To any of you following the blog, my apologies for being away. Sometimes life gets busy.
the topic I’ve been pondering is in the title. Anyone who enters into psychotherapy does so because they want to change. Something’s wrong; the person is unhappy– typically diagnosable with a mental disorder. In many cases, people will simply see a primary care doctor and get a prescription for some kind of medication rather than engage in talk therapy. This is another way of dealing with the symptoms. The person’s hope is that it’s possible to change without having to do anything other than learn how to take the medication regularly. However, they may have to learn to deal with other issues, such as side effects from medication. These may include things like weight gain and sexual dysfunction. But if the side effects are less unpleasant than the symptoms, then they’ll do it.
Other people may not want to take medications. Is it possible to get relief from symptoms through talk therapy alone? Well, yes. Cognitive therapy in particular has been examined in clinical trials and found to be equal to medication– and with no physical side effects. The length of treatment in many cases is about the same amount of time you would spend taking a class at a community college– and the work is probably not as hard as some of those courses! But there is homework, and cognitive therapists will tell you that if you don’t do the homework, you won’t get the results.
I’ve had various experiences with clients over the years, but one thread is that people hope that by coming to therapy they’ll get “all better real fast.” If I could do that for people (to the extent and at the rate they want) I’d have a clinic with my name on it and infomercials on TV. So the bad news is, the miracle cure in the world of talk therapy doesn’t exist (yet– let’s be optimistic). BUT the good new is, there is a clear and workable path to feeling better, and for many it is not that long. AND the principles for change have long been well known.
Let me digress, but for a purpose. I take guitar lessons. My teacher has been teaching for forty years. He has a student who has been with him for thirty years. I mentioned this to someone I know who is a professional musician. They asked, “isn’t that unethical to charge someone for lessons after that long? shouldn’t they just be playing together as equals?” I tactfully brought this up with my teacher, who I believe to be ethical, and he smiled. “He doesn’t practice,” he said. “He only plays when we’re together, and he does guitar camp for a week once a year.”
I hope the point is quickly taken. There are, in fact, people who come to therapy and are greatly engaged during the session, but who then leave and do nothing to change during the time before the next session. These people make slow progress. I typically give clients homework. I tell them that getting better is a process of learning and change. Some work harder than others. How hard are you working on the changes you want to make?