Does Therapy Really Work?

In the bright, shiny new year, it can be exciting to think about all you can accomplish in the following 12 months. Motivation for change that allows us to start off strong. The vision of how a changed you will show up at the next family gathering or future party can fuel those first months of new choices and viewpoints.

As we approach the third month of the year, some of that enthusiasm for change may have waned or gotten lost in the stroll up to the Girl Scouts cookie booth. Not surprisingly, the start of a new year, with new goals, leads many people to search for a therapist.

Most people come to therapy because there is an identified problem in their lives. Sometimes the problem or life transition results in symptoms of depression or anxiety that then change many aspects of how they experience their lives and relationships.

What is therapy?

Clinical psychology and the practice of therapy is built on diagnosing what is wrong and then developing a treatment plan to make it right.

Simplistically, clients show up saying all of this is wrong in my life. I have tried to do some things to adjust my experience but it’s not working. Can you please help me fix it?

In essence, it starts from a deficit based mentality; a something is wrong with me way of thinking.

In actual practice, that is not completely how therapy works.

My clinical training consisted of early exposure to chronically mentally ill patients in hospitals. Later, I began training in outpatient centers and eventually college counseling centers with less chronic and severe mental illness.

My therapeutic style has developed A LOT in the past 22 years from my first clinical rotation.

As a young therapist in training, I benefited from being exposed to different clinical populations as well as having advanced, senior clinicians as supervisors.

The biggest benefit was that every single therapy session I did as a non licensed trainee was video taped. This is a common supervision practice in a good clinical training setting.

Of course, videotaping a therapy session and being paired with a trainee requires advance consent of the client. And I remain indebted and humbled by those brave clients who agreed to not just see a newbie therapist but have their sessions taped.

While it was cringe worthy at first to see and hear myself on tape, the fact that my supervisors reviewed the tapes in advance of our supervision sessions was a gift from the therapy gods.

Graduate school is filled with books and journal articles telling you how and why to do specific psychological practices Actual supervised tape review of your clinical work is the best way to hone your craft as a therapist and learn how to actually be a therapist.

What is it like to see me as a therapist?

22 years of clinical practice later, with 16 years of being a licensed clinical psychologist, my therapeutic style has definitely changed and become more skilled. Part of this is due to advanced continued education and frankly a whole hell of a lot more life experiences.

As a disclaimer I do not record ANY therapy sessions.

I also have developed a significant shift in how I view a client beginning therapy. My beginning clinical training was the product of the early 2000s which was heavy on not just evidenced based practice, but required a thorough diagnosis of what was wrong with the client.

Spoiler alert: In 2023, I don’t view my clients through a lens of what is wrong with them.

Legally and ethically, I have to collect paperwork ahead of the session and inform clients of their legal rights and obtain informed consent for treatment. This is standard paperwork you have signed at every medical doctor’s appointment. My entire practice is electronic, so it is a quick process that takes about 5 minutes on your phone.

I did decide to stop collecting a detailed intake form before I ever meet with a prospective client. A detailed intake form usually involves clients listing what is wrong with them and why they are seeking therapy. Sometimes they include what a client views as their current strengths.

It also is a detailed form asking a lot of personal questions and sending it into the cyber world to a complete stranger. A lot of questions that focus on what is wrong with a person.

This is a big departure from how I was trained and how I initially ran my clinical practice.

I changed it because it doesn’t really fit with how I want to act and be present as a therapist. I believe that trust develops over time and should not begin by disclosing painful details on a form.

I also believe if we want to change a defective view or experience of ourselves it should not start with writing down all the things we think are wrong with who we are.

The first couple of sessions begin through relationship development by asking prospective clients to tell me what they like about their lives. To tell me what they do to relax, to identify the people, settings, and events in their lives that they like.

I ask prospective clients “where are you at now and where do you want to be when we finish therapy?”

Yes, I also ask a lot of questions about what made them book an initial appointment. What are the painful parts of their lives that are causing them to need assistance.

Not every person can verbalize what exactly they want to shift in their lives. Sometimes part of therapy is discovering what exactly that shift is. Depending on the level of psychological distress, not everyone can identify what is going well or even what they like about themselves.

However, I believe it is important from the beginning to acknowledge one day our work will end and therapy will not be an ongoing part of life. That clients will take what they learned in therapy about themselves outside of my office and continue that learning once our therapeutic relationship ends.

If I can’t build hope in the beginning that therapy will one day not be needed, then I am not someone I would want to see as a therapist.

Why does someone seek therapy?

When someone is reaching out for therapy, there is typically a precipitating event or an upcoming life transition that is causing a significant amount of distress.

Psychological distress can manifest in symptoms of depression, anxiety, increased irritability, and a lot of other negative experiences.

A lot of emotions and expressions that are uncomfortable.

Their psychological pain can manifest in more fights with partners, shorter tempers with bosses, direct reports, or children. It can also make people stop enjoying the things they used to enjoy or do to feel good.

In essence people seek therapy because something is so wrong, they may have lost sight of what remains right or what they need to do to experience right.

Legally and ethically, I still provide a diagnosis. This is required if clients wish to use their health insurance to be reimbursed for their out of pocket therapy expenses. It is also how I was trained and what I continue to believe remains a best practice.

So yes, I still diagnosis, treatment plan, and provide evidenced based interventions that are aimed to reduce the symptomatology associated with the diagnosis and the presenting problems.

That’s the shop talk answer.

What do you talk about in therapy?

Of course I talk to a client about what feels wrong. What made them book that initial appointment. What their lived experience is and identify what they want to change. A lot of therapy is about a person identifying what they want to change.

My clinical style is much more integrative at this stage in my later mid career. I have instructed all of my former trainees they can’t say integrative until they have practiced independently for at least 5 years.

Because honestly it takes longer than graduate school to truly learn even one style of therapy.

In all of my practicum and internship settings, I was trained in cognitive behavioral therapy. Suddenly in the middle of graduate school, the Third Wave of CBT and evidenced based practice crashed on all of us. So I really had to get good at evidenced based interventions that reduced symptomatology.

Now, from an integrative style, while I rely heavily on cognitive behavioral therapy, I also use interpersonal psychotherapy, narrative psychology, and truly am grounded in a strength based perspective.

More importantly, together in those first sessions, we begin to determine what their individual and unique goals are for therapy.

During the initial and following session, I propose some ideas for how we would approach those goals. I don’t just focus on what is wrong with them.

Yes, I do want all of my clients to feel better, resolved, happier, content when their therapy journey ends with me. I want their “problems” to not feel like problems anymore.

Therapy should increase coping strategies, emotional regulation skills, and the ability to view and identify multiple perspectives about painful events.

In essence, I want my clients to see and believe they have more control over their lived experience and how they respond to the external world.

Does therapy ever end?

Often, clients start therapy and are so disconnected what they are doing to actually survive and cope with overwhelming emotional and relational pain.

This overwhelming feeling and increased experience of distress can dull a person’s ability to identify and believe in their own capabilities and strengths.

Psychological distress can cover the most vibrant experiences in a gray or even black cloak of despair.

Therapy is not about changing what makes a person unique. I believe therapy is about building on the individual and unique positive characteristics of every person.

Successful therapy should identify untapped inner strengths that maybe have been quieted or ignored. Successful therapy is about turning pain and psychological distress into emotional strength and resilience.

Endings with clients are sad because I no longer have the incredible privilege of witnessing their life journeys.

Ending are also much sweeter when a client doesn’t credit me with the identified personal changes but instead gives the credit rightfully to themselves.

At the end of our work, I hope the identified strengths, skill sets, coping mechanisms, positive qualities, and personal characteristics they have at the end of therapy they now see were present all along. Present before they even met me.

The experienced change is due to their bravery to see themselves truly and live authentically. To live in a vibrant world, not dulled gray or black but that includes shades of both they have control over.

Want to experience therapy?

Connect with Me!