Psychotherapy

Psychotherapy is useful in the management of many mental health illnesses, along with drug therapy where necessary. Simply medicating without self-awareness or a desire to improve often does not yield good outcomes. Therefore, in such cases, psychotherapy is necessary to improve the overall mental health status of the patient. Conditions for which psychotherapy is commonly used in clinical practice include:

• Anxiety disorders
• Obsessive-compulsive disorder (OCD)
• Phobias
• Panic disorder
• Post-traumatic stress disorder (PTSD)
• Mood disorders such as:
  • Depression
  • Mania
  • Bipolar disorder
• Addictions such as:
  • Alcoholism
  • Drug dependence
  • Compulsive gambling
  • Sex addiction, etc.
• Eating disorders such as:
  • Anorexia nervosa
  • Bulimia nervosa
• Personality disorders, such as:
  • Borderline personality disorder
  • Dependent personality disorder
• Psychotic disorders, like schizophrenia, in which complete or partial detachment from reality is common.

However, psychotherapy is not limited to only those suffering from clinically diagnosable or identifiable mental health disorders. Psychological therapy can help individuals experiencing mental duress navigate through the struggles of their daily lives better. One can consider meeting with a mental health professional to address any mental health issues they feel they need assistance with. Some possible examples can be:

• To resolve conflicts: With your partner, spouse or someone else in your life. Specialised counselling, such as couples therapy, is available to address problems arising within a civil partnership or marriage.
• To relieve anxiety or stress: For many people, stress may arise due to pressure at the workplace or due to other specific triggers unique to them. In order to lead a better life and achieve mental peace, counselling can be sought.
• To cope with major life changes: Such as divorce, the death of a loved one or the loss of a job.
• To learn to manage unhealthy reactions: Such as anger issues or passive-aggressive behaviour that may be impacting a person’s life.
• To come to terms with their health status: An ongoing or serious physical health problem like disability following a stroke, diseases that need lifelong therapy like HIV or AIDS,  conditions that need a drastic lifestyle modification such as diabetes or diseases with a poor prognosis, possibly terminal, like cancer or long-term (chronic) pain.
• To mentally recover from physical or sexual abuse or witnessing extreme violence.
• To cope better with the mental stress arising from sexual problems, whether they're due to a physical or psychological cause. (Read more: Sexual health)
• To help sleep better: Sometimes lack of sleep, or the inability to sleep, may not be due to a medical reason but a psychological one. Before resorting to medication or for a better long term solution for insomnia, psychotherapy can be tried.

(Read more: Chronic illness and mental health)

Various approaches, methods and techniques to psychotherapy exist. Some may be more beneficial than others to tackle specific mental health issues. 

• Cognitive Behavioural Therapy (CBT): Cognitive behavioural therapy is a type of talk-based therapy that helps patients identify negative thoughts, emotions and their actions and behaviours in response to them by breaking them down into smaller parts and replacing them with positive ones. Cognitive therapy is aimed at helping patients recognise unhelpful or nagging thoughts they may have and understanding why they arise and what emotions and actions they bring about. Harmful thought patterns, such as incorrect notions held in phobias, are broken. The second part of this therapy, which is behavioural therapy, addresses what (and why) actions or behaviours occur in response to the harmful thoughts and uncomfortable emotions. For example, the anxiety that is caused by fearful thoughts can prevent the patient from doing certain tasks. Overall, the patient breaks down the process behind undesirable behaviours, with the help of the psychotherapist, in the following chunks: 
  • Situations
  • Thoughts
  • Emotions
  • Physical feelings
  • Actions

After learning and understanding why negative behaviour arises, the patients, with the help of the psychotherapists, work towards replacing them with positive thoughts, feelings, actions and behaviours. 

• Psychodynamic and psychoanalysis therapies: Psychodynamic and psychoanalytic approach of psychotherapy focuses on changing problematic behaviours, feelings and thoughts by discovering their unconscious meanings and motivations. Where in cognitive behavioural therapy (CBT) patients learnt to recognise and correct negative thoughts, feelings and actions, in psychodynamic therapy they gain insight into their unconscious thoughts and motivations behind actions. Both approaches are useful in their rightful places. 
• Acceptance and commitment therapy: This subtype of psychotherapy helps patients become aware of and accept their thoughts and feelings, allowing them to commit to making changes to help themselves better adjust and cope with situations. 
• Interpersonal psychotherapy: This specialised variety of psychotherapy focuses on interpersonal relationships. Interpersonal psychotherapy addresses current relationships in the patient’s life and the strain that may be present in any of them. These relationships could be between spouses, partners, parents, friends, coworkers or any other important person in the patient’s life. 
• Supportive psychotherapy: Supportive psychotherapy involves efforts by the psychotherapist to alleviate stress or anxiety in the patient by any means possible. The mental health professional focuses on comforting, advising, encouraging, reassuring, and mostly listening, attentively and sympathetically. 
• Humanistic psychotherapy: The principle ideology behind the humanistic approach to psychotherapy is that it emphasizes the patient’s capacity to make rational choices and develop to their maximum potential. What this means is that by fully understanding one’s own unique worldview, gaining true self-acceptance and overcoming external criticism and disapproval, a safe space to work towards personal growth is created. Subtypes of humanistic psychotherapy are: 
  • Gestalt therapy 
  • Client-centred therapy 
  • Existential therapy
• Integrative psychotherapy or holistic psychotherapy: Many psychologists, psychiatrists and psychotherapists do not limit themselves to a single approach but rather integrate the principles of several to give a well rounded holistic therapy experience to patients who might benefit from it.

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Psychotherapy is a broad term given to the psychological strategies of alleviating and addressing mental health problems by scheduled regular interaction with trained psychiatrists, psychologists or other mental health professionals, either in place or in addition to medical drug-based therapy. The key principle of psychotherapy is to motivate the individual seeking therapy to change problematic behaviours, improve interpersonal relationships, build social skills and overcome other undesirable problems felt by the patient. While the benefits of psychotherapy are multifold, four major ones can be summarised as:

• It helps a person handle emotions arising from stressors or problems. This holds true whether the emotional conflict in one's life is devastating or a mild inconvenience.
• It can give you skills and teach you how to dissect a problem and how to best solve it on your own without experiencing undue mental duress.
• Irrespective of how big or small your perceived mental health issues are, talking with a therapist can give you perspective and help develop healthy coping mechanisms.
• Psychotherapy can help you understand your own unique worldview, learn self-acceptance and figure out what is really important to you.

(Read more: Homeopathic Treatment, Medicines, Remedies for Mental Disorders)

Psychotherapy sessions usually take place in a one-on-one interpersonal setting, usually at the therapist’s office. However, nowadays, sessions can be conducted over the telephone or through video calling (telemedicine) as well. Some types of sessions can occur in a group setting, where an environment of welcoming and understanding is fostered amongst members (patients and the psychotherapist). Usually, sessions last 45 to 60 minutes. Patient-psychotherapist confidentiality is upheld throughout the therapy and beyond.

During your first session, the psychotherapist will ask you to fill out forms or take a medical history regarding your previous physical or mental illnesses. Some other information like your family history, personal history and medication prescriptions will be sought. It usually takes a few sessions for the psychotherapist to ascertain the patient’s personality, needs and current mental health status. The patient also takes this time to figure out whether the psychotherapist’s approach, attitude and personality match their needs. The psychotherapist will also explain the following during the first session:

• The type or approach of psychotherapy that will be used
• The goals of the psychotherapy
• The duration of each session
• An estimated number and frequency of sessions that may be required

While the benefits of psychotherapy in the right candidate are many, some possible negative effects can also arise. Possible problems with psychotherapy can be either due adverse treatment reaction (ATR), which means that the correct treatment produces some expected negative effects, or due to negligence or malpractice by the psychotherapist. Some possible negative effects of psychotherapy are:

• Re-traumatisation: Suppressed memories can be brought up on initiation of treatment.
• Brief reactive psychosis: When treatment begins, a short period of reactive symptoms, such as psychosis in schizophrenics, is expected.
• Depression: If the intensity of therapy is not properly tempered, reliving trauma and negative memories can cause the patient to slip into depression.
• Symptoms presentation: Acquiring new symptoms as well as worsening of existing symptoms can occur.
• Dependence on psychotherapists: Patients may become overly dependent on the psychotherapist to function. The psychotherapist can come to be viewed as an external locus of control by the patient. Patients may become unable to make independent judgements or decisions.
• False or implanted memories: The patient may believe certain false memories to be true.
• Implanted philosophies: Personal philosophies and beliefs of the psychotherapist can be adopted without examination by the patient.
• False insight: Patients may begin to feel like they have extra insight into the human psyche and can often use empty language or technical jargon that they don’t understand.
• Narcissism: Excessive self-absorption can occur in the patient.
• Transference: Patients can redirect feelings, sentiments or attraction for another person onto the psychotherapist.
• Iatrogenic malingering: Patients can end up pretending to be ill to continue receiving medical or psychological support.

(Read more: Yoga for mental health)