A Guide to Psychotherapy
Psychotherapy is sometimes referred to as counselling, talking therapy, psychosocial therapy, or simply therapy. It can help people deal with mental health conditions, as well as emotional problems and self-development.
This guide breaks down every aspect of psychotherapy, in order to provide direction to individuals who are considering therapy, as well as concerned loved ones.
This guide addresses common questions about psychotherapy such as:
What Is Psychotherapy?
What Conditions Can Psychotherapy Treat?
How Long Does It Take?
Types of Psychotherapy
How Can I Find a Good Psychotherapist?
Where Does Psychotherapy Take Place?
What Are Psychotherapy Sessions Like?
How Can I Tell if Psychotherapy is Working?
How Can I Get the Most Out of Psychotherapy?
Psychotherapy and Confidentiality
Psychotherapy and Medication
Benefits of Psychotherapy
Challenges of Psychotherapy
Facing emotional or mental problems can seem daunting, but psychotherapy is a tried-and-true method that can help individuals improve their state of mind and find ways to cope with their problems.
Psychotherapy is a type of talk therapy that can help you to resolve issues that might be concerning you. This could be a specific condition such as depression or anxiety, or it could be used to help you find meaning in your life, improve interpersonal relationships, or reach a certain goal.
It normally entails private, face-to-face meetings with an objective psychotherapist who will encourage you to talk openly about your problems. In some cases, it might involve your partner or family members or take place in a group setting with others who find themselves in a similar situation to yours.
The aim is not only to fix the issues that are currently plaguing you, but also to equip you with the skills needed to deal with any other problems that might arise after treatment has ended.
Psychotherapy is often recommended for people who are suffering from psychological problems, but it can also be useful for people who are experiencing a time of great difficulty or transition. Here are a few of the more common conditions that psychotherapy can be used to treat:
- Depression and other mood disorders
- Anxiety disorders such as phobias, panic disorder, post-traumatic stress disorder, or obsessive-compulsive disorder
- Eating disorders such as anorexia, bulimia, or compulsive overeating
- Personality disorders such as dependent personality disorder and borderline personality disorder
- Addictions including drug dependence, alcoholism, and compulsive gambling
- Psychotic issues such as bipolar disorder and schizophrenia
It is difficult to give a firm time frame for a course of psychotherapy because there are many factors that play a role in how long it will take to see results, including:
- The type of problem that needs to be dealt with
- The amount of time this problem has been present
- The severity of your symptoms
- How well the type of therapy used suits your personality
- How frequently your sessions are
- How quickly you make progress
- The amount of support you are getting outside of psychotherapy from family or friends
- The amount of stress you are under
People with small, specific issues might find that six sessions are enough to turn things around, whilst those with very complex and numerous problems could need 24 or more sessions in order to bring about a permanent change. Many people notice significant progress after around 12 sessions.
Psychotherapy is a very broad term that encompasses a number of approaches that might be used individually or together, depending on the psychotherapist’s training, the client’s personality and the issues he or she wishes to address. Some types of psychotherapy are tailored for specific conditions, others can work with a wide range of issues. Here are a few of the most common approaches:
Cognitive Behavioural Therapy (CBT):
This type of therapy aims to uncover the automatic thoughts that shape people’s behaviours and actions. Once the client is made aware of any flawed ways of thinking, they are then given techniques to replace these thoughts with more productive thinking patterns, thus bringing about the desired changes in their feelings and actions. CBT has enjoyed a surge in popularity recently thanks to its effectiveness in treating depression and anxiety, although it is not the only type of therapy that can help with these issues. To learn more click here.
Counselling: These days many people use the term “counselling” when referring to psychotherapy. Counselling is similarly, a type of therapy that involves talking about feelings and thoughts, with the aim of helping people overcome issues which are troubling them. It can help people to recognise how the actions of others affect them and find new ways to cope with their current and future problems. To learn more click here.
Humanistic Psychotherapy: This is a client-centred type of therapy that emphasis the relationship between the therapist and client. It is based on the idea that each individual has the power to develop their potential and make the most of their life. It helps develop a stronger sense of self and embrace personal responsibility. To learn more click here.
Psychoanalytic or Psychodynamic Psychotherapy: This is one of the older forms of psychotherapy that a lot of people have heard about. It focuses heavily on childhood experiences and unconscious thoughts and is normally a long-term treatment. It might entail bringing repressed feelings to the conscious mind using techniques such as free association and dream interpretation. To learn more click here.
Gestalt Psychotherapy: This approach views the client as the expert on his experiences and the therapist as an expert on solving problems. Gestalt therapists are trained in finding alternative solutions to problems that can bring about permanent change. Techniques such as role-playing might be employed. Gestalt therapy focuses on the here and now and aims to bring together all of the parts of a human being including the physical, mental, and spiritual. To learn more click here.
Person Centred Psychotherapy: This approach is based on the belief that people are essentially good and desire to change and grow personally. The therapist is empathetic and supportive but acts as the client’s equal rather than taking control. The therapist tries to take client’s point of view and helps to nurture their sense of self-worth. To learn more click here.
Existential Psychotherapy: This approach helps individuals to see which things in life they have the power to change and helps them accept the things that they cannot change. It shows people how to work within the limits of their environment to bring about positive change. It is based on the belief that the world is subject to random occurrences and that people are defined by the choices they make. To learn more click here.
Interpersonal psychotherapy: This therapy has been newly created by the NHS to cover the limitations of providing CBT only, to NHS patients. It is very similar to other previously established psychotherapies (see those mentioned above and below). It focuses on dealing with problems in your relationships with other people and boosting interpersonal skills such as, how you relate to your family, colleagues, or friends.
Integrative psychotherapy: This type of therapy employs a blend of several of approaches (such as the aforementioned) that can be tailored to address an individual’s specific needs. In contrast to older forms of psychotherapy (e.g. psychodynamic) which can spend a lot of time exploring one’s past, some newer integrative psychotherapies tend to be more proactive and use a more modern mix that many people find empowering. This method can provide clients with more flexibility when it comes to treatment and is useful for a range of problems. To learn more click here.
Starting psychotherapy can feel like a big step for many people and the task of finding a therapist can be a challenge in itself. The therapist’s skill and rapport with you is a strong determinant of how successful your therapy will be. A bit of homework beforehand can go a long way toward making the process as smooth and successful as possible.
Find a therapist.
Once you have decided that you would like to give psychotherapy a try or find out more about it, there are several ways you can go about finding a therapist. You can ask friends or family members for a recommendation. You can search privately via the internet or consult a reputable psychological association in your country, such as the UKCP, BACP or HCPC in the UK. On the NHS, your GP can give you a referral or if you want more control over the process you can self-refer on the NHS via local IAPT schemes, if your borough has one. You can also check with your health insurance plan. Some employers have assistance programs that offer a set number of therapy sessions with an external provider. Your HR Department will have information on this.
Research the costs.
Talk to the psychotherapists you are considering, to find out about their fees and payment options. If you plan to use insurance, find out what coverage is available. Some plans only cover a certain amount of sessions per year. Psychotherapy on the NHS is free, however, sometimes waiting times can be lengthy.
Check the qualifications of the therapists you are considering.
A few things you might want to consider are the therapist’s education, background, certification, and licensing. If you are dealing with severe anxiety or depression or another serious disorder, you should seek a therapist who has good experience and a track record in helping people address these issues.
Interview potential therapists.
You want to find a therapist who can provide the type of therapy required to meet your particular needs. Not all therapists provide every type of psychotherapy, so this is something you’ll want to establish before choosing someone. It is also important that you feel comfortable with the therapist and have a good rapport with him or her. You can get a feel for this during your first meeting, or sometimes it will be possible to “interview” the therapist ahead of your first paid session over the telephone.
Here are some questions you might want to ask a potential psychotherapist:
- How long have you been practicing psychotherapy?
- What licensing do you have?
- What are your areas of expertise?
- What experience do you have dealing with clients who have similar problems to mine?
- What kind of treatments do you use? Have they been proven effective?
- What are your fees?
- Do you accept my insurance?
Some psychotherapists work out of an office in a medical clinic, while others work in an office building or even a home office. Most people meet with their therapist once per week for around 45 to 60 minutes, although this can vary depending on the individual and the issue at hand. You might also receive psychotherapy in a hospital setting if you have been admitted for treatment. In some cases, psychotherapy might be conducted over the phone or via the internet. Video conferencing can be used for clients who want to speak to someone face-to-face but have transportation or time constraints or cannot find a qualified psychotherapist in their area.
Normally, the first meeting will provide an opportunity for you and your therapist to assess one another. Your therapist will decide if she/he is able to help you with the problems you are hoping to address, but it is also a chance for you to see if you think you can work well with this particular psychotherapist. The first session will typically be devoted to gathering information about you, your needs, and your goals. You might be asked to fill a questionnaire about your current level of wellbeing. You can talk about what you hope to accomplish and approximately how long it might take to deal with the issues in question.
In most types of psychotherapy, your therapist will encourage you to openly discuss your feelings, thoughts, and problems. Whilst many people find it is a relief to discuss their concerns and experiences with an objective listener, for some, opening up might feel a bit difficult at first, and this is normal. Your psychotherapist can help you to become more comfortable, so you can get the most out of the process.
In some cases, your therapist might ask you to do “homework”. This usually involves practicing something you have learned during your sessions or keeping a log of thoughts and behaviours that might be discussed during future sessions. These assignments are designed to help you build on what you have learned and apply these lessons to everyday life.
An integrative psychotherapist will normally use a number of different approaches that are tailored to your specific personality and situations. Although psychotherapy is considered a talking therapy and the bulk of the sessions are likely to be spent conversing, some types also employ other techniques such as written exercises, behavioural exercises, drama, art, or music.
In one of your first meetings, you and your psychotherapist will have established clear goals and outlined how long it is likely to take before you start noticing some progress. Sometimes you can start to feel better from the first meeting, but other times when there are many issues to cover, it can take more time to understand the various contributing factors. So make sure enough time has passed before you start questioning if things are working. Keep in mind that certain goals will take longer to reach than others, and how long it takes to deal with a particular issue, varies from person to person.
If you feel a sense of hope and relief early in your therapy, you are probably on the right track. If it any point you feel like you have hit a plateau or are regressing, be sure to bring it up with your therapist right away, so that he or she, can adjust the plan of treatment accordingly. Keep the lines of communication open and don’t be afraid to speak up if you think something isn’t working for you. Psychotherapists are trained in adapting treatment to individual needs.
Keep in mind that a good psychotherapist will listen to you without criticising you or making you feel judged. He/She will help you find ways to deal with your problems, in a way that really works for you. If your psychotherapist doesn’t seem to really “get you”, or is not helpful to you in addressing certain issues, it might be time to look for another therapist with whom you experience more comfort and potential for change.
If you want to maximise what you gain from your sessions with your psychotherapist, here are a few things you can do:
Remember that therapy is a partnership.
Having a great therapist is a big part of the equation, but therapy is most effective if you actively participate. Be sure you and your therapist are in agreement regarding the big issues and how to deal with them. You should also work together to set goals and measure your progress.
Commit to being open.
If you are going to the effort of attending therapy sessions, you owe it yourself to make the effort to be honest and open. You need to be willing to share your experiences, thoughts, and feelings. You also should be open to considering new ideas, insights, or ways of doing things. If you are holding back in discussing anything because you are embarrassed, worried about your therapist’s reaction, or don’t want to dig up painful emotions, tell your therapist and you can work together on broaching the topic in the most sensitive way.
Be realistic in your expectations.
Although many people start to feel better after just a few sessions, no one is going to get instant results. Certain emotional issues might require some very hard work to overcome. Some people might even feel slightly “worse” in the early stages of therapy as they address the impact of difficult pasts or confront current conflicts. This is often because feelings which have been held back or blocked off, come to the surface, so they can be acknowledged and laid to rest in a way that prevents them causing problems again, in the future. If you can be patient with the process and accept the fact that change won’t happen overnight, great achievements may be gained.
Stick with the plan.
Skipping therapy sessions can delay you from reaching your goal and stunt your momentum. Where possible, try and make a point of attending all of your sessions and think about what you want to discuss in advance. Write down important points that occur to you between sessions so you don’t forget them once your appointment comes. Be sure to follow through on journaling or other homework assignments your therapist gives you.
Because it is so crucial for you to feel comfortable speaking openly in psychotherapy, your therapist is bound by rules of confidentiality that prevent him or her from revealing things you disclose in sessions to other people. This means that the things you say to your therapist will be held in the strictest confidence.
If there is an immediate threat to your safety or that of others or they are legally required to do so, a psychotherapist may need to break that confidence in certain situations, such as if:
- You are threatening to harm or kill someone imminently.
- You are threating to harm or kill yourself imminently.
- You are abusing a child or an adult who is vulnerable, such as someone older than 18 who is disabled or hospitalized.
- You are unable to safely take care of yourself.
In some cases, psychotherapy can be just as effective as medication. In other cases, a combined approach might be prescribed, when the symptoms of a specific mental health condition cannot be eased by psychotherapy alone.
Medication can sometimes be used to bring about immediate relief during times of intense trauma, but psychotherapy can equip people with coping mechanisms that can be used for the rest of their lives. For this reason, medication might be used in conjunction with psychotherapy.
- It can help you understand your feelings, moods, thoughts, and behaviours.
- It can help you gain a sense of control over your life.
- It can improve your interpersonal relationships.
- It can give you healthy coping skills to respond to any challenging situations you might currently be facing.
- It can teach you effective ways to deal with challenges that arise in the future.
- It might require you to explore painful experiences or feelings from your past.
- It requires a time commitment.
- You might need to try a few therapists before finding one you click with.
- You might be emotionally uncomfortable at times.
Further Reading and Resources for Psychotherapy