Introduction to Psychotherapy
By Frederick W, Brown, MD
August 18, 2022
Category: Articles
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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 life.

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 trauma,
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 manner.

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.

        SUMMARY

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.


 

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