What is Psychotherapy?
Psychotherapy, or "talk therapy", is a way to treat people with a mental disorder by helping them understand their illness. It teaches people strategies and gives them tools to deal with stress as well as unhealthy thoughts and behaviors. Psychotherapy helps individuals manage their symptoms better and function at their best in everyday life. Sometimes psychotherapy alone may be the best treatment for a person, depending on the illness and its severity. Other times, psychotherapy is combined with medications. Clinician's work with an individual or families to devise an appropriate treatment plan.
What are the different types of psychotherapy?
There are a variety of psychotherapy modalities. There is no "one-size-fits-all" approach. In addition, some therapies have been scientifically tested more than others. Some people may have a treatment plan that includes only one type of psychotherapy. Others receive treatment that includes elements of several different types. The kind of psychotherapy a person receives depends on his or her needs.
The section below explains several of the most commonly used psychotherapies. However, it does not cover every detail about psychotherapy. Patients should talk to their clinician about planning treatment that meets their needs.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a blend of two therapies: cognitive therapy (CT) and behavioral therapy. CT was developed by psychotherapist Aaron Beck, M.D., in the 1960's. CT focuses on a person's thoughts and beliefs, and how they influence a person's mood and actions, and aims to change a person's thinking to be more adaptive and healthy. Behavioral therapy focuses on a person's actions and aims to change unhealthy behavior patterns.
CBT helps a person focus on his or her current problems and how to solve them. Both patient and therapist need to be actively involved in this process. The clinician helps the patient learn how to identify distorted or unhelpful thinking patterns, recognize and change inaccurate beliefs, relate to others in more positive ways, and change behaviors accordingly. CBT can be applied and adapted to treat many specific mental disorders.
CBT for depression
Many studies have shown that CBT is a particularly effective treatment for depression, especially minor or moderate depression. Some people with depression may be successfully treated with CBT only. Others may need both CBT and medication. CBT helps people with depression restructure negative thought patterns. Doing so helps people interpret their environment and interactions with others in a positive and realistic way. It may also help a person recognize things that may be contributing to the depression and help him or her change behaviors that may be making the depression worse.
CBT for anxiety disorders
CBT for anxiety disorders aims to help a person develop a more adaptive response to a fear. A CBT therapist may use "exposure" therapy to treat certain anxiety disorders, such as a specific phobia, post traumatic stress disorder, or obsessive compulsive disorder. Exposure therapy has been found to be effective in treating anxiety-related disorders. It works by helping a person confront a specific fear or memory while in a safe and supportive environment. The main goals of exposure therapy are to help the patient learn that anxiety can lessen over time and give him or her the tools to cope with fear or traumatic memories. A recent study sponsored by the Centers for Disease Control and Prevention concluded that CBT is effective in treating trauma-related disorders in children and teens.
CBT for bipolar disorder
People with bipolar disorder sometimes need to take medication, such as a mood stabilizer, and CBT is often used as an added treatment. The medication may help stabilize a person's mood so that he or she is receptive to psychotherapy and can get the most out of it. CBT can help a person cope with symptoms and learn to recognize when a mood shift is about to occur. It also helps a person with bipolar disorder stick with a treatment plan to reduce the chances of relapse (e.g., when symptoms return).
CBT for eating disorders
Eating disorders can be very difficult to treat. However, some small studies have found that CBT can help reduce the risk of relapse in adults with anorexia who have restored their weight. CBT may also help reduce some symptoms of bulimia, and it may also help some people reduce binge-eating behavior.
CBT for schizophrenia
Treating schizophrenia with CBT is challenging. The disorder usually requires medication first and research has shown that CBT, as an add-on to medication, can help a patient cope with schizophrenia. CBT helps patients learn more adaptive and realistic interpretations of events. Patients are also taught various coping techniques for dealing with "voices" or other hallucinations. They learn how to identify what triggers episodes of the illness, which can prevent or reduce the chances of relapse. Patients learn skills oriented techiniques to cope with life's challenges. The clinician teaches social, daily functioning, and problem-solving skills. This can help patients with schizophrenia minimize the types of stress that can lead to outbursts and hospitalizations.
Dialectical Behavior Therapy
Dialectical behavior therapy (DBT), a form of CBT, was developed by Marsha Linehan, Ph.D. Initially, it was developed to treat people with suicidal thoughts and actions. It is now also used to treat people with borderline personality disorder (BPD). BPD is an illness in which suicidal thinking and actions are more common. DBT also teaches effective self regulation techniques to cope with anxieties and fears.
The term "dialectical" refers to a philosophic exercise in which two opposing views are discussed until a logical blending or balance of the two extremes—the middle way—is found. In keeping with that philosophy, the clinician assures the patient that the patient's behavior and feelings are valid and understandable. At the same time, the clinician coaches the patient to understand that it is his or her personal responsibility to change unhealthy or disruptive behavior.
DBT emphasizes the value of a strong and equal relationship between patient and clinician. The clinician consistently reminds the patient when his or her behavior is unhealthy or disruptive—when boundaries are overstepped—and then teaches the skills needed to better deal with future similar situations. DBT involves both individual and group therapy. Individual sessions are used to teach new skills, while group sessions can be used to provide the opportunity to practice these skills.
Interpersonal Therapy
Interpersonal therapy (IPT) is most often used on a one-on-one basis to treat depression. The current manual-based form of IPT used today was developed in the 1980's by Gerald Klerman, M.D., and Myrna Weissman, M.D.
IPT is based on the idea that improving communication patterns and the ways people relate to others will effectively treat depression. IPT helps identify how a person interacts with other people. When a behavior is causing problems, IPT guides the person to change the behavior. IPT explores major issues that may add to a person's depression, such as grief, or times of upheaval or transition. Sometimes IPT is used along with antidepressant medications.
IPT varies depending on the needs of the patient and the relationship between the clinician and patient. Basically, a clinician using IPT helps the patient identify troubling emotions and their triggers. The clinician helps the patient learn to express appropriate emotions in a healthy way. The patient may also examine relationships in his or her past that may have been affected by distorted mood and behavior. Doing so can help the patient learn to be more objective about current relationships.
Family-focused Therapy
Family-focused therapy (FFT) was developed
by David Miklowitz, Ph.D., and Michael
Goldstein, Ph.D. FFT includes family members
in therapy sessions to improve family
relationships, which may support better
treatment results.
Clinicians work to identify difficulties and
conflicts among family members that may be worsening the patient's illness. Therapy is meant to help members find more effective ways to resolve those difficulties. The therapist educates family members about their loved one's disorder, its symptoms and course, and how to help their relative manage it more effectively. When families learn about the disorder, they may be able to spot early signs of a relapse and create an action plan that involves all family members. During therapy, the therapist will help family members recognize when they express unhelpful criticism or hostility toward their relative with bipolar disorder. The therapist will teach family members how to communicate negative emotions in a better way. Several studies have found FFT to be effective in helping a patient become stabilized and preventing relapses.
FFT also focuses on the stress family members feel when they care for a relative with a mental illness. The therapy aims to prevent family members from "burning out" or disengaging from the effort. The therapist helps the family accept how mental illness can limit their relative. At the same time, the therapist holds the patient responsible for his or her own well being and actions to a level that is appropriate for the person's age and/or functioning level.
Rational Emotive Behavior Therapy (REBT)
Rational Emotive Behavior Therapy's (REBT) main premise is that events alone do not cause a person to feel depressed, enraged, or highly anxious. Rather, it is one’s beliefs about the events which contributes to unhealthy feelings and self defeating behaviors. Fundamental to Rational Emotive Behavior Therapy is the concept that emotional suffering results primarily, though not completely, from our evaluations of a negative event, not solely by the events themselves. In other words, human beings on the basis of their belief system actively, though not always consciously, disturb themselves, and even disturb themselves about their disturbances.
REBT teaches the individual to identify, evaluate, dispute, and act against his or her irrational self- defeating beliefs, thus helping the individual to not only feel better but to get better. REBT is an active-directive, solution-oriented therapy which focuses on resolving emotional, cognitive and behavioral problems in individuals.
Psychotherapy for children and adolescents
Psychotherapies can be adapted to the needs of children and adolescents, depending on the mental disorder. For example, the NIMH-funded Treatment of Adolescents with Depression Study (TADS) found that CBT, when combined with antidepressant medication, was the most effective treatment over the short term for teens with major depression. CBT by itself was also an effective treatment, especially over the long term. Other studies have found that IPT is an effective treatment for child and adolescent depression (for more informaiton see references noted below).
Psychosocial treatments that involve a child's parents and family also have been shown to be effective, especially for disruptive disorders such as conduct disorder or oppositional defiant disorder. Some effective treatments are designed to reduce the child's problem behaviors and improve parent-child interactions. Focusing on behavioral parent management training, parents are taught the skills they need to encourage and reward positive behaviors in their children. Similar training helps parents manage their child's attention-deficit/hyperactivity disorder (ADHD). This approach, which has been shown to be effective, can be combined with approaches directed at children to help them learn problem-solving, anger management and social interaction skills.
What other types of therapies are used?
In addition to the therapies listed above, many more approaches exist. Some types have been scientifically tested more than others. Also, some of these therapies are constantly evolving. They are often combined with more established psychotherapies.
Other types of therapies sometimes used in conjunction with the more established therapies include:
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Expressive or creative arts therapy. Expressive or creative arts therapy is based on the idea that people can help heal themselves through art, music, dance, writing, or other expressive acts.
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Animal-assisted therapy. Working with animals, such as horses, dogs, or cats, may help some people cope with trauma, develop empathy, and encourage better communication. Companion animals are sometimes introduced in hospitals, psychiatric wards, nursing homes, and other places where they may bring comfort and have a mild therapeutic effect. Animal-assisted therapy has also been used as an added therapy for children with mental disorders.
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Play therapy. This therapy is used with children. It involves the use of toys and games to help a child identify and talk about his or her feelings, as well as establish communication with a clinician. A clinician can sometimes better understand a child's problems by watching how he or she plays. Research in play therapy is minimal.