People come to therapy either because unfortunate things have happened to them or because they are unhappy with themselves, or both. Let’s take a look at each of these situations:

Unfortunate Things Have Happened: Some people seek therapy because something fateful has happened in their lives: they’ve lost a spouse or a job, they’ve gotten in trouble with the authorities, they’ve failed at something they were trying to do, they’ve been given an ultimatum by someone who matters to them, a child has crashed and burned, someone they loved has died.

What they want from therapy is support and guidance, some comfort, help getting back on their feet. They aren’t interested in examining their childhoods -- the crisis is now and they want relief. Totally understandable.

If the problem is really not of their making, if the fates dealt them a bad hand, they may get back on their feet quickly with just a little help. A therapist may be able to help reassemble the pieces in short order. Sometimes therapies really can accomplish their goals in just a few sessions, sometimes in just a matter of months. Therapist and patient need to keep their focus.

But it’s more complicated if the problem really isn’t external – if the job was lost, or the coursework failed, or the relationship sabotaged, because stuff inside was keeping the person from functioning well. The therapist may have to start by helping his patient understand that the disaster wasn’t just a matter of bad luck or chance or the unkindness of strangers. If the patient and therapist can get there, then the hard work begins.

Life Doesn’t Go Easy: Others come for treatment because they’re unhappy with how they are functioning or feeling. They may be painfully depressed, or anxious, or guilty, or alone, or sad all the time. They may have difficulty managing relationships, or they may keep getting in trouble at work, or be unable to study, or be blocked in creative pursuits, or have trouble coping with a chronic illness, or be unable to have sex comfortably.

Problems of this sort have usually been going on for a time. They may have gotten worse recently, which has prompted thoughts of seeing a therapist. Medication may be very helpful, but it’s usually not enough by itself. Talking helps. It’s a very common experience for patients to feel, when therapy goes well, that the therapist is the first person that they’ve really been able to open up to, fully, and that that it’s the first time they’ve really felt understood.