Psychotherapy is, in certain cases, a hugely effective choice, which properly alleviates pain, not by magic or chance, but for three solidly founded reasons. 

Firstly, our unconscious feelings become conscious. A founding idea of psychotherapy is that we get mentally unwell, have a breakdown, or develop phobias, because we are not sufficiently aware of the difficulties we've been through. Somewhere in the past, we've endured certain situations that were so troubling or sad, they outstripped our rational faculties and had to be pushed out of day to day awareness. For example, we can't remember the real dynamics of our relationship with a parent. We can't see what we do every time someone tries to get close to us, nor trace the origins of our self sabotage or panic around sex. Victims of our unconscious, we cannot grasp what we long for, or terrified by. In such cases, we cannot be healed simply through rational discussion, as proponents of CBT implicitly propose, because we can't fathom what's powering our distress in the first place. Psychotherapy is a tool for correcting or self ignorance in the most profound ways. It provides us with a space in which we can, in safety, say whatever comes into our heads. The therapist won't be disgusted, or surprised, or bored. They've seen everything already. In their company, we can feel acceptable, and our secrets sympathetically unpacked. As a result, crucial ideas and feelings bubble up from the unconscious and healed through exposure, interpretation and contextualisation. We cry about incidents we didn't even know before the session started, that we've been through, or felt so strongly about. The ghosts of the past or seen in daylight, and a laid to rest. 

There's a second reason why psychotherapy can work so well: transference. Transference is a technical term that describes the way once therapy develops, a patient will start to behave towards the therapist in ways that echo aspects of their most important, and most traumatic past relationships. A patient with a punitive parent might, for example, develop a strong feeling that the therapist must find them revolting or boring. Or a patient who needed to keep a depressed parent cheerful when they were small, might feel compelled to put up a jokey facade, whenever dangerously sad topics come into view. We transfer like this outside therapy all the time, but they're what we're doing doesn't get noticed or properly dealt with. However, psychotherapy is a controlled experiment that can teach us to observe what we're up to, understand where our impulses come from, and then adjust our behaviour in less unfortunate directions. A therapist might gently ask a patient why they are so convinced they must be disgusting, or they might lead them to see how their use of jokey sarcasm is covering up underlying sadness and terror. The patient thereby starts to spot the distortions in their expectations set up by their history, and develops less self defeating ways of interacting with people in their lives going forward. 

Then, the third reason why psychotherapy works. It is the first good relationship. We are many of us critically damaged by the legacy of past bad relationships. When we were defenceless and small, we didn't have the luxury of experiencing people who were reliable, who, listened to us who set the right boundaries that helped us to feel legitimate and worthy. However, when things go well, the therapist is experienced as the first truly supportive and reliable person we've yet encountered. But they become the good parent we so needed, and maybe never had. In their company, we can regress to stages of development that went wrong and relive them with a better ending. Now we can express need, we can be properly angry and entirely devastated and they will take it, thereby making good years of pain. One good relationship becomes the model for relationships outside the therapy room. The therapists moderate, intelligent voice becomes part of our own inner dialogue. We are cured through continuous repeated exposure to sanity and kindness. 

Psychotherapy won't work for everyone. One has to be in the right place in one's mind. One has to stumble on a good therapist. And be in a position to give the process due time and care. That all that's with a fair wind psychotherapy also has the chance to be the best thing we ever get around to doing.


SUMMARY
Psychotherapy can be effective because it helps uncover unconscious feelings and thoughts, utilises transference to understand past relationships, and provides a good relationship model for future interactions. Psychotherapy works by helping patients understand and change distorted expectations. 

Psychotherapy's effectiveness in treating mental illness through unconscious awareness, transference, and good relationships.

• Psychotherapy helps uncover unconscious feelings, heal through exposure and interpretation.

• Patient learns to spot distortions in expectations, develop less self-defeating ways of interacting with others.

• Good relationship with therapist becomes model for outside relationships, leading to cure through repeated exposure to sanity and kindness.