Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More
Very recently, someone asked me this question. Actually, it is a commonly asked question and often has another question just hiding behind it. The other question is often in the form of, “I have a psychotherapist but nothing is any better than before.” In fact, I hear another comment behind the first one and it goes something like this: Why should I need therapy, why should I not be independent? The answer to these questions is never simple or easy. However, here is my effort at some answers.
Taking the last question first, “why should I need therapy anyway,” the answer is that it is not just “you who need therapy but, really, most of us.” We live in a complex world where the individual gets lost in the masses of people. That makes it very difficult for countless numbers to feel as though there lives have any meaning. In a mobile world, where war is completely impersonal and includes fatalities among civilians including women and children; where neighbors live near one another for a couple of years and move; where corporations lay off employees as though they are unimportant throw away cogs in a machine; in which marriages do not last and family seems to have so little meaning; it is common for people to suffer an existential angst whereby they wonder why they are on this earth and just what their lives are supposed to mean. If these are not enough reasons to seek psychotherapy I do not know what is.
With regard to the first question, does therapy help everyone, the answer is that there is nothing in this life that is ever true of every person. There is just too much diversity of temperament, life style, economics, personal motivation, personality and so on, for any universal truth about therapy to fit all people.
Having said all of this, let us take a closer look at many of the variables that influence a therapeutic experience and can determine its outcome.
1. A lot depends upon the motivation to change that a client brings to the therapy. When someone is strongly motivated to change because they feel unhappy and are ready to learn there is a lot of impetus to grow as a result of treatment.
2. Trust between the therapist and client is enormously important. Of course, trust does not develop immediately. Instead, as in any relationship, trusts takes time to build. However, it can help a lot to see a therapist who has been referred to you by friends and acquaintances who know their work. Reputation can be important.
3. A lot depends on how a particular therapist works, but, even so, certain facts should hold true: For example, it is important that the therapist, whether he is psychodynamic or cognitive behavioral, should be someone a client feels comfortable speaking to. Some people prefer a more formal therapist while others prefer someone is warmer and more familiar. Nevertheless, it is important that the client feels treated with respect and dignity.
4. It is my professional opinion that, regardless of the approach, the therapist and client work in the “here and now,” or the present. While client history is somewhat important, present day circumstances are what are most important.
5. Part of working in the “here and now” is focusing on the relationship between client and therapist. After all, it is that relationship in which all the client ways of thinking and interacting get repeated. That is why it is important for both to focus on the real relationship in the therapy office.
It is always vital that the therapist not be critical or judgmental of the client. There may be disagreements and areas of tension and they need to be discussed and clarified. However, the role of the therapist is not to be the judge. Naturally, some people may enter psychotherapy expecting or fearing judgment but that, too, should be clarified and worked through in the treatment.
A few comments about cognitive behavioral therapy:
While a CBT may rest more on changing patterns of thinking, especially automatic thoughts into more helpful thoughts, it remains my opinion that client feelings and transference issues come into play anyway. Those issues, it seems to me, need to be addressed, especially if a client remains in treatment for a long time.
Length of time:
Psychotherapy is not meant to be a life long pursuit. In fact, if a client finds that they are still in therapy for more than two or three years, they really need to discuss that with their therapist. Ultimately, the goal of therapy is to finish and leave. Contrary to what some people believe, even Sigmund Freud, the first real modern day psychotherapist, saw people for no more than a year and many for a shorter time than that. It is true that he worked with patients on a daily basis except for Sundays. Nevertheless, the point is that treatment is supposed to be completed.
How does a client know if therapy is finished?
When someone finds that they are feeling better, functioning at work, has improved relationships at home and has a social life, there is a very good assumption that they have completed their work. It is then important to discuss this with the therapist. In fact, some therapists may raise this issue to the client. Whoever raises the issue of completion first, the main idea is that it be discussed and a finishing date be selected.
This next is related to the second question, nothing is any better than before I entered therapy:
If a lot of time has gone by and there is no improvement then it is important that the client begin discussing seeing someone else or having a consultation.
No, therapy does not help “everyone,” but, there are all the variable to consider before deciding that therapy is for you or not.
Today, we have the advantage of using medications in those serious situations where it is called for, to help make therapy more beneficial and available for those individuals who need that.
I would rather make an error on the side of believing a certain therapist or type of treatment is not for me than to simply conclude that it cannot help me.
Your comments and questions are encouraged