Psychotherapy - How it works 

How psychotherapy works 

CBT expert

Professor David Clark explains how cognitive behavioural therapy (CBT) works and who could benefit from it.

Media last reviewed: 24/04/2013

Next review due: 24/04/2015

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One of the key objectives of psychotherapy is to help you gain a better understanding of the issues that are troubling you.

It can help you work out new ways of approaching situations that you find difficult, as well as suggesting new methods to help you cope.

Developing a trusting relationship with your psychotherapist is very important, and will help you to talk about long-standing problems. However, developing trust can take time. Depending on the disorder and the style of psychotherapy, some treatment courses may need to last for several months or, in some cases, years.

Types of psychotherapy

There are many different types of psychotherapy. The type used will depend on your personal needs and which method your psychotherapist thinks will be most helpful for resolving your issues.

The different types of psychotherapy are discussed in more detail below.

Psychodynamic (psychoanalytic) psychotherapy

Psychoanalysis is based on the modern developments of the theories of Sigmund Freud. Freud believed that bad thoughts and experiences from childhood are repressed but continue to influence your feelings as an adult.

In psychoanalysis, a long time is spent talking about your personal relationships and the thoughts you have about other people. You are encouraged to discuss the past as well as the present. This allows the analyst to identify links between past events and how you think and act now.

Psychodynamic therapy is a less intensive form of psychoanalysis. It relies more on the way the relationship develops between you and your therapist than other types of therapy do. Your therapist may encourage you to talk about your childhood experiences with your parents and others to help reveal your unconscious thoughts.

Art, music and movement therapies often use the psychodynamic model of working, but encourage alternative forms of self expression and communication as well as talking. Even young children can take part and this is known as ‘play therapy’. Musical or technical skills are not needed for this type of therapy to be successful.

Cognitive behavioural therapy (CBT)

Behavioural psychotherapy and cognitive therapy are combined in cognitive behavioural therapy (CBT).

Cognitive therapy focuses on ways in which your thoughts and beliefs may be causing emotional problems. Your therapist will discuss these issues with you so that you can try to develop more helpful ways of thinking and are able to overcome the problems.

Behavioural psychotherapy can be used to help you gain a healthy, structured life. It is also often used to overcome a specific fear or phobia by helping you change the way you act. Your therapist may encourage you to gradually face these fears and help you to relax and feel comfortable as you do it.

During CBT, you and your therapist agree on tasks for you to do in between sessions. This will help you deal with problems yourself so that you no longer need therapy.

CBT is usually aimed at a specific problem and the sessions are often brief. A course usually consists of 6-20 sessions.

Cognitive analytical therapy (CAT)

During early sessions of cognitive analytical therapy (CAT), the therapist will discuss your life story, mapping out with diagrams potential problems that have occurred. You may also exchange letters with the therapist to help you both understand what is causing the problem.

A CAT therapist uses diaries and progress charts. These help you to develop skills that can be used to help you continue improving after the therapy sessions have finished.

Like CBT, CAT is often brief and may consist of about 16 sessions.

Humanistic therapies

Humanistic therapies encourage you to explore how you think about yourself and to recognise your strengths. The aim is to help you think about yourself more positively and to improve your self-awareness.

There are a several types of humanistic therapies, which are described below.

  • Person-centred counselling – aims to create a non-judgmental environment where you can feel comfortable talking about yourself and are able to accept who you are. Your counsellor will try to look at your experiences from your point of view.
  • Gestalt therapy – takes a holistic approach, focusing on your past experiences including your thoughts, feelings and actions to help improve your self-awareness. This type of therapy often involves activities such as writing or role-playing.
  • Transactional analysis – aims to identify communication problems and change unhelpful patterns of behaviour. You will analyse the decisions you have made so that you understand the effect they have had on your life. This type of therapy also helps you to trust your decisions and improve the way you feel about yourself.
  • Transpersonal psychology – encourages you to explore who you really are as a person. It involves using techniques such as meditation and visualisation.
  • Existential therapy – is based on the theories of philosophers, such as Soren Kierkegaard and Friedrich Nietzsche, to help increase your self-awareness and broaden your views of the world. Existential therapy is not concerned with your past, but instead focuses on the choices to be made in the present and future.

The website of the Counselling Directory has more information about the different types of humanistic therapies.

Interpersonal psychotherapy (IPT)

Interpersonal psychotherapy (IPT) has been shown to be particularly effective in treating depression. Your therapist will be interested in how your relationships with others can be managed as healthily as possible to help with recovery and staying healthy.

Your therapist will help you develop a new approach to dealing with any recent interpersonal difficulties.

IPT consists of about 12 -16 sessions.

Family and marital (systemic) therapy

Family therapy focuses on family relationships, such as marriage, and encourages everyone within the family or relationship to work together to fix problems rather than blaming each other.

There is often more than one therapist involved to make sure everyone in the group has their say.

The therapist encourages group discussions or exercises that involve everyone, and promotes a healthy family unit as a way of improving mental health.

Page last reviewed: 22/05/2013

Next review due: 22/05/2015


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The 4 comments posted are personal views. Any information they give has not been checked and may not be accurate.

User883311 said on 26 June 2014

Great summary and detail. The real core is less the modality though, as they all have more in common than they have different, but the relationship with the therapist.

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Anonymous said on 23 June 2012

I have severe mental health problems. Because I am white, middle class and pay taxes for these services the NHS refuses to give me any help

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feindb said on 05 March 2012

Thanks for an excellent article on psychotherapy and various types. As a therapist I will share with my followers on facebook and twitter.

Debra Feinberg, LCSW

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cuttysark said on 26 April 2011

I love the last paragraph of this article. Perhaps this recognition that getting to trust the therapist takes time and that therapy may need to last several months, even years, could be put into practice? I was very lucky to have a really good therapist who I trusted, but then funding was cut and my sessions ceased, long before I needed them to. Since then (5 years ago) I've been unable to obtain any suitable psychotherapy as it can only be offered on a limited basis, i.e. 12 weeks or sessions. This is just not enough for me as my problems have developed over 30+ years and are very deep-seated.

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