I recently read an article in the Guardian (1 March 2025) by neurologist Suzanne O’Sullivan. She writes of a startling rise in medical diagnoses of chronic conditions and mental health disorders, adding that “ordinary life experiences, bodily imperfections, sadness and social anxiety are being subsumed under the category of medical disorder. We are not getting sicker, we are attributing more to sickness.”
This led me to wonder: if our bodies are screaming in distress, what is not being heard? What can psychotherapy offer that is different from diagnosis?
The discipline of psychotherapy has been called “the hard work miracle” (Stephen Johnson, Characterological Transformation, 1985). I see it as digging a garden — planting seeds and waiting for them to grow. It provides a broader space for healing, where through being profoundly understood and cared for, our basic human needs are met. It is an exploration, not a rush to conclusions.
I have personally experienced psychotherapy as a tool for transformation and healing. Over the last 20 years, insights from neuroscience have made it more holistic, as Bessel van der Kolk’s The Body Keeps the Score lays out. Many therapies now acknowledge that mind and body are not separate. Distress can manifest physically, and while psychotherapy may not cure all conditions, it brings balance and fullness of life. When someone expresses ‘dissonance’, what they most need is empathy and astute understanding. When received at the right time, it can be powerful, like a “bulls-eye in the forehead”—painful but relieving.
We sometimes call someone who comes for psychotherapy a patient. This is fitting; we need patience to untangle the knotted ball of string within us. Change is slow and rarely easy, sometimes requiring entry into a dark, frightening place—for both therapist and patient.
Like gardening, psychotherapy is not easy. I understand the pull towards diagnosis; facing pain is hard, and we have innumerable ways to avoid knowing about it. Opening up, being honest about our conflicts, and entrusting ourselves to another is an act of bravery.
The discipline of psychotherapy is slow and involves offering a steady, unwavering beam of light. Learning this role, I have come to love the peaceful state required. I could not do this if someone had not first given their consistent, unfaltering gaze to me. I have learned to sit calmly with myself, focusing powerfully on another, whatever happens.
Seeds need light as they take in goodness in the dark. The skill of the practitioner is to keep offering that light, even when meaning remains unclear. There must be no rush — just curiosity about the ‘now’. Repeated observations and ideas may be rejected, not because the person is difficult but because conflicting parts within them demand attention.
Bumping into these obstinate elements can make the gardening process difficult. A person may know they need help yet remain entangled in the external world, trying to please others while hating themselves. They may be driven by trauma towards a flight response that doesn’t allow them to rest, or a tendency to smooth over painful truths. These parts may dominate so completely that peace feels unattainable.
I love gardening, being involved with giving plants the space to thrive. Psychotherapy works similarly: when parts of ourselves are understood and befriended, they settle and coexist in peace. For this to happen, we must be met consistently with interest, compassion, care, acceptance, firmness, perseverance, and honesty. Carl Rogers called these the core conditions, and they truly work.
Like a deep, dark soil, these core conditions are something I believe in. I love entering the dark, coming to tolerate obstacles and see where light can be shone. The silent quality of attentive listening is like that light, enabling us to see ourselves over time. Carl Rogers wrote about potato seeds in a basement with only a chink of light, towards which their sprouts will grow. The light is the attention of the bending gardener listening with so many hidden qualities in the blend of soil.
I love witnessing those who accept themselves begin to grow, and make choices that help them flourish. This growth is often gradual, like slow weight training. I love psychotherapy. It is a hard work miracle that moves us from sickness to health without pathologising. It has profoundly changed my life and those of many I have known. To be deeply accepted for our own mix of ingredients, free to be who we are, can be liberating. Maybe these core conditions, in such short supply today, could be the welcome salve for our current sickness.