Department of Psychiatry
Penn Behavioral Health

PAH Outpatient Behavioral Health Clinic

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Newsletter: April 2013

Why should I try Psychotherapy?

(Even if I don’t have a mental illness!)
Kristin Kopple, MA

Attitudes towards psychotherapy vary in our culture.  While some consumers are familiar with the potential benefits and process of therapy, others have concerns and doubts that range from “Why would I pay to talk to someone?” to “Only people who are really sick need psychotherapy!”  Psychotherapy seems to carry a stigma with it, the stigma of mental illness.  While psychotherapy is often indicated for individuals with mental illness, it is also appropriate for people with much less severe and non-clinical issues.   The goal of this article is to explain what psychotherapy is, how and when it can be helpful, what we think makes it work, and what a client might expect in terms of their commitment.

Only relatively recently, the Surgeon General of the United States produced a report on Mental Health in the US in which he stated unambiguously, “Mental health is fundamental to health” (Satcher, 2000).  Mental health is an aspect of well-being that allows individuals to better maintain their physical health as well.  The report also concluded that numerous mental health treatments that have been shown by research to be effective are available to the general public. 

What is psychotherapy?  

When we say “psychotherapy,” we are referring to what is commonly thought of as “talk therapy.”  Psychotherapy takes many forms, but most would agree that it is a process for alleviating some kind of mental or emotional distress.  At its core is a relationship between a client and a skilled clinician.  This relationship provides a safe and supportive environment in which the client can untangle intense emotions, explore aspects of themselves that they do not understand or wish to change, and address painful feelings or complex personal problems.   The client and therapist meet regularly on an agreed-upon schedule, usually once a week.  The client’s role is to describe, explain and express to the therapist and thereby to themselves as well, their thoughts and feelings about themselves or about problematic situations.  The therapist’s role is to listen, encourage, interpret and accept the individual’s concerns and difficulties without judgment. As the client gains insight into the ways he or she as a person interacts with his or her environment, the individual’s everyday experience and well-being improve.  Clients come to understand themselves in the context of their world.  They may also become more aware of how problematic situations or feelings came to be, how to improve daily functioning, and potentially how to prevent similar situations from arising.  Individual psychotherapy can be separate from or in addition to other forms of mental health treatment, such as medication, group therapy or couples or family therapy. 

Therapy works by helping us develop self-awareness and understanding of our behaviors and the forces that drive them.  Some therapists propose that non-conscious emotions and motivations influence our behavior in ways that produce outcomes we may not think we expect or desire.  Bringing these motives and emotions to awareness helps us make decisions more effectively and with better results.

Therapy also helps with emotional expression, and allows the client "to recognize, clarify, accept, and learn to tolerate or change [his/her] emotional experience" (Levitt, Butler & Hill, 2006, p. 321).  It allows the release and expression of emotions that may feel dangerous to express in other contexts.  In this way it can provide relief from emotional tension and pain, and consequently help us better manage potentially destructive emotions, such as anger, aggression and sadness. 

What makes psychotherapy different from talking to a friend, family member or spouse?

While many people have strong trusting relationships, they may nevertheless be troubled by feelings, thoughts or behaviors that they do not wish to share with the people they interact with in their daily lives.  Psychotherapy provides a unique opportunity for open and honest discussion of all aspects of the concern without running the risk of insulting someone, hurting their feelings, or losing their respect and good regard.  There are several key aspects of the client-therapist relationship that makes this possible.

Confidentiality.  When you enter psychotherapy voluntarily, your therapist is ethically bound not to share any information they learn from you in session.  They are even bound not to disclose that you are being seen by them, unless you give express, written permission for them to do so.  This means that you can talk with your therapist about things you are thinking about without jeopardizing your job, your relationships or family.  You don't have to worry that your information will be told to anyone unless you tell them yourself.

Acceptance without judgment:    A key feature of the therapist’s job is to fully understand your problems as you experience them.  To do this, the therapist will accept your point of view without placing a value on your viewpoint, without judging the correctness or social implications of your views.  By setting aside her own opinions and preferences she may be able to objectively help you evaluate potential consequences, but her overarching purpose is to help you determine what is important for you, and how you can achieve it.

Client-focused relationship.  The client-therapist relationship exists solely to help you, the client, in your difficulties.  Unlike with friends and family, the therapist does not expect you to listen to his or her problems when you have finished talking about yours.  He/she expects nothing in return except payment for time.  One of the reasons that therapists reveal very little about themselves is so that focus remains on the client.  Because the therapist is not also your brother-in-law or your friend, you are free to discuss your concerns without worrying about protecting yourself from potential disapproval or reprimand.

Clinical expertise.  Due to the therapist’s training and experience, and because of his/her choice of profession, you can discuss painful experiences or serious concerns without worrying about protecting the therapist.  His or her training and expertise also allow the therapist to bring scientific theory and clinical experience to help problem-solve or treat the issues most troubling you.  

What happens in psychotherapy sessions?

The main thrust of most talk therapies is for the client to do just that – to talk about problems, concerns and painful experiences in a safe environment.  It is the therapist’s role to listen, to ask questions, to reflect and sometimes to interpret what he or she hears you, the client, describing about your situation and feelings.  Because of the therapist’s training and expertise, he or she may ask questions no one has had the courage to put to you before, or that you would be afraid to answer to anyone else, but that are nonetheless important to your understanding what you really want out of life, and what you need to be happy and successful.   Many therapists will make use of different expressive modalities to whatever advantage best suits you, such as writing, artwork, drama, narrative stories or music.

Therapy is an active process, in which you and your therapist work together in what master psychotherapist Nancy McWilliams calls “a comfortable collaboration” (McWilliams, 2004).  The therapist does not solve your problems; rather, he or she helps you determine what you want and what will best help you achieve your goal.  You contribute to the process by engaging in self-reflection and introspection, and by actively participating in problem-solving.   In many therapies, you and your therapist together will develop coping strategies and methods for changing unwanted behaviors.  The therapist contributes by providing safety, structure, support, and feedback.  Some therapists use exercises completed outside of session, to help you extend what you learn about yourself in sessions to your everyday life. 

What can I get out of therapy?

Many people choose to work on specific problems that seem to come up again and again in their lives.  Or they may have specific symptoms they wish or need to manage or unwanted behaviors they would like to eliminate.  Therapy is also a good space in which to evaluate new ways of handling a problem or chronic issue without running the risk of needlessly disappointing or hurting those you care about most.  Therapy is a safe environment for discussing painful experiences, without burdening those close to you or without threatening them.  People often find that therapy itself is an excellent way to ease the stress of living with powerful feelings, and it is a good source for strategies for coping with stress as well. For those who have a mental illness, therapy can help build an understanding of that illness, and to bring expectations and experience into line with each other.  Most people who engage in psychotherapy end with a fuller understanding of their strengths and weaknesses, how the two interact to create problems, and how to use this understanding to best advantage in their personal and professional lives.  Through therapy, they develop a stronger sense of the power they have to bring about change in their own lives, to make choices and establish priorities. 

When should I consider psychotherapy?

Psychotherapy can help with a host of problems and situations.  Often, people turn to psychotherapy when they are not sure who they want to be, what they want to do, or what they want to get out of life, or when they are confused about how to find satisfaction.  Many people turn to psychotherapy when they are facing important transitions, such as finishing graduate school, starting a new job, making a career change or becoming a parent.  Therapy can be useful in other times of stress as well, such as coping with changes at work, preparing for important academic or professional exams, or taking on new responsibilities in caring for an ailing parent or child.  Therapy can also be helpful in making critical decisions, for instance, considering getting married or divorced, deciding whether or not to relocate for a promotion at work, or considering how to allocate resources in your will.  Some people turn to therapy to help solve a specific problem, obtain a particular goal or address specific symptoms, or they may wish to tackle longstanding problems or patterns that continually thwart their efforts towards success or satisfaction. 

How quickly does Psychotherapy work?

Psychotherapy treatment can last anywhere from a few months, to address acute issues of adjustment or very specific dilemmas, to several years, to unravel more complex issues that have built up over time.  Not every course of psychotherapy need be long-term.  Sometimes, even when individuals are aware that problems are longstanding and pervasive, they may still choose to address a specific set of issues that are current in their life.  When those issues have been resolved or appropriately addressed and the individual can move forward in a productive and satisfying way, the individual may choose to discontinue psychotherapy.

Often people feel better immediately upon entering psychotherapy, having taken steps to address their situation and suffering.  However, not every session will feel like an improvement.  Some sessions may be difficult and lead to complex feelings outside of the therapy session.  Such apparent setbacks can be precursors to important progress in therapy, and can be followed by significant improvements in mood and productivity.

What do I have to commit?

Commitment to therapy is an important aspect of the client’s role in the process.  As a client, you can expect to commit your time, in the form of 50 minute sessions at least once weekly.  While under some circumstances less frequent sessions may be arranged, a weekly (or more frequent) commitment usually produces the most consistent results.  Clients can also expect to commit some financial outlay.  Health insurance plans vary in what they cover and how much members are expected to cover out-of-pocket.  Furthermore, not all psychotherapists accept insurance.  Fees will also vary based on the credentials and experience of the therapist.  Still, those who have had a successful course of psychotherapy know that the money spent working with a good therapist has saved them those fees many times over in poor decisions, or has been an invaluable investment in their future productivity. 

Resources for interested clients:

http://www.goodtherapy.org/Psychodynamic.html

http://www.huffingtonpost.com/wendy-jacobson/what-good-psychodynamic-t_b_461426.html

www.apsa.org/portals/1/docs/news/JonathanShedlerStudy20100202.pdf

Additional References:

Levitt, H., Butler, M. and Hill, T. (2006). What clients find helpful in psychotherapy: Developing principles for facilitating moment-to-moment change.  Journal of Counseling Psychology, Vol. 53, No. 3, pp. 314-324.  DOI10.1037/0022-0167.53.3.314

McWilliams, N. (2004). Psychoanalytic Psychotherapy: A Practitioner’s Guide. New York: Guilford Press.

Shedler, J. (2010).  The efficacy of psychodynamic psychotherapy.  American Psychologist, Vol. 65, No. 2, pp. 98-109.  DOI: 10.1037/a0018378

Satcher, D.S. (2000).   Executive Summary: A report of the Surgeon General on mental health. Public Health Reports, Vol. 115, No. 1, pp. 89-101.

 

 

 

 

 

 

 

 

 

 

 

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