Medically reviewed by Steven Gans, MDon February 18, 2018
Psychotherapy is a general term that is used to describe the process of treating psychological disorders and mental distress through the use of verbal and psychological techniques. During this process, a trained psychotherapist helps the client tackle specific or general problems such as a particular mental illness or a source of life stress.
Depending on the approach used by the therapist, a wide range of techniques and strategies can be used. However, almost all types of psychotherapy involve developing a therapeutic relationship, communicating and creating a dialogue, and working to overcome problematic thoughts or behaviors.
Psychotherapy is increasingly viewed as a distinct profession in its own right, but many different types of professionals engage in psychotherapy regularly. Such individuals include clinical psychologists, psychiatrists, counselors, marriage and family therapists, social workers, mental health counselors, and psychiatric nurses.
Types of Psychotherapy
When many people hear the word psychotherapy, they immediately imagine a patient lying on a couch talking while a therapist sits in a nearby chair jotting down thoughts on a yellow notepad. There are actually a variety of techniques and practices used in psychotherapy. The exact method used in each situation can vary based upon a variety of factors, including the training and background of the therapist, the preferences of the client, and the exact nature of the client’s current problem.
Some of the major approaches to psychotherapy include:
Psychoanalytic Therapy: While psychotherapy was practiced in various forms as far back as the time of the Ancient Greeks, it received its formal start when Sigmund Freud began using talk therapy to work with patients. Some of the techniques commonly used by Freud included the analysis of transference, dream interpretation, and free association. This psychoanalytic approach involves delving into a patient’s thoughts and past experiences to seek out unconscious thoughts, feelings, and memories that may influence behavior.
Behavioral Therapy: When behaviorism became a more prominent school of thought during the early part of the twentieth-century, techniques such as different types of conditioning began to play an important role in psychotherapy. While behaviorism may not be as dominant as it once was, many of its methods are still very popular today. Behavioral therapy often uses classical conditioning, operant conditioning, and social learning to help clients alter problematic behaviors.
Humanistic Therapy: Starting in the 1950s, the school of thought known as humanistic psychology began to have an influence on psychotherapy. The humanist psychologist Carl Rogers developed an approach known as client-centered therapy, which focused on the therapist showing unconditional positive regard to the client. Today, aspects of this approach remain widely used. The humanistic approach to psychotherapy focuses on helping people maximize their potential. Such approaches tend to stress the importance of self-exploration, free will, and self-actualization.
Cognitive Therapy: The cognitive revolution of the 1960s also had a major impact on the practice of psychotherapy, as psychologists began to increasingly focus on how human thought processes influence behavior and functioning. Cognitive therapy is centered on the idea that our thoughts have a powerful influence on our mental well-being. For example, if you tend to see the negative aspects of every situation, you will probably have a more pessimistic outlook and a gloomier overall mood. The goal of cognitive therapy is to identify the cognitive distortions that lead to this type of thinking and replace such thoughts with more realistic and positive ones. By doing so, people are able to improve their moods and overall well-being.
Cognitive-behavioral Therapy: The approach known as cognitive-behavioral therapy (CBT) is a type of psychotherapeutic treatment that helps patients understand the thoughts and feelings that influence behaviors. CBT is commonly used to treat a wide range of disorders including phobias, addiction, depression, and anxiety. CBT is a type of psychotherapy that involves cognitive and behavioral techniques to change negative thoughts and maladaptive behaviors. This approach involves changing the underlying thoughts that contribute to distress and modifying the problematic behaviors that result from these thoughts.
Formats of Psychotherapy
Psychotherapy can also take a number of different formats depending on the style of the therapist and the needs of the patient. A few that you might encounter include:
- Individual therapy, which involves working one-on-one with a psychotherapist.
- Couples therapy, which involves a therapist working with a couple to help improve how the two function in their relationship.
- Family therapy, which centers on improving the dynamic within families and can include multiple individuals within a family unit.
- Group therapy, which involves a small group of individuals who share a common goal. This approach allows members of the group to offer and receive support from others, as well as practice new behaviors within a supportive and receptive group.
Some Things to Consider Before You Try Psychotherapy
There are a number of issues or concerns for both therapists and clients. When selecting a therapist, consider whether you feel comfortable divulging personal information to the therapist. You should also assess the therapist’s qualifications, including the type of degree he or she holds and years of experience.
People who provide psychotherapy can hold a number of different titles or degrees. Some titles such as “psychologist” or “psychiatrist” are protected and carry specific educational and licensing requirements. Some of the individuals who are qualified to perform psychotherapy include psychiatrists, psychologists, counselors, licensed social workers, and advanced psychiatric nurses.
When providing services to clients, psychotherapists need to consider issues such as informed consent, patient confidentiality, and duty to warn. Informed consent involves notifying a client of all of the potential risks and benefits associated with treatment. This includes explaining the exact nature of the treatment, any possible risks, costs, and the available alternatives.
Because clients frequently discuss issues that are highly personal and sensitive in nature, psychotherapists have a legal obligation to protect a patient’s right to confidentiality. However, one instance where psychotherapists have a right to breach patient confidentiality is if clients pose an imminent threat to either themselves or others. Duty to warn gives counselors and therapists the right to breach confidentiality if a client poses a risk to another person.
How Effective Is Psychotherapy?
One of the major criticisms leveled against psychotherapy is one that calls into question its effectiveness. In one early and frequently mentioned study, psychologist Hans Eysenck found that two-thirds of participants either improved or recovered on their own within two years, regardless of whether they had received psychotherapy.
However, in a meta-analysis that looked at 475 different studies, researchers found that psychotherapy was effective at enhancing the psychological wellbeing of clients. In his book The Great Psychotherapy Debate, statistician and psychologist Bruce Wampold reported that factors such as the therapist’s personality as well as his or her belief in the effectiveness of the treatment played a role in the outcome of psychotherapy. Surprisingly, Wampold suggested that the type of therapy and the theoretical basis of the treatment do not have an effect on the outcome.
How to Know If You Need Psychotherapy
While you might realize that psychotherapy can help with life’s problems, it can sometimes be difficult to seek help or to even recognize when it is time to talk to a professional.
One key thing to remember is that the sooner you seek assistance, the sooner you will start to experience relief. Instead of waiting until your symptoms get out of control, you should consider getting help as soon as you start to recognize that there might be a problem.
Some key signs that it might be time to see a psychotherapist include:
- The issue is causing significant distress or disruption in your life. If you feel that the problem you are facing interrupts a number of important areas of your life including school, work, and relationships, it may be time to see if psychotherapy can help.
- You are relying on unhealthy or dangerous coping mechanisms. If you find yourself dealing with your problem by smoking, drinking, overeating, or taking out your frustrations on others, seeking assistance can help you find healthier and more beneficial coping strategies.
- Friends and family are concerned about your well-being. If it has reached a point where other people are worried about your emotional health, it may be time to see if psychotherapy can improve your psychological state.
- Nothing you have tried so far has helped. You’ve read self-help books, explored some techniques you read about online, or even tried just ignoring the problem, yet things just seem to be staying the same or even getting worse. Just remember that you don’t have to wait until your problems become so overwhelming that coping seems impossible. Help is available and the sooner you reach out, the sooner you’ll be back on track to a healthier, happier state of mind.
Choosing a Therapeutic Technique and Therapist
If you feel that you have a problem that might benefit from psychotherapy, your first step might be to discuss your concerns with your primary care physician. Your doctor may begin by first ruling out any physical diseases that might be contributing to your symptoms. If no other cause can be found, your doctor may then refer you to a mental health professional that is qualified to diagnose and treat the symptoms you are experiencing.
Your symptoms often play a role in the type of treatment and type of therapist you choose. If your doctor suspects that you are experiencing problems that might require the use of prescription medications in addition to psychotherapy, he or she may refer you to a psychiatrist. A psychiatrist is a medical doctor who can prescribe medications and has specific training in the treatment of psychological and psychiatric conditions.
If your symptoms suggest that you might benefit from some form of talk therapy without the addition of prescription drugs, you may be referred to a clinical psychologist or counselor.
Referrals from friends and family members can also be a great way to find a therapist who can help you address your concerns. Psychotherapy is very much both an art and a science, however. If things do not seem to be working, or you just don’t seem to “click” with your current therapist, do not be afraid to seek out other professionals until you find someone with whom you can connect.
As you evaluate any psychotherapist, consider some of the following questions:
- Does the therapist seem professional and qualified?
- Do you feel comfortable sharing your feelings and experiences?
- Do you like the therapist’s conversational style?
- Are you satisfied with the extent of your interaction with the therapist?
- Does he or she seem to understand what you are feeling?
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- Smith, M.L. What Research Says About the Effectiveness of Psychotherapy. Psychiatric Services; 2006.
- Eysenck, H. J. (1957). The effects of psychotherapy: An evaluation. Journal of Consulting Psychology. 1957;16: 319-324.
- Henrik, R. (1980). The Psychotherapy Handbook. The A-Z handbook to more than 250 psychotherapies as used today. New American Library; 1980.
- Wampold, B. E. The Great Psychotherapy Debate: Models, Methods, and Findings. Routledge; 2001.