Therapy Demystified

I remember my first exposure to the concept of therapy.  It was from my mother, of course.  I was complaining about something not being fair (bedtime, no dessert, sibling rivalry?). She said, "Levana, if you don't like it, tell your therapist when you get older."  I had no idea what this meant, but in retrospect, it's hilarious.  Therapy seemed to be this magical place I could go to when I had a problem with my parents.  It was someplace I could go to get everything I was angry about off my chest and have someone agree with me 100%.  Somewhere where I was always right and they were always wrong and then I would feel better when the session was over.  Along the way I figured out that there was a little more to it than that. That's when I became really interested in the idea of helping people through talk therapy. I have seen therapists over the years for both personal and professional reasons.  I believe in the power that self exploration with a well trained and compassionate therapist can have on an individual.  Without therapy, I believe that I would have struggled much longer and more acutely in stressful times.  I am a true proponent of psychotherapy as a treatment for many conditions, with or without combined medical care.  That's why I am still amazed when I speak to people who resist or hesitate when it comes to seeking out therapy.  Especially when it is recommended or even mandated by their physician.  Recently I spoke with a friend who very eloquently articulated her explanation for this.  She understands that when she has a headache and takes Advil, her headache goes away,  If her appendix bursts and she has surgery, the pain will no longer be there. If she takes Xanax in the midst of a panic attack, she is able to relax and let go of the anxiety.  She doesn't understand how sitting and talking to someone can make her symptoms go away.  It seems burdensome to take the time and money for a treatment that has unknown results.

It occurred to me how mystical the therapeutic process must seem to people.  You walk in the room and there is a person sitting there who will somehow get you to change all of your bad thoughts, behaviors and feelings.  Just by lying down on the leather chaise and complaining, you will be happy and everything will turn out okay.  But how does the therapist do her magic? How does she see inside your heart and mind and make the necessary changes? And will you have to talk about how your parents screwed you up for years on end? (Surprisingly, this is has been a common question that I have been asked repeatedly).   Maybe if we were able to demystify psychotherapy, more people would be willing to give it a try.  I don't speak for all therapists out there, as there are various types of therapies and modalities, but here are some basic facts about psychotherapy.

What actually happens when you meet with a therapist?

These days most people don't have a couch to lie down on (Sorry Freud!).  A therapist usually has an office with several chairs or a comfortable couch for her client to relax in.  The room is setup for the therapist and client to have a conversation.  Everyone is equal in the room.  Psychotherapy requires the openness of a client and the training and expertise of a therapist.  Without both of these factors, psychotherapy treatment will not produce good results.

Who decides on the goals of therapy?

You do!  Therapy is your time to work on what you feel is problematic in your life.  Your therapist will likely collect a history of the identified issue as well as general physical/mental/social background.  After that, she will ask you what you would like to work on and how you would like her to help you.  The therapist may advise on any other topics that she feels may also be pressing, but you ultimately set the goals of treatment.

How do I know if I found the right therapist?

There have been studies that have shown that the relationship between the client and therapist is just as important as the techniques used in the session.  It is critical that you feel comfortable and connected to the person with which you are making yourself most vulnerable.  Keep in mind that therapist are people and not all therapists will work well with all clients.  That being said, it is important to find someone who is experienced in the area of your concern.  You can ask the therapist about her education, experience and training.  During the treatment process it is vital that you are honest with your therapist about anything that makes you feel uncomfortable in therapy.  She can help you work through your feelings or change the approach she is taking with you.

So how is all of this talking going to help me?

Many therapists use some version of a treatment modality called Cognitive Behavioral Therapy (CBT).  The idea behind it is that your thoughts and beliefs affect your behaviors.  For example, if you have the belief that you are a boring person it might lead you to avoid meeting new people and isolating yourself.  The treatment then addresses underlying thoughts and beliefs in order to change the behavior you identified as being a problem.  We need to understand why you have these behaviors and then learn ways to change the thinking that causes them.

CBT is also based on the idea that clients need to be able to identify these thoughts as well as their solutions in their own.  This is not to say that the therapist sits there silently while you figure out everything on your own.  We would be out of business if this were the case! The therapists' job is to ask the client questions that can help lead him to the answer himself.

Will I feel better right away?

It depends.  Is it easy for you to express yourself or do you struggle with communication?  Do you have a passing life stressor or major trauma to work on?  Does your problem affect one area of your life or all? These are some factors that can make therapy take longer for an individual to see results.  It is very common for clients to feel worse before they feel better because they are facing issues that they haven't dealt with before or have been avoiding.  Others may feel relieved right away because they just needed someone to talk to.

How do I know when i am done?

Over the course of treatment, your sessions will be less frequent based on your progress.  As you improve, you and your therapist will talk about ending therapy.  You will revisit your goals and together can decide if you've reached them or not.  Keep in mind that therapy is not a one shot deal.  Just like any medical intervention, you can utilize it again your symptoms return or if new issues arise.

Does psychotherapy seem less mysterious now? No head shrinking, brainwashing or someone telling you what to do.  Or endless complaining about your mother.  That is best done over a glass of wine with your siblings.