Understanding psychotherapy and how it works

Psychotherapy is a collaborative treatment based on the relationship between an individual and a psychologist. Grounded in dialogue, it provides a supportive environment that allows you to talk openly with someone who’s objective, neutral, and nonjudgmental. You and your psychologist will work together to identify and change the thought and behavior patterns that are keeping you from feeling your best.

By the time you’re done, you will not only have solved the problem that brought you in, but you will have learned new skills so you can better cope with whatever challenges arise in the future.

A psychologist can help you work through such problems. Through psychotherapy, psychologists help people of all ages live happier, healthier, and more productive lives.

In psychotherapy, psychologists apply scientifically validated procedures to help people develop healthier, more effective habits. There are several approaches to psychotherapy—including cognitive-behavioral, interpersonal, and other kinds of talk therapy—that help individuals work through their problems.

When should you consider psychotherapy?

Because of the many misconceptions about psychotherapy, you may be reluctant to try it out. Even if you know the realities instead of the myths, you may feel nervous about trying it yourself.

Overcoming that nervousness is worth it. That’s because any time your quality of life isn’t what you want it to be, psychotherapy can help.

Some people seek psychotherapy because they have felt depressed, anxious, or angry for a long time. Others may want help for a chronic illness that is interfering with their emotional or physical well-being. Still others may have short-term problems they need help navigating. They may be going through a divorce, facing an empty nest, feeling overwhelmed by a new job, or grieving a family member’s death, for example.

Signs that you could benefit from therapy include:

• You feel an overwhelming, prolonged sense of helplessness and sadness
• Your problems don’t seem to get better despite your efforts and help from family and friends
• You find it difficult to concentrate on work assignments or to carry out other everyday activities
• You worry excessively, expect the worst, or are constantly on edge
• Your actions, such as drinking too much alcohol, using drugs, or being aggressive, are harming you or others

What are the different kinds of psychotherapy?

There are many different approaches to psychotherapy. Psychologists generally draw on one or more of these. Each theoretical perspective acts as a roadmap to help the psychologist understand their patients and their problems and develop solutions.

The kind of treatment you receive will depend on a variety of factors: current psychological research, your psychologist’s theoretical orientation, and what works best for your situation.

Your psychologist’s theoretical perspective will affect what goes on in his or her office. Psychologists who use cognitive-behavioral therapy, for example, have a practical approach to treatment. Your psychologist might ask you to tackle certain tasks designed to help you develop more effective coping skills. This approach often involves homework assignments.

Your psychologist might ask you to gather more information, such as logging your reactions to a particular situation as they occur. Or your psychologist might want you to practice new skills between sessions, such as asking someone with an elevator phobia to practice pushing elevator buttons. You might also have reading assignments so you can learn more about a particular topic.

How long does a psychotherapy session last?

The length of a psychotherapy session varies, but it is usually between 45 and 60 minutes. However, in some cases, sessions can last 90 minutes or longer, particularly when specific therapeutic approaches are used or complex situations are resolved. The frequency and total duration of treatment are determined by the individual needs of each person and the therapist’s recommendation. To establish an appropriate treatment plan, the therapist and the client agree on the frequency and duration of the sessions at the start of the treatment process.

Treatment in Psychotherapy

Often psychotherapy is known as “dialog therapy,” and that’s exactly what you’ll do during your treatment. You and the psychologist will engage in a dialogue regarding your problems and how to solve them.

What elements should be addressed in psychotherapy session?

Schedule: For the time being, it is best if each week is the same so that a habit can be formed, which will greatly benefit the work in session. In turn, review the adherence to the schedule because the hours are fixed, and if you arrive 5 minutes late, he has lost that time and will not be able to recover it at the end.

Session time: This type of therapy uses a set time for each session.

Payment method: Once the amount of professional fees has been determined and agreed upon, payment can be made at the end of the session or at the end of the month.

Missing a session: Due to the volume of demand, the patient agrees to cancel a session 24 hours in advance. See the Annex form for turn cancellations and absences without notice.

Holidays: Generally, the therapist takes the month of January off so that the patient knows when the sessions will be interrupted and because it is common for things to happen to the patients on the days before vacation that they will have to work and interpret if necessary.

What should I expect as I continue psychotherapy?

As your psychotherapy goes on, you’ll continue the process of building a trusting, therapeutic relationship with your psychologist.

As part of the ongoing getting-to-know-you process, your psychologist may want to do some assessment. Psychologists are trained to administer and interpret tests that can help to determine the depth of your depression, identify important personality characteristics, uncover unhealthy coping strategies such as drinking problems, or identify learning disabilities.

If parents have brought in a bright child who’s nonetheless struggling academically, for example, a psychologist might assess whether the child has attention problems or an undetected learning disability. Test results can help your psychologist diagnose a condition or provide more information about the way you think, feel and behave.

You and your psychologist will also keep exploring your problems through talking. For some people, just being able to talk freely about a problem brings relief. In the early stages, your psychologist will help you clarify what’s troubling you. You’ll then move into a problem-solving phase, working together to find alternative ways of thinking, behaving, and managing your feelings.

You might role-play new behaviors during your sessions and do homework to practice new skills in between. As you go along, you and your psychologist will assess your progress and determine whether your original goals need to be reformulated or expanded.

In some cases, your psychologist may suggest involving others. If you’re having relationship problems, for instance, having a spouse or partner join you in a session can be helpful. Similarly, an individual having parenting problems might want to bring his or her child in. And someone who has trouble interacting with others may benefit from group psychotherapy.

As you begin to resolve the problem that brought you to psychotherapy, you’ll also be learning new skills that will help you see yourself and the world differently. You’ll learn how to distinguish between situations you can change and those you can’t and how to focus on improving the things within your control.

You’ll also learn resilience, which will help you better cope with future challenges. A 2006 study of treatment for depression and anxiety, for example, found that the cognitive and behavioral approaches used in psychotherapy have an enduring effect that reduces the risk of symptoms returning even after treatment ends. Another study found a similar result when evaluating the long-term effects of psychodynamic psychotherapy.

Soon you’ll have a new perspective and new ways of thinking and behaving.

How can I make the most of psychotherapy?

Psychotherapy is different from medical or dental treatments, where patients typically sit passively while professionals work on them and tell them their diagnosis and treatment plans. Psychotherapy isn’t about a psychologist telling you what to do. It’s an active collaboration between you and the psychologist.

In fact, hundreds of studies have found that a very important part of what makes psychotherapy work is the collaborative relationship between psychologist and patient, also known as a therapeutic alliance. The therapeutic alliance is what happens when the psychologist and patient work together to achieve the patient’s goals.

So be an active, engaged participant in psychotherapy. Help set goals for treatment. Work with your psychologist to come up with a timeline. Ask questions about your treatment plan. If you don’t think a session went well, share that feedback and have a dialogue so that the psychologist can respond and tailor your treatment more effectively. Ask your psychologist for suggestions about books or websites with useful information about your problems.

And because behavior change is difficult, practice is also key. It’s easy to fall back into old patterns of thought and behavior, so stay mindful between sessions. Notice how you’re reacting to things and take what you learn in sessions with your psychologist and apply it to real-life situations. When you bring what you’ve learned between sessions back to your psychologist, that information can inform what happens in his or her office to further help you.

Through regular practice, you’ll consolidate the gains you’ve made, get through psychotherapy quicker, and maintain your progress after you’re done.

Should I worry about confidentiality?

Psychologists consider maintaining your privacy extremely important. It is a part of their professional code of ethics. More importantly, it is a condition of their professional license. Psychologists who violate patient confidentiality risk losing their ability to practice psychology in the future.

To make your psychotherapy as effective as possible, you need to be open and honest about your most private thoughts and behaviors. That can be nerve-wracking, but you don’t have to worry about your psychologist sharing your secrets with anyone except in the most extreme situations.

If you reveal that you plan to hurt yourself or others, for example, your psychologist is duty-bound to report that to authorities for your own protection and the safety of others. Psychologists must also report abuse, exploitation, or neglect of children, the elderly, or people with disabilities. Your psychologist may also have to provide some information in court cases.

Of course, you can always give your psychologist written permission to share all or part of your discussions with your physician, teachers, or anyone else if you desire.

Psychologists take confidentiality so seriously that they may not even acknowledge that they know you if they bump into you at the supermarket or anywhere else. And it’s OK for you to not say hello either. Your psychologist won’t feel bad; he or she will understand that you’re protecting your privacy.

Assessing psychotherapy’s effectiveness

Some people wonder why they can’t just talk about their problems with family members or friends. Psychologists offer more than someplace to vent. Psychologists have years of training and experience that help people improve their lives. And there is significant evidence showing that psychotherapy is a very effective treatment.

How effective is psychotherapy?

Hundreds of studies have found that psychotherapy helps people make positive changes in their lives.

Reviews of these studies show that about 75% of people who enter psychotherapy show some benefit. Other reviews have found that the average person who engages in psychotherapy is better off by the end of treatment than 80% of those who don’t receive treatment at all.

How does psychotherapy work?

Successful treatment is the result of three factors working together:

• Evidence-based treatment that is appropriate for your problem
• The psychologist’s clinical expertise
• Your characteristics, values, culture, and preferences

When people begin psychotherapy, they often feel that their distress is never going to end. Psychotherapy helps people understand that they can do something to improve their situation. That leads to changes that enhance healthy behavior, whether it’s improving relationships, expressing emotions better, doing better at work or school, or thinking more positively.

While some issues and problems respond best to a particular style of therapy, what remains critical and important is the therapeutic alliance and relationship with your psychologist.

What if psychotherapy doesn’t seem to be working?

When you began psychotherapy, your psychologist probably worked with you to develop goals and a rough timeline for treatment. As you go along, you should be asking yourself whether the psychologist seems to understand you, whether the treatment plan makes sense, and whether you feel like you’re making progress.

Some people begin to feel better in about six to 12 sessions. If you don’t start seeing signs of progress, discuss it with your psychologist. Your psychologist may initiate a conversation about what to do. If he or she doesn’t, bring it up yourself. You could ask your psychologist about additional or alternative treatment methods, for example. Sometimes speaking up to your psychologist can be very empowering, especially since your psychologist will be understanding and nonjudgmental instead of offended.

Keep in mind that as psychotherapy progresses, you may feel overwhelmed. You may feel more angry, sad, or confused than you did at the beginning of the process. That doesn’t mean psychotherapy isn’t working. Instead, it can be a sign that your psychologist is pushing you to confront difficult truths or do the hard work of making changes. In such cases, these strong emotions are a sign of growth rather than evidence of a standstill. Remember, sometimes things may feel worse before they get better.

In some cases, of course, the relationship between a patient and the psychologist isn’t as good as it should be. The psychologist should be willing to address those kinds of issues, too. If you’re worried about your psychologist’s diagnosis of your problems, it might be helpful to get a second opinion from another psychologist, as long as you let your original psychologist know you’re doing so.

If the situation doesn’t improve, you and your psychologist may decide it’s time for you to start working with a new psychologist. Don’t take it personally. It’s not you; it’s just a bad fit. And because the therapeutic alliance is so crucial to the effectiveness of psychotherapy, you need a good fit.

If you do decide to move on, don’t just stop coming to your first psychologist. Instead, tell him or her that you’re leaving and why you’re doing so. A good psychologist will refer you to someone else, wish you lucky, and urge you not to give up on psychotherapy just because your first attempt didn’t go well. Tell your next psychologist what didn’t work to help ensure a better fit.

Knowing when you’re done

You might think that undergoing psychotherapy means committing to years of weekly treatment. Not so.

How long should psychotherapy take?

How long psychotherapy takes depends on several factors: the type of problem or disorder, the patient’s characteristics and history, the patient’s goals, what’s going on in the patient’s life outside psychotherapy, and how fast the patient is able to make progress.

Some people feel relief after only a single session of psychotherapy. Meeting with a psychologist can give a new perspective, help them see situations differently, and offer relief from pain. Most people find some benefit after a few sessions, especially if they’re working on a single, well-defined problem and didn’t wait too long before seeking help.

If you’ve been suffering from extreme anxiety, for example, you might feel better simply because you’re taking action—a sign of hope that things will change. Your psychologist might also offer a fresh perspective early in your treatment that gives you a new understanding of your problem. And even if your problem doesn’t go away after a few sessions, you may feel confident that you’re already making progress and learning new coping skills that will serve you well in the future.

Other people and situations take longer—maybe a year or two—to benefit from psychotherapy. They may have experienced serious traumas, have multiple problems, or just be unclear about what’s making them unhappy. It’s important to stick with psychotherapy long enough to give it a chance to work.

People with serious mental illness or other significant life changes may need ongoing psychotherapy. Regular sessions can provide the support they need to maintain their day-to-day functioning.

Others continue psychotherapy even after they solve the problems that brought them there initially. That’s because they continue to experience new insights, improved well-being, and better functioning.

How do I know when I’m ready to stop?

Psychotherapy isn’t a lifetime commitment.

In one classic study, half of psychotherapy patients improved after eight sessions. And 75% improved after six months.

You and your psychologist will decide together when you are ready to end psychotherapy. One day, you’ll realize you’re no longer going to bed and waking up worrying about the problem that brought you to psychotherapy. Or you will get positive feedback from others. For a child who was having trouble in school, a teacher might report that the child is no longer disruptive and is making progress both academically and socially. Together you and your psychologist will assess whether you’ve achieved the goals you established at the beginning of the process.

What happens after psychotherapy ends?

You probably visit your physician for periodic check-ups. You can do the same with your psychologist.

You might want to meet with your psychologist again a couple of weeks or a month after psychotherapy ends just to report how you’re doing. If all is well, you can wrap things up at that follow-up session.

And don’t think of psychotherapy as having a beginning, middle and end. You can solve one problem, then face a new situation in your life and feel the skills you learned during your last course of treatment need a little tweaking. Just contact your psychologist again. After all, he or she already knows your story.

Of course, you don’t have to wait for a crisis to see your psychologist again. You might just need a “booster” session to reinforce what you learned last time. Think of it as a mental health tune-up.

Source:

American Psychological Association. (2012, January 1). Understanding psychotherapy and how it works.