This information is for anyone who may have been offered psychotherapy, thinks that they might need psychotherapy or simply wants to know more about psychotherapy.
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There are different types, but they are all 'talking treatments' in which you talk with another person. It can help you to overcome:
- emotional problems
- relationship problems
- troublesome habits
- problems, such as hearing voices.
The person carrying out the treatment is usually called a therapist, while the person being seen is the patient or client.
Most psychotherapies can be done one-to-one or in groups. Some can now be done using the internet.
Psychodynamic (psychoanalytic) psychotherapy
Psychodynamic psychotherapy gives you a regular time to think - and talk – about the feelings you have about yourself and other people (especially your family and those you are close to). You discuss:
- what's happening in your life at the moment - how you do things and the part you play in things going right or wrong for you
- what has happened in the past
- how the past can affect how you are feeling, thinking and behaving right now.
The therapist will help you to make these connections between the past and the present. He or she will often comment on what happens in the sessions as you talk together. This can help to show how some of the things that you feel, do and say are not driven by your conscious thoughts and feelings, but by unconscious feelings from your past. And if it is happening in the therapy sessions, it will also be happening in your day-to-day life. When you understand these connections better, you can make decisions based on what you want or need now, not what your past experiences drive you to do.
Psychodynamic psychotherapy usually involves regular, 50-minute meetings. These can be weekly or more often if needed. If you have a more straightforward problem, you may only need a few weeks or months of therapy. If your problems are more complicated – or long-standing – you may have to carry on for several months or longer.
Cognitive behavioural therapy (CBT)
Behavioural psychotherapy helps you overcome problems by changing how you behave. For example, you may need to overcome a fear, or phobia. The therapist will help you, very gradually, to spend more and more time in the situation you fear – and will help you to feel comfortable and relaxed in that situation.
Cognitive therapy focuses more on the way that what you believe and think can keep problems going. It helps you to test any unhelpful beliefs by talking about them, and then developing ideas that are more helpful for you. You then try these out in between sessions and so develop more helpful ways of thinking and acting. It can take account of what has happened in the past, but mainly looks at the present and future.
Cognitive behavioural therapy (CBT) combines these two techniques. It is structured, usually aimed at a particular problem and is fairly brief (6-20 sessions). It's a bit like being coached – you have a number of exercises to do between sessions. In a way, you learn to become your own therapist. The National Institute for Health and Care Excellence (NICE) recommends CBT as a treatment for a wide range of problems. For further information, see our factsheet on cognitive behavioural therapy.
Family and marital therapy
Your problems may not just be yours – there may be problems in your marriage, relationship or family. So, family and marital therapies:
- involve everybody concerned
- look at the relationships involved
- look at how everybody involved thinks about how they get on.
In marital therapy, a therapist or pair of therapists meet with a married or committed couple, so that they can work on their problems together. The therapy might deal with problems between the partners or stresses that both partners are facing (i.e. loss of a child).
Family therapy sessions are sometimes observed by other therapists or recorded. This can help the therapists and family members to reflect on what has happened during the discussion. Systemic psychotherapy works with a family's strengths to help family members think about (and try) different ways of behaving with each other.
Cognitive analytical therapy (CAT)
Like CBT, this is usually quite short, often about 16 sessions. The therapist helps you to:
- describe how your problems have developed from the events of your life and your personal experiences;
- look at the ways of coping you have developed to deal with these problems;
- think of ways of changing your ways of coping so that you feel better and can cope more easily.
The therapist puts this all into writing after your first few sessions. At the end of treatment, the therapist gives you a final letter which summarises your difficulties and the ways you have worked out how to cope better.
Interpersonal therapy (IPT)
This is a treatment for depression, but it has also been used with other problems. It aims to help you to understand how your problems may be connected to the way your relationships work. It then helps you to find out how to strengthen your relationships and find better ways of coping.
Mentalisation-based therapy and Dialectic behaviour therapy
These therapies are mostly aimed at helping people with borderline personality disorder. Both treatments involve regular sessions over a period of 12 to 18 months. The treatment may include a mix of individual and group session.
This is often provided in primary care, at your GP's surgery. It is usually fairly short, and aims to help you to be clearer about your problems – and by being clearer, to come up with your own answers. It is often used to help someone cope with recent events they have found difficult. It does not aim to help you change as a person, as most of the other therapies described here do.
You meet a therapist on your own to talk together in a quiet room, usually for 50 minutes or so.
You meet regularly with a group of people who have similar problems and a psychotherapist. The sessions are usually longer than in individual psychotherapy, often around 90 minutes. It is not provided because it is cheaper but because it is the best treatment for some people. It is particularly helpful if you have problems in relationships that happen again and again. It is actually powerful and encouraging to find that you aren't alone with your problem – and that you may even be able to help other people in the group.
These approaches may be different but they all help you to understand better how you work - which can help you to make changes in your life. Psychotherapists may use a combination of techniques to suit you. For example, you may start with individual therapy and then move to group therapy, or from marital work to individual treatment.
Psychotherapy usually involves regular meetings at the same time and same place every week or two weeks. In most cases you will agree the length of the treatment with your psychotherapist within a month or so of starting. What happens during a session is usually considered confidential and will only be discussed with the psychotherapist's supervisor.
Through your GP
Your GP has always been able to refer you for psychotherapy, but there have often been long waiting lists – and, in some areas, very little psychotherapy available. However, the Improving Access to Psychological Therapies programme (IAPT) means that psychotherapy services for depression and anxiety in England are more readily available.
Many GPs also have mental health workers and counsellors working in their surgeries. For less serious problems you may be able to use self-help material from books or online. These can be combined with some contact with a therapist to guide and support you while you work through them.
Your GP may refer you to a:
- Community Mental Health Team (CMHT): if you are referred to a CMHT they will find out what you need and refer you, either to someone in the team, or to a local specialist psychotherapy service.
- Specialist Psychotherapy Service: these departments have a team of professionals specialising in different kinds of psychotherapy, including a consultant psychiatrist in psychotherapy. They can do a thorough assessment of what you need and match you with the person on the team who can best meet your needs.
- Consultant psychiatrist in psychotherapy: a consultant psychiatrist in psychotherapy is trained as a medical doctor, psychiatrist and specialist in psychotherapy. Because their training and experience is particularly wide, they can often help out with complicated problems or help to work out what sort of treatment is most likely to help.
- Through your psychiatrist or community mental health team: if you are already seeing a psychiatrist, you can ask him or her how you could receive psychological therapy as part of your care.
- Referring yourself: you may be able to refer yourself to some psychotherapy services – they are usually a part of your local mental health services and provided by a local NHS Trust. Check out the Trust website to find out what they offer.
- Private psychotherapy: you may want to think about private treatment because it's more convenient or you want to have more choice. It is important that any psychotherapist you see is properly qualified. There are plans for all psychotherapists to be registered – this will be a way of checking that a therapist is properly trained. For the time being, your GP may be able to recommend a qualified psychotherapist for an assessment. Personal factors are very important - don't be afraid to 'shop around' for someone who suits your needs and whom you feel happy to go on seeing. A list of organisations is available at the end of this leaflet for further information.
You may find that a self-help book is useful to you - there are a number of books now on the market, mostly based on CBT principles. These will not usually be a substitute for psychotherapy, but may be enough with mild anxiety or depression.
There are currently two software programmes recommended by the Department of Health:
- Beating the Blues for people with mild and moderate depression.
- FearFighter for people with panic and phobia.
These can both be used via an internet connection.
The National Institute for Health and Care Excellence (NICE) produces regular guidelines and updates on therapies that research has shown to work. There is now good evidence that the psychotherapies can help anxiety, depression, the effects of trauma and psychotic symptoms.
This will depend on what sort of problem you need help with, how bad it is and how long it has been going on for. Long-term psychodynamic psychotherapy seems to work better than short-term therapies if you have complicated or long-standing problems.
Your sessions are confidential. However:
- Your therapist will usually send a letter to the person who has referred you to explain why psychotherapy may help – and another letter to let them know when the therapy is expected to start and finish.
- They may discuss your sessions with their psychotherapy supervisor.
- If the therapist feels that you have become a danger to yourself or (rarely) other people, your therapist has to tell others – although they would usually discuss this with you first.
'Highly accessible and amusing' - Skinner R and Cleese J: Families and How to Survive Them
A professional association and voluntary regulator of the psychoanalytic psychotherapy profession, publishing a Register of practitioners who are required to follow their ethical code and meet their fitness to practise standards. Telephone 020 7561 9240; Email: firstname.lastname@example.org
A multi-disciplinary interest group for people involved in the practice and theory of behavioural and cognitive psychotherapy and provides further information on CBT and a list of trained psychotherapists. Tel: 0161 705 4304; General Enquiries: email@example.com
Professional body for the education, training and accreditation of psychotherapists and psychotherapeutic counsellors. Our membership includes over 7,800 individual therapists and more than 70 training and accrediting organisations. Tel: 0207 014 9955; Email: firstname.lastname@example.org
- Cuijpers, P, van Straten, A, Andersson, G, van Oppen, P (2008) Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies. Journal of Consulting and Clinical Psychology. 76; 6; 909-922.
- Fonagy, P (1999). An open door review of outcome studies in psychoanalysis. London: International. Psychoanalytical Association.
- Knekt, P, Lindfors, O, Harkanaen, T, et al (2008) Randomized trial on the effectiveness of long-and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up. Psychological Medicine, 38, 689–703.
- Leichsenring, F, Rabung, S Effectiveness of long-term psychodynamic psychotherapy: a meta-analysis. JAMA; 300(13): 1551-1565.
This factsheet was produced by the Royal College of Psychiatrists' Public Education Editorial Board. Series Editor: Dr Philip Timms Expert review: Dr Sarah Robertson, the Royal College of Psychiatrists' Medical Psychotherapy Faculty; Dr Martin Briscoe and Dr Melvyn Zhang.