INDEX OF ARTICLES
What is Psychotherapy?
What About Brief Therapy?
EMDR - Eye Movement Desensitization and Reprocessing
NEW! What Is Brainspotting?
Individual Psychotherapy: When to Start and When to Finish
Couples Therapy/Marriage Counseling
When Does A Child Need Therapy?
How Much Does Therapy Help?
What Can You Do When Therapy Does Not Seem To Go Well? -- A Second Opinion
What About Medication?
Who Should You Talk To About Medication?
Why Pay For Your Psychotherapy Rather Than Use Your Insurance?
What is Psychotherapy?
Psychotherapy is a powerful, time-honored and proven method of helping people change the way they feel and manage their lives. Therapy is the practice of talking things through with a skilled and trusted professional who, by using a variety of techniques, can help clients make positive changes in their lives. It is a healing method based upon both the science of psychology and the skills of understanding, teaching, supporting and confronting.
In therapy, it is important for clients to be self-aware and open, but for most people, this is difficult. Feelings of shame hinder self-awareness and openness. To be successful, the therapist must support the client and avoid shaming and judging. Over time, by openly and honestly talking about feelings, the client learns to trust that the therapist will be able to provide understanding and support even while discussing behavior about which the client and/or therapist may disapprove.
Psychotherapy is confidential and private. No information about therapy sessions can be released to anyone without client permission. (There are legal exceptions to confidentiality when someone is a danger to themselves or others and when there is evidence of the physical or sexual abuse of children. These exceptions can be explained in more detail by a therapist.)
Psychotherapy is individual. A skilled professional has a knowledge of many therapeutic techniques and is able to use them to meet individual needs.
Effective therapy moves at the client's individual pace. A therapist knows how to time interventions according to a client's readiness. Together, client and therapist decide the frequency of sessions and when it is time to end the therapy.
Human beings have the amazing ability to control or alter the course of their lives. Furthermore, we are biologically programmed to control and change our fate most effectively when we discuss our feelings with a helping person. This is why the effects of talking to another person are more profound than the effects of talking to ourselves, especially when the other person can listen skillfully and respond empathically. Psychotherapists use the skills and knowledge of psychology. The power of the healing relationship between patient and therapist grows over time.
Research shows that with trained, empathic and experienced therapists, people can make great improvements in their personal, emotional, occupational and interpersonal lives. In fact, millions of people have benefited from psychotherapy. Solving problems in therapy can prevent many of the social tragedies of our time, including depression, domestic violence, child abuse, school failure, substance abuse and suicide.
by Cynthia Kale, Ph.D. and Evelyn Bassoff, Ph.D.
In the present era of managed-care health care, the most commonly recommended therapy for people with emotional problems is brief and symptom-focused. Increasingly, the health insurance industry requires that mental health providers find quick solutions to reduce their client's distressing symptoms. 'Quick fixes', however, often do not produce sustainable changes for complex human problems. A more effective treatment is psychodynamic psychotherapy.
What is psychodynamic psychotherapy? It is a therapy that addresses the client's inner conflicts which may, for example, derive from early traumas or troubled relationships with parents. Through a deepening and compassionate self-understanding, clients free themselves from the destructive aspects of their past. In psychodynamic psychotherapy, clients look beyond the symptoms of their unhappiness to their causes: they learn why they feel as they do and how their feelings came about. They see the big picture (which is why psychodynamic psychotherapy is also called 'insight-oriented' psychotherapy) and they begin to make lasting changes that may have been impossible in brief therapy.
The quality of the relationship between therapist and client is a critical factor in successful psychodynamic therapy. The therapist becomes a true ally as well as a reliable and skillful collaborator in the healing process. In fact, as the best research in psychology has demonstrated, a successful outcome and a strong therapeutic relationship go hand in hand.
Some facts about psychodynamic therapy:
-- Treatment typically lasts at least one year.
-- It emphasizes autonomy, improved self-esteem and self-understanding.
-- For people who want to make sense of their whole life story and get at the root of
their problem, it is a therapy of choice.
-- It is a treatment with goals more ambitious than symptom relief; it aspires to increase personal awareness and growth.
-- It is an alternative for those who have tried other treatment and found it unsuccessful.
What About Brief Therapy?
Consumers generally want their therapy to be as brief as possible, and today more people are talking about brief therapy techniques. Many researchers and therapists call 30 sessions of therapy - 'brief'. Other therapists consider 'brief' to be just a few sessions. It is important to know what a therapist means when referring to 'brief therapy'.
Research generally shows that therapy must be longer than a few sessions to be helpful. Studies suggest that at least 68 sessions are necessary for the benefit of psychotherapy to be measurable. The research that proved psychotherapy is beneficial was based on analyzing hundreds of studies of therapy that averaged 17 or more sessions.
Whether brief therapy works for you depends on what you are looking for from therapy and the kind of problem you bring to therapy. Many times, people see a therapist for just a few visits. This can be successful if a client is looking for a brief consultation or is dealing with a temporary crisis. Sometimes a therapist can help individuals or families change very quickly. Most therapists use brief therapy when it is appropriate. What is important is making sure that your goals are accomplished.
Because it can be helpful for many people, it makes sense to consider brief therapy. However, long standing, difficult, complicated, or more serious problems often need more time. Longstanding problems rarely change overnight. But even for these difficult problems, there has been a trend over the last thirty years for therapy to be shorter.
Some insurance and managed care companies encourage almost everyone to use an ultra-brief therapy that lasts only a few sessions. Unfortunately, there has not been any research showing this kind of therapy to be effective. If you have experienced brief therapy that didn't work for you, it may have been the wrong treatment, and a longer term therapy may be what you need.
As an informed consumer, you should ask your therapist about the length of your therapy. Your therapist may not know the exact duration of your therapy, but can help you understand how therapy moves forward and how you can tell when it is complete.
EMDR - Eye Movement Desensitization and Reprocessing
By Ina Robbins, Ed.D.
What is EMDR?
In 1987, Dr. Francine Shapiro was strolling through a park mulling over several things that were disturbing her. As she was thinking, her eyes began to move back and forth very rapidly. She noticed this unusual eye movement, and that when she resumed thinking about what had been bothering her, it was no longer upsetting to her. Being a psychologist, she was curious about what she had just experienced. She began experimenting more with herself and her colleagues by asking them to think of a disturbing event and move their eyes rapidly. She consistently found similar results. This was the beginning of Eye Movement Desensitization and Reprocessing (EMDR). Since then, over 150 scientific studies have shown the effectiveness of EMDR in treating Post-Traumatic Stress Disorder. There are now over 60,000 therapists who have been trained internationally.
How does EMDR help?
Dr. Shapiro found that rapid eye movement greatly reduces the distress that people feel when they remember a traumatic event in their life. A traumatic experience tends to get stuck in the nervous system and causes us to relive the shock, fear, anger and sadness that we originally felt whenever we think about it. EMDR stimulates both sides of the brain and seems get the traumatic memories unstuck so that the brain can do its natural processing of emotions. Researchers think that this is similar to the rapid eye movement that people have during dreams, which are another time that the brain processes emotions. Once the traumatic memories are processed, we have a more balanced perspective and the disturbing emotional and bodily reactions clear away.
What can I expect from an EMDR session?
It is best to receive EMDR from a therapist who has completed an EMDR International Association approved training program. An EMDR therapist often uses other therapeutic methods in addition to EMDR, and the therapist will explain how EMDR will be incorporated into your treatment. Depending on personal preference, auditory tones, hand clickers, or tapping on both sides of the body are now used to stimulate both sides of the brain in the same way that moving the eyes side to side does. An EMDR therapist also teaches relaxation skills to help manage the emotions that often arise when reprocessing traumatic life experiences. In the beginning, EMDR sessions can be 75 - 90 minutes in length.
Who can EMDR help?
Originally, EMDR was studied and used to help rape survivors and Vietnam vets with specific single traumas. Now, almost two decades later, EMDR has developed from a technique to a comprehensive approach to psychotherapy. It is used with pre-school children, children, teens, adults, and the elderly. It is effective in reducing the traumatic effects of accidents, crime, rape, war, incest, abuse, natural catastrophes, illness and the death of a loved one. Addictions, specific fears, anxiety, depression, stress reduction and performance enhancement are also improved with EMDR.
By Melanie K. Young, Psy.D.
What is Brainspotting?
Brainspotting is a focused treatment method that can be used as a part of your psychotherapy. It helps to identify, process, and release deep sources of emotional and physical pain. The brainspot is a relevant eye position that accesses the therapeutic issue. It is well established that a person’s recall of memories is associated with eye movement and/or eye position.
Specifically, the brainspot is the eye position chosen by either the client or the psychotherapist, as the client slowly scans his/her field of vision while thinking about the issue of focus. Often, the individual can locate the brainspot by noticing an intensification of emotion or body sensation in a particular spot. The therapist may also find the brainspot by observing reflexive responses such as changes in the individual’s eyes, facial expression, breathing or body position.
How does Brainspotting help?
Much of the medical and psychological literature now acknowledges that a large number of requests for medical care are linked to the consequences of the accumulation of stress on the human body. Trauma can be lodged in parts of the brain and nervous system that is out of the rational, conscious mind. Brainspotting therapy helps clients release painful emotions and change maladaptive patterns of behavior. It can assist in reducing excessive reactions to present situations and relationships. Brainspotting is a way to work on trauma in a manageable and contained situation. There is a sense of spontaneity and often surprise in how one moves naturally toward healing. Many individuals describe a sense of profound, positive release following Brainspotting sessions. Brainspotting can also be used to build and develop resources to help cope with stresses.
What can I expect from a Brainspotting session?
Brainspotting was developed by David Grand, Ph.D., and it is important to receive Brainspotting from an experienced psychotherapist who trained through his approved workshops. You and your therapist can discuss how to incorporate Brainspotting into your overall treatment. A Brainspotting session can last up to 90 minutes but can often be effectively used in shorter sessions as well. Typically, you will listen to a CD, which sends soothing background music and/or nature sounds from one ear to the other while focusing on the memory or issue chosen. You can anticipate that repetitive feelings and patterns begin to shift in positive ways that are unique to your own personality and history. The therapist can also teach relaxation skills and resourcing tools to help manage any intensity that arises.
Whom can Brainspotting help?
Brainspotting can be integrated into a wide range of healing modalities. It can be helpful for children, adolescents, adults and seniors for treating the effects of experience that caused distress to lodge in the brain and body. It is an effective and efficient treatment tool for the psychological aspects of trauma, medical conditions, and chronic illness. Many individuals have found it useful for reducing stress, anxiety, phobias, and anger. Additionally, Brainspotting can enhance peak performance of athletes, musicians, and other types of artists and performers.
Individual Psychotherapy: When to Start and When to Finish
by Ina Robbins
When do I need outside help?
We each feel our emotional pain differently. Therefore, we must make a personal
decision about when to enter therapy. We generally seek therapy when there is a crisis or a persistent disturbance in our thoughts, feelings, or behavior that interferes with our
work or relationships. You may want to enter therapy when:
-- You have trouble making or keeping satisfying relationships or have repetitive problems in your relationships.
-- You have trouble obtaining or keeping a satisfying job or your behavior keeps you from advancing in your career.
-- You realize that an emotional problem has gone on for too long or seems to be getting worse.
-- You keep behaving in a way that is self-defeating, out of control, or a sign of addiction.
-- You are often bothered by traumatic memories.
-- You are preoccupied, worried, confused, or disoriented.
-- You feel depressed, up and down, anxious, fearful, agitated, or too angry.
-- You find that no one in your support system can help solve the problem, and you, yourself, are stuck.
-- You are self-destructive or harmful to others.
When am I done?
Therapists and clients together plan the work of psychotherapy. Likewise, together they
decide when therapy is finished. Some of the signs that therapy is finished are:
-- You know the sources of your problems and can deal with them effectively.
-- You encounter significantly fewer problems.
-- You know how to take care of yourself and maintain your mental health.
-- You can tolerate the pain and difficulties of life without developing symptoms like those that brought you to therapy.
-- You handle your relationships and your work well.
Couples Therapy/Marriage Counseling
Partners in intimate relationships start out with many hopes, both realistic and unrealistic, for creating a rich, satisfying life together. Unfortunately, the stresses from life's events, disappointments in the partner, and the reality of tedious routines often lead to disillusionment. When this happens, some couples fight, some grow apart, and some find themselves living in great pain, tension and suffering. These are the times couples enter therapy. Frequently, they have reached the point of considering separation or divorce.
Is it the intent of marriage counselors to prevent couples from splitting up? No -- that's
the couple's decision. Because the counselors are skilled outside professionals, they can help most couples greatly improve their relationships. However, the improvement may not be enough for the couple to choose to stay together. Because many couples see counselors when they are contemplating divorce, couples often decide to work on their marriage for a while before making the commitment to remain married.
A counselor may see the couple together at each session or may want to see the partners individually. Counselors also vary in the amount of privacy they encourage each person to maintain. Some focus on childhood issues, expectations, and relationship patterns. Some therapists focus mostly on communication and problem solving.
When Does a Child Need Therapy?
Contrary to the wishful myth we have often heard, children are not more adaptable and
less affected by problems than adults. The opposite is true -- children have fewer coping skills and less control over themselves or their environment. They are not able to verbally describe emotional problems but exhibit their distress in a number of symptoms that include irritability, sleeping problems, eating problems, personality change, physical complaints, disregard for personal safety, school problems, problems getting along with others, acting younger than their age and acting older than their age.
Every child will be distressed at times. How does a parent know when psychotherapy is needed? This depends on how severely distressed a child is, how long the child has been distressed, the child's personal strengths for handling problems and what kind of help is available. Child therapists can help evaluate if therapy is necessary. If therapy is needed, therapists may work in several different ways: sometimes they assist the parents and teachers to design techniques for helping the child, sometimes they see children and parents together in family therapy and sometimes they see children alone.
How Much Does Psychotherapy Help?
Psychotherapy can help almost everyone. Studies show that, on the average, people with emotional or interpersonal problems who use psychotherapy do better than those who don't. The amount of improvement depends on the person, the type of therapy, the length of therapy, and the type of problem.
People often ask if psychotherapy can 'cure' a person. They are thinking of a person's emotional problem as an illness. Medical tradition leads us to think in terms of illness and cure. This is often useful, particularly when treating some emotional problems that are like illnesses and may be called a mental illness. However, this is not always the best way to think about using psychotherapy. Some problems can be completely solved by psychotherapy and can be thought of as 'cured'. At other times psychotherapy helps people solve emotional or interpersonal problems. In many of these situations, it does not make sense to think that the person is 'sick' when they start psychotherapy or 'well' when they finish. A useful way to think about therapy in these cases is that the person has grown, improved, gained insight, or solved specific problems.
Sometimes people have a chronic mental illness, and psychotherapy helps the person to cope with the illness. In many of these cases, the symptoms and problems cannot be completely cured. But here, psychotherapy is helpful because it can make an important difference in improving the quality of a person's life.
Each person is different and unique. The amount of improvement you should expect is something you can discuss with your therapist.
What Can a Client Do When Therapy Does Not SeemTo Go Well? -- A Second Opinion
Occasionally, a client in psychotherapy does not improve or even seems to get worse. At times, clients may question if their therapist is providing the right treatment. Often there is an uncomfortable period of emotional turmoil during therapy. Other times, clients may become angry or feel hurt because of something their therapist said or did. These situations can be difficult for a client to evaluate.
Even in the best of therapy, there are difficult times. When people discuss personal and sensitive topics, they often become very sensitive to the therapist's reaction. In these situations, a client may be easily hurt or angered by their therapist. Trusting anyone is difficult for many clients. Frequently, the reliving of past emotions happens in therapy, and past conflicts may seem to be repeated in therapy. This is called transference. A major part of therapy is separating these past feelings from the present. The process of experiencing these difficult feelings with new skills is healing -- but it is difficult.
When problems or concerns do come up in therapy, it is important to discuss them with your therapist. Remember that therapists are professionals, and part of their job is to answer your questions about therapy. If the answers your therapist gives don't seem satisfactory, then getting a second opinion is a good idea. Second opinions are your right and also a good way to take care of your health.
To get a second opinion, contact another therapist and ask for a second opinion evaluation. This can be done either with or without the knowledge of your current therapist. However, if you decide to continue in therapy, it is important to be open and honest with your therapist about your concerns, and the second opinion should be discussed with your ongoing therapist.
What About Medication?
Making a decision to use medication is individual and complicated. Some problems get better primarily with medication and other kinds of problems get better primarily with psychotherapy. Still other problems respond best to medication and psychotherapy combined. Most often, when people take medication for emotional problems, they do better if they also seek psychotherapy.
The best reason to take medication is that, for many people, it can cure their symptoms without side effects or other adverse consequences. There are, however, some reasons people choose not to take medication. Some people prefer to avoid medications, some have tried medications and had unpleasant side effects, and others find that medication doesn't help enough to be worthwhile.
It is important to be an informed consumer. Ask your psychotherapist for advice and information about referral to a medical doctor for a medication evaluation. Ask your medical doctor for advice also. Get as much information as you can about the different treatments for your own individual problem. Then use this information to make your personal decision about when and how to use medication and/or psychotherapy.
Who Should You Talk To About Medication?
When considering medication for mental health problems, a person must ask a medical doctor for a medication evaluation. Sometimes the family doctor or a general practitioner is consulted, and other times it makes sense to see a specialist - a psychiatrist. If a person has a therapist, the therapist can be helpful in making the decision to try medication and may recommend a specific doctor or assist with the referral to a doctor of your choice.
Why do people choose to ask a family doctor for medication? Many people prefer to ask their family doctor for a medication evaluation because they know their doctor, feel comfortable with their doctor, and can easily make an appointment with their doctor. Much of the psychiatric medication prescribed in this country is prescribed by family doctors, and generally they charge less for an evaluation than a psychiatrist.
Why see a psychiatrist for medication? Sometimes people prefer to consult a specialist rather than a general practitioner. Psychiatrists usually can offer both psychotherapy and medication management, but often, patients will see a psychiatrist just for medication and see another professional for psychotherapy. Before prescribing medication, the psychiatrist generally will take a thorough history and conduct a comprehensive verbal evaluation. As a specialist, the psychiatrist is more knowledgeable than a family doctor about how treatment can be effective and will usually spend more time with each client than a family doctor. If the medication or diagnosis is complicated, consulting with an expert is a good idea.
Why do some patients have a one-time consultation with a psychiatrist? Although patients may receive medication from a family doctor, there are still times that it makes sense to consult with a psychiatrist. If the medication and treatment are not working as well as hoped, patients may decide to consult with a specialist about additional ideas for treatment. Sometimes the psychiatrist can give the general practitioner recommendations for changes in medication or treatment that will give better results.
When patients would like an additional evaluation from a psychiatric specialist, patients may ask their therapist or family doctor for a referral to consult a psychiatrist or may independently choose to call a psychiatrist. Sometimes after the consultation, patients continue medication follow-up with the psychiatrist, and other times, the patient continues with the family doctor. Usually family doctors are happy to have the consultation and helpful advice from a specialist.
Why Pay for Your Psychotherapy Rather Than Use Your Insurance?
You want privacy.
Whenever insurance is used, some information (such as your diagnosis) is available to
the insurance company and, at times, to employers. Managed care companies often ask for detailed personal information about clients in order to make payment decisions. This
judgmental review can undermine the sense of privacy necessary for effective psychotherapy. When clients pay for psychotherapy out of pocket, there is no loss of privacy to managed care companies, insurance companies or employers.
You want to choose your own therapist.
Many insurance companies limit the choice of therapists. Some of these 'preferred
providers' offer good treatment, keep their clients' interests foremost, and try to keep
treatment brief without sacrificing quality. At times, however, the insurance company asks the preferred providers to divide their loyalty between the client and the insurance company. Many clients prefer to choose their psychotherapist personally and avoid seeing a therapist with a potential conflict of interest between the client and the insurance company. Other clients may want to work with a therapist who was highly recommended but may not be on the company or preferred provider list.
You want to choose the type and length of treatment.
Managed care programs often limit the choice of therapy. While some interfere very little with the consumer's choice of type or length of therapy, others make many of the important treatment decisions - the length of treatment, the type of therapy, the use of medication and referral to self-help groups instead of professional services. Some companies provide only ultra-brief therapy and referrals. Self-paying for therapy may be necessary in order to receive the type and length of treatment needed.
You don't want a managed care employee making judgments about you.
When managed care is responsible for payment, they have the power to influence your
treatment. A company employee evaluates your motivation, the severity of your problem, and your progress, and makes treatment recommendations. The therapist must take the company's recommendations into consideration or risk losing the contract to work with the company altogether. Many clients prefer paying for their own treatment to eliminate influence from an outsider.
You don't want to be labeled 'sick'.
Whenever insurance is used for psychotherapy, the treatment must be 'medically necessary', which means that your therapist must give you a psychiatric diagnosis. When you pay directly, you may seek consultation from a mental health professional for any reason you choose. People use therapy for personal growth, for help coping with stressful life situations, and for marriage and family difficulties, as well as for chronic and serious psychological problems.