So, How does therapy work exactly?

This is such a big question! And since blogs are relatively short, I’m going to rise to the challenge of tackling this in a succinct way. There are many different types of therapy, and many different styles, and ways of working. Personally, I was trained in psychoanalysis which is based on Freudian theory and working with the unconscious. What that means is trying to help the client bring into awareness those things he/she may not be aware of. Sounds simple, but it’s very complex. If they aren’t aware of those “things”, how do they become conscious? Through a lot of talk and free association. When the client is free to talk without judgment or prompts, the idea is that they are able to get to underlying thoughts and feelings that they are not usually in touch with. There is also a lot of focus on transference. This means that we move through life relating to others how we have been related to and how we have been responded to, but again we aren’t usually aware of this. For example, if someone had an overly critical parent, that person may expect others to be critical as well, even though he/she may be dealing with some  very different people who may not respond that way at all. Or, they may continue to find critical people and attach themselves to these “types” of people because it’s familiar. But are they aware that they do this? Most likely not. If the expectation is there, of facing criticism, this may impact the individual in many ways. Perhaps they don’t exercise their voice, and they remain introverted or socially isolated. Or maybe they don’t exert themselves at work for fear of judgment. On the other hand, attaching oneself to negative people may further reinforce their negative self-esteem. So it’s important to help that person understand their background, their past relationships, and how that may impact their current functioning. We tend to repeat what we know/what is familiar, and we are usually not aware of doing so. 
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I consider myself a psychodynamic psychotherapist. This means that I work with making the unconscious conscious as I described, and I work with transference. However, over the years I have shifted to also incorporating working from an interpersonal framework with some cognitive behavioral methods. I have observed that folks want results. They want interaction. And they want some tools to help them through the everyday while they are working on increasing self-awareness.
An interpersonal approach focuses on building interpersonal skills and communication skills towards the goal of strengthening relationships. Since I also work from a psychodynamic perspective, I believe that this can also be addressed through the transference of the client-therapist relationship, practicing and modeling. A  cognitive-behavioral approach addresses your thought processes (often negative, distorting, or overwhelming) and offers concrete adjustments or homework to address those faulty ways of thinking and develop coping skills.

Now where does a psychiatrist, psychologist, and social worker come in? In short, a psychiatrist attends medical school and specializes in brain chemistry; the focus is on the use of medication to address symptoms. Some psychiatrists also conduct therapy, but it is important to question their training. Perhaps they have also been trained in therapy. If they have not, remember they are coming from a medical model, and therefore are likely to focus on medication as an intervention of treatment. 
A psychologist also works to understand thoughts, emotions, feelings and behavior. In addition, they are trained to make assessments and conduct psychological testing - often for diagnoses (ie: ADD) and learning disabilities. 

A social worker, depending on their focus of education, has many possible paths. A social worker has a broad understanding of resources, human dynamics, and development. A social worker can also be a therapist. However, in my opinion, it’s important that they have more than two years of graduate school to be trained as a therapist. A social worker considers context: not only how a person is functioning, and what may have led to stressors, crises, or difficulties but also the impact of the greater environment on said functioning. For example, culture, race, political climate, geographic location, poverty, etc. Each of these titles, psychiatrist, psychologist, and social worker can fall under the umbrella of therapist/psychotherapist.
Are you looking for a therapist? It’s ok to ask questions! This doesn’t mean you are challenging the professionalism or credentials of the person; you have the right to know how the person is trained; their philosophy; their style of therapy.

It’s important that you find what works for YOU. I get it, you may not know. But what is most important is that you feel you have found a good fit. It may take meeting a couple of therapists, and having an introductory session. It’s that important to take the time to do so. You are on what may be a long journey. You are on a path of self-discovery and healing. It can be frightening to begin therapy - you don’t know what is going to come up, and you don’t know what you may end up feeling. Not having that kind of control is scary! There may be times you leave feeling a bit down. But I strongly believe you have to work through your stuff in order to get past it. And there will be many times you leave encouraged, supported, validated, and having gained insight. Consider it a necessity like your morning cup of coffee. Or a luxury like getting your hair done, or getting a massage. Invest in yourself!

We discuss more aspects of finding the right therapist on episode #78.

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