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How Therapy Actually Works

Lisa Abdilova

It's time to let go of this outdated, stigmatized perception of therapy.

Personally, I am convinced therapy works, because I've read the outcomes research and studied the healing effects of therapeutic alliances. I've also heard countless stories from professionals and therapists all over the world about the transformative powers of their supporters.

Maybe you're not so sure about therapy yet though, and that's okay. If the stigma wasn't so strong, maybe more of these stories could reach you too. Imagine your friends posting "Therapy worked for me!" on your Facebook feed.

Till then, hear Jay Reid, data scientist & psychotherapist intern, explain the benefits of therapy, the importance of the right match, and how he knows therapy works.

LA: "Hey Well Connected Now, it's me, Lisa Abdilova, here with San Francisco therapist-in-training, Jay Reid, who I'm excited to introduce you to. I'll ask Jay some questions to give you an inside look into how therapy actually works. It's going to be great. Now I want to give you the chance to introduce yourself to our community of professionals all over the world.

JR: Great, thanks Lisa. My name's Jay Reid, and I'm a practicing psychotherapist intern in downtown San Francisco. I've been doing that for the past 3 years, and I'm really excited to be here today.

LA: Awesome. So, I know that you come from a data science background, and so, of course when it comes to data science, having quantitative, objective data that you can look at is important. Well, I'm wondering if you can tell us based on that experience--

How do you know therapy works?

JR: Having the analytics mindset does help with this question, and I know it on three different levels.

The first one is my own experience. I've been in my own psychotherapy, or been a client, and found it to be immensely helpful in me achieving the goals in my life that I want to, that are right for me, and correspond to my deepest values - what I want in my life.

The second one would be the changes I see take in effect in my own clients in my own clinical work-- where by building a very trustworthy, attuned relationship with someone, I've seen them make use of that to go into their own lives and make decisions where they're showing a higher valuation for themselves, their feelings, their experience, then maybe they've done in the past, or maybe doing that with their partner, becoming more capable of understanding that partner's experience and connecting to it and then enjoying a much richer and deeper relationship.

The third part that tells me therapy works is nothing I've discovered, but rather 60 years of psychotherapy process and outcome research.

What research shows is that people who receive psychotherapy are better off symptom-wise than 80% of those who do not go, or who go untreated, and don't receive psychotherapy.

You know it's big because these findings are controlled studies where someone is getting psychotherapy, and someone who looks very similar to that, who's randomly assigned, is put on a waiting list.

During that time, the person who receives psychotherapy improves remarkably better than the person on the waitlist. So it's not just sort of "time heals all wounds" - it's that something effective is happening in therapy.

LA: Yes!

What other factors do you think are important in finding just the right therapist for someone?

JR: Well, I think it's about fit -- how understood [you feel], and part of the process of feeling understood, I tend to think, means not feeling judged or labeled, or in any way undermined or anything like that, but really feeling aligned with by the therapist. Research supports this too.

What research finds is it's not necessarily the brand of therapy, such as cognitive-behavioral-therapy (CBT) or psychoanalytic analysis, or Acceptance and Commitment Therapy (ACT), that have different rates of improvement, or one's more effective than the other.

It's actually the quality of the alliance between the therapist and the client that is one of the most predictive factors of symptom improvement.

That corresponds to common sense too. Lots of people who go to therapy may, in the first session, feel like I just can't connect with this person, and unfortunately, they may leave.

So, I think a service like Well Connected Now is actually doing a great thing, because you're saying hey, we're not going to leave you in the lurch if you don't feel that alliance. We're going to help you and circle the wagons so you do find that person. And research supports that is going to lead to better outcomes for your customers, which is why we're all in this anyway, right.

LA: Exactly, Yes! It's so unfortunate how many people have taken the daring and courageous step to go into a therapist's office for the first time, and then ended up walking out feeling worse then they came in.

Unfortunately, a lot of those people have written off therapy altogether, and what we want to show, is that hey, maybe that specialist that you talked to didn't practice the most evidence-backed approach to what you were struggling with. Maybe they didn't have that background, because they didn't specialize in what you're struggling with.

Jay, tell us, for example, if a client was struggling with addiction or body image issues, how different would their therapist be from someone who'd be coming in with social anxiety?**

JR: Well, that's a good question. Things like addiction and eating disorders can occupy their own sort of niche. In the sense that, and I've worked in addiction, and in those cases, I liken it to doing psychotherapy, but with the awareness that if the addiction really takes hold with the client, it's a possibility that they're going to take the car and drive it 30 mph into a brick wall... It could be that life threatening.

So, you've got this specter of a potentially bad outcome happening, and you're also trying to provide what good therapy is: support, attunement, empathic understanding. So, it's markedly different in that way because you never want to discount the severity of the addiction, and you know within addiction and body image disorders, it's a body and mind "disorder" that affects their thinking. So, being watchful of that addictive or binge/purging way of thinking and processing reality and countering it is different. There's a bit more urgency to that in the work, then say if someone wasn't in the throes of of an addiction or an eating disorder where their health was potentially being compromised. So, I think that it's extremely important [to find the right therapist], particularly in those areas. In other disorders like social anxiety, which I think, is another good example, because you may read a lot that CBT is the only treatment for social anxiety - you'd read that maybe on an internet website, but the research also suggests otherwise.

Psychodynamic therapy achieves similar outcomes at termination, and in a few studies, better outcomes at 6 months follow-up, which supports this other finding that it's not necessarily the type of therapy, it's the quality of the connection.

LA: Yea, it's this balance of it being so important that the match is compatible, and it's also important that the therapist has some frame of reference to the distorted thinking patterns behind those challenges.

JR: Yea, another point too about finding fit and the therapists' contribution to that is them feeling effective in treating this type of problem. And if it happens to be addiction, if you're not trained in that and experienced in it, it's going to be hard to feel effective and have a sense of confidence in that.

And that likely will be felt or at least noticed by the client, and that could pull down the alliance and make it harder. I think they all work together hand in hand to create a right fit or alliance.

LA: Wow, so it's their lack of familiarity and potential expertise in that area that could effect their confidence, which could get in the way of the actual connection.

JR: Right. So that is good because all the training we go through- it's for a reason--which is cool that it actually plays into the outcome in that way - potentially a little indirectly via the alliance, but still importantly, nonetheless.

LA: Great, thank you.

For the people who haven't been to a therapy session before, could you tell us more about what types of conversations come up?

JR: Sure. I should first say that people don't usually lie down, and a lot of us don't have beards or wear glasses or elbow patches.

So, you're sitting across from one another, and what I - I mean some therapists are different - but what I tend to do is say this is your time, and what I'd like you to do is just talk about what's on your mind.

In the course of doing that, what I will be trying to do is follow you and reflect that back to you, and that's not just verbally -- I really try to get myself into the experience you're having. Even non-verbal things like facial expressions can all be part of that. This is all towards the goal of you feeling comfortable in going even deeper into your experience and what you're feeling and exploring it.

You'll know that you're not going to get labeled or questioned or judged. You're being sought to be understood.

Once that really gets under your skin, then you really believe it and feel that that's what's happening here, then you begin to make really good use of the time.

You go and feel things, become aware of things that just weren't necessarily there before, or see the same thing but from a different vantage point that generally serves your interest.

So, I think it's a good thing and hopefully most people will feel better after a therapy session when practiced in this way then not. I think feeling better is a marker of good things, and you shouldn't necessarily have to feel bad or not understood.

LA: It's also amazing to have someone that could listen to all the skeletons you may be hiding in your closet, and be able to tell you that hey, they like you anyway. They still want to see you next week and that you still have incredible strengths that balance out the qualities you may be beating yourself up for, or that may be limiting you.

So many challenges are treatable, and not enough people know what therapy can do for them, or what therapists can do for them, which brings me to my next question --

Based on your experience in the corporate and data science world, what do you think most people don't know about what therapists are actually like?

JR: Well, I've found that in the corporate cultures I've been exposed to, everything is about solving the business problem at hand, and you build relationships with people and they're close, but depending on the environment you're in, there's going to be certain limits about how much you can disclose about how you're feeling that day or something that's on your mind, or things like that.

If you're in an environment where that's just not part of the interpersonal currency, like it's not normal, in a sense, to say yea, I'm having a terrible day. I had a bad argument with my partner last night or something to that effect, so that you can get that off your chest, feel a little bit better, feel a little connected to somebody else, and then move on to the problem at hand--then it can create a kind of thing where people are wrestling with a lot of stuff, but kind of within the silo of their own mind, and potentially not with the awareness that there's a better way to do it.

You can go talk to somebody and that feeling like you're walking with somebody in this, rather than having to deal with it all within yourself is just so empowering for the person, for people, but I don't think that that is a widely known or felt sentiment. I think it's more like just- handle-it-all-myself. It's certainly not welcome in a lot of corporate cultures, so I'm just going to do my own thing.. that's how I'm going to do it.

Unfortunately, a lot of times then, things may need to come to a head, before it's time to reach out. So, yea, it'd be great if therapy were less stigmatized and more openly accepted and recognized for the benefits that it can hold.

LA: Yea, and that more people could reach out sooner. Research shows now that it takes people an average 10 years of struggling before they ask for help, and.. Why? You don't need to wait that long.

There's people who can help, and they've spent years in professional training figuring out exactly what types of questions to ask and what types of skills to teach to help you get through the tougher side of life.

You don't have to do it all on your own. You can find a great therapist like Jay Reid right here, or of course we could help you find just the right mentor, coach, or therapist through Well Connected Now. Any last words?

JR: I just want to thank you for this opportunity. I think Well Connected Now provides such an important service, especially because of that stat -- you know offering a very accessible touchpoint for people to get into the world of empowering themselves with therapy or coaching or mentorship. It's such an important mission, and I'm just really happy to be a part of it today.

LA: Thank you. We're rebranding mental health together, right?! #FightTheStigma.

Alright well, we hope to hear from you soon. Thank you so much for taking the time and thank you all for listening.

Take care of yourselves.

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