FAQ’s About Therapy

What Is Psychotherapy?

Psychotherapy is an interpersonal, relational intervention used by trained psychotherapists to aid clients in problems of living. This usually includes increasing individual sense of well-being and reducing subjective discomforting experience.

Psychotherapists employ a range of techniques based on experiential relationship building, dialogue, communication and behavior change and that are designed to improve the mental health of a client or patient, or to improve group relationships (such as in a family). Psychotherapy may be performed by practitioners with a number of different qualifications, including psychologists, marriage and family therapists, licensed clinical social workers, counselors, psychiatric nurses, music therapists, and psychiatrists.

Most forms of psychotherapy use spoken conversation. Some also use various other forms of communication such as the written word, artwork, drama, narrative story, music, or therapeutic touch. Psychotherapy occurs within a structured encounter between a trained therapist and client(s).

Main Systems of Psychotherapy

Psychoanalysis – the first practice to be called a psychotherapy. It encourages the verbalization of all the patient’s thoughts, including free associations, fantasies, and dreams, from which the analyst formulates the nature of the unconscious conflicts which are causing the patient’s symptoms and character problems.

Cognitive Behavioral – generally seeks to by different methodologies identify and transcend maladaptive cognitions, appraisal, beliefs and reactions with the aim of influencing destructive negative emotions and problematic dysfunctional behaviors.

Psychodynamic – is a form of depth psychology, the primary focus of which is to reveal the unconscious content of a client’s psyche in an effort to alleviate psychic tension. Although it has its roots in psychoanalysis, psychodynamic therapy tends to be briefer and less intensive than traditional psychoanalysis.

Existential – is based on the existential belief that human beings are alone in the world. This aloneness leads to feelings of meaninglessness which can be overcome only by creating one’s own values and meanings.

Humanistic – emerged in reaction to both behaviorism and psychoanalysis and is therefore known as the Third Force in the development of psychology. It is explicitly concerned with the human context of the development of the individual with an emphasis on subjective meaning, a rejection of determinism, and a concern for positive growth rather than pathology. It posits an inherent human capacity to maximise potential, ‘the self-actualing tendency’. The task of Humanistic therapy is to create a relational environment where this tendency might flourish.

Brief Therapy – is an umbrella term for a variety of approaches to psychotherapy. It differs from other schools of therapy in that it emphasizes (1) a focus on a specific problem and (2) direct intervention. It is solution-based rather than problem-oriented. It is less concerned with how a problem arose than with the current factors sustaining it and preventing change.

Systemic Therapy – seeks to address people not at an individual level, as is often the focus of other forms of therapy, but as people in relationship, dealing with the interactions of groups, their patterns and dynamics (includes family therapy & marriage counseling).

Transpersonal Therapy – Addresses the client in the context of a spiritual understanding of consciousness.

person in a session


There are dozens of approaches, which continue to be developed around the wide variety of theoretical backgrounds. Many practitioners use several approaches in their work and alter their approach based on client need.

How Do I Know If I Have a Substance Use Problem?

Substance Use is a problem if it causes trouble in your relationships, in school, in social activities, or in how you think and feel. If others in your life have told you that you have a problem, you should consider this. If you have continued to use in spite of negative consequences, that could be an indication of a problem. If you are concerned that either you or someone in your family might have a substance use problem, consult your personal health care provider.

What Can I Do if I or Someone I Know Has a Substance Use Problem?

Consult your personal health care provider if you feel you or someone you know has a substance use problem. Other resources include a psychotherapist, psychiatrist, mental health counselor and the National Drug and Alcohol Treatment Referral Routing Service available at 1-800-662-HELP. This service can provide you with information about treatment programs in your local community and allow you to speak with someone about alcohol problems. You may also call Santa Barbara Psychotherapy for out-patient counseling or for referral information for adjunct and more intensive treatment approaches.

Take the CAGE Questionnaire:

The CAGE questionnaire was developed by Dr. John Ewing, founding director of the Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill. CAGE is an internationally used assessment instrument for identifying problems with alcohol.

Please answer the one response to each item that best describes how you have felt and behaved over your whole life.

  1. Have you ever felt you should cut down on your drinking?



  1. Have people annoyed you by criticising your drinking?



  1. Have you ever felt bad or guilty about your drinking?



  1. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?



This quiz is scored by allocating 1 point to each ‘yes’ answer. Total scores of 2 or above are thought to be clinically significant and may indicate alcohol dependence.

How Do I Know if I Have a Drug Addiction?

Drugs are chemicals that have a profound impact on the neurochemical balance in the brain which directly affects how you feel and act. People who are suffering emotionally sometimes use drugs, not so much for the rush, but to escape from their problems. They are trying to self-medicate themselves out of loneliness, low self-esteem, unhappy relationships, or stress.  This is a pattern that too often leads to drug abuse and addiction.

Drug abuse or substance abuse, involves the repeated and excessive use of prescription or street drugs. In one way or another, almost all drugs over stimulate the pleasure center of the brain, flooding it with the neurotransmitter dopamine which produces euphoria. That heightened sense of pleasure can be so compelling that the brain wants that feeling back, again and again.

What Can I Do if I or Someone I Know Has a Drug Problem?

The first thing you need to do is call a local drug addiction treatment center and tell them about your situation. The treatment center can then refer you to local or county agencies. Those agencies are often in a good position to offer help. You may also call Santa Barbara Psychotherapy for out-patient counseling or for referral information for adjunct and more intensive treatment approaches.

Common Signs and Symptoms of Drug Abuse:

Health and behavior

Continuing to use drugs even though you have health problems that are affected or caused by your drug use

Irritability, anger, hostility, fatigue, agitation, anxiety, depression, psychosis (seeing or hearing things that are not there), lack of coordination, difficulty concentrating

Financial and legal issues 

Paying bills late, collection agencies calling, inability to keep track of your money

Being arrested, doing things that you would normally not do, such as stealing to obtain drugs

Employment or school       

Continuing to use drugs even though you realize your job or education is in jeopardy

Missing work or school, or going in late due to drug use

Family and friends  

Feeling annoyed when other people comment on, or criticize your use of drugs

Feeling remorse or guilt after using drugs

Associating with questionable acquaintances or frequenting out of the ordinary locations to purchase or use drugs

Social life      

Scheduling your day around using drugs

Focusing recreational activities around obtaining drugs, using drugs, or recovering from drug use  

Using drugs when alone

What Is Bipolar Disorder?

Bipolar disorder, formerly called manic-depressive illness, is a condition that affects more than two million Americans. People who have this illness tend to experience extreme mood swings, along with other specific symptoms and behaviors. These mood swings or “episodes” can take three forms: manic episodes, depressive episodes, or “mixed” episodes.

The symptoms of a manic episode often include elevated mood (feeling extremely happy), being extremely irritable and anxious, talking too fast and too much, and having an unusual increase in energy and a reduced need for sleep. It’s also very common for someone to act impulsively during a manic episode, and engage in behaviors that are risky or that they later regret, like spending sprees. And in over half of all manic episodes, people are troubled by delusions or hallucinations. For example, they may think they have a relationship with someone famous, claim to be an expert in an area they really know nothing about, feel paranoid (unusually fearful), or hear voices that are not there.

The symptoms of a depressive episode often include an overwhelming feeling of emptiness or sadness, a lack of energy, a loss of interest in things, trouble concentrating, changes in normal sleep or appetite, and/or thoughts of dying or suicide.

A mixed episode includes symptoms that are both manic and depressive.

What Causes it?

The symptoms of bipolar disorder are thought to be caused by an imbalance of key chemicals in the brain. The brain is made up of billions of nerve cells that move a constant stream of information from one to the other. To keep the information flowing, the cells release chemicals known as “neurotransmitters.” Two key neurotransmitters that are needed for brain function are dopamine and serotonin, which play a crucial role in emotional health.

Many scientists believe that when the levels of these neurotransmitters aren’t quite right, it may result in bipolar disorder. For instance, too much dopamine in certain parts of the brain can cause symptoms such as delusions, while too little dopamine in other parts of the brain can cause symptoms such as a lack of emotion and energy.

How Can Medicine Help Me?

The exact way medicine for Bipolar I Disorder works is unknown. However, experts believe that medicine works by adjusting dopamine, instead of completely blocking it, as well as affecting serotonin.

Although there is no cure for bipolar disorder, medicine can play a key role in helping you manage your symptoms and extreme mood swings. It can help make your behavior more even and predictable.

Many people act very agitated, uncooperative, and aggressive during acute manic episodes, which can be frightening. Medicine can help get these behaviors back under control. Once that’s achieved, your healthcare provider may recommend continuing medicine (along with psychotherapy and support from your family and friends) to help you stay stable.

But taking medicine as prescribed and staying on it can be hard. You may feel like you don’t need medicine when your symptoms improve. And because the side effects can be bothersome, you may want to stop taking medicine altogether. It’s important to continue taking your medicine until you talk with your healthcare provider.

If you have questions about how your medicine is working, you should talk to a psychiatrist.

Counseling, training, and support:

With counseling, including psychotherapy, training, and support from family and friends, you may find it easier to deal with the emotions and stresses of bipolar disorder.

What Is Anxiety?

Generalized anxiety disorder or GAD is characterized by excessive, exaggerated anxiety and worry about everyday life events. People with symptoms of generalized anxiety disorder tend to always expect disaster and can’t stop worrying about health, money, family, work or school.

In people with GAD, the worry often is unrealistic or out of proportion for the situation. Daily life becomes a constant state of worry, fear and dread. Eventually, the anxiety so dominates the person’s thinking that it interferes with daily functioning, including work, school, social activities and relationships.

What Are the Symptoms of GAD?

GAD affects the way a person thinks, but the anxiety can lead to physical symptoms, as well. Symptoms of GAD include:

Excessive, ongoing worry and tension

An unrealistic view of problems

Restlessness or a feeling of being “edgy”


Muscle tension



Difficulty concentrating


The need to go to the bathroom frequently


Trouble falling or staying asleep


Being easily startled

In addition, people with GAD often have other anxiety disorders (such as panic disorder, obsessive-compulsive disorder and phobias), suffer from depression, and/or abuse drugs or alcohol.

What Causes Generalized Anxiety Disorder?

The exact cause of GAD is not fully known, but a number of factors — including genetics, brain chemistry and environmental stresses — appear to contribute to its development.

Genetics: Some research suggests that family history plays a part in increasing the likelihood that a person will develop GAD. This means that the tendency to develop GAD may be passed on in families.

Brain chemistry: GAD has been associated with abnormal levels of certain neurotransmitters in the brain. Neurotransmitters are special chemical messengers that help move information from nerve cell to nerve cell. If the neurotransmitters are out of balance, messages cannot get through the brain properly. This can alter the way the brain reacts in certain situations, leading to anxiety.

Environmental factors: Trauma and stressful events, such as abuse, the death of a loved one, divorce, changing jobs or schools, may lead to GAD. GAD also may become worse during periods of stress. The use of and withdrawal from addictive substances, including alcohol, caffeine and nicotine, can also worsen anxiety.

How Common Is Generalized Anxiety Disorder?

About 4 million adult Americans suffer from GAD during the course of a year. It most often begins in childhood or adolescence, but can begin in adulthood. It is more common in women than in men.

What is Depression?

Depression is a mental health disorder that can affect the way you eat and sleep, the way you feel about yourself, and the way you think about things. A depressive disorder is more than a passing mood. It is not a sign of personal weakness, and it cannot be willed or wished away.

A depressive disorder involves the body, mood, and thoughts. People who are depressed cannot “snap out of it” and get better. Without treatment, symptoms can last for months or years. Treatments such as antidepressant medications and psychotherapy can reduce and sometimes eliminate the symptoms of depression.

Types of Depression

Depressive disorders come in different forms. Three of the most common are Major Depression, Dysthymia, and Bipolar Disorder. Even within these types of depression there are variations in the number of symptoms, their severity, and persistence.

Major depression is manifested by a combination of symptoms (see symptom list below) that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Some people have a single episode of depression, but many have episodes that recur.

Dysthymia is a less severe type of depression that lasts a long time but involves less severe symptoms. If you suffer from dysthymia you probalby lead a normal life, but you may not be functioning well or feeling good. People with dysthymia may also experience major depressive episodes at some time in their lives.

Bipolar Disorder (also called manic-depression) is another type of depressive disorder. Bipolar disorder is thought to be less common than other depressive disorders. If you have bipolar disorder you are troubled by cycling mood swings – usually severe highs (mania) and lows (depression). The mood swings are sometimes dramatic and rapid, but usually are more gradual. When in the depressed stage, a person can have any or all of the symptoms of a depressive disorder. When in the manic stage, the individual may be overactive, overtalkative, and have a great deal of energy. Mania affects thinking, judgment, and social behavior, sometimes in ways that cause serious problems and embarrassment. A person in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state, where the person is out of touch with reality.


Persistent sad, anxious, or “empty” mood

Feelings of hopelessness, pessimism

Feelings of guilt, worthlessness, helplessness

Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex

Decreased energy, fatigue, being “slowed down”

Difficulty concentrating, remembering, making decisions

Insomnia, early-morning awakening, or oversleeping

Appetite and/or weight loss or overeating and weight gain

Thoughts of death or suicide; suicide attempts

Restlessness, irritability

Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain


Abnormal or excessive elation

Unusual irritability

Decreased need for sleep

Grandiose notions

Increased talking

Racing thoughts

Increased sexual desire

Markedly increased energy

Poor judgment

Inappropriate social behavior

Some depression runs in families. Researchers believe that it is possible to inherit a tendency to get depression. This seems to be especially true for bipolar disorder (manic depression). Studies of families with several generations of bipolar disorder (BPD) found that those who develop the disorder have differences in their genes from most who don’t develop BPD. Some people with the genes for BPD don’t actually develop the disorder, however. Other factors, such as stresses at home, work, or school, are also important.

Major depression also seems to run in families, but it can also develop in people who have no family history of depression. Either way major depressive disorder is often associated with changes in brain structures or brain function.

People who have low self-esteem, who are consistently pessimistic, or who are readily overwhelmed by stress, are also prone to depression. Physical changes in the body can also trigger mental health problems such as depression. Research demonstrates that stroke, heart attack, cancer, Parkinson’s disease, and hormonal disorders can cause depression. The depression can contribute to the person’s medical problem, as then can become apathetic and unwilling to care for their physical needs. A severe stressor such as a serious loss, difficult relationship, financial problem can also trigger a depressive episode. A combination of genetic, psychological, and environmental factors is often involved in the onset of depression.

Depression in Women

Studies suggest that women experience depression up to twice as often as men. Hormonal factors may contribute to the increased rate of depression in women; such as menstrual cycle changes, pregnancy, miscarriage, postpartum period, pre-menopause, and menopause. Women may also face unique stressors such as responsibilities both at work and home, single parenthood, and caring for children and for aging parents.

Many women are particularly vulnerable to depression after the birth of a baby. The hormonal and physical changes, as well as the added responsibility of a new life, can be factors that lead to postpartum depression in some women. Some periods of sadness are common in new mothers; but a full depressive episode is not normal and requires intervention. Treatment by a sympathetic health care provider and emotional support from friends and family are important in helping her to recover her physical and mental well-being and her ability to care for and enjoy her baby.

Depression in Men

Men are less likely to suffer from depression than women, but three to four million men in the United States are affected by the depression. Men are less likely to admit to depression, and doctors are less likely to suspect it. More women attempt suicide, but more men actually commit suicide. After age 70, the rate of men’s suicide rises, peaking after age 85.

Depression can also affect the physical health in men differently from women. One study showed that men suffer a high death rate from coronary heart disease following depression. Men’s depression may be masked by alcohol or drugs, or by working excessively long hours. Rather than feeling hopeless and helpless, men may feel irritable, angry, and discouraged.

Even if a man realizes that he is depressed, he may be less willing than a woman to seek help. In the workplace, employee assistance professionals or worksite mental health programs can help men understand and accept depression as a mental health disorder that needs treatment.

Depression in the Elderly

It’s not normal for elderly people to feel depressed. Most older people feel satisfied with their lives. Depression in the elderly is sometimes dismissed as a normal part of aging; causing needless suffering for the family and for the individual. Depressed elderly persons usually tell their doctor about their physical symptoms; and may be hesitant to bring up their emotions.

Some symptoms of depression in the elderly may be side effects of medication the person is taking for a physical problem, or they may be caused by a co-occurring illness. If a diagnosis of depression is made, treatment with medication and/or psychotherapy will help the depressed person return to a happier, more fulfilling life. Recent research suggests that brief psychotherapy is effective in reducing symptoms in short-term depression in older persons who are medically ill. Psychotherapy is also useful in older patients who cannot or will not take medication.