As I am a psychotherapist in London EC1, I’ll keep the explanations in relation to how psychotherapy works and what the therapist does within my experience and knowledge framework.

1. What Does A Psychotherapist Actually Do?
You might have seen some caricature or perhaps a scene in a comedy show portraying a therapy
session as this: a patient lying on the couch talking and talking, and a psychotherapist or
psychoanalyst sitting behind either sleeping, or doodling on a notebook, or doing something else
besides listening to what the poor patient was saying. I even saw one cartoon where there was a
skeleton instead of the therapist sat behind the patient, as if the analyst had long died whilst the
patient was still talking.
Well, although it is a funny anecdote (if you’re not the neglected patient, that is), it hardly represents
the truth. And it shouldn’t, because it’s an anecdote and it’s meant to be funny. Right, but what
exactly does a psychotherapist do? How does therapy work? How can talking therapy help?
In this little article I’ll try to address some of these questions as clearly and accessibly as a can, so
you can understand a bit about what a therapist does and how psychotherapy works.
Firstly I should say that there are many different types of talking therapies, and many different
approaches and theories to base them. Besides that, every therapist has his/her own way of
working, a ‘personal touch’, which is nothing more than a style of conducting the sessions. Although
the theories and techniques in each approach in psychotherapy are solid and should be applied to
any therapy, each psychotherapist will inevitably bring his/her own way of working with these. Most
importantly, every client is unique, and therefore each therapy will inevitably become unique and
specific.
Just so you can get the picture: there are some important general guidelines to be followed in
psychotherapy and counselling, but they are experienced differently both by the therapist and the
client as they work together. Because therapy takes place in the meeting of two minds, it is expected
that this encounter will produce something unique. And this is the beauty of psychotherapy: it
represents diversity and flexibility.
As I am a psychotherapist in London EC1, I’ll keep the explanations in relation to how
psychotherapy works and what the therapist does within my experience and knowledge framework.
So here are a few general considerations on what psychoanalytic psychotherapy involves.
Talking helps: there is something very therapeutic in talking. When something happens in our life,
good or bad, it’s always good to talk about it. Some of us feel more inclined to do so, whilst others
tend to keep things more to themselves. But telling something to someone else allow us to revisit
what happened, to think and to elaborate more on what is being recounted. As we do so it helps us

2. gain new perspectives. Something liberating and releasing happens when we talk. So in
psychotherapy you will feel this very desirable effect. But it doesn’t stop there, otherwise our friends
or family would do the job. A psychotherapist is trained to listen in a non-judgmental and confidential
way. He/she will help you find new ways of thinking about what is being talked about, pointing to
aspects that perhaps were not as evident and clear at the time. A psychoanalytic psychotherapist will
also pay attention to what the client communicates in an unconscious level, the hidden meanings
beyond and underneath the words, or to patterns that the patients perhaps is not so much aware of.
These will bring about important realisations, which can lead to awareness and change.
Neutrality: as you talk to your therapist, you might observe that he/she does not react or respond in
the same was as other people. They might seem less affected by what may be very painful to you.
This doesn’t mean that the therapist doesn’t feel anything, or that he/she is cold and dismissive. The
psychotherapist is in fact allowing you and him/her some internal space for thinking. This will give the
patient freedom to express anything without worrying too much about horrifying the therapist, as well
as provide the therapist with an internal breathing space to formulate interventions and
interpretations. Believe me, although you may wish so, you don’t need for the therapist to be your
friend. You need him to point out the truth, which will help you develop and change.
Interpretations: as the psychotherapist listens to you, he/she will be formulating in the mind some
interventions, trying to uncover the meaning of what you may communicating, be it in a conscious or
unconscious level. When a therapist shares an interpretation, he/she may be trying to disrupt
unhealthy defensive measures, calling out unconscious feelings, challenging contradicting thoughts
and helping the patient to face pain and difficulty. This can feel very painful at times, but it is
absolutely necessary for the psychotherapy work to take place. It will eventually help the patient to
acquire the tools necessary to carry on knowing themselves better, so that they are not caught up in
unhealthy patterns or left overwhelmed with disconnected feelings.
Building links: interpretations have also the function of linking up scattered elements in the mind
that may be repressed, projected onto others, converted into symptoms (e.g OCD, depression,
stress, anxiety). This is also therapeutic.
Identifying patterns: the psychotherapist will help the patient to identify patterns of behaviour,
feelings or relationship that may be affecting their life. This is important as it will allow the patient to
reacquire the chance to change such patterns, by becoming aware of them.
Finding meaning: there is meaning underneath every word, feeling, thought or behaviour, and the
psychotherapist is there to help you find this meaning.
Thinking instead of acting: sitting down with a psychotherapist and talking about your problems
gives the patient a chance to develop the ability to think instead of act on every impulse that kicks in.
The psychotherapist will help the patient to find an internal breathing space, so when situation rise
he or she will be able to carefully think before making any decision.
As a psychotherapist in London EC1, I could spend ages listing every aspect of what a
psychotherapy does and how psychotherapy works. As this is not possible, I hope this little article
has captured some of the essence of what psychotherapy entails. But instead of just trying to learn
from a blog post, why not experience for yourself?