Individual Therapy

What Is Individual Therapy?

Individual therapy consists of a mental health and/or substance use disorder treatment professional who will work with you on a one-to-one basis with in-person sessions. Individual psychotherapy is by far the most common type of therapy and consists of several different therapeutic approaches.  

The primary goal of individual therapy is to increase understanding of our own thoughts and behavior patterns.  With therapy, we can learn how to manage our stress, develop skills, identify and manage  interpersonal difficulties and more.  We learn ways to make healthy decisions and set and achieve our goals, but first we must achieve a stability in order to reach these goals, and our therapy should include and address medical, psychological, social, vocational and legal problems and needs.  

Effective treatment addresses all these needs, not just drug abuse.  It is also important that treatment be tailored to the individual’s age, gender, ethnicity, and culture. In a group outpatient setting, many of these needs may not be addressed individually.  Individual therapy is limited and time constrained.  Mental health issues, medications, and other specific needs may be referred out of the facility as case management rather than incorporated into the holistic approach of addressing all needs simultaneously. 

Most outpatient facilities for substance use disorders focus on the substance abuse and are not adequately prepared to provide effective and thorough treatment of co-occurring disorders.  In addition, most outpatient facilities utilize a group participation format, and individual treatment is infrequent and lacking.  Outpatient substance use disorder facilities focus on the substance use disorder, while in individual treatment, the focus is entirely on all aspects of the individual concurrently.  

Many people entering substance use treatment will benefit from medications, especially when combined with counseling.  Non medication assisted outpatient treatment facilities often decline patients who are on methadone or benzodiazepine medications, as most are abstinent based and group format based.   Methadone, buprenorphine, and naltrexone are effective in helping individuals addicted to heroin or other opioids stabilize their lives and reduce their illicit drug use.  Acamprosate, disulfiram, and naltrexone are medications approved for treating alcohol dependence.  These medications are dispensed under the care of medical professionals, and monitored by a trained team, which also includes addressing thsubstance use disorder.  In this setting, psychologists or psychiatrists are often part of the team and include mental health treatment.  

Many patients with a substance use disorder  also have other mental health disorders.  Co-occurring disorders are prevalent and patients presenting with one condition should be assessed for the others.  As many as 6 in 10 people with a substance use disorder also suffer from another mental health disorder.  For these individuals, one condition becomes more difficult to treat successfully as an additional condition is intertwined.  When entering treatment either for a substance use disorder or for another mental health disorder, all people should be assessed for the co-occurrence of the other condition.  Simultaneous treatment in an integrated fashion is generally the best treatment approach for these patients.

 

Choosing a  Therapist

When seeking help for a substance use disorder, choosing a therapist is a daunting task.  Referrals from your primary care physician may be helpful; in addition, asking friends or loved ones for a recommendation is another option.

Many employers offer an EAP service (Employee Assistance Program).  An Employee Assistance Program (EAP) is a voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services to employees who have personal and/or work-related problems.  In addition, most insurance providers offer a call in number for questions to help find providers within your network.  

If you are enrolled in college, many student health services offer counselors who may provide, or can refer to, services for substance use disorders.  

SAMHSA (Substance Abuse and Mental Health Services Administration) has a national database and the link is provided below.  

Types of Therapists

Psychologists

  • A psychologist will diagnose a mental disorder or problem and determine what’s best for the patient’s care. They often work in tandem with a psychiatrist, who is also a medical doctor and can prescribe medication if it is determined that medication is necessary for a patient’s treatment. 

Therapist

  • A therapist is a broader umbrella term for professionals who are trained—and often licensed—to provide a variety of treatments and rehabilitation for people. Therapists can be psychoanalysts, marriage counselors, social workers and life coaches, among other specialties. A therapist’s goal is to help patients make decisions and clarify their feelings in order to solve problems. Therapists provide support and guidance, while helping patients make effective decisions within the overall structure of support. When selecting a therapist, their education, licensing and professional credentials should be essential considerations.

Professional Addiction Counselors

  • .A substance abuse counselor is a support system for people with drug and alcohol problems, eating disorders and other behavioral issues. They teach individuals how to modify their behavior with the intention of full recovery.  Because clients are susceptible to relapses, many substance abuse counselors work with clients on an on-going basis.  In addition, many substance abuse counselors are in recovery themselves, choosing to pursue this career as a result of their own recovery.   As a result of this, they are able to directly relate to the recovery experience first hand.  

The Therapist-Client Relationship

With individual therapy, professionals and clients develop a rapport with each other, a connection that allows them to feel comfortable around each other so that they can talk honestly and freely. The more open and honest the communication is between a therapist and client, the more likely it is that treatment will be effective.

The subjects and topics that get discussed between a therapist and a client depend on the client’s goals and the therapist’s expertise. A client may wish to make significant changes in fundamental personality characteristics, or may wish to focus particular attention on a specific condition or topic. Therapists are often trained in multiple forms of therapy and utilize different approaches for different concerns (or sometimes multiple approaches for one concern).

Therapist-Client Confidentiality

Therapists are professionally bound to act in clients’ interests (called a fiduciary responsibility). They also must preserve the confidentiality of their clients’ identities and the content of what clients discuss with them.  

Exceptions to Therapist-Client Confidentiality

A therapist is legally obligated to break this confidentiality if:

  • The therapist believes a client is in immediate danger of self-harm
  • The therapist reasonably believes a client may harm someone else
  • The client is too disabled to take care of basic needs like food, clothing and safety
  • A judge directly orders a therapist’s treatment records

What to Expect

Before beginning treatment, clients and therapists can and should communicate about what to expect from psychotherapy. Doing so helps both parties establish goals that are both reasonable and well understood.

During the first session, clients should expect to discuss the reasons they are seeking therapy. The therapist will listen to these concerns and will also need to gather information about your mental and physical health. It may take several sessions for a therapist to get a solid understanding of a client’s needs and how to best help.  Many times, therapists will utilize an in-depth bio-psychosocial assessment (sample on page).  

You may opt to interview multiple therapists and get a sense of who seems to be a good fit for your needs. A therapist may also decline to further treat a client if it does not seem like a good fit or the concerns are outside of the therapist’s expertise. In this case, the therapist is professionally and ethically obligated to provide a referral to another therapist.

Session Structure

In therapy sessions, the client usually does most of the talking, with the therapist providing feedback as necessary or as requested. This practice encourages client self-confidence and keeps the focus of the sessions on the client’s needs. Sessions can provoke many feelings: joy, relief, sadness, anger, shame, guilt and fear, among others. Therapists can help clients make sense of those feelings and help clients utilize their understanding of these feelings to improve their emotional functioning.

Sessions in individual psychotherapy are typically 45-60 minutes in length, generally taking place in a therapist’s office. In a growing number of instances, therapy takes place via video conferencing or through the use of smartphone applications. Such access is often a necessity for clients who live in remote areas, and can be a significant convenience for those who live closer to city centers.

More About Psychotherapy

 

Several types of individual psychotherapy have been developed in the last 100 years, each of which has particular characteristics, strengths and benefits.

Cognitive Behavioral Therapy

CBT: This is a type of therapy which helps clients understand the connections between their thoughts, beliefs, emotions and actions. Cognitive behavioral therapy empowers clients to change how they feel by changing the way they think.

CBT

Perhaps the most versatile of the types of therapy is effective in the treatment of:

  • Major depressive disorder
  • Panic disorder
  • Generalized anxiety disorder
  • Obsessive-compulsive disorder
  • Post-traumatic stress disorder
  • Substance use disorders
  • Class C personality disorders
  • Chronic pain

Dialectal Behavioral Therapy

DBT is an evidence-based psychotherapy that began with efforts to treat borderline personality disorder. There is evidence that DBT can be useful in treating mood disorders, suicidal ideation, and for change in behavioral patterns such as self-harm and substance use.

What's Unique About Dialectical Behavioral Therapy?

The term “dialectical” comes from the idea that bringing together two opposites in therapy — acceptance and change — brings better results than either one alone.

A unique aspect of DBT is its focus on acceptance of a patient’s experience as a way for therapists to reassure them — and balance the work needed to change negative behaviors.  DBT is a mix of individual therapy and selective group therapy.

Standard comprehensive DBT has four parts:

  • Individual therapy
  • Group skills training
  • Phone coaching, if needed for crises between sessions
  • Consultation group for health care providers to stay motivated and discuss patient care

Psycho-Dynamic Psychotherapy

The first type of psychotherapy utilized to effectively treat anxiety, it has developed and evolved.  Psychodynamic psychotherapy is just as effective as other talk therapies in the treatment of depression. A form of this therapy called brief psychodynamic therapy is particularly effective in the treatment of addiction. Its hallmarks are self-reflection and self-examination.  

Goals of Psychotherapy

For clients, goals of individual therapy may differ depending on their needs. However, all therapists aim to achieve the following:

  • A strong sense of trust between client and therapist
  • Open and honest communication
  • Understanding the benefits of the client-therapist relationship
  • Utilizing those benefits to understand a client’s established thought and behavior patterns
  • Increasing the client’s self-awareness of emotions and typical defense mechanisms
  • Fostering a strong internal structure to effectively manage feelings and emotions

Individual Therapy in Addiction and Mental Health Treatment

The power of individual therapy is based on the idea that it is beneficial to be able to articulate feelings without judgment, and that it is healing to be heard and understood. Individual therapy can help build some of the internal structure that wasn’t adequately developed previously.

Group Vs. Individual Therapy

Group therapy for addiction provides peer support for individuals in recovery and allows clients to feel more connected to others and less alone, but the foundation for success in recovery treatment is a personalized approach. 

Individualized therapies are customized to the needs of each person where they are.

Resources:  

  • https://www.samhsa.gov/
  • https://www.drugabuse.gov/
  • https://www.allpsychologyschools.com/
  • https://www.healthline.com/

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