About Therapy



Does psychotherapy work?

In a word, yes. Psychotherapy researchers have conducted thousands of scientific studies on the benefits of therapy and have published hundreds of summaries, reviews, and meta-analyses to make sense of them all (Lambert & Ogles, 2004; Wampold, 2010). Their studies are of many types. Some focus on specific treatments for specific disorders, while others consider a range of treatments for a variety of disorders. They take place in private practices, clinics, hospitals, counseling centers, and universities. They measure the outcome of therapy immediately after it ends or after some delay. They consider feedback from the client, the therapist, or both. Again and again, the same finding emerges: psychotherapy helps people (Lambert, 2011; Seligman, 1995).

Statistically, patients who undergo psychotherapy, on average, are better off after therapy than about 80% of those with similar problems who do not (Lambert & Simon, 2008; Smith, Glass, & Miller, 1980). The benefits of therapy typically translate into meaningful, lasting changes in patients’ day-to-day lives. Of course, psychotherapy doesn’t help every client every time, and some problems are more difficult to treat than others, but failure is definitely the exception to a strong rule of success (Lebow, 2006; Striano, 1988). So, it’s certainly reasonable for you to expect therapy will benefit you as well.

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What makes psychotherapy work?

Another consistent finding among psychotherapy researchers is that the same ingredients (often called common factors) seem to make different kinds of therapy work. That’s not to say that specific factors aren’t proven for some specific disorders. For example, for patients with phobias, gradual exposure to the feared object or situation is a proven, specific treatment strategy. But the more general truth is that a few basic, common factors of therapy are crucial to its success (Stricker, 2010; Wampold, 2001).

The most well-established of these common factors is the therapeutic alliance—in other words, the strong, collaborative relationship between therapist and patient (Crits-Christoph, 2011; Horvath et al., 2011; Norcross & Lambert, 2011; ). The word “alliance” captures the nature of this coalition of trusting partners working constructively toward a mutually shared goal. The therapeutic alliance is especially important from the perspective of the patient. The comfort level, the feel for the “fit” between the patient and the therapist are huge predictors of how beneficial therapy will be. As you consider therapists, trust your own sense of the working relationship you feel you could form with each one.

Another common factor that leads to success in all kinds of therapy is hope, in other words a positive expectation about the outcome of therapy (Constantino et al., 2011). No matter the methods used, confidence that things will get better—communicated by the therapist and felt by the patient—can be therapeutic in and of itself.

A final common factor that leads to success is paying attention to a problem and acknowledging it, rather than sweeping it under the rug (Prochaska & Norcross, 2010). All therapists, regardless of their training or style, enable you to examine life problems, especially the kind that you might otherwise choose to brush aside.

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When is psychotherapy necessary?

The decision to see a therapist is often made under stress or in pain. Patients frequently cite one or more of these reasons for seeking therapy

  • negative thoughts or feelings
  • depression or mood swings
  • stress or anxiety
  • problems with drugs, alcohol, sex, or food
  • excessive anger, frustration, or guilt
  • constant worries or obsessions
  • relationship concerns, communication problems, or loneliness
  • stress due to chronic illness
  • school problems, employment concerns, workplace stress
  • life changes
  • issues of sexuality or sexual identity
  • problems following traumatic events or the after-effects of childhood mistreatment
  • domestic violence or other forms of abuse

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When do children or adolescents need therapy?

Children and adolescents need therapy when their problems or symptoms seem prolonged or serious, or when they have simultaneous problems in several areas of their lives.

Children and adolescents are less able and sometimes less willing than adults to talk about their problems. They may show their distress in a variety of ways including irritability, sleep or eating problems, personality changes, or physical complaints. They may have problems with loved ones, in school, or in making and keeping friends.

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How long will therapy last?

The length of therapy depends on lots of things—the nature and extent of problems a patient works on, the goals, and the type of therapy, among others. Some people are under the very outdated impression that therapy always lasts a very long time, or that it goes on indefinitely. That’s simply not true. Sometimes, successful therapy can be quite brief—perhaps 6-8 visits, or even fewer. Other times, especially for long-standing or more serious problems, it can take many months (Harnett, O’Donovan, & Lambert, 2010; Steenbarger, 2008).

Asking prospective therapists about the expected length of therapy is a great idea. They may not be able to give you a definitive answer immediately, but as your therapist gets to know you, an informed answer should be available.

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How can I pay for therapy?

The financial cost of therapy can be significant, so planning on how to pay for it makes sense. There are two categories of payment methods: out-of-pocket and third-party payment. Out-of-pocket payment means that the patient pays for all services directly (by check, credit card, cash, etc.). Third-party means that a health insurance company, managed care company, or similar party pays some or all of the bill, either directly to the therapist or as a reimbursement to the patient (after the client has paid the therapist).

There are advantages and disadvantages to both out-of-pocket and third-party payment. Out-of-pocket payment is certainly more expensive, but it allows the patient to have more control over various aspects of the therapy— the selection of a therapist, the goals, how long therapy will last, and access to shared information. Third-party payment is certainly less expensive, but it gives the health insurance or managed care company control over those same choices. The company may require a patient to choose one of their “in-network” contracted therapists; it may put limits on the amount of money or time it will allow for the therapy, which can affect the goals of therapy; and it may require a therapist to share patient information—at the very least, a psychiatric diagnosis but maybe more. Once that information enters the company’s computer system, a therapist cannot guarantee its privacy.

Feel free to ask prospective therapists about your payment options and how they could affect your therapy.

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What are the advantages of PSYCHOTHERAPY SAINT LOUIS therapists?

In order to join PSYCHOTHERAPY SAINT LOUIS, therapists must make a commitment to the core values that have steered the organization since its inception: confidentiality and choice in psychotherapy. Specifically, members of PSYCHOTHERAPY SAINT LOUIS agree to these Principles of Ethical Practice:

  • An individual has the right to choose his or her own therapist.
  • Patient and therapist together shall determine the course of psychotherapy.
  • Therapists shall preserve client confidentiality.
  • Reimbursement methods should support ethical clinical practice.
  • Mental health professionals should practice in an interdisciplinary community that promotes competent and ethical clinical practice.

These Principles of Ethical Practice represent a step above basic laws and ethical guidelines in the mental health professions. They reflect a higher commitment to a beneficial client experience in therapy, which third-party payers haven’t always prioritized because of their fiscal responsibility to their shareholders. This doesn’t mean that members of PSYCHOTHERAPY SAINT LOUIS can’t accept insurance—many do, some don’t—but regardless of the payment arrangement, our members strive to uphold these values of confidentiality and choice in their work with all their clients.

Regarding confidentiality in psychotherapy, PSYCHOTHERAPY SAINT LOUIS members recognize that solid therapy is founded on trust and that maintaining privacy is essential to preserving trust. We never disclose information from your therapy sessions unless you give us permission to do so (for example, to talk with your doctor; or if your child is the client, to talk with your child’s teacher). In very rare cases, the law may require any therapist to break confidentiality to protect someone at risk (for example, in cases of child abuse). Ask any prospective therapist more about your confidentiality and its limits.

Regarding choice in psychotherapy, PSYCHOTHERAPY SAINT LOUIS gives you the opportunity to choose a therapist in a uniquely informed way. Our therapist directory provides detailed descriptions about each member’s background and practice. The description includes training, areas of clinical focus, a photo, location, and contact information. Choosing a therapist for yourself or your child deserves the same time and effort you would devote to researching any other major life decision, and PSYCHOTHERAPY SAINT LOUIS’s directory is the tool to conduct that research.

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What kinds of therapists belong to PSYCHOTHERAPY SAINT LOUIS?

PSYCHOTHERAPY SAINT LOUIS includes members from a variety of mental health professions: psychiatrists, psychologists, social workers, marriage and family therapists, and professional counselors. All are state licensed in their professional discipline. Being state licensed means that they completed a professional graduate training program, practiced under supervision for a required period, and passed a formal licensing exam administered by the state.

There is a lot of overlap in the work therapists from different professions do, but each profession has its own emphasis. At the same time, two therapists licensed in the same profession may practice in very different ways. Be sure to read the full description in a prospective therapist’s listing, and ask more questions over the phone or during your initial session. Below, we attempt to offer some basic information about the unique training and practice in each of the mental health professions represented in PSYCHOTHERAPY SAINT LOUIS:

  • Psychiatrists (whose names are followed by M.D. or D.O.) have completed four years of medical school, a year of medical internship, and three years of psychiatric residency. Child psychiatrists have undergone additional training in their specialty. All have taken a national examination to be certified in psychiatry and licensed to practice. Psychiatrists have been trained especially to understand the biological aspects of emotional and behavioral problems and mental illnesses. They often prescribe medication, and some practice psychotherapy. They are the only medically trained members of PSYCHOTHERAPY SAINT LOUIS.
  • Psychologists (whose names are followed by “M.A.,” Ph.D.,” “Psy.D.,” or “Ed.D.”) have completed four or five years of coursework and a one year clinical internship. After earning their degrees, they have practiced an additional year or two under supervision in order to become eligible for licensure. As psychotherapists, psychologists specialize in individual, family, group, or marital therapy for problems ranging from mild to serious. Some offer psychological testing for vocational, educational, or personality problems.
  • Marriage and Family Therapists (whose names are followed by “LMFT”) have completed at least a two-year master’s degree, though a small number also earn doctoral degrees. They have undergone two years of supervised practice. As psychotherapists, they work with individuals, couples, and families to resolve the relationship problems that often bring pain and confusion to individuals’ lives.
  • Clinical Social Workers (whose names are followed by “LCSW”) have completed a two-year master’s degree in social work (M.S.W.) or a doctoral degree (Ph.D.) plus two years of supervised clinical practice. As psychotherapists, clinical social workers address personal, relationship, and family problems through individual, group, couples, and family therapy.
  • Professional Counselors (whose names are followed by “LPC”) have completed at least a two-year master’s degree program followed by two years of supervised clinical practice. As psychotherapists, they work with individuals, couples, families, and groups to resolve personal and interpersonal problems. Their expertise can vary widely.

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References

Constantino, M. J., Glass, C. R., Arnkoff, D. B., Ametrano, R. M., & Smith, J. Z. (2011). Expectations. In J. C. Norcross (Ed.), Psychotherapy Relationships That Work: Evidence-Based Responsiveness (2nd ed.), pp. 354-376. New York: Oxford University Press.

Crits-Christoph, P., Gibbons, M. B. C., Hamilton, J., Ring-Kurtz, S., & Gallop, R. (2011). The dependability of alliance assessments: The alliance–outcome correlation is larger than you might think. Journal of Consulting and Clinical Psychology, 79, 267-278.

Harnett, P., O’Donovan, A., & Lambert, M. J. (2010). The dose-response relationship in psychotherapy: Implications for social policy. Clinical Psychologist, 14, 39-44.

Horvath, A. O., Del Re, A. C., Fluckiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. In J. C. Norcross (Ed.), Psychotherapy Relationships That Work: Evidence-Based Responsiveness (2nd ed.), pp. 25-69. New York: Oxford University Press.

Lambert, M. J. (2011). Psychotherapy research and its achievements. In J. C. Norcross, G. R. Vandenbos, & D. K. Freedheim (Eds.), History of Psychotherapy: Continuity and Change (2nd ed.), pp. 299-332. Washington, DC: American Psychological Association.

Lambert, M. J., & Ogles, B. M. (2004). The efficacy and effectiveness of psychotherapy. In M. J. Lambert (Ed.), Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (5th ed., pp. 139–193). New York: Wiley.

Lambert, M. J., & Simon, W. (2008). The therapeutic relationship: Central and essential in psychotherapy outcome. In S. F. Hick & T. Bien (Eds.), Mindfulness and the Therapeutic Relationship (pp. 19–33). New York: Guilford.

Lebow, J. (2006). Research for the Psychotherapist: From Science to Practice. New York: Routledge.

Norcross, J. C. (2010). The therapeutic relationship. In B. L. Duncan, S. D. Miller, B. E. Wampold, & M. A. Hubble (Eds.), The Heart & Soul of Change: Delivering What Works in Therapy (2nd ed.), pp. 113-142. Washington, DC: American Psychological Association.

Norcross, J. C. & Lambert, M. J. (2011). Evidence-based therapy relationships. In J. C. Norcross (Ed.), Psychotherapy Relationships That Work: Evidence-Based Responsiveness (2nd ed.), pp. 3-21. New York: Oxford University Press.

Norcross, J. C. & Wampold, B. E. (2011). Evidence-based therapy relationships: Research conclusions and clinical practices. In J. C. Norcross (Ed.), Psychotherapy Relationships that Work: Evidence-Based Responsiveness (2nd ed.), pp. 423-430. New York: Oxford University Press.

Prochaska, J. O., & Norcross, J. C. (2010). Systems of Psychotherapy: A Transtheoretical Analysis (7th ed.). Belmont, CA: Brooks/Cole.Seligman, M. E. P. (1995). The effectiveness of psychotherapy: The Consumer Reports survey. American Psychologist, 50, 965–974.

Smith, M. L., Glass, G. V., & Miller, T. I. (1980). The benefits of psychotherapy. Baltimore: Johns Hopkins University Press.

Steenbarger, B. N. (2008). Brief therapy. In M. Hersen & A. M. Gross (Eds.), Handbook of Clinical Psychology (Vol. 1, pp. 752–775). Hoboken, NJ: Wiley.

Striano, J. (1988). Can Psychotherapists Hurt You? Santa Barbara, CA: Professional Press.

Stricker, G. (2010). Psychotherapy Integration. Washington, DC: American Psychological Association.

Wampold, B. E. (2001). The Great Psychotherapy Debate: Models, Methods, and Findings. Mahwah, NJ: Lawrence Erlbaum.

Wampold, B. E. (2010). The Basics of Psychotherapy: An Introduction to Theory and Practice. Washington, DC: American Psychological Association.

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Psychotherapy Saint Louis
2650 S. Hanley Rd., Suite 100
St. Louis, MO 63144

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