Feeling Bugged? Write Doctor Debug for "Psychological advice with punch!" (tm)
Dear Dr. Debug:
I am a middle-aged married man, college-educated and a business professional. Even though I completed college-level psychology courses, I'm still confused about the definition and purpose of psychotherapy. Could you help me and your readers understand more about "talk therapy?" -- Signed: Perplexed About Psychotherapy.
It's unfortunate that the words "counseling" and "psychotherapy" have become interchangeable. They should not be. Psychotherapy is a very particular form of counseling. I am opposed to using the term "talk therapy" to describe psychotherapy because it under-defines what is going on in psychotherapy and dumbs it down. To me, psychotherapy is more "talk-and-think-things-through therapy," with the emphasis on thinking things through.
What a psychotherapist can provide for a client consists of: (1) setting up an atmosphere of trust, confidentiality, collaboration, and team work, (2) hearing, listing and clarifying the client's primary concerns, (3) assisting in naming and prioritizing the primary concerns, (4) figuring out how much of the client's concerns are related to environmental, developmental, social, psychological or biological matters, (5) assisting in understanding the experiences, beliefs and behaviors that are involved in maintaining the identified problems, and (6) creating strategies and working on goals.
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. It is not a free-form exercise in stream of consciousness, 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 beliefs about themselves, others and life. Many 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 behaving.
There are also very targeted psychotherapeutic techniques that focus on assisting the client to relax about, or relate differently to, situations that trigger unhealthy flight-or-fight responses. These techniques are often called desensitization.
Because programmed beliefs and behaviors often get triggered in the therapy process and affect interactions between client and therapist (usually called "transference"), therapists will often point this out as it is happening, and assist clients in finding healthier ways of thinking, feeling, reacting 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. For more information about psychotherapy, please visit www.AllAboutPsychotherapy.org. -- Best wishes, Dr. Debug.
Ron Sterling, M.D. (Dr. Debug) is an award-winning psychiatrist in Seattle, Washington. He has been writing for newspapers and magazines since 1998 on subjects ranging from good manners to senior mental health. He hosts and maintains the well-known Internet mental health center, DearShrink.com. The Doctor Debug column is dedicated to assisting with the "debugging of malfunctioning elements in our own personal programming."
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