How does psychotherapy heal? What is the mechanism that turns simple talking into feeling better & having a better life overall?
Psychotherapy does not heal. ‘Healing’ is a medical term, and has been used as a metaphor in this context - ‘mental health’, ‘mental illness’ - for so long that we have ‘concretized’ it - forgotten it is a metaphor - but also because it suits the interests of a few doctors and of Big Pharma for us to do so (since they literally claim to ‘heal’ - it’s in their job descriptions).
You cannot ‘heal’ what is not physically injured, and that is partly why you ask this question. I mean, if ‘simple talking’ healed your broken arm, or your severed artery, we would all start asking ‘how did you do that?’
Ok. So what does psychotherapy - and it's big sister Psychoanalysis - do?
They both do many things, but in relation to the metaphor of ‘healing’, I would put it this way. Although with its weird zoo of incomprehensible pseudo-scientific disorders would suggest otherwise, our mind, like our body, is an holistic and integrated developmental unity. The human mind develops in interaction with its environment, a ‘transformational’ relationship, which begins usually, but not always with the mother/primary carer, and gradually enlarges under her supervision, to include father, family and the outside world. We should realize that these interactions are highly subjective, and that the earlier the experience the more formative it is likely to be.
In these interactions we develop our range of responses to situations, and our coping mechanisms in the many struggles we encounter; we construct our way of being, our psychological defense mechanisms; we discover what we want, what we fear, what is safe, what is unsafe.
These developments can be ‘good enough’ adaptations which will help us to manage successfully later when we are independent adults. However, internal (genetic) factors, or subjective elements (misapprehensions caused by temperament), or adverse environmental features (ill mother or father, losses or deaths in the family, accidents, abuse), may cause us to construct premature or dysfunctional psychological ways of coping or of understanding our world.
Psychotherapy, through its particular ‘setting’, which includes the person and the focused but free-floating mind of the therapist, offers a pale facsimile of that transformational relationship we once ‘enjoyed’ in infancy, or at least some aspects of it, and enables - with some struggle usually - the possibility of modifying and re-developing those coping structures and unconscious fantasies which no longer protect or facilitate us. It is not ‘simple talking’; nothing ‘simple’ about it; neither was the infantile relationship with your mother, since you had to learn to speak (part of the ‘transformation’). But we are not just ‘talking heads’, else we could really talk our way our of depression, anxiety and paranoia, which we can’t.
So no cure. Not exactly ‘healing’ either. Rather, ‘working through’ what we prefer not to ‘know’ - which may result in what we call ‘gaining in-sight’, and as a consequence, development and change.