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Whether therapy works or not is like posing the question, does medicine work?

Whether therapy works or not is like posing the question, does medicine work?  I would see that as “ what medicine are you picking?” And “for what purpose?”

I explain to people who call me, in answer to an opening question, how much do you charge,” that the question signals that these callers believe that all therapy is alike. Nothing could be more false.

What Exactly Does A Therapist Do | When Does Therapy Start Working


The people who come to see me have done much research to find a discipline to help them. Unfortunately, therapists today don’t do nearly enough problem- solving.

In my view, experiences where therapists listen or treat people by focusing on how the client feels rather than how the client affects others, do NOT work.

For therapy to work it must teach new behaviors. Clients need to learn better things to do with what they feel rather than doing  what they do that isn’t working for them. Hence, if what they did worked they wouldn’t be seeking help.

So, whether “therapy” works depends on the kind of therapy, the person of the therapist, and whether the client takes the advice of a well-seasoned therapist.

What Exactly Does A Therapist Do?

Once again, all therapies and therapists are not alike.  Since I have practiced problem-solving therapy for over 35 years, I have watched the power of this model.

It is not a listening experience but a doing experience. The therapist needs to be optimistic about life, relationships, and skilled at understanding the steps for coaching people to get on the right path out of the woods.

Psychiatry in the early 40’s was much different than it is today. The movie, Now Voyager, depicted the first problem- solving therapist. There exists in the movie, a young girl who is house-bound and under her mother’s tyranny. She is understandably depressed. The good doctor arrives and recommends his sanitarium. He explains that that is where he would like her to go. “There”, he says, “I can tell you to go down this path . When you reach the end, don’t turn right, turn left.”  This is my idea and the idea of the wonderful researchers from Palo Alto at MRI.  This is where the field of teaching people the TOOLS for talking together began and the notion that problems exist within relationships and not within people.

Therefore, the job of the therapist is to give people tools for problem-solving, to be interactive, and to model a relationship for the people who come to the office.

Does Therapy Work For Everyone?

There is no magic in therapy. The job of the therapist is to be able to model connection with others. The therapist needs to be clear and able to establish an understanding as to the problem to be solved and to collaborate with clients on possible solutions.

People who seek help need to take the therapy medicine as with any treatment.

I have a lovely practice comprised of people who are well-motivated to improve their relationships.  They keep appointments and do their homework. It is a joy to watch them do better.

Does Therapy Work For Anxiety?

Sometimes people are so anxious that they need adjuncts to a talk therapy. Exercise is the single best treatment. Also,  neurofeedback. The problem with the latter is that it is expensive and not yet covered by insurance.

When treating anxiety, it is important to determine if the anxiety is about things real or imagined. If it is about concrete things, then it is possible to move to  resolve those things.  If the anxiety is about imagined things, then the move is to understand the attachment to those imagined things, and track the anxiety to its source.

Exercise, neurofeedback, and possibly medication, are useful tools in treating anxiety. The medication and/or neurofeedback can relieve anxiety enough to  provide better and calmer thinking.  This can lead to forming new habits as a result of being able to think before doing. Teaching people to get information and to have a plan are also part of good treatment.

Does Therapy Work For Depression?

Absolutely!  Exercise and doing things about which we feel good are the best treatments.

Depression is physiological. Therefore, treatment is about stimulating the brain hormones of which there are three.  Serotonin allows us to expect, remember, and experience pleasure. Dopamine is about depression and norepinephrine keeps mood regular and stable. When one or more of these is dry we get depressed. Some medications can help to save Serotonin but nothing makes it. Alcohol and drugs dry the brain hormones.

Therefore, it is very important when depressed to avoid alcohol and drugs, to exercise, to learn new habits in therapy to enhance relationship skills,  and to be very aware that medication while using alcohol and drugs renders the medication much less effective. Also, to get the most out of any antidepressant, one must exercise in order to make the serotonin that the medication helps to save.

When Does Therapy Start Working?

In problem-solving therapy there is always a phone interview to start. Real problem- solving therapists always find out about the problem on the phone. Thus, we say that therapy starts with the first phone call. When it works, people make a connection with the therapist on the phone and they come to the office.

It has also been written that people who seek a “change-oriented” therapy have already begun to change before the first phone call is made. I see this often.

As some people in crisis will do anything for improvement, change occurs rapidly. For others, change means removing the emotional blocks that interfere with doing sensible things.  This takes longer as people identify the emotional blocks and work to change them. This comes with an awareness that behavior is always purposeful. Often people who come for help have behaviors that serve purposes out of their awareness. Connecting behaviors that don’t work with what those behaviors are trying to solve helps many people find better solutions to their problems.


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