How can a therapist get the most out of therapy?

For a session between an analyst and their patient to truly work, we need to listen, think and feel

The goings-on in the consulting room have become more transparent of late. Thank goodness. We know more than the hackneyed clichés supplied by the movies in which the therapist knows all and bestows wisdom on those who, prone on a couch, consult with them.

Therapists are interested in how the individual, the couple or the family experiences and understands their difficulties. That has to be a starting place. We can be of value if our first port of call is to listen, to gradually feel ourself into the shoes of the other, to absorb the feelings that are being conveyed and to think and then to say some words.

The thinking and talking that I do inside the consulting room is at odds with many features of ordinary conversation. Not that it is mysterious, but it isn’t concerned with conventional ways of sharing or identifying. The therapist makes patterns and theorises, but they are also reflecting on the words that are spoken, how they are delivered – in a staccato fashion, or flatly, or stop and start – and how the words, once spoken, affect the speaker and the therapist themselves.

Words can give voice to previously unknown feelings and thoughts. Words can illuminate. That’s why it’s called the talking cure. But just as words reveal so, too, can they obscure, and this gets us to the listening and feeling part of the therapy. Whatever and however the utterances are delivered, they will have an impact on me as a therapist. I might feel hopeless, I might feel energised, I might feel pushed away, I might feel demanded of, I might feel pulled to find solutions.

The influence of the other is what makes any relationship possible or impossible. A therapist is trained to reflect on how those who consult with them affect them. As I try to step into the shoes of the analysand and then out again, my endeavour is to hold both those experiences, plus an awareness of my ease or discomfort with what I encounter in the relationship.

Of course, a hallmark of a therapist’s feelings will be curiosity and interest, but when my feelings are inflected with what can feel like foreign emotional hues, I wonder whether this is a useful reflection of the analysand’s psyche. Is what is conveyed at a feeling level a clue to the difficulties that beset the individual seeking help?

While we can only do an approximation of stepping into another’s shoes and their story, we do a rather more surgical discussion inside ourselves with the feelings that come upon us. I once felt I was covered in dandruff in a session, but not the session before or after. Another time, I was heavy with depression and yet five minutes after the person left, I was enlivened. A few sessions later, I felt like a purring pussy cat, a feeling I was to have with that person and no one else. These feelings were incredibly helpful intimations alerting me to aspects of what the individual was burdened by or what they craved. Their desires and difficulties did not come in words but through feelings which, when I could find the words for myself, could be shared and made sense of.

Feelings are the bread and butter of our work in the consulting room. They inform or modify our ideas and they enable us to find an emotional bridge to what can so hurt for the people we are working with. Along with the more commonly thought-about theories and ideas we have about the psyche, they are an essential part of the therapist’s toolkit, certainly for me. The talking cure means talking, yes. It also means the therapist is listening, thinking and feeling.

In Therapy by Susie Orbach is published by Wellcome Collection & Profile Books at £8.99. To order a copy for £7.64, go to


Susie Orbach

The GuardianTramp

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