About Psychotherapy

Psychotherapy, also sometimes called talk therapy, is the treatment of a mental disorder through a series of conversations and interactions with a trained therapist. When people imagine a psychotherapy session, they may picture themselves lying on a couch, describing recent dreams or using free association to help uncover what may be repressed in the unconscious. This type of therapy, known as Freudian psychoanalysis, is a long and expensive process that often requires three to five sessions a week for several years. Freudian psychoanalysis is rarely used today.

Most patients with depression or anxiety who see a therapist are treated with other forms of psychotherapy. Several types of psychotherapy are commonly used today, including

  • psychodynamic,
  • cognitive,
  • behavioral,
  • interpersonal,
  • supportive and
  • group therapy.

These types of treatments differ from Freudian psychoanalysis. For example, most therapy involves the patient sitting in a chair having a face-to-face conversation with the therapist, and the therapy is often focused on a specific issue and lasts for a limited time period.

In addition, psychotherapists interact with the patient by posing questions and offering advice, rather than allowing the patient to free-associate uninterrupted.

Psychotherapy can be provided by any licensed health care professional who has appropriate training, including a psychiatrist, psychologist, clinical social worker or clinical nurse specialist. Therapy sessions are usually conducted in the therapist's office once per week for 30 to 60 minutes.

Although the various types of psychotherapy are based on different principles, they do share some common features. Having a general sense of what will occur in a therapy session may help you feel more comfortable if you are beginning psychotherapy for the first time.

The therapist will try to put you at ease during the first few visits, but feeling nervous or uncomfortable from time to time is normal and should not be taken as a sign that the therapy is not working.

At the first visit, the therapist will thoroughly assess your emotional and physical health. This will involve asking questions about your current psychological condition, your medical history, any past emotional problems or substance abuse, any medications you are taking, and any family history of mood or emotional disorders. This information will help the therapist identify factors that may be contributing to your disorder or needs that should be addressed during therapy.

Also, you and your therapist will work together to set goals during the first few weeks. Goals vary from patient to patient. Some people want to relieve the symptoms of depression, while others want to explore deep-rooted thoughts and behaviors. Goals can be general, such as "being more confident" or "having a better relationship with my spouse." You should assess your progress toward your goals periodically but not at every session, since therapy can be a slow process.

A psychotherapist will try to help you change your thoughts and behaviors without telling you what to do. In most types of psychotherapy, the therapist will encourage you to talk but may also ask questions or give advice. The therapist should not control the conversation but should help you focus the discussion to make it as productive as possible.

Different types of therapists will address your problems in different ways. Take the example of a patient who is a perfectionist and is upset when he or she achieves anything less than complete success. A psychodynamic therapist might encourage the patient to think about past experiences—such as having a parent who was overly critical—that might be causing this problem.

A cognitive therapist focuses on the present rather than the past and tries to change current patterns of negative thinking. For example, making a mistake might cause the patient to think, "I can't do anything right." A cognitive therapist would help the patient realize the negative impact of this type of thinking and provide a different reaction: "I make mistakes sometimes, but I am a competent person."

A behavioral therapist would help the patient see how he or she gravitates to people who are overly critical and would suggest ways to identify and overcome such behavior, eventually helping the patient to seek out people who are more supportive.

A psychotherapist, especially a cognitive or behavioral therapist, may also assign homework to be done between sessions. These assignments might include writing down thoughts and feelings or having an uncomfortable or dreaded conversation with a relative or friend.

Updated by Remedy Health Media

Publication Review By: Karen L. Swartz, M.D.

Published: 18 Jun 2013

Last Modified: 06 Nov 2015