Mental Health

Could you benefit from talk therapy?

By Harvard Health Publications

"Maybe you should consider seeing a therapist..."

Every year, one in five adults in the United States experiences a mental disorder or an emotional problem serious enough to warrant treatment. Although psychotherapy is a cornerstone of psychological treatment, the initial suggestion — whether it comes from your physician, spouse, or best friend — can raise many questions. Are my loved ones tired of discussing my problems? Does my doctor think I’m crazy? Can talking really help? Would medicine work just as well? Will my insurance help pay? How do I find the right person to talk to? This article discusses how psychotherapy works in treating depression and other common psychological conditions.

What is psychotherapy?

Psychotherapy — often referred to as talk therapy — addresses troubling symptoms and emotions using psychological techniques rather than, or along with, medication or other physical approaches. There are many theories and styles of psychotherapy, but the two most popular forms are psychodynamic therapy and cognitive behavioral therapy.

Which works best? There’s no simple answer. Just as many forms of aerobic exercise can help you achieve cardiovascular fitness, many types of therapy can help you understand yourself better, change behavior that is wrong for you, and help relieve bothersome symptoms. You may do better with one type than with another, or find that a blended approach, drawn from different schools of psychotherapy, suits you best. Your regular participation in the process is more important than the type of therapy you choose. Most important is the match, or rapport, between you and your therapist.

Although most therapists emphasize one type of intervention, a good therapist can incorporate elements of others as well. Whatever approach the therapist adopts, she or he should develop a trusting alliance with you, suggest fresh ways for you to perceive your problems, and help alleviate your symptoms and your sense of isolation.

Psychodynamic therapy

Psychodynamic therapists believe that past experiences and feelings of which you’re not consciously aware can influence your present emotional well-being and ability to function. Through regular discussions with a therapist, you can gain insight into your motivations and conflicts and learn more productive ways to cope with them.

"Psychodynamic therapy can be very helpful if you feel like your life is repeating old patterns or you aren’t clear what direction you want to take," says Harvard Medical School psychiatrist Margaret S. Ross, M.D.

The process of psychoanalysis developed by Sigmund Freud may be the most familiar form of psychodynamic therapy, but it’s not the most common. Psychoanalysis is designed to uncover the unconscious roots of your symptoms and help you apply this understanding to your current life. Classic psychoanalysis is time-consuming (it requires meeting several times a week, possibly for many years) and not widely used today. However, it’s still influential in the thinking behind much psychodynamic therapy, which can be short- or long-term, and may focus broadly or more narrowly on a particular issue or symptom.

Another common focus of psychodynamic therapy is an individual’s interaction with other people. Psychodynamic therapy can help you identify what you seek in a relationship (your needs), the healthy and unhealthy ways of meeting those needs, and ways to improve your ability to communicate. Such therapy can help people cope with the loss of a relationship, conflicts within relationships, or the demands of shifting roles (such as retirement or caring for a parent). One system of therapy with this emphasis, called interpersonal therapy, combines elements of psychodynamic therapy, cognitive behavioral therapy, and other techniques. Therapy is limited to three or four months and focuses on psychological difficulties sparked by recent conflicts or transitions. While not widely available, it is coming into more common use.
Selected resourcesAmerican Psychiatric Association 703-907-7300 http://www.psych.orgAmerican Psychological Association 800-374-2721 (toll free) http://www.apa.org4Therapy.com Network 888-484-3727 (toll free) http://www.4therapy.comNational Mental Health Association Resource Center 800-969-6642 (toll free) http://www.nmha.org

The cognitive behavioral approach

Cognitive behavioral therapy (CBT) is less focused on the underpinnings of feelings and instead emphasizes how to change the thoughts and behaviors that are causing problems. CBT can be used to alter difficult behaviors, such as smoking, procrastination, or phobias, and can also help address conditions such as depression and anxiety.

Cognitive behavioral therapists believe that you can change your feelings by changing your thoughts and actions. For example, you may have patterns of distorted thinking — excessive self-criticism or guilt, always anticipating the worst, attributing untoward motives to others — that make you vulnerable to feeling bad. CBT teaches you to recognize these patterns as they emerge and alter them. The "behavior" part refers to learning more productive responses to distressing circumstances or feelings — such as relaxing and breathing deeply instead of hyperventilating when in an anxiety-provoking situation.
Body and mindPsychological disorders have physical symptoms — fatigue is a hallmark of depression — and many medical disorders have psychological symptoms. For example, an overactive thyroid can make you irritable, depressed, and anxious; an underactive thyroid can make you depressed and slow-thinking. It’s easier to treat these symptoms if their medical basis is recognized. Otherwise, psychotherapy alone won’t relieve even the psychological symptoms, and failure to treat the medical condition can be dangerous.If you consult your primary care physician about psychological problems, a physical exam and testing can rule out a medical disorder. If you go directly to a psychologist, social worker, or other therapist who isn’t a physician, that person should keep in mind the possibility of medical problems and suggest a medical evaluation if appropriate.



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Last Updated: 08/04
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