Psychotherapy is often used either alone or in combination with medications to treat mental illnesses. Called "therapy" for short, the word psychotherapy actually involves a variety of treatment techniques. During psychotherapy, a person with a mental illness talks to a licensed and trained mental health care professional who helps him or her identify and work through the factors that may be triggering the illness.
How Does Psychotherapy Help?
Psychotherapy helps people with a mental disorder to:
- Understand the behaviors, emotions, and ideas that contribute to his or her illness and learn how to modify them
- Understand and identify the life problems or events -- like a major illness, a death in the family, a loss of a job, or a divorce -- that contribute to his or her illness and help him/her understand which aspects of those problems he/she may be able to solve or improve
- Regain a sense of control and pleasure in life
- Learn healthy coping techniques and problem-solving skills
Types of Therapy
Therapy can be given in a variety of formats, including:
- Individual: This therapy involves only the patient and the therapist.
- Group: Two or more patients may participate in therapy at the same time. Patients are able to share experiences and learn that others feel the same way and have had the same experiences.
- Marital/couples: This type of therapy helps spouses and partners understand why their loved one has a mental disorder, what changes in communication and behaviors can help, and what they can do to cope. This type of therapy can also be used to help a couple that is struggling with aspects of their relationship.
- Family: Because family is a key part of the team that helps people with mental illness get better, it is sometimes helpful for family members to understand what their loved one is going through, how they themselves can cope, and what they can do to help.
Approaches to Therapy
While therapy can be done in different formats -- like family, group, and individual -- there are also several different approaches that mental health professionals can take to provide therapy. After talking with the patient about their disorder, the therapist will decide which approach to use based on the suspected underlying factors contributing to the condition.
Different approaches to therapy include:
Psychodynamic therapy is based on the assumption that a person is having emotional problems because of unresolved, generally unconscious conflicts, often stemming from childhood. The goal of this type of therapy is for the patient to understand and cope better with these feelings by talking about the experiences. Psychodynamic therapy is administered over a period of at least several months, although it can last longer, even years.
Interpersonal therapy focuses on the behaviors and interactions a patient has with family and friends. The primary goal of this therapy is to improve communication skills and increase self-esteem during a short period of time. It usually lasts three to four months and works well for depression caused by mourning, relationship conflicts, major life events, and social isolation.
Psychodynamic and interpersonal therapies help patients resolve mental illness caused by:
- Loss (grief)
- Relationship conflicts
- Role transitions (such as becoming a mother, or a caregiver)
Cognitive-behavioral therapy helps people with mental illness to identify and change inaccurate perceptions that they may have of themselves and the world around them. The therapist helps the patient establish new ways of thinking by directing attention to both the "wrong" and "right" assumptions they make about themselves and others.
Cognitive-behavioral therapy is recommended for patients:
- Who think and behave in ways that trigger and perpetuate mental illness
- Who suffer from depression and/or anxiety disorders as the only treatment or, depending on the severity, in addition to treatment with antidepressant medication
- Who refuse or are unable to take antidepressant medication
- Of all ages who have mental illness that causes suffering, disability, or interpersonal problems
Dialectical behavioral therapy (DBT) is a type of cognitive behavioral therapy used for high-risk, tough-to-treat patients. The term "dialectical" comes from the idea that bringing together two opposites in therapy -- acceptance and change -- brings better results than either one alone. DBT helps a person change unhealthy behaviors such as lying and self-injury through keeping daily diaries, individual and group therapy and phone coaching.
DBT was initially designed to treat people with suicidal behavior and borderline personality disorder. But it has been adapted for other mental health problems that threaten a person's safety, relationships, work, and emotional well-being.
Comprehensive DBT focuses on four ways to enhance life skills:
- Distress tolerance: Feeling intense emotions like anger without reacting impulsively or using self-injury or substance abuse to dampen distress.
- Emotion regulation: Recognizing, labeling, and adjusting emotions.
- Mindfulness: Becoming more aware of self and others and attentive to the present moment.
- Interpersonal effectiveness: Navigating conflict and interacting assertively.
Therapy works best when you attend all scheduled appointments. The effectiveness of therapy depends on your active participation. It requires time, effort, and regularity.
As you begin therapy, establish some goals with your therapist. Then spend time periodically reviewing your progress with your therapist. If you don't like the therapist's approach or if you don't think the therapist is helping you, talk to him or her about it and seek a second opinion if both agree, but don't discontinue therapy abruptly.
Tips for Starting Therapy
Here are some tips to use when starting therapy for the first time:
- Identify sources of stress: Try keeping a journal and note stressful as well as positive events.
- Restructure priorities: Emphasize positive, effective behavior.
- Make time for recreational and pleasurable activities.
- Communicate: Explain and assert your needs to someone you trust; write in a journal to express your feelings.
- Try to focus on positive outcomes and finding methods for reducing and managing stress.
Remember, therapy involves evaluating your thoughts and behaviors, identifying stresses that contribute to your condition, and working to modify both. People who actively participate in therapy recover more quickly and have fewer relapses.
Also, keep in mind, therapy is treatment that addresses specific causes of mental illness; it is not a "quick fix." It takes longer to begin to work than medication, but there is evidence to suggest that its effects last longer. Medication may be needed immediately in cases of severe mental illness, but the combination of therapy and medicine is very effective.