.

Together we are responsible for the regularity of meetings, compliance with the agreed rules of our relationship and for the relationship itself, trying to be sincere and respectful in them. We honestly discuss new turns in therapy, our doubts and the limits of our joint “power”.

And although it is impossible to determine in advance exactly how long the therapy will last and what its result will be, with such a distribution of responsibility, we have every reason to hope for changes for the better in the client’s life.