NYC Psychotherapist Blog

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Saturday, February 10, 2018

How Far Do You Want to Go in Your Psychotherapy?

In a prior article, Psychotherapy is an Active Process: The More Engaged You Are In It, the More You Get Out of It, one of the issues that I discussed briefly was the decision as to how far you want to go in psychotherapy--everything from symptom relief to delving deeper into your unconscious process to get to the root of your problem.

How Far Do You Want to Go in Psychotherapy?

As I mentioned in that article, each client makes this decision in consultation with the psychotherapist.  But, ultimately, the decision is up to the client.

If you're new to psychotherapy, you might not understand what your choices are and the implications of these choices.  So, I will provide describe different types of therapy.

Choices in Psychotherapy
The following scenarios describe various choices in psychotherapy for the same client, Ted, at various points in his life:

Short Term Symptom Relief Therapy:  When you choose short term symptom relief, you're usually choosing brief therapy to get rid of a symptom and you're not delving deeper into the problem once you start to feel better.  Ted had his first experience of attending psychotherapy when he saw a psychotherapist to deal with his panic attacks.  Since Ted wasn't interested at that point in more than symptom relief, his psychotherapist taught him how to do breathing exercises and to meditate.  Within a few weeks, Ted was feeling better and he decided to end therapy (see my articles: Tips For Overcoming Panic AttacksWhat is the Difference Between Fear and Anxiety? and Getting Help in Therapy For Anxiety Disorders).

Longer Term Symptom Relief Therapy: Longer term symptom relief is therapy that is longer than short term therapy but shorter than more intensive therapy.  Ted managed well with what he learned in his short term therapy for a few months.  Then, he began a stressful new job and became symptomatic again.  He returned to therapy with the same psychotherapist, and he told her that he still wanted only symptom relief, but he was willing to stay in therapy for a longer period of time to deal with his panic attacks.  Since he stopped doing the breathing exercises and the meditation, his psychotherapist reinforced the stress management techniques she taught him when he first came to her.  She also added more coping techniques so he could deal with the current stressors on his job.  When he felt better and he was no longer experiencing panic attacks, he told his therapist that he wanted to leave therapy.  He understood that he could return in the future.

EMDR Trauma Therapy: Ted returned to his psychotherapist a year later.  He rarely had panic attacks anymore and when he had them, he knew how to calm himself.  However, he was now experiencing persistent anxiety after he met his father again for the first time since he was a young child.  Their meeting was fraught with tension on both sides.  Ted's father wanted to reconcile their relationship, but Ted was leery because he had a lot of resentment towards his father for abandoning the family.  In addition, Ted realized that his boss had similar characteristics to his father, and Ted was getting emotionally triggered whenever he had to work closely with his boss.  His psychotherapist recommended that they do EMDR therapy to work on the unresolved trauma as well as the current situation with his boss.  She explained to Ted that EMDR therapy tends to be faster and more effective than regularly talk therapy.  Gradually, Ted was able to work through his traumatic reactions within a year of beginning EMDR therapy.  He realized that he could have stayed in therapy to develop deeper insights into himself, but he told his therapist that he would return if he felt the need for delving deeper (see my articles: What is EMDR Therapy?How EMDR Works - Part 1: EMDR and the BrainHow EMDR Works - Part 2: Overcoming Trauma, and What is Adjunctive EMDR Therapy?).

Grief Work in Therapy:  Grief work is focused specifically on helping a client to grieve and mourn a loss.  It can be short term or long term.  With regard to Ted, a couple of years later, Ted found out that his father died.  At the time, they were not speaking because they were not able to reconcile their relationship.  When he received the call that his father died, Ted felt profoundly sad for the loss of his father as well as the loss of not ever having a father that met his emotional needs.  He also felt sad because any chance of reconciling their relationship was gone, and he felt very guilty about this as well.  He returned to his psychotherapist and they did grief work to help Ted get through this difficult time.  Between sessions, Ted kept a journal and wrote about his feelings about his father.  He also organized a photo album with pictures of his father and himself from when Ted was younger.  He was able to work through his grief, and he let his therapist know that he was feeling better and he wanted to discontinue therapy (see my articles: Grief: Coping With the Loss of a Loved One: Common ReactionsComplicated GriefThe Theme of Complicated Grief For a Mother in the Movie, Phantom ThreadHolding Onto Grief as a Way to Stay Connected to a Deceased Love One and Trying to Understand Your Father).

Contemporary Psychodynamic Psychotherapy: Psychodynamic psychotherapy is a form of psychoanalysis.  Generally, it focuses on the unconscious mind and might include dreams and daydreams.  It usually also includes exploring transference issues.  When Ted returned to therapy, he felt lost.  He had just ended an enmeshed two year relationship with a woman that he loved very much when they first started seeing each other.  Gradually, they grew apart, and Ted sensed that he contributed significantly to the demise of the relationship because he had problems committing to his then-girlfriend.  He believed that he had issues with trust and this is what made it difficult for him to make a long term commitment.  He felt he was now ready to delve deeper into his unconscious mind to get to know himself better.  He agreed to attend open ended contemporary psychodynamic psychotherapy with the understanding that he could leave therapy whenever he wished; however, his therapist recommended that it would be better to work together towards termination in therapy when the time came.  Sometimes, Ted brought in dreams to discuss with his therapist.  He was also interested in exploring the unconscious underpinnings of his problems.  Gradually, his therapist helped Ted to make connections between his original panic attacks, his history of childhood emotional neglect, the loss of his father, and his problems with making a commitment in a relationship.  Ted also felt more emotionally integrated in contemporary psychodynamic psychotherapy (see my article: Discovering the Unconscious Emotions at the Root of Your Problems and What Unconscious Decisions Have You Made That Are Impacting Your Life?).

The scenarios above show how one person can choose various forms of psychotherapy over a period of time depending upon the problem and what the client is ready to deal with at the time.

Each form of therapy mentioned above serves a particular purpose and could be appropriate at various times in a client's life.

Getting Help in Psychotherapy
When you decide that you would like to attend psychotherapy, the first step is to contact a psychotherapist for a consultation (see my article: The Benefits of Psychotherapy).

During the consultation, you give an overview of your problem and asks the psychotherapist questions about how she works, what type of therapy she does, her expertise and so on.

The psychotherapist will usually make a recommendation within a few sessions as to what form of therapy she thinks would be best for the client given his or her particular problems.  There are usually a few different ways to work, as outlined above, and depending upon the therapist's expertise.

The choice as to which type of psychotherapy is generally up to the client, unless the therapist thinks that the client needs a higher level of care or a different type of therapy.

Over time, as shown in the examples above, a client can return for different types of therapy (assuming that the therapist does these different forms of therapy) or the client can go to a different therapist (see my article: Returning to Therapy).

If you have been unable to resolve problems on your own, you could benefit from seeing a licensed mental health professional to help you to resolve your problems (see my article:  How to Choose a Psychotherapist).

Freeing yourself from problems that are hindering you from maximizing your potential can lead to living a more fulfilling and meaningful life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article:  The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.