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TherapyPsychotherapy: Introduction, Types, Benefits, EffectivenessTHC Editorial Team December 11, 2020The Japanese Footbridge, Claude Monet, 1899, Courtesy National Gallery of Art, WashingtonContents What Is Psychotherapy?Psychotherapy is a wide-ranging term encompassing numerous healing and treatment practices that aim to help people identify and reduce the impact of challenging emotions, thoughts, and behaviors.1 Psychotherapy is widely recognized as a legitimate and beneficial healing practice.2 Although exploring certain feelings and experiences can feel uncomfortable and sometimes painful, it is typically a low risk endeavor when working with a skilled and licensed therapist.3 The term “psychotherapy” is often used interchangeably with “therapy,” “talk therapy,” or “counseling.” Psychotherapy’s effectiveness has been proven for a range of conditions, including4
Psychotherapy can also positively impact more mentally healthy individuals who may be seeking growth in various aspects of life, including mental resilience, stress management, emotional balance, improved relationships, and many others.5 Types of PsychotherapyThere are numerous forms of therapy; some studies have indicated over 1,000.6 These different types of therapy utilize various approaches, follow specific theories, and have varying levels of scientific evidence demonstrating their effectiveness.7 A leading researcher in psychotherapy, Bruce Wampold, characterizes the different forms of psychotherapy, which have primarily emerged over the last century, as waves:2
There is considerable overlap between therapeutic approaches and types. A therapist’s selected approach is based on the condition they are treating; their training, experience, and expertise; client-specific factors; and the therapist-client relationship. Some of the main approaches to psychotherapy are described below. Psychoanalytic and Psychodynamic TherapiesPsychodynamic psychotherapy, also known as contemporary psychoanalytic therapy, began with Freud’s theory of the unconscious, repression, and free association. The theories underlying psychoanalytic therapies presuppose that mental conflict originates from powerful unconscious forces that are unexpressed or stuck and require constant monitoring and suppression for the individual to keep them from awareness.8 These therapies involve working with a skilled therapist to examine thoughts, feelings, and emotions. A strong therapist can help identify unconscious patterns that result in challenging behavior or feelings and explore how they may have been caused or influenced by a client’s past. By bringing these unconscious inner workings to consciousness, the client can start to overcome the unhelpful behaviors and feelings that these internal forces caused.9 Creative art therapies, including art therapy, music therapy, writing therapy, dance therapy, and play therapy, typically follow the psychodynamic approach. These methods, especially play and art therapy, are often utilized with young children.10 Psychodynamic therapy is primarily used for treating anxiety disorders, depression, and borderline personality disorder.9 Learning Theory–Based TherapiesAnother general class of psychotherapy is based on learning theories, which are principles aimed at understanding how individuals learn. The primary learning theory-based therapies are behavior therapy, cognitive therapy, and cognitive behavioral therapy (CBT). Behavior Therapy.Behavior therapy focuses on the development and modification of typical and maladaptive (problematic) behaviors. Primary behavioral therapies include systematic desensitization, prolonged exposure therapy (also called flooding), behavioral reversal, panic control treatment, and behavioral activation. Cognitive Therapy.Cognitive therapy is based on the belief that people react to their interpretation of their experiences, which may not always align with reality. Emotional disturbances are considered to emerge from unhealthy and/or unrealistic interpretations of these experiences. Cognitive therapy aims to bring conscious awareness to these challenging cognitive processes and modify or eliminate the challenging belief systems.11 Cognitive therapy makes use of questioning in an approach known as the Socratic dialogue, or guided discovery.11 This process is intended to clarify the problem; assist the client in understanding their thoughts, images, and assumptions; explore the client’s interpretations, or meanings, of events; and assess the consequences of maintaining potentially dysfunctional interpretations. Behavioral and cognitive approaches are often integrated into cognitive behavioral therapy, described below. Cognitive Behavioral Therapy.This type of therapy involves a combination of cognitive and behavioral approaches designed to identify and challenge distorted thoughts, behaviors, and emotions that contribute to distress. Since its beginning, CBT has been rooted in scientific research and, as such, is often a preferred psychotherapy approach given its proven effectiveness. It is also a short-term (often 6–20 sessions), goal-oriented therapy, typically aimed at a specific problem and often covered by health insurance providers. CBT has demonstrated effectiveness for several conditions, including depression, anxiety disorders, alcohol and drug problems, relationship difficulties, eating disorders, pain, fatigue, and some forms of severe mental illness.13 Experiential, Mindfulness-Based, and Humanistic TherapiesExperiential Therapy.Experiential therapies emphasize the importance of promoting and using an individual’s understanding gained through experience (or knowing by experience) to facilitate internal change. “Experiential self-knowledge is seen as essential to the achievement of personal wholeness, integration, self-coherence, and the adaptiveness that supports personal choice and continued growth.”14 Types of experiential therapies include emotion-focused therapy, person-centered/client-centered therapy, gestalt therapy, and existential psychotherapy. Experiential therapies can be short-term (16–20 sessions) or considerably longer term. The duration is agreed upon by the therapist and client and often depends on their mutual goals and expectations of therapy.14 Experiential and some mindfulness-based and acceptance-based therapies (see below) have been labeled as “third wave” cognitive behavioral treatments, which identify emotion as central to both the problem and the path to healing and incorporate emotional work with strategies for addressing challenging behavior.5 Mindfulness- and Acceptance-Based Therapies.These therapy practices involve openness to and acceptance of unpleasant thoughts, emotions, and experiences that are inevitable parts of life. Theories behind such practices suggest that accepting “unpleasant inner experiences with willingness, openness, curiosity, compassion, and a nonjudgmental stance”15 is a healthier approach than avoiding or suppressing these states—which can paradoxically increase their frequency and intensity. Essential mindfulness- and acceptance-based therapies include acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and mindfulness-based cognitive therapy (MBCT). Mindfulness- and acceptance-based approaches have been used successfully to treat generalized anxiety disorder (GAD).15 Humanistic Therapies.Influenced by humanistic philosophy, humanistic therapies encourage people to think about themselves in a more positive light and improve their self-awareness.10 The humanistic approach champions people’s ability to make rational choices and develop their optimal potential and capacity.16 Three primary types of humanistic therapy include client-centered therapy, gestalt therapy, and existential therapy. In client-centered therapy, therapists emphasize their concern, care, and interest to help clients change. Gestalt therapy promotes the importance of being aware of the present moment and accepting personal responsibility in one’s life. Existential therapy emphasizes “free will, self-determination, and the search for meaning.”16 Existential psychotherapy is based on existential philosophy. Types of existential therapy include logotherapy (also known as existential analysis) and existential-humanistic psychotherapies.17 In the view of existentialism, to be human is to experience a range of feelings, including painful ones, such as anxiety, guilt, regret, and despair. In trying to repress or suppress these emotions, people deny the reality of their existence and, as such, limit their ability to live full and fulfilling lives.17 Existential therapy aims to help clients live more authentically and thus experience more fulfillment. Feminist PsychotherapyFeminist therapy is based on the belief that gender roles, gender role status, attitudes toward women, social norms, and other social, cultural, and legal norms related to women can create disadvantages.2 Feminist therapy emphasizes empowerment and egalitarianism and aims to be affirming to its clients, who often have experienced discrimination, harassment, and other distressing issues related to gender, sexuality, and power.2 Postmodern/Poststructural TherapiesMargarita Tarragona, a positive psychologist, described the class of therapies often referred to as postmodern or poststructural in the following way:18 A new generation of therapies has been developing since the past quarter of the twentieth century. These therapies are variously called postmodern, narrative, discursive, conversational, poststructuralist, collaborative, and social-constructionist…. Discursive and conversational suggest that therapy is seen as a conversation and as a linguistic process. Narrative refers to a strong interest in the way people create meaning in their lives through stories or narrations of their experience. Social constructionist emphasizes that knowledge, meaning, and identity are constructed through interaction with others. Poststructuralist identifies therapists who don’t think of human difficulties as manifestations of deep or underlying structures. Collaborative describes the kind of relationship that these therapists hope to establish with their clients and the process of therapy as a joint endeavor. Poststructural therapies aim to assist people to pay less attention to what certain social norms say life should be about, consider how the stories of their lives shape their lives, and develop preferred and more fulfilling stories of identity.19 Interpersonal PsychotherapyInterpersonal psychotherapy (IPT) focuses on how unhealthy conditions can be triggered by relationship issues and challenges, such as death and loss, disputes, and relocation, among others.10 The interpersonal therapist helps a person identify and understand underlying interpersonal complications, including losses or changes in personal or professional roles, unresolved emotions such as anger or grief, conflicts with significant others, and general challenges with relating to others. IPT can help people learn healthier ways to experience and express their emotions and how they communicate and relate to others.20 IPT is commonly used to treat depression but can also be used to treat a variety of conditions.9 Family (Systemic) TherapyFamily therapy is any form of therapy that focuses on modifying or improving the functioning of a family as a unit and its internal systems or dynamics.6 Family systems theories primarily focus on the collective family process rather than the individual.6 Although most family therapy approaches follow systems theory, other theories and practices are applied as well.6 Types of family therapy include structural family therapy, Hayley’s problem-solving therapy, the Mental Research Institute model, Milan systemic therapy, solution-focused therapy, cognitive behavioral therapy, psychoeducational, Bowen, experiential, and narrative therapy. Couples TherapyCouples therapy, also known as marriage counseling, is a type of psychotherapy usually administered by licensed marriage and family therapists (LMFTs) and focuses on strengthening romantic relationships. Conflict in such relationships often arises when people communicate inefficiently or avoid talking about problems over time. It addresses issues such as intimacy, commitment, and attachment, among others. Couples therapy is similar to family therapy as the relationships share many features, including the importance of healthy communication, relating, problem solving, and attachment.6 Group TherapyGroup therapy utilizes a group setting and focuses on interpersonal (social), intrapersonal (psychological), or behavioral changes to improve clients’ emotional, psychological, or behavioral challenges.21 Benefits of group therapy include its resource efficiency—in that it can benefit several clients at once while reducing the cost of treatment—and its effectiveness in treating a wide variety of disorders and disabilities.21 Some of the therapeutic processes involved in group therapy are catharsis, cohesion (or positive bond between group members), universality (part of a similar group), insight, vicarious learning, interpersonal learning, self-disclosure, and modeling.21 Integrative TherapiesMany therapists combine aspects from different psychotherapeutic approaches and fine-tune their treatment according to each person’s individual needs.16 Integrative psychotherapies are described as “those models of psychotherapy in which the theories, principles, or techniques from two or more separate forms of treatment are combined in an organized and systematic way.”22 Integrative therapies are expanding for several reasons, including an ongoing increase in the number of types of psychotherapy, the unfounded clear superiority of any specific school of psychotherapy, common factors that can improve outcomes, and an overall greater interest in psychotherapy integration.22 Potential Benefits of PsychotherapyOne can derive numerous benefits through an effective healing and/or growth practice and, specifically, psychotherapy. Among the benefits of psychotherapy are an overall improvement in well-being; symptom reduction and relief from various distressful conditions; and personal, interpersonal, and spiritual growth. In their transtheoretical approach, leading behavioral researchers Prochaska and DiClemente identified 10 processes of change that operate across different types of psychotherapy, which can also be considered areas of healing and growth of a client. These include the following:23
Effectiveness of PsychotherapyThe effectiveness of psychotherapy has been verified by decades of scientific research.24 Analyses of thousands of scientific studies have demonstrated that about 75%–80% of patients who enter psychotherapy show improvement.2,24 These findings span a range of therapy modalities and disorders. One of the important developments in psychotherapy research is that psychotherapy is as effective as psychiatric medicines for many conditions.2 Further, a primary strength of psychotherapy compared to psychiatric medication is that the psychotherapy appears to have longer-lasting effects, has fewer adverse side effects, and requires fewer additional courses of treatment.2 In many cases, however, a combination of psychotherapy and medicinal treatment appears to work better.25 The Society of Clinical Psychology provides valuable information about effective treatments for psychological conditions based on “best research evidence.” Although it claims that other psychological treatments may also be effective in treating these conditions, these other treatments “have not been evaluated with the same scientific rigor as the treatments” they mention.26 Below are various psychological disorders and the therapy approaches that have proven effective in treating them.26 DepressionStrong research support
Modest research support
Anxiety DisordersGeneralized Anxiety Disorder.Strong research support
Mixed Anxiety Disorder.Modest research support
Panic Disorder.Strong research support
Modest research support
Social Anxiety Disorder.Strong research support
Specific Phobias.Strong research support
Posttraumatic Stress Disorder.Strong research support
Modest research support
Schizophrenia, Related Disorders, and Other Severe Mental Illnesses.Strong research support
Modest research support
Getting Started With PsychotherapyPsychotherapy often starts when a person independently pursues a therapist or when a therapist is recommended by a loved one, acquaintance, general practitioner, or another medical doctor. How to Choose a Suitable TherapistWhen considering a therapist, a person should be mindful of the following:1
Psychotherapy SessionsAccording to the American Psychiatric Association (2019), psychotherapy sessions typically follow a common format:20
Critical Success Factors of PsychotherapyFactors that contribute to the level of success and effectiveness of psychotherapy include24
Future of PsychotherapyThe discipline and practice of psychotherapy are continuously evolving. Advancements in the field aim for greater effectiveness, increased accessibility, and improved understanding of its benefits. Below are specific ways these aims might be achieved: Greater effectiveness.
Greater accessibility.
Improved understanding of benefits.
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Subscribe to our mailing list.What does the research indicate about the effectiveness of psychotherapy?Scientific evidence shows that psychotherapy is generally as effective or more effective than medications in treating depression, especially when consumer satisfaction and long-term follow-up are considered.
Which of the following best summarizes the research on the effectiveness of psychotherapy?Which of the following best summarizes the research on the effectiveness of psychotherapy? There are no significant differences in the overall effectiveness of behavior therapy, humanistic therapy, and psychodynamic therapy.
What is the general conclusion about the effectiveness of psychotherapy?Conclusion. Psychotherapy is highly effective; numerous meta-analyses of thousands of studies have underscored the effectiveness of psychotherapy treatment.
Which of the following is the most important determinant of the effectiveness of psychotherapy?Which of the following is the most important determinant of the effectiveness of psychotherapy? trying to get the patient to identify irrational and self-defeating thoughts.
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