This site is in the process of change to preserve the thinking and writing of the late David Jacobs, Ph.D.
For the past 35 years I have endeavored to develop my understanding of why people become stuck in persistent and distressing psychological problems and how to help. When I am asked what I specialize in as a therapist, I find this a somewhat misleading question. Real people have complex psychological and interpersonal problems. There may be a very conspicuous problem, but protracted discussion usually reveals a complex web of interrelated psychological and interpersonal difficulties.
Although no two people are the same with regard to biography and personality, I have lately thought it is useful to conceptualize what is actually the matter (why does the person have the persistent problems he/she has, although the precise problem configuration varies from person to person) in terms of three related areas or fault lines: 1. negative self feelings and attitudes, 2. impaired or underdeveloped ability to self-soothe by drawing on internal resources or turning to others for assistance, and 3. impaired ability to realistically trust other people and develop trusting relationships. In other words, although the person seeking therapy typically names a specific complaint or difficulty from which he/she wants relief, the real (generative) problem is usually along the lines I have outlined. It is the real problem that must be addressed if significant and enduring benefit from therapy is to be obtained.
Stated most baldly and abstractly, but to the point, the fault lines I outlined above can only be upgraded via the experience of an important and positive relationship between client and therapist. It is the experience over time of being in a certain kind of relationship that matters. Advice, instruction, education, insight, etc. matter very little when it comes to significant and enduring personal change. Advice and so on cannot engage psychic life at a deep enough level to enduringly influence personal characteristics that were established and solidified during the pre-adult years of development within the crucible of family life. Only direct relationship experience can affect those aspects of psychic development that were formed in the crucible of relationship experiences (e.g., self feelings mainly derive from how one was actually treated by family members growing up). Only the therapist is really in a position to offer a corrective emotional experience. This is because the therapist is at work, and so can be dedicated to the task at hand, which is to consistently offer a corrective emotional relationship. It's no one else's job---spouses for example do not enter marriage to selflessly dedicate themselves single mindedly to providing a corrective emotional relationship while keeping their own needs strictly on the back burner. But being at work does not prevent the therapist from developing real feelings for and about the client. When two people meet consistently for a long time real feelings develop. This is how it is with human beings. But at the same time the therapist is at work and is dedicated to the work.
If significant and enduring change in living life is what is being sought (what else?), the way forward is the development of an important relationship over time between therapist and client. The legacy of maltreatment growing up is not easily or quickly altered. It's second nature. That's why it takes so much work, dedication, and time to overcome it. It doesn't yield to thought or resolutions. You give yourself good advice and don't follow it. Other people give you good advice you ignore or can't follow. Only direct experience of a certain kind can make a dent in what has become second nature (bad self feelings, fear, distrust, etc.). An experienced therapist realizes this and patiently works on developing a relationship that you can trust and is important to you and therefore can make a difference. You may be impatient, frustrated, etc., but an experienced therapist knows this is part of the process and helps you persevere. If you persevere in good faith it makes a difference.