Transformation in the Therapeutic Process
By Barbara Kaplan, Ph.D.

What is "transformation" in the therapeutic process? It is not just change but it is respect for change...a partnership process as the therapist will change along with the patient but most importantly the therapist will be a witness to the patient's growth. This growth may be seen when the patient takes new risks or considers new ideas, but above all, it should involve the patient’s independent choice. I can remember back to my first psychiatric job and the team meeting I attended one morning before patient activities started. The head psychiatrist of our unit asked me what my goals were for my new male patient. Instead, I told him what the patient’s goals were for himself. The psychiatrist looked surprised as they weren’t the typical mental health goals reiterated at meetings by staff members, yet it seemed natural that the goals for change should be determined by the individual entering into treatment as only he knows himself best and he will be inclined to change if the goals have meaning for him.

Rather than someone to set goals, the person entering into therapy needs to feel understood. There may be times when a patient leaves therapy feeling sad or hurt, as painful material surfaced and sometimes gets relived. That still is very different from being hurt by an individual. A therapy patient should not feel judged or directly hurt by a therapist. The way I see it, true empathy means I do not take you away from what you are feeling, even if it entails some dark or tough stuff. Instead empathy means meeting you where you are and hearing whatever it is you need me to hear. This is what I mean by the expression “being a witness” to the growth of the person in therapy. I recall a patient with whom I did some grief work. There had been a series of losses but one in particular was especially hard to recover from. The woman I was treating said that the hardest part of the whole experience was the reaction she got from family and friends. She said they tried to distract her from her grief as “too much time had passed” and they felt she needed to “move on” and change her life in some way. The missing element was that she needed to go through the pain and be supported in the process. Only then could she move on and feel ready for change.

Change may be conscious, unconscious or a combination of the two but no matter what it is, and how it progresses, the therapist and patient are committed to it. Transformation also means rebirth, a kind of shedding of old skin to allow the new to grow. It can be painful but gainful too. Transformation (or change) involves movement, openness and hard work. One of my adolescent patients told me that change is small and transformation is “really big”, even life altering. After speaking more about it with him, I learned that he felt he had changed a lot in therapy but it took a series of many small steps and he didn’t recognize it at first. In fact, he described the transformation as something that snuck up on him. One day, he realized he had let go of old hurts and abandoned old ways of dealing with pain. He said he also learned how much easier it is to do all of that with a “cheerleader in one’s corner”.

There is a path I talk about in metaphorical ways, with my patient. We both are walking along the path together and I do not know any more then my patients where it will take us. I only know that I am devoting my time and effort, with true concern and compassion for the people I work with, to venture down that path, walking by their sides, encouraged that there is a light at the end of that path (maybe even sunlight) to aid us in navigation. My belief in growth and change will hopefully provide incentive, yet I know full well, that only the patient himself or herself truly knows how fast or slowly we need to walk, and when we need to turn a corner or sit down for awhile before walking some more. The path is more easily taken by two than by one and that I believe both professionally and with my heart.

Barbara Kaplan, Ph.D. is a clinical psychologist working on Long Island, New York.
Her e-mail address is and her phone number is (917) 686-3948.