Considering Counseling
Have you been feeling depressed, anxious, or just "out-of-control?" If so, you are not alone.
According to the National Center for Health Statistics, in the US, there were around 47 million visits to doctors for mental problems in 2005. And just like many physical ailments, these types of disorders are usually highly treatable through therapy.
Whether you are coping with a life transition, depression, loss, general anxiety, or more serious conditions, such as schizophrenia or bipolar disorder, chances are good that therapy can help.
What Kind of Therapy Should You Seek?
There are two primary types of therapy: medication and talk.
Medication Therapy
Medications are used for certain psychological conditions caused by a biochemical imbalance, such as depression and bipolar disorder. Medication can only be prescribed by a doctor or psychiatrist, and it is generally used along with talk therapy, so that psychological issues and biochemical problems may be treated at the same time.
Talk Therapies
Talk therapies, also known as counseling or psychotherapy, treat psychological or emotional problems through verbal communication. Although they are based on psychological theories, talk therapies also fulfill a very basic human need to share problems and connect with others.
"As society becomes more mobile, people seek counseling for issues that they might have confided to a neighbor, friend, or family member three generations ago," notes Mary Guindon, PhD, at Johns Hopkins University Counseling and Human Services Department. "Counseling is help for the everyday problems of living. It doesn't make the problem less painful, but it does help normalize it, so that clients are no longer coping in a vacuum."
Some types of counseling may be better suited to your particular issues, as well as your personality, time, and budget. Listed below are some of the most common types; however, keep in mind that most therapists tend to use a combination of one or more approaches.
Psychoanalysis
- Description: developed by Sigmund Freud in the 1900s, focuses on identifying repressed feelings and issues that influence current behavior. The process is complex and lengthy, and it is less widely used today.
- Recommended for: problems stemming from childhood conflict
- Duration: 3-6 years
Cognitive-Behavioral Therapy
- Description: focuses on examining and changing unhealthy thought processes that shape behavior patterns
- Recommended for: depression, anxiety disorders, eating disorders, substance abuse
- Duration: average 15-25 sessions
Psychodynamic Therapy
- Description: identifies and interprets unconscious feelings to bring about behavioral change. The effectiveness of this therapy is an area that needs to be studied more. Medication is usually part of this treatment.
- Recommended for: people with certain personality disorders or chronic mental disorders
- Duration: may be as short as 25 sessions, or as long as several years
Couples, Marital, and Family Therapy
- Description: focuses on the interactions of a unit or system rather than individual members. This approach is based on the idea that the problems of an individual must be understood in the context of a larger system.
- Recommended for: couples, families, children, or teens with emotional disorders or serious diseases, or experiencing traumatic events
- Duration: weeks to months
Group Therapy
- Description: one of the most widely used forms of psychotherapy, works toward self-understanding, self-acceptance, and modification of the problem behavior
- Recommended for: adolescents and people who share similar diseases or disorders, such as substance abuse, compulsive gambling, and eating disorders.
- Duration: may be brief or long-term
What Kind of Training Is Involved?
Be aware of your therapist's licensing and credentials. The following is a brief summary of training:
- Psychiatrists—medical doctors, the only type of therapist who can prescribe medication
- Psychoanalysts—have completed training at an analytic institute, although institutes may vary
- Psychologists (PhD, PsyD)—have about five years of graduate training in psychology and usually an undergraduate degree in psychology
- Licensed social workers (LICSW)—have a Master's degree and two years of postgraduate training
Where Do You Get Help?
Most of the time, you will choose a therapist affiliated with your health plan. You may also check with your doctor, other community mental health agencies, local colleges or universities, hospitals, and government social service agencies for referrals.
What Should You Ask Your New Therapist?
As a therapy client, there are standard practices and procedures that you should expect. According to the American Counseling Association (ACA), your therapist should be able to inform you of:
- Their credentials and qualifications, as well as areas of expertise
- The purposes, goals, techniques, procedures, limitations, and potential risks and benefits associated with therapy
- Matters of confidentiality, privacy, and disclosure of information
- Financial arrangements prior to beginning the counseling relationship
How Do You Know When You're Finished?
For some, the answer is clear: when insurance stops paying for the sessions. But for those who are able to continue therapy to its natural conclusion, the termination of therapy is an important step. Some people are tempted to end therapy prematurely because they are reluctant to tackle difficult issues, or are fearful of becoming dependent.
In general, "individuals who are ready to end therapy usually feel that they have made progress. They feel more confident, hopeful, accepting, and aware of their emotions and needs. It may be easier for them to get along with others and to recognize and avoid pitfalls and self-defeating behavior," say Dianne Hales and Robert E. Hales in their book, Caring for the Mind.
Ultimately, though, the progress and termination of therapy will be your decision.
Resources:
American Counseling Association
Mental Health America
Canadian Resources:
Canadian Psychiatric Association
Canadian Psychological Association
References:
Hales DR, Hales RE, Frances A. Caring for the Mind: The Comprehensive Guide to Mental Health. New York, NY: Bantam Books; 1995.
Malmberg L, Fenton M. Individual psychodynamic psychotherapy and psychoanalysis for schizophrenia and severe mental illness. Cochrane Database of Systematic Reviews. 2001;(2):CD001360. DOI: 10.1002/14651858.CD001360
Mental health disorders. National Center for Health Statistics website. Available at: http://www.cdc.gov/nchs/fastats/mental.htm. Updated July 2008. Accessed July 29, 2008.
Last reviewed June 2008 by Theodor B. Rais, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.