Psychotherapy or "talk therapy," whether conducted in-person in an office or remotely via videoconferencing, can be broadly described as a collaborative relationship between a patient and a psychotherapist that alleviates suffering and dysfunction, increases self-awareness, facilitates growth and change, and enhances well-being. 

 

The therapeutic relationship works in part because of clearly defined roles and responsibilities held by each participant. This framework creates the safety to take risks and the support to make changes. Social scientists and practitioners alike have long debated the “active ingredients” of psychotherapy and how it works, and it is variously seen as a science, an art, and even a bit of magic.

 

Psychotherapy is both a way of understanding human behavior and of helping people with their emotional difficulties and personal problems - issues that are causing them distress and/or disturbances in their functioning. Therapy is designed to help patients of all ages address areas of concern or dissatisfaction in their lives and understand how their thoughts and feelings affect the ways they act, react, and relate to others. In addition to alleviating symptoms and internal and/or interpersonal distress, psychotherapy aims to help people experience life more fully, enjoy more satisfying relationships, and better integrate all parts of their psyches and personal narratives. Regardless of the specific problems and concerns a patient brings to therapy, the overarching objectives are to improve their quality of life and sense of wholeness.

 

The process of psychotherapy varies depending on the personalities of the psychologist and patient, and the particular problems the patient brings to therapy. Therapists have different styles and ways of conducting therapy, some more active and directive than others, and a variety of methods may be used to treat the problems that a patient hopes to address. Because self-knowledge and self-awareness are seen as key elements in changing attitudes and behavior, psychotherapy likely involves the development of insight, along with new tools and skills for managing life more effectively.

 

Psychotherapy is not like visiting a medical doctor. Instead, it calls for very active and ongoing engagement and effort on the part of the patient. In order for therapy to be effective, the patient must work on the issues being addressed, both during sessions and between appointments. Considering that a typical therapy session is only one hour in a 168-hour week, it makes sense that the patient must import and integrate what is being learned in therapy into their day-to-day lives for real progress to occur. New insights must be applied and new skills practiced. Though the process of change can be challenging and even frustrating at times, the amount of work invested in therapy is directly proportional to the benefit derived from it. 

 

In addition to active participation in and beyond the therapy, successful psychotherapy involves transparency on the part of the patient. It is essential that the therapy patient is open and honest with the therapist, even if doing so is painful or embarrassing. Lack of complete openness strips therapy of its meaning and potency and can perpetuate or exacerbate psychological problems, such as dissociation and denial. Contrary to popular belief, therapists are not mind readers and usually cannot tell when patients consciously or unconsciously conceal things. Therapists can only help patients to the extent that they are provided with the whole, unvarnished truth. 

 

Participating in psychotherapy takes courage, the courage to face oneself and one’s demons. Painful emotions and memories of painful experiences press for expression and release. Avoidance or suppression will not make them go away. Though therapists cannot magically erase the anxiety and pain associated with such issues, they can provide pacing, support, and tools that may help reduce the intensity of the work. Therapists can help patients slowly overcome feelings of hopelessness and helplessness, and can gently nudge them past avoidance and resistance, but ultimately, the desire to get well and function well can only come from the patient. Patient motivation is perhaps more determinant of therapeutic outcome than any other factor.

 

Whether or not psychotherapy “works” also depends a great deal on the patient’s ability and willingness to experience all relationships deeply, especially the therapeutic relationship. Within the crucible of this relationship, patients have an opportunity to view themselves more accurately, to identify repetitive patterns of behavior, and to make connections between past and current conflicts that illuminate the way they relate to themselves and to others. Patients are encouraged to talk about thoughts and feelings that arise in therapy, including feelings toward the therapist. Sometimes misunderstandings can occur between a patient and a therapist and sometimes patients develop troublesome feelings toward their therapist, such as anger, fear, or attraction. It is essential that all of these feelings be discussed and worked through in the context of therapy. These feelings are important because elements of one’s history of important affections and hostilities toward significant others are often transferred onto the therapist and the process of therapy. The skilled therapist uses the relationship itself to provide a “corrective emotional experience” for the patient.

 

The relationship between a patient and a therapist is a real relationship, though special and possessing unique characteristics that make it therapeutic. By relating to a patient authentically, the therapist affords the patient honest feedback and the safety to practice new skills and experiment with new ways of being and relating. Depending on the theoretical orientation and technical approach of the therapist, he or she may assume a variety of roles in relation to a patient. These roles might include expert, advisor, guide, confidante, coach, consultant, navigator, teacher, mentor, parent, shaman, or guru. The key to a successful therapeutic outcome is the proper match between the personal manner and style of the therapist and the needs of the patient. A “good fit” is crucial, and prospective patients are best served by taking the time to find it.

 

Psychotherapy can be relatively short-term (8-16 sessions) when the focus is limited to resolving specific symptoms or problem areas, or longer-term when the treatment targets more pervasive or long-standing difficulties or patterns of behavior. Variables that determine the course and length of therapy include session frequency, the nature and severity of the symptoms or problems brought, the motivation of the patient, and the quality of the patient-therapist relationship.

 

One need not be suffering from a diagnosable “mental illness” or even be symptomatic to benefit from psychotherapy.  Many people enter therapy for increased self-awareness and personal growth, rather than to solve problems or alleviate suffering. Thankfully, the stigma that was once associated with consulting a mental heath professional has diminished, and engaging in psychotherapy is considered one of many paths to greater wholeness as a human being.

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