Monday, June 21, 2010

What Makes it Psychotherapy?

Years ago, I had a student who repeatedly asked me how psychotherapy works. "How is it different than a conversation?"

When I think of psychotherapy, I think in terms of the
talking itself as being the aspect that helps-- and yes, of course it can be used in conjunction with medications. I think of it as being structured--in terms of time and place and frequency-- and being all about the patient. And whether or not it's actually discussed, some of what works is about the relationship--most people don't get better talking to someone they despise, and the warmth, empathy, feeling listened to and cared for, well, they're all important. And I also think of it as being a process over time. These are all parts of my definition, however, and they may not be parts of yours.

So what about about a one-time event? If someone meets with a therapist once, has wonderful insights and feels better, is that psychotherapy? (--Clink, this is your cue to put up a post about the taxi driver in New Orleans). If someone meets with their priest/hairdresser/auto mechanic once or twice or 57 times and feels better, is that psychotherapy? If someone talks to a friend over coffee every morning while the dogs play, is that psychotherapy (...clearly, it is "therapy" because most things involving either chocolate or coffee have some therapeutic value)? If a patient meets with a therapist every week for an hour-long session for years on end, but never utters a single word, is that psychotherapy?

Some psychiatrists include education about illness and medication as part of their definition of psychotherapy. Others measure it by time---if it's 20 minutes it's a med check, if it's 45 minutes, it's psychotherapy....

Okay, so what makes it 'psychotherapy?' FYI: there's no "right" answer.