# Sticky  Are You Considering Psychotherapy? Read This.



## conscius

As a way of introduction, I have an academic and research background in psychology and have also been a consumer of psychotherapy for a number of years. Using a question/answer format, this post (and this thread) are meant to provide information on psychotherapy. Though I've tried to stay general in scope and cover lots of ground, this information applies mostly to people living in Western world. My hope is that some people find this thread useful. 

_I spent the last couple of hours writing this and reviewed it once but still, let me know if you find errors (grammar, spelling, factual) in this post._

*What is psychotherapy?* 

It is a psychologically informed therapy provided with the purpose of treating emotional problems.

*Is psychotherapy the only way a person can hope to deal with their emotional problems? *

No. There are many alternatives. Throughout history and throughout the world, people have taken different personal, social, medical (e.g. psychiatric medications), and religious approaches to ameliorating pain and suffering. Sometimes people come for therapy only after having tried the alternatives available to them.










*What are the different kinds of psychotherapy?*

There is CBT, family therapy, psychodynamic therapy, humanistic therapy, and others. The following website divided them into five categories: Different approaches to psychotherapy

*What is CBT?*

CBT, or cognitive-behavioral therapy, is a well-researched form of psychotherapy, the modality most likely to be offered to a new therapy patient dealing with anxiety or depression. CBT is short term, structured, and present-focused. It often uses homework assignments, and attempts to change one's behavior and thinking patterns in order to improve emotional distress and bring about positive change.

http://www.anxietybc.com/sites/default/files/What_is_CBT.pdf

*"Homework assignment"? What does that look like?*

Here's a generic worksheet I just made in MS Paint. Don't take the example too seriously.  What you do is evaluate a situation that has caused you distress, rank it (e.g. 7/10), then rethink the situation and reevaluate your emotional reaction (reduced worry to 3/10). 

 

For the entry "Thought Distortion," in the worksheet, see the list of cognitive distortions:

http://www.apsu.edu/sites/apsu.edu/files/counseling/COGNITIVE_0.pdf 

*Who is a psychotherapist?*

That's an umbrella term. People from different fields(medicine, psychology, social work, etc) and with different educational attainment (masters, PhD, PsyD, MD, etc) can provide therapy. Wiki has a decent entry on different kinds of therapists (such as LCSW, MFT, LPC) in US:

Training and licensing of clinical psychologists - Wikipedia, the free encyclopedia
*
What is the orientation of a therapist?*

No, it's not sexual orientation but theoretical orientation, meaning which modality they specialize in. Based on a number of studies, the majority of therapists (who are also members of the American Psychological Association), have an eclectic orientation. This means they combine elements from different modalities. For instance, cognitive exercises (from CBT), focus on childhood (from psychoanalysis), mindfulness (borrowed from religious, in particular, Buddhist views), and so on.

*What kinds of problems can you to therapists for?*

People go for therapy to deal with pretty much anything you can imagine. Some go to have just someone to talk to about personal things. Some, just to know more about themselves. Some wanted to deal with a particular problem they're having, be it in relationships or work. Some see a therapist only during major changes in their lives, be it marriage, death of parents, pregnancy, divorce, sex reassignment surgery, coming out to people in their lives, serious illness, etc. Many people who opt for therapy have a diagnosable mental illness, as defined by DSM, but some don't. 










*What is DSM?*

This book, Diagnostic and Statistical Manual of Mental Disorders, currently in its fifth edition (DSM-5) is published by the American Psychiatric Association. DSM classifies mental disorders based on descriptive criteria. For instance, depression would be diagnosed based on someone meeting a number of criteria, such as feeling depressed for at least two weeks, in addition to problems with sleep, eating, guilt, etc. Given that insurance coverage and treatment plans are based on these diagnostic codes, DSM is probably the most important book in all of mental health system. And it lists several hundred disorders!









*How much does therapy cost?*

Some therapists use "sliding scales", going as low as $50 dollars an hour, while others only charge upward of $300 dollars. So depends on where you live (and what kind of insurance you have). Some approaches, such as psychoanalysis, require frequent sessions (several times a week), so the cost can quickly skyrocket if there is no insurance coverage. The good news is that compared to years ago, some forms of therapy are more likely to be covered these days.

*Is psychotherapy effective? *

In dealing with common problems like anxiety and depression, and using bona fide treatments, therapy seem to be quite effective. For some issues, like psychopathy or pedophilia, therapy has had little success. In general there are controversies and unanswered questions in the field, but not really about its effectiveness.

*What are these controversies and major questions in psychotherapy?*

There are many, such as:

-How to define "mental illness" in a way we can all agree on?
-Is therapy is always more effective than other "treatments", like exercise, placebo (be it sugar pills or just having someone to talk to), or psychiatric medications? How much more?
-Which modality is most effective? Are they all equally effective, as some research suggests?
-Why and for whom and when does psychotherapy work/doesn't work? 
-How does change happen?
-How to do higher quality research on therapy?










*Is therapy safe?*

Some forms of therapy, such as rebirthing or recovered memory techniques, are seen as potentially harmful. Commonly provided therapies, such as CBT, are seen as safe.

*Can a therapist harm you?*

It's possible. You can get traumatized from working with an incompetent or unethical therapist or someone who practices controversial types of therapy, as stated above. Sexual relations with clients is also one of the main reasons some people have filed complaints or sued their therapists.
*
How to find a psychotherapist?*

Again, depends on the location. In US, for instance, you can get recommendations from your physician or local community health center, or use this link, from the American Psychological Association:

Psychologist Locator - Welcome / Text Search

*How to decide on a psychotherapist?*

First, google them, find all you can about them on your own.

Then, during your first couple of sessions, don't by shy about asking them lots of questions. I would recommend you ask:

-First, that they're registered and licensed by a recognized agency. This is very important.
-Their educational background.
-How long they've been practicing.
-Their area of specialization/expertise.
-Their hours and how often they will be seeing you.
-Rate/payment/cancellation policy.
-What options you have during a crisis.
....

Trust your instinct. If something looks off, don't ignore it. Remember, you're the one in charge. It's not just the therapist taking you on, it's you paying for a professional service and as customer of such service, you can choose.

*What are some warning signs of a bad therapist?*

Here's the long list of ethical codes that APA uses:

Ethical Principles of Psychologists and Code of Conduct

It requires therapists to avoid causing harm, maintain high levels of competence, refrain from sexual harassment, and so forth.

Again, this is about trusting your instincts. Inappropriate touching (most therapist are very careful about anything more than a handshake), abusive or very personal comments, contact outside session, etc, are not acceptable.

Remember, no matter how you were treated by others in the past, you have certain rights, including legal rights.  Check beforehand so you know your legal rights (where you live) and also your rights in the therapeutic relationship. Often the he basics are that you need to be treated with respect (respect for your autonomy, freedom, privacy, and dignity), that you can refuse services at any time, that you have the right not to be discriminated against, that the therapist has to give you warning before ending his relationship with you for whatever reasons....

*What kind of therapist is most likely to help me?*

Once you find a licensed and competent therapist who specializes in the problem you need treatment with, it is about choosing the therapist that you feel most comfortable with.

Some research indicates that a good rapport and a personality match with a therapist are more important than the modality of therapy! So make sure you have a good feeling about this person, they "get" you, you feel at ease. 

Also it's not bigotry if you decide to see a black therapist if you're black, or see a trans/gay therapist if those are the issues you struggle with. It's all about you in there, this is very personal and intimate work. If you don't feel really relaxed and really understood, it's less likely you will open up and work on the roots of your pain. So therapy will not be as successful.

*Okay, anything else before I see a therapist?*

See a General Practitioner. By one estimate, as much as 20% of psychological problems have a medical basis. One person told me she thought she had depression and only a year later she learned she had anemia. Make sure there are no major medical problems masquerading as psychological disorder. 

Also, understand the nature of psychotherapy. Therapy is not about changing others, it's about changing yourself. This is so important and central to the practice yet many (including myself in the past) do not pay attention to it when going for therapy. The therapist will not change others nor will she save you. The good therapist will help you regain your strength and will teach you tools to go out there and face the world again and get better results and suffer less. 

_Comments, questions, answers, personal experiences, are all welcome. But please keep them constructive and to the point, so this thread can serve as a guide to help people make informed decisions about therapists. Thank you. 
_


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## darthvader92

i'm more of a video gamer


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## Doktorin Zylinder

Oh, we're all crazy; it just depends to what extent and who's measuring. :crazy::crazy::crazy::crazy::crazy:


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## 539885

Thanks for the informative post! I loved the amusing panels in between. Great way to break up walls of text while emphasizing a point.

I have had therapy and my dad is a social worker, so within my parameters of understanding I didn't see any errors. Was actually illuminating as to what methods my therapist used.


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## Hollow Man

Here's a good video about why and who can go. This video represents my experience seeing therapists and usually what I get out of it.


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## Laughmore

Where does neuro-linguistic programming (NLP) fit into the spectrum of clinically recognized treatments? or does it?


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## Sara Torailles

Laughmore said:


> Where does neuro-linguistic programming (NLP) fit into the spectrum of clinically recognized treatments? or does it?


It's considered pseudoscience.


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## auraaa

Going to an experienced and licensed hypno-psychotherapist has literally *changed* my life and my outlook on things for the better. I highly recommend it to people who have had issues like me with depression, suicidal tendencies, anxiety, social problems and a need for closure. Finding the right one for me has had me feeling a renewed, improved person in just two months. If you think that you are lost and with no purpose on this world, a psychotherapist can show you the right path to better things in life.


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## Wellsy

Nice short summary of Cognitive Behavioral Therapy.
Cognitive behavioral therapy - National Library of Medicine - PubMed Health


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## BigApplePi

I like this video. He refers to "mental health." I would add, "emotional health." After all it is emotional troubles which are the motivator to get another's neutral view.


OdetoBegin said:


> Here's a good video about why and who can go. This video represents my experience seeing therapists and usually what I get out of it.


I've had a good deal of it and it has helped me get my feelings on straight.


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## Metalize

It would be nice to have more organizations like Dignitas, I think. They have a mandatory psycho-counseling session with newcomers anyway.


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## Zen Lizard

Excellent and very informative post. Thank you for taking the time to make it!


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## dragthewaters

There's an app called Pacifica that you guys should try out if you are interested in learning more about how therapy actually works, or if you are unable to see a therapist for whatever reason. It's a free app and it basically helps to teach you CBT and mindfulness skills. So you can kind of get an idea of what therapy is all about before you decide to spend the $$$ or time to go to one. I mentioned it to my psychiatrist yesterday and he said he actually recommends it to his patients.


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