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Welcome to Psychotherapy (or "counseling" if you prefer). Our goal is to explain psychotherapy in clear and accessible language -- to demystify the whole subject, without trivializing it. In reading through these pages, you can learn about depression, phobias, anxiety, obsession, attention deficit, learning disability, and a host of other related issues; there are also sections on behavior therapy, children and adolescents, couples, biofeedback, and many more. Primarily, though, you will come away understanding psychotherapy: What it is, how it works, why go, why stop (and when), and what should and should not happen there. 

Psychology, especially psychotherapy, does not translate well into sound bites. A little background is going to make all of the material much clearer. I urge you, therefore, to resist temptation: Donít jump straight to "Choosing a therapist", "When to stop", or whatever else. Instead, try going in the order presented. Also please avail yourself of the many links to case examples and further discussions. You are welcome to visit our forum and ask your questions anonym to the doctor.  Particularly if something seems simplistic, obvious, or vague, these links should be a big help. Some of the case examples are rather long as they illustrate more than one or two points. Donít feel you have to stay with the case from beginning to end. They will be referred to several times so youíll find your way back to them when they are relevant.

Why psychotherapy?  

Put into words, the stuff of psychotherapy can seem hopelessly obvious. One thinks: Of course your depressed friend has nothing to be depressed about; why can't he see it? Why can't you just tell him so, give him some books about depression and how to overcome it, and end the problem that way? Of course the overly timid, cautious, and withdrawn man became that way because he grew up with an intolerant, volatile parent; everyone else who knows the family can see that, and they can see that this man has no reason anymore to be so scared. If they can see all this, why canít he do the same and get moving with his life? Of course the arrogant, know-it-all only irritates the very people heís trying so hard to impress? Why canít he keep quiet a bit, so that he doesnít end up jobless, friendless, and solitary?

The short answer is that it's too painful. Your depressed friend is stuck in this depression partly because, believe it or not, it is easier to feel depressed than to face what really hurts. It is easier for him to believe that everything about him is worthless, however much this flies in the face of all the data, than it is to cope with whatever else is going on. That is why his depression seems so irrational to us -- because itís a distraction from something else. Meanwhile we can only drop our jaws in disbelief as this handsome, talented, successful man mopes that he has nothing and is worthless. The bright and attractive woman who attaches herself to one unreliable and dishonest man after another prefers -- at an unconscious level -- to cry or rage over the current man's behavior rather than to feel and acknowledge more pervasive and unwieldy dissatisfaction with herself and her life. Even the timid soul finds it more comfortable to flinch his way through life than to face all the rage, despair, and fear involved in questioning his habitual view of himself and the world.

Important: These irrational patterns of feeling, perception, and behavior are not chosen or established on a conscious level! Clearly most of us would not engage in such silly behavior on purpose. But these habits develop outside of awareness (and nonverbally) where we canít get at them. Why this is so, and how it happens, was explained in previous three sections

It is this unconsciousness that is key to understanding "Why psychotherapy" (as opposed to other kinds of help). For just as the problems are established somewhere outside your awareness, so too must the cure reach into this area. Otherwise the treatment wonít work. Learning on an intellectual level is rarely sufficient. Take a look at these case examples

see the difference between intellectual learning and the kind of personal insight that is the goal, and the great gift, of psychotherapy.

Just what are "psychological problems"? Whatís a symptom?

Iíve said that symptoms are the expression of oneís being lost or stuck. Now why should that be? How do panic, obsession, phobia, depression, etc. express our having lost track of what we feel, believe, perceive, want, and need? The answer lies in understanding symptoms and defenses.

We all have at least an intuitive sense of what a defense is. When we tell little Suzie to pick up a strayed toy and she erupts with "I didnít put it there!", when our school chum, Harry, treats Linda with extra coldness and disinterest while we all know heís sweet on her, we speak of these behaviors as "defensive". What we mean is that the person is trying, in an especially obvious and graceless manner, to avoid the pain of, and at the same time maximize their control over, their uncomfortable spot. Suzie is feeling accused, put down, even humiliated; Harry fears rejection, humiliation, and a blow to his perhaps already tenuous self-esteem. Rather than acknowledge these unpleasant experiences, the two devote their energy to defense -- to protecting the self and self-esteem.

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Now imagine Harry is extra sensitive in this area, maybe because of his past history, maybe because of his inborn temperament, who knows. For whatever reason, he grows up always on the alert for this kind of humiliation. In response, he redoubles his bravado, behaving towards others with ever more disinterest, independence, "cool". The more uncomfortable he is the more aloof he acts. This sets up a vicious cycle, because those uncomfortable moments are precisely when he most needs reassurance -- and thatís just when heís the least open and approachable. As his discomfort rises, then, he treats more and more people with indifference, even disdain. Perhaps he loses his job and must interview for a new one. With the added pressure and humiliation of needing approval from the people interviewing him, he becomes even more irritable and off-putting. Needless to say, no-one will hire him. He begins to rage inside at all the people who donít appreciate or help him, ruminating on his anger to the point of losing sleep. To relieve the tension, he retreats nightly to marijuana, alcohol, and watching too much television late into the night. The rest of the time, he begins to suffer back pain and a nasty skin rash. Eventually whoever he lives with, canít stand it any longer and leaves.

A personality that began as "defensive" has bloomed into one full of symptoms -- depression, drug abuse, various anxieties, insomnia, "personality problems", even paranoia. Under "DSM Diagnosis", his health insurance claim might list Depressive Disorder, Obsessive Compulsive Personality Disorder, Conversion Disorder, Paranoid Personality Disorder (itís really called that), or several other possibilities.

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