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How Therapy Works: The Therapist's Job

I love a good story. One of my favorite pastimes is sitting down with a good book, movie, or TV show, and in doing so have come to the realization that the public image of therapists is an inconsistent concept. Consider for a moment the wildly varied terms people use to refer to clinicians; we have been called everything from “gurus” and “coaches” to “shrinks” and “quacks”. You could argue that this stems from the wildly conflicting portrayals of therapists in the media, where I have seen characterizations ranging between soft-spoken guides, incompetent buffoons, and sex-crazed ethical nightmares (which comes up so often I almost expect it when a therapist is introduced in a show). As a result, I have found that the concept of clinicians and the therapeutic process has been muddied in the eyes of people unfamiliar with therapy.

I would argue that inconsistency in the perception of therapists leads to confusion about the process of therapy itself. Terms such as CBT, DBT, ACT, psychoanalysis, EFT, transactional analysis, PMTO, eclecticism, and others are often flouted about in a way that makes it seem like their characteristics and distinctions (not to mention what the letters in the acronyms even mean) should be common knowledge, rather than something you need to attend school for 6 or 7 years to understand. In part two of my How Therapy Works series, I want to explore the therapeutic process and help clients understand what they might expect from their therapist, and I am using an example from the media to do so.


Just about every clinician I know aspires to have the same effect on their clients as Sean Maguire has in the life of the titular Will in the film, Good Will Hunting. Robin Williams gives a surprisingly grounded performance from an actor best known for his frenetic comedy and rapid-fire improvisation, and he imbues Sean with a wisdom that is at once profound and relatable (though an assist from Matt Damon and Ben Affleck’s script has to be acknowledged). While not a perfect portrayal of the therapeutic process, Good Will Hunting serves as an effective example of what therapy is and how it works, particularly in what a therapist may be trying to accomplish in session. It also helps that it is heartfelt and crowd-pleasing!


The basic premise of the film is that a troubled genius named Will (Matt Damon) is taken under the wing of Gerald Lambeau (Stellan Skarsgård), an ambitious MIT mathematician. When Will gets in trouble with the law, Lambeau attempts to keep him out of prison by enrolling him in therapy with Sean. The movie focuses heavily on the relationship between Will and Sean and the manner in which Will develops as a result of his time in therapy. It gets a “two thumbs up” rating from me, not just for the depiction of therapy, but also for the screenplay and performances. **Disclaimer: the movie is rated R for some violence and strong language throughout, including some sex-related dialogue and accounts of abuse. Some of the example clips include uses of this language.


In exploring the film, I want to highlight four sessions between Sean and Will that provide good examples of what the process looks like and will be relevant across nearly every methodology of therapy.



“October 21st, 1975”



This is not the first session sequentially in the movie, but is an excellent example of one of the key elements therapists will work to establish in the beginning of treatment: rapport. Therapy works best if it is an interaction between two humans who recognize each other as humans, rather than a faceless “expert” working with a hapless patient.


Those of you who have seen the movie will remember that Will struggles to form close relationships because of the fear of the pain inherent to attachment. Sean could easily rattle off some textbook illustration of loss and five quick coping skills to dealing with it, but he chooses a more relatable option. He is able to connect with Will on a personal level by illustrating details of his own marriage and loss, but goes even beyond that. Rewatching this scene, it strikes me how out of place Sean–with his soft-spoken manner and questionable sweater choices–appears when he talks about baseball because it is the last thing I would expect from him in that moment. I’m not from Boston, but I hear that the Red Sox are kind of a big deal there, and Will is able to see Sean in a new light when he recognizes that they share a love of the team. Viewers can observe clearly how Will instantly responds to discussion of a huge moment in Red Sox history and how he and Sean are able to bond over accounts of the game and even the gait of the batter. The therapist and client are able to find common ground over a shared passion, and their relationship evolves from there. (I particularly enjoy the overhead shot of the office that depicts Sean’s office similar to a baseball diamond, symbolizing the progress he is making with Will).


The significance of this rapport is that in Will’s eyes Sean is no longer just some professional with a bunch of letters after his name, but a figure that he can relate to and understand. This relationship is what gives him the security to let his guard down with Sean as therapy progresses, which is why therapists place such a strong emphasis on rapport. It may not be as dramatic or as personal as it appears in the movies, but therapists will work to bring the focus of early sessions to a clients’ humanity, rather than the disorder. In exchange, therapists will often share a bit of their humanity as well. This casual sincerity is what makes discussion of the difficult subjects possible, and forms the foundation of effective therapy.



“You’re Just a Kid”



To reiterate, Will is a genius. It is reasonable to consider that he may know more about the theory and practice of therapy than any of the therapists he could meet with. He rips apart multiple therapists before his first meeting with Sean, and then nearly succeeds in doing the same to him. Sean, however, eventually lays out exactly what he can offer to Will by delivering the monologue that likely won Robin Williams, Matt Damon, and Ben Affleck their Oscars. The speech illustrates the disconnect between Will’s book knowledge and lack of actual experience: “If I asked you about art, you’d probably give me the skinny on every art book ever written…but I bet you can’t tell me what it smells like in the Sistine Chapel…”. \


In order for therapy to work, clients need to believe that it can work and that their therapists have something to offer. I will often explain to my clients that therapy is a collaborative process: I bring the knowledge of the science, and they bring their knowledge of themselves. Sean almost serves the reverse role in his practice with Will: Will knows the science, but Sean helps Will to see that the experience is what he is missing when it comes to improving his life. Taking the time to explore how and why therapy works becomes the next crucial part of the process.


*I will throw out the disclaimer that you are unlikely to get an eloquent monologue from your therapist illustrating this point (if you read my previous post, you also know how I feel about therapists monologuing), and in most situations it will be unethical for your therapist to meet you in a public place like a park bench.



“Your Move, Chief”



I am cheating with this one, because the line of dialogue in the header is the last words spoken by Sean to Will in the park bench scene, but it illustrates Sean’s intention in the session following the scene. The only words Sean says throughout that entire hour are “No smoking”, and Will opts to sit in silence. Though this seems counterproductive, Sean is giving Will the opportunity to choose to participate in sessions, essentially playing a game of therapeutic Chicken.


A rule of thumb that therapists often follow is “don’t work harder than your clients”. Your therapist will want to give you the opportunity to direct sessions and discuss the topics that are important to you. This is unlikely to take the form of an hour of silence (though I have heard of successful therapy occurring when clinicians have done so), though the concept is summarized well in this scene. Depending on their preferred modality of treatment, therapists may have an agenda and a plan of their own to follow, but therapy only works if the client decides to engage. Sean is standing back to allow Will to make the next move, in a similar manner that real therapists will incite initiative from their clients.



“It’s Not Your Fault”



We have finally gotten there, perhaps the most famous scene in the movie. Sean and Will discuss their own experiences having been physically abused as children, when Sean suddenly walks up to Will and repeats “It’s not your fault” over and over again until Will finally breaks down crying and hugs Sean. The catharsis of the scene speaks for itself as Will lets go of the burdens he had been bearing his whole life. Sean successfully challenged Will to confront and reject the core belief that he held for years, and Will was finally able to free himself from the shame he carried. This scene represents what people consider the “breakthrough” session, where everything finally clicks with the client and they finally come to terms with their past and can move forward. In fact, the movie ends shortly afterwards with Will driving off into the sunset having overcome his traumatic childhood.


As I consider my time working with clients, there are often specific sessions that I can point to as turning points in their journeys. These occur when people can connect their experiences with their current emotional and behavioral patterns. We are all affected by our pasts, for better and for worse. In the case of the darkest experiences, it often feels easier to put those experiences in a box and bury them deep so we do not have to deal with the pain of confronting them head on. Unfortunately, burying emotions is more akin to planting a seed; rather than staying put, they will grow until they burst through the surface in ways we don’t expect. Therapy is often about digging these experiences up and facing them because doing so is the only way to free ourselves from their hold over us.


This session provided the film with its required emotional and dramatic climax to wrap the story up neatly, but I want to emphasize that though I have seen sessions like this in my practice, real life is rarely so cut and dry. It’s unlikely that a single session will send you off to a happily ever after; many clients still struggle even after “breakthroughs”, and their journeys are generally more complicated than fiction. Furthermore, these breakthroughs are not necessarily an automatic part of therapy; I have seen clients experience successful therapy without having significant “AHA” moments. Despite these qualifiers, therapy can (and some may argue should) be a life-changing process. Essentially, there is no single correct way to experience therapy, but successful therapy will involve examination of personal tendencies and pain.


*It is worth noting that though Sean hugs Will in this scene, most therapists will avoid this type of close, intimate contact as a matter of ethics.


Conclusion


Many depictions of therapy in the media only serve to sow confusion regarding the concept of the practice, but I am happy to comment on Good Will Hunting’s (relatively) accurate and effective portrayal. Therapy is a weird concept; the idea of sitting down and spilling your life story and secrets to a complete stranger is an uncomfortable prospect, to say the least, and I hope that this post makes the idea of therapy less daunting for anyone considering it.


I do want to reemphasize that Sean Maguire is not the perfect example of a therapist. In his first meeting with Will, he grabs Will by the neck after Will provokes him. While this is an excellent way to milk dramatic tension out of a movie scene, any real therapist who commits such an act is likely to do significant psychological damage to their clients, not to mention risk opening themselves up to malpractice suits and the loss of their licenses. Though I am using the movie to illustrate examples of actual therapy, it is important to separate this fictional story from reality.


All disclaimers aside, at the end of the day, therapy does not need to be a mysterious concept. Will’s story ends after Sean helps him turn his life around following a sensical process that applies in real life. If you strip it down to its bare-bones state, therapy is simply real people doing their jobs following methods proven to be effective by scientific study. There is a method to the madness, and you can take comfort in understanding there is a road map to follow.


-Connor Jewell, LPC


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