Psychotherapies and psychological treatments

There are different types, but they are all 'talking treatments' in which you talk with one or more other people. Most mental health problems can be addressed with one or other psychotherapeutic approaches, for example:

• stress and anxiety
• emotional problems
• relationship problems
• troublesome habits
• other 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. Although all psychiatrists receive training in psychotherapy, most psychotherapy is not provided by psychiatrists.

Psychotherapy is a profession in the NHS, meaning that your therapist may simply have the title of psychotherapist, but psychotherapy is also carried out by clinical and counselling psychologists, nurse practitioners, social workers, counsellors and others.

Most psychotherapies can be carried out one-to-one or in groups. Some can now also be carried out 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 is 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, and
• how the past can affect how you are feeling, thinking and behaving right now.

The therapist will help you to make 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 may not be driven solely by conscious thoughts and feelings, but also by unconscious feelings from your past. Ways you respond and behave in the therapy sessions often mirror the way you act 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.

Individual 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 longer. Although most psychodynamic therapy is carried out individually, it is also regularly carried out in groups. Analytic groups commonly last for an hour and a half, occur weekly or twice weekly, and contain up to 10 people plus a therapist. 

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 and thinking about them, and then developing ideas that are more helpful for you. You then try these out 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 essence, 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. CBT is often provided in groups. 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.

Family and marital therapies:

• involve everybody concerned
• look at the relationships they have with one another
• look at how everybody involved thinks about their interactions and relationships

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.

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 family therapy 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. It uses techniques and understanding derived from both cognitive and psychodynamic approaches, and commonly involves letters and diagrams in developing an understanding of your problems.

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 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 will usually include a mix of individual and group sessions.

Counselling

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 tends not to aim to help you change as a person, as most of the other therapies described here do.

Group therapy

All the above approaches can be used in groups.

In group therapy you meet regularly with a group of people who have similar problems, along with one or more psychotherapists. The sessions are usually longer than in individual psychotherapy, often around 90 minutes. It is particularly helpful if you have problems in relationships that happen again and again.  It is powerful and encouraging to find that you are not alone with your problem – and often group members are important in each other’s recovery.

Therapeutic communities

Therapeutic communities are based on the idea that interactions between people brings about change. It is by belonging to a group of peers who provide regular feedback and support that a person becomes more self-aware. The community functions as a microcosm of society, providing a safe environment in which to challenge your fears, understand the roots of your difficulties, and adapt your behaviour. Therapeutic communities are used particularly for people with complex difficulties which affect their relationships, including personality disorders.

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.

The different approaches share many objectives and techniques, and the different ways they approach a problem can be complimentary. It not, however, recommended that you have more than one psychotherapy at a time. 

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 and some of these will take self-referrals.

Some 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, usually including a consultant medical psychotherapist. 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 trained as a medical doctor, psychiatrist and specialist in psychotherapy. Because their training and experience is particularly wide, they can often address complicated problems or advise on what sort of treatment is most likely to help.
• Through your psychiatrist or community mental health team: if you are already seeing a psychiatrist or other mental health worker, 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 your local Mental Health Trust website to find out what they offer.
• Private psychotherapy: you may want to think about private treatment because it is more convenient, or you want to have more choice. It is important that any psychotherapist you see is properly qualified, and registered with a national body (see list at end). In this way you can be certain that your therapist or counsellor is properly trained and adheres to the highest professional and ethical standards. Your GP may be able to recommend a qualified psychotherapist for an assessment. Personal factors are very important - don't be afraid to look 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 to help with mild anxiety or depression.

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, personality disorder, and psychotic symptoms among other conditions. 

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. You should take professional advice.

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.  

• Burns and Burns-Lundgren: Psychotherapy: a very short introduction
• Skinner R and Cleese J: Families and How to Survive Them

British Association for Behavioural and Cognitive Psychotherapies

A multi-disciplinary interest group for people involved in the practice and theory of behavioural and cognitive psychotherapy. Provides information on CBT and a list of trained psychotherapists. Tel: 0161 705 4304; General Enquiries: babcp@babcp.com.

British Psychoanalytic Council (BPC)

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: mail@psychoanalytic-council.org.

The British Psychological Society (BPS)

The BPS provides a Directory of Chartered Psychologists, and oversees their standards of education, training and practice.

UK Council for Psychotherapy (UKCP)

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: info@ukcp.org.uk.

• 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.

Produced by the RCPsych Public Engagement Editorial Board:

• Expert Review: Dr Steve Pearce
• Series Editor: Dr Phil Timms 
• Series Manager: Thomas Kennedy