John Rapp, LCSW
 
Psychotherapist

Common Questions about Therapy

Does therapy work?  

People typically come to therapy because they have been unable to overcome an emotional and/or relationship problem on their own.  Sometimes, help from friends or family cannot be as objective as a therapist's.  Other times, no clear problem presents, but something feels lacking in life.  Research demonstrates therapy benefits about 75% of patients. The highest remission rates seem to occur in the treatment of phobias with exposure therapy - 90%.  Treatments for conditions like depression, binge eating disorder, and bulimia produce remission rates more like 60%.  A single course of therapy does not always work.  Research is ongoing to understand whether better matching people to the right type of treatment or therapist can help.

What happens in the first session?

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In the first session, I start by trying to understand what has driven you to seek therapy.  What problems are you facing in your life?  What are you goals for treatment?  What are your expectations of or concerns about therapy?  Have you tried therapy before and what has it been like?  If past therapy has been difficult or unhelpful, we can try to determine the reason.  Perhaps we may need to watch out for similar problems or work differently. I also explain how I might try to assist you in reaching your goals.  I may also assess if you are sufficiently committed to therapy and able participate actively enough for a meaningful therapy to take place.  As the session closes, we will discuss whether we are a good fit, and if not, what other options you have.

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How long does therapy last?

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It is not possible to determine an exact duration at the outset of therapy.  To some extent, the duration depends on the complexity and severity of your difficulties.  Long-standing problems tend to require deeper and longer work than temporary or situational problems.  Another factor is the loftiness of your goals.  For example, some patients may simply want to better manage their depression. Others may want to better understand what drives it and resolve its underlying issues.  Largely, how long you stay will be up to you.  I will work with you to identify when graduation from therapy is appropriate and help you process any feelings about leaving.

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What is Cognitive-Behavior Therapy (CBT)?

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CBT addresses what maintains problems in the present, with less emphasis on what may have caused them.  The cognitive aspects of CBT aim to help patients change by identifying and challenging problematic thoughts and beliefs. The behavioral strategies teach patients how to feel better by first changing their behavior, for example, by facing irrational fears or becoming more active in spite of feelings of depression.

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What is Interpersonal Therapy (IPT)?

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Interpersonal therapy assumes that certain problems like depression, binge eating, and bulimia are caused or influenced by events happening in relationships.  IPT assists patients in working through issues like grief, life transitions, relational conflicts, or social isolation to alleviate psychological symptoms.

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What is psychodynamic therapy?

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Modern psychodynamic therapy is rooted in Freud's ideas and omits his more outlandish claims.  Dynamic therapy assumes that we are largely influenced by factors outside of our awareness - thoughts, feelings, beliefs, patterns of relating, etc.  By bringing these factors into conscious awareness, we can have more self-understanding and more control over our lives.

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For more information on the nature and efficacy of psychodynamic therapy, see the following link:

https://www.apa.org/pubs/journals/releases/amp-65-2-98.pdf

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Do the best therapists not take insurance?

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I prefer to use my health insurance when I see a provider; I believe my patients are entitled to the same privilege.  I prefer that financial constraints not interfere with needed care.  

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What is mental health?

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Mental health is likely more than the absence of psychological symptoms, but also the presence of positive inner capacities/resources, a more whole version of oneself, and a life with greater meaning and freedom.  Such capacities may include (SWAP-200; Shedler & Westen, 2007):

• The ability to use talents and energy effectively and productively

• The capacity to sustain meaningful relationships characterized by genuine intimacy and caring

• Meaning in belonging and contributing to a larger community

• Fulfillment in mentoring and nurturing others

• Empathy

• Assertiveness

• Appreciation for and responsiveness to humor

• The ability to hear emotionally-threatening information and make use of it

• The ability to come to terms with, make meaning of, and grow from painful experiences

• The capacity to recognize alternative viewpoints, even when strong feelings arise

• A moral and ethical code

• Comfort and ease in social situations

• Contentment and happiness in life's activities

• Expression of emotion of appropriate quality and intensity

• Psychological insight - the ability to understand self and others in subtle and nuanced ways

• Meaning and satisfaction in pursuing long-term goals