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What to Expect From Therapy
Who Receives Psychotherapy?
Most people, at one time or another, need some help. For some, talking with a therapist helps them understand ways to improve their life. Sometimes people seek therapy at the advice of a physician or a health agency. Sometimes it’s overwhelming life stress or a particular crisis that causes a person to decide to go to therapy. And many times people enter therapy to gain insight and acceptance about themselves and to achieve personal growth. Psychotherapy is for anyone who is unhappy with the way he or she acts or feels, and wants to change.
What Is Psychotherapy?
In general terms, psychotherapy is a relationship in which one person enlists the professional assistance of another for the purpose of bringing about changes in his or her own feelings, thoughts, attitudes, and/or behavior. The task of the psychotherapist, therefore, is to help individuals make the changes they wish to make. Sometimes the person entering therapy knows changes are needed but doesn’t know what changes to make or how to go about making them. A psychotherapist helps the person figure this out.
How the psychotherapist goes about helping a client will depend upon the therapist’s training and theoretical orientation. This orientation will affect the therapist’s style and focus, as well as the methods and techniques used in psychotherapy. Most therapeutic orientations fall under three general categories: Behavior Therapy, Psychoanalytic/ Psychodynamic Therapy, and Humanistic Therapy.
Behaviorally oriented therapists practice a particular kind of therapy known as behavior therapy. Behavior therapy involves the application of findings from behavioral science research to help individuals change in the way they would like to change. Behavior therapy places a strong emphasis on the principles of learning and on how faulty learning may cause problems in a person’s life. There is also an emphasis in behavior therapy on checking up on how effective the therapy is by monitoring and evaluating the client’s progress. Most behaviorally oriented therapists believe that the current environment is most important in affecting the person’s present behavior. The procedures used by behavior therapists are generally intended to improve the individual’s self-control by expanding the person’s skills and abilities. Almost all behavior therapists assign homework and the practice of new behaviors as part of their therapy.
Another type of behavior therapy is cognitive behavior therapy or cognitive therapy. Cognitive therapists believe that many problems stem from irrational and dysfunctional thoughts, ideas, and beliefs, and that these thoughts may affect a person’s behavior and emotions. The goal of cognitive behavioral therapy is to modify a client’s way of thinking so that a change in behavior and emotions can occur.
In order to do this, cognitive therapists often assign such monitoring tasks as keeping track of thought patterns and performing experiments in everyday life to see if the ideas or beliefs are actually correct.
Psychoanalytically or psychodynamically oriented therapists believe that many psychological problems stem from unconscious impulses and conflicts that develop and are repressed in childhood. To treat psychological problems, psychoanalytic therapists attempt to help the client bring these repressed (held down) feelings into conscious awareness and to work through them and gain insight into them. Some techniques used by psychoanalytically oriented therapists include dream interpretation and free association, in which the unconscious is explored by having the client relax and say whatever comes to mind.
Humanistically oriented therapists emphasize people’s built-in abilities to achieve self-fulfillment. Humanistic therapists try to help people grow in their self-awareness and self-acceptance. Humanistic therapists spend less time on past events and focus more on the present. They help clients focus on feelings and conscious, rather than unconscious, material. Humanistic therapists use techniques that encourage people to take responsibility for their actions and feelings, rather than looking for unconscious motivations behind them.
You will probably want to ask potential therapists if they adhere to a particular orientation and what that might mean for your therapy experience. Most psychotherapists are not rigid in their orientations but are flexible in that they use ideas, techniques, and methods from various orientations.
Psychotherapy is also given in different ways. Besides individual and group therapy, couples/relationship and family therapy are generally available. There are also psychotherapy groups whose members may have a single interest or problem. These alternative approaches to therapy also can vary widely depending upon the therapist’s orientation.
What Happens in Psychotherapy?
The therapeutic process varies depending on the orientation of the therapist. It also differs for each individual client depending on the client’s circumstances. However, there are some common aspects of therapy that you are likely to experience when you enter a therapeutic relationship. To begin with, your first session with a therapist should be a consultation session. This consultation does not commit you to working with the therapist. The goals in the consultation are to find out whether psychotherapy would be useful to you and whether this particular therapist is likely to be helpful. During this session, you may want to discuss with the therapist any values that are particularly important to you. If your therapist’s views are very different from yours, you may want to find a more compatible therapist.
This first session is a time for you to determine whether you will feel comfortable, confident, and motivated in working with this particular therapist. You should also feel that you can trust and respect your therapist and that your therapist is understanding of your situation. This is also the time for the therapist to decide whether he or she is a good match for you. At times, a therapist may refer you to another therapist who may be able to work better with you.
After you’ve decided to work with a particular therapist, the next few sessions are usually devoted to talking about the circumstances that have brought you to therapy. Generally, during this time (assessment) your therapist will be asking quite specific questions about the concerns or problems causing your distress and about when and where they occur.
Assessment also can be done more formally, through the use of questionnaires or tests. A therapist can use a variety of techniques in assessment. Initial assessments are used to get therapy started; however, a good therapist will continue to assess a client’s problems throughout therapy and change the direction of therapy, if needed.
After the initial assessment stage, the rest of psychotherapy is devoted to helping you gain insight and solve current problems and/or help you change the emotions, thoughts, and/or behaviors that you want to change. The goals you bring to therapy are the gist of the therapeutic process. How these goals are accomplished depends a great deal on both the orientation of the therapist and the techniques the therapist may use with you.
Some therapists may require more activity during therapy than just talking with you about particular issues. These activities may include such things as role playing or homework assignments in which you practice some of the techniques introduced in therapy (like relaxation skills or communication methods). Therapists also differ on how strongly they determine how therapy proceeds. Some therapists may take a more directive role, while others let the client direct the course of therapy.
The amount of therapy you receive will also vary depending on the orientation of the therapist and/or the specific treatment plan used. Some therapies are relatively short, while others require a longer time commitment. Each session of therapy usually lasts about an hour, and you generally meet with your therapist once a week. However, such time schedules are rarely rigid and may be changed to fit the needs of you and/or your therapist. It is a good idea to ask your therapist about the general techniques he or she may use with you in therapy, as well as about the length and frequency of therapy you might expect.
Some therapists use other forms of treatment in addition to psychotherapy. These treatments may include such things as pharmacotherapy (medication) or other biomedical therapies, outside support groups, and/or physical health treatments.
Finally, after a period of time you and your therapist may agree that therapy has been successful in helping you achieve your goals; and, thus, therapy is no longer needed. Even after therapy has ended, some therapists may ask you to come back several months later for follow-up visits to check on how you are doing.
If you encounter new problems or feel that past problems still haven’t been resolved, you may choose to return to therapy, either with the same therapist or with a new therapist. One important thing to remember is that therapy is not a “cure-all” for everyone, and you should always consider other alternatives when a particular therapy isn’t working for you.
What Should Not Happen in Psychotherapy?
The relationship between client and therapist is based on mutual trust and respect. If either party violates this trust and respect, there may be adequate reasons to end therapy. Licensed therapists are expected to adhere to a code of ethics when seeing clients. Most professionals would agree that violations of a client’s confidentiality, infringement of a client’s legal or civil rights, sexual harassment and/or sexual relations, and physical or verbal abuse should not be tolerated in a therapeutic relationship.
If you feel that your therapist is acting in an unethical manner with you or exploiting you in some other manner, you should speak with your therapist about your concerns. If your therapist avoids your concerns or does not address them to your satisfaction, you should consider changing to another therapist. In addition, you can report the therapists’ behavior to your local psychological or psychiatric association.
Psychotherapy can help you in many ways. Like most human endeavors, it needs time and motivation for the most successful outcomes. Finding the right therapy and the right therapeutic orientation for you is the best start.