Will Psychotherapy Help Me?
I subscribe to Mark Manson’s Monday morning newsletter which I greatly enjoy. He has a talent for putting together ideas and adding his own twist to them that’s both interesting and informative.
A couple of months ago he wrote a piece entitled “How to get better.” He talked about the value of psychotherapy, journaling, and meditation to improve self-awareness and effectively deal with psychological and emotional issues. Although I’m interested in all three ideas, I want to speak to the first one today which is the value of psychotherapy.
Mark’s basic premise was that psychotherapy does help people, and based on research he cited, he listed four findings:
- Therapy as a whole helps people and increases their well-being while also reducing symptoms such as anxiety and depression.
- These improvements occur regardless of the type of therapy offered or even the credentials of the therapist.
- Those who remain in therapy for longer periods of time get better results.
- It’s not understood how or why therapy works. It just does.
I read the studies he cited, and true enough they did point to these conclusions for the most part. The benefit of longer-term therapy was related to more complex problems and the use of a psychodynamic approach as opposed to other modes of therapy. I’ll get back to this in a minute, but first let me talk about the other three conclusions.
Why Therapy Works
I have some ideas that I’d like to share as to that why. These ideas are not based on any particular research studies, so in that regard, these are my opinions, however, these opinions have evolved over 35+ years of being involved in and providing psychotherapy to a great number of people.
Let’s go through them, and hopefully you’ll find something that rings true, especially if you’ve been in therapy yourself.
When you talk to someone about emotional issues, especially if you’re feeling those emotions as you speak about them, and the person you’re speaking to can listen and empathize, there’s a transfer of the emotions from you to that person as the process goes along.
The therapist contains your emotions for you during this interchange and holds them as you work them through. This process creates mental space for you so that you can unload so to speak the burden of the feelings and pull them out and look at them. You gain some distance.
Even if you’re not analyzing what you’re saying, the transfer and containment of your emotions by the therapist is very relieving and begins to open up the opportunity for new perceptions on your part. A lot of the therapeutic process is about containment.
This brings me to the second thing.
Acceptance without Prejudice
An interchange like this will not work if the person listening and containing has their own personal agenda that creates resistance to the containment process. In other words, the therapist or person listening must also be totally open to the experience, accepting of what they’re hearing without judgment or prejudice, and have no personal need to change the course of what’s being revealed other than to be there and be receptive.
That’s why talking to a friend or relative sometimes does not have this same effect, because the listener is personally involved and can’t listen with that degree of acceptance and objectivity.
Removal of Isolation
One of the biggest benefits of therapy is the reduction of feelings of isolation.
We’re not meant to be disconnected. A primal desire and need for all of us is to have a witness to our lives. We want to be seen and known. At least we start out that way.
As we have experiences, trauma can move us toward withdrawal and isolation to avoid pain, however, the desire to be known is still a primal desire. What happens in those cases where we withdraw to self-protect is that we become emotionally isolated, which can feel like exile and a disconnect both from ourselves and everyone else.
At the heart of clinical depression is a sense of isolation, and often profound isolation.
This is where long-term therapy benefits really play out, because the longer you see a therapist, especially if it’s regularly, the less isolated you feel. The deeper the relationship with the therapist becomes, the more connected you feel. You have a caring witness to your life. This opens you back up to yourself and to others.
The Therapist’s Credentials
In Mark’s article, he said
Dozens of studies have struggled to find much measurable benefit to the therapist’s training or credentials. Many studies show that people benefit speaking to amateurs just as much as they do professionals. So, not only does the modality seem to not matter, but the therapist’s credentials don’t even seem to matter that much either.
While there may be some truth to this, I don’t totally agree. There are characteristics of the therapist that should be considered when deciding on what works and who to see. Let me go them briefly.
A Good Fit
Not every therapist works for every person. You must feel comfortable with the person you’re going to allow yourself to confide in and let down your defenses with. The person you’ve selected may be highly qualified, yet you may not feel comfortable with her or like her approach. Everyone isn’t for everyone.
There must be some feeling of connection, and some trust that “this person” can understand you.
I’ve seen people who click very well with me and feel I can help them, and others who don’t. Therapists are people with their own backgrounds, personal experiences, biases, and perceptual abilities.
You have to feel comfortable with the person you’re revealing yourself to, because therapy is a process of self-unfolding, and if you’re not comfortable, you won’t reveal yourself or trust your innermost feelings with that person. The fit is important.
Professional Demeanor and Training
There are basic rules which are non-negotiable, and unfortunately, not all therapists follow them. Here they are:
- The therapist must be able to focus on the client. This means being quiet and listening, not talking about personal stuff unless a personal disclosure truly could be helpful, and maintaining proper boundaries. There are therapists who talk the whole session, who reveal way to much about themselves and their personal lives, and who do not observe reasonable boundaries outside of session. If this type of behavior goes on, the therapy will not work or help someone feel better. The clients can end up feeling used or taken advantage of.
- Familiarity with a variety of treatment modalities is also helpful, as well as knowing how and when to use them. Again this takes training. A good therapist can use different treatment approaches depending on the needs of a client based on the material presented. At the very least, a therapist should have a good understanding of transference and countertransference, knowledge of defense mechanisms, and of object relations theory. Otherwise, he may not be able to separate his own issues from the client’s.
- Professional conduct that’s part of good training, and licensing is necessary. This includes punctuality, reliability, reasonable accessibility, and above all, confidentiality.
- I would add one more which is life experience. You don’t need to have experienced everything a client brings in, but some life experience that provides an inside view is helpful. For example, a 70 year old woman is not likely to feel that a 25 year old therapist will be able to relate to her problems. A parent would probably prefer a therapist who is a parent herself. A married couple might be more comfortable with a therapist who is married.
Can the therapist really listen to you? Is she interested in what you have to say and how you feel? Does she check in with you to clarify what you mean? Do you feel understood? If the answer is yes to all these, then you will get better if you stick with it.
In general, the therapist must be able to listen attentively and reflectively. Therapists go through training to learn how to do this, and an experienced therapist can do it very well.
It’s not just a matter of reflecting back what you hear, but hearing the various layers of messages and reading motivations, perceptions, and underlying beliefs that aren’t always spoken. These are not skills that most “amateurs” have, not because they couldn’t have them, but because they haven’t been trained properly and haven’t had a lot of experience practicing and honing them.
I’m a fan of long-term therapy and here’s why. True therapy is based on the relationship that develops between client and therapist. It takes time for anyone to truly reveal who they are, and this is done in layers and waves over the course of regular sessions.
No matter how willing you are to tell the therapist everything you can about yourself up front, who you really are unfolds over time as the therapeutic relationship develops. You can’t hurry this process along.
This conclusion was driven home by a German study published in the Journal of the American Medical Association in October of 2008. The authors reviewed 23 studies with 1053 patients, all receiving traditional psychodynamic psychotherapy over one year with at least 50 sessions conducted.
The analysis showed that, in contrast to shorter therapies, long-term psychodynamic psychotherapy significantly benefited patients with complex mental disorders. Furthermore, follow-up evaluations indicated that patients continued improving after therapy ended. The number of therapy sessions, rather than the duration of total treatment, predicted who would respond.
Complex mental disorders include chronic depression and anxiety disorders, and personality disorders as well as multiple mental disorders.
Psychodynamic psychotherapy is an offshoot of psychoanalytic psychotherapy in that it pursues unconscious material that affects current experience and behavior. For many therapists, the approach is not analytical in terms of a strictly Freudian framework, but focuses more on discovering where someone is stuck in the present due to unresolved issues originating in the past. In other words,
Your past is in the past unless it’s in your present.
And if so, it needs to be worked through. In general, the focus is on primary relationships experienced during your developmental years.
Psychodynamic therapy is built on the relationship that develops between client and therapist. It’s not a bag of tricks, or a cookbook of techniques to follow. It’s an unfolding that proceeds through an ongoing conversation that affords the client room to wander and explore, and find what lies within.
This is a process of self-revelation that creates greater self-awareness which is one of the goals of psychodynamic psychotherapy. The more you know about yourself, the more you’re able to meet the challenges of your life and control it’s trajectory.
Last Bit of Advice
If you decide to embark upon therapy – and I believe it’s for everyone whether or not you’re symptomatic – consider trying it for at least six months and preferably a year on a weekly basis. That can be expensive depending on whether you can use your insurance to help offset the cost, and that must be a consideration. But if you can do it, I think you’ll find the benefits far outweigh the costs.
Self-awareness is extremely important to every other aspect of your life. It’s foundational. It’s goes hand in hand with empathy and the ability to have relationships, to work and be creative, and to function optimally. I hope you try it if you haven’t already!
As always I’m interested in your comments, experiences, and ideas. Please leave them below.
Leichsenring, F., & Rabung, S. (2008). Effectiveness of long-term Psychodynamic psychotherapy: A meta-analysis. Journal of the American Medical Association, 300(13), 1555-1565.
Perren, S., Godfrey, M., & Rowland, N. (2009). The long-term effects of counseling: The process and mechanisms that contribute to ongoing change from a user perspective. Counseling and Psychotherapy Research, 99999:1.
Miller, M. (2008, December). Commentary: The value of long-term psychodynamic psychotherapy. Harvard Mental Health Letter.
Knekt, P., Lindfors, O., Laaksonen, M., Raitasalo, R., Haaramo, P., Jarvikoski, A, & The Helsinki Psychotherapy Study Group. (2008). Effectiveness of short-term and long-term psychotherapy on work ability and functional – A randomized clinical trial on depressive and anxiety disorders. Journal of Affective Disorders, 107(1-3), 95-106.
Zarel, R. (2012, May). Psychotherapy wars: The long and the short of it. Psychology Today.