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 develop their own jargons and theories, but the stages of treatment tend to be remarkably similar regardless of orientation and duration.

The patient knows things are not going well and that help is needed. The specific presenting problems are varied and very individual, but usually include some combination of symptoms, troubling behaviors, interpersonal friction, work problems, disappointment, 

, demoralization, increased stress, and/or a loss of support. The patient often has little awareness of underlying contributing factors and no idea what to do next.

As a result of the therapy—either in sessions, with 

between sessions, or ideally both—patients become increasingly aware of the emotions, thoughts, and behaviors that have created their problems, and also their reduced competence in dealing with them. They may be misinterpreting other people's motives, not recognizing their behaviors that have a negative impact on others, avoiding things that cannot be avoided, becoming too easily frustrated and demoralized, pushing people away, or any of the hundreds of ways people get stuck in vicious cycles of self-perpetuating, self-destructive behavior.

Stage 3: Corrective Emotional Experiences

Insight alone never cured anything except ignorance but becoming intellectually aware of what is causing the problem sets the stage for trying new ways of thinking, feeling, and behaving—both inside and outside the sessions. Chain reactions of corrective emotional experiences replace the downward spiraling caused by previous vicious cycles with virtuous cycles of recovery. Some corrective emotional experiences occur naturally within the context of 

, but most must come from deliberate efforts made by the patient to think in new ways, feel suppressed emotions, try new things, and stop avoiding feared situations.

If the therapy is successful, the new and healthier ways of thinking about, feeling, and acting competently in the world are internalized and become automatic.

Schools of therapy differ markedly in their theories of change, but they are very similar in their stages of change.

Crucial contextual factors in promoting change are also similar across therapies. There must be a strong therapeutic alliance. Patients must come with—or be induced to develop—at least some motivation for change and a positive expectation that therapy can help. The most effective therapies and therapists will not get very far in the process if the patient has fixed negative expectations and a fixed unwillingness to try new thoughts, feelings, and behaviors.

The stages of therapy interact with its duration in complex ways. Going from Stage 1 to Stage 2 is usually the maximal goal for patients seen only for evaluation, but some patients seen only once are able to carry forward the insight gained and achieve Stages 3 and 4 on their own through life experience or with additional later therapy. When they work well, brief treatments of 6 to 20 sessions can encompass all 4 stages. Stalemated long-term treatments may never get beyond the first or second stage. And this model of change does not apply to supportive treatments in which stability, not change, is the goal.


The best way to understand the different therapy schools is to study what they do in practice, not what they say in theory. All therapies, however seemingly different their specific techniques, succeed by facilitating corrective emotional experiences. The paths to achieve this may vary greatly, but their destination is the same.

, we discuss the issues covered in this blog in more depth. You can view the episode 

is professor and chair emeritus in the department of psychiatry at Duke University.

Despite their differences, all psychotherapies have these things in common—and are important to consider.

Stages of Change Common to All Psychotherapies

A frequent criticism of psychiatry is that psychiatrists do not learn, practice, or value 

. Even critics within the field routinely complain that psychiatry has “lost its mind,”

 while outside critics frequently portray “toxic” biological psychiatrists in competition with with humane psychotherapists from other disciplines.

 The psychiatrist, as the story goes, is interested only in diagnosing and medicating the patient—not in understanding, supporting, or working psychotherapeutically with him or her. This story, widely reported as fact in the media,

 is an outdated and harmful myth—one that discounts the realities of psychiatric training, the complexity of the psychiatric treatment relationship, and the resurgence of interest in psychotherapy among psychiatry residents.

In the mid-20th century, psychotherapy was the treatment of choice for most mental disorders. Even after the development of the first effective 

 in the 1950s and 60s, psychotherapy remained the mainstay of psychiatric treatment, especially in the psychoanalytically dominated United States. By the late 1980s, however, the field had shifted in a biological direction. The development of selective serotonin reuptake inhibitor (SSRI) antidepressants, in particular, led to great excitement in the promise of biological investigation and treatment. Nevertheless, psychotherapy continues to be practiced by psychiatrists, with some psychiatrists devoting the entirety of their academic and clinical careers to the study and practice of psychotherapy.

The idea that psychiatry is currently divorced from psychotherapy is, in fact, divorced from reality. Here are 4 fundamental examples of the union between psychiatry and psychotherapy:

1. Psychiatry residents receive significant formal instruction in psychotherapy.

One of us (DM) is director of residency training at a psychiatry department in the northeast, and the other (MR) teaches in that program and also serves as codirector of the psychotherapy track for a psychiatry residency program in Florida. As such, we have direct knowledge of the quality and extent of training psychiatry residents receive in psychotherapy. By contrast, most critics of psychiatry do not teach in psychiatry departments and have little to no firsthand knowledge of psychiatric residency curriculum.

Training in supportive, psychodynamic, and cognitive-behavioral psychotherapy is nationally mandated for all psychiatry residents.

 Residents must also learn to integrate psychotherapy with 

 and spend a substantial amount of time practicing psychotherapy during their outpatient training. They attend several year-long didactic courses in psychotherapy and are individually assigned psychotherapy supervisors (many of whom are psychiatrists themselves). Didactic instruction typically covers a range of psychotherapy topics, such as case clinical formulation, transference, countertransference, and psychotherapeutic technique. Clinically, residents see patients for both short-term and longer-term psychotherapy treatments.

Approximately 1 quarter of psychiatry residencies also offer specific psychotherapy tracks for residents with particular interest in psychotherapy and for those who plan to pursue additional training in specific psychotherapies (eg, psychoanalytic training) postresidency.

 Many individuals, even mental health professionals, assume psychotherapy training is weaker for psychiatry than for other mental health disciples such as psychology and social work. Yet a national survey conducted in 2006 showed that psychiatry compared favorably to other disciplines for evidence-based forms of therapy training.

 Thus, the claim that psychiatrists do not learn psychotherapy is false.

2. Psychotherapy is a part of almost all clinical interactions.

While it is true that most psychiatrists nowadays do not offer traditional 45- or 60-minute psychotherapy appointments to all their patients,

 psychotherapy continues to be practiced in some form by most psychiatrists. From a psychodynamic perspective, every interaction between doctor and patient, even in the hospital setting, is an opportunity to relate to the patient psychotherapeutically. Sudak and Taormina

 have described the integration of cognitive-behavioral therapy into “medication management” visits, and Iannitelli and colleagues

 have recently discussed the application of psychodynamic principles during psychopharmacological treatment.

Undoubtedly, most psychiatrists engage in some supportive 

 during brief visits, even if they do not formally label or bill it as such. Moreover, Tadmon and Olfson

 found that 47% of psychiatrists continue to offer 45- to 60-minute psychotherapy sessions. Thus, claims that psychotherapy has simply disappeared from psychiatric practice are false.

3. In the past decade, there has been a resurgence of interest in psychotherapy and psychosocial approaches among psychiatry residents.

A 2012 survey of residents reported that 82% of them consider “psychotherapy to be integral to their identity as psychiatrists.”

 Another survey showed that residents want more psychotherapy training rather than less.

 Our experience matches the results of such research. In fact, we have observed an increasing number of psychiatry residents interested in learning and practicing psychotherapy during the past decade.

In recent years, psychiatry has become a popular and competitive specialty choice among medical students, who describe their interest in learning the art of engaging deeply with suffering patients and combining psychosocial treatments with biological interventions. Many residents are particularly eager to learn psychotherapy methods and rightfully view psychotherapy as a core, foundational skill in the practice of clinical psychiatry. Meanwhile, some professional organizations are specifically devoted to the advancement of psychotherapy training within psychiatry, such as the American Academy of Psychodynamic Psychiatry and Psychoanalysis.

4. Many leading psychotherapy scholars are psychiatrists, and this has been the case for decades.

Some of the leading figures in American and global psychotherapy are psychiatrists, including Otto Kernberg, MD; Glen Gabbard, MD; and the recently deceased 

Aaron Beck, MD, father of cognitive-behavioral therapy.

 Several psychiatrists who are leading researchers in psychopharmacology have also undertaken research validating medical psychotherapy.

 Psychiatrists comprise a significant percentage of membership of the American Psychoanalytic Association. They are also frequent presenters at national psychotherapy conferences and contributors to psychotherapy journals. 

a leading journal of psychotherapy theory and practice, is a journal of the American Psychiatric Association. Thus, the psychiatric profession remains integral to psychotherapy development and research.

Psychotherapy continues to be a core aspect of psychiatrists’ training and identity. Psychotherapy training also continues to be a substantial and mandatory component of residency training for all psychiatrists. Contrary to popular assumptions, it is not critical that all psychiatrists practice traditional psychotherapy as part of their practice. No one becomes alarmed if all cardiologists do not practice cardiac catheterization, and no one should worry that “only” half of all psychiatrists currently offer traditional 45-minute psychotherapy sessions. But all psychiatrists should continue to support psychotherapy’s place in mental health treatment, and its place in the holistic, biopsychosocial treatment that psychiatrists routinely offer.

For decades, both critics and leading psychiatrists have worried that psychotherapy among psychiatrists will one day die out and be forgotten. Yet for decades, reports of its demise have been greatly exaggerated.

is instructor of psychiatry at the University of Central Florida College of Medicine in Orlando and adjunct instructor of psychiatry at Tufts University School of Medicine in Boston. He is a psychoanalytic psychotherapist in private practice in Tampa. He can be reached at 

is a psychiatrist and director of training for the general psychiatry residency at Tufts Medical Center in Boston. He frequently speaks as an advocate for mental health and is author of 

Science Over Stigma: Education and Advocacy for Mental Health, 

published by the American Psychiatric Association. He can be reached at 

Of Two Minds: An Anthropologist Looks at American Psychiatry. 

Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. 

5. Harris G. Talk doesn’t pay, so psychiatry turns instead to drug therapy. 

https://www.nytimes.com/2011/03/06/health/policy/06doctors.html

6. ACGME program requirements for graduate medical education in psychiatry. 2021. Accessed May 4, 2022. 

https://www.acgme.org/specialties/psychiatry/program-requirements-and-faqs-and-applications/

Psychotherapy tracks in US general psychiatry residency programs: a proxy for trends in psychotherapy education?

8. Weissman MM, Verdeli H, Gameroff MJ, et al. 

National survey of psychotherapy training in psychiatry, psychology, and social work. 

Trends in outpatient psychotherapy provision by U.S. psychiatrists: 1996-2016. 

Integrate brief CBT interventions into medication management visits.

12. Iannitelli A, Parnanzone S, Pizziconi G, et al. 

Psychodynamically oriented psychopharmacotherapy: towards a necessary synthesis. 

13. Lanouette NM, Calabrese C, Sciolla AF, et al. 

Do psychiatry residents identify as psychotherapists? A multisite survey. 

Psychotherapy training: residents’ perceptions and experiences. 

Biological v. psychosocial treatments: a myth about pharmacotherapy v. psychotherapy. 

16. Miklowitz DJ, Efthimiou O, Furukawa TA, et al. 

Adjunctive psychotherapy for bipolar disorder: a systematic review and component network meta-analysis. 

Psychotherapy: A Core Psychiatric Treatment

 and an alphabet soup of 50 different named psychotherapies (

Part of this sectarian proliferation is caused by narcissistic founders' complex; part by guild interest; part by competitive parochialism; part by institutional rigidity and inertia; and part by failure to keep up with the psychotherapy research.

The result is devastating. The different schools self-destructively engage in sniping internecine warfare, instead of joining together to form an integrated and harmonious psychotherapy.

There is absolutely no good reason for competition among therapies—none is by itself necessary or sufficient, and most are completely complementary, even synergistic. Therapists who worship a narrow technique fail to grow as therapists and do a disservice to their patients. They are like hammers always in search of a nail.

We have seen, live or on tape, many of the famous representatives of the different forms of therapy conduct sessions, sometimes with the same patient. Although therapists from the various persuasions used different terms to describe what they thought they were doing, what they actually said, and the nature of the therapeutic alliance they formed, all of them were usually remarkably similar. Experienced and skilled therapists of whatever school are a lot more alike than they are different. And they are a lot more alike than their followers and trainees, who are likely to follow their founder's beliefs more than their actual behaviors.

Psychotherapy training programs tend to be remarkably parochial, rather than ecumenical. Their theoretical disputes often have the ring of how many angels can fit on the head of a pin. Our use of religious terminology to describe the behavior of psychotherapy schools is deliberate—and not meant to be flattering.

If we focus on a level of abstraction that is somewhere between the higher order theoretical constructs of a therapy school and the specific techniques that it uses clinically, there is a sweet spot middle point where we can find the greatest similarities. This will be the subject of our next blog and podcast.

For more information on ending the therapy civil wars, go to our fifth episode of the 

is distinguished professorin thepsychology department

Stony Brook University. Find them on Twitter @AllenFrancesMD and @GoldfriedMarvin.

There is absolutely no good reason for competition among therapies—none is by itself necessary or sufficient, and most are completely complementary, even synergistic. 

Ending the Psychotherapy Civil War

It does not take a psychiatrist to recognize raw courage. Most of us know courage instinctively and viscerally when we see it: the unidentified Chinese man who stood in front of a column of tanks leaving Tiananmen Square

; the firemen charging up the stairs of the World Trade Center on 9/11; and now, the president and 

, as they stand up to a brutal and pitiless aggressor. Few Americans could have listened to Ukrainian President Volodymyr Zelenskyy’s recent speech before the US Congress without feeling moved by this “profile in courage.”

As psychiatrists, we embrace several human values: professional duty and responsibility, surely, but also values inherent in the psychotherapeutic process. We value rational and respectful dialogue; attentive listening; and empathic, compassionate care. But it seems to me that 

 as a key value in psychotherapy is rarely discussed. Yet without courage on the part of both patient and therapist, the entire psychotherapeutic journey would be thwarted in the first few steps. As Manuel Manotas, PsyD, has rightly observed

“Engaging in the process of therapy is a courageous endeavor that is not for the faint of heart. Successful therapy demands that you see what you do not want to see within yourself. We all have parts that we don’t want to see—parts that scare us and that we have carefully hidden deep inside. Good therapy is meant to help us uncover those parts. Even in the safety of a strong therapeutic relationship, that is no walk in the park.”

Psychiatrist Bruce A. Kehr, MD, has made a similar point

“At its core, the psychotherapeutic relationship requires shared courage on the part of the patient and the therapist. At the beginning of psychotherapy, and from time to time throughout its course, the experience can feel quite scary for the patient. Coming to terms with certain realities heretofore avoided is emotionally challenging and may feel daunting and overwhelming. At times, extremely painful feelings, embarrassing or shameful fantasies, and troubling memories will arise during the course of therapy, all demanding the courage to confront, explore, understand, and resolve them.”

Yes, I know: The kind of courage required to face bombs and bullets is not entirely the same as that required to face painful repressed memories or posttraumatic flashbacks. In some ways, these internal threats may be even more terrifying than the external dangers of war. But both kinds of courage require intense focus, fierce determination, and unflagging perseverance—and, of course, hope. An old-fashioned word, rarely used these days, captures some of these qualities: 

As the Ukrainian president, Zelenskyy has sometimes been patronized or disparaged for his previous career as a comedian.

 The rabbis of the Talmud (Ta’anit 22a) understood a deeper truth about comedians. Here is the story:

A Rabbi was walking in a Persian marketplace when the Prophet Elijah himself appeared to him. The Rabbi asked Elijah, “Is there anyone in this marketplace who merits a place in the World to Come?”

At first, Elijah said, “No.” But a short while later, 2 men walked by, and Elijah told the Rabbi that the 2 men would be granted a spot. Burning with curiosity, the sage approached the 2 men and asked them what they did.

“We are jesters,” they told him. “We cheer up those who are depressed.”

Yes—and often the patient and therapist, like the stand-up comedian,

 find it hard to persevere in the face of darkness, discouragement, and disappointment. Sustaining oneself in the midst of that internal struggle takes genuine courage.

is professor emeritus of psychiatry and lecturer on bioethics and humanities, SUNY Upstate Medical University; clinical professor of psychiatry, Tufts University School of Medicine; and editor in chief emeritus of 

1. Almond K, Widener J. The story behind the iconic ‘Tank Man’ photo. 

https://www.cnn.com/interactive/2019/05/world/tiananmen-square-tank-man-cnnphotos/

2. Key moments from Zelensky’s address to Congress. Washington Post YouTube page. March 16, 2022. Accessed March 24, 2022. 

https://www.youtube.com/watch?v=aU_Qte__Gj0

3. Manotas MA. Courage, vulnerability, and strength: how therapy empowers us.GoodTherapy.September 24, 2015. Accessed March 24, 2022. 

https://www.goodtherapy.org/blog/courage-vulnerability-strength-how-therapy-empowers-us-0924154

4. Kehr BA. Courageous unstoppable you: facing yourself to find happiness. Potomac Psychiatry. January 15, 2021. Accessed March 24, 2022. 

https://www.potomacpsychiatry.com/blog/psychotherapy-and-courage

5. Longanimity. Dictionary.com. Accessed March 24, 2022. 

https://www.dictionary.com/browse/longanimity

6. Volodymyr Zelenskyy. Wikipedia. Accessed March 24, 2022. 

https://en.wikipedia.org/wiki/Volodymyr_Zelenskyy

7. G-d Bless the Comedians. Seeking Simcha. February 23, 2015. Accessed March 24, 2022. 

https://www.seekingsimcha.com/?s=comedians

8. Christensen J. The sad clown: the deep emotions behind stand-up comedy. CNN. December 4, 2018. Accessed March 24, 2022. 

https://www.cnn.com/2017/03/01/health/sad-clown-standup-comedy-mental-health/index.html

The people who make us laugh are more important than you might think. 

Courage and the War in Ukraine: How a Brave Comedian Embodies a Key Value in Psychotherapy

Depending on how you look at it, manuals have either played a heroic role in the history of 

 or have been responsible for its degradation.

Without manuals, we could not have built the substantial evidence base that proves the efficacy of psychotherapy and justifies its compensation.

But manuals are also accused of many sins: (1) corrupting the art of psychotherapy in pursuit of its science; (2) cheapening the therapeutic relationship by constraining it within a rigid and artificial strait jacket; (3) distorting psychotherapy training; and (4) increasing the competition among therapies and retarding their integration.

 therapy are particularly bitter in their criticism of manuals—blaming them for the rapid spread of 

 and the reduced popularity of their own approach. They admit that dynamic therapy is harder to standardize and study but argue that creating an “evidence base” has been fetishized at the expense of providing what is best for patients.

We must admit to them, to ourselves, and to you that we were unwitting cogs in the machine that was responsible for the undeserved power psychotherapy manuals have gained in clinical work, training, and in decisions about what forms of treatment deserve to be covered by insurance.

During the early 1980s, we first met as members of the 

National Institute of Mental Health (NIMH)

 Psychotherapy Study Section that decided which research grants were worthy of funding. Perhaps the major deciding determinant in our deliberations was whether the treatments to be studied had been manualized. It was considered a fatal flaw in any application if the treatment lacked the standardization provided by a manual, as well as adherence checks to make sure its instructions were being followed.

It is among our proudest career accomplishments that our NIMH group funded the early controlled studies of cognitive therapy, behavior therapy, cognitive-behavior therapy, dialectic-behavior therapy, and family therapy. But we are correspondingly rueful that the need for manuals in research studies resulted in their over-valuation in clinical, educational, and reimbursement decision making.

It is noteworthy that the Becks, who pioneered CBT manuals to help in research studies, have been opposed to their use in training and clinical practice. They recognized (as do most experienced clinicians) that it is impossible to simultaneously follow the patient if you are also slavishly trying to follow the manual. The manual-driven therapist becomes distracted, unemphatic, robotic, and unintuitive in adopting an attitude of do-what-the-manual-demands.

Some research studies have found treatments that more closely follow the letter of the manual achieve better outcomes than those that drift away. But this almost surely reflects correlation, not causality. Much more likely, patients who are easy-going and have good outcomes allow therapists to stick close to the manual, while the tougher patients, with less optimistic outcomes, require therapists to be more flexible, creative, and less worshipful to the manualized instructions.

It is crucial to flexibly follow the patient; not slavishly worship the manual. People are complicated and their problems are far too individual and specifically personal to ever be comprehended within any pat set of rules. It is not harmful to read manuals as a general background to understand the principles of any given therapy, but it is soul deadening to follow a manual like an automaton.

Manuals have another, more general and unforeseen detrimental effect. They encourage competition among therapies—emphasizing their differences as well as minimizing their similarities and complementarity.

Combining techniques is the best way of treating most patients—not sticking to manuals that atomize therapies and encourage reductionism. Psychotherapy integration is perhaps the most crucial topic in our field and deserves its own blog(s). Stay tuned for much more on this in later blogs.

, we discuss the issues covered in this blog in more depth, with some lame jokes thrown into the mix. Watch us 

Depending on how you look at it, manuals have either played a heroic role in the history of psychotherapy or have been responsible for its degradation.

Follow Your Patient, Not A Manual

 ever written on how psychotherapy works. The clarifying lens of Zen philosophy focuses our attention on common factors that drive change across the different forms of psychotherapy. Its author, Yutaka Ono, MD, is a master clinician most famous for bringing cognitive-behavior therapy (CBT) to 

Ancient Zen precepts, which evolved in China more than 1500 years ago, provide an excellent guide to today's best practice of psychotherapy.

. All human encounters are special, irreplaceable, and to be treasured. And few encounters are as meaningful as those that occur in therapy—enriched by unusual intimacy; the sharing deep secrets; emotional catharses; uncovering unacceptable thoughts; and revealing embarrassing experiences. No session should ever be routine, and therapy should never be the slightest bit boring for either participant.

 Every patient contact is a once-in-a-lifetime experience with the potential to powerfully change both the patient and the therapist. This is akin to the Zen concept 

, where "ichigo" means "whole life" and "iche" means "one meeting." Progress in psychotherapy does not occur in small, slowly incremental steps. We never know when something we say will stimulate a great leap forward. So, we must always, in every session, be alert for the chance to create a magic moment.

 “Life is a series of natural and spontaneous changes. Don’t resist them—that only creates sorrow. Let things flow naturally forward in whatever way they like.”

Everything is impermanent: your thoughts, your pains, your sufferings, your body, and so on. Whatever we see in our environment was once different and will soon be different yet again. This insight creates the happy expectation that therapy can be life-changing in a positive way. It also helps to reverse hopelessness and demoralization as well as promote acceptance and resilience when confronting life's inescapable losses.

 Things are never what they seem because our perception of them is so inherently subjective, self-serving, and fallible. Searching below the surface of our own attitudes and of the external world is necessary if one is ever to see things straight on and apprehend the real meaning of life.

 There is a radical difference between the experiential approach of the Zen master and the rational approach of ancient Stoic philosopher. But they do share a common understanding, re: how best to manage painful experiences. Both accept that: natural disasters will happen; people are often thoughtless or cruel; we age, get sick, and die; hardships and losses are a constant part of life. We cannot change bad events, but we can change how we react to them by learning acceptance; detachment; meditation; and desensitization via deliberate exposure to painful experiences.

 Zen is experiential, not didactic. Enlightenment relies heavily on intuition, metaphor, and poetry. The master can point in the general direction toward wisdom, but each person must find their own personal path. One's potential strength lies only within oneself; only what is internally learned is of any importance; and only by one's own personal efforts can it be increased.

 Zen speaks in puzzling riddles. Here is a typical example: "To study Zen is to study the self. To study the self is to forget the self. To forget the self is to be awakened by all things.”

Life's quandaries often have no ready solutions—we must accept that the only certainty is uncertainty.

, (the founder of Rational Emotive Therapy) acknowledged the powerful influence of the ancient Stoic philosophers in shaping their theories and therapy techniques. Less consciously, they were simultaneously injecting Zen concepts into basic foundations of the therapy methods they created.

Zen concepts are most explicit and fundamental in Dialectic Behavior Therapy (DBT), as created by 

. Linehan’s faith in Zen practice emerged from her lived experience of severe psychiatric problems during her adolescence that resisted all psychiatric treatments but responded well to Zen. DBT is a happy melding of ancient Zen practice with modern psychological techniques.

But the really great thing about the Zen concepts we have discussed is that they apply so broadly to every clinical encounter: across professions (eg, psychiatry, psychology, general medicine, social work, nursing, occupational therapy, etc); across durations of contact (eg, single meetings that last only a few minutes versus long term therapies that continue for years); and across the 50 schools of psychotherapy.

—and also periodically reread it—to forever renew the excitement that should always inform our work.

 podcast on the importance of magic moments in psychotherapy, which you can view 

The clarifying lens of Zen philosophy focuses our attention on common factors that drive change across the different forms of psychotherapy. 

Zen and the Art of Psychotherapy

 podcast, my co-host Marvin Goldstein, PhD, quoted Sidney Blatt, PhD, as saying he felt best as a person when doing psychotherapy.

I immediately resonated with Blatt's insight, realized it also applied to me, and spent the next week trying to figure out why I felt like a better man while doing therapy than in most, if not all, of my other roles in life.

I came up with these 3 interacting ways in which doing therapy is therapeutic for the therapist.

First, and perhaps foremost, is the utter unselfishness that is required if one is to correctly function as a therapist. I'm by nature not a very selfish person, but my motives aren't always purely selfless—even with those I love most. But I can recall only a few instances during a long career when I knowingly put my personal interests above my patient's—and these all had to do with choosing family first (as when my kids were born or a family member became ill). Having been unselfish with patients helped me learn how to be unselfish with others and, in the process, made me a better person.

Second comes the special intimacy that's inherent in the therapeutic relationship. I've felt closer to some of my patients than to almost everyone else in my life. It is a special privilege to share in other people's most private experiences, thoughts, feelings, hopes, heartbreaks, griefs, disappointments, and triumphs. Doing psychotherapy brought out depths of feeling in me I did not naturally have and saved me from becoming the shallow, frivolous, and immature person that was my likely destiny.

Finally, doing therapy helps therapists because it is so gratifying to be helpful to others. Not every therapy works, but most do at least to some extent, and sometimes you get to see people make really giant leaps in their lives. It's impossible to know how much you are actually contributing, and unfair and unwise to ever take credit, but it certainly feels good to be part of your patient's feeling and doing better.

I've always felt extremely grateful to my patients for letting me see the world through their eyes and teaching me so many things about life I never could have learned any other way. But I never recognized the added bonus--they were also making me a much better person and this allowed me to feel better about myself.

For more on this topic, watch the second episode of our 

Sometimes what you do for others benefits you, too. 

Big Bonus Of Doing Psychotherapy—It Makes You a Better Person

This is the first of what will be a series of weekly blogs drawn from our podcast of the same topic and covering the most crucial questions of psychotherapy. We think it will be useful across all clinical disciplines, for practitioners, trainees, patients, and families.

, had the brilliant intuition that the "common factors" across the various types of psychotherapy may be more important to successful outcomes than the specific techniques that distinguish them. He cleverly called this the "Dodo Bird Verdict" after Dodo's famous quote in 

, "Everyone has won, and all must have prizes."

Nine decades have passed, allowing time for hundreds of controlled studies and dozens of meta-analyses, but controversy still roils regarding the relative strength of the specific versus the nonspecific factors in promoting 

1. A good therapy relationship is necessary to good outcome—but not always sufficient; and

2. Specific techniques are most differentially helpful when treating specific symptoms or behaviors (eg, anxiety, eating, or borderline personality disorders).

by Jerome Frank, MD,  PhD, gave the best description of common factors in psychotherapy and traced them to the ancient rituals practiced by shamen and shawomen.

 develop a powerful relationship. They share the belief that the shaman has special powers to heal the patient, and both have high expectations of success. The shaman allows the patient to enter a magic circle of healing and performs magic healing rituals. As a result, the patient develops insights into the causes and cures of his problems and has a corrective emotional experience, and the symptoms disappear. The patient then reenters the everyday world, healed and renewed.

It is no coincidence that modern psychotherapy so closely resembles ancient shamanic practice. Human nature is remarkably stable—what worked 50,000 years ago still works today. Expectation of symptom relief and reversal of demoralization (plus regression to the mean via tincture of time) remain very powerful drivers of change.

But modern psychotherapy also differs markedly from shamanic practice in its secular belief system: reliance on the methods of science and the development of specific, effective, and empirically supported techniques.

Every therapist should be highly skilled in establishing and maintaining powerfully healing psychotherapeutic relationships with a wide variety of patients. Every therapist should also have a toolkit of specific psychotherapeutic techniques and the wisdom to know when to use which technique with which patient. Therapists who rely only on the relation or only on the techniques restrict their therapeutic range and shortchange their patients.

This brings up the interesting question of how the

is similar to, but also different from, all other human relationships.

The similarities are obvious and pervasive. The therapist/patient relationship is just a special case of all human relations and the principles that apply to them mostly apply to it. Therapists who are good at relating to others tend to be good at relating to patients. Therapists who are bad at relating to people tend to be bad therapists. Patients who relate well in life tend to relate well in therapy and are considered easy patients. Patients who relate poorly to others in life are the ones who most need us and most teach us, even if they are considered difficult patients.

The therapy relationship also differs markedly from most other interpersonal relationships in ways that we will detail in our next blog. (Spoiler: It is more intimate, less selfish, more mutually helpful, and more assisted by high expectations and effective techniques).

 to our first podcast covering these issues in more depth.

is distinguished professor in the psychology department

Exploring the importance of the psychotherapeutic relationship.

Talking About Psychotherapy: A New Blog

“There is more to the surface than meets the eye.”

Aaron T. Beck, MD, passed away peacefully on November 1, 2021, on All Saints Day in the Christian tradition, at the notable age of 100.

Psychotherapy