What is psychotherapy

... and what can I expect?

According to the Psychotherapy and Counselling Federation of Australia "Psychotherapy is a holistic engagement that focuses on the mental, emotional, relational or spiritual health of a human being. It is useful when psychological, developmental, relationship and wellbeing issues arise in life". People have been engaged in some kind of "talking-cure" or "wise-counsel" for millennia. However, it wasn't until the mid 19th century that the English psychiatrist Walter Cooper Dendy coined the term psychotherapy. At the turn of the 20th century Sigmund Freud famously developed a theory to understand the mind, unconscious processes and a framework for what became the practice of psychoanalysis. Freud's ideas have been endlessly explored and adapted and have given rise to a range of practices which may be broadly called psychodynamic and particularly emphasis and seek to explore how thoughts, feelings and behaviour link to early experiences. Freud considered that therapists needed training, personal therapy and supervision of their practice (and these remain the foundations for becoming a therapist).

Over the 20th century and to this day there has been a proliferation of different 'schools' of non-medical therapies. To date there are at least 400 schools of psychotherapy all with somewhat differing views about the way emotional problems should be thought about and addressed. One of the most influential was Carl Rogers who developed what has become known as the "person-centred" approach to psychotherapy. Carl Roger's proposed that if a therapist demonstrated unconditional positive regard, warmth and congruence then this in itself was sufficient to bring about healing and change. Subsequent research has consistently demonstrated that the quality of the relationship between therapist and client is the most predictive of positive change even more than technique used.

A great expansion and investment in research on psychotherapeutic approaches focusing on particular problems or symptoms has taken place so that we now consider some types of talking therapy or approaches more or less "evidence based". Organisations such as beyond blue regularly review the evidence for particular kinds of therapies for high prevalence problems such as depression. Frequently, brief and educative interventions such as cognitive behavioural therapy (and variants) come out on top, in part because there has been a considerable effort to standardise, manualise and subject these "interventions" to trial by institutes of research and academic departments. Cognitive behavioural therapy (CBT) was developed by Aaron Beck and a variation on the same theme (called Rational Emotive Behaviour Therapy or REBT) by Albert Ellis. Richard Lakeman developed an e-book / e-therapy programme based on REBT in 1998 (click here to visit). CBT or some variation is probably the most dominant form of therapy readily available in Australia. CBT has a pedigree stretching back to stoic philosophy. Epictetus (a first century Stoic philosopher) sums up a key underpinning premise of CBT -“Man is disturbed not by things, but by the views he takes of them.” The point of CBT is therefore to help on examine and shift irrational or self-defeating beliefs about the world and thereby reduce suffering, negative emotions or compulsive behaviour. This is not to dismiss the unconscious (REBT and CBT both have views on how we come to develop underlying rules, or schemata from early experiences). CBT however provides some relatively efficient ways to alleviate certain kinds of distressing symptoms.

There is no consensus on the differences between counseling and psychotherapy. Counseling perhaps more properly describes helping with specific problems (e.g. relationship counseling) or with making important life decisions (e.g. guidance counseling or pregnancy counseling).

Are all psychotherapies equal and what kind of psychotherapy might be useful?

This really depends on what one is looking for from psychotherapy and what the problem is that one hopes to solve. There does appear to be some convincing evidence that some psychotherapeautic approaches are better for dealing with acute trauma (e.g. Exposure or Eye movement desensitization and reprocessing or EMDR). In relation to high prevalence problems such as depression and anxiety then CBT and interpersonal therapy have the hits on the board in terms of symptom reduction. However, it is worth noting that the research to support these claims arises from a biomedical paradigm where syndromes such as 'depression' are treated as entities in themselves. Depression can arise for lots of different reasons and a skilled and highly trained therapist can help explore the reasons and choose the best therapeutic approach. With complex problems it is advisable to consult with a therapist who has training in more than one modality. As Abraham Maslow famously observed "if all you have is a hammer, everything looks like a nail". A well trained therapist ought to have a tool box of evidence based therapies at their disposal and make a careful selection after considering the problem.

Many people seek some kind of psychological or emotional support or are recommended therapy when they confront a crisis. A skilled therapist can help people through a crisis period by facilitating access to the right kind of support, helping the person mobilise effective coping strategies, and helping the person to problem solve and maintain a reasonable perspective on events. Sometimes just getting through a difficult time is all the person wants and needs. Psychotherapy is the next step after a crisis towards recovery.