What does a psychotherapist do on a daily basis

What to Expect at the Psychotherapist

Once you’ve found the right psychotherapist for you, you’ll have to do initial paperwork so they can understand you and your medical history. The first few sessions will help your therapist to get to know you and your situation. This let’s them determine the best style of treatment.

Psychotherapists can treat both adults and children. There may be short-term plans to heal immediate issues or long-term treatment plans to treat more complex challenges.

There are multiple types of therapy based on your particular circumstance and preference. These include: 

Cognitive behavioral therapy (CBT)

This type of therapy helps you identify and change behavior patterns and thinking that may be harmful to you. You’ll work on replacing them with accurate thoughts and functional behaviors.  

Interpersonal therapy (IPT)

This short-term treatment helps you understand your underlying interpersonal issues. It trains you to express your emotions better and improve communication with others. 

Psychodynamic therapy

Psychotherapists use this method to address and treat childhood trauma in order to improve behavior and mental wellness. 

What exactly does a psychotherapist do?

A psychotherapist helps people cope with and overcome mental health problems.

A psychotherapist or therapist is a trained professional who assists people with various mental health conditions such as stress, depression, anxiety, insomnia, addiction, bipolar disorder, negative behavior patterns, bipolar disorder, schizophrenia and other debilitating feelings. Psychotherapy is also called talk therapy and can help treat challenges and symptoms associated with mental health and emotional conditions by helping a person understand their repressed feelings, hence equipping them to face new challenges both in the present and future. Psychotherapists are nonjudgmental and compassionate. They are specifically trained to carefully listen and analyze the psychological needs of their patients and help them accordingly.

Psychotherapy is similar to counselling and the two can overlap. Psychotherapy is deeper and addresses the underlying causes of the problems, as well as helps the person solve them. There are different licenses held by professionals who practice psychotherapy, including social workers, licensed professional counselors, psychologists, psychiatrists and mental health nurse practitioners. Although each of them may have different approaches in treating psychological difficulties, many mental health conditions may involve a team of various mental health professionals. This is especially true for more serious conditions such as addiction, schizophrenia, bipolar disorder and major depressive disorder with suicidal tendencies. In many cases, based on the mental health condition, patients require psychotherapy and medication. Healthy lifestyle improvements, such as regular exercise, adequate rest and other specific activities recommended by the psychotherapist also play an important role in the recovery process and overall well-being.

In general, psychotherapists act as a guide toward helping their patients understand their condition and feelings, cope with daily life and manage their mental health to be able to function normally. This includes maintaining relationships and performing adequately at work or school, thus improving their quality of life. The time taken for patients to feel better varies based on their primary diagnosis, their support system and the patients themselves. Some patients feel better after a few sessions, whereas some may need years or lifelong sessions of psychotherapy to manage their mental health. To see positive results, patients ultimately need to understand they have a problem, recognize the need for change and follow the treatment plan advised by the specialist. About 75% of people who have undergone psychotherapy have been shown to benefit from it.

Psychotherapy and medication: In many cases, based on the mental health condition, patients require psychotherapy and medication. For many mental health disorders, medication has proven to be more useful than psychotherapy. In other cases, patients benefit more from a combination of medication and psychotherapy than from either one alone.

Many people enter the profession later in life, having already been employed in a similar field.

What does a psychotherapist do? Typical employers | Qualifications and training | Key skills

Psychotherapists work with clients who are affected by difficulties such as depression, phobias, stress, anxiety, emotional and relationship problems, physical or psychosomatic disorders and behavioural problems. Activities may include:

• performing therapy sessions in a controlled environment
• using verbal interaction to explore behaviour, attitudes and emotions
• helping clients to understand and address their inner conflicts.
• carrying out different forms of psychotherapy, such as hypno-psychotherapy or couples psychotherapy.

Therapy with young children often focuses on communication through undirected play with art materials and toys. Treatment can take a year or more, depending on the nature of the problem. Child psychotherapists work in child and adolescent mental health services (CAMHS) teams based in the community.

• The NHS, including hospitals, local clinics and health centres
• Student health services
• Psychoanalytical institutes
• Child guidance clinics
• Special needs schools
• Psychiatric units
• Private consultancies

Advertisements appear online, including on the NHS jobs website , the British Association of Counselling and Psychotherapy (BACP) website and in the British Psychoanalytic Council website. Many psychotherapists are self-employed, although this requires a good network of contacts for referrals.

If you wish to work for the NHS, you’ll need to undertake appropriate recognised training. You will usually need a relevant undergraduate degree or professional qualification as well as experience of working with vulnerable adults or children, training at postgraduate level and registration with a professional body such as the UK Council for Psychotherapy (UKCP), the Association of Child Psychotherapists (ACP) or the British Psychoanalytic Council (BPC).

Relevant postgraduate courses are typically accredited by the UKCP, ACP or BPC. Individual employers will specify the qualification they require. You may be accepted on to a training course with any degree discipline, or you might be required to have a psychology degree. Similarly, qualifications in nursing, medicine, social work, sociology and related subjects can be helpful. The NHS offers a limited number of child psychotherapy training posts, which provide varying levels of financial support.

Qualification can take four to six years to complete. Many students train part-time while working. Previous experience of working with people with mental health problems is advantageous, so psychotherapy is not normally a first career choice. Many people enter the profession later in life, having already been employed in a similar field.

Private practice psychotherapists, however, are not registered or licensed and so are not required to gain formal qualifications.

• Resilient listening skills
• Observation
• Sensitivity
• Sincerity
• Discretion
• Empathy and rapport
• Positive outlook
• Excellent communication skills

What is Psychotherapy?

Learn about psychotherapy.

Psychotherapy, or talk therapy, is a way to help people with a broad variety of mental illnesses and emotional difficulties. Psychotherapy can help eliminate or control troubling symptoms so a person can function better and can increase well-being and healing.

Problems helped by psychotherapy include difficulties in coping with daily life; the impact of trauma, medical illness or loss, like the death of a loved one; and specific mental disorders, like depression or anxiety. There are several different types of psychotherapy and some types may work better with certain problems or issues. Psychotherapy may be used in combination with medication or other therapies.

Therapy Sessions

Therapy may be conducted in an individual, family, couple, or group setting, and can help both children and adults. Sessions are typically held once a week for about 30 to 50. Both patient and therapist need to be actively involved in psychotherapy. The trust and relationship between a person and his/her therapist is essential to working together effectively and benefiting from psychotherapy.

Psychotherapy can be short-term (a few sessions), dealing with immediate issues, or long-term (months or years), dealing with longstanding and complex issues. The goals of treatment and arrangements for how often and how long to meet are planned jointly by the patient and therapist.

Confidentiality is a basic requirement of psychotherapy. Also, although patients share personal feelings and thoughts, intimate physical contact with a therapist is never appropriate, acceptable, or useful.

Psychotherapy and Medication

Psychotherapy is often used in combination with medication to treat mental health conditions. In some circumstances medication may be clearly useful and in others psychotherapy may be the best option. For many people combined medication and psychotherapy treatment is better than either alone. Healthy lifestyle improvements, such as good nutrition, regular exercise and adequate sleep, can be important in supporting recovery and overall wellness.

Does Psychotherapy Work?

Research shows that most people who receive psychotherapy experience symptom relief and are better able to function in their lives. About 75 percent of people who enter psychotherapy show some benefit from it.1 Psychotherapy has been shown to improve emotions and behaviors and to be linked with positive changes in the brain and body. The benefits also include fewer sick days, less disability, fewer medical problems, and increased work satisfaction.

With the use of brain imaging techniques researchers have been able to see changes in the brain after a person has undergone psychotherapy. Numerous studies have identified brain changes in people with mental illness (including depression, panic disorder, PTSD and other conditions) as a result of undergoing psychotherapy. In most cases the brain changes resulting from psychotherapy were similar to changes resulting from medication.2

To help get the most out of psychotherapy, approach the therapy as a collaborative effort, be open and honest, and follow your agreed upon plan for treatment. Follow through with any assignments between sessions, such as writing in a journal or practicing what you’ve talked about.

Types of Psychotherapy

Psychiatrists and other mental health professionals use several types of therapy. The choice of therapy type depends on the patient’s particular illness and circumstances and his/her preference. Therapists may combine elements from different approaches to best meet the needs of the person receiving treatment.

• Cognitive behavioral therapy (CBT) helps people identify and change thinking and behavior patterns that are harmful or ineffective, replacing them with more accurate thoughts and functional behaviors. It can help a person focus on current problems and how to solve them. It often involves practicing new skills in the “real world.” CBT can be helpful in treating a variety of disorders, including depression, anxiety, trauma related disorders, and eating disorders. For example, CBT can help a person with depression recognize and change negative thought patterns or behaviors that are contributing to the depression.
• Interpersonal therapy (IPT) is a short-term form of treatment. It helps patients understand underlying interpersonal issues that are troublesome, like unresolved grief, changes in social or work roles, conflicts with significant others, and problems relating to others. It can help people learn healthy ways to express emotions and ways to improve communication and how they relate to others. It is most often used to treat depression.
• Dialectical behavior therapy is a specific type of CBT that helps regulate emotions. It is often used to treat people with chronic suicidal thoughts and people with borderline personality disorder, eating disorders and PTSD. It teaches new skills to help people take personal responsibility to change unhealthy or disruptive behavior. It involves both individual and group therapy.
• Psychodynamic therapy is based on the idea that behavior and mental well-being are influenced by childhood experiences and inappropriate repetitive thoughts or feelings that are unconscious (outside of the person’s awareness). A person works with the therapist to improve self-awareness and to change old patterns so he/she can more fully take charge of his/her life.
• Psychoanalysis is a more intensive form of psychodynamic therapy. Sessions are typically conducted three or more times a week.
• Supportive therapy uses guidance and encouragement to help patients develop their own resources. It helps build self-esteem, reduce anxiety, strengthen coping mechanisms, and improve social and community functioning. Supportive psychotherapy helps patients deal with issues related to their mental health conditions which in turn affect the rest of their lives.

Additional therapies sometimes used in combination with psychotherapy include:

• Animal-assisted therapy – working with dogs, horses or other animals to bring comfort, help with communication and help cope with trauma
• Creative arts therapy – use of art, dance, drama, music and poetry therapies
• Play therapy – to help children identify and talk about their emotions and feelings

Finding and Choosing a Psychotherapist

Psychotherapy can be provided by a number of different types of professionals including psychiatrists, psychologists, licensed social workers, licensed professional counselors, licensed marriage and family therapists, psychiatric nurses, and others with specialized training in psychotherapy. Psychiatrists are also trained in medicine and are able to prescribe medications.

Finding a psychiatrist or other therapist with whom an individual can work well is important. Sources of referrals include primary care physicians, local psychiatric societies, medical schools, community health centers, workplace Employee Assistance Programs (EAP), and online resources (see links to online locators below).

Federal law requires that in most cases mental health services, including psychotherapy, be covered by health insurance similar to other medical care costs. (Read more about insurance coverage of mental health care)

Online Locators for Psychotherapy/Counseling:

References

1. American Psychological Association. Understanding psychotherapy and how it works. 2016.
2. Karlsson, H. How Psychotherapy changes the Brain. Psychiatric Times. 2011.
3. Wiswede D, et al. 2014. Tracking Functional Brain Changes in Patients with Depression under Psychodynamic Psychotherapy Using Individualized Stimuli. PLoS ONE. 2014.http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0109037

Physician Review

Ranna Parekh, M.D., M.P.H.

Lior Givon, M.D., Ph.D.

January 2019