- What is psychotherapy?
- Other types of psychotherapy
- Who can implement a psychotherapy program?
- Where can psychotherapy take place?
- What is the format of psychotherapy?
- Goals of psychotherapy
- Does psychotherapy work and how does it work?
The term “psychotherapy” refers to a broad range of practices, techniques, theories and perspectives. It is difficult to define because there are literally hundreds of different types of practices that all call themselves psychotherapy. In order to clarify, the professional field needs to be divided between psychology, which is mainly taught in the universities, and psychotherapy, which may be taught in university but most trainings are offered by private organisations. There is some overlap between psychology and psychotherapy which can be confusing for the lay public.
Psychodynamic or psychoanalytic psychotherapy is the practice that has evolved out of the original Freudian and Jungian traditions. Contemporary practices have developed and diversified. Psychotherapy is well established in Europe and America and is now growing in Australia, where it is primarily found in the major cities.
Psychotherapy is also called depth therapy and is concerned with the meaning of experience and behaviour. “Meaning” refers to an understanding of ourselves in our lives, in the world, that is essentially our own. In other words, meaning is personal to each of us, rather than fixed or derived from some external source. No textbook or theory can say what something means to us because we are all different and experience things in different ways. Therapists are trained to help each client come to their own understanding and insight about where meaning is to be found or created.
Meaning emerges organically through dialogue and crystallises out of a process of shared exploration. This is why clients tend to meet on a regular, perhaps weekly basis. History, culture and the broad field of language all situate us in a personal context in which we may discover the underlying reasons and meanings of our existence, as well as conflicts, problems or particular issues.
The profoundly personal discourse of psychotherapy is structured by what we know and remember and what remains buried or secret, even to our conscious awareness. Our growing insight into what becomes uncovered enables what is sometimes called the subtext, the symbolic, or the unconscious, to come into view.
The encounter with and realisation of the unconscious distinguishes analytic or dynamic psychotherapy from other approaches. It leads us to a fuller sense of our often unrecognised motivations, intentions and feelings which underlie the workings of the mind, how we act and generally the way we are. This process of discovery opens possibilities for development through a coming-to-terms with both our limits and our potentialities, while negotiating the path between our fragility and our strengths.
Therapy attends to specific personal issues, past and present. Insight into the meanings of such issues, however, is not merely for the sake of creating psychological explanations. Over time, the obstacles which prevent us from resolving issues and moving on in our lives need to be dismantled. Realisation of thoughts and feelings and their connections promotes integration which, in turn, is empowering. Bringing the inner life to therapeutic work often results in clarity which contributes to a more authentic sense of ourselves as relational beings, although this path may, at times, be painful and difficult.
Analytic therapy is largely a non-directive process of self-discovery and personal development, occasioned by the use of a professional relationship. The private space offered in therapy should provide an uncommonly safe, confidential and reliable environment to explore areas we normally might prefer not to reveal openly. Giving time and attention to ourselves on a regular basis cultivates the conditions for emotional maturation and a greater capacity for autonomy and effectiveness. Ultimately, such development inspires self-acceptance, personal authority and a feeling of purpose and aliveness. We thereby improve our possibilities for satisfaction and fulfilment through enhanced capacities to connect with other people, to cultivate intimacy, especially through a better quality of communication and mutual understanding.
Psychotherapy can be viewed through a number of possible paradigms such as:
- A psychological treatment for particular disorders;
- A method of reducing, relieving and healing mental suffering;
- An analysis of the narrative story of our personal lives;
- A review of our histories, a stock-take of where we have been and
what we have been through;
- A journey of personal discovery of our own inner world;
- A maturational process of self-awareness and emotional growth; and
- A path for spiritual growth and awakening. Emotional growth often
lays the foundation for spiritual development by illuminating and
revealing some our deepest metaphysical questions and enabling us
to come to terms with “reality” as it is.
Psychoanalysis is a form of psychotherapy that is generally considered to be more intensive and in-depth. One of the distinguishing features of psychoanalysis is the frequency of sessions and the duration of treatment. Clients may attend sessions three or four or five times per week and continue over a long period of time, sometimes many years.
The original tradition of psychoanalysis is referred to as classical psychoanalysis, which has declined in popularity but is still practiced. A more contemporary development is called relational psychoanalysis and psychotherapy. The relational movement is known for being less rigid and less dogmatic in terms of the theoretical adherence of its proponents.
Another form of psychoanalysis that has grown in popularity is the thought and practice associated with its original thinker, Jacques Lacan. Lacan set out to revise and expand upon the ideas of Sigmund Freud and advocated “a return to Freud”. Lacan’s writing is often dense and difficult to understand, but nevertheless there is significant interest in Lacanian psychoanalysis in Australia. Lacan viewed analysis as being an encounter with the unconscious, and was less concerned with issues of client’s history and childhood experiences.
There is a broad category of psychotherapy that is different from both psychology and psychodynamic psychotherapy, called humanistic psychotherapy (or psychology). Practices such as Gestalt, Psychosynthesis, Neuro-Linguistic Programming and Transactional Analysis are all examples of a humanistic approach.
The principal philosophical difference between the humanistic approach and the psychoanalytical approach is that the humanistic therapies have a set technique that aims for specific ends or goals. Psychoanalytical therapy is open, non-directive and has no pre-determined endpoint or goal. A typical goal of humanistic therapy is to fulfil our potential. There are significant overlaps between the different types of therapy practice.
A significant alternative practice to both humanistic therapy and psychodynamic therapy is called existential psychotherapy. The existential therapists have criticised and rejected some of the principle theoretical concepts of psychoanalysis such as “the unconscious” and “transference”. Existential therapy is derived from the branch of philosophy called existentialism, which is concerned with issues of human freedom and responsibility, ethics, and our mortality. For example, existential therapy believes that we all carry an element of anxiety that is a natural tension based upon our lived sense that life is finite and that each of us will die one day. How we experience both the freedom and responsibility that emerges from this view is a typical subject for the existential approach.
Training in psychotherapy differs from training in psychology. The basis of psychology training in university is research, statistics and an understanding of research methodology. Training in psychotherapy has a number of distinct components that are often similar despite differences in theory. The components of training include theoretical seminars, extensive personal therapy for the trainee, and then clinical supervision once practising. Undertaking personal therapy for oneself is a distinguishing feature of a proper psychotherapy training, whatever the orientation.
What is confusing for the “consumer” is that all kinds of practices may be called “psychotherapy”, including psychological practices such as cognitive behavioural therapy (CBT) or dialectical behaviour therapy (DBT). These practices follow what is called the scientist practitioner model, whereas analytical psychotherapists usually follow what is called a working alliance. The working alliance refers to the partnership of client and professional who work together to explore the client’s issues.
Many professionals practice what they may call psychotherapy, including:
- Occupational therapists
- Social workers
- Psychiatric nurses
We recommend identifying the exact practice, the form and degree of training, and the qualifications of any practitioner, so that clients may have some understanding in advance of what sort of practice they are undertaking and whether or not this is right for them.
The first principle of any psychotherapy practice is that it should be safe and feel safe for the client.
- In the consulting room of a qualified professional
- As part of a psychotherapy, psychology, counselling, doctors’ or psychiatry practice
- In a public or private hospital
- Inpatient clinics
- Some qualified therapists practice from their own homes
Different people respond to different psychotherapies implemented in a variety of ways. While some people may prefer the one-on-one interaction with their chosen therapist, others may prefer the dynamic of group interactions. After talking to you, a qualified professional will be able to suggest which format is best for you, your family and your situation. The most common formats are:
- Individual psychotherapy
- Couple or marital psychotherapy
- Family therapy
- Parent therapy
- Play therapy for children
- Group therapy
Because people who are seeking therapy are motivated by different needs and issues, the goals of psychotherapy will vary greatly depending upon what is required and what is sought.
Psychology often addresses what it sees as errors of thinking. Both psychology and psychotherapy will address something like depression in quite different ways. Psychology tends to be affirming and supportive and help people develop a better sense of self-esteem. Psychotherapy, on the other hand, often sees that the depressed client is suffering from an experience of loss and that the corresponding feelings of anger and grief may not have had an opportunity to be sufficiently processed. This example shows how goals will depend upon the person and also upon the orientation of the therapist.
It is most important that clients feel they can be frank, open and candid about what they want and need from psychotherapy. It is also important for clients to ask what they can reasonably expect from the process.
Psychotherapy works better for some people than others and psychotherapy takes longer for some people than others. It is practically impossible for a psychotherapist to know the exact duration and efficacy of therapy at the outset.
There is no doubt that the effectiveness of psychotherapy depends upon the client putting themselves into it. Being more open will help psychotherapy to work. Being direct and communicating honestly, including if a client is not happy about anything that happens as part of the process, helps therapy to work. Being prepared to reflect and consider what goes on inside oneself, bringing thoughts, feelings, dreams, fantasies and significant experiences (past and present) to therapy, is an important part. What we most want, our deepest desires, and getting in touch with what really matters is central to the psychotherapy process. Being willing to take some responsibility for what happens to us also helps psychotherapy to work.
Ultimately, psychotherapy works best when clients are truly ready to use this process. But part of the process may involve examining what prevents us from being “ready” when there are obstacles or resistances in the way of working therapeutically. Often, people say they are afraid to change or afraid to open up before having therapy. Then, afterwards, when they have and feel better for it, the same people say, “I don’t know why I waited so long!”
Kindly written and reviewed by Jan Resnick, PhD (Psychology) Senior Psychotherapist and Supervisor at Amygdala Consulting (Claremont), Advisory Board Member of ASCA (Adults Surviving Child Abuse, Sydney), Editorial Advisory Board Member of Psychotherapy in Australia, and of Virtual Medical Centre & Virtual Psychiatry Centre.
|For more information on how psychotherapy can be used in the treatment of anxiety, watch Jan Resnick’s video on Psychotherapy for Anxiety.|
|For more information on how psychotherapy can be used in the treatment of depression, watch Jan Resnick’s video on Psychotherapy for Depression.|