Psychotherapy

Abstract

To nonpsychiatric physicians the term psychotherapy often sounds vague and mysterious. Yet, the art of providing healing through the clinician–patient relationship is as old as medicine itself. Psychotherapy is a form of treatment that uses psychologic techniques within the context of this confiding clinician–patient relationship to treat mental symptoms and relieve emotional distress. Psychotherapy may be the main approach to treatment of identified symptoms, or it may be used as an adjunct to pharmacotherapy. The clinician–patient relationship at the core of psychotherapy can be distinguished from other confiding relationships a person may have with family members, friends, mentors, and advisors. In psychotherapy, there is a clearly identified provider of care and a recipient of that care. The provider is specially trained to deliver the care in a professional and coherent way, using specific psychologic techniques. Both the provider and the patient focus their attention on the patient’s specific problems and work together in partnership to address the elements of psychologic distress and improve the patient’s symptoms. The goal of psychotherapy may differ depending on the patient and his or her situation. Sometimes, the goal of psychotherapy is symptom reduction (eg, to decrease anxiety, improve mood, or reduce friction in an interpersonal relationship). It may be used to help an individual replace unhealthy, counterproductive ways of thinking or reacting with more adaptive ones. In other instances, the goal of psychotherapy may be educational or instructive and involve teaching techniques to expand an individual’s coping abilities or communication skills. All forms of psychotherapy develop an individual’s self-awareness and help bolster appropriate self-esteem. The therapeutic setting between patient and clinician establishes validation that the patient’s concerns are worth addressing and provides a sense of hopefulness that things can improve. As new options are explored and new techniques for dealing with distressing situations are discussed, patients develop an increased sense of mastery and feel less overwhelmed by life circumstances. Psychotherapy may take three main forms of: (1) individual, (2) couples or family, or (3) group. In individual psychotherapy, a single patient and therapist work together, focusing on the patient’s unique attitudes, perceived experiences, and behaviors that are associated with his or her current distress.