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Psychotherapy

Introduction

Psychotherapy is a type of therapy used to treat emotional problems and mental health conditions.

It involves talking to a trained therapist, either one-to-one, in a group or with your wife, husband or partner. It allows you to look deeper into your problems and worries and deal with troublesome habits and a wide range of mental disorders, including depression and schizophrenia.

Although psychotherapy is usually a talking therapy, sometimes other methods may be used. This could be art, music, drama or movement rather than talking.

Psychotherapy can help you to discuss feelings that you have about yourself and other people, particularly family and those close to you. In some cases, couples or families are offered joint therapy sessions together.

A therapist will treat sessions as confidential. This means you can trust them with information that may be embarrassing or secret.

Read more about how psychotherapy works.

What is a psychotherapist?

A psychotherapist is a mental health professional who is trained to listen sympathetically to someone’s problems in order to find out what is causing them difficulties and help find a solution. As well as listening and discussing important issues with you, a psychotherapist can suggest strategies for resolving problems and, if necessary, help you to change your attitudes and behaviour.

Some therapists teach specific skills to help you tolerate painful emotions, manage relationships more effectively or improve behaviour. You may be encouraged to develop your own solutions, and in group therapy the members support each other with advice and encouragement.

What is psychotherapy used to treat?

Some of the conditions that psychotherapy and other talking therapies might be used to treat include: 

Types of psychotherapy

There are several different types of psychotherapy that have been proven to be effective and are offered on the NHS. These are described below.

  • Psychodynamic (psychoanalytic) psychotherapy is where a psychoanalytic therapist will encourage you to say whatever is going through your mind. This will help you to become aware of hidden meanings or patterns in what you do or say that may be contributing to your problems.
  • Cognitive behavioural therapy (CBT) is a form of psychotherapy that examines how beliefs and thoughts are linked to behaviour and feelings. It can teach skills that retrain a person’s behaviour and style of thinking to help them to deal with stressful situations.
  • Cognitive analytical therapy (CAT) uses methods from both psychodynamic psychotherapy and CBT to work out how someone’s behaviour causes them problems and how to improve it through experimentation and self-help.
  • Interpersonal psychotherapy (IPT) looks at the way in which illness can be triggered by events involving relationships with others, such as bereavements, disputes or relocation. It helps people to cope with the feelings involved as well as to work out coping strategies.
  • Humanistic therapies aim to find out how someone thinks about him or her self and to create a non-judgemental, understanding environment between the person and their therapist.
  • Family and marital (systemic) therapy is a type of therapy that involves other members of the person’s family and helps them to work out problems together.

Most psychotherapy treatments involve meeting a therapist regularly (usually once every week or fortnight), although it may be more often if needed. Individual sessions usually last for about 50 to 60 minutes, whereas group sessions are longer. Short-term psychotherapy may involve anything between 6 and 20 sessions.

Read more about how psychotherapy works.

How can I get psychotherapy?

The best place to start if you are interested in psychotherapy is with your GP. If your GP or another healthcare professional refers you to a qualified psychotherapist, you will receive psychotherapy through the NHS free of charge.

However, psychotherapies are not always available on the NHS, and you may need to have private treatment. A private 50-minute session can cost £35-100.

There are several professional bodies you can use to find a psychotherapist, including the British Association for Counselling & Psychotherapy and the UK Council for Psychotherapy.

Read more about the availability of psychotherapy.

Self-help

If you have a problem, such as mild anxiety or depression, which you feel you may be able to improve yourself without professional treatment, there are many self-help books available. These are mainly based on cognitive behavioural therapy (CBT). For information on the range of books and websites available for self-help you may wish to consider the websites of charities involved in your condition.

Book Prescription Wales is a scheme that aims to help people with mild to moderate emotional problems to make use of high quality self-help books that have been specially selected by psychologists and counsellors working in Wales.

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How does it work?

One of the key objectives of psychotherapy is to help you gain a better understanding of the issues that are troubling you.

It can help you work out new ways of approaching situations that you find difficult, as well as suggesting new methods to help you cope.

Developing a trusting relationship with your psychotherapist is very important. It will help you to talk about long-standing problems. Developing a trusting relationship can take time. Depending on the disorder and the style of psychotherapy, some courses of treatment may need to last for several months or, in some cases, years.

Types of psychotherapy

There are many different types of psychotherapy. The specific type used will vary depending on your personal needs and which method your psychotherapist thinks will be most helpful for resolving your issues.

The different types of psychotherapy are discussed in more detail below.

Psychodynamic (psychoanalytic) psychotherapy

Psychoanalysis is based on the modern developments of the theories of Sigmund Freud. Freud believed that bad thoughts and experiences from childhood are repressed but continue to influence your feelings as an adult.

In psychoanalysis you will spend a long time talking about your personal relationships and the thoughts you have about other people. You will be encouraged to discuss what has happened to you in the past as well as the present. This allows the analyst to find links between past events and how you think and act now.

Psychodynamic therapy is a less intensive form of psychoanalysis. It relies more on the way the relationship develops between yourself and the therapist than other types of therapy do. Your therapist may encourage you to talk about your childhood experiences with your parents and other people, to help you reveal unconscious thoughts.

Art, music and movement therapies often use the psychodynamic model of working but encourage alternative forms of self expression and communication as well as talking. Even young children can take part and this is known as ‘play therapy’. No musical or technical skills are needed for this kind of therapy to be successful.

Cognitive behavioural therapy (CBT)

Behavioural psychotherapy and cognitive therapy are separate techniques that are combined in cognitive behavioural therapy (CBT). In CBT you and the therapist will agree on tasks for you to do between sessions. This will help you to deal with problems yourself so that you no longer need therapy.

Cognitive therapy focuses on ways in which your thoughts and beliefs may be causing emotional problems. Your therapist will discuss these issues with you so that you can try to develop more helpful ways of thinking and are able to overcome the problems.

Behavioural psychotherapy may be used to help you gain a healthy structured life. It is also often used for overcoming a specific fear or phobia by helping you to change the way you act. Your therapist may encourage you gradually to face these fears and help you to relax and feel comfortable as you do it.

Cognitive behavioural therapy (CBT) is usually aimed at a specific problem and the sessions are often brief. There are normally six to twenty sessions.

Cognitive analytical therapy (CAT)

During early sessions of cognitive analytical therapy (CAT), the therapist will discuss your life story, mapping out potential problems that occurred with diagrams. You may exchange letters with the therapist several times, to help you both understand what is causing the problem.

A therapist who uses CAT will use diaries and progess charts. These will help you to develop skills that you can then use to continue improving once the therapy sessions are over.

Like CBT, CAT is often brief and may last about 16 sessions.

Humanistic therapies

Humanistic therapies aim to find out how you think about yourself and to recognise your strengths. The way you think about yourself can be improved by personal growth, self-direction and by taking on responsibilities. There are several types of humanistic therapies, which are listed below.

  • Person-centred counselling aims to create a comfortable environment where you can express yourself to try to find out what makes you happy and how your life experiences might have stopped you achieving this.
  • Gestalt therapy promotes self awareness to help you get over past experiences that are causing problems in the present. It may also use experiments created by you and the therapist.
  • Transactional analysis aims to help you analyse the decisions you make in life by recognising three ‘ego-states’ that people use to relate to each other. These are known as the inner parent, inner child and inner adult.
  • Transpersonal psychology involves discussing spirituality and self development to try to encourage someone to find their true self and happiness.
  • Existential therapy uses the work of philosophers, rather than focusing on the past, to help you discuss responsibility, broadening the mind and increasing self-awareness.

Interpersonal Psychotherapy (IPT)

Interpersonal pyschotherapy (IPT) has been shown to be particularly effective in the treatment of depression. The therapist is particularly interested in how relationships with other people can be managed as healthily as possible to help with recovery and staying healthy.

The therapist will help you to create an individual approach to dealing with any recent interpersonal difficulties. This therapy lasts for about 12 to 16 sessions. The last four sessions are used to consider how to manage any future relapses.

Family and marital (systemic) therapy

Family therapy focuses on family relationships, such as marriage, and encourages everyone within the family or relationship to work together to fix problems rather than encouraging blame. There is often more than one therapist involved to make sure everyone in the group has their say.

A therapist who uses family and marital therapy will encourage group discussions or exercises with everyone involved and will promote a healthy family unit as an effective way of improving mental health.

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Availability

Psychotherapy is available in some areas of the NHS by referral from your GP. However, there are often long waiting lists to see psychotherapists, so you may also wish to consider seeing a private therapist.

Mental health workers and psychotherapists already work in some GP surgeries. If there is not one available in your surgery, your GP may be able to refer you to a:

  • community mental health team (CMHT), which will decide what treatment is needed and refer you on to someone in their team or a specialist psychotherapy service
  • specialist psychotherapy service, which will carry out an assessment to find out what treatment is needed and refer you to one of its team of psychotherapists
  • consultant psychiatrist in psychotherapy, who will be trained and experienced in a wide variety of methods and can help work out which treatment is needed

If you are already seeing a psychiatrist or a local mental health team, they may be able to help you get psychological therapy as part of your treatment.

Alternatively, you may be able to refer yourself through your local NHS trust if they offer psychotherapy services as part of their local mental health services.

Private psychotherapy

You can also arrange to see a private psychotherapist or psychoanalyst. However, psychotherapy is currently an unregulated profession, so if you choose to see a private therapist, make sure that they are fully qualified and have received their training through a recognised professional organisation such as the:

Your GP may also be able to recommend a qualified psychotherapist who can offer a treatment with evidence that shows it can treat the disorder from which you are suffering. It is important to be aware that different therapies may be recommended for different disorders.

Self-help

If you have a problem, such as mild anxiety or depression, which you feel you may be able to improve without professional treatment, there are many self-help books available. These are mainly based on cognitive behavioural therapy (CBT). For information on the range of books and websites available for self-help you may wish to consider the websites of charities involved in your condition.

Book Prescription Wales is a scheme that aims to help people with mild to moderate emotional problems to make use of high quality self-help books that have been specially selected by psychologists and counsellors working in Wales.

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