About Psychotherapy

Finding a therapist

Because the need for therapy or counselling is often urgent and the result of a crisis, the referral may come from a family doctor or a friend who’s benefited from treatment. It may even happen through a random internet search, like the one that may have led you to this page. All of these routes to a particular therapist’s office involve some element of luck. But that also means, of course, that you could land up with a type of therapy that isn’t suitable for you, or you miss out on a type of therapy that could be more appropriate for your problem.

What I would like to provide is some information about the different types of therapy available, and the questions it may be useful to ask about a therapist’s training and way of working.

Qualifications and professional background

People offering psychological treatment come from different professional backgrounds. In South Africa, psychologists are registered in several categories, including clinical, counselling and educational psychology. The HPCSA provides information about these categories and professional registration.

A professional title is one part of the picture. It is also useful to ask about the person’s particular training, experience and therapeutic approach, and whether they work with the difficulties that concern you.

Some people see both a psychiatrist and a psychologist, with medical treatment and psychotherapy forming different parts of their care. What is appropriate depends on the person and the difficulties involved.

Questions worth asking

What is your professional background and training?
What approach do you use, and how does it shape the sessions?
Do you have experience working with the difficulties I am describing?
How will we think about the focus, frequency and duration of therapy?

These questions can help make an unfamiliar process more understandable. They can also begin a conversation about whether the therapist and the way of working feel suitable for you.

Professional registration information: HPCSA Professional Board for Psychology.

Therapeutic approaches

The different approaches to therapy are very often the product of the particular university a therapist studied at. For example, Stellenbosch University focuses more on cognitive psychotherapy, while the University of Cape Town uses a more psychodynamic psychoanalytic approach. I will try to explain theoretically, in the briefest and simplest way, how different therapists may approach the same case. Let me exemplify these differences through the fictitious case of Mr Jones.

The case of Mr Jones

Mr Jones decided to see a therapist. This was an uncharacteristic decision for the very conservative man who rarely spoke about his emotional world and believed that all could be overcome with the right attitude.

So what happened? One day, out of the blue, his wife of 30 years announced that she had been having an affair with his best friend Dan for the past two years and that she was leaving him. After much probing, she proceeded to confess that this was not the first affair she'd had and that, prior to her relationship with Dan, she'd had an eight-year affair with her married work colleague.

These disturbing findings catapulted him into a deep depression from which he was unable to recover. He became tearful and prone to uncontrollable anger when provoked; in fact, he had been arrested by the police after a road-rage incident. Needless to say, this affected his work performance and his relationship with his children. The normally calm, accommodating person with an easy disposition became unrecognisable, both to himself and those who knew him, and was steadily getting worse. His children, friends, and work colleagues became increasingly worried about him and suggested that he speak to someone.

There are a number of ways of understanding and working with what Mr Jones is presenting.

The cognitive behavioral method would be to focus on helping him deal with his symptoms. He needs to accept what has happened, find ways to deal with his rage, grieve for the loss of his wife and express his emotions. In this case, the treatment would most likely be short-term and the therapist would try to equip the broken man with tools and mechanisms to work through and deal with his symptoms so that he can move forward with his life.

On the other hand, a psychodynamic, psychoanalytically trained therapist, such as myself, will focus more on what it was that brought Mr Jones to this point. How could he have been so blind to his wife’s infidelities for so long? What is there in his history that has led him to this desperate point? I would also assume that the rage and sadness he displays have probably been buried in his unconscious mind for a long time, longer than the years he’s been married to his wife, and have now erupted to the forefront. I would want to find out more about his background and who he is as a person so that we can both understand why he is where he is today.

In essence, I would see this terrible event as a wake-up call and also an opportunity for Mr Jones to ‘find out who he really is’. To achieve this he will need to do some soul-searching. This will happen through the dialogue between us and the exploration of his life, his childhood and his previous relationships.

This type of therapy is often longer-term, not because I would insist that Mr Jones stay in therapy for a particular period of time, but because the work that we will be doing will move far beyond the particular event that brought him to me.

Very often individuals choose to stay in therapy long after the bad feelings and crises have been resolved. It becomes a space where they can reflect on and investigate who they are, how they operate in the world, and what they really want and need in order to feel happy and fulfilled.

Connecting with a therapist

Therapy – be it long-term or short-term, behavioural or analytical, medication-based or not – is first and foremost a relationship between two people.

When people come to see me for the first time, one of the most important things we need to establish is how they feel about being with ME. Do I feel like the right person for them? Do they feel comfortable and safe with me?

You need to feel that there is some potential, at least, to develop a relationship with a particular therapist. If it doesn’t feel right, don’t force it; shop around and see a few other people first. Be serious about who you choose to work with. It’s important to find someone with whom you feel at ease and can trust.