Psychotherapy is a talking treatment for mental health problems with roots in the “talking cure” of psychoanalysis that was established by Freud at the end of the 19th century.
If you’d like to know more about what psychotherapy is and how it can benefit people, this article is for you.
In this article, we’ll explain the differences between psychotherapy and psychological therapy, different approaches to psychotherapy, psychotherapy techniques interventions, and best of all, the role of positive psychology in psychotherapy.
If that wasn’t enough, we will even explain the differences between various mental health interventions that are often confused with each other to further clarify what psychotherapy actually is.
Before you continue, we thought you might like to download our three Positive Psychology Exercises for free. These science-based exercises explore fundamental aspects of positive psychology, including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.
Psychotherapy is an umbrella term that refers to a range of talking treatments that aim to resolve clients’ psychological problems and promote mental health.
It can be offered as a standalone treatment or alongside medication. It may be a time-bound course of treatment but is often long term and determined by an individual client’s needs (Wampold, 2019).
While most trainee psychotherapists belong to one of the core mental health professions, such as medicine, nursing, psychology, or social work, nonclinical trainees are also accepted in some programs. These people may have been in psychotherapy themselves as clients for a lengthy period and decided to switch careers (Wampold, 2019).
All psychotherapists have to undertake psychotherapy themselves during training and are required to attend supervision after they qualify to safeguard clients. Registered psychotherapists have typically undertaken between three and five years of intensive training in their therapeutic modality. They are bound by codes of ethics specific to their approach and accrediting professional body (Zur, 2007).
Psychotherapists meet their clients at a predetermined time and place either for private one-to-one sessions or in a confidential group setting. Psychotherapy is often delivered weekly or biweekly by appointment for an hour at a time. A psychotherapist has no contact with their clients between sessions to maintain clinical boundaries (Zur, 2007).
For a more in-depth discussion of what psychotherapy is and how it’s used, check out this PDF from the Southern California Psychiatric Society.
What is psychological therapy?
Psychological therapy refers to a range of psychological interventions that aim to improve a client’s mental health. Psychological therapies are often delivered over a specified number of sessions and may include a range of non-talk-based interventions.
The American Psychological Association (2023) positions the following as the five major approaches to psychotherapy.
1. Psychoanalysis and psychodynamic therapy
Psychoanalysis was the original talking therapy developed by Freud in the late 19th century. Since then, psychoanalysis has evolved into several different schools, and its model of the mind and relationships was developed further by psychodynamic therapy (Pick, 2015).
In short, both work with the concept of the unconscious mind, defense mechanisms, and transference and countertransference in the therapeutic relationship as the vehicle of therapeutic change. However, psychodynamic therapists also explore the client’s social context for sources of suffering, such as economic stressors, abuse, bullying, racism, sexism, and homophobia (Gaztambide, 2021).
Psychoanalysis is intensive and long term, typically occurring five times a week for many years. Patients lie on a couch, which encourages regression to early stages of development and the origins of unconscious conflicts. The differences and similarities between psychoanalysis and psychodynamic therapy are discussed in the related linked articles.
2. Behavior therapy
Behavior therapy is based on the behavioral science that was pursued in earnest during the early 20th century by John Watson (1924/1997) and taken further by B. F. Skinner (1963, 1965).
In short, behavior therapy includes a range of interventions that aim to change a client’s problematic behavior without delving into their past. It understands the human mind as a complex stimulus–response mechanism that is subject to conditioning, a learned response to the environment (McKenna, 1995).
Behavior therapists do not believe in the concept of the unconscious. Rather, problematic behavior is thought to be a learned coping response that can be unlearned. Behavior therapy interventions reward adaptive behaviors with positive reinforcement and extinguish unwanted behaviors. It is often used in rehabilitation programs, especially for clients with substance abuse problems, and to treat phobias (Haynes & O’Brien, 2000).
3. Cognitive therapy
Cognitive therapy was developed following Aaron Beck’s (1987) research into the psychoanalytic idea that depression is anger turned inward. If this was true, Beck expected to find that the dreams of people with depression would be full of violence and aggression since their defenses against such impulses would be relaxed during sleep.
However, Beck (1987) instead found that these individuals’ dreams were characterized by loss, emptiness, and failure, much like their conscious reports during therapy sessions.
This led Beck to examine patients’ speech during psychoanalysis for similar themes, and he noticed his patients would often verbalize their negativity with specific cognitive distortions, which he labeled automatic thoughts.
These automatic thoughts were the basis of the depressive style of thinking that, for Beck, became the major focus of inquiry and change. Therapy according to Beck’s (1979) cognitive model of psychopathology focused on modifying these automatic thoughts and testing them against reality.
The most common derivative of cognitive therapy today is Cognitive-Behavioral Therapy (CBT). This approach has, in turn, given birth to a third wave of cognitively oriented behavioral therapies that incorporate mindfulness training to develop cognitive defusion from unhelpful thoughts, including mindfulness-based cognitive therapy, MBSR, and ACT.
4. Humanistic therapy
Humanistic therapy typically refers to a range of client-centered approaches based on the humanistic psychology of Abraham Maslow, the existential psychology of Viktor Frankl and Rollo May, and the human potential movement. The work of Carl Rogers (2003) dominates the overall therapeutic approach and clinical technique.
Humanistic therapy focuses on a client’s search for personal growth, meaning, and self-actualization, rather than alleviating the symptoms of mental health problems. Therefore, it has much in common with positive psychology and the science of optimal human functioning.
Humanistic psychotherapy regards the client as the expert of their experience rather than the therapist, hence it is “person centered.”
The relationship between the therapist and client is collaborative, and the therapist expresses unconditional positive regard for the client using empathy and active listening skills. The aim is to convey congruence and authenticity in the therapeutic encounter and establish a relationship that facilitates the client’s human flourishing.
5. Integrative or holistic therapy
Some psychotherapists prefer an eclectic approach that draws on a range of techniques and models of the human mind. A holistic, integrative approach to psychotherapy is client centered and uses a combination of all the other approaches mentioned above to restore the client’s personality into an integrated whole that meets each moment openly without the protection of defenses, preformed judgments, or expectations (Hawkins & Ryde, 2019).
This involves working with transference and countertransference to connect the client to disowned or unresolved parts of themselves and integrating them into a cohesive personality. It entails the gradual dissolution of defense mechanisms that inhibit spontaneity and limit psychological flexibility in problem-solving and relationships to facilitate the client’s authentic reengagement with the world (Hawkins & Ryde, 2019).
Yager and Feinstein (2017) laid out general psychotherapy techniques that lead to successful sessions. This approach is broken into the following steps:
This includes being compassionate and respecting the patient’s self-esteem and struggles.
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 clarify contradictions.
This includes considering how the client’s and the therapist’s cognitive biases may shape the session, as well as considering any other factors (sociological, interpersonal, developmental, etc.) that might shape the client’s thinking before finally asking the client whether or not they agree with the explanations and conclusions.
This includes presenting interpretations to the client so they can agree or disagree with them, not enabling the client’s destructive or deceptive behaviors, and teaching the client the skills required to deal with their issues (such as communication, coping, and self-soothing skills).
Clinicians often 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-45.2 (OQ-45.2), 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-30.2 (Y-OQ-30.2) for children and adolescents, which can either be completed by the client or their parent(s). Psychotherapists who use these tools can assess the effectiveness of treatment plans and modify them as required.
5 Popular Psychotherapy Interventions
In this section, we explore popular science-based psychotherapy interventions that take the therapeutic relationship beyond offering emotional support during difficult times.
These interventions can result in therapeutic breakthroughs resulting in the client’s enhanced self-awareness, insight, and eventually behavioral change.
1. Active listening
Active listening is a core psychotherapeutic skill that is essential for understanding and honoring the client’s strengths and struggles. It goes far beyond the kind of listening we offer loved ones during difficult times by demonstrating an active engagement with the client that builds the therapeutic alliance — the bedrock of therapeutic change.
A recommended read is this article on active listening techniques to improve these skills. Active listening is also useful for other helping professionals.
2. Transference interpretation
This involves attending to how the client may relate to the therapist and trying to make sense of the therapeutic relationship by consciously or subconsciously referring to experiences they’ve had in the past.
Resolving transference helps to dissolve destructive relational patterns that may be affecting the client’s life outside therapy.
When a psychotherapist engages in active listening, they are likely to uncover how their client is investing current situations with meaning by referring to things that have happened in the past.
3. Cognitive reframing
A psychotherapist is often involved in challenging a client’s cognitive distortions that have a negative impact on their perception of reality by helping them restructure and reframe unhelpful thoughts. Cognitive distortions include magnification, over-generalization, catastrophizing, rumination, and automatic thoughts.
When a psychotherapist combines active listening with transference interpretation, they will be involved in challenging and reframing unhelpful or unrealistic thoughts or patterns of thought.
4. The empty chair
As psychotherapy progresses, the client is likely to present what is called unfinished business in the therapeutic session. This refers to unresolved emotions related to past and current experiences that may hinder progress unless they are expressed and resolved.
Unfinished business may involve a loss of some kind, such as grief, a relationship breakup, or conflict avoidance that is designed to preserve an existing relationship. Giving a client the opportunity to explore and express their emotions safely using the empty chair technique can help release the energy that is required to contain these emotions.
The psychotherapist makes use of an empty chair and invites the client to imagine they are addressing the person and their unfinished business with them. It can involve an imaginary dialogue or a general catharsis of previously unexpressed emotion.
Sometimes a psychotherapist will become aware of a persistent blockage in a client’s thinking that resists therapeutic change. The miracle question is a solution-focused technique that invites the client to imagine how their life would look without their current or recurring problems.
Psychotherapy: a new normal - Aruna Gopakumar
Psychotherapy & Positive Psychology
Positive psychology has made highly beneficial contributions to psychotherapy by establishing the importance of wellbeing and human flourishing as the goal of therapeutic change rather than mere symptom relief.
While many approaches to psychotherapy focus on treating psychopathology, positive psychology is concerned with the promotion of optimal human functioning (Seligman & Csikszentmihalyi, 2000).
We have several articles that explore how positive psychology can drive therapeutic change, including:
Given the numerous health professions with the “psych” prefix and range of therapies available, we’ve put together a list of comparisons to clarify the differences between psychotherapy and related but distinct health professions.
Psychotherapist vs. psychologist
A psychotherapist may have a grounding in one of the core clinical professions, as mentioned above. However, they may also be a layperson who has trained in psychotherapy.
A psychologist will have a bachelor’s degree in psychology and a specialist graduate degree in the area of psychology that they practice, such as clinical psychology, educational psychology, or organizational psychology. Sometimes, psychologists go on to train as psychotherapists.
Psychotherapy vs. counseling
A psychotherapist typically undergoes a longer, more intensive training than a counselor. Both are talking treatments that can be used to alleviate a client’s mental health problems.
However, counseling can also help resolve temporary life problems such as bereavement, relationship breakdown, and life/work balance issues. Sometimes, counselors go on to train as psychotherapists.
Psychotherapy vs. psychiatry
While a psychotherapist treats mental health problems by talking through them, a psychiatrist is medically trained as a doctor and will prescribe medication as a treatment for mental health problems. However, a psychiatrist may also train as a psychotherapist.
Psychotherapy vs. therapy
While a psychotherapist works exclusively in the mental health field, a therapist is a term applied to someone practicing any type of healing modality that alleviates a range of health problems affecting both the mind and body.
While psychotherapy refers to a range of talking therapy approaches to working with mental health problems, psychoanalysis uses psychoanalytic techniques only and does not include any other types of psychotherapeutic interventions.
A psychoanalyst is a type of psychotherapist, but not all psychotherapists are psychoanalysts.
Psychotherapy vs. CBT
Again, while psychotherapy refers to a wide range of talking therapy interventions, CBT refers to a very specific form of psychotherapy that draws on both cognitive and behavioral psychology.
A Cognitive-Behavioral Therapist is a specific type of psychotherapist. Meanwhile, psychotherapy refers to a range of approaches with roots in other psychological traditions.
A Take-Home Message
Psychotherapy is a clinically boundaried talk-based treatment for a range of issues and mental health problems. It includes a range of approaches, but it is the depth and quality of the relationship that is key to psychological transformation.
A good psychotherapist will offer support and expand clients’ understanding of themselves beyond the scope of other personal relationships.
None of us can avoid the emotional suffering entailed in living life as a human being. Therefore, many of us will have times when psychotherapy could help us navigate life problems and integrate the lessons that psychological suffering can teach us.
We hope you found this article helpful and that the differences between psychotherapy and other mental health professions are now clear. Let us know if you have any questions in the comments.
American Psychological Association. (2023). Different approaches to psychotherapy. Retrieved April 24, 2023, from https://www.apa.org/topics/psychotherapy/approaches.
Beck, A. (1979). Cognitive therapy and the emotional disorders. Plume.
Beck, A. (1987). Cognitive therapy of depression. Guilford Press.
Gaztambide, D. J. (2021). A people’s history of psychoanalysis: From Freud to liberation psychology. Lexington Books.
Hawkins, P., & Ryde, J. (2019). Integrative psychotherapy in theory and practice: A relational, systemic and ecological approach. Jessica Kingsley.
Haynes, S. N., & O’Brien, H. W. (2000). Principles and practice of behavioral assessment. Kluwer Academic.
Lambert, M. J. (2017). Maximizing psychotherapy outcomes: Beyond evidence-based medicine. Psychotherapy and Psychosomatics, 86(2), 80–89.
McKenna, G. (1995). Learning theories made easy: Behaviourism. Nursing Standard, 9(29), 29–31.
Pick, D. (2015). Psychoanalysis: A very short introduction. Oxford University Press.
Rogers, C. (2003). Client-centred therapy: Its current practice, implications and theory. Robinson.
Seligman, M., & Csikszentmihalyi, M. (2000). Positive psychology: An introduction. The American Psychologist, 55(1), 5–14.
Skinner, B. F. (1963). Operant behavior. American Psychologist, 18(8), 503–515.
Skinner, B. F. (1965). Science and human behavior. Free Press.
Wampold, B. E. (2019). The basics of psychotherapy: An introduction to theory and practice. American Psychological Association.
Watson, J. B. (1997). Behaviorism. Routledge. (Original work published 1924)
Yager, J., & Feinstein, R. E. (2017). Tools for practical psychotherapy: A trans-theoretical collection (or interventions which have, at least, worked for us). Journal of Psychiatric Practice, 23(1), 60–77.
Zur, O. (2007). Boundaries in psychotherapy: Ethical and clinical explorations. American Psychological Association.
About the author
Jo Nash, Ph.D., is a writer, editor, and writing coach. Jo obtained her Ph.D. in Psychotherapy Studies from the University of Sheffield, where she was a Lecturer in Mental Health at the Faculty of Medicine for over a decade.
Today, Jo combines her passion for language with mindfulness skills when coaching writers to help them cultivate flow and optimize productivity. She is the creator of the ‘focused flow’ approach to writing coaching.