The key to successful therapy – psychotherapy; includes related article

Paul G. Quinnell

The Key to Successful Therapy

Anxiety, depression, headaches, panic attacks, anger, loneliness–these and other signs of distress are what prompt most people to seek out therapy. And while they’re usually unsure about what’s causing the problem, they hope the therapist will relieve it directly–or at least help them find relief for themselves.

This pain is the first thing I see when someone comes into my office, and it becomes the first order of business: Relieve the person’s distress as quickly as possible. But although symptoms usually bring people to therapy, simply relieving distress won’t produce lasting benefits. This requires goal-setting, a task I consider the heart of successful therapy. This usually happens in two stages: early, short-term objectives followed by later, long-term goals.

To get the most out of therapy, it’s important to understand how the process operates. Therapists generally start with what we call our working hypothesis–a best-guess answer to the age-old therapy question: Why now? What, we ask ourselves, tipped the scales? What happened that brought this man or woman to this particular office at this particular time?

We try to come up with some sort of answer by the end of the first interview. Doing so helps us make a better diagnosis of what’s wrong, which in turn often suggests a specific treatment. Moreover, as we accumulate more and more research, better diagnoses should lead to more effective therapies. The answer to “why now” also makes it more apparent exactly what the client needs and expects from us.

If the answer is simple, the goals we set later can usually be simple. If the client says, “I want you to teach me to be strong enough to ask my boss for a raise,” the therapist can say yes he can or no he can’t. “I want to lose 30 pounds” or “I’m afraid of heights and I’d like to fly to Chicago to see my mother” are equally clear.

It is the rare client, however, who comes to a first appointment with such specific, measurable goals. Most are much less sure what it is they hope therapy will accomplish, beyond giving them some immediate relief. But unless goals are set as soon as possible, clients may waste time and money looking for help that doesn’t exist, and therapists may waste the clients’ time working on problems the clients don’t consider problems.

Stage One: Setting Early Goals Here’s how to start deciding what you want your therapy to accomplish: 1. As best you can, jot down what you think is causing you distress. This list of events, relationships or stresses can be long or short, but simply writing them down can help you understand better what has been going on, and going wrong.

Bringing this information to your first session will help the therapist understand you better from the start, and the process of preparing it may help you collect your thoughts for the first appointment. Your insight reveals a lot about how you think and how you understand the way life works. Left to their own devices and theories, therapists may come up with all sorts of reasons their clients are suffering. They can be dead wrong and start therapy off on the wrong track, heading in the wrong direction. 2. After the first visit, consider carefully how comfortable you felt. Will you and the therapist be able to work together week after week? Since a good relationship is so important in successful therapy, you should feel a satisfying level of trust and understanding early on.

If you didn’t like her, or felt he talked down to you, or found yourself drawing away and losing hope, look for another therapist. Research suggests that patient-therapist compatibility is the best predictor of how well therapy will go. It’s important, however, not to give up on therapy itself just because you don’t click with the first person you see. 3. As you work with your chosen therapist in setting early goals, try to make them measurable in some way. This isn’t always easy, but when the changes you want can be measured, it’s a lot easier to tell, down the road, how well the therapy is working.

For example, if you and your mother have a disastrous relationship, one goal might be to carry on a telephone conversation with her without losing your temper. After you’ve done this three or four times, you’ll know you’ve made progress.

Sleeping through the night without nightmares, raising your grade-point average, gaining or losing weight, giving a speech without your knees knocking together–all are measurable goals that will let you know how the therapy is going. Goals that are broad, vague or built on psychobabble (“I want to get my head together,” or “I want to be a fully realized human being”) are neither helpful to you or your therapist nor are they easily achievable.

It’s best to help set your own goals. But if you like leaving difficult questions to the experts or find this goal-setting business confusing, don’t worry about it. A big part of any therapist’s job is to help you clarify exactly what it is you want to change and to help you agree on what the two of you will do together to achieve it.

Long-Term Goals:

The Important Next Step While agreeing on early, measurable goals is vital, I often spend much of my time helping a client clarify longer-term goals for change that are really goals for life: success, rewarding relationships, creative expression, a sense of competence and confidence in handling conflict–the ability, in Freud’s words, “to love and work.”

Because determining what you’d like to do with the rest of your life involves your personality, beliefs, values, dreams, ambitions and imagination, there is no easy way to go about it. But successful therapy demands precisely this sort of self-exploration: looking into your future after carefully examining your past and, in the process, preparing you to set a fresh course for the life you want.

One recent client–I’ll call her Sandra–is a good example of how the process works. She had come through her divorce successfully, moved to a new apartment and was thinking of changing her job. After 20-some sessions, we were sorting out the kind of future she wanted. It was the first time in her life, Sandra told me, that she felt truly responsible for her own future. The experience was both heady and frightening.

“Ted always made the big decisions,” she explained. “I guess I just came to rely on him. In a way, I can feel myself wanting you to tell me what to do next.”

But Sandra had learned the therapist’s Prime Directive: We help people grow; we don’t tell them where and how. She had also learned that excessive dependency could be destructive. As we entered the final stages of therapy, Sandra was doing the hard work, setting goals for herself, her future.

“It’s scary,” she admitted, “this taking charge of my life. But then again, it feels pretty good.”

COPYRIGHT 1989 Sussex Publishers, Inc.

COPYRIGHT 2004 Gale Group

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