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David Baxter PhD

Late Founder
Psychotherapy: Improve your mental health through talk therapy
September 3, 2004
Mayo Clinic staff

Psychotherapy is a general term for a way of treating mental and emotional disorders by talking about your condition and related issues with a mental health professional. It's also known as talk therapy, counseling or psychosocial therapy.

Through these talk sessions, you learn about the causes of your condition so you can better understand it. You also learn how to identify and make changes in troubling behavior or thoughts, explore relationships and experiences, find better ways to cope and solve problems, and set realistic goals for your life. Psychotherapy can help you regain a sense of happiness and control in your life and help alleviate symptoms caused by mental illness, such as hopelessness and anger.

Learn about the different types of psychotherapy and what each has to offer. Ask your doctor if psychotherapy might be right for you.

Your treatment plan
Psychotherapy can be short term, lasting just a couple of sessions over a few weeks, or it can take many sessions over several years. It can take place in individual, couples, family or group sessions.

Sometimes psychotherapy is combined with different types of treatment, such as medication. The treatment plan best suited for your needs depend on such factors as the type of mental illness or condition you have, how long you've had it, other medical issues, previous treatments, personal preferences and even cost and insurance coverage. Talk to your doctor about which options are best for you.

Types of psychotherapy
Among the many types of psychotherapy are:

[*]Behavior therapy. Behavior therapy focuses on changing unwanted or unhealthy behaviors, typically using a system of rewards, reinforcements of positive behavior, and desensitization. Desensitization is a process of confronting something that causes anxiety, fear or discomfort and overcoming those responses. If you have a fear of germs that prompts you to excessively wash your hands, for instance, you might be trained in ways to stop the excessive washing.

[*]Cognitive therapy. This type of therapy is designed to help you identify and correct distorted thought (cognitive) patterns that can lead to feelings and behaviors that are troublesome, self-defeating or self-destructive. It's based on the premise that how you interpret your experiences in life determines the way you feel and behave. If you're depressed, for instance, you might see yourself and your experiences in negative ways, which adds to the symptoms of depression. Like behavior therapy, cognitive therapy focuses on your current problems to alleviate symptoms, rather than addressing underlying or past conflicts. Unlike behavior therapy, however, your experiences are an important part of the cognitive therapy process.

[*]Cognitive-behavioral therapy. This type of talk therapy combines features of both cognitive and behavior therapy to identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. It's based on the idea that your own thoughts not other people or situations determine how you behave. Even if an unwanted situation has not changed, you can change the way you think and behave in a positive way.

[*]Creative art therapy. This type of therapy uses the creative process to help people who might have difficulty expressing their thoughts and feelings. Creative arts can help you increase self-awareness, cope with symptoms and traumatic experiences, and foster positive changes. Creative art therapy includes art, dance and movement, drama, music and even poetry.

[*]Dialectical behavior therapy. This is a type of cognitive-behavioral therapy whose primary objective is to teach behavioral skills to help you tolerate stress, regulate your emotions and improve your relationships with others. It was designed for people with borderline personality disorder, who often have suicidal behavior. But it has been adapted for other conditions, too, including people with eating disorders or substance abuse issues. Dialectical behavior therapy is derived, in part, from a philosophical process called dialectics, in which seemingly contradictory facts or ideas are weighed against each other to come up with a resolution or balance. For instance, you might learn about accepting who you are while at the same time making changes in your thoughts and behaviors.

[*]Exposure therapy. This is a form of behavior therapy that deliberately exposes you to the very thing that you find upsetting or disturbing. It's especially useful for people with obsessive-compulsive disorder or post-traumatic stress disorder. Under controlled circumstances, exposure to the event or things that triggers your obsessive thoughts or traumatic reactions can help you learn to cope with them and work through the traumas.

[*]Interpersonal therapy. This approach focuses on your current relationships with other people. The goal is to improve your interpersonal skills, how you relate to others, including family, friends and colleagues. You'll learn how to evaluate the way you interact with others and develop strategies for dealing with relationship and communication problems.

[*]Play therapy. This type of therapy is geared for young children at specific development levels. It uses a variety of techniques, including playing with dolls or toys, painting or other activities. These techniques allow children to more easily express emotions and feelings if they lack the cognitive development to express themselves with words.

[*]Psychoanalysis. In this therapeutic approach, you examine memories, events and feelings from the past to understand current feelings and behavior. It's based on the theory that childhood events and biological urges create an unconscious mind that drives how you think, feel and behave. In this therapy, you explore those unconscious motivations to help make changes to improve your life. You might also do dream analysis and free association talking about whatever happens to come to mind. Psychoanalysis is a long-term, intensive therapy that often involves several sessions a week with a psychoanalyst for several years. In formal psychoanalysis, you lie on a couch and the therapist sits unseen behind you. The practice evolved out of theories developed by Sigmund Freud.

[*]Psychodynamic psychotherapy. This type of therapy, based on the theories of psychoanalysis, focuses on increasing your awareness of unconscious thoughts and behaviors, developing new insights into your motivations, and resolving conflicts to live a happier life. It's one of the most common types of psychotherapy. It's less intense than psychoanalysis and is usually done sitting face to face with a therapist. It's also less frequent usually once a week and is shorter term, usually a year or less. Psychodynamic psythotherapy includes a variety of therapeutic techniques, such as exploring your past, confronting your beliefs and actions, offering support, and interpreting your thoughts and behavior. That process allows you to become aware of and acknowledge the link between a feeling, thought, symptom or behavior and an unconscious meaning or motivator. With that new understanding, you can modify unwanted behavior or thoughts.

[*]Psychoeducation. This approach focuses on teaching you and sometimes family and friends about your illness. Psychoeducation explores possible treatments, coping strategies and problem-solving skills. You might learn about resources in your community, such as support groups. You can also learn about symptoms that might indicate a potential relapse so you can take steps to get appropriate treatment. It can be especially useful for people with chronic or severe illnesses, such as schizophrenia.

Meeting your needs
The therapeutic process can be daunting and uncomfortable, especially in the beginning. But within a few weeks, you should begin to see an improvement in your symptoms, including relief from distress, better decision-making abilities, improved relationships and new coping skills.

If that's not happening, talk to your doctor. You might not be getting the right kind of treatment for your situation.

"Treatment must be tailored to an individual," notes Keith Kramlinger, M.D., a psychiatrist at Mayo Clinic, Rochester, Minn. "If results aren't what you hoped for or you don't feel right about the treatment, get a second opinion. Therapy is not a one-size-fits-all treatment. With so many different types of treatment available, you and your health care provider can sort through the options and work toward improving the quality of your life."
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