Is Good Psychotherapy Worth the Investment?

“The good therapist fights darkness and seeks illumination.”
– Irvin Yalom, Love’s Executioner
I met Nick in 1998, when he was 55 years old. He informed me that he had been unhappy for most of the first 50 years of his life. His twenties were spent in a marriage that plummeted into divorce. For 30 years, he struggled to find the right woman, but nothing worked. In 1997, he met Barb who quickly became the love of his life. Nick and Barb married in 1998. The last 10 years have been the happiest in Nick’s lifetime.
When I met Nick he was stuck in his head. He could not let himself feel many feelings, including sexual passion. Although Barb found his marriage offer attractive, she refused to marry him unless he was willing to undergo psychotherapy… deep, solid, and rich psychotherapy. Because Nick knew she was the ticket to a rich future, he agreed.
By agreeing that he would learn to feel passion, Nick gave himself the wedding gift of his lifetime. He promised that he would overcome the family imperative to be intellectual and “right” in every decision. He promised that he would learn to enjoy touching Barb’s middle-aged body. He promised that he would learn to speak up when she frustrated him rather than withdraw into stony and condescending silence. He promised himself and Barb a better life. And he got it.
Nick worked hard and long in psychotherapy, both in a couples group with me and in individual work. He learned to listen to his wife’s heart and to be assertive instead of withdrawing from her. He learned to love to touch Barb even though she had developed a little belly. He learned the secret of the best life has to offer.
This level of treatment required an ongoing commitment for all involved. We worked with the structure of Nick’s personality to repair problematic areas. Nick called this “psychosurgery,” and reported that it hurt to unearth old wounds.
Psychotherapy caused frustration as Nick rethought preciously automatic bad habits. At each turn, when we asked whether treatment was of enough value to continue, Nick said he wanted to move forward. Now, a decade later, Nick is certain that psychotherapy allowed him access to deep and abiding joy in his life. Treatment gave Nick emotional wings and access to unknown parts of himself. He shifted from living in black and white to living in Technicolor.
Now in his sixties, he is muscular, handsome, smiling and happy for the first time. He and Barb celebrate their lives together by travelling, by visiting their four adult children, by vacationing with their grandchildren, and by enjoying simple meals together in their waterfront kitchen. Together they care for Nick’s aged mother, Barb’s dysfunctional brother, and the illnesses each has collected over decades of life lived actively. Together they face a future that is rich precisely because they are together.
• Did it require patience? It did.
• Did it give Nick more manly qualities? It did.
• Did it require help from Barb to gently melt walls that were firmly entrenched? It did.
• Did it require a budget? It did, but less than one might think.
Repeated research studies over the last 20 years, indicate that psychotherapy, “the talking cure,” results in improvement for over 75 percent of the clients it treats and that, in fact, psychotherapy is correlated with fewer relapses in treating moderate amounts of depression and anxiety, than medication. So, psychotherapy is far from touchy-feely verbal mush, as its cynics call it. It is a professional skill.
In this age of managed care and pre-certification for four behavioral management sessions, it is easy to lose sight of the value of psychotherapy at the level of personality work. It is easy to assume that a job done quickly can substitute for the thorough and deep work that Nick did. Eight sessions of cognitive counseling for depression is far better than no treatment. But Nick and others who want a brighter future than their life has been able to offer, the in-depth psychotherapeutic experience can be life altering. And, because my colleagues feel an ethical responsibility to provide affordable care in today’s economic crisis, psychotherapy is within reach for all.
How to find in-depth psychotherapy: In-depth psychotherapy is done by psychiatrists, psychologists, clinical nurse practitioners, and social workers especially trained and licensed to provide this level of work. To learn if a clinician provides this treatment, you need to ask if they are trained at the level of personality integration. They can tell you.
To ask yourself: How might my love life, family life or career be richer if I engaged in in-depth psychotherapy?
To read: Irvin Yalom, MD. Love’s Executioner, 1989. NY: Basic Books
Judith Coche, PhD, ABPP practices depth psychotherapy with individuals, couples, families and groups in stone Harbor and Rittenhouse Square, Philadelphia. Find her at www.cochecenter.com.