Psychotherapy is the treatment of individuals with emotional problems, behavioral problems, or mental illness primarily through verbal communication. At one time the term psychotherapy referred to a form of psychiatric treatment used with severely disturbed individuals. Counseling, on the other hand, refers to the treatment of people with milder psychological problems or to advice given on vocational and educational matters. Counseling psychologists usually work in schools or industrial firms, advising and assisting people. Today the distinction between psychotherapy and counseling is quite blurred, and many mental health professionals use the terms interchangeably.
Psychotherapy is an important form of treatment for many kinds of psychological problems. In most types of psychotherapy, as well as counseling, a person discusses his or her problems one-on-one with a therapist. The therapist tries to understand the person’s problems and to help the individual change distressing thoughts, feelings, or behaviors. People often seek psychotherapy when they have tried other approaches, like counseling, to solving a personal problem. For example, people who are depressed, anxious, or have drug or alcohol problems may find that talking to friends or family members is not enough to resolve their problems. Sometimes people may want to talk to a therapist about problems they would feel uncomfortable discussing with friends or family, such as being sexually abused as a child. Finding a therapist to talk to who is knowledgeable about emotional problems, has patients’ best interests at heart, and is relatively objective can be extremely helpful.
Psychotherapy differs in two ways from counseling or from the informal help or advice that one person may give another. First, a trained, certified, or licensed therapist conducts psychotherapy. In addition, treatment methods in psychotherapy are guided by well-developed theories about the sources of personal problems.
The concept of counseling, on the other hand, is essentially liberal in that the assumptions underlying its theory and practice are, first, that each individual has the right to shape his own destiny and second, that the relatively mature and experienced members of the community are responsible for ensuring that each person’s choice shall serve both his own interests and those of the society to which he belongs. Anybody can give advice to anyone who needs it. Thus, counseling can take place almost anywhere and at anytime. The counselor does not attempt, however, to solve the person’s problems for him. Adjustment is an individual matter that each person must discover for himself, and the counselor mainly tries to clarify the person’s own thinking so that he can be guaranteed the fulfillment of his personal needs and aspirations.
Mental health professionals agree that the effectiveness of therapy depends to a large extent on the quality of the relationship between the client and therapist. In general, the better the rapport is between therapist and client, the better the outcome of therapy. If a person does not trust a therapist enough to describe deeply personal problems, the therapist will have trouble helping the person change and improve. For clients, trusting that the therapist can provide help for their problems is essential for making progress.
The founder of person-centered therapy, Carl Rogers, believed that the most important qualities in a therapist are being genuine, accepting, and empathic. Almost all therapists today would agree that these qualities are important. Being genuine means that therapists care for the client and behave toward the client as they really feel. Being accepting means that therapists should appreciate clients for who they are, despite the things that they may have done. Therapists do not have to agree with clients, but they must accept them. Being empathic means those therapists understand the client’s feelings and experiences and convey this understanding back to the client.
What is more effective then? Psychotherapy or counseling? This question has been hotly debated for decades, and research on this issue presents many difficulties. In conducting studies that compare different therapies, researchers seek to make sure that each treatment group is as similar as possible. For example, researchers may limit the groups to people with the same severity of depression. In addition, within each treatment group, researchers try to make sure that therapists are using the same techniques and are trained similarly. However, patients do not come to therapy with simple problems that fit easily into studies. Furthermore, therapists of the same theoretical orientation may vary in their techniques and in the skillfulness with which they apply them.
Because of these problems, there is no conclusive answer about which type of therapy is best. Most studies have failed to demonstrate that any one approach is superior to another.
Some researchers suggest that all therapies share certain qualities, and that these qualities account for the similar effectiveness of therapies despite quite different techniques.
Almost since the inception of psychotherapy, therapists and their clients have asked, “Does it work? Does psychotherapy help people resolve their problems, feel better, and change the way they deal with other people?” Therapists and clients are not the only ones asking these questions. In recent years, the agencies that fund mental health services—health insurance companies, health maintenance organizations, and government organizations—have increased their scrutiny of the effectiveness of various psychotherapies in an effort to contain costs.
Measuring the effectiveness of psychotherapy is an extremely complex task. Asking psychotherapists or their clients, “How helpful has therapy been?” is only a start. The answer does provide some information about how therapists and their clients perceive therapy. However, it does not answer the question of whether psychotherapy is effective because both therapists and clients have vested interests in believing that therapy succeeded. Therapists want to uphold their professional reputation and sense of competence, and clients want to feel that their investment of time and money has been worthwhile. Because of these biases, most studies of effectiveness rely on other evaluations of a client’s improvement: psychological tests given before and after treatment, reports from the client’s friends and family, and reports from impartial interviewers who do not know the client or whether the client received any therapy.
It is evident that psychotherapy and counseling each have their own specific functions in different problems. It is safe to assume that if counseling does not work, then it could be psychotherapy that can do the job. For instance, all therapies offer people hope for recovery. People who begin therapy often expect that therapy will help them, and this expectation alone may lead to some improvement. Also, people in psychotherapy may find that simply being able to talk freely and openly about their problems helps them to feel better. Finally, the support, encouragement, and warmth that clients feel from their therapist lets them know they are cared about and respected, which may positively affect their mental health.