As you’ve seen throughout this chapter, a wide range of therapies is available to help people who are troubled by psychological symptoms and disorders. Like our friend Marcia, whose story we told in the Prologue, many people benefit psychologically from psychotherapy. As the first part of the chapter showed, psychotherapy can help people by providing insight, developing more effective behaviors and coping strategies, and changing thought patterns.
The biomedical therapies, discussed in the second part of the chapter, can also help people with psychological problems. This was also true in Marcia’s case, when she reluctantly agreed to try an antidepressant medication. For almost a year, Marcia took a low dose of one of the SSRI antidepressant medications. It helped in the short term, lessening the feelings of depression and anxiety and giving her time to work through various issues in therapy and develop greater psychological resilience. Today, people are increasingly being helped by a combination of psychotherapy and one of the psychotropic medications.
As our discussion of the effectiveness of psychotherapy has shown, characteristics of both the therapist and the client are important to the success of psychotherapy. In the Psych for Your Life section at the end of this chapter, we describe the attitudes that should be brought to the therapeutic relationship, discuss some general ground rules of psychotherapy, and dispel some common misunderstandings. The Psych for Your Life section will help you understand the nature of the therapeutic relationship and provide information useful to anyone who may be considering entering psychotherapy.
What to Expect in Psychotherapy
The cornerstone of psychotherapy is the relationship between the therapist and the person seeking help. But the therapy relationship is different from all other close relationships. On the one hand, the therapist–
The following guidelines should help you understand the special nature of the therapy relationship and develop realistic expectations about the process of psychotherapy.
626
Find a competent, qualified psychotherapist.
Where should you go for help? Most colleges have a student counseling center or medical clinic where you can ask to see a counselor or request a referral to a qualified therapist. You can also ask family members, friends, your family doctor, or a religious leader for suggestions.
If possible, learn more about the therapist before your first visit (APA Help Center, 2012a). What are her qualifications? What approach does she take to treatment? Does she have experience with treating problems like yours?
Along with professional background, personal qualities are also important. When psychotherapists were asked how they chose their own therapists, openness, warmth, and caring were among the top criteria (Nordal, 2010).
Perhaps most importantly, you should feel comfortable with your therapist. Many psychotherapists offer a free initial consultation. So if you don’t feel comfortable with the first psychotherapist you meet, don’t hesitate to try out a couple of therapists before making your decision (Amada, 2011).
Strengthen your commitment to change.
Therapy is not about maintaining the status quo. It is about making changes in terms of how you think, feel, act, and respond. For many people, the idea of change produces mixed feelings. You can increase the likelihood of achieving your goals in therapy by thinking about the reasons you want to change and reminding yourself of your commitment to change (Hettema & others, 2005; Miller & Rose, 2009).
Therapy is a collaborative e ort.
Don’t expect your therapist to do all the work for you. Therapy is a two-
Don’t confuse catharsis with change.
In the chapter Prologue, Marcia mentions the cathartic effect of therapy. Catharsis refers to the emotional release that people experience from the simple act of talking about their problems. Although it usually produces short-
Don’t confuse insight with change.
Despite what you’ve seen in the movies, developing insight into the sources or nature of your psychological problems does not magically resolve them. Nor does insight automatically translate into healthier thoughts and behaviors. Instead, insight allows you to look at and understand your problems in a new light. The opportunity for change occurs when your therapist helps you use these insights to redefine past experiences, resolve psychological conflicts, and explore more adaptive forms of behavior. Even with the benefit of insight, it takes effort to change how you think, behave, and react to other people.
Don’t expect your therapist to make decisions for you.
One of the most common misunderstandings about psychotherapy is that your therapist is going to tell you how to run your life. Not so. Virtually all forms of therapy are designed to increase a person’s sense of responsibility, confidence, and mastery in dealing with life’s problems. Your therapist won’t make your decisions for you, but he or she will help you explore your feelings about important decisions—
Expect therapy to challenge how you think and act.
As you confront issues that you’ve never discussed before or even admitted to yourself, you may find therapy very anxiety-
Think of therapy as a psychological magnifying glass. Therapy tends to magnify both your strengths and your weaknesses. Such intense self-
627
Your therapist is not a substitute friend.
Unlike friendship, which is characterized by a mutual give-
Therapeutic intimacy does not include sexual intimacy.
MYTH SCIENCE
Is it true that it is never ethical for therapists to date clients?
It’s very common for clients to have strong feelings of affection, love, and even sexual attraction toward their therapists (Martin & others, 2011; Pope & Tabachnick, 1993). After all, the most effective therapists tend to be warm, empathic people who are genuinely caring and supportive (Beutler & others, 2004). However, it is never ethical or appropriate for a therapist to have any form of sexual contact with a client. There are no exceptions to that statement. Sexual contact between a therapist and a client violates the ethical standards of all mental health professionals. A psychotherapist who engages in sexual behavior with a client risks losing his or her license to practice psychotherapy.
How often does sexual contact occur? About 9 percent of male therapists and 3 percent of female therapists admit that they have had sexual contact with clients (Pope & others, 2006).
Sexual involvement between client and therapist can be enormously damaging (Norris & others, 2003; Pope & others, 2006b). Not only does it destroy the therapist’s professional objectivity, but it also destroys the trust the client has invested in the therapist. When a therapist becomes sexually involved with a client, regardless of who initiated the sexual contact, the client is being exploited.
Rather than exploiting a client’s feelings of sexual attraction, an ethical therapist will help the client understand and work through such feelings. Therapy should ultimately help you develop closer, more loving relationships with other people—
Don’t expect change to happen overnight.
Change occurs in psychotherapy at different rates for different people. How quickly change occurs depends on many factors, such as the seriousness of your problems, the degree to which you are psychologically ready to make needed changes, and the therapist’s skill in helping you implement those changes. As a general rule, most people make significant progress in a few months of weekly therapy sessions (Harnett & others, 2010). You can help create the climate for change by choosing a therapist you feel comfortable working with and by genuinely investing yourself in the therapy process.