What Is Therapy? An “Expert” Answers This for Us

Dr. Rob,

I’m a second year graduate student in Psychology at ________ and I’m just starting to develop my therapy skills. At our school we are encouraged to speak to undergraduate students about therapy and its merits but, truth be told, I’m not very good at it. Do you have any success or failure stories about educating potential clients about therapy and what it can do for them?

Alex


When I was a second year graduate student I was 25 years old with a baby-face that belonged in a junior high school yearbook. Granted it was an amazing face but most of the professional words that came out of it were met with skepticism if not outright laughter and mockery due to my lack of professional credibility. In retrospect I’m probably lucky I wasn’t stoned to death so I sympathize with your plight.

Many people come into mental health practices feeling miserable but have no idea how seeing a psychologist or psychiatrist can be helpful. Often these people have had symptoms that they’ve simply dealt with needlessly and will come in when a friend or family member pushes them to seek help. During my first year of graduate school I saw a young man, I’ll call him Jason, who had scheduled an appointment because he recently had been having poor sleep, trouble concentrating on his schoolwork and he felt “jittery” most of the day. His symptoms were very scary for him and, having never seen a mental health professional before, the idea of talking to someone about his problems was very foreign. That in combination with my imposing height (5’11”), massive girth (165 lbs.) and eyes (green) probably left him feeling very intimidated by the entire situation.

After talking with Jason for about 30 minutes it was clear that he was suffering from what is known as Generalized Anxiety Disorder. The treatment options for GAD are therapy, medication or a combination of both. When anxiety isn’t debilitating (i.e., the person attends school or work without major impairment) and hasn’t been a problem for a lengthy period of time medication isn’t usually considered a first line of treatment unless the patient prefers it. Therapy can usually work pretty well in cases like these.
One of my professors warned me to be careful of the terminology used when offering treatment to clients who are not expecting it or have never been in therapy before. The word “psychotherapy” can scare people simply because of the “psycho” part. We have Alfred Hitchcock to thank for that. “Therapy” is a little vague and is used in many different settings (e.g., physical therapy). Jason was pretty distressed at being told that he had an “anxiety” problem so carefully chosen words were required.

“I think you could benefit from having someone to talk to,” I said.

“What do you mean, talk to someone? Like a psychiatrist? Do I have to go to the hospital??”

“No no,” I said, smiling my big baby-face smile in an attempt to seem like a mental giant who has all the answers. “I mean sitting down with one of the graduate students here and talking through some of your difficulties.”

“Wait, do you mean, like, psycho-ther-a-py?” he said with a look that was half suspicion, half terror. He pronounced the word ‘psycho-ther-a-py’ with a fearful timbre, as if I had just offered him a ‘pe-nis-ec-tomy.’

“What?! Psychotherapy? That’s ridiculous. Here, um…we call it ‘growth enhancement.'” Strangely this term is almost the opposite of the Penisectomy that came to mind when he said ‘psychotherapy.’

“Growth enhancement? I don’t understand. Like counseling?”

“Yes yes! Counseling is a great term!”

“Mr. Rob, I don’t understand all these terms and you’re confusing me. Just call it what is and tell me what’s involved.”

Therapist Rule: A client’s belief in his success can play a significant role in therapy outcome. Thus it is important that he be given accurate and ideally hopeful information about what therapy can do for him to maximize the likelihood for a positive outcome.

Having been called out on my idiocy (a real shocker there), I fessed up. “You’re right, let’s call it what is. I’m suggesting that you see a therapist for psychotherapy. Psychotherapy is just a fancy term for using talk to help people feel better about psychological problems. It helps people to change the way they think, feel and behave. It helps people to lead happier lives. In your case I would recommend a therapist who could help you to better understand what exactly is making you anxious and show you ways to control it.”

“But how does talking help?”

“That’s a great question and the truth is that no one knows for sure exactly how it works. That being said you might want to think of your brain as a muscle. If you hurt a leg muscle and went to physical therapy you would exercise that muscle, stretch it, move it, get it active. The same is true for your brain. It needs to be worked-out properly. A good therapist can help you to get your brain to flex itself and to think differently. This will make you feel better. In other words, having a guided series of discussions can help you change your thoughts and feelings. How does that sound?”

“I know I want to feel better.”

“Then why don’t you try it for awhile. I really do think it will help.”

“Will you be my therapist, Mr. Rob?”

“No, I’m just a first year. I only do evaluations at this point. And stop calling me ‘Mr. Rob.’ I’m only three years older than you and you’re making me feel like some perverted uncle.”

Sure enough Jason began working with a therapist in the clinic. Although I never did get the details of his sessions, I was told that he got some very good results in a reasonable time frame and was off and running. Apparently Jason’s departure was a real downer to the female students as he was ‘so hot’ that they were upset he wasn’t coming into the clinic anymore. They still had me, though, so they really had no right to complain. Whatever, graduate students clearly don’t know a good thing when they see it.

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11 Responses to “What Is Therapy? An “Expert” Answers This for Us”

  1. Anonymous says:

    I think it’s your humble modesty that I find most refreshing!

  2. Paula says:

    Hi Rob
    Amusing yet informative as always. 🙂 Glad to see you back as I missed your Thursday update last week.
    Paula
    Dr. Rob Note: Sorry about the missed post. My mom finally bought me that Wii that I’ve been angling for (http://www.shrinktalk.net/archives/defense_mechanisms.phtml) and man is that thing addictive.

  3. Anonymous says:

    I am in my second year of graduate school, and every client so far but one has looked at my baby face with skepticism. Mental health has to be one of the very few, if not the only, fields where it actually helps to have a few gray hairs!

  4. Wayland says:

    Does ANY girl know a good thing when she sees it?

  5. Design says:

    A great read as always Dr Rob. I particularly like your “Therapist Rule:” bits 🙂

  6. Charles D says:

    Haha, I love the side thoughts you add in there.
    And I’m glad to hear your mom got you a Wii so you can play with your pokemans.

  7. J says:

    I’d say bring the Wii into work and play vs the young adults you see, but they might tear you a new one.

  8. dr. smooch says:

    What, no talk about the concept of a therapeutic alliance?

  9. Elisa says:

    This was a really helpful as well as witty post, Dr. Rob! Thank you.

  10. Stigma is still an issue, unfortunately. Framing is everything. Good post.

  11. Seviah says:

    Either because of who I am and have always been (let’s posit a single subjectivity for this one) or because of the startling extent to which I’ve lost that person or because of my compulsion to offer the tribute demanded by the ghosts in my attic, because they too are who I am, I will always see therapy not only as training in the habits of mind, but also as a way of conferring meaning on those behaviors.

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