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PSYCHOTHERAPY

The practice of alleviating psychological distress through understanding and cognitive (mind) techniques


Introduction

Simply put, psychotherapy is the practice of alleviating psychological distress through talking rather than drugs; indeed, it is often referred to as ‘talking therapy’.

Psychologists specialising in psychotherapy work with a wide range of distress usually at the point when it is severe enough to affect a person’s well being, work, relationships and other aspects of their daily lives. It can be so severe as to be defined in terms of mild to serious mental ill-health and many psychotherapy specialists work in health service settings.

Psychotherapy and Psychiatry

An important reason for favouring a psychological approach is that individual distress is often the result of problems in human relationships and so is not best seen as a personal ‘disorder’ but more in terms of the effect of the way a system of relationships works. So psychologists specialising in psychotherapy will often consider the wider context such as relations within a family or at work. Some psychotherapists work directly with families and other groups of people.

Psychiatrists are medical practitioners who frequently take a medical approach to mental health and often prescribe drugs to alleviate distress. Medical approaches tend to see distress in terms of symptoms that indicate ‘disorders’ in much the same way as physical disorders are indicated. A diagnosis of a disorder, such as ‘obsessive-compulsive disorder’, ‘depression’, ‘anorexia nervosa’, ‘and post-traumatic stress disorder’, is linked to a prescribed treatment perhaps in the form of a drug or a specified psychological intervention.

This approach can be very effective for some people. However, although psychologists specialising in psychotherapy may refer to ‘disorders’ as a form of shorthand, they emphasise the value of an approach more rooted in psychology than in medicine. This is because, unlike a physical disease that may be linked to a particular virus, bacterium or genetic condition, psychological distress is more often linked to the way a person experiences events such as loss, accidents, war trauma, physical attacks, work stress, relationship difficulties, sexual abuse, emotional neglect during childhood and so on.

Where Can Psychotherapy Help?

The psychological effects of experiences such as loss, accidents, war trauma, physical attacks, work stress, relationship difficulties, sexual abuse, emotional neglect during childhood and so on can be profound and will be affected not only by the severity of the experience itself but also by such things as a person’s history of distressing events, learned ways of coping, differences in personality and temperament and so on.

Of course, common patterns can be identified, such as ‘flash-backs’ to traumatic experiences, and therapists have developed specific techniques that are helpful to many people.

Nevertheless, it is often very important to understand an individual person’s distress in the context of his or her own history and experience, personal coping strategies and personality. In this way the psychotherapy can be tailored to the individual.

The overwhelming evidence concerning the effectiveness of psychotherapy identifies two major contributors to successful therapy. These are firstly, factors relating to the person seeking therapy, such as their motivation to confront difficulties and work to make changes and, secondly, aspects of the relationship between the therapist and his or her client.

Particular techniques are shown to be useful but are less important and finally a general expectation of success, itself contributes to success. These findings are perhaps not surprising when we consider the nature of psychotherapy.

Unlike treatments based on drugs that can directly affect the body’s chemistry or destroy bacteria, psychotherapy is dependent on the therapist and client working together both to understand a client’s distress and to find ways forward suited to his or her personal circumstances and resources. It is a co-operative process. Psychotherapists bring psychological knowledge and understanding to offer clients and clients bring first hand knowledge of their unique experience and circumstances.

In order for this to happen clients need to feel comfortable with their therapists and be willing to talk openly and freely about themselves and work collaboratively. Therapists need to provide a safe and confidential environment and offer a relationship in which clients feel accepted and understood in their own terms as the basis on which a more psychologically informed understanding can be built.

The Science Behind the Practice

Psychologists specialising in psychotherapy draw upon theory and research to guide their therapeutic work and to ensure that their practice is based on the best evidence available. Human beings are, of course, very complex and psychological theories and research reflect that complexity. Human psychology cannot be scientifically studied as a whole any more than the human body can. So, just as e.g., the digestive and circulatory systems can be studied as specialist areas, specialised areas of psychology have developed in relation to different aspects of experience and behaviour.

Examples of areas that have relevance for psychotherapy are:

Research in such areas is useful in identifying common processes and patterns.

For example, our ability to change problematic behaviour and ways of thinking is informed by our understanding of learning processes. Common patterns in the ways in which a baby’s attachment to its mother (or other parental figure) is affected by her behaviour have been identified and seen as leading to difficulties in later life that can be helped by therapy.

Drawing on research into the nature of stress is useful in supporting people in stressful situations and helping them to devise better coping strategies. Understanding how behaviour can be shaped by expectations, linked to particular roles that individuals play in groups and families, is useful in changing problematic relationships.

The list is potentially endless and, in addition to the areas of general psychological research that have contributed to effective therapeutic work by furthering our understanding beings, specific research into psychotherapy has also been carried out. This has developed our understanding of what makes therapy effective and also identified particular interventions that are especially useful for common difficulties such as ‘flashbacks’ to traumatic experiences, obsessions and compulsions, anxiety and panic attacks of humans.

Finding the Right Psychotherapist

All psychologists specialising in psychotherapy have degrees and post-graduate professional training in psychology and the practice of psychotherapy. The majority are clinical and counselling psychologists, whose post-graduate training includes psychotherapy, but others have trained initially in other areas such as forensic and educational psychology. All, therefore, have an extensive knowledge of general psychology, which provides the foundation of their specific training and experience as practitioners of psychotherapy. They are all able to work with a wide range of difficulties and distress and will take time to assess the potential for useful work with each client.

It is very important to note that all psychologists registered with the British Psychological Society adhere to the Code of Ethics and Conduct that sets a high standard of ethical practice and that the Society has a complaints procedure for dealing with breaches of the code.

As a potential client, finding a therapist can, nevertheless, be confusing. Because of the complexity of human experience and behaviour and the range of theories and research that has developed, a range of approaches to psychotherapy has also developed. Psychotherapists, therefore, often describe their work in terms of the specific approaches in which they have trained. Common approaches are ‘cognitive or cognitive-behavioural’, ‘humanistic or person-centred’, ‘psychodynamic or psychoanalytic’, ‘systemic’ and so on. Many will, however, describe their work as ‘integrative’ because they draw on more than one approach. Because the relationship between therapists and their clients is so central, this is often not as important as finding someone with whom you feel comfortable and able to work co-operatively. It can, however, be the case that a particular approach will suit your own outlook and temperament or particular difficulty. The following are brief descriptions of these common approaches.

They have differing emphases and techniques but all are rooted in a psychological understanding of how we develop and learn from relationships and life experiences, to think, feel and behave, to make and maintain relationships and to respond to events and situations.

  • Cognitive and cognitive-behavioural approaches: These approaches focus on how we learn to think and behave. Psychological distress can be related to patterns of thinking and behaviour that cause difficulties and therapists often work with clients to identify these patterns and change them.
  • Humanistic and person-centred approaches: These approaches focus on the conditions that affect our sense of self and the ways we feel about and value ourselves. Much distress can be linked to a lack of self-worth and therapists often work with clients to understand how they have learnt to see themselves and to build self-esteem.
  • Psychoanalytic and psychodynamic approaches: These approaches focus on the ways early experiences in family relationships can affect our development and well being throughout life. Such experiences can have profound effects that are largely unconscious and therapists often work with clients to understand and ameliorate distress rooted in early experience.
  • Systemic approaches: These approaches focus on systems of relationships in families and groups and the ways that individuals are shaped by group expectations and the roles they play. Therapists often work with individuals, families or groups to understand and change patterns of relationship that cause difficulties.

From even such brief descriptions, it can perhaps be seen that any one person’s difficulty in coping with a particular situation, or their more general distress, anxiety or depression, may contain elements of all of the above and that different approaches often represent different ways in and differing means to similar ends.

A great deal more could be said about each of these approaches and about other approaches and techniques.


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