How does therapy actually work, how do you find a good one, and what’s the difference between counseling/therapy/psychiatrists/psychologists/etc.?
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In my experience, therapists are often more of an informed 3rd party that you bounce ideas off of without fearing judgement. Something most people lack in their lives. Genuinely, I’d advise even healthy people to see one. You can think of it as your primary doctor is for physical stuff and your shrink is for mental stuff. Even if nothing is wrong you should check up with both occasionally.
Why do some people need regular therapy/counseling throughout life and some don’t? My sister and I grew up in the same household and are and have always been very close and similar, but she goes to counseling every week and has been for years. I have no desire or need for it and live a very happy fulfilled life. We have gone through many of the same good and bad life experiences yet the ways we cope with them are very different. Is there any psychology behind this?
Cognitive-behavioral therapies and most other therapies that are popular assume that you know what’s wrong with you (your ‘symptom’) and then they try to fix it.
Psychodynamic and psychoanalytic therapies assume that you don’t necessarily know what the problem is — that the problem is unconscious, and that there are reasons that you want the problem there. Understanding those reasons is the *real* problem.
I’m a big advocate of the latter, even though they’re “out of fashion” because people want quick fixes. Go find a local psychoanalytic institute, and be prepared to spend a lot of time. In exchange you will get to know yourself and change in a far deeper way than is likely with other therapies.
I’ve seen 5 therapists and two psychiatrists. Nothing they did ever helped me :/
Imo, for some people, therapy is a massive waste of time and money. And for many many people, medication will destroy your brain and life. I have tried 8 different meds, and to this day (I quit them all) I still don’t feel back to normal. I feel semi depersonalized because the drugs fucked me up permanently. I can’t focus and I get anxiety now. I’d be very very fucking careful if you are considering meds. I was ruined by them
Not sure if this was mentioned here, but there are also currently 5 states in the US in which Clinical Psychologists with a post doctoral degree in psychopharmacology can prescribe within the field of mental health (e.g. SSRIs, MAOIs, etc.)
This is an interesting (and for some people controversial) trend towards granting psychologists prescription privileges.
You’ve gotten a lot of great answers but I wanted to clarify what you mean by how does it work. Do you mean, how does it “fix” mental illness or struggles? If that’s what you mean, I’d love if you could provide more information about what your concern is if you have one or are asking for a friend. A lot of the comments gave great descriptions on the different modalities (approaches) of therapy but they still have some variation based on the issue being addressed (ie personality disorder, mood disorder, substance abuse, trauma, etc).
I wanted to address the middle part of your question. Some of what I’ll mention is a repeat of previous comments but it’s important enough to say again. If you’re asking because you or a friend/family member is considering treatment please consider the following:
-Finding a good fit is HARD. Even harder if you’re in distress. Don’t give up but more importantly don’t give in. If it’s not working that’s okay…therapists know that their work is incredibly subjective and will sometimes even refer you to a colleague they believe will be a better fit. In the end the effort is worth it.
-Don’t discount group therapy. For a lot of people it’s super uncomfortable at first and it takes awhile to acknowledge it’s helpful. For sure it’s not for everyone, but it’s not as awful as a lot of people assume it is.
-Most primary care providers will prescribe antidepressants if you’re experiencing mild-moderate symptoms. That being said, seeing a psychiatrist is definitely a better option if insurance covers it and/or you’ve got significant symptoms. I’ve compared it to this: if you occasionally have symptoms of asthma your PCP will likely run some tests, prescribe an inhaler and they’ll monitor you. If you have significant respiratory issues, they’ll refer you to a specialist who can ensure all aspects of the illness are being treated.
I hope you’re able to find the answers you need.
Simple explanation:
Therapy tries to teach you how to better process, cope with, or otherwise address whatever the issue is.
When repeated, it can also make these better coping mechanisms automatic.
A psychiatrist is a physician and can therefore prescribe medications, order labs and imaging tests, etc. A psychologist cannot.
I’m going to vastly oversimplify how it works, but:
Me: shows up to therapy as a simmering cauldron of low self-esteem and negative self-talk
Therapist: gets me to talk about these things
Therapist: helps me explore where these things probably came from (i.e., formative years with fucked-up parents)
Therapist: validates that things were severely fucked-up; provides thoughts on how it could have been handled better (if you really trust and respect your shrink, this voice will eventually replace the shitty-parent voice in your head)
Me: continues week-by-week to report new stimulus from my life and how I am handling these things
Therapist: understands current course of action based on deep understanding of my past, continues to validate current feelings, but also suggests different ways to handle and interpret these things going forward
Me: very slowly learns a different way of thinking about life and about myself, and of handling the things the world throws at me
I really believe in therapy as a long-term iterative process. It doesn’t happen in a weekend workshop; you have to keep experiencing the world and give your brain the chance to assimilate the possibility of doing things differently.
Lots of good points here. I’d add one thing.
Therapy is work. Sometimes, it’s grueling work.
Think of it along the lines of physical therapy. Let’s say your arm’s all screwed up. Just showing up at the PT office isn’t going to magically fix anything. They’ll give you some guidance, in the form of exercises that kind of hurt. And you have to do them, over and over again. It’s not much fun. No ‘major break throughs’ will suddenly miraculously heal you.
Once I figured this out, I got a lot more out of therapy. It’s something you have to actively participate in, and it takes a long time. No miraculous healing here either.
Not really an answer to the question, but Thank You.
I’m struggling right now, both with the idea of going to a therapist and finding one (why does it have to be so difficult??). This thread has been very informative, helpful, and terribly coincidental!
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