MayoClinic.com reprints
This single copy is for your personal, noncommercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, use the reprints link below.
· Order reprints of this article now.
Psychotherapy
By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/psychotherapy/MY00186
About our e-newsletters
- Free e-newsletters
- Mayo Clinic expertise
- We do not share your e-mail address
Housecall, our weekly general-interest e-newsletter, keeps you up to date on a wide variety of health topics with timely, reliable, practical information, recipes, blogs, questions and answers with Mayo Clinic experts and more. Our biweekly topic-specific e-newsletters also include blogs, questions and answers with Mayo Clinic experts, and other useful information that will help you manage your health.
Housecall Archives
Mayo Clinic Housecall
Stay up to date on the latest health information.
What you get
- Free weekly e-newsletter
- Mayo Clinic expertise
- Recipes, tools and other helpful information
- We do not share your e-mail address
Definition
Psychotherapy is a general term for addressing mental health concerns by talking with a psychologist or other mental health provider.
During psychotherapy, you learn about your condition and your moods, feelings, thoughts and behaviors. Psychotherapy helps you learn how to take control of your life and respond to challenging situations with healthy coping skills.
There are many specific types of psychotherapy, each with its own approach. The type of psychotherapy that's right for you depends on your individual situation. Psychotherapy is also known as talk therapy, counseling, psychosocial therapy or, simply, therapy.
Why it's done
Psychotherapy can be helpful in treating most mental health problems, including:
- Anxiety disorders, such as obsessive-compulsive disorder (OCD), phobias, panic disorder, and post-traumatic stress disorder (PTSD)
- Mood disorders, such as depression and bipolar disorder
- Addictions, such as alcoholism, drug dependence or compulsive gambling
- Eating disorders, such as anorexia and bulimia
- Personality disorders, such as borderline personality disorder or antisocial personality disorder
- Schizophrenia and other disorders that cause detachment from reality (psychotic disorders)
Not everyone who benefits from psychotherapy is diagnosed with a mental illness. Psychotherapy can help with a number of life's stresses and conflicts that can affect anyone. For example, it 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 passive-aggressive behavior
- Come to terms with a chronic or serious physical health problem such as diabetes, cancer or chronic 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 (insomnia)
In some cases, psychotherapy can be as effective as medications such as antidepressants. However, depending on your specific situation, psychotherapy alone may not be enough to ease the symptoms of a mental health condition. You may also need medications or other treatments.
Risks
In general, there's little risk in psychotherapy. Because it can explore painful feelings and experiences, though, you may feel emotionally uncomfortable at times. Some forms of psychotherapy, such as exposure therapy, may require you to confront situations you'd rather avoid — such as airplanes if you have a fear of flying. This can lead to temporary stress or anxiety. But the coping skills you learn should help you later on to manage and conquer negative feelings and fears.
How you prepare
You might decide on your own that you want to try psychotherapy, or a doctor, relative, friend, employer or someone else may suggest psychotherapy to you. Here's how to get started:
- Find a therapist. You can find a therapist on your own — looking through the phone book or on the Internet, for instance. Or, get a referral from a doctor, health insurance plan, friend or other trusted source. Many employers offer counseling services or referrals through employee assistance programs (EAPs).
- Understand the costs. If you have health insurance, find out what coverage it offers 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, spend some time thinking about what issues you'd like to work on. While you also can sort this out with your therapist, having some sense in advance may provide a good starting point.
Check qualifications
Before seeing a psychotherapist, check his or her background and education. Psychotherapist is a general term, rather than a job title or indication of education, training or licensure.
Trained psychotherapists can have a number of different job titles. Nearly all have a master's degree or doctoral degree with specific training in psychological counseling. And, all counselors are required to meet state certification requirements. Medical doctors who specialize in mental health (psychiatrists) can prescribe medications as well as provide psychotherapy.
Some common types of psychotherapists and their titles include:
- Psychiatrists (M.D. or D.O.)
- Psychologists (Ph.D. or Psy.D.)
- Licensed professional counselors (L.P.C.)
- Licensed social workers (L.C.S.W.)
- Psychiatric nurse (A.P.R.N.)
What you can expect
Your first therapy session
Your first psychotherapy session is usually a time for the therapist to gather information about you. The therapist may ask you to fill out forms about your current and past physical and emotional health. All of this information helps the therapist gain a deeper understanding of your situation. It might take a few sessions for your therapist to fully understand your situation and concerns and to determine the best approach or course of action.
The first session is also an opportunity for you to interview your therapist to see if his or her approach and personality are going to work for you. Make sure you understand:
- His or her approach or type of therapy
- What type of therapy is appropriate for you
- The goals of your treatment
- The length of each session
- How many therapy sessions you may need
At any time during therapy, especially in the beginning, don't hesitate to ask the therapist questions.
If you don't feel comfortable with the first psychotherapist you see, try someone else. Having a good "fit" with your therapist is critical for psychotherapy to be effective.
Starting psychotherapy
You'll go to a therapist's office for psychotherapy sessions. A therapist may have an office in a medical clinic, an office building or home office. Psychotherapy can also take place in a hospital if you've been admitted for treatment. You'll probably meet with your therapist once a week for a session that lasts 45 to 60 minutes.
Types of psychotherapy
There are a number of effective types of psychotherapy. Some work better than others in treating certain disorders and conditions. In many cases, therapists use a combination of techniques. Your therapist will consider your particular situation and preferences to determine which approach may be best for you.
Common psychotherapy techniques include:
- Cognitive behavioral therapy, which helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. This is the most common type of therapy and is generally set up in a structured, goal-oriented format with a set number of sessions.
- Interpersonal therapy, which focuses on your current relationships with other people to improve your interpersonal skills — how you relate to others, such as family, friends and colleagues.
- Psychodynamic psychotherapy, which focuses on increasing your awareness of unconscious thoughts and behaviors, developing new insights into your motivations, and resolving conflicts to live a happier life.
- Dialectical behavior therapy, a type of cognitive behavioral therapy that teaches behavioral skills to help you tolerate stress, manage your emotions and improve your relationships with others.
- Acceptance and commitment therapy, which helps you identify your thoughts and feelings, learn to accept them, and then commit yourself to the changes you want to make.
- Family therapy, which helps individuals within a family understand and improve the way family members interact with each other and resolve conflicts.
- Group therapy, which brings together a small group of people facing a similar mental illness or situation, with a discussion led by a qualified counselor or mental health provider.
- Marriage counseling, also called couples therapy, which gives partners — married or not — the tools to communicate better, negotiate differences, problem solve and even argue in a healthier way.
- Psychoanalysis, which guides you to examine memories, events and feelings from the past to understand your current feelings and behavior.
- Art therapy, also called creative art therapy, which allows you to express thoughts and feelings through music, dance and movement, drama, drawing, painting, poetry, or other forms of artistic expression.
- Exposure therapy, a form of behavior therapy that deliberately exposes you to what you find upsetting or disturbing in a structured way, which can help you learn to overcome your fears.
- Play therapy, which uses a variety of play techniques to encourage children to more easily express emotions and feelings if they're unable to do so with words.
- Psychoeducation, which teaches you about your illness, including treatments, coping strategies and problem-solving skills.
During psychotherapy
For most types of psychotherapy, you and your therapist sit facing each other during sessions. 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.
Because psychotherapy sometimes involves intense emotional discussions, you may find yourself crying, upset or even having an angry outburst during a session. You may also feel physically exhausted after a session. Your therapist is there to help you cope with such feelings and emotions.
Your therapist may ask you to do "homework" — activities or practices that build on what you learn during your regular therapy sessions. Over time, discussing your concerns can help improve your mood, change the way you think and feel about yourself, and improve your ability to cope with problems.
Confidentiality
Except in very specific circumstances, conversations with your therapist are confidential. However, there are certain situations in which a therapist is required by law to report any concerns to authorities. These include:
- Threatening to harm yourself or commit suicide
- Threatening to harm or take the life of another person
- Admitting to abusing a child or a vulnerable adult — someone over age 18 who is hospitalized or made vulnerable by a disability
Length of psychotherapy
The length of treatment generally depends on why you're being seen. It may take only weeks to help you cope with a short-term situation. Or, treatment may last a year or longer if you have a chronic mental illness or other long-term concerns.
The number of psychotherapy sessions you need- and how frequently you need to see your therapist — depends on such factors as:
- Your particular mental illness or situation
- The severity of your symptoms
- How long you've had symptoms or have been dealing with your situation
- How quickly you make progress
- How much stress you're experiencing
- How much your mental health concerns interfere with day-to-day life
- How much support you receive from family members and others
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 to feel better about yourself and your life.
Getting the most out of psychotherapy
Psychotherapy isn't effective for everyone. But you can take steps to get the most out of your therapy and help make it a success:
- Make sure you feel comfortable with your therapist. If you don't, look for another therapist with whom you feel more at ease.
- Approach therapy as a partnership. Therapy is most effective when you're an active participant and share in decision making. Make sure you and your therapist agree about the major issues at hand and how to tackle them. Together, you can set goals and gauge progress over time.
- Be open and honest. Success with psychotherapy depends on your willingness to share your thoughts, feelings and experiences. It also depends on your willingness to consider new insights, ideas and ways of doing things. If you're reluctant to talk about certain things because of painful emotions, embarrassment or fears about your therapist's reaction, let your therapist know.
- Stick to your treatment plan. If you feel down or lack motivation, it may be tempting to skip psychotherapy sessions. Doing so can disrupt your progress. Try to attend all sessions and to give some thought to what you want to discuss.
- Don't expect instant results. Working on emotional issues can be painful and may require hard work. It's not uncommon to feel worse during the initial part of therapy as you begin to confront past and current conflicts. You may need several sessions before you begin to see improvement.
- Do your homework between sessions. If your therapist asks you to read, journal or do other activities outside of your regular therapy sessions, follow through. Doing these homework assignments is important because they help you apply what you've learned in the psychotherapy sessions to your life.
- 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.
- Gafford J, et al. Psychological treatment of psychiatric disorders in primary care. http://www.uptodate.com/home/index.html. Accessed June 22, 2010.
- Let's talk facts about psychotherapy. Healtyminds.org. http://www.healthyminds.org/Document-Library/Brochure-Library/Lets-Talk-Facts-Psychotherapy.aspx, Accessed June 22, 2010.
- Barbara Woodward Lips Patient Education Center. Understanding psychotherapy for adults. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2010.
- Practice guideline for the treatment of patients with major depressive disorder. Arlington, Va.: American Psychiatric Association practice guidelines, 2nd ed. http://www.psychiatryonline.com/popup.aspx?aID=49371&print=yes. Accessed June 22, 2010.
- Counselors. Occupational outlook handbook, 2010-11 Edition. http://www.bls.gov/oco/ocos067.htm. Accessed June 29, 2010.
Find Mayo Clinic on