The room is dimly lit and there are shelves packed with leather-bound books along the walls. You’re laying down on a couch spewing your deepest, darkest secrets to some stranger who’s favored responses seem to be, “how does that make you feel?” or “your parents are the reason you’re like this.” Meanwhile, this stranger is fiercely scribbling on a notepad what you speculate is your dooming diagnoses and who knows what else.
This is the image that typically comes to mind for most when they imagine psychotherapy. Generally, folks gain their impression of what therapy is through the media. Just like any stereotype or cliché, some are true. However, they often are not seen in the proper context and therefore misunderstood. So, let’s breakdown some of the misconceptions of therapy and bring some clarity here. Once we have defined our terms and definitions, I’ll then discuss types of psychotherapy, what to expect during treatment, how it can be used, and why you might consider it as an option to enhance your life and athletic career. For the sake of this article, I will refer to mental health practitioners (psychologists, mental health counselors, marriage and family therapists, and clinical social workers) as therapists and their practice as therapy.
What is Psychotherapy?
In order to fully understand what therapy is, let’s briefly look at its past and how it has evolved. Most people are familiar with Sigmund Freud, though the father of modern psychology was actually Wilhelm Wundt. He established the official start of psychology as a separate and distinct science in 1879 when he opened the Institute for Experimental Psychology at the University of Leipzig in Germany. Prior to then, philosophy was the only field that explored human behavior and mental health. Wundt set the stage for future experimental psychologists by analyzing the workings of the mind in a more structured way, with emphasis on objective measurement and control.
Early psychologists focused on treating “patients” who had diagnosable mental illnesses by reducing symptoms, otherwise known as the medical model. The approach targeted a problem that needed fixing, because something was inherently wrong with the person. Whereas today, a “client” may seek therapy for any number of reasons aside from a clinical diagnosis. The problem is still addressed, but the focus is far more on the individuality of the person. This is known as the wellness model that is primarily used today.
Ask any mental health professional what therapy is and they will give you their own conceptualization of it and how they approach treatment. However, peel back all of the colorful adjectives and variety of answers, and you’ll find common ground. In psychotherapy, therapists utilize evidence-based practices to assist others in developing healthy, more effective thoughts and behaviors.
Interestingly, there are quite a few parallels between a physique/nutrition coach and a professional therapist. Think of an effective therapist as a “mind coach”. They create an individualized treatment plan in consideration to your specific goals. Therapy is also a means to an end. It can be a one-time deal, a few months of sessions, or longer depending on what you’re going through and what you’re looking to accomplish. By the end of therapy, not only will you have resolved the originating issue, but you will also have learned new skills to appropriately handle other future challenges.
Types of Psychotherapy
There are many different empirically-supported approaches to psychotherapy. Practitioners generally blend elements from several styles of psychotherapy in order to support the client’s individual needs. This is nowhere near a comprehensive list of therapeutic modalities; however these are some of the most widely practiced and likely to encounter:
Psychodynamic theory began to develop in 1874 by Ernst Wilhelm von Brücke. He supervised the infamous Sigmund Freud, who was a first-year medical student at the time. Freud later branched off on his own to develop “psychoanalytic therapy”. However, other Neo-Freudians, such as Carl Jung, Alfred Adler, Melanie Klein, Anna Freud, and Erik Erikson, continued to evolve psychodynamic therapy. Psychodynamic therapy places an emphasis on unconscious psychological forces that drive behavior, thoughts, and emotions. These forces have been influenced by early childhood experience. The primary focus of psychodynamic therapy is to improve self-awareness to change patterns to fully take charge of one’s life and uncover unconscious content to alleviate psychic tension. Psychodynamic therapy has shown to be effective for depression, anxiety, panic disorders, personality disorders, and eating disorders.
Cognitive Behavioral Therapy (CBT)
CBT has multiple historical roots that influenced its development, beginning with Epictetus, a Stoic philosopher. The modern roots of CBT were later heavily influenced by Albert Ellis, Aaron Beck, and Donald Meichenbaum in the 1950’s. This form of therapy aims to address dysfunctional emotions, maladaptive behaviors, and cognitive processes through a number of goal-oriented, systematic procedures. CBT proposes that our emotions are influenced by our interpretation of an event, not because of the event itself. If you’re one that does well with homework, this modality provides plenty of skill-based practices and tasks. Clients can also expect the therapist to be more directive and hold very planned and structured therapy sessions. CBT has been effective in treating depression, anxiety, eating disorders, issues with anger, substance use, OCD, and PTSD.
Eye Movement Desensitization and Reprocessing (EMDR)
A relatively new kid on the block, this modality was developed by Francine Shapiro in the 1990’s. The goal of EMDR is to reduce negative emotions associated with distressing memories of traumatic events. In order to facilitate developing more adaptive coping mechanisms, EMDR uses an eight-phase approach that involves the client recalling the trauma while receiving bilateral sensory input, such as side-to-side eye movements. It is most commonly used to treat anxiety, panic, PTSD, and trauma.
All in the name, this therapy focuses as much as possible on the client. It was pioneered by Carl Rogers in the 1940’s, who believed people will naturally grow and find solutions to their problems when they experience therapeutic alliance that is genuine, warm, empathic, and provides “unconditional positive regard”. The therapist presents with a laissez-faire essence and gives little to no direction. Throughout the process, the therapist reflects the client’s own concerns to help them become aware of conflicting statements of biases in their perceptions of reality. This therapeutic modality is helpful for those who struggle with grief, depression, anxiety, stress, and other mental health concerns.
Dialectical Behavioral Therapy (DBT)
Marsha Linehan originally developed DBT to treat borderline personality disorder in the late 1980’s. DBT combines cognitive-behavioral approaches (ex. emotion regulation and reality testing) with acceptance approaches (ex. distress tolerance and mindful awareness). Clients learn new skills to take personal responsibility to change unhealthy and/or disruptive behavior. Both individual and group therapy are involved in this treatment approach. DBT is helpful for those who struggle with borderline personality disorder, eating disorders, substance use, suicidal ideation or behavior, difficulty building and maintaining healthy relationships, managing an extreme range of emotions or self-harm.
It is important to note that the therapeutic approach has little to do with the success of therapy, which leads us to the next part of our discussion.
Does Psychotherapy Work?
Studies consistently showbehavioral and emotional interventions work as well, if not better than medication to treat anxiety, depression, and mental health issues like OCD. Of those who receive psychotherapy, most achieve much better outcomes than they would have had they not received psychotherapy (Lambert & Ogles, 2004; Wampold, 2001, 2007). In clinical trials, psychotherapy has been shown to be effective in treating depression, anxiety, marital dissatisfaction, substance abuse, health problems (including smoking, pain and eating disorders) and sexual dysfunction in various populations, including children, adolescents, adults, and elders (Chambless et al., 1998).
One of the most determining factors of effective therapy is the therapeutic alliance between the therapist and the client. Meaning, both parties work collaboratively towards a goal where there is effective communication and trust.
Effective therapists also have certain qualities that distinguish them from those that are not. Briefly, some of the qualities include having a sophisticated set of interpersonal skills, the ability to form a working alliance with a broad range of clients, an acceptable and adaptive explanation for client distress, a treatment plan that is consistent with the explanation provided to the client, and a competency in therapeutic interventions.
Again, similar to training and nutrition, there is no magic pill. In order for therapy to be effective, it requires effort from both the client and therapist. Change does not manifest solely from going to sessions, but also from implementing and practicing the skills you learn in your daily life. So, starting therapy with that mindset — prepared to do the work, both in and out of session — will go a long way.
When Should You Consider Psychotherapy?
There are some misconceptions that therapy is only for those who have severe mental illnesses or are on the brink of a mental break down. Honestly, you can benefit from therapy at any point in your life, no matter who you are.
Nobody is immune to normal human experiences, such as stress, anxiety, sadness, or depression. Of course, we can sometimes navigate through these issues on our own, whether with the help of our support system, reading books, a lifestyle change, or taking a class. On the other hand, we may notice our behavior patterns haven’t changed, which in turn affects important areas of our lives (social and occupational). At its worst, stress, anxiety, and depression can be absolutely debilitating, putting our health and lives at risk.
Certainly, those issues are valid reasons to seek therapy. However, they are not required. Here are some other great examples of when to consider therapy:
- Feeling sad, anxious, burnt out, or lost.
- Feeling miserable at your job and wanting to learn how to cope.
- Wanting to be more self-aware or emotionally intelligent.
- Wanting to improve your relationships.
- Having a goal you want to achieve, but needing some help or motivation.
- Needing help forgiving someone in your life.
- Wanting to learn mindfulness techniques and self-care exercises.
- Becoming ready to talk about something that happened in the past.
Is Having a Therapist Who Knows the Sport Ideal?
A therapist’s experience as a competitive athlete does not guarantee effective treatment. Indeed, given how frequent mental health issues are among competitors (Helms et al., 2014), simply being a competitor isn’t enough to ensure a therapist can help you. It’s understandable to think that only a competitor can know what another competitor is truly going through. There is some truth to this, and certainly, there is an unspoken bond that exists between competitors because they can relate to what one another is going through. A therapist – or anyone for that matter – who has been through the contest prep process can say things to the athlete like, “I know what you are going through, because I have been there.” However, it’s important to also consider just how many people with different backgrounds struggling with unique problems that therapists are able to help.
Sympathy and shared experience are important, but the ability to give you an alternative perspective, help you reframe your experience, and provide support and guidance is not dependent on shared experience. If it was, fathers wouldn’t be able to comfort their daughters, mothers wouldn’t be able to comfort their sons, and victims of trauma would only be able to seek out therapists who themselves were once victims. Of course it can provide a safe feeling, and a sense of earlier understanding to have a therapist who sympathizes, but really, what is needed is knowledge, ability, and most importantly empathy which is not quite the same thing as sympathy due to shared experience.
Researcher Brené Brown (2010) rightfully proclaimed, “Empathy fuels connection, while sympathy drives disconnection.” Saying you understand is unhelpful and probably not true. And let’s be honest—it’s usually a ploy to rush people out of their emotionalism, which sends the message, “I really don’t care enough to walk with you through your suffering.”
Briefly, empathy is the experience of understanding another person’s thoughts, feelings, and condition from his or her point of view, rather than from one’s own. There may even be value in getting a perspective that differsfrom your own, especially when going through the mental loops of anxiety or depression. This is not to say sympathy isn’t important, and certainly a therapist can be even more effective when their client has a strong support network of people who do sympathize due to shared experience. In fact, many therapists help their clients facilitate these connections as a part of ongoing treatment plan to ensure long-term wellness. For example, you might seek therapy as someone who struggles with addiction in addition to anxiety and depression, and your therapist (who isn’t an addict and doesn’t suffer from anxiety or depression), might suggest attending a support group as an adjunct to your sessions.
Instead, focus a search in finding a therapist with a specialization towards athletes. A therapist who specializes in working with a particular population has learned specific subject matter relating to the population and has become competent in that work. This specialization also supports risk management, because of the depth of knowledge they have gained about the population. In matters of therapy, specialization trumps generalization. Going back to our parallel world with physique/nutrition coaches, I would imagine someone contemplating contest prep or a powerlifting meet would select a coach that primarily works with such athletes rather than a boot camp instructor (no offense to boot camp instructors!). As a client, one will naturally have a more favorable view of therapy and the therapist if the service is specialized than being offered general treatment.
Armed with this information, I hope you have a better understanding of what psychotherapy is and how it is beneficial to have a therapist who specializes in an athlete’s needs as much as a coach would. By taking steps to improve your mental health you will invariably influence all aspects of your life, including your goals as an athlete.
Mental Health Resources
About my therapeutic background and approach:
Amanda Rizo, M.S.
Associate Professional Clinical Counselor
I take a culturally-inclusive and integrative approach to therapy; incorporating modalities such as Cognitive Behavioral, Solution-Focused Brief, Motivational Interviewing, and Mindfulness-Based. I have worked with clients experiencing anxiety, depression, OCD, eating disorders, substance abuse, trauma and PTSD, relationship difficulties, and life transitions. I believe a successful therapeutic relationship is based on careful listening and honest feedback. I help clients cultivate authentic relationships in their lives; both with themselves and others. I work collaboratively with my clients to identify and achieve their goals for therapy and strive to meet the client where they are in the present moment. I genuinely believe change is possible and attempt to instill hope in all of my clients.
How to get in contact with me:
National Alliance of Mental Illness
National Suicide Prevention Lifeline
Call 1-800-273-TALK (8255)
Substance Abuse and Mental Health Services Administration
National Eating Disorders Association
Choosing a therapist:
Barak, A., Hen, L., Boniel-Nissim, M., & Shapira, N. (2007). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human Services, 26, 109-160.
Brown, B. (2010). Power of Vulnerability [Video file]. Retrieved from https://www.ted.com/talks/brene_brown_on_vulnerability?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare
Chambless, D. L., Baker, M. J., Baucom, D. H., Beutler, L. E., Calhoun, K. S., Daiuto, A., et al. (1998). Update on empirically validated therapies, II. The Clinical Psychologist, 51, 3-16.
Helms, E. R., Aragon, A. A., & Fitschen, P. J. (2014). Evidence based recommendations for natural bodybuilding: nutrition and supplementation. Journal of the International Society of Sports Nutrition, 11, 20.
Lambert, M. J., & Ogles, B. M. (2004). The efficacy and effectiveness of psychotherapy. In M. J.Lambert (Ed.), Handbook of psychotherapy and behavior change(5th ed.). New York: John Wiley & Sons.
Wampold, B. E. (2001). The great psychotherapy debate: Model, methods, and findings. Mahwah, NJ: Lawrence Erlbaum Associates.
Wampold, B. E. (2007). Psychotherapy: the humanistic (and effective) treatment. American Psychologist, 62, 857-873.