Psychotherapy refers to a range of treatments that can help with mental health problems, emotional challenges, and some psychiatric disorders.
It aims to enable patients, or clients, to understand their feelings, and what makes them feel positive, anxious, or depressed. This can equip them to cope with difficult situations in a more adaptive way.
Psychotherapy can provide help with a range of problems, from depression and low self-esteem to addiction and family disputes. Combined with medication, it can play a role in treating bipolar disorder and schizophrenia.
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What does therapy look like?
Some forms of psychotherapy last only a few sessions, while others are long-term, lasting for months or years. Sessions are usually for one hour, once a week, and they follow a carefully structured process.
Psychotherapy is sometimes called "the talking cure."
Sessions may be one-to-one, in pairs, or in groups. Techniques can include other forms of communication, such as drama, narrative story, or music.
A psychotherapist may be a psychologist, a marriage and family therapist, a licensed clinical social worker or mental health counselor, a psychiatric nurse, psychoanalyst, or psychiatrist.
Talking cure or medication?
Psychotherapy is sometimes called the "talking treatment" because it uses talking, rather than medication.
Psychologists and psychotherapists are different from psychiatrists and psychiatric nurse practitioners.
A psychologist or psychotherapist tends to view individual distress as the result of human relationship problems, rather than a personal disorder. Psychotherapy focuses on the wider context of relations within a family or at work.
A psychiatrist is a medical doctor, and is more likely to prescribe drugs to relieve symptoms, but many psychiatrists also use psychotherapy techniques. Similarly, psychiatric nurse practitioners also prescribe medications to relieve symptoms, but also use psychotherapy techniques in combination with medication.
Combining psychotherapy with medication, such as antidepressants, can help in a range of mental health, behavioral, and emotional issues.
As scientists learn more about biological markers for conditions such as depression, opening the way for new drugs, treatment of psychological conditions could change in the future.
What types of psychotherapy are there?
There are a number of styles and approaches in psychotherapy.
Behavioral therapy can help clients to understand how changes in behavior can lead to changes in how they feel. It focuses on increasing the person's engagement in positive or socially reinforcing activities.
The approach assesses what the client is doing, and then tries to increase the chance of having positive experiences.
The goal is for desirable behavior responses to replace undesirable ones.
Behavioral therapy can help people whose emotional distress stems from behaviors that they engage in.
Cognitive therapy starts with the idea that what we think shapes how we feel.
Depression, for example, may stem from having thoughts or beliefs that are not based on evidence, such as "I am useless," or "Everything goes wrong because of me."
Changing these beliefs can change a person's view of events, and their emotional state.
Cognitive therapy looks at current thinking and communication patterns, rather than the past.
The therapist works with the client to confront and challenge inappropriate thoughts by encouraging different ways of viewing a situation.
Cognitive therapy can help in treating post-traumatic stress disorder (PTSD).
Cognitive behavioral therapy (CBT) pairs cognitive with behavioral therapy, to address both thoughts and behaviors.
This approach focuses on interpersonal relationships.
Psychotherapy can involve movement, drama and music, can help people of any age, and can be done in groups, pairs, or one-on-one.
Depression, for instance, may stem from a person's relationship with others. Learning skills for improving communication patterns may help the client to manage the depression.
First, the therapist may help the client to identify relevant emotions, and where these are coming from. Then they can help them to express the emotions in a healthier way.
For example, someone who responds to feeling neglected by getting angry may trigger a negative reaction in a loved one.
Learning to express the hurt and anxiety calmly can increase the chances of the other person reacting positively.
The client learns to modify their approach to interpersonal problems, understand them, and manage them more constructively.
People who might benefit from this type of therapy include individuals who are eager to please others at their own expense, or who find that they have volatile interpersonal relationships.
A family therapist looks at symptoms in the family context. Some conditions require the treatment of the family unit. An example is when a client has depression because of marital problems.
Cognitive therapy, behavioral therapy, and especially interpersonal therapy may help.
Identifying family patterns that contribute to behavior disorder or mental illness can help family members to break negative habits and patterns.
Often, family therapy focuses on improving communication within the family. Participants learn new ways of listening and how to ask and respond to questions openly rather than defensively.
Family therapy generally involves discussion and problem-solving sessions with the client and the family, as a group, in couples, or one-to-one.
A group therapy session usually involves between 6 and 12 clients and one therapist. The participants have similar problems, and they benefit from the therapist, and by observing how others handle their issues and respond to feedback.
Getting feedback from other people with related problems can give a new perspective and help to facilitate improvement and change.
Group therapy can help those who may feel a sense of isolation because of their issue.
Although participating in a group may seem intimidating, it helps people to realize that they are not alone, and that others share the same problem. The sense of support is generally powerful and many participants in group therapy find the experience rewarding.
Psychodynamic therapy, or insight-oriented therapy, focuses on the deep-seated causes of behavior. For instance, patterns of behavior stemming from a person's upbringing or earlier life experiences, which continue to impact present-day behaviors.
The aim is to increase self-awareness and understanding of how the past affects present behavior.
The client will consider unresolved issues and symptoms that stem from past dysfunctional relationships. Unresolved problems can underlie behaviors such as drug or alcohol abuse.
This can help people to understand the source of their emotional distress, usually by exploring motives, needs and defenses that they are not aware of.
It can help people whose symptoms have not been resolved by other forms of psychotherapy.
Does psychotherapy always work?
Psychotherapy has the benefit of giving clients someone to talk to. It can create a new way of looking at difficult problems, and help people move towards a solution.
Psychotherapy can help people to understand themselves better.
Participants can gain a better understanding of themselves and their own goals and values, and can develop skills for improving relationships.
It can help to overcome specific problems, such as an eating disorder or a phobia.
In order for psychotherapy to work, the person must be actively engaged and work during the session as well as between sessions, by practicing new skills, for example.
What makes psychotherapy work?
Psychotherapy is a two-way process, and there must be a trusting relationship between the client and the therapist.
To benefit from the process, a person must first want to participate. They should then attend appointments as set, be honest when describing symptoms and be willing to complete any assignments set.
Some clients may they experience changes they had not expected, or did not want.
Some people do not like to have to relive unpleasant events, but this does not happen in all psychotherapy techniques.
No therapist can ever predict when an unpleasant memory will resurface, but if it does, the therapist is skilled in addressing the recalled memory.
Psychotherapy can seem expensive and time-consuming. If treatment is considered necessary, the Mental Health Parity Act require that insurance companies pay for mental health care similar to the way they pay for medical care.
However, the definition of "reasonable and appropriate" or "medically necessary" may vary.
Referral to a therapist may happen through a family doctor, or people can find a therapist through the Yellow Pages or on the internet.
Written by Yvette Brazier