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Psychotherapy: A More than Oncer Per Week Commitment

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

I have found, over the years that some people enter psychotherapy with the naive expectation that taking a medication will cure their emotional troubles. Along with this unrealistic expectation is the equally unrealistic belief that just coming to a session and talking for one hour per week will answer their questions enable them to feel happier in their lives. In my long years of experience as a therapist I have learned that there are no "quick fixes" for our psychological and mental problems and issues. In fact, achieving goals in therapy depends upon the patient working hard during the week in order to move treatment forward and towards its successful conclusion.

How does this work?

First, it is important from the outset for patient and therapist to set realistic goals and objectives to aim for and achieve. This helps make treatment more specific. Without goals and objectives psychotherapy can feel very "fuzzy" and unclear to the patient. In addition, if is the therapist who sets the goals then the patient cannot take ownership and responsibility for the treatment. Goals and objectives must be set by patient and therapist deciding cooperatively what is most important to achieve and they need to be stated in specific and concrete terms.

Second, it is important that the patient be given homework assignments. Assignments can be in the form of reading and completing forms to help them examine their behaviors, thoughts and feelings during the week. Ultimately, the purpose is for the therapist to enable the patient to learn how to replace unhelpful and unrealistic or distorted thoughts with those based more on objective facts. One of the great manuals that I have my patients purchase and use during and after treatment is the one by Burns, the Feeling Better Handbook (available at most book stores). In it Dr. Burns explains cognitive behavioral therapy and asks the reader to do a variety of exercises to help him modify thinking in order to interrupt depressive and anxiety producing thoughts with those that are more helpful and empowering. For instance, if I am a hypochondriac I may believe that I will become ill with the Aids virus just by shaking hands with clients. I need to explore the actual facts of the situation and come to a more realistic conclusion such as: "It is difficult or impossible to spread and catch the Aids virus except through an exchange of fluids through intercourse or through injecting myself with drugs using newly infected needles. What I can realistically conclude is that my chances of getting the Aids virus is zero because I am not gay nor am I a drug abuser of any type. Then, I can feel a lot less anxious.

Third, it is important for the patient to bring with them their log entries accumulated each week from doing the homework so that we can explore the nature of the thoughts that gave rise to depression or anxiety.

Fourth, homework involves doing suggested activities to reduce stress, anxiety and depression. These activities include such things as:

1. Meditation

2. Yoga

3. Exercise

4. Deep breathing and muscle relaxation

5. Applying the learning from cognitive behavioral therapy by interrupting the automatic thoughts that cause problems.

In no way am I implying that patient and therapist do not talk about problems in the present and in the past. It is just that, in discussing these things, patient and therapist have tools to help alter thoughts and feelings about both the present and past.

My point is that psychotherapy is hard but rewarding work. Feeling and functioning better does not happen as a result of a "magic pill" or by the therapist "curing the patient."

Your comments and opinions are encouraged.

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