Psychotherapy and its Uses

Psychotherapy can be defined as the treatment of mental and emotional disorders using psychological methods by trained psychotherapists. The Royal College of Psychiatrists describes psychotherapy as "... helping people overcome stress, emotional problems, relationship problems or troublesome habits ... they are all treatments based on talking to another person..."¹

The overall aim is to enhance and improve the patients mental health by changing the patients perception and analysis of uncomfortable experiences.

Various techniques are used in psychotherapy including some of the following

• Improving relationships
• Better communication (spoken and written)
• Modifying behaviour patterns that will persist in the long-term

• Patients - individual or group setting
• Therapists - can be one or more; usually an educational or coach type role
• Mode of interaction e.g. face to face, telephone
• Duration - usually weeks or even years
• Regular sessions are usually necessary

There are many problems that can be addressed but they fall into two broad groups

1. Clinical conditions - therapy aimed at specific features
2. Everyday problems - this is more often called counselling and often psychotherapy and counselling are used interchangeably. However, it is important to note that counselling is usually non-directional (i.e.non-goal orientated) whilst most psychotherapy is goal orientated.

There are various types of psychotherapies including

• Acceptance therapy
• Psychoanalysis
• Behavioural therapy e.g. phobia treatment
• Cognitive behavioural therapy
• Dance therapy
• Counselling
• Psychodynamic therapy
• Existential therapy
• Family therapy

Studies looking at the effectiveness of psychotherapy usually involve the use of questionnaires. The results of studies at present are mixed and generally there is a lack of difference with treatment. However, psychotherapists believe this is related to the inherent problems of using a questionnaire in these studies.

Behavioural therapy

A direct approach is used to alter patients behaviour in certain, usually specific circumstances e.g. panic, phobias. A recent analysis of patients with dementia has suggested that behavioural therapy may help patients with neuropsychiatric symptoms - however further research is needed.^2,3 Behavioural therapy has also been used with some success in reducing obesity, smoking cessation and reducing alcohol consumption.^4,5

Cognitive behavioural therapy

Sessions are based on focused therapy with an objective to alter distorted ways of thinking combined with behavioural techniques. This has been particularly successful in depression. In adolescents and children with depression cognitive behavioural therapy can be used alone or prior to using antidepressants. However, its beneficial use is mainly in those with mild to moderate depression.⁶ Unfortunately, a recent meta-analysis of 37 studies found that although collaborative care improved outcome in adult patients with depression the addition of psychotherapy did not alter outcomes in the short nor long-term. However, the sessions were few and brief.⁷ Other studies of cognitive therapy in adults with depression have shown more favourable results and some even comparable to affects with medications.⁸ Cognitive behavioural therapy is also useful in panic symptoms and attacks - a finding supported by meta-analyses, however some of these are over ten years old.⁹

Psychodynamic therapy

This explores the self conscious/unconscious effects on external relationships e.g. feelings towards those close to us. This method reviews past experiences and determines how they are affecting the patients current situation and ability to make choices. A meta-analysis reported that various psychological techniques including psychodynamic therapy helps improve glycaemic control in children and adolescents - however the changes were slight and not seen in adults.¹⁰

Existential therapy

This is based on existential philosophy aiming to change an individual's ability to develop and preserve a sense of meaning and purpose throughout their life. It has been used in patients with metastatic breast cancer and helped to reduce their distress.¹¹

The following problems have occurred in patients under going therapy

• Some patients feel worse - the cause is unclear but may be related to the in-depth analysis that occurs
• Strong emotions towards the therapist
• Dependence upon the psychotherapist

Psychotherapy involves a number of techniques in which patients are encouraged to express their thoughts and work through their actions and thus deal with stresses associated with every day life or illnesses. Its uses are widespread and despite some disappointing results from trials on the shop floor psychotherapy does appear to help a number of individuals even if only for a short time period. The beneficial effects of simply speaking and listening to our patients problems must not be underestimated and we should bear in mind that "talking therapy" has been occurring throughout the ages.