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The Challenges of Psychotherapy. Towards a Relational and Process Perspective

This week's post is by Enara Garcia, Marie SkÅ‚odowska-Curie Actions Postdoctoral Fellow at Department of Psychology, University of Southern Denmark.
  

Enara Garcia 

In recent years, psychotherapy has become a central cultural reference point for understanding ourselves and regulating our distress. Yet the more therapy saturates public discourse, the more urgent it becomes to ask what kind of psychotherapy we actually need. I have been investigating therapeutic relationships from embodied perspectives for some years. What follows is a personal reflection on why psychotherapy needs a more critical, relational, and process‐sensitive orientation.

A first step is rethinking what we mean by mental health. Rather than treating mental conditions as cognitive dysfunctions or biomedical pathologies, I understand mental health as our capacity to create not only meaningful worlds, but also worlds that are significant for us. This requires distinguishing meaning—the content of experience—from significance—the felt value that orients us within experience.

Much of today’s mental health crisis stems from a collapse of significance. We live amid an overflow of psychological content: diagnostic labels circulate on social media, everyday suffering is psychologized, and self‐monitoring apps promise emotional optimization. Yet this excess of meaning coexists with a loss of significance, belonging, and existential orientation. Fragmented social contexts, precarious relationships, and dehumanizing work conditions erode our ability to inhabit meaningful lives. No technical intervention can compensate for this. What we need is a collective reimagining of the frameworks that make life feel worth living.

If experience is co‐constructed, psychotherapy is not simply a method for symptom reduction. It becomes a relational training ground: a space for intimacy, negotiation, mutual care, and embodied attunement. Each moment of genuine contact—each shift in posture, each tremor in the voice, each shared silence—can reshape the experiential landscape for both therapist and client.

This stands in stark contrast to standardized intervention models, which assume that identical treatments can be applied to people with the same diagnosis regardless of who delivers the intervention, who receives it, or the context in which it takes place. Instead, I see psychotherapy as a form of participatory sense‐making, which highlights the reciprocity, relationality, and co‐embodiment that make therapeutic encounters unique and irreducible to protocols.

However, there are three challenges that contemporary psychotherapy needs to face: 

First, therapy is often criticized for individualizing structural suffering. And this is true, but when mental health is understood as fundamentally relational, therapy becomes one of the places where this relational reality is lived more intimately, opening a space for negotiation and both individual and social transformation.

Second, therapeutic relationships are inherently asymmetrical, and this opens the door to epistemic injustices. Patients' subjective experiences might be overshadowed by medical discourse. Thus, we need an engaged, second‐person epistemology to counteract the risk of over‐interpreting or overriding the client’s perspective. Going back to the body is crucial here, as it is the locus where experiential and expressive features come together and where individual and shared meanings are manifested.

Third, we are developing beings, not reducible to momentary characteristics or snapshots. In the context of human becoming, therapeutic change is never linear. Relational ruptures, conflicts, relapses, and recoveries are not obstacles to self-transformation but essential phases of becoming. We need a process‐centered psychotherapy, which takes the dynamic nature of personal growth and uncertainty as primordial. This implies cultivating the therapist’s embodied presence and their sensitivity to the unfolding of the shared trajectory of the therapeutic process.

In conclusion, I believe the field has correctly shifted from problem‐based to person‐centered approaches, placing the patient ́s perspective in the middle. Now, a process‐centered psychotherapy pays attention not only to who the person is or what the problem is, but to how the therapeutic process itself evolves. It invites therapists to accompany, facilitate, and care for this unfolding, recognizing that transformation emerges not from techniques but from the shared creation and negotiation of new possibilities for meaning and significance. 

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