A therapy session is, in some ways, a chemistry experiment: under the right conditions, the right combination of client and therapist can yield the desired results, but one wrong element can make the whole thing blow up.
Sussing out exactly what went wrong, though, can be a tricky process. Over the years, researchers have conducted plenty of studies to figure out how patients feel during therapy; the problem is, most of these studies relied on patients describing their experiences after their sessions were over, relying on memory to condense entire appointments into a few key moments. Technically, scientists weren’t really studying how therapists helped or hurt patients during sessions — they were studying how patients remembered their sessions.
But a new study published late last year in the Journal of Clinical Psychology found a way to work around this problem — and its findings highlight just how easily a therapy session can swing from good to bad (or vice versa).
The inspiration for the study setup was, of all things, a cooking show: Author Jonathan Swift, an assistant professor of psychology at Idaho State University, happened to catch an episode of “Food Network Star,” where contestants do live cooking demonstrations to try and win their own programs.
The audience members rated the chefs by twisting dials on remotes, letting the show know how engaging contestants were at every second. Swift, realizing that he could use the same technology to get live feedback on therapy, bought some remotes from the company that made the devices for the show and recruited 16 people who agreed to let their therapy sessions be filmed. Afterward, participants watched their videos, rating their sessions moment-by-moment as they explained to Swift and his colleagues what was happening throughout.
The results, he says, were surprising: There were no common patterns that could explain why a therapist was effective or useless. In fact, depending on the patient and even the minute, the same techniques could be classified as helpful or harmful. Some of the highest-rated moments, for example, were ones patients described as, “The therapist was listening to me.” And the lowest-rated moments? “The therapist was listening to me.” The same was true of expressing support, which sometimes patients took as actually supportive and other times as judgmental.
“The difference was all in the timing,” Swift explains. “Listening was rated highly when the client was on track and talking about something important, but rated much lower when the client believed he or she was talking about unmeaningful things.”
He was also surprised, he says, by the roller coaster of positive and negative moments that participants reported. You may remember a therapy session as a breakthrough or an awkward waste of time, but the impression you carry with you after the fact isn’t necessarily an accurate reflection of how you felt things were going while you were sitting on the couch.
“Sessions with clients often have several helpful and hindering moments and lots of moments in between,” Swift says. “Conducting a treatment session really is a dynamic process, and sessions are not just entirely good or entirely bad.”
The takeaway for therapists, Swift explains, is that having a toolbox of skills and strategies doesn’t necessarily guarantee a productive session — they need to stay in tune with their clients so they can deploy the right methods at the right times. Otherwise, even seemingly helpful techniques can actually drag a client down.
And there’s a lesson in there for the people on the receiving end of the therapy, too: It’s easy to get discouraged and give up on therapy after a few bad moments during treatment, but this study showed that those annoying bits are just part of the package. Even the most productive sessions will come with frustrations and moments of misunderstanding.
“It is important to remember that psychotherapy involves a relationship with the therapist,” Swift says. “And like any other relationship, there are going to be ups and downs.” Therapy isn’t just about therapists fixing passive patients; it’s a process with two active participants, both of whom need to read each other and work together to keep things back on track. So next time your therapist lets you prattle on about something that doesn’t matter, let them know. Being a good therapist is though, for that hour, making it your job to help them do theirs.