By Alan Koenigsberg, M.D.
There have been more articles about psychotherapy in the newspapers these last few weeks than I have read in years. And yes, I actually buy and get real paper newspapers every morning. The articles discussed rules of psychotherapy, why “everybody” is in therapy, does it work, what different kinds are there, etc.
So, in this article, I’m going to discuss some basics about what psychotherapy is and what it isn’t.
First, there are many different kinds of therapy. There are physical therapy, occupational therapy, psychotherapy, vocational therapy, music therapy and on and on. For this article, “therapy” will refer to psychotherapy.
Secondly, what therapy isn’t: It’s not counseling. Counseling is the process in which a person or people come to a counselor for advice. It could be a couple who argues about how to raise their children, save or spend money; the counselor will listen to each person and then give them tools to learn to negotiate with each other.
For example, with concerns about how to divide up money, the counselor could suggest establishing a budget, negotiate who pays for what, have each person develop savings of their own and so on.
Psychotherapy is different. Generally, we work with one person at a time. If I had a person in psychotherapy who told me that he argues with his wife all the time about money, sex, raising the children and religious concerns, I would focus on why they tend to argue and ask about that. I wouldn’t tend to delve into the nitty-gritty about the details. I would encourage them to look inward and develop those skills.
Most of the patients I work with have the knowledge and wherewithal to generally know what their options are; they have serious difficulty in doing what they know.
The kind of psychotherapy I was trained to do, and do today, is generally known as insight-oriented psychotherapy and is considered classical psychotherapy. The person is acknowledging they have difficulties or struggles with being assertive, setting healthy boundaries, difficulties with relationships, low self-esteem or a lack of self-awareness, not knowing why they do certain things that aren’t good for them.
The goal of psychotherapy is self-awareness and can be started at any adult age. I have had patients in their 70s begin therapy with me.
Most therapists that do this kind of work meet once or twice weekly for 50-minute sessions, the same day and time every week. This involves a serious commitment of time, money and substantial effort.
In-depth psychotherapy is often one of the most rewarding investments a person can make in their lifetime. They learn about themselves in a safe environment, free from criticism, with a professional who listens attentively and points out blind spots and areas of focus, asks questions and helps the person gain a better understanding of their true motivations, aspirations, goals, prejudices, strengths and weaknesses.
They gain the skills to make rational, healthy decisions, adjust unrealistic expectations, develop a deeper sense of maturity and a more sobering perspective on life and live in reality.
Think about learning a completely new language, spending a few hours a week practicing. Assuming one can speak well, learning a new language is a mental process and it takes years to become close to fluent.
Or imagine learning a new musical instrument, practicing a few hours each week. How long would it take to become seriously proficient?
Clearly, making significant changes to our brain takes time for our minds to adjust to new concepts, make new connections and have it become second nature. That’s why psychotherapy cannot be rushed, needs to be regular, in-person and done by an experienced professional.
Lastly, this kind of work is best done face-to-face, in-person, in an office that provides privacy and is free of distractions and where serious work can be done.
Alan Koenigsberg, M.D., is a practicing psychiatrist and clinical professor of psychiatry at UTSW Medical School in Dallas.