What do you do in individual therapy? Understanding mental health treatment. Part 4: Individual therapy

We have finally arrived at our final act on this series of understanding mental health treatment! I am aware that this series did not cover couples therapy and family therapy which are also different kinds of treatment. I will most likely address couples and family therapy in future articles. For now, this series on understanding mental health treatment is coming from the perspective of an individual seeking services rather than a couple or group.

Individual therapy is what most people think about when they think mental health treatment. No, people are not laying down on the couch while a psychologist is doodling pictures on their notepad (though I wouldn’t be surprised if there are some still out there!) This form of treatment is definitely the most customized to the person on addressing specific needs. In most cases, people seek out individual treatment because they want to feel better and to get support in achieving certain goals. There are certain experienced symptoms that are distressing and a person simply wants them to go away. The symptoms can range from uncomfortable emotional states (e.g., sadness, anger, anxiety), somatic discomforts (e.g., chest pains, muscle tension, stomachaches), skill deficits (e.g., social skills, anger management), and undesirable circumstances (e.g., strained relationship with spouse, sexual problems, lack of friends). The hope of therapy is to change those distressing symptoms into resolution and a state of relief.

One common misconception is that the therapist has magical powers to make the symptoms go away while the client plays a passive role. While the therapist may have some psychology knowledge and special skill sets, the therapy process is very collaborative and requires a lot from the client for change to occur. Clients need to want that change more than the therapist does as well as be willing to make changes that are often uncomfortable and challenging. As the saying goes, “You can lead a horse to water but you cannot make it drink.” I may have all the best intentions and desire the very best for my clients but I cannot do “Jedi mind tricks” to make someone want something they do not want. Those are the therapist’s limitations!

In terms of interventions to help relieve clients of their symptoms, there are two kinds of interventions similar to the two kinds of groups: 1) insight-focused and 2) skills-based. I really like the analogy of different kinds of art to illustrate the differences. In insight-focused interventions, it is like having a huge block of marble with the masterpiece of Michelangelo‘s David trapped inside of it. The work of the artist is to chip away at the unnecessary marble to reveal the masterpiece that is already inside. Likewise, insight focused interventions involve asking the right questions and helping the client make the necessary neural connections to understand what got them in this mess to begin with. This is under the premise that “The truth shall set you free.” It is hard to know what the solutions are to your problems if you do not know the reasons as to why you have problems. By getting rid of the barriers and extra noise involved in someone’s life, the client is able to see clearly what the core problems are so that it can inform you on what to do next. Sometimes I do not even need to give any sort of recommendation to clients. When the client has the safe space to be honest with him or herself and put everything out in the open, the client realizes what needs to be done which can create a very powerful “ah-ha” experience. I believe the best solutions are the ones that clients come up with themselves! The therapist simply helps people recall, realize, and make the brain connections to get them there.

The second type of interventions are skills-based interventions. Skills-based interventions can be compared to a painter working with a blank canvas. This is when the “expert” role kicks in and the therapist teaches the client skills that one never had before. Like a canvas, the therapist helps paint onto the canvas something new and a beautiful creation unfolds. Some common examples are teaching coping strategies such as deep breathing techniques, muscle relaxation skills, imagery-based skills, and different ways of seeing the same situation. The key to success with skills-based interventions is demonstration, practice in session, and more practice outside of session. I do not believe in a one-size-fits-all technique so I will often teach many different skills to add to one’s toolbox with the goal of discovering the skill that works best for the individual.

Lastly, individual therapy needs to be meaningful to you the individual. It is the therapist’s job to formulate a treatment plan and understand the possible reasons for these challenges but ultimately what is most important to you will be most important to the therapist. A skillful therapist will know how to blend and shift between insight-focused interventions and skills-based interventions depending on what the client needs most. Your voice matters and it is important for you to speak up on what is most important! For more entries like this, please visit me on my blog.