All About Psychotherapy
-- Updated June 10, 2010 --


    Welcome to the "All About Psychotherapy" page at™. DearShrink is an Internet Mental Health Center hosted by Ron Sterling, M.D., a General and Geriatric Psychiatrist who also specializes in Adolescent and Family Therapy.

    The mission of this page is to provide information and resources for understanding psychotherapy and the differences between psychotherapy, psychoanalysis, counseling and coaching. Just type in your Web browser address window to find us again, or bookmark us.

    This page contains an answer to a reader question, an explanation of the concept of "programming," and links to Web sites about transactional analysis, cognitive behavioral therapy, and other types of psychotherapy.

Psychotherapy 101

    Dear Dr. Sterling:

      I am a middle-aged, married male. I am college educated and a business professional. Even though I completed college-level psychology courses, I am still a little confused about the definition of "psychotherapy." If I am confused about it, I wonder how many other people must be confused about it. Could you say a few things to help me and your readers understand more about "talk therapy." -- Signed: Perplexed About Psychotherapy.

    Dear Perplexed:

      Thank you for writing! Understanding "talk therapy" can be a challenge, mostly because there are so many different forms of counseling which have emerged since psychoanalysis was invented in 1896. Among many other things, "talk therapy" can consist of giving general advice, coaching for a particular psychological or social skill, perfecting stress-reduction techniques, or working on self-confidence.

      It is unfortunate that the words "counseling" and "psychotherapy" have become interchangeable. They should not be. Psychotherapy is a particular form of counseling. I am opposed to using talk therapy to describe psychotherapy because the term talk therapy under-defines what is going on in psychotherapy and dumbs it down. To me psychotherapy is more "talk-and-think-things-through therapy." The emphasis is on the "think things through."

      Hopefully, what a psychotherapist provides for a client consists of: (a) setting up an atmosphere of trust, confidentiality, collaboration, and team work, (b) hearing, listing and clarifying the client's primary concerns, (c) assisting in naming and prioritizing the primary concerns, (d) assisting in figuring out how much of the client's concerns are related to environmental, developmental, social, psychological or biological matters, (e) assisting in the creation of a strategy about how to deal with or work on those primary concerns, and (f) working on the learning experiences, theories, and behaviors that may be involved in maintaining the identified problems.

      In my opinion, psychotherapy in its best form is a guided, active, and targeted analysis and learning process based on the concerns and the goals of the client. Thus, it is not a "free-form" exercise or "stream of consciousness" process such as psychoanalysis, nor is it a superficial debriefing about last week's life events.

      There are many theoretical orientations that influence what is done in psychotherapy. For instance, learning theory therapists will tend to assist their clients in understanding how certain experiences taught them to have certain belief systems and theories about themselves, about others and about life. Our belief systems significantly affect how we think and behave. Some belief systems can set us up for experiencing frequent problems in our lives. By examining our beliefs and understanding where they came from, we can consciously intervene and find new ways of thinking and, thus, new ways of behaving. Cognitive behavior therapy owes much of its power to our understanding of learning theory.

      There are also very targeted psychotherapeutic techniques that do not necessarily involve a thorough examination of belief systems, but focus on learning to relax about or relate differently to situations that trigger unhealthy flight-or-fight responses in us. These techniques are often called desensitization.

      Because many of our programmed beliefs and behaviors will get repeated in the therapy process with our therapists (sometimes called "transference"), good therapists will point this out as it is happening, and assist us in finding healthier ways of thinking, feeling, and behaving. This process is often called "having a corrective emotional experience."

      Psychoanalysis, on the other hand, is a process for gaining awareness about ourselves based on the technique of free association. The client is encouraged to talk about whatever comes to mind, allowing the contents of the unconscious mind to slip past the censorship of the ego. This technique may be the best way to uncover the unconscious. In that sense, psychoanalysis lends itself more to research than to making changes in our lives. Many studies show that people in psychoanalysis make changes at no greater rate than people in no analysis at all. Psychoanalysis is not psychotherapy. Confusion about these two very different processes has led to an inaccurate conventional wisdom that psychotherapy is not very helpful.

      Not all conditions can be "fixed" by psychotherapy or counseling alone. In my clinical experience and in the research literature, it is clear that many conditions, such as clinical depression, chronic severe anxiety, attention deficit disorder, bipolar disorder and schizophrenia are significantly influenced by neurobiological processes. These conditions can be positively altered by appropriate medication. Even though we now know that the brain is not static and nerve cells can change, grow, and rejuvenate under the influence of new learning, stress reduction and exercise, the magnitude of such changes can often be accelerated with correct medication. There are certain conditions which we just cannot think, or talk, ourselves out of.

      For many of us, psychotherapy may seem to be irrelevant, unacceptable or too uncomfortable. We may come from an environment where our friends and family did not support the process of revealing our private thoughts, feelings and beliefs to another person. We might have been taught that we should be able to handle our problems without someone else's help.

      Tolerating a certain amount of discomfort when pursuing a new learning experience is the definition of adventure. If we bump into a challenging situation that we are unprepared for, or we find ourselves repeatedly creating difficulties for ourselves and others, the adventure of good psychotherapy may be an important part of the solution for us. I hope this helps. -- Best wishes.

What Does the Word "Programming" Have to do with Mental Health?

    In this computer age, most of us understand the word programming to mean "to provide a machine with a set of coded working instructions." Software products for use on our home computers are sets of complex coded instructions that assist us with whatever specific task we need help with, such as typing documents or doing mathematical or bookkeeping calculations.

    So, what does the word "programming" have to do with mental health? The short answer is that much of what we experience in life gets turned into sets of programmed beliefs and automatic response systems that exert great influences on our decisions and behavior.

    Transactional analysts, cognitive therapists and neuro-linguistic therapists often talk about programming and have been using the term to describe certain aspects of the learning process since at least 1950. However, not all learning constitutes programming.

    "Programming" refers to learning that has an influence on how we process information. Not all learning experiences end up influencing our automatic behaviors, beliefs, or thinking patterns. In fact, as we grow older, learning new ways of thinking, believing, or behaving are often blocked by our older and earlier programmed ways. That is the whole problem with programming -- the older it is and the earlier in life it takes place, the harder it is to change.

    There are both "hard-wired" and "soft-wired" aspects to our programmed beliefs and behavior. The hard-wiring aspect refers to biological and so-called instinctive behaviors -- drinking fluids, eating food, sleeping, fleeing, fighting, and reproductive behavior (having sex). Soft-wired beliefs about drinking fluids, for instance, can influence what we drink, but ultimately, if we don't drink fluids, we die in about seven days. Many of our instinctual programmed behaviors can be modified, but usually only within certain limits, without resulting in significant, adverse biological consequences.

    Like computers, humans begin life with more-or-less similar basic operating systems which become modified over time by the other software that is loaded up and the options that are chosen.

    Psychological and social programming describes a process where:

    • We have an experience.

    • If that one experience is intense in some way (traumatic or inspiring), it may teach us something that will not be easy to forget (it programs us). If that same or similar experience is frequently repeated, our beliefs based on that experience will become even stronger (the programming becomes more difficult to change).

    • Once we have a programmed belief, we behave and operate on the basis of the belief, even if it is does not lead to healthy behavior and even if it goes against what the hard data indicates (the truth).

    • Once we have a programmed belief, we will not only operate on the basis of the belief, but we will set up situations in which we can continue to keep the belief and not have to change it (self-fulfilling prophecies or expectations).

      All of us, including scientists, are prone to take data and try to make it fit into our pre-existing belief systems. If we are optimists, this could lead us down a road in which we could underestimate threats. If we are pessimists, this could lead us down a road in which we underestimate goodness and opportunities. (I reserve the term "realist" for those of us who are attempting to learn about our biases and develop enough self-awareness to be able to sort out our biases from the uncolored facts.)

      On a simpler level, this human tendency to interpret data to keep a belief is called "bias." We all have our biases, which are either strongly-held or weakly-held and which can have significant effects on how we feel about ourselves, others, and life.

    • When we set up situations (relationships and life experiences) to keep our old beliefs, we end up having the same experience over and over and our programming becomes more hardened and difficult to change.

    Books such as "Your Erroneous Zones" and "You'll See it When you Believe it" discuss the issues of our biases, how we got them, and what they do to us. We filter reality through our biases, and they can either set us up for constructive and healthy experiences, fairly "neutral" experiences, or they can set us up for frightening and unhealthy experiences.

    Until we study ourselves enough to know what constitutes our major biases, where they came from, and how they influence us, we are operating on what I call "autopilot." Some people have very constructive "autopilot" programs, others do not. Those of us with constructive autopilot programs may not run into difficulties that cause us to seek psychotherapy. However, until we enter into the process of self-examination and awareness of our programming, whether we are in the hands of good or bad autopilot programs, we are living a mostly unexamined life. If we are living an unexamined but happy life, we cannot say we are choosing that happy life, we can only say we have a happy life, but we are not fully aware of why.

    We can each gain awareness of our biases and our programming by examining our lives and reading about mental wellness, psychology and relationships. In my opinion, psychotherapy may be the best way to examine critical and core issues related to our programming. Most people do not engage in the pursuit of self-awareness through psychotherapy unless they are experiencing troubles and difficulties.

Links to More Information and Resources about Psychotherapy.

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    Other Advice destinations at DearShrink include:, where Dr. Sterling posts answers and links about mental health, medications, psychiatry, and counseling; and,, where Dr. Sterling provides comprehensive answers and information about senior mental health and caregiver support.

Thank You for Stopping By!

            -- Best wishes, Dr. Sterling

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