In my experience, patients most often begin psychotherapy while in the midst of intense emotional crises that feel too overwhelming to manage. A patient may be feeling significant emotions such as anxiety, sadness, or hopelessness, or report being in a state of inertia or “feeling stuck.” The presenting stressor may be an ongoing conflict with a loved one, the death of a parent, a feeling of disconnectedness from the world, or problems related to one’s work environment. The person who presents for the first therapy visit often has exhausted his or her coping mechanisms and is looking for guidance.
Because of this state of major internal distress, psychotherapy has become associated with being “defective.” But the bulk of what we do in therapy is not fixing the defects. It’s about beginning a new experience. It’s about learning and ultimately choosing the way you want to live with a better understanding of how previous experiences have shaped and influenced the person you have become.
Psychotherapy is about giving people space to live a more meaningful, purposeful and authentic life with a greater appreciation for the risks, benefits and alternatives to behaving and thinking in certain ways. It is also about developing self-awareness and what Heinz Kohut describes as a “realistic and reliable self-esteem.” Psychotherapy helps people accept the things that cannot be changed and leads to a life with greater integrity. Integrity is a state of existence that is most consistent with one’s own morals and values.
In today’s medical culture, managed care insurance companies often decide whether psychotherapy is clinically indicated, whether they will pay for it, and for how long. There is strong evidence that psychotherapy can be effective and can lead people to live healthier, more productive, and adaptive lives. While media portrayals of psychotherapy are far better than they have been in the past, there continues to be caricatured representations of therapy portrayed on the countless reality television shows.
We all share responsibility for distorting the image of psychotherapy. There continues to be conflict within the field of psychology where there is little collaboration between practitioners influenced by different theoretical orientations such as cognitive behavioral therapy and psychodynamic psychotherapy. The time is now to disseminate accurate knowledge of the utility of psychotherapy. It is in everyone’s interests to dispel the stigma surrounding psychotherapy so that more people are encouraged to take advantage of it.