What is the purpose of psychotherapy? What are the goals?

Psychotherapy is a talking process between a patient and a psychotherapist that involves looking at feelings, behaviors, impulses, and thoughts through a process of self-reflection. The purpose of psychotherapy is to explore life patterns and to learn what works and what gets in the way of feeling successful and fulfilled. The goals are to reach one’s fullest potential. This is done by changing, improving, and unlearning habits that get in the way and strengthening habits that are working. This includes learning and developing new habits. The basic idea of psychotherapy is that the past influences the present, and understanding this connection can be helpful in planning the future.

How does psychotherapy work? What is the psychotherapist’s part? What is the patient’s part?

Psychotherapy works by making connections among feelings, thoughts, impulses, and behaviors to understand what gets in the way of meeting life’s goals. This includes learning how to get around those obstacles and unlearning emotional habits that do not work. The psychotherapist is the tour guide, mentor, teacher, coach, and supporter through this process. The patient’s part is to show up and be who he or she is. This means participating in the process, asking questions, challenging the psychotherapist when necessary, and continuing to work through any hard parts of psychotherapy as a partner with the psychotherapist.

Why does psychotherapy sometimes seem hard and why does it take time?

Psychotherapy seems hard because sometimes it is hard. If it were easy, everyone would stay home, do it by themselves, and save a lot of time and money. It takes dedication and courage to decide what to change and then to do it. Psychotherapy is like everything else that matters—it takes work. It takes time because it has taken time to get to the present day, so it takes time to learn, grow, and develop into the person the patient hopes to become.

How is behavior (and behavioral self-control and change) an important part of psychotherapy?

Behavior is a way to communicate with others and to get emotional needs met. However, behavior cannot be out of control, or it is disruptive and does not help to meet life’s goals. For example, other people will not want to be in a relationship with an out-of-control person. Therefore, the out-of-control person will not get his or her needs met. Improved behavioral self-control can be an important part of psychotherapy as well as an important part of getting health care needs met.

Why do patients sometimes feel some of the same feelings in psychotherapy that they feel in the rest of their lives, and that originally brought them into psychotherapy?

Feelings, thoughts, impulses, or behaviors from one situation or relationship can be “”transferred” onto another situation or relationship where they may not belong or fit, including onto psychotherapy. This is a way of remembering, called “transference.” We may not be aware of this transfer. That is, it may be unconscious. The feelings or behaviors may seem stronger than necessary and may not make sense in the present situation. This is often seen in everyday life with expressions such as, “He/she really pushes my buttons,” “He/she really rings my chimes,” or when we see or feel something and wonder, “Where did this come from?” An important part of psychotherapy is learning that these feelings, thoughts, impulses, and behaviors belong to the past and do not have to run our present lives. This includes any feelings related to the psychotherapist that may have come up as part of the process.

How can these experiences be used to meet the goals of psychotherapy?

By becoming aware of and understanding the connections between past and current feelings, behaviors, impulses, and thoughts, we can understand how to make different choices and have different reactions in the present and future.

Why do patients sometimes feel stuck in psychotherapy and how can they get unstuck? How can this stuck/unstuck process help to meet the goals of psychotherapy?

We all have “resistances” that get us stuck and get in the way of everyday life and meeting life’s goals. These are old emotional habits that began as ways to help us feel safe. They protect us against ideas, thoughts, memories, or behaviors that may have once been threatening, frightening, or upsetting. When we feel stuck, it is because we have reached a sticking point that we have never been able to get past before. We secretly do not want to change, because in some odd way the familiar is comfortable, even though we are trying to change and the old way is not really working anymore. Here, with a well-trained psychotherapist, is where old patterns can be recognized and unlearned, new patterns can be learned, we can get unstuck from sticking points, and make progress toward reaching life’s goals.

What does research show about making psychotherapy work effectively?

Research shows that psychotherapy focused on feelings, instead of just behaviors or thoughts, is most effective. In addition, it is most effective to focus on recurring themes and patterns (emotional habits), and to look at how the past has helped to form the present, so that the future can be different and we can meet life’s goals.

How can patients know if psychotherapy is working effectively?

Psychotherapy works when both patient and psychotherapist are committed to working as a team. There is progress. They both work together to get past difficult or “stuck” spots in the process and move forward. Making errors or getting stuck, if properly addressed and corrected, does not have to mean a failed psychotherapy. It can lead to growth.

How can patients know when psychotherapy is successfully completed?

When the issues that brought the patient to the psychotherapist’s office in the first place are no longer present, or are barely present—rearing their heads primarily only in times of stress and more easily handled—psychotherapy is done. The patient feels able to handle life’s ups and downs without the psychotherapist. Leaving psychotherapy is as important as coming. It should be accompanied by feelings of balance, self-confidence, and hope for the future. Rough spots or “stuck spots” have been resolved. The psychotherapist and the patient have worked through many transferences, including any that came up as part of the process between them. An important and challenging task for the psychotherapist is to be able to keep the patient engaged in the psychotherapy process during the rough spots. Ultimately, it is important to know how and when to help the patient see that psychotherapy is completed. It is time to say goodbye, as difficult as that may be sometimes, and go on to a fulfilling, content, hopeful life.

Peggy A. Rothbaum is a psychologist.