Mental Health Matters—A Monthly Column


For our 4th edition of Mental Health Matters, I thought it would be interesting to discuss the topic of psychotherapy. For that purpose I have invited Robin Dromey, a licensed clinical social worker and MSW, LCSW at Senior Life Solutions based at Putnam Co. Memorial Hospital to answer some common questions about this important form of mental health treatment.
First, the term "counseling" is sometimes used interchangeably with "therapy". Are these the same or are there important differences?

Counseling services tend to involve short-term solution focused treatment. Such services serve patients with a specific problem including improving relationships, stress related issues or lifestyle changes. In many cases patients who seek out counseling services are proactive with an awareness of their presenting concerns.

Therapy may consist of all the components of counseling with some additional services, such as the duration and pace of services. The therapeutic process helps the patient find the root to the causes of emotional and behavioral problems. Therapy and counseling may overlap in some areas. As a result, it is important to identify to the professional the presenting issue a patient wants to resolve. Both counselors and therapists are trained to evaluate one's needs and provide him/her with the appropriate recommendations for treatment.

OK. I understand you do both group and individual therapy. Therapy about mental and emotional issues often involve issues that are very personal and about which we might feel embarrassed, ashamed or just don't want others to know a lot about. Isn't that a problem for someone entering group therapy?

I believe this depends on the patient and the issues he/she is experiencing. It depends on past issues with the patient and the prior amount and quality of therapy he/she has experienced. If patient has had past trust issues due to trauma, diagnosis, or poor quality of therapy, this may be very difficult; so it may take more time to get him/her to open up. So what is important is for that therapist to develop a therapeutic alliance and trustworthy relationship with the patient to get him/her to open up so he/she can benefit from both individual and group therapy. I feel that opening up in group therapy depends on how other group members open up. A patient also has to develop a trustworthy relationship with his/her group members. Group therapy helps group members realize that they are not alone in what they experience and that others experience similar symptoms and experiences. It does help patients to know that what they process in group is confidential.

Are there any advantages to having therapy in a group vs individually. Also, some of your clients are in both individual and group; can you explain how the combination might be helpful or maybe even necessary in some cases?

There are cases where patients trust the therapist with more deep issues that he/she may not be ready to share with the group. In many cases with time this changes when the patient develops trust with group members. There are times, depending on his/her diagnosis and experiences with mental illness, he or she may feel judged or misunderstood by other group members if he/she expresses all his/her thoughts and experiences with group members. This again depends on the severity of one's mental illness. When I do have patients that have more severe mental illness that other group members may not understand, I educate the group on the variety of mental illnesses; so they do not make judgment on that group member.

Alright, now this may be hard to answer in a limited amount of space, but can you tell us how psychotherapy works? Are there some "active ingredients"of effective psychotherapy that have been identified?

There are many different styles of group therapy including: gestalt, brief therapy, supportive-expressive, cognitive- behavioral, psycho-educational, and psychodrama and many more. Whatever style a therapist decides to use depends on his/her training and the diagnoses and problems of the patient. I believe that there are primary factors to the therapeutic experience. I believe such factors include: having groups that incorporate a instillation of hope, universality (others are experiencing similar thoughts, feelings and experiences), imparting information, altruism, (being able to help others with his/her story and provide support), the corrective recapitulation of the primary family group (group becomes like family), development of socializing techniques, imitative behavior modeled by the therapist, group cohesiveness (refers to that attractiveness that members have for their group and for other members), catharsis (expressing feelings, positive and negative), and existential factors (taking responsibility for way he/she lives his/her life).

Finally, I understand that the Senior Life Solutions program is referred to as "intensive outpatient treatment". That sounds a little intimidating; is the program for people in crisis? What makes it intensive?

It can be for people both in crisis (depending on degree of crisis) and those who have suffered from mental health issues for many years. If a patient is completely out of reality or a threat to him/herself; then he/she would need inpatient treatment to become stabilized. The reason we call it intensive therapy is because they receive group therapy three times a week and individual therapy depending on their needs up to 4 times a month. Such therapy depends on the degree that pts. are impaired in their daily functioning. The more impaired the more intense his/her therapy, especially individual therapy. A patient in intensive therapy receive more therapy hours than in traditional outpatient therapy. For example, patients in outpatient therapy most generally receive one hour of therapy a week. In intensive therapy, our patients receive 3 hours a week of group therapy and one hour of individual therapy monthly, depending on the case.

Thanks Robin. Your responses reflect a deep understanding of the psychotherapeutic process. I invite readers to write or call staff at Senior Life Solutions with any follow up questions.