Psychotherapy is a type of treatment for a variety of mental disorders that has been used in psychology for decades.
This article will cover what psychotherapy is and how it can benefit people with various disorders.
This article will also discuss some ways that psychotherapists can improve their own practice for the betterment of their clients.
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What is Psychotherapy? A definition
According to the American Psychological Association (APA), psychotherapy can be defined as a “collaborative treatment … between an individual and a psychologist” where the psychologist uses “scientifically validated procedures to help people develop healthier, more effective habits“. For a more in-depth discussion of what psychotherapy is and how it’s used, consult this PDF from the Southern California Psychiatric Society.
For our purposes, we can define psychotherapy as a psychological treatment for a variety of mental health disorders that may or may not be delivered in concert with pharmaceutical treatment.
5 Psychotherapy Techniques, Tools & Exercises
One recent paper laid out a generalized approach that psychotherapists should take to lead successful sessions (Yager & Feinstein, 2017). This approach is broken up into four steps:
- Relating: This includes respecting the patient’s self-esteem and struggles, as well as being kind.
- Exploring: This includes paying attention to what a client says (as well as what they don’t say) and their body language, as well as asking questions to better understand the client and clear up contradictions.
- Explaining: This includes considering how the client’s and the therapist’s cognitive biases may be shaping the session, as well as considering any other factors (sociological, interpersonal, developmental, etc.) that could shape the client’s thinking, then finally ask the client whether or not they agree with your hunches and conclusions.
- Intervening: This includes presenting one’s interpretations to the client so they can agree or disagree with them, not enabling the client’s destructive or dishonest behaviors, and teaching the client ways to deal with their issues (such as coping skills).
Another issue with psychotherapy is that clinicians generally underestimate the number of clients who leave treatment with no benefit, or at risk of deterioration (Lambert, 2017). The first step to correcting this issue is to make therapists aware of the discrepancy between how they think treatment is progressing and how the client is actually progressing.
One way to do this is the Outcome Questionnaire-45 (OQ-45), which is a 45-question self-assessment that clients can complete at the end of each session to track their therapeutic progress. If therapists offer this option to clients, they can more quickly identify clients in need of modified treatment plans.
There is also a Youth Outcome Questionnaire-30 (Y-OQ-30) for children and adolescents, which can either be completed by the client or their parent(s). By using these tools, psychotherapists can ensure their treatment plans are effective and modify them if they are not.
For more information on how to be an effective psychotherapist, consult this PDF from the American Psychological Association.
How to Deal with Resistance in Psychotherapy: Techniques for Therapists
One way to deal with resistance in psychotherapy is for the therapist to ask the client for feedback at the end of each session, and attempt to modify their treatment plan in response to that feedback (Esmiol-Wilson et al., 2017). For example, certain clients whose feedback was solicited expressed that their therapist did not understand their situations because of their own privilege as a therapist. The therapist was then able to recognize this and incorporate it into their treatment so that they could deal with their client from a more honest and open perspective.
Another study looking at resistance in psychotherapy focused specifically on in-session distress (Yasky et al., 2016). These researchers had clients complete post-session questionnaires which asked them to identify any in-session distress they experienced. From there, the therapists were more careful to monitor in-session distress and discussed this distress with their client when they felt it was becoming an issue. When in-session distress was identified and discussed, clients completed more therapy sessions and achieved better post-therapy outcomes.
This idea is reinforced in the description of a case study of a man who sought therapy for anger issues at the behest of his wife (Dowd, 2016). When the therapist was encountering extreme resistance from the client, she briefly stopped the session and (politely) confronted him about his resistance, allowing the client to feel that he was being listened to. From there, the therapist gave the client more control by allowing him to structure the session himself, at which point he became less guarded and was eventually able to resolve some of his issues (with multiple psychotherapy sessions).
The common thread in all three of these papers is the idea of adaptability. In all cases, therapists encountered resistance when they ran the sessions by the book and somewhat rigidly. By getting direct feedback from the client, the therapists were able to modify their treatment plans to address the client’s concerns, and from there they encountered less resistance.
Since psychotherapy is supposed to be an individualized process, the ability to adapt a treatment plan is crucial for any therapist encountering resistance.
The 10 Best Psychotherapy Interventions
While different psychotherapy interventions can be useful for different people and for different disorders, here are 10 of the best-proven psychotherapy interventions out there.
Three psychotherapy treatment plans which have been described as empirically supported treatments (ESTs) are cognitive-behavioral therapy (CBT), psychodynamic psychotherapy, and supportive psychotherapy (Feinstein et al., 2015). According to the Mayo Clinic, CBT “helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones”. Psychodynamic psychotherapy consists of “increasing your awareness of unconscious thoughts and behaviors, developing new insights into your motivations, and resolving conflicts”, while supportive psychotherapy “reinforces your ability to cope with stress and difficult situations“.
Psychotherapy incorporating aspects of mindfulness-based stress reduction (MBSR) has been shown to be effective for reducing symptoms of stress and anxiety (Call et al., 2014). According to the Center for Mindfulness at the University of Massachusetts, MBSR aims to help you “[d]evelop the ability to cope more effectively with both short-term and long-term stressful situations”. This is an interesting finding because mindfulness and the teachings of MBSR can easily be incorporated into traditional psychotherapy.
Short-term psychodynamic therapy with mentalization-based therapy (STMBP) has been shown to be an effective treatment for a major depressive disorder (MDD) (Bressi et al., 2017). According to Dr. John Grohol with PsychCentral, mentalization-based therapy (MBT) aims to “[help] people to differentiate and separate out their own thoughts and feelings from those around them”. This is another example of how a simple adaptation of a traditional psychotherapy treatment can make it beneficial to more people.
Psilocybin-assisted psychotherapy has been shown to be effective in reducing stress and anxiety symptoms in cancer patients (Belser et al., 2017). In this study, psilocybin-assisted psychotherapy referred to a long psychotherapy session during which the client had been administered psilocybin. Unlike most psychotherapy, psilocybin-assisted psychotherapy would likely only consist of a single session, though that session may be part of a longer, multi-session treatment plan.
Interpersonal psychotherapy (IPT) has been shown to reduce depressive symptoms in adolescents (Pu et al., 2017). According to the Mayo Clinic, IPT “focuses on addressing problems with your current relationships with other people to improve your interpersonal skills”. IPT can be effective in treating disorders that lead to social deficiencies, as well as in marriage and family therapy.
Cognitive hypnotherapy (CH) has been shown to be effective in treating anger issues (Dowd, 2016). Cognitive hypnotherapy is an “integration of hypnosis with CBT” that initially arose as a way to use hypnosis to treat depression (Alladin, 2012). This is a good example of how traditional psychological ideas (such as hypnosis) can be made more palatable to skeptics through integration with more modern, empirically-supported treatments.
Dialectical behavior therapy (DBT) has been shown to be effective for reducing suicidal ideation as well as depression and anxiety symptoms in combat veterans (Goodman et al., 2016). Dialectical behavior therapy is “a type of CBT that teaches behavioral skills to help you handle stress, manage your emotions and improve your relationships with others”, according to the Mayo Clinic. While DBT is an adaptation of CBT, it is widely used enough to merit its own mention.
A type of art therapy called short-term clay art therapy (CAT) has been shown to be effective in improving the mental health of participants with MDD (Nan & Ho, 2017). According to the American Art Therapy Association, art therapy is “an integrative mental health and human services profession that enriches the lives of individuals, families, and communities through active art-making, creative process, applied psychological theory, and human experience within a psychotherapeutic relationship”. Art Therapy can help children, adolescents, and less vocally-expressive adults get more out of a psychotherapy session than traditional talk therapy.
What is the Best Psychotherapy Counseling Treatment
Since psychotherapy is such a personal undertaking, there is no single best “one-size-fits-all” treatment. That said, cognitive-behavioral therapy (CBT) is often considered the most effective treatment for the widest range of disorders. For example, therapist-led (as opposed to self-administered) CBT has been shown to be effective for both bulimia nervosa (BN) and consequential depressive symptoms (Linardon et al., 2017). CBT has also been shown to be effective (by itself or in concert with other treatments) for anxiety, general depressive symptoms, depressive symptoms in insomniac patients, tinnitus distress, and smoking cessation (Dragioti et al., 2017).
Functional analytic psychotherapy (FAP, a subset of CBT) has also been shown to be effective for decreasing interpersonal difficulty in nursing home residents (Singh & O’Brien, 2017). As we saw above, other adaptations of CBT (such as DBT and cognitive hypnotherapy) have also gained acceptance, showing its versatility as well as the variety of disorders it can be useful for. All of that said, it can be tempting to think that CBT is easily the best treatment for most disorders since it has been shown to be useful for such a wide variety of disorders.
There has been a recent pushback on the efficacy of CBT, though, as some researchers argue that many papers compare CBT to being on a waiting list or no treatment (as opposed to the typical treatment for the disorder in question) and that some psychologists allow their own “allegiance” to CBT to bias their study of its effectiveness (Leichsenring & Steinert, 2017).
Other recent research has challenged the supposed superiority of CBT for certain disorders, such as one paper showing that psychodynamic therapy is at least as effective for treating MDD as CBT is (Driessen et al., 2017). This shows the importance of challenging conventional wisdom in psychology research, so that knowledge is driven by empirical research findings rather than popular consensus.
With those criticisms acknowledged, CBT is still a very useful treatment for a variety of disorders and is a crucial part of psychotherapy.
While it may not always be the best treatment option for every case, its versatility makes it an important treatment plan for any psychotherapist to be well-acquainted with. For an in-depth look at CBT, consult this website from the Centre for Addiction and Mental Health.
A Take Home Message
Psychotherapy comes in many different forms and can be used to treat many different disorders, but at the end of the day, it is a personalized process that requires a psychotherapist who is keenly aware of their client’s personal needs. For example, while CBT is an effective treatment for a variety of disorders, it may require adaptation (such as in the cases of DBT and CH) to best help a client, and in other cases, it may not even be the best treatment plan available. Aside from specific treatment plans, some psychotherapy sessions require feedback from the client and adaptability from the psychotherapist to be maximally effective.
In other words, while the goal of many psychotherapy treatments is to get the client to challenge their own thoughts and assumptions, psychotherapists would also do well to interrogate their own beliefs rather than accept them as fact.
- Alladin, A. (2012). Cognitive Hypnotherapy for Major Depressive Disorder. American Journal of Clinical Hypnosis, 54(4), 275-293. doi:10.1080/00029157.2012.654527
- American Art Therapy Association. (u.d.). About Art Therapy. Retrieved from https://arttherapy.org/about-art-therapy/.
- Belser, A.B., Agin-Liebes, G., Swift, T.C., Terrana, S., Devenot, N., Friedman, H.L., Guss, J., Bossis, A., Ross, S. (2017). Patient Experiences of Psilocybin-Assisted Psychotherapy: An Interpretive Phenomenological Analysis. Journal of Humanistic Psychology, 57(4), 354-388. doi:10.1177/0022167817706884
- Bressi, C., Fronza, S., Minacapelli, E., Nocito, E.P., Dipasquale, E., Magri, L., Lionetti, F., Barone, L. (2017). Short-Term Psychodynamic Psychotherapy with Mentalization-Based Techniques in Major Depressive Disorder patients: Relationship among alexithymia, reflective functioning, and outcome variables - A Pilot study. Psychology and Psychotherapy-Theory Research and Practice, 90(3), 299-313. doi:10.1111/papt.12110
- Call, D., Miron, L., Orcutt, H. (2014). Effectiveness of Brief Mindfulness Techniques in Reducing Symptoms of Anxiety and Stress. Mindfulness, 5(6), 658-668. doi:10.1007/s12671-013-0218-6
- Dowd, E.T. (2016). Resistance and the Wounded Self: Self-Protection in Service of the Ego. American Journal of Clinical Hypnosis, 59(1), 100-113. doi:10.1080/00029157.2016.1163656
- Dragioti, E., Karathanos, V., Gerdle, B., Evangelou, E. (2017). Does psychotherapy work? An umbrella review of meta-analyses of randomized controlled trials. Acta Psychiatrica Scandinavica, 136(3), 236-246. doi:10.1111/acps.12713
- Driessen, E., Van, H.L., Peen, J., Don, F.J., Twisk, J.W.R., Cuijpers, P., Dekker, J.J.M. (2017). Cognitive-Behavioral Versus Psychodynamic Therapy for Major Depression: Secondary Outcomes of a Randomized Clinical Trial. Journal of Consulting and Clinical Psychology, 85(7), 653-663. doi:10.1037/ccp0000207
- Esmiol-Wilson, E., Partridgem R., Brandon, M., Kollar, S., Benning-Cho, S. (2017). From Resistance to Buy-In: Experiences of Clinicians in Training Using Feedback-Informed Treatment. Journal of Couple & Relationship Therapy - Innovations in Clinical and Educational Interventions, 16(1), 20-41. doi:10.1080/15332691.2016.1178615
- Feinstein, R., Heiman, N., Yager, J. (2015). Common Factors Affecting Psychotherapy Outcomes: Some Implications for Teaching Psychotherapy. Journal of Psychiatric Practice, 21(3), 180-189. doi:10.1097/PRA.0000000000000064
- Goodman, M., Banthin, D., Blair, N.J., Mascitelli, K.A., Wilsnack, J., Chen, J., Messenger, J.W., Perez-Rodriguez, M.M., Triebwasser, J., Koenigsberg, H.W., Goetz, R.R., Hazlett, E.A., New, A.S. (2016). A Randomized Trial of Dialectical Behavior Therapy in High-Risk Suicidal Veterans. Journal of Clinical Psychiatry, 77(12), E1591-E1600. doi:10.4088/JCP.15m10235
- Grohol, J. (2016). Mentalization Based Therapy (MBT). Retrieved from https://psychcentral.com/lib/mentalization-based-therapy-mbt/.
- Lambert, M.J. (2017). Maximizing Psychotherapy Outcome beyond Evidence-Based Medicine. Psychotherapy and Psychosomatics, 86(2), 80-89. doi:10.1159/000455170
- Leichsenring, F., Steinert, C. (2017). Is Cognitive Behavioral Therapy the Gold Standard for Psychotherapy? The Need for Plurality in Treatment and Research. Journal of the American Medical Association, 318(14), 1323-1324. doi:10.1001/jama.2017.13737
- Linardon, J., Wade, T., Garcia, X.D., Brennan, L. (2017). Psychotherapy for bulimia nervosa on symptoms of depression: A meta-analysis of randomized controlled trials. International Journal of Eating Disorders, 50(10), 1124-1136. doi:10.1002/eat.22763
- Mayo Clinic. (u.d.). Psychotherapy. Retrieved from https://www.mayoclinic.org/tests-procedures/psychotherapy/details/what-you-can-expect/rec-20197200.
- Nan, J.K.M., Ho, R.T.H. (2017). Effects of clay art therapy on adults outpatients with major depressive disorder: A randomized controlled trial. Journal of Affective Disorders, 217(1), 237-245. doi:10.1016/j.jad.2017.04.013
- Pu, J.C., Zhou, X.Y., Liu, L.X., Zhang, Y.Q., Yang, L.N., Yuan, S., Zhang, H.P., Han, Y., Zou, D.Z., Xie, P. (2017). Efficacy and acceptability of interpersonal psychotherapy for depression in adolescents: A meta-analysis of randomized controlled trials. Psychiatry Research, 253(1), 226-232. doi:10.1016/j.psychres.2017.03.023
- Singh, S., O'Brien, W.H. (2017). Functional Analytic Psychotherapy for Nursing Home Residents: A Single-Subject Investigation of Session-by-Session Changes. Journal of Contemporary Psychotherapy, 47(3), 173-180. doi:10.1007/s10879-016-9352-5
- UMass Medical School Center for Mindfulness. (u.d.). Mindfulness-Based Programs. Retrieved from https://www.umassmed.edu/cfm/mindfulness-based-programs/.
- Understanding psychotherapy and how it works. (u.d.). American Psychological Association. Retrieved from http://www.apa.org/helpcenter/understanding-psychotherapy.aspx.
- Yager, J., Feinstein, R.E. (2017). Tools for Practical Psychotherapy: A Transtheoretical Collection (or Interventions Which Have, At Least, Worked for Us). Journal of Psychiatric Practice, 23(1), 60-77. doi:10.1097/PRA.0000000000000208
- Yasky, J., King, R., O'Brien, T. (2016). Resistance, early engagement and outcome in psychoanalytic psychotherapy of patients with psychosomatic disorders. Counselling & Psychotherapy Research, 16(4), 266-276. doi:10.1002/capr.12093