A Day in Psychotherapy

# En hverdag i psykoterapi Working in psychotherapy is fundamentally about meeting people's inner lives: thoughts, feelings, relationships and the personal history each person carries. I recently visited a high school to talk about psychology, psychotherapy and the challenges many young people face today. The conversations gave me a chance to share some of the core insights I carry from clinical work, from group therapy to individual treatment, and from theories of mentalization to concrete experiences from everyday life at Solvangen. In this note I want to share the main themes I talked about — not as a recipe, but as reflections grounded in practice and theory. I hope it can increase understanding of what psychotherapy really is, and why feelings like anxiety, shame and sadness are often meaningful signals rather than merely symptoms of illness. ## Gruppeterapiens dynamikk Group therapy is a special arena. In a typical group setting eight people sit in a circle and bring up what is close and painful without the hidden supports we often have in everyday life. From Irvin D. Yalom's work on group psychotherapy we know that the group offers a unique opportunity to experience mirroring, validation and corrective experiences in relation to others. Social evaluation and social games often become visible in a direct way here. The goal in group therapy is to create a space where honesty and openness can have room. When people can express genuine feelings without fear of being judged, they can discover how their own thoughts and feelings become distorted in encounters with others. I have seen how such processes lead to deeper self-understanding: a shared experience of loneliness can turn into the recognition that one is not alone in having difficulties. In practice this means the group functions both as a relational source of challenge and of support. ## Mentalization: understanding ourselves and others Mentalization is about the ability to understand ourselves and others as beings with thoughts, feelings, desires and intentions. The concept has been emphasized in the work of Peter Fonagy and colleagues, and underlies mentalization-based therapy (MBT). The ability to mentalize allows us to see our inner experience from different perspectives — both from the inside ('I feel this') and from the outside ('others may perceive me this way'). When mentalization fails, small conflicts can escalate. A feeling of shame or criticism can be interpreted as rejection, and reactions become strong and maladaptive. In therapy we work on rebuilding this reflective capacity: noticing one's own feelings, exploring what they might mean, and at the same time daring to assume that others also have complex inner lives. For young people this can be particularly important: relational difficulties at school or home are often more closely linked to weakened mentalization than to 'personal failure'. ## Feelings as signals, not judgment I encounter a lot of anxiety and depression in clinical work. An important nuance is to understand symptoms as signals from the psyche — information about what is important to address — rather than solely as pathological states. Anxiety can, for example, have two main origins: a bodily, automatic readiness response (fight, flight, freeze) and a thought-based worry where unease spins around future threats. This twofold distinction is clinically useful. Bodily anxiety reactions often require interventions that regulate the nervous system — breathing exercises, exposure and gradually increasing tolerance for bodily sensations. Thought-based worries often respond well to cognitive approaches and mentalization: examining the assumptions underlying the worry, and testing hypotheses in reality. Aaron Beck's cognitive model provides effective tools for this by making automatic thoughts visible and challenging them. Depression often appears as an accumulation of several types of reactions: reduced energy, diminished ability to feel pleasure, increased self-criticism and withdrawal from relationships. Many of these symptoms are closely tied to issues of self-worth and self-assertion. When a person feels they 'have no value' or that their needs are not important, motivation and social engagement often decline. Here, work on self-esteem and small, concrete experiences that contradict negative self-perceptions is central. ## Shame, envy and the inner critic Feelings such as shame and envy are often underlying drivers of psychological distress. Shame makes people hide and strive for perfection to avoid perceived rejection. Envy can create vulnerability and anger turned both inward and outward. The inner critic — a voice of condemnation and demands — often has roots in early parenting: strict correction, high expectations or lack of emotional availability in childhood. In therapeutic meetings we work to name this criticism, explore its origins and gradually cultivate a more supportive inner voice. Here, insights from attachment theory (John Bowlby) are useful: how early relational experiences shape internal working models of self and others. Through a secure relationship in therapy many people can experience something different than what their inner critic claims — a corrective experience that is important for healing. ## Childhood experiences and children as symptom carriers Childhood experiences play a large role in how we handle emotions as adults. Many adults carry strategies developed in response to parental demands and boundaries. Some learned to be quiet to avoid conflict; others developed over-responsible behavior to maintain an unstable caregiving situation. These patterns often appear in therapy as 'automatic' reactions. I also often see that children act as symptom carriers for the family system. A child may show behavioral problems or emotional unrest that actually express interactional difficulties within the family. In such cases interdisciplinary work and family involvement are crucial. By working with both the child and the parents one can address underlying dynamics and create change at the system level. ## Being genuine in relationships: a therapeutic value Genuineness — being honest and present in encounters with others — is a powerful therapeutic force. In therapy I strive to be authentic while maintaining boundaries and safety. When people meet a therapist who can be both empathic and clear, they get a model for how they can be more open in their own relationships. This is not about perfect transparency, but about making room for difficult feelings and acknowledging them without shame. Genuineness often brings relief: saying the difficult thing out loud reduces some of its power. In group therapy this becomes especially visible; others' reactions can both validate and challenge, and through this there is often learning in how to be vulnerable without becoming overwhelmed. ## The nature of anxiety and how we meet it Anxiety is best understood when we hold two perspectives at once: the body's alarm and the mind's narratives. Bodily anxiety is often fast, automatic and especially geared toward immediate danger. Thoughts, however, can spin hypothetically: 'What if...' — creating persistent worry that drains energy. In treatment we often combine approaches: exposure therapy and techniques for nervous system regulation on one hand, and cognitive processing and mentalization on the other. Psychoeducation about how body and mind interact is also important; sometimes it helps to know that the discomfort is not dangerous in itself, but a sign that the nervous system is activated. ## Psychosis and treatment perspective Psychosis differs from the symptoms we've discussed in that the experience of reality can change fundamentally — one may have hallucinations or fixed delusions. Treatment of psychosis often involves a combination of antipsychotic medication, psychosocial support, cognitive therapy adapted to psychosis (CBTp) and family interventions. Early intervention is important for prognosis. When working with psychosis respect for the patient's subjective experience is essential. At the same time we work with reality testing, stress reduction and building supportive networks. Interdisciplinary collaboration between psychiatrists, psychologists, social workers and other health professionals is often crucial to provide comprehensive support. ## Interdisciplinary practice: experiences from Solvangen In my work at Solvangen interdisciplinary collaboration has been a central strength. When different professionals contribute their expertise — from medical assessment to educational and social interventions — the patient receives a holistic offer. Such collaboration makes it possible to address complex difficulties from several angles simultaneously. Interdisciplinary work requires good communication, respect for different perspectives and a shared understanding of treatment goals. When this works, I more often see lasting changes: better sleep, more stable emotional regulation, and an increased ability to function at school or work. ## Closing reflections: make room for humanity Psychology and psychotherapy are about helping people navigate their inner landscapes. It requires both practice and theory, but above all a space where people can be honest with themselves. Many of the troubles I encounter — anxiety, depression, shame — are not necessarily signs of an inherent 'weakness', but signals that something in life or relationships needs to be seen and processed. Genuine openness in therapeutic relationships can be deeply healing. When we help make inner experiences less shameful and more understandable, we lighten the burden for the person who struggles. Learning to mentalize, to recognize the body's warnings, to challenge the inner critic and to experience safe relationships is at the core of much of the work I do. The goal is not perfection, but increased understanding, greater acceptance and more room for humanity. It is demanding work, both for the recipient of help and for those who provide it. Yet it is also meaningful: seeing people gradually carry themselves with more calm, meet relationships with greater clarity, and find strength in vulnerability is what makes this everyday life in psychotherapy so significant. --- **Want to dive deeper into this topic?** This is a topic psychologist Sondre Risholm Liverød talks more about in the podcast episode of the same name. You can find the episode as part of the practice materials at [BeBalanced.ai](https://bebalanced.ai).