Psychotherapy 101

By Melissa Richman, PSY.D, LCSW, DAPA

Psychotherapy is perhaps the most misunderstood practice in society today. Most people who engage in Psychotherapy truly have no idea what they are doing there each week. Those of us in my profession often hear patients say things like, “Psychotherapy is talking, but I don’t know how it helps,” or “Everyone else is in therapy, so I should be too.” These ideas are certainly true in many forms, but in my years of practice, my experience has taught me that most people cannot give a clear explanation of what therapy actually is.

So what is Psychotherapy? Quite simply, it’s just another relationship in your life. I like to refer to a therapist as a “corrective relational partner.” A good therapist learns to identify various aspects of their client’s personality, emerging from childhood, and then takes that client on a personal journey, to help identify and repair those critical aspects from childhood that have created an impasse in their ability to have stable, fulfilled, and/or solid relationships. As children, all humans require certain needs to be met by our parents. Since childhood is never perfect, most of us grow up with our needs having never been met or needs that were excessively met.

Then, as emerging adults, many people develop specific symptoms or protections against those neglected or over met needs, with behaviors that quite often get in the way of being able to develop and maintain fulfilled relationships. Many patients experience failed relationships, fear of intimacy, jealousy, or even symptoms as pervasive as anxiety and depression. The therapist and the psychotherapy must allow for the corrective relational experience to occur.

The problems that clients present to therapists are what I consider to be symptoms of deeper underlying psychic issues. These issues come from their psychological structure or memory, learned from childhood in their relationships with their parents. These symptoms can range in different clients from mild to severe, which then define the intensity of the treatment needed.

Symptoms protect us from feeling the deeper root of our pain. For example, anger is a less frightening emotion then feeling that hurt, shame, or pain. Depression is another symptom, one that masks anger turned inward. Any kind of an addiction is also a symptom; addiction just a fancy word for a compulsive process that takes one out of the reality of what is really going on. We all have symptoms, and a good therapist teaches their patient during their relationship how best to manage those symptoms to improve their life.

Psychotherapy is not advice, nor is it a form of “self help”. Self-help, and the quick, informal advice that may help in the moment, but does not foster a deeper shift that allows for one to have true change in his or her life. Through the corrective emotional relationship with the therapist, a patient is able to tread into the deep territories of one’s soul and fill up those empty holes. He or she may increase their self-esteem, and minimize their relationship symptoms, and hopefully resolve the initial problem that first brought the client to therapy.

It is important to understand that we all have relationship issues, aspects of ourselves that get in the way of truly feeling fulfilled in our lives. This is not to say that our parents are bad people or should have done a better job. Hey. That’s just life. Unless our parents have done their own work before they had kids, then less-than-perfect-parenting is sure to always occur. No one ever had a perfect childhood!! And that includes therapists too!

No one is perfect; there is no such thing as that. Therapy teaches the client to understand and learn how to manage their symptoms, not erase them, and how to have continuous improvement in life’s relationships. It is that simple. Effective therapy helps lower the intensity of the symptoms. As they get closer to the underlying psychological issues in the relationship with the therapist, many patients feel too overwhelmed, and may leave therapy prematurely, which can be detrimental to their emotional health. I tell my patients that this is the most important time to stay in therapy.

Psychotherapy should be your “Relationship 101” class. Who you are in the office with your therapist, and how you function in the rest of your relationships takes place right before your eyes during each therapy session. The only difference is that in therapy, you get to work these issues through with a relationship expert. A caring therapist ventures into a mutually beneficial relationship with each client, in the essence of hope and compassion, and will hopefully lead the client on a journey to a better place. My goal as a therapist is to alter one’s subjective experience through an improved relationship, improving my client’s life and relationships with the rest of the world. A solid corrective emotional experience between therapist and patient will allow the patient to find true resolve and peace in his or her life.

10 TIPS FOR SUCCESSFUL THERAPY

Tell the truth; be authentic and genuine to the best of your ability.
Treat Psychotherapy as another relationship in your life, with the therapist as your corrective relational partner.
Who you are in the office is exactly who you are in life.
Learning to have an honest relationship with the therapist will teach you to have healthy relationships with yourself and the world.
Psychotherapy is not advice giving, nor a self-help class.
Psychotherapy teaches you to have a healthier relationship by repairing those deeper things that may need fixing from childhood.
Sometimes we got too much of our needs met in childhood, and sometimes we did not get enough of our needs met in childhood. These situations will trigger symptoms that bring you into therapy in the first place and become part of who we are in our adult lives.
Know and identify your patterns and symptoms in relationships
Know that Therapy can be painful but can be the safest relationship you will ever know.
Therapy is a journey, with the end result being to have a happy relationship with the most important person of all, you!

East and West Practices in Psychotherapy

“Trauma constantly confronts us with our fragility and with man’s inhumanity to man but also with our extraordinary resilience.” — Bessel Van Der Kolk,

The mind/body connection exists in us all. It is the link between a person’s thoughts, attitudes, and behaviors and their physical health while somatization is the expression of psychological or emotional factors as physical (somatic) symptoms. It means a tendency to experience and communicate psychological distress in the body. All of us at some time or another have had this experience often finding out that nothing medically is presenting despite feeling ill. Incorporating eastern strategies such as meditation and mindfulness complements western therapies in service of mental and emotional health and the therapeutic process. My philosophy offers a generous well-rounded treatment/healing experience. For me, the eastern world supports the deeper understanding of the here and now with the western psychotherapies looking at your past. Both practices focus on healing, and relieving suffering. This is how psychotherapy, mindfulness, and meditation work together. Mindfulness is taught as a strategy to assist in activating the calm of your parasympathetic nervous system. The calming offers a deeper awareness of what might really be going on inside in connecting the mind/body. It assists and creates a soothing foundation to move into the discomfort that may happen during your psychotherapy. This will be a significant part of our treatment experience as it offers another way to enter the deeper aspects of one’s emotional life.

One of the most important aspects of psychotherapy is learning to think about oneself through the understanding of your unconscious. Mindfulness opens you to listen what you want to think about, and how you want to think about what you want/feel. This is conscious. One is unconscious and the other is conscious. As a clinician making the unconscious conscious is the marrying of psychotherapy and mindfulness/meditation. I speak often in my practice of healthy separateness in healthy relationship. Mindfulness shares a similarity of detaching from your thoughts and living in the present moment without expectations of others with psychotherapy delving into your truths, feelings, pain, and the narrative of your life past and present. I like most psychotherapists bear witness to your experiences from the past and the enactments in the present with the support of eastern philosophy of impermanence and LETTING GO. The relationship between eastern and western practice is offers and connection to a valued life. Meaning is everything and when we face our feelings, our history, our truth and learn to go there we learn to tolerate discomfort, face, and feel into the truth about being alive. I believe this is the basis of intimacy, contentment, ego integrity, and healthy relationship. Transformation is hopeful.

Most importantly, it is the relationship we build that matters to create trust and safety so I can hold that space for you. What happens in the relationship is where the repair/ corrective process happens. The clinician must convey that they walk their talk, have done and do their own work and exudes a psychological fitness to build that healing environment for you. If a therapist cannot sit in their body, how can they help you sit in yours. In western psychotherapy practice, we say the therapist can only take you as far as they have gone themselves. This is crucial when you work with a psychotherapist. In final, the benefits of a mindfulness practice are equanimity, self-compassion, emotional flexibility while psychotherapy brings awareness, resolution, attention to what needs to be expressed, known, and respected that being psychological flexibility.