Psychotherapy
Being told to “get therapy” is like being told to “take medicine.” There are a dozen distinct treatments with different mechanisms and different targets, and choosing badly is why people conclude therapy does not work for them.
Why a prescriber writes about this
Most psychiatric nurse practitioner students complete their clinical hours entirely under another nurse practitioner. My 625 supervised hours are arranged differently — 500 under a psychiatrist, and 125 specifically under a clinical psychologist to learn psychotherapy.
That was deliberate. A prescriber whose only tool is medication will interpret every presentation as a medication problem. Anxiety maintained by avoidance gets a dose increase instead of exposure work, and the dose increase does not fix it, because avoidance is not responsive to serotonin.
What this writing is for
Not to replace a therapist, and not to teach you to treat yourself. It is to let you walk into a referral knowing what you are asking for — which modality fits your problem, what the sessions will actually involve, and which questions distinguish a therapist trained in a protocol from one who has read about it.
For most people that information is the difference between therapy that works and a year spent politely talking.
"Just talk to someone" is useless advice
Therapy is not one product. A guide to the main approaches and what each is actually for.
What actually happens in CBT
Closer to a training programme than to talking about your childhood. That surprises people.
EMDR, DBT, ACT: what the acronyms actually mean
Therapist directories are full of initials with no explanation. Here is what they are.
Therapy for people who analyse everything
You can describe your own patterns better than your therapist can. That is the problem.
Why a prescriber should understand psychotherapy
A prescriber who cannot tell therapy-shaped problems from medication-shaped ones will reach for the prescription every time.