What is Psychotherapy?
Psychotherapy is a healing art that aims to help you feel more comfortable within yourself and function better in the world. A client (or patient) in psychotherapy typically meets one-on-one with a psychotherapist (most commonly just called a therapist), who helps them to explore their thoughts, feelings, and experiences in a safe, non-judgemental space. The therapist can also guide the client through changing how they relate to aspects of their lives that feel uncomfortable or painful, and teach them practical coping skills.
The core of psychotherapy is the relationship between the client and the therapist. While there are many different forms of psychotherapy, all of them involve the therapist creating an environment where the client feels safe opening up, sharing what’s going on and getting help. A sense of trust and connection between client and therapist has been consistently found to be the most important part of therapy—responsible for roughly two-thirds of the benefits.
Psychotherapy may be used to treat or help treat virtually all mental and emotional health disorders, as well as help people deal with the ordinary stresses of living or navigating relationships with others. You don’t have to have serious emotional challenges to see a therapist—many people use it as a means of supporting wellness. Psychotherapy can also be useful for someone struggling with disease or illness that has an emotional or stress-related component.
Psychotherapy is performed by mental health professionals. These include social workers, psychologists, psychiatrists, counselors and other trained professionals. Mental health professionals are either licensed to practice on their own, or work under a licensed supervisor.
“A lot of my clients meet with me just to be growing in positive ways amidst the ups and downs of life,” shares psychotherapist Karolynn Coleman, LCSW. “We can always benefit from meeting with someone to expand our awareness of what’s happening and gain more skillful means for the benefit of ourselves and others. Some people call therapy a two-person meditation. Also, when people are experiencing high stress it’s very important and helpful to have very high levels of support.”
How does psychotherapy work?
Many people associate psychotherapy with the image of a client lying on a couch talking to their therapist. That’s not wrong (although most people don’t lie down during therapy anymore). Psychotherapy is about listening, communication and empathy—the heart of any good relationship. Different forms of therapy take different approaches to treatment, but the goal of any therapist is to help their clients to share and work through any issue that they may be struggling with.
History and philosophy
The modern practice of psychotherapy began to develop during the 19th century. Early psychotherapists studied the role of the mind in healing various ailments, incorporating what was then called the talking cure into their practices. Hypnosis often played a role. Sigmund Freud, the most famous early proponent of psychotherapy, believed that most psychological disorders were the result of experiences in childhood, which created conflict within a person’s unconscious mind. Freud developed an approach called "psychoanalysis," which involved a long-term exploration of a patient’s life and memories in an attempt to uncover and resolve unconscious conflicts.
Over the course of the 20th century, psychotherapy began to thrive as a discipline. Some therapists followed in Freud’s path, while others developed different approaches that focused on various aspects of thinking, behavior, and relationships with others. Some therapies were emphatically practical: the goal was to identify and change problem behaviors and associated thought patterns. Others sought to treat deeper, more existential forms of suffering. Carl Rogers, a prominent psychologist of the mid-to-late 20th century, taught that helping the client to feel unconditionally accepted was the most important aspect of therapy. Cognitive-behavioral therapy, which aims to explore and challenge beliefs that may be inaccurate and create a negative impact on how you perceive the world around you, became especially popular.
In recent decades, there has also been an increasing interest in mindfulness, and related concepts like present moment acceptance. These ideas, which are prominent in Eastern philosophies like Buddhism and Taoism, have become part of many approaches to psychotherapy. Freud’s belief in the importance of childhood experiences also continues to play a major role in influencing how therapists practice, although his original theories have been either developed considerably or discarded.
There is a medical aspect to psychotherapy. Therapists may assess and diagnose their clients with mental and emotional health disorders. This can be useful for dealing with certain conditions, as it can help indicate what approach to therapy might be most appropriate.
However, many therapists prefer to view their clients holistically. They don’t see you as sick, but simply as someone seeking to grow and work through stumbling blocks that come up along the way. From this perspective, a therapist isn’t treating you, but acting as a guide or helper. Any diagnosis they may make is seen more as an indication of where you are in the moment, rather than a permanent label or who you are.
Psychotherapy is both an art and an evidence-based practice. The relationship between a client and therapist is not something that can be quantified. However, many different therapeutic approaches have been rigorously studied, and there is significant evidence supporting all of the major approaches to therapy.
Many therapists describe their work as a balancing act: being present and human with their clients, while retaining awareness of the proven best practices for how to treat a given condition. They must also take into account that everyone is different; just because a particular therapeutic technique works well most of the time doesn’t mean it will work for any one particular client. This means that for the therapist as well as the client, a therapy session is a work in progress.
Many contemporary forms of therapy—including dialectical behavioral therapy (DBT) and the related cognitive behavioral therapy (CBT)—are manualized. This means practitioners often follow a set, evidence-based outline for how to conduct treatment. However, the therapist is also meant to improvise within the established framework.
“I don’t think so much in terms of diagnosis, but rather in descriptive behaviors, what behaviors are working or not working, and learning to deal with them more skillfully. I find DBT is a very effective form of treatment, done individually and in a group—usually both—which is a way of having he strategies go deeper. Often people who’ve had trauma find it very difficult to have empathy for themselves. When they see the struggles others go through they can progress to having empathy for themselves and to effectively integrating the strategies. The groups are very, very powerful.”
It’s a great idea to communicate with your therapist about what works and what doesn’t, as this can help you get more out of the experience.
Types of psychotherapy
There are literally hundreds of different types of psychotherapy. Many are simply minor variations on one another, however, major distinctions do exist. Some therapists focus on the present—helping you explore what problems are going on in your life right now and how to deal with them. Others are more interested in the past—how your history is causing conflict in your mind. Some primarily aim to help you feel accepted for whatever is coming up during the session.
In other words, some therapists want to help you problem solve, others want to explore your unconscious mind, and some want to support your continued growth. Many therapists combine different approaches as needed. In addition, some types of therapy, like family therapy or couples counseling, are explicitly focused on relationships.
While most psychotherapy is talk therapy, some therapists, especially those who work with children or people suffering from trauma, use other methods, including art, music, writing or role-play to help their clients express themselves. Some therapists also incorporate practices like mindfulness meditation or deep breathing into their sessions.
Psychotherapy can last anywhere from a few weeks to years. That depends on both you and what you want out of therapy, and the type of therapy or style of the therapist. Some specific types of therapy are meant to last 3-6 months; others are much more open-ended. It is also common for people to be in and out of therapy—seeing their therapist periodically, as needed. If you are seeking therapy specifically to deal with a mental or emotional health disorder, a therapist can assess you and help you determine what type of psychotherapy might be best suited to working with your condition.
A few of the more prominent types of psychotherapy include:
Cognitive behavioral therapy (CBT)
One of the most popular forms of psychotherapy today, cognitive behavioral therapy aims to help you change how you perceive events. CBT focuses on identifying and shifting thought patterns that might be making life harder for you—conscious or unconscious beliefs that could be interfering with your well-being. CBT is typically a more organized, goal-oriented form of psychotherapy; sessions often follow a structure and tend to be focused on the present, rather than the past. It is commonly used to treat a wide range of mental health disorders.
Dialectical behavioral therapy (DBT)
An offshoot of CBT, dialectical behavioral therapy was developed by Dr. Marsha Linehan as a treatment for borderline personality disorder. DBT combines many aspects of CBT, an emphasis on developing mindfulness, and accepting the present moment exactly as it is. It has become an increasingly popular treatment for many mental health disorders, including depression, addiction, PTSD and mood disorders. DBT has proven especially effective at treating conditions that may not respond well to other forms of therapy.
Acceptance and commitment therapy (ACT)
Acceptance and commitment therapy is grounded in the practices of mindfulness, present moment acceptance, and letting your values guide your actions. An ACT therapist could help guide you in developing the ability to observe yourself, let go of your identification with your thoughts and accept your experience in any given moment. ACT also aims to help you identify what matters to you, and pursue it.
Originally developed by Carl Rogers, person-centered therapy is based on the idea that the therapist should offer the client empathy and unconditional positive regard. The goal of person-centered therapy is to give you a space to freely express yourself and be accepted for whatever comes out. Therapists practicing person-centered therapy also aim to be more open and vulnerable themselves during sessions.
An evolution of the psychoanalysis practiced by Freud, psychodynamic therapy seeks to explore the unconscious mind. Therapists practicing this approach believe that psychological suffering is usually the result of childhood trauma or difficulties and seek to help you explore and let go of the layers of psychological defenses you may have built around early wounds. Your relationship with your therapist is meant to bring any psychological issues you are struggling with up to the surface, where they can then be examined.
Family therapy can be any type of therapy that is designed to develop and heal relationships between family members and strengthen the functioning of the family unit. While typically several or all members of the family attend sessions together, family systems therapy, pioneered by Murray Bowen, a psychiatrist and professor at Georgetown University, facilitates family therapy with just one person. This approach looks at the whole intergenerational family system. Marriage or couples counseling is also common.
Mindfulness-based stress reduction (MBSR)
Mindfulness-based stress reduction is an eight-week program created by Jon Kabat-Zinn, a scientist and Buddhist practitioner. MBSR involves weekly group meetings in which participants learn how to develop mindfulness and let go of stress through practices like meditation, body scanning, and yoga. The goal of MBSR is to help you live with greater acceptance and ease. While not a traditional form of talk therapy, MBSR is a popular therapeutic intervention.
While psychotherapy usually takes place in a one-on-one session between a client and therapist, group therapy has become increasingly popular. A group therapy session offers clients a chance to receive support from the other members of the group, as well as the therapist. Therapy groups typically consist of 5-10 clients, with a therapist leading each session. There is no one type of group therapy; the therapist may employ whatever school or type of psychotherapy they deem appropriate. Group therapy tends to be less expensive than individual therapy.
What are the benefits of psychotherapy?
Psychotherapy can be used to treat virtually all mental and emotional health conditions, reduce stress, improve relationships, navigate difficult life circumstances, develop self-awareness and expression, and otherwise support your well-being and quality of life.
Some specific benefits of therapy include:
Supporting mental and emotional health
Therapy is commonly used to help people who are struggling with mental and emotional health problems. These include conditions like depression, anxiety, trauma, post-traumatic stress disorder (PTSD), bipolar disorder, and personality disorders. Therapy can also be helpful for processing grief or loss, or otherwise coming to terms with painful emotional experiences.
Dealing with short-term problems
Many people, when confronted with unexpected, painful life circumstances—like losing a job, a breakup or money problems—can experience feelings of fear, sadness, frustration and other similar emotions. These are completely normal and don’t mean that there is anything wrong with you, but they can still be overwhelming and difficult to live with. Therapy can help you explore and express these feelings and the situation that may have caused them, making it easier to move forward.
Improving quality of life
Therapy can be a useful wellness tool. Many people use therapy as a means of lowering their stress, expressing themselves and learning how to navigate life with greater ease. Sometimes, it’s just good to have someone you can talk to.
Developing healthy relationships
Therapy can be a great way to get better at relating to others. For many people, therapy offers an opportunity to be completely honest with someone, and be accepted for that. Building a supportive, trusting relationship with a therapist can help you experience what that sort of dynamic feels like, which makes it easier to go about establishing relationships like that outside of therapy. In addition, a therapist can help you (and your loved ones) to work through conflict in relationships.
Growing your self-awareness
Therapy can help you become more aware of yourself and how you are as a person. Therapists comfortable with mindfulness techniques are often especially useful in this regard and can help you to see yourself more clearly. This can help you live with greater ease.
Safety and side effects
Psychotherapy is safe and has no side effects in the typical sense. However, a psychotherapy session can sometimes bring up painful emotions or trauma. A trained therapist is equipped to help you deal with this in the moment, but it is not uncommon for such feelings to continue after the session is over. That is normal and okay.
However, if your feelings become too overwhelming, or if you otherwise feel that you may harm yourself or attempt suicide for any reason, call 911 or the National Suicide Prevention Lifeline at 1-800-273-8255. You can also reach out via web chat.
The following expert reviewed and contributed to this article:
Karolynn Coleman, LCSW, psychotherapist and certified meditation teacher.
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