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Psychotherapy

by Dr. Lynn Margolies

 

A clinical psychologist is a highly trained expert of the mind and heart who understands feelings, thinking, behavior, relationships, healthy and unhealthy coping, painful and disruptive symptoms, psychological growth and change. Psychologists can teach people to become happier within themselves and relationships, be more successful, feel better physically and psychologically, break destructive patterns, leave abusive relationships, get along better with others, make difficult life decisions, cope with and heal adversity/pain/trauma, manage feelings, ease life transitions, improve performance, understand themselves and others, cope with difficult people, maximize growth and potential, and develop inner peace and strength. Psychologists can help people become aware of their blind spots, develop new perspectives, become healthier and more flexible, have more options, find the right path (career, love, self-growth, spiritual), and have greater control over their lives.

There are many different approaches to therapy. Use of one orientation or another depends on the psychologist’s training, style, and personality. Some psychologists use one approach with all patients; others are eclectic, and some tailor their approach based on particular patients' needs, symptoms and personality. Although the approaches are often seen as distinct, in the implementation and even theoretically there is often overlap. Rigidly adhering to one way of thinking or approaching therapy often limits results and misses the whole picture, and may result in an approach that feels foreign or false to the patient.

The psychodynamic approaches focus on understanding where the problems or symptoms came from. In this type of therapy, the therapist helps the patient recognize how the past is repeated in the present and understand the templates for relationships that were formed in childhood which are now being unconsciously repeated.

Therapy approaches informed by attachment theories have become more popular recently as new research emerges. These approaches use empirically-based and neurobiological research to understand problematic relationship styles. Scientific studies on attachment have found that symptoms in adult relationships can be reliably predicted from objectively identifiable, early patterns of attachment between parents and children. Therapists using attachment-based approaches work within a framework of carefully attuned listening and responding aimed at healing unconscious, psychological and biological processes in the brain and promoting the development of higher level capacities. Such capacities include the ability to recognize and reflect upon what is happening in one's own mind and the minds of others, and sort out one from the other. This approach to therapy is also particularly helpful when used to guide parents and teach strategies to help them understand and react in ways that optimize children’s psychological and brain development and improve parent-child relationships.

Cognitive-behavioral approaches emphasize learning to recognize and change maladaptive thought patterns and behaviors, improve how feelings and worries are handled, and break the cycle of dysfunctional habitual behaviors. This perspective helps people see the connection between how they think, what they tell themselves, and the feelings and actions that follow.

Interpersonal, relational approaches emphasize identifying and understanding (self-defeating) patterns in relationships, figuring out why this is happening now - given in a particular context or relationship, and how to change patterns that don’t work and develop healthier ones. In this approach, relationships and the here-and-now are the focus.

Systemic approaches understand problems in a contextual framework and focus on understanding and shifting the current dynamics of relationships, families, and even work settings. The roles and behaviors that people take on in a particular family or context are understood as determined by the unspoken rules of that system at large and the interplay of how everyone is acting with one another in that system. Change in any part of the family system or group is the route to changing symptoms and dynamics, whether or not the “identified patient” is specifically involved in those changes. In this type of therapy, the “identified patient” in a family - the one seen by family members as having the problem is viewed by the therapist as part of a larger system that is creating and/or sustaining this problem. This approach can be particularly useful when one member of a family seems resistant to therapy or to change because it opens up other avenues where interventions can occur.

Other therapeutic approaches are centered around self-expression, with therapy providing a safe and private place to express feelings, confusion, worries, secrets, ideas. Here, therapy provides a context where self-expression and self-exploration can occur comfortably, with a knowledgeable person outside of the sphere of one’s personal life.

In general, people find therapy to be most useful when therapists are responsive, engaged, and offer feedback - regardless of the therapists’ orientation. Also, many people who have been in therapy, or interviewed different therapists, report that they feel most comfortable and have better results when there is a good match between therapist and patient. Whether the match is good can be determined by whether the patient likes and feels comfortable with the therapist and whether the therapist has experience and training in treating the problem at hand. In addition, some of what makes a good match has to do with “chemistry.” Chemistry involves more subtle factors such as personality style of the therapists and its intuitive feel to the patient - whether or not this is someone with whom he/she would want to talk and confide.

What can therapy do and why does it work? Therapy can help people in many ways, for example: empowering them, increasing self-awareness and understanding of others and relationships, diffusing conflict and painful feelings, teaching interpersonal and coping skills, facilitating problem-solving, allowing self-expression, and changing unhealthy patterns.

Therapy offers a reliable, supportive structure in which people can actively focus and work on themselves and relationships, without being judged. Change through therapy works through a variety of means. The therapy relationship is healing both experientially - through interactions with the therapist in the therapy relationship itself - as well as through learnings which occur during the process. Research on therapy and the brain has shown that therapy changes the brain’s structure and function (by adding new neuronal connections, fostered by learning and new experiences) in ways comparable to medications’ effect on psychological symptoms. Therapy offers people the possibility of engaging in new behaviors and feelings, which in turn are positively reinforcing, and ultimately provide the basis for sustained life improvement.

 

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Copyright © 2004 - 2017 by Lynn Margolies, Ph.D. All Rights Reserved.
Psychologist, Newton Centre, MA.
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