Psychotherapy

What Is Psychotherapy?

Psychotherapy, also called talk therapy, is a type of mental health treatment.

It’s often used either alone or with medications to treat mental disorders. During a psychotherapy session, you talk to a doctor or a licensed mental health care professional to identify and change troubling thoughts.

Benefits of Psychotherapy

Psychotherapy helps people with a mental disorder to:

• Understand the behaviors, emotions, and ideas that contribute to their illness and learn how to modify them
• Understand and identify the life problems or events -- like a major illness, a death in the family, a loss of a job, or a divorce -- that contribute to their illness and help them understand which aspects of those problems they may be able to solve or improve
• Regain a sense of control and pleasure in life
• Learn healthy coping techniques and problem-solving skills

Types of Therapy

Therapy can be given in a variety of formats, including:

• Individual: This therapy involves only the patient and the therapist.
• Group: Two or more patients may participate in therapy at the same time. Patients are able to share experiences and learn that others feel the same way and have had the same experiences.
• Marital/couples: This type of therapy helps spouses and partners understand why their loved one has a mental disorder, what changes in communication and behaviors can help, and what they can do to cope. This type of therapy can also be used to help a couple that is struggling with aspects of their relationship.
• Family: Because family is a key part of the team that helps people with mental illness get better, it is sometimes helpful for family members to understand what their loved one is going through, how they themselves can cope, and what they can do to help.

Approaches to Therapy

Psychotherapy can treat a wide range of of mental disorders, including:

• Depression
• Bipolar disorder
• Anxiety
• Anorexia, bulimia, and other eating disorders
• Posttraumatic stress disorder (PTSD)
• Schizophrenia
• Addictions
• Personality disorders

Psychotherapy can help you:

• Understand the behaviors, emotions, and ideas that may be behind your illness and how to change them
• Identify the life events, such as an illness, divorce, or childhood trauma, that may be at the root of your problems
• Regain a sense of control and pleasure in life
• Learn healthy ways to address problems
• Learn how to work with others to resolve conflicts

Sometimes psychotherapy can be an effective first treatment for mental disorders. But for many people, a combination of talk therapy and medication may work best.

Psychotherapy Formats

Therapy can be given in a variety of formats, including:

• Individual. This involves only you and your therapist.
• Group. You and others get therapy together. Everyone shares their experiences and learns that others feel the same way and have had similar experiences.
• Marital/couples. This helps you and your spouse or partner understand what changes in communication and behaviors can help and what you can do together. This type of therapy can also help a couple that is struggling with parts of their relationship.
• Family. Because family is a key part of the team that helps you get better, it is sometimes helpful for you family members to understand what you are going through, how they can manage their feelings, and what they can do to help.

Types of Psychotherapy

There are several approaches that mental health professionals can take to provide therapy. After talking with you about your disorder, your therapist will decide which approach to use.

Different approaches to therapy include:

Psychodynamic therapy

Psychodynamic therapy is based on the assumption that you are having emotional problems because of unresolved, generally unconscious conflicts, often stemming from childhood. The goal of this type of therapy is for you to understand and better manage these feelings by talking about the experiences. Psychodynamic therapy is done over a period of at least several months, although it can last longer, even years.

Interpersonal therapy

Interpersonal therapy focuses on the behaviors and interactions you have with family and friends. The goal of this therapy is to improve your communication skills and increase self-esteem during a short period of time. It usually lasts 3 to 4 months and works well for depression caused by mourning, relationship conflicts, major life events, and social isolation.

Psychodynamic and interpersonal therapies help you resolve mental illness caused by:

• Loss or grief
• Relationship conflicts
• Role transitions such as becoming a parent or a caregiver

Cognitive-behavioral therapy

Cognitive-behavioral therapy helps people with mental illness identify and change inaccurate perceptions that they may have of themselves and the world around them. The therapist helps you establish new ways of thinking by directing attention to both the "wrong" and "right" assumptions you make about yourself and others.

Cognitive-behavioral therapy is recommended for people:

• Who think and behave in ways that trigger and perpetuate mental illness
• Who suffer from depression or anxiety disorders as the only treatment or, depending on the severity, in addition to treatment with antidepressant medication
• Who refuse or are unable to take antidepressant medication
• Of all ages who have mental illness that causes suffering, disability, or interpersonal problems

Dialectical behavior therapy

Dialectical behavior therapy (DBT) is a type of cognitive behavioral therapy used for high-risk, tough-to-treat patients. The term "dialectical" comes from the idea that bringing together two opposites in therapy -- acceptance and change -- brings better results than either one alone. DBT helps you change unhealthy behaviors such as lying and self-injury through keeping daily diaries, individual and group therapy, and phone coaching.

DBT was initially designed to treat people with suicidal behavior and borderline personality disorder. But it has been adapted for other mental health problems that threaten a person's safety, relationships, work, and emotional well-being.

Comprehensive DBT focuses on four ways to enhance life skills:

• Distress tolerance. Feeling intense emotions like anger without reacting impulsively or using self-injury or substance use to dampen distress.
• Emotion regulation. Recognizing, labeling, and adjusting emotions.
• Mindfulness. Becoming more aware of yourself and others and attentive to the present moment.
• Interpersonal effectiveness. Navigating conflict and interacting assertively.

Supportive therapy

Your therapist coaches you on how to learn to manage your anxiety and unhelpful thoughts on your own. This approach helps bolster your self-esteem.

Alternative and complementary forms of therapy also may help. You can use them in combination with regular psychotherapy.

• Animal-assisted therapy. Dogs, horses, and other animals may help ease anxiety, depression, and bring comfort.
• Art and music therapy. This can allow you to express and process your grief and other feelings.

Tips for Effective Psychotherapy

Effective therapy depends on your active participation. It requires time, effort, and regularity.

Keep these tips in mind as you start your therapy:

• Attend all of your scheduled appointments.
• Work with your therapist to set goals at the start. Review them from time to time.
• Identify sources of stress. Try keeping a journal and note stressful as well as positive events.
• Reset priorities. Emphasize positive, effective behavior.
• Make time for recreational and pleasurable activities.
• Communicate. Explain and assert your needs to someone you trust. Write in a journal to express your feelings.
• Focus on positive outcomes and finding methods for reducing and managing stress.
• Be open and honest. Success depends on your willingness to share your thoughts, feelings, and experiences and to consider new insights, ideas, and ways of doing things. If you're reluctant to talk about certain issues because of painful emotions, embarrassment, or fears about your therapist's reaction, let your therapist know.
• Stick to your treatment plan. If you feel down or lack motivation, it may be tempting to skip psychotherapy sessions. Doing so can disrupt your progress. Try to attend all sessions and to give some thought to what you want to discuss.
• Don't expect instant results. Working on emotional issues can be painful and may require hard work. You may need several sessions before you begin to see improvement.
• Do your homework between sessions. If your therapist asks you to document your thoughts in a journal or do other activities outside of your therapy sessions, follow through. These homework assignments can help you apply what you've learned in the therapy sessions to your life.

How to Choose a Therapist

It’s important that you like and feel comfortable with your therapist. Thousands of licensed psychologists and other licensed professionals work in the U.S. Considering interviewing them by phone, video, or in person until you find a good match. You can find them by asking your family and friends for referrals, searching on the internet, checking with your health insurer, or contacting your local university.

Before you pick a therapist, you may want to ask:

• How much they charge
• If they accept insurance
• Hours for appointments
• Years of experience
• Areas of expertise
• Their treatment approach
• Whether or not they offer telehealth (virtual appointments)

What to Expect During Psychotherapy

Most therapy sessions last 45-50 minutes. It’s a guided conversation. Your therapist may ask many questions, especially when you’re starting out. They may want to know about your history and experiences, and about your feelings and worries.

It’s best that you both agree on the goals for your treatment. Your therapist may want to schedule more sessions. Some therapists can prescribe medication if necessary.

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