What is Psychotherapy: 15 Techniques and

Exercises (+PDF)
15 NOV 2017
JOAQUÍN SELVA
11 COMMENTS

SOURCE>https://positivepsychologyprogram.com/psychotherapy/

Last Updated on August 17, 2018

Psychotherapy is a type of treatment for a variety of mental disorders that has

been used in psychology for decades.

This article will cover what psychotherapy is and how it can benefit people
with various disorders.

This article will also discuss some ways that psychotherapists can improve
their own practice for the betterment of their clients.

This article contains:

 What is Psychotherapy? A definition

 5 Psychotherapy Techniques, Tools & Exercises
 How to Deal with Resistance in Psychotherapy: Techniques for Therapists
 The 10 Best Psychotherapy Interventions
 What is the Best Psychotherapy Counseling Treatment
 A Take Home Message
 References
The Positive Psychology Toolkit
What is Psychotherapy? A definition
According to the American Psychological Association (APA), psychotherapy
can be defined as a “collaborative treatment … between an individual and a
psychologist” where the psychologist uses “scientifically validated procedures
to help people develop healthier, more effective habits“. For a more in-depth
discussion of what psychotherapy is and how it’s used, consult this PDF from
the Southern California Psychiatric Society.
For our purposes, we can define psychotherapy as a psychological treatment
for a variety of mental health disorders that may or may not be delivered in
concert with pharmaceutical treatment.

5 Psychotherapy Techniques, Tools & Exercises

One recent paper laid out a generalized approach that psychotherapists
should take to lead successful sessions (Yager & Feinstein, 2017). This
approach is broken up into four steps:

 Relating: This includes respecting the patient’s self-esteem and struggles, as

well as being kind.
 Exploring: This includes paying attention to what a client says (as well as
what they don’t say) and their body language, as well as asking questions
to better understand the client and clear up contradictions.
 Explaining: This includes considering how the client’s and the
therapist’s cognitive biases may be shaping the session, as well as
considering any other factors (sociological, interpersonal, developmental,
etc.) that could shape the client’s thinking, then finally ask the client
whether or not they agree with your hunches and conclusions.
 Intervening: This includes presenting one’s interpretations to the client so
they can agree or disagree with them, not enabling the client’s destructive
or dishonest behaviors, and teaching the client ways to deal with their
issues (such as coping skills).

Another issue with psychotherapy is that clinicians generally underestimate the

number of clients who leave treatment with no benefit, or at risk of
deterioration (Lambert, 2017). The first step to correcting this issue is to make
therapists aware of the discrepancy between how they think treatment is
progressing and how the client is actually progressing.
One way to do this is the Outcome Questionnaire-45 (OQ-45), which is a 45-
question self-assessment that clients can complete at the end of each session
to track their therapeutic progress. If therapists offer this option to clients, they
can more quickly identify clients in need of modified treatment plans.

There is also a Youth Outcome Questionnaire-30 (Y-OQ-30) for children and

adolescents, which can either be completed by the client or their parent(s). By
using these tools, psychotherapists can ensure their treatment plans are
effective and modify them if they are not.

For more information on how to be an effective psychotherapist, consult this

PDF from the American Psychological Association.

How to Deal with Resistance in Psychotherapy: Techniques for

Therapists
One way to deal with resistance in psychotherapy is for the therapist to ask
the client for feedback at the end of each session, and attempt to modify their
treatment plan in response to that feedback (Esmiol-Wilson et al., 2017). For
example, certain clients whose feedback was solicited expressed that their
therapist did not understand their situations because of their own privilege as
a therapist. The therapist was then able to recognize this and incorporate it
into their treatment so that they could deal with their client from a more honest
and open perspective.

Another study looking at resistance in psychotherapy focused specifically on

in-session distress (Yasky et al., 2016). These researchers had clients
complete post-session questionnaires which asked them to identify any in-
session distress they experienced. From there, the therapists were more
careful to monitor in-session distress and discussed this distress with their
client when they felt it was becoming an issue. When in-session distress was
identified and discussed, clients completed more therapy sessions and
achieved better post-therapy outcomes.
This idea is reinforced in the description of a case study of a man who sought
therapy for anger issues at the behest of his wife (Dowd, 2016). When the
therapist was encountering extreme resistance from the client, she briefly
stopped the session and (politely) confronted him about his resistance,
allowing the client to feel that he was being listened to. From there, the
therapist gave the client more control by allowing him to structure the session
himself, at which point he became less guarded and was eventually able to
resolve some of his issues (with multiple psychotherapy sessions).

The common thread in all three of these papers is the idea of adaptability. In
all cases, therapists encountered resistance when they ran the sessions by
the book and somewhat rigidly. By getting direct feedback from the client, the
therapists were able to modify their treatment plans to address the client’s
concerns, and from there they encountered less resistance.

Since psychotherapy is supposed to be an individualized process, the ability

to adapt a treatment plan is crucial for any therapist encountering resistance.

The 10 Best Psychotherapy Interventions

While different psychotherapy interventions can be useful for different people
and for different disorders, here are 10 of the best-proven psychotherapy
interventions out there.

Three psychotherapy treatment plans which have been described as

empirically supported treatments (ESTs) are cognitive-behavioral
therapy (CBT), psychodynamic psychotherapy, and supportive psychotherapy
(Feinstein et al., 2015). According to the Mayo Clinic, CBT “helps you identify
unhealthy, negative beliefs and behaviors and replace them with healthy,
positive ones”. Psychodynamic psychotherapy consists of “increasing your
awareness of unconscious thoughts and behaviors, developing new insights
into your motivations, and resolving conflicts”, while supportive psychotherapy
“reinforces your ability to cope with stress and difficult situations“.
Psychotherapy incorporating aspects of mindfulness-based stress
reduction (MBSR) has been shown to be effective for reducing symptoms of
stress and anxiety (Call et al., 2014). According to the Center for Mindfulness
at the University of Massachusetts, MBSR aims to help you “[d]evelop the
ability to cope more effectively with both short-term and long-term stressful
situations”. This is an interesting finding because mindfulness and the
teachings of MBSR can easily be incorporated into traditional psychotherapy.
Short-term psychodynamic therapy with mentalization-based therapy (STMBP)
has been shown to be an effective treatment for a major depressive disorder
(MDD) (Bressi et al., 2017). According to Dr. John Grohol with PsychCentral,
mentalization-based therapy (MBT) aims to “[help] people to differentiate and
separate out their own thoughts and feelings from those around them”. This is
another example of how a simple adaptation of a traditional psychotherapy
treatment can make it beneficial to more people.
Psilocybin-assisted psychotherapy has been shown to be effective in reducing
stress and anxiety symptoms in cancer patients (Belser et al., 2017). In this
study, psilocybin-assisted psychotherapy referred to a long psychotherapy
session during which the client had been administered psilocybin. Unlike most
psychotherapy, psilocybin-assisted psychotherapy would likely only consist of
a single session, though that session may be part of a longer, multi-
session treatment plan.
Interpersonal psychotherapy (IPT) has been shown to reduce depressive
symptoms in adolescents (Pu et al., 2017). According to the Mayo Clinic, IPT
“focuses on addressing problems with your current relationships with other
people to improve your interpersonal skills”. IPT can be effective in treating
disorders that lead to social deficiencies, as well as in marriage and family
therapy.
Cognitive hypnotherapy (CH) has been shown to be effective in treating anger
issues (Dowd, 2016). Cognitive hypnotherapy is an “integration of hypnosis
with CBT” that initially arose as a way to use hypnosis to
treat depression (Alladin, 2012). This is a good example of how traditional
psychological ideas (such as hypnosis) can be made more palatable to
skeptics through integration with more modern, empirically-supported
treatments.
Dialectical behavior therapy (DBT) has been shown to be effective for
reducing suicidal ideation as well as depression and anxiety symptoms in
combat veterans (Goodman et al., 2016). Dialectical behavior therapy is “a
type of CBT that teaches behavioral skills to help you handle stress, manage
your emotions and improve your relationships with others”, according to the
Mayo Clinic. While DBT is an adaptation of CBT, it is widely used enough to
merit its own mention.
A type of art therapy called short-term clay art therapy (CAT) has been shown
to be effective in improving the mental health of participants with MDD (Nan &
Ho, 2017). According to the American Art Therapy Association, art therapy is
“an integrative mental health and human services profession that enriches the
lives of individuals, families, and communities through active art-making,
creative process, applied psychological theory, and human experience within
a psychotherapeutic relationship”. Art Therapy can help children, adolescents,
and less vocally-expressive adults get more out of a psychotherapy session
than traditional talk therapy.

What is the Best Psychotherapy Counseling Treatment

Since psychotherapy is such a personal undertaking, there is no single best
“one-size-fits-all” treatment. That said, cognitive-behavioral therapy (CBT) is
often considered the most effective treatment for the widest range of
disorders. For example, therapist-led (as opposed to self-administered) CBT
has been shown to be effective for both bulimia nervosa (BN) and
consequential depressive symptoms (Linardon et al., 2017). CBT has also
been shown to be effective (by itself or in concert with other treatments)
for anxiety, general depressive symptoms, depressive symptoms in insomniac
patients, tinnitus distress, and smoking cessation (Dragioti et al., 2017).
Functional analytic psychotherapy (FAP, a subset of CBT) has also been
shown to be effective for decreasing interpersonal difficulty in nursing home
residents (Singh & O’Brien, 2017). As we saw above, other adaptations of
CBT (such as DBT and cognitive hypnotherapy) have also gained
acceptance, showing its versatility as well as the variety of disorders it can be
useful for. All of that said, it can be tempting to think that CBT is easily the
best treatment for most disorders since it has been shown to be useful for
such a wide variety of disorders.

There has been a recent pushback on the efficacy of CBT, though, as some
researchers argue that many papers compare CBT to being on a waiting list
or no treatment (as opposed to the typical treatment for the disorder in
question) and that some psychologists allow their own “allegiance” to CBT to
bias their study of its effectiveness (Leichsenring & Steinert, 2017).

Other recent research has challenged the supposed superiority of CBT for
certain disorders, such as one paper showing that psychodynamic therapy is at
least as effective for treating MDD as CBT is (Driessen et al., 2017). This
shows the importance of challenging conventional wisdom in psychology
research, so that knowledge is driven by empirical research findings rather
than popular consensus.
With those criticisms acknowledged, CBT is still a very useful treatment for a
variety of disorders and is a crucial part of psychotherapy.

While it may not always be the best treatment option for every case, its
versatility makes it an important treatment plan for any psychotherapist to be
well-acquainted with. For an in-depth look at CBT, consult this website from
the Centre for Addiction and Mental Health.

A Take Home Message

Psychotherapy comes in many different forms and can be used to treat many
different disorders, but at the end of the day, it is a personalized process that
requires a psychotherapist who is keenly aware of their client’s personal
needs. For example, while CBT is an effective treatment for a variety of
disorders, it may require adaptation (such as in the cases of DBT and CH) to
best help a client, and in other cases, it may not even be the best treatment
plan available. Aside from specific treatment plans, some psychotherapy
sessions require feedback from the client and adaptability from the
psychotherapist to be maximally effective.

In other words, while the goal of many psychotherapy treatments is to get the
client to challenge their own thoughts and assumptions, psychotherapists
would also do well to interrogate their own beliefs rather than accept them as
fact.