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Dr. Julia Vigna Bosson: What Makes Therapy Work

Julia VB Cropped & SizedAs part of an ongoing series, the staff at Union Square Practice will be sharing their thoughts on an important question: “What makes therapy work?” This week, Dr. Julia Vigna Bosson shares her thoughts.

If you’ve been following this series on our blog, the first ingredient that I’ll cite as crucial to effective therapy will sound pretty familiar—that’s a trusting, open, and judgment-free relationship between the therapist and the patient. All of our therapists have mentioned the therapeutic relationship as an essential tool in a patient’s recovery, and that’s not surprising—if you don’t feel comfortable with a therapist, how can you be expected to address those issues that make you feel most vulnerable and are causing the most problems? Whether the alliance between patient and therapist is formed within the first three minutes or the first three sessions of treatment, what’s certain is that without it, the therapy won’t be optimally effective.

This next ingredient isn’t often named as being crucial to successful therapy, but it should be—that’s an active, engaged patient. Don’t get me wrong, I’m not saying that my patients have to be full of energy and cheer for therapy to work, but it’s important for a patient to want to change and to be willing to put in some hard work to effect his desired changes. A person can’t be “therapized” against his will. Rather, therapy is an interactive process that requires the patient’s participation in and out of session. Without active participation on the part of the patient, the results of therapy can be greatly limited, even with the most effective therapist.

As long as we’re talking about therapists, let’s hold them accountable too.  It is essential for a therapist to embody traits like warmth and empathy. However, those aren’t the only therapist attributes that make treatment work—a therapist should be highly skilled as well, and that’s my third ingredient. A therapist who has treated hundreds or thousands of patients facing a variety of challenges is much more likely to be effective than one who doesn’t have the appropriate experience or training to address her patients’ clinical concerns. This, by the way, is one reason that I love working at Union Square Practice—because I am surrounded by talented professionals who take pride in improving their patients’ lives and who have the expertise to do so.

So far, I’ve really only talked about the people involved and the relationship between them as key ingredients that make therapy work. But there are other, more technical components involved too, and I’ll consider these components as a group to be my fourth ingredient. From a cognitive-behavioral perspective, which is what informs our general approach at USP, therapy works when patients are able to recognize and amend maladaptive thinking patterns and behaviors. This generally takes some practice, which means patients usually need to do some “homework” outside of session to make therapy work. Of course, this will be much more effective if patients understand what I, as their therapist, am asking them to do and why. From the beginning of treatment onwards, I make sure to explain each step to my patients and to include them as active participants in their own therapy because I’ve found that this sort of clarity helps to make therapy work.

Ultimately, what makes therapy work? This is my recipe: therapy works when a skilled therapist and a motivated patient have a trusting and open working relationship that involves identifying and changing unhelpful thinking and behavior patterns, which is generally achieved through clear explanations and lots of practice.  There are, no doubt, countless other factors that contribute to effective therapy, but these are among my favorite ingredients, to name a few.

If you have any questions about how therapy works, contact me via Twitter @DrVBosson!

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