“Doc it feels like a fairy tale to me. How Rahul (names changed to maintain confidentiality) and I have come through such turbulent times and now we are in calm waters, back to how we were, maybe even better, before we went through the challenges of the past two years.” Shreya said this recently in a marital therapy session with the three of us present. They both expressed how grateful they were that I helped in so many ways. And I, like always, put the success of the sessions back onto the clients I work with, because it is their persistence, patience, strength, fortitude, and the sight of the goals despite the tough process that makes the journey meaningful for them and for me in a way. I have seen this more so for the couples I work with. If they know they want to make it work, they literally go through the fire and come out unscathed and happier on the other side, because there is so much at stake.

I will be honest. Therapy sessions are no cake walk when done right. It starts off with people feeling extremely vulnerable as they reach out for a person who they have to learn to trust with their inner most world. “How can I bare my anxieties, angst, frustrations, problems, my core to a person I just don’t know?” “Will I be judged for seeking out help?” “Am I so weak that I can’t deal with this on my own?” And yet they realize that the mounting burden of their miseries far outweigh the rawness they feel in their gut and they make that first contact with someone like me.

Healing is a journey whose trajectory is unknown. There is no straight line from point A to point B in most cases, I have seen. And using this example of the fairy tale, let me write about what actually goes on behind the scenes in therapy, what factors determine outcomes of those sessions, what about people like Shreya and Rahul who have gone through so much in two years makes them finally see the light at the end of a dark tunnel which often had obstacles thrown in the way too. These observations hold true for individual therapy as well as couples therapy and I may use examples of either/or as I write along.

Here are my “Top 10 recommendations for making therapy successful”

For what specific reason(s) am I seeking therapy? Am I on the same page as my partner on the aspects we need to work on? Is it improving communication and conflict management skills, building emotional intimacy, working through an incident (or a series) which caused the relationship to fracture, figuring out whether they have it in them to make the relationship work or should they part ways, parenting tips, or anything else that is unique to the couple’s relationship that warrants attention. In case goals are misaligned, well, then they work towards addressing that conflict first and be on the same page. 

When difficult conversations happen, they leave us rattled, undoubtedly. What was suppressed for long, emerges like a tempest at times, which one may not be braced for. One of the foremost things to do in therapy is to learn how to manage those emotional sweep-aways, be able to ground yourself, and to drop an anchor so that you are able to manage your thoughts and emotions and bring them to baseline while the work continues to be underway. These skills vary from mindfulness techniques, to setting boundaries, to communicating effectively, or to learn when to take a time out and reconvene at a later time, when the emotional surge has subsided. These are customized based on the individual’s preferences, their unique nature, and what they are willing to work with and build on.

One of my favorite memories of my childhood is when my mother would start knitting a sweater, and in preparation, she would make neat spheres of wool so that she could knit tangle-free. I would be asked to stand with my arms bent at the elbows, shoulder width apart with the wool wrapped around my hands while she lovingly sorted through the knots and tangles and made those spheres. Therapy is something like that. Sorting through tangles, with love and compassion, to wade through the mess, to get stuck at some point, and to focus with love and attention so that the mess eases out. When people are making progress, and there is often a small blip or a slight relapse, they panic. Bad days will happen even when therapy is progressing well, while the frequency and/or the severity may reduce but nevertheless blips are expected. If they take that in their stride, centre and ground themselves, it bodes well, but if they get distressed at yet another stressor adding to the burden, and that distress remains then precious time is lost. We all will have some bad days even when life is going well, so it’s best to just take that in our stride, and work through those difficult moments. It would be best if people can learn to rides these tides and stay focused on their goals, have trust in the process, and keep forging ahead. That’s how life is!

When a therapist facilitates sessions, there are interventions or suggestions that nudge people to deeper reflections, to face issues, which often entails stepping out of their comfort zones. When they trust the process, each other, and most importantly the therapist, when guards and facades are dropped, an inner transformation due to the collaborative work often emerges. I am forever grateful to those people, who have placed their faith, their lives, their inner worlds in my hands, and have walked along with me, unwaveringly with their hopeful sights on a better tomorrow. It makes it easier to navigate those moments when we as therapists have also been at the receiving end of anger, bitterness, harsh words, and other transference issues from clients.

Being honest not just with themselves, but with each other, and the therapist. There is truth to “Truth comes with a price,” “Truth is a bitter pill to swallow.” Clients often find it difficult to speak the truth for several fears: of hurting their partner, of being at the receiving end of their anger, of shame, of issues escalating manifold, or for fear of disrupting the peace and harmony that has evaded them so long. And so sensitive issues are often withheld which threaten the basic foundation of any relationship, let alone a therapeutic one. Transparency, honesty, and facing the truth rather than finding comfort in hiding behind it and delaying the inevitable revelation may seem a difficult path to traverse, but is the one to walk on for sure. When couples express their thoughts and emotions freely, without censoring anything, without walking on egg shells, and when they can patiently listen to and understand each other, is when lasting changes happen.

When we were at the depth of processing a very sensitive issue that had confronted Shreya & Rahul in the past, another major stressor showed up in their life, which again threatened to shake the foundation of their relationship. Conflicts escalated temporarily, and in their despair and while engaging in catharsis, they both asked if the relationship was worth the struggle they were finding themselves in. They then stepped back and saw that their emotions were ruling their thoughts and they again laid their eyes on the goal of making their relationship work because of the high value they both had in each other’s life and how they had shared dreams of raising a family together, parenting their two teenage kids, traveling the world, sharing interests and hobbies, being each other’s cheerleaders, supporting each other’s dreams, and just the simple fact that despite the challenges and incidents there was a whole lot of love they had for each other. When they were able to step away from seeing everything through the lens of their frazzled emotions, and saw what they were working towards, and what they would lose if they let go, they were back with a renewed commitment and a focus on working things through.  

Therapy isn’t about me wielding a magic wand, as most people think or ask me in jest. I like being redundant once my work is done which means that the people I work with have to learn the skills and do the deep work that therapy entails. They shouldn’t be seeing me for life. Therapy is a two-way street, and I like active participation of the clients because after all, it is their life that they are shaping. There are skills we like clients to learn, and however difficult they may seem, or whatever resistance shows up, if those learnings are indicated, then motivation must be built to imbibe them. While catharsis has its role in sessions, only engaging in that and not showing any visible shifts in well-being means that more work needs to be done. I have found the most successful outcomes in clients who take charge of their lives, assume responsibility for their actions, and are open to feedback.

One of the most challenging concepts that couples particularly struggle with is “agreeing to disagree.” They want their partners to see and endorse their point of view and it often culminates in two people trying to argue with each other in an endless loop, without putting their own agendas aside and listening and understanding effectively. It becomes a battle of the egos. Sometimes all we need to hear is, “It makes sense to me how you saw this, and what your perceptions and needs are. I get it. I can see why this can upset you.” Easier said than done, one might think, right? But why? It’s because we struggle with not being heard and our point of view being accepted. If one person wants to win, the relationship invariably loses. If we reach out and empathize with our partner, with a focus on hearing out each other, and reaching a resolution, we are looking at some good times. I have often noticed a softening when I hear someone say, “Do you think I understood what you were trying to say? If not, what do I need to know to understand your perspective better? And making sure that there is a deeper understanding and connect.

Why are we so afraid to look deep within, to see how events and generations and histories, and even our own thoughts, feelings, and actions have influenced us? Why are we afraid of looking at our scars and inner wounds and why do we not allow ourselves to look at our inner child with compassion and do the necessary work to heal? Therapy is akin to just tenderly taking care of a wound and healing it for good than just applying a band aid for a temporary fix. If we commit to dig deep to unearth what lies buried and  repressed that is causing angst in the here and now, we will move towards a longer lasting impact and a better, integrated self. Words that a former client said to me still ring in my ears, “Doc, band aids don’t fix bullet holes.”

We rarely give ourselves kudos for a job well done, for small wins that make a difference to our days and lives. Could we get out of bed and start our day without being engulfed with self-critical thoughts or bursting into a flood of tears? Did we manage to have an amicable, peaceful conversation about a stressor rather than getting into a heated argument? Did I enjoy going out with a friend rather than staying holed up at home feeling sad and depressed? These are small wins which cumulatively help us to reach towards our final goal/destination. Celebrate them!

Therapy needs to be owned by the people receiving it. If you are investing in your mental health, it will serve you well to take responsibility for it and to play your part in ensuring a successful outcome. When hearts and minds come together to heal, a wondrous metamorphosis happens. So, if you are considering investing in your mental health, do make a mental note of these pointers so that you come away healed and transformed. It can be magical that way.