Psychotherapy
Overview
Psychotherapy is a structured and collaborative interaction between a licensed mental health professional and their client. Psychotherapy consists of numerous approaches, including psychodynamic, existential-humanistic, behavioral, and cognitive therapies. Licensed mental health professionals (i.e., psychotherapists, psychologists) determine the most appropriate type of psychotherapy that best aligns with their clients’ specific/individual needs. Some of the conditions psychotherapy is used to treat include: depression, anxiety disorders, stress, major life changes, interpersonal problems, and mood disorders.[1]
History & Developments
Psychotherapy’s history dates back to ancient Greece, where philosophers like Socrates and Plato explored the nature of the mind and human behavior. In the late 19th century, Austrian neurologist Sigmund Freud modernized psychotherapy by introducing psychoanalysis, which aimed to uncover repressed thoughts and emotions to heal psychological disorders.[2] Providing alternative approaches to psychoanalysis, in the 20th century, American psychologist Carl Rogers introduced person-centered therapy, while American psychiatrist Aaron T. Beck developed cognitive behavioral therapy.[3] The field of psychotherapy continued to expand and incorporate various schools of thought and evidence-based treatments. Thus, psychotherapy has become a diverse field with multiple approaches and techniques tailored to address various mental health concerns.
Types of Psychotherapy
Psychodynamic therapies explore hidden psychological processes that emerge in clients’ current actions.[4] Moreover, existential-humanistic therapies utilize a broad array of approaches for case conceptualization, therapeutic aims, intervention tactics, and research methodologies, prioritizing clients over their symptoms.[5] Conversely, behavioral therapies aim to change and improve a client’s behavior and emotional response through various techniques concentrating on observable actions and reactions. Alternatively, cognitive therapies identify and change dysfunctional thought patterns and beliefs to enhance emotional well-being and behavior.
Cognitive Behavioral Therapy (CBT) identifies and changes negative thought patterns and behaviors contributing to psychological distress and dysfunction.[6] For example, CBT may help clients with social anxiety challenge their automatic intrusive thoughts.
Dialectical Behavior Therapy (DBT), based on dialectical philosophy, has four key components: mindfulness, emotional regulation, distress tolerance, and impersonal effectiveness.[7] For example, DBT may help a client experiencing panic attacks by using a distress tolerance skill (e.g., deep breathing) to stay calm during moments of intense anxiety.
Interpersonal Therapy (IPT) primarily focuses on addressing and improving interpersonal problems to alleviate stress.[8] For example, IPT may help a grieving client explore the impact of their loss on their relationships and manage the interpersonal issues related to their bereavement.
Psychodynamic Therapy is a form of talk therapy that explores how past experiences and unconscious thoughts influence an individual’s current behavior, emotions, and relationships.[9] For example, psychodynamic therapy may help clients explore their childhood experiences to gain insight into the origins of their current emotional struggles.
Efficacy
In the 1950s, Psychologist Hans J. Eysneck argued that psychoanalysis and other talk therapies were particularly ineffective in treating mental health disorders in comparison to the natural course of the disorder. These claims were based on his belief that client improvements from psychotherapy were simply a “placebo effect”, asserting that the recovery rates of psychotherapy were similar to those who did not receive any treatment at all. However, a study by Munder et al. (2018) identifies the efficacy of psychotherapy treatments for depression and examines Eysneck’s claim that “psychotherapy is not effective”.[10] Munder et al. removed outliers from their dataset and corrected for publication bias. In the study, psychotherapy was also considered without any other interventions, with wait list controls determining the approximate course of depression. They found that psychotherapy was more effective by a factor of 0.70 than no interventions.[11]
Another aspect of psychotherapy that has been questioned is the effectiveness of routine care. McAleavey et al. (2017) examined the concerns that psychotherapy deteriorates some clients during therapy. Utilizing a sample size of 9,895 respondents across university counseling centers, they found that routine psychotherapy noteworthily improved all clients' self-reported symptoms.[12]
For those experiencing extreme distress, psychotherapy should often be paired with other treatments and services for clients (e.g., psychiatric medication management), to be most effective. Additionally, the effects of psychotherapy are consistent for most diagnostic conditions, with the effectiveness tending to vary by the condition's severity rather than by the diagnosis.[13-17]
Benefits & Limitations
Psychotherapy provides a safe and confidential space for client’s to express their concerns, thoughts, and feelings. The licensed mental health professional guides their clients, while offering empathy and emotional support. Through the many forms of psychotherapy, reduction of the symptoms in various mental health conditions (e.g., depression and anxiety) is evident. Additionally, clients learn how to develop positive coping mechanisms and learn to manage stress, conflicts, and difficult emotions in more adaptive, healthier ways. In turn, this modality enhances self-awareness as clients better understand themselves, patterns of behaviors, and motivations. Moreover, psychotherapy helps with improved communication and relationship skills, such as family dynamics.
Despite the many benefits, psychotherapy does have some potential downfalls. Namely, it can be costly and time-consuming.[18] Access to a licensed mental health professional can be limited depending on geographical barriers, financial constraints, lack of insurance, social barriers, and a possible long waitlist. Psychotherapy requires time and effort on the part of the attending client and progress may seem slow or gradual based on their individual case and history.[19] It can be especially beneficial to a client to first ensure that their prospective therapist specializes in the area of support that the client needs. Additionally, if a client’s financial situation is strained, utilizing services such as sliding scale or lower-fee options can be especially useful.
Overall, psychotherapy offers many benefits including emotional support, symptom reduction, improved coping skills and enhanced self-awareness. As with any therapeutic modality, its limitations related to time and cost should be carefully considered by a therapist based on their client’s history, need and presentation. If you would like to explore how psychotherapy might benefit you, please reach out to a licensed mental health professional (e.g., a psychotherapist, psychologist or psychiatrist) to learn more about your options.
Contributed by: Kelly Valentin
Editor: Jennifer (Ghahari) Smith, Ph.D.
references
1 Psychotherapies. (2023). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/psychotherapies
2 Mitchell, S. A., & Black, M. J. (2016). Freud and beyond: A History of Modern Psychoanalytic Thought. Basic Books.
3 Carl Rogers, PhD: 1947 APA President. (n.d.). https://www.apa.org. https://www.apa.org/about/governance/president/carl-r-rogers
4 Treatment, C. F. S. A. (1999). Brief Interventions and Brief Therapies for Substance Abuse - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK64952/
5 Ibid.
6 Institute for Quality and Efficiency in Health Care (IQWiG). (2016, September 8). Cognitive behavioral therapy. InformedHealth.org - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK279297/
7 Dialectical Behavior Therapy | Behavioral Research & Therapy Clinics. (n.d.). https://depts.washington.edu/uwbrtc/about-us/dialectical-behavior-therapy/
8 Markowitz, J. C. (2004, October 1). Interpersonal psychotherapy: principles and applications. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414693/
9 Treatment, C. F. S. A.
10 Munder, T., Flückiger, C., Leichsenring, F., Abbass, A., Hilsenroth, M. J., Luyten, P., Rabung, S., Steinert, C., & Wampold, B. E. (2018). Is psychotherapy effective? A re-analysis of treatments for depression. Epidemiology and Psychiatric Sciences, 28(03), 268–274. https://doi.org/10.1017/s2045796018000355
11 Ibid.
12 McAleavey, A. A., Youn, S. J., Xiao, H., Castonguay, L. G., Hayes, J. A., & Locke, B. D. (2017). Effectiveness of routine psychotherapy: Method matters. Psychotherapy Research, 29(2), 139–156. https://doi.org/10.1080/10503307.2017.1395921
13 Beutler, L.E. (2009). Making science matter in clinical practice: Redefining psychotherapy. Clinical Psychology: Science and Practice, 16, 301-317. DOI: 10.1111/j.1468-2850.2009.01168.x
14 Beutler, L.E. & Malik, M.L. (2002a) (Eds.), Rethinking the DSM (3-16). Washington, D.C.: American Psychological Association.
15 Beutler, L.E. & Malik, M.L. (2002b). Diagnosis and Treatment Guidelines: The Example of Depression. In L.E. Beutler & M.L. Malik (Eds), Rethinking the DSM (251-278). Washington, D.C.: American Psychological Association.
16 Malik, M.L. & Beutler, L.E. (2002). The emergence of dissatisfaction with the DSM. In L.E. Beutler & M.L. Malik (Eds.), Rethinking the DSM (3-16). Washington, D.C.: American Psychological Association.
17 Wampold, B.E. (2001). The great psychotherapy debate: Model, methods, and findings. Mahwah, N.J.: Lawrence Erlbaum Associates.
18 Karasu, T. B. (1986). The Psychotherapies: benefits and Limitations. American Journal of Psychotherapy, 40(3), 324–342. https://doi.org/10.1176/appi.psychotherapy.1986.40.3.324
19 Hoch, P. H. (1955). AIMS AND LIMITATIONS OF PSYCHOTHERAPY. American Journal of Psychiatry, 112(5), 321–327. https://doi.org/10.1176/ajp.112.5.321