What is
psychotherapy?

Sometimes we understand. A relationship gets explored, links get made between past and present, a recurring pattern is noticed, or language is finally found for something hard to name.

Sometimes we feel. Understanding something intellectually doesn’t always change how it feels. Grief, anger, fear, shame, longing, relief or uncertainty can be given enough space to be experienced rather than immediately explained away.

Sometimes we look backwards. Earlier relationships and experiences can matter, not because every present difficulty comes from childhood, but because some patterns have histories.

Sometimes we stay firmly in the present. Work, relationships, sex, bodies, disability, money, family, access, loneliness, fatigue, identity. What happened yesterday may matter more than what happened twenty years ago.

Sometimes we experiment. A new sentence, a boundary, imagery, body awareness, a behavioural experiment, a different response. Good experiments aren’t tests to fail. They’re ways of discovering what happens.

Sometimes we make a practical plan. Therapy doesn’t always need to go deeper. Sometimes what’s needed is information, an advocate, an accommodation, a difficult conversation or a concrete next step.

And sometimes we realise therapy is not the whole answer. That matters too.

Psychological theories are useful because they help notice things that might otherwise be missed. But a useful theory can become a poor explanation when applied too quickly.

Therapy can help someone recognise avoidance, but fatigue is not automatically avoidance. Therapy can explore dependency, but needing assistance is not automatically unhealthy dependence. Therapy can work with anxiety, but fear is not automatically irrational when real risks exist. Body psychotherapy can notice posture, movement and sensation, but a bodily difference is not automatically psychological defence. Therapy can help someone regulate anger, but sometimes the first question should simply be: why are you angry?

Psychotherapy should be able to question the client. It should also be able to question its own explanation.

Disabled people bring the same enormous range of human life into therapy as anybody else: love, conflict, sexuality, grief, ambition, family, trauma, boredom, shame, joy, work, identity, fear, desire, and ordinary everyday problems. Disability doesn’t need to become the explanation for everything. But it can change the context.

A person may live with pain, fatigue, changing capacity, medical intervention, care relationships, inaccessible environments, stigma, bureaucracy or repeated experiences of being underestimated. Those realities matter psychologically. And sometimes they matter before psychology.

A staircase is not a cognitive distortion. Inaccessible transport is not avoidance. Discrimination is not an attachment style. Poor healthcare cannot be resolved through mindfulness.

Therapy may help with what those experiences have done to somebody. That doesn’t mean therapy should relocate the original problem inside them.

A question worth sitting with: is wearing glasses a disability? The answer tends to reveal more about where the boundary around disability gets drawn than it does about glasses.

Disability may be visible or non-visible, lifelong or acquired, stable or fluctuating, physical, sensory, cognitive, neurological, psychological or multiple, and experienced very differently by different people.

A person whose capacity fluctuates may need flexibility that somebody with a stable impairment doesn’t. Someone with a visible disability may spend less time explaining that it exists, but more time dealing with assumptions about it. Someone with a non-visible disability may repeatedly have to decide whether to disclose it at all.

There is no single disabled experience.

Autism, ADHD, dyslexia and other neurodevelopmental differences can be understood through more than a deficit lens. The useful clinical question is not simply “how do we make this person behave more typically?” It may instead be: what helps this person think, communicate, regulate and participate?

That could mean changes to language, sensory environment, pace, session structure or methods of communication. Stimming does not automatically mean distress. Avoiding eye contact does not automatically mean disengagement. A different communication style does not mean somebody has less to communicate.

The method should be able to adapt to the person. Not only the person to the method.

• Do I need to understand this?
• Do I need enough space to feel something about it?
• Do I want to try something different?
• Do I need practical change?
• Does somebody else need to change?
• Does a system need to change?
• Or do I simply need somebody to hear this accurately?

More than one answer can be true. That’s often where therapy begins.

Some people arrive knowing exactly which approach they want. Many don’t. Self-diagnosing the right psychotherapy before contacting a therapist isn’t necessary. It can be more useful to ask:

• What am I struggling with?
• What do I want to be different?
• Do I want practical work, deeper exploration, or both?
• How do I communicate best?
• Can this therapist adapt when something doesn’t work for me?
• Can I disagree with them?

The relationship and the therapist’s responsiveness often matter at least as much as the label on the approach.

Therapy is not a therapist knowing you better than you know yourself. It doesn’t require disclosing everything. It’s not endless discussion of childhood. It’s not positive thinking. It should not require becoming less disabled, less dependent or more “normal.” It’s not automatically successful because the therapist can explain what’s happening. And disagreement does not automatically mean resistance.

At its best, therapy is collaborative enough for both people to remain curious.

Some of the most useful disability-informed questions are surprisingly simple.

• Am I noticing something, or have I already decided what it means?
• What does my theory assume about a healthy body or person?
• What am I calling resistance? Could this be pain, fatigue, access, communication or realistic fear instead?
• What feelings does dependency evoke in me?
• Can this client disagree with my interpretation safely?
• Am I asking the person to adapt to my method when the method could adapt to them?

No need to become an expert in every impairment. What’s needed is enough curiosity to notice when the usual explanation may not fit.

Explore resources for therapists →

Worth asking a prospective therapist:

• How do you think about disability?
• How flexible is your way of working?
• What happens if an exercise or method doesn’t work for my body?
• Can sessions be adapted around communication, fatigue or sensory needs?
• How do you distinguish psychological avoidance from physical limitation?

And perhaps most importantly: what happens if I disagree with you?

The aim isn’t finding somebody who knows everything about disability. It’s finding somebody who can remain curious enough to learn what disability means in this specific life.