Psychotherapy and Counselling

There are many reasons why individuals seek the services of psychotherapists and counsellors. They provide treatment for mental health disorders like depression or anxiety, and also help in difficult decision-making processes and life crises.

Psychotherapy and counselling, alongside medication, plays a vital role in treating mental healt disorders.

This overview covers key psychotherapy approaches, such as Cognitive Behavioural Therapy (CBT), depth psychology-based therapies and person-centered therapies.

Crossover Between Psychotherapist and Counsellor

A person seeking to find a psychotherapist or counsellor to “talk” to might want clarification on the difference between counselling and psychotherapy.

All licensed counsellors/psychotherapists through their academic training and internship requirements, have been trained in the “talking cure” called interchangeably counselling or psychotherapy.

People wildly accept the words “counsellor” and counselling”, because of their neutral and non-stigmatized meaning. The lines between the terms counselling and psychotherapy couldn’t be clearly defined as both words are used interchangeable describing the “talking-cure”.

The term “counselling” is specific for the Anglo-Saxon therapeutic couture. In German there is only one word “psychotherapy” describing the verbal interaction between the therapist and patient.

Psychotherapist and counsellor. The requierments

Psychotherapists called also counsellors are professionals trained in the therapeutic “talking cure” called psychotherapy or counselling. A qualified psychotherapist is a graduate in psychology or a medical doctor additionally trained in the psychotherapy. Such training lasts several years and requires thousands of hours of supervised therapeutic experience. The reason is to teach the therapist understanding the mechanism of the invisible “engines”, the emotional complexes behind the human behaviours. Because of this “hidden agenda” psychiatric conditions are incomprehensible to lay people. Therefore, patients in major crisis need professional help from a qualified psychotherapist.

During the psychotherapeutic training the future therapist must create an awareness of emotional processes taking place between him and the patient. In the psychotherapy the therapist triggers emotional reactions in the patient. Such transfer of feelings from patient to therapist is called transference. Correspondingly, “countertransference” refers to therapist’s feelings and attitudes influenced by the therapist’s own unsolved problems projected into the patient.

Therapeutic relationship in counselling and psychotherapy

An essential component of counselling is the trustworthy relationship between the counsellor and the patient. In a collaborative effort with the patient, the counsellor will know what therapies to put in place to effect positive change. Patients use the non-judgmental, safe setting of the session to freely explore their unique, individual problems.

The counsellor takes the role of a guide to facilitate positive change in the patient. Counselling gives patients an opportunity to discover their own answers and take positive steps to resolve their issues.

When is counselling and psychotherapy helpful?

Psychotherapy is crucial in treating mental or psychosomatic disorders by alleviating psychological distress. It’s a structured, planned process between patient and therapist for resolving personal and interpersonal conflicts and modifying behavioral issues. Psychotherapy uses psychological methods focusing on experiences and behaviors, emphasizing verbal and nonverbal communication. Most psychotherapeutic methods aim to help patients develop coping strategies, increase self-efficacy, and build self-confidence through communicative and/or practice-based techniques. Therapy often includes individual and group sessions.

In recent years, psychotherapy has significantly evolved, adapting to patients’ specific needs rather than adhering to traditional school-based methods like psychoanalysis. Many forms today are tailored to specific disorders, known as disorder-specific or disorder-oriented approaches.

There are many reasons to consider psychotherapy, from traumatic events to severe mental disorders. Therapy is crucial when you can no longer manage issues alone or maintain daily life, especially if problems persist or worsen. Deciding on therapy should involve a psychiatrist, psychotherapist, and general practitioner.

Seek professional help if:

• while experiancing unexplained emotional changes.
• lack of concentration, thought disruptions, or daily life difficulties.
• sociall withdrawal or feeling increasingly mistrustful of others.
• experiancing persistent mood swings, aggression, or irritability.
• when life challenges feel overwhelming, and coping seems impossible alone.
• in case of prolonged sleep issues.
• when anxiety dominates life, restricting faily activities.
• if excessive drinking can’t be stoped and impacts work or personal life.

Talking to a Psychotherapist or Friend?

Humans are “social animals” and as such they need the interaction with other people exchanging views, opinions and getting advice. That’s why it’s essential to have someone to talk to when we’re feeling overwhelmed or struggling with our emotions. Our self-awareness and sense of belonging to a particular group, language and culture couldn’t be formed without mirroring ourselves in the people around us. The family and friends are at the core of the social network indispensable for our normal functioning.

It’s only natural that people facing problems will turn for help to their family and friends. However, there are situations in life which might overwhelm individual’s capacity to cope leading to severe psychiatric problems. In such situations support and advises from the family or friends are not enough. The collapse of individual’s coping mechanisms is the demarcation line where the professional help from a psychotherapist becomes necessary.

Getting professional help from a counsellor fosters personal development and addresses and heals symptoms of mental health disorders, such as depression, anxiety, addiction, OCD etc.

The counselling sessions can take place over the course of months up to years in variating frequency from weekly to monthly.

Therapeutic neutrality in psychotherapy

Friends and family members often have personal opinions, biases, and emotional connections to the people they care about. While this can be comforting, it can also make it difficult for them to provide objective support and advice. In contrary, the psychotherapist has an external look at the system in which his patient’s lives and acts.

Therapists are also trained to be objective, meaning that they don’t take sides, providing an unbiased perspective, helping individuals to understand their thoughts and emotions and make positive changes in their lives.

Even for the therapists Freud created important role excluding from the therapy family members and close friends of the psychotherapist. The reason has been articulated above: the psychotherapist must be objective in his judgment which excludes too close emotional involvement with his client.

Structured approach in counselling and psychotherapy

In contrast to speaking with a friend, psychotherapy provides a structured approach to problem-solving and emotional regulation. Psychotherapist helps clients set specific goals, identify underlying issues, and develop coping strategies to address their challenges. This structured approach can be incredibly helpful for individuals who feel overwhelmed or struggle to manage their emotions effectively.

For which conditions can psychotherapy or counselling be used?

Some people hesitate to seek professional help for mental health issues. For many, visiting a psychiatrist or psychotherapist is burdened by prejudice, fear, or feelings of personal failure. Many tend to blame themselves and believe they should manage their condition alone. However, even occasional but recurring emotional issues should not delay professional guidance. Untreated mental health issues can easily escalate, cause additional health problems, and make recovery harder.

Psychotherapy alone or in combination with medication can be used for treatment of following disorders:

• depression
• generalized anxiety disorder (GAD)
• social and specific phobias
• panic disorder
• PTSD
• ADHD
• Psychosis (in close cooperation with a psychiatris)
• obsessive-compulsive disorder (OCD)
• personality disorders: borderline, narcissistic
• bipolar disorder
• eating disorders: anorexia and bulimia
• addiction
• anger management
• chronic pain
• marital conflicts
• grief and loss

The variety of disorders shows why tailored therapy forms are essential for patients’ needs. Psychotherapy can occur individually (you and the therapist), in couples, family, or group settings. Given the diversity of methods, scientific studies are crucial to confirm psychotherapy’s effectiveness.

Psychodynamic or In-Depth Psychotherapy Technics

The first method of psychotherapy that focused on unconscious conflicts and motivations was Freudian psychoanalysis. However, in the past hundred years the therapeutic techniques based on psychoanalysis evolved. Psychotherapy practitioners categorize techniques derived from psychoanalysis as “Psychoanalytical Therapy,” “Psychodynamic Therapy,” or “In-depth Psychotherapy.” On the other spectrum stands the behavioral psychotherapy.

The psychodynamic psychotherapy aims to create patients’ awareness of their inner world. While increasing their insight of the inner conflicts (rooted in the past or in the presence) helping to resolving the conflict’s destructive force causing the symptoms. The psychodynamic psychotherapies aim to induce deeper personality changes fostering patient’s emotional development as well as more conscious and fullfiled life.

On average psychoanalytical psychotherapy lasts longer than cognitive behaviour therapy. It often requires a few years of treatment. The investment of time, money, and emotional energy can produce significant rewards in terms of improved relationships, creativity, professional and social progress.

Classical Psychoanalysis

Classical psychoanalysis, developed by neurologist Sigmund Freud (1856–1939), is the foundation of psychotherapy.

Freud believed each person has three inner parts: the “Id” for unconscious drives, the “Ego” for reality connection, and the “Superego” as a conscience shaped by external values, like those of parents.

Freud saw sexual drive (libido) as central to mental energy, expressed in age-typical phases from infancy to adulthood. He believed that disruptions in early libido development is the rootcause of patient’s futer problems.

Freud viewed mental disorders, especially the neuroses as the effect of unresolved childhood problems. Psychoanalysis aims to make these unresolved conflicts conscious. Analysts pay attention to patient resistance to processing unconscious experiences and the defense mechanisms developed to balance desires and reality.

In sessions, patients freely share current thoughts and feelings, a technique Freud termed “free association,” central to psychoanalysis. Freud believed patients would eventually reveal a “pattern” that clarifies their conflict to the therapist. By re-experiencing early feelings, especially towards family, the patient “transfers” childhood wishes and emotions onto the analyst, allowing early situations and experiences to be interpreted.

Differences between psychoanalysis and contemporary psychodynamic technics

Since its initial formulation Freud, psychoanalysis has evolved and are largely replaced notably through Ego Psychology, Self-Psychology, and Object Relations Theory. The position of patient lying on the sofa has been abandond in favour of the position of equality in which patient and psychotherapist sit close to eachother.

Today, classical psychoanalysis is rarely practiced due to its long duration and limited empirical support for effectiveness. Contemporary psychodynymic psychotherapysts also revised Freud’s narow explination of the conflict’s exclusivelly sexual nature. They aknwololdged that the conflicts can be caused by unresolved traumatic child events but also by much more “prozaic” problems like lost of social position, conflcts at work or in the relationships, also without pre-existent negative chidlhood experiances.

Psychoanalytical therapy

The term “psychoanalytical psychotherapy” belonging to psychodynamic psychotherapies, has been established by C.G. Jung, who wanted to distinguish his method from Freud’s psychoanalysis. It was Jung who abandoned the sofa and turned the psychotherapy into a dialog between the therapist and the patient. The modification introduced by Jung became a standard used by several variations of psychodynamic psychotherapy.

The other difference of today’s psychoanalytical therapy is lower frequency of the sessions compared to the original psychoanalysis. Freud use dto see his patients 5 to 6 times per week. Today the frequency has been reduced to once per week or even less.

Dynamics of psychodynamic psychotherapy

The analytical treatment process is the most comprehensive form of psychotherapy. Psychodynamic or in-depth psychotherapy focus on unconscious conflicts often stemming from childhood trauma or negative upbringing experiences. Therapists aim to raise patients’ awareness of their inner world, which influences their insight of their past and present relationships and helps them understand and resolve their problems.

The conteporary psychodynamic psychotherpy focus on the transference in the interaction with the therapists and on its intepretation. Here, patients revisit painful memories, gaining cognitive and emotional insight within a stable therapeutic bond. On average psychoanalytical psychotherapy lasts longer than cognitive behaviour therapy. It often requires a few years of treatment. The investment of time, money, and emotional energy can produce significant rewards in terms of improved relationships, creativity, professional and social progress.

The Transference Focused Therapy (TFT) is used for treatment of personality disorders. The therapist is concentrating on the interpretation of transference in “here and now”. TFT concentrates on present psychological conflicts, addressing underlying motivations and relationship conflicts causing the patient’s distress. The therapist helps to manage patient’s emotions and impulses, providing the cognitive corrective support. The therapist’s approach is active and goal-oriented, requiring quick diagnosis, with therapy sessions conducted in an everyday conversational setting where patients observe the therapist’s gestures and expressions.

Depth psychology-based therapies are proven effective for treatment of depression, various forms of anxiety, OCD, PTSD, and the TFP for treatment of Borderline Personality Disorders, using transference-focused and mentalization-based approaches.

Transference

The term “transference” originates from Freudian psychoanalysis. It refers to the patient’s feelings and attitudes towards the therapist influenced by the patient’s old patterns. Transferences are typically unconscious involving the fundamental dynamics from infancy.

We all “transfer” our feelings in our everyday lives. Both loving and constructive feelings and attitudes can be transferred, as well as aggressive and conflicting old relationship dynamics.

Example: An employee is repeatedly devalued harshly and unfairly by her supervisor. Nevertheless, she admires him and tries to please him through good performance and an attractive appearance. In relationships as well, she repeatedly seeks out strong partners, often experiencing violence, yet she does not leave. In doing so, she transfers feelings that actually belong to her violent father onto her boss or partner. She desires confirmation or affection from them, which she longed for from her father but never received.

Countertransference

In psychodynamic psychotherapy, countertransference refers to therapist’s emotional reactions towards the patient based on therapist’s own feelings, biases, and desires. The observation of this phenomenon traces back to Sigmund Freud. Freud noticed that the transfer of feelings between patient and the therapist works in both directions. Because of countertransference there is a risk that therapist departs from his objective position.

In the therapeutic relationship understanding the process of transference and countertransference is considered fundamental. Analysing the flow of feelings between the patient and the therapist allows to reconstruct patient’s past disease-causing relationship patterns. In the second step they can be addressed, understood and neutralized in the therapeutic setting.

Working with transference and countertransference

The transference from patient to the therapist, if understood, is always a valuable therapeutic tool. In contrary the countertransference must be considered a disruptive factor. Transference and countertransference processes are a kind of “time machine”, as old, usually childhood constellations and the associated feelings are activated during the therapeutic process.

To handle this constructively in therapy, the psychotherapist must be aware of his own “blind spots”, his transference tendencies. That’s why the training in the psychodynamic psychotherapy requires the therapist to be analysed by an experienced supervisor.

The process of transference interpretation explores the connections between patient’s current problems and his childhood dynamics helping to find ways out of the crisis. Thus, working with transference requires specialized training and extensive personal therapy for the therapist.

Defence Machanisms in Psychodynamic Psychotherapies

Freud, the father of psychoanalysis, initiated the exploration of defence mechanisms in the 19th century. He understood the defence mechanism as unconscious processes in relation to Id, Ego, and Super-Ego (Freud, 1894). His daughter, Anna Freud, continued to examine and to define these mechanisms in the 20th century. She described them as “unconscious resources” employed by the ego to reduce the tension between the Super-Ego and the Id.

Unfortunately Freud never provided a complete compilation of defense mechanisms or an encompassing theory of defenses. Anna Freud did make an effort to develop a methodical classification of defense mechanisms, but her list is excessively focused on psychopathology.

The aim of the psychodynamic psychotherapy is to identify the defence mechanisms to get the inside into the nature of the conflict. By acknowledging and identifying conflicts, patients enhance self-awareness and gain an understanding of the reasons of their behaviors, which caused the suffering. These insights prove valuable for individuals dealing with various mental health disorders like depression, anxiety, phobias, eating disorders, personality disorders and more. Therefore, the comprehension of defense mechanisms is crucial for clinicians to advance in their therapeutic approach.

Since Freud a century of exploration and a quarter century of empirical investigation, defence mechanisms have garnered significant attention and understanding in the field of psychodynamic psychology.

The Id, Ego and Super-Ego

According to Freud, the mind consists of three components: the Id, Ego, and Super-Ego. The Id represents basic needs and desires, acting as a pleasure center. In contrast, the Ego interacts with the external world and controls impulses and defines our conscious perception. The Super-Ego holds rules and “guide behavior.”supervises” the Ego. It’s identical with the “moral institution” controlling on the concious and unconscious level our thought, feelings and actions. The defence mechanisms serve the Ego from the “punishing” and oppressing Super-Ego.

Ideally, these components work together harmoniously. Freud suggested that in conflicts, individuals employ defense mechanisms to safeguard their self-concept or self-esteem. When self-esteem or self-image is in danger to be jeopardized, individuals employ defence mechanisms.

To uphold self-esteem, individuals unconsciously develop defense mechanisms. Despite the individuals are unaware of using these mechanisms, their presence indicates a perceived threat to self-esteem and self-concept.

The defence mechanism are only deployed to decrease the tension crated by a conflict. The main role of defence mechanisms is the Ego-protection. They help to maintain our favorable conscious perception about ourselves, protecting it from unpleasant thoughts and feelings. In the majority of cases defence mechanisms operate fully unconsciously, sometimes semi-consciously but always without our voluntary control. It means they are activated automatically and the individuals don’t even realize when they get active. During the transition from childhood to adolescence and eventually into adulthood, the defense mechanisms may endure, regress, or evolve along with the changing and challenging life circumstances.

Primitive, moderate level and mature defence mechanisms

Defense mechanisms are categorized by their level of sophistication. The less primitive ones are typical in the childhood and in adults with Borderline Personality Organization. The latter were unable to acquire more elaborated defence mechanisms during their socialization process.

The neurotic defences provide a moderate level of adaptiveness.

In “normal” people defensive mechanisms also are at work. However, they possess a high grade of maturity allowing the highest level of adaptation by promoting the integration of affects with ideas.

Primitive Defense Mechanisms

Primitive defence mechanisms can be observed in children and adults with personality disorders. They manifest as immature actions, disavowal, and image distortion. A heavier reliance on these immature defences indicates limited awareness of emotional and cognitive aspects of internal conflicts or external stressors. These mechanisms serve to block out unacceptable thoughts, emotions, and behaviours, shielding the individual from perceived threats.

The description “primitive” used for the defence mechanisms doesn’t mean that people in whom such mechanisms operate are less intelligent. As we said, the defence mechanisms work on unconscious or semi-conscious level and they can’t be influenced by individual’s will power. However, the nature of the mechanism itself is unsophisticated (“primitive”) and the person remains unaware when and how the defence mechanism activates and evolves.

Acting Out

Acting Out involves engaging in extreme behaviours to express thoughts or emotions that seem inexpressible otherwise. Instead of saying, “I’m angry”, an individual who acts out may throw objects or punch the wall. This release of pressure often brings a sense of calm and peace. For instance, a child’s temper tantrum reflects acting out when they don’t get their way with parents. Self-injury common in personality disorders can also serve as a form of acting out, expressing emotional pain through physical means.

Splitting

Another primitive defence mechanism is “splitting,” where both positive and negative impulses are compartmentalized. The individual simplifies experiences into rigid categories of all-good and all-bad, devoid of any shades of grey. By combining “splitting” with “projecting,” the individual unconsciously disowns their undesirable qualities, attributing them consciously to someone else. Splitting occurs in individuals with Borderline Personality Organization. The other two primitive defences, idealization and devaluation, serve the defence mechanisms in splitting reflect individual’s difficulties in maintaining a balanced view of others.. The hidden defence mechanism behind those two is projection.

Idealization

In Idealization the individual is projecting excessive positive qualities into an object (other person). Such projection protects him from emotional conflicts, preserving the illusion of perfection. However, idealization swiftly shifts to intense anger, known as devaluation, towards the once idealized person.

Devaluation

In Borderline Personality patients, idealization can quickly turn into devaluation due to the incapability to differentiate perception. Such individual can’t create a differentiated picture of other human being, seeing only its extreme qualities: good and bad, perfect or imperfect.

Devaluation characterizes an object as worthless, exaggerating its negative qualities. Challenged or disappointed, the patient swiftly devalues the formerly idealized object, avoiding the stress of ambiguity.

Interacting with individuals with Borderline Personality Disorder (BPD), people experience confusion as they shift from being idealized to devalued. These cycles make it difficult for individuals with BPD to maintain stable relationships.

Projection

occurs when one attributes their undesired thoughts, feelings, or impulses to another person who doesn’t possess them. Projection is used to avoid expressing unacceptable thoughts or to alleviate discomfort associated with those thoughts. For instance, a spouse may feel angry at their partner for not listening, while it is the angry spouse who struggles with attentive listening. Lack of insight and self-awareness contribute to projection.

Projective identification

Projective identification was introduced by psychoanalyst Melanie Klein. It is a defence mechanism allowing individuals to distort reality for a socially acceptable self-image. Unlike projection, projective identification can alter the behaviour of the person being projected onto. This occurs through interpersonal interaction, where the projector pressures the projected to think, feel, and act in line with his projection. The person being projected onto may experience subtle pressure to conform to the desired behaviour or belief. Projective identification is closely linked with splitting and omnipotent control, where the individual tries to maintain control over their environment.

Denial

involves rejecting reality and acting as if painful events, thoughts, or feelings wouldn’t exist. Denial is a highly primitive defence mechanism commonly observed in early childhood development but also in patients with Borderline Personality Organization, or severe addictions. Such individuals employ denial in their daily lives to avoid confronting uncomfortable emotions or aspects they refuse to acknowledge. For example, a heavy alcoholic may deny having a drinking problem as not existent.

Intellectualization

refers to an excessive emphasis on rational thinking when faced with unacceptable impulses, situations, or behaviours, devoid of emotional engagement. Rather than dealing with associated painful emotions, individuals rely solely on intellectual analysis to distance themselves from the impulse, event, or behaviour. For example, a person receiving a terminal medical diagnosis might focus on discussing futile medical procedures instead of expressing sadness and grief.

Neurotic defence mechanisms

The neurotic defensive category falls in the middle range of adaptiveness, encompassing neurotic and obsessional defences. These defences allow individuals to address either the emotional or cognitive aspects of internal or external stressors one by one. By keeping the conflict out of awareness, these defences mechanism prevents overwhelming anxiety.

Displacement

involves redirecting thoughts, feelings, and impulses meant for one target onto another person or object. People resort to displacement when they cannot express their emotions directly to the intended recipient safely. A common example is a man who gets angry with his boss but suppresses it for fear of job loss. Instead, he comes home and takes out his anger on the dog or starts an argument with his spouse. Displacement proves ineffective as it causes additional problems by misdirecting emotions.

Reaction Formation

involves transforming unwanted or dangerous thoughts, feelings, or impulses into their opposites. For instance, a person who hates its boss and desires to quit the job may instead display excessive kindness and express a desire to work there indefinitely. Inability to express negative emotions leads to an exaggerated display of positivity to mask anger and dissatisfaction.

Dissociation

refers to losing track of time, personhood, and adopting an alternate representation of oneself to carry on. Those who dissociate frequently lose connection with their usual thought processes, memories, and even their sense of time. Individuals with a history of childhood abuse often experience some form of dissociation. In extreme cases, dissociation can lead to a belief in multiple selves (commonly known as “multiple personality disorder”). Dissociative individuals often hold a disconnected view of themselves and their world. Their experience of time and self-image may lack continuous flow, allowing them to detach from the real world temporarily and seek solace in an alternate realm devoid of overwhelming thoughts, emotions, or memories.

Repression

entails unconsciously blocking unacceptable thoughts, feelings, and impulses. Repressed memories are inaccessible due to unconscious suppression. However, memories are not carved in stone; they can be influenced and distorted by life experiences, external influences, and individual perception.

Regression

occurs when individuals revert to an earlier stage of development to cope with unacceptable thoughts or impulses. For instance, an overwhelmed adolescent experiencing fear, anger, and burgeoning sexual desires may exhibit behaviours from their earlier childhood, such as bedwetting. Similarly, adults facing immense stress may regress by retreating to their beds, avoiding everyday activities.

Undoing

is the attempt to retract an unconscious behaviour or thought that is deemed unacceptable or hurtful. For instance, after unintentionally insulting your partner, you may spend the next hour complimenting their attributes to counterbalance the damage caused by your remark.

Rationalization

involves reframing perceptions or offering alternative explanations to justify one’s thoughts or actions when faced with changing circumstances. For example, a woman who is dumped by a man she admires might reinterpret the situation as “I knew he was not right for me.”

Isolation of affect

this defence mechanism was already observed and described by Sigmund Freud. Isolation of affect is a defence based on separating emotions from ideas. In such way affects gets unconscious and emotionally neutral. This mechanism plays a significant role in OCD (Obsessive-Compulsive Disorder) and is commonly observed in non-disordered individuals after a traumatic experience, often causing PTSD. Detachment is achieved through repetitive intrusive thoughts and ritualistic behaviours.

Compartmentalization

involves separating parts of oneself, behaving as if separate sets of values exist without awareness of their integration. For example, an honest person cheats on their income tax return, keeping their two value systems distinct and unconnected, unaware of the cognitive dissonance.

Mature Defense Mechanisms

The mature defensive category represents a high-adaptive level, comprising the most effective defence mechanisms operating in “normal” individuals. Emphasizing the use of mature defences enables individuals to integrate and partially acknowledge their feelings, ideas, desires, and thoughts related to internal conflicts. By integrating emotions with thoughts, these defences optimize and potentially resolve psychological distress.

Suppression

is a defence mechanism helping to deal with distressing mental contents (conflicts). Individuals consciously push these contents out of awareness until they can cope with them adaptively. Suppression resembles repression, but in repression, the conflict remains inaccessible to consciousness, while in suppression the temporarily unconscious conflict, gets conscious and gets solved when the opportunity arises. Unlike repression, suppression does disrupt self-awareness but only temporarily.

Sublimation

is the redirection of libido from unacceptable impulses, thoughts, or emotions into socially acceptable actions. For instance, channelling sexual impulses into artistic activities or increased professional performance provides a productive outlet, preventing destructive actions and anxiety.

Sublimation can also manifest through humor or fantasy. Humor is a “vehicle” of sublimation, acting as a defence mechanism by transforming unacceptable impulses into jokes, reducing the inner tension. The nature of humor contains aggressive impulses which can be related to external objects, making jokes about someone else or about the individual himself. Fantasy, on the other hand, involves channelling unattainable desires into imaginative scenarios. Th action doesn’t happen in real but only in the fantasy of the subject.

Compensation

is a psychological process that counterbalances perceived weaknesses by emphasizing strengths in other areas. Recognizing that one cannot excel in all aspects of life, a person may compensate for a lack of skill in one area by emphasizing their proficiency in another. For example, someone with not very appealing appearance compensate this deficiency trough extraordinary professional success.

Other non-typical defence mechanisms

Identification with the aggressor

refers to a defence mechanism in depth psychology where a person who is physically and/or emotionally abused or oppressed by an aggressor unconsciously identifies with them. The person internalizes and adopts personality traits, values, and behaviours of the aggressor without their conscious knowledge and often against their conscious will, turning them into self-parts/ego states.

Starting with submission to a repressive and authoritarian upbringing structure, this reaction safeguards one’s psychological system as a last resort. It protects against a potential collapse in the face of overwhelming attacks. Paradoxically, while it maintains self-functioning temporarily, the consequences of identifying with the aggressor undermine self-integrity and well-being. Personal autonomy development is suppressed.

The well-known example of the identification with the aggressor is the so-called Stockholm Syndrom.

Conversion

The term conversion is on the one side a defence mechanism on the other a DSM 5 approved diagnosis.

Conversion as defence mechanism means a process where psychological conflict manifests through somatic symptoms. According to Freud, conversion in hysteria occurs when the unbearable idea’s excitation is transformed into a physical manifestation, which he proposes calling “conversion.”

In conversion, individuals exhibit seemingly physical symptoms, but without any diagnostic findings supporting such symptoms. However, a connection between the symptoms and distressing events can be presumed. This means that a conflict is not accepted by the Ego (consciousness) and is “converted” into a physical manifestation, often symbolically representing the conflict. Symptoms can include blindness, deafness, seizures, or paralysis.

A frequently cited example involves a woman who is being betrayed by her husband and “wants to close her eyes to this fact.” She becomes blind without any organic findings.

Dissociation

This term also encompasses dissociation as defence mechanisms and certain psychiatric diagnosis with dissociative symptoms.

Dissociation is the phenomenon of a temporary gap in consciousness. In dissociation the consciousness “switches off” certain contents to safeguard the Ego. It shields individuals from integrating highly distressing thoughts, feelings, or memories into the consciousness.

For instance, during therapy, a patient recounts a deeply traumatic event to his therapist. As he recalls the experience, he suddenly feels overwhelmed, exhausted, and momentarily “switched off” for several seconds. This dissociative episode shields the individual from re-experiencing the traumatic event.

Dissociation as defence mechanism occurs in following mental health disorders:

• Post-Traumatic Stress Disorder (PTSD)

• Dissociative amnesia: This involves an inability to recall personal details or events from one’s life. Typically, the amnesia is limited to a specific time period, although rare cases may entail complete identity loss.

• Depersonalization, Derealization Disorder (DDD): Depersonalization refers to feeling detached from oneself, as if observing actions from a third-party perspective. Derealization, on the other hand, involves a sense of the surrounding world being unreal, akin to a dream-like state.

• Dissociative Identity Disorder (DID): Individuals with Dissociative Identity Disorder experience a fragmented sense of self, perceiving themselves as different people in varying contexts or possessing multiple identities within one body.

Defence Mechanisms. Summary

Defense mechanisms are learned behaviours, developed during the childhood and early adolescence. The concept was originally developed by Sigmund Freud trough the careful observation of his patients.

The main aim of the psychodynamic psychotherapy is to create awareness of the defence mechanisms and the conflict behind it. By doing so, the individual gets access to the “lumber room” of his psyche, hidden under the threshold of consciousness. During the psychotherapeutic process the conflict will be gradually solved, making the defence mechanism obsolete.

The first ever scientific, evidenced based proof of their existence was delivered by Carl Gustav Jung in his word association experiment. Understanding the defence mechanism is the central aim of the psychodynamic psychotherapy.

Cognitive Behavioral Therapy (CBT)

Behavioral therapy is effective for various conflicts, mental illnesses, and disorders. Because it incorporates thought patterns, it’s now often called Cognitive Behavioral Therapy (CBT). It is one of the most frequently used, scientifically validated psychotherapeutic methods today, effective in treating diverse mental health issues. Based on modern learning theory, it holds that behavior can be learned, maintained, and unlearned. “Behavior” includes observable actions as well as thoughts, feelings, and motives.

Psychological disorders are seen as mislearned responses to external and internal stimuli, aiming to unlearn maladaptive behavior or learn necessary responses. Patients are encouraged to develop positive, active behaviors.

CBT is problem-focused. Initially, therapists and patients work together to analyze core problems and underlying behavior patterns, identifying factors that trigger or maintain reactions. Therapy goals are then clearly defined, principles explained, and a structured plan is set. The patient actively participates, completing tasks or “homework” between sessions, with an emphasis on “self-help” methods for better everyday coping. Therapy typically ends upon goal achievement.

Behavioral therapy is used for treatment of anxiety, depression, psychoses (like schizophrenia), eating disorders (like anorexia), addictions (e.g., alcohol problems), obsessive-compulsive disorders, sexual dysfunctions, psychosomatic issues, and various childhood and adolescent disorders.

Cognitive Techniques

help individuals crating an insight and solving their problems. Cognitive therapy can be used for treatment of conditions like depression, anxiety, OCD, and more. Patients often generalize, focus narrowly, or think in extremes. Therapy first involves self-observation, identifying issues, recognizing personal blocks, developing alternatives, and reevaluating thoughts and behaviors—like distancing oneself, reinterpreting situations positively, or viewing problems as challenges.

Exposure Techniques

Exposure techniques reduce fear by confronting avoided thoughts or situations, especially useful for anxiety, PTSD, eating disorders, and OCD. Two main methods are systematic desensitization and flooding. Systematic desensitization uses relaxation to gradually face fears, from mild to intense, aiming for a fear-free experience—especially for specific phobias, like test anxiety.

In flooding, patients face their greatest fear directly, staying in the situation until the fear decreases, learning they can control both the situation and their anxiety.

Operant Techniques

This behavior therapy form promotes new, desired behavior mainly through positive reinforcement (rewards). The idea is that positive consequences encourage repeating desired behaviors. Positive reinforcements can be social (e.g., praise, attention) or material (e.g., tokens), with patients choosing their own motivational incentives. In contrast, negative consequences, like punishment, reduce behaviors in operant methods.

Modeling

Modeling is based on people observing and imitating complex behaviors of role models, integrating them successfully. This includes adopting complex action or behavior patterns. For example, with OCD, the therapist demonstrates “normal” hand-washing or checking a locked door.

Building Skills

Developing specific skills in underdeveloped areas complements other treatments effectively. In role-playing, patients practice behaviors to handle challenging situations better. For social deficits (e.g., social phobia), contact training helps patients express needs and assert themselves. Besides social skill training, problem-solving, and communication training are also key.

Disorder-Specific Methods

Those cognitive behavioral method has been developed adressinf disorder specific problems.

Dialectical Behavior Therapy (DBT)

DBT, a specialized cognitive behavioral therapy, was created for treating borderline personality disorder. DBT focuses on emotional regulation, seeing symptoms (e.g., self-injury) as attempts to reduce emotional distress. Therapy helps patients recognize their distress and develop effective coping strategies for intense emotional states. DBT also addresses self-image and interpersonal behaviors, integrating trauma techniques as needed.

Studies show DBT is effective in treating borderline personality disorder.

Cognitive Behavioral Analysis System of Psychotherapy (CBASP)

CBASP, uniquely designed for chronic depression, combines interpersonal, cognitive, behavioral, and psychodynamic strategies. It targets social learning, helping patients distinguish past dysfunctional relationship patterns from present interactions with the therapist and others, altering negative interaction styles. Explicit transfer hypotheses are developed to clarify “confusions” during therapy, guiding patients in distinguishing the therapist from past key figures. Building behavioral skills is also essential in CBASP.

Studies indicate CBASP is as effective as medication, with combined CBASP and pharmacotherapy being most successful.

Humanistic Therapies

The humanistic approach rests on the concept of self-actualisation—every individual has an innate tendency to advance their potential and improve themselves.  Above all, the approach focuses on care and empathy for the client. Therefore, therapy sessions are centred around positivity and shaped around particular preferences and needs of the individual. Humanistic therapies include client-centred therapy, gestalt therapy and existential therapy.

Origins of humanistic therapies

The important theoretical movement of humanistic psychology sprung up in the 1950s and 1960s. Often psychologists, psychotherapists, and counselors refer to this as the “third force” in psychology. It evolved in response to perceived limitations of psychoanalysis (1st force) and behaviorism (2nd force).

The origin of humanistic psychology is attributed to the psychologist Abraham Maslow, who in his groundbreaking work emphasized the idea of self-actualization and developed a developed a five-tier model of human needs called “Hierarchy of Needs,” which are often depicted within a pyramid. He and contemporary psychologists like Carl Rogers, Fritz Perls, and Marc Rollo felt these existing theories did not address the meaning of behavior and the nature of healthy growth.

According to humanistic psychologists, humans are not pushed by unconscious motives (Freudian psychoanalytic view), or passively shaped by their learning experiences (Watson’s behavioristic view). Humanistic psychologists, psychotherapists, and counselors believe human beings determine their own fates through the decisions they make. In other words, people have a powerful inborn tendency to grow, improve, and take control of their own lives. These psychologists believed outside forces influence humans, but their own free will determines their behavior.

Humanistic psychologists, psychotherapists and counselors realize that this branch of psychology is the least scientific. This is because many of the issues with which they are concerned do not lend themselves to scientific scrutiny. These topics revolve around the ideas of free will, values, the essential goodness of people, the motives that inspire the creation of art and philosophy and the uniqueness of every human personality.

There are 3 branches of humanistic psychology in humanistic therapy

1. Client Centered Therapy associated with Abraham Maslow and Carl Rogers.

2. Gestalt Therapy associated with Fritz Perls

3. Existential Therapy most prominently associated with Marc Rollo, Viktor Frankel, and Irving Yalom

Self-Actualization

Maslow proposed that the goals of humanistic psychology in therapy are directed toward helping people achieve freedom, hope, self-fulfillment, and strong identities. Psychologists and psychotherapists guide a person to become more self-actualized through self-directed change, while building self-esteem, along the way. Abraham Maslow posited that fundamental needs (biological and safety) must be satisfied before an individual is able to progress to psychological needs (love and esteem), which in turn must be met before the person can meet self-actualization needs.

Person-Centered Therapy

Developed by Carl Rogers, person-centered therapy emphasizes forming a therapeutic relationship, focusing on empathy, respect, and authenticity. As implied by “person-centered,” the concept of the person is vital in Rogers’ work.

Rogers believed all living beings have a self-preservation and growth tendency, the “actualizing tendency,” driving individuals to realize their potential. Rogers’ ideal is the “fully functioning person,” someone open to all experiences.

Theory

Carl Roger developed a theory of “the self” that explains nicely how positive change comes out of humanistic psychotherapy.

He believed that “the self” had 3 components to it:

1. Perceived Self (how person sees self & and others see them)

2. The Real Self (how a person really is).

3. And the Ideal Self (how person would like to be).

When a person has a conflict between his perceived self and his real self a state of incongruence occurs. It is this incongruence that can cause symptoms, such as anxiety or depression, or feeling stuck and discontent. The focus of therapy is to help the client self-actualize into his ideal self. Dr. Rogers often used the following phrase during his counseling sessions, “So, you find it hard to believe that they would love and accept you if they knew who you really were” (Rogers, 1959).

Therapy goals

Rogers believed all living beings have a self-preservation and growth tendency, the “actualizing tendency,” which drives individuals to realize their potential. Rogers’ ideal is the “fully functioning person,” someone open to all experiences.

Like other scientific therapies, person-centered therapy aims for the “healing of abnormal physical or mental conditions.” However, its inherent goals differ: therapy reorganizes the patient’s self-structure, allowing more experiences to become part of self-identity. Patients become open to immediate experiences, perceive themselves and others more realistically, solve problems better, and gain self-confidence and responsibility.

The closest one can come to describing a specific technique in client centered psychotherapy is to have unconditional positive regard for the client and to use reflection to facilitate insight. Reflection is when the therapist reflects the emotions of the client in order to help clients become aware of the meanings of their statements.

Person-centered therapy is proven effective for treatment of depression, anxiety, adjustment, and somatic disorders.

Gestalt Therapy

Gestalt therapy is a complex psychological humanistic therapy. It is a system that stresses the development of client self-awareness and personal responsibility. The psychologist, psychotherapist, or counselor takes an active role (questioning and challenging the client) to help the client become aware of his or her true feelings.

The focus of Gestalt Therapy is on the whole person. Psychologists, counselors and psychotherapists look at how the mind (e.g. thoughts) and body (e.g. body language, physiological sensations) are integrated and how the person integrates into the environment (e.g. workplace, school, friends). During counseling Gestalt Therapy facilitates clients’ integrating themselves as whole persons and restoring balance in their environment.

In psychotherapy, clients become aware of what they are doing, how they are doing it, and how they change themselves, and at the same time, learn to accept and value themselves. Individuals, according to this approach, define, develop, and learn about themselves in relationship to others, and that they are constantly changing.

Key element of Gestalt therapy

Awareness is a key element in Gestalt Therapy, as it is seen as the essence of a healthy person and the goal of treatment. When people are aware, they can self-regulate in their environments. Self-regulation skill is necessary for reliable emotional well-being. Behaviorally, self-regulation is the ability to act in your long-term best interest, consistent with your deepest values. (Violation of one’s deepest values causes guilt, shame, and anxiety, which undermine well-being.) Emotionally, self-regulation is the ability to calm yourself down when you’re upset and cheer yourself up when you’re down (Stosny, 2011).

According to Gestalt Therapy underlying causes of a lack awareness are:

1. When there is a preoccupation with the past, flaws or strengths, or fantasies etc. that the person no longer sees the whole picture.

2. Low self-esteem

There are three ways people may achieve awareness:

1. Contact with the environment (family, school, friends, work etc.) through seeing, listening, touching, speaking, moving, smelling, and tasting individuals can grow. This happens when they react to the environment and change.

2. Here and now: Gestalt therapy focuses on reaching awareness of the present moment and the present context. Through counseling and psychotherapy, clients learn to discover feelings that may have been suppressed or masked by other feelings. Further in counseling therapy, these previously suppressed emotions are acknowledged, and a person learns how to accept and trust them. Needs and emotions that were previously suppressed or unacknowledged can surface as well. Through this process, a person gains a new sense of self when the overall awareness increases. In the here and now the clients learn to avoid dwelling on the past or anxiously anticipating the future. Past experiences can be explored during counseling sessions, but the counselor or psychotherapist and client will focus on exploring what factors made a particular memory come up in this moment, or how the present moment is impacted by experiences of the past.

3. Responsibility: Here people take responsibility for their own life instead of blaming others.

Humanistic psychology facilitates the clearing of “unfinished business”

Unfinished business refers to people who do not finish things in their lives and as a result of this stop their personal development. Examples of unfinished business are resentment, rage, hatred, pain, anxiety, grief, guilt, and abandonment. People with unfinished business often resent the past and because they can’t focus on the here and now. One of the major goals of Gestalt Therapy is to help people work through their unfinished business and bring about closure.

Existential Therapy

Existential therapy is more a way of thinking than a neatly defined model with specific techniques.

It is a philosophical approach to therapy, which assumes we are free to choose and are responsible for our choices. At its best, existential psychotherapy realistically confronts the ultimate concerns including the difficult facts of life, such as death, loss, responsibility, loneliness, freedom, meaningless and suffering. Psychotherapists and counselors who practice existential psychotherapy, or are influenced by this school of thought, believe that mental health disorders, such as generalized anxiety disorder, depression, panic attacks, and their symptoms, anger, sleeplessness, meaninglessness, are a result of existential angst (fear) and imbalance.

During psychotherapy and counseling, the goal is to understand and relieve the symptoms of mental health disorders. Through this client centered approach, the client can discover his/her actual subjective experience or “being” (Dasein/German). The focus of the treatment is on the here-and-now, but anything that emerges from the past will be processed and dealt with. Coming to terms with reality—the things we struggle with– without denying, avoiding, distorting or downplaying it is key to existential therapy.

Logotherapy

Logotherapy is a meaning centered form of humanistic therapy developed by Viktor Frankl. The word logos is a Greek word and translates to meaning. He was an Austrian psychiatrist and neurologist who developed logotherapy in response to being imprisoned in a concentration camp. During this horrific experience he made observations and gained insights that led to his developing logotherapy.

The Viktor Frankle Institute of Logotherapy (2017) states:
“Viktor Frankl’s Logotherapy is based on the premise that the human person is motivated by a “will to meaning,” an inner pull to find a meaning in life. The following list of tenets represents basic principles of logotherapy:

1. Life has meaning under all circumstances, even the most miserable ones.

2. Our main motivation for living is our will to find meaning in life.

3. We have freedom to find meaning in what we do, and what we experience, or at least in the stand we take when faced with a situation of unchangeable suffering.” (VFIL, 2017)

Victor Frankl said, …”the meaning of life always changes, but it never ceases to be. According to logotherapy, we can discover this meaning in life in three different ways: (1) by creating a work or doing a deed; (2 ) by experiencing something or encountering someone; and (3) by the attitude we take toward unavoidable suffering.” (Frankel, 1984, p. 133)

Holistic or Integrative Technics of Councelling and Psychotherapy

The integrative or holistic approach is also known as the multimodal or pluralistic approach. Many counsellors and psychotherapists don’t draw upon one particular approach. Instead, they combine techniques from different schools of psychotherapy and plan interventions taking into account the needs of the client.

Interpersonal Therapy

Originally, IPT is a short-term therapy (around 20 sessions) focused on treating unipolar depressive episodes. For recurrent depression, a maintenance phase of several months is usually added. IPT directly addresses patients’ life contexts related to depression, including complicated grief, role transitions, loneliness/social deficits, and interpersonal conflicts. Treatment uses a medical model with or without medication, aiming to reduce depression symptoms and support emotional and behavioral coping with interpersonal and psychosocial stressors. The therapist actively supports, instills hope, and advocates for the patient.

Though not yet covered by insurance, IPT is recommended in international guidelines and is one of the most evidence-based, well-researched depression treatments. IPT has been recognized by the Scientific Advisory Board for Psychotherapy as a scientifically validated method for mood and eating disorders (e.g., depression, bipolar disorders).

Mentalization-Based Therapy (MBT)

MBT, developed by Anthony Bateman and Peter Fonagy, combines psychodynamic, systemic, client-centered, and dialectical-behavioral approaches. Mentalization refers to interpreting one’s own and others’ behaviors by attributing mental states. This ability, formed in early, secure attachments, enables infants to engage in affective, pre-verbal communication with caregivers, essential for mentalization development. MBT aims to help people understand their and others’ desires, thoughts, and emotions as underlying actions, involving self-reflection, empathy, and relationship exploration. Originally developed as a manualized program for Borderline Personality Disorder, MBT includes individual and group therapy.

Foundations of MBT

Developed in England, MBT aims to improve mentalization abilities in inpatient, partial, or outpatient psychiatric settings. Mentalization, essential in psychotherapy, affects both self and other perception, with deficits linked to severe psychological disorders. This program includes individual and group therapy over at least 18 months.

Methods of MBT

MBT goals include better behavioral control, emotional regulation, nurturing relationships, life goals, and frustration management. Therapists foster curiosity by forming a collaborative alliance, avoiding an “expert” role, and exploring the patient’s inner world together, enhancing the patient’s trust and learning in social settings.

MBT Setting

MBT centers on a safe therapeutic relationship, providing structured interventions focused on the present to stabilize self-esteem, emotions, and relationships, incorporating past events only as they impact the patient’s current experience.

Systemic Family Therapy

Family therapy aims to help members identify and address relationship issues together. All affected family members participate as needed, with the goal of improving individual well-being through better relationships.

A family therapist doesn’t provide solutions but helps family members develop new ways of interacting. Individual issues or symptoms are viewed as part of a broader dynamic involving multiple people. Interventions focus on understanding problems in their context.

EMDR (Eye Movement Desensitization and Reprocessing)

Eye Movement Desensitization and Reprocessing (EMDR) therapy is a well established psychotherapy technic used for treatment of PTSD, anxiety, depression, and panic attacks. EMDR is a therapy method on its own and not easy to be categorized.

The therapist guides the patients to be mindfully aware of the symptoms and memories of the trauma and their effects on his mind and body. As treatment progresses, symptoms should decrease and disappear.

Effectiveness of Psychotherapy

With a range of psychotherapy approaches available, the question emerges: Which one works best? The answer to that question is that it is somewhat surprising. It seems that most psychotherapies are equally effective. This may seem strange because these approaches often differ significantly in their: beliefs about human nature, views on the cause of psychological problems, and treatment methods. This leads to a critical question: What are the shared ingredients that make these diverse therapies effective?

What defines effectiveness of psychotherapy

Before delving into the common factors that contribute to psychotherapy’s success, it’s crucial to understand the remarkable effectiveness of psychotherapy. Research underscores several key factors contributing to successful treatment with psychotherapy:

Effectiveness

Psychotherapy yields results surpassing many medical interventions, including flu vaccines and some cardiology treatments, often without the side effects associated with medication. Moreover, psychotherapy produces longer-lasting effects than medication, with lower relapse rates.

Common Factors

Several factors, such as the therapeutic relationship, empathy, patient expectations, psychoeducation, and other “common factors,” significantly impact therapy outcomes.

Client Cantered Monitoring

Regularly informing both the therapist and the client about progress improves the quality of psychotherapy and reduces the likelihood of treatment failure for patients not making expected progress.

Flexibility and Adherence

Adherence to treatment protocols is not linked to better outcomes. Instead, therapists who flexibly tailor treatment to each client tend to achieve the best results.

Structured Treatment

Therapies that incorporate structured actions directed at the client’s problems tend to be more effective than non-structured approaches.

Three essential components for effective psychotherapies

Several research overviews highlight three fundamental elements common to all effective psychotherapies:

1. Positive Relationships:

A strong, emotionally charged bond between the psychotherapist and patient is a common factor among all effective therapies.

2. Compelling Rationales:

Each successful therapy provides patients with a psychologically grounded and culturally contextualized explanation for their emotional distress. This explanation must be adaptive, offering viable and believable solutions to specific problems.

3. Targeted Change:

Effective therapies incorporate procedures and rituals that guide patients to enact positive, helpful, or adaptive actions.

The Essence of Effectiveness

To truly understand the concept of effective change, it’s important to grasp what it entails. The central message of the book “Unifying Effective Psychotherapies: Tracing the Process of Change” (Fraser, 2018) emphasizes that change in all successful therapies revolves around shifting or reversing problematic patterns. These patterns are often described as vicious cycles of attempted solutions that only exacerbate the initial problem. These solutions, though they may seem logical, invariably fail to resolve the issue.

Qualities needed for success

Embracing change within psychotherapy can be daunting, as it often means stepping away from familiar patterns. To facilitate effective change, three key qualities must be present:

• A Trusted Guide: A therapist who establishes a trusted and empathetic connection with the patient, offering support throughout the therapeutic journey. This element alone can influence positive change substantially.
• A Compelling Explanation: A clear, understandable explanation for the patient’s problems that makes sense to them and offers a rationale and related tasks for resolution. The chosen explanation must resonate with the patient for therapy to succeed.
• A Clear Target for Change: Effective therapies pinpoint the need to reverse persistent, detrimental solution patterns. Once the cycle is disrupted, change can gain momentum and flourish. Without this focus on pattern reversal, no therapy is likely to succeed.

In summary, regardless of the psychotherapy approach chosen, the presence of three fundamental elements—a positive therapeutic relationship, a compelling rationale, and a clear focus on changing problematic patterns—is essential for therapy to be effective.

Finding the Right Counsellor or Psychotherapist

If you are looking for mental healthcare, you might feel overwhelmed by the different specialists in this field. You will find psychiatrists and psychologists offering their services. This article offers you a guideline on how to find the right mental health specialist for your needs:

• If you suffer from severe symptoms that curtail your ability to function in daily life, it is advisable to make an appointment with our psychiatrist for a psychiatric consultation to assess if medication is indicated.
• When you are you are mildly or moderately depressed, while still maintaining a good level of professional and social functioning, an appropriate starting point would be to see one of our psychologists for an assessment.
• Should you be uncertain about whom to see, consult with one of our psychologists to assess if you need a psychiatric evaluation.

Not all patients getting psychotherapy/counselling need medication to improve and heal. For some “talk therapy” is enough. However, when a patient takes medication, it is advisable to also get psychotherapy. Above all, research studies have proved that the combination of psychiatric treatment (medicine) and psychotherapy (counselling) yield the best treatment outcomes for mental health.

Counselling for Chronic Pain

Falling ill or having an accident can cause a great deal of pain and mental health concerns relating to such an event.  Feeling pain is a universal human experience.  It has no boundaries and crosses all ages, genders, and ethnicities.  Pain serves the purpose of alerting us to problems with our body.  It brings attention to injuries and often accompanies illnesses and diseases that require special attention. Physical pain and mental health are interconnected. Counseling in Dubai at CHMC can help with pain management and address mental health.

Acute pain

Pain of a short duration is acute pain. Acute pain is sharp and specific. A few examples for this are broken bones, a tooth ache, or surgery.  Such pain is expected to subside within 6 months and the person will go on with his or her life in the usual way.

Chronic pain

Pain that lasts more than 6 months and is ongoing is chronic pain.  This type of pain persists even though the body has healed from injury of illness.  Some people can suffer from chronic pain in the absence of injury or apparent illness.  A few examples of chronic pain are arthritis, nerve pain, or certain types of headaches.

Chronic pain syndrome

According to the Institute for Chronic Pain (ICP), Chronic Pain Syndrome can develop when a person suffers from chronic pain, which essentially increases physical and emotional pain in a vicious cycle. This cycle often begins with insomnia, when a person with chronic pain has trouble sleeping.  Ongoing sleep deprivation then can cause irritability, depression and anxiety and possibly a breakdown of a person’s ability to work.  Being unable to work, this person can experience financial distress.  Worrying about money will cause more insomnia and associated physical and mental health problems.  Becoming financially dependent or being unable to function in the person’s role within the family can trigger guilt, feelings of inadequacy, and meaninglessness in life.  Essentially a person’s ability to cope with everyday life breaks down. 

It is essential to help individuals with chronic pain to avoid secondary physical and emotional problems as outlined in the vicious cycle of chronic pain syndrome.

Counseling and treatment for chronic pain

Medical doctors and allied healthcare professionals can provide state-of-the-art treatments for chronic pain.  Such treatments can include medication, surgery, physiotherapy, and rehabilitation; however, pain does not only have a biological sensation but includes psychological and emotional factors.  When people suffer from ongoing pain, they can become overwhelmed with sadness, depression, anger, hopelessness, anxiety, and fear of re-injury.  Clearly, a person suffering from chronic pain requires treatment that addresses physical, emotional and psychological factors. Counseling will improve mental and physical wellbeing.

This is how a counsellor can help:

• Sleep problems can be identified and addressed.
• Through counseling individuals suffering from chronic pain can improve coping skills and learn to manage anxiety, depression and sleep disorders.
• Through Cognitive Behavioral Therapy (CBT) persons suffering from chronic pain can learn to change negative thoughts. Through this process, they develop more control over their emotions, moods, and pain.
• Counseling geared towards mind-body treatments for chronic pain include:

Relaxation techniques

Mindfulness Training

Hypnosis

Exploration of what an individual finds distracting, soothing and helpful

Some persons will also benefit from seeking a psychiatric evaluation to determine if certain psychiatric medications will offer relief from their pain symptoms and address insomnia, anxiety and depression.

Do not despair if an illness or accident has changed your life.  Continue to explore the things you can do to accept and manage the condition.  You don’t have to let it define you.  You can seek mental healthcare treatment to feel better, mentally and physically.

Psychotherapy and Counselling. Overview

The first method of psychotherapy was the psychoanalysis developed by Sigmund Freud. Today, the classical Freudian psychoanalysis with the patient lying on a sofa and the therapist out of sight, sitting behind the analyst, and making now and then few commentsis rarely practiced.

Freud’s psychoanalysis is the common source for later psychotherapeutic technics, called psychodynakic or in-depth psychotherapies. In those methods the frequency of treatment sessions is lower than in the classical Freudian psychoanalysis.

Contemporary techniques of psychotherapy and counselling

The underlying principle of Psychotherapy is the scrutiny of everything that could serve the change. Depending on the method psychotherapy follows the two main roads. One of them is the behaviourism based on the principal of conditioning. The second is based on the psychodynamic approach looking more “behind the scenes” trying to find the root cause of the problem. Today those scholls are not separated by a sharp boundary. Behaviourism is using some elements of psychodynamic methods, and vice versa. The modern psychotherapeutic procedures include client centred holistic approach towards the person’s life. Ideally the psychotherapy involves building an understanding of the person’s trough self, his hidden “blueprint” for life.

Cognitive-Behavioural Therapy (CBT)

The cognitive-behavioural approach focuses on the interrelationship between thoughts, emotions (feelings) and behaviour. Cognitive-behavioural interventions aim to improve an individual’s distressing psychological condition. Above all, CBT techniques help people develop more functional cognitions and behaviours. The approach is based on the cognitive model of psychopathology (Beck 1964). The model suggests that it is not the situation itself that results in our emotions and behaviours, but the way we appraise, or interpret the situation.

Cognitive behavioral therapy CBT is a scientific evidence-based psychotherapy technique. CBT for mental health disorders, like depression, anxiety, or PTSD), reduces or eliminates distressing mental health symptoms. CBT applied to everyday life challenges, also offers a useful tool for daily coping. A very simple way to explain CBT is to say that if you change how you think about an incident, you will change how you feel about it and behave with emotional maturity.

Psychodynamic psychotherapies

Psychodynamic psychotherapie provide an effective treatment for a range of psychiatric disorders, such as depression, disticnt phorms of anxiety, OCD. The therapy can be also appied in stable phase of bipolar disorder. A modified psychodynamic psychotherapy, called Transference Focused Psychotherapy (TFP) concentrating, as the name suggests, on the trnasference but “in here nad now”, is one of the most effective treatment method for borderline personality disorder.

Distinct phorms of psychodynamic psychotherapies can contribute significantly to patients’ mental and physical health, sense of well-being, and ability to manage their lives more effectively. It can help not only to cure psychiatric disorders, but can also help people seeking a greater sense of understanding of themselves and their unconcious motivations leading to more meaningfull and fullfied life. Jung described his psychoanalytical psychotherapy as a “catalyst” of the individuation proces.

However, the decition if one of the psychodynamic technics is the treatment of choice for a particular problem depends on a variety of factors. It is helpful to have one preliminary consultations with an experienced psychotherapist before deciding whether psychdynamic psychotherapy is appropriate.

Goals of psychotherapy and counselling

Family and friends can provide support and comfort helping an individual to master minor life problems. However, while family and friends can offer a shoulder to cry on, psychotherapist provides professional therapy with structured approach focused on solving deep rooted problems a lay person is not aware of.

The psychotherapy shouldn’t be misunderstood as a “mental short cut” finding the solution for person’s problems in weeks. It takes always time, at least one year to close the “inner gap” between the superficial understanding, the Ego-Consciousness. The symptoms appear by the tension created by the gap between our inner needs and the conscious self, e.g. the superficial understanding of what we are.

The main aim of psychotherapy is to devise the exceptional future the person aims for. Psychotherapy is a procedure with the potential to produce extraordinary results through consistency of the therapeutic proces and less trough the frequency—of the sessions. Time used therapeutically is itself a therapeutic agent. The person needs time to reflect on his life and to implement the changes of his “life paradigm”.

Psychotherapy roles

The general conditions required for the psychotherapy are: a certified therapist, standardized setting, an emotionally neutral place and strong observation of the confidentiality rules.

Depending on the therapy technic the counselling sessions can take place over the course of months up to years in variating frequency from weekly to monthly.

Psychotherapist’s expertise

Psychotherapists are experts in mental health and have received extensive training in the field. They are equipped with a range of therapeutic techniques and tools to help individuals work through their issues and make meaningful changes in their lives.

Confidentiality roles

One of the most significant benefits of psychotherapy is that patient’s information remains secret. Therapists are bound by ethical and legal standards that protect the privacy of their clients. It means that every problem discussed in therapy stays between the patient and the psychotherapist. This level of confidentiality can be incredibly reassuring for individuals who are concerned about their privacy or feel uncomfortable sharing personal information with others.

If indicated, the counsellor will refer to a psychiatrist to assess if medication is advised as an additional treatment approach.

FAQ. Psychotherapy and Counselling

There are many reasons people conclude that they need to see a psychotherapist.  Some individuals are seeking personal development because they feel stuck; others suffer from depression, anxiety, OCD and burnout, or are having marital problems. The first difficulty is the question how to choose the right specialists for my mental health condition.

Is every psychologist a psychotherapist?

The answer is no. Psychologist is an academic degree. A person who finished studies in psychology is not by default a psychotherapist. The license in psychotherapy requires a postgraduate training consisting of several hundred hours theory and supervised psychotherapy.

What is counselling?

During counseling sessions peaple talk about their specific current problema and how to address and solve them. The counselor does not advise, but takes the role of a guide to facilitate positive change.  Patients use the nonjudgmental safe setting of a counseling session to freely explore their unique problems.  This gives them an opportunity to discover their own answers to be able to take positive steps to resolve their issues.  Counseling sessions have a present day, solution based focus.  Counseling often is a short term therapy, as compared to psychotherapy. 

What is psychotherapy?

Psychotherapy, or “therapy” in short, often is longer in duration than counselling.   Psychotherapy can take place over the course of 1 or 2 years where clients see their therapist 1 to 4 times per month. 

During psychotherapy, psychological problems that are built up over the course of a long time are explored. Patients gain more insight into their feelings and actions. Emotional issues underlying problems and difficulties are identified and healing promoted. 

Many mental health professionals will call themselves counsellors because this is a widely accepted and non-stigmatized mental health care service.  The lines between counselling, psychotherapy, and psychotherapy are often crossed. There might be initial counselling work during which deeper, lifelong behavioural and emotional patterns are discovered, requiring psychotherapy. Conversely, there might be a patient in therapy who will benefit from solution-focused counselling to resolve a current issue. 

Qualifications of a licenced psychotherapist

The first difficulty is the question of how to choose the right specialists for my mental health condition. Is every psychologist a psychotherapist? The answer is no. Psychologist is an academic degree. A person who finished studies in psychology is not by default a psychotherapist. The license in psychotherapy requires postgraduate training consisting of several hundred hours of theory and supervised psychotherapy.

There are four important things for you to note when you are looking for a qualified psychotherapist:

1. Look for licenced psychotherapists with a Master’s Degree or PhD in psychology from an accredited university with additional training in psychotherapy.
2. They will have the clinical skills to diagnose and treat mental health disorders (depression, anxiety, OCD, etc.).
3. They have the professional knowledge know when to refer to a psychiatrist for pharmacotherapy (medication to balance brain chemistry)
4. If you have mental health benefits on your insurance plan, the insurance companies request that you see a licenced psychotherapist to reimburse you for the sessions.

Psychotherapist versus Psychiatrist

Some people don’t understand the difference between psychiatrist and psychotherapist.

A psychiatrist is a mental healthcare provider who prescribes medication.  Psychiatrists are medical doctors with additional specialisation in psychiatry.  If you think you might need medication to treat a mental health disorder, e.g. depression, anxiety, or OCD, a psychiatrist would be the right choice for a consultation.

Life Coach versus Psychotherapist

The difference between the psychotherapist and life coach is licensure. Life coaching is an unlicensed profession.  However, they have set up their own standards of education and training hours and are self-governing. There are a number of life coaches in Dubai. However, it is in your best interest to have a closer look at the life coach’s education (degrees) and training hours. In general, psychotherapists are psychologists with extra training in psychotherapy. On the contrary, life coaches participate only in a few weeks of training.

Please be aware that life coaches most likely do not have the education, training, and experience to diagnose and treat mental health disorders.

What is the difference between psychoanalysis and psychodynamic or in-depth psychotherapy?

The terms psychodynamic or in-depth therapy refer to the same method of psychotherapy with their roots in Freudian psychoanalysis. Freud viewed mental disorders as the effect of unresolved childhood problems. Today’s psychodynamic psychotherapies deal also with the unconscious, not seeing every problem of their clients as the effect of a childhood trauma or a sexual suppression. While Freud’s psychoanalysis required several sessions per week, the contemporary psychodynamic psychotherapy sessions are less frequent: once per week or even less. Modern psychotherapists abandon the sofa and sit close to the patients, creating a dual interaction with their clients.

What qualities do I look for in a psychotherapist?

This is a very important question because a positive, therapeutic relationship needs to build between the client and the therapist. Every client has unique needs to feel safe, secure, and understood. Think about whom you would be comfortable opening up to.  Would it be a person of the same or opposite sex?  Would you like to speak in your native language to feel like the most subtle of nuances will be picked up?  Is it important to you to make and understand cultural references?  Is religion a factor?  Does the age and personal status of the person working with you make a difference?

Clearly, these are questions that can guide you in choosing a psychotherapist. Most professionals post a bio from which you can learn most basic details. It will be upon meeting the psychotherapist that you will be able to feel if someone is a good match, and you will be able to ask questions.  Personally, I am an open book, but a professional does have the right to respectfully maintain their privacy.

Therapy is a process through which you heal, gain insights, grow, and find a positive way to go forward in your life. Therefore, in therapy, you should always feel respected, not judged, and not be told how to manage your life. 

Sources

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Diamond, S. (2011). What is existential psychotherapy? https://www.psychologytoday.com/blog/evil-deeds/201101/what-is-existential-psychotherapy, retrieved June 10, 2017

Dryden, W., & Mytton, J. (1999). Four approaches to counselling and psychotherapy. London: Routledge.

Freud, Sigmund. 1961. The standard edition of the complete psychological works of Sigmund Freud. Vol. 19, The ego and the id. London: Hogarth.

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