Lifestyle Choices

Psychological approaches work best for persons who are able and willing to describe their thoughts and feelings. In other words, they must be reasonably verbal about their problems. Many patients are so preoccupied with physical symptoms that they are unwilling to discuss their thoughts and emotions. Some are obviously anxious and or sad but deny experiencing these emotions. They will be less likely to benefit from psychological therapies.

Remember that therapists do not dish out advice; if at all, they give advice sparingly. Hence whatever general advice is given should be taken seriously.

If a patient attends psychotherapy just to receive advice, he will be disappointed. Psychotherapy is hard work and requires commitment. Description of events and verbalising emotions can be painful as it is a reliving of past hurts and disappointments.

What sort of therapy will be administered depends on the skills and expertise available. If a particular agency has therapists skilled in CBT and the patient is assessed to require Dynamic Psychotherapy, then the patient should be referred to colleagues who are trained in administering Dynamic Psychotherapy or referred to another agency where such expertise is available.

Patients need to understand the rationale of the therapy. If they can better accept the rationale of a certain therapy, then they should be referred for that therapy. In Dynamic Psychotherapy, patients must have a genuine wish to understand themselves, be motivated, be able to form a therapeutic relationship with the therapist, and withstand the emotions that arise from transference, yet not be excessively dependent on the therapist. They should have a degree of psychological mindedness which means they are able to think in abstract terms, able to express thoughts and feelings and are able to think symbolically about the unconscious meanings of their behaviour.

In the case of CBT, the presence of negative thoughts and a willingness to subject these thoughts to testing and to relook at the situations from alternative perspectives is important for success in this method. Furthermore, since homework is essential for progress in therapy, patients must cooperate with homework assignments.

Obviously there should be a good match of patient and therapist. Both should feel comfortable with each other. Patients should accept the rationale of a particular therapy before embarking on the treatment because commitment is required to attend and to complete homework assignments in the case of CBT. These conditions are not intended to discourage people from seeking psychotherapy. Instead they are intended to optimise the chances of benefitting from psychological interventions or counselling.

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