Mind Matters -- June 2004
Written by Ron Sterling, M.D. and Published in Northwest Prime Time Magazine

Psychotherapy 101
by Ron Sterling, M.D. -- June 2004

    Dear Dr. Ron:

      I am an older adult married female, going on 70. I am college educated and a retired 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 Curious:

      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 those primary concerns, and (f) working on the dysfunctional learning, theories, and behaviors that may be involved in maintaining the identified problems.

      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. Sometimes, this process is called "having a corrective emotional experience."

      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.

      Psychoanalysis is a process for gaining awareness about ourselves that is based primarily on the technique of "free association." The technique of free association may be the best way to uncover the "unconscious." In that sense, psychoanalysis lends itself more to research than to a process for making changes in our lives. Many studies have shown 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.

      Often, for many of us older folks, the process of psychotherapy may seem to be irrelevant, unacceptable, or uncomfortable. We were either brought up in a period of time when our culture did not support the concept of revealing our private thoughts and feelings to some other person, or we might believe that "old dogs can't learn new tricks."

      Seeking a certain amount of discomfort by pursuing a new learning experience is the definition of adventure. My feeling is that no matter how old we get, if we bump into a situation that we are unprepared for or we find ourselves repeatedly creating difficulties for ourselves or for others, the adventure of good psychotherapy has a place for us. I hope this helps. For more resources and information about psychotherapy, please visit AllAboutPsychotherapy.org. -- Best wishes, Dr. Ron.

        Author Bio:

        Ron Sterling, M.D. is a 64 year-old General and Geriatric Psychiatrist with a private practice in Seattle. He invites you to e-mail him at with any questions about mental wellness or emotional, relationship, or aging concerns. He is the only person who reads e-mail sent to Dr. Ron. Please be assured that your questions and identities are completely confidential and protected. For more information about Dr. Ron and for resources related to senior mental health, please go to SeniorMentalHealth.org. Read our Disclaimer. If you wish to understand more about Dr. Sterling's potential biases in health care advocacy, please check his Conflicts of Interest Disclosure Statement

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