Psychotherapy, sometimes referred to as talk therapy or counseling, is a process of personal discovery and goal attainment, caring for the patient’s emotional and relational health, similar to the way a physical therapist might treat a torn ligament. The American Counseling Association defines counseling as “a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals.1”
Psychotherapy is practiced using many different modalities and provides treatment to a myriad of psychological disorders and adjustment concerns. The length of treatment is determined by the severity of the personal distress and can last anywhere from one session to several years of weekly treatment. In addition to variability in length of treatment, the cost of psychotherapy can be anywhere from a few dollars an hour when services are provided by interns to hundreds of dollars an hour when services are provided by a doctorate level practitioner with years of experience.
Participating in psychotherapy or talk therapy for help with psychological distress is shown to be effective in alleviating problematic emotional, cognitive, and behavioral symptoms. Talk therapy can be as effective as medication in the treatment of mental health concerns such as depression and may facilitate more sustained improvement than the use of medication alone.2 Many individuals may be reluctant to rely on pharmaceuticals to improve mental health and have found lasting benefit from psychotherapy.
What Is Psychotherapy?
Psychotherapy has been practiced and refined for more than 100 years. Traditionally, when individuals think of psychotherapy, figures such as Sigmund Freud and Carl Jung come to mind, with patients lying on couches and free associating to identify defense mechanisms and unconscious desires.
Since the beginning of the profession, many different approaches and modality of psychotherapy have been developed and refined. Psychotherapy in general continues to show high levels of efficacy for improvement of overall mental health functioning in those who are motivated recipients of the service.
Individuals experiencing mental health concerns often seek help from their general practitioner as a first line of treatment. It is common for that GP to refer the individual to both a psychiatrist for consideration of medication if the symptoms are severe and a psychologist, therapist, or counselor for psychotherapy as an evidence-based treatment for symptom alleviation. Studies continually show best results for clients when medication is combined with psychotherapy, although both are found to be efficacious on their own.3
Does Psychotherapy Work?
While the research into the effectiveness of psychotherapy for the treatment of mild to severe mental health concerns continues to show promising and positive results, the modalities practiced vary in effectiveness depending on the population and concerns presented. For this reason, psychologists have identified best-practice approaches to the treatment of different issues and mental health concerns that might arise in an individual’s life.
When using a best-practice, or evidence-based approach to psychotherapy, the effectiveness of treatment is even greater and the vast majority of clients receiving treatment report positive experience and outcomes of psychotherapy. The goals of psychotherapy change depending on the modality practiced and the individual’s identified desires. However, the overarching goal of psychotherapy is to provide increased functionality and coping in relation to the issues or stressors driving treatment. Goals and the length of treatment are often agreed upon by the client and therapist.
What Are the Types of Psychotherapy?
There are a variety of approaches and theoretical orientations used in psychotherapy. The traditional approach of psychoanalysis continues to be practiced, in addition to humanistic, cognitive, behavioral, and postmodern approaches. There are currently more than 400 theories of psychotherapy being utilized4, with fewer than 15 over-arching classifications.
While each modality and practice of psychotherapy have their benefits and drawbacks, each has been shown to be effective in treating mental health concerns with a variety of client issues.
A psychoanalytical approach to psychotherapy involves detailed exploration into how an individual experiences life, including early life experiences. Understanding how events and situations have helped to form the patient’s inner experience and influence the relational dynamics present in the patient’s life is at the core of a psychoanalytic approach.
Psychoanalysis is the traditional model of therapy often thought of when considering therapy. Traditionally, this modality is more long-term due to the depth of understanding involved. A psychotherapist practicing psychoanalysis may refer to themselves as a psychoanalyst and work to interpret and provide insight into the experiences brought forth by the patient. Psychoanalysis involves the client gaining perspective and insight into themselves and their relationships in order to make conscious decisions that will lead to goal attainment.
Humanistic approaches encompass many different theoretical orientations, such as person-centered, existential, and gestalt; each relying on the idea that the client is an expert in their own unique world and each client brings with them their own way of perceiving the world.
Through humanistic psychotherapy, this self-understanding is illuminated to allow the client to make whatever decisions are going to be most likely to lead to positive experiences and allow them to reach the goals that brought them into treatment. This modality relies heavily on the relationship cultivated with the provider and work in the here and now experience of the therapy hour.
Understanding that the client interacts with the practitioner as they do with the rest of society, the relationship provides a vehicle for critical understanding and illumination of blind spots, allowing for the client to make intentional changes to meet goals. A humanistic approach to psychotherapy can be particularly helpful when individuals struggle in making decisions, knowing self, and finding meaning.
A behavioral approach to psychotherapy is unique in the focus on what the client is doing, rather than centering on feeling or thinking. When a behavioral approach to psychotherapy is employed, clients may experience a systematic approach to behavior modification. The focus is on how to change behavior and how current behavior is sustained or extinguished.
This approach relies on structured and measurable changes in behavior to meet client goals. A behavioral approach to psychotherapy can be most effective in treating symptoms that are behavioral in nature, such as phobias, obsessive and compulsive disorders, and panic attacks.
Through a behavioral approach, the practitioner acknowledges that changes to behavior are vastly easier than changes to emotions and thoughts, therefore, the focus is on changing the behavior with the understanding that the thoughts and feelings will follow.
Cognitive approaches to psychotherapy focus on the thoughts and thought processes of the patient. Through identifying thinking errors, irrational beliefs, and faulty assumptions, clients can be more intentional in changing thoughts to reach goals in life. When a cognitive approach is employed, clients are led on a journey of understanding thoughts, including how these thoughts impact behaviors and feelings.
Psychotherapy from a cognitive lens allows clients to evaluate their thoughts and beliefs to influence decision in life goal attainment. A cognitive approach to psychotherapy has shown remarkable efficacy and is able to be more systematically applied to client issues than some of the other, more unstructured theories.
A cognitive behavioral therapy (CBT) approach to psychotherapy is a blending of both the behavioral and cognitive approach. Thus, this modality involves a focus on both the thoughts and behaviors and how these play off each other. In addition to understanding the interplay between thoughts and behaviors, the emotional response and reaction are illuminated and discussed.
Clients experiencing a CBT approach to psychotherapy are likely to encounter a systematic analysis of their thoughts and behavior, including how thoughts impact behaviors and facilitate emotions. In general, CBT is found to be one of the most evidence-based approaches to psychotherapy and is widely practiced around the world. This approach is easier to manualize, replicate, and study than some other approaches, leaving it the treatment of choice for many providers.
The dialectical behavioral approach to therapy (DBT) was first developed by Marsha Linehan for the treatment of Borderline Personality Disorder.5 This approach was first introduced to decrease suicidality and manage self-harm. Since its inception, DBT has been shown to be an effective approach for the treatment of a variety of mental health concerns and is widely used across various disciplines (psychologists, social workers, counselors).
Clients partaking in this method of treatment can expect a focus on thoughts, behaviors, and emotions, with the addition of increased mindfulness. DBT provides a systematic approach to symptom reduction in addition to focus on metacognitions and the here and now.
Interpersonal psychotherapy (IPT) is an approach that is highly utilized and practiced all over the world, primarily for the treatment of mood disorders.6 The overall goal of IPT is to increase social functioning of the patient and allow for higher efficacy in interpersonal relationships.
This approach focuses on relationships in the client’s life and how these relationships are impacted by and impact the client. Through an IPT approach, the client is able to better understand self in relation to others, and is able to make more intentional choices in meeting goals in life.
Brief Solution-Focused Therapy
This postmodern approach to psychotherapy is one that relies on utilizing the natural strengths and tools that the client already possesses. Solution-focused (SF) therapy requires the client to identify what is working and build on the exceptions to the problem that are naturally existing and inherent in the client.
This approach is individualized, is based on many tenets of positive psychology, and the goals are specific to the issue driving treatment. A Solution-Focused approach allows clients to gain efficacy and solve the immediate issue that has brought them into treatment without exploration of the past and deconstruction of beliefs. SF therapy is often experienced as hopeful and strength-building.
Other Types of Psychotherapy
In addition to the modalities discussed above, there are other forms of treatment such as art therapy, equine and animal-assisted therapy, experiential therapies, play therapy, and body-focused therapies that are used to assist clients in meeting their goals. While these approaches are not as widely-used, they can be effective for various clients.
Formats of Psychotherapy
In addition to a variety of different theoretical orientations and approaches, there are also a myriad of delivery formats for psychotherapy. The formats for delivery can depend on needs or resources of the client, in addition to what is available in their community or state.
Individual psychotherapy is a one-on-one format of the patient working directly and solely with the therapist. By far the most popular form of psychotherapy, individual therapy allows for an intimate exploration of needs and goals. Those with mood disorders, adjustment issues, and trauma often gravitate toward individual therapy over other formats due to the safety and focus of being with one other person. Individual psychotherapy may be delivered in person or through an online format.
Family therapy is an approach that allows a detailed look at the system of the clients. Family therapy often entails bringing the immediate family in for help, often with one member of the system identified as the patient. While the family identifies the problem, the therapist works to help each family member understand their role in the system and the understanding of how one change in the systems can mean reorganization of the whole structure.
Family therapy may consist of the immediate family and one psychotherapist to extended family and multiple therapists working in conjunction during the session.
Couples psychotherapy is used to help couples, whether dating, engaged, married, or divorced, work through issues that may be impacting their ability to successfully be in relationship with each other. When approaching psychotherapy from a couple’s format, neither member of the couple is the client. Instead, the relationship they share becomes the focus of the treatment.
Instead of centering on individual understanding, the couples’ therapist works to gain perspective and insight into the working between the members of the couple. Couples therapy is often more structured and shorter lasting than individual psychotherapy and is a great choice for those struggling in their relationships with current or previous partners.
Group therapy is a format of psychotherapy allowing for small groups of individuals to congregate around a goal or issue. There are many different types of psychotherapy groups and the number of people allowed in each group is often dependent on the issue, number of facilitators, and type of group approach employed (i.e. psychoeducational, process, experiential, task, etc.).
Group therapy is a great approach for individuals who are hoping to learn about themselves in relation to others or who want additional support with their issue. Group therapy can be a good choice for clients with limited resources, as this form of treatment can be more cost-effective.
Video psychotherapy has taken off over the past five years. Presently, there are several different platforms that offer individual and couples video-based psychotherapy for a weekly, monthly, or yearly subscription fee. In addition to these platforms, many psychotherapists are expanding their practices to incorporate online therapy sessions as the need in rural areas and time-stretched clients increases.
Video psychotherapy mirrors face-to-face psychotherapy with variation in how much control the therapist has over the environment and how much of the body language the therapist is privy to as a function of camera positioning. Online therapy can be a great option for clients in isolated areas, who need help in non-traditional hours, or who are apprehensive about walking into a therapist’s office.
In addition to the above-mentioned formats of psychotherapy, there are additional modalities that allow for successful treatment of psychological distress depending on client needs.
Understanding that we live in a society where time is precious, technology is assisting in allowing for more formats of psychotherapy, including:
Some clients may opt to use messaging to securely and confidentially communicate with a psychotherapist. Similar to texting with a therapist, the provider responds to short messages from clients as time allows, therefore, contact is not instantaneous.
This format of psychotherapy is similar to messaging with the exception of delay in response. When using chatroom formats of psychotherapy, the messaging is instantaneous and a written conversation commences for the agreed upon length of time, comparable to traditional psychotherapy.
This format of psychotherapy requires the client to read books related to their identified issues as a primary means of treatment. The therapist is available to discuss these books with the client, but the source of improvement comes from reading.
What Can Psychotherapy Help With?
Psychotherapy can help with a variety of issues; from adjustment problems in life after a stressor to major and significant mental health concerns. Substantial effort has been made to reduce the stigma around seeking mental health treatment, in part due to the significant improvement in self-understanding and relational satisfaction inherent in working with a psychotherapist regardless of the severity of the issue.
Talk therapy can be a helpful approach in working through decisions, identifying areas for improvement, building self-efficacy and understanding, and working through significant mental health concerns such as trauma, anxiety, and depression.
As psychotherapy was initially developed to manage more severe mental health issues, psychotherapy can be quite useful in the treatment of:
- Obsessive and compulsive disorders
- Impulse-control disorders
- Personality disorders
- Adjustment disorders
Everyone can benefit from seeing a psychotherapist, particularly those who might benefit from having an independent person hear their concerns and problem-solve solutions. Everyday life occurrences can disrupt our functioning and send us looking for someone to talk to.
Common life events that trigger the need for psychotherapy are:
- Loss of a relationship
- Death of a loved one
- Traumatic events
- Changes to job status
- Birth of a child
In addition to everyday life occurrences that can trigger the need for talk therapy, some general feelings and issues can arise in life that require trained helpers. Some of these feelings and issues include:
- Relationship concerns
- Grief and loss
- Parenting stress
- Difficulty making decisions
- Disappointments and regrets
- Shame and guilt
- Dissatisfaction with work
Who Can Offer Psychotherapy?
The vast majority of those offering psychotherapy have a graduate degree at a minimum. A psychotherapist may hold an advanced degree in psychiatry, psychology, counseling, or social work. In order to obtain a license to practice psychotherapy in every state in the US, practitioners are required to obtain a significant number of hours as an intern before receiving their full licensure.
Traditionally, psychiatrists and psychologists with doctorate degrees have offered psychotherapy. As the mental health needs of the world increase, so do the need for supplemental resources to meet these needs. Therefore, there has been a significant increase in practitioners holding master’s degrees in mental health fields obtaining licenses to practice psychotherapy.
Those offering psychotherapy may hold degrees in:
- Marriage and family therapy, LMFT
- Clinical mental health counseling, LPC/LCPC/LMHC
- Social work, LCSW/LICSW
- Psychology, PsyD., Ph.D.
- Psychiatry, M.D., D.O.
- Psychiatric nursing, A.P.R.N., N.P. (with formal psychotherapy training)
- Physician Assistant, P.A. (with formal psychotherapy training)
Cost of Psychotherapy
Generally speaking, the cost of psychotherapy can range from $50-$250/hour depending on the qualifications and expertise of the provider. When psychotherapy is offered by a fully clinically licensed individual, most insurance companies will reimburse the cost of this service when the provider is in-network. A list of approved providers can be obtained by calling your insurance company.
How to Find a Psychotherapist
One of the biggest struggles clients tend to report when deciding to give psychotherapy a try is finding a provider who is available to meet when they are free and is skilled to manage their issue. While the Department of Labor Statistics reports that more than 665,500 counselors are working in various settings1, accessing one can be difficult. Insurance companies will commonly provide a list of approved psychotherapy providers that are in-network.
Those not seeking to use insurance benefits or who do not have insurance are often left to search the internet for providers in their area. This directionless searching can lead to hundreds of providers and confusion about what credentials and designations to look for and how to evaluate if the provider is able to manage their issue.
When seeking a psychotherapist there are many considerations to make, such as how far you are willing to travel and what hours you are requiring, as well as what type of person you are going to feel most comfortable sharing intimate details of your life with. Research into the effectiveness of psychotherapy continually points to the importance of the therapeutic alliance, or relationship, as a vehicle for client change. With this in mind, some clients may meet with two, three, or more therapists before they find one they deem to be a “good fit.”
Key questions to ask a psychotherapist when considering
- What theory do you approach psychotherapy from?
- How long does it usually take for clients with issues similar to mine to experience some relief?
- How do you evaluate the effectiveness of the services you offer?
- How long have you been practicing and do you have any specializations?
- How much do you charge? Do you take insurance?
- What does a typical session look like? How long does it last and how often would we meet?
- What can I do to prepare for my first session?