Lisa Padfield | Clinical Psychologist
Stellenbosch, South Africa

What is therapy?

Counselling or therapy or psychotherapy: these terms are used interchangeably.  Therapy is a process in which a trained professional employs psychological strategies (rather than medical or pharmaceutical ones) for addressing emotional problems.   Most often, the aim is to improve your ability to manage your life challenges through, for example, strengthening communication and coping skills, reducing inter-personal conflict, enhancing your understanding of problematic patterns etc. 

Therapy is a process. This is a deceptively simple statement.  It means that what becomes important is a willingness and openness to immerse oneself in an evolving, dynamic process.  Often the outcome is not guaranteed.  Often it is not even clear.  People generally come to me with broad statements such as “I have trouble communicating” or “I am unhappy”.  Part of the work is to arrive at a shared understanding of what is wrong and, therefore, what needs to change.  The overall aim of psychotherapy is to deepen our understanding of ourselves.

So you can expect to spend most of our session time in what I call the “emotional landscape” of your experience.  What do I mean?  Instead of us focusing exclusively on the current difficulties or symptoms (such as “I’m really stressed at work” or “I don’t know whether to stick it out or get divorced” or “I’m worried about how much I’m drinking” etc.), our work will be to try to uncover the root causes of the difficulties.  For example, underlying patterns of communication, how your personal history impacts how you are in the world, exploring the nature and source of the inter-personal conflict etc.  In other words, rather than spending time on what is going on on the surface, we will delve into what is really going on for you emotionally. For example, an unsatisfying work life may actually be about your parents’ expectations; unhealthy relationships may be tangled up with old anger or deep-seated fears or untreated depression. For many people this focus on feelings is uncharted territory and it can take some getting used to.

Read more about what therapy is.

What do I mean by "process"?

We will talk. And in so doing we will develop a shared understanding both of what the difficulties are and, of how they might be addressed. 

You will work hard in a way that is probably completely unfamiliar to you. Working on oneself or doing internal work is not something most of us are taught to do as children.  And like most things, it’s harder to learn new skills as an adult.

There will be change. Part of what makes people delay the decision to come to therapy is that they know, at a gut level, that things will never be the same again.  Together we will open the very can of worms that you have spent a lot of time and energy avoiding. Initially it may not be clear how the change will manifest. The nature of the change will be determined through the process. 

You may discover positive things. You may discover positive things about yourself and about your relationships. For example, we may uncover the healthy patterns that have helped you thus far, or that you have inter-personal strengths you were unaware of etc.

Therapy is a bit like taking a road trip.  You may know where you want to end up, but there are many different routes to get there.  Part of the process will be figuring out which route would be most helpful for you.

What can you expect from me as the therapist?

 You can expect me to be direct, but in a gentle way.  Therapy is often a highly-charged, emotional space in which feelings can run high.  It is my job to make sure that this stays contained and does not feel overwhelming or unsafe at any point. 

Where will we start?

We’ll start with a first meeting.  The goal will be twofold: for me to hear what you’re struggling with, and for you to check me out.  I’m a firm believer in ‘client-therapist fit’.  If we decide to work together, therapy would entail weekly sessions, at least initially, thus a big commitment in terms of time and money. 

How long will it take?

This is, quite simply, impossible to quantify.  The short answer is that therapy takes as long as it takes: anything between a few weeks and many years.  We live in a world where quick fixes are sought but seldom found.  Most people come to therapy after they’ve tried almost everything else (such as ignoring the problem, a variety of pills, having an affair, working longer hours, having a baby, drinking more, changing jobs etc.).  Part of the work is often to unlearn unhelpful patterns, in addition to learning new interpersonal skills.  This takes time and cannot be rushed.

A process, by its very nature, only has a clear starting point.  The end point can only be determined jointly by you and I.  Together we will determine when to bring the process to a close.  Obviously there will always be practical constraints such as time and money, which will need to be taken into consideration. 

Many factors will determine the duration of the process:  the nature of your specific difficulties, your commitment to the process, how regularly we meet etc.  Therapy works best when there’s continuity.  That means that as a client you make a commitment to attend to yourself at least once a week initially, for however long it takes to get to a point where you feel that you’ve resolved what needed to be addressed.

Can all psychological / emotional problems be "fixed"?

It’s important to realise that any therapeutic process has its limitations.  We as psychologists are not magicians: we cannot change people’s personalities, we cannot directly change the circumstances of your life.  Often people seek out a therapist after years of unhappiness.  During that time, patterns of relating which are unhelpful or even destructive may have become entrenched.  So while people come to therapy with the hope that things will improve, for some the most therapeutic outcome is arriving at place where you manage your life challenges better and in healthier ways.  At its very best, a successful therapy process will bring about personal growth, healing and enrichment.  

Why would you go through a therapy process?

If you want any of the following:

  • more out of your relationships
  • to get out of a stuck place in your life
  • to learn more about yourself
  • to move on from a life crisis such as an affair, the loss of a child etc.
  • to grow your intimate relationship so that it feels more meaningful
  • to assess where you are in your life in the face of life changes e.g. your kids have left home, you’ve started a new business or been retrenched, your first child has been born, one of your parents has died, you’ve been diagnosed with a serious illness etc.

Read more about who may need therapy.

How do I choose a therapist?

Read more about how to find the right therapist for you.

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