What is Therapy?

Psychotherapy:  an encounter in which 2 or more people, one of whom is a trained professional, meet privately and confidentially to talk about and work on solutions to problems, usually of a personal or interpersonal nature.

Psychotherapists come from many disciplines:  nursing, psychology, social work, the ministry, psychiatry, and many individuals study and become licensed through various fields of practice, including marriage and family therapy, substance abuse treatment, personal coaching, and so on. I should also point out that not all mental health professionals offer psychotherapy.

For example, some psychiatrists offer psychotherapy but most focus on diagnosis and medication management;  some psychologists offer testing and evaluation, but do not provide psychotherapy; and substance abuse counselors focus on problems associated with substance use but do not usually have the requisite training for treating mental health disorders such as depression.  

Life, wonderful as it may be at times, often presents us with challenges and difficulties we cannot easily understand or overcome. To put it simply:  everyone has problems. Most of us work continuously to manage these problems and preserve enough time, energy, and money to enjoy life and enjoy other people. In other words, we all do the best we can not to let the problems and challenges weigh us down too much. In some cases we do OK, and in others we struggle a great deal.

A therapist can provide a number of very critical things that you cannot get from friends, family, and co-workers:

• neutrality and impartiality:  the therapist is a neutral person whose mission is to understand and help you with your best interests in mind, and with no other agenda than to assist you in achieving your treatment goals
• privacy:  services are offered in a private, confidential setting, that insures the privacy of your concerns and your records
• special knowledge:  therapists possess knowledge, training, and understanding about the kinds of problems you are facing

A therapist basically does 3 things:

1)  asks questions, observes, listens and actively seeks to understand your experience, in an empathic way;

2)  assists you to solve problems by encouraging you to make changes in your thinking, perception, and behavior, by guiding you and making suggestions for how to succeed with these changes

3)  teaches or imparts skills, tools, and strategies which help you manage and prevent future problems

I would suggest you seek help if:

A) you are unsure you have a treatable condition and you want an evaluation or opinion about it; 

B) you know or strongly suspect you have a treatable disorder and you aren’t managing it well enough, or you see your mood, thought processes, or level or functioning deteriorate in some way, or;

C) something personal and upsetting has happened and you want a safe, private place to talk about it.

You can understand therapy as having 3 phases:  the first phase involves “role induction” during which the therapist explains his or her role in the helping process and sets the stage for trust, disclosure, and active participation through dialogue on the part of the client.  History is obtained, problems are defined, goals and hopes for change are elicited and shaped. An agreement to work together precedes the next phase. 

       In the second phase, client and therapist work collaboratively in examining what possible changes in the client’s way of being or way of handling the problems might be warranted, and focus both on greater understanding and the client’s taking charge of change….one could say the first phase addresses the therapist’s needs (to make a correct assessment, discuss matters such as confidentiality and fees, and launch therapy in an orderly and constructive way) while what happens in the second phase depends on the needs of the client.  If much listening and exploration is sought by the client the therapist should endeavor to offer this approach;  if rapid, pragmatic change is the goal (as, for example, in the case of panic disorder) the therapist should apply methods known to be most effective in alleviating the presenting symptoms and strive to impart coping skills that will enable the client to tackle the problems outside of therapy, and on into the future. Where self-understanding is sought, longer-term therapy provides time for individuals to discover more about the internal workings of their lives, draw connections between past experiences and current trends of thinking, feeling, and volition, and develop a stronger sense of mastery in regard to current and future challenges.  

       The final phase involves review of what has been accomplished, acknowledgement of any regrets or unfulfilled expectations, and words of closure. At that same time, referrals may be made for any remaining practical needs (e.g., financial planning, vocational counseling, legal assistance, etc.) for which psychotherapy is not the appropriate resource.

Thumbnail sketches such as this do little justice to the complexity of therapeutic relationships, yet it may serve as a road map for a basic understanding of the process. Psychotherapy also occurs within a number of modalities: individuals, couples, families, groups; it can last a session or two, or many months (or years). Much of it follows the general outline above.

One peculiarity about psychotherapy lies in the nature of the “interactive loop” between client and therapist:  the therapist listens and talks some, usually revealing very little about his or her personal life, while the client reveals a great wealth of personal information. Their relationship is not one of reciprocal knowledge, as in a friendship. The focus, as it were, is always on the client, which leaves some clients feeling quite awkward, especially toward the beginning and especially if the client has difficulty trusting others. Perhaps a comparison would help: you typically do not learn much about your physician’s health when you are examined by a physician, and while your plumber makes a knowledgeable analysis of that clogged drain, he or she rarely feels compelled to reveal a personal history of drain problems. The therapist’s lack of personal disclosure promotes a neutral, unbiased stance. Except for relationships with clergy (and occasionally lawyers), there are very few relationships with professionals in which you - the client - are expected to disclose extraordinary detail about your private world. Your relationship with the psychotherapist may be like no other in the expectation that you disclose, as necessary, what is most deeply personal about you.

Please refer to "How to Choose a Therapist".

Sometimes treatment produces good results, sometimes it has little or no effect; rarely is it detrimental. My own anecdotal observation, together with psychotherapy outcomes research, suggests that success in therapy stems from several critical factors: 1) the skill and experience of the therapist (which includes the degree to which the therapist applies techniques of his or her therapeutic approach diligently and consistently); 2) motivation of the client for change, and 3) whether the interaction between the client and therapist generates a sense of collaboration and hope for change. Of course, the change process is many times more complex than this, and many factors come into play.  Success also must be measured in light of what is sought: the client who seeks a few, practical behavioral changes (e.g., wants to “feel better”) may achieve swift, positive results. In contrast, the client who wishes to work on changing attitudes or deeply ingrained patterns of feeling or behavior will have a longer, more challenging task ahead.  Commitment to the process and diligent efforts on the part of both client and therapist contribute to success in therapy.