For many people, therapy is the best investment that they will ever make. A successful course of therapy is much like getting a correct prescription for glasses, in that it can alter the way a person sees the world. Though the process is more involved than getting a prescription, the results can be equally dramatic.

At the same time, psychotherapy requires a commitment of time, emotional vulnerability, and financial resources. Many people are understandably ambivalent about beginning the process. In this article, I will explore research on the benefits of psychotherapy that underscore why investing in therapy can be a wise decision.

What Therapy Seeks to Accomplish

To understand why committing to therapy is a good idea, it is worth reflecting on what therapy accomplishes. Most people who enter therapy come with only the broad knowledge that they have psychological distress. Yet their symptoms are often a reflection of irregularities in the brain.

A person seeking therapy will likely have had painful experiences. These incidents may have heightened their brain’s sensitivity to threats. These incidents could have diminished the brain’s reaction to positive social experiences as well. The way the person’s brain adapted to manage past pains may no longer be serving them well in the present. Instead, these changes may be contributing to emotional distress.

Neuroimaging studies have shown therapy can help re-balance the activity in people’s brain structures. This holds true for people with depression, phobias, posttraumatic stress (PTSD), and other conditions. Therapy can strengthen activity in the brain regions that allow people to reflect on and reinterpret distressing events. It can also reduce activity in the regions of the brain that send out fear signals.

The Value of Therapy

Anyone who has completed a successful course of therapy can attest to its value. But it can be hard to have the faith it takes to invest in the process long enough to see results. People who are considering therapy for the first time or who did not have a good fit with their first therapist may be nervous about making a commitment.

While therapy is certainly a commitment of resources, it is often worth the investment. Recent studies may help assign some concrete numbers to therapy’s value. One group of researchers looked at the relative value of therapy to direct financial compensation. They found therapy was 32 times more cost-efficient at alleviating psychological distress than money.

Another study compared how much life satisfaction is derived from changes to personality versus from monetary gain. Neuroticism, a tendency to react to stressors with negative emotions, was one of the most influential personality traits. The study found a significant reduction in neuroticism had the same value to life satisfaction as being given $314,000. As it happens, reduced neuroticism is a common outcome of therapy.

Therapy may also improve a person’s physical health. Research shows processing traumatic experiences can improve a person’s immune functioning. For people who have received a mental health diagnosis, engaging in therapy reduces their overall future medical costs by about 17%.  People who do not receive treatment can expect to see their overall medical costs increase by about 12% over time.

While these studies on the benefits of therapy may seem surprising, on some level they are intuitive. A person who resolves a physical symptom such as lower back pain often has a lasting increase in life satisfaction. This boost would be hard to replicate through material gain because the outcome is with the person wherever they go. Through reworking our brain’s functioning, therapy can provide a similar increase in well-being. While therapy is certainly a commitment of resources, it is often worth the investment.

References :

1. Abbass, A. A., Nowoweiski, S. J., Bernier, D., Tarzwell, R., & Beutel, M. E. (2014). Review of psychodynamic psychotherapy neuroimaging studies. Psychotherapy and Psychosomatics, 83(3), 142-147. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24732748
2. Boyce, C. J. & Wood, A. M. (2010). Money or mental health: The cost of alleviating psychological distress with monetary compensation versus psychological therapy. Health Economics, Policy, and Law, 5(4), 509-516. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19919728
3. Boyce, C. J., Wood, A. M., & Powdthavee, N. (2013). Is personality fixed? Personality changes as much as “variable” economic factors and more strongly predicts changes to life satisfaction. Social Indicators Research, 111(1), 287-305. Retrieved from https://link.springer.com/article/10.1007/s11205-012-0006-z
4. Chiles, J.A., Lambert, M.J., & Hatch, A.L. (2002). Medical cost offset: A review of the impact of psychological interventions on medical utilization over the past three decades. In N. A. Cummings, W.T. O’ Donohue, & K.E. Ferguson (Eds.), The impact of medical cost offset on practice and research: Making it work for you. Reno, NV: Context Press.
5. Karlsson, H. (2011, August 11). How psychotherapy changes the brain. Psychiatric Times, 28(8). Retrieved from http://www.psychiatrictimes.com/psychotherapy/how-psychotherapy-changes-brain
6. Pennebaker, J. W., Kiecolt-Glaser, J., & Glaser, R. (1988). Disclosure of traumas and immune function: Health implications for psychotherapy. Journal of Consulting and Clinical Psychology, 56(2), 239-245. Retrieved from https://www.researchgate.net/publication/19783166_Disclosure_of_Traumas_and_Immune_Function_Health_Implications_for_Psychotherapy
7. Veenhoven, R. (2008). Healthy happiness: Effects of happiness on physical health and the consequences for preventive health care. Journal of Happiness Studies, 9(3), 449-469. Retrieved from https://link.springer.com/article/10.1007/s10902-006-9042-1

People come to psychotherapy because they want to feel better. A big part of a therapist’s ability to help a person feel better lies in their taking a loving stance toward that person. This stance starts with a therapist’s understanding that it takes courage for another person to come to them and their sense of feeling privileged by the trust that person invests in them. The rest of this article describes the other core ways in which therapy involves love and why this matters.

Faith and Compassion

Having faith in a person’s inherent goodness, as well as compassion for how that person’s life experiences have influenced them, is integral to helping them. This love stems in part from a therapist’s appreciation of the vulnerability inherent in being human. People are vulnerable to being hurt by others. When they are in contact with individuals, families, work environments, or even cultures that are filled with anger, criticism, premature loss, or emotional distance, it is almost inevitable they will start to internalize these experiences and develop corresponding psychological symptoms.

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Children are particularly vulnerable to this phenomenon due to their limited power to assert themselves, and they often have no recourse but to accept messages that are hurtful. When people have been hurt, they start to believe negative things about themselves (e.g. “I’m hopeless,” “I’m a failure”) as well as negative things about others (e.g., “People will hurt me if I trust them,” “No one will ever care about me”). Not surprisingly, they also experience feelings such as anxiety, anger, and shame that accompany these beliefs and tend to act reflexively on these emotions. These reflexive actions make it harder to connect with others and reinforce their negative beliefs about themselves and others.

Therapy helps people to break out of these negative cycles by allowing them to have a new kind of experience with their therapist that feels more positive and empowering. When a therapist approaches a person with a basic belief in their goodness, over time a person can feel a therapist’s faith in them and internalize it, which starts to shift what they believe about themselves. A therapist’s compassion for the person they work with also contributes to this change.

An internalized sense of being loved by one’s therapist can vastly change how a person experiences the world.

People are understandably concerned about being judged when they come to therapy. They may be afraid that a therapist is going to try to force them to change, or that a therapist will condemn them for some of the choices they make. Rather than criticizing or blaming a person for how they feel and behave, a compassionate therapist helps a person to understand how they are doing the best they can given what their experiences have taught them. They also help the person to think about new approaches to addressing their challenges that may help them feel better in the long run. This compassion is also internalized and helps people make sense of their lives in ways that are less focused on blaming themselves or others and leave more room for them to take positive steps toward change.

Patience and Humility

Therapy is inherently challenging. It is common in the course of many long-term therapies for there to be moments where a person feels stuck as well as moments where they feel disappointed or angry with their therapist. If a therapist tries to force a person to change before they are ready, or if they handle a person’s disappointment defensively, these impasses can be destructive.

Rather than blaming a person for feeling stuck or disappointed, a therapist coming from a place of love recognizes their own fallibility and tries to take ownership for any contributions they may be making to a person’s discontent. They also try to help that person see the role they may be playing in it. These moments become opportunities to build trust and for the person to gain greater self-understanding, rather than being harmful moments that reenact earlier painful experiences the person has had. Many people have been traumatically shamed and/or abandoned when expressing negative feelings toward others, and it can be a profound experience to have a therapist who does neither of these things and instead tries to patiently help them understand their pain and continues to care for them.

Conclusion

Just as people can be hurt in their relationships, they can also heal in them. Therapy is not just a set of techniques, it is a special type of relationship that is oriented toward helping people to heal from past experiences.

An internalized sense of being loved by one’s therapist can vastly change how a person experiences the world. In addition to symptoms diminishing, other people who once seemed threatening may become sources of connection and the future may seem more hopeful. Generosity and compassion flourish in those who have felt loved, leading them to touch the lives of others. Fittingly, many therapists have been touched by another person’s love in their own therapy and find it to be a deep privilege to be trusted and to pass on the gift.

References:

1. Harrist, R. S., Quintana, S. M., Strupp, H. H., & Henry, W. P. (1994). Internalization of interpersonal process in time-limited dynamic psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 31(1), 49.
2. McAdams, D. P., Reynolds, J., Lewis, M., Patten, A. H., & Bowman, P. J. (2001). When bad things turn good and good things turn bad: Sequences of redemption and contamination in life narrative and their relation to psychosocial adaptation in midlife adults and in students. Personality and Social Psychology Bulletin, 27(4), 474-485.
3. Neff, K. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85-101.

People enter psychotherapy with the desire to feel better, but they are often unsure how therapy will help them accomplish this goal. A common refrain from people hesitant to enter therapy is, “How is talking going to help?” People are used to talking to other people to get practical solutions to problems, and while problem-solving does have a place in therapy, change also occurs on a much deeper and unconscious level. This process has to do with the way the human brain is programmed and cannot easily be mimicked outside of a relationship with a psychotherapist.

Our brains are always evolving unconsciously through our relationships. People who experienced painful relationships growing up have been trained to expect hurtful experiences with others. It takes a new type of relationship—in particular, a therapeutic relationship—to retrain the brain to expect more positive experiences, which is a big part of ultimately feeling better.

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Why Can’t a Therapist Just Tell Me What to Do?

To understand why the therapeutic relationship can be so valuable and cannot be mimicked by, for example, advice in a self-help book, it is instructive to look at how the human brain has evolved. Broadly, there are three parts of the human brain that represent different phases of evolution: There is the reptilian brain, which evolved first and is responsible for the automatic control of vital bodily functions such as breathing; the limbic brain, which evolved second and is responsible for the regulation of emotion and behavior; and the neocortex, which evolved last and is responsible for higher-order functions such as symbolic thought, language, and reasoning.

When a person asks their therapist or a friend what they should do about something, they are essentially asking for a neocorticol solution—something that is rational and can be consciously implemented. Often, however, their problems are a result of hurtful experiences in their earlier relationships that have caused changes in their limbic brain, and only a new type of relationship can alter their limbic brain to produce fewer negative emotions and more positive ones.

Brain Wiring in Our Youth: How Emotional Issues Begin

Our emotions are meant to help us survive in a world in which we need the help of others. Over time, our limbic brains evolved to automatically create emotions, such as anger and sadness, that are meant to help us navigate the social world. When someone mistreats us, evolution has programmed us to become angry to try and change their behavior. When someone rejects us, we feel sad so we can mourn the loss of what we wanted with them and move forward with our lives.

However, when we are young and particularly dependent on others for survival, whether our emotions actually help us navigate the world has a lot to do with how other people—our parents in particular—respond to them. A child who responds to unfair or disappointing experiences with anger and is further punished for doing so may, over time, come to unconsciously pair the expression of anger with pain. As this occurs, rather than directly experiencing anger at times of unfair treatment or disappointment, they may instead experience anxiety about having anger because their brain has been trained by their social environment to expect that anger will hurt rather than help. Their limbic system is in effect attempting to prevent further emotional pain in the form of being punished, but the cost is another type of emotional pain in the form of persistent anxiety. This can be particularly problematic when people enter into new relationships (friendships, romantic relationships) where there would not be the same costs associated with the open expression of an emotion like anger, but earlier experiences still create anxiety and inhibit its expression.

Retraining the Brain with Psychotherapy

A psychotherapy relationship allows a person to essentially retrain their limbic system to no longer expect negative reactions to the expression of certain emotional experiences, and in doing so can alleviate the anxiety and unconscious emotional suppression their earlier experiences programmed into them. The therapeutic relationship does this in part because the parameters of psychotherapy recreate the type of relationship in which a person was first forced to suppress their emotions: one where they are dependent on another person to meet their needs.

A successful course of therapy helps restore a person’s emotional flexibility and empowerment so they can have greater agency in their relationships.

Just as a parent has a daunting task in meeting all of a child’s needs, so too does a psychotherapist, especially since many people arrive to therapy wanting a conscious, rational solution to their problems when such a solution often does not exist. Therapy presents a unique opportunity to heal and feel better by the way the therapist solicits and responds to feelings such as disappointment, anger, and sadness that emerge over the course of treatment. Rather than punishing a person for having these emotional experiences in the same way that may have occurred when they were younger, a therapist can actively solicit, explore, and normalize their feelings. This helps to retrain a person’s limbic system to no longer pair the expression of those emotions with punishment. As this de-coupling unconsciously occurs, the person becomes more easily able to tolerate the experience and expression of emotions.

Thriving in Adulthood

This shift in tolerance for emotions naturally causes a person’s anxiety level to diminish because their mind is no longer fighting to ward off their innate emotional impulses. In addition to symptom relief, the beautiful part of this process is it restores a person’s ability to constructively access their emotions for their original purpose—as a way of helping to navigate the social world. It is hard to thrive in relationships when we have been programmed to believe we must accept the mistreatment of others or that we cannot show others when we are hurting and in need of care. As adults, this is often no longer the case, but our early experiences may make such underlying beliefs unconsciously feel true.

A successful course of therapy helps restore a person’s emotional flexibility and empowerment so they can have greater agency in their relationships. The result can be genuinely transformative, and studies suggest people who have been through therapy show less activity in the areas of the brain responsible for creating negative emotions. Talking, it turns out, can help quite a bit when the person you are talking to is a skilled and compassionate therapist.

If you’re struggling, reach out to a therapist in your area for help.

References:

1. Bowlby, J. (2005). A secure base: Clinical applications of attachment theory (Vol. 393). UK: Taylor & Francis.
2. Cozolino, L. (2010). The neuroscience of psychotherapy: Healing the social brain. New York, NY: W.W. Norton & Company.
3. Damasio, A. R. (2006). Descartes’ error. New York, NY: Random House.
4. Grecucci, A., Theuninck, A., Frederickson, J., & Job, R. (2015). Mechanisms of social emotion regulation: From neuroscience to psychotherapy. In Emotion regulation: Processes, cognitive effects and social consequences, pp.57-84.
5. Karlsson, H. (2011). How psychotherapy changes the brain: Understanding the mechanisms. Psychiatric Times, 21.
6. Lewis, T., Amini, F., & Lannon, R. (2007). A general theory of love. New York, NY: Vintage.
7. MacLean, P. D. (1990). The triune brain in evolution: Role in paleocerebral functions. Berlin: Springer Science & Business Media.