Introduction to Treatment

Patients seek help from a psychotherapist because they experience difficulties in life, relationships, work, or how they feel about themselves. They may feel stuck in some way that they may not yet be able to identify, or they may have readily identifiable psychological symptoms. There is usually therapeutic benefit in someone listening to their story without judgment. It is also usually helpful if someone offers judgment in the form of genuine hope for change and a procedure to achieve relief from emotional suffering. Part of our goal as psychotherapists also involves helping the patient become curious about him/herself, enabling greater possibility of change in perspectives about meaning and experience.

When a suffering individual seeks psychotherapeutic help, there is an immediate benefit which has been described as the restoration of hope or of morale, activated in most people simply from seeking help. Three phases have been described as typical of a psychotherapeutic encounter (Howard et al., 1993; Howard et al., 1996):

• Improvement of subjective well-being (occurring within a session to a few sessions).
• Reduction in symptomatology (requiring a few to many weeks).
• Enhancement of life functioning and character or personality change (requiring a longer time).

The first of these three tend to occur due to the power of nonspecific factors in the psychotherapeutic situation. Hence the finding of similar, early results in studies of different “brands” (see Ablon et al., 2006) of short term treatment at or soon after the completion of treatment.  However, these short term benefits tend to disappear with time, unless changes are accomplished in the preconditions for the development of a symptomatic illness in the patient’s emotional life.

A psychodynamic psychotherapist attempts from the outset to engage in a specific type of relating in conversation about the patient’s presenting difficulties, thereby determining the nature and severity of the patient’s problems, personality traits, patterns in how the patient relates to others, and how the patient sees him/herself. Assessing both strengths and weaknesses, the therapist can form a rudimentary plan for how best to alleviate the patient’s suffering. Depending on the specific psychotherapist and patient, this assessment may include a clinical diagnosis, but the assessment should best involve the formulation of a flexible and workable description of the patient’s emotional difficulties, because formal diagnosis itself tells so little of the nature of the person. Of course, this understanding is always enriched by observations of how the patient relates to the therapist him/herself. Click here for an example of one patient and psychoanalyst’s initial meeting, and the analyst’s efforts to engage an anxious, inexperienced patient about why she presented for treatment.

Early considerations in introducing a patient to psychotherapy involve creating a productive engagement between therapist and patient, and agreeing more or less on a plan for the future. Click here or continue to scroll down to read about general considerations in how to engage patients seeking psychotherapy.