A Patient’S Guide to Psychotherapy: And an Overview for Students and Beginning Therapists

By Donald B. Colson, PhD

How therapy works often remains shrouded in mystery for prospective patients and therapists in training, which does nothing to help either party.

Donald B. Colson, who spent his career as a therapist and psychoanalyst, makes the process user friendly with this overview of what you can expect from therapy. Taking a no-nonsense approach, he explores how to tackle problems head on and work with a therapist to solve them. Beginning students of psychotherapy, graduate students, and therapists in training will also find the text instructive.

Colson reviews the reasons someone might seek therapy as well as how to find a therapist that meets your needs. He also explains how therapy works and highlights key concepts such as the centrality of relationships, attachment, unconscious processes, defenses, transference, and counter-transference.

Youll also learn the main reasons patients seek relief, how therapists facilitate change, and the uses and misuses of diagnosis and diagnostic labels.

Seeking help from a therapist does not show weakness; it takes much more courage to confront personal problems than it takes to avoid them. Start overcoming fear, anger, shame, guilt, and troubled relationships with A Patients Guide to Psychotherapy.

• Language: English
• Publisher: iUniverse
• Release date: Apr 15, 2016
• ISBN: 9781491792124

Donald B. Colson, PhD

Donald B. Colson, Ph.D., was raised in Boston, Massachusetts. He worked for thirty-three years at the Menninger Clinic, serving as its director of psychology, teaching, and research. He went on to operate a private practice focusing on group and individual therapy and psychoanalysis. He is retired and lives in Southern California.

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A PATIENT’S GUIDE TO PSYCHOTHERAPY

AND AN OVERVIEW FOR STUDENTS AND BEGINNING THERAPISTS

Copyright © 2016 Donald B. Colson.

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the author except in the case of brief quotations embodied in critical articles and reviews.

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ISBN: 978-1-4917-9211-7 (sc)

ISBN: 978-1-4917-9212-4 (e)

Library of Congress Control Number: 2016904207

iUniverse rev. date: 04/13/2016

CONTENTS

Preface

Introduction

Chapter 1:   1 Your Psychotherapy

A.   Why Begin Psychotherapy

B.   Selecting a Therapist

Chapter 2:   2 Essential Concepts

A.   We are a product of our relationships

Children and caretakers

Neglectful parents

Self Absorbed Parents

Chaotic parents

Our selection bias

B.   Attachment Is a Path To Our Styles of Relating

Family emotional atmosphere and fit

Styles of attachment

A lack of attachment

C.   Unconscious processes: Feelings and Thoughts Which We reject

Unconscious guilt: I am not worthy

Dreams and the unconscious

D.   Defenses: Our means of Reducing Emotional Pain

Repression as censorship

Dissociation as a division or breaking-up of experience

Denial and avoidance as negation and flight

Reaction formation as purging and transformation.

Projective identification as expulsion and control

E.   Boundaries: Where do I end and you begin?

Boundaries protect and confine

The rude therapist

Boundaries are most clear when they are violated

Negotiation of boundaries provide opportunities for growth.

A slippery slope

F.   Transference and Countertransference

Transference shows in emotionally colored perceptions of the therapist

Unconscious emotion

Chapter 3:   3 Symptoms

A.   Depression can be intolerably painful

B.   Anxiety and Panic

C.   Post traumatic stress is pervasive

Chapter 4:   4 Stages of Therapy

A.   The experience of beginning

B.   Initiating a process of inquiry

C.   Timing is important

D.   Collaboration

E.   Facilitating change

Listening and questioning

Confronting and clarifying

Interpretation

Transference and countertransference interpretation

Working through

Enactment

Psychological Mindedness

Empathy

F.   The long Mid-Phase

G.   Ending as a blessing and curse

H.   Some gains from psychotherapy.

Chapter 5:   5 Hidden Influences

A.   The issue of research support

B.   Patterns of reimbursement

C.   Neuroscience and psychiatry

D.   Issues In Diagnosis

Summary and Conclusions

References

PREFACE

Often in the initial stage of my work with new patients I wished that I had something in writing to explain the therapy process. My opinion is that there is too little attention to providing education for our patients. I am now writing to help fill that gap by explaining therapy to patients, what is involved and what to expect from therapy. I will also be pleased if beginning students of psychotherapy, those in graduate schools, training programs, psychiatric residencies find this text instructive. My experiences doing psychotherapy, teaching and conducting research have reinforced my view of the need for such a text. Perhaps a bit about my background will help to better understand the source of this interest and my qualifications for writing about the subject.

When in 1965 I began post-doctoral training in clinical psychology at The Menninger Clinic (TMC) I had little idea about how influential that training would be. While there I honed skills in psychotherapy and diagnosis and became sure that I wanted to pursue training as a psychoanalyst. I studied with some very accomplished psychoanalysts whom I came to admire for their use of psychoanalytic thinking to understand people. The training helped me discover a path to practice the most extensive and intensive form of psychotherapy, namely psychoanalysis. I learned the application of psychoanalytic knowledge not only to individual psychotherapy but also to group psychotherapy, residential treatment, consultation, supervision, diagnosis and teaching. Conducting psychotherapy was, for me, immeasurably enhanced by psychoanalytic training. Over the years I have supervised and taught psychiatrists, psychologists, social workers and others, all made possible by my occupying various positions in the Menninger School of psychiatry and psychology postdoctoral training program. I did become a psychoanalyst and later was appointed by The American Psychoanalytic Association as a supervising and training analyst which involved training others to become analysts. I was awarded honorary positions at Menninger to support teaching and research. I developed and administered a psychoanalytic psychotherapy training program which still thrives. I became a fellow of The American Group Psychotherapy Association. Also at Menninger I served as Director of Psychology with administrative responsibility for more than 25 psychologists. As part of my academic work I coauthored one book and published over forty articles in professional journals.

INTRODUCTION

Most people in therapy will be satisfied to obtain relief from suffering and improved self-esteem. However, some will also want to delve into how therapy works. I write this book primarily for people already in or considering psychotherapy. Perhaps some others, like a family member, might like to understand the process. The book may also be of interest secondarily to various student groups as an overview of psychotherapy: graduate students in mental health areas, in psychotherapy training programs and study groups. For the readership of experienced therapists there are clearly much more detailed discussions in greater depth elsewhere. If written for the advanced professional the book would be much longer, review more literature, and have many more references. But this effort is primarily designed for patients and for that group it is quite comprehensive.

I describe myself as psychoanalytically oriented and explain to my patients the difference between psychoanalysis and therapy guided by psychoanalytic principles. Psychoanalytic refers to an extensive field of study and practice, beginning with Sigmund Freud and grounded in ideas of internal and interpersonal conflict and unconscious mental processes. The therapy conducted by many therapists, while not labeled as psychoanalytic, rests on psychoanalytic principles, for example the concepts of transference and countertransference to be discussed later. Psychoanalytic therapy can be any number of sessions and duration can be as brief or as long as needed. Psychoanalysis, on the other hand, is more specialized, the most intensive and extensive form of therapy. It is not for the majority of people. It is frequent meetings(three to five sessions a week), typically continues for several years and must be conducted by a psychoanalyst. The training takes five or six years and sometimes longer. It is well worth keeping in mind that there are many individuals for whom psychoanalytic psychotherapy, with less frequent meetings is as effective or more so than psychoanalysis (Wallerstein, 1986). With experience therapists gradually come to believe in the usefulness of inquiry and exploration.

There are few professions both more taxing and rewarding than being a psychotherapist. It is our privilege as therapists that our courageous patients share the details of their hopes, fears, vulnerabilities, and most private thoughts and concerns. We are honored with the rich life stories entrusted to us. I often tell my patients of my appreciation for trust they extend to me.

In contrast to the view, held by some misguided and fearful people that therapy is for the weak, the use of therapy, in fact, requires strength. More courage is needed to tackle personal problems that to avoid them. In some ways, treatment is not easy. There are stresses on the patient and therapist. You must attend regularly, tolerate the financial sacrifice, make therapy a priority in your life. As patient you are faced with an ambiguous task with only a few guidelines to direct you. You will be invited to explore painful experiences involving fear, anger, shame, guilt and troubled relationships. Uncertainty, an inherent part of the therapy experience for both patients and therapists, is among the hardest feelings to tolerate. However, therapists are trained to deal with uncertainty. As you have not had such training, it is the therapist’s job to educate as