Psychotherapy (sometimes called “therapy” or “counseling”) is a general term for treating mental health problems by talking with a psychiatrist, psychologist, licensed social worker, licensed marriage & family therapist, licensed professional counselor or other mental health providers. These providers’ expertise and experience is largely based on the extent of education they have earned, such as having a doctorate degree, a masters degree, bachelor or associate degree. Mental health problems include, but are not limited to, anxiety, depression, schizophrenia, PTSD, relationship difficulties, grief and loss, stress management, and addiction. Psychotherapy is a collaborative treatment based on the relationship between an individual, couple or family and a therapist. The purpose of this process is to help a person(s) change and overcome problems in desired ways.
The process of choosing a therapist is a personal one, but it can seem confusing or overwhelming given the number of options to consider. For example, one needs to determine the location of a provider close to their home, work, or busline; the suitable time of day and day of week for scheduling appointments consistent with the provider’s availability; the possible preference of gender and age; the credentials, education level and experience, and specialties of provider; the issue of language; therapeutic approaches that provider relies upon, such as Cognitive Behavioral Therapy or Narrative Therapy; references from friends or agencies; and to a large extent, the connection made with a prospective provider during an initial phone conversation. Checking local therapist directories, such as Psychology Today, and exploring individual therapists’ websites online may also be helpful.
Depending on an agreement with therapist and client (as well as insurance company mandates), a session typically lasts 45-60 minutes. The initial assessment session is likely to last longer, usually 75-90 minutes, to accommodate for information gathering and development of treatment goals. Sometimes providers like myself will start sessions with a mindful meditation exercise for 5-10 minutes, intended to relax the client and help s/he focus on the present moment instead of staying distracted by outside concerns. Often providers initially do a check-in, asking the client to discuss the past week, identifying things that worked out well, such as getting positive feedback on a job presentation, and things that the client struggled with, such as a depressed mood and difficulty sleeping. These issues would be discussed in more detail, exploring the skills and strengths that helped the client be successful, and the challenges inherent in the client’s difficulties. New healthier behaviors would be examined and practiced, as well as strategies for dealing with overwhelming or stuffed feelings, and rigid or distorted thoughts. Old patterns of interacting with others and making sense of one’s self and the world would also be reflected upon, in motivating the client to make helpful changes and improvements in functioning and enjoyment in life. As a session ends, a summary of the session highlights would be reviewed and commitments for next week agreed upon.
The duration of treatment depends collaboratively on the therapist’s professional recommendation and the client’s personal choice. Some providers generally recommend 8-12 sessions as a reasonable amount of time to build rapport, explore briefly the history and current status of one or two important issues, and teach new skills and strategies for achieving positive change. Sometimes clients want to spend more time in therapy working on in-depth issues such as long term personal growth, ongoing mental illness, addiction recovery maintenance, childhood or sexual adult trauma, personality disorders such as narcissism or borderline tendencies, and family or relationship patterns of unhealthy attachment or interaction. In addition, sometimes a client’s insurance company or Employee Assistance Program will only allot for so many sessions for the specific issues presented. As a provider, I try to work with my clients regarding their goals for therapy and the possible limitations they may face such as time, resources, motivation or capability. I also educate them on the importance of wellness and health, and on the powerful benefits of therapy in terms of overall functioning and satisfaction in life. And I always encourage them of the opportunity they have in coming back for “refresher” visits or a recommitment to continuing to work on new issues.