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What is Psychotherapy? Is It Right for Me?

Psychotherapy or "talk therapy," whether conducted in-person in an office or remotely via videoconferencing, can be broadly described as a collaborative relationship between a patient and a psychotherapist that alleviates suffering and dysfunction, increases self-awareness, facilitates growth and change, and enhances well-being. 

 

The therapeutic relationship works in part because of clearly defined roles and responsibilities held by each participant. This framework creates the safety to take risks and the support to make changes. Social scientists and practitioners alike have long debated the “active ingredients” of psychotherapy and how it works, and it is variously seen as a science, an art, and even a bit of magic.

 

Psychotherapy is both a way of understanding human behavior and of helping people with their emotional difficulties and personal problems - issues that are causing them distress and/or disturbances in their functioning. Therapy is designed to help patients of all ages address areas of concern or dissatisfaction in their lives and understand how their thoughts and feelings affect the ways they act, react, and relate to others. In addition to alleviating symptoms and internal and/or interpersonal distress, psychotherapy aims to help people experience life more fully, enjoy more satisfying relationships, and better integrate all parts of their psyches and personal narratives. Regardless of the specific problems and concerns a patient brings to therapy, the overarching objectives are to improve their quality of life and sense of wholeness.

 

The process of psychotherapy varies depending on the personalities of the psychologist and patient, and the particular problems the patient brings to therapy. Therapists have different styles and ways of conducting therapy, some more active and directive than others, and a variety of methods may be used to treat the problems that a patient hopes to address. Because self-knowledge and self-awareness are seen as key elements in changing attitudes and behavior, psychotherapy likely involves the development of insight, along with new tools and skills for managing life more effectively.

 

Psychotherapy is not like visiting a medical doctor. Instead, it calls for very active and ongoing engagement and effort on the part of the patient. In order for therapy to be effective, the patient must work on the issues being addressed, both during sessions and between appointments. Considering that a typical therapy session is only one hour in a 168-hour week, it makes sense that the patient must import and integrate what is being learned in therapy into their day-to-day lives for real progress to occur. New insights must be applied and new skills practiced. Though the process of change can be challenging and even frustrating at times, the amount of work invested in therapy is directly proportional to the benefit derived from it. 

 

In addition to active participation in and beyond the therapy, successful psychotherapy involves transparency on the part of the patient. It is essential that the therapy patient is open and honest with the therapist, even if doing so is painful or embarrassing. Lack of complete openness strips therapy of its meaning and potency and can perpetuate or exacerbate psychological problems, such as dissociation and denial. Contrary to popular belief, therapists are not mind readers and usually cannot tell when patients consciously or unconsciously conceal things. Therapists can only help patients to the extent that they are provided with the whole, unvarnished truth. 

 

Participating in psychotherapy takes courage, the courage to face oneself and one’s demons. Painful emotions and memories of painful experiences press for expression and release. Avoidance or suppression will not make them go away. Though therapists cannot magically erase the anxiety and pain associated with such issues, they can provide pacing, support, and tools that may help reduce the intensity of the work. Therapists can help patients slowly overcome feelings of hopelessness and helplessness, and can gently nudge them past avoidance and resistance, but ultimately, the desire to get well and function well can only come from the patient. Patient motivation is perhaps more determinant of therapeutic outcome than any other factor.

 

Whether or not psychotherapy “works” also depends a great deal on the patient’s ability and willingness to experience all relationships deeply, especially the therapeutic relationship. Within the crucible of this relationship, patients have an opportunity to view themselves more accurately, to identify repetitive patterns of behavior, and to make connections between past and current conflicts that illuminate the way they relate to themselves and to others. Patients are encouraged to talk about thoughts and feelings that arise in therapy, including feelings toward the therapist. Sometimes misunderstandings can occur between a patient and a therapist and sometimes patients develop troublesome feelings toward their therapist, such as anger, fear, or attraction. It is essential that all of these feelings be discussed and worked through in the context of therapy. These feelings are important because elements of one’s history of important affections and hostilities toward significant others are often transferred onto the therapist and the process of therapy. The skilled therapist uses the relationship itself to provide a “corrective emotional experience” for the patient.

 

The relationship between a patient and a therapist is a real relationship, though special and possessing unique characteristics that make it therapeutic. By relating to a patient authentically, the therapist affords the patient honest feedback and the safety to practice new skills and experiment with new ways of being and relating. Depending on the theoretical orientation and technical approach of the therapist, he or she may assume a variety of roles in relation to a patient. These roles might include expert, advisor, guide, confidante, coach, consultant, navigator, teacher, mentor, parent, shaman, or guru. The key to a successful therapeutic outcome is the proper match between the personal manner and style of the therapist and the needs of the patient. A “good fit” is crucial, and prospective patients are best served by taking the time to find it.

 

Psychotherapy can be relatively short-term (8-16 sessions) when the focus is limited to resolving specific symptoms or problem areas, or longer-term when the treatment targets more pervasive or long-standing difficulties or patterns of behavior. Variables that determine the course and length of therapy include session frequency, the nature and severity of the symptoms or problems brought, the motivation of the patient, and the quality of the patient-therapist relationship.

 

One need not be suffering from a diagnosable “mental illness” or even be symptomatic to benefit from psychotherapy.  Many people enter therapy for increased self-awareness and personal growth, rather than to solve problems or alleviate suffering. Thankfully, the stigma that was once associated with consulting a mental heath professional has diminished, and engaging in psychotherapy is considered one of many paths to greater wholeness as a human being.

What is Telepsychology? Is It Right for Me?

Telepsychology refers to the provision of psychological services remotely using telecommunication technologies, such as interactive videoconferencing (via the Internet), telephone, mobile devices, e-mail, chat, or text-messaging. It is alternatively referred to as telemental health (TMH), teletherapy, telehealth, telemedicine, remote therapy, online therapy, e-therapy, video therapy, or virtual therapy. Though Telepsychology has been in existence for many years, it has recently experienced an explosion in the face of COVID-19, the global pandemic. Unable to safely meet patients face-to-face in their brick-and-mortar offices, psychologists world-wide have re-tooled their practices to work with their patients remotely. The infrastructure to support this “virtual revolution” is likewise evolving, including technological innovation, legislative enactment, and buy-in of the health insurance industry. In the face of a public health crisis, many rules governing the provision of telehealth that made it prohibitive in the past have been relaxed or suspended, and "red tape" has been slashed. Telepsychology’s time has come, and it’s here to stay!

 

Psychotherapy in particular has “translated” well to virtual venues because the objectives and processes are the same, whether conducted traditionally in the psychologist’s office or remotely on a video platform. The encounter is still live, still face-to-face, and still driven by the auditory and visual communication that’s been “grist for the mill” of the psychotherapeutic process for eons. The laws and professional standards that govern the delivery of in-person, in-office psychological services, including those regarding confidentiality and record-keeping, also apply to Telepsychology services. 

 

Telepsychology has revolutionized the delivery of mental health services by removing barriers and expanding access to care. The ability to work together without being in the same physical location addresses challenges associated with the following conditions and circumstances:

 

  • Public health emergencies, such as COVID-19, where proximity is inadvisable due to threat of viral spread 

  • Homebound due to chronic illness, disability, physical immobility, or certain psychological conditions (e.g., agoraphobia, severe depression)

  • Lack of safe, reliable transportation

  • Stress of traveling, parking, and sitting in a waiting room

  • Living in a small community where privacy/anonymity is a concern

  • Living in a rural or remote community where services are limited or not available at all

  • Lack or limitation of local providers with a particular needed specialization

  • Difficulty taking time off work or school to travel to appointments

  • Geographical distance between patient and psychologist

  • Acute illness with concern of contagion, undesirability of being away from home, and/or inadvisability of travel

  • Child-care or elder-care responsibilities

  • Inclement weather and associated travel advisories 

  • Stigma associated with accessing mental health care

 

The primary challenge associated with technology-assisted treatment is technology itself. Though wireless connections drop, videos freeze, and sound quality can be spotty, these “glitches” are no more likely to happen than getting stuck in traffic on the way to your provider’s office or endlessly circling the block to find a parking space. 

 

There’s a substantial empirical base for the efficacy of Telepsychology. The vast majority of comparative research studies suggest that Telepsychology is as effective as traditional, in-person psychotherapy. Once considered merely a “viable alternative,” it has now become a preferred modality for many consumers who find it to be a safe, private, flexible, convenient, and efficient way to access services. 

 

Thanks to a global pandemic and associated legislative mandates, most insurance companies now cover Telepsychology services, often at the same rate as in-person services. However, some third-party payors may not cover services delivered remotely or may cover them at a lower rate. If you are using your insurance to pay for services, in- or out-of-network, it’s important that you contact your insurance company to determine the Telepsychology benefits of your particular plan. 

 

You’re a good candidate for Telepsychology if… 

  • You’re located in the Commonwealth of Massachusetts where I’m licensed. While the status of interjurisdictional practice is rapidly evolving, current licensing laws require that the treating psychologist be licensed in the same state where the patient is located and prohibit psychologists from practicing across state lines.

  • You have a computer with a webcam and a reliable, secure Internet connection (hardwire or Wi-Fi), or a smartphone or other device with video and audio capability.

  • You have access to a quiet, private place, free from distractions and interruptions.

  • You are not currently in a crisis situation requiring high levels of support or intervention.

 

Despite its many advantages, Telepsychology isn’t for everybody. If, at any point, we determine that you would be better served by in-person psychotherapy or other services, I will assist you with a referral to a provider in your area. 

New Patient Forms

If you're a new patient with a scheduled appointment, the following .pdf documents and forms are for your use. The first set is for your information and to be retained for reference. The second set is to be printed, filled out, and returned to me electronically prior to your initial appointment. Please click on each document to open and download.

Informational documents to be read prior to initial appointment:

Forms to be completed and returned prior to initial appointment:

Form to be completed later, as needed:

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© 2020 L. Saxon Elliott, Psy.D.