Therapy - can it help, and if not, what then...

I often get asked if psychotherapy can be helpful from folks curious to try it but worried about what it is and if it is effective. My first exposure to talk therapy was the HBO series In Treatment. From that lens, I got the idea that therapy was going to be really intense, serious, based in your past and possibly…sexy? As I learned more about it in my training and personal experience, I found out that it is a lot of things…it can be intense and serious, but it can also be skills based and present focused but definitely not sexy, although you should be able to talk about sex in session if you want.

Therapy can be most effective when certain fundamental elements are in place. One of the most crucial factors is to ensure you feel heard and understood by the therapist. If the person falls asleep (yes, it’s happened to one of my therapists before) or you are unable to connect within the first few sessions, it’s best to move on. If you are unable to find a therapist who aligns with your needs, it does not imply that you are untreatable or that the therapist is ineffective. It simply indicates that they are not the right fit for your needs. The success of therapy often depends on chemistry, unconscious factors and the expertise of the therapist in the area of need for the client, rather than personal traits of the client or therapist.

Another important factor is whether you are ready and willing to be in therapy. Sometimes people start therapy because a partner is asking or they think they should go, but are not open to the process (it takes vulnerability and a willingness to look at parts of yourself that are painful to explore). If you are not open to the process and willing to be vulnerable and curious about what you bring into the world, then it may not help. Other people may think therapy is a place to vent. There are some therapists who do that with clients, but in most cases this is not useful. It keeps the brain circuits re-engaged in negative thinking. It also keeps you stuck in a victim mentally. This results in you giving up control to external factors. Your mental health problems are not your fault and you are not a bad person for having these struggles, but there are factors that are in your control that you are responsible for changing if you want to get better.

Therapy works best if your symptoms are at a level where you can actually participate in therapy. If your depression, anxiety, substance abuse, psychosis or mania is at the point that it is severely restricting your function, sometimes intensive outpatient treatment, inpatient treatment or trial of medications is warranted. Therapy is not a panacea.

Hopefully, therapy helps you understanding yourself and change the stories you are telling yourself that are keeping you stuck. But what if you have been in interpersonal psychotherapy for a long time and maybe things have improved but not completely. This may be an indication that it is time to find a psychotherapy that is more structured. Cognitive Behavioral Therapy (CBT), Mindfulness based psychotherapy, Eye Movement Desensitization and Reprocessing (EMDR), Internal Family Systems (IFS), and may others can be a better fit. They can help you identify skills and tools to address your symptoms directly or reframe the way that you perceive your thoughts. Other times, you may be talked out and psychotherapy that is mind or cognitively based is not the answer. You may need somatic psychotherapy, yoga therapy, or other body based therapies for better symptoms relief and function. Our bodies can need more healing than our thoughts can access, especially if trauma is at the core of our symptoms.

Finally, talk therapy can be helpful but re-assessing goals regularly with your therapist is also key for progress. Maybe the initial reason you started therapy is not what is pertinent to your needs any longer. Can the treatment be adjusted to your current struggles to better serve you? Or, do you still need therapy at this point in your life? You can ask your therapist if a pause to treatment would be a good idea if you are not sure, and if they are open to re-engaging in the future if needed. You can also trust yourself and your intuition about this. Therapy can be helpful at any stage of life, but it is also not necessary at all stages in order for you to lead a fulfilling life.