I am finite. I am limited. I cannot tell the end from the beginning. Sometimes that makes for a good time at the movies as I wait in suspense to see not only what is going to happen next, but also how it will all turn out.That’s what made for an enjoyable time the last two excursions to the theatre ‘The Life of Pi’ and ‘Skyfall’. However, when people come to me for psychotherapy, for counselling to help resolve a problem, there is this unspoken need to know how it’s all going to turn out.In the medical model, you take some pills that are supposed to relieve some symptoms, and then, in a matter of days, things change, and it all turns out well. End of symptoms. End of problem. I know it doesn’t actually work like that, but that is the model and all attempts are to work that model to a happy ending.One approach to doing clinical psychology is to adopt the medical model. As such, ‘interventions’ are created to reduce symptoms and to lead to a happy ending. That approach in psychotherapy works far less well than it does in medical practice. Psychotherapy works, but how it works is still being understood. Current research is aimed not so much on figuring out which approach to psychotherapy is better than others (for all established models of psychotherapy work about equally well), but at figuring out what the mechanisms of change actually are.Such research has come up with several factors. One is the relationship between therapist and client. Another is what is variously called “extra-therapeutic factors” or “client factors”.In other words, one thing that makes for significant change is the environmental, societal, and situational facts that exert an influence on both client and therapist; these things are not controllable, although they are understandable and can be taken into account as the process of therapy unfolds. They affect how people think and feel, and they are key ingredients in how any given person makes up the meaning of his or her experience. It is this meaning that then influences what a person does, and subsequently how they feel. For instance, if I believe that this country is against me and that people in this country basically don’t like me because of my race or where I come from, then when I walk down the street I start out with a low level anxiety that puts me on guard.However, if the meaning I make up from the factors in my environment leads me to believe, to tell myself a story that has me living in a welcoming country filled with people who actually do care about one another as human beings apart from their skin colour and national origin, then my starting experience is something quite different. It is this starting place, this background understanding of the nature of a person’s life, that gives meaning to any given development within such a context.Second, the connection between therapist and client is essential to positive outcomes in psychotherapy. That relationship develops within the context I just mentioned, the given starting point for the clinical process, but if the two people in question can connect, can establish therapeutic contact, then a two-person “bubble” forms in which they affect one another. It is not a one-person psychology in which the therapist does things to the client (that is the medical model). Rather, this is what is called an “intersubjective” process; the relationship emerges from the functioning of the two persons (the two subjects) in question, in which they meet as equal human beings but as two people with significantly different roles. They enter into an agreement in which it is understood that they meet mostly in favour of the client, although there are certainly benefits to the therapist of their meeting.The client comes to solve a problem, alleviate suffering, dissolve dysfunction, change, grow, and become healthier and successful with regard to the situation that constitutes his or her life. The therapist comes to make a living, and to make a living at doing something important and significant to his or her life. It is the opportunity to make a difference in the lives of other people, meeting them at critical moments in their lives that attracts people to the vocation of psychotherapy. In their meeting the client finds support, and the therapist finds satisfaction in work well done. The client often unleashes emotions that are difficult to handle. The therapist listens and is touched by stories, one after another of distress, suffering, and self-destruction, and if the therapist is truly making him or herself available to the client, then the therapist becomes emotionally moved by the tragedy, loss, and anguish he or she participates in with each client and with each story that unfolds between him or herself and the various clients.I don’t believe there is any kind of work quite like it. It is a privilege to be with people as they open up like they would never dare do outside of therapy. However, it comes with a price, because ultimately no therapist knows the end from the beginning, and no therapist can make all the pain and suffering go away, wave a magic wand and make people stop hurting themselves and others with destructive behaviour. No therapist is God, who does know the end from the beginning, can get inside a person and wisely guide him or her. Consequently, the best any therapist can do is to be with the client in the current moment of their situation and to apply their clinical approach, hoping for the spark of insight, the will to try something different, and for what probably seems like good luck to some but the grace of God to others. Without that, the price to be paid is to watch people come and go without making progress; to watch people do the same lame thing hoping for something different to happen and deluding themselves that it will. In such cases the therapist shakes his or her head and tells him or herself, “Well, maybe they’ll make it happen. Maybe it’ll work out, because heaven knows, I sure don’t know the end from the beginning.”