Understand What Therapy Actually Is...

Hello everyone.. Hope you all are well and safe in this challenging time. We all know that this is a difficult time we are facing and due this pandemic & lockdowns we are stuck at home. These challenging situations have created many issues in our lives. And mental health issues have increased too. As many of us are seeking professional help, or many of us not seeking, we should know about therapy.

Many of us have experienced a situation, where we had taken advice from our elders, friends or relatives. And talking to them helped us a lot. Yes, those talking can sooth us for a temporary period of time, but that doesn't signify as THERAPY. As a psychologist, I can understand that there's a pre-notion about therapy in people and they think that therapy is just 'talking'. 

To your surprise, IT'S NOT. Yes, talking is an essential part of therapy but it's just not casual talking what happens in a therapy session. It's much more than that... And to understand this, please read up this post.. I hope you will find it informative and will gain some insight about 'what happens in therapy...'???

What Is Therapy?

The belief that people with psychological issues can change, learn more adaptive ways of perceiving, evaluating and behaving is the conviction underlying all Psychotherapy. Therapy takes time and it offers no magical transformations in the client.Because change can be hard and people tend to find it easier to bear with their present problems than to challenge themselves to make an effort to change their current situation. But, surely, it holds promise even for the most severe mental health issues.

In it's core, Therapy is a unique relationship between the clinician and the patient within which there is communication which can relieve distress and set conditions for relearning and personal growth. More elaborately, psychotherapy describes any intentional application of psychological techniques by a clinician to the end of effecting sought-after personality or behavioral changes. (Source: Modern Clinical Psychology, by Sheldon J. Korchin) 

So, psychotherapy is a professional relationship, which involves an expert offering services to a needful person. The former (expert) attempts to help the later (client) with his issues in life, psychological disorders, helps to be self sufficient and also responsible. The therapist's singular goal is to advance the well-being, autonomy, and personality competence of his client. The client is assured of privacy, confidentiality and moral neutrality. 

Major Purposes of Therapeutic Intervention: 

The goals of psychotherapy differs from client to client, as each client has their own issues and the therapist addresses those issues through psychotherapy. Goals are mainly decided and defined according to the issue at that moment. Though, there are some basic purposes of the whole therapeutic intervention which are same at the ground level. These are the purposes, a therapist tries to fulfill during the whole treatment period. 

These are: (given by Sundberg and Tyler, 1962)

• Strengthening the patient's motivation to do the right things.
• Reducing emotional pressure by facilitating the expression of feeling. (Cathersis)
• Releasing the potential for growth.
• Changing habits.
• Modifying the cognitive structure of the person.
• Gaining self-knowledge.
• Facilitating interpersonal relations and communications.
• Gaining knowledge and facilitating decision making.
• Effecting changes in the patient's social environment.
• Altering states of consciousness in order to extend self awareness, control, and creativity.

The Therapeutic Process: 

Establishing Initial Structure- Here the therapist makes it clear to the client about the timing of the sessions, duration of the sessions and also planning the strategy of the whole process. The most important is the client is made understood about the role of the parties in the session and also the boundaries.

Rapport Development- The therapist approaches the client in a very non-judgmental way and is open to whatever the client has to say. Therapist tries to understand the client and make a rapport with the client. Here the trusting relationship grows between the client and therapist.

Knowing The Client- This is in technical way taking case study of the client. The therapist takes the entire case study from the client as well as the informants. And also tries to understand the client and know his sufferings. 

Identifying The Problem- Problem identification is the mutual effort of therapist and client, they both work together to find out the problem that the client has been facing. Here, majority of the work is done by the client. The therapist works as a facilitator here.

Decision Making- In this step, the gathered information about the client is evaluated to find the best solution of the client's problem. For decision making all the relevant information is gathered and arranged according to the priority of actions. Then the effectiveness of information used is analyzed. Appropriate choice of decision and solutions are made according to the importance of action.

Plan Of Action- Plan of action is a step to achieve desired goal. To obtain the desired result the client is meant to do what is planned in the session with the therapist. This step very specifically tells the client how to maintain and make necessary modification in his/her behavior.

Follow Up- This process is a long term process and it does not end with one session. It takes on and average 12-21 sessions or more (client and issue specific) to resolve any issue the client is facing. So follow up is needed and if any client stops therapy in between it is that person's sole choice. In the follow up sessions the therapist and client together evaluates the implementation of action plans and also the progress of the client. If any changes needed that is also decided in these sessions.

Termination- The termination stage is the final stage. The therapist discusses the whole process of termination in the first session only. And before the termination, the therapist makes the client aware of the termination, to help the client sink that in. But that does not mean, if the client ever needs the help of the therapist, the therapist won't help. Always remember, the doors of the therapist is always open for the clients whenever they need help, obviously with appointment.

The Therapeutic Relationship: What One Can Expect From Therapy?

The therapeutic relationship evolves out of what both client and therapist bring to the therapeutic situation. The outcome of psychotherapy normally depends on whether the client and therapist are successful in achieving a productive working alliance. The client's major contribution is his or her motivation. It has been seen that, the clients who are pessimistic about their chances of recovery or who are ambivalent about dealing with their problems and symptoms respond less well to treatment (Mussell et al., 2000). The establishment of an effective therapeutic working alliance between client and therapist is seen by most investigators and practitioners as essential to psychotherapeutic gain. 

Although definitions of the therapeutic alliance vary, it's key elements are, a sense of working collaboratively on the problem, agreement between client and therapist about the goals and tasks of therapy, and an affective bond between patient and therapist (Constantino et al., 2001; Martin et al., 2000). Clear communication is also important. This is no doubt facilitated by the degree of shared experience in the backgrounds of client and therapist.

Almost as important as motivation is a client's expectation of receiving help. This expectancy is often sufficient in itself to bring about substantial improvement, perhaps because clients who expect therapy to be effective engage more in the process (Meyer et al., 2002). To the art of therapy, a therapist brings a variety professional skills and methods intended to help people see themselves and their situations more objectively - that is, to gain a different perspective. Therapy sessions also provide the clients a safe setting in which he/she is encouraged to practice new ways of feeling and acting, gradually developing both the courage and the ability to take responsibility for acting in more effective and satisfying ways in the society. To bring such changes, a psychotherapist helps the client give up old and dysfunctional behavior patterns and replace them with new, functional ones. (Source: Abnormal Psychology, by Butcher and Hooley)

The Effectiveness Of Therapy: 

The effectiveness of psychotherapy has been markedly seen throughout the years. Studies of the therapeutic relationship show that how well clients do over the course of therapy is predicted by the ability of their therapist to form a strong alliance with them (Baldwin et al., 2007). Psychotherapy can often accelerate improvement or bring about desired behavior change that might not otherwise occur. Most researchers today would agree that psychotherapy is more effective than no treatment (Shadish et al., 2000). The chances of an average client benefiting significantly from psychological treatment are, overall, impressive (Lambert & Ogles, 2004). Research suggests that, about 50 percent of clients show clinically significant change after 21 therapy sessions. After 40 sessions, about 75 percent of clients have improved (Lambert et al., 2001). We know that progress in therapy is not always smooth and linear, but there is always an effectiveness of therapy seen in most of the clients. (Source: Abnormal Psychology, by Butcher and Hooley)

In this context, I would like to say one thing which is very vital, "One who does not want to take/go for therapy, He/she cannot be given therapy". So, it depends a lot on the client's willingness to get better through therapy.

*Source: Abnormal Psychology, by Butcher and Hooley & Modern Clinical Psychology, by Sheldon J. Korchin

I hope, this blog could explain the concept and process of therapy in a simplified way. All the informations written here are from authentic sources and I have mentioned the sources too. If you have any questions regarding this do write in the comment section. Please share your feedback with us. Will be posting more about different therapy approaches. And if you like our posts then do follow our blog.

Till then, take care.. See you soon..

~ Angira Gupta..