Psychotherapy: the talking cure James Tighe Psychotherapy is often seen as synonymous with psychiatry. However, the 'talking cure' includes several therapeutic approaches used to treat emotional distress, psychiatric disorders and everyday stress.

In this article

What is psychotherapy? Who are psychotherapists?

What happens during psychotherapy? Counselling or psychotherapy?

Brief lay guide to the history of psychotherapy The last half of the 20th century

It's a process that allows a person to come to a fuller understanding of their abilities, difficulties, motivations or worries in conjunction with the therapist.

This confidential relationship is mutually trusting and can continue for months or even years. "It's the most intimate relationship you'll ever have with another human being," says consultant clinical psychologist Caroline Garland of the Tavistock Clinic, London. "The therapist knows their patients better than anybody else in their lives."

They usually have an advanced qualification in one of the mental health professions - psychiatry, psychology, nursing - and additional training in psychotherapy, although it's becoming more common for psychotherapists to have in-depth psychotherapeutic training rather than this foundation.

In addition, therapists tend to be curious and non-judgemental people who believe that clients can be helped to get better.

Sessions take place at the same place and time, usually every week or every fortnight, and whatever is said or done during the 50 or 60 minutes is confidential.

In individual therapy, the client and therapist usually sit in chairs (the chaise longue is rarely used these days).

Group therapy involves three or more clients, and can be the best kind for certain types of problem.

Some people use a combination of therapeutic techniques, such as individual and marital therapy (where a couple meets with one or two therapists).

No matter what the technique, the underpinning principle is that psychotherapy is no magic cure; rather, the capacity for cure lies within each person. Over time, clients develop a sense of mastery over their situations, feelings, thoughts and behaviours.

To find out about therapeutic services in your area, contact your GP or local health authority, who can refer you to a range of psychotherapists with recognised qualifications, or see our list of professional organisations.

The problem for the lay person trying to understand therapy is that there are so many schools of psychotherapy, but the subject seems less mysterious once you have an overview of the different types and their history.

The difference between the two is a hotly debated issue. The British Psychological Society defines counselling as a system intended to 'help people improve their sense of wellbeing, alleviate their distress, resolve their crises and increase their ability to solve problems and make decisions for themselves'.

This suggests it works best with people who already have a sense of wellbeing and are able to solve problems and make decisions but need a helping hand during a crisis.

Psychotherapy might be more helpful for psychological problems that have built up over years than at a time of crisis or distress. Given the variety of opinion on this subject, there's bound to be someone who reads this and disagrees, and they'll probably have a view worth listening to.

Ultimately, the only way to decide for yourself is to get involved in the debate by reading. A good place to start is A Complete Guide to Therapy: From Psychoanalysis to Behaviour Modification, by Joel Kovel (ISBN 0394733363).

Psychoanalytic theory was the first modern approach to psychotherapy, and even today many schools of psychotherapy are defined by the ways they differ from psychoanalysis.

Psychotherapy's concerned with instincts and the unconscious mind, based on the idea that we may have memories or thoughts that we've masked using our mental energy in getting on with the demands of everyday life.

In psychoanalysis you uncover these thoughts and memories, which is a long and demanding process. This is where the popular view of the patient lying on the couch comes from. The client must say whatever comes into their head, and allow their thoughts to follow their instincts and see where they lead.

Psychoanalytic theory suggests that, for some people, the tension between their repressed thoughts and their conscious thoughts leads to psychological problems, which is when psychoanalytic psychotherapy is required. The therapist uses psychoanalytic theory to confront, interpret or reconstruct the patient's interpretations of the world in a way that helps to solve their problems.

Sigmund Freud, the father of psychoanalysis, and his colleagues noticed that when people with psychological problems were listened to attentively and sympathetically they tended to develop strong positive feelings towards the listener. They called this 'transference'.

Freud and his colleagues realised they developed their own feelings - counter-transference - towards the patient, which affected their own reaction. When therapy goes wrong and becomes abusive, it's normally because the therapist has mismanaged this part of the process.

Coupled with psychoanalytic theories of repressed emotion, this brought a whole new dimension to Freud's work. There were, however, thinkers who disagreed with Freud, which led to the proliferation of schools of psychoanalytic thought.

One group felt that the operation of transference and counter-transference in everyday activity was the core of many problems, which led to what's now known as the psychodynamic approach to psychotherapy.

There are some therapists who see no real difference between psychoanalytic approaches and psychodynamic ones. Certainly, they're very closely related. But the influence of psychodynamic theories has been felt in many other areas of psychotherapy.

Games People Play: The Psychology of Human Relationships (ISBN 0345410033) by Eric Berne is an accessible look at psychodynamic theories.

By the 1950s, various forms of analytic and dynamic psychotherapy were well established. Into this came the figure of Carl Rogers, who approached therapy from a humanist point of view, believing that all individuals are unique. This led to the understanding that each individual has unique problems, for unique reasons, and needs unique solutions.

This led to person-centred psychotherapy. The therapist enables the client to explore their feelings by asking a series of open questions, needing more than a simple yes or no answer. Each question refers to what the client has just said about their feelings, so in each session the issues are explored more deeply.

According to this approach, psychological problems are not based in unconscious thoughts but in a failure to examine your conscious thoughts thoroughly. In the 1960s, a group of therapists developed cognitive therapy from this view. They believe in good 'mental hygiene'. The sort of routine they get their patients to go through goes something like:

• What am I thinking about?
• How does that thought make me feel?
• Do I believe in that thought?
• If I become aware that I don't really believe the thought, does it make me feel different?

People who use this type of therapy find it effective for specific problems, and it's been used as the basis of the self-help packages on this site. But, of course, a Freudian might say that to take instinctive thoughts and rationalisation them in this way is simply to repress the problem even further.

This article was last reviewed in September 2006.
First published in June 2000.