For anyone who feels psychologically vulnerable or fragile, going in search of psychotherapy or a psychotherapist can seem like a particularly trying undertaking.
Among all the psychotherapies (more than 200 officially listed), are there any more effective than others? When and how should it be used?
What is psychotherapy?
The field of psychotherapy is still young, and constantly evolving, and many controversies remain. Several schools of thought clash.
In the current state of knowledge, three main conclusions seem to be necessary:
- the majority of well-conducted psychotherapies give good results;
- the success of the therapy would depend first and foremost on the motivation and commitment of the subject;
- The therapeutic alliance that is established between the patient and his therapist would be much more decisive in predicting the outcome of the treatment than the particular technique used by the provider.
The main principles of psychotherapy
Psychotherapy is defined as “psychological treatment for a mental disorder, behavioral disturbance or any other problem causing psychological suffering or distress.
The goal is to promote significant changes in the client’s cognitive, emotional, or behavioral functioning, interpersonal system, personality, or health status.
This treatment goes beyond helping to cope with common difficulties or providing advice or support.”
Psychotherapy must be distinguished from other types of approaches such as:
- Psychiatry aims to treat mental illnesses such as personality structure problems (for example, schizophrenia and paranoia), severe behavioral disorders (violence), and neuropsychological abnormalities (dyslexia). She usually uses medication, but also psychotherapy;
- the helping relationship is more akin to emotional and respectful support; it is an attitude, but not a treatment;
- Personal development (or personal growth) uses the same tools as psychotherapy, but generally to meet the need to know oneself better, an existential quest, or a desire for emotional, relational, sexual, social, human, spiritual, and professional fulfillment.
Hundreds of studies conducted over the past few decades, and grouped into study syntheses and meta-analyses, have shown that psychotherapy can help effectively treat several psychological problems such as:
- depression;
- panic disorder;
- anxiety;
- eating disorders;
- various personality disorders.
The cross-checking of these studies led to the conclusion that any well-conducted psychotherapy, regardless of the particular technique used, is likely to yield good results.
This hypothesis was first presented in 1976 in a study entitled Comparative studies of psychotherapies: is it true that “everybody has won and all must have prizes”? (Comparative studies of psychotherapies: is it true that “everyone has won and everyone should receive a prize”?).
The subtitle of the study comes from the book Alice in Wonderland, by Lewis Caroll, in which the dodo, the judge-bird, states that everyone who participated in the race won.
The study concluded that all kinds of therapies, very different from each other, demonstrated comparable effectiveness in dealing with similar problems. It was then hypothesized that “common factors” present in the majority of psychotherapies could be at the origin of what is now called the “sleeping effect”.
Since then, several syntheses of studies, meta-analyses, and scientific works have examined the phenomenon, and although there remains some dissension, most researchers now agree on the validity of the sleep effect.
It was noted, however, that the various approaches could indeed be equivalently provided that they were bona fide, a Latin expression that literally means “in good faith”.
For therapy to be bona fide, the therapist must have at least a master’s degree or equivalent training, the treatment must be based on sound psychological principles, and the client’s problem must reasonably be able to be treated by a psychotherapeutic approach.
The benefits of psychotherapy
Psychotherapy has many benefits, here are the main ones:
- stop suffering psychologically (phobias, anxieties, anxiety, panic, recurrent depression);
- solve emotional or relational problems (obsessions, shyness, self-esteem, love failures);
- modify behaviors that are detrimental to well-being (post-traumatic stress, various addictions, imaginary ailments, sexual dysfunctions);
- dealing with an existential crisis and redefining one’s life goals (after which I run, career reorientation);
- others also use it, not so much to solve specific problems, but to acquire new tools in order to achieve their full potential or to improve the match between their values and the reality of their lives;
- Well-being and personal development: better self-esteem and more precise knowledge of one’s needs.
The different psychotherapies
There are four main psychotherapeutic approaches.
Psychodynamic or analytical therapy (psychoanalysis)
Strongly influenced by psychoanalysis (whether Freud, Jung, or others), approaches to psychodynamic therapy appeal to the notion of the unconscious. They focus their efforts on finding links between current difficulties and past experiences, including repressed and unresolved conflicts.
The person is led to become aware of the influence of these conflicts on his functioning in order to understand them and gradually get rid of them.
We aim for profound and lasting changes in the patient. Generally, psychoanalytic psychotherapies last at least one year, with one or more sessions per week.
How does the therapy work?
These steps can go a long way from the most apparent symptom.
We start therapy because of a problem at work and we find ourselves treating an emotional lack.
Some of the classic tools of psychoanalytic therapies are:
- free verbal association;
- dream analysis;
- keeping a personal diary;
- taking into account transfer phenomena, i.e. projecting unconscious desires or situations from the client to his therapist.
In recent years, brief psychodynamic psychotherapies have emerged. They are spread over a shorter period of time (from 10 to 40 sessions) and are most often focused on a well-defined event or behavior.
Cognitive behavioral therapy
Some psychological difficulties may be related, among other things, to inappropriate thoughts or behaviors that one has learned or adopted, often in spite of oneself.
These inappropriate behaviors can be similar to “uncontrollable” reactions that automatically arise in certain circumstances (as soon as I see a police officer, I feel guilty, if I don’t have a lover, I’m worthless, etc.).
Cognitive and behavioral therapies (CBT) offer to objectively observe and analyze these behaviors and thoughts with detachment, learn new behaviors, and replace unwanted thoughts or emotions with others that are more adapted.
How does the therapy work?
We look for concrete problems to solve and a therapeutic approach is established in common (progressive deconditioning, clarification of defense mechanisms, changes in beliefs, etc.).
Generally, the difficulty to be faced is segmented into its various components and new attitudes and positive behaviors are valued as they take hold.
Depending on the case, we will work more on the cognitive dimension (thinking) or on the behavioral dimension (actions).
When CBT works with the unconscious, the framework is not that of psychoanalysis (fantasies, desires, impulses, etc.), but that of cognitive patterns that give meaning to emotions and behaviors.
It is these patterns that are being tried to be relaxed or changed. Treatment usually consists of 10 to 25 sessions per week.
Brief therapies
Approaches such as brief therapies, solution-oriented therapies, and neurolinguistic psychotherapy can be considered part of behavioral approaches.
How does the therapy work?
One of the fundamental goals of brief therapy is to reduce the duration of treatment (no more than ten sessions).
To achieve this, we try to define the problem with maximum precision and tackle limited problems as precisely as possible.
We are not looking for causes, but rather focusing on:
- what is changeable;
- solutions;
- skills;
- action.
Humanistic or existential therapy
The approaches of humanistic or existential therapy are based on the intrinsic capacities of the human being to control his existence and to realize himself fully.
This therapeutic family can be divided into four subgroups:
- mind-body therapies;
- transpersonal therapies;
- creative or expressive therapies;
- talking therapies.
How does the therapy work?
The therapist enters into a relationship with a client rather than treating a patient. The focus is on becoming aware of the person’s difficulties and strengths, and then on the here-now.
The therapist promotes self-exploration and experimentation with new ways of being or acting.
Mind-body therapies
As their name suggests, mind-body therapies act on the psyche through the body. They do this in different ways:
- using the energy of breathing (holotropic breathing);
- by a touch on the part of the therapist (Trager);
- using the body as a trigger for analytic verbalization (bioenergy);
- and finally by allowing the movement to help the psyche to rebalance itself (EMDR).
In all these approaches, we use the body to get in touch with our inner states or to intervene in the psyche.
For example, the gentle touches of the Rubenfeld synergy on a particular part of the body can bring certain emotions to the surface.
A deeper massage in this place will revive hidden memories and arouse an intense release of emotions.
Once emotions are released, it becomes easier to make conscious choices and avoid certain harmful behaviors dictated by overly ingrained habits.
Transpersonal psychologies
Transpersonal psychology is concerned with “non-ordinary states” of consciousness:
- ecstasy;
- the feeling of connection with the Universe;
- the acute awareness of his inner being;
- mysticism.
Concerned with the “full realization” of the person, transpersonal psychology is concerned with the disturbances resulting from the confinement of the unlimited potentials of consciousness in the limited structures of the ego. As it can manifest itself at the time of existential crises or so-called crises of spiritual emergence.
If in classical psychology, the models are efficient, motivated, efficient, and well-integrated socially, those of the transpersonal are saints, sages, and heroes of humanity.
This is not to say that this approach denies the importance of a healthy ego. On the contrary, it is from solid and balanced foundations that the human being could reach other dimensions.
Creativity
These therapies appeal to the creative abilities inherent in each individual. Whether through drawing (see our art therapy sheet), dance, music, etc., and without having to possess any artistic talent, the person is called to let emerge what is hidden deep inside.
The person who practices therapies based on creativity will be able to consider his problems from a new perspective, discover unusual solutions, and apply them in an original way.
These approaches appeal to the multiple dimensions of the being and solicit, through the body, imagination, intuition, thought, and emotions.
The word
Talk-based therapies are relatively conventional, with therapists and clients engaging face-to-face.
The relationship of trust, intimacy, and security with the therapist is fundamental. It allows awareness and discoveries that can then lead to changes in behavior and attitude.
Various exercises are also sometimes used:
- Visualizations;
- role-playing;
- drawing;
- Dream analysis.
Systemic or interactional therapies
The systemic approach considers that there are no sick individuals per se, but that discomforts come rather from interactions with those around them (family, friends, work team, etc.).
The question is not why the problem exists or persists, but how it continues.
The objective is to change the relationship between the individual and his entourage. Meetings are therefore frequently made with several people (as a couple, with children, between employees, etc.).
In systemic or interactional therapy, we will then focus on:
- the various modes of communication;
- lifestyle habits;
- the respective expectations;
- social relations, etc.
It is from them that changes can be initiated. Psychodrama, where everyone plays a role (which can be their own or that of another member of the group), is one of the tools used in these approaches.
Psychotherapy in practice
The psychotherapist
The psychotherapist installs a therapeutic framework to ensure safety and the relationship of trust with the consultant, a major element for successful psychotherapy.
The therapeutic framework is defined by:
- the place, periodicity, and duration of the sessions;
- the price;
- the rules applied in the event of a breach of a session;
- methods;
- the codes of ethics to which the psychotherapist adheres.
This framework is explained by the psychotherapist during the first session, and the person who consults gives his agreement, it is like a psychotherapeutic contract between the consultant and the therapist.
If the framework were to change, it is necessary to establish a new agreement. This is essential to ensure the quality of therapeutic work.
A relationship of trust is essential between psychotherapist and consultant. This relationship will allow the latter to go further on his personal quest and to be in a dynamic of progression of therapeutic work.
Choosing the right psychotherapist
If you are considering psychotherapy, here are some ways that could help you get the most out of it:
- be prepared;
- clarify your goals, your expectations, and your hopes;
- Define the duration of your goals: are they short-term or long-term?
- Is the discomfort precise or diffuse?
- Ask yourself what you are willing to invest, in time, money, and personal commitment.
Facilitate the establishment of a strong therapeutic alliance
Look for an approach, framework, and style of therapist that matches the type of person you are and your values.
You can consult the summary table and go see in more detail the sheets of the psychotherapies that interest you.
Ask for advice
Don’t hesitate to ask for references from people you trust:
- friends who have already been there;
- your doctor;
- a health professional, etc.
In addition, several professional orders and therapists’ associations offer referral services.
You will be able to discuss with them the type of speaker you are looking for, and they will be able to offer you different choices among their members.
Make sure you choose a competent therapist
Before choosing your therapist, ask yourself the following questions:
- if he is not a member of a professional order; Is he part of a recognized association that has standards of practice, a code of ethics, that offers remedies, etc.?
- What is his experience?
- Can it provide you with references?
Evaluate the quality of the alliance
If the quality of the therapeutic alliance from the first meetings does not seem satisfactory to you, quickly consider an alternative.
Trust yourself, studies show that clients are much better than therapists at judging the quality of the therapeutic alliance.
Keep in mind, however, that you are not looking for a friend, but a competent professional who can help you, move you forward, and confront you if necessary.
And then dive in. Remember that your involvement and collaboration are paramount.
The relationship between patient and therapist
The quality of the therapeutic alliance is 30%. The essential therapeutic alliance is generally described as follows:
- in a spirit of collaboration, the client and therapist agree on their respective tasks, and consider them important and relevant;
- the objectives of the therapy are clear, well-understood, and endorsed by both parties;
- An emotional bond based on trust, involvement, acceptance, and great empathy on the part of the therapist connects the two people.
Dr. Michael Craig Miller, the editor of the September 2004 Harvard Mental Health Letter, summed up the importance of the therapeutic alliance. He argues that it is essential to the success of any psychotherapy and, as a number of studies and reviews have shown, that it is more decisive than any other specific aspect of treatment.
Research shows that the stronger the alliance, the better the results.
However, the fact that the provider is friendly, open, or welcoming is not enough, the patient must also feel that he is truly understood and that the therapist is trustworthy and completely competent.
In a review of studies on therapist-therapeutic alliance relationships, it was found that the main qualities that a therapist should demonstrate to create a strong alliance are to be:
- flexible;
- honest;
- respectful;
- trustworthy;
- warm;
- interested;
- open.
The use of various techniques such as supporting the expression of emotions, exploring and reflecting on the patient’s past as well as accurately interpreting these observations would also contribute to the alliance.
Proceedings of a session
In general, the sessions have a similar setting. The average duration and the price may vary depending on the specialty practiced and the psychotherapist.
First, there is customer reception, which involves the following steps:
- collection of speech;
- Listen;
- Exploring the reasons for consultation.
The psychotherapist sets the framework for the sessions:
- duration;
- tariff;
- Cancellation method, all this in order to guarantee rigorous work.
The duration of the therapy varies according to the specific need of the consultant and the goals he wishes to achieve.
Contraindications of psychotherapy
Not everyone is trained in psychotherapy.
Psychiatry, for example, focuses on medical prescriptions and not psychological follow-up as a priority.
The psychotherapist must know how to refer the consultant to other specialists if he does not have the appropriate skills to follow him, for example, in the case of schizophrenia, bipolarity, or depression.
Psychotherapy does not replace a necessary medication follow-up in the context of certain pathologies, it can complement it.
Specialist’s opinion on psychotherapy
Being supervised in one’s practice is essential to succeed in quality therapeutic work and really helps the consultant to advance and overcome certain mechanisms (repetition of family patterns, strong negative beliefs).
The involvement and interaction of the consultant and the psychotherapist is a co-creation that will allow him to move forward in his process by bringing the necessary awareness for change.
The consultant will then be able to register in a new dynamic of life, calm down and use all his potential whether in the areas:
- affective;
- family;
- professional.
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