Patrick Pomfrey, Psy.D., is a doctor of clinical psychology in Fairfield, Iowa.
Dear Dr. Pomfrey,
Life was tough when I was a kid. My family was dysfunctional even in its best moments. My father was a bipolar alcoholic, and my mother, I don’t know what it was. She was physically present but emotionally absent, like a robot. Both are dead now. The past shouldn’t be bothering me so much, but it is. Maybe I need therapy, but I don’t even know what that means. Does it really work? Can I go to any therapist? What does a therapist do and what should I prepare for? I’m willing but confused.
The answers to your questions are as complicated as the field of Clinical Psychology is multifaceted and at times divided. There are over 100 types of psychotherapy from which a therapist can chose. To add to the confusion, there are eight to ten different types of therapists, each with varying levels of education.
Psychotherapy has two main models. Essentially, the first model addresses the unconscious mind while the second model deals with the conscious. Each school of psychotherapy springs from one of the two models.
If you bear with me, I’ll briefly describe five major therapies prevalent today. Hopefully, this will assist you in selecting a type of therapy beneficial to you.
Psychoanalysis (PA) was developed primarily by Sigmund Freud early in the 20th century. Here the patient lies on the couch and “free associates” or says whatever comes to mind—without editing. The therapist seeks to bring to light the patient’s unconscious impulses and internal conflicts. PA also emphasizes early childhood experiences and innate stages of development.
Object Relations (OR) holds that relationships are fundamental to the health and well-being of the individual. It posits that we gain self-identity in relationship to another. OR maintains that when relationships are absent or not working, the individual suffers from anxiety, depression, and other forms of distress.
Cognitive Therapy (CT) does not generally recognize the unconscious mind or give significant consideration to events in the patient’s life. Its sole concern is language. CT maintains that thought is the primary cause of anxiety, depression, anger, broken relationships, etc. Its premise is that language influences your experience of life to a highly significant degree. CT teaches “truth-based techniques” that allow the individual to think rationally and create healthy emotions.
Biopsychology or Health Psychology (HP) addresses the physiology. HP in general believes that the problems in the mind begin in the body. A psychologist (in conjunction with a medical professional) in this field may be interested in neurotransmitter levels in the brain, nutrient therapy, blood tests for toxins, etc.
Transpersonal Psychology (TP) is one of the fastest growing fields of clinical psychology. TP maintains that the spiritual dimension of life is fundamental to psychological health and well-being.
Each of these five schools of psychotherapy by itself can be useful. However, recently a new model has emerged—the Integrative Approach. Many psychologists, including myself, feel it is most beneficial to address their clients’ concerns with aspects of each of the five schools of thought. The Integrative Approach seeks to disentangle the patient from their problems in the different spheres in which they actually occurred, e.g., childhood, relationships, toxic thought patterns, etc.
You asked if therapy works. The short answer is yes. Research shows psychotherapy can be very effective. However, you need to choose a therapist wisely. Research also informs us that it is predominately the therapeutic alliance or relationship between the therapist and the client that is responsible for a positive outcome. Of course, it is also important that the therapist is well-trained.
And finally, I hear you when you say you are “willing.” But please know—therapy is not easy. It requires honesty, vulnerability, patience, and the motivation to change. If you wait for the therapist to wave a magic wand to change you or “fix” you—you may be waiting a long time. The journey is yours. A good therapist will not insist on where you should go, what you should think or how you should behave. A respectful therapist will work in collaboration with you and provide insight and techniques to help you attain your goals. A skilled psychotherapist does not take the helm of the ship, but stands by your side assisting you in navigating the ocean of your life.