Psychotherapy (sometimes called “talk therapy”) is a term for a variety of treatment techniques that aim to help a person identify and change troubling emotions, thoughts, and behavior. Most psychotherapy takes place with a licensed and trained mental health care professional and a patient meeting one on one or with other patients in a group setting.

Someone might seek out psychotherapy for different reasons:

• You might be dealing with severe or long-term stress from a job or family situation, the loss of a loved one, or relationship or other family issues. Or you may have symptoms with no physical explanation: changes in sleep or appetite, low energy, a lack of interest or pleasure in activities that you once enjoyed, persistent irritability, or a sense of discouragement or hopelessness that won’t go away.
• A health professional may suspect or have diagnosed a condition such as depression, bipolar disorder, post-traumatic stress or other disorder and recommended psychotherapy as a first treatment or to go along with medication.
• You may be seeking treatment for a family member or child who has been diagnosed with a condition affecting mental health and for whom a health professional has recommended treatment.

An exam by your primary care practitioner can ensure there is nothing in your overall health that would explain your or a loved one’s symptoms.

Psychotherapy can be an alternative to medication or can be used along with other treatment options, such as medications. Choosing the right treatment plan should be based on a person's individual needs and medical situation and under a mental health professional’s care.

Even when medications relieve symptoms, psychotherapy and other interventions can help a person address specific issues. These might include self-defeating ways of thinking, fears, problems with interactions with other people, or dealing with situations at home and at school or with employment.

Elements of Psychotherapy

A variety of different types of psychotherapies and interventions have been shown to be effective for specific disorders. For example, the treatment approach for someone who has obsessive-compulsive disorder is different for someone who has bipolar disorder. Therapists may use one primary approach or incorporate other elements depending on their training, the condition being treated, and the needs of the person receiving treatment.

Elements of psychotherapies may include:

• Helping a person become aware of ways of thinking that may be automatic but are inaccurate and harmful (for example, someone who has a low opinion of their abilities). The therapist helps the person find ways to question these thoughts, understand how they affect emotions and behavior, and change self-defeating patterns. This approach is central to a type of psychotherapy called cognitive behavioral therapy (CBT).
• Identifying ways to cope with stress and developing specific problem-solving strategies.
• Examining a person’s interactions with others and offering guidance with social and communication skills.
• Mindfulness and relaxation techniques, such as meditation and breathing exercises.
• Exposure therapy for people with anxiety disorders. In exposure therapy, a type of CBT, a person spends brief periods in a supportive environment, learning to tolerate the distress caused by certain items, ideas, or imagined scenes cause. Over time, the fear associated with these things may dissipate.
• Tracking emotions and behaviors to raise awareness and the impact of each on the other.
• Supportive counseling to help a person explore troubling issues and provide emotional support.
• Creating a safety plan to help someone who has thoughts of self-harm or suicide recognize warning signs and use coping strategies such as contacting friends, family, or emergency personnel.

Note that there are many different types of psychotherapy. Other therapies are often variations on an established approach, such as CBT. There is no formal approval process for psychotherapies like there is for the use of medications from the Food and Drug Administration.

However, for many therapies, research involving large numbers of patients has provided evidence that treatment is effective for specific disorders. These "evidence-based therapies" have been shown in research to reduce symptoms of depression, anxiety, and other disorders.

Understanding Your Condition

What is depression?

Depression is an illness that involves the brain. Depression is different from feeling sad or down for a few days. If you are depressed, you may have symptoms almost every day. You may be sad, lack energy, or feel tired most of the time. You may not feel like doing activities you used to enjoy.

You may also:

• Have trouble thinking and paying attention
• Have trouble sleeping or sleep too much
• Eat too little or too much
• Feel hopeless, helpless, worthless, or guilty
• Avoid being with people
• Have thoughts about your own death, harming yourself, or suicide

Note: If you think about suicide or harming yourself, call your health care professional right away. The National Suicide Prevention Lifeline is available at 1-800-273-TALK (8255), or go to www.suicidepreventionlifeline.org.

Medical experts are not sure what causes depression. It could be caused by changes in the chemicals in your brain, stress in your life, or other causes. Depression also runs in some families.

Depression is very common. In 2014, about 17.5 million adults (or 1 in every 14 adults) in the United States had depression that needed treatment.

Depression can be a serious health problem, but treatment can help.

Understanding Your Options

How do depression treatments compare?

There are many ways to treat depression. You may have to try several treatments before you find something that works for you. Your health care professional may first suggest an antidepressant medicine or talk therapy (also called counseling).

One type of talk therapy is called cognitive behavioral therapy. When researchers compared it with antidepressants as a first treatment for depression, they found:

• Cognitive behavioral therapy works as well as antidepressants to improve depression symptoms.

Two other types of talk therapy (interpersonal therapy and psychodynamic therapy) might also work as well as antidepressants, but more research is needed to know for sure.

Some other treatments for depression include exercise programs, acupuncture, and dietary supplements (such as St. John's wort and SAMe). These treatments may work as well as antidepressants, but more research is needed to know for sure.

This summary will cover each of the treatments discussed above, their possible side effects, and what researchers found. This summary can help you talk with your health care professional about which treatment or combination of treatments may be best for you.

What about treatments that are not in this summary? You may hear about additional treatments for depression that some people may find helpful. If any depression treatment interests you, discuss it with your health care professional.

What are antidepressant medicines?

Antidepressants improve the way your brain uses certain chemicals that control your mood and stress levels. Some examples of antidepressants include bupropion (Wellbutrin®), citalopram (Celexa®), fluoxetine (Prozac®), and venlafaxine (Effexor®).

Depression symptoms improve for three out of every five people who try antidepressants as their first treatment.

If you try an antidepressant, you should take it for at least 8 weeks to see if it will help. If the antidepressant does not help enough, you may need to try a different one. Some people need to try several antidepressants before finding one that works.

What are possible side effects of antidepressants?

The U.S. Food and Drug Administration (FDA) lists the following possible side effects of antidepressants:

• Nausea and vomiting
• Weight gain
• Sleepiness
• Diarrhea
• Sexual problems
• Trouble sleeping

More serious side effects are much less common. These include heart problems, too little sodium (salt) in your blood, and liver damage. Antidepressants can also cause a life-threatening reaction called "serotonin syndrome." Serotonin syndrome can cause shivering, diarrhea, fever, seizures, and stiff muscles.

Never stop taking an antidepressant without first talking with your health care professional, even if you start feeling better.

WARNING: Antidepressants may raise the risk of suicidal thoughts or behavior in adults age 24 or younger.Families and health care professionals should closely watch people of all ages who start taking an antidepressant. They should look for symptoms that get worse, suicidal thoughts or behaviors, or other unusual changes in behavior.

What is talk therapy?

Talk therapy is a type of treatment in which you talk with a trained therapist. You may meet with the therapist one-on-one or in a group. Sessions are usually once a week. If you try talk therapy, you should have at least eight sessions to see if it helps.

Talking with a therapist about issues that have to do with your depression may upset you. You may feel angry, nervous, or sad. Working through these feelings may be part of getting better. It is important to tell your therapist if talk therapy upsets you or if your depression symptoms get worse.

There are many types of talk therapy. The chart below lists three types of talk therapy that researchers compared with antidepressants.

A word about sticking with your treatment: Depression treatments may take several weeks to start working. When a treatment helps, you may need to stick with it for a while longer to keep depression from coming back. That is why it is important to stick with your treatment. Ask your health care professional how long you will need treatment. Be sure to talk about problems you may have sticking with it.

What are some other treatments for depression?

You may have heard of some other treatments for depression, such as those listed in the chart below. Always talk with your health care professional before starting any of these treatments.

Only a few studies have been done on these other treatments as a first treatment for depression. The studies suggest that:

• Exercise programs, acupuncture, St. John's wort, and SAMe may improve depression symptoms about as well as antidepressants, but more research is needed to know for sure.
• Fish oil does not appear to improve depression symptoms as well as antidepressants, but more research is needed to know for sure.

A word about dietary supplements: The FDA approves the quality and safety of all prescription and over-the-counter medicines. But dietary supplements--such as St. John's wort, SAMe, and fish oil--do not need FDA approval. That means the label on the bottle may not tell you exactly what is in the bottle.

It is also important to know that St. John's wort and SAMe can cause serious side effects when taken with certain medicines or other supplements.

What are possible side effects of these other treatments?

What if my first treatment does not help enough?

If your first treatment did not help enough, your health care professional can help you switch to a different treatment or add another treatment to the first one.

Researchers looked at second treatments after the first treatment with an antidepressant did not work. They found that:

• For some people, switching to a different antidepressant improved depression symptoms. The type of antidepressant they switched to did not matter. Symptoms improved about the same with all second antidepressants.

Researchers also found the following about second treatments, but more research is needed to know for sure:

• Adding cognitive behavioral therapy to the first antidepressant appears to work about as well as adding a second antidepressant to the first one.
• Stopping antidepressants and switching to cognitive behavioral therapy appears to work about as well as switching to another antidepressant.

Making a Decision

What should I think about?

You and your health care professional can decide what might be best to treat your depression. But first, your health care professional needs to know how you feel about your depression and your treatment options.

Here are some things to think about. Be sure to share your thoughts with your health care professional.

• How is depression affecting your daily life?
• Which possible side effects from treatment concern you?
• How much time are you able to put into your treatment?
• How might the cost of treatment affect your decision?
• If you were treated for depression in the past, what helped?
• Which treatment feels like the best fit for you?

Ask Your Health Care Professional

• Which treatment or combined treatments do you think may be best for me? Why?
• How long will it take to know if a treatment is working?
• What do I need to know about possible side effects from treatments?
• If a treatment helps, how long would I need to continue it?
• How does the use of alcohol and other substances affect depression and its treatment?

Two types of therapy are psychotherapy and biomedical therapy. Both types of treatment help people with psychological disorders, such as depression, anxiety, and schizophrenia. Psychotherapy is a psychological treatment that employs various methods to help someone overcome personal problems, or to attain personal growth. In modern practice, it has evolved into what is known as psychodynamic therapy. Biomedical therapy involves medication and/or medical procedures to treat psychological disorders. We will explore the various psychotherapeutic orientations outlined in the table below.

Psychotherapy techniques

Various Psychotherapy Techniques

Psychoanalysis was developed by Sigmund Freud and was the first form of psychotherapy. It was the dominant therapeutic technique in the early 20th century, but it has since waned significantly in popularity. Freud believed most of our psychological problems are the result of repressed impulses and trauma experienced in childhood, and he believed psychoanalysis would help uncover long-buried feelings. In a psychoanalyst’s office, you might see a patient lying on a couch speaking of dreams or childhood memories, and the therapist using various Freudian methods such as free association and dream analysis (Figure). In free association, the patient relaxes and then says whatever comes to mind at the moment. However, Freud felt that the ego would at times try to block, or repress, unacceptable urges or painful conflicts during free association. Consequently, a patient would demonstrate resistance to recalling these thoughts or situations. In dream analysis, a therapist interprets the underlying meaning of dreams.

Psychoanalysis is a therapy approach that typically takes years. Over the course of time, the patient reveals a great deal about himself to the therapist. Freud suggested that during this patient-therapist relationship, the patient comes to develop strong feelings for the therapist—maybe positive feelings, maybe negative feelings. Freud called this transference: the patient transfers all the positive or negative emotions associated with the patient’s other relationships to the psychoanalyst. For example, Crystal is seeing a psychoanalyst. During the years of therapy, she comes to see her therapist as a father figure. She transfers her feelings about her father onto her therapist, perhaps in an effort to gain the love and attention she did not receive from her own father.

Today, Freud’s psychoanalytical perspective has been expanded upon by the developments of subsequent theories and methodologies: the psychodynamic perspective. This approach to therapy remains centered on the role of people’s internal drives and forces, but treatment is less intensive than Freud’s original model.

Play therapy is often used with children since they are not likely to sit on a couch and recall their dreams or engage in traditional talk therapy. This technique uses a therapeutic process of play to “help clients prevent or resolve psychosocial difficulties and achieve optimal growth” (O’Connor, 2000, p. 7). The idea is that children play out their hopes, fantasies, and traumas while using dolls, stuffed animals, and sandbox figurines (Figure). Play therapy can also be used to help a therapist make a diagnosis. The therapist observes how the child interacts with toys (e.g., dolls, animals, and home settings) in an effort to understand the roots of the child’s disturbed behavior. Play therapy can be nondirective or directive. In nondirective play therapy, children are encouraged to work through their problems by playing freely while the therapist observes (LeBlanc & Ritchie, 2001). In directive play therapy, the therapist provides more structure and guidance in the play session by suggesting topics, asking questions, and even playing with the child (Harter, 1977).

In psychoanalysis, therapists help their patients look into their past to uncover repressed feelings. In behavior therapy, a therapist employs principles of learning to help clients change undesirable behaviors—rather than digging deeply into one’s unconscious. Therapists with this orientation believe that dysfunctional behaviors, like phobias and bedwetting, can be changed by teaching clients new, more constructive behaviors. Behavior therapy employs both classical and operant conditioning techniques to change behavior.

One type of behavior therapy utilizes classical conditioning techniques. Therapists using these techniques believe that dysfunctional behaviors are conditioned responses. Applying the conditioning principles developed by Ivan Pavlov, these therapists seek to recondition their clients and thus change their behavior. Emmie is eight years old, and frequently wets her bed at night. She’s been invited to several sleepovers, but she won’t go because of her problem. Using a type of conditioning therapy, Emmie begins to sleep on a liquid-sensitive bed pad that is hooked to an alarm. When moisture touches the pad, it sets off the alarm, waking up Emmie. When this process is repeated enough times, Emmie develops an association between urinary relaxation and waking up, and this stops the bedwetting. Emmie has now gone three weeks without wetting her bed and is looking forward to her first sleepover this weekend.

One commonly used classical conditioning therapeutic technique is counterconditioning: a client learns a new response to a stimulus that has previously elicited an undesirable behavior. Two counterconditioning techniques are aversive conditioning and exposure therapy. Aversive conditioning uses an unpleasant stimulus to stop an undesirable behavior. Therapists apply this technique to eliminate addictive behaviors, such as smoking, nail biting, and drinking. In aversion therapy, clients will typically engage in a specific behavior (such as nail biting) and at the same time are exposed to something unpleasant, such as a mild electric shock or a bad taste. After repeated associations between the unpleasant stimulus and the behavior, the client can learn to stop the unwanted behavior.

Aversion therapy has been used effectively for years in the treatment of alcoholism (Davidson, 1974; Elkins, 1991; Streeton & Whelan, 2001). One common way this occurs is through a chemically based substance known as Antabuse. When a person takes Antabuse and then consumes alcohol, uncomfortable side effects result including nausea, vomiting, increased heart rate, heart palpitations, severe headache, and shortness of breath. Antabuse is repeatedly paired with alcohol until the client associates alcohol with unpleasant feelings, which decreases the client’s desire to consume alcohol. Antabuse creates a conditioned aversion to alcohol because it replaces the original pleasure response with an unpleasant one.

In exposure therapy, a therapist seeks to treat clients’ fears or anxiety by presenting them with the object or situation that causes their problem, with the idea that they will eventually get used to it. This can be done via reality, imagination, or virtual reality. Exposure therapy was first reported in 1924 by Mary Cover Jones, who is considered the mother of behavior therapy. Jones worked with a boy named Peter who was afraid of rabbits. Her goal was to replace Peter’s fear of rabbits with a conditioned response of relaxation, which is a response that is incompatible with fear. How did she do it? Jones began by placing a caged rabbit on the other side of a room with Peter while he ate his afternoon snack. Over the course of several days, Jones moved the rabbit closer and closer to where Peter was seated with his snack. After two months of being exposed to the rabbit while relaxing with his snack, Peter was able to hold the rabbit and pet it while eating (Jones, 1924).

Thirty years later, Joseph Wolpe (1958) refined Jones’s techniques, giving us the behavior therapy technique of exposure therapy that is used today. A popular form of exposure therapy is systematic desensitization, wherein a calm and pleasant state is gradually associated with increasing levels of anxiety-inducing stimuli. The idea is that you can’t be nervous and relaxed at the same time. Therefore, if you can learn to relax when you are facing environmental stimuli that make you nervous or fearful, you can eventually eliminate your unwanted fear response (Wolpe, 1958).

How does exposure therapy work? Jayden is terrified of elevators. Nothing bad has ever happened to him on an elevator, but he’s so afraid of elevators that he will always take the stairs. That wasn’t a problem when Jayden worked on the second floor of an office building, but now he has a new job—on the 29th floor of a skyscraper in downtown Los Angeles. Jayden knows he can’t climb 29 flights of stairs in order to get to work each day, so he decided to see a behavior therapist for help. The therapist asks Jayden to first construct a hierarchy of elevator-related situations that elicit fear and anxiety. They range from situations of mild anxiety such as being nervous around the other people in the elevator, to the fear of getting an arm caught in the door, to panic-provoking situations such as getting trapped or the cable snapping. Next, the therapist uses progressive relaxation. She teaches Jayden how to relax each of his muscle groups so that he achieves a drowsy, relaxed, and comfortable state of mind. Once he’s in this state, she asks Jayden to imagine a mildly anxiety-provoking situation. Jayden is standing in front of the elevator thinking about pressing the call button.

If this scenario causes Jayden anxiety, he lifts his finger. The therapist would then tell Jayden to forget the scene and return to his relaxed state. She repeats this scenario over and over until Jayden can imagine himself pressing the call button without anxiety. Over time the therapist and Jayden use progressive relaxation and imagination to proceed through all of the situations on Jayden’s hierarchy until he becomes desensitized to each one. After this, Jayden and the therapist begin to practice what he only previously envisioned in therapy, gradually going from pressing the button to actually riding an elevator. The goal is that Jayden will soon be able to take the elevator all the way up to the 29th floor of his office without feeling any anxiety.

Sometimes, it’s too impractical, expensive, or embarrassing to re-create anxiety- producing situations, so a therapist might employ virtual reality exposure therapy by using a simulation to help conquer fears. Virtual reality exposure therapy has been used effectively to treat numerous anxiety disorders such as the fear of public speaking, claustrophobia (fear of enclosed spaces), aviophobia (fear of flying), and post-traumatic stress disorder (PTSD), a trauma and stressor-related disorder (Gerardi, Cukor, Difede, Rizzo, & Rothbaum, 2010).

Some behavior therapies employ operant conditioning. Recall what you learned about operant conditioning: We have a tendency to repeat behaviors that are reinforced. What happens to behaviors that are not reinforced? They become extinguished. These principles can be applied to help people with a wide range of psychological problems. For instance, operant conditioning techniques designed to reinforce positive behaviors and punish unwanted behaviors have been an effective tool to help children with autism (Lovaas, 1987, 2003; Sallows & Graupner, 2005; Wolf & Risley, 1967). This technique is called Applied Behavior Analysis (ABA). In this treatment, child-specific reinforcers (e.g., stickers, praise, candy, bubbles, and extra play time) are used to reward and motivate autistic children when they demonstrate desired behaviors such as sitting on a chair when requested, verbalizing a greeting, or making eye contact. Punishment such as a timeout or a sharp “No!” from the therapist or parent might be used to discourage undesirable behaviors such as pinching, scratching, and pulling hair.

One popular operant conditioning intervention is called the token economy. This involves a controlled setting where individuals are reinforced for desirable behaviors with tokens, such as a poker chip, that can be exchanged for items or privileges. Token economies are often used in psychiatric hospitals to increase patient cooperation and activity levels. Patients are rewarded with tokens when they engage in positive behaviors (e.g., making their beds, brushing their teeth, coming to the cafeteria on time, and socializing with other patients). They can later exchange the tokens for extra TV time, private rooms, visits to the canteen, and so on (Dickerson, Tenhula, & Green-Paden, 2005).

Cognitive therapy is a form of psychotherapy that focuses on how a person’s thoughts lead to feelings of distress. The idea behind cognitive therapy is that how you think determines how you feel and act. Cognitive therapists help their clients change dysfunctional thoughts in order to relieve distress. They help a client see how they misinterpret a situation (cognitive distortion). For example, a client may overgeneralize. Because Ray failed one test in his Psychology 101 course, he feels he is stupid and worthless. These thoughts then cause his mood to worsen. Therapists also help clients recognize when they blow things out of proportion. Because Ray failed his Psychology 101 test, he has concluded that he’s going to fail the entire course and probably flunk out of college altogether. These errors in thinking have contributed to Ray’s feelings of distress. His therapist will help him challenge these irrational beliefs, focus on their illogical basis, and correct them with more logical and rational thoughts and beliefs.

Cognitive therapy was developed by psychiatrist Aaron Beck in the 1960s. His initial focus was on depression and how a client’s self-defeating attitude served to maintain a depression despite positive factors in her life (Beck, Rush, Shaw, & Emery, 1979). Through questioning, a cognitive therapist can help a client recognize dysfunctional ideas, challenge catastrophizing thoughts about themselves and their situations, and find a more positive way to view things (Beck, 2011).

Cognitive-behavioral therapists focus much more on present issues than on a patient’s childhood or past, as in other forms of psychotherapy. One of the first forms of cognitive-behavioral therapy was rational emotive therapy (RET), which was founded by Albert Ellis and grew out of his dislike of Freudian psychoanalysis (Daniel, n.d.). Behaviorists such as Joseph Wolpe also influenced Ellis’s therapeutic approach (National Association of Cognitive-Behavioral Therapists, 2009).

Cognitive-behavioral therapy (CBT) helps clients examine how their thoughts affect their behavior. It aims to change cognitive distortions and self-defeating behaviors. In essence, this approach is designed to change the way people think as well as how they act. It is similar to cognitive therapy in that CBT attempts to make individuals aware of their irrational and negative thoughts and helps people replace them with new, more positive ways of thinking. It is also similar to behavior therapies in that CBT teaches people how to practice and engage in more positive and healthy approaches to daily situations. In total, hundreds of studies have shown the effectiveness of cognitive-behavioral therapy in the treatment of numerous psychological disorders such as depression, PTSD, anxiety disorders, eating disorders, bipolar disorder, and substance abuse (Beck Institute for Cognitive Behavior Therapy, n.d.). For example, CBT has been found to be effective in decreasing levels of hopelessness and suicidal thoughts in previously suicidal teenagers (Alavi, Sharifi, Ghanizadeh, & Dehbozorgi, 2013). Cognitive-behavioral therapy has also been effective in reducing PTSD in specific populations, such as transit workers (Lowinger & Rombom, 2012).

Cognitive-behavioral therapy aims to change cognitive distortions and self-defeating behaviors using techniques like the ABC model. With this model, there is an Action (sometimes called an activating event), the Belief about the event, and the Consequences of this belief. Let’s say, Jon and Joe both go to a party. Jon and Joe each have met a young woman at the party: Jon is talking with Megan most of the party, and Joe is talking with Amanda. At the end of the party, Jon asks Megan for her phone number and Joe asks Amanda. Megan tells Jon she would rather not give him her number, and Amanda tells Joe the same thing. Both Jon and Joe are surprised, as they thought things were going well. What can Jon and Joe tell themselves about why the women were not interested? Let’s say Jon tells himself he is a loser, or is ugly, or “has no game.” Jon then gets depressed and decides not to go to another party, which starts a cycle that keeps him depressed. Joe tells himself that he had bad breath, goes out and buys a new toothbrush, goes to another party, and meets someone new.

Jon’s belief about what happened results in a consequence of further depression, whereas Joe’s belief does not. Jon is internalizing the attribution or reason for the rebuffs, which triggers his depression. On the other hand, Joe is externalizing the cause, so his thinking does not contribute to feelings of depression. Cognitive-behavioral therapy examines specific maladaptive and automatic thoughts and cognitive distortions. Some examples of cognitive distortions are all-or-nothing thinking, overgeneralization, and jumping to conclusions. In overgeneralization, someone takes a small situation and makes it huge—for example, instead of saying, “This particular woman was not interested in me,” the man says, “I am ugly, a loser, and no one is ever going to be interested in me.”

All or nothing thinking, which is a common type of cognitive distortion for people suffering from depression, reflects extremes. In other words, everything is black or white. After being turned down for a date, Jon begins to think, “No woman will ever go out with me. I’m going to be alone forever.” He begins to feel anxious and sad as he contemplates his future.

The third kind of distortion involves jumping to conclusions—assuming that people are thinking negatively about you or reacting negatively to you, even though there is no evidence. Consider the example of Savannah and Hillaire, who recently met at a party. They have a lot in common, and Savannah thinks they could become friends. She calls Hillaire to invite her for coffee. Since Hillaire doesn’t answer, Savannah leaves her a message. Several days go by and Savannah never hears back from her potential new friend. Maybe Hillaire never received the message because she lost her phone or she is too busy to return the phone call. But if Savannah believes that Hillaire didn’t like Savannah or didn’t want to be her friend, she is demonstrating the cognitive distortion of jumping to conclusions.

How effective is CBT? One client said this about his cognitive-behavioral therapy:

I have had many painful episodes of depression in my life, and this has had a negative effect on my career and has put considerable strain on my friends and family. The treatments I have received, such as taking antidepressants and psychodynamic counseling, have helped [me] to cope with the symptoms and to get some insights into the roots of my problems. CBT has been by far the most useful approach I have found in tackling these mood problems. It has raised my awareness of how my thoughts impact on my moods. How the way I think about myself, about others and about the world can lead me into depression. It is a practical approach, which does not dwell so much on childhood experiences, whilst acknowledging that it was then that these patterns were learned. It looks at what is happening now, and gives tools to manage these moods on a daily basis. (Martin, 2007, n.p.)

Humanistic psychology focuses on helping people achieve their potential. So it makes sense that the goal of humanistic therapy is to help people become more self-aware and accepting of themselves. In contrast to psychoanalysis, humanistic therapists focus on conscious rather than unconscious thoughts. They also emphasize the patient’s present and future, as opposed to exploring the patient’s past.

Psychologist Carl Rogers developed a therapeutic orientation known as Rogerian, or client-centered therapy. Note the change from patients to clients. Rogers (1951) felt that the term patient suggested the person seeking help was sick and looking for a cure. Since this is a form of nondirective therapy, a therapeutic approach in which the therapist does not give advice or provide interpretations but helps the person to identify conflicts and understand feelings, Rogers (1951) emphasized the importance of the person taking control of his own life to overcome life’s challenges.

In client-centered therapy, the therapist uses the technique of active listening. In active listening, the therapist acknowledges, restates, and clarifies what the client expresses. Therapists also practice what Rogers called unconditional positive regard, which involves not judging clients and simply accepting them for who they are. Rogers (1951) also felt that therapists should demonstrate genuineness, empathy, and acceptance toward their clients because this helps people become more accepting of themselves, which results in personal growth.

Therapists have different professional backgrounds and specialties. See below for information that can help you find out about the different credentials of therapists and resources for locating therapists.

The approach a therapist uses depends on the condition being treated and the training and experience of the therapist.Also, therapists may combine and adapt elements of different approaches.

Once you’ve identified one or more possible therapists, a preliminary conversation with a therapist can help you understand how treatment will proceed and whether you feel comfortable with the therapist.Rapport and trust are important. Discussions in therapy are deeply personal, and it’s important that you feel comfortable with the therapist and have confidence in their expertise. These preliminary conversations may happen in person, by phone, or virtually. Consider trying to get answers to the following questions:

• What are the credentials and experience of the therapist? Do they have a specialty?
• What approach will the therapist take to help you? Do they practice a particular type of therapy? What is the rationale for the therapy and its evidence base?
• Does the therapist have experience in diagnosing and treating the age group (for example, a child) and the specific condition for which treatment is being sought? If a child is the patient, how will parents be involved in treatment?
• What are the goals of therapy? Does the therapist recommend a specific timeframe or number of sessions? How will progress be assessed, and what happens if you (or the therapist) feel you aren't starting to feel better?
• Are medications an option? Is this therapist able to prescribe medications?
• Are the meetings confidential? How is confidentiality assured? Are there limits to confidentiality?

Digital Health Options

The telephone, internet, and mobile devices have created new opportunities to provide more readily available and accessible interventions, including in areas where mental health professionals may not be physically available. Some of these approaches involve a therapist providing help at a distance. Still, others—such as web-based programs and mobile apps—are designed to provide immediate information and feedback in the absence of a therapist.

The symptoms of mental disorders can have a profound effect on someone’s quality of life and ability to function. Treatment can address symptoms as well as assist someone experiencing severe or ongoing stress. Some of the reasons that you might consider seeking out psychotherapy include:

• Overwhelming sadness or helplessness that doesn’t go away
• Serious, unusual insomnia or sleeping too much
• Difficulty focusing on work, or carrying out other everyday activities
• Constant worry and anxiety
• Drinking to excess or any behavior that harms self or others
• Dealing with a difficult transition, such as a divorce, children leaving home, job difficulties, or the death of someone close
• Children’s behavior problems that interfere with school, family, or peers

Seeking help is not an admission of weakness, but a step towards understanding and obtaining relief from distressing symptoms.