The Role of Psychotherapy in Mental Health Treatment

The world of mental health has changed dramatically in recent decades. More and more mental illness has been tied to underlying biological markers.

Schizophrenia, depression, bipolar illness, panic disorder, and many other forms of mental illness are rooted in genetics and biology. And thus, psychotropic medication has become front and center in treatment. As a psychologist, trained in the art of assessment and psychotherapy, I am often asked what role my profession will play in addressing human suffering? What can psychotherapy actually do?

The relationship between client and therapist in psychotherapy is first and foremost a unique relationship. It is a relationship that is both intimate and professional, where the most difficult and private parts of a person’s thoughts and feelings can be expressed. It is a contained relationship; one meets with a psychologist or other mental health professional usually once per week, sometimes more or less often.

It is within this oasis away from the rest of life that one’s deepest emotions, worries, conflicts, and struggles can be explored and understood. There is no judgment within this oasis and it is not the professional’s job to tell the client what he or she “should” or “shouldn’t” feel or do. It is rather the psychotherapist’s job to help a patient find his or her real truth and direction.

I often think of the analogy of the sport of curling. In this sport, a stone slides on the ice. There is a member of the team who sweeps in front of the stone in order to remove impediments that might slow down or alter the course of the stone. This sweeper is much like a good psychotherapist helping to clear the way so that the client can find his or her natural, “right” path but never actually directing the patient to take any particular course.

There are many different kinds of psychotherapy and practitioners who are trained in particular psychotherapeutic methods. Therapy can be short term and goal focused or longer term and more open-ended. It can focus on a person’s behavior, thought patterns, emotions, or relationships, or it can incorporate all of these elements.

There is not one kind of therapy that is better than another. It depends on the nature of the issues being worked on and also on the way a person feels most comfortable approaching his or her pain. Some people come into therapy with very specific issues they want to address and do this in a time-limited, focused way. Other people may not even know what draws them to a psychologist’s office, beyond knowing that “something just doesn’t feel right.” Whatever the orientation and duration of the therapy, it is a trusting, collaborative relationship between and professional and client that makes it work.

So what does psychotherapy actually do that medication alone cannot do? If one is depressed, antidepressant medication will alleviate many of the symptoms of that depression. It will allow a person’s mood, sleep, appetite, energy, motivation, and outlook on life to improve. And those changes are major. If a person is terribly anxious, medication will calm down the nervous system and make life more doable.

But what can the medication not do? Let’s take as an example a person who becomes seriously depressed after an important relationship ends. Medication is introduced and the symptoms of depression begin to lift. The person feels less fatigued, less hopeless, more able to eat and sleep. The symptoms are managed. But what emerges in therapy is that there is a pattern for this person of selecting partners who tend to be emotionally unavailable. And this is the issue for the therapy. Why might he or she be gravitating to relationships that are destined to disappoint? Until the person explores the answer to that question, there is a strong likelihood that the depression will recur.

Or imagine another client who has a grief reaction following the death of a loved one. But rather than the grief abating with time, it worsens and grows into a major depressive episode. Once again, medication will be immensely helpful in alleviating symptoms. But psychotherapy would be aimed at getting to the reasons why the course of grief has “stalled” and grown roots in the psyche. Perhaps there is guilt about having mixed feelings towards the person who died. Or perhaps there is earlier traumatic loss in the client’s life and the recent death has brought it to the surface. It is psychotherapy that addresses these deeper issues and casts light on what lies beneath the symptoms.

There is another way that psychotherapy can be helpful that is much less specific than these two examples. Being listened to deeply is something that we all seek and in the world of texts, emails, Facebook posts, and Twitter, all of which celebrate a short attention span, the desire to be deeply heard may be stronger than ever in people. Psychotherapy provides a space to explore one’s own internal world in a nonlinear, unedited, open way and to have another human listen to more than just the words that are being spoken.

There are times when a person seeks psychotherapy for what feel like nebulous reasons: “What is my life really about?” “Why is my work no longer satisfying?” “What will I be about when my kids leave the house for college?” “Why don’t I feel close to my loved ones?” “Why am I scared of aging?”

We all need help at times with these more existential questions. And psychotherapy provides space to gain clarity in a powerful and effective way.