What Is Therapy All About Anyway?

One of the most confusing things about psychotherapy is how many different types there are. However, for the most part they center around finding ways to change thoughts, feelings, and behavior. The "cognitive" therapies start with thoughts first, looking for resulting changes in feelings and behavior. The "psychodynamic" therapies are famous for their emphasis on feelings, with the expectation that thoughts and behavior will change as a result. And the "behavior" therapies, of course, start with behavior with an expected change in thoughts and feelings.

Of course, all three interact with each other, and each approach listed above has merit. (Every therapist uses all three approaches to some degree whether they admit it or not.) Nevertheless, specific problems can have better results with a focus on one type of approach over another.

For example, when a person is overwhelmed with a feeling (say, depression or anxiety) an approach with a cognitive-behavioral emphasis is often most helpful. All three elements may be needed in therapy, but to work on feelings only and leave out thoughts and behavior can cause progress to happen very slowly. It is my belief that all three elements should exist in good therapy, with the emphasis shifting back and forth as needed.

There are other important factors:

If we baked cakes like we solve problems, most of us would put a pan of flour in the oven and expect to get a cake out. We would focus on only one ingredient. However, problems (like cakes) usually have more than one ingredient. Some of the important factors that affect, and sometimes cause, problems include:

Genetics and biology

Depression, bipolar disorder (manic-depression), attention deficit disorder, and other disorders can have genetic components. Sometimes the treatment needs to include medication for success to be possible. Sometimes the medication is temporary, sometimes it is permanent (as in the medical illness of diabetes). See below for more information about medication.
Temperament: What affects one individual may not affect another,
depending on their temperament. Every temperament has strengths and weaknesses.
Intellectual and neurological gifts and limitations. An individual's
cognitive make-up is an important aspect of their ability to get along in everyday life. Relationships are impaired by learning disabilities that limit an individual's concentration during conversation. Professional advancement can be stifled by an inability to comprehend oral instructions, when written ones can be followed with ease.

Culture

Emphases within a culture can have a lot to do with anxiety and depression.
Sub-cultures and cultural differences between people can also be very significant. A therapist needs to understand the culture of the client.
Socioeconomic limitations affect the resources an individual has to learn to solve problems or otherwise find help with them. This often increases a sense of powerlessness and depression.

Experiences

Abuse leaves memories and wounds that can ve very resistant
to change. See the page on post traumatic stress for recent treatment advances related to traumatic memories.
Trauma later in life (auto accident, rape, war experiences) also leave deeply upsetting and disrupting wounds. See the same page mentioned above about recent treatment advances related to traumatic memories.
Loss of a loved one, especially a child or mate.

What is empathy and why is it important?

We all have problems. Often, however, we have bad feelings about the fact that we have a certain problem. That is where empathy comes in. To have empathy is to understand, and to some extent feel, from a distance what another person is going through. When a person has a significant problem they often feel alone, frightened, or "different". Empathy says, "Your feelings are not beyond my grasp to understand, and, in fact, they are shared by many other people." Research has shown that one of the most important qualities of a good therapist is the ability to be empathic. Then a client can be freed up enough to address the original problem--if it even still exists. Sometimes the feelings about a problem are bigger than the "problem" itself!

What about medication?

One of the most scary topics for many people is the issue of medication. Talk about feeling like a failure! ("I can't even feel right without medication?") However, if we're honest we realize that we put many chemicals in our bodies every day that are not naturally present--in foods we eat and air we breathe. Why would we be surprised if our body chemistry is "out of wack"?

And beyond that, emotions vitally influence the way our body functions. Under stress, for instance, the body produces a large outpouring of adrenaline. The outpouring causes an increase in heart rate and blood pressure (to get more blood to the muscles, brain and heart), faster breathing (to take in more oxygen), tensing of muscles (preparation for action), increased mental alertness and sensitivity of sensory organs (to assess the situation and act quickly), increased blood flow to the brain, heart and muscles (the organs that are most important in dealing with danger) and less blood to the skin, digestive tract, kidneys and liver (where it is least needed in times of crisis). In addition, there is an increase in blood sugar, fats and cholesterol (for extra energy) and a rise in platelets and blood clotting factors (to prevent hemorrhage in case of injury).

Who knows what type of effects the long term experience of strong emotions may have on the emotional and nervous system? Beyond the fact that we are "human spirits with souls", we are a chemical/electrical system that funtions in complex ways. Feelings are not linked to our physical bodies, not only to the part of us which is beyond the physical. At times, and always in moderation, medication may be adviseable. An appointment with a competent psychiatrist can help determine this. However, medication is seldom the only answer.

David C. Bissette, Psy.D. Alexandria, VA 703-705-6161