Psychotherapy << `sy` koh THEHR uh pee >> is any treatment of mental or emotional problems by psychological means. Most psychotherapy takes the form of conversations between a therapist and one or more patients or clients in a therapist’s office. Psychotherapy is similar to counseling, but counseling is more likely to take place in schools or other settings.
There are three principal types of psychotherapists: (1) psychologists, (2) psychiatric social workers, and (3) psychiatrists. Most psychologists have a Ph.D. degree and practical training in assessing and treating psychological problems. Psychiatric social workers typically have a master’s degree and training in psychotherapy. Psychiatrists have an M.D. degree and are the only mental health professionals permitted to prescribe drugs, such as antidepressants. Psychiatric nurses may also play a role in psychotherapy.
Psychotherapists use a wide range of techniques based on different ideas and theories about the causes of psychological disorders. Some psychotherapists use one form of therapy for all their patients. Other therapists vary their techniques to suit the nature of each patient’s problems. Researchers have found that different therapies have similar effectiveness and that psychotherapy helps most patients who seek treatment. Successful psychotherapy depends on several factors including the therapist’s empathy (understanding of another), the motivation and resources of the client, and the quality of the relationship between client and therapist. Most important is the ability of the therapist and client to work together to resolve the client’s problems.
Most techniques of psychotherapy may be classified according to four general approaches. These approaches are (1) psychodynamic-interpersonal (2) cognitive- behavioral, (3) humanistic-experiential, and (4) family-couples. Most psychotherapy is done individually, but any of these approaches can be done in groups, where clients can support and learn from each other.
Psychodynamic-interpersonal psychotherapy.
The best-known type of psychodynamic psychotherapy is psychoanalysis, a method of treatment developed by the Austrian physician Sigmund Freud in the late 1800’s and early 1900’s. Psychoanalysis was based on the theory that psychological disorders are caused by conflict between conscious and unconscious influences. For example, an individual’s sexual desires may conflict with his or her moral standards. Psychoanalysts believed that people developed various defense mechanisms, such as repression (the unconscious exclusion of memories and thoughts from consciousness), to deal with these conflicts. The goal of psychoanalysis was to bring repressed conflicts to conscious awareness so that the patient could understand and deal with them.
Psychoanalysts used several techniques to penetrate a patient’s defense mechanisms, including dream interpretation and free association, in which the patient relaxes and talks about anything that comes to mind. Mostly, however, these therapists investigated the patient’s life history, especially memories of important relationships.
Freudian psychoanalysis is rarely practiced today, but it has given rise to a wide variety of other psychodynamic therapies. These include approaches developed by Alfred Adler of Austria, Erich Fromm and Karen Horney of Germany, and Carl Jung of Switzerland. These approaches focus more on interpersonal relationships than did Freud’s methods.
Cognitive-behavioral psychotherapy
is based on the idea that psychological problems result from behaviors or ideas that people have either learned or failed to learn. Therapists who practice this approach believe that self-defeating behaviors or thoughts may be learned from other people or reinforced by previous experiences. In addition, a person seeking therapy may not have learned effective skills for handling stressful situations. The individual may have learned to avoid such situations instead of learning to develop effective behaviors for coping with them.
There are many kinds of behavioral and cognitive psychotherapy. Behavior therapies emphasize change in observable behavior, such as helping depressed clients engage in more pleasant activities. Cognitive therapies often try to change self-defeating thought patterns by challenging the thoughts and encouraging clients to practice positive thinking. These therapies also may try to help clients develop more realistic goals.
Humanistic-experiential psychotherapy
emphasizes a person’s present experiences and potential for growth and self-fulfillment. The therapies in this approach try to help clients become more aware of their immediate experiences, develop their own self-understandings and solutions, and appreciate their own worth. Therapists treat their clients as equals. Therapists do not interpret clients’ past life or relationships or try to change specific behaviors. Instead, they provide an atmosphere of acceptance and support where clients can honestly explore their problems.
The most common type of humanistic-experiential psychotherapy is client-centered therapy, also called person-centered therapy. The American psychologist Carl R. Rogers developed this therapy. It assumes that the troubled individual is the best expert for solving his or her own problems. In this approach, the therapist listens carefully and restates the client’s feelings and thoughts instead of trying to explain the problem or tell the client what to do.
Other humanistic-experiential approaches include Gestalt therapy, existential therapy, and experiential therapy. Gestalt therapy, developed by the German psychiatrist Frederick S. Perls, often uses various exercises to solve problems. For example, a therapist may have a client act out internal conflicts as an imaginary conversation between two parts of the self. Existential therapies emphasize human freedom, choice, responsibility, and loneliness, and the search for meaning in the face of the inevitability of death. Experiential therapies use combinations of humanistic approaches rather than a single one. All humanistic-experiential approaches try to help clients make constructive choices by becoming more aware of their emotions.
Family-couples psychotherapy
attempts to help people deal with problems in close relationships. In this approach, one or more therapists work with the members of a family as a group. They may also meet with individual family members. Family-couples therapists believe that even if only one family member seems to have a problem, all the members are involved in some way. The therapists try to help family members develop better communication, establish well-defined family roles, and construct boundaries that allow each person to develop as an individual as well as a member of a family.
