This is Therapy

Demystifying Therapy

“People are over-therapized.”

“You don’t need therapy, just go watch the sunset.”

“Therapy will turn you into a bootleg Brene Brown who talks about boundaries and yet exhibits zero boundaries when striking up a conversation about croutons at Panera.”

OK, that last one’s not a real quote, but the others are regularly heard in casual conversation. Therapy’s seemingly everywhere now, even though the vast majority of Americans still don’t receive any kind of mental-health treatment.

Even so, misunderstandings around the practice abound, and there appears to me that there’s a general aversion to therapy in American culture. This makes sense. Introspection isn’t necessarily historically valued in our society, much less assisted introspection via professionals, thus many of us still use terms like “shrinks.”

As in, they’ll shrink your dome piece and Freud you up. While some will never want to understand it, it’s a relatively simple concept. The Oxford dictionary defines therapy as “the treatment of mental conditions by verbal communication and interactions.” I tend to think of therapy simply as assisted emotional and mental problem solving.

Therapy basics

It sounds relatively simple because it is. Imagine you’re a therapist (I don’t call Gabriel Byrne’s character from In Treatment). A client comes into– or Zooms into– your office experiencing a mental-health struggle that’s causing them distress and/or impairing their life functioning in some sort of way. For example, say they’re exhibiting symptoms of anxiety that cause them mental anguish throughout the day while also impairing their ability to adequately complete tasks in their daily life. So, they seek your help. Straightforward, right?

Now, there are a variety of strategies, called modalities, that the therapist can use depending on the population they’re working with. This is often informed by their own treatment philosophy. Some of the options are: Cognitive Behavioral Therapy (CBT- think challenging your thoughts of anxiety), Dialectical Behavior Therapy (DBT- think skills such as emotional regulation for people experiencing substances), psychodynamic (think free association a la Jung).

The psychodynamic approach is what most pops into my head when I think of therapy– it’s the old-school, pipe-tobacco-smoking “analysis” sessions of the mid 1900s. You lay on a couch and try to interpret the meaning of your dreams that have been infested with bears, tigers, and crocodiles (does anyone else have these dreams?) as the analyst takes long, tobacco-exhaling pauses. A few other strategies include Narrative Therapy and Solution Focused Therapy, and then there are the multiplicity of family and couples’ therapy modalities.

Following the process

Whatever the modality, most therapists follow the same general process with clients: engaging clients in treatment and building rapport; assessing clients (this can include diagnosis, but also risk assessments and assessments for suicidality and homicide); treatment planning, where the therapist starts to employ the interventions in their modalities; ongoing evaluation using scales and other approaches; and termination (yes, therapy, like snack wraps, aren’t meant to last forever).

From there, there are many ways therapy can go. But the guiding principle is that the client has agency. Therapy is about empowering people to make the choices to arrive at the life they want– that’s the ultimate goal of therapy. In order to reach that goal, the therapist helps the client resolve those mental/emotional problems. The common understanding these days is that the root causes of problems like depression, anxiety, and OCD are based in trauma, usually childhood. Longer-term modalities focus on resolving these traumas by driving at their root causes. This can help clients understand the causes and stop the cycle of self-blame that afflicts so many people.

But not everyone has time for that. And not everyone even wants to investigate the labyrinths of their past. Some people just want their symptoms gone as quickly as possible, making short-term approaches like Solution Focused Therapy attractive. In this approach, therapy only lasts a few sessions up to 3 months. It emphasizes client strengths and empowerment, having the client take ownership for what it is they want to change and how they want to change it without focusing on the problem. No Dr. Melfi-style, decade of psychodynamic therapy here.

Ultimately, no matter the approach, the client has to own the process. In this story, the therapist is the guide, and the client is the hero.