Your Questions, Answered

Psychotherapy can help with a wide range of problems. You may have difficulties with your relationships, your family, your career. You may be struggling with your creativity, or your sexuality. You may be feeling depressed or anxious. Perhaps you have suffered a bereavement. Maybe you see yourself repeating self-destructive behaviours again and again  without understanding why. Or you may have lost your sense of purpose in life, and be searching for greater meaning. Whatever your internal emotional problem, psychotherapy can help. In fact, research has demonstrated that the average person who has received treatment is better off at the end of therapy than 80% of those who haven’t yet entered therapy. (Lambert & Ogles, 2004, Wampold, 2007.)

We will schedule an initial session. I recommend an extended initial session of 90 minutes or more, schedules permitting, as in my experience the regular 45 minutes is never usually enough time for the first meeting. You will have a lot you want to tell me and I will have a lot I want to ask, and the extra time gives us the space to really begin exploring your issues in depth, to make real headway in understanding their underlying causes, and also to begin the work of creating change. By the end of this session you should have a really good sense of how I work and of whether working together could be helpful to you. After this initial extended session, if you decide you want to continue, we would usually meet for 45 minutes each week, in a regular time slot, until we have achieved your therapeutic goals.

The duration of therapy varies from individual to individual, as it depends on so many factors, including the nature of your problems. It used to be thought that people required years of therapy to achieve results, but we now know that for many people this is not the case and that it is possible to effect lasting change in a relatively short amount of time. For some people as few as ten sessions can be enough, for others forty or sixty sessions. For some people more long term work is necessary. We will aim to work together until all of your goals for therapy are met, although of course it is your right to stop therapy at any point.

Confidentiality is extremely important. It is vital that you feel you can speak freely and openly in your therapy session. I can assure you I take confidentiality very seriously.

The great news is that therapy does work. (Lambert & Ogles, 2004, Wampold, 2007.) And here’s how:

Most of us struggle with difficulties at some point in life. Very often we are unaware of the deeper, underlying causes of our problems, we just know that things aren’t working for us; we’re suffering. What we discover in therapy is that many of our problems are the result of outdated coping mechanisms, deeply rooted in emotional learnings from the past.

All of us learn various coping strategies for dealing with the world from an early age. We learn from what we’re taught, but also from what we experience. The problem comes when the lessons learned in past situations don’t work so well in the present. We then behave automatically based on emotional experiences from the past, when the present situation actually requires a different response. These outdated coping strategies then start to cause us problems, leaving us less adaptable to different situations, and sometimes causing the very opposite of what we want.  

In therapy, we will work together to explore your problem deeply, so we can discover the original emotional learning that is at the root of the problem, and then work through all the feelings involved to provide you with the new emotional experience required for your symptoms to fall away. 

This is not just theory: we now have an ever growing body of research, and the latest findings from neuroscience, to tell us how and why therapy works.

Neuroscience now shows us that experiences involving strong emotion leave a particularly strong impression on our brains. (Milner, Squire & Kandel, 1998; Roediger & Craik, 1989; Siegel, 1999; Toomey & Ecker, 2007; van der Kolk, 1996). The lessons learned in these emotionally charged situations become the source of our habitual patterns of behaviour when facing similar situations. We respond automatically in these situations  based on the original learning, usually without even being aware of the original implicit learning. (Ecker, Ticic & Hulley, 2012, McGaugh 1989, McGaugh & Roozendaal, 2002, Roozendaal, McEwan & Chattarji, 2009.) Thankfully, due to neuroplasticity –that is, the life-long changeability of the brain – we now know that the old learning can be erased completely and replaced by new learning, leading to new, more helpful responses to life’s situations.  What’s required for this process to occur is a new emotional experience to imprint new lessons on the brain. When this happens, the old symptoms fall away, freeing a person’s potential to live life fully. (Ecker, Ticke & Hulley, 2012.) This is what the deep work of emotionally engaged therapy achieves.

Throughout the history of psychotherapy different methods and models have been developed, with different names and methodologies, like psychoanalysis, CBT, person centered therapy, etc.  Proponents of a particular model will often claim that their model is more effective than another model. In fact, all the research to date shows that no model, or style of therapy, is more effective than another. In comparison studies, time and again, different models are shown to be equally effective. (Luborsky, Singer & Luborsky, 1975; Robinson, Berman & Neimeyer, 1990; Shapiro & Shapiro, 1982; Wampold, Minami, Baskin & Tierney, 2002.)

At the same time, we can see from the research that individual therapists differ greatly in their effectiveness. Whichever model of therapy is being used, effective therapy is a result of what the best individual therapists are actually doing in the sessions. (Wampold 2005.) So it’s most important that you find an effective therapist to work with, regardless of his or her model of therapy.

It’s so important for you to find the right therapist for you. The best way for you to assess whether I can be helpful to you is for us to schedule an initial session, kind of a ‘trial therapy’, and to trust your experience of that initial meeting. You are the person who is best placed to know what works for you. 

That said, the research now gives us a good idea of how the best therapists get superior results for their clients:

• Client engagement is vital for a successful outcome, so the best therapists will encourage you to engage as deeply as possible with the work of therapy. (Orlinsky, Rønnestad, Willutzki, 2004)

•A collaborative working partnership between client and therapist is essential for a successful outcome. (Tryon & Winograd, 2002.) Therapy doesn’t work when the client remains passive while the therapist is viewed as the all-knowing expert, so the best therapists will invite you to be an equal partner, to work actively and collaboratively with your therapist to achieve your goals. (Orlinsky, Rønnestad, Willutzki, 2004.) The best therapists will also endeavour to provide a nurturing and supportive atmosphere, listening attentively without judgement, in order that the two of you can deeply understand your experiences, your feelings and your wishes. (Bohart & Tallman 2010.)

•Working with emotions leads to more profound and lasting results, for all the reasons outlined above in answer to the question ‘How does therapy work?’ We now know that cognitive insight and awareness, whilst helpful, are simply not sufficient by themselves to effect lasting change. However, when we work at the deeper, emotional level, where we can get to the root of the problem, we can achieve a transformation that endures. (Ecker, Ticke & Hulley, 2012; Fosha, Siegel & Solomon, 2009; Malan & Coughlin Della Selva, 2007.) The best therapists will work with you to create an emotionally charged therapy, in which you can access, understand and experience your deepest feelings (Anderson, Lunnen & Ogles 2010; Bohart & Talliman, 2010) to help you get to the core of your difficulties and create lasting change.

•Agreement on the goal leads to better results, so the best therapists ensure they clearly understand your goal for therapy at the outset, so your work together can be focused towards helping you achieve that goal. (Norcross, 2010). This finding shows up across studies. (Tryon & Winograd, 2002.)

•Therapists who seek feedback from their clients achieve better results. Research shows that your assessment of your therapy is a more reliable indicator than the therapist’s assessment. Therapists tend to overestimate how effective their work is from session to session, and so the best therapists will check in with you regularly to find out how you’re experiencing the session and how you’re experiencing your progress in therapy. This way any issues or concerns can be identified and dealt with. (Lambert, 2010.) 

•The best therapists are enthusiastic, and keep improving their skills through deliberate practice. They are always stretching themselves to learn from feedback, to identify the specific skills they need to develop further, to work at expanding their capacity to help different people with increasing effectiveness. (Miller, Hubble & Duncan, 2007.)

In our work together, as your therapist, I will always aim for these things. I can’t promise to be a perfect therapist – (there’s no such thing, just as there’s no such thing as a perfect person) – but I will always aim to work at my highest capacity and encourage you to work at your highest capacity too. If we are both deeply engaged, actively working together collaboratively, and in a focused way, prioritising your inner emotional experience, we can achieve the change you hope for. I will often seek feedback from you informally throughout the sessions, to find out how you are experiencing me and the work. If we notice after a while that we are not making the progress you would like, we can look at making adjustments, and if necessary refer you to another therapist. The most important thing is that we help you get the results you are looking for.

Please phone me on (347) 988-3299, or email me: james@jptherapy.nyc

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