There are lots of wacky movie images of “therapy”, such as psychoanalysts from Freud’s time talking to people lying on couches, or clients and therapists running off into the sunset together (breaking all rules of professional conduct). Such images can therefore make “therapy” probably not something the average Kiwi manager feels like recommending to their staff! This month, we outline a few simple ways to think about how modern psychological therapy might be helpful in the workplace. Next month, we’ll cover why it takes a number of therapy sessions to make a difference.

Psychological therapy is an incredibly useful tool that can help with a range of issues. Often people seek therapy to tackle difficult life challenges, to improve physical or mental health, to learn better strategies for managing work stress or changing habits that are no longer helpful.

Therapy is an active and collaborative process where the psychologist and client work together to create changes and to improve the problems that brought the client to therapy. It is not a passive process.

A good analogy is to think of the comparison between having physiotherapy or surgery. What are the differences? In surgery, we go in and someone else solves the problem (hopefully) for us, after which we wake up to a changed body. Physiotherapy, on the other hand, involves active work on our part – the physiotherapist undertakes an assessment of the problem to help define what isn’t working well and why, then teaches you some stretches and exercises to help strengthen the body, you go away and (hopefully!) practise those exercises, getting stronger and stronger as you go, returning to the physio to refine and build on those exercises and gains. However, if you do not practise between sessions, progress is slow or non-existent. As you continue through physiotherapy getting stronger, your sessions may reduce in frequency as you are more and more able to continue building strength and doing your exercises independently.

In these ways, psychological therapy is a lot like physiotherapy, and a lot more similar to physiotherapy than it is to surgery. This is one of the reasons that therapy can take time. Unfortunately, many people attending therapy – either referred by themselves or by their workplace – are referred only for a very short number of sessions, sometimes as few as one or two. While for some individuals and some problems, a couple of sessions may be enough, there are some important things to know about how therapy works and why it often takes a while.

Therapy is not telling the client what to do

The psychologist’s role is not to “tell” the client what to do, but rather help the client to explore their difficulties and potential solutions, and make decisions about which actions will be most helpful. This framework does not mean that the therapist doesn’t offer suggestions or input, in fact these are both important parts of the psychologist’s role, but that ideas and strategies are worked on collaboratively. Think back on a time you were having difficulties and weren’t quite sure what to do. What was more helpful for you then – having someone tell you to do exactly x, y, and z, and send you on your way? Or was it having someone discussing with you what wasn’t working, why it wasn’t working, and your ideas as well as theirs about options to improve the situation? We know very clearly from psychological research that this second strategy is more effective, creates less push-back from people, and contributes to more significant, longer term changes in behaviour and in an individual’s problem-solving abilities for future challenges.

The relationship between therapist and client is what drives change

One of the most important components of psychological therapy is the relationship between the psychologist and the client. In fact, research indicates that it is the quality of this therapeutic relationship that is responsible for the majority of change clients make in therapy. Understandably, it takes some time for a warm, trusting relationship to be well established.

Psychological therapy takes work

As the parallel to physiotherapy helps explain, therapy is not a passive process. It requires willingness and work from the client, which can be hard and tiring. For this reason, psychologists gauge how quickly to move and how much to push in working with each client. Each session should feel like a bit of a push, not just like having a comfortable chat with a friend, but also mustn’t put the client off coming back. For this reason, it can be hard to gauge how long therapy will take, and it will naturally take longer if the person is feeling overwhelmed or unmotivated (feelings which often accompany referrals to a psychologist).

People can wait too long to come to a psychologist

Often people don’t come to a psychologist when things are just starting to get wobbly and cause difficulties. They typically wait until things have become much worse, and until they have tried absolutely everything that they can think of to “fix” the problems. This tendency to wait applies equally to teams and managers, where typically they will not seek outside support for an employee until things have deteriorated significantly. As a result, there can be a lot of work to do when people present for therapy. People may also feel quite helpless or unable to change due to how long the problems have been going on for. The individual or their support people (including work supports) might also be so burnt out by the problems after so long that they feel unable to put the work required in to change or to support change. All of these factors act against rapid progress in therapy – even while making it even more crucial that an experienced professional like a psychologist is at last getting involved.

Given that people typically put off going to a psychologist until things have deteriorated significantly, they are also often coming with multiple problems, in the same way that many of us store up two or three ailments before booking an appointment with our GP. As a result, unpacking what is actually going on and how each problem is affecting the others is the first task of therapy.

Behaviour change takes time

Most people are referred to a psychologist (either by themselves or by their workplace) because something that they are doing isn’t working well. This problem could be how they are feeling, or how they are interacting with others such as colleagues or a partner. And as mentioned above, no-one comes to therapy the first time they do something which doesn’t work. People come to therapy for problems which occur again and again. In this way, by the time the client comes to therapy, the unhelpful behaviour is likely already a well-established habit. Therefore, the therapist and client together need to figure out what new behaviours to try and what works best over time. That takes more than one meeting! We’ll talk more about the time that psychological therapy can take next month.

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