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Psychotherapy Doesn't Work

Question:

When you medications have been working for a year and your psycho-therapy does not show results, when do you know to quit psycho-therapy? I started psycho-therapy July 2000 till august, then I stopped because of job changes. I started two weeks ago and it just seems to go slow, I just talk and the psychologist listens, but it is not like the medicine that can take a pill and feel results almost within hours. When do you know to call it quits on psycho-therapy?

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  • Dr. Dombeck responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
  • Dr. Dombeck intends his responses to provide general educational information to the readership of this website; answers should not be understood to be specific advice intended for any particular individual(s).
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  • Always consult with your psychotherapist, physician, or psychiatrist first before changing any aspect of your treatment regimen. Do not stop your medication or change the dose of your medication without first consulting with your physician.
Answer:

Psychotherapy is not like medicine. Medicine works on you directly at a chemical level. You can be passive with regard to medicine and it will still work. You don’t have to do anything to make it go – it just works on your body and brain and causes (hopefully therapeutic) changes. Psychotherapy isn’t like medicine at all. You have to be more active with regard to psychotherapy than you do with medicine or it simply won’t work. This is because psychotherapy works at a behavioral and social level rather than at a brain level. You have to take therapy to heart – act it out in your entire social and behavioral life – if it is to help you. If you are just talking about stuff in a mechanical sort of way therapy will have little ability to help you.

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p> There are different types of psychotherapies that are practiced out there. Not all of them are equivalent. The type of therapy you seem to be getting is called counseling. As therapies go, counseling approaches are fairly passive. Mostly what counselors do (as therapists) is to listen and accept you. Counseling can be very helpful for some forms of human suffering, but it is just not very good for treating depression. What you want is a therapist who can take a more active role in your care and who can provide you with a scientifically verified type of therapy specifically shown to be helpful for treating depression. There are two of these types of therapies out there. One is called “cognitive behavioral therapy for depression” (based on the work of Beck and colleagues) and the other is called “interpersonal therapy for depression” (based on the work of Weissman and colleagues). Find a therapist who can provide one of these approaches for you and give the new therapy the time and attention it needs to work for you. Any decent therapy should be given at least a three month trial with your full attention to the therapy during that time before you start to rule it out as not working. Also – recognize that there is no instant and easily observable ‘cure’ that therapy will provide you with. Therapy is like working out with weights in a gym. You see results over time – not instantly. Like working out with weights, therapy can produce a better, healthier you – but you’ll have to do the work in order to get the results.

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p> Good Luck

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