Good question! There are at least a few ways to answer this.
First, psychotherapy is kind of like cooking, or science - the word encompasses myriad traditions, practices and “flavors” that may have little resemblance to one another. Not all approaches actually work, for two reasons. The first is that some just don’t work. I’ll get back to that point. The second is that even among authentic approaches, there is still a need for a right fit. The patient has to feel comfortable and connected to their therapist. This does take time but the potential of this developing should be pretty apparent from the initial meeting. And the therapist’s approach needs to be resonant for the patient. If the therapist specializes in dream work and the client is uninterested in dreams, then obviously that won’t work very well. So a good fit will be determined by both the feeling of resonance between the patient and therapist, and by them being interested in working in the same ways.
For example, the work that I do could potentially be accessed through different doorways by a bodyworker, acupuncturist, intuitive healer, Jungian psychoanalyst or wilderness therapy guide. And what might be right for a patient may change over time. At one point a somatic therapist may be exactly what they need to heal by developing more inner awareness. At another point the healing may be best facilitated by connecting more to the outer world through experiences in nature. So there is no one right way, only the right place and the right people at the right time.
I can say without any reserve that authentic psychotherapy need only possess two qualities: First, that it is based in having new experiences, because this is the only way that people change. Second, these experiences must come spontaneously from within a person, rather than being imposed upon the patient by an “expert”. These two points are extremely important and distinguish between authentic approaches and what could be considered ineffective or even colonial approaches. It’s worth writing more about this because this is a subtle point and one that is rarely talked about in the field, though there are many good critical resources (check out the book “Critical Psychology”, “Constructing the Self, Constructing America”, or Adam Curtis’s documentary “Century of the Self”)
So much of “psychotherapy” today is of the cognitive variety. Cognitive Behavioral Therapy (CBT) has gained a near monopoly thanks to highly questionable research practices which have gained it traction in the university system (see Jonathan Shedler’s work if you are a science nerd interested in deconstructing the way data is manipulated and truth is obscured). Because all therapists must go to graduate school in order to become licensed, CBT is often the sole approach that they are exposed to today, though it was much different in past decades.
When people say “cognitive therapies” they really just mean CBT. And the problem with CBT is two-fold. First, it is a profound misunderstanding of human being because it targets (and I use that word in the militaristic connotation in which they themselves use it) only one aspect of our experience. It falls prey to the reductionist “single cause” obsession that has gripped so much of science today, whether regarding human suffering or planetary crisis. Like our planet, humans are very, very complex, and merely changing one’s thoughts is hardly a way to deep transformation.
True transformation comes out of experience - experiencing split off, hidden, and undeveloped parts of ourselves. It is through this process that we see clearly the core beliefs that produce our thoughts and their origins in childhood and cultural wounding. This process helps develop our deeper sense of knowing, intuition and wisdom. As we go along we develop a greater relationship to a love and sense of safety that is much larger than the limits of our skin. None of these experiences come out of a simple reprogramming of our thoughts, which is more like an SNL Stuart Smalley skit than anything that could be considered serious clinical work. This is exactly why New Year’s resolutions don’t work, because they don’t come from the right place and they don’t address root causes.
For instance, at the core of someone with low-self esteem may be an overwhelming sense of shame. An authentic therapy would help them to move towards those feelings so that they could finally be fully felt and integrated. In doing so they would make contact with that young, wounded part of themselves, encounter memories and body sensations that laid the foundation for their earliest experiences, and re-open the channel of love towards this inner child, shifting deep beliefs about worthiness. This shifts the entire consciousness of the person and the thoughts change organically with it. When there is no longer a feeling of shame pervading every experience and social interaction, there is no longer a need to use negative thinking to manage those feelings.
None of this could ever happen with CBT, where the “therapist” as “expert” will tell the patient that they need to replace their negative thinking with new thoughts, while never addressing the underlying wound. This is like putting a band-aid on something that needs stitches, leaving it to fester and acting as if it isn’t there. But of course, it will erupt at inopportune times and continue to cause suffering until it is truly healed. This is why even though there is an army of CBT therapists putting in millions of clinical hours each year, and even though one in four middle age women are now on anti-depressants, the incidences of mental health disorders, suicide, and drug overdose continue to rise exponentially. In spite of what the experts say, at a macro scale it’s crystal clear that the dominant approaches are not only not working, but quite possibly making things worse. If I’m building a dam and the water keeps getting higher on my side, that’s a good indicator I’m not doing something right.
The second, and even more important problem with CBT is that it is by nature colonial. It would be one thing if CBT was neutral, if it was as ineffective at treating human suffering as memorizing multiplication tables. But it’s worse. CBT takes the dominant ideology - radical individualism and separation, disconnected from nature, heart and community; one which implicitly accepts a status quo fundamentally based on the exploitation of people of color, poor countries and the entire planet; and one where the worldview of academia is taken as the only True Religion - and imposes it onto people in their weakest, most vulnerable and receptive state. It is identical to the cult guru, finding the most disempowered people to dominate and control. Of course, cult gurus do not feel as if they are doing this, nor do therapists practicing CBT. Both are completely assured in their good intentions that they have privileged access to a truth that is worth imposing onto others, just as missionaries, slave owners and perpetrators of genocide throughout Western history. This is the quintessence of any plan, of any origin, imposed from without on another more vulnerable group.
You think that might sound extreme but it is the same mentality played out over and over again. Any time you have a person that is not exclusively trusting the experience of their patients, they are imposing their own version of reality. The academic worldview claims that cognition is all that matters and that we are basically just meaningless biological machines following determinist rules through a short life in an empty universe. The academic worldview dismisses everything we experience as “subjective” and therefore wisdom cannot exist. Dreams can only be nocturnal brain farts. Intuition can only be magical or even delusional thinking. And love is nice, but really it’s just some neurochemicals that nature designed so we would fuck more. This is what I call the genocide of subjectivity, and consultation rooms today are filled with its victims.
And in true missionary form, this version of reality is being exponentially exported to other countries. When I was in graduate school a professor proudly presented their project in India, where they were teaching people in the countryside to use CBT - in other words, to think like they do. This is culture murder and it continues to amaze me that the West keeps colonizing the hearts and minds of others, even under the banner of social justice. This is absolutely inexcusable. The reality of this practice is the killing off of the precious, marginalized worldviews that we need now, more than ever, to cure the Western mind’s obsession with abuse and control of all things living.
So what is psychotherapy? Well, it very much depends on who is doing it, what their training is, what their unconscious motivations are, and what kind of experience they are facilitating. If you take anything away from this essay, psychotherapy is not neutral. It is a deep practice of personal change, no matter who performs it - but you may not get the change your heart wants, the change your soul needs, the change the natural world longs for, but instead the change the patriarchal society demands so you can be a more obedient, docile citizen that produces and consumes while thinking all the right thoughts. At least, that is what the licensed expert told you, so it must be true, right?