Therapy 101: Breaking Down the Basics for Beginners
Written By: Heather Rolland, LCSW and Dr. Beata Lewis
Are you thinking about trying psychotherapy, but not sure what to expect?
It’s a rare film or television show that presents therapy accurately, and while that’s fine for entertainment, it can be worrisome for folks considering taking the plunge. I’ll try to demystify and shed light on what therapy is, and what it isn’t, what is reasonable to expect from yourself, your therapist and the process, and just how long it can take. If you’re wondering if therapy is for you, and if it’s worth it, read on.
First of all, let’s take a look at the alphabet soup of letters after a professional’s name. There are quite a few licensed practitioners of psychotherapy in the United States and there are some limits as to who can do what. One fundamental distinction is that only medical doctors (people with the letters MD or DO after their name), nurse practitioners (NP, NPP, and a few other collections of letters), and physician’s assistants (PA) can write prescriptions for medications. Therapists and counselors do not have this ability, and only some people who prescribe medication also offer psychotherapy. The two aspects of mental health care – psychopharmacology (i.e. medication) and psychotherapy (talking) – have become separated into two specialties. Many clinics or group practices have both types of professionals on staff.
Psychotherapy – the talking cure, as it has been called – can be offered by social workers (LMSW stands for licensed master social worker; in LCSW the C is for clinical and indicates a higher level of training), Licensed Marital and Family Therapists (LMFT), psychologists with either PhD or PsyD after their name, Licensed Mental Health Counselors (LMHC), and in some settings nurses with a psychiatric specialty, as well as all of the professionals who can prescribe medicine.
Part of maintaining our license and ensuring our ongoing ability to practice involves continuing our education. All the above listed professionals must complete continuing education before renewing their license – social workers, for example, are required to complete 36 hours of continuing education every three years. This means we’re all engaged in increasing our knowledge and staying current with trends in treatment and research, so that we can adjust our thinking, methods, and techniques.
Let’s talk about methods and techniques. Being a therapist involves a lot more than simply asking “how do you feel about that?” There are two main ways that psychotherapy seeks to help people identify and then deal with their mental health issues. The first is via symptom reduction. We ask you about your symptoms and then we try to help you find ways to decrease their frequency and/or severity. How we do this is the technical part of being a therapist – it’s our toolkit, our bag of tricks.
For some therapists, these tools are all the same brand (a decent analogy might be that Kitchen Aid makes dishwashers, refrigerators, mixers, and stoves – different tools to achieve different goals, but all come from the same factory). We refer to that as using a particular modality. Cognitive behavioral therapy (CBT), short term solution focused therapy (SFT), dialectical behavioral therapy (DBT), and acceptance and commitment therapy (ACT) are all examples of modalities. Many therapists adopt an eclectic approach, using different modalities as the client and the situation warrants. Some therapists develop a deep affinity and expertise in a particular modality and stick with that as their mainstay. Both of these approaches to therapy can be great; neither one is better.
Every modality has its own lingo and jargon, and most have specific exercises or interventions that therapists use to help identify and then ease symptoms. In CBT this might look like thought stopping or identifying cognitive distortions, while SFT might stress behavioral change. Some modalities are very structured and sessions can be almost scripted, while others are more flexible around language or how therapy sessions flow.
The other way that therapists help people is a lot less clearly defined but it’s incredibly effective. This is witnessing, creating a therapeutic bond, sometimes even “lending our ego” to people who want our help. We use words like validation or empathy, but the core of what we do is help people who are struggling 1) to feel that their struggle is meaningful 2) to know that they are heard and held – intellectually and emotionally, not physically! – and that their words and experiences have landed somewhere and been received 3) to feel that our witnessing of their struggle means they are not alone in facing whatever it is that has brought them to our office and 4) that engaging in this process with us, the therapist, is a safe place to rehearse for engaging with other people in the world. We’re a place where people can practice.
What should you expect from us?
Social workers are educated and trained first and foremost to hold every person we see with “unconditional positive regard.” That’s a mouthful, but it is a foundational social work tenet. Another is “starting where the client is at” which if you’ll pardon the grammar, is also foundational. We begin where you are, and we accept you, unconditionally, as you are.
Expect to feel things, both in session and when you reflect upon your sessions during the week. Expect to have feelings or memories pop up and expect to have raw or fragile moments. And expect to move through these challenges and feel stronger, clearer, and more aware of who you are. Therapy doesn’t cure feelings states like anxiety or depression but it’s reasonable to expect that with our toolkit and your hard work, we can chase some symptoms into remission. Some of the modalities mentioned above are well studied and shown to be extremely effective: CBT for anxiety and insomnia are examples of this.
How long does it take?
Sometimes, people are able to make use of coping skills and happy to move on after a handful of sessions. Other people choose to take more time and develop trust in order to work on processing deeper experiences or heal from trauma. This can be episodic: we might work on one issue or symptom for a while then stop. When a new life transition presents new challenges or reopens old wounds, we’re here to help once again.
Your therapist is human; expect us to get it wrong sometimes. Expect us to own our whoopsies and missteps, apologize when we curse or belch in session (we really try not to), or lose our focus for a moment. We don’t have all the answers and some situations don’t have answers. In those cases, where there is no easy or clear path forward, we believe in your ability to craft your own solution with our support, and we cheer you on as you do it, knowing exactly how hard you’ve worked.
For most of us, doing this work is an honor. Watching our clients grow, thrive, and flourish is moving work. If you’re considering therapy, or considering therapy again, we’d be honored to be a part of your journey.
Mind Body Seven clinicians offer treatment in Brooklyn and via teletherapy for adolescents and adults. If have not worked with us and want to get started please contact us here, so we can set you up with the clinicians that best suit your individual needs. If you are an existing patient get in touch with us here to set up your next appointment.
