So how does this whole therapy thing work?

THERAPY

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So how does this whole therapy thing work?

EMOTIONAL REGULATION & NERVOUS SYSTEM • February 23, 2015

One question I receive from clients – maybe above all other questions ­ is this: “So how does this whole therapy thing work?”

There’s no one single “right” way to answer this question, “How does therapy work?” ­Each therapist will have their own answer to it. But, personally as a relational, humanistic therapist, I like to think that therapy is a journey that both client and therapist make together in a quest to help you experience greater wholeness and aliveness. I believe that by entering therapy, you as a client inherently become an emotional pioneer and a soul adventurer of sorts. And I, as the therapist, receive the privilege of accompanying you along the way as a guide and companion.

As we embark on the journey together from the very first consult call to the intake session and beyond ­- we begin a process of deep, curious exploration together, exploring the terrain and topography of your life, of your unique challenges, your dreams, wishes, life narratives, and more.

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Like with any journey, we may set off thinking we know where we want to go.

While that may very well be the destination you end up at along the way, we may also encounter unexpected matters which, when faced and explored in the spirit of curiosity, can sometimes be the greatest gifts of the journey. Together, we hold a mindset of genuine curiosity about everything we encounter — the expected and unexpected alike — and a willingness to return to that exploration week after week.

It’s important to note that, on this journey, I am not the expert of you. As a client, you are the expert of you; as the therapist, I’m the expert in helping you get more in touch with you and, yes, in helping you develop the awareness and tools you may need along the way. But make no mistake­ no one, not I or anyone else­ is as much of an expert on you as you are.

The therapeutic part of therapy happens in the relationship between client and therapist.

I believe this is so because our patterns, beliefs, and conditioning are put down early in relationship and it is only through relationship that these patterns and wounds can be illuminated and then (within the context of a reparative relationship) be healed and transformed, a process which resultingly leads to an increased sense of aliveness and wholeness.

The journey of therapy is absolutely about gaining new awareness and a­ha’s about your life. It’s also about cultivating tools, skills, and new behaviors that you can employ in the therapy room and beyond. But most importantly, I believe, therapy is the chance to develop a profoundly special and unique type of relationship that can help you experience yourself and your life in a different and deeply transformative way, the effects of which may last for the rest of your life.

Therapy isn’t a fix applied to a broken person. It’s a relationship that creates the conditions for you to access more of who you already are. That’s what I’m here for.

Warmly,

Annie

 

Frequently Asked Questions

This is part of our comprehensive guide on this topic. For the full picture, read: How Therapy Actually Works: A Complete Guide.

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References

• Norcross, J. C., & Lambert, M. J. (2018). Psychotherapy relationships that work III. Psychotherapy, 55(4), 303-315.
• Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9-16.
• Schore, A. N. (2003). Affect regulation and the repair of the self. Norton & Company.
• Mitchell, S. A., & Aron, L. (1999). Relational psychoanalysis: The emergence of a tradition. The Analytic Press.
• Siegel, D. J. (2012). The developing mind: How relationships and the brain interact to shape who we are. Guilford Press.
• Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond. Guilford Press.
• Aron, L. (1996). A meeting of minds: Mutuality in psychoanalysis. The Analytic Press.
• Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work. Routledge.
• Leichsenring, F., & Rabung, S. (2008). Effectiveness of long-term psychodynamic psychotherapy: A meta-analysis. JAMA, 300(13), 1551-1565.

How Therapy Works — and Why Driven Women Often Resist It First

In my experience, driven, ambitious women come to therapy having already tried everything else. They’ve read the self-help books, listened to the podcasts, journaled, meditated, and hired coaches. They arrive having optimized everything except the wound itself. And the wound, it turns out, is the one thing that doesn’t respond to optimization.

What I see consistently is that the women who benefit most from therapy are the ones who can stay long enough to let it surprise them. The first few sessions are often about testing — is this therapist going to tell me what I want to hear? Is this safe? Is this real? That testing is normal and healthy. It’s the nervous system doing its job. The therapeutic relationship becomes a living experiment: can I be fully known here and still be met with warmth?

Morgan is a 37-year-old general counsel at a technology company. From the outside, she’s the person everyone calls when things go wrong. But when her marriage began unraveling, she didn’t know who to call. She arrived in my office with a legal pad of notes — she’d prepared for the session as if it were a deposition. “I want to be efficient,” she told me in our first meeting. Three months in, she forgot to bring the legal pad. “I realized I was using it to stay in control,” she said. “And I don’t need to be in control here.” That shift — from managed self-presentation to genuine presence — is what makes therapy therapeutic. You can take the first step by scheduling a consultation to find the right fit.

Mira, a 35-year-old cardiologist, came to her first therapy session with a legal pad. She had written down the problems she wanted to solve, prioritized by urgency, with estimated timeframes. She told me she had “read a lot about therapy” and wanted to make sure they were “on the same page about deliverables.” I didn’t find this amusing — I recognized the gesture. This is what driven women do when they enter a domain they don’t have a map for: they import the tools that work in other domains. The legal pad was not a problem. It was an invitation. It told me exactly where we were starting.

The resistance to therapy that driven women often feel is not, in my experience, primarily intellectual skepticism about the process. It’s a particular kind of vulnerability aversion — the sense that sitting with another person and not knowing the answer, not having the strategy, not being competent, is a form of danger rather than a form of growth. Women who have organized their entire external lives around being the most prepared person in the room have profound difficulty with the experience of not knowing. And therapy, done well, requires not knowing. It requires sitting in uncertainty long enough to let something true emerge.

Allan Schore, PhD, neuropsychologist and researcher in affect regulation and attachment, has spent decades documenting how the therapeutic relationship creates the conditions for genuine neurological change — not through cognitive insight alone but through the moment-to-moment experience of being with another person who can hold, reflect, and help regulate emotional states. This is what makes therapy different from reading about therapy, different from a very good podcast, different from coaching alone. The repair happens in the relationship. And the relationship, for driven women, is often the most unfamiliar and most necessary part.

The Science of Why the Relationship Is the Therapy

One of the most durable findings in psychotherapy research is that the quality of the therapeutic alliance — the collaborative, trusting relationship between therapist and client — predicts outcomes more consistently than the specific modality used. This has been replicated across hundreds of studies and is sometimes called the “common factors” finding: it’s not EMDR versus CBT versus psychodynamic therapy that matters most. It’s whether the client and therapist trust each other, share goals, and experience the work as a genuine partnership.

John Norcross, PhD, psychologist and professor of psychology at the University of Scranton and editor of Psychotherapy Relationships That Work, has synthesized this research extensively. His conclusion: therapist empathy, positive regard, and agreement on goals are among the strongest predictors of therapeutic outcome — stronger, in many cases, than technique. This is counterintuitive for driven women, who often want to know: which technique works best? The answer is more humbling and more human than that: what works best is feeling genuinely understood by someone who is genuinely trying to help. You can explore what that kind of support looks like for you through individual therapy with Annie.

Both/And: Progress and Pain Can Share the Same Timeline

Driven women often approach healing the way they approach everything else: with goals, timelines, and measurable benchmarks. They want to know how long therapy will take, what “done” looks like, and whether they’re doing it right. I understand the impulse — it’s the same competence that built their careers. But healing from relational trauma doesn’t follow a project management timeline, and treating it like one can become its own form of avoidance. (PMID: 36340842)

Dalia is a corporate attorney who, after eight months of therapy, told me she was frustrated with her progress. “I still got triggered last week,” she said, as though a single difficult moment erased months of genuine change. What Dalia hadn’t noticed — because she was measuring against perfection — was that the trigger resolved in hours instead of days, that she reached out for support instead of isolating, and that she could name what happened in her body instead of just pushing through.

Both/And means Dalia can be making real, measurable progress and still have moments where the old patterns surface. It means healing isn’t a straight line, and a setback doesn’t erase the foundation she’s built. For driven women, this is perhaps the most radical reframe: that effectiveness in recovery isn’t about eliminating hard days. It’s about changing your relationship to them when they come.

Tessa, a 39-year-old executive director, described her first year in therapy as “the worst year of my life that somehow also saved it.” The things she needed to grieve — the childhood she hadn’t been allowed to grieve, the relationship she’d ended but never fully mourned, the version of herself she’d had to suppress to function — were still there, just below the surface of her very functional life. Therapy didn’t create the pain. It created the conditions for the pain to finally move. And both things were true: the year was genuinely hard, and it was also the beginning of something that had needed to begin for a long time.

This Both/And is one I return to with clients consistently: healing is not comfortable. Progress in therapy often looks, from the inside, like getting worse before getting better — because the early stages of therapeutic work involve naming and feeling things that previous coping strategies were specifically designed to route around. The driven woman who expects therapy to produce immediate relief is not wrong to want that. She may need to know that the path to genuine relief sometimes runs through some discomfort that her very effective external-life strategies were designed to avoid.

The Systemic Lens: The Cultural Expectations That Slow Healing

When we tell driven women to “get help” for their trauma, we often fail to acknowledge what getting help actually requires: financial resources for quality therapy, schedule flexibility for consistent appointments, a workplace culture that doesn’t penalize prioritizing mental health, and a social environment where vulnerability is safe. These aren’t universally available. For many women, they aren’t available at all.

Even driven women with financial means face systemic obstacles. The pressure to be constantly productive means therapy often gets scheduled in margins that don’t allow for the emotional processing the work requires. The cultural expectation that women should “handle things” quietly means many driven women hide their therapeutic work from colleagues, friends, even partners — adding the burden of secrecy to the already demanding work of healing. The medicalization of trauma into neat diagnostic categories often fails to capture the complexity of what relational trauma actually looks like in an accomplished life.

In my work, I try to hold the systemic reality alongside the individual journey. You are doing courageous, difficult work. And the world around you was not built to support that work. Both things matter. Understanding the structural constraints isn’t an excuse to stop — it’s a reason to be more compassionate with yourself about the pace, and more outraged at a system that makes healing harder than it has to be.

The cultural narrative around therapy in professional environments deserves direct examination. In many of the worlds my clients inhabit — medicine, law, executive leadership, venture capital — seeking therapy carries a residual stigma that has only partially been addressed by the broader mental health conversation of the last decade. The leaders who post publicly about being in therapy are usually doing so from a position of established credibility. The associate who goes to therapy worries about what it might mean for how she’s perceived. The cultural cost of being seen as someone who struggles is not evenly distributed.

This matters because it shapes who seeks help and when. Driven women often wait until they are well into burnout, relationship breakdown, or physical illness before they allow themselves to reach for support — because the cultural message they’ve received is that needing support is evidence of inadequacy. The systemic challenge is not just to make therapy more accessible. It’s to dismantle the idea that needing help is incompatible with being capable. These two things have never been opposed. The most effective leaders I work with are not the ones who need nothing. They are the ones who have learned to be honest about what they need and to ask for it without shame.

If what you’ve read here resonates, I want you to know that individual therapy and executive coaching are available for driven women ready to do this work. You can also explore my self-paced recovery courses or schedule a complimentary consultation to find the right fit.

The cultural water that ambitious women swim in deserves naming explicitly. Joan C. Williams, JD, distinguished professor at UC Hastings College of Law, has documented extensively how women in high-status professions face what she calls the “double bind” — judged harshly when they’re warm (read as not competent enough) and judged harshly when they’re competent (read as not warm enough). Add a relational trauma history to that bind, and the inner monitoring becomes nearly continuous. Healing has to include a clear-eyed look at how much of the exhaustion isn’t yours alone — it’s a load you’ve been carrying for systems that were never designed to hold you.

How to Begin: Starting Therapy When You Don’t Know What to Expect

In my work with new clients, one of the most common things I hear in the first session is: “I didn’t know it would feel like this.” Sometimes that’s a welcome surprise — therapy is warmer, more collaborative, less clinical than they’d imagined. Sometimes it’s a harder kind of surprise: realizing that putting something into words makes it more real, not less. Whatever the specific experience, what I want to offer here is some honest orientation — not a sales pitch for therapy, but a clear-eyed picture of what the process actually involves, so you can walk in with realistic expectations and some sense of what you’re choosing.

Therapy is fundamentally a relationship. That’s the part the self-help books and the wellness content often skip over — because it’s harder to package than a technique or a framework. But the research is clear: the quality of the therapeutic relationship is one of the strongest predictors of outcome. What that means practically is that finding the right therapist matters enormously, and that some trial and error is normal. A few sessions in, you should have some sense of whether you feel genuinely seen, whether the therapist’s style matches how you process, and whether the work feels meaningful even when it’s difficult. If those things aren’t present, it’s not therapy that isn’t working — it may be this particular fit.

Once you’ve found a good fit, the early work tends to involve what I’d call assessment and alliance-building: your therapist learning your history, your patterns, your goals, and your way of being in the world, while you simultaneously learn whether this is a space where you can be honest and vulnerable. That stage takes time. Don’t expect dramatic transformation in the first few sessions — but do expect to feel something: a sense of being heard, maybe some relief at finally naming things, possibly some emotional activation as long-held material surfaces.

Different therapists work in different ways, and it helps to understand what approach your therapist uses and why. If you’re working with someone trauma-informed, they may draw on modalities like EMDR, Somatic Experiencing, or Internal Family Systems (IFS) depending on what’s most relevant to your history and goals. These aren’t just techniques — each one reflects a particular understanding of how trauma is stored and how healing happens. If you’re curious about your therapist’s approach, ask. A good therapist will explain their thinking in plain language without being defensive about the question.

What therapy isn’t: a place where someone tells you what to do, fixes you, or gives you the answer. I know that’s sometimes what people are hoping for — especially driven, goal-oriented women who’ve built their lives around solving problems efficiently. Therapy is more like a lab for self-understanding than a prescription pad. Your therapist is a trained guide, not an authority on your life. The insights and changes that emerge from the work are yours. They come from you, facilitated by the relationship and the process.

It’s also worth knowing that therapy can feel worse before it feels better. When you start paying conscious attention to things you’ve been managing by not looking at them, there can be a period where the feelings intensify before they begin to metabolize. That’s not a sign that therapy isn’t working. It’s often a sign that it’s working exactly as it should. A good therapist will help you stay in the window of what’s tolerable — moving toward the material without overwhelming your capacity to function.

If you’re ready to take that first step and want to understand what working with a trauma-informed therapist specifically looks like, I’d invite you to explore therapy with Annie in more detail. And if you’re not sure whether you’re ready for therapy or what kind of support fits your situation, our short quiz can help you get clearer before you take the leap. The whole therapy thing works — not perfectly, not always linearly, but genuinely. And it starts with one honest conversation.

What I see consistently in my work with driven, ambitious women is that the body holds the truth long before the mind catches up. By the time a client lands in my office describing what isn’t working, her nervous system has been signaling for months — sometimes years. The tightness in her jaw at 3 a.m., the way her shoulders climb toward her ears during certain conversations, the unexplained fatigue that no amount of sleep seems to touch. These aren’t separate problems. They’re a single integrated story the body is telling about an emotional terrain the conscious mind hasn’t been able to face yet.

One of the most important things I tell clients in early sessions is this: the patterns we’re going to look at together aren’t character flaws. They’re the residue of strategies that once kept you safe. The over-functioning, the difficulty resting, the way you find yourself absorbing other people’s moods before you’ve registered your own — every one of these adaptations made sense in the original environment that shaped them. The work isn’t to shame the strategy. It’s to update the system that keeps generating it.

Medical Disclaimer