Therapy is sometimes called the “talking cure”. Somehow a norm has been established that therapy consists primarily of talking about your problems. The therapist may listen, ask questions, or say “Ummhh”. They may make an interpretation, or offer a suggestion. Through this process, one feels better, and life is improved, right? Hang on a minute!

Unfortunately, one can spend a lot of time, energy and resources in therapy without much result. Or worse: All the talk about your difficulties may reinforce them. When not much changes after dutifully “doing therapy”, this can lead one to conclude that they are defective, or beyond help.

With some forms of therapy, I sometimes wonder if one could be better served visiting a pet store and playing with the puppies and kittens, or maybe cleaning one’s bathroom. The animals are almost sure to restore one’s faith in the essential goodness of life. The cleaning may bring the satisfaction of seeing that one’s work produces results, and at very least the bathroom will be cleaner. If one is averse to work, one might get more relief from suffering just listening to Car Talk.

I’m being a little snarky. But my concern is about people’s time and resources being wasted. Many people report to me that they have done multiple years of therapy with little result. Perhaps I’m not hearing from all the people who’ve been successfully helped, and consequently are no longer seeking therapy.

But the reports I repeatedly hear from clients are that their previous therapy mostly involved talking, followed by talking. And thus they are left to wonder: Isn’t there another way, something I can actually do?

Of course there is value in some talk. The therapist and client must communicate about the action that will be taken. For sure, an opportunity to be heard, to speak the truth, to hear oneself say out loud something previously unspoken, can be profound. Practicing saying no, or yes, can be a powerful step toward new patterns. Many of us have found that understanding the history of a behavior or feeling or belief helps us to see it for what it is- a relic of the past which no longer serves.

But at the same time I see that sometimes what passes for therapy is simply talking about problems. I’m aware that with many clients, I could have a grand old time simply talking with them, exchanging opinions, and proposing theories. But I feel an ethical responsibility to resist that temptation.

There is virtually no convincing research indicating that talk-focused therapy, or what is often called insight therapy, creates lasting improvement in people’s lives. The underlying assumption of much therapy is that if you understand your problems, and how they formed, this will alleviate them. I believe this underlying assumption must be questioned if one is to get results from therapy.

If not simply talking, what does therapy look like? Let’s look briefly at a few options.

Skills-based work approaches therapy differently: The therapist teaches the clients skills regarding the targeted life problem. This consists primarily of teaching, practicing and then collecting data to see if progress is being made. For example: A person suffering from anxiety learns specific skills to better tolerate the feelings. They also develop skills to interrupt the cycling of the thought-feeling interaction that cranks the anxiety toward panic. The client practices these skills, and reports back about where they got traction. Thus, skills may take different forms: more adaptive concepts to apply in thinking about the anxious feeling; methods to apply the concepts; interventions to redirect the thought-feeling mix that fuels the unpleasant experience; new beliefs about the nature of feelings, like what they can and cannot do (they cannot harm us, for example). These skills may be drawn from approaches such as CBT, DBT, mindfulness, and others.

Present-focused work leaves aside the need to understand how the problem was created, it’s history, and perhaps even what “meaning” it may hold. It works with the issue as a phenomenon, a problem- like a leaky roof. Physical symptoms such as headache are often approached this way. We may not spend a lot of time wondering about and discussing what caused the pain. We quickly assess our options for working with it as soon as possible. In present-focused therapy, someone afflicted with negative self-esteem, for example, learns to interrupt the negative thoughts and replace them with positive ones. They learn to direct their mental activity to what is likable about them. They set up a contract to do things they believe will help them feel better, and get support to do them, even when they don’t feel like it. These skills draw on mindfulness, DBT, behavioral psychology, and other sources.

Body-based work may include practices the client learns to do involving the physical body to reduce or clear the problem. For instance, with depressed mood and poor energy, many clients benefit from learning practices that effect the body’s energy. Yoga teaches that energy is greatly effected by the breath. I often teach clients to use yoga-based breath practices to stoke energy. They may also learn, practice and collect data on actions that help boost mood, from daily walking to UV light to removing negative thoughts and replacing them with energizing and uplifting ones. Another body-based tool is focusing the attention on a target, such as the breath. Robust research findings have shown this to reduce stress hormones in the blood, and activate the prefrontal cortex of the brain, the most “skillful” part of the brain. These sources include yoga, mindfulness, focusing, somatic experiencing, lifestyle change, and others.

Positive psychology works to grow the qualities, experiences or beliefs the client wishes to have more of, rather than focusing on the problem. The more time one spends thinking about, talking about, and nurturing the positive stuff, the more life becomes positive. Funny how that works. Alcoholics Anonymous, arguably the best cognitive-behavioral training program ever developed, employs this by emphasizing that people must interrupt “stinkin’ thinkin’ “ (negative beliefs) with gratitude-based thinking. The more one thinks about gratitude, the more grateful one becomes. Neuroscience research is now presenting a steady stream of findings indicating that how we use the brain, and our thoughts, can retrain it, heal it, and physically transform it.People in AA and others undeniably report this over and over again. The skills of positive psychology may include mantra, affirmation, list-making, planned activities, visualization, behavior contracts, and training the mind.

It’s a tremendously exciting time in the mental health field. Many new ways of working are being developed through research, and rediscovered from old traditions and common sense. The good news is there are many concrete, applicable and practical things one can learn to effect any life problem, trauma symptom, mood problem or negative belief.

Starting work with a new therapist should include specific questions about their approach, and specifics about what skills they can teach. Asking such questions in an ongoing treatment relationship is appropriate too. Like Click and Clack, the client needs to keep their eye on how the rubber meets the road. Otherwise, it’s just a lot of talk, and a perfectly good hour may be wasted.