Orientation to Psychotherapy
What benefit can I expect from psychotherapy?
- Symptom relief
This may take the form of sleeping better at night, reduced anxiety and tension, less intense emotional reactions and more rewarding interpersonal relationships.
- Insight
Making what is unconscious conscious, "Know thyself." Once unconscious patterns in relationships or triggers to anxiety or depression become conscious this places a person in a position to make a positive change.
- Agency
Having an internal sense of freedom, no longer being controlled by anxiety or depression, thinking and feeling for oneself, and setting limits or boundaries on self and others.
- Identity
Establishing an identity that is derived from internal integrity and authenticity, a capacity to live by one's values and to be honest about one's feelings, attitudes, and motivations. The flip side to this ideal is experiencing one's identity solely by reference to connections outside of your self, for example, being defined by a job or career or marriage or role (e.g., parent).
- Self-Esteem
Recognizing and accepting one's faults and shortcoming and not being dragged down by them. Self-esteem often comes from increased self-knowledge, awareness of your own thoughts and feelings and what you want from life. Self-esteem also derives, in part, from doing something (a job, hobby, role, etc.) well.
- Recognizing and Handling Feelings
Moving to a place where one can know what they are feeling, to understand why they are feeling that way, and to have the internal freedom to handle emotions in ways that benefit yourself and others. A key aspect of mental health and happiness is an acute awareness of our emotional life. We feel whether we want to or not and all must grapple with how to handle feelings; whether we ignore and stuff them, express them physically, or have them periodically escape through anxiety that feels foreign.
- Ego Strength and Self-Cohesion
Ego strength and self-cohesion are 'psychobabble' terms that refer to the capacity to cope with life's difficulties in a realistic and adaptive way; or put another way, to deal with the stress inherent in life and not fall apart. When stressed, one ideally does not want to be paralyzed by guilt nor give way to impulses and act irrationally.
- Love, Work, and Mature Dependency
The capacity to love and work are what Sigmund Freud, the founding father of modern psychotherapy, viewed as the ultimate goal of psychotherapy.
Moving to accepting what cannot be changed and taking on a new capacity for addressing what can be changed is an overarching goal of psychotherapy. One way to think of how therapy unfolds is to slowly accept the fact that one's psychological problems reflect accidents of a complicated fate and endowment, not some personal defect or failure; and moving to the painful appreciation that even thought this is true, no one but you can be responsible for solving those psychological problems.
Mature dependency refers to handling one's natural dependency in their own best interest. Dependency is often a negative word in our culture, but we are all dependent to one extent or another on other people.
- Pleasure and Serenity
Grieving over what is not possible and getting onto what is sets the stage for being able to feel pleasure and a sense of serenity.
How long does treatment take?
This is always a tough question, and there are no hard and fast rules. Some people need as little as 10 sessions to receive significant symptom relief and / or address the crisis that brought them to therapy. Research has demonstrated significant symptom relief in about 20 to 25 sessions, on average, for a variety of problems, but many problems take much longer to fully address, particularly long standing difficulties with relationships. One way to think about this is that many mental problems and relationship difficulties derive from many years of deeply entrenched experience and therefore may take a few years (one to three) of treatment to fully overcome.
What is the therapy relationship?
The therapeutic relationship is a rather unique relationship, unlike any other you probably have encountered as it is not a friendship, romantic relationship, parent / child relationship, work relationship, etc. Some nuts and bolts: It is a relationship with many unique aspects: You pay someone for their time, usually for one or two 50 minute sessions a week, don't talk to that person outside the sessions (or only briefly, usually by telephone), don't experience the usual give and take you get from other relationships (that is, you don't know a lot about the therapist personally because they don't share all that much about themselves), there is no physical contact, and while you can talk with anyone you like about your therapy, the therapist can't speak a word of it to anyone (except under certain circumstances, see limits of confidentiality). So this is what it is not, what then, is it?
The therapy relationship is a microcosm, a laboratory, a chance to study a relationship close range (with the above boundaries), and by investigating what happens in the therapy relationship between the you, the patient, and me, the therapist, we have an opportunity to discover thoughts and feelings that happen to you elsewhere, in other relationships. We also discuss things no one talks about in social situations, but nevertheless are present in all social situations and influence them. In the session of therapy I may ask you how you are feeling and what you are thinking about me or our work together to get a better understanding of how your relationships outside of therapy work or fail. To put it another way, the relationship that develops between you and the therapist mirrors, in part, how your relationships develop outside the therapy session. By examining in a frank and honest manner the relationship in therapy you have with the therapist, you can get a better understanding of how your relationships work or fail outside of therapy. With this knowledge, you can then go about modifying how you relate to others to have more rewarding relationships. Many psychotherapists view the task of psychotherapy is to build a relationship with a patient so that relationship becomes the agent of change.
What is my job as the patient?
The role of patient (Latin: one who endures) in psychotherapy is fundamentally to look at oneself honestly and be willing to work on that self. Easily said, difficult to do. Without a doubt, the job of the patient is much harder than that of the therapist. In therapy, it will be your job A.) to talk about what is foremost on your mind, B.) be willing to carefully think about interpretations given by the therapist BUT be willing to reject them if they feel wrong and discuss why C.) be honest about your thoughts and feelings about the therapist and the therapeutic relationship so as to learn more about how your relationships outside of therapy work (this is difficult and may take time to get comfortable doing) D.) think about the last therapy session between the sessions (a lot of what happens in therapy goes on between the actual sessions ) E.) be willing to apply what you learn in therapy to you life outside of therapy (or then, what is the point of therapy?).
Material for this is taken in part from Nancy McWilliams' Psychoanalytic Case Formulation (1999) and Irvin Yaloms' The Gift of Therapy (2002).