Maelstrum: What is the most popular form of therapy in the US? How long should I wait before deciding a particular psychiatrist is right for me? And when do I know that I am ready to end therapy?

Therapy is a very broad and general term covering a wide spectrum of talk therapies as well as so-called physical therapies that range from particular types of massage to prescribing medication and even, rarely, to electroconvulsive shock treatment for severely depressed people who do not respond to other treatment. But for the sake of simplicity, I shall assume that you are asking about psychotherapy. The "talking cures," or psychotherapies, range from very brief interventions of a few sessions to intensive exploratory investigation of the factors influencing your behavior that lie outside of your conscious awareness. Sigmund Freud was the first modern physician to systematically use talking cures. The discipline that he developed, psychoanalysis, is the best known and most extensively studied of these long-term psychotherapies and may last from three to five years, if not longer. Psychoanalysis is also the model behind many less intense (i.e., fewer sessions per week or month) psychotherapies. These are all called dynamic psychotherapies because they attempt to increase a person's understanding and awareness of the factors outside of consciousness that influence our mood and behavior. Free association (or saying to the doctor whatever comes to mind), multiple sessions each week and lying on the couch are some of the formal cornerstones of this kind of therapy. The analyst-therapist tends to be less talkative and interactive than in other forms of psychotherapy. Often the source of the unconscious factors that influence feelings and behavior is buried in one's past. For example, a child who loses a parent suddenly at an early age may grow into an adult who is unable to make satisfying intimate relationships. She may unconsciously be so fearful of repeating that pain felt when the mother was lost that she avoids or unwittingly sabotages relationships that have the potential to become loving or expose vulnerability.

Dynamic psychotherapies are still probably the most popular and common form practiced in the United States. But so called behavioral psychotherapies are also gaining popularity. These attempt to teach new behavior patterns without exploring the historical roots of a person's self-defeating behavior and without developing insight. Examples include smoking or drinking cessation programs such as the well known 12-step programs and "fear of flying" or other phobia treatment clinics. Cognitive therapy, (discussed in question four) is a brief therapy that is a hybrid between the dynamic and the behavioral types.

How to tell whether a particular psychiatrist is right for you?

First, when selecting a therapist, develop a short list of individuals with the most extensive training and credentials available. If you have access to a friend in the field whose judgement you respect, ask her for assistance in developing your short list. Then, interview the top two or three therapists on your list. This is a kind of road test that will enable to you to better determine how you feel about the therapist's personality and style of working with patient. Trust your instincts! If you immediately feel uncomfortable with an individual, don't chose them. It may only get worse with time. Unfortunately, since therapists make their living by selling their time, most psychotherapists will expect to be paid for these evaluation sessions. But that cost should be viewed in the context of how much will be spent seeing a therapist one or more times a week, for several years' time. If it influences the ultimate success of treatment, it is money well spent.

If your problems are depression, extreme mood swings, or more severe mental symptoms such as hallucinations, or if your emotional problems are related to a known physical condition such as menopause or a chronic illness, be sure to select a psychiatrist rather than a non-medical therapist (Ph.D., M.S.W. or M.F.C.C.). All of these disciplines can provide psychotherapy, but only an M.D. can prescribe the medication you may require to feel better.

When will you know to end therapy?

Ending treatment is rarely a clear cut decision. Unlike with the stock market, there's no bell when the treatment is over. But a critical question to ask throughout a course of psychotherapy is, "Am I getting what I came for (or what I changed my goal to) or am I wasting my precious time and money?" The best therapists are able to acknowledge when treatment is not working and will stop, recommend getting a second opinion, or refer their patient to another therapist — perhaps for a different kind of therapy. One size does not fit all. However, it may be time to stop if treatment has proceeded constructively and important changes have occurred in how you feel about yourself and how you behave with others, or if your life is generally better and feels much more under your own control. Usually, this is a joint decision made by a patient in partnership with her therapist. Not infrequently, though, it is made unilaterally by the patient without sufficient discussion or examination of what has been accomplished and what has not. This kind of unilaterally and often abrupt termination occurs most often when the treatment has been foundering.