Does talk therapy actually work?

One of my clients Romana drew the image above. The title ‘naval gazer’ accurately sums up what can happen when too much time is spent dwelling on problems, suppressing pain, and not enough time healing, actively evaluating options and challenging any unhelpful assumptions. In a state of paralysis, many people get bogged down.

Sometimes, a simple but effective way to get unstuck is to explore a range of different thinking styles – ideally, ones that challenge crippled thinking, open up possibilities and move you into a state of inspired, solutions-focused action. This is where working with a therapist can help. However, many people resist going to see a counselor or therapist because they assume that all they will achieve from the session is ruminating on their problems and more navel-gazing.

This couldn’t be further from the truth. A skilled counselor can not only provide much-needed support but also act as an objective, independent sounding board who can help you get to the root of your issues, add a liberal dose of much-needed empathy and understanding and support you to make the changes necessary to empower your life. As one of my clients told me, “It wasn’t until someone listened to me, really listened, that I knew what I really thought.”

All too often, no one gives us the space to think or express our emotions. Well-meaning family members, work colleague, friends and even strangers may dispense advice—not all of it is helpful. Take the example of Simon whose wife of thirty-years had recently died. “You just need to suck it up and get on with it,” a friend told him. Working through his grief in therapy proved to be a much more helpful and healing approach.

“I thought I should be able to handle it. I told myself I wouldn’t get upset, ” he told me.

“Who told you that when you lose someone you love very, very much that you shouldn’t feel something?” I asked. He shrugged.

We both agreed it was natural to cry. I suggested that if he didn’t feel anything – if he didn’t feel loss, or grief, sadness or pain, he would be inhuman. Cognitively we can often fool our minds, but the heart is often our greatest, and most honest, teacher.

In our Western culture, so many people, particularly men, bottle up their feelings. So many negative emotions are stuffed down and repressed.Some experts say that these repressed feelings are contributing factors behind the escalating rates of depression, anxiety, alcohol addiction, drug abuse, and suicide.

Tom, whose sister took her own life when he was in his earlier 20’s recalls his parents praising him for showing a lack of emotion, “Good boy for not crying,” they told him. Bottling trauma is neither helpful nor good.

Now in his fifties, Tom suffers from mood swings, anxiety, and depression. Rather than seek help releasing these feelings, including anger toward his parents, he abuses alcohol in an attempt to anaesthetize dark feelings. And he’s not alone. As I share in my books, Your Beautiful Mind: Control Alcohol and Love Life More, and Mind Your Drink: The Surprising Joy of Sobriety (Control Alcohol, Discover Freedom, Find Happiness and Change Your Life) a great many people drink alcohol to mask or numb the symptoms of their wounds.

No one escapes walking in this world without some degree of hurt. But for many people, this hurt is profoundly deep. The first cuts, experts (and songwriters) say are the deepest—very often these wounds are inflicted during childhood. Tragically, what should be a happy time of innocence is one of incalculable pain. Incest, rape, physical abuse, emotional neglect—and many more horrid things happen to people growing up.

Many wounded souls never receive therapy. Reasons vary. For some, it appears too costly, for others they think that talking to a therapist make them weak. Tony Soprano, one of the toughest characters to storm across our TV screens in the award-winning show, The Sopranos, sought therapy to deal with repressed emotions which contributed to his anxiety attacks.

In 2017 movie superstar Brad Pitt revealed he had a shocking drinking problem that wrecked his marriage and tore his young family apart. “I feel retarded when it comes to expressing my emotions,” he said as he opened up about his battle with alcohol. To help him kick the alcohol habit he opted to face his demons and learn how to express and handle emotions by seeking the services of a qualified and skilled counselor.

Asking for help, whether this is addiction counseling, relationship therapy, coaching to deal with stress at work, anxiety, depression, suicidal thoughts, or something else, isn’t easy for many successful people. However, it’s often what you need to gain a fresh perspective, overcome obstacles, heal wounds and expand your life. You may like to check out this interesting series discussing why men struggle to express their feelings.

As a qualified counselor and holistic therapist, I know that very often integrative talk-therapy which draws on an eclectic range of techniques such as Cognitive Behavioral Therapy (CBT), Rational Emotive Behavioral Therapy (REBT) and other modalities, including creative and art-based techniques can be extremely effective.

Therapy needn’t be gloomy. A lot of healthy healing can be achieved using playfulness and fun. Personally and professionally I believe in magic and the power of beauty, joy, love, purpose, and creativity to transform peoples’ lives. These are also scientifically-validated tools that enhance spiritual health and aid recovery.

Creativity in its various guises is a natural antidote to stress, anxiety, and depression, which explains why art therapy is such a potent and popular tool. Art therapy is a form of experiential therapy, an approach to recovery and healing that addresses emotional and spiritual needs through creative or physical activity. People don’t need to have a background in the arts or any artistic talent to participate. They need only to be open to experiencing and engaging actively to benefit.

I have trained in a technique called Interactive Drawing Therapy and have found it to be an incredible tool in my own life and in my sessions with others. The simplest of drawings, a line, a color, a scrawled phrase or word can powerfully access parts of the psyche we often repress, bringing unhelp subconscious belief to light. In an alchemical process, wounds are spun into gold.

When I first trained in Interactive Drawing Therapy the teacher asked for a volunteer. No hands were raised so he picked me. What harm could it do, I thought, being as skilled as I was at keeping a lid firmly on my feelings.

“Draw an animal,” he said.

Sure, I thought. Great. Harmless. I drew a giraffe.

“Put some color on the page,” the teacher gently guided.

My giraffe became pink with green, purple and yellow spots. What fun I thought.

“Where is she?” the teacher asked. “Draw this on the page.”

I drew large grey and black rectangles, symbolizing office blocks, cars belching smoke, and a road, not unlike Lambton Quay, in Wellington, New Zealand where I went to work in a job I hated every weekday.

“Put some words on the page,” the teacher whispered.

“She doesn’t want to stand out.”

And then it dawned on me, just as the words slipped onto the page. That giraffe was me. And the fact was I did stand out—naturally. I had always been different. And I had struggled unsuccessfully to belong.

“She can’t help but stand out,” my tutor affirmed. “It’s who she is.”

For me, this awareness was so new, so potent, so transformative, that I knew instantly there was work to do. I began to understand the deep social anxiety I had felt as a child and carried with me through adolescence—and with it the drinking and reckless behavior I had adopted to belong, to bolster the confidence I never felt, to hide the discomfort of living in my own skin.

When I completed my counseling training many years ago I was also introduced to Albert Ellis’s Rational Emotive Behaviour Therapy (REBT). REBT originated in the mid-1950s as Ellis became increasingly aware and frustrated by the ineffectiveness of traditional psychoanalysis to produce a change in his patients.

The REBT worldview is that people often make themselves emotional victims by their own distorted, unrealistic, and irrational thinking patterns. Ellis takes an essentially optimistic view of people but criticizes some humanistic approaches as being too soft at times and failing to address the fact that people can virtually “self-destruct” through irrational and muddled thinking.

According to Ellis and the REBT worldview, all people are born with self-defeating tendencies. When something goes against your goals, your values or desires, feelings of failure, rejection, etc., can set in; but you have a choice.

You have a choice of feeling terrified, panicky, depressed, self-pitying, self-doubting, etc.—and succumbing to these emotions.

But these feelings can prevent you from making positive changes—and may drive you to drink, for example.

Which emotion you choose, according to REBT practitioners, is thought to mainly depend on your belief system—not your goals and values, but what you tell yourself when your goals and values are thwarted or blocked.

We all have a rational set of beliefs called “preferences.” In this context, “rational” means self-helping beliefs, such as, “I don’t like what is going on.” “I wish it weren’t so.” “How annoying?” “Let’s see what I can do about it.”

Many people very frequently pick irrational beliefs, referred to as “demands,” such as, “Because I don’t like what is going on, it absolutely should not be allowed.” “It can’t happen.” “I can’t stand it.” “Everyone should love me–if they don’t, I am worthless.” “It’s horrible, I think I’ll give up” (or, when taken to the extreme, “I’ll kill myself”).

Ellis’ therapeutic approach is not to challenge the clients’ goals and values, but instead attack their absolute demands about achieving these values. The emphasis of the therapy is on changing the way the client thinks about the behavior or the upsetting event, rather than on changing the behavior itself.

This is a critical point—it is not the actual event but our view of the event that is critical.

The task of the REBT therapist is to help clients’ challenge and self-correct thought patterns and minimize irrational ideas, while simultaneously helping them to change their dysfunctional feelings and behaviors. Challenging the irrational statement is key to changing an entire philosophy of life.

The ABCDEF Method

Perhaps Ellis’s most important concrete methodological contribution is his A-B-C–D-E-F theory, which can be summarized as follows:

A – the “objective” facts, events, behaviors that an individual encounters. (I call this, ‘the activating event’).

B – the person’s beliefs about ‘A’

C – the emotional consequences, or how a person feels and acts about ‘A’

D – disputing ‘B’ irrational beliefs

E – the effect that disputation has on the client

F – new feelings and behaviors

Example:

I helped a friend apply the ABCDE method following a Boxing Day alcohol-fuelled drama which impacted his son. The following is an edited extract (I have changed names to protect people’s privacy):

A – the activating event and “objective” facts, events, behaviors encountered.

Following Boxing Day, Tim, who is nineteen, rang and told his father, Simon about an alleged assault between him and his mother’s new boyfriend. Tim says both his mom and her boyfriend were drunk.

B – the beliefs about ‘A’

Simon is waiting to speak to the ‘old-one’ (his ex) to determine the facts but believes his son’s account of what happens. The ‘old one’ is not returning his call.

He believes the reason she is not returning his call is because she is at fault, and that an assault did occur.

C – the emotional consequences, or how Simon feels and acts about ‘A’

Simon’s emotions are heightened. He’s feeling frustrated, powerless, angry, resentful and fearful for his son’s safety. Yet, aspects of his son’s version of what happened concern him. He feels confused as to what really occurred.

Simon drinks 3 bottles of beer and goes to the bottle store to buy more.

Simon believes alcohol relaxes him, minimizes stress, and helps him stay calmer and in control while he waits.

Over the course of the evening (3 hours), he drinks five 500ml bottles of beer (11 standard drinks.) Feeling stressed, I join him—minimizing my drinking by consuming small quantities in six crystal glasses (in total 500 ml, or 2.2 standard drinks.)

After speaking to ‘the old one’ and his son on a three-way call, and resolving all misunderstandings, I asked how he feels now that he knows his son is not at risk. He shuts me down and says, “I don’t want to talk about it.”

He doesn’t speak to me again that evening.

D – disputing ‘B’ irrational beliefs

Rather than work myself into a state, I challenged my belief that by drinking with Simon we would both be relaxed. Alcohol is a depressant, it depletes your energy, and increases symptoms of stress already triggered by external events, I reminded myself.

It increases anxiety, melancholy, gloom, and aggression, which is why Tim’s mom and her partner argued, and why Tim ‘lunged’ at this stepfather when he told him to mind his business.

I counsel myself, “Alcohol is ethanol, a flammable, colorless chemical compound—it’s poison, also used to fuel cars, masquerading as a happy drink.”

E – effect that disputation has

The episode strengthened my resolve never to drink during times of stress, and my conviction that I don’t want to ingest poisons.

Simon’s knowledge that his ex is an alcoholic causes him to question his own dependency on alcohol during times of stress.

This change in thinking affects Simon by making him more committed to controlling his drinking and being a role model to his son.

F – new feelings and behaviors

Simon and I felt calmer and more optimistic about the benefits of not drinking.

Simon felt more empowered and in control now that he has discovered the truth about his ex’s drinking and how her relationship with a man who drinks excessively affects his son.

He decides to take control by helping Tim find a way to gain his independence and leave home, knowing that despite urging his ex to seek help for her drinking that, as with other times, this may have fallen on deaf ears.

Tim successfully finds work that he loves which means he is seldom at home and tells his father that alcohol has no place in his own life. Tim is happier sober!

As a holistic practitioner and life coach I also know there is a wide range of alternative healing approaches that yield remarkable, extremely quick results. It concerns me, and a lot of other health professionals, that too often people turn to antidepressant medication, Despite research that cites the lower effectiveness, for many people this still appears to be the solution of choice prescribed by many medical professions.

“Pills are cheap,” my doctor told me when I asked her why counseling wasn’t recommended to more people. It may be cheap, but worrying it is not always effective and the side-effects can also do more harm than healing. Rather than offer short-term help very often people come to rely on medical prescriptions for decades. In an extract from his book, Lost Connections: Uncovering The Real Causes of Depression – and the Unexpected Solutions, Johann Hari, who took antidepressants for 13 years, says masking the pain does not offer long-term relief and calls for a new approach.

“I was a teenager when I swallowed my first antidepressant. I was standing in the weak English sunshine, outside a pharmacy in a shopping centre in London. The tablet was white and small, and as I swallowed, it felt like a chemical kiss. That morning I had gone to see my doctor and I had told him – crouched, embarrassed – that pain was leaking out of me uncontrollably, like a bad smell, and I had felt this way for several years. In reply, he told me a story. There is a chemical called serotonin that makes people feel good, he said, and some people are naturally lacking it in their brains. You are clearly one of those people. There are now, thankfully, new drugs that will restore your serotonin level to that of a normal person. Take them, and you will be well. At last, I understood what had been happening to me, and why.

However, a few months into my drugging, something odd happened. The pain started to seep through again. Before long, I felt as bad as I had at the start. I went back to my doctor, and he told me that I was clearly on too low a dose. And so, 20 milligrams became 30 milligrams; the white pill became blue. I felt better for several months. And then the pain came back through once more. My dose kept being jacked up, until I was on 80mg, where it stayed for many years, with only a few short breaks. And still the pain broke back through.”

You can read a summary of his views, including his claims of an over-riding profit motive by pharmaceutical companies, in his interview with The Guardian. ‘Is everything you think you know about depression wrong?”

A good therapist will often share strategies that can help you rebalance the hormones in your brain, or refer you to other health professionals like nutritionists and dietitians. There are a great many ways to increase serotonin in the human brain without drugs, including meditation, exercise, sunlight, vitamins, and other low-cost approaches. Many will save you money, boost your health, help you reduce weight and improve your relationships—here I’m talking about eliminating or cutting back alcohol consumption.

Alcohol has been found to significantly reduce serotonin 45 minutes after drinking. As this article in SpiritScience claims, there is also a clear link between alcohol consumption and violence or other types of aggressive behavior. Aggression is also heavily linked to low serotonin levels and may be due to alcohol’s disrupting effects on serotonin metabolism.

In an article which appears in Psychology Today, F. Diane Barth, a psychotherapist, and psychoanalyst in private practice in New York City cites research confirming the ineffectiveness of antidepressant medication compared with other therapies, including talk therapy. In the November 2010 issue of Scientific American Mind: “Getting to Know Me: Psychodynamic therapy has been caricatured as navel-gazing, but studies show powerful benefits,” claims Jonathan Shedler. Shedler, is an associate professor of psychiatry at the University of Colorado School of Medicine and director of psychology at the University of Colorado Hospital Outpatient Psychiatry Service. As Barth notes, Shelder ‘combines anecdotes from clients and therapists with fascinating research to explain something that those of us who have practiced “insight” therapy (sometimes also called “talk” therapy) have known for a long time: psychodynamic psychotherapy works. It helps clients find solutions not only to specific symptoms but also to difficulties at work, in their social lives, and with self-esteem.

For example, Shedler writes, “One major study found an ‘effect size’-a measure of treatment benefit – of 0.97” for psychodynamic psychotherapy. “For CBT (cognitive behavioral therapy), 0.68 is a typical effect size. For antidepressant medication, the average effect size is 0.31.”

Barth describes seven features that researchers have found contribute to the power and effectiveness of psychodynamic psychotherapy: “exploring emotions, examining avoidances, identifying recurring patterns, discussing past experience, focusing on relationships, and examining the patient/therapist relationship.”

As a result of counseling, many people choose to connect or reconnect with lapsed spiritual or religious rituals. I love integrating spiritual approaches into my ‘talk therapy.’ Many people have lost their union with God because of the hypocritical dogma which has polluted many faith systems. However, prayer, for example, comes in many shapes, colors, and textures.

Many recovering alcoholics, prosperous creatives and successful business people, including Deepak Chopra, Julia Cameron, Wayne Dyer and Louise Hay, refer to prayer in several forms, including describing it as the voice of God, intuition, higher self, inner goddess, or their Sacred Divine. In her book Illuminata: A Return to Prayer, Marianne Williamson, who also shares her early dysfunctional relationship with her mother, speaks of prayer as a way of “focusing our eyes,” dramatically transforming our orientation, releasing us “from the snares of lower energies,” and aligning “our internal energies with truth”.

Prayer, or invoking a higher power, is revered by many for its power to help them reclaim their strength, find their inner power and overcome tragedy. You may enjoy reading my earlier post on spiritual approaches to the treatment of alcohol addiction—https://www.thejoyfulartist.co.nz/spiritual-approaches-to-the-treatment-of-alcohol-addiction/

Whether you elect to seek the services of a therapist, put your faith in God, divine wisdom, spirituality or something else, the truth is very often that safety, guidance, and strength comes from a place within. The right therapist can act as a much needed and much-valued guide who supports you to find solutions to your problems and develop strategies you can apply yourself to regularly to stay well.