26/07/2025
Psychotherapy, uncertain art, uncertain science
December 2019
I used to be an occasionally good university teacher before changing professions to practicing psychotherapy full time. This was over in Perth, Western Australia. We had a syllabus to follow, lectures and tutorials to run and they followed a pretty standard course. Since then, I’ve worked solely as a psychotherapist. There are similarities to teaching – we want the best for those under our care – but the way we go about it is very different. As psychotherapists, we observe and guide the other person(s), and we participate in their lives, aiming to bring forth insights, understanding, different ways of doing things, as well as strengthening their sense that only they are the authors of their lives.
Psychotherapy is art and science: fumbling, uncertain, creative, experimental; it’s a growing body of psycho-social-spiritual knowledge, it’s an understanding of the dynamics between people; it’s sometimes methodical, ordered, and follows a clear beginning, middle and end; it’s helped by therapist self-awareness (which is very important) and depends on just seeing what is effective and what isn’t, it unfolds, it explores, and it’s not a journey that finishes with the last therapeutic session. It’s part of a life time of self-discovery. Those coming to therapy or counselling or whatever you call it should not expect clear cut outcomes all the time; it’s not an anti-inflammatory pill for the mind, despite what some might tell you. A course of treatment is a dubious way of talking about what is a much more subtle and impactful process. Here is a therapeutic conversation that has goals along the way, but they are reached via improvisation, intuition, acute listening and trial and error. That is the best therapy, as I and several others see it. Yes, we can strictly follow the protocols of psychotherapeutic schools and models and rituals, but when we do so, we cease to actually listen to what our client is saying in her words, her body, indeed her whole demeanor. When we get caught up in saying the ‘right thing’ we have stopped listening to what is. I fear I have missed quite a number of people as I’ve observed and participated in their therapeutic journeys, by doing exactly this. For that, I sorry.
One thing I need to say with regards to not listening properly to a client is that it forces me to sit with my own discomfort, to tolerate uncertainty and the hoard of ghosts of self doubt, but to also aim to be more present, more sensitive, next time. Irvin Yalom says of this that such is a prerequisite for the profession. Ours is a somewhat wobbly profession. We try to steer an even course through uncertain waters, while knowing that this goes against much of the common perception of what we do. That idea is that what we do follows predictable, measurable pathways but very often it doesn’t work that way, and that’s ok. The outcomes may be quite different from what could’ve expected at the outset.
Though I speak of such things, I also know that the journey we travel together isn’t without a safety net, well, actually a few safety nets. Psychotherapists have been trained (in my case, university trained at a post-graduate level), we have experience, we are monitored by a colleague or colleagues in supervision, we participate in ongoing professional and personal development, we are bound by a rubric of ethics, we are insured, we abide by the laws surrounding our practice and, basically, we just care what happens to our clients.
Ours is a caring profession. We guide, we accompany, we share, but we do so from a fairly objective position. If we did it any other way, both of us would be lost. But in participating with the client in a deeply human way, we allow them, and us, to be changed at the very heart of the therapeutic encounter. This is a rich, wonderful collaboration where both client and therapist are nourished in a journey that reintroduces the client to the authorship of their own lives, and that’s good to be part of.
