Dr. Jonathan Fader: “What Makes Therapy Work?”

As part of an ongoing series, we asked the staff at Union Square Practice for their thoughts on the important question: What makes therapy work?”  This week, Dr. Jonathan Fader shares his thoughts.

What makes therapy work?

I think that therapy works when you’re meeting with someone who you feel has compassion for what you’re going through and who also understands your situation. This leads to the feeling of being supported.  Perhaps it’s my work in Sport Psychology, but I think that in order for any form of therapy to be effective, there generally needs to be a strategy or “game plan”. By this I mean a series of structured, pragmatic suggestions about how you’re going to deal with the stresses or situations that are negatively affecting you and your life. This process can be challenging and I think most people do best with a positive “coach” who sees the best in them and can help them direct their own positive qualities towards the areas in their life that need improving.

Personally, I don’t think that any style of therapy is going to work unless you have a therapist who is truly on your side–someone who you feel really gets it. The way I work as with the people in our practice is to first try my best to understand what this person is going through at this particular point in his or her life.


In fact, my immediate goal during those first few sessions is to develop and offer them a sense of empathy for their struggle, and to really connect with them as a human being. Once that connection is there–which usually happens in the first few meetings–then we’ve established a safe space where we can begin using evidence-based strategies for improvement. Now the focus shifts to increasing a person’s adaptive, positive thoughts and actions–a process that for me usually involves a style of therapy called Cognitive Behavioral Therapy (CBT).

Many types of therapy focus on solely gaining an understanding. While that I think that self-understanding is important, I also believe that an individual truly feels better when the therapist can help them focus on which behaviors can be changed in their life environment in order to establish more positive feelings or more satisfaction in life. This direct work on changing behaviors and thoughts is central to CBT.

I work with people to help them change their thoughts about themselves, about relationships, about situations and other people in their lives. The aim here is to empower them to create an improved narrative (story) about themselves. The thing about this is that this new narrative is real–it’s based on real facts about what’s going on in their lives–but is also in many ways a story whose trajectory captures the very best aspects of themselves, and helps them feel and act in more positive ways moving forward.  In other words, it’s not just “positive thinking” its “objective optimism”.

Fader_2012-12-08_MDC_0075__MarcosdeCastro2012

Actually, now that I’ve started talking about it, I also think that therapy works best when you have a space to talk to someone who is nonjudgmental.

I say this because one or the challenges in life in talking to friends and family members about our issues or problems is that they have a bias. They have a personal stake in what we do. It’s often difficult as a friend or family member not to render judgment and to resist giving premature advice. I someone who can really help you figure out what you want to do.

As I tell the people I work with in my practice, “I’m not here you tell you what to do or boss you around–that’s for your friends and family. What I’m trying to help you do is to figure out the pros and cons of where you’re at: whether or not that’s about a relationship, a work situation, your thoughts about yourself, your relationship with a particular substance or behavior, or anything else.” And from there I can help them figure out what they want to do about these issues, and work with them to help develop a series of actions that are most likely lead to that outcome.

In that process I really think it’s important that I, as a therapist, really be a collaborator as opposed to an authority figure who is simply going to just try to tell someone what I think they should do. Motivation is really important in this work, and I try to work with people to try to sustain their motivation by finding out not only what it is they want to do but also why they want to do it. Motivation is the gas and therapy is the car. Creating the roadmap together is sometimes hard work–but for myself and the people I have worked with it has truly been the most worthwhile and fulfilling kind of work imaginable.

If you have any questions about how therapy works, get in touch with me on Twitter @drfader!