Psychotherapy, or therapy for short, is the practice of treating mental health by psychological means rather than medical means. The main way to deliver psychotherapy is through talking, which is why psychotherapy is also called "talk therapy." Psychotherapy can also involve movement and expression that isn't just talking such as with art therapy. In my book, "The Guide to Getting Help," I explain in detail,what psychotherapy is.
What is Psychotherapy?
Psychotherapy, or therapy, covers a broad set of theories and activities that typically involve a professional helper working with clients on problems that may relate to emotions, behaviors, thoughts, feelings, and bodily sensations. I’ll use the term psychotherapy in this book to be clear that we aren’t talking about physical therapy or any other types of therapy. Within the realm of psychotherapy, there’s a vast array of methods used that are based upon varying evidence, research, philosophies, and theoretical models. These variations in method and school of thought will be briefly covered later in the book (see pg. 40). You can think about the differences in psychotherapy approaches as being similar to the differences in musical styles. Jazz and rock 'n' roll might sound drastically different, but we understand both as types of music.
What’s important to know is that after decades of study and research, we know that the alliance between the client and the psychotherapist is a more important factor for determining whether therapy is successful than which method is used. As Sperry and Carlson (2013) say, “It is the therapist and not the treatment that influences the amount of therapeutic change that occurs. Relationship skills or developing a therapeutic alliance is the cornerstone of therapeutic excellence.”
What this means is that if you’re looking for a therapist, what’s most significant is how much you feel you can talk with them about what can be deeply personal and intimate topics. In short, a perfect psychotherapy method doesn’t exist anymore than a perfect style of music exists. There are likely many psychotherapists from varying schools of thought that you can build a therapeutic alliance with, and the alliance is what’s most important when deciding who to work with.
What are the goals of psychotherapy?
I believe the goals of psychotherapy are to help the client 1) manage stress and their symptoms in healthier ways; 2) understand themselves better, including what their motivations are and how they create relationship patterns in their life; 3) generate meaning in their life; and 4) be able to experience a broader range of human emotions.
Our mission as helpers is to support the client while we work on problems, but also to help them develop the skills and self-confidence to, in some ways, become their own therapist as they continue through life. A good therapist wants to help empower the client. A bad therapist wants the client to be dependent on them. That said, a long-term relationship with a counselor can be beneficial as long as both the client and counselor are working in good faith and growth is still occurring. The critical component of determining the quality of the relationship is intent. The intent of a good therapist is to help the client grow out of unhealthy behaviors and maladaptive relational patterns and into a more integrated self. Outside of limitations imposed by insurance companies, the client is ultimately the one who gets to decide whether to stay in therapy, not the helper.
How does psychotherapy work?
The good news is that there’s general consensus and evidence that psychotherapy works with most people. However, there is disagreement about exactly how psychotherapy works. Nevertheless, I consider the simplest and clearest understanding of psychotherapy to be one that explains it as being comprised of three general domains: exploration, insight, and action.
When I’m working with a client, we’ll always be working on all three areas, but some require more focus than others depending on where we are in our work together. During exploration, I’ll get to understand them and their story, needs, and feelings. With insight, I can help shine a light on areas that may have been hidden from them. With action, we’ll experiment with ways they can change specific behaviors to help them work toward a life that means something more to them and feels more real and alive than what they’re currently experiencing.
Why does psychotherapy work?
There are many theories about exactly why therapy works. A popular one says that there are a few common factors to all types of therapy and those are the main reasons why it works. Some common factors given credit for helping create change are the alliance between client and therapist, empathy, expectations, cultural sensitivity, and collaboration (Wampold 2015). In some ways, we can say that therapy might work when the therapist and client both genuinely care about the process and the two can collaborate on the purpose of the therapy. And yes, the purpose can just be to understand oneself better.
When psychotherapy doesn’t work
It’s important to know that sometimes psychotherapy doesn’t work. Clients have many factors in their lives that impact the therapy. Substance use, missed sessions, motivation, the influence of significant people, and many more factors have a bearing on the outcome. There are no guarantees in therapy. Sometimes the critical areas that must be explored in therapy are too uncomfortable and so clients drop out before the relationship can have a positive effect. While counselors can help their clients cope with the strong feelings that come up in therapy, it’s not always the case that people are willing to expose themselves to the emotions that therapy brings up.