Psychotherapy

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Psychotherapy is a dialogue-based, collaborative process that requires the involvement and commitment of both client and therapist.² During sessions, therapists provide nonjudgmental support to help clients identify unhelpful thoughts, feelings, and behaviors³ and work toward achievable goals. In some therapeutic approaches (such as psychodynamic therapy),⁴ this may involve exploring past experiences and unconscious processes that may contribute to behavior, whereas other approaches (like cognitive behavioral therapy) tend to emphasize current challenges.

There are many different therapeutic approaches, which rely on different psychological theories. However, they may work through similar mechanisms. Recent research has found that the therapeutic alliance, or positive rapport and engagement between therapist and client, is a central component of many types of psychotherapy.

Psychotherapy sessions may look a little different depending on the client’s needs and the therapist’s background. However, most forms of talk therapy begin with information gathering, relationship building, and an overview of the therapist’s approach. 

The following are evidence-based approaches that can impact your experience in therapy. 

Cognitive behavioral therapy (CBT)

CBT is generally a short-term, solutions-oriented form of therapy that emphasizes the relationship between thoughts, feelings, and behaviors, and it’s often considered the gold-standard of psychotherapy. 

During CBT sessions, clients may learn to identify unhelpful, inaccurate thoughts through guided discovery and then learn how to reframe them through cognitive restructuring. CBT may also emphasize problem-solving skills, communication skills, and relaxation techniques.

CBT can be adapted to address many types of mental health conditions and disorders, such as anxiety disorders, depressive disorders, psychotic disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). 

Dialectical behavior therapy (DBT)

DBT is a modified version of cognitive behavioral therapy (CBT) that was developed as an evidence-based therapy for people experiencing borderline personality disorder (BPD) (one of 10 personality disorders in the DSM-5), but it may be effective for other mental disorders, such as depression, anxiety, eating disorders, and post-traumatic stress disorder (PTSD). 

The word dialectical means “contradiction,” or the “existence of opposites.” DBT emphasizes both the validation of the client’s experiences and the development of healthier coping mechanisms. DBT may include techniques such as mindfulness, emotional regulation, distress⁵ tolerance skills, self-soothing, and boundary setting.

Interpersonal therapy (IPT)

IPT typically emphasizes the importance of interpersonal relationships to relieve distress and improve quality of life. This type of therapy utilizes the medical model, meaning that it views mental disorders through the lens of biological predisposition instead of blaming the individual. IPT is usually conducted as a short-term therapy for grief, major depressive disorder, and other mental disorders. When used in conjunction with medications prescribed by a health care provider, IPT can also be helpful for bipolar disorder and some eating disorders. 

During IPT sessions, clients may be guided through techniques including imagery, role-playing, or mindfulness, with the goal of improving communication skills and relationships to address mental health challenges. 

Psychodynamic therapy

Psychodynamic therapy and psychoanalysis both tend to emphasize the discovery of unconscious motivators as they are manifested in challenging thoughts, feelings, and behaviors. Typically, these forms of therapy are conducted over a longer period, and they often involve discussions about past experiences. 

Psychodynamic therapy may include the discussion of troubling or confusing emotions, avoidance, experiences, relationships, fears and desires, and patterns present in thoughts, feelings, behaviors, or relationships.

Many therapists apply an integrative or eclectic approach to therapy, drawing from multiple approaches to meet the unique needs of their clients. 

It’s estimated that 26% (approximately one in four) of American adults experience a diagnosable mental disorder each year, and less than a third of Americans say their mental health is excellent. 

Whether you’re experiencing a mental illness or not, the following signs indicate that you may benefit from psychotherapy: 

• You frequently find yourself feeling tense, worried, overwhelmed, exhausted, lonely, sad, helpless, or empty.
• You’re experiencing intense mood swings or difficulty regulating your emotions.
• You’ve made an effort to improve your mental health without success.
• You’re finding it difficult to carry out daily functions or concentrate on tasks, such as work projects, homework, or other responsibilities.
• You’ve noticed changes in your sleep, such as sleeping excessively or not enough.
• You’re experiencing frequent stress about things like work, parenting, relationships, or physical conditions.
• You’ve experienced trauma, such as abuse or a natural disaster.
• You’re grieving the loss of a loved one or experiencing a major life stressor (such as job loss, divorce, or the birth of a child).
• You’re using substances or otherwise using an unhelpful coping mechanism to handle stressors.
• You’re experiencing thoughts, feelings, or behaviors that are harmful for yourself or others.

The overarching goals of psychotherapy are to improve emotional, behavioral, and social functioning to improve quality of life and well-being. This often involves: 

• Helping clients build self-awareness and an understanding of their thoughts, feelings, and behaviors
• Relieving emotional distress 
• Developing healthy coping mechanisms 

Specific goals for therapy may vary depending on the individual. Therapists often work with their clients to develop a treatment plan involving specific, measurable, achievable, realistic, and time-bound (SMART) goals. SMART goals can break down overarching goals into manageable chunks.

Examples of SMART goals might include: 

• I will limit my use of social media to 30 minutes per day this month. 
• When I want to express my feelings to my spouse, I will use “I” language this week and give them space to respond without interjecting. 
• I will practice five minutes of meditation before bed two or more days this week. 

Over time, reflecting on SMART goals may help individuals monitor their progress, stay motivated, and improve self-efficacy. 

Modern psychotherapy continues to be an evolving field. Recently, many studies have evaluated the effectiveness of online talk therapy, which can be a cost-effective and flexible alternative to in-person therapy. 

For example, a 2021 study investigated the benefits and short-comings of online group psychotherapy, finding that some people may benefit from online group therapy more than in-person group therapy and that a therapeutic alliance can be effectively established online. However, the study noted that group cohesion may be slower to develop online than in in-person settings. 

Another study, which was published in BMC Psychology in 2022, aimed to evaluate the effectiveness of online psychodynamic therapy for college students. The authors found that online psychodynamic therapy was nearly as effective as in-person therapy for relieving psychological distress.

A  2017 review of studies found that online cognitive behavioral therapy (CBT) can be effective for many mental disorders, including depressive disorders, generalized anxiety disorder, panic disorder, obsessive compulsive disorder (OCD), specific phobias, and bipolar disorder.  

Overall, research findings show that online therapy can be comparable to in-person therapy, that it can increase availability of mental health services, and that many people are satisfied with their experiences in online therapy.