According to Medilexicon's medical dictionary, psychotherapy is "Treatment of emotional, behavioral, personality, and psychiatric disorders based primarily on verbal or nonverbal communication and interventions with the patient, in contrast to treatments using chemical and physical measures." Simply put, psychotherapy aims to alleviate psychological distress through talking, rather than drugs.
Psychotherapy is commonly used for psychological problems that have had a number of years to accumulate. It only works if a trusting relationship can be built up between the client and the psychotherapist (in psychology "client" can mean "patient"). Treatment can continue for several months, and even years. Psychotherapy may be practiced on a one-to-one basis, or in pairs, and even in groups. Generally, sessions occur about once a week and last one hour.
Some people refer to psychotherapy as "talking treatment" because it is generally based on talking to the therapist or group of people with similar problems. Some forms of psychotherapy also used other forms of communication, including writing, artwork, drama, narrative story or music. Sessions take place within a structured encounter between a qualified therapist and a client or clients. Purposeful, theoretically based psychotherapy started in the 19th century with psychoanalysis; it has developed significantly since then.
A psychotherapist may be a psychologist, marriage and family therapist, occupational therapist, licensed clinical social worker, counselor, psychiatric nurse, psychoanalyst, or psychiatrist. In the UK psychotherapy will be free if the patient is referred by a GP (general practitioner, primary care physician).
One of the main problems with psychotherapy, according to experts, is that the client stops coming to sessions. A study carried out by researchers from Northwestern University's Feinberg School of Medicine found that when patients receive psychotherapy for depression over the phone, most of them continue with the therapy.
Talking versus drugsPsychologists generally view individual distress as the result of human relationship problems, rather than as the result of a personal disorder. A psychologist who specializes in psychotherapy will generally consider the wider context of relations within a family or at work. Psychiatrists and medical doctors tend to take a more medical approach to mental health and are more inclined to prescribe drugs to alleviate stress. This is a general difference between a psychologist's approach and a psychiatrist's - however, there are many psychiatrists who also use psychotherapy.
Many studies have demonstrated that the most effective treatments for mental illnesses and problems, especially depression, involve a combination of both medication and psychotherapy - this study found that a combination of psychotherapy and antidepressant medication appears to be the most effective treatment for adolescents with major depressive disorder.
The majority of psychiatrists, however, do say that psychotherapy is a crucial part of mental health treatment, and is often the only necessary effective treatment in many cases. The American Psychiatric Association stated "Many mental health problems can be resolved with psychotherapy alone, and psychotherapy is often a crucial component in the success of treatment with medication". However, what people say and what they actually do not always match - this study found that a declining number of office-based psychiatrists appear to be providing psychotherapy to their patients.
In a study, German scientists demonstrated that cellular biological markers could be associated with response to psychotherapy.
Some types of psychotherapies
- Behavior therapy
This type of therapy focuses on helping the client understand how changing his/her behavior can eventually lead to changes in how they are feeling. Emphasis is made on focusing on increasing the person's engagement in positive or socially reinforcing activities. This approach carefully measures what the client is doing and then tries to increase the probability that he/she has positive experiences.
Put simply, behavior therapy aims to substitute undesirable behavior responses with desirable ones.
- Cognitive therapy
How we feel is determined by what we think - this is the theory behind cognitive therapy. For example, if a person has depression it may be the result of having the wrong thoughts and/or beliefs. If these faulty beliefs are corrected then the client's view of events and his/her emotional state may change for the better. According to several studies, people with depression often have erroneous beliefs about themselves - they may relate negative events to themselves without any evidence, they may see life situations in absolute terms (black and white), and they may see only the negative aspects of things and commonly distort the importance of particular events.
Put simply, the way we think about things affects how we feel emotionally. Cognitive therapy's thrust is on our current thinking, behavior and communication, rather than looking into the past.
The cognitive therapist works with the client to confront, or challenge the erroneous thoughts by pointing out other ways of viewing situations. By doing this it is hoped that the client's mood improves. Cognitive therapy has been found to be especially effective in treating post-traumatic stress disorder (PTSD), as this article explains.
There are doubts about the effectiveness of cognitive therapy for elderly people with depression. This study, which explains that further studies are required, found that there was not enough compelling evidence showing the effectiveness of cognitive therapy for elderly patients with depression.
Cognitive behavioral therapy can improve quality of life, a study on tinnitus patients revealed, even when the volume of the noise remains the same.
- Family therapy
A family therapist sees the client's symptoms in the context of the family. For example, if a client has depression, this could be because of an issue within the family, such as may be the case with a teenager whose parents are having marital problems. Cognitive therapy, behavior therapy, and especially interpersonal therapy may be employed in family therapy.
Put simply, family therapy identifies family patterns that contribute to behavior disorder or mental illness - it helps family members break those habits/patterns.
Family therapy generally involves discussion and problem-solving sessions with the client and his/her family - session may be in a group, in couples, or one-to-one.
A family therapist may use a genorgam - this is a family tree constructed by the therapist. It looks at past relationships and events and what impact these may have had on the client's emotional state. Often, family therapy focuses on improving communication within the family - clients are taught to listen, ask questions and respond openly rather than defensively.
Researchers into post-partum depression at Boston University School of Social Work found that, unlike other psychotherapies, the presence and contribution of the infant are unique to mother-infant treatment and act to catalyze change throughout the therapeutic process.
Patients suffering from bulimia, aged 12-19, respond better to family-based treatments than supportive psychotherapy, according to researchers from the University of Chicago.
- Interpersonal therapy
Here the client's interpersonal relationships are the focus. For example, a depressed client's problem may be treated by improving his/her communication patterns - how he/she relates to others may be having an impact on his/her depression. The therapist may start by helping the client identify what his emotion is and where it is coming from. The client will also be helped in learning how to express emotions in a healthy way. For example, if a client usually responds to a feeling of being neglected by his spouse with anger and sarcasm - this results in the spouse reacting negatively. The client will learn to express his hurt and anxiety calmly, increasing the chances that the spouse will react in a more positive way.
Put more simply, interpersonal psychotherapy focuses on the client's relationship with family members and peers and the way the client sees himself/herself. It explores issues in relationships with other people. The aim is to help the client identify and modify interpersonal problems, understand them, and to manage relationship problems.
The majority of women with recurrent depression may be able to prevent subsequent depressive episodes with monthly maintenance interpersonal psychotherapy, say researchers from the University of Pittsburgh School of Medicine.
- Group therapy
In group therapy there are usually between 6 to 12 clients and one therapist in a session. All the clients have related problems. The clients benefit from the therapist, and also by observing how other clients suffer and respond to feedback. Getting feedback from other people with related problems gives the clients a different perspective and is frequently helpful in triggering improvement and change.
Taking part in group psychotherapy can help men who have erectile dysfunction to overcome their problem, and adding sildenafil (Viagra) to group therapy was found to be more effective than sildenafil alone, according to a team of Cochrane researchers.
- Psychodynamic therapy
This is also called insight-oriented therapy. It focuses on the automatic processes as they are exhibited in a person's current behavior. This type of therapy aims to increase the client's self-awareness and understanding of the impact of the past on present behavior. It enables the client to take a good look at unresolved issues and symptoms that arise from past dysfunctional relationships and exhibit themselves in the need and desire to abuse substances.
Put simply, psychodynamic therapy helps people understand the roots of emotional distress, usually by exploring unconscious motives, needs and defenses.
Psychodynamic therapy is especially effective for people with complex mental disorders, personality and chronic mental disorders, as this meta-analysis revealed. Another study carried out by researchers at the NewYork-Presbyterian Hospital/Weill Cornell Medical Center found that psychodynamic therapy is efficacious in treating panic disorder.
What does psychotherapy treat?Psychotherapy is used for treating many different problems. Some alone, and some in combination with drugs. The most commons ones are listed below:
- Post-traumatic stress disorder
- Low self-esteem
- Anxiety disorder, including phobias
- Emotional crises
- Marital problems
- Family disputes
- Obsessive-compulsive disorder
- Personality disorders
- Problems stemming from child abuse
- Behavioral problems
- Bipolar disorder (in combination with drugs)
- Schizophrenia (in combination with drugs).
What are the benefits of psychotherapy?Professor Mick Cooper, of the University of Strathclyde, England, writes that the most important factor in successful therapy is the client, not the therapist.
Participating in psychotherapy offers a number of benefits for the client. It is usually helpful to have somebody who really does understand you. Therapy may give the client a fresh perspective on a difficult problem and direct the client towards a solution. Most patients will say that the benefits of psychotherapy include:
- Being able to understand yourself and your personal goals and values better.
- Developing skills for improving relationships.
- It helps the client overcome certain problems, such as an eating disorder, depression, or anxiety.
- Obtaining a solution to the problems or concerns that made the client seek therapy.
What are the disadvantages of psychotherapy
- Some clients may find that the treatment results in changes they had not expected, or did not want.
- Some people do not like to have to relive unpleasant events (not all psychotherapy techniques make the client do this).