Psychotherapy

Overview

Psychotherapy is an approach for treating mental health issues by talking with a psychologist, psychiatrist or another mental health provider. It also is known as talk therapy, counseling, psychosocial therapy or, simply, therapy.

During psychotherapy, you learn about your specific issues and how your thoughts, emotions and behaviors affect your moods. Talk therapy helps you learn how to take control of your life and respond to challenging situations with healthy coping skills.

There are many types of psychotherapy. The type that's right for you depends on your situation.

Why it's done

Psychotherapy can help treat most mental health issues, including:

• Anxiety disorders, such as social anxiety, obsessive-compulsive disorder (OCD), phobias, panic disorder or post-traumatic stress disorder (PTSD).
• Mood disorders, such as depression or bipolar disorder.
• Addictions, such as alcohol use disorder, drug dependence or compulsive gambling.
• Eating disorders, such as anorexia or bulimia.
• Personality disorders, such as borderline personality disorder or dependent personality disorder.
• Schizophrenia or other disorders that cause detachment from reality.

Not everyone who benefits from psychotherapy is diagnosed with a mental illness. Psychotherapy can help with the stresses and conflicts of life that can affect anyone.

For example, psychotherapy may help you:

• Resolve conflicts with your partner or someone else in your life.
• Relieve anxiety or stress due to work or other situations.
• Cope with major life changes, such as divorce, the death of a loved one or the loss of a job.
• Learn to manage unhealthy reactions, such as road rage or other aggressive behavior.
• Come to terms with an ongoing or serious health issue, such as diabetes, cancer or long-term pain.
• Recover from physical or sexual abuse or witnessing violence.
• Cope with sexual problems, whether they're due to a physical or psychological cause.
• Sleep better if you have trouble getting to sleep or staying asleep.

In some cases, psychotherapy can be as effective as medicines, such as antidepressants. But depending on your situation, talk therapy alone may not be enough to ease the symptoms of a mental health condition. You also may need medicines or other treatments.

Risks

Psychotherapy generally involves little risk. But because it can explore painful feelings and experiences, you may feel emotionally uncomfortable at times. A skilled therapist who can meet your needs can minimize any risks.

Learning coping skills can help you manage and conquer negative feelings and fears.

How you prepare

Here's how to get started:

• Find a qualified mental health therapist. Get a referral from a health care provider, health insurance plan, friend or another trusted source. Many employers offer counseling services or referrals through employee assistance programs, also known as EAPs. Or you can find a therapist on your own. You could start by looking for a professional association on the internet. Look for a therapist who has skills and training in the area that you need help addressing.
• Understand the costs. If you have health insurance, find out what coverage is available for psychotherapy. Some health plans cover only a certain number of psychotherapy sessions a year. Also, talk to your therapist about fees and payment options.
• Review your concerns. Before your first appointment, think about what issues you'd like to work on. You also can sort this out with your therapist but having some sense in advance may provide a good starting point.

Check qualifications

Before seeing a psychotherapist, check the person's background, education, certification, and licensing. Psychotherapist is a general term rather than a job title or an indication of education, training or licensure.

Trained psychotherapists may have different job titles, depending on their education and role. Most have a master's or doctoral degree with training in psychological counseling. Medical doctors specializing in mental health are known as psychiatrists. They can prescribe medicines, and some may provide psychotherapy.

Examples of psychotherapists include:

• Psychologists.
• Psychiatrists.
• Licensed professional counselors.
• Licensed social workers.
• Licensed marriage and family therapists.
• Psychiatric nurses.
• Other licensed professionals with mental health training.

Make sure that the therapist you choose meets state certification and licensing requirements. The key is to find a skilled therapist who can match the type and intensity of therapy with your needs.

What you can expect

Your first therapy session

At the first psychotherapy session, the therapist usually gathers information about you and your needs. You may be asked to fill out forms about your physical and emotional health. It might take a few sessions for your therapist to fully understand your situation and concerns and determine the best course of action.

The first session is also an opportunity for you to interview your therapist. You'll be able to see whether the therapist's approach and personality are going to work for you. Make sure you understand:

• What type of therapy will be used.
• The goals of your treatment.
• How long each session will be.
• How many therapy sessions you may need.

Ask questions anytime during your appointment. If you don't feel comfortable with the first therapist you see, try someone else. Having a good fit with your therapist is critical for effective treatment.

Starting psychotherapy

You'll likely meet your therapist weekly or every other week for 45 minutes to one hour. These sessions could be held in the therapist's office, or you could meet during a video visit. Psychotherapy also can take place in a hospital if you've been admitted for treatment. In the hospital, psychotherapy focuses on safety and becoming more mentally and emotionally stable.

Types of psychotherapy

Some types of psychotherapy work better than others in treating certain disorders and conditions. Your therapist will consider your situation and preferences to determine which approach or combination of approaches is best for you.

Some psychotherapy methods proven effective include:

• Cognitive behavioral therapy (CBT), which helps you identify unhealthy, negative beliefs and behaviors and learn healthier coping skills.
• Dialectical behavior therapy, a type of CBT that teaches behavioral skills to help you handle stress, manage your emotions and improve your relationships with others.
• Acceptance and commitment therapy, which helps you become aware of and accept your thoughts and feelings. It also helps you commit to making changes and improves your ability to cope with, and adjust to, challenging situations.
• Psychodynamic and psychoanalysis therapies, which focus on increasing your awareness of thoughts and behaviors that you may not be aware of. These therapies help you find out what motivates you and help you resolve conflicts.
• Interpersonal psychotherapy, which focuses on problems with your relationships with other people to improve how you relate to others, such as family, friends and co-workers.
• Supportive psychotherapy, which improves your ability to cope with stress and difficult situations.

Online apps are available that use several methods.

Psychotherapy formats include individual, couple, family or group sessions. These formats can be effective for all age groups.

During psychotherapy

For most types of psychotherapy, your therapist encourages you to talk about your thoughts and feelings and what's troubling you. Don't worry if you find it hard to open up about your feelings. Your therapist can help you gain more confidence and comfort as time goes on.

Because psychotherapy sometimes involves intense emotional discussions, you may find yourself crying, becoming upset or even having an angry outburst during a session. You also may feel physically exhausted after a session. Your therapist can help you cope with these feelings and emotions.

After a session, your therapist may ask you to do specific activities or practice what you learned. Over time, discussing your concerns can improve your mood and change the way you think and feel about yourself. It also can improve your ability to cope with problems.

Confidentiality

Except in rare cases, conversations with your therapist are confidential. But a therapist may break confidentiality if there's an immediate threat to safety or when state or federal law requires reporting concerns to authorities. Your therapist can answer questions about confidentiality.

Length of psychotherapy

The number of psychotherapy sessions you need and how frequently you need to see your therapist depends on factors such as:

• Your mental health issues.
• Severity of your symptoms.
• How long you've had symptoms or have been dealing with your mental health issues.
• How quickly you make progress toward your treatment goals.
• How much stress you're experiencing.
• How much your mental health concerns interfere with daily life.
• How much support you receive from family members and others.
• Cost and insurance limitations.

The length of psychotherapy sessions also can depend on the method used. For example, cognitive behavioral therapy consists of a shorter course of treatment. But dialectical behavior therapy can take longer. Your therapist can help you understand how long treatment will take.

It may take only weeks to help you cope with a short-term issue. Or treatment may last a year or longer if you have a long-term mental health issue or other long-term concerns.

Results

Psychotherapy may not cure your condition or make an unpleasant situation go away. But it can give you the power to cope in a healthy way and feel better about yourself and your life.

Getting the most out of psychotherapy

To get the most out of psychotherapy, take these steps:

• Make sure you feel comfortable with your therapist. If you aren't comfortable, look for another therapist who can make you feel more at ease.
• Approach therapy as a partnership. Psychotherapy is most effective when you actively participate and share in decision-making. Make sure you and your therapist agree about the major issues and how to work on them. Together, you can set goals and measure progress over time.
• Be open and honest. Success depends on your willingness to share your thoughts, feelings and experiences. It also depends on whether you're willing to consider new insights, ideas and ways of doing things. If you hesitate to talk about certain issues because of painful emotions, embarrassment or fears about your therapist's reaction, let your therapist know.
• Follow your treatment plan. If you feel down or lack motivation, it may be tempting to skip psychotherapy sessions. But doing so can slow your progress. Try to attend all sessions and think about what you want to discuss.
• Don't expect instant results. Working on emotional issues can be painful, and it may require hard work. You may need several sessions before you begin to improve.
• Do your homework between sessions. If your therapist asks you to document your thoughts in a journal or practice coping skills outside of your therapy sessions, follow through. These assignments can help you apply what you've learned in the therapy sessions.
• If psychotherapy isn't helping, talk to your therapist. If you don't feel that you're benefiting from therapy after several sessions, talk to your therapist about it. You and your therapist may decide to make some changes or try a different approach that may be more effective.

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