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How Is Modern Psychotherapy Different?

Modern therapy is different from traditional therapy.

“You know that I’ve tried therapy several times, and it hasn’t helped,” a new client said to me.

“Yes, but that may be partly because you kept going to traditional therapists. Maybe you should have tried a different, more modern type of therapy like this one,” I suggested.

“What do you mean?”

“Modern therapy is very different from traditional therapy,” I answered. I went on to explain how therapy has changed and why the new form of therapy might help her.

For example, modern therapy is goal-focused and future-oriented. In contrast, traditional therapy spends most of the time talking about the past. A modern therapist or counselor will probably explicitly ask, usually during the first session, “What is your goal for therapy?” He or she might also ask, but perhaps in a future session, “What would you like to have done when you look back ten years from now? What kind of person, personally and professionally, would you like to be?”

Modern therapy is collaborative. The doctor doesn't necessarily know best. You and your therapist will work together to find what is most helpful. The therapist will tailor what you do in session and between sessions to your needs.

Modern therapy focuses on developing skills and learning tools to help you manage the difficulties in life. Insight is no longer the focus. You will be helped to learn how to be more accepting of your own quirks and the quirks of others. At the same time, you may learn how to tolerate the discomfort of doing difficult often anxiety-producing but important things in your life, for example, asking for a promotion or having a difficult discussion with your partner. You may actually practice (role play) doing something like asking for a promotion in the session with the therapist.

Modern therapy and counseling are often briefer and also sometimes intermittent. Some people may go to a therapist once or twice a week, and that is the right model for them. But others may go on an as-needed basis.

Most modern therapists will discuss the possible role of genetics and neurochemistry. They may encourage you to work to re-wire or re-train your brain. That is, some of your responses are conditioned, habitualized or automaticized responses. To learn new responses, you will probably do special exercises and try new approaches.

Modern therapy sessions are more or less structured. You might not be aware of the structure, but in general each session has seven distinct parts:

1. Introductory “small talk” coupled with on-going assessment

2. Discussing your between-session experiences. Specifically, if you intended to try to do something between sessions, how did that go?

3. Making sure that you both understand the goals for therapy.

4. Deciding on what specifically you want to work on during that session.

5. Doing in-session therapy, which might include practicing a new tool to use to better manage your emotions and/or behaviors.

6. Deciding on what you might like to work on during the coming week.

7. Wrap-up

Your therapist may not follow this structure if something really troubling has happened and you just want to talk or vent. Talking and venting may help, on occasion. But, unfortunately, normally, by themselves, they do not. They may even make matters worse, especially if the therapists lets you go on from session to session.

As I said earlier, you may not be aware of the structure of modern therapy sessions. Better therapists do not stick rigidly to this structure, but not having any structure at all in mind may lead to a lot of meandering and waste of time.

A good, modern therapist will not let the session wander all over the place. “What do you want to work on?” is a common question at the beginning of a session and sometimes even during the session: “But I’m a little unclear. What did you say you wanted to work on?” may help clients focus on what matters most to them at that time. Such questions also help clients become more mindful of the discrepancy between what they say they want to work on and what they are actually doing.

Between-session work is very important in modern therapy. A great deal can be learned from what happened between sessions, but for the therapist, this can be the trickiest part of the session. Sometimes you, the client, could not or did not do what you had intended to do. If not handled carefully by the therapist, that can make you feel worse. On the other hand, accountability was what my client was looking for. She wanted someone to help her do what she wanted to have done during the week. She wanted to find a therapist who would help her learn not to blame herself. It is much better to “blame” the strategy or technique you are using. She needed help developing better strategies to manage her emotions and behaviors.

One time, after a frustrating week for my client, I suggested, “Perhaps you were manifesting “experiential avoidance,” a wonderful term (and concept) used in Acceptance and Commitment therapy. I will send a link to your email. You may find that helpful in understanding what is preventing you from getting done what you want to get done. ‘Failure’ in homework, if handled correctly, can help you become more motivated to try other strategies instead of beating up on yourself.”

How quickly can you tell if you have found the right therapist? If for some reason you do not “click” with that therapist, don't question your intuition. Try another one. A maximum of three sessions should help you decide whether or not a therapist may be able to help you.

You are human, and you want to share your story with another human being. You want someone else to understand what you are going through. But at some point, a good therapist may suggest some form of exercise to do in session or between sessions, an exercise that may help you learn a new tool or strategy to better handle your problems. I have suggested everything from doing a cost benefit analysis (CBA) to writing a list of positive accomplishments to learning something new, such as how to bake a key lime pie.

If your therapist never suggests that you try to do something between sessions or if a therapist forgets to ask about what you had intended to work on, you probably have found another traditional therapist.

Maybe something new and different would work for you. Try it out!

More from F. Michler Bishop Ph.D.
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