Psychotherapy and Counseling: Getting the Most out of Therapy

Understanding psychotherapy

The goal of good psychotherapy is change, and a qualified therapist is professionally trained to help you identify and work towards your goals. A good therapist is someone you can easily talk to and cares about you and your problems. Therapists are professionally trained to work with you to identify areas in your life that you want to change and support you through the process. The quality of your relationship with an empathic, knowledgeable therapist is what matters most.

Why therapy and not medication?

The thought of being able to solve your problems with taking a pill each day can sound appealing. If only it was that easy! Mental and emotional problems have multiple causes, and medication is not a one stop cure for them. It may help ease the symptoms, but may have side effects and does not provide complete relief.

Therapy can be time consuming and challenging, as uncomfortable emotions and thoughts can arise as part of the treatment process. However, therapy provides long lasting benefits and support. Learning and addressing underlying causes of your mental or emotional problem not only provides symptom relief, but gives you tools for identifying and avoiding triggers in the future. Therapy also provides you with management and coping skills to help you stay grounded, and helps you modify behaviors that you would like to change.

Myths about therapy

I don't need a therapist. I can just talk to my friends. While the support of friends and family is important, therapy is different. Therapists are professionally trained as listeners to help you get to the root of your problems and guide you to a solution.
Therapy is only for mentally ill people who can't handle their problems. Therapy is for people who have enough self-awareness to realize they need a helping hand. Therapy helps you learn tools and techniques to improve your intimate relationships and quality of life.
The therapist will fix my problems. The therapist focuses on the unhealthy patterns and symptoms in your life that you need to change. The therapist is somewhat like a personal trainer in a gym – they can be a guide, but you still have to do the work.

Choosing a therapist

There are so many types of therapies and therapists; it might feel a little overwhelming to get started. Choosing the right therapist for you can take some time and work, but it’s worth the effort. The connection you have with your therapist is essential. You need someone who you can trust, with whom you feel comfortable discussing difficult material, and who will be a partner in your recovery. Therapy won’t be effective unless you have this bond, so take some time at the beginning to find the right person.

Experience matters. Look for a therapist who is experienced in treating problems that you have. Often, therapists have special areas of focus, such as depression or eating disorders.
Learn about different treatment orientations. Many therapists do a blend of orientations. However, it’s a good idea to learn about the different treatment types, because that can affect your therapist’s way of relating and suggested length of treatment.
Check licensing. Make sure your therapist has a current license and is in good standing with the state regulatory board. Regulatory boards vary by state and by profession.
Trust your gut. Even if your therapist looks great on paper, if the connection doesn’t feel right, if you don’t trust the therapist, or experience their interest in you or caring about you, go with another choice. A good therapist will respect this choice and should never pressure you or make you feel guilty.

Finding a good therapist in your area

There are several ways to go about finding a therapist in your area. Some starting points include:

Your family doctor. Your family doctor can be a starting point in finding a therapist after ruling out other underlying causes of mental health distress.
Family or friends. Often a good referral can be found by people with direct knowledge of a therapist.
Senior centers, community clinics. These agencies often provide therapy on a sliding scale.
Provider listing by your insurance. Keep in mind that not all mental health professionals will be covered by your insurance.
Mental health associations. Sometimes mental health associations provide databases of therapists that specialize in certain areas, such as depression or anxiety. Local chapters may also be a good place to ask.

Search for a Mental Health Professional
The following types of mental health professionals have advanced training in therapy and certification by their respective boards. Many professional organizations provide online searches for qualified professionals. You may also want to double check with your state regulatory board to make sure the therapist’s license is up to date and there are no ethical violations listed.
Psychologist	Psychologists have a doctoral degree in psychology (Ph.D. or Psy.D.) and are licensed in clinical psychology. Search for a psychologist.
Social worker	Licensed Clinical Social Workers (LCSW) have a Master's degree in social work (MSW) along with additional clinical training. Search for a social worker.
Marriage and family therapist	Marriage and Family Therapists (MFT) have a Master's degree and clinical experience in marriage and family therapy. Search for a marriage and family therapist.
Psychiatrists	A psychiatrist is a physician (M.D. or D.O.) who specializes in mental health. Because they are medical doctors, psychiatrists can prescribe medication. Search for a psychiatrist.

Paying for psychotherapy

Many insurance companies provide limited coverage for psychotherapy. Read through your plan carefully to see what benefits you have. Insurance coverage for therapy usually has limits as to how many sessions you can have and who you can see. Some types of mental health professionals might not be covered. You may need a referral through your primary care physician.

Keep in mind that some therapists do not accept insurance, only accepting payment directly from the patient. Sometimes these therapists will accept sliding scale payments—what you can afford to pay per session. Don’t be afraid to ask what arrangements can be made if you feel the therapist could be a good fit for you.

Affordable psychotherapy

Take a look around your community for service agencies or organizations that may offer psychotherapy at discounted rates. Senior centers or family service agencies are a good start. Agencies that involve interns in training also can be an option for psychotherapy. An intern may be a good choice for you if the intern is enthusiastic, empathetic and has quality supervisory training. However, an intern’s time at the agency is limited, so when the training is finished, you either need to stop the therapy or find another therapist.

Types of therapy

Most therapists don’t limit themselves to one specific type of therapy, instead blending different types in order to best fit the situation at hand. This can offer many powerful tools for the therapist to use. However, therapists often have a general orientation that guides them.

Some of the more well-known psychotherapy approaches include:

Cognitive Behavioral Therapy. Cognitive-behavioral therapy (CBT) uses a combination of both cognitive and behavioral therapy. CBT explores both thinking patterns and harmful or self-destructive behaviors that might accompany them. The therapy then combines changing the thinking patterns along with changing the behavior.
Psychodynamic Psychotherapy. The theory behind psychodynamic psychotherapy is that our past – adverse childhood experiences or other unconscious conflicts – is the basis for problems that persist into adulthood, such as unusually low self-esteem, anxiety, or a feeling of being incomplete. This type of therapy is generally more long term.
Interpersonal Psychotherapy. Interpersonal psychotherapy (IPT) is a short term, structured approach based on the view that our current problems are maladaptive behaviors rooted in our previous interpersonal relationships.
Family Therapy. Family therapy involves treating more than one member of the family at the same time to help the family resolve conflicts and improve interaction. It is often based on the premise that families are a system. If one role in the family changes all are affected and need to change their behaviors as well.
Group Therapy. Group therapy is facilitated by a professional therapist, and involves a group of peers working on the same problem, such as anxiety, depression or substance abuse, for example. Group therapy can be a valuable place to practice social dynamics in a safe environment and get inspiration and ideas from peers who are struggling with the same issues.
Couples Therapy (Marriage Counseling). Couples therapy involves the two people in a committed relationship. People go to couples therapy to learn how to work through their differences, communicate better and problem-solve challenges in the relationship.

Which type of therapy is the best?

There is no one type of therapy that is the best, any more than there is one best style of car or one best kind of food. It depends on each person's individual needs and wishes. Some specific techniques have been found to be more useful than others in dealing with certain specific types of problems (such as phobias). In general, research about the "best" model of therapy always reaches the same conclusion: the most critical factor is the relationship between you and your therapist. If you feel comfortable and trusting in that relationship, the model of therapy, like your car, is just the vehicle that will help you move ahead to lead a more fulfilling life, regardless of the circumstances that bring you to seek assistance.

What to expect in therapy

Every therapist is different, but there are usually some similarities to how therapy is structured. Normally, sessions will last about an hour, and often be about once a week, although for more intensive therapy they maybe more often. Therapy is normally conducted in the therapist’s office, but therapists also work in hospitals and nursing homes, and in some cases will do home visits.

Your first therapy sessions

The first session or two of psychotherapy is normally a time for the therapist to gather information about your mental and physical health history, evaluate your situation and work with you to develop a treatment plan. In some clinics, some of this initial intake information may be done by a person different than your therapist.

This is also an important time for you to be evaluating your connection with your therapist. Do you feel like your therapist cares about your situation, and is invested in your recovery? Do you feel comfortable asking questions and sharing sensitive information? Remember, your connection is critical, so if you are feeling uncomfortable, don’t hesitate to consider another therapist.

How long does therapy last?

Everyone’s treatment is different. How long therapy lasts depends on many factors. You may have complicated issues, or a relatively straightforward problem that you want to address. Some therapy treatment types are short term, while others may be longer. Practically, you might also be limited by your insurance coverage.

However, discussing the length of therapy is important to bring up with your therapist at the beginning. This will give you an idea of starting goals to work towards and what you want to accomplish. Don’t be afraid to revisit this issue at any time as therapy progresses, as goals often are modified or changed during treatment.

Evaluating your progress

Evaluating your progress should be ongoing throughout therapy. There is no smooth fast road to recovery, but many twists, turns and the occasional backtrack. Sometimes, what seemed like a straightforward problem turns into a more complicated one. Your therapist should work with you in this progression and reevaluate goals and progress with you as necessary. Remember, therapy is not a competition. You are not a failure if you do not meet your goals in the target number of sessions. Look for overall progress and learning along the way.

Therapy will not always feel pleasant. Painful memories, frustrations or feelings might surface. This is a normal part of therapy and your therapist will guide you through this process. However, use caution if these feelings are so overwhelming that you are miserable after each session and start dreading therapy sessions. You might need to slow down. Be sure to communicate with your therapist how you are feeling.
How do I know if therapy is working? Growth and change is difficult for everyone, and you won’t be a new person overnight. Look for long-term patterns in growth and change. Your overall mood might be improving, for example. You may feel more connected to family and friends. A crisis that might have overwhelmed you in the past you handle with much less stress. Don’t be frustrated with temporary setbacks. It can be challenging to stretch yourself and break old, entrenched patterns.

Making psychotherapy work for you

Therapy is hard work, but the rewards are worth it. Here are some tips for getting the most out of your therapy:

Don’t expect the therapist to tell you what to do. You and your therapists are partners in your recovery. Your therapist can help guide you and make suggestions for treatment, but only you can make the changes you need to move forward.
Make a commitment to your treatment. Don’t skip sessions unless you absolutely have to. If your therapist gives you homework in between sessions, be sure to do it. If you find yourself skipping sessions or are reluctant to go, ask yourself why. Are you avoiding painful discussion? Did last session touch a nerve? Talk about your reluctance with your therapist.
Share what you are feeling. You will get the most out of therapy if you are open and honest with your therapist about your feelings. If you feel embarrassed or ashamed, or something is too painful to talk about, don’t be afraid to tell your therapist. Slowly, you can work together to get at the issues.

When to stop therapy

When to stop therapy depends on you and your individual situation. Ideally, you will stop therapy when you and your therapist have decided that you have met your goals. However, you may feel at some point that you have got what you need out of therapy, even if your therapist feels differently.

Leaving therapy can be difficult. Remember that the therapeutic relationship is a strong bond, and ending this relationship is a loss—even if treatment has been successful. Talk about this with your therapist. These feelings are normal.

To Learn More: Related Helpguide Articles

Depression Treatment: Diagnosis and treatment options.
Anxiety Therapy: Cognitive Behavioral Therapy, Exposure Therapy, and Other Options

Relationship Help: Building Great Relationships with Emotional Intelligence
Stress Management: How to Reduce, prevent, and Cope with Stress

Related Articles

Topics

Psychotherapy and Counseling

Finding a therapist and getting the most out of therapy

In This Article: