What is Psychotherapy and Who Does It Help?

What is Psychotherapy and Who Does It Help?

We all need our safe spaces where we can just “be” and speak freely. Psychotherapy may be that space.

You might or might not be surprised to learn that what you may have considered a therapy staple is, in fact, a rare occurrence. Few psychotherapists really have a chaise lounge for you to lie on.

In fact, not all psychotherapists work in the same way or offer the same services. The psychotherapy experience can vary widely depending on the therapist, modality you choose, and your goals.

The duration of therapy can also vary. It could be short term, or it could go on for years, depending on your needs and preference.

And with the ebb and flow of life, it’s not uncommon for many people to go through short-term therapy many times during their lifetime.

It’s also not uncommon to have questions and even reservations when deciding if and when to start psychotherapy. Learning more about what therapy entails and what the options are may help you feel more at ease when making a decision.

Psychotherapy is often referred to as talk therapy. It’s a term used to define an intervention or treatment for various mental health conditions and everyday challenges and concerns.

This intervention or treatment can involve different methods and strategies, and it’s usually tailored to your needs, too.

Psychotherapy is structured on sessions that can last between 40 and 120 minutes and repeat from a few times a week to once a month.

According to Stephanie Rojas, LMHC, “therapy is a protected space to work toward improving your mental health.”

This space can be a solo endeavor, or one where your whole family or partner work as a team with you.

In some instances, group therapy can also be effective, and this caters to individuals with a common goal or diagnosis.

Rojas explains that during your first few sessions of individual therapy, a therapist may ask a series of personal questions.

“This is to understand you best, and that’s what therapy is – a personal journey that requires time, strength, and patience,” she explains.

You may also have questions for your therapist during these first few sessions.

In general, it’s important to pay attention to how each session feels at first, says Rojas. “Notice if you’re feeling welcomed, accepted, validated, and understood. A therapist should work toward making you feel seen and heard.”

Building a rapport with your therapist may or may not happen in the first or second session. Once rapport is built, however, you may feel reassured in your decision to start therapy, Rojas says.

The therapeutic relationship is part of therapy and can make a world of difference in measuring your own progress toward meeting your mental health goals.

Psychotherapy has benefits for everyone, but typically, people seek out therapy to solve a problem.

Both adults and children can attend therapy and work through emotional, psychological, and mental challenges. These can include difficulty concentrating on tasks or feeling sad or confused about life.

Unlike what many people believe, therapy isn’t for “severe” cases only. Anyone can begin therapy at any time to improve or work through common concerns.

For example, you might be wondering how to improve your relationship with your parents. Therapy can help you with that.

Or, you may want to become more determined when aiming to meet your goals. A therapist can also support that process.

Psychotherapy can help you change specific behaviors or thought patterns, and it can also help you overcome challenges.

Sometimes, therapy might help you become aware of who you are or why you do some things.

When you start therapy, you might have your own goals, or you might express what’s on your mind, and your therapist can help you set those goals.

Regardless, Jeffrey M. Cohen, PsyD, believes it’s important to always work with a therapist who sets goals.

“Make sure that your goals for your therapy are clear,” he says. “You set the goals, and your therapist helps you reach them.”

Setting goals might make therapy feel more effective for you. You can often revise them and reflect on how far you’ve come since you started.

Ideally, the goals you set for therapy should be “measurement-based,” so they allow you and your therapist to monitor your progress.

Therapy is not limited to those times you’re seeking or working through a specific diagnosis. It also offers benefits for everyday challenges, and therapy can often be set for a short period of time.

Why you begin therapy is entirely up to you, and most therapists will work with you even when you’re unclear on what you want to get out of it.

Some of the most common reasons to seek therapy include:

  • anxiety episodes
  • symptoms of depression
  • trouble sleeping or other sleep disturbances
  • eating disorders
  • traumatic stress
  • addictive behaviors
  • conflict resolution
  • processing grief in general or after losing a loved one
  • marriage-related challenges
  • developing specific personal skills

Cohen explains that unlike talking with a loved one, therapy is “clinically validated to work.” That’s because it’s rooted in science and based on evidence.

“An evidence-based therapist is utilizing strategies and techniques that are clinically validated to help people,” Cohen explains. “Psychotherapy empowers people with coping skills to navigate life’s challenges.”

Research shows that many psychotherapy approaches are effective for a variety of instances.

A literature review, for example, found that long-term psychoanalytic therapy is highly effective for both reduction of specific symptoms and changes in personality. These effects seem to be long term.

Therapy is also effective for conditions that might take years to develop and are sometimes challenging to treat.

For example, another literature review showed that psychodynamic and cognitive behavioral therapies were effective in treating symptoms of different personality disorders.

How effective therapy is also depends on how much work you do during and in between sessions.

Even though a therapist might help you identify practical ways to change or improve behaviors, it’s up to you to do the “homework” and follow the guidance.

Therapy isn’t always the same. Many approaches look at human behavior and the psyche differently. Consequently, their strategies vary greatly.

These are a few common psychotherapy approaches:

Cognitive behavioral therapy (CBT) helps you identify thoughts and behaviors you want to change, and the therapist helps you create a plan to make those changes.

Acceptance and commitment therapy (ACT) is about accepting your thoughts and feelings without trying to change them. This therapy helps you do what matters to you in life by committing to action steps.

Dialectical behavior therapy (DBT) incorporates a dialectical worldview, which means two opposite ideas can be true simultaneously. DBT focuses on replacing problem behaviors with effective behaviors.

Psychoanalytic therapy seeks to access your unconscious mind to understand why you do what you do.

There are dozens of psychotherapy approaches. Which one is the best psychotherapy type? The one you feel most comfortable with!

Identifying what works better for you might not be a straightforward process, Rojas says. She recommends asking yourself these questions before deciding on a therapy approach:

  1. Do you want to go to therapy on your own, or do you want a family member to attend or your partner? Are you interested in being in a group with other people focusing on a similar goal? This will help identify if you want individual, family, couples, or group therapy.
  2. What do you want to work toward? For example, if you want to reduce your anxiety, it’s important to seek a therapist who has experience working with clients with this condition.
  3. Are you looking for medication in addition to therapy? If so, you’ll want to look for a psychiatrist, someone who is trained in mental health and can prescribe medication.

Once you’ve narrowed down a therapist who can speak to your needs, that individual will have an idea of which modality may be best for you.

This doesn’t mean you have to agree. In fact, sometimes you might want to try different approaches first before settling down with one.

There is also the possibility you might like a therapy approach, but you don’t connect with the therapist you’ve found.

“Finding the right therapist might be overwhelming, but it is important to keep in mind how comfortable you feel with this therapist and if you can continue to over time,” says Rojas.

Despite the possibility of the process being overwhelming, the benefits of therapy outweigh the possible roadblocks in your search.

Although many people prefer a one-on-one therapy format, the choice might not be as clear if your goal is to work through a relationship-based challenge.

In many instances, you’ll be able to combine formats, such as having some individual sessions and a few family or couple sessions, too.

You might want to begin with individual sessions and then work your way through integrating your loved ones into the process.

These are the therapy formats:

  • Individual therapy: A series of one-on-one sessions with a therapist. Many modalities can be applied.
  • Group therapy: Sessions in which many people working toward the same goals express their thoughts and feelings while being guided by one or more counselors or therapists. “In a group setting, psychotherapy may focus on skills to help participants build the life that they want,” Cohen explains.
  • Couple’s or family therapy: A series of sessions where family members meet with a therapist to provide experiences and concerns about a common topic.

Having the option to attend therapy from your home is essential. Still, you might wonder if online therapy sessions are as effective as in-person ones.

Experts believe that telemental health, or online therapy, is as effective as face-to-face therapy.

A few things you might want to keep in mind if you go with online care:

  • Verify your therapist’s credentials.
  • Save a quiet time and space for those sessions, if possible.
  • Double-check your internet connection and make sure you have a “plan B,” such as a phone number to call if you get disconnected.

The potential concerns about online therapy can often be corrected, says Brittany Johnson, LMHC.

“One drawback could be that the person’s home environment is not conducive to a therapy setting,” she says. If this is the case, sitting in your closet or your car could allow for privacy.

“It’s harder for the therapist to read the body language or pick up the nonverbal behaviors,” she adds. The solution, which many therapists have found, is asking probing questions that allow for deeper connections.

It depends. Because there are many reasons to attend therapy, the duration may vary according to your goals. Some people stay weeks in therapy and find their goals have been met. Others stay for years.

Duration of therapy might be a good topic for your first session. A few factors that may affect duration of therapy include:

  • personal goals
  • life situations that may be contributing to the challenge you want to work on
  • how long you’ve experienced symptoms
  • whether you’re working on a specific challenge or a general personal growth process
  • overlapping symptoms from different mental health conditions
  • frequency of your sessions

Sometimes, like many other relationships, a therapeutic bond might not work out. This can stem from different reasons, from chemistry to a therapist’s misconduct. Still, this doesn’t mean therapy cannot help you at all.

If you’re not feeling at ease in your therapy process, you could consider a different therapy approach or another therapist with different or more experience. You might also explore other types of therapy if talking isn’t what you want to focus on right now.

If your symptoms are severe, medication can help. Otherwise, approaches such as art therapy might provide a healing space without talking that much.

“For some people, talk therapy works great, while others may not want to talk or process their somatic or psychological reactions,” says Johnson. Either way, therapy does take participation.

Johnson recommends incorporating self-help books and coaching, if necessary.

Psychotherapy is a general term that is used to describe the process of treating psychological disorders and mental distress through the use of verbal and psychological techniques. During this process, a trained psychotherapist helps the client tackle specific or general problems such as a particular mental illness or a source of life stress.

Depending on the approach used by the therapist, a wide range of techniques and strategies can be used. Almost all types of psychotherapy involve developing a therapeutic relationship, communicating and creating a dialogue, and working to overcome problematic thoughts or behaviors.

Psychotherapy is increasingly viewed as a distinct profession in its own right, but many different types of professionals offer it, including clinical psychologists, psychiatrists, counselors, marriage and family therapists, social workers, mental health counselors, and psychiatric nurses.

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According to the American Psychological Association (APA), psychotherapy can be defined as a “collaborative treatment … between an individual and a psychologist” where the psychologist uses “scientifically validated procedures to help people develop healthier, more effective habits“. For a more in-depth discussion of what psychotherapy is and how it’s used, consult this PDF from the Southern California Psychiatric Society.

For our purposes, we can define psychotherapy as a psychological treatment for a variety of mental health disorders that may or may not be delivered in concert with pharmaceutical treatment.

Benefits of group therapy

Joining a group of strangers may sound intimidating at first, but group therapy provides benefits that individual therapy may not. Psychologists say, in fact, that group members are almost always surprised by how rewarding the group experience can be.

Groups can act as a support network and a sounding board. Other members of the group often help you come up with specific ideas for improving a difficult situation or life challenge, and hold you accountable along the way.

Regularly talking and listening to others also helps you put your own problems in perspective. Many people experience mental health difficulties, but few speak openly about them to people they don't know well. Oftentimes, you may feel like you are the only one struggling — but you're not. It can be a relief to hear others discuss what they're going through, and realize you're not alone.

Diversity is another important benefit of group therapy. People have different personalities and backgrounds, and they look at situations in different ways. By seeing how other people tackle problems and make positive changes, you can discover a whole range of strategies for facing your own concerns.

Psychotherapist Salary & Job Outlook

Psychotherapist salaries range with their specific role. Psychologists, for instance, make on average $75,000 per year, which translates to about $36 per hour, according to the Bureau of Labor Statistics. Social workers, on the other hand, can expect to make considerably less – about $47,000 per year and $23 per hour – while psychiatrists are at the high end of the salary spectrum when it comes to psychotherapy: $193,680 per year, or $93 per hour.

At first blush, it may seem like psychiatry is an obviously better role, but be sure to take into account the attendant duties that come with practicing psychiatry. The medical career path is very demanding, and requires you learn about a range of bodily systems beyond the brain, which may not interest some. Plus, you must meet federal regulations regarding the prescription of medication, which some find dull or onerous.

Demand for all these roles is growing at a rate much faster than average. Psychiatry careers are rising at a rate of 15 percent, while the rate is 19 percent for psychology and 12 percent for social work. If you complete your schooling and build a good resume, you will have no problem finding a job.

Clinical Psychologists and Psychiatrists: What’s the Difference?

For people who are seeking mental health services, the various types of providers available to help can seem overwhelming, especially if you’re not familiar with what each mental health specialist does. But among all these professionals, it’s likely that psychiatry and clinical psychology are most often confused. In part, this may be because clinical psychologists who hold either a PhD or a PsyD would be addressed as “Doctor,” just as a psychiatrist with either an MD or a DO.

Psychiatrists are also doctors, but are trained in medical school and receive degrees either as a Doctor of Medicine (MD) or as a Doctor of Osteopathic Medicine (DO). An exception to this is nurse practitioners who can specialize in psychiatry, and thus provide many of the same services as psychiatric physicians. These Psychiatric Nurse Practitioners (PNP) receive their education in nursing school, but then go on to obtain additional training in the practice of psychiatry. In this article, our discussion of psychiatrists will include nurse practitioners.
Between the two disciplines of clinical psychology and psychiatry, there are other similarities, but some important differences, nonetheless.

There is some real overlap between what clinical psychologists and psychiatrists offer. So, let’s first take a look at some of their similarities before we get to the differences. Both clinical psychologists and psychiatrists spend several years in the education and training of mental disorder evaluation and treatment, along with behavioral science. In practice, both can provide assessment, diagnosis and therapy for mental health disorders. When it comes to assessment, they both would conduct the clinical interview to understand a person’s presenting complaints and issues, and personal, health and family histories.

Both sets of professionals would also use the information and guidance of researched sources, such as the DSM-5, to develop a diagnosis, and begin to construct an appropriate treatment plan. Clinical psychologists and psychiatrists could include consultation with family members or other professionals involved in that person’s life and care. They both could also offer psychotherapy services along with their specific training and expertise to do so, along with other specialized services to improve social, occupational and interpersonal functioning.

Now let’s look at the differences, and why someone might be seen by either a psychologist or a psychiatrist. With respect to training, psychiatrists receive the great part of their education and experience in medical studies. Like other physicians, they are immersed in understanding human anatomy, physiology, medication diagnostics, and diseases and how to treat them. They graduate from medical school just the same as any physician, or nursing school in the case of nurse practitioners, and then go on to complete their specialty (a “residency”) in psychiatry.

This training after medical school provides them with a unique insight into mental disorders by studying brain and central nervous system functioning, and pharmacology, which is the study of medications and their effects on the body. Because of their larger knowledge of medical practice, they are in position to know how other diseases, including endocrine and metabolic disorders, poor nutrition, drug or alcohol abuse, or brain injuries can affect the mind and behavior.

They also can understand medication interactions, so that prescriptions for psychiatric disorders can be provided safely. During their residency program, most psychiatrists also get training and education in therapy styles and techniques.

Clinical psychologists typically do receive some training in understanding how the body—especially the brain—affects behavior, but it’s not their specialty. The emphasis for psychologists is on mental processes, including cognition (thoughts), mood and emotion, and behavior, along with understanding people in the context of the world around them, especially in their interpersonal interactions.

Psychologists offer focus on how the thoughts and behaviors of an individual can be changed to improve functioning, or how their deeper or repressed thoughts and emotions can be brought out and clarified for better understanding and awareness.

Psychiatrists generally do not provide psychological testing as clinical psychologists do, but they often work in collaboration with psychologists in the total assessment and diagnostic process of an individual, couple or family. Psychiatrists can also use the data from certain tests provided by psychologists to help determine what course of treatment may be most appropriate for any given psychiatric patient.

And while psychiatrists have the background to understand the intricacies of the brain and its effect on cognition, mood and behavior, some psychologists known as neuropsychologists focus on how the brain influences these areas of functioning, as well. Clinical neuropsychologists can provide specialized tests to assess how certain areas of the brain that are not functioning optimally due to disease, damage or developmental problems affect the daily lives of those individuals. Neuropsychologists may then work to provide therapies to address these problem areas, or provide test results to psychiatrists, along with neurologists or other therapists in a collaborative approach to care.

One obvious difference between psychiatrists and clinical psychologists is that psychiatrists can prescribe medications for mental disorders (although there are some exceptions as mentioned above). Psychiatrists generally provide a medication evaluation as a part of their initial assessment process. This is to see first if a person’s psychiatric condition might benefit from medications.

Not everyone who goes to a psychiatrist for an assessment might be appropriate for meds, but many people find relief from psychological symptoms with the aid of medication. If it is determined by the psychiatrist that a medication or combination of medications can be helpful, then a prescription would be suggested and provided, along with any additional treatment recommendation, often including psychotherapy.

It is then customary to schedule follow-up sessions with the psychiatrist to manage the medications and address any problems or issues as treatment progresses. This is often the primary role of a psychiatrist in mental health care. If he or she is not providing any therapy services beyond medications, the psychiatrist will often allow the patient to work with the therapist, such as a clinical psychologist, on their deeper and more complex life issues, while making sure the medications are effective, and offer little or no side effects.

Again, not every person seeking mental health services may require medication. Generally, psychotherapy is considered the treatment of choice, with or without medications involved. But when medications are indicated, the psychiatrist and therapist can provide a dual treatment approach that can offer the best outcomes. And there may also be instances when therapy is concluded, but the need for medication continues. In this case, medications may be renewed and occasionally monitored by the treating psychiatrist after meetings with the psychologist is no longer needed.

The Positive Psychotherapy Model (inc. Table with Brief Session Descriptions)

Similar to other therapy models, the PPT model focuses on a series of sessions aimed at uncovering ideas, desires, vulnerabilities and strengths, and working through them to reach positive reframing and overall balance between the positive and the negative.

The below outline of sessions is a brief overview of the PPT model. Some versions of this relate more to the approach developed by Pesechkian, and as with all therapy models, there can be slight nuances depending on the therapist and where they practice.

Session and Topic Description
Orientation to PPT Current Positive Resources Psychological distress is discussed as a lack of positive resources, such as positive emotions, relationships, meaning, and accomplishment.
To explore this, the therapist might use an exercise that encourages the individual to write a one-page, real-life story that called for the best in them and has a positive ending.
Individual Character Strengths In this session, individual character strengths are explored, and the concept of engagement and flow is introduced.
To begin exploring individual character strengths, the individual may be asked to identify what they believe are their signature strengths both in the session and through an online self-report.
They may also ask two other close persons to rate their signature strengths.
Signature Strengths & Positive Emotions Following on from the last session, signature strengths are discussed in more detail.
As an exercise, the therapist may ask the individual to compile a signature strengths profile, which could include setting SMART (specific, measurable, achievable, realistic, and timely) goals.
Good vs. Bad Experiences, Symptoms or Memories The concept of how negative experiences and symptoms can be perpetuated is discussed in alignment with positive experiences.
The therapist might use an exercise that asks the individual to explore a memory or experience that elicited feelings of anger, bitterness, or resentment and how these feelings further perpetuated the negative experience.
Forgiveness Forgiveness is explored as a resource to reframe negative symptoms and feelings into more positive emotions.
The therapist might use a letter-writing exercise that asks the participant to remember a negative experience and to write out a letter of forgiveness towards the perceived transgressor/s of the scenario – themselves included.
Gratitude Alongside forgiveness, gratitude is explored as a resource for generating better balance, and to view individual circumstances more positively.
The role of positive and negative memories, feelings, and symptoms are discussed with an emphasis on gratitude for all the lessons both of these states have allowed for.
The therapist might use gratitude journaling as an exercise to help build more focus and awareness of all the things for which the individual is grateful.
Mid-Therapy Check At this point, the therapist may follow up on any at-home tasks related to the forgiveness and gratitude sessions, and to revisit any of the previous sessions that may feel unresolved.
This is also the opportunity for the individual to discuss their perceived gains or hurdles they might be experiencing so far as an outcome of the sessions.
As an exercise, the therapist may seek to explore different ways the individual can overcome any of the hurdles, utilizing their signature strengths uncovered previously.
Satisficing vs. Maximizing The therapist may now introduce the two concepts of satisficing (mainly, being ‘good enough’) and maximizing.
The individual may be asked to explore the different ways in life they have not felt ‘good enough’ and to tell the story of one experience where they did feel good enough, and one where they did not.
Again, these can be explored regarding the individual’s signature strengths.
Hope and Optimism The additional concepts of optimism and hope are explored.
As an exercise, the therapist may ask the individual to think about a time when they may have felt they lost out on something, only to discover it opened up new opportunities.
Positive Communication Various interventions that involve developing positive communication, such as Active-constructive, are explored and referenced in association to the individual’s signature strengths.
Signature Strengths of Others The importance of recognizing, acknowledging, and associating with the signature strengths of the key people the individual has close relationships with is explored.
As an exercise, the therapist may ask the individual to draw up a ‘Family Strengths Tree’ where the individual asks their significant relationships to complete an online self-report strengths test and identify their signature strengths.
These can then be discussed in the session.
Savoring The concept of savoring is explored, as well as some of the techniques and strategies that can be used to prevent adaptation, along with techniques and strategies to safeguard against adaptation.
Gift of Time and Positive Legacy The benefits of kindness, sharing, and helping others are explored and discussed in alignment with therapeutic outcomes.
As an exercise, the therapist might ask the individual to make plans for how they might give the gift of their time utilizing their signature strengths.
The Full Life In the final session, ‘The Full Life’ is discussed in terms of what the individual feels they have that leads to this.
Therapeutic gains are discussed, focusing on positive emotions, engagement, and meaning.
How to keep this momentum going is also discussed, and ways of doing this are devised with the individual taking the lead and considering their signature strengths to achieve this.

As mentioned, the above is a brief overview of the sessions that can be included in the PPT model. If you’d like to find out more about the model and detailed descriptions of the sessions, as well as interventions and positive psychotherapy exercises that can be used within them, you can find more information through the Positive Psychology Toolkit.

Using Developmental Psychology in Treatment

Research in developmental psychology has provided an understanding of how people progress. More specifically, it aims to describe and address the basic milestones that are likely to occur at certain ages. If an individual is not meeting a milestone at the expected time, a developmental psychologist can assess the situation and often develop intervention strategies to help people continue through the typical stages of development.

Helping professionals versed in the concepts of developmental psychology may be able to help people in treatment increase their understanding of what to expect at any given point in life. Erikson's theory of development, for example, describes the typical/expected outcomes and challenges that are likely to occur at each stage of development, and individuals who have knowledge of these stages may find it helpful to know what to expect when they, their children, or other family members are going through a life transition or important phase.

Developmental psychology can also contribute to the understanding and treatment of developmental disabilities.

Concerns and Limitations of Depth Therapy

Depth therapy is typically a lengthy and relatively expensive form of therapy. Before starting depth therapy, the therapist should share information about the potential costs associated with the treatment. Individuals seeking therapy should also be aware that other forms of treatment may address the issues prompting them to seek treatment in a shorter period of time. Due to a desire to decrease the cost of health care, many insurance companies require providers of therapy to conduct planned and time-limited therapy. Depth therapy is not well-suited to the constraints of many health insurance companies, and people seeking treatment should be aware their treatment may not be covered by insurance.

Historically, the various forms of depth therapy were used to treat a number of mental health conditions, but according to recent studies, as well as anecdotal evidence from mental health practitioners, depth therapy may be better suited to some individuals than others. These approaches typically involve intense emotional work and require a high level of motivation on the part of the individual participating in treatment. Some individuals may prefer a briefer, more solution-focused treatment approach. Depth therapy also requires people to confront feelings and memories that may be painful, and those participating in depth therapy should understand the approach will likely elicit strong, potentially negative emotions and that they may feel worse before they begin to feel better.