Looking for a Therapist: A primer on psychotherapy
I have come to appreciate some simple truths as I hit mid-life that a former, younger version of myself would have dismissed with a smug smile and a raised eyebrow as if to say, "maybe for you". One of these simple truths is...life is hard.
I have a wonderful family, a fulfilling job, a loving marriage...and still life is hard. I say this knowing my good fortune and knowing others have it much harder. I also say this knowing that suffering is not a competition. It does no good to compare. It is universal. Therefore, in my view, simply being human is justification enough to find yourself in need of a therapist.
What the research has shown time and again is that not only does therapy work, but it does not really matter what kind of therapy you are getting. There are many different therapies these days. And I will mention a few later on. Many therapies overlap in their approach and the skills they teach. To be effective, all therapies rely on one thing: the therapeutic alliance.
Therapeutic alliance is a fancy term for the relationship you have with your therapist. It is the presence and feeling of trust, genuine empathy and mutual respect in the relationship. When looking for a therapist, prioritize this first and foremost. Ask yourself if you feel deeply understood and validated. Make sure you feel emotionally safe and that what is being discussed and worked on is important to you.
In some patients who may see a therapist precisely because forming this kind of a relationship has been impossible, the therapeutic alliance is all the more important. This is because the relationship is the treatment in many ways. A skilled therapist will recognize when a dysfunctional pattern or dynamic is occurring in the relationship. The task then is to process this; the therapist trying to model how it might be different this time around. This is what is known in our field as a "corrective experience". This can happen in any form of therapy, but there is one where the relationship between the therapist and patient is the main focus: Transference-focused therapy.
After finding a therapist, the rest is far less important but I usually organize therapies very broadly into two categories. The first are therapies that focus on the here and now. Cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) are examples of this. They focus on teaching skills to handle challenges in the present. These therapies can assign homework and regular practice to encourage change over the short to long term. These skills often involve building awareness of one's emotions, the triggers for these emotions as well as an awareness of one's thoughts that may influence behaviors. Clients are taught how to observe their thinking and emotions without getting caught up in them with a skill called mindfulness, found in DBT and Acceptance and Commitment therapy (ACT). Mindfulness is, by itself, a therapy also. Another skill worth mentioning is the ability to be open-minded to what another person may be thinking or feeling. That perhaps your singular version of an event may not be the only possibility. This is the focus of Mentalization therapy.
The second broad category of therapies are less skill-based and put more emphasis on the past with the hope of gaining more self-awareness and insight. Very simply put, these therapies are based on the idea that our first relationships as infants/children have imprinted on us a pattern of relating with ourselves and others that we then play out, unconsciously, in other relationships thereafter for better or for worse. These therapies rely on bringing what is unconscious to light, that suffering can be alleviated, behaviors can change, and healing can take place when this occurs. Therapies with this approach include schema-focused therapy, psychodynamic therapy and psychoanalytic therapy. These therapies also tend to be longer term and each session less structured when compared with CBT or DBT.
Having done therapy and having had therapy, I have found it to be one of the greatest gifts. When the fit with the patient is good, both the relationship and the work you do together are tremendously and deeply meaningful. For me, therapy gave me the gift of self. I am a person who no longer relies on others for my self-esteem or for direction in important decisions in my life. It is very hard to put into words what it is like to know and to feel you are meant to be no other than yourself, and that that person is worthy. I will go so far as to say I believe it is every person's calling in their lifetime to discover this for themselves: who you are meant to be, and what you offer to the world, on your own terms.
Certainly some days are more difficult than others and I can lose my way. But it is a feeling and a knowing that can not be undone and are my guides for life especially in difficult times.