Not What or Why, But How: Navigating the Profound Depths of Therapeutic Process

In therapy, the crux lies not only in the words spoken but in the manner in which they are expressed. Clients may reveal, hold back, or convey their thoughts with unique speed and pressure. These subtle nuances are not mere idiosyncrasies; they serve as windows into their inner experiences, fears, and challenges. The process of expression often holds the key to unlocking the deeper layers of a client's narrative. We also know that this is challenging: clients' experiences in the initial phase of therapy unveils a common theme — "Holding back and struggling to open up." Through in-depth interviews and interpersonal process recall, participants revealed fears related to negative emotions, bodily limitations, feelings of unworthiness, and struggles with loyalty to loved ones. This reluctance to open up was rooted in concerns about the consequences of revealing inner experiences, emphasising the need for therapists to build safety in psychotherapeutic work; and to help clients feel safer as discussions move from content to process.

Imagine a client describing a personal struggle and getting visibly emotional. A content-focused therapist might delve into the specifics of the struggle, what happened or why it happened examining the associated thoughts and emotions. A process-focused approach, on the other hand, may explore the sudden emotional shift itself, inquiring about the experience of expressing vulnerability in that moment. Consider a scenario where a client recounts a challenging situation at work. In a content-focused Cognitive Behavioural Therapy (CBT) approach, the therapist may delve into the specifics of the event, aiming to identify and challenge negative thought patterns related to the workplace. However, a process-focused CBT approach would scrutinise how the client shares this narrative. Does the client rush through the recounting, perhaps avoiding certain details? Is there a palpable sense of urgency or tension in their communication? The therapist, attuned to the process, might gently inquire about the client's experience of sharing, aiming to uncover patterns or emotions associated with the act of storytelling itself. They will help you by highlighting the role of underlying beliefs, assumptions, and rules that maintain repeating patterns in life. These patterns often replicate in the therapy room, providing a fertile ground for exploration as a process rather than a singular incident.

Therapist: "Tell me about what happened at work."

Patient: "Well, my colleague said something that really upset me, and I just couldn't handle it."

A content-focused Cognitive Behavioral Therapy approach might lead the therapist to delve into the specifics of the event, aiming to identify and challenge negative thought patterns related to the workplace. However, a process-focused approach would look at how the client shares this narrative.

Therapist: "I sense there's more to this. Can you share what it's like for you to talk about this?"

Here, the therapist pays attention to pauses, hesitations, or a hurried tone. Is there an underlying emotion that the client seems to be avoiding? By exploring the process, the therapist could gently inquire about the experience of sharing this workplace incident.

Therapist: "I noticed you hesitated when talking about your colleague's comment. Can you share more about that moment?"

Patient: "I guess I didn't want to admit how much it bothered me. It felt silly."

Within the therapeutic realm, the unspoken carries profound meaning. Non-verbal cues, communication patterns, and the things clients choose not to say offer a rich tapestry of insights. Therapists who attune themselves to the unspoken can uncover fears, concerns, or transference that may not find explicit expression in the content of the conversation.

Central to this exploration is the work of Mary Jo Peebles-Kleiger, whose insights delve into the art and science of planning psychotherapy. Peebles-Kleiger emphasizes the importance of creating a safe space for clients to explore their inner experiences. This involves thoughtful planning on the therapist's part, ensuring that the therapeutic environment fosters openness and trust. Peebles-Kleiger's work extends beyond the initial phases of therapy. She underscores the need for therapists to understand the dynamics of the therapeutic process throughout the entire journey. By paying attention not just to what clients say but how they say it, therapists can navigate the intricate terrain of therapeutic relationships.

In the tapestry of therapy, the essence lies not just in the words shared but in the way they are expressed. Clients' unique communication styles and hesitations are gateways to deeper exploration and healing. By embracing the power of process over content, therapists can navigate the intricate terrain of therapeutic relationships, fostering an environment where understanding the 'how' takes precedence, leading to transformative outcomes.