and mints. It was like the elephant in the living room that we all saw but no one talked about.”
“Well, it’s out in the open now,” Anna’s therapist replied. “Let’s see if we can find a way to make things better.”
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What Is Psychotherapy?
Definition and Common Factors of Therapy
Most mental health professionals spend the majority of their time practicing psychotherapy. Unfortunately, no one has provided a definition of psychotherapy that satisfies all practitioners. One influential definition of psychotherapy has been offered by Raymond Corsini (2005), an expert in helping others:
Psychotherapy is a formal process of interaction between two parties … for the purpose of amelioration of distress in one of the two parties relative to any or all of the following areas: cognitive functions (disorders of thinking), affective functions (suffering or emotional discomforts), or behavioral functions (inadequacy of behavior)…. The therapist [has] some theory of personality’s origins, development, maintenance and change along with some method of treatment logically related to that theory and professional and legal approval to act as a therapist.
According to this definition, psychotherapy is an interpersonal process. Therapy must involve interactions between at least two individuals: a therapist and a client. The therapist can be any professional who has specialized training in the delivery of mental health services. Therapists can include psychologists, psychiatrists, counselors, and social workers; however, therapists can also include paraprofessionals who have received training and supervision in the use of psychosocial interventions (Hill, 2020).
The therapist uses a theory about human development and the causes of psychopathology to develop a means of alleviating the client’s psychological distress. The client is an individual experiencing some degree of distress or impairment who agrees to participate in the therapeutic interaction to bring about change.
The purpose of psychotherapy is to alter the thoughts, feelings, or overt actions of the client to alleviate symptoms and improve well-being. Change occurs primarily through interactions with the therapist. Specifically, the therapist provides conditions, consistent with his or her theory of psychopathology, to improve the functioning of the client.
Jerome Frank (1973) has suggested that certain factors are common to all forms of psychotherapy. These common factors include the presence of a trusting relationship between the client and therapist, a specific setting in which change is supposed to take place, a theory or explanation for the client’s suffering, and a therapeutic ritual in which the client and therapist engage to alleviate the client’s distress or impairment. Frank argues that these common factors of psychotherapy have been primary components of psychological and spiritual healing since ancient times (Frank & Frank, 2004).
The famous psychologist Carl Rogers (1957) argued that there are three necessary and sufficient conditions for therapeutic change. Rogers developed person-centered psychotherapy as an approach to treatment that focused chiefly on these three factors.
First, the therapist must show empathy toward the client. Specifically, the therapist must strive to understand the world from the client’s perspective and take a profound interest in the client’s thoughts, feelings, and actions.
The therapist must also respond to the client with congruence—that is, the therapist must show his or her genuine feelings toward the client and avoid remaining emotionally detached, distant, or disengaged. Rogers described the ideal therapeutic relationship as “transparent”—that is, the client should easily witness the clinician’s genuine feelings during the therapy session. The therapist does not try to hide her feelings or put on airs.
Finally, the therapist must provide the client with unconditional positive regard—that is, the therapist must be supportive and nonjudgmental of the client’s behavior and characteristics in order to establish a relationship built on trust and acceptance. The therapist must communicate that she values the client and will support the client’s decisions. Rogers believed that clients whose therapists provided them with these three conditions would experience the greatest benefits from treatment (Rogers, 1961).
The Therapeutic Alliance
An essential ingredient of successful treatment is the therapeutic alliance or collaborative relationship between the client and the therapist. The therapeutic alliance has both an emotional and cognitive component. With respect to emotion, the client and therapist must experience a positive emotional connection based on trust and support. With respect to cognition, the client and therapist must agree on the goals of therapy and the steps that are needed for reaching those goals. Building these emotional bonds and agreeing on the course of therapy are primary tasks early in treatment (Karver, De Nadai, Monahan, & Shirk, 2018).
The therapeutic alliance is important because it predicts children’s success in psychotherapy. Children who experience a greater connection with their therapists, and agree on the goals of treatment, show greater involvement in therapy, report a higher willingness to change their behavior, and display more openness during their sessions. Similarly, parents who build close relationships with their child’s therapist are more likely to attend sessions with their child and follow through on recommendations to help their children. In contrast, a weak alliance predicts poor participation in therapy, an uncooperative or confrontational approach to treatment, and high likelihood of dropout (Norcross & Lambert, 2020).
Few practitioners dispute the importance of the common factors of therapy and the need for a strong alliance. However, most clinicians regard these elements as necessary, but not sufficient, to bring about change. Consequently, they supplement these common factors and alliance-building techniques with specific strategies and tactics consistent with their theories of human development and the origins of psychopathology. The specific therapeutic methods they use depend on the system of psychotherapy they practice, the presenting problem of the client, and the family’s goals and resources (Karver et al., 2018).
Review
Psychotherapy is a professional relationship between at least two people with the goal of alleviating distress or impairment and promoting growth and competence. This goal is achieved by altering the way the client thinks, feels, or acts in the context of the relationship.
Rogers identified three factors that lead to change in therapy: (1) empathy, (2) congruence, and (3) unconditional positive regard.
The therapeutic alliance describes the collaborative relationship between the clinician and the client. The quality of the relationship predicts change in therapy.
What Are the Major Systems of Psychotherapy?
There are hundreds of systems or “schools” of psychotherapy. They can be loosely categorized in terms of the level at which they approach clients’ presenting problems. These levels include the child’s (1) immediate symptoms and overt actions, (2) patterns of thinking, (3) interpersonal relationships, (4) family structure and functioning, and (5) awareness of oneself (Prochaska & Norcross, 2019).
Behavior Therapy
Behavior
