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, psychotherapists provide nonjudgmental support to help clients identify unhelpful thoughts, feelings, and behaviors³ and work toward achievable goals. In some therapeutic approaches (such as psychodynamic psychotherapy),⁴ this may involve exploring past experiences and unconscious processes that may contribute to behavior, whereas other approaches (like cognitive behavioral psychotherapy) 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 psychotherapist 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 psychotherapist’s background. However, most forms of talk therapy begin with information gathering, relationship building, and an overview of the psychotherapist’s approach. 

Types of psychotherapy

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

Cognitive behavioral therapy (CBT)

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

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

CBT psychotherapy 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 psychotherapy is a modified version of cognitive behavioral psychotherapy (CBT) that was developed as an evidence-based psychotherapy 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 psychotherapy emphasizes both the validation of the client’s experiences and the development of healthier coping mechanisms. DBT psychotherapy may include techniques such as mindfulness, emotional regulation, distress⁵ tolerance skills, self-soothing, and boundary setting.

Interpersonal therapy (IPT)

IPT psychotherapy typically emphasizes the importance of interpersonal relationships to relieve distress and improve quality of life. This type of psychotherapy 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 psychotherapy 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 psychotherapy

Psychodynamic psychotherapy 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 psychotherapy are conducted over a longer period, and they often involve discussions about past experiences. 

Psychodynamic psychotherapy 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 psychotherapists apply an integrative or eclectic approach to psychotherapy, 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 psychotherapy may vary depending on the individual. Psychotherapists 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 psychotherapy, which can be a cost-effective and flexible alternative to in-person psychotherapy. 

Psychotherapy studies

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