Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

A physician’s perspective on what therapy is

Maire Daugharty, MD
Conditions
January 11, 2021
281 Shares
Share
Tweet
Share

Therapy is a treatment intended to heal a disorder. That’s the medical perspective anyway, and it’s not wrong, but it’s maybe only part of the picture. Therapy frequently begins by addressing a primary complaint or problem in a collaborative relationship that grows over time. And during that time, while the client is assessing trustworthiness, the clinician continues to work towards an effective therapeutic alliance. How this exactly occurs depends a little bit on the lens through which one looks but a common factors approach observes that the relationship is the most important ingredient in therapy. Although all of this is true, it didn’t really make sense when I was initially curious about what really makes therapy work. First of all, what is the “work” of therapy? Isn’t it just two people talking, and eventually, someone’s depression or anxiety or anger gets better? And what does the collaborative process really mean? One’s talking, one’s listening, one takes notes, the other goes home to survive another week. What gives, what’s this really all about.

I think it’s hard to describe therapy because it is a different process for everyone. No one’s depression, anxiety, dissolving relationship, or sh*tty boss is the same. No one’s defining experiences are alike. Our expectations of life and of the people around us all differ and contribute to where and who we are. And all of that shows up in therapeutic work. We bring what’s on our mind to the therapy hour and talk about it, a therapist makes interventions, some subtle some obvious, and two things happen. We go home, and our minds continue to work on the issues, and our expectations begin to change over time. To really understand this, it’s helpful to understand how language develops in infancy.

Infants are born making similar sounds all across the globe. It is in interaction with another adult human being that a particular language’s unique facets develop out of those universal sounds. Some sounds are attended to, others ignored, and the baby is exposed to all of the sounds of language that eventually become part of the native tongue. The infant brain is wired to soak up and sort out language. Similarly, the infant brain soaks up expectations of important people based on experiences with an early primary caregiver; mom, dad, grandparent, or whoever fulfills that role. Infants who are denied regular, meaningful human interaction do not develop as has been formally observed and documented in multiple studies. At the most extreme end of the spectrum, these babies fail to thrive, and they die. Babies who do have adults to interact with grow up to reflect expectations learned in those earlier interactions. Because there is no explicit memory for this early foundational experience, much of our behavior is driven by assumptions for which we have no awareness. This is contemporarily described, in part, by attachment styles.

Inferences about early relationships can be made based on how we interact with others, especially those of importance like spouses or intimate partners. For example, when a conflict arises between you and someone you love, are you more likely to tackle it head-on, pretend it doesn’t exist, ignore it, hope it will go away, get very depressed or anxious, get angry, or insist on one outcome? Our typical response tells us a little bit about how we expect things to work out, and we often behave accordingly. Neuroplasticity plays a huge role in the observation that our underlying expectations, even those we are only vaguely aware of at best, can change. This is where the collaborative relationship comes in, as well as some of the work of therapy. As we are pitting our unexplored, implicit expectations against what we expect to be a wall of some sort, a consistent unexpected response begins to alter the tracks of our mind. Neurobiology has come a long way in explaining so many of the observations initially made by Freud a hundred years ago, and built upon by so many theoreticians since. Maybe we should talk more about this.

Maire Daugharty is an anesthesiologist.

Image credit: Shutterstock.com

Prev

Reducing death from COVID-19 pneumonia before widespread vaccination

January 11, 2021 Kevin 0
…
Next

2020 in hindsight: What we can learn

January 11, 2021 Kevin 0
…

Tagged as: Psychiatry

Post navigation

< Previous Post
Reducing death from COVID-19 pneumonia before widespread vaccination
Next Post >
2020 in hindsight: What we can learn

More by Maire Daugharty, MD

  • Physician struggle with feelings of betrayal

    Maire Daugharty, MD
  • The weight of the pager

    Maire Daugharty, MD
  • Trauma is ever-present in the practice of medicine

    Maire Daugharty, MD

Related Posts

  • Prescribing medication from a patient’s and physician’s perspective

    Michael Kirsch, MD
  • A physician’s addiction to social media

    Amanda Xi, MD
  • How a physician keynote can highlight your conference

    Kevin Pho, MD
  • Chasing numbers contributes to physician burnout

    DrizzleMD
  • The black physician’s burden

    Naomi Tweyo Nkinsi
  • I can’t breathe: an anesthesiologist’s perspective

    Audrey Shafer, MD

More in Conditions

  • The surprising medical mystery of a “good” Hitler: How a rescued kitten revealed a rare movement disorder

    Teresella Gondolo, MD
  • The power of coaching for physicians: transforming thoughts, changing lives

    Kim Downey, PT
  • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

    Althea Halchuck, EJD
  • An obstetrician-gynecologist reveals the truth about reproductive planning and how to navigate society’s expectations

    Yuliya Malayev, DO, MPH
  • Nose-brain connection: The surprising link between allergies and mental health revealed

    Kara Wada, MD
  • Is the rise in mental illness due to greater awareness or a true increase in incidence?

    Zahid Awan, MD
  • Most Popular

  • Past Week

    • How chronic illness and disability are portrayed in media and the importance of daily choices for improved quality of life

      Juliet Morgan and Meghan Jobson | Physician
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • Emulating Michael Jordan’s winning mindset: a path to success for health care professionals and entrepreneurs

      Harvey Castro, MD, MBA | Physician
  • Past 6 Months

    • The growing threat to transgender health care: implications for patients, providers, and trainees

      Carson Hartlage | Policy
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
  • Recent Posts

    • The pros and cons of taking a gap year during medical school

      Med School Insiders | Education, Sponsored
    • A family physician’s journey on the OIG list and the struggle to return to practice [PODCAST]

      The Podcast by KevinMD | Podcast
    • Heartwarming stories of cancer patients teaching us about life and the human spirit

      Johnathan Yao, MD, MPH | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • The meaning of death in medicine: the role of compassionate care in end-of-life patient care

      Ton La, Jr., MD, JD | Physician
    • From skydiving to saving lives: a surgeon’s journey on adversity, passion, and perseverance [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • NT-proBNP for All; Risky Weekend HF Admits; Ticagrelor for Infective Endocarditis?
  • Clinical Challenges: Test Your Knowledge of Dry Eye Disease
  • Clinical Challenges: Meibomian Gland Dysfunction Underdiagnosed and Undertreated
  • Best Exercise Time; FDA's Diabetes Guidance; Weight Discrimination Illegal in N.Y.C.
  • 10 Asian Americans in Healthcare Worth Following on TikTok

Meeting Coverage

  • New Model Aims to Study Intestinal Fibrosis in Crohn's Disease
  • Hypertension Tied to Worse Survival After Surgery for Upper Tract Urothelial Cancers
  • The Role of Amyloid PET in the Management of Alzheimer's Disease
  • New Inflammation Inhibitor Proves Effective and Safe for Dry Eye Disease
  • No Access to Routine Healthcare Biggest Barrier to HPV Vaccination
  • Most Popular

  • Past Week

    • How chronic illness and disability are portrayed in media and the importance of daily choices for improved quality of life

      Juliet Morgan and Meghan Jobson | Physician
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • Emulating Michael Jordan’s winning mindset: a path to success for health care professionals and entrepreneurs

      Harvey Castro, MD, MBA | Physician
  • Past 6 Months

    • The growing threat to transgender health care: implications for patients, providers, and trainees

      Carson Hartlage | Policy
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
  • Recent Posts

    • The pros and cons of taking a gap year during medical school

      Med School Insiders | Education, Sponsored
    • A family physician’s journey on the OIG list and the struggle to return to practice [PODCAST]

      The Podcast by KevinMD | Podcast
    • Heartwarming stories of cancer patients teaching us about life and the human spirit

      Johnathan Yao, MD, MPH | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • The meaning of death in medicine: the role of compassionate care in end-of-life patient care

      Ton La, Jr., MD, JD | Physician
    • From skydiving to saving lives: a surgeon’s journey on adversity, passion, and perseverance [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

A physician’s perspective on what therapy is
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...