Could you benefit from talk therapy?
By Harvard Health Publications (2004)
Maybe you should consider
seeing a therapist..."
Every year, one in five adults in the
What is psychotherapy?
Psychotherapy — often referred to as talk therapy —
addresses troubling symptoms and emotions using psychological techniques rather
than, or along with, medication or other physical approaches. There are many
theories and styles of psychotherapy, but the two most popular forms are
psychodynamic therapy and cognitive behavioral therapy.
Which works best? There’s no simple answer. Just as many
forms of aerobic exercise can help you achieve cardiovascular fitness, many
types of therapy can help you understand yourself better, change behavior that
is wrong for you, and help relieve bothersome symptoms. You may do better with
one type than with another, or find that a blended approach, drawn from
different schools of psychotherapy, suits you best. Your regular participation
in the process is more important than the type of therapy you choose. Most
important is the match, or rapport, between you and your therapist.
Although most therapists emphasize one type of
intervention, a good therapist can incorporate elements of others as well.
Whatever approach the therapist adopts, she or he should develop a trusting
alliance with you, suggest fresh ways for you to perceive your problems, and
help alleviate your symptoms and your sense of isolation.
Psychodynamic therapy
Psychodynamic therapists believe that past experiences
and feelings of which you’re not consciously aware can influence your present
emotional well-being and ability to function. Through regular discussions with
a therapist, you can gain insight into your motivations and conflicts and learn
more productive ways to cope with them.
"Psychodynamic therapy can be very helpful if you
feel like your life is repeating old patterns or you aren’t clear what
direction you want to take," says
The process of psychoanalysis developed by Sigmund Freud
may be the most familiar form of psychodynamic therapy, but it’s not the most
common. Psychoanalysis is designed to uncover the unconscious roots of your
symptoms and help you apply this understanding to your current life. Classic
psychoanalysis is time-consuming (it requires meeting several times a week,
possibly for many years) and not widely used today. However, it’s still
influential in the thinking behind much psychodynamic therapy, which can be
short- or long-term, and may focus broadly or more narrowly on a particular
issue or symptom.
Another common focus of psychodynamic therapy is an
individual’s interaction with other people. Psychodynamic therapy can help you
identify what you seek in a relationship (your needs), the healthy and
unhealthy ways of meeting those needs, and ways to improve your ability to
communicate. Such therapy can help people cope with the loss of a relationship,
conflicts within relationships, or the demands of shifting roles (such as
retirement or caring for a parent). One system of therapy with this emphasis,
called interpersonal therapy, combines elements of psychodynamic therapy,
cognitive behavioral therapy, and other techniques. Therapy is limited to three
or four months and focuses on psychological difficulties sparked by recent
conflicts or transitions. While not widely available, it is coming into more
common use.
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Selected resourcesAmerican
Psychiatric Association 703-907-7300 http://www.psych.org
American Psychological Association 800-374-2721 (toll free) http://www.apa.org 4Therapy.com Network
888-484-3727 (toll free) http://www.4therapy.com
National Mental Health Association Resource Center 800-969-6642 (toll free) http://www.nmha.org |
The cognitive behavioral
approach
Cognitive behavioral therapy (CBT) is less focused on the
underpinnings of feelings and instead emphasizes how to change the thoughts and
behaviors that are causing problems. CBT can be used to alter difficult
behaviors, such as smoking, procrastination, or phobias, and can also help
address conditions such as depression and anxiety.
Cognitive behavioral therapists believe that you can
change your feelings by changing your thoughts and actions. For example, you
may have patterns of distorted thinking — excessive self-criticism or guilt,
always anticipating the worst, attributing untoward motives to others — that
make you vulnerable to feeling bad. CBT teaches you to recognize these patterns
as they emerge and alter them. The "behavior" part refers to learning
more productive responses to distressing circumstances or feelings — such as
relaxing and breathing deeply instead of hyperventilating when in an
anxiety-provoking situation.
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Body and mindPsychological
disorders have physical symptoms — fatigue is a hallmark of depression — and
many medical disorders have psychological symptoms. For example, an
overactive thyroid can make you irritable, depressed, and anxious; an
underactive thyroid can make you depressed and slow-thinking. It’s easier to
treat these symptoms if their medical basis is recognized. Otherwise,
psychotherapy alone won’t relieve even the psychological symptoms, and
failure to treat the medical condition can be dangerous.If you consult your
primary care physician about psychological problems, a physical exam and
testing can rule out a medical disorder. If you go directly to a
psychologist, social worker, or other therapist who isn’t a physician, that
person should keep in mind the possibility of medical problems and suggest a
medical evaluation if appropriate. |
Not going it alone
Most talk therapy involves one-on-one meetings with a
psychotherapist, but other configurations can be helpful, too, depending on
your needs.
Group therapy. Several people meet in regular sessions with a
therapist. Interacting with others and hearing their problems can support your
efforts to change and reduce your sense of isolation. Group therapy can be
particularly helpful for people with difficulties in social interaction because
it provides a place to practice and get feedback from others. A group may be
organized around a single topic, such as anxiety, bereavement, or a medical
condition — or it may be concerned with more general issues, on the
understanding that most people cope with similar problems.
Before joining a group, you will be interviewed by the
therapist and may be asked to commit to a certain number of sessions. Group
therapy may be combined with individual sessions.
Family therapy. This involves the family unit. It’s usually brief and
focused on problem solving. It can help families correct miscommunication,
change dysfunctional patterns of blame, or adjust to altered circumstances,
such as a chronic illness or adult children moving back home. It may be especially
helpful when an individual’s psychological problem affects other members of the
family.
Couples therapy. Also called marital therapy and marriage counseling,
couples therapy focuses on your relationship with your partner. The process may
be much like individual psychotherapy, or the couples therapist may act as a
mediator, finding acceptable compromises when there is conflict. The therapist
helps you and your partner examine your patterns of interaction and determine
what changes are needed for each person to be satisfied.
Support groups. Support groups are usually organized around a specific
issue, such as bereavement, a particular illness, divorce, or recovery from
addiction. A professional usually does not lead them, and, strictly speaking,
they are not a form of psychotherapy. But they can be extremely helpful for
individuals or families confronting certain circumstances or striving to
sustain healthy behavior changes. Like group therapy, support groups may be
time-limited or ongoing. Insurance doesn’t cover all support groups.
When is psychotherapy
appropriate?
While medications are essential for the adequate
treatment of certain mental disorders, such as schizophrenia, bipolar disorder,
and severe depression, research shows that improvement is often greater when
psychotherapy is added. By helping you understand and cope with the disorder,
talk therapy can also help you stay in treatment and avoid relapse.
Anxiety disorders can be treated with psychotherapy,
medication, or both. CBT is the most common treatment for phobias, that is,
irrational fears of certain objects or situations. If you have generalized
anxiety or obsessive-compulsive disorder, CBT can help you learn to respond
differently in situations that cause anxiety. A combination of
psychotherapeutic approaches is required to help people with post-traumatic
stress disorder (PTSD) come to terms with their trauma, losses, and painful
memories.
Either talk therapy or medication can be used to treat
mild to moderate depression, but combining them may be particularly effective.
For example, researchers at the
Recent research comparing before-and-after brain scans of
people being treated for depression suggests that medication and psychotherapy
counter depression in different ways (Archives
of General Psychiatry, January 2004). Among people receiving
psychotherapy (as CBT), PET scans showed increased blood flow in the limbic, or
"emotional," system, and decreased activity in certain
"thinking" areas of the brain. Subjects who took antidepressants
showed different changes in the same brain regions. This may help explain why
individual responses to treatment vary so much.
For seasonal affective disorder, a type of depression
that recurs in the fall and winter, the standard approach is regular exposure
to bright light. But new research indicates that CBT may work just as well, by
helping patients revise their negative thoughts about the lack of light and
learn ways to cope with winter darkness.
After diagnosing depression, a primary care doctor is
more likely to prescribe an antidepressant, and a psychiatrist is more likely
to recommend psychotherapy and an antidepressant. (A psychiatrist is also more
likely to prescribe the antidepressant at the correct dose for you.) Your
preferences should be considered. If your primary care physician prescribes an
antidepressant, you can request a referral for psychotherapy, or wait to see
how you respond to the medication, which may help you participate more
effectively in talk therapy.
A psychiatrist may both provide psychotherapy and
prescribe medication, but most psychotherapists cannot prescribe drugs. If
you’re seeing a non-M.D. psychotherapist, she or he may recommend that you ask
your physician about a prescription for an antidepressant. In that case, it’s
important for the therapist and prescribing physician to collaborate in
providing the best care for you.
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Who offers psychotherapy?Therapists
differ in training, philosophy, and experience. When choosing a therapist,
you may find that the "fit" is more important to you than the
therapist’s specific discipline. Insurance companies usually restrict payment
to practitioners licensed in your state. • Psychiatrists are physicians who complete at least four years of
psychiatric residency (in addition to four years of medical school).
Psychiatrists can prescribe medication and hospitalize patients, if needed.
This level of training is often essential in treating schizophrenia, bipolar
disorder, and severe depression. A psychiatrist may offer psychotherapy or
concentrate strictly on medical treatment. When looking for a psychiatrist,
ask whether she or he performs psychotherapy and what type. • Most clinical psychologists have doctoral
level training (Ph.D. or Psy.D.) in clinical psychology. Psychologists
receive extensive training in psychotherapy, but may have less experience
than a psychiatrist in handling serious mental illnesses such as
schizophrenia. A psychologist is not usually able to prescribe medication or
admit someone to the hospital.• Clinical
social workers have master’s degree level training. While not all
specialize in psychotherapy, many receive training in therapy and
understanding how people function within their families and communities.• Marriage and family therapists are
master’s level professionals trained to help with conflicts within marriages
and families. They may have less training and experience in individual
therapy. Psychotherapy is also available from other licensed mental health
practitioners, including psychiatric nurses, clinical nurse specialists, and
trained members of the clergy. Although it’s impossible to predict exactly
how many therapy sessions you’ll need, it’s reasonable to ask a therapist for
an estimate of how long therapy will take, and how and when she or he will
evaluate your progress. |