Why Psychotherapy Works

Posted: August 6, 2011 in Psychology
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Why Psychotherapy Works

For someone who has studied nothing about psychology, there’s no mystery about how it works. They have no interest in the question. As far as they know, if someone has emotional problems they go to a psychologist or psychiatrist, receive therapy or medication and get better. A sunny idealized view, but one that is occasionally true.

The reality is that sometimes therapy and medication have no effect or even make the patient’s problems worse. But, this article isn’t about how psychology fails. The question is, why does it often succeed?

Modern mental health treatment at a hospital is most often a combination of therapy and drugs. Psychologists specialize in therapy. Psychiatrists specialize in medications. The question of the day is, “What makes therapy effective?” To answer that question, we first need to know the general principals of therapy.

How is Therapy Structured?

There are dozens of flavors of psychotherapy. They have a variety of focuses depending on the original thinker who invented them. They may focus on the self, society, sex, emotions, the past, life goals, the list goes on. No matter which therapy is used, there are several steps which must be followed.

1. The presenting complaint. What does the patient say has gone wrong? It can take some time to understand a patient’s problem because they will often present a related problem that is easier to talk about. For example, they may say they have an internet addiction and further questioning reveals that it is a porn addiction. Or they are feeling depressed because their career isn’t going well and they’re always broke, but as the interview progresses it becomes clear they have an anxiety problem because they’ve started selling illegal drugs to cover their expenses.

2. The underlying problem. There is always a reason for psychological problems. Porn addiction can be caused by a poor social life which provides few possibilities for a healthy sexual relationship. Always being broke comes from living beyond ones means.

In some cases, the cause is chemical and medication may be the only answer. For therapy to move ahead, this underlying problem must be found.

3. The psychotherapist’s theory. The therapist can readily see how the patient’s problem fits into the treatment theory they’ve studied. Now they must teach the theory to the patient, or at least enough of the theory so the patient can resolve their problem.

The efficacy of the therapist’s chosen theory for a particular problem can vary greatly. For example, a theorist who focuses on sexual causes based on that part of Freud’s work will have trouble helping with an economic problem. But, they don’t need to look far for an answer. Freud also introduced the concepts of the id, ego and superego. The therapist can turn to these in the search for an answer.

Some psychological theories are rather narrow. For this reason, many therapists study several theories. Others refer patients that don’t fit their treatment to another therapist. Given that the therapist uses a theory that’s a good fit for solving the patient’s problem, treatment moves on to the next phase.

4. Resolving the problem. Now that the problem has been identified and put into the context of a psychological theory, the theory can be used to work out a solution. The depth of the patient’s belief in the theory and desire to solve the problem has a lot to do with the success of the therapy. An entirely internal issue can take years to resolve. A behavioral issue can be cured more quickly given a patient who is willing to change their behavior.

This has told you nothing about how to do psychotherapy. A therapist has at least a bachelor’s degree in psychology and one or more years of training in the theory they use. But that’s not the topic of this article. The question is, “Given that psychological theories are something someone has made up, why do they work to solve psychological problems?”

Psychotherapeutic Fantasies?

Yes and no. If we didn’t have the ability to think, we would simply follow the path of animals. Eat, survive, and reproduce. Thoughts and feelings are apparently irrelevant. But we create a psychological world for ourselves. We get a lot of help from our friends (and relatives and enemies and outside influences). Our psychological world is an imaginary world. It is created by our culture, our society, our religion, our relationships, and any other input that has an influence on our understanding of the world.

Sometimes the psychological world we create for ourselves is maladaptive. We develop a belief sytem that either makes us feel bad in itself or that causes us to behave in ways that make us unhappy. Imagination is more important than knowledge because it’s our illusions that cause all of our psychological problems.

For example, consider the person who believes that the pursuit of pleasure will lead to happiness. In reality, happiness comes from choosing to be happy. The pursuit of pleasure only leads to a need for more of the same pleasures. The pursuit of happiness also fails because a person is not happy if they are pursuing happiness. When you are pursuing something, you don’t have it. It’s a misunderstanding of the distinction between being and becoming.

What psychotherapeutic theories do is create a way of imagining our psychological world that will allow us to solve a problem. This is similar to how a religion will help a person by giving them a concept within which they need to overcome their vices (which solves many financial problems) and have hope for a better life after death (which makes it easier to bear a difficult current life).

Why does psychology work? Because it gives the patient a worldview that allows them to work out solutions to problems they could not solve using the concepts they had learned through life experience.

Article text copyright 2011 David Arthur Smith. All Rights Reserved.


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