Psychotherapy is an interactive process between a person and a qualified mental health professional (psychiatrist, psychologist, clinical social worker, licensed counselor, or other trained practitioner). Its purpose is the exploration of thoughts, feelings, and behavior for the purpose problem solving or achieving higher levels of functioning.
Psychotherapists are bound by professional and legal standards of ethics, such as protecting the confidentiality of information provided by clients or patients, not engaging in inappropriate behavior with a client or patient, and protecting the safety of children by reporting suspected child abuse to legal authorities.
The generally acknowledged father of modern psychotherapy was Sigmund Freud, a neurologist in 1880s Vienna, Austria, who noted that some of his patients did not seem to have a physical cause for their symptoms. Freud became intrigued with the relationship between the mind and physical symptoms. In 1886, he opened an office for the practice of what he named "psychoanalysis," which incorporated dream interpretation, free association, and the three levels of consciousness: the id (primitive drives and impulses), the ego (normal waking mental functioning), and the superego (conscience, self-regulation of right and wrong).
Psychoanalytic theory is one of four major approaches to psychotherapy. The others are behavioral (primarily concerned with behavioral processes and outcomes), humanistic (focused on existential issues, meaning, and self-actualization), and transpersonal (focused on transcendent awareness and the spiritual dimensions of life). These four main approaches are blended in many different varieties of psychotherapy.
To define diagnoses and symptoms of mental disorders, the American Psychiatric Association published the first Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952 with around 60 disorders. The DSM was last revised in 2000, creating the DSM-IV-TR. This is the standard reference used by psychotherapists and the healthcare system for defining and describing mental disorders and symptoms. The next revision of the DSM is scheduled for 2011 or later.
Psychotherapy is conducted in private individual, couple, group, or family sessions. Generally, sessions range from 50 minutes for individuals to 90 or 120 minutes for groups. The number of sessions varies widely depending on the problems being addressed and the context (outpatient, inpatient, payment source). "Brief therapy," the approach preferred by health insurance companies that cover mental health services, is generally defined as up to eight sessions. The opposite extreme, psychoanalysis, may be multiple times per week over several years.
The cost of a psychotherapy session depends on several factors, including the type of therapy, the education and experience of the therapist, and the geographical location. An hour of therapy may range from $5 or $10 an hour at a community or non-profit mental health center to over $200 an hour for a doctoral level practitioner in private practice.
People who have received professional training in psychotherapy include psychiatrists, clinical psychologists, clinical social workers, marriage and family counselors, and some pastoral counselors. A psychiatrist is a board-certified physician (M.D. or D.O.) with a four-year residency in psychiatry. Unlike other therapists, psychiatrists can prescribe medications. Clinical psychologists have at least a master's degree and usually a doctoral degree and are licensed by the state. Clinical social workers as well as marriage and family therapists/counselors have at least a master's degree and are licensed by the state. Some states have other designations for licensing purposes (e.g., mental health counselor or clinical professional counselor). In all cases, a license requires a number of hours of supervised experience beyond the professional degree, the passing of an exam, and periodic continuing education courses.
Pastoral counselors may have minimal to extensive training in psychotherapy. They may or may not be licensed by the state and practice under the auspices of being clergy.
Psychotherapists may have extensive training in a specific type of psychotherapy or multiple types. They may also specialize in working with a certain age group (children, adults, elderly) or with people with a certain type of problem (e.g., mental illness, coping with medical illness, marital and family relations, domestic violence or abuse, educational functioning, substance abuse).
Acceptance and commitment therapy, art therapy, behavior therapy, behavioral medicine, biofeedback, body psychotherapy, brief therapy, CBT, client-centered therapy, cognitive-behavioral therapy, cognitive bibliotherapy, cognitive restructuring, cognitive therapy, common factors therapy, compliance therapy, counseling, CT, DBT, dialectical behavior therapy, existential psychotherapy, family therapy, forensic psychotherapy, gestalt therapy, group therapy, guided imagery, humanistic psychotherapy, hypnosis, hypnotherapy, internet-based cognitive-behavioral therapy, interpersonal psychotherapy, Jacobson's progressive relaxation therapy, Jungian analysis, Jungian therapy, marital therapy, mind/body medicine, MST, multi-systemic therapy, music therapy, narrative therapy, nondirective psychotherapy, personal therapy, play therapy, projective identification, psychoanalysis, psychoanalytic psychotherapy, psychodrama, psychodramatic psychotherapy, psychodynamic psychotherapy, psychoeducation, psychosynthesis, rational emotive behavior therapy, rational emotive therapy, relaxation therapy, sand tray therapy, schema-focused therapy, Schultz' autogenic training, sex therapy, solution-focused therapy, somatic psychotherapy, spirituality-focused psychotherapy, supportive-expressive group therapy, supportive psychotherapy, talk therapy, talking cure, telephone-administered cognitive-behavioral therapy, transcendental mediation, transference-focused psychotherapy, unconscious psychotherapy, visualization.
Note: Psychotherapy is sometimes used in combination with drugs or herbal medicine to help alleviate psychological symptoms. This monograph pertains primarily to psychotherapy as a modality in itself and does not evaluate related drugs or herbs. We do, however, note some circumstances where combined therapy is recommended or where psychotherapy should not be relied upon alone.