What is Psychotherapy
Psychotherapy is a procedure in which various mental or emotional difficulties or disorders of personality are treated by some sort of communication between a psychotherapist and at least one patient. The nature of the difficulties, the specific setting for the procedure, and the particular sort of communication between the participants can vary quite a bit depending on the type of psychotherapy and how it was conceived (e.g. group psychotherapy, marital psychotherapy, play psychotherapy with children, behavioral therapy, or psychoanalysis). Different kinds of experiences in therapy can help different patients with distinct emotional difficulties. However, despite all the individual variability in that, there seem to be a few common factors associated with being helpful. The Psychoanalytic Research Consortium (PRC) and many other psychotherapy researchers have attempted to describe this process in detail. In the PRC, we have assessed a few common factors associated with a helpful psychotherapy process. Some of these factors are specific to the psychotherapist, some are specific to the patient, and some have to do with how patient and psychotherapist relate to one another. Through our clinical research, we feel we can help determine how best to listen and respond to another person in a particular way feels helpful to patients with various kinds of emotional difficulties.
Along with relevant clinical examples, we have provided a description of several aspects of this process:
- Why do patients come for help?: Patients generally consult a psychotherapist because of some distressing feeling they are having. The therapist is well advised to assume that the patient may not be at all aware of the underlying problems in relationships, for example, that could end up in the depression which they describe as the reason for coming for help. Interviewing skill and capacity to grasp the inner life of the patient are crucial components of initial interviews, as well was being important throughout treatment. Helping the patient clarify the problem in a way the patient finds meaningful is often the first, most important building block to develop a therapeutic alliance.
- The therapeutic alliance: An integral part of the psychotherapy process involves forging and maintaining the sense that patient and psychotherapist are working together collaboratively on common, shared goals, and with agreed-upon means of achieving these goals. This therapeutic alliance between psychotherapist and patient has been shown to correlate strongly with successful outcomes in psychotherapy, perhaps more than anything else. There are many factors that contribute to a stronger therapeutic alliance between patient and psychotherapist, and other issues that could contribute to a weaker alliance. Character problems of the patient (or psychotherapist) may interfere with the formation of a trusting therapeutic alliance, and the therapist’s skill in addressing these difficulties in the therapeutic relationship has been shown to lead to a better therapeutic result (cf. Høglend, P. Hersoug, A.G., Bøgwald, K.P., Amlo, S., Marble, A., Sørbye, Ø., Røssberg, J.I.,, Ulberg, R., Gabbard, G. & Crits-Christoph, P. (2011). Effects of Transference Work in the Context of Therapeutic Alliance and Quality of Object Relations. Journal of Consulting and Clinical Psychology 79, 697–706).
- What psychotherapists say: Psychotherapists make use of several kinds of interventions as they listen to patients and decide how best to respond to their difficulties. At times, a psychotherapist may choose to encourage the patient to elaborate on what has already been said, to clarify something the patient said, to provide support or guidance, or to interpret a novel meaning in what has been said. Psychotherapists at times relate a pattern or theme the patient repeatedly talks about, and at times links various themes or several experiences the patient has had in the past and present moment. A therapist attempts to engage the patient in a particular kind of conversation, designed to be helpful in understanding and managing the patient’s difficulties.
- What patients say: Patients attempt to describe their feelings in a variety of different ways. At times, they may explore speaking about what the experience of the emotion is like, and at other times, they may choose to reflect on the meaning of an emotional experience. Some of the patient’s speech is focused on the past, some speech attempts to imagine some sort of future, and some is focused on the present in the room with the psychotherapist. At times, the patient is describing a set of feelings that seem to be at odds with one another in a confusing way, at times the patient attempts to reconcile extreme or overwhelming thoughts or feelings, and at other times it is important for the patient to describe matters of self-esteem, and associated feelings of shame or pride. The patient attempts to engage the therapist in a particular kind of conversation as well, often with reference to how they relate to others and conceive of themselves as a person.
- Interactions between patient and psychotherapist: The interaction between patient and psychotherapist can be productive or stagnant in a number of different, complex ways. How responsive each participant is to the other, how distant each one feels from the other, and the extent to which patient and psychotherapist can reflect on their experiences in the here-and-now can all have different effects depending on the context of the relationship. As patient and psychotherapist engage in their conversations, the conversations themselves affect how they each relate to one another, and these changes in relatedness can be helpful in understanding aspects of the patient’s experience.
- How do patients benefit: Patients in psychotherapy do not just experience improvements in their symptoms and the issues for which they may have sought treatment in the first place. In addition, they learn how to feel less stuck, develop insight into how their mind works, develop a heightened sense of self and improved self-confidence, a more adaptive sense of who they are, and more effective and versatile ways of understanding and relating to others (Connolly, M.B. & Strupp, H.H. (1996). Cluster Analysis of Patient Reported Psychotherapy Outcomes. Psychotherapy Research, 6, 30-42). Thus, many positive changes from treatment cannot be known at the outset, even though in most cases, these changes are greatly valued after psychotherapy has completed.
PRC Psychotherapy Manual
In this site, we are interested in how psychotherapy works, and what actually occurs when it is helpful in alleviating a patient’s emotional distress. We have written the PRC Psychotherapy manual, as an educational tool for clinicians, researchers, and psychotherapy students to help characterize various aspects of the psychotherapy process. This manual provides many important clinical illustrations of different components of the psychotherapy process. We hope this helps you understand various elements of psychotherapy that are common to most types of therapy and different theoretical orientations.