S USED throughout
this website, psychotherapy can be defined as follows:
between a professional and a client that leads to changesfrom a less
adaptive state to a more adaptive statein the clients thoughts,
feelings, and behaviors.
On this website,
the professional in the above definition will be assumed to be a
psychologist, although other mental health practitioners may be licensed to conduct psychotherapy.
as defined here, has ethics
which can be distinguished from the ethics of counseling
that focus on helping a person solve normal problems.
may be used in conjunction with psychotherapy, for present purposes medication
will not be considered the essence of psychotherapy, because psychotherapy
really depends on the use of the clients own mental experiences to
bring about the desired changes.
Clearly, in the above definition, adaptive
is a very subjective concept. My attitude toward the matter is
As long as you
generally adhere to the law of the culture in which you live, and if you
are satisfied with your life, then there is no problem and no need for
psychotherapy. At this point, the science of psychology reaches a
limit and must stop.
There are many
things, however, that are legal and socially acceptable and that nevertheless
pose a grave danger not only to ones mental health but also to ones
spiritual life. Thus there is a further spiritual
dimension to adaptive
life, but I wont make this an issue in general psychotherapy
unless a client has a specific desire to discuss it.
if you get too far out of line, life will let you know it: first, by
whispering in your ear (i.e., through
next, by kicking you in the
butt (i.e., through the
repetition of unpleasant,
conflicts); and finally, by pulling the rug
out from under you (i.e., you end up in
prison or hospital).
As you will learn
from what follows, there are many theoretical approaches to the practice
A Key Principle
About Psychological Change
QUESTION: How many
psychologists does it take to change a light bulb?
ANSWER: Only one, but the bulb must really want to be changed.
This joke reflects
a fundamental point about psychology. Any change that happens in your
life must come from you and your own efforts. Although a psychologist
can guide you, no one can do the work for you.
As I say throughout
this website, psychology is not about getting rid of
symptoms. Unlike politics, and even unlike medicine,
psychology is not about waging war or getting
of anything. Instead, its about making peace withby listening
to and understandingyour symptoms. And, curiously enough, once you
listen to, rather than fear,
your symptoms you might be enlightened by a profound wisdom that will become
a great blessing to your life.
The light of
truthor insight, in psychological termshowever, is not
sufficient in itself to bring about behavioral change. For psychological
change to occur, a person must react to insight with shock. A hardened, blind
heart must feel sorrowsorrow for all the
injury and pain that it has inflicted on others while stuck in its own blindness.
It will no longer blame others for its own misery. Instead, it will see the
ugliness of its own behavior for what it is. Shocked by the past, it will
be motivated to change the present.
And so it can
be said that the only basis for lasting psychological change is
todays world, psychoanalysis can take on a variety of forms, varying
from practitioner to practitioner and from country to country. Thus you can
find some practitioners who describe their treatment modality as a form of
psychoanalysis when you can find other practitioners describing a similar
treatment modality as psychodynamic psychotherapy (see
In its pure form
(that is, as developed by Sigmund Freud at the early 1900s), however,
psychoanalysis can be quite demanding and expensive.
It requires daily
(yes, daily!) visits to the psychoanalyst.
You lie on a
couch with the analyst sitting out of sight behind you.
You are required
to say whatever comes into your mind, without holding back anythingthis
is technically called free association (see
The analyst uses
silence as a technique to encourage you to free associate and hardly ever
says anything except to make an interpretation (i.e., the unconscious
motives behind your actions or thoughts are pointed out to you).
There are no
excuses for missing a session, and payment is required whether you attend
the session or not.
. . . and this
goes on for several years.
If you have the
time and the money, psychoanalysis can be a helpful form of psychological
treatment. Moreover, when I was a doctoral student, I was in Lacanian
psychoanalysis (as a personal choice beyond what my school required for student
psychotherapy), and I found it excellent training for psychotherapy in
But the truth
of the matter is that there are today less expensive and less time-consuming
ways to conduct psychotherapy. You should remember one thing from this discussion
about psychoanalysis: its fine if you want it as a form of treatment,
but because it is so intensive and expensive, never let psychoanalysis be
imposed on you without explanation. You at least deserve to know what
you are paying for. Please review the section on
rights if you havent yet done so.
in the past were
but many analysts today are also psychologists. Only those who have graduated
from a psychoanalytic training institute and who have completed a training
analysis are qualified to conduct psychoanalysis. Most psychologists,
however, including myself, dont fit this description. Perhaps thats
why we have the next topic, psychodynamic psychotherapy.
psychotherapy uses some of the same theories and principles of understanding
the mind as does psychoanalysis, but it uses different technical procedures.
(When psychodynamic psychotherapy uses techniques very similar to psychoanalysis
without actually being as rigorous as psychoanalysis, it is often called
usually just once a week. (Highly motivated clients, or clients who are
emotionally unstable and need extra support, may want to meet two or three
times a weekif the cost is not prohibitive.)
The client and
the psychotherapist sit face-to-face.
usually talks quite a lot, compared to the
silence of the
an interactive process between the client and the
pays quite a bit of attention to
motivation and can rely heavily on
length can range from 1 to 12 sessions (brief psychotherapy),
to about 20 sessions (another definition of brief psychotherapy), to several
years. Theres no real consensus here, so its a good idea to discuss
treatment length with your psychologist.
But why does psychotherapy take so long?
There are essentially
two reasons. In the practical sense, even 12 sessions of treatment
might seem like a long time, especially when compared to a 15-minute office
visit with a physician. Yet these 12 sessions are really about equivalent
to a weekend workshop in which you learn a new skill. For that matter, a
full year of weekly psychotherapy is about equivalent to an intensive 10-day
seminar. So remember that whatever you are learningwhether it is to
get an education, to acquire new job skills, or to overcome depression or
anxietythe process takes hard work, commitment, and a considerable
investment of time and money.
psychological sense, many individuals have a reluctance to speak about
their deep and private inner experiences. Most likely, some of your private
thoughtsthe most dark and ugly onesare so shameful and
frightening that you would not reveal them to anyone,
not even your own psychotherapist. Is it any wonder, then, that
psychotherapy can take a really, really long time?
psychotherapy is what many persons mean when they mention
psychotherapy. Actually, many variations on this theme exist,
Jungian Analytical Psychology,
Group psychotherapy, and on and on. I will not discuss here the details of
any of these theories of counseling or psychotherapy. See the Additional
Psychoanalysis and Psychodynamic Psychotherapy
psychotherapists job is not to be a nanny or a
friend; rather, the psychotherapist
must help clients understand their unconscious
motivation. Hence the psychotherapist must act with a certain
therapeutic neutrality, never acting from personal desire,
and always keeping every word and action of the
therapeutic relationship (also called the
alliance) deliberately focused on the clinical
process of healing.
It is common,
and even expected, for the client to experience feelings for the psychotherapist
that are called a
transference reaction; these feelings
are really no different than common
or hate. The psychoanalyst Jacques Lacan taught
that this common love is a belief in
another;  that is, it is
a belief that the other person has some knowledge you lack. (Hate, being
the reciprocal of love, means that your belief in the other person has, for
some reason, dissolved.) And in this transference the clients intense
belief in the psychotherapist can cause some difficult problems that
must be resolved within the psychotherapeutic work.
your feelings can resemble the mixed feelings (i.e., love and hate) you had
in childhood for your parents, and you can begin to treat your psychotherapist
according to these feelings, all out of proportion to what is actually happening
in the psychotherapy. In such a case, you need to realize that the
psychotherapist is only doing his or her job of bringing these feelings to
light; its your feelings, not the person of the psychotherapist,
that are important.
can come to believe that your psychotherapist has the personal ability to
redeem your sense of inner worthlessness, and so you can start to feel
special and become very fond of, or
even sexually attracted to, him or her. The therapeutic cure, however, must
come from facingnot seducingyour
more about Erotic Transference
transference isnt handled carefully it will lead to disaster. For example,
many clients have had their lives ruined by sexual affairs with their
psychotherapists, all because the psychotherapist took the clients
erotic feelings personally and failed to help the client understand their
can also frighten you into terminating
psychotherapy prematurely, rather than working through the
feelingsespecially the angry feelingswithin the treatment. For
example, during the therapeutic process you will experience many emotions
that are similar to the intense and confusing emotions you felt as a child.
Disappointment. Anger. Confusion. Feeling misunderstood.
Feeling devalued. Feeling abandoned. Many different eventssome of them
just chance occurrences during psychotherapy, and some of them deliberate
therapeutic interventions by the psychotherapistwill trigger these
emotions. (Experiencing these negative reactions to the psychotherapy process
itself is called a negative
transference. Just remember
that when you feel an emotion in psychotherapy, the therapeutic task will
be to name it as an emotion and understand it
as an emotionnot get caught in it as if it were your helpless destiny.
For if you get caught in it, you will feel victimized
and will blame
the psychotherapist for your pain, and the entire therapeutic process will
feel like judgment and criticism. And then, in deep bitterness, you will
want to get away from the psychotherapy just as you wanted to
get away from the original emotions as a child.
Counter-transference can be considered the reverse of transference; that is,
the term describes the psychotherapists unconsciously activated
reactions to the client. If these feelings are taken personally, the
psychotherapist could become angry, abusive, spiteful, indifferent, or even
seductive. If the counter-transference gets too intense the psychotherapist
might have to end the treatment and refer the client to someone else, for
the clients own protection.
however, should be distinguished from the psychotherapists
in-the-moment feelings about the psychotherapeutic situation, because
these feelings can be used clinically. For example, if your psychotherapist
begins to feel bored, it could be an indication that you are unconsciously
avoiding an important issue.
psychotherapists emotional reactions to the treatment are neither
right nor wrong. The real issue is whether these
feelings are used clinically, for therapeutic
In the technical
language of psychoanalysis,
is a mental process by which one word or image spontaneously brings to mind
other words or images. In both psychoanalysis and psychodynamic psychotherapy
it can be very important for you to just say what comes to your mind, without
censoring yourself, because this process allows your psychotherapist to make
interpretations about your psychological defenses.
For example, as you identify a thought or mental image that occurs along
with a feeling, you can focus your attention on that thought or image and
ask yourself what other thoughts or images come to mind. Following the
tracks of a string of associations can lead you to the original
experience that engendered the feeling in the first place.
hindrance to free associationand to the progress of psychotherapy
itselfis the childhood experience of having to guard the things you
say and do so as to avoid getting criticized by a demanding parent. When
this defense continues into adulthood, it not only obstructs your capacity
for honest and intimate interpersonal communication,
but it also causes you to feel afraid of saying anything spontaneously in
psychotherapy. Not knowing what is hidden in your
unconscious, you will feel terrified that anything
you say might be more revealing of the truth than you would like.
The simple, but
hard, solution to this dilemma is to commit yourself to getting to the truth
of your life, no matter how painful it may be. In all reality, the truth
wont kill you; on the contrary, the truth will set you free from your
slavery to unconscious fear.
therapeutic concept to consider is
Freud defined resistance as whatever interrupts the progress of analytic
work,  such as being late,
missing a session, holding back your
thoughts in the moment (i.e., refusing to speak about them) or avoiding a
particular issue. In its most simple and practical sense, resistance results
from fear, often the fear of having to face and relinquish
ones victim anger. In other words, the task
of treatment is the complex and frightening task of being able to recognize
and overcome the tendency to lie to yourself.
Lacan warned us not to confuse resistance with
defense  and formulated
the famous statement that there is no other resistance to analysis
than that of the analyst
himself.  In other words,
if the psychotherapist makes interpretations or interventions that are clinically
inaccurate, the client will get defensive, and that will interrupt the
therapeutic work. In plain English, this means that a client will only explore
therapeutic material so far as is comfortable in the moment; the psychotherapist,
therefore, must always be aware of just how far the client is willing to
go and not push the client beyond these temporary limits. Imprudent
attempts to push a client can end up pushing the client right out of
The above definition
of resistance applies specifically to the process of psychoanalysis,
but can be applied as well to psychotherapy in general. There is, however,
a resistance to life itself that can be encountered
in the psychotherapy as a resistance to being healed. Many people
come to psychotherapy with some part of their inner
livesa dark part usually steeped in feelings of hatred and
bitternessthat has been kept as an unspoken secret in their hearts
and that they would not dare to reveal to anyone, not even their own
psychotherapists. This resistance, therefore, derives not from the
psychotherapist but from the clients unconscious
masochism, a subtle but tragic dynamic by which the
client believes that he or she, in being humiliated, can prove that someone
else is a fraud. Uncovering and healing this
hidden masochism, therefore, is often a core element of psychodynamic
about the psychotherapy process can be found
on the Questions and Answers About Psychotherapy
actually several kinds of Cognitive-Behavioral therapies (spelled
behavioural in British English), and they all employ the same general
premise: in contrast to the psychodynamic emphasis on insight into
motivation, the cognitive-behavioral therapies emphasize the ability of
people to make changes in their lives without having to understand why the
change occurs. As such, these therapeutic techniques usually take much
less time and are therefore less costly than psychodynamic
As a trade-off
to the cost, though, the client usually must do considerable work, such as
homework writing assignments and practice of techniques learned in the office.
Failure to complete tasks as assigned is taken as a lack of motivation and
an unwillingness to change behaviors.
more-or-less pure cognitive therapiessuch as Aaron Becks
Cognitive Therapy, focus on changing certain
patterns. The premise, in Becks words, is that the way we
perceive situations influences how we feel emotionally, and so by changing
thoughts, then behaviors will also change. The pure behavioral therapies,
such as classical conditioning or operant conditioning, focus on changing
behaviors. And some forms of treatment such as Rational Emotive Behavior
Therapy (REBT)developed by
Albert Ellismix cognitive and behavioral elements.
REBT used to be called Rational Emotive Therapy (RET); the name change
reflects the understanding that rational beliefs, emotions, and behaviors
are all interdependent and that psychotherapy should work on all these levels.
In this regard, its interesting to note that the psychodynamic forms
of psychotherapy focus on understanding experiences, and, as a side
effect, thought processes and behaviors are changed as well.
This leads to
a simple moral: If you want to get into a house, it doesnt matter
whether you get in through the front door or the back door. Which form
of psychotherapy you choose depends only on personal preference, time, and
money. Some therapies that work wonders with one person are a complete flop
with another person. You should pay attention to this fact, especially if
you are using Managed Care to provide your treatment.
What is the
difference between Cognitive-Behavioral therapy and Psychodynamic
in its pure formsuch as conditioningis really not much different
from animal training. You can teach an animal to respond to behavioral or
verbal commands, but the animal doesnt have to understand a thing about
its own behavior; it responds simply to
reinforcement or fear of punishment.
Cognitive-Behavioral therapies are a blend of behavioral techniques and cognitive
techniqueshence the name Cognitive-Behavioraland so they
do involve some amount of thoughtful awareness. Still, this sort of awareness
does not need to be extensive. You could compare it to learning to drive
a car and stopping at a stop sign simply because you tell yourself that if
you dont stop you run the risk of being pursued by the police and fined.
Theres some philosophical processing going on here, but its not
necessarily very sophisticated. And so, in the same way, learning to take
deep breaths when angry, for example, is relaxing, but its a relatively simple
and using the example of driving, psychodynamic psychotherapy is a bit like
learning to drive by developing the understanding of the reason for
stopping at stop signs (that is, the need to be cautious when entering any
intersection lest you collide with something) and also you extend this basic
reason to other behavior (that is, you learn to look beyond simple
behavior into its motives and consequencesfor example, you come to
understand the need to begin a trip by planning the route and checking the
gas and oil, rather than just turning the key and going). And so you learn,
when feeling angry,
for example, to track the anger back into similar earlier experiences and
feelings, many of them previously
thus you come to understand the components of your current feelings, and
you are enabled to take actions with full awareness of the origins and
consequences of your motives.
Many people want
nothing more than to turn the key and go, and to watch out for
police along the way. Its your choice.
I do not intend
to give a description here of all the variations of Cognitive-Behavioral
treatment, but I will mention the modalities with which I have experience,
primarily in regard to pain management,
management, and performance enhancement:
uses electronic devices to measure physiological processes such as breathing
rate; heart rate; skin temperature; skin conductance (which varies with
perspiration); and muscle tension, which is measured by a process called
surface electromyography (EMG). A biofeedback unit processes the electronic
signals and feeds back the information to the user in the form
of sounds, or graphs on a computer screen. There is no magic here; simply
by practice a client can learn to alter these various physiological processes.
The goal usually is to change them from a state of nervous arousal to a state
of deep relaxation.
is usually quite expensive, and any professional who uses it clinically must
receive considerable technical training, usually from biofeedback training
organizations (see Additional Resources, below).
Some companies, however, make simple biofeedback devices for self-treatment
at home. These devices can be helpful for those persons who have difficulty
with the more imaginative relaxation techniques.
Relaxation techniques strive for the same goal
as biofeedback, but with these techniques there is no need for any machines.
You just learn to recognize the feeling of tension in your body and then
you learn to release the tension. Its a simple process, but it takes
practice. I teach three kinds of relaxation: Progressive Muscle
Relaxation (in which you tense and relax various muscles, progressively, through your body),
Guided Imagery (in which you visualize relaxing
images and situations), and Autogenics
(in which you learn to create a feeling of warmth and heaviness throughout
Click on these links for short courses in self-administered progressive muscle relaxation and autogenics training.
Systematic Desensitization, used primarily to treat
related to one particular issue, is also a simple process whose effectiveness
depends on practice. Essentially you create an anxiety hierarchy (a graded
list of anxiety-provoking items) and then proceed to pair each item with
the feeling of being deeply relaxed. Eventually this training process allows
you to remain relaxed even when thinking about the anxiety-provoking situation.
Finally, you learn to confront the real situation while remaining calm and
relaxed. Click on the link for a short course in self-administered
been often misunderstood and sometimes almost diabolic properties have been
imputed to it. The facts are much less dramatic, though the therapeutic results
of hypnosis can be spectacular. Hypnosis is primarily
a state of deep relaxation, the same as can be achieved by any other relaxation
technique. Once you achieve this state of relaxation, you can be given
suggestions about new ways to experience your life. Thats
Of course, the
suggestions that are given to you should be suggestions about things you
already know unconsciously. That is, the hypnotist helps you
to fulfill potential thats already there and to utilize skills you
already possess. The ability to understand your needs properly is what separates
outstanding practitioners from the rest, and this is why the best hypnotists
are experienced, licensed
clinicians with diverse training.
Some people are
concerned that a hypnotists suggestions can cause them to do improper
things. Thats a wise concern. You should find a hypnotist who is licensed
by your state, and it would be preferable that the hypnotist also be a
psychologist with clinical training. Nevertheless, research has shown
that people are remarkably resistant to following hypnotic suggestions that
are against their sense of morality. Persons who act like chickens for
a stage hypnotist are likely the same sort of persons who wear lamp shades
when they get drunk.
therapeutic hypnosis employs suggestions for newer, healthier ways to get
on in the world and utilizes the fact that most people really want to
get better. Click on this link for information that I have provided about
what I call negative hypnosis. For more information about hypnosis in general, visit
the website of the Milton
H. Erickson Foundation. Dr. Erickson was an absolute master of treatment
not much understood in the field of psychology, is an extraordinaryand
I mean that literally: extra-ordinary, beyond the ordinaryform of
cognitive-behavioral treatment. It can free you from all neurotic anxiety
if you pray out of pure
love, with all your mind and all your heart and all your strength as
a renunciation of your social-psychological identity
In short, mastery
of any of these techniques allows you to stay calm and relaxed in any situation,
and that is a crucial element in making your life satisfying and
advertisingno sponsorjust the simple truth . . .
Jacques Lacan, Seminar of 21 January 1975. In Mitchell, J. &
Rose, J. (Eds.), Feminine Sexuality: Jacques Lacan and the école
freudienne (New York: W. W. Norton [paperback], 1985). See p. 169.
Note that in the traditional Freudian concept of transference
the feelings transferred onto the psychotherapist are considered to be
unrealistic; in Lacans terms, transference is simply a fact of life,
both in and out of the psychotherapy office. For more about the transference,
see Lacans The Transference and the Drive and The
Field of the Other and Back to the Transference, in The Four Fundamental
Concepts of Psychoanalysis, (New York: W. W. Norton, 1981).
2. More specifically,
Freud used the term negative transference to refer to the resistance
engendered in the patient by the threat of the uncovering process
3. Sigmund Freud,
The Interpretation of Dreams (Second Part), in Vol. V, The standard
edition of the complete psychological works of Sigmund Freud (London:
Hogarth Press, 1953). See p. 517.
4. Jacques Lacan,
The Freudian thing, or the meaning of the return to Freud in
psychoanalysis. In Écrits: A selection, trans. Alan Sheridan
(New York: W. W. Norton, 1977). See p. 129.
5. Jacques Lacan,
The direction of the treatment and the principles of its power.
In Écrits: A selection, trans. Alan Sheridan (New York: W.
W. Norton, 1977). See p. 235.
Association for Applied
Psychophysiology and Biofeedback provides extensive information
Institute of San Francisco provides information and treatment in
Ryans index of papers on Client-Centered Therapy
Albert Ellis Institute
provides information about Rational Emotive Behavior Therapy:
self-help, psychotherapist referrals, workshops, lectures, training, and
Beck Institute for
Cognitive Therapy and Research provides information about
Cognitive Therapy: workshops, lectures, training, and publications.
The National Association of
Cognitive-Behavioral Therapists provides current information concerning
cognitive-behavioral psychotherapy, including a searchable National Referral
Database of certified cognitive-behavioral therapists.
Questions and Answers about Rational Emotive Behavioral
Therapy from the Albert Ellis Institute.
& Answers about Cognitive Therapy from the Beck
Counseling - Non-Profit Information, Guidance and Referral Assistance
Crisis Counseling from the Center for Mental Health
& Bacon Family Therapy Website provides an overview of important
family systems therapists and historical concepts.
Family Systems Theory & Concepts provides a
slide presentation of basic family systems concepts.
Psychotherapy Homepage provides an introduction to group psychotherapy
for the layman.
(Many practitioners in some of these ways of life are not
licensed, so be careful.)
the Advancement of Gestalt Therapy provides information about
Psychology, Logotherapy, & the Will to Meaning provides an
introduction to Existential therapy.
Transactional Analysis Association provides resources and information
about Eric Bernes Transactional Analysis (TA).
Family Therapy and Resistance provides an introduction to
Existential therapy in the context of family therapy.
Glasser Institute provides information and training in Glassers
American Society of
Clinical Hypnosis Founded by Milton H. Erickson, MD
in 1957, ASCH promotes greater acceptance of hypnosis as a clinical tool
with broad applications.
Milton H. Erickson
Foundation provides information and training in the style of hypnosis
used by Dr. Erickson, who was a master at healing unconscious conflicts using
unusual and paradoxical techniques.
for Clinical and Experimental Hypnosis Founded in 1949,
The Society for Clinical and Experimental Hypnosis (SCEH) is an international
organization ... dedicated to the highest level of scientific inquiry and
the conscientious application of hypnosis in the clinical setting.
Psychological Hypnosis APA Division 30 brings together
psychologists and other professionals interested in scientific and applied
hypnosis. Our mission is to educate the profession and the public, to develop
new and innovative clinical interventions and research methods, and to evaluate
current treatment approaches.
C. G. Jung Home
Page provides information about Jungian training and treatment.
for the Study of the Psychoanalytic Arts To advance
the study of psychoanalytic epistemology, theory, practice, ethics, and education
within a psychological framework consisting of philosophy, the arts, and
the anthropic sciences as opposed to biology, medicine, and the natural
The American Psychoanalytic
Association represents all member psychoanalysts.
The Lacanian School
of Psychoanalysis in the San Francisco Bay area, offers training
in Lacanian psychoanalysis.
by Wolfgang Albrecht, in Berlin; provides links to pages with information
related to Psychoanalysis.
The Psychoanalytic Institute
of Northern California offers psychoanalytic training.
The San Francisco Psychoanalytic
Institute is a psychoanalytic training institute in San
The San Francisco Society
for Lacanian Studies provides lectures and information about Lacanian
Lacan Related Papers provides links to numerous
Links provides links to Lacanian sites and is an extensive resource
for Lacanian articles and papers.
Strategic Therapy from Jay Haley on
Related pages within A Guide to Psychology
and its Practice:
Consumer Rights and
Diagnosis in Clinical
How To Become a
The Limits of
or Counseling or ...?
Questions and Answers
Reasons to Consult
INDEX of all subjects
on this website