This article answers some critical questions about what is psychotherapy is, how long it lasts and what to expect. There is further information on three types of psychotherapy, Cognitive Behavioural Therapy or CBT, Dialectical Behavioural Therapy or DBT and Systemic Therapy or Couples Therapy.
What is psychotherapy?
Psychotherapy or talking therapy is a form of treatment for psychological problems that does not involve prescribed medication. Instead, you would be encouraged to speak with your psychotherapist about your thoughts, feelings, and behaviour.
There are many different types of talking therapy, but they all aim to:
- Give you a safe time and place to talk to someone who won’t judge you.
- Help you make sense of things and understand yourself better.
- Help you resolve complicated feelings, or find ways to live with them.
- Help you recognise unhelpful patterns in the way you think or act, and find ways to change them (if you want to).
Talking is an essential part of our relationships. It can strengthen your ties with other people and help you stay in good mental health. And being listened to helps you feel that other people care about you and what you have to say.
What happens during psychotherapy?
Talking therapy sessions can take many different forms, depending on your needs, the type of therapy you have and where or how that therapy is delivered. Choosing the right kind of psychotherapy for you can be tough and most people need help from their therapist to help them decide.
Once you decided on the type of therapy you want to have, you will usually have a number of planned, regular sessions lasting for around 50 minutes. How often you see your therapist, and how many sessions you have, will depend on your needs and your situation. You may see your therapist on a one-to-one basis or in a group, or you may speak to them over the telephone or online. In your sessions, you may go through specific exercises designed to help you with the problem you are experiencing, or you might have more general discussions about how you are feeling. You may also be given some exercises to practice at home between your sessions. Typical sessions start with introduction and assessment, during which your therapist will introduce themselves to you and find out a little bit about you and your needs. Usually, at this point, your therapist may also ask you to fill in some forms designed to measure your overall wellbeing. They will then ask you to fill in the same form at other points during the course of your therapy. By completing the same form when you start and at different times during your psychotherapy, you can track your improvement and troubleshoot any problems.
Although your therapist has the knowledge of different coping strategies and can help you understand where your difficulties come from, it’s important to remember that you decide what you want to talk about and how to take things forward. Your therapist will help you make a plan and suggest different ways of helping you deal with difficulties.
Do psychotherapy and counselling work?
Your decision to try therapy to help you cope with distressing feelings is a courageous and vital first step towards your recovery. Talking about your thoughts and feelings can be very difficult. At first, however, it can help you deal better with times when you feel troubled about something. It can help you work out what is really bothering you and explore what you could do about it. If you turn a worry over and over in your mind, the problem can grow.
For anyone having therapy, it can be challenging to notice quick improvement. That’s because psychotherapy often takes time and effort to work. However, research suggests that psychotherapy is a powerful form of treatment for mental health difficulties as it can not only improve a person’s wellbeing but also equips them with tools to deal with problems in the future. Indeed, many people have found that therapy helped them feel better about themselves, improved their quality of life and their overall wellbeing for years to come. Apart from your own feelings about how well the therapy is going, your therapist would typically use questionnaires to measure both symptom reduction and your wellbeing. They would ask you to fill those in regularly to see objectively how well the therapy is going.
Research has shown that the relationship you have with your therapist is really important in how successful you find any talking therapy. It is essential that you feel comfortable with your therapist and able to open up to them. Regardless of the type of psychotherapy they practice, if you do not like, feel comfortable with or trust that person, you are less likely to feel able to open up to them, and are less likely to have a positive experience.
Psychotherapy or medication?
It can be challenging to decide which one is best for you. This decision will need to be made taking account of your beliefs, situation and the problems that you seek support for. Although medication can be beneficial in the treatment of mental health problems, it can also have some negative effects. Here are some points to help you make that decision:
- Medication can be a powerful tool in easing your symptoms. If you feel depressed and lack the motivation to do things, it can lift your mood and make it easier to ‘get going’.
- Medication can often have side effects. Their severity and type will depend on the dose and type of the medicine but may include sexual problems, grogginess, tiredness, weight gain, dizziness, dry mouth.
- Although medication can make you feel better in the short-term, it does not cure the symptoms but rather ‘hides them away’. When you stop taking medication, your symptoms are likely to return and be even more challenging to cope with.
- Some types of medication can also be addictive and make you dependent on it.
- There is no medication to treat some mental disorders, such as Personality Disorder.
If you decide to try therapy instead of medication, it could take longer for you to notice an improvement in how you feel. However, this improvement is more likely to last as psychotherapy with a Clinical Psychologist can teach you more helpful ways of coping with difficulties in the future. Although psychotherapy does not have any specific side effects (with minor exceptions), you may feel some distress during the course of it. This is because you may need to talk about some things that are upsetting to you. Usually, these are the things we’re avoiding to explore in our everyday lives. Your therapist is aware of this and will guide you in a way that any distress is not more than you can manage.
Research shows that therapy can be as effective as medication in treating many mental health problems, such as anxiety or depression. However, sometimes a combination of psychotherapy and medication may be most helpful. A Clinical Psychologist knows when this may be required and will advise you of your options.
Cognitive Behavioural Therapy
What is Cognitive Behavioural Therapy or CBT?
Cognitive Behavioural Therapy, commonly referred to as CBT, is a form of talking therapy. It is based on the finding that our thoughts, beliefs and physical sensations impact on how we feel and behave in relation to ourselves and the world around us. The research shows that CBT can be very effective in the treatment of a range of mental health problems. CBT can be delivered via individual sessions, group therapy, online therapy or self-help materials. CBT aims to teach new ways of coping with distress by changing the way we behave and think about ourselves and the world around us.
Who can CBT help?
Cognitive Behavioural Therapy is a relatively flexible therapy that can be adapted to meet your particular needs. The National Institute for Health and Care Excellence (NICE) particularly recommends CBT for depression and anxiety. However, evidence suggests it can be an effective treatment for a range of mental health problems, such as:
- anxiety and panic attacks
- bipolar disorder
- borderline personality disorder
- eating problems
- obsessive-compulsive disorder (OCD)
- post-traumatic stress disorder (PTSD)
What to expect during CBT therapy?
In CBT you work with a therapist to identify and challenge any negative thinking patterns, and behaviours which may be causing you difficulties. In turn, this can change the way you feel about situations, and help you to change your behaviour in the future.
Cognitive Behavioural Therapy teaches coping skills for dealing with different problems. You may learn ways of coping with different situations, thoughts, feelings and behaviours. An important part of CBT is ‘take-home exercises’. Some people argue that these are what makes CBT so effective! The exercises aim to help you put to practice the skills that you will learn during sessions.
If you decide to try CBT, you would most likely be invited to have weekly sessions lasting approximately 50 minutes. In the first few sessions, your therapist may ask you some questions about your past, your reasons for coming to therapy and discuss your goals and plans for the sessions. However, the focus of your sessions would be on what is going on in your life right now and how your past experiences impact the way you see the world now. CBT sessions tend to be quite structured and focus on changing unhelpful behaviours or thinking patterns. Your psychotherapist will be quite active during the session, guiding you with questions and exercises. Some of the techniques you may cover during your CBT sessions include behavioural activation, thought challenging and relaxation techniques.
How long does CBT take?
Cognitive Behavioural Therapy is a short-term treatment. Depending on the type and severity of your difficulties, CBT can take between 4 and 12 weeks or more.
Dialectical Behaviour Therapy
What is Dialectical Behaviour Therapy or DBT?
Dialectical behaviour therapy (DBT) is a type of talking treatment, which is based on Cognitive Behavioural Therapy (CBT). However, it also uses mindfulness techniques to help accept and manage change. In Dialectical Behavioural Therapy, you will work with your therapist to find the right balance between acceptance (accepting yourself as you are) and change (making positive changes in your life). DBT can help you learn to manage your difficult emotions by letting yourself experience, recognise and accept them.
Who can DBT help?
Dialectical Behavioural Therapy has been recommended by the National Institute for Health and Care Excellence (NICE) to treat problems associated with emotionally unstable/borderline personality disorder (EUPD/BPD). Dialectical Behavioural Therapy has also been used to treat several other different types of mental health problems, such as:
- Suicide attempts
- Eating disorders
What to expect during DBT therapy?
Dialectical Behavioural Therapy typically consists of individual therapy sessions and DBT skills groups. In DBT sessions you would expect to learn skills in the following areas:
- Mindfulness focuses on helping you to accept your situation and be present in the current moment.
- Distress tolerance is geared towards increasing your endurance of negative emotions, rather than avoiding them.
- Emotion regulation covers strategies to manage and change intense emotions that are causing problems in your life.
- Interpersonal effectiveness consists of techniques that would help you to communicate with others assertively, maintain self-respect, and strengthen relationships.
- Work in overcoming the effects of any past trauma and PTSD.
If you decide to try Dialectical Behavioural Therapy, you would be invited to have weekly 45-60 minutes sessions. Initially, you would be offered an assessment or pre-treatment phase of DBT. This is where the therapist will look at how suitable DBT is for you. You will typically be offered several sessions where you will learn about the DBT model and, if you decide it is the right therapy for you, you will be asked to commit to the treatment.
During the sessions, your therapist would help you learn new skills to replace unhelpful behaviours and help you achieve your goals. You would learn techniques to help you reduce suicidal and self-harming behaviours and address any issues that might come in the way of you getting treatment. Your therapist would also help you reach your goals and improve your quality of life by addressing other issues such as other mental health problems or problems in your personal life such as employment or relationship problems.
Your therapist is likely to ask you to fill out diary cards as homework which you can use to monitor your emotions and actions. You will be asked to bring these cards with you to your therapist each week to help you look for behaviour patterns and triggers that occur in your life. You then use this information to decide together what you will work on in each session.
Apart from one-to-one sessions, Dialectical Behavioural Therapy involves skills training in groups, usually delivered on a weekly basis as well as telephone crisis coaching to support you in using new skills in your day-to-day life. If you are having individual therapy only, these training sessions will be delivered during your regular one-to-one sessions.
How long does DBT take?
A full course of DBT takes six months or more.
Family and couples therapy
What is family and couples therapy?
Family and couples therapy (also referred to as systemic therapy) looks to help couples members of a family understand each other better, change negative behaviours and resolve conflicts.
Often miscommunication within a couple or a family is at the heart of a problem. Family therapy can help you resolve misunderstandings and challenges within a relationship, and support you in resolving conflict and improving communication. Family therapy gives everyone involved the chance to express and explore their feelings in a safe, non-judgemental environment.
Who can family therapy and couples therapy help?
Working alongside a therapist, families and couples can discuss difficulties and differences within their relationships to improve communication and find a way forward, together. Family and couples therapy is appropriate for all ages and can even be useful for individuals. Typically a family therapist can help you deal with a range of problems, from relationship difficulties to coping with trauma and mental illness. Some examples include:
- When a family or couple wants to improve their relationship.
- When a member of the family is struggling with addiction, living with a mental illness, disability or chronic illness.
- When parents/guardians are worried about their child’s behaviour.
- When parents/guardians are separating and are worried about the impact on the family.
- When a family is coping with loss or trauma.
What to expect during therapy?
If you decide to try family or couples therapy, your sessions would typically last between 50 and 90 minutes and take place weekly. The therapy sessions would usually start with an assessment to help your therapist understand what difficulties you are facing and what you would like support with. Your therapist would also explain how they will be able to support you and discuss a plan for future sessions. Usually, the whole family/couple will be seen together, so you are all ready to speak and hear each other.
In the sessions, therapists will avoid taking ‘sides’ or blaming particular individuals. Instead, they will encourage everyone involved to talk about their experiences, listen to others and explore ways to move forward. During sessions, your therapist would also try to clarify each person’s beliefs, values, needs, hopes and assumptions to help them understand each other better.
Your particular circumstances and goals will be taken into consideration, with your therapist adapting their methods depending on people’s ages, needs and preferences.
How long does family therapy and couples therapy take?
Family/couples therapy tends to be a short-term treatment (up to 12 weeks/sessions). However, the length of the psychotherapy would depend on the issues brought to the sessions and goals of the individuals within a family or a couple.