What Makes Therapy Therapeutic

Mental health in Saudi Arabia online therapy What Makes Therapy Therapeutic

An Honest Look at What Therapy Actually Is, from an Arab cultures perspective—Shaped by the Hard Questions You've Asked.

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THE QUESTION

Think about therapy. You sit with a stranger and talk about your pain. You don’t know what they believe, what they value, how they live. For generations, people brought these struggles to family, to friends, to spiritual leaders—people whose values they knew and shared. So why a therapist? What is it that a therapist does that’s so therapeutic? What does it mean when I go to therapy, that all else failed — and somehow therapy is better?

I’ve gotten this question from my family, trying to understand what I do as a therapist. From people considering going to therapy for the first time. And even from people desperate to help a family member, thinking “If a therapist can help, so can I”—waiting to hear from me what it is that a therapist offers that they can’t provide themselves. The idea that a stranger could help your loved one in ways you can’t is a painful one too.

It’s a question I’ve sat with myself. Working in mental health, you live on the border between theory and what actually happens in the room. Research can tell you which technique works better than another, for whom, under what conditions. But research doesn’t calm a concerned father. He’s not asking which technique has the best effect size. He wants to know what his daughter is getting into. What actually happens in that room. What makes therapy therapeutic, because it does not seem very logical to think that just talking about the problem will make it go away.

It’s a hard question. But let’s study it together and see where it takes us. I’ll do my best not to wander off, I want to get to the heart of this matter. And if I do, let me know.

THE WISODM

Let’s start with wisdom. Therapists must be wise? They understand the human condition better than the rest of us, that is why they are therapists? No. I don’t think that’s it. I’ve known plenty of therapists who were confused about their own lives, struggling, and still did their job competently. Whatever it is that makes therapy work, I’m sure it is not this.

When I was an undergrad, I wanted to be a psychoanalyst. They are a kind of therapist that follows a tradition that interprets psychological pain more than it tries to stop it. It is more art than science. One thing fascinated me most: as part of their training, they had to go through years of therapy themselves before they could practice. The tradition took seriously the idea that the therapist needed to do their own inner work. To become, in some sense, wise.

That’s not how most therapy works anymore. Our understanding of psychological pain has become more medical. For one, we don’t call it psychological pain we call it mental health disorder. Therapy is protocol-driven. Techniques, worksheets, exposure plans. These don’t require wisdom. Your therapist, like your doctor, might not be any wiser than you.

So we can set that aside. It’s not wisdom. Let’s keep looking.

THE TECHNIQUE

What about technique? Perhaps there’s a method all therapists share, some common thread running through every approach. But that’s not it either. The field is scattered. Behaviorists and Jungians and trauma specialists, working from different philosophies, sometimes barely speaking the same language. I know therapists who don’t follow any specific school—they just try to be practical, see what works. And people get better.

So if it’s not wisdom, and it’s not one unifying technique. Let’s keep going.

THE SAFTY

At the very least, in therapy, there should be an expectation that your privacy will be respected. Your welfare comes first. In practice, that means the therapist isn’t allowed to use you to meet their own needs—not emotionally, not financially, not in any other way that puts their needs above yours. And if something goes wrong, there should be accountability. This is why we have supervision. When your therapist mentions recording a session or consulting with colleagues, that’s the structure of accountability at work. A system that makes something like psychotherapy possible.

Now, does this framework do the healing? No. But it holds the space where healing can happen.

These structures aren’t always perfect. They vary from place to place, and not every setting has the same level of oversight. So I’d encourage you to ask questions. Understand who your therapist is accountable to. Ask if they’re supervised, and by whom. It’s not rude to ask. You’re part of this system, and you should know how it works.

OK, but still, an ethical framework isn’t therapy. So what actually makes therapy therapeutic.

THE SPACE

When there is psychological pain, and we dedicate our time to it, whether in a clinic, private office, or a Zoom call from the other side of the world, we are creating a therapeutic space.

I’m careful here. I won’t say we fix the pain. because I don’t know if psychological pain is something to cure, like a wound? To remove, like a growth? I’ve seen competent therapists disagree completely on this. What I’m saying here is that having this space matters when we use it to give attention to the pain.

I remember once as a child playing tag with my friends. Old neighbourhoods in Greece have rough unpaved roads. I slipped, fell and scraped both knees on the gravel. I knew it was bad. I just looked down and saw my skin was in rough shape! I started crying. At home my grandmother was nursing me, using the red stuff (Betadine) with a cotton ball. I was still kicking and crying when my grandfather walked in smiling and said “The neighbours called, they said someone was crying.” I had woken him up from his afternoon nap. He said “Let me see,” and put on his reading glasses and examined my knee. He joked around and said “Look Aseel, one thing is for sure—by the time you get married, it will have completely healed. In the meantime, let’s get you a wheelchair” I was too grumpy to play along. He said “Look at it Aseel, it’s not that bad. Its just a little scrape” I took a peek, and after my grandmother had cleaned it up, it actually looked fine. I then embarrassingly realized it didn’t even hurt. I was crying because I was scared. Until my grandfather came, I was just too scared to look at my pain, scared of how bad it could be.

This space pulls us out of the daily loop, even if just for an hour. The self-blame. The job that follows you home. The regret. The cigarettes, the shopping, the scroll. All the ways we keep the pain at a distance until it only finds us at our most desperate—when we should be sleeping, or with the people we love.

Having a scheduled time for looking at our pain, widens the space further. The way one honest conversation can be enough, when you know you can try something this week, sit with discomfort, and return next week to talk it through—the hour mixes into the days around it. The space grows larger than itself and we have room to think and feel more.

Are we getting closer to an answer? Yes, we are closer but not there yet. Couldn’t we have this space with a grandfather? Even prayer is a kind of space. Why therapy?

The space alone might be enough, sometimes. We need this kind of time with the people we love. With ourselves. A grandfather who listens. A prayer that settles something. A long walk where we can think clearly.

So what does therapy offer that these don’t?

THE PSYCHOLOGY

Everything I mentioned so far, in some way, could be something that we could already have in our lives. People who are looking out for our best interests, a space for us to look at the pain, it could even be regular and reliable. Here’s what I’ve come to: the field of psychotherapy, in addition to that, has people who have thought carefully about how to use the space.

I deliberately haven’t mentioned any therapeutic training so far. Not because I don’t believe in them—I do. But techniques work best when everything else is in place. The ethical frame. The dedicated space. Once those are there, the training matters. A therapist has given thought to what they’re doing—or is supervised by someone who has, or has learned methods built by those who came before. That lineage of care and attention is real.

But can’t anyone just read the same psychology books you read and learn to apply these therapeutic techniques themselves.

YOU

If you read the books, do the training, and enter into the legal and ethical system, then yes, you could do exactly what a therapist does. Essentially, that is what a therapist is.

I hope this can demystify therapy. Ground it in reality. Hopefully enough for you to realise that therapy is not something that will happen to you, or your loved ones. You work together with someone who has done their best to prepare to be of help. That means that your family, your faith and your values will be part of the process.

What I can say to the concerned father about therapy is this: therapy brings together a lot of things that have the potential to be very helpful. Therapists (should) have the responsibility of trying to keep all these things together and do the best they can without putting their own needs and beliefs ahead of yours — and we understand this very clearly. However, I always tell people I refer to other therapists this: Understand who your therapist is accountable to. Ask if they’re supervised, and by whom.

It’s not rude to ask. I would not have written this if it were not for all the people who bravely asked.

By Aseel Aborashid, a therapist and mental health professional in Saudi Arabia, working with eating disorder, mostly people struggling with over eating (known as binge eating) work stress, and sleep difficulties. I work with client in Arabic, English and Greek.

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