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What is process versus content in therapy?

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Process in therapy refers to the entire process of the therapeutic relationship between the therapist and the patient. Content refers to what the therapist and the patient actually talk about during their sessions. This might include the patient’s life history or things that have been bothering them lately.

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I would explain the difference between process therapy and content therapy by discussing process therapy as what is happening in the long-term, and content therapy as what is happening in a specific counseling session. Process therapy refers to the journey towards wellness that the therapist and patient are jointly working on. This could be related to a long-term trauma that the patient is dealing with. Let us take, for example, a man who was physically abused by his father as a child. The “process” of understanding and overcoming this trauma would be classified as process therapy.

Content therapy, on the other hand, refers to what the patient chooses to speak to the counselor about in a session. Using this same example, the man may choose in a particular session to say nothing about his childhood trauma, but rather to speak about difficulties he is having in seeing eye to eye with a colleague. While his response to the colleague will be influenced by the trauma that he suffered as a child, this trauma is not the immediate issue being discussed.

Content therapy and process therapy are thus linked, and it is by listening to the content of what he or she is told that the counselor is able, in the long term, to assist with the process.

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The concepts of process and content in therapy generally tend to relate to the respective roles of therapist and patient. The therapist’s main focus is on the process, the totality of the therapeutic relationship as it exists between her and her patient. The patient, on the other hand, is chiefly focused on the content of therapeutic sessions, which is the things that are actually said, the problems that are discussed, and so on.

Examples of content would include pertinent details from a patient’s life story, or recent events in their lives that are relevant for discussion and examination in a therapeutic setting.

To put it simply, content is what you say, and process is why you say it, or the underlying meaning behind what you say. So for instance, a patient may tell her therapist that she’s feeling perfectly fine. But in actual fact, she may not be fine at all and is simply being evasive.

In other words, the content—in this particular example the patient saying, “I feel perfectly fine”—doesn’t tally with the process, the actual experience, of what’s happening here and now, both inside the patient and between herself and her therapist. For most therapists, it's the process that is the most important aspect of therapy.

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Process and content are two pieces to an overall idea of therapy and are also their own versions of therapy altogether. Process therapy deals with the actions and process, both of how something came to be (such as a negative reaction or experience) and how to resolve it (what steps need to be taken). Content therapy, focuses instead on the event or object—the content. Essentially it is a focus on the actual problem, and the therapy is revolved around confronting the issue and accepting it in order to move on.

For example, process therapy would deal with how someone came to have anxiety by addressing the stresses in the individual's life from a young age and then make a path forward to address those stresses and fix the problem. Content therapy, however, decides to address the fact that you are anxious and come to terms with that situation. By accepting it, the content therapist will be able to help them find rational ways of confronting it or working around it but in a different way than process therapists would.

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Process therapy is related to actions (versus what is going on in a clinical patient's mind, or what the expectations and goals motivating his or her behavior are). Content therapy examines how the patient's situation is delivered as a narrative (i.e., what is the ostensible problem and motivating force—physical hunger, pain, social needs, etc.). What a patient tells the therapist is the relevant content. What is motivating to engage in or subject themselves to such behaviors is the process. Ideally, therapists address both the content and processes of a patient's circumstances, and neither to the exclusion of the other. Therapists aim to give patients tools to address the expectations and motivators that result in certain behaviors with process-based therapy, while also identifying the specific problems (content) which the patient is combating.

Content is "what" of a discussion, argument, relationship, etc. Process is the "why" or "how," these dynamics manifest themselves. Generally, process-based therapy is helpful when patients themselves may themselves not be able to identify the reasons for certain behaviors.

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