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Monday, September 12, 2011

How Does Psychotherapy Work, Part 1

Most patients think that they sign up for psychotherapy and they go in and talk in order to “vent” their feelings. Others think they are going it to see a counselor (like a lawyer or financial advisor) who will tell them what to do and how to behave.

Some of this is true. Venting your feelings or “getting it all out” in a safe environment may be helpful in cases of grief where a loved one has died, but I have also met patients who have had therapists where they have been venting every week for seven years… and they still aren’t better. So venting is part of the process in some cases. Some therapists will tell you what to do and how to behave, but this may not be a hallmark of a good therapist. Good therapists work with you in hopes that you see better ways to behave, interact, and function and act on those in your own way.

Below are some concepts that govern certain types of psychotherapy. Yes, just like there are several types of medications that work in several different ways, there are different types and styles of psychotherapy:

Analytical or psychodynamic therapy suggests that your past (your parents, your upbringing, your environment, your friends, and all of the good and bad things that ever happened to you) shapes who you are and dictates how you behave in the present. If you learn about yourself and your past then gain insight into your patterns and behaviors, you can learn to react differently in the future and your symptoms will gradually improve.

Cognitive-behavioral psychotherapy (CBT) suggests that patients have developed automatic negative and self-defeating thoughts. CBT does not care if problems came from your parents or elsewhere but cares that in the ‘here and now’ that you are suffering as your automatic thoughts (for example: I always fail, I am never any good, everyone always abandons me) trigger negative emotions (sadness, anger, despondency) which you get stuck in and become depressed or anxious. CBT therapists teach skills and resiliency in regards to fighting through and counteracting these negative, automatic thoughts.

There are likely 20 other forms of psychotherapy, each with their own underlying theory and process of reducing psychiatric symptoms.

Finally, biologically-minded therapists think that psychotherapy may activate certain brain areas and deactivate others, thus lowering symptoms. Yes – talking to a therapist actually changes brain patterns and activity. My future blogs will look at some of these more closely.

Posted by: Thomas L. Schwartz, MD at 1:58 pm

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