What is Therapy?

Most therapists want to increase their clients’ consciousness, which in turn helps people understand their thoughts and feelings in relation to a problem. This understanding in turn, opens up the idea of having different options or choices to learn new ways to cope with life stressors. Some therapists believe that this process is about change: However, therapists are more than just change agents. I will be discussing therapy; the history and types of therapy, how to evaluate the need for treatment, the benefits of therapy and how to prepare for the initial interview.

What is Therapy?

Psychotherapy is a blanket expression pertaining to the healing interplay or approach negotiated between a qualified expert and a patient, couple, group, family, or client. The difficulties discussed are emotional in nature and can differ in terms of the origins, triggers, impacts, and possible recommendations. Accurate evaluation is reliant on the practitioner’s ability and can develop or emerge as the clinician gains understanding, awareness and comprehensive expertise.

Therapy includes interactive processes between a person or group and a qualified mental health professional (psychologist, clinical social worker, licensed counselor, or psychiatrist). Its purpose is the exploration of feelings, behaviors and thoughts to increase problem solving skills or achieve higher levels of functioning. Psychotherapy  is a gift to oneself and strives to increase a sense of well-being. Psychotherapists apply a variety of methods based on communication, discussion, experiential relationship building and performance, all of which have the intention to improve the mental health of a client, or to enhance relationships.

The History of Therapy

History of Therapy

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Mental Illness was a test from the Gods

Treatment of emotional or mental difficulties can be traced to remote times. The classical Greeks were the earliest to recognize psychological ailments as a medical disease, rather than a symbol of evil gods. While their knowledge of the essence of the mental illness was not always accurate, and their practices somewhat unique, they did acknowledge the treatment benefit of reassuring and consoling statements. With the collapse of the Roman Empire, the Middle Ages witnessed the return of a faith in the paranormal as a foundation for mental illness and the practice of cruelty to obtain confessions of diabolical possession. However, some physicians such as Paracelsus (1493-1541) were advocates for psychotherapy in healing mental disturbances.

Helpful, theoretically-based psychotherapy was presumably first cultivated in the Middle East during the 9th century by the Persian doctor and mental mastermind, Rhazes, who was the leading physician of the Baghdad psychiatric hospital. Although there is a scattering of writings that report to the benefit of discussing problems in the treatment of emotional difficulties, the English psychiatrist Walter Cooper Dendy originally launched the phrase “psycho-therapeia” in 1854. Contemporary, scientific psychology usually dates to 1879 as signifying the opening of the first psychological clinic by Wilhelm Wundt. However, endeavors to design techniques for evaluating and managing mental distress existed long beforehand. In an unofficial sense, psychotherapy can be stated to be in fashion through the centuries as individuals received emotional guidance and reassurance from professionals.

Freuds Image is from the LIFE Photo Archive.

Freud The LIFE Photo Archive.

Therapies  launching was with the invention of psychoanalysis, the “talking cure” developed by Sigmund Freud. He explained psychoanalysis around the crossing of the century and created intellectual augmentations to the field with his explanations of infantile sexuality, the unconscious, the use of fantasies, and the representation of the human psyche. Freud’s practice with troubled patients led him to conclude that emotional disturbance was the result of holding memories or thoughts in the unconscious. A few of the methods regularly applied covered free association, dream analysis and transference. Psychoanalysis essentially listening to the client and presenting interpretations would lead these recollections to consciousness and consequently diminish symptoms. Psychotherapy was given its conventional origin just as soon as Sigmund Freud began applying talk healing to work with clients. For the subsequent fifty years, Freud’s practices of psychoanalysis and its numerous versions remained the central therapy adopted in clinical practice.

Clinical psychologists concentrated on psychological assessment and the application of psychotherapy was assimilated into the profession after the Second World War. Shortly afterwards scholars, such as, Alfred Adler and Carl Jung began to propose new interpretations about mental functioning and transformation. Several other theorists helped to improve the broad orientation, which covers multiple the treatments based on Freud’s fundamental belief of causing the unconscious, conscious. The following significant methods of therapy were developed, not as the effect of distinct thoughts, but due to economic concerns. Traditionally, psychotherapy was a lengthy process often requiring years of processing. The treatment grew more universally accessible and the importance was placed on developing more concise methods. The humanist psychologist Carl Rogers explained a process recognized as client-centered therapy, which centers on the therapist giving unconditional positive regard to the patient. The interpersonal therapy was explained by Carl Rogers during the 1940s and on the expression of kindness, genuineness and acceptance from the therapist to the patient. Starting in the early 1950s, the school of thought known as humanistic psychology began to have a significant impact. Client-centered therapy remains one of the most widely used models in the field of clinical psychology.

Behaviorism developed into a leading school of thought during the beginning of the twentieth-century, procedures such as conditioning and association played an influential role. Behaviorism today may not be as prevailing, however, numerous practices are nevertheless quite common. The application of behavioral psychology adopted teachings from animal psychology to heal behavioral and emotional difficulties. Behavioral treatment frequently utilizes social learning, classical conditioning and operant conditioning to assist clients change problematic behaviors. Over the years behavior therapy has been improved to include the importance of thoughts and feelings. The cognitive reconstruction of the 1960s likewise produced a significant influence on the application of psychotherapy, as psychologists started to concentrate on how internal states influence performance and functioning. Cognitive Behavioral Therapy develops as a method of treatment that assists patients understand their anxious thoughts and feelings that influence behaviors. CBT is regularly practiced today treating a broad range of ailments, including depression, anxiety, addiction and phobias. This blended cognitive-behavioral therapy has matured into being a primary treatment for various psychiatric conditions. By the late 1960s our nation was under stress and there existed over 60 various types of psychotherapies, extending from guided imagery (mental images and stories) to psychodrama. At this time essentially all therapeutic modalities offer brief therapy intended to assist the client manage problems of everyday life.

The Purpose of Therapy

According to a critique of the research, conducted by the American Psychological Association, psychotherapy is effective and creates long-term improvements in emotional well-being. In turn, these health improvements decrease a demand for services. However, information provided by the government and insurance industry state that the use of psychotherapy decreased over the last decade while the use of medications to address mental and behavioral concerns increased. Treatment is a commitment to improve emotional and physical health. Many have difficulty understanding the fact that going to therapy might provide real tangible benefits. Others view this process as being an invasion of privacy. A few people may be truly independent and have fears of losing that freedom, or have fears of the label “crazy” which surprisingly is a belief that continues to exist. Women tend to embrace the therapy relationship easier than men, as this is one environment where they can go without fear of repercussion.

Those in the business are bombarding society with announcements that point to drugs being the key to unlocking all life’ problems. Health Psychologists assist people evaluate those messages with research-based knowledge about how treatment provides a safe, effective solution that has lasting improvements in mental and physical health. Therapy is practical for a variety of mental and physical conditions with results being larger than those produced by many health related treatments. Recommendations continue to be a last resort from practitioners in the health community despite research stating that clients do certainly obtain benefit. Therapy is an emotional process and professionals are mindful during these challenging encounters because of the value that they place on the therapeutic alliance. The goals vary and often include reducing stress or learning to develop problem solving skills, which enables patients to experience a meaningful, productive, purposeful life.

The Types of Therapy Psychotherapy

  1. Behavioral – Focuses on reducing maladaptive patterns of performance to enhance cognitions, interactions and emotional responses.
  2. Brief therapy is a general name for a variety of methods. Brief therapy deviates from other classes of treatment in that it stresses centering the attention on one problem and there is direct intervention. This method is solution-based and not problem-oriented as it is not as concerned with what manner a difficulty emerged, than with the prevailing factors supporting the difficulty that inhibit change.
  3. Cognitive behavioral – Seeks to recognize maladaptive thoughts, beliefs, evaluations and responses, with the intention of changing harmful negative emotions and altering problematic dysfunctional practices.
  4. Existential – Has a link to philosophy primarily with the belief that people are alone in the world. Being alone creates isolation which points to thoughts and views of having a meaninglessness existence. These beliefs can be subdued only by constructing one’s own values and meanings of life.
  5. Humanistic – Humanistic psychology has philosophical roots and some qualities of existentialism. This theory emerged in reaction to psychoanalysis and behaviorism which some consider to be the Third Force in the development of psychology. The treatment concern pertains to the psychological development of the individual and has an emphasis on subjective meaning towards positive growth. Humanistic theory believes that human beings have an inherent capacity to maximize their potential and people have a tendency to want to become self-actualizing. The task of humanistic therapist is to build a relational atmosphere where this tendency might thrive.
  6. Psychoanalytic –  The first method to be declared psychotherapy. Psychoanalysis encourages the verbalization of all thoughts, including free associations, fantasies and dreams from which the therapist formulates the nature of unconscious conflicts that are causing the symptoms and character problems.
  7. Psychodynamic – A method whose central focal point is to expose the unconscious content of a client’s mind in an attempt to ease psychological stress. Though its origins are in psychoanalysis, psychodynamic treatment is brief and less intense.
  8. Systemic – Community psychology is a systemic psychology which seeks to approach people, not on a personal level but as people in relation. This therapy includes family, marriage and group counseling in which interactions, patterns and dynamics are the focus of the therapists’ attention.
  9. Transpersonal – Acknowledges the patient in the context of having a spiritual recognition of awareness.

Why choose therapyWhy people choose therapy

Counseling using mindfulness approaches is helpful for those who are facing a change, experiencing a loss or for those wanting to greet the day with more passion. People should consider treatment when they believe their lives have no meaning, when the distressed feeling interferes with the quality of life or when they want to develop an area that is already in acceptable working condition.

The decision to seek treatment is for most people a conscious courageous choice to try to change or solve a difficult life circumstance. Clients usually decide which issues to consider which leads to the therapist and client jointly determining ways to tackle. After the first couple of sessions there will be a discussion that includes other areas to explore, ways to cope with the present problem and examine the methods to problem solve. Therapists should describe the approximate length of time it will take to investigate and resolve the issue.There have been times in my career when, I have asked a client, “How can I help?”, only to feel that look of shock and awe. These people are unmistakably tongue tied and timid, which is certainly understandable, and over time they gradually relax enough to explain. However, some patients in an indignant tone, blatantly state, “I don’t know why I am here. This is your job to tell me”, which eventually guides us down the trail of uncharted territory and ineffectual treatment. These folks usually feel the pressure to accept counseling by their physicians, family, friends and preachers and are highly opposing to receiving treatment and they usually fear judging. Unfortunately, under these conditions, unless the patient is gravely disabled (suicidal, psychotic), this first session is frequently the last.

Seeking help is a sign of courage. There are many reasons people choose to proceed with counseling as many view the process as being a learning experience and an opportunity to improve something. In fact, most people make a conscious decision to enhance the quality of their life, which could mean stirring the motivation up to run a marathon. People do not have to be severely ill to go as some have trouble with sustaining pleasure and joy with life while others seek motivation to develop a skill.

How to evaluate the need for therapy

How do people discover and assess the need to see a professional therapist? Many may have attempted to cope with the problem by themselves, discussed the problem with friends, co-workers, minister or anyone who was willing to listen. At times just talking out a problem with a sympathetic listener will help, though, if talking about the concerns has not helped it might be a good idea to assess the benefits of going into treatment. A professional therapist can observe the situation in a non-judgmental fashion and has the qualifications to assist with problem solving. Most people will be investing a reasonable amount of time, money, and energy into treatment which means they should choose a therapist wisely, possibly a referral from a friend or a therapist that they have known in the past. Find a therapist that promotes an emotional connection not one that is acting superior or indifferent during the session. Therapy is more about the relationship and less about the technique. When someone senses this emotional bond treatment is more likely to be extremely useful and the therapy will be on the path to success.

Time and Therapy: People can choose whether they are willing to seek advice from a professional by asking if going to therapy is worth taking an hour out of the week to talk about the problem. If the answer is yes, then they are probably ready. If no, then they may not be ready and there will always be the opportunity to revisit the idea in the future. For most of the population the answer to the question is that simple.

Motivation and Therapy: People delay entering treatment for various reasons. Often they think that their problems are problems which they should be able to solve alone and others believe no one else needs to be aware of their business. Isolated people do not have a strong support system and it is difficult if not impossible to reach out to others to ask for help. It takes courage to sit in a vulnerable position, especially to a professional. This reaching out takes motivation, and it is scary to admit having problems. If people are fearful about scheduling an appointment, they can view this process as being a once in a lifetime experience just to assess if treatment is worth the risk. After all for most, the decision to go to therapy is a choice.

It is essential for people to understand that anything in life people do for the first time is anxiety provoking. If folks can keep this thought in mind while walking into the counselors’ office they may realize that the therapist is also meeting them for the first time. People who decide to make the appointment can choose never again to go back should they think that this experience was just too traumatizing.

Success and Therapy: It is reasonable to expect that clients will come to a deeper understanding of themselves and their problems. It is reasonable to expect they will learn new ways to cope with problems, thoughts, feelings and life events. It is reasonable to expect that people will feel more empowered and in control of life. However, it is not reasonable to expect that treatment will solve every problem in life. Life’s’ problems change routinely according to the events. With long term treatment, it is reasonable to expect that the ability to cope with new problems independently will improve over time.

Successful treatment facilitates change in the way people react to situations. It is the therapists’ responsibility to encourage the exploration of finding new ways to cope and promote a deeper understanding of the complexities in life. As the treatment proceeds the process increases a sense of awareness “an aha moment” that supports the perception of empowerment and self-respect. This is success in therapy.

What are the Benefits of Therapy?  

Therapy may provide a new perspective on a challenging problem and guide towards a resolution. Educator Mick Cooper, of the University of Strathclyde, England, communicates that the most significant determinant in successful treatment is the client. The benefits of treatment are:

  1. Acquisition of a broader understanding of personal values and goals.
  2. Develop abilities that cultivate healthy relationships.
  3. Manage and discover ways to cope with difficulties, such as an eating disorder, depression, bipolar illness, schizophrenia, physical illness, pain, abuse, codependency or stress.
  4. Make advancements in learning problem solving skills

One essential advantage of treatment is that the process gives people a safe and secure place to explore problems and therapists have the training to listen and analyze. The healing environment places a high value on the worth of the person. Everyone deserves a safe and secure environment to express thoughts freely without the risk of judgments.The patient and the therapist work together to establish realistic goals that they want to achieve from the treatment. Making meaningful choices that effect well-being might be a new experience that can be extremely empowering, thus raising self-esteem. Therapy focuses on the patient while the therapist does their best to help achieve the goals. Psychotherapy teaches life skills that continue beyond the course of treatment. While medication is appropriate in some instances, research confirms that a combination of medication and therapy is usually most effective in treating depression and anxiety. It should also be noted that the effects produced including those for different age groups and across a range of mental and physical health disorders, are comparable to or better than the results produced by drug treatments for the same disorders. Without the potential for harmful side effects that drugs often exhibit. The results of therapy tend to last longer than psycho-pharmacological treatments and rarely produce dangerous side effects.

The Rules of Therapy: Privacy and Confidentiality

There are extremely strict privacy rules pertaining to psychology and everything the therapist examines is in strict confidence. However, psychologists have a legal mandate to report any severe and persistent suicidal threats, any threats to hurt someone and any abuse against a child or senior citizen. Throughout the process therapists encourage people to ask questions of any and all types, as clients are hiring them to help. Therefore write down questions and “ask away”.

How to Prepare for Therapy – The Initial Interview

Preparing for therapy

  1. Be willing to discuss the problem areas and events leading up to making the decision to enter treatment.
  2. How long has this problem been difficult and were there any triggers (loss of employment, death of a loved one, medical illness).
  3. Have there been any prior treatments or psychiatrist visits which would include hospitalizations.
  4. Therapists may review developmental or childhood experiences along with discussing any emotional problems within the biological family.
  5. Make preparations to describe thoughts, moods and behaviors.
  6. The therapist will review how people are taking care of themselves (eating, exercise, social activities, hobbies).

The treatment plan is then discussed and a preliminary completion date should be provided (usually 4-6 months on a weekly basis for 45 min). If the client or therapist is skeptical about scheduling another appointment it is reasonable to request thinking about rescheduling and then call the office for a follow-up meeting in the near future.

The Last Therapy Session

Counseling is warm, kind and gentle in its approach but it requires courage and personal strength to work through the process. Treatment has many benefits and advantages for everyone who walks the path. The last session involves a fundamental overview of how people believe they progressed and the evaluation can be performed by using a percentage rating scale. The discussion usually includes ways in which the person can independently “take on the world.” Hopefully most will show that strut and be satisfied feeling as treatment takes action, time and commitment and everyone deserves to “stand up straight and walk tall”.

Click image to understand How to have success in therapy

Click image to understand How to have success in therapy


To sum up, it takes courage and curiosity to enter into the “what is therapy” arena because this is one strategy that explores a persons’ inner life. Treatment helps people understand that they do, in fact, have choices, and then examines the different ways to achieve goals associated with that choice. Feel free to explore. Once people understand and work through this process they will begin to feel empowered and become much more proactive in taking care of life.

Health Psychology for Everyday Life, the book

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© Dr. Cheryl MacDonald

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Cheryl Ann MacDonald, RN., Psy’D.
Health Psychology of San Diego

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