Defining Psychotherapy

"Psychotherapy" is an umbrella term that describes the use of psychological methods, particularly when based on regular personal interaction, to help a person change and overcome problems in desired ways. Other terms that can be used more or less interchangeably with the term "psychotherapy" include "counseling" and "therapy." Psychotherapy is defined by the interaction or treatment between a trained professional and a client, patient, family, couple, or group. The problems addressed are psychological in nature and can vary in terms of causes, influences, triggers, and resolutions.

History of Psychotherapy

It can be said that psychotherapy has been practiced through the ages, as medics, philosophers, spiritual practitioners, and others used psychological methods to heal people. In the Western tradition, by the 19th century a mental-treatment movement (then referred to as "moral treatment") developed based on certain therapeutic methods. In 1853 Walter Cooper Dendy introduced the term "psycho-therapeia" regarding how physicians might influence the mental states of sufferers and thus their bodily ailments.

In the late 1800s, Sigmund Freud (now known as the father of psychotherapy) developed psychoanalysis, an early Western form of psychotherapy. Psychoanalysis is based on overcoming the desires and negative influences of the unconscious mind. It encourages patients to use free association as a way to come to insights about unresolved issues from the past that are resulting in emotional or behavioral problems in the present.

Trained as a neurologist, Freud began focusing on problems that appeared to have no discernible organic basis; he theorized that they had psychological causes originating in childhood experiences and the unconscious mind. Techniques such as dream interpretation, free association, transference, and analysis of the unconscious mind were developed. Many theorists, including Anna Freud, Carl Jung, and Erik Erikson, built upon Freud's fundamental ideas and developed their own systems of psychotherapy. These were all later categorized as psychodynamic, meaning any approach that focused on the psyche's conscious and unconscious influences on the self and external relationships.

Behaviorism and behavioral therapy developed in the 1920s, relying on principles of operant conditioning, classical conditioning, and social-learning theory to bring about therapeutic change in observable symptoms. The approach became commonly used to treat phobias, as well as other disorders.

Goals of Psychotherapy

The purpose of psychotherapy is to explore thoughts, feelings, and behaviors with the goal of problem-solving or achieving higher levels of functioning. Psychotherapy aims to increase the individual's sense of their own well-being. Psychotherapists employ a range of techniques based on experiential relationship-building, dialogue, communication, and behavior change that are designed to improve the mental health of a client or patient, or to improve group relationships (such as in a family). During psychotherapy, an individual will often talk with a trained professional about how they feel, think, and react to challenges in life, with the ultimate goal of resolving or reducing negative symptoms of an emotional or mental health problem.

Types of Psychotherapy

Many forms of psychotherapy use spoken conversation; others use various other forms of communication such as the written word, artwork, drama, storytelling, or music. Psychotherapy occurs within a structured encounter between a trained therapist and a client. Depending on the individual and the types of symptoms they are experiencing, a particular method of psychotherapy may be employed. For instance, psychotherapy with children and their parents often involves play, role-play, and drawing, with a co-constructed narrative from these non-verbal and displaced modes of interacting. Common types of psychotherapy include the following.

Psychodynamic Therapy

The primary focus is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension. Although its roots are in psychoanalysis, psychodynamic therapy tends to be briefer and less intensive than traditional psychoanalysis.

Humanistic Therapy

This form is explicitly concerned with the human context of the development of the individual with an emphasis on subjective meaning, a rejection of determinism, and a concern for positive growth rather than pathology. It posits an inherent human capacity to maximize potential.

Behavioral Therapy

These methods focus exclusively on behaviors, or on behaviors in combination with thoughts and feelings that might be causing them. Those who practice behavioral therapy tend to look more at specific, learned behaviors and how the environment has an impact on those behaviors. Two primary types include operant conditioning and classical conditioning. 

Cognitive and Cognitive Behavioral Therapy (CBT)

Cognitive therapy seeks to identify maladaptive cognitions (thoughts), appraisals, beliefs, and reactions, with the aim of influencing destructive negative emotions. CBT combines cognitive therapy and behavioral therapy to address maladaptive cognitions as well as dysfunctional behaviors.

Group Therapy

In this type of therapy, one or more therapists treat a small group of clients together as a group.

Eclectic Therapy

Recently, many practitioners have begun to take what's known as an eclectic approach, meaning they combine aspects of multiple types 0f therapies. This approach can be useful in that is uses the techniques and theories that work best in a specific patient's scenario, rather than sticking solely to the methods of one discipline.

Other Approaches to Therapy

There are a number of other approaches to psychotherapy as well. For instance, eye-movement desensitization and reprocessing (EMDR) alleviates symptoms for individuals who have experienced severe trauma. Body-centered therapies focus on the links between the mind and the body in order to access greater awareness of the physical body and the emotions.

Medical vs. Humanistic Model

A distinction can be made between those psychotherapies that employ a medical model and those that employ a humanistic model. In the medical model, the client is seen as unwell and the therapist employs their skill to help the client regain health. The extensive use of the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders) in the United States comes out of the medical model. The humanistic or non-medical model, in contrast, strives to depathologize the human condition. The therapist attempts to create a relational environment conducive to experiential learning and help build the client's confidence in their own natural process, resulting in a deeper understanding of themselves. The therapist may see themselves as a facilitator/helper.

Efficacy

Large-scale international reviews of scientific studies have concluded that psychotherapy is effective for numerous conditions. One line of research consistently finds that different forms of psychotherapy show similar effectiveness. Further analyses seek to identify the factors that various psychotherapies have in common that seem to account for this; for example, the quality of the therapeutic relationship, the interpretation of the problem, and the confrontation of painful emotions. However, specific therapies have been tested for use with specific disorders, and regulatory organizations in both the UK and the US make recommendations for different conditions.

The Helsinki psychotherapy study was one of several large long-term clinical trials of psychotherapies that have taken place. Anxious and depressed patients in two short-term therapies (solution-focused and brief psychodynamic) improved faster, but after five years, long-term psychotherapy and psychoanalysis gave greater benefits. Several patient and therapist factors appear to predict suitability for different psychotherapies.

Some are skeptical of the healing power of a psychotherapeutic relationship. Some dismiss psychotherapy altogether in favor of biomedical treatments. Others have pointed out ways in which the values and techniques of therapists can be harmful as well as helpful to clients or people clients are in relationships with—critics point out that people have, after all, been weathering crises long before psychotherapy was introduced.