Section Learning Objectives

• Clarify reasons why an individual may need to seek treatment.
• Critique myths about psychotherapy.

3.3.1. Seeking Treatment

3.3.1.1. Who Seeks Treatment?

Would you describe the people who seek treatment as being on the brink, crazy, or desperate? Or can the ordinary Joe/Jane in need of advice seek out mental health counseling? The answer is that anyone can benefit from therapy. David Sack, M.D. (2013) writes in an article entitled, 5 Signs Its Time to Seek Therapy, published in Psychology Today, that “most people can benefit from therapy at some point in their lives” and that though the signs one needs to seek help are obvious at times, people often try “to sustain [their] busy life until it sets in that life has become unmanageable.” So when should we seek help? First, if we feel sad, angry, or not like ourselves. We might be withdrawing from friends and families or sleeping more or less than we usually do. Second, if we are abusing drugs, alcohol, food, or sex to deal with life’s problems. In this case, our coping skills may need some work. Third, in instances when we have lost a loved one or something else important to us, whether due to death or divorce, the grief may be too much to process. Fourth, a traumatic event may have occurred such as abuse, a crime, an accident, or chronic illness. Finally, if we have stopped doing the things we enjoy the most. Sack (2013) says, “If you decide that therapy is worth a try, it doesn’t mean you’re in for a lifetime of “head shrinking.” In fact, a 2001 study in the Journal of Counseling Psychology found that most people feel better within seven to 10 visits. In another study, published in 2006 in the Journal of Consulting and Clinical Psychology, 88 percent of therapy-goers reported improvements after just one session.”

3.3.1.2. When Friends, Family, and Self-Healing are Not Enough

If you are experiencing any of the aforementioned issues, you should seek help. Instead of facing the potential stigma of talking to a mental health professional, many people think that talking through their problems with friends or family is just as good. Though you will ultimately need these people to see you through your recovery, they do not have the training and years of experience that a psychologist or other mental health professional has. “Psychologists can recognize behavior or thought patterns objectively, more so than those closest to you who may have stopped noticing — or maybe never noticed. A psychologist might offer remarks or observations similar to those in your existing relationships, but their help may be more effective due to their timing, focus, or your trust in their neutral stance” (http://www.apa.org/helpcenter/psychotherapy-myths.aspx). You also should not wait to recover on your own. It is not a failure to admit you need help and there could be a biological issue that makes it almost impossible to heal yourself.

3.3.1.3 Prevention

As a society, we often wait for a mental or physical health issue to emerge, and then we scramble to treat it. More recently, medicine and science have taken a prevention stance that involves identifying the factors that cause specific mental health issues and implementing interventions to stop them from happening, or at least minimize their deleterious effects. Our focus has shifted from individuals to the population. Mental health promotion programs have been instituted with success in schools (Shoshani & Steinmetz, 2014; Weare & Nind, 2011; Berkowitz & Bier, 2007), in the workplace (Czabała, Charzyńska,  & Mroziak, B., 2011), with undergraduate and graduate students (Conley et al., 2017; Bettis et al., 2017), in relation to bullying (Bradshaw, 2015), and with the elderly (Forsman et al., 2011). Many researchers believe the time is ripe to move from knowledge to action and to expand public mental health initiatives (Wahlbeck, 2015).

3.3.1.4. So What Exactly is Psychotherapy?

The APA states that in psychotherapy, “psychologists apply scientifically validated procedures to help people develop healthier, more effective habits.” Several different approaches can be utilized including behavior, cognitive cognitive-behavioral, humanistic-experiential, psychodynamic, couples and family, and biological therapies/treatments. (article quoted can be found at: http://www.apa.org/helpcenter/understanding-psychotherapy.aspx)

3.3.1.5. The Client-Therapist Relationship

What is key is the client-therapist relationship. APA says, “Psychotherapy is a collaborative treatment based on the relationship between an individual and a psychologist. Grounded in dialogue, it provides a supportive environment that allows you to talk openly with someone who’s objective, neutral, and nonjudgmental. You and your psychologist will work together to identify and change the thought and behavior patterns that are keeping you from feeling your best.” It’s not just about solving the problem you saw the therapist for, but also about learning new skills to better help you cope in the future when faced with the same or similar environmental stressors.

So how do you find a psychotherapist? Several strategies may prove fruitful. You could ask family and friends, your primary care physician (while your physician can help you find a therapist it is not advisable to seek a diagnosis or treatment from them as they often don’t have the time to conduct the formal assessments required for valid and reliable diagnosis), look online, consult an area community mental health center, your local university’s psychology department, state psychological association, or use APA’s Psychologist Locator Service (https://locator.apa.org/?_ga=2.160567293.1305482682.1516057794-1001575750.1501611950). Once you find a list of psychologists or other practitioners, choose the right one for you by determining if you plan on attending alone or with family, via telehealth or inperson, what you wish to get out of your time with a psychotherapist, how much your insurance company pays for (and if you have to pay out of pocket how much you can afford), when you can attend sessions, and how far you are willing to travel. Once you have done this, make your first appointment.

But what should you bring? APA suggests, “To make the most of your time, make a list of the points you want to cover in your first session and what you want to work on in psychotherapy. Be prepared to share information about what’s bringing you to the psychologist. Even a vague idea of what you want to accomplish can help you and your psychologist proceed efficiently and effectively.” Additionally, they suggest taking report cards, a list of medications, information on the reasons for a referral, a notebook, a calendar to schedule future visits if needed, and a form of payment.

What should you expect? Your therapist and you will work to develop a full history which could take several visits. From this, a treatment plan will be developed. “This collaborative goal-setting is important, because both of you need to be invested in achieving your goals. Your psychologist may write down the goals and read them back to you, so you’re both clear about what you’ll be working on. Some psychologists even create a treatment contract that lays out the purpose of treatment, its expected duration and goals, with both the individual’s and psychologist’s responsibilities outlined.”

After the initial visit, the mental health professional may conduct tests to further understand your condition but will definitely continue talking through the issue. They may even suggest involving others, especially in cases of relationship issues. Resilience is a skill that will be taught so that you can better handle future situations.

3.3.1.6. Does it Work?

APA writes, “Reviews of these studies show that about 75 percent of people who enter psychotherapy show some benefit. Other reviews have found that the average person who engages in psychotherapy is better off by the end of treatment than 80 percent of those who don’t receive treatment at all.” Treatment works due to finding an evidence-based treatment that is specific for the person’s problem; the expertise of the therapist; and the characteristics, values, culture, preferences, and personality of the client.

3.3.1.7. How Do You Know You are Finished?

“How long psychotherapy takes depends on several factors: the type of problem or disorder, the patient’s characteristics and history, the patient’s goals, what’s going on in the patient’s life outside psychotherapy and how fast the patient is able to make progress.” It is important to note that psychotherapy is not a lifelong commitment and it is a joint decision of the client and therapist as to when it ends. Once over, expect to have a periodic check-up with your therapist. This might be weeks or even months after your last session. If you need to see them sooner, schedule an appointment. APA calls this a “mental health tune-up” or a “booster session.”

Chapter Recap

With the conclusion of Chapter 3, you now have the necessary foundation to understand each of the groups of disorders we discuss in the remaining chapters. In Chapter 3 we discussed clinical assessment, diagnosis, and treatment. In terms of assessment, we covered key concepts such as reliability, validity, and standardization; and discussed methods of assessment such as the clinical interview, psychological tests, personality inventories, neurological tests, physical examination, behavioral assessment, and intelligence tests. In terms of diagnosis, we discussed the classification systems of the DSM-5-TR and ICD-11. For treatment, we discussed reasons why someone may seek treatment, self-treatment, psychotherapy, the client-therapist relationship, and evidence for the success of psychotherapy. We discussed some of the specific therapies in Chapter 3 but will cover others throughout this book and in terms of the disorders they are used to treat.