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I have found, over the years that some people enter psychotherapy with the naive expectation that taking a medication will cure their emotional troubles. Along with this unrealistic expectation is the equally unrealistic belief that just coming to a session and talking for one hour per week will answer their questions enable them to feel happier in their lives. In my long years of experience as a therapist I have learned that there are no "quick fixes" for our psychological and mental problems and issues. In fact, achieving goals in therapy depends upon the patient working hard during the week in order to move treatment forward and towards its successful conclusion.

First, it is important from the outset for patient and therapist to set realistic goals and objectives to aim for and achieve. This helps make treatment more specific. Without goals and objectives psychotherapy can feel very "fuzzy" and unclear to the patient. In addition, if is the therapist who sets the goals then the patient cannot take ownership and responsibility for the treatment. Goals and objectives must be set by patient and therapist deciding cooperatively what is most important to achieve and they need to be stated in specific and concrete terms.

Second, it is important that the patient be given homework assignments. Assignments can be in the form of reading and completing forms to help them examine their behaviors, thoughts and feelings during the week. Ultimately, the purpose is for the therapist to enable the patient to learn how to replace unhelpful and unrealistic or distorted thoughts with those based more on objective facts. One of the great manuals that I have my patients purchase and use during and after treatment is the one by Burns, the Feeling Better Handbook (available at most book stores). In it Dr. Burns explains cognitive behavioral therapy and asks the reader to do a variety of exercises to help him modify thinking in order to interrupt depressive and anxiety producing thoughts with those that are more helpful and empowering. For instance, if I am a hypochondriac I may believe that I will become ill with the Aids virus just by shaking hands with clients. I need to explore the actual facts of the situation and come to a more realistic conclusion such as: "It is difficult or impossible to spread and catch the Aids virus except through an exchange of fluids through intercourse or through injecting myself with drugs using newly infected needles. What I can realistically conclude is that my chances of getting the Aids virus is zero because I am not gay nor am I a drug abuser of any type. Then, I can feel a lot less anxious.

Third, it is important for the patient to bring with them their log entries accumulated each week from doing the homework so that we can explore the nature of the thoughts that gave rise to depression or anxiety.

Fourth, homework involves doing suggested activities to reduce stress, anxiety and depression. These activities include such things as:

1. Meditation

2. Yoga

3. Exercise

4. Deep breathing and muscle relaxation

5. Applying the learning from cognitive behavioral therapy by interrupting the automatic thoughts that cause problems.

In no way am I implying that patient and therapist do not talk about problems in the present and in the past. It is just that, in discussing these things, patient and therapist have tools to help alter thoughts and feelings about both the present and past.

My point is that psychotherapy is hard but rewarding work. Feeling and functioning better does not happen as a result of a "magic pill" or by the therapist "curing the patient."

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

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Thank you!

Offensive - - Oct 15th 2010

Hi, I was reading this article and found it mostly helpful and enjoyable save one part. "What I can realistically conclude is that my chances of getting the Aids virus is zero because I am not gay nor am I a drug abuser of any type." I don't think I need to explain myself but I will. To suggest that only gays and drug abusers are at risk for HIV infection is not only incorrect and misleading it is also offensive and stereotypical. To suggest to someone that is unrealistically afraid of infection that they don't have to worry based on that information is misleading to that person.

- Lucy - Mar 18th 2009

Mary, Couldn't agree more with Dr. Scwartz. Get a new therapist. And don't hold back those feelings

The Therapist's Commitment - Allan N Schwartz - Mar 16th 2009

Hi Mary,

What you describe in your E. Mail about the behavior of your therapist is very troubling. Psychotherapy is NOT the place for a therapist to discuss their personal life, whether it is vacation plans or anything else. In addition, it is very troubling that she is cancelling your sessions to travel and gives you homework without ever discussing it with you.

I do not like saying this but it seems to me like it is necessary for you to find a new therapist. Here are some additional thoughts I have:

1. You must let her know how you are feeling about what she is doing. It is very unhealthy for you to keep your feelings and thoughts to yourself.

2. You could bring charges against her at the state controlling or licensing board because her behavior borders on the unethical and, really, is unethical.

3. Remember, you are paying her and why? She is not delivering the service that you contracted for.

4. Find a new therapist.

Dr. Schwartz

commitment of therapist - Mary - Mar 15th 2009

I have been attending therapy for just over two years now.  I note the importance of "homework" between sessions and would welcome this.  However I have found from the beggining that my therapist will suggest that I do something like collage, or writing etc and bring it to the next session, which I always do, however it is never asked for or raised again by the therapist.  Im always left with a sense that shes forgotten that she suggested it, therefore each sessions appears to be isolated from the one before or the next one.  This causes me real frustration.  Ive also noticed that since the beggining of this year, she is out of the country a lot with other commitments and Im left with a sense that her work in this country is secondary to other stuff, which is fine, however im left paying my fee, and what is it for.  At an appointment two weeks ago, she asked me to do something and bring it to the next appointment.  I did do it and found it really difficult to deal with, I arrived for my appointment last week and the first thing she told me was about very exicting develoepemnts in her personal life and how she wouuld be away for a number of weeks, She was clearly very happy and kept smiling  I sat there thinking how can I bring out this work, which was very painful for me, when shes clearly over the moon about this news and therefore distracted.  I left the session at that point and received an email the next day asking to let her know why I had left so soon after arriving.  She clearly had not a clue what she had done,I was really pleased with her news, knowing how important it was to her, but should she not have left it until the end of the session?

You also mention stating goals etc, this is something that she has never done with me and I really relate to the term "fuzzy" but more for the client in this case.

I would love to hear if anyone else if having these kinds of experiences within therapy

Mary

A committment that - RJS - Feb 1st 2008

My psychotherapy (twice and sometimes three times per week) was the one committment I could make at that time. For me it took over ten years. But the fact that I kept that committment, (regardless of how many times I felt angry, hurt, or thought I was RIGHT and the therapist was wrong and therefore I had to leave)is what eventually led to my major transformation.

I used to spend much of my time crying. I had no full time work, and no full time relationship with a special man. I was very anxious, self conscious,had a binge eating disorder and I was just full of basic self hate.

My life now looks better than I'd ever envisioned it could......but it wasn't magic....it was that ole "Keep Coming Back", that committment. I hardly ever cry now. I've been happily employed as a Hospice Music Therapist for almost fifteen years. I married my "Mr. Right" last year at 58 years old. I'm taking antidepressants, prescibed to me years ago. I feel basically stable, centered,with a lot of love to give....even to myself.

My life is very full now and I no longer need therapy, but I share my story for any who hessitate to make that committment, or who doubt the enormity of the healing impact of therapy in one's life.