By Margaret Parish, Ph.D. 
Does the past matter? Many people considering psychotherapy ask this question. Psychoanalytic psychotherapy in particular aims to help people understand their lives, which often includes revisiting and reflecting on the past. Unpleasant events that one might rather forget can suddenly seem painfully present during therapy, and sometimes people feel worse before they feel better. Is this really necessary?
A recent series of articles in the New York Times highlights situations in which better understanding what happened during a past event can offer relief from suffering. Critical care specialists are beginning to recognize that Post Traumatic Stress Disorder (PTSD) can follow hospitalization in an intensive care unit. Arriving at the hospital critically ill or injured, a patient in the ICU undergoes extreme physical procedures during which they are often terrified, sedated, confused, in pain, and radically out of control.
To help with the psychological aftermath, ICU nurses in some hospitals have begun keeping diaries  that describe concretely what happens there – what led to the hospitalization and what physical procedures are performed. Reading this diary later allows the patient to compare hazy and frightening memories to a record of events written from a different perspective. Matching strange memories to this record can help to explain the experience and place it in a coherent social context, relieving the solitary, confusing terrors of PTSD.
People in psychotherapy may or may not have experienced extreme trauma, but many have suffered disturbances that remain only partially understood – events they did not understand and in which they felt alone with very strong feelings. Childhood events can be among the most confusing, because children are just learning to make sense of the social world, and they depend on others to help them understand emotional experiences. When this kind of support is absent, for whatever reason, the effects can persist into adulthood, creating symptoms, distorting relationships, and limiting choices.
It is much harder to account for many of life’s troubling events than it is for what happens during a medical procedure, and most people cannot have the equivalent of an ICU nurse present at every moment to record what happens from a different perspective. This is where a psychotherapist can help to understand past events in their contexts, offering guidance and perspective as a person reviews what he or she has suffered. Often during this process family members and others can also provide different points of view about shared past events, further mitigating the aloneness that makes painful experiences particularly difficult to bear.
Ultimately psychotherapy is future-oriented, aiming to free a person from suffering and from other impediments to living a fulfilling, meaningful life, now and in the future. For many, gaining clarity about burdensome aspects of the past is an important part of this work.