FAQs on Goal-Oriented Therapy, Psychotherapy and More

If you are hurting inside, or your life just doesn’t seem to be working, talking with friends or family members can sometimes help you feel a little better for a while. But even the most well-meaning friend can’t provide therapy. Therapy is a treatment process that uses specialized techniques of caring that have been designed to offer effective, long-lasting help for people suffering from a wide range of difficulties, such as emotional distress, anxiety, marital strife, fears, a significant loss, or a clinical disorder. Therapy can also help fulfill aspirations for personal growth or self-improvement.

One of the biggest misconceptions about therapy is that seeing a therapist is a sign of weakness. In fact, quite the opposite is true. Recognizing the need for help and seeking professional therapy is a sign of both strength and your determination to live a productive and meaningful life! Working together, you and your therapist will identify your goals (what you want to have happen) and agree on how you’ll know when you are making progress. Therapy has one clear and definite purpose: that something of positive value and constructive usefulness will come out of it for you.

Therapy has often been called the talking cure since the exchange of words between the client and therapist can appear to be the most obvious form of communication that is going on. In reality, therapy can offer a much richer experience than the simple exchange of words and advice. The thoughts and feelings you share and the professional techniques the therapist uses are not nearly as important as the relationship you build together. Because the relationship with the therapist is so essential to the effectiveness of the process, it is very important that you find someone with whom you feel a comfortable connection, a therapist who makes you feel understood.

As therapy progresses and your trust in the therapist’s non-judgmental acceptance of your thoughts and feelings is established, you will actually use the relationship as an opportunity to reshape significant emotional experiences and work through problems in your life. In therapy, you intentionally make yourself vulnerable to another human being and you may talk about some things that are very painful for you.

However, it is the very process of trusting that it’s safe to release your feelings–the good and the bad–and knowing that the therapeutic relationship permits you to safely explore deeply felt sources of conflict and dissatisfaction that will finally allow you to make lasting, positive changes in your life.

Consumer Reports (1995, November) published an article which concluded that patients benefited very substantially from psychotherapy, that long-term treatment did considerably better than short-term treatment, and that psychotherapy alone did not differ in effectiveness from medication plus psychotherapy. Furthermore, no specific modality of psychotherapy did better than any other for any disorder; psychologists, psychiatrists, and social workers did not differ in their effectiveness as treaters; and all did better than marriage counselors and long-term family doctoring. Patients whose length of therapy or choice of therapist was limited by insurance or managed care did worse.

One of the most frequently asked questions about therapy is: Will what I tell the therapist be kept private and confidential? The answer is yes. You have a right to expect absolute privacy and confidentiality in therapy. Without your explicit consent, the therapist is prevented by law from discussing information you share during your sessions with anyone else. Knowing and trusting that anything you say will be safely contained in the therapeutic space is essential to meaningful therapy.

In addition to maintaining absolute confidentiality, the therapist is responsible for establishing an environment that ensures your privacy in every way possible. It’s important to be aware of the impact even the subtlest intrusions can have on your sense of privacy. Encountering another client in the waiting room, hearing someone speaking in the next room during your session, or having your therapist speak on the phone to another client or personal friend are all situations that could make you feel that outsiders are intruding on your therapeutic space and that there is not sufficient privacy for you to talk freely. If this should ever happen to you, tell your therapist as clearly and immediately as possible.

There are some limitations to confidentiality in therapy. The legal system acknowledges that there are times when the client, society or both can benefit from release of information. State and Federal case law defines the circumstances in which confidentiality can be breached. The most common circumstances include:

Third-party reimbursement If your insurance coverage pays for any of the costs of your therapy, you are giving your consent for information such as your diagnosis and appointment dates to be shared with your insurance company.

Defense of malpractice or professional complaint If you were to allege that your therapist engaged in malpractice or some other unethical act, the therapist has the right to disclose information from your sessions in their defense of your charges.

Danger to self or others All states allow a therapist to reveal the name of a client who is deemed a real and present danger to self (e.g., suicide) or others. Some states even require that the therapist warn or attempt to protect the person against whom the threats are being made.

Abuse of children, elderly, or mentally or physically handicapped In most states a therapist is required to report credible knowledge of current or past abuse. This applies to situations in which the client is the one who was abused as well as to situations in which the client is the abuse.

This didactic approach allows for the client and the therapist to develop clearly defined goals as to the focus of the therapeutic relationship. Though varied psychoanalytic approaches are integrated into this process, the client leaves each session understanding where s/he stands in relation to the mutually agreed upon goal(s). The duration of the therapy may be short or long-term depending on the magnitude of the goal and the starting point of the client. Having concrete and clear goals allows the entire therapeutic process to remain more focused than the traditional open-ended approach to therapy.

John Carnesecchi, MSW, LCSW, CEAP, founder and Director of GTS, practices an integrative and didactic approach to therapy that includes many techniques from the following well- respected orientations: Cognitive/Behavioral (CBT), Gestalt, Freudian, Dialectical Behavioral (DBT), Humanistic, Imago Relationship Therapy and Coaching.

Therapy is often used for life-enhancing help in fulfilling aspirations for personal growth or self-improvement. Each year, millions of people seek therapy and receive real help for a number of problems and issues. Therapy can address a wide range of concerns such as depression, relationship concerns, parenting goals, emotional distress, career issues, substance abuse, significant loss, and clinical disorders or conditions.

Mental health professionals often develop expertise in specific areas and establish preferred modes of therapy. At GTS, we work with our clients to determine the most effective treatment plan even when it does not include their preferred orientation or just one specific technique. This can sometimes involve elements of several different types of therapy, for example, a combination of behavioral therapeutic techniques and psychodynamic therapeutic techniques, becoming what are referred to as an “eclectic or integrative approaches” to therapy.

Therapy is completed when the goals of the patient have been achieved. When the patient is able to comfortably experience all his/her feelings, both good and bad, without having to act them out, and when he is able to comfortably related all of these feelings to the analyst and act in his/her own best interest, the therapy is complete.

Short-term therapy can be up to two years. Some clients may only require as little as six sessions to help decide if college is for them or others may take up to two years to help improve marital communications. Short-term therapy is time limited and is often used for clients who are higher functioning and have specific and narrowly focused goals. The therapist will also confront issues in a manner that is active, overt and solution-focused. Please note: Candidates that have chronic disorders may not be a candidate for short-term therapy. After the initial 3-5 sessions a therapist will be better able to assess which therapy modality is most appropriate.

Therapy is best done in-person. For many people who are homebound due to illness, have nonnegotiable responsibilities or are nervous to engage a therapist in-person, can slowly become comfortable with a therapeutic relationship over the phone or on the computer. This approach is not for all clients and generally falls under the short-term therapy modality and/or homebound client. If a client is assessed as having long-term needs s/he will be encouraged to in-person help. Many times the phone sessions involve getting the client into a therapist office and examining the obstacles that may prevent the client from doing so.

During the course of every psychoanalytic therapy, the patient demonstrates behavior that interferes with the progress of the treatment. This interference is called resistance. Because psychoanalytic therapy helps the patient achieve freedom of thought and action by talking freely, the negative emotional forces that caused his/her symptoms manifest themselves as obstacles to the talking therapy. The patient may:

Become unable to talk any longer.
Feel he has nothing to say.
Need to keep secrets from his therapist.
Withhold things from the therapist because he is ashamed of them.
Feel that what he has to say isn’t important.
Repeat himself constantly.
Refrain from discussing certain topics.
Want to do something other than talk.
Desire advice rather than understanding.
Talk only about thoughts and not feelings.
Talk only about feelings and not thoughts.
These and many other forms of possible resistance keep the patient from learning about herself/himself, growing and becoming the person he wants to be. Together the patient and the therapist study the meaning and purpose of the resistance and try to understand the key to unlocking it and allowing the patient to continue growing. Modern therapists recognize that a patient may need to resist, and use a relaxed approach to aid him/her in overcoming the problem.

Often joked about in cartoons, the couch is a much misunderstood, but useful tool in advancing the treatment process. For most psychoanalytic patients, it offers an opportunity to relax, undistracted by the therapist’s visible presence, and comfortably reports thoughts, and feelings as they arise. The use of the couch also emphasizes that therapy is not ordinary social conversation, but a specialized form of communication.