- Ryan Drewianka
A Guide to Psychotherapy
If you've ever tried to search for a therapist you'll know there are several different types of therapy, dozens of approaches (that you may know nothing about), and handfuls of acronyms (that you also may know nothing about).
What does it all mean, and can it even help?
I hope to provide you with a guide that answers some of the questions you might have about therapy. The more you know about something, the less scary it can be!
What is Psychotherapy?
If you Google this question, you'll undoubtedly find a bunch of websites that use language such as "mental illness" or "mental disorders," and then state that psychotherapy is a form of treatment for these things. Although technically -- and in Minnesota, legally -- accurate, I feel like that language adds to the societal stigma of therapy.
In essence, psychotherapy is a talk-based process that aims to help people gain awareness of their inner world, and in doing so use that insight to change their behaviors and overcome the challenges in their life. This process happens across a period of time, and generally occurs in weekly or biweekly sessions.
Some clients may feel like only a handful of sessions are necessary to accomplish their goals, whereas other clients may stay in therapy for years. Some may exit therapy after completing their goals and then decide to come back years later to work on a new challenge.
Benefits of Psychotherapy
It's well-known that seeing a therapist can be extremely beneficial after having experienced a traumatic event or anything that elicits challenging emotions like heartbreak or grief.
And, counseling can be incredibly valuable for so many other reasons!
Below are examples of some of the benefits that mental health counseling can provide:
Better understand the connections between your thoughts, feelings, beliefs, needs, and behaviors within various contexts
Work through and make meaning out of challenging experiences
Learn healthy coping or grounding strategies to the stressful triggers in your life
Treat substance use problems
Gain awareness of unconscious motivations behind the actions you take
Better understand your self -- who you are as a person and what you value
Satisfying relationships: friendships or partnerships with stronger communication skills and increased vulnerability, connection, and trust
Live a more fulfilling or authentic life; a life abundant in joy and love rather than fear and shame
Who Can Provide Psychotherapy?
There are many different mental health professionals that can provide psychotherapy services, and I believe that's one of the contributing factors behind the confusion of seeking counseling. Below is brief summary of who can provide psychotherapy and what their credentials look like.
Licensed counselors have earned their master's or doctoral degree from a counseling program that trains them in the many approaches to individual counseling. They generally receive light training on group or family therapy theories and techniques.
In Minnesota, counselors can hold one of two licenses. The first is called the Licensed Professional Counselor (LPC), though due to various reasons a majority of folks choose to pursue the Licensed Professional Clinical Counselor (LPCC) license.
Clinical Social Workers
Clinical social workers have earned their master's or doctoral degree from a graduate program that specializes in social work, in addition to having completed specific courses on mental health evaluation and treatment. Although social workers provide many helpful roles in society, only clinical social workers are permitted to practice psychotherapy.
For clinical social workers in Minnesota, this credential is called the Licensed Independent Clinical Social Worker (LICSW).
Marriage and Family Therapists
Marriage and family therapists have earned their master's or doctoral degree from a graduate program that specializes in couples and family counseling. These programs focus their education on a "systems" view of how human challenges arise, and provide minimal courses on individual and group counseling theories and techniques.
In Minnesota, their credentials are Licensed Marriage and Family Therapist (LMFT).
Clinical psychologists have earned a doctoral degree from a clinical or counseling psychology program. After graduating, and before becoming licensed, they also have to complete a supervised, year-long internship.
In Minnesota, a clinical psychologist's credentials are listed as Licensed Psychologist (LP).
In Minnesota, clinical trainees are defined as individuals who are enrolled in, or have completed, an accredited graduate program that prepares them for independent licensure as a mental health professional. These folks must be supervised by a licensed professional.
Since clinical trainees are working toward their independent licensure, you won't see any of the above acronyms except for their degree.
Psychiatrists/Psychiatric Nurse Practitioners (NPs)
Psychiatrists are medical doctors who have completed medical school and focused their residency (specialized training) on psychiatry. Similarly, psychiatric NPs have earned a master's or doctoral degree specializing in psychiatric care.
Although psychiatrists and NPs do receive training in mental health as well as how to conduct psychotherapy, they primarily focus on the management of medications in treating mental health challenges.
Psychiatrists, NPs, and primary care providers are the only professionals who are permitted to prescribe and manage medications for clients.
Types of Psychotherapy
Therapy can come in all different shapes and sizes depending on the needs of the client. Below are the different types of counseling services that are typically provided:
This type of therapy consists of one-on-one sessions between you and your therapist. These typically last anywhere from 30-60 minutes, with the average session lasting about 50 minutes.
These types of sessions are most helpful for focusing on personal challenges, your inner world (thoughts, feelings, needs), or your specific role within a relationship.
Sessions for this type of therapy include you, your partner, and your therapist. Notice that it's not called "marriage" counseling -- any relationship is welcome in these sessions! These generally last anywhere from 60-90 minutes.
This type of therapy is different from individual counseling because the couple is seen as the client; the relationship is what's receiving therapy.
Couples counseling can be most helpful for focusing on interpersonal topics within a relationship, such as communication challenges, sex therapy, emotional distance, infidelity or affair recovery, or pre-marital counseling.
Family therapy sessions include any or all of your family members, plus your therapist. These sessions typically last about 60 minutes but could extend beyond that.
In these sessions the family itself is seen as the client; the family system is what's receiving therapy. Individuals within the family will certainly have their own work to do, but these sessions focus on what causes the relationship dynamics within the family.
Family therapy is most helpful for focusing on how family dynamics may contribute to stress or conflict at home (e.g., communication styles, love languages, roles in the family, etc.).
Sessions for this type of therapy typically include 6-12 clients, plus 1-2 therapists depending on the size of the group. These sessions typically last 1.5-2 hours and are provided in two formats: open groups, where members can come and go as they please; and closed groups, where the same members who begin the therapy group will conclude it as well.
Group therapy sessions are unique in that you participate as an individual; however, the therapy isn't gleaned just from the therapist(s), but from peer feedback as well!
This type of therapy is most helpful for focusing on interpersonal dynamics, expanding social supports, or providing/receiving unique perspectives regarding the challenges you're experiencing in your life. Some group therapists may recommend that you participate in individual therapy as well to supplement the work from a different perspective.
Widely known as "telehealth," the use of online therapy has exploded since the Covid-19 pandemic began. Telehealth can be used for any of the above types of therapies, though there are pros and cons to weigh.
The cons of online therapy could include limited confidentiality, unreliable technology, lack of human connection and body language, limited support in crisis situations, and the fact that it's likely not appropriate for clients with severe safety concerns or serious psychiatric illnesses.
However, for some, the pros of telehealth may outweigh the cons. Some pros can include increased convenience and flexibility, increased access for those in rural or remote areas, increased access for clients with physical limitations, and the possibility of increased approachability for those with severe anxiety.
Approaches to Psychotherapy
Just like there are several medical remedies for the same physical health condition, there are a bunch of different ways a psychotherapist might approach the challenges their clients face. Below are a few very broad categories of therapy that you might encounter when searching for a therapist. Click here for a full list.
This approach to psychotherapy focuses on helping you change current problematic thoughts, feelings, and behaviors by discovering their unconscious motivations and dynamics, often beginning in childhood. This type of therapy encourages you to explore your emotions, defenses, and relationships as a way to develop awareness about unconscious patterns and unresolved problems.
Cognitive Behavioral Therapy (CBT)
CBT is an approach to psychotherapy that focuses on the relationships between our thoughts (cognitive), actions (behavioral), and feelings as the crux of mental anguish, as they are reflections of our core beliefs about ourselves.
By being able to challenge our thoughts, we can affect how we feel about a particular scenario, and therefore decide in full awareness how we can behave toward it. Acting differently toward that scenario will then affect how we think and feel about it in the future.
A humanistic style of therapy highlights that the client is the authority on their inner experiences, goals, motivations, and ultimately what is best for them; not the therapist. The belief that every individual has inherent worth and the capacity for positive growth underlies this approach.
Therapists that utilize this approach may emphasize a more relaxed, reflective style of counseling that encourages change by validating their feelings and experiences.
Creative arts therapy: using various art forms, music, or poetry to achieve the goals listed above.
Play therapy: this type of therapy specifically helps young children process events and explore their thoughts and emotions through play.
Animal-assisted therapy: using animals with highly empathic traits as the catalyst for therapy.
Keep in mind that very rarely does a therapist stick to one type of therapy; most use an integrative approach by using techniques drawn from several different approaches.
Does Psychotherapy Work?
Like many things in life: it depends.
On one hand, there are many variables that can influence the effectiveness of therapy, ranging from the nature and severity of your challenges to the therapist's treatment plan.
On the other hand, several studies have suggested that therapy is effective at treating a wide variety of conditions. Studies have also highlighted that some factors positively affect therapeutic outcomes more than others.
The good news is that there are several things you can do to get the most of therapy!
Be open and honest with your therapist: Vulnerability is hard. But therapy is designed to be a place where it's not only lovingly welcomed, it's utterly necessary to heal and grow. Remember, the therapeutic alliance is the most valuable aspect of therapy.
Feel the feels: Avoidance is a major driver of continued suffering. Accept and embrace uncomfortable emotions with your therapist to better process and understand them.
Know that therapy is a process: Emotional scars are much more complex than physical ones, and healing those wounds will take time.
Do the work: Your therapist will likely see you for about one hour per week. Take the awareness and insights you learn within that hour to apply them to your everyday life; it's your life and that's where the healing is!
Maintain consistency as best you can: Even though it is only one hour per week, it's the commitment to that hour that counts. Maintaining a relationship and staying on track with the treatment plan becomes much more difficult with sporadic sessions.
If you have any questions that weren't covered in this guide, feel free to reach out and I'd be happy to address them!
If you feel like you're ready to reap some of the benefits of therapy, click here to schedule a free 15-minute phone call to see if we might be a good fit to work together.