The interviewees in my book talked about declining quality of health care. Do people even know or remember what it is like to get quality health care? Doctor visits are often too short to be adequately through. Psychotherapy is too often too brief, with a focus on “quick fix.” Psychotherapy isn’t just about talking. It involves careful, thorough study and application of knowledge to the issues that patients bring with them. So, what are we missing? In order to address this question about psychotherapy, I wrote a FAQ:
What is the purpose of psychotherapy?
What are the goals? Psychotherapy is a talking process between a patient and a psychotherapist that involves looking at feelings, behaviors, impulses, and thoughts through a process of self-reflection. The purpose of psychotherapy is to explore life patterns and to learn what works and what gets in the way of feeling successful and fulfilled. The goals are to reach one’s fullest potential. This is done by changing, improving, and unlearning habits that get in the way and strengthening habits that are working. This includes learning and developing new habits. The basic idea of psychotherapy is that the past influences the present and understanding this connection can be helpful in planning the future.
How is behavior (and behavioral self-control and change) an important part of psychotherapy?
Behavior is a way to communicate with others and to get emotional needs met. However, behavior cannot be out of control, or it is disruptive and does not help to meet life’s goals. For example, other people will not want to be in a relationship with an out of control person. Therefore, the out of control person will not get his or her needs met. Improved behavioral self-control can be an important part of psychotherapy as well as an important part of getting health care needs met.
Why do patients sometimes feel some of the same feelings in psychotherapy that they feel in the rest of their lives, and that originally brought them into psychotherapy?
Feelings, thoughts, impulses, or behaviors from one situation or relationship can be “transferred” onto another situation or relationship where they may not fit. This is a way of remembering, although we may not be aware of what we are doing. The feelings or behavior may seem stronger than necessary and may not make sense in the present situation. This is often seen in everyday life with expressions such as “He/she really pushes my buttons”, “He/she really rings my chimes”, or when we see or feel something and wonder “Where did this come from?” An important part of psychotherapy is learning that these feelings, thoughts, impulses, and behaviors belong to the past and do not have to run our present lives. This includes any feelings related to the psychotherapist that may have come up as part of the process.
How can these experiences be used to meet the goals of psychotherapy?
By becoming aware of and understanding the connections between these past and current feelings, behaviors, impulses, and thoughts, we can understand how to make different choices and have different reactions.
Why do patients sometimes feel stuck in psychotherapy and how can they get unstuck? How can this stuck/unstuck process help to meet the goals of psychotherapy?
We all have “resistances” which get us stuck and get in the way of everyday life. These are old emotional habits that began as ways to help us feel safe. They protect us against ideas, thoughts, memories, or behaviors that may have once been threatening, frightening, or upsetting. When we feel stuck, it is because we have reached a sticking point that we have never been able to get past before. We secretly don’t want to change, because in some odd way the familiar is comfortable, even though we are trying to change and the old way is not really working anymore! Here, with a well-trained psychotherapist, is where old patterns can be recognized and unlearned, new patterns can be learned, and we can get unstuck and make progress toward reaching our goals.
What does research show about making psychotherapy work effectively?
Research shows that psychotherapy focused on feelings, instead of just behaviors or thoughts is most effective. In addition, it is most effective to focus on recurring themes and patterns (“emotional habits”), and to look at how the past has helped to form the present.
How can patients know when psychotherapy is successfully completed?
When the issues that brought the patient to the psychotherapist’s office in the first place are no longer present, or are barely present, rearing their heads primarily only in times of stress, and more easily handled, psychotherapy is done. The patient feels able to handle life’s ups and downs without the psychotherapist. Leaving psychotherapy is as important as coming. It should be accompanied by feelings of balance, self confidence, and hope for the future. Rough spots or “stuck spots” have been resolved. The psychotherapist and the patient have worked through many transferences, including any that came up as part of the process between them. An important and challenging task for the psychotherapist is to be able to keep the patient engaged in the psychotherapy process during the rough spots. Ultimately, it is important to know how and when to help the patient see that psychotherapy is completed. It is time to say goodbye, as difficult as that may be sometimes, and go on to a fulfilling, content, hopeful life.
We need to increase mental health benefits and force the insurance companies to honor them. Our well being depends on it.
Peggy A. Rothbaum is a psychologist and can be reached at her self-titled site, Dr. Peggy Rothbaum. She is the author of I Have Been Talking with Your Doctor: Fifty doctors talk about the healthcare crisis and the doctor-patient relationship.
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