When You Don't Know Where to Turn / A Self-Diagnosing Guide to Counseling and Therapy

by Steven J. Bartlett

Psychotherapy tends to be more concerned than counseling with fundamental personality-structure changes. Frequently, psychotherapy is a longer-term process. Frequently, too, the problems treated in psychotherapy are hard to pin down and are less specific. They include chronic depression, pervasive ("free-floating") anxiety, generalized lack of self-esteem, and so on. Such difficulties are not well defined; their causes may be vague or uncertain, and often much time must be spent to get at their basis. Psychotherapy seeks to bring about an intensive self-awareness of the inner dynamics—the internal forces and the principles that govern them—that are involved in chronic forms of personal distress. Sometimes, as in analytical psychotherapy or psychoanalysis, attention is focused on the role of unconscious processes in inner conflicts; treatment attempts to resolve these conflicts by understanding the unconscious forces involved.

The term psychotherapy is often used to imply more advanced professional training, whereas counseling is something individuals with more modest academic credentials may practice. Whether a professional is called a counselor or a therapist has to do with his or her level of training, with the setting in which services are offered, and, to a certain degree, with that person's theoretical orientation.

In practice, these differences in outlook frequently amount to differences in emphasis rather than approach. In this book, I will speak of counseling and psychotherapy interchangeably unless there is a need to be especially restrictive.

THERAPY: THE ART OF CHANGE

HOW WE ARE ABLE TO CHANGE

We are what we do ... and may do what we choose.
Allen Wheelis, How People Change

Freud identified five causes of personality development:

* growth and maturation
* frustration
* conflict
* inadequacy
* anxiety

By the time we become adults, most of us have developed sets of defenses to enable us to cope with everyday problems in spite of feelings of frustration, conflict, inadequacy, and anxiety. But as these feelings become more pronounced, when we encounter situations that intensify these feelings, we must put more and more energy into our defenses. They allow us to continue living and acting in habitual ways, usually by hiding, by denying, and sometimes by distorting our perceptions of reality.