Psychotherapy – Types, Conditions Treated and Alternatives

Psychotherapy

Also called: Counseling, Talk Therapy

Summary

Psychotherapy is a widely used method for improving emotional or behavioral issues and treating mental illnesses. During psychotherapy, patients are encouraged to discuss their condition and any related issues with a mental health professional, such as a psychiatrist, psychologist or clinical social worker.

Psychotherapy is based on the theory that patients can improve their emotional well-being and mental health by talking about their concerns or problems with a therapist, who in turn can help them find better ways to cope, solve problems and set realistic goals for improvement.

Psychotherapy is used to treat various emotional disorders and mental illnesses including depression, anxiety disorders and eating disorders. In addition, psychotherapy can help people deal with difficult situations in their lives including divorce, the death of a loved one and chronic illness (e.g., cancer).

Common forms of psychotherapy used to treat emotional and mental health disorders include cognitive behavior therapy(CBT), psychodynamic psychotherapy and psychoanalysis.

Prior to psychotherapy, a psychotherapist will perform a mental health evaluation to assess the patient’s emotional and mental condition. At this time, the therapist will also discuss and determine the type, duration and goals of treatment with the patient.

Psychotherapy may be conducted in one-on-one sessions between a patient and a therapist or as part of group therapy. Therapy may also involve couples or family members meeting with a therapist. Although it is typically administered in an outpatient setting, psychotherapy may also be incorporated during inpatient psychiatric care or day treatment programs.

Therapy may be short term, lasting only a few weeks or months, or may last for longer periods of time. The duration of treatment generally depends on the patient’s needs, the severity of the condition and the therapist’s recommendation.

Research shows that psychotherapy can effectively treat patients with depression and anxiety, including accompanying symptoms, such as fatigue and pain. In addition, research indicates that a person’s emotional and physical health and well-being are interconnected. Many people are treated with some form of psychotherapy in addition to medications.

In some cases, individuals are treated with a combination of psychotherapy and medications (called pharmacotherapy).

About psychotherapy

Psychotherapy, also known as talk therapy, is a widely used method for treating emotional disorders and mental illnesses. Patients are encouraged to discuss their condition as well as any related issues with a mental health professional. Psychotherapy can also help people deal with difficult situations in their lives including divorce, the death of a loved one and chronic illness, such as cancer.

Psychotherapy is based on the theory that patients can improve their emotional well-being and mental health by talking about their concerns with a trained therapist. By using a number of different approaches and techniques, a therapist can help patients find better ways to cope, solve problems and set realistic goals.

Several kinds of mental health professionals practice psychotherapy. A psychiatrist is a licensed physician with a medical degree (M.D. or D.O.) who is specifically trained in the diagnosis, treatment and prevention of mental and behavioral disorders, and  can prescribe medications. A psychologist is a mental health professional who has a doctoral degree (usually a Ph.D., Psy.D., or Ed. D.) in clinical, counseling, or educational psychology and has also met state or provincial licensing criteria to diagnose and evaluate mental and emotional disorders, conduct psychological tests, and use psychotherapy to treat patients. Unlike psychiatrists, psychologists are not physicians and cannot prescribe medications. Other professionals, such as clinical social workers and marriage and family therapists, may hold master’s degrees and state licenses to practice psychotherapy.

Prior to psychotherapy, a psychotherapist will perform a mental health evaluation to assess the patient’s emotional and mental condition. The purpose of the evaluation is to help the therapist gather as much information as necessary to assess the patient’s problems and their severity. The therapist will also discuss the type, duration and goals of treatment with the patient at this time.

Psychotherapy may be conducted in several ways. Patients may meet individually with a therapist. Couples or families may also meet with a psychotherapist to discuss problems within relationships, or how one person’s mental health condition (e.g., bipolar disorder) affects the group. Finally, some psychotherapists lead group therapy sessions, with up to a dozen patients working together with one therapist.

Although it is typically administered in an outpatient setting, psychotherapy may also be incorporated during inpatient psychiatric care or day treatment programs. Therapy may be short term, lasting only a few weeks or months, or may last for longer periods of time. The duration of treatment generally depends on a patient’s needs and a psychotherapist’s recommendation.

In some cases, mental illness is treated with a combination of psychotherapy and medications (called pharmacotherapy). The medications prescribed (e.g., antidepressants) can vary and typically depend on the type and severity of the disorder. In severe cases, psychotherapy may not be recommended until a patient’s acute psychiatric symptoms (e.g. mood swings) have stabilized through the use of medications.

Research shows that psychotherapy is effective in treating people with emotional difficulties. According to a study in patients with recurrent major depression, cognitive psychotherapy proved as effective as medication treatment with antidepressants and appeared to maintain its effectiveness over time.   

Conditions treated with psychotherapy

Psychotherapy is commonly used to treat various emotional problems and mental illnesses, such as:

  • Depressive disorders. Chronic conditions marked by feelings of sadness, anger or frustration that may interfere with a person’s life. These include dysthymia, major depression, bipolar disorder,postpartum depressionandseasonal affective disorder.
  • Anxiety disorders. Emotional disorders characterized by a debilitating and disruptive anxiety that can interfere with a patient’s daily activities. Types of anxiety disorders include phobias, panic disorder, obsessive-compulsive disorder(OCD) and post-traumatic stress disorder(PTSD).
  • Personal stress. Many normal life situations and relationships may become aggravated enough to benefit from professional help. Grief, marital or other relationship issues and job-related stress are just a few of the problems handled in psychotherapy.
  • Eating disorders. These involve serious disturbances in eating behavior including unhealthy reduction of food intake (anorexia nervosa), severe overeating and/or dangerous methods to prevent weight gain, such as self-induced vomiting (bulimia nervosa).
  • Schizophrenia. A complex and disabling psychiatric disorder that impacts a person’s ability to distinguish between real and unreal experiences, think logically, have normal emotional responses and behave appropriately in social situations.
  • Borderline personality disorder(BPD). A condition that causes patients to have periods of unstable emotions that seriously affect their lives.
  • Insomnia. The inability to sleep for a reasonable amount of time to maintain adequate restfulness.
  • Substance abuse. The chronic use of a substance, usually alcohol or drugs, which alters mood or behavior and causes significant harm in an individual’s life.

Types and differences of psychotherapy

The most common forms of psychotherapy used in the treatment of emotional and mental health disorders include:

  • Behavior therapy. Also called behavior modification, the goal of this therapy is to replace undesirable behaviors with healthier ones. Some techniques used in behavior modification include:
    • Positive reinforcement. A technique in which positive behavior is rewarded.
    • Desensitization. A technique in which patients confront situations that cause discomfort, fear or anxiety and overcome negative emotions.

Exposure therapy is a common form of behavior therapy in which a therapist repeatedly exposes the patient to a disturbing object or situation until the patient learns to cope and work through the trauma.  It is often effective for patients with phobias, obsessive-compulsive disorder(OCD) and post-traumatic stress disorder(PTSD).

  • Cognitive therapy. A therapy that involves identifying distorted patterns of thinking, which are called maladaptive schemas. These are fundamental core beliefs or assumptions that are part of the perceptual filter people use to view the world. An example of a maladaptive schema is a statement such as “The world is an evil or dangerous place.”
  • Cognitive behavior therapy(CBT). A type of psychotherapy that combines techniques used in both behavior therapy and cognitive therapy. The goal of cognitive behavior therapy is to help patients change negative thought patterns, beliefs and behaviors so that they can manage their symptoms and enjoy more productive, less stressful lives.

An example of CBT is Dialectical behavior therapy (DBT), which includes both individual and group sessions that focus on skills for addressing suicidal behavior, handling stress and controlling emotions. Initially designed for patients with borderline personality disorder(BPD), DBT is now used for other emotional disorders and conditions (e.g., eating disorders, substance abuse).

  • Psychoanalysis. In this therapy, patients examine their memories, events and feelings from the past to understand present feelings and behavior. Psychoanalysis is based on the theory that mental health disorders are caused by the repression of traumatic experiences or subconscious desires.
  • Psychodynamic psychotherapy. Based on the principles of psychoanalysis, this form of psychotherapy emphasizes understanding the issues that motivate and influence the way a patient behaves, thinks and feels. Psychodynamic psychotherapy is based on the theory that a person’s behavior is determined by their past experiences, genetics and current situation.
  • Interpersonal therapy(IPT). This therapy focuses on a patient’s relationship with other people. The purpose of interpersonal therapy is to improve a patient’s interpersonal skills.
  • Psychoeducational therapy. This type of psychotherapy focuses on teaching patients – and sometimes family members and friends – about their illness. It explores treatment options, coping strategies and problem-solving skills.

    In this therapy, patients can learn about resources in their community, such as support groups. Patients can also learn to recognize symptoms to prevent a relapse. Psychoeducational therapy can help treat patients with a chronic or severe mental illness, such as schizophrenia.
  • Supportive therapy. This therapy is based on the assumption that patients improve when there is someone to talk to who is validating what they are saying. It involves efforts to enhance the therapist-patient relationship and the patient’s self-esteem, and to minimize anxiety.
  • Integrative psychotherapy. This type of therapy utilizes a combination of treatment strategies from various types of psychotherapies. For example, a psychotherapist may combine treatment strategies from psychodynamic psychotherapy and cognitive behavior therapy to treat a patient’s mental illness.
  • Play therapy. Form of therapy that uses toys, games and art to enable children to express themselves and allows a psychotherapist to address their problems.
  • Group therapy. Therapy involving multiple patients with only one therapist. All members of the group participate and analyze each other’s problems under the guidance of a therapist.
  • Family therapy (including couples or marriage therapy). Rather than treating just the individual, this therapy treats the family as a whole with a focus on family dynamics (the interaction of the family members).

In addition, psychotherapy make take place individually (individual therapy) or in a group setting (group therapy).

Complementary and alternative therapies

Complementary or alternative therapies belong to the category of mind–body therapies, which seek to strengthen communication between the mind, body and spirit.  Some of these therapies may be used with psychotherapy (complementary therapies) or in place of it (alternative therapies).

Some types of complementary and alternative therapies include:

  • Animal-assisted therapies. Working with animals, under the guidance of a mental health professional, can help some patients with conditions such as depression by reducing loneliness and anxiety.
  • Expressive therapies (e.g., art, dance and/or music therapy). Some patients may find happiness and relaxation from these therapies, which encourage imagination and self-expression.
  • Acupuncture. One of the oldest and most commonly used medical procedures in the world. It involves inserting fine needles into specific points in the body to restore and maintain health. Acupuncture can regulate functions including heart rate, body temperature and breathing. It can also help treat insomnia and bring about positive emotional changes.
  • Yoga. An ancient Indian discipline that uses breathing exercises, posture, stretches and meditation to balance the body’s energy centers.
  • Biofeedback. A technique that uses electrodes to measure bodily functions (e.g., breathing, heart rate, blood pressure, skin temperature, muscle tension) and teaches patients to alter these functions through relaxation and mental imagery.
  • Biologically-based therapies. These include the use of substances found in nature, such as herbs, food and vitamins. For example, St. John’s wort is an herbal supplement which may be used to treat several mental conditions, including mild to moderate depression.

These therapies may be an important resource for patients with emotional disorders or mental illnesses whose moods have been stabilized. However, individuals taking medication should talk with their physician before beginning any of these therapies, especially if treatment involves the use of herbal supplements. For example, people taking certain heart and cancer drugs or birth control pills are usually advised to avoid St. John’s wort.In addition, people who experience depression or any other mental health disorder are at serious risk of major health consequences, including suicide. Therefore, patients should always contact a physician rather than trying to treat themselves with these types of therapies.

Questions for your doctor about psychotherapy

Preparing questions in advance can help patients to have more meaningful discussions with their healthcare providers regarding their conditions. Patients may wish to ask the following psychotherapy-related questions:

  1. What is your experience as a psychotherapist?
  2. What degrees and licenses do you hold?
  3. Do you have special training in treating patients with my condition?
  4. What type of psychotherapy do you recommend for my condition?
  5. What occurs during a regular therapy session?
  6. How long will my treatment last?
  7. Will I need medication as well? Are you able to prescribe medication or will I need to see an additional healthcare professional?
  8. Will psychotherapy cure my condition?
  9. Can you recommend any complementary therapies for my condition?
  10. Given my mental health history, what is the best way to prevent a relapse?
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