In the realm of physical health, the difference between a medical practitioner and a patient is clear-cut. The doctor holds specialized knowledge about the human body that the patient typically does not possess. This expertise enables the practitioner to reinterpret the patient’s symptoms—what may feel like a simple sore ankle to the patient might be diagnosed as an inflamed Achilles tendon by the doctor. Though the patient might not fully understand the diagnosis, they often accept it on faith, trusting that the treatment will lead to recovery. In many ways, these dynamics parallel the relationship between psychotherapist and client, but with some critical nuances that reflect the diverse approaches within psychotherapy.
The Role of Trust and Understanding in Therapy
In medicine, trust in the practitioner’s expertise allows the patient to endure seemingly unrelated treatments, such as receiving a shot in the arm for a stomach issue. Similarly, in psychotherapy, the therapist often bridges the gap between the client’s subjective experience and a broader, theoretical understanding of their difficulties. However, unlike in medicine, psychotherapy’s success relies heavily on the client’s ability to connect with and internalize the therapist’s insights. This shared understanding—often referred to as a “common factor”—is foundational to therapeutic progress (Bambling & King, 2001).
Different clients have different needs when it comes to this process. Some may require a prolonged period of feeling deeply understood before they are open to new perspectives (Kohut, 1981). Others might actively seek a fresh framework for understanding their experiences from the outset (Mermelstein, 2002). The therapist’s role, then, is to balance empathy with interpretation, tailoring their approach to the client’s readiness and needs.
Different Models, Different Approaches
Cognitive Behavioural Therapy (CBT) and psychoanalysis illustrate two distinct approaches to fostering understanding and change in therapy. CBT emphasizes transparency and collaboration. From the outset, clients are introduced to the CBT model, with the hope that they will “buy in” to its logic. The therapist’s role is somewhat akin to a teacher, equipping clients with tools and strategies they can use both within and outside of sessions. This approach often appeals to those seeking immediate, practical solutions to their challenges.
Psychoanalysis, on the other hand, often requires a leap of faith from the client, especially in the initial stages. Rooted in the exploration of unconscious processes, psychoanalysis involves the therapist offering interpretations that may initially feel foreign or disconnected from the client’s conscious understanding. Over time, these interpretations aim to uncover hidden patterns and meanings, fostering a deeper self-awareness that is unique to this modality. While CBT focuses on restructuring problematic thoughts, psychoanalysis seeks to make the unconscious conscious, transforming what was once irrational into something comprehensible and meaningful.
Matching the Approach to the Client’s Needs
Both CBT and psychoanalysis offer valuable tools, but their effectiveness often depends on the client’s preferences, goals, and readiness for change. Some clients thrive with CBT’s structured, goal-oriented approach, while others benefit from the exploratory, interpretive nature of psychoanalysis. The therapist’s skill lies in discerning which approach—or combination of approaches—is best suited to the individual.
For example, a client struggling with a sudden onset of obsessive-compulsive behaviours in response to a significant life event might find immediate relief through CBT’s focus on cognitive restructuring and exposure techniques. Whilst they may not be interested in understanding why these symptoms occurred and may be unconcerned with whether they will turn up in new ways in the future. Conversely, the same client may be struggling with obsessive-compulsive behaviours that are linked to a history of difficulties and life changes. This client may acknowledge and be grappling with longstanding relational patterns and might achieve more profound, lasting change through psychoanalytic exploration of their unconscious motivations and transference dynamics.
Toward a Collaborative Understanding
The ultimate goal of any therapeutic approach is to offer the client something they cannot achieve on their own. This might be a new perspective, a deeper understanding, or practical tools for managing their difficulties. Therapists must walk a fine line between being an empathetic collaborator and a knowledgeable guide. Avoiding the role of “expert” altogether risks depriving the client of valuable insights, while overly rigid adherence to a theoretical model can alienate those who need to feel deeply understood.
When done well, therapy is not about imposing a foreign solution but about co-creating a path to understanding and growth. Just as a doctor’s prescription is validated by the patient’s recovery, a therapist’s interpretations and interventions must resonate with the client’s lived experience to foster lasting change. The “pills” of therapy—whether they take the form of CBT’s structured strategies or psychoanalysis’s deep insights—must ultimately dissolve into the client’s understanding, leading to a sense of clarity and empowerment.
Conclusion
Therapy is not a one-size-fits-all endeavour. Each client comes with unique needs, and effective therapy requires a thoughtful balance of understanding, interpretation, and collaboration. Whether through CBT’s pragmatic techniques or psychoanalysis’s exploration of the unconscious, the essence of therapy lies in its ability to meet clients where they are and guide them toward where they want to be. In this way, therapy becomes a shared journey, with the therapist offering both the map and the companionship needed to navigate it.
References
Bambling, M. & King, R., (2001). Therapeutic Alliance and clinical practice, Psychotherapy in Australia, 8(1), 38-43
Kohut, H., (1981). On Empathy, The Search for the Self, V4, International Universities Press.
Mermelstein, J.J., (2002). Kohut’s Understanding and Explaining Steps: Clinical Considerations Influencing the Need for a Prolonged Understanding-Only Phase, Progress in Self Psychology, 18: Postmodern Self Psychology, NJ: The Analytic Press.
Kane Solly Psychology 
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