Frequently Asked Questions: Therapy in Orange County

What is a Therapist or Psychologist?

Practicing therapists and psychologists have the professional training and clinical skills to help people learn to cope more effectively with life issues and mental health problems.
After years of graduate school and supervised training, they become licensed by their states to provide a number of services, including evaluations and psychotherapy. Psychologists and therapists help by using a variety of techniques based on the best available research and considering someone’s unique values, characteristics, goals, and circumstances.

How Does a Therapist or Psychologist Help?

Practicing therapists use an assortment of evidence-based treatments to help people improve their lives. Most commonly, they use therapy (often referred to as psychotherapy or talk therapy). There are many different styles of therapy, but the psychologist or therapist will choose the type that best addresses the person’s problem and best fits the patient’s characteristics and preferences.

How Are Psychologists and Therapists Trained?

A doctoral degree to practice psychology requires at least 4-6 years of full-time study after completing an undergraduate degree. Therapists go through 2-3 years of full-time studies. Coursework includes areas such as ethics, statistics, individual differences, and the biological, cognitive-affective, and social bases of behavior, as well as specific training in psychological assessment and therapy. While in graduate school, psychology students may also participate in research and teaching. A one-year full-time supervised internship is required prior to graduation and in most states, an additional year of supervised practice is required before licensure. Psychologists must pass a national examination and additional examination specific to the state in which they are being licensed. Once licensed to practice, psychologists must keep up their knowledge, which is demonstrated by earning several hours of continuing education credits annually, as required by their state’s license and regulations.

Isn’t Cognitive-Behavioral Therapy (CBT) more “evidence-based” as a successful treatment than Psychodynamic/Psychoanalytic Psychotherapy?

After an extensive review of many studies (called a meta-analysis) comparing psychodynamic psychotherapy CBT, Jonathan Shedler concludes with exhaustive statistical analyses, “empirical evidence supports the efficacy of psychodynamic therapy. Improvements for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as ’empirically supported’ and ‘evidence-based.’ In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, non psychodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice (relationships variables such as good rapport). The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings.” Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist. Vol. 65, 98-109. (

Is discussing the past in psychotherapy really necessary?

To paraphrase W. Bion, therapy is not about what happened before, or what will happen next, but about what is happening right now. The difficulty is that many people are unaware of how their past continues to be lived out in the present. For instance, one finds oneself afraid to get close to others. This fear is usually based upon experiences from the past. Finding ways to understand the past, including the defenses we erect against becoming more oneself and being free to live now in relationships becomes a task in therapy so that the past can be buried, and so that new events in one’s life can be lived as fully and spontaneously as possible.

Will a diagnosis of me be made? How important is a diagnosis?

A diagnosis is made when your conditions meet the criteria for a problem (disorder) that afflicts your life and is required by the insurance company for billing. Some therapists feel that a diagnosis is necessary to have a treatment plan or approach to therapy. Other than having a general idea of what is going on, the psychoanalytic psychotherapist (such as Tyra Butler) typically views a treatment plan to be largely illusory, since the unfolding realities of the therapy cannot be planned, or have an agenda, and since the exploration of the unconscious requires no pre-conceived ideas, but must necessarily be explored and created (or re-created) in the dynamic of the relationship. This exploration is often so valuable because it gives opportunity to experience the problematic behavior, while at the same time, helping to find new feelings, insights, and ways of experiencing that become a way out of the self-defeating behavior, and towards a more positive and accepting view of oneself and one’s life.

But doesn’t my diagnosis tell the therapist where the problems are?

The diagnosis, from a psychoanalytic perspective, tells very little, describing generally observed behaviors, and often really hides the problem. Although a diagnosis is a clue, it does not inform us about the meaning of the symptoms. A related concept is a psychopathology. By breaking up the word into its parts:
psyche = soul, pathos = suffering, logos = meaning.
Thus, the word can be seen as meaning the “meaning of the suffering of the soul.” From here, we can see that the reasons, purposes, and meanings of symptoms become important to the healing process. Just like a fever is a sign of sickness, it is also part of the restorative cure.

Why does psychotherapy need a relationship to be effective?

In the words of Irvin Yalom, the very “heart of psychotherapy, is a caring, deeply human meeting between two people,” in which the therapist has a dual role of both observer and participator in the lives of their patients. And the relationship is not defined by a patient and his/her problems, but instead, “we must speak of us and our problems, because our life, our existence…we are, all of us, in this together.”

Is “transference” really necessary?

Transference is actually a reality of all relationships. It is what we project from our previous experience onto relationships. In psychoanalytic treatment, when we are the “patient” or “client,” we enter into the therapy relationship having been accustomed to being treated in a certain way. Transference is meaningful because when those feelings and experiences re-occur in the therapy relationship, there is a chance to have a different response and the possibility of having a new and different experience of the self. In this manner, while transference feelings can carry some very difficult feelings, transference also seems to always carry the potential of unlocking ourselves as well as pointing to ways of living more completely those unlived parts of ourselves.

What is Psychodynamic Therapy?

Psychodynamic therapy is a conversation between therapist and patient or client that is based on the assumptions that:
Much of our behavior and many of our thoughts and feelings are outside our awareness
Talking with an experienced professional can help people understand how they think, feel, and behave. Understanding one’s own mind can lead to greater freedom to live one’s life well.
The thoughts and feelings that arise in psychotherapy provide keys to understanding oneself with the help of an experienced therapist.

What is Psychoanalysis?

“Psychoanalysis” refers to a theory of the mind as well as a therapeutic method, both of which originated with Sigmund Freud, although it has been adapted to contemporary approaches to therapy.
Troubled human behavior, relationships, emotions, and thoughts tended to improve when patients become aware of previously “unconscious” feelings, conflicts, beliefs, and motives that lay behind their problems. When these could be addressed in the context of the analytic situation, patients obtain relief from emotional pain and find new solutions to their personal difficulties.
More than a century since Freud’s early discoveries, psychoanalysts continue to study how people think, feel, love, hate, learn, develop, and cope – using a method of listening and thinking that is similar to that of Freud. It involves getting to know one unique individual at a time.
Therapy is a place in which the analyst can help the patient step back and look at his or her inner world as well as problems in everyday life. How the patient experiences the analyst and behaves in the session can often provide a lens through which learning takes place.
It is an approach to therapy that addresses a person’s life problems through unhurried, in-depth discussion. This common-sense and comfortable approach allows you to speak freely without being judged or criticized. Psychoanalysts are trained and experienced in helping you resolve current dilemmas and strengthen your ability to handle future difficulties and decisions. This approach also has the effect of enriching and deepening self-knowledge and understanding.
Early psychoanalytic theory and practice have undergone many revisions, but some of the major principles of psychoanalysis remain intact. For example:
Each individual develops uniquely, based on a complex interweaving of mental and physical endowment, upbringing, and experiences. Our actions and reactions, thoughts, and dreams have meaning. Their meanings can be explored through psychoanalysis.
Our lives and behavior are governed not only by rational choices but also by thoughts and feelings outside our current awareness.

What are the similarities between psychotherapy and psychoanalysis?

Both are methods of personal therapy derived from psychoanalytic theory. Both entail speaking as frankly as possible with a trained professional in order to reach a deeper understanding of the complexities of one’s feelings, behavior, and mind.
Typically, people participating in either one of these therapies report feeling enriched by the insights and understanding they achieve.
Both types of therapy, as practiced by a psychoanalyst, are unique to each individual patient. Cookie-cutter solutions and managed care constraints never dictate the treatment approach. Rather, the analyst discusses his or her clinical judgment and recommendations with the individual and together they plan how best to address the presenting problems. In every case, confidentiality is a necessary condition for treatment to occur.

What are my options for psychotherapy, in terms of sessions and fees?

The standard amount of sessions is once weekly for the general population, and this can provide support and help you work through some issues on a long-term basis. It can be effective for some people, depending on one’s life circumstances and what you are trying to accomplish in therapy.
However, for some, it may be in your best interest to pursue sessions twice (or more) weekly, which would be more intensive therapy, and it moves the progress of therapy forward in a much more in-depth and quicker manner. Particularly if you are working through trauma, long-standing interpersonal or relational issues, if you’re in crisis, or if you have a physical condition/ailment that may be related to emotional or mental well-being.
When we meet, we will discuss your options and what you feel is best for yourself in moving forward. The fee will also be negotiated on either a weekly or monthly basis.