For some, going to therapy or counseling is an intimidating, and at times, scary process. We all have schemas of what a therapist’s office looks like or how he or she will act in the first initial encounter. One can imagine that there will be a bookshelf with lots of books on it; perhaps a rug, a lamp, a painting or two, and some couches and chairs. For people who have never been to therapy, there is often this internal perception that someone will be sitting behind them in a chair frantically scribbling on a pad of paper with the occasional, “hmmmmmmm” and “how does that make you feel?”

Now that the one has an idea of what a therapist’s office may look like, then comes the type of treatment, or also known as theoretical orientation, a professional practices from. If the clinician has a web site on Psychology Today profile, words and letters like Cognitive Behavioral Treatment (CBT), Acceptance and Commitment Therapy (ACT), Solution Focused Brief Therapy, (SFBT),or Dialectical Behavioral Therapy (DBT) come up. At the most basic level, all of these approaches guide mental health professionals to help understand and conceptualize the medical condition the patient is coming in for. Whether it is depression, anxiety, a personality disorder, or psychosis, these theoretical underpinnings have tools, interventions, and a lens in which to view the patient and their world.

There are three important factors that direct these various types of orientations and interventions. One is what the patient is coming into treatment for, the other is what is expected of the patient from session to session, and the thierd one is what are the expectations in regards to how long therapy will last. Depending on the therapist you ask and the medical condition/s someone is coming to therapy for, some may say one session, others up to 12-18 sessions, while others may say years of twice a week treatment. When I work with people in treatment and often ask myself, “Is the problem occurring at the symptom/surface level or is the condition rooted within one’s personality?” Nancy McWilliams and Glen Gabbard are both experts in the field of Psychodynamic/ Psychoanalytic treatment and focus on the importance of one’s personality as it relates to current functioning. This type of treatment focuses on gaining insight into unconscious thoughts, feelings and patterns based on past relationship that are playing out in the current moment. This modality argues that defenses, conflicts, deficits and patterns of relating to others occur out of our own awareness but impacts us in our day to day life. Both Drs. Gabbard and McWilliams have treated people for decades and provided support and guidance that go beyond just symptom reduction and truly focus on insight, relationship improvement, increased awareness of one’s internal life, and psychological mindedness.

As a Psychodynamic/ Psychoanalytic orientated psychologist, I often discuss that symptoms may have lead a person to schedule an appointment with me, but in order to get to the origin of one’s depression, anxiety, marital woes or _________, there will be a need to explore aspects of one’s mental life that may have forgotten, put out of awareness or unconsciously defended against. Common themes or sayings that come up in the initial consult sound like, “Why can’t I find a husband/wife?” or “Why is it so hard for me to hold a job?” or “I am not sure why they left me?” Moving beyond just treating symptoms and getting to the core one’s personality can be scary, intimidating, exciting, and/or nerve-racking. It is important to note that this process is done as a partnership and created between both the therapist and the patient. Like any healthy relationship, therapy is no different. There needs to be trust, openness, willingness to explore, and reflection done by both parties with the intention to change and grow. Regardless of the type of therapist you may seek out, co-creating a relationship together with the intention to help and heal is vital. Think for a moment about some of the most positive experiences you have had in your life. Most likely they involve other people sharing that experience with you. It could be the birth of a child, getting a job, graduating from school, all of these events happen in the arena of others with their love and support; the beginning of therapy is built on this same foundation.