Psychotherapy
Psychotherapy is counseling by a trained psychologist or psychiatrist in order to help a patient work through a difficult issue. Psychotherapy is a key element in the treatment of substance abuse disorders, but it is also recommended for people with mental illnesses, anxiety disorders, mood disorders, eating disorders, sleep disorders, personality disorders, and psychoses. Some people who are not struggling with formally diagnosed mental disorders enter psychotherapy because they are going through family or career conflicts, recovering from physical or sexual abuse, need to improve anger management, or need to learn stress reduction techniques. Others just go into counseling to better understand themselves and to grow as individuals.
Psychotherapists can have a variety of qualifications. Psychiatrists are medical doctors who specialize in mental diseases. Psychologists usually have PhDs or Psy.Ds with emphasis on psychotherapy, but they are not graduates of medical schools. Licensed professional counselors, licensed social workers, and psychiatric nurses can also provide psychotherapy.
A typical session lasts 45 minutes to an hour. The format can be individual or one-on-one, in which the only people in the room are the patient and therapist. Group therapy involves a therapist leading a group of people who share experiences and learn from one another. Couples therapy is between a therapist and a couple working through problems in their relationship. Finally, family therapy involves members of the same family working with a psychotherapist who helps them develop better means of communication or deal with a crisis, such as a family member in drug rehabilitation.
A person in treatment for a substance abuse disorder usually will go through psychotherapy within all of these formats, not only while he is in a formal, full-time treatment program, but also once he returns to his normal life.
The most commonly used one-on-one psychotherapy for substance abuse disorders is called "cognitive behavior therapy," which is designed to help a person identify limiting beliefs and replace them with positive ones. Another common one is "dialectical behavior therapy," which helps people better tolerate stress, improve relationships, and manage emotions. Some people will also need to undergo "psychoanalysis," which involves going back over the past to understand why you behave the way you do in the present. Some therapists require their patients to do homework, such as keeping a journal, filling out a workbook, and so forth.
Besides individual, group, family, and couples therapy, a person in substance abuse treatment will probably also experience art, music and/or drama therapy, in which a therapist uses the fine arts to help patients express their thoughts and feelings.
How long you have to remain in psychotherapy depends on individual factors such as your personal rate of progress and the severity of your problems.
A psychotherapist is a trained professional who guides a client through each therapeutic session and helps him to change the self-destructive patterns of thought and behavior that are sabotaging his life. Client and therapist usually meet in confidential sessions at least once a week for 40 minutes to one hour.
Psychotherapy is a major part of drug and alcohol treatment. If a client is living in a residential treatment center, she may see her therapist three or four times a week, as well as participate in group, family, and/or couples therapy.
The goal of psychotherapy is for a client to gain insight into his problems so he can change his life. Although many people in substance abuse treatment programs are there by court order or because their families, loved ones, or even employers intervened and pressured them to enter treatment, talented psychotherapists can help them take responsibility for the problems their substance abuse has created for others and for themselves, as well as help them to understand the necessity for change.
The theory behind psychotherapy is that people do not willingly become self-destructive. They are often unconscious as to why they continue drinking or using drugs after their lives have spun out of control, especially if they want to quit using their substances. Psychotherapy helps them develop insight, a term defined as a sudden intuitive understanding of an old situation. Insight brings unconscious motives into awareness so that the patient becomes aware of why he is acting the way he is and can affect change. A good psychotherapist does not give advice, but rather helps clients solve their own problems in their own individual ways and in their own time. For this reason, a psychotherapist cannot determine how many sessions will be needed. Once he and the client agree that a treatment has been effective, then they can decide together to end it.
Besides "insight," clients in psychotherapy experience a phenomenon called "resistance." This means that as the therapist gets closer to the deepest and most secretive areas of their psyches, clients resist talking about it. They give reasons why they don't want to talk about a particular issue, and this is known as being "defensive" or "resistant". It is up to the therapist to help clients feel enough trust and courage to let go of their defenses so that they can develop insight into their problems. Resistance is hardest to break through when a patient's problem involves an entire lifestyle, as is true for substance abuse and alcoholism. There is usually less resistance over a specific issue, such as treating a phobia about elevators.
The vast majority of people in treatment for drug and alcohol problems have psychiatric comorbidities, which means they not only are diagnosed with substance dependency, they also have at least one other mental problem, most often depression, attention deficit disorder/hyperactivity, borderline personality, and so forth. The comorbidity is often one of the underlying causes of the substance abuse. For example, a person with untreated attention deficit disorder/hyperactivity may have experienced repeated academic failures, problems in relationships, difficulties holding a job, and other extraordinary stressors that are contributing to current alcohol or drug abuse. Many people who are clinically depressed are "numbing" their feelings with chemicals. All these issues must be addressed during psychotherapy.
As the person in psychotherapy begins to change, the most important people in his life have to allow and support his lifestyle changes or his substance abuse treatment will fail. For example, if both spouses use drugs and one enters treatment, that relationship must change or it is doomed to fail. If a teenager has been drinking and acting out because of family pathology, his family dynamics must change or he cannot return home and stay well. For this reason, residential treatment centers offer family or couples therapy to people who are closest to the person undergoing treatment.
Since Sigmund Freud first invented psychotherapy a hundred years ago, many psychologists have broken away from strict Freudian principles and developed new approaches. Most practicing psychotherapists are eclectic, and know how to use different theories and techniques to best serve each individual client. However, cognitive behavioral therapy is most often a component of substance abuse treatment. Under this theory, the therapist helps a client to recognize the distorted beliefs and patterns of thinking that are perpetuating her self-destructive behaviors. For example, a person struggling with alcoholism may have an underlying belief, "I cannot get through my day without a drink." A person who has become psychologically dependent on a party drug lifestyle may believe, "None of my friends will like me unless I do ecstasy." Cognitive behavioral therapy used in conjunction with medications has been shown to work faster in many substance abuse cases than conventional psychotherapy.
Clients who enter a residential treatment program are often assigned to a therapist at that time. The directors of a good therapeutic program will only employ top-notch people who meet state licensing criteria and the educational requirements of their profession. Anyone can use the title "psychotherapist." However, certain other titles refer only to professionals with certain kinds of training.
Psychiatrists have the most extensive professional qualifications, in that they have graduated from colleges and then medical schools, undergone extra training in psychiatry, and passed state licensing tests. Only psychiatrists can prescribe medications. A "psychoanalyst" is a person who graduated from an institute that provides training in psychoanalysis. Psychologists have PhDs in psychology, which means they have about five years of graduate level training in the field after four years of college. However, some PhDs who pass licensing tests do not have actual training in human psychology, but rather they have studied the behavior of laboratory animals, written treatises on theories of psychology, etc. Psychologists with the PsyD degree have up to four years of training beyond college with an emphasis in actual counseling, and not the science of psychology. A psychologist with a Masters degree has two years of graduate training, although some also do internships to gain experience working with clients. Social workers who have the title "LCSW" are "licensed clinical social workers," which means they are trained in one-on-one or clinical therapy.
One of the best ways to find a good psychotherapist is to ask friends, your doctor or attorney for a referral. Sometimes a therapist's qualifications are not as important as the individual "chemistry" between you and that person. After two or three sessions, if you do not feel comfortable or if you do not feel that your therapist's comments are helpful, it is time to find a new one.
