Because seeing a psychiatrist costs money, so today, I’m here to talk to you about how you can improve your psychotherapy and spend that money efficiently from the visitor’s point of view. I have divided psychotherapy into about seven steps from start to finish, and we will look at them step by step below. First, what makes you want to see a psychiatrist. Psychotherapy is different from medication. Medication is when a doctor prescribes a drug, you take it, and then your job is done and the doctor and the drug do the rest. Psychotherapy is where you and the therapist form a “therapeutic alliance” and work together towards a common goal. It requires the participation and effort of both you and the therapist. The foundation of this therapeutic alliance is your willingness to put in the effort to change yourself. Of course, the cost of therapy is one kind of effort, but in psychotherapy, in addition to the cost of therapy, it also requires you to put in the effort to understand and express yourself, which cannot be replaced by the therapist. Before going to see a therapist, think about “What kind of changes do I want to make in myself through psychotherapy?” This question is a very important place to start. Example: “Unstartable Therapy” (I want to solve my pain) A gentleman describes himself as being in pain, having numerous “psychological problems” such as lack of self-confidence, fear of talking to his boss, etc., and keeps asking the therapist, “How do I solve my pain? The therapy cannot begin because the man is actually dependent on the therapist. He lacks self-reflection and has the inner intention of leaving himself in the care of the doctor and letting the doctor take responsibility for him, while he has no intention of making any changes himself. “Another gentleman came to therapy with the idea of learning about himself, hoping to discover his potential. After 100 sessions, no “potential” was discovered. Because there was no goal to the therapy, he and the therapist were just bouncing around in the ocean without a goal, and the chances of change from the therapy were slim to none. Taking the first gentleman as an example, perhaps a good expression would be: I want to become more courageous in expressing my thoughts and emotions to my supervisor through psychotherapy. Second, tell the doctor the basics of your situation. Your current problems are the result of a combination of your past experiences and present circumstances. Tell the therapist your basic situation, which includes the following: Your current situation: your age, job, marital status, who you live with, how your relationships are, and so on. Major Symptoms: i.e. what made you decide to come to see a therapist now – why precisely now and not last month or next year? What happened? Upbringing: How did you get through childhood? Who was your primary caregiver? What are some memorable events? You can recall your memories according to the time sequence of “0-1 year old, 1-3 year old, 3-6 year old, elementary school, middle school, college, and work”. The relationship with your parents, especially at an early age, is the most important aspect of this memory. Trauma: Surgery, violence, sexual assault, abandonment, death of a loved one, etc. Sexual experiences: how you feel in terms of sex, how you feel about your own sex, etc. After the therapist understands your basic information, he or she will make an assessment of you, in which the therapist will roughly pinpoint your problem areas and decide on a treatment plan. It usually takes about four interviews to make this assessment. Example: Homosexuality in the Seventh A college girl begins her therapy by describing her poor relationship with her dormitory mates. The therapist thinks it’s a relationship problem; in the third interview, the girl tells of her misery, and the therapist thinks it’s a depression problem; it’s not until the seventh interview, when the girl stammers out that she doesn’t get along well with her classmates because she’s in love with another girl in the dormitory, that the real problem surfaces. Clearly telling the therapist what your problem is will save a lot of money and energy. Third, agree with your therapist on the goals of your psychotherapy and establish your treatment settings. The goal of therapy is not exactly the same as the purpose of your visit to the therapist. After meeting with the therapist for a few times, the therapist will discuss your goals of therapy with you, which will be clearer and more explicit than the initial idea. The treatment setup includes the length of the session, how often you will meet, how you will pay, how you will handle late arrivals and missed appointments, how you will change the time of the session, and the rules that you and the therapist will follow during the session. Adherence to the setting is a mutual obligation between you and the therapist. The “setup” is like a third person in the treatment room that is there to make sure that you and the therapist are working in a meaningful way. It is understandable that you may need to change the settings on the fly for various reasons. But if you change the time just to go on a date with your girlfriend, then it’s time to consider whether you’re motivated enough to undergo therapy. After this has been accomplished, therapy has officially begun. Fourth, place importance on expressing your feelings, especially towards the therapist. Psychological problems are generally problems of emotion, not thinking, so feelings are the most important tool you and your therapist have. A question therapists often ask is, “What kind of feeling was that?” Example: 100 Types of Anger Anger is just a word, and different people may feel anger in completely different ways; for example, a man who is angry often fantasizes about tearing a dog in half from the corner of his mouth, while a woman who is angry often stands in a doorway and cries while breaking into tears. Free association and expression reduces moral constraints. Because the therapist will not judge your “good or bad” from the moral point of view, on the contrary, most of the time, what you “dare not” to express, is precisely the most important. (e.g. “The Seventh Homosexual”) There is a word called “action”. It means that emotions that are not expressed in words are expressed in actions. For example, being late, being silent, giving a gift, inviting a therapist to dinner, etc. We can learn from “seeing into action”. We can find out what thoughts and feelings you want to express, but don’t say, from the “seeing in action”, the following are some examples. Being late: This is often a sign of your inner conflict. For example, wanting to come to therapy, but being afraid of being hurt by the pain of the treatment. Giving gifts and treats: often suggests that you want to take control of the therapy situation. “Eating people’s words” may be your way of trying to make the therapist become under your control without you realizing it. Silence: often suggests that you are attacking the therapist. For example, “You’re my therapist, you’re supposed to understand me 100%, but you can’t, and I’m so angry that I don’t want to say anything more!” When you have these thoughts and behaviors, think: what am I going to express in this way? Fifth, about conflict, tension (tension) in therapy. Tension is bound to arise between you and your therapist when the therapy is going on at a certain stage, and you will have some positive or negative feelings, such as falling in love with your therapist, or hating your therapist. There is no need to be afraid of these feelings, and you are encouraged to express them directly. In psychotherapy, the therapist has the responsibility and the ability to live with whatever feelings you express. And one thing that both you and the therapist need to be clear about is that the feelings in therapy represent your unfulfilled desires, and very often these desires have a deeper meaning than just having a real meaning – they represent your childhood fantasies and unfulfilled desires, which are the crux of the problems that have led you to your current problems. Example: The patient in the silent example above had a neglected childhood. His mother was too busy with her own affairs and demanded only what she wanted from him, never inquiring affectionately about his needs and feelings, and showing no understanding of him whatsoever. Because he had to rely on his mother to live, he buried his anger at his “unappreciative mother” deep inside and learned to be “silent. In a real sense, his anger was that he hated the therapist for not being able to understand him, but in a deeper sense, it was because he saw the therapist as a “mother who understands me,” but the therapist could not, and so he went through his childhood again, experiencing the same kind of anger. This time, with the therapist’s encouragement, he did not hide his anger, but tried to express it slowly and bravely. The therapist’s tolerance made him believe that he could express his emotions and that he would not be killed by the “cold-blooded therapist” (his mother) for expressing his emotions, and he began to become more able to express his feelings in real life. When these feelings come up, it means that you have reached a critical point in your therapy, and expressing them bravely and carefully to the therapist is a sure way to facilitate the therapy. “Some therapies are “lively”, with no tension between therapist and patient, and a good “fit”. This often means that there is no depth to the therapy, just a speech or a debate. True healing is inevitably accompanied by pain, because the uncovering of scars is painful in itself. “There is an American therapist who has developed the concept of “corrective experience”, which means that “the therapist gives the patient whatever he or she needs to feel”, in other words, the therapist gives the patient whatever he or she needs to feel. “In other words, if the patient lacks an understanding mother, the therapist has to play that role. As soon as this theory was thrown out, the poor therapist was immediately criticized by therapists all over the country. Because the true meaning of “the therapist will give the patient whatever she needs” is that the therapist is the patient’s God and can give the patient everything. This theory violates the basic principle of therapy – therapy is to help patients grow and become independent, not to help patients indulge in the world of fantasy, retreat into a child. Sixth, how long will it take. There is no standard answer to this question. Different schools of therapy have different cycles. With regard to dynamical psychotherapy, or psychoanalysis, the reference answer is: a short course of less than 30 sessions; a long course of up to several years. The length of hospitalization is three months, and while three months may be sufficient for focused symptom management and restoration of social life skills, it is far too brief for personality change. The approach we recommend is to decide roughly how long it will take, based on the goals you set with your therapist at the beginning, and it is a good idea to continue treatment through regular outpatient visits after the hospitalization is over. Example: “Who’s sick?” People who see a psychiatrist are often seen as “sick”, a phenomenon to which Americans in the 1980s had a subtle answer. In the 1980s, when psychoanalytic therapy became popular in the United States, people at first ridiculed those who were analyzed as sick, while those who were analyzed made a strong retort, and eventually changed the direction of public opinion: “Those who don’t undergo the analysis are sick”. Because there is no doubt that everyone encounters problems in the process of growing up (probably no one dares to say that he or she has never encountered problems), and those who accept the analysis are facing these problems, while those who don’t accept the analysis are “even afraid to accept the analysis”, and they think that the problems are so serious that they don’t even dare to see a psychiatrist. Seventh, about closure. Ideally, closure is a process. There should be a period of time between the time you ask for closure and the time you stop seeing the therapist, during which you can be more fully prepared to face life alone and deal with the separation from the therapist. Closure is painful because closure means separation. In reality, for a variety of reasons, therapy is often forced to end when it is not fully prepared. But just as shocking love doesn’t always have a beautiful ending, effective therapy, too, doesn’t always have a beautiful ending. What matters is the change that comes to you during the course of treatment. At any time, you have the right to end. However, we recommend that you discuss the reasons and feelings for ending with your therapist before you do so. Because closure can be “closure” or it can be “shedding” or “running away”. It is important to remember that the time of greatest tension is the time to discuss this with your therapist, and it is a shame to choose to “run away” out of fear. It is also possible for the therapist to offer closure, or to make a referral. Again, the therapist has an obligation to discuss this with you at the time of the offer.