In the late 1700s Franz Joseph Gall put forth the idea that the growth of a human brain caused subtle protuberances—you know, bumps?—on the outside of a person’s skull. And Gall insisted he could assess a patient’s character and mental capacity by examining each person’s bumps.

He was wrong, you know.

The therapy biz as we know it has been around a little more than 100 years. In the late 1800s some remarkable progress was made in the medical world with the detection of microorganisms and the beginning of modern surgery. About then some compassionate doctors turned to trying to alleviate the suffering of those with painful mental and emotional conditions.

Some of their first efforts left a lot to be desired. Even down till the 1950s there were treatments such as lobotomies and shock therapy that give us the creeps. (Incidentally, shock therapy—electroconvulsive therapy, ECT—is still prescribed and has been found effective in treating the worst depressions. The dosage given now is much lower and the results are more uniformly positive.)

By the year 2005 psychotherapy has grown up a lot. It is often healthy and helpful. Not everybody needs it but there is no reason to feel ashamed of entering into therapy either. I respect the persons who come to me for help. I think it takes humility and guts to inquire after our pain, our weaknesses and our blind spots. And I admire a person who wants to take responsibility for her life and grow in wisdom. What’s not to like about that?

There isn’t just one way to look at psychotherapy. There are so many therapies, in the hands of so many therapists, treating so many patients with so many problems that we cannot say it is all one way. But here are a few general observations.

A therapy appointment is different from sitting down and talking to a friend in this major way: you get to pick the subject, and it is your turn to talk only. You are paying the person to listen to you and bring their education and expertise to bear so that you can get a wide-angle view of who you are and what some of your motivations might be.

Some therapists are quiet, saying very little. Some ask questions, direct the conversation and show more of who they are. Some will focus on your language, patterns of thinking and expression, and try to help you move into more productive ways of thinking. This is the gist of cognitive or behavioral therapy, and it is the most common approach today. It gets people noticing some of their automatic thoughts, challenging them and moving out the door quickly.

Some therapists incline towards a deeper work. They wait and listen and encourage a relationship with you, their client. They are convinced that over time you will bring your same traits into your relationship with the therapist that you had with your early caretakers, and that you try to use in all your other relationships. He depends on your transference, which he then tells you about. When you discover such unconscious habits of yours, you may decide to alter them for a more fulfilling life.

I like to work this way with people. It takes us to deep places and deep moments of healing. But it isn’t the only way, and it may not be what you prefer. A large benefit from this approach happens when a person reveals who he is, including some of his weaknesses, and he finds himself still accepted and valued by the therapist. Over time the client comes to accept himself, feels great relief from former feelings of self-rejection and shame. This approach underlies what I write in chapter 1 of the 10 by 10 workbook.

When you start to talk about your problems you may feel tremendous relief. Let’s hope. But as you relax your defenses and face what you have been avoiding you may also start to feel worse—even a lot worse, at least for a while. Just like when you cleanse a wound. It is healthier to face your pain, but it is harder, too. That may be why you waited till you did. Many other folks do the same thing.

But you don’t stay in the pain. Assuming your therapist is caring and competent, you make your way through the pain to a place of healing. It may take a while—that will correspond with how injured you are and how much support you have in your world. But you will get better. The hurting does end. And that is your reward for all your courage and suffering and hard work.

I’d say that depends on how you FUNCTION. If you are able to get up in the morning, care for yourself, care for your responsibilities and do the things that are meaningful for you, then therapy may or may not be that helpful to you. If you are very depressed, or if you cannot control your temper, then I urge you to give therapy a try. If you are relying on a compulsion (an eating disorder, alcohol abuse, self-harm) to get through your days, I urge you even more to try some form of therapy. If you have children and you are neglecting or abusing them GO TO THERAPY. Right away. Try at least 3 or 4 appointments at weekly intervals. You may not know what to think after one appointment, but after a small number you will either have a sense of “Yeah, this is helping me…” or not. If you are confused or have questions or are not happy with how things are going, speak up to the professional you see. (Also notice if you might be picking at flaws in the therapist as a way of getting out of going. You wouldn’t be the first.)

There is a well-defined hierarchy in the mental health field—and don’t dare forget it. A PSYCHIATRIST is at the top. He is a physician who would ideally be in position to offer expert psychotherapy to complement his medical knowledge. He would be able to see how your somatic illnesses and your mental/emotional distress interrelate.

In my experience most of these guys don’t offer in-the–trenches counseling because they charge so much for appointments. They basically prescribe meds, often in appointments only 15 minutes long, spaced 3 months apart. You may wait 6 weeks or more for an appointment, and pay up to $150 an hour for it—though they are typically insurance reimbursable.

PSYCHOLOGISTS have the letters Ph.D. or Psy. D. after their name. They are called “doctor” but are not medical doctors. (Confusing, right?) In most states these cannot prescribe medications. They have a lot of extra college training and thus their charge is usually higher—perhaps $100 to $125 an hour, or more. It seems to me that this higher tier of practitioners establish their fee by building down from what a psychiatrist charges, as I suppose athletes do: “If HE is getting $8 million a year to play, then I should at least be getting $5 million.”

SOCIAL WORKERS, COUNSELORS, and PSYCHIATRIC NURSES hold a Master’s Degree in some area of counseling, which works out to about 4 years less training than a Ph. D. gets. As a rule a master’s-level professional has a total of about three years of schooling and a supervised internship. It isn’t very much training, and it doesn’t make a college graduate an expert. He or she would need much more experience and training to actually be a skilled mental health practitioner.

And there are those who hang out a shingle to practice some form of therapy with NO CREDENTIALS AT ALL. In some states there is such a mishmash of regulation and no-regulation (New York would be one such state) that a person can advertise as a practitioner of some form of therapy without any training at all, without any professional credentials. Yes, something like a palm reader.

I advise you not to seek the services of such a person. I think that even those with the minimum credentials don’t have enough. So I suggest that you be cautious about trusting your care to someone who wants to sidestep membership in a respected credentialing body. Credentialing bodies such as the American Psychological Association or the National Board for Certified Counselors are voluntary organizations. Practitioners join and agree to uphold ethical standards of practice as a way of demonstrating their professional integrity. That doesn’t prove that the therapist is highly skilled, but it tells you that he is adhering to an established professional code of conduct. He isn’t hiding who he is.

I don’t think it serves you well to go through life suspicious, but DO listen to your own ears and eyes. If you are not comfortable with someone, move on. If they don’t seem to be paying attention, move on. If they seem creepy move on. If they use double entendres or seem to be seductive MOVE ON NOW! It is the full responsibility of the therapist—in any of the above disciplines—to act in a way that is unambiguous, professional, safe and respectful.

Some people find that taking psychotropic meds like an antidepressant or an anti-anxiety agent gives them enough of a lift that they are otherwise able to go about their lives in a productive way. Some find that if they have a good therapy relationship to rely on that they do not feel so much anxiety and no longer use the meds, or not as much.

Folks who are very impaired often use both. I have worked with very depressed people who even with antidepressants and regular therapy found it difficult to get through their lives. In my mind, use what you need; use what allows you to get out the door and participate in the activities that are important to you.

Some of us just have an itch to know ourselves more deeply, and to understand what makes us tick. We are also endlessly fascinated about human interactions. So we go into the book store and find our feet keep moving us to the section about self help and relationships and all that. Therapy can be useful in that way, too. It is a chance for us to learn more about the influences we grew up with, and what drives are inside us. We can learn how to communicate more skillfully, and ask for what we want. We may also be grateful to get to know any ways that we may tend to be overbearing or intimidating to those in our world.

You may also tap some dormant passions and talents in yourself, and find yourself enlarging as a person. Therapy may help you find the confidence to take a bold step or two for yourself. You may not need to know these things to function in your world, but you might find you like yourself better and others like you better, too, as a result. And your new learning may open up deeper ways for you to show love, gratitude and humility in your world. That wouldn’t be bad at all, would it?