INTRODUCTION TO PSYCHOTHERAPY

Lily is a 21-year-old college student suffering many symptoms of generalized anxiety disorder and major depressive disorder. She grew up in a dysfunctional, rural, low socioeconomic status family with significant interpersonal violence between her parents (e.g., pushing and shoving, throwing objects at each other, accompanied by angry outbursts). Although Lily was not the object of abuse, she finds the family environment aversive and spends as much time as she can away from home, which she accomplishes by working diligently at school and participating in as many school activities as possible. She is dedicated to attending college and “never returning home.” However, she finds that she feels alienated from the other students at the urban liberal arts college she attends because they are from cosmopolitan upper middle-class and upper-class homes and do not share much in common with her.

Lily’s social life is sparse and spends most of the time studying by herself. She is motivated to change, and she and her therapist have focused on increasing social activities. Lily has made some friends during the course of therapy and is feeling better, displaying fewer symptoms and reporting greater well-being. She presented to the sixth session agitated and reported that she had not completed the homework that had been assigned. When the therapist noted her agitated state, she responded, “I don’t want to talk about it.” The therapist had several thoughts: “Has something happened to Lily, such as a sexual assault?” “Is she ashamed that she did not complete the homework?” “Is our relationship not sufficient for Lily to disclose more difficult material?” “Was the focus on interpersonal relationships with other students not optimal?” “Was Lily simply being compliant with therapy because she is motivated to accomplish any task?” “Was the progress noted previously superficial?” But the most urgent question was: “What do I say to her at this moment and how do I say it?”

As you can see, the above case study poignantly illustrates how complex the task of therapy can be and typically is. There is much important background knowledge needed: a firm understanding of biological, social, ecological, cultural, affective, and cognitive bases of behavior. But what is most important in psychotherapy is a good road map of how therapy unfolds – a guide to action. A map is a representation of reality, and one would not set out across country without one. In psychotherapy, the representation of reality used to guide therapy is theory. Theory provides the framework for therapeutic action: which questions to ask, what to attend to, how to respond to client verbal and nonverbal behavior, when and how to intervene, and how to assess progress. Every aspect of therapy is saturated with the theoretical perspective of the therapist. As it will become apparent, there is no one “best” road map for therapy; there are a number of viable theories from which to choose.

WHAT IS PSYCHOTHERAPY?

Basically, psychotherapy in general refers to a treatment that involves a relationship between a therapist and patient. It can be used to treat a broad variety of mental disorders and emotional difficulties. The goal of psychotherapy is to eliminate or control disabling or troubling symptoms so the patient can function better. Such a therapy given can help build a sense of well-being and healing. Problems helped by psychotherapy include difficulties in coping with daily life, the impact of trauma, medical illness, or loss, like the death of a loved one, and specific mental disorders, like depression or eating disorders. In this case, psychiatrists and other mental health professionals can provide psychotherapy whenever it is necessary for their patients or clients to be treated.

Furthermore, psychotherapy belongs to a class of healing practices that involves talk as the medium to address psychological distress. In many ways, psychotherapy is an amorphous practice because it is delivered by a variety of professionals and paraprofessionals, including psychologists, psychiatrists, counselors, marriage and family therapists, and social workers. According to the American Psychological Association (APA), psychotherapy can be defined as a “collaborative treatment between an individual and a psychologist”, whereas the psychologist uses “scientifically validated procedures to help people develop healthier, more effective habits”. Psychotherapy is widely accepted as a legitimate and beneficial healing practice in the United States and in many other countries. It is estimated that more than 10 million Americans receive psychotherapy annually. About 3% of the U.S. general population uses outpatient psychotherapy services. However, out of those who use outpatient services, the percentage that uses only psychotherapy has been declining—from 15.9% in 1998 to 10.5% in 2007.

Meanwhile, psychotherapy is a primarily interpersonal treatment that is (1) based on psychological principles, (2) involves a trained therapist and a client who is seeking help for a mental disorder, problem, or complaint, (3) is intended by the therapist to be remedial for the client disorder, problem, or complaint, and (4) is adapted or individualized for the particular client and his or her disorder, problem, or complaint. By examining aspects of this definition helps clarify the boundaries of psychotherapy or other similar practices. However, keep in mind that there are aspects of the definition, boundaries, and practices about which many will quibble or slightly argue about them. Yet, as various theories are presented, it is important to confine the discussion to the practice of psychotherapy.

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