Psychotherapy is one modality to help people change. It is usually what is
meant by "talk – therapy." There are many, many different
types of psychotherapy, which makes it hard to generalize in a way that
applies to every type of psychotherapy. The goal of psychotherapy is to come
to a different understanding of your emotional experience when considering a
particular situation, and be able to have different thoughts and feelings and
behavior with respect to this in your present life. Sometimes this results in
improved insight (understanding.) Even better, the goal would be actual
behavioral change (able to have more choice of options) in a setting /context
in which coping is very difficult.
Because of the way the brain works, often the initial reasons for seeking help
(presenting symptoms) may just be the tip of the iceberg and successful
therapy may need to uncover issues/experiences which happened in the past
which you may or may not have linked to the current symptoms.
Psychotherapy is thought to benefit mostly “psychological
symptoms." However, artificial separation of you and me into
"mind" or "body" is too simplistic. We are both mind and
body, all intertwined in a complex interrelated way and functioning in our
skin. Many physical symptoms, including headache, insomnia, eating problems,
allergies, and/or pain, can often be helped by psychotherapeutic methods.
Psychotherapy is expensive, and the comments below are designed to help you
make the most out of the process, so that you learn faster/progress more /
feel better sooner, and the psychotherapy process is therefore less expensive.
WHO CAN BENEFIT FROM PSYCHOTHERAPY?
The quick and easy answer is… Everyone. One way to describe the goal
of psychotherapy is to “improve functioning.” Top-notch athletes
don't stop exercising/practicing because they are very good, they
continue exercising/practicing because they want to optimize and improve
their performance. When looked at in this framework, psychotherapy is about
learning how to improve psychological performance/ improve coping with
Everyone has anxiety and depression when going through life,
initiating/maintaining/dissolving relationships, dealing with job stress,
acute and chronic illness, disappointments, and numerous other situations
which life brings us. The time in your life when you develop most of your
coping skills is adolescence. That is when most of us learn to deal with
powerful inner emotions. However, learning to cope, and self-regulate takes
time; and exposure to parents/friends/teachers who can be good role models in
“learning how to cope” is very beneficial. Approximately 20-40% of
us have had optimal parenting, and have developed coping skills with which we
can deal with much of what life brings us. However, even with optimal
parenting and the development of good coping skills, some situations such as
severe relationship disruptions, and/or unexpected losses of loved ones can
lead to feeling overwhelmed.
Many of us not had optimal parenting, and so we develop unhealthy methods to
deal with these strong emotions. These unhealthy methods usually entail using
alcohol, drugs, unhealthy eating, inappropriate sexual behaviors, and/or
adventure seeking/acting out. All of these methods do have the benefit of
"immediate change/relief" from disturbing feelings, but they all
have their own individual long-term consequences which are detrimental. More
often than not, the above "coping shortcuts," have emotional,
health, relationship, financial, and/or legal consequences; which now have to
be dealt with in addition to the original issues which are still present.
Psychotherapy entails learning coping methods which work fairly quickly, and
do not have adverse or detrimental consequences.
PREPARATION FOR PSYCHOTHERAPY
It is important to have an understanding of "state dependent
learning," so that you can best profit from the psychotherapeutic
experience. State-dependent learning means that memory recall is "best" in the same
pharmacological state in which the learning took place. For example, if you
learn to drive a car while sober, of course you do the best driving while
you are sober; and the more one drinks the worse your driving becomes.
Driving is worse when intoxicated as your brain is in a different state (and
less able to recall the sober ideas/skills) than it was when the behavior
was learned. This is true not only for behavioral skills (driving) but also
for cognitive skills (belief change, learning, insight.) Therefore, the
following guidelines are useful.
Please do not smoke or consume any alcohol or drugs for four – five
hours before the therapy session. It takes four – five hours for the
" learnings" from psychotherapy to be assimilated by your brain, so
is preferable if you do not smoke, use alcohol or drugs for five hours
following the session. If you wish to mentally review what occurred
during psychotherapy, that likely will be helpful. Studies show that
memory loss (forgetting) is extensive in the first few hours after learning,
so it is important to review with yourself what the session was like, what you
learned, how you changed, etc. within a few hours of the psychotherapy. Making
notes will be even more helpful! It usually is not helpful to discuss
the process with friends or significant others following psychotherapy for 4-5
hours as it is unlikely that they are trained and therefore may make comments
which are inadvertently detrimental.
Because of "state-dependent learning," the use of benzodiazepines
(Xanax, Valium, Librium, etc.) is discouraged during psychotherapy. Some
people find that when these medicines are decreased, it becomes harder to
recall psychotherapeutic learnings. However, these medicines cannot be
decreased suddenly. Please discuss this with your therapist or with me if this
is an issue.
PROGRESS IN PSYCHOTHERARPY
Another important issue to clarify at the onset of psychotherapy is that
progress is definitely not linear. That means that there is not definite
improvement after each and every session. The brain exists primarily to
"keep us safe/surviving" in the world. This includes not only safe
in the external world (being alert to avoid being hit by cars, physically beaten
up, etc.,) but also minimizing severe discomfort in our internal world
(thoughts and powerful emotions.) Often a person deals with an issue in
psychotherapy, feels better, and then the brain/unconscious says, "now
that this person has handled this issue, they are strong enough to handle
this other issue," and more distress occurs. In general, certainly one
would expect improvement over time, as you become more able to handle
different situations/issues, but every session will not result in
you’re feeling better.
This is comparable to experiencing some pain/soreness when you were becoming
physically stronger when pushing yourself during exercise. In physical
training, some pain/soreness is accepted as part of the path to gaining
physical strength. It also needs to be accepted that in psychotherapy, there
will be some emotional pain when you are becoming psychologically stronger.
However, good therapists are sensitive to this issue and will do their best to
help you manage this emotional pain accompanying growth. For majority of time,
the anxiety/ discomfort should occur during the therapy session, so that you
can deal with it with your psychotherapist.
In addition, there is another important issue you need to understand. Your
family may not understand the psychotherapy process and may be concerned if
they see you having some emotional distress following your sessions They are
unable to understand that this distress/discomfort is part of the change
process and needs to be accepted. Another issue is that sometimes your
growth/change will lead you to engage in behaviors which family/friends do not
appreciate, and which in fact may be upsetting to them. This is a very common
and is to be expected. You are the one seeking to change your
thoughts/feelings/behaviors, and, of course, this will not result in change in
your family/friends. Actually, some of them may prefer the "you before
psychotherapy," as you were more compliant, passive, subservient etc.
This is something that you can "work through," with your provider,
and means that your improvement is noticeable to others. This issue is common
and frequently complex. Your friend/family/significant other may even say that
“we are glad you are making this change” but act in a different
This leads to the last issue which I left for last as it is the most complex.
We – Fred, Roger, Mary or Susan are not really a single entity, as our
legal and social systems imply. We have a modular brain, consisting of many
sub-systems, parts, systems or neural networks. Many terms here have been used
over the centuries, as this concept is quite old and continues to be studied.
Neuroscientists and clinicians are seeking better understanding of the fact
that we all have modules/parts which are often contradictory (the preacher who
frequents prostitutes, the priest who abuses children, the loving husband who
has an affair, or someone who says, “I want to lose weight” and
frequently eats ice cream). Robert Kurzton in
Why everyone (else) is a Hypocrite, has written extensively about
this in a book which is not light reading. This modularity of minds is perhaps
one of the major factors psychotherapy is sometimes a long process, as
“one part wants one thing” and “another part wants something
else.” It is difficult to generalize further about this, so will leave
this topic for now.
In conclusion, most people find the psychotherapy process to be worthwhile,
and very glad that they engaged in it. There may be some temporary
discomfort, and any therapist will work with you to minimize this. A vast
majority of therapists will help you manage emotional reactions which are
overwhelming. Being aware of your modules/parts may initially be
frustrating, but with successful therapy the outcomes of your various
modules/parts will become more aligned. Because of state dependent learning,
it is best to minimize benzodiazepines/ drugs/ alcohol for 4-5 hours before
and after the psychotherapy session. It is recommended to set aside some
time after psychotherapy for mental review of the session, or to write
yourself a brief note regarding your recollections, insights, and plans. If
you discuss this with a close friend or family member, make certain he or
she is supportive and understanding, as your brain is still “open/
malleable/ plastic” for a few hours after psychotherapy, and a
“negative Nellie” may be able to have some impact, decrease the
benefit. After a few hours, the changes are more permanent, and
“negative Nellie” will have nil impact on your new perspectives
on past issues and plans for change.