Dr. Madeline Daniels

Why Go to a Psychologist?

With all the medications, techniques, and self-help books and manuals, why go to a real person therapist? Simple, it’s because the process is more important than the procedures. Psychologists use the fancy term of the ‘intentional utilization of the client’s frame of reference.’ But what that really means is that the person doing the therapy is an integral part of whether the treatment is effective.

Considerable research has taken place in recent years on what is called ‘Empirically Based Treatment.,’ In other words, the idea that research could prove the best, most effective treatment, regardless of which therapist is administering the therapy. While research studies certainly do suggest that some treatment techniques are more helpful than others with some diagnoses, controversy has raged around the role of the individual therapist, and whether they are important to treatment.

Back in the 1960’s, the great psychologist Carl Rogers suggested that the ‘necessary and sufficient conditions’ for therapeutic change were: 1) empathetic understanding, 2) unconditional positive regard, and 3) congruence, or empathy, warmth, and genuineness. Studies since then have indeed indicated that these characteristics on the part of the therapist do seem to be a significant portion of the effective ingredients in psychotherapy and are very consistently related to positive patient outcomes.

Let’s look at the nature of therapy itself. If you understand more about how therapy works, you’ll find it easier to pick the right therapist for you. You’ll also be able to make the most of your time in therapy. Although you’ll most likely be meeting with your therapist only once a week (or less), you will actually be engaged in the process of self-growth all 168 hours in the week!

Basically psychotherapy consists of developing a relationship (known technically as a ‘therapeutic alliance’) between client and therapist, learning more about your problems and their source, and exploring alternative ways of coping. It should be obvious that one of the most important parts of this process is the relationship between you and your therapist. If you are not comfortable with someone, you will be less likely to relax and open up with them.

This does not mean that you should be looking for a clone of yourself, someone who looks like you, is your gender and ethnicity, was raised in your neighborhood, and agrees with you on everything including politics and religion. That would probably be counterproductive, since you need a new perspective and someone who does not share your biases but can help you open your mind and grow.

Someone who speaks your actual native language may be very valuable, because feelings and private thoughts are often more easily expressed in our ‘mother tongue’ than in a second language.

You should feel that you can trust your therapist. The best therapists come across as understanding and knowledgeable, but do not give you the impression that they are looking down on you. They have training and experience in helping people work out their problems, but this does not make them superior to you. You are both equals, with knowledge to share with each other.

A good therapist is not usually judgmental. He or she may help you realize which behaviors are detrimental to you, but does not do so in a way that makes you feel put down. After all, you’re a team, working together to build a better life for you. Your therapist may not always agree with you but should be able to explain a different point of view in a way that respects your right to disagree.

Therapy can provide a place for you to relax and talk freely about yourself, get support and encouragement from an honest listener, and obtain suggestions that may be valuable in forming new patterns. A professional therapist has experience to draw from, and can provide a calm look from another perspective.

One common mistake that people make is thinking that their therapist will provide ‘all the answers’ or a magic overnight solution. This is not the case. You have to be willing to work together to explore the possibilities. A good therapist can make this process easier, but cannot solve your problems for you.

I have worked literally with thousands of people over a 30 year career. I have learned that every individual is unique and that I can’t choose the solution that will work for you just because it worked for someone else. But I do know that I learned a lot about finding solutions from all those people, and that if I share that with you, one of their ideas might just be one that works for you too!

It helps if you and your therapist have a sense of humor, respect for each other, and compassion for the general problems of being human. You may sometimes be angry at each other, or disagree strongly about a course of action, but basically your common spirit of cooperation should come through.

Remember too that therapy is often not an easy nor a pleasant process. You may be encouraged to explore feelings you have been avoiding because they are unpleasant. You may be asked to explain things you have taken for granted. You may be asked to work hard on doing new behaviors or building new habits. You may have to take a new look at how you handle old relationships. Change is often uncomfortable until we become used to new ways. Be patient with yourself, and with the process.

Be honest with your therapist about what you hope to gain from therapy and be prepared for a realistic response about what it will take to achieve those goals. If you are angry or dissatisfied, say so and work together to resolve the difficulties. Be ready to work hard together to accomplish your task. Therapy is a place to practice these skills with much less risk than any other area of life! Make the most of it!

Growing and learning is not always easy. It takes effort as well as desire on your part. Working with a good therapist can ease ‘growing pains’ and help you adapt to desired changes more effectively. Together you can work towards a happier and healthier life.

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So what are all these different types of psychotherapy that Evidence-Based studies are testing? Don’t psychologists just sit and talk to (or listen to) their patients? What could be the differences that seem to be so important?

While it may sound confusing, understanding the variety of approaches from which you can choose works to the consumer’s advantage, if you understand them well enough to make an educated choice.

The easiest way to understand different therapy methods might be to look at three areas: the way you think, the way you feel, and the way you act. Often your therapist will work with you to facilitate changes in all three areas. But specific approaches to therapy often emphasize one of these three areas.

Cognitive restructuring, reality therapy, and rational-emotive therapy are all terms that refer to methods that help you focus on how you think about things. Your attitude towards life and relationships has a big effect on how you react to new events or daily stresses. In other words, a problem exists partly because you think of it as a problem.

Cognitive therapies help you understand how you think, and help you explore other perspectives towards the world. Once you begin to see your part in creating a problem, you may be freer to explore other ways of handling difficulties. You may even find that you no longer think of some things as ‘difficulties’ any more. Even if you still have problems, you may find yourself better able to deal rationally with them.

Emotion-oriented therapies help you understand how you feel. Such approaches as psychoanalysis and psychodynamics explore the life experiences you have had that shape your present feelings about yourself and others. Other techniques help you get in touch with your feelings as you are experiencing them now.

Sand tray, focusing, dream analysis, art therapy, and role-playing all allow you to understand your emotions better. Free association techniques can help you uncover patterns you weren’t aware of. Relaxation, hypnosis, and Gestalt techniques may allow you to experience yourself in new ways.

As for the third area we mention, some therapies deal directly with the way you act. Behavioral techniques may desensitize you to a phobia, or teach you to break old habits like smoking or over-eating. Behavior modification techniques like conditioning ad reinforcement help you learn new behaviors for dealing with the problems in your life. You may use biofeedback equipment to teach your body to slow down and function better.

With behavior-oriented therapies, you may be asked to keep records of the behaviors you are trying to change. You may plan exercises to practice at home or in social situations. You and your therapist may plan a step-by-step program to improve your life, and reward yourself for each change.

These categories are oversimplified, of course, but they may help you to understand the complexity of methods available. There are well over 200 different kinds of therapy practiced today. Many of the techniques discussed above are combined depending on the needs of the individual patient.

For example, biofeedback may be used in conjunction with feeling-oriented techniques to help you learn to feel less stressed. Hypnosis may be used to uncover old memories and attitudes, as well as to reinforce new behavioral goals. A good therapist will always be willing to explain why he or she is using a particular technique. The decision of what you want to accomplish and how to do that is made through the cooperation of client and therapist.

Of course there are other categories of therapies, based on situational factors or time constraints. Group therapy is useful in some cases, and may be used alone or as an adjunct to individual therapy. Family therapy is a form of group therapy that is limited to specific people. (i.e. family members) Time-constraints may be set by need, demand, or the limitations of insurance coverage or payment costs. It simply means that there is a specific time set to accomplish a specific goals. Long-term therapy is more open-ended and may last six months to two years, depending on the nature of the problem and your goals.

Remember that therapy is a cooperative process. Feel free to ask your therapist why he or she is recommending a particular form of treatment, and make sure both of you understand the goals you have set.

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Much confusion centers around the practitioners who actually offer therapy. The terms ‘Psychiatrist,’ ‘Psychologist,’ and ‘Psychotherapist’ are not interchangeable. Add Marriage and Family Therapists (MFT), Marriage and Family Clinical Counselors (MFCC), and Licensed Clinical Social Workers to the list, and it is no wonder consumers are confused! (Okay, I left out a whole bunch of other labels like Life Coach, etc. but the area is confusing enough without lumping in all the other specialty titles. More on those at another time.) Each of the above terms designates a specific category of practitioner. The exact category is defined by the regulations of the state where that therapist resides, a fact that adds to the consumer’s confusion.

The descriptions following are general guidelines only! Check your state boards for state requirements!

A psychiatrist is an M.D. (Medical Doctor) with a specialty in psychiatric practice. This means she or he is licensed by the Medical Board within the state, and can prescribe medication.. They can evaluate patients to determine whether organic or biochemical factors are present. In other words, they can help determine if there are physiological factors that are affecting the patient’s state of mind. In some states (at least in the past) they were the only practitioners allowed to admit a person to the hospital for psychological reasons.

In most parts of the country, and in most arenas, a psychologist is a clinician with a Masters or Ph.D. level of education in psychology. State licensing boards usually require meeting extensive standards in clinical psychology training and experience, as well as passing a written (and sometimes a oral) state-administered examination. This type of training includes the ability to administer a complete battery of psychological tests for diagnostic or assessment purposes.

Someone certified as a pastoral counselor must usually be a recognized religious leader, such as priest, minister, rabbi, or imam. Usually they are also required to have a Masters or Doctoral degree in pastoral counseling, and extensive supervised experience in counseling. A social worker with the initials ACSW after his or her name is a member of the Academy of Clinical Social Workers and may also be listed in their National Register. Both of these categories have separate licensures in various states (California included) so again, be sure and check local requirements and regulations!

In order to evaluate the competency of any therapist, the consumer needs to be ready to ask questions about that that person’s background. Because of the wide number of options available, and because of the wide variety in state regulations, it really pays to shop around for a therapist. Ask your family doctor for a recommendation, or ask friends who have had practical experience with the therapists in your area. When you get the names of possible resources, call and ask questions.

What is that person’s educational background and area of specialty? How many years of experience have they had, and how much of it was in a supervised training context? What professional organizations do they belong to? Are they licensed or certified by any state, regional, or national association? Check out the requirements of your health insurance carrier, and find out whether they will cover the costs of therapy with that person.

Therapy can be a big help, but it requires an investment of your time and energy to make the right choices. For something as important as your health, happiness, and well-being, it is well worth the effort to uncover as much information as possible before you choose a therapist.

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Now we need to consider when therapy is appropriate, and what you can expect from it. How do you know when you need professional help? Let’s look at some basic guidelines for when therapy might help.

When emergency strikes, definitely call for crisis intervention. A crisis is any sudden event or realization that is disruptive or dangerous. This includes acts of violence such as rape, child abuse, or violent fights. But it may also include the realization that you or someone you care about is having a problem with drugs, alcohol, thoughts about suicide, depression, sex, or illness.

A personal crisis can exist if you feel overwhelmed by daily pressures, or by an unexpected change in your life, such as death, divorce, moving, or illness. Sometimes people hesitate to seek help at the first sign of a crisis, hoping it will pass if they ignore it. This almost never works! Calling for crisis intervention at the first sign of trouble can keep things from escalating into a major disaster.

Any major traumatic event usually triggers some referral to resources. But people who face trauma daily may be as much in denial of the negative effects as someone with just one problem area. Police officers, firefighters, correctional officers, nurses, doctors, - the list of people who encounter day-to-day horror and stress is enormous. Since it is their work, many consider it an ‘occupational hazard’ to be dealt with by ignoring and being ‘tough.’ But if they were exposed to hazardous wastes or biotoxins, most would have enough common sense to go into a medical doctor and get tested. The same way, being exposed to the toxic effects of even small traumas on a daily basis should trigger a psychological checkup. Better safe than sorry!

If you have been feeling bad for a long time, you may not think of it as an emergency, but it is still important to get help as soon as possible. The longer any problem drags on, the more difficult it can be to cope with it. If you have been feeling depressed for a long time, having continuing difficulties in relationships, or feeling constantly exhausted and fatigued, you should consider psychotherapy as a way to improve your mental health.

If your physician has ruled out physical reasons for headaches, sleeping problems, or chronic pain, or is giving you messages that medical science has no ‘magic wand’ to help, psychotherapy should be considered. The mind and the body function as a unit. Feeling bad about yourself emotionally can often create or intensify physical problems.

Of course, physical problems can really make you feel bad about yourself, especially when they result in disabilities or limitations, so it can become a the-chicken-or-the-egg dilemma: which came first? Psychotherapy can help break this vicious cycle, especially if the medical doctor is suggesting life style changes may help your current feelings or your prognosis.

If your life has been disrupted by a chronic illness or major surgery, verbal therapy in conjunction with the medical care you receive can help you recover from the impact faster, and help you build a healthier life for the future. Learning how to deal with stress, learning to grow to adapt to life changes, learning how to feel better about ourselves: these are all places where therapy can be of value.

Psychotherapy is not a magic cure-all, but it can improve your coping skills and your ability to handle whatever life throws at you. Studies have repeatedly shown that overall, people in psychotherapy tend to get well faster than people without psychological treatment.