What Therapy Is
A therapy session is a conversation between a mental health specialist and someone in need of a mental health adjustment. Some sessions are held privately, so the conversation moves between the therapist and the person who needs care with no outside interruptions. But some therapy sessions are held in group settings, so people who need care might get help from a clinical professional as well as peers.
People go into therapy for all sorts of reasons, including:
- Marital difficulties
- Substance abuse
Therapy often makes people feel a whole lot better. In fact, the American Psychological Association says that about 50 percent of people with emotional difficulties felt better after only eight sessions of therapy, while about 75 percent of people felt better after six months of care.
Those improvements are due, in part, to the professionalism of people who provide therapy, and those professionals can come from all sorts of different clinical backgrounds. Mental Health America reports that clinical psychologists, clinical social workers, counselors, nurses, therapists, psychiatrists, peer specialists, and other professionals might provide therapy to people in need, although what they can do varies greatly from one state to the next.
In some states, people who provide this level of counseling cannot prescribe medications or diagnose disease. But in other states, these people can prescribe and diagnose.
In any case, people who provide therapy in rehab facilities are typically required to prove that they have completed some form of professional education. Often, these people are required to prove that they have special certifications in addiction care. So they are not people who simply decide to help without understanding what kind of help is required. They must have schooling before they can get started.
Just as there are many different types of professionals who can provide therapy, there are all sorts of different therapy types that might be put to use when a person has a problem with drugs or alcohol. These are just a few of the different therapy approaches a team might use to help a person in need.
Cognitive Behavioral Therapy (CBT)
The National Alliance on Mental Illness explains that CBT focuses on exploring the connections between a person’s feelings, thoughts, and decisions. That means therapists work to help their clients name their thoughts and examine them closely, before they choose to either believe and/or act upon those thoughts.
People utilizing CBT are often encouraged to challenge their thoughts directly, either with visualization exercises or with meditation. If possible, people replace negative and untrue thoughts with more positive options, rather than acting blindly. For people with addictions, CBT can help reveal how prior trauma leads to poor decisions involving drugs. The techniques skilled in CBT can help people to deal with that trauma rather than medicating it with drugs.
Dialectical Behavior Therapy (DBT)
While CBT approaches can be very helpful for people with addictions, some find the questioning aspect of CBT hard to accept. They feel attacked and ignored in their therapy sessions, and they may not get the same level of benefit as a result.
DBT uses the same theoretical underpinning found in CBT, but the overall approach is slower. People undergoing DBT form very close alliances with their therapists, and they attempt to find a balance between changing past behavior and accepting elements of life that really are working.
This form of therapy can be remarkably helpful for people with borderline personality disorder, particularly when that mental illness sparks thoughts of suicide. In a study of 180 people with borderline personality disorder, published in The American Journal of Psychiatry, researchers found that most had significant reductions in suicide attempts after one year of treatment, along with other lifestyle benefits. Studies like this demonstrate how DBT might be truly helpful for one group of people in need.
Therapy works best when people come sober to each and every session. Unfortunately, some drugs of abuse can be so damaging that people in recovery crave a hit between therapy sessions, and they may even skip sessions in order to take drugs.
Contingency Management ties bonuses or prizes to ongoing excellent participation in care. People in these programs might get prizes for completing therapy sessions, for submitting clean urine tests, or for speaking up in group therapy sessions.
The National Institute on Drug Abuse (NIDA) reports that this form of therapy has been proven effective in the treatment of addictions to:
It is not a form of addiction therapy, per se, but it can help people to stay focused on their other therapy programs. And that could help them to really fight back against the urge to use.
Motivational Enhancement Therapy
Just as people might not get the most out of therapy if they arrive to sessions while under the influence, people with addictions may not get the help they need if they do not feel the need to improve. People in denial may sit in a therapy session for hours, but they may not take any of the lessons to heart. If they do not, they may not really get better.
Motivational Enhancement Therapy can help. Here, professionals help people to look closely at how their lives have changed due to addiction, and whether or not those changes are really positive. NIDA says that the therapy typically takes hold in about five sessions. In the first session, the person answers questions. In the others, the therapist provides feedback and probes deeper into underlying issues. At the end of the therapy, people may truly see the need to tackle the addiction, and that could help them really work while in therapy.
While most therapy types mentioned here involve the work of a professional and someone with an addiction, there is one other form of therapy that is slightly different. It follows 12-Step principles, and it is typically provided by peers.
This 12-Step therapy begins with the premise that addictions develop due to a form of weakness that could be overcome with the help of a higher power or spiritual aid. People build up that connection to the divine through group discussions and homework. They may keep going to meetings in this model for the rest of life, to ensure that the sobriety gained is both maintained and preserved.
NIDA says this 12-Step model has been proven effective in people with addictions to alcohol. The model has also been adapted for work with different substances of abuse and behavioral addictions as well.
While people with addictions can benefit from spending time with other addicted peers, they may also need to spend time with their families, working through the issues that developed both before the addiction appeared and while the addiction was in play. Family therapy can assist with that.
Family therapy sessions are designed to strengthen the bonds between someone who has an addiction and the family members who can provide ongoing support. Some sessions are held in group formats, where everyone is in the same room and discussing the same issue. But some sessions include just one or two family members who need to discuss things privately. The therapist is present and always in charge, but the family has the opportunity to talk to one another, too. The lessons they share could impact family relations in a powerful way.
After family therapy, a person with an addiction might be less likely to blame the family for the drug use. The family might know just what to do to help that person to stay sober. This one intervention could have remarkable benefits.
People who enroll in addiction treatment programs may not be able to order specific types of therapy off a menu or list, but they do have some degree of control. After the initial assessment phase, clinicians typically pull together a treatment program that details what form of therapy will be used, how many sessions will be provided, and how long the therapy will last. People enrolled in care can make changes to this plan in the beginning of care, or they can amend the plan as it progresses.
Some people are well versed with the therapy system when they enroll in care, and they feel confident with the idea of weighing in on what works for them and what does not seem to give them relief. But many people just do not feel capable of this kind of conversation.
For example, the New England Journal of Medicine suggests that about 3.7 million people with severe mental illnesses did not have health care prior to the passage of the Affordable Care Act. People like this might not have had any kind of therapy experience in the past, and they might not know what sort of care would be best.
An open and honest attitude might be best for people like this. By expressing what has happened to them in the past and what they would like to get from therapy in the future, they can get the help they need, even if they have never had therapy before. Their teams will help ensure that.
Working through Therapy
Mayo Clinic points out that therapy sessions typically don’t provide instant results. It takes time to pick up the lessons of therapy, and sometimes, people feel worse in the early stages of therapy than they did before the conversation started. A sense of patience can be very helpful. Choosing to trust the team, and working hard in therapy, could bring about the results people want.
Approaching the therapy with a sense of teamwork can also be beneficial. People who trust their therapy teams and share openly with them can walk away with insights that would be hard to get, should they choose to hide, dissemble, or lie. Openness and honesty, and even a dash of affection, could help the therapy to progress just a little quicker.
The Association for Behavioral and Cognitive Therapies also suggests asking these questions as therapy progresses:
- Are the therapy instructions clear?
- Are those instructions moving me toward my goals?
- If I follow these plans, will I make progress?
- Are there alternate steps I could take?
- Are there side effects I should know about?
Answers to these questions might prompt a frank discussion between someone in care and someone providing care. In some cases, those discussions could lead to an entirely different form of therapy and/or a different approach to addiction.
There are no set guidelines, when it comes to time spent in therapy. Some people find that they learn incredibly quickly in their addiction therapy sessions, and they feel ready to move on to another form of care, or out of care altogether, just a few weeks or months after they start their sessions. But others have deep issues to untangle and difficult wounds to heal, and they might need to spend quite a bit of time in therapy. People like this might need different forms of therapy in different rotations in order to see a big improvement.
Thankfully, therapists are aware of the fact that people heal at their own rate, and they do not pressure people to move either faster or slower than they feel ready for. Therapists just want people to get better, and if you have an addiction, a therapist could be the ally you need in order to take control.