Introduction to Treatment

Patients seek help from a psychotherapist because they experience difficulties in life, relationships, work, and 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. It may be helpful for them to have someone listen to their story without judgment and accept them as they are. It may also be helpful if someone offers hope for change, clinical judgment, and a procedure to achieve relief from their emotional suffering. Part of our goal as psychotherapists also involves helping the patient become curious enough to establish flexible and adaptive meanings for experiences that may seem to the patient meaningless, confusing, or overwhelmingly painful.

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. In fact 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.

Meanwhile, a psychotherapist attempts from the outset to make a particular kind of connection, in order to engage in a conversation about these difficulties. The therapist thereby determines the nature and severity of the patient’s problem, patterns of how the patient relates to others and how the patient sees him/herself, a formulation of the patient’s maladaptive personality traits and baseline psychological strengths, and a rudimentary plan for how best to alleviate the patient’s suffering. Depending on the psychotherapist, this assessment may involve use of a specific diagnosis, or it may involve the formulation of a more flexible and less defined narrative to describe the patient’s emotional difficulties. Of course, eventually, this narrative and associated plan include considering some aspects 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 to learn about general considerations in how to engage patients seeking psychotherapy.