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Friday, June 30, 2017

What Kind Of Therapy Is Best For Me?

What kind of therapy is best for me?
By David G. Markham, L.C.S.W.
Question:

I have been depressed and unhappy for many years, and have finally wondered whether psychotherapy can help me. I have done some reading and talked to friends and I know that there are psychoanalytically trained therapists and cognitive behavioral therapists, and people who do all kinds of therapy. I found a web site which said there are over 500 different kinds of psychotherapy. I even wonder if hypnosis would help me?  How can I choose what kind of therapy would be best for me?

Answer:
You have asked an excellent question and one which many people find perplexing. There are many ways I could answer your question. Let's start with the practical approach first.

I think the best way to find a therapist is to ask friends, relatives, your doctor or pastor if they know of a good therapist.  I think the best way to find a therapist is the same way to find any professional, by asking other satisfied clients.

A more conceptual way of answering your question would be to share a little bit about the therapy field. There are many schools of therapy which have their own training programs and credentialing standards. These programs  "certify" the competence of the practitioners in their method. The fact is that competence does not equal effectiveness. In other words, a practitioner can be very competent and heavily credentialed but still not help the client achieve any better outcomes than someone less well trained. This seems to be a puzzle in the field. Often psychotherapy training programs and institutes claim that their credentialing standards exist to protect clients. Interestingly, there is no evidence that any particular model or technique gets better results than others when scientifically evaluated.

When researchers examine the outcome in psychotherapy they find that the variables which contribute to good outcome are as follows: extra-therapeutic factors 40%, relationship factors 30%, hope and expectancy 15%, model and technique of the therapist 15%

Extra-therapeutic factors include things like persistence, openness, faith, optimism, supportive family, membership in a religious community, satisfying work, good friends, enjoyable hobbies, and all the other positive things in a client's life before they enter therapy.

Relationship factors include feeling understood by the therapist, having trust and confidence in the therapeutic relationship, feeling cared about, etc.

Hope and expectancy sometimes has been referred to as the placebo effect, that is, does the client believe that therapy can help? The more the client believes that therapy can help, the more likely it is that it will.

The model and technique of the therapist only accounts for 15% of the outcome, while the other three factors account for 85% of the likelihood of a positive outcome.

So, to answer your question about how to choose a therapist, I think it is important to find a therapist whom you feel understood by, whom you come to feel you can trust and put your confidence in. A couple of visits should be enough to make this determination. If you have met with a therapist two or three times and still don't feel understood by that person, or feel you can trust and put your confidence in that person, it is not that psychotherapy can't help, it is just that you have a bad match and you should save your time and money and try again with someone else.

The outcome research is very clear that psychotherapy does help and that the majority of people who use psychotherapy report improvement in as few as 4 sessions.

The overall length of therapy depends on the client’s goals and purposes. In a crisis, most clients find things improving in 4 to 8 sessions. For other problems and concerns, clients may want to continue in therapy for several months. It usually isn’t necessary to meet with the therapist weekly after the initial phase of therapy (the first 3 or 4 visits) and clients may want to meet with the therapist every other week or every three weeks, or once per month. Sometimes people want to see how things go for a period of time and return on an as needed basis.
Usually within a month or two, most clients find that they are managing things more effectively in their lives, and they are feeling better.

Reference ; The Heroic Client, Barry Duncan and Scott Miller, San Francisco: Jossey-Bass, 2000, pp.56-61

Thursday, June 29, 2017

Approval can be like a drug

Approval can be like a drug.
By David G. Markham, L. C.S.W. _ R.

I went to church yesterday and the priest said in his homily that approval is like a drug.

I started thinking that he's right. Approval makes people high. Some people will do anything for it. I have known people who have cheated, lied, stole, killed, screwed, taken drugs just to make others happy so they can get their approval.

What is it that makes some people crave approval?

Low self esteem? Insecurity? Low self confidence?

Some people need to be loved by others because they don't love themselves, and because they don't love themselves they don't believe that anyone else could really love them either, and because nobody else seems to love them, they don't love themselves. Dog chasing its tail. Vicious circle.

Advertisers know how to play on this lack of love and craving for approval. That's how they sell their products. They tell us that if we wear these clothes, and use this perfume, and drive their car, then other people will approve of us and we will be happy.

My son worked with some guys who robbed the Olive Garden at 2:00 AM when they were closing. Got away with $258.00 to be split three ways for hip hop clothes for the rapper's concert coming up on Saturday night. Got caught. Got three to five in State prison.

I knew these kids' mother. She claims they didn't do it. My son says the guys were bragging about it looking for approval.

Preacher's right. Approval is just like a drug.

Some people will do anything for it. Even ruin their lives.

How to kick the habit?

When you quit, you go through withdrawal. You get depressed. You get anxious. You get paranoid thinking people are saying nasty things about you.

When you start being yourself and saying "No" to people, they start to wonder what's gotten into you. They will say that you are being bad, or that you are crazy, or that you are being disloyal and not wanting to fit in with the group any more.

You start finding new friends and new things to do. You start to realize that you are looking for satisfaction and fulfillment from using your talents and abilities in ways that you enjoy, and that you find following your interests rewarding. If people approve, that's great. If they don't, you still had a good time.

Having a mind of your own feels good. Standing on your own two feet feels solid. Counting for something which is important to you, gives you confidence.

Kick the habit, and be yourself. Take yourself out to dinner and see how you enjoy the company. Wherever you go, that's where you'll be, and you won't need the approval drug.


Remember the bumper sticker that says "If you don't stand for something, you'll fall for anything."