What is Psychotherapy?

I notice in many movies that involve mental health treatment there is a similar depiction of psychotherapy. There is the patient lying flat on the psychoanalysis couch talking about his or her problems while staring at the ceiling. The therapist, meanwhile, is sitting in a chair behind the patient with note­pad in hand. Sometimes the therapist is depicted as sleeping or daydreaming, or inserting an “Um­hm, tell me more” or “how does that make you feel?” In one comedy movie, the therapist actually left the room to eat a sandwich and came back just in time to announce the end of the appointment while wiping his mouth with a napkin.

Believe it or not, psychotherapy does not always look like that. “Psychotherapy” is actually general term. It is used as a broad description of any kind of relationship between a patient (some people prefer the term “client”) and a therapist who may be a psychiatrist (which is a physician), psychologist (PhD or Psy D), social worker, or counselor. People without any training at all can provide psychotherapy. I would even go as far as to say that people get psychotherapy from friends, family, significant other’s and even obnoxious co­workers that are too nosy and may give “psychotherapy” when it is not wanted.

There are numerous different kinds of therapies and some that even have empirical evidence for them working. Most people think of psychoanalysis when they think of psychotherapy. That is a specific kind of therapy developed by Sigmund Freud. It is based on “stream of consciousness” and building off of strong repressed emotions and therefore is intense and requires sessions at a frequency much greater than once per week. His theory on psychoanalysis is based on “drives” and the attempt to control them: we are all born with an innate desire to seek pleasure and to be lazy; the primitive desires of hunger rage and sex, termed by Freud as the “id”.    The opposite of this, is the “super­ ego”, which contains the morality of a person and keeps a person in line with social norms. Finally, Freud labeled the “ego” which is our conscious mind that mediates between the id and the super­ego.

Freud believed that problems with anxiety and depression (he termed this neurosis or hysteria) stemmed from repressed desires from the id that people had that were in conflict and not balanced with the super­ego. His initial theories for this centered on an imbalance due to sexual abuses or problems in infancy and early childhood, but he later modified these to include uncomfortable unconscious wishes or desires that were not sexual in nature, traumatic memories, and painful emotions. He developed the psychoanalysis couch for this because he believed that the position of lying down best facilitated people’s ability to tap into their unconscious.

Freud’s theories are interesting and still relevant to all of psychotherapy, but psychotherapy does not always have to be psychoanalysis and talk of sex and unwanted desires. The beauty of psychotherapy is that it takes many shapes and forms and can be molded and shaped to what suits you the best. The key to finding the right fit for psychotherapy is to have open communication with the therapist, which is generally established through trust. Therapists love to work with people who are willing to open up and level with them, but they are also willing to work with people who have trouble even doing that. Sometimes that becomes the focus of the therapy. The gist of this is to remember that psychotherapy takes on many shapes and sizes and most people can find the right fit. It is for people with severe mental illness and for people who are perfectly healthy. It can be scary to divulge deep­seated fears, apprehensions, feelings and problems. It is uncomfortable to think of looking at change and to admit problems; but people are built to communicate and rely on one another for help and support. Give it a try sometime. It can be an incredibly liberating experience to talk about yourself in that way.