What To Expect From Psychotherapy

Excerpted by New York Psychotherapy Group from:
Harvard Women’s Health Watch

Mental health isn’t much different from physical health. None of us is in perfect condition, and we occasionally need to seek professional help for our aches and pains.

However, finding treatment for physical conditions often seems a much easier matter than locating the right type of psychotherapy. This may be because we as patients don’t have as clear a notion of what to expect. Success is usually determined by the subjective judgment of two people – patient and therapist.

Thus, it’s important to find a therapist with whom you can work well if you’re considering psychotherapy, whether for crisis intervention, help in negotiating a life transition, treatment for a well-defined condition like depression, or assistance in changing unproductive patterns in your life. There are several types of mental-health professional to whom you might turn. Of those who most often provide mental-health services, psychiatrists (MD’s) alone can prescribe psychoactive medications; psychologists (PHDs), social workers (LC.SWs or MSWs), and mental-health nurses must work with physicians when they think drug treatment might be a necessary or helpful adjunct.

Regardless of your therapist’s academic credentials, he or she should do a thorough evaluation during the first few visits. Like your medical clinician, your therapist needs a good deal of factual information about you, including an account of your current psychological problem, a history of past emotional problems, a medical history, the medications you’re currently taking and your past use of drugs and alcohol. The therapist should also get a family history of mental disorder. Like inherited physical diseases, hereditary forms of mental illness often become evident at different stages of life. He or she needs to be able to rule out other potential causes of the problem, such as physical illness or the side effects of drugs.

Also during the first few visits, the two of you will design a plan for your therapy that addresses your problem and establishes realistic goals. For example, some people may want only to relieve a depression; others may desire to change deep-seat mindsets and behaviors. If you’re working within the guidelines of a health-insurance plan, your goals may have to be directed at what can reasonably accomplished in a limited period. Of course, if your therapist is in private practice you can negotiate a fee or contract to continue therapy beyond that point.

*The patient/therapist relationship. Psychotherapy works by using a relationship to effect change. Because it’s impossible for therapy to be successful if your relationship with your therapist isn’t, it is very important that you’re generally comfortable with the person and the setting. This isn’t to say that you won’t feel ill at ease form time to time as new issues emerge for you to confront. Throughout, you should have the sense that your therapist is attentive and available; you should feel that he or she is someone whom you can trust and whom you feel has your best interests at heart.

*The process. Therapy is a series of conversations rather than a monologue. Contrary to the stereotype, therapist are not supposed to be coolly detached observers; expect your therapist to ask questions, make comments, and offer opinions and suggestions. He or she should not so much control the discussion as try to help you move it in the most productive direction.

As you talk, the therapist will not only be paying close attention to the content of the conversation, but also will be forming impressions of you, noting things you might not be aware of, and monitoring the emotions you engender in him or her.

*Transference. The therapy setting encourages the development of transference – the unconscious act of superimposing feelings derived from past relationships onto present ones – which can then be used to help the patient understand his or her reactions. At times, you may feel anger, hostility, or overwhelming love for your therapist. The therapist will often deal with these responses in a way that you don’t anticipate – for example, by greeting a hostile outburst with curiosity rather than anger – and in doing so may help you to recognize, analyze, and interpret your emotions.

Therapists are trained not to act on the patient’s feelings or their own, but to use their emotional response to patients as a guide to understanding the patient’s interpersonal issues and style. You can’t expect you therapist to physically affectionate or to become involved in your activities. In fact, such behavior is considered a boundary violation and a breach of professional ethics (see “When Your Therapist Gets Too Close”, HWHW, February 1994).

Psychotherapy has many purposes. It can provide relief from anxiety, phobia, obsession, compulsion, or depression. It can facilitate mourning or enable you to resolve a crisis. It can make it possible for you to change those things you can and to bear situations that can’t be altered. It may also help you to know and like yourself a little better. At the end of the process, you should be happier and more productive.