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The Ins and Outs of Psychotherapy

Updated: Aug 12

The connection we have to our world is complex. Each human sees outside of themselves with a unique perspective. The distinctive features of our perspectives are impossible to thoroughly articulate, and difficult to even fully grasp.

Our perspectives are created in our inner world. We have drives, physiologic needs, sensations, affective emotional states, thoughts, memories, perceptions and name just a few of the things that go on inside a human being. The brain is considered by many scientists, and those at Trivial Pursuit, to be the most complex system we have encountered on the planet. The inner world is a universe of systemic integrations of the list above that culminates in the totality of our experience. The brain is an element of the inner world, sure, but not without its connectivity to the sensory and nervous systems, hormonal systems, cardiorespiratory and digestive systems and all the others that co-create our sense of any moment. It is then the MIND that puts it all together and adds reflective awareness to define our internal world.

But our inner world can only create that perspective if it has something to encounter and engage. The outer world is formative in all our sensing, perceiving and experiencing. Familial and friend relationships, ethnic and cultural norms and experiences, geographic landscapes, socioeconomics, societal privilege and hardship, educational and health contexts, governmental and political realities all shape the humans we become. It is impossible to distinguish self from outer and other. It is impossible to conceive of a self as a closed system without the input and stimulus of the outer/other. In fact, we are learning more every day that the line between self and other or singular and collective/connective is pretty fluid. I say we learn that increasingly every day, but that isn't quite true. We learn science's PROOF of that more and more every day. The mystics have known it (in their way) all along.

Why does this matter in therapy? This matters because we do not have the world in the room; we only have you. Furthermore, we have no mechanisms to assist you with your relative context, other than our influence with you. This is a major element of frustration and tension in therapy.

  • How is talking going to help anything?

  • What can she do for me from that chair?

  • How does she not understand that these things aren’t my fault and there is little that I can do about them?

When you enter into psychotherapy, there will come a moment where your therapist looks at you and says a version of "and so what can you do, think, feel or believe differently about this situation?" I promise she is not doing that to blame, shame or critique you. Rather, she is leveraging the only power she has...the power to de-construct and re-construct your internal world. But in the face of a complex external world that causes so much distress, the question often feels somewhere between useless and accusatory. It is the only question that matters though…and all of the discussion that emanates from it. In fact, when you start to hear that from your therapist, it means you are into the real work.

Therapists have the capacity, ability and responsibility to work in this way. Therapists are also limited to working in this way. In fact, the mechanism of action of all treatment in psychotherapy is within the therapeutic bond created through, and around, these guided conversations. Our arms can't reach out of the room...not even to swat a fly. This is how I explain the borders of the discipline to students and young therapists.

In the room, we harness the power of the social learning brain and put it to work on the issues that brought you into see us. The social learning brain is responsible for a lot of really interesting phenomena, including that we can do math better when our mom is with us than when she isn’t. Our brains and bodies adapt and grow when the foundation of a healthy, safe attachment bond is present and supports them.

In my practice, I have many clients who face chronic and/or or extreme versions of hardship. The toughest element of our work together is that the worse the hardship is, the harder it is to change it. And the more pushing we must do to stretch the shape of the internal world. Clients can often make steps to change their context. Particularly when thorough therapy has helped them to see the system they are in and assess whether it is healthy for them or not. Learning the ways in which your context has impacted and defined your perspective is hugely liberating and usually does away with any shame or self-loathing one might have. But past the shame, we are into the real work which is the re-building of the structures of the inner world that keep us from enjoying our experience of our life. That may mean change on the outside and a revolution in one context...or change on the inside that creates acceptance and resolves the distress. Either way, it is de-constructing and re-constructing the inner world with an eye to shifting the experience we have of our own life.

That is the ultimate task, not to enjoy life, but to enjoy our experience of it.


Britta Regan West MA, RCC, TITC/CT-CFST Clinical Counsellor, Clinical Traumatologist, Compassion Fatigue Specialist

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