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What is Psychotherapy?

Written with Nechama Quinn, MSW

So you think you (your friend!) might need therapy. Now what? This article is an attempt to make that decision a bit easier. Become an educated consumer and learn what the field has to offer and how to get the right kind of help.

We’re going to start off with the assumption that people who are looking into therapy are struggling with emotions that are not helping them live the life they want, so things are not working. Now, there is a hierarchy to this which I will explain as follows.

  • There are those that need therapy. These people have big ineffective emotions that are getting in their way of their day to day functioning. They need help now. The good news is that there is help! Fast and efficient treatments are (baruch hashem!) available and successful at treating so many problems that need intervention.

  • Then there are those who want therapy. These people have big emotions that are not getting in the way per se of their actual functioning, but their quality of life is affected.

  • Then there are those who might want therapy because they would like to grow and gain insight into areas of herself and life. They don’t need it, and it’s mainly enhancing their quality of life then anything else.

Now going backwards: For the last kind, I would suggest any kind of therapist can be helpful there. There are many insight oriented therapists (or a psychodynamic orientation, if you want the history) that can provide that.

However, when there is a real need or want to go to therapy, please get the right kind of help! The first step is knowing that you are not looking for insight, you are looking for treatment and solutions.

If you (or your friend) are in the second category, the therapy you are looking for should include:

  • A proper assessment (that takes 2-4 sessions)

  • A conceptualization/diagnosis of the problems

  • A treatment plan, meaning a model that they are following that addresses this particular problem

  • Evaluation of the treatment plan with ongoing assessment and a changing the plan, if needed based on assessment.

Then most importantly is:

  • Reaching treatment goals

  • Maintaining treatment goals and titration of treatment

  • Graduation!

Yes, therapy should end. Problems should get solved, (emotions are here to help!) and the changes should be sustained over time.

What to be wary of:

Therapists who are treating based on their opinions and experience. This has been proven to be insufficient for effective treatment. Mainly, what you want to see is someone who follows up to date research on what treatments are effective.

In proper science jargon, we call this Evidence Based Practice. What that means is the therapist is choosing treatment based on three things: because they have the best/most quality research proving their effectiveness; the therapist’s own experience and success in using these treatments; and the client’s preferences.

A note on the research process:

The way a treatment becomes the most recommended is through conducting RCT’s. A treatment that does not have enough RCT’s is not considered evidence based, (yet). We just don’t know for sure that it solves the problems we are looking to treat.

Some examples of these awesome evidence based treatments are:

  • Behavioral Activation or Cognitive Therapy for Depression

  • Mindfulness Based Cognitive Therapy for repeated episodes of depression

  • Acceptance and Commitment Therapy for...everything :)

  • Dialectical Behavior Therapy for emotion dysregulation

  • Exposure for anxiety-based disorders (anxiety, panic, OCD, specific phobias)

  • Prolonged Exposure or Cognitive Processing Therapy for PTSD

  • Parent training for child struggles.

A note on alternative treatments:

As with anything in the medical world, alternative treatments have their place in the world and are helpful. However, you don’t find many people choosing them as their first choice for treatment. They are something to explore IF standard treatment has not worked for you (and it was being provided by someone who knew how to do it!)

It’s important to note that these treatments do provide some relief when shame is present, (which it always is!). However, that is not enough to treat other ineffective emotions like intense sadness and fear (depression and anxiety).

Essentially all of the treatments listed above are founded on taking an “opposite all the way” approach to ineffective emotions. This is a simple concept but nuanced and complex in actual deliverance. effective treatment when an emotion is not serving a helpful function and instead is severely debilitating.

Lchaim to a frum world that… :))

RM Notes

Problem: Most frum mhp are unaware of ebp. Change that by changing community expectations.

Article: What you should expect from therapy. - Intake, conceptualization, often diagnosis, treatment plan, assessment, measure of outcomes regularly, working hypothesis with change and direction based on assessment. This should all be standard of care.

Evidence based treatment: clinician experience, client preference, and current research

Standard of care to expect from therapy treatment

When a person starts therapy, the goal is to solve the problem that the person is experiencing in his life, maintain the solution, and eventually leave therapy. To effectively reach that goal, therapy treatment should include four main standards of care.

Standards of Care in Treatment

  1. Intake

The goal of an intake session is for the therapist to learn pertinent information about the client’s background and presenting problem.

  1. Conceptualization of the problem and diagnosis

Once the therapist knows how the problem presents and the context by which it occurs, he should provide a conceptual framework representing a theory behind why the problem exists and through what mechanisms it is maintained. In most cases, this will also include a diagnosis.

  1. Treatment plan

With a conceptualization in place, the therapist is able to construct a robust treatment plan. The treatment plan demonstrates how therapy will solve the presenting problem based on the conceptualization.

  1. Assessment

To ensure that treatment is working, a therapist should assess a client’s progress at regular intervals through methods that provide clear measurements of outcome. Generally, this is done via widely-accepted written assessments that can often be administered quickly in session or at home.

The advantage of regular, measurable assessments is that they can direct treatment quickly and efficiently. If, after a fair amount of time, there has been no improvement or positive change, the therapist should use that information to change the treatment plan in a way that will best serve the client’s needs.

Evidence-Based Practice

Treatment types which typically meet these four standard of care criteria often are evidence-based practice treatments. Evidence-Based Practice means a treatment that is based on three main standards:

  1. Clinician Experience

A therapist should treat clients according to his training, skills, and expertise. If a certain type of treatment could help a client and the therapist is not experienced or trained in that treatment, then it is the wrong treatment to use at that time.

  1. Client Preference

Treatment should be based on what the client prefers. If a certain type of treatment could help the client and the client does not feel comfortable with those methods, then it is the wrong treatment to use at that time.

  1. Current Research

Treatment should be backed and supported by the most current research which states that this method of treatment has been proven to be effective. If a certain type of treatment has not been proven by research to be effective, then it is the wrong treatment to use at that time.

If a treatment matches all three of these criteria, then it is considered Evidence-Based Practice and has been proven to have high success rates.

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