Questions About Therapy:
What Is Talk Therapy?
If you’re thinking that you need therapy and have started working on finding a therapist, it’s important to consider the type of therapy you would like to participate in. As you do your research, you’ll likely come across several different types of therapy – including Cognitive Behavioral Therapy or personal growth therapy, for example. You’re almost certain to see “Talk Therapy” pop-up in your research, too. So, what is talk therapy?
Broadly, (and technically speaking) “talk therapy” is essentially an umbrella term for any type of psychotherapy that involves talking with a therapist about the issues you’re facing, and getting their ideas and guidance for how to resolve them.
In clinical terms, “talk therapy” can apply to extremely different types of therapy: Very directive, structured, evidence-based approaches to therapy like cognitive-behavioral therapy ; or hopeful, strengths-based approaches like positive psychology; or skills-based behavioral strategies to manage things like ADHD; or intensive exposure-based trauma work. All are types of “talk therapy.”
“Talk therapy” is just the broad term people use to describe what happens in the therapy room between therapist and client, and to differentiate it from other types of behavioral healthcare like medication therapy.
But, truthfully, when therapists use a specific approach like CBT or positive psychology that is how they describe what they do, and you usually understand that going into the work. Informally, when therapists use the term “talk therapy” they are talking about non directive, “person centered” and insight oriented therapy experience.
Here’s what you need to know about that, in order to be a truly educated consumer, and make informed decisions for yourself.
Non-Directive, Insight-Oriented Talk Therapy
As we discussed above, there are many different kinds of psychotherapy. But to me, the term “talk therapy” actually suggests something more specific. When I think of “talk therapy” I think of a certain type of traditional, insight oriented, non-directive therapy.
For example: When you think of therapy, what stereotypes spring to mind? If you’re like many people, you probably envision a patient lying on a chaise lounge, droning on about his parents as a therapist, sitting upright in a large leather chair talking notes on a clipboard and intermittently saying, “Oh,” “I see,” and “How does that make you feel?” Or, “Tell me more about your father.” (Bonus points if the therapist has an Austrian accent.)
While this mental picture is a bit simplistic, it is a picture of classic talk therapy, grounded in old-school psychoanalysis: Free associating to a non-directive, sphynx-like therapist, who does not agree nor disagree, but who reflects you back to you.
Herr Frued started spelunking into the depths of the Ids and Egos of his patients as they talked about whatever came to mind (on his couch, five days a week, for years. Years!) What emerged from this was interesting: Over time people would project whatever they believed onto the blank canvas of the therapist. They’d get angry with them, or attribute hurtful things, or fall in love with them, imagining all sorts of things to be true about the therapist.
Of course, they knew nothing at all about this black box of a person, so whatever they believed was entirely the creation of their own minds. In this way, both they, and the therapist could come to understand the patients formerly subconscious beliefs — particularly how they viewed themselves and others.
This type of intensive psychoanalysis was fascinating, to be sure, but not particularly practical or — when researchers started shining a light on outcomes — not always that helpful in resolving mental health conditions. While you can still find psychoanalysts (and their close cousins the Jungian dream analysts), the science of evidence-based therapy has largely moved on.
In the 1960’s and 1970’s there was a new movement in therapy championed by pioneers like Carl Rogers, Fritz Perls, and Virginia Satir, that were very much about “getting in touch with your feelings.” Understanding yourself was the goal, and this happened in therapy that allowed you to talk about yourself without direction or guidance, (unless you were being asked to talk to the therapy pillow like it was your father), and notice the thoughts, and feel the feels.
Expressing emotions was considered “cathartic” and the fact that you had a non-judgmental relationship with a therapist was felt to be curative in itself — like simply being in their presence was healing. This type of therapy was and is all about “processing” and “working through things” to find your own answers.
But by the 1990’s researchers exploring evidence-based approaches to therapy ruined all the fun: They flipped on the lights, and chased all the hippies out of their touchy-feely encounter groups at Esalen. As it turns out, when you compare groups of people who go through different types of therapy, the ones that get the best results (meaning that they feel better and experience lasting positive changes) are not the ones with the most insight, or the ones who have had the chance to tell a therapist how they feel.
The most successful types of therapy, in terms of outcomes, are the ones that help people make actual changes in the way that they think, feel, and behave; or that provide targeted treatment that helps them learn how to manage (and resolve) mental health symptoms.
This second generation of non-directive, insight-oriented talk therapy is what I think of when I think of “talk therapy.” And, you should know that this type of therapy is still commonly practiced, and there is a time and place when it can be extremely helpful. It is absolutely useful for working through terribly hard feelings like grief and loss, and having an empathetic, connected relationship with a therapist can be incredibly healing and can help you believe that you are worthy of love and respect, if you have a long history of hurtful relationships.
But these experiences in the therapy room may not always lead to substantial change outside its doors — particularly if you are dealing with issues that would be better served by more active approaches. While it is still really interesting to think about which colors your feelings feel like, or finally figure out why certain situations trigger you, or tell a sympathetic therapist everything that you think and feel week to week, this does not always lead to change. Insight and self awareness, yes, fascinating conversations, for sure.
At the same time, it’s also true that other types of therapy and approaches to personal growth work are more likely to help people resolve mental health symptoms, solve actual problems in their lives, or create positive changes in the way they think, feel, or behave.
If you’re considering getting a therapist, it’s important to understand the different types of therapy so that you can be empowered to choose the best one for you (or ask for what you need from your therapist. If you could benefit from gentle, non-directive, introspective therapy, that’s great. But it’s also easy to fall into that type of therapy without really understanding what’s happening — and sometimes, to your detriment.
Talk therapy is routinely practiced, particularly in private practice settings where therapists have little oversight. If you decide you need therapy, you will have no problem finding a professional willing to do free-wheeling, insight oriented talk therapy with you. There are pros and cons to talk therapy — times that it can be helpful, and situations where it’s a waste of time and money (particularly if you have a bad therapist). The key is finding the right therapist for your needs.
When Talk Therapy Works: “Healing Through Words”
Talk therapy, broadly called “psychotherapy,” involves a mental health professional aiming to help his or her patient with various mental health illnesses through the process of talking to them. Psychotherapy strives to help patients gain insight, love themselves, process emotions, feel more secure, and ultimately, to resolve symptoms.
When measuring outcomes (symptom resolution of mental health conditions) the efficacy of psychotherapy depends on a variety of factors, primarily the patient’s specific condition and the competence of the therapist. While it is difficult to determine how effective psychotherapy will be for any individual patient, numerous studies have shown psychotherapy to be beneficial for the majority of people using it as a way of improving their mental health. The APA reported that “about 75% of people who enter psychotherapy show some benefit.”
However, there can be a big difference in outcomes between evidence-based forms of psychotherapy and aimless “venting about your problems” talk therapy.
Intentional Therapy For Specific Issues
Generally speaking, if you’re looking for help to resolve a specific condition like depression, anxiety, post-traumatic stress disorder, or to get help for an issue like an eating disorder and body image issues, or a substance use problem, your best bet is to get involved in targeted, purposeful treatment focused on helping you get better.
In these cases, your therapist should utilize an evidence based approach that has been shown by research to help people recover. Here is a resource that I put together with more information about evidence-based approaches to therapy, and some general guidelines for how to figure out which types of therapy have been found to be helpful for the treatment of specific conditions.
However, depending on what you’re going through, there can also be times when gentle, non-directive, insight oriented talk therapy that is not focused on outcomes can be exactly what you need.
Why is Talk Therapy Helpful?
There are some situations in which non-directive, insight oriented talk therapy works and can have many positive components. There are situations you might be facing where the last thing you need is “treatment,” and a therapist eager to help you feel better and make positive changes. Like if you just experienced a terrible trauma, or lost a loved one, or are facing a terminal cancer diagnosis: You don’t need some cheerful therapist trying to get you to do cognitive-behavioral worksheets.
Sometimes, the most helpful thing is to have a companion to walk with you through the hardest, darkest parts of your experience. (And hopefully, out the other side, into a place of meaning and inner peace). Talk therapy is the vehicle for that. And there is a time and place where that is the best, and most helpful type of therapy you could possibly do.
Here are a few others.
Talk Therapy is Good For: Building a Relationship with a Therapist
The seemingly simple process of building a relationship with a therapist can be immensely healing and can lead to personal growth, and successful talk therapy often achieves this. Especially for people with deep-seated trust issues, or who have had damaging relationships with people in the past (often starting from childhood) the presence of someone that can be relied upon for unconditional support and positive regard is healing in itself.
A good talk therapist will listen to you without judgment and will help you feel like you’re okay exactly as you are. Experiencing your therapist’s compassion and understanding will, over time, help you feel more compassionate and understanding towards yourself.
This type of “talk about anything” therapy can help you make contact with parts of yourself that you haven’t been fully aware of in the past. Perhaps most notably, people feel that they can speak openly with therapists about things that they may not feel comfortable telling anyone else in their lives, such as trust issues, loneliness, low self-esteem, a loss, anxiety, depression, or body positivity issues, among others. Being open with a therapist can help you be honest with yourself, and can help you open up to other (safe) people in your life too.
Once that foundation is established and you’ve experienced some healing through your relationship with your therapist, you might then be better able to make use of more active types of therapy.
Talk Therapy is Good For: Your Brain
In addition to the numerous studies and anecdotal evidence that backs up the efficacy of psychotherapy, neuroscience seems to support the approach, as well. By promoting the “development of cognitive, emotional, and behavioral abilities,” talk therapy provides patients an “enriched environment” that promotes the growth of “more neurons, more synaptic connections, greater number of capillaries, and more mitochondrial activity.”
Any type of therapy that helps you have new ideas, and new insights can help your brain develop new pathways. Simply having the chance to talk about something that you don’t usually talk about can stimulate your brain in positive ways — creating new associations, and potentially, new possibilities.
The Gaining of Insight
Just talking about things can help your brain develop new neurons on an unconscious level in talk therapy, but things start to get really exciting when you develop new insight on a conscious level. The process of discussing important, emotionally-charged topics with a therapist helps people see things in new ways from new angles and facilitates new mental connections. We call this process “gaining insight.”
Gaining insight is one of the clearest, most demonstrable benefits of talk therapy. While some people might have the notion that talk therapy is just speaking your thoughts out loud with someone else in the room, the process of doing that – and receiving feedback – is more profound. Simply ruminating on a thought will not get you anywhere. Confronting it head on with a therapist in talk therapy, however, will help you gain insight.
One of the best things about therapy is when it provides you with “Aha!” moments — times when you understand yourself or your situation in a new, clear, and valuable way. Being able to connect your own dots and say, “Aha! Now I know why I am the way that I am! This makes sense now!” is invaluable.
It’s also useful: Gaining new understanding and new self awareness can often be the first step towards creating changes that last, particularly when your new idea is coupled with a new action, or new practice. (However, if you’re with a card-carrying non-directive therapist who responds to every question with a question, you might not get practical suggestions from them about what to do with these new insights).
But even if a non-directive therapist won’t offer a lot of specific guidance, that might still be okay. Sometimes, through the process of talking through issues, people involved in talk therapy are able to find their own answers. The deliberate act of articulating their thoughts helps them to organize their ideas in a way that makes “the solution” into focus.
Self-Awareness and Understanding
Some of the insight gained during talk therapy will often deal with immediate and practical issues in your life, but much of it will inevitably be geared toward self-awareness and understanding. An effective talk therapist helps you by illuminating long-standing beliefs and patterns. As a result, you can become more aware when you’re thinking, feeling, and behaving in your familiar and (possibly) unhealthy patterns, question your “default settings,” and possibly adapt to new, healthier ways of being.
Another important part of talk therapy is referred to in a general way as “processing.” Events in our lives often have profound subconscious effects that we don’t always consciously notice right away. Mentally working through the impact of events in our lives can take long periods of time, depending on how important and/or severe they are. Often, talk therapy can stimulate and promote “processing,” bringing it from a passive action that takes place in a small way in your daily life to a priority that helps move it forward – quicker and more efficiently.
Specific Situations In Which Talk Therapy is Excellent
Now that you have an understanding of how talk therapy works, let’s talk about some specific presenting issues that are often best addressed through this gentle, introspective approach.
Grief, Loss, Bereavement
Talk therapy’s emphasis on conversation, building a relationship, processing, and insight make it particularly effective in certain situations. If you’re dealing with grief and loss in particular, talk therapy is a great option.
Since dealing with grief and loss is more about processing and making meaning than about creating change, talk therapy might be the perfect environment for expressing and dealing with feelings in a safe space.
Furthermore, when you’re living through incredibly difficult life experiences, non-directive therapy can become a sanctuary for you to talk about what you’re feeling, with a safe person who can tolerate your feelings. Many times, when we are very distressed, the well meaning people who love us try to “make us feel better” in a way that isn’t really helpful and can block our progress.
We don’t need to feel better. We need a safe space to cry and be angry, or anything else that we feel. We are moving through emotions during times like these, and non-directive talk therapy helps you do that.
As mentioned previously, the construction of a close, intimate relationship between therapist and patient is one of the biggest strengths of talk therapy. Since non-directive therapists are usually focusing on listening first and foremost rather than trying to “fix” or “solve” anything, people can feel very close and connected to their therapist: almost like a surrogate parent. In fact, “reparenting” can be an important component of long term therapy.
This type of healing takes time to achieve (often measured in years) but is particularly beneficial for people with serious attachment issues, or who experienced early childhood abuse.
The trust and intimacy that can be fostered during talk therapy — especially when combined with trauma treatment, or evidence-based practices that help people learn how to manage their feelings outside of sessions — can be incredibly healing and powerful.
The Limitations of Talk Therapy
While the benefits of talk therapy are many, particularly for the situations I described above, non-directive, insight oriented talk therapy comes with some serious limitations, as well. Sometimes people spend large amounts of both time and money on talk therapy and get little out of it. This is especially true for people who accidentally wind up with a non-directive, insight oriented therapist, when they really needed to be with a therapist who used a more active approach.
In the worst cases, people in unfocused talk therapy can start to feel really stuck: Endlessly rehashing the past, and talking about how they feel in the present, without it translating into forward movement, or progress towards something better.
The Biggest Myth of Talk Therapy
Yes, building a relationship with a therapist and talking through issues with them is often beneficial. At the same time, however, it will not be sufficient to treat many issues and it’s often insufficient for helping people move forward in their lives. Indeed, the biggest myth of talk therapy is that the act of talking to a therapist is curative, in and of itself.
There are absolutely situations like the ones I described above (attachment wounds, grief and loss) where the work of therapy really does happen in the room, through interacting with your therapist.
But for most other situations, therapy needs to be more intentional — at least, eventually. I have found that it’s often really helpful in the beginning states of therapy (and of coaching, for that matter) to have a period of exploration where the goal really is to achieve understanding. This helps you understand yourself, gain new insights, and develop a new level of self awareness.
But this is for a reason: When you have these new insights, it gives you a handle on “the problem.” As in, “Okay, I now understand why I am the way I am, what’s important to me, how I feel, and the things that have been negatively impacting me or getting in the way of my health or happiness….so now what do I do with this?”
The Problem With Talk Therapy: Insight Alone Isn’t Enough
Processing, understanding oneself, and gaining insight are all valuable things for anybody. Understanding why you are the way you are is only the first step towards real growth, though.
You could spend hours learning why, exactly, your car won’t start without being any closer to understanding how to fix it.
This is one of the most serious limitations of talk therapy. Especially with therapists who aren’t comfortable challenging their clients, there is the risk of rehashing the same issues endlessly for the purpose of “gaining insight.” In situations like this, insight can fade into the background and any hope of new understanding is lost with each re-exploration of the same tired ideas and events. Then, an echo chamber can form in which old ideas are reinforced and you actually become disempowered rather than empowered.
Talk Therapy: Emphasis on Understanding Rather than Change
Many mental health professionals that specialize in talk therapy seem to have the philosophy that a patient’s understanding of their own nature will somehow automatically create change. Unfortunately, this isn’t true. It’s just not that easy.
Growth = Emotional Safety + Appropriate Challenge
Talk therapy is great for fostering the first half of this equation and improving your skills for emotional self-care, but often severely lacking in the second part. Building a relationship and talking openly – both of which happen during well-run talk therapy – are great ways to build emotional safety. The appropriate challenge needed to stimulate real personal growth, however, doesn’t seem to be a focus for many talk therapists.
Therapy happens in stages. First comes insight. But then what next? You know why you feel triggered in certain situations. But what do you do with that information? It’s when you get to this point in the therapy process that a therapist who is all about insight-oriented talk therapy will say, “I don’t know, what do you think you should do?” Or perhaps, even more annoyingly, “It sounds like you’re feeling a lot of urgency about needing to do something. Let’s sit with that.”
In contrast, a therapist with a more action-oriented approach (or better yet, a life coach) will — at that point — shift into helping you find concrete answers to that question, learn how to do things differently, let things go that aren’t helping you, and start making an action plan to translate the things you’re learning about in therapy into real-world changes. Learn more about the differences between therapy and coaching.
Does Talk Therapy Work?
If you’re dealing with grief, loss, or attachment issues, talk therapy may be your best option. Having a therapist who helps you stay in that painful space (rather than avoid it) slow, non-directive talk therapy can be the most healing experience for you.
However, after a certain point, if you’ve gained awareness and are ready for action it might keep you stuck. With an abundance of talking and an absence of emphasis on moving forward, people in insight-oriented, non-directive talk therapy can sometimes end up feeling stuck in the past, or just stuck in the present. They’re talking about how they feel, but not doing anything about it. And, predictably, their feelings don’t change, even though they are telling their therapist about it every week. They’re not moving forward!
But remember, therapy happens in stages, and there are many different types of therapy. You might know off the bat that you’d do better with a more action-oriented, focused approach. That’s great: When you’re looking for a prospective therapist, you’ll know it’s probably not a good fit for you if they describe their approach as “non-directive, insight-oriented, and all about holding the space to help you process your feelings.” If you’re looking for action, that type of therapy will be incredibly frustrating for you!
However, it might also be true that you’ve been working with a therapist for a while using talk therapy techniques, and you’ve benefited from them! And now… you’re ready for a more active approach.
Pro Tip: It is 100% okay to tell your therapist how you’re feeling about your work with them, and what you need from them. You can say, “It’s been so helpful to gain insight, and I really appreciate the way you listen to me. I understand myself so much better now, and now… I’d really like to get your help in translating some of these new awarenesses into my life outside the therapy room, and talk about how to move forward from here.”
Your therapist will likely really appreciate hearing about what you need to get out of the work, so that they can adjust their approach to continue meeting your needs. Of course, if your therapist gets defensive or responds to you in a way that feels invalidating, it may be the case that your work with them has gone as far as it can, and it’s time to find a different helper to support your continued growth.
There are seasons for everything. A season to talk, a season to learn, and also a season to do. Sometimes you can do it all with the same therapist. Sometimes you can’t. But it’s okay. You get to be in charge of your process. I hope that reading about talk therapy helps empower you to make informed decisions about the best approach for you — and advocate for yourself!
Your partner in growth,
P.S., if you have some immediate needs, or want to get a sense of what coaching is like, you can try one of our one-time solution sessions.
Dr. Lisa Marie Bobby is the founder and clinical director of Growing Self. She is a licensed psychologist, a licensed marriage and family therapist, and a board-certified coach, as well as the author of “Exaholics: Breaking Your Addiction to Your Ex Love,” and the host of The Love, Happiness & Success Podcast.
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