Psychotherapy Facts

What exactly is therapy?

Therapy is actually a generic term applied to the application of any technique used to improve a person’s physical or mental health functioning. We are using the term on this site as synonymous with psychotherapy, which is the application of techniques aimed at improving a person’s mental, social, and interpersonal functioning.

What should I expect from my therapist?

The relationship between a therapist and a client is an extremely important one and should not be taken lightly. Your therapist is the person with whom you need to be honest, the one with whom you will share some of your darkest secrets, your fears, and your dreams. He or she will need to listen to you, understand what it’s like to be you, and guide you to the answers. Your therapist will need to be honest with you and to educate you on issues related to mental health and your current struggles.

Knowing this, your therapist above all should be someone with whom you feel comfortable. There are a lot of therapists out there, from Master’s level counselors to doctoral level psychologists, each one with a different personality and a slightly different approach to treatment. Find one you like. If you don’t feel comfortable, discuss it. If that doesn’t help, then consider a different therapist. Remember, you are the client, which means the therapist works for you.

Who needs therapy?

There are many reasons people seek the help of a mental health professional, from simply wanting someone to talk with and use as a sounding board to serious mental illnesses. There are several reasons therapy might be considered needed: (1) if you are seriously thinking about suicide; (2) if you are seriously thinking about hurting someone else; (3) if your thoughts, behaviors, or emotions are causing significant problems in your life or have the immediate potential to cause significant problems (such as in kleptomania, pyromania, manic episodes, serious depression, or agoraphobia).

The next question is ‘who could benefit from therapy?’ Simple, pretty much anyone. Therapy isn’t just for people with a serious mental illness, it’s also very helpful for people with mild to moderate depression, anxiety, relationship difficulties, sexual concerns, etc., etc., etc. Recent studies have concluded that approximately one in five people in this country will suffer from depression at some point in their lives, and that around 20 million people are suffering from its consequences as you read this. Studies also show that one in every ten people has a diagnosable mental illness, but that only 20% are seeking help.

Does therapy work?

Simple answer…yes, but it really depends on how you define success. Therapy can help a person solve significant issues in their life, can greatly reduce and even eliminate symptoms of depression and anxiety, can improve relationships, social skills, and even work performance and motivation. But can it cure you of all your woes? It’s not a magic wand, unfortunately, and therapy only works as well as the factors involved (client’s motivation, dedication, and openness, therapists experience and skill, and external factors such as time, resources, and support).

Are there different types of psychotherapy?

When describing ‘talk’ therapy or psychotherapy, there are several factors that are common among most types. First and foremost is empathy. It is a requirement for a successful practitioner to be able to understand his or her client’s feelings, thoughts, and behaviors. Second, being non-judgmental is vital if the relationship and treatment are going to work. Everybody makes mistakes, everybody does stuff they aren’t proud of. If your therapist judges you, then you don’t feel safe talking about similar issues again. Finally, expertise. The therapist must have experience with issues similar to yours, be abreast of the research, and be adequately trained.

Aside from these commonalties, therapists approach clients from slightly different angles, although the ultimate goal remains the same: to help the client reduce negative symptoms, gain insight into why these symptoms occurred and work through those issues, and reduce the emergence of the symptoms in the future. The three main branches include Cognitive, Behavioral, and Dynamic.

Therapists who lean toward the cognitive branch will look at dysfunctions and difficulties as arising from irrational or faulty thinking. In other words, we perceive the world in a certain way (which may or may not be accurate) and this results in acting and feeling a certain way. Those who follow more behavioral models look at problems as arising from our behaviors which we have learned to perform over years of reinforcement. The dynamic camp stem more from the teaching of Sigmund Freud and look more at issues beginning in early childhood which then motivate us as adults at an unconscious level.

Cognitive approaches appear to work better with most types of depression, and behavioral treatments tend to work better with phobias. Other than these two, no differences in terms of outcome have been found to exist. Most mental health professionals nowadays are more eclectic in that they study how to treat people using different approaches. These professionals are sometimes referred to as integrationists.

How long does therapy take?

The length of therapy really depends mainly on the issues being addressed and the desire of the individual to feel better. Other factors play a role, such as support from friends and family, stressors, intelligence, and amount of insight. Typically, however, some disorders require only short term treatment such as simple phobias, impotence, and other very specific issues. Some disorders can take years to get to a resolution such as with victims of severe sexual or physical abuse, bipolar disorder, or some personality disorders. During this time, however, treatment can wax and wane, so to speak, with periods of really good days, weeks, and months, and periods of not so good days. Treatment can also progress more stepwise, with small gains being made at a steady pace.

How much does therapy cost?

Much like the previous question, this one doesn’t have an absolute answer. Several variables play a role in the cost of treatment for mental illness: (1) education and experience of provider; (2) type and length of therapy; (3) geographical location. When discussing cost of treatment, most look at the amount of money it costs for a one hour therapeutic session. The average rate varies from location and professional, but can range anywhere from $5 or $10 at a community mental health center or other government funded agency to over $200 for a doctoral level practitioner in private practice.

What are the differences between therapy and medication in terms of treatment and outcome?

Therapy and medication are not necessarily rivals, and are often used together for the maximum benefit of the client. There are some disorders where medications are almost always used, such as with schizophrenia and bipolar disorder (manic-depressive disorder). Those suffering from other disorders, such as those related to depression and anxiety, can benefit from medication, even if it only serves as a temporary fix until the effects of therapy take hold.

Those who oppose the increased use of medication for the treatment of mental disorders argue that they provide a quick fix but do not address the underlying issues involved. In other words, medication covers up the symptoms without getting at the disorder. Therapy, on the other hand can be focused on both the symptoms and the underlying issues.

In summary, medication is the treatment of choice, although often combined with therapy, for disorders such as schizophrenia and bipolar disorder. Medications typically work faster than therapy but once discontinued, the symptoms will return unless the underlying issues are resolved. Therapy is a slower process and results may not be felt as quickly, but it is a longer term solution for many mental health issues.

What’s the difference between mental health professionals?

Psychologist

A doctoral degree which means a minimum of four years of graduate training beyond the bachelors degree is required in most states, as well as one year of internship and at least one year of post-graduate residency. Typically psychologists complete core coursework in therapy, assessment, and research and are required to pass competency exams and complete a dissertation prior to receiving their degree.

To be licensed, psychologists must pass a national and state examination. Some states grant different licenses for school, counseling, and clinical psychologists. School psychologists usually work in
educational settings and specialize in working with and providing assessment to children and their families. Counseling psychologists typically work with individuals dealing with transitional and developmental problems, career issues, and mental health problems of less severe psychopathology. Clinical psychologists are trained to work with all mental health issues but may have more training with more severe psychopathology and less with developmental and career issues. Most states license counseling and clinical psychologists under the general term ‘psychologist’ and the scope of treatment overlaps much more than it has in the past.

Psychologists treat all forms of mental illness although specialties are not uncommon. Specialties include children, adolescents, adults, geriatric, forensic, neuropsychology, and health psychology. All psychologists are trained as generalists but may have one or more specialties depending on their training and experience.

Social Worker

Social workers must hold a bachelors degree in social work although many complete a Master’s program (two years beyond their bachelor degree) leading to the Master of Social Work degree. Social workers are often referred to as the liaison between the patient or client and the community.
According to the Occupational Outlook Handbook (1998-1999), “Social work is a profession for those with a strong desire to help people. Social workers help people deal with their relationships with others; solve their personal, family, and community problems; and grow and develop as they learn to cope with or shape the social and environmental forces affecting daily life. Social workers often encounter clients facing a life-threatening disease or a social problem requiring a quick solution. These situations may include inadequate housing, unemployment, lack of job skills, financial distress, serious illness or disability, substance abuse, unwanted pregnancy, or antisocial behavior. They also assist families that have serious conflicts, including those involving child or spousal abuse.”

Mental Health Counselor

Mental health counselors typically have a Masters degree in psychology, social work, counseling, mental health counseling or related field and pass a state exam in order to be licensed. Mental health counselors can practice independently in some states, although most are employed in clinics and hospitals. They perform individual, couples/family, and group therapy, and may assist psychologists with testing and other forms of treatment.

Marriage and Family Therapist

Like mental health counselors, a Master’s degree is typically the minimal requirement for marriage and family therapists. They receive special training in the dynamics of families and relationships and often treat couples who are having marital or relationship difficulties and families struggling with dysfunctional interactions. Many marriage and family therapists are provided more general training, allowing them to perform individual and group therapy as well for a variety of mental health related issues.