“So, You Think You Need Psychotherapy…!”
“So, You Think You Need Psychotherapy…!”

By William Schacht, MS, LCSW

You’re stuck and you know it.  Either the mirror or someone else said, “Maybe you should go a talk to someone.”  So you will.  You will go for “psychotherapy.”

Psychotherapy can be a wonderfully effective process to help a person get unstuck, back on track, and feeling good again.

But what, exactly, is “psychotherapy?”

Ask 100 licensed mental health providers this question and you’re apt to get 100 different answers.  A client saying any given sentence to 100 different psychotherapists will certainly get 100 distinct therapist responses.  This truth is mind-boggling to a human being in need of psychotherapy and a therapist to deliver it.

This is just as challenging for the psychotherapist because most clients enter their first session with little to no idea of just what psychotherapy is.

Let’s try to see through this fog.

For starters, allow me to suggest that psychotherapy is more like baseball pitching than house construction.  Every psychotherapist’s sentence spoken to a client is unique and may be extremely effective in one instance and may not be useful at all in another.

As a practicing psychotherapist for 38 years and a clinic owner for 25 years, allow me to define the process that I and the licensed mental health professionals I hire at Performance Enhancement Health Services, SC use to facilitate psychotherapy clients.  This process may be called a “functional focus” psychotherapy.

The process begins with an “Initial Evaluation” session which results in the psychotherapist forming a professional opinion regarding the client’s diagnosis/diagnoses, a “prognosis” (probability of success), and treatment plan.  The diagnoses referenced are in a book called the ICD 10.  Each diagnosis has a list of “symptoms” or circumstances that, to a degree, the client must tell the therapist are occurring or have previously occurred in their life for the diagnosis to be assigned.

The therapist may recommend an additional session or psychological testing to ensure that an accurate diagnosis is generated.

The therapist writes an “Initial Evaluation” document.  This document is is presented to the client (and the parents/guardian of a minor age child client), as professional opinion of the therapist and for acceptance of that opinion by the client.  The client is asked by the therapist to sign an informed consent form to begin treatment.

Psychotherapy treatment is the therapist facilitating the client through a 3-step process:


In this first step, the client identifies, in concrete measurable terms, what he/she wants to produce as the desired results of the therapy.  In business language, these are called “deliverables” – how the client and therapist will determine success or failure.

This is typically the hardest part of the process.  Some clients never succeed at this.

Most clients are good at telling the therapist what they DO NOT WANT.  “I don’t want to feel the way I am feeling.”  “I don’t want to be thinking these thoughts I am thinking.”  I don’t want these things that are happening to me to continue to happen.”

But, telling someone what you do not want for dinner has absolutely no correlation to declaring what you do want for dinner.

And, most clients are quite adept at declaring what they want in abstract terms.  When I ask couples in relationship counseling want they want to produce from their work, the majority will say something like, “We want to be better communicators and happier.”   Yes, everyone in the room, including the therapist, wants to be a better communicator and happier.  But, better communication can be defined in a gazillion different ways and what makes one human being happy may or may not be the cause of happiness for some other people.

It is essential that a client creates concrete, measurable desired results and that the therapist understands those results in the terms the client has defined them.  This mutual understanding creates synergy between client and the therapist and maximizes the potential for an enjoyable therapeutic relationship and client satisfaction.

Failure in Step I can lead to wasted time in therapy and the client not feeling in control of the therapeutic process.


Imagine that the moment you begin your first visit with a psychotherapist, you are a magnificent machine with four (4) distinct components (like a 4-cylindar car motor) that are all functioning in a particular way.  We can say you are entering psychotherapy in “Position A.”

The 4 components can be defined as…

You have an “Intellectual Self.”  You think.  You have the ability to produce thoughts, both consciously and non-consciously.  At any given moment you have a set of thoughts that exist and can be changed.

You have an “Emotional Body.”  You have the capacity to feel and you have feelings in response to countless stimuli you encounter each day from the world outside of you and your own thoughts.

You have a “Physical Self.”   You have a tactile or physical sensation of the world around you and of you.

You have a “Spiritual Self.”  You have the capacity to experience existence beyond what is seen and what science can explain.  This may be defined as a relationship to and experience of God.  This is also defined, at times, as the experience of collective consciousness or all things being connected.

What a client and therapist “LEARN” in STEP II is how the client is organized in “Position A” Intellectually, Emotionally, Physically, and Spiritually in relationship to the his/her concrete, measurable, desired results.

In other words, the client and therapist ponder, “Am I (client) organized intellectually, emotionally, physically, and spiritually today in a way that is consistent with the ability to produce my desired results?”  Either the machine (client) is positioned to produce the results or is not.  It is that simple.


If and when a client and therapist learn in Step II that there are inconsistencies between the client’s desired results and how the client is currently organized intellectually, emotionally, physically or spiritually the client, along with therapist support, creates a change plan of action that results in the client evolving to a distinct “Position B” from which the client can produce the identified desired results.

Example of Intellectual Discrepancy:

A client wants to get a college degree in engineering, but does not believe he/she can pass the required math courses of the program.

Example of an Emotional Discrepancy:

A client wants to date, but feels so terrified each time he thinks about asking a woman out for a date for fear she will say “NO” that he never asks.

Example of a Physical Discrepancy:

A client wants to lose 20 pounds but will not change current diet or exercise.

Example of a Spiritual Discrepancy

A client believes in God wants to have a good relationship and is angry with God because one of their children died of an incurable disease.

A therapist will use various treatment methods and techniques in which they have been trained to support a client in letting go of discrepancy positions identified and creating a distinct position from which the client is able to produce desired results.

From the new position(s), a client acts to generate desired results.

When a client achieves enough of a percentage of his/her desired results and has learned the skills associated with their change to the extent they can continue to use those skills, therapy can be defined as successful and discharge will occur.

In Summary…

When you choose your psychotherapist, you now have the option to present this article to him/her and ask if what is written here is consistent with his/her definition of “psychotherapy.”   You want to be certain you begin your therapeutic relationship with a shared understanding of the process.