This web page is about psychotherapy.
It is mainly intended for patients being treated in the Central Denmark Region as well as their relatives.
It describes what psychotherapy is and how various mental illnesses can be treated with psychotherapy.
We hope this information will help you learn more about psychotherapy.
What is psychotherapy?
Psychotherapy – also called talk therapy – is used to treat a wide range of mental illnesses.
In some cases, psychotherapy may be the only form of treatment you need. In other cases, psychotherapy can be included as part of your treatment on an equal footing with, for example, medication
Two main lines of therapy
There are many different forms of psychotherapy. There are two main lines of therapy in the treatment of adults: cognitive therapy and psychoanalytic therapy.
Both types of therapy can be offered as individual therapy or group therapy.
A course of cognitive therapy is usually shorter than a course of psychoanalytic therapy. A course of cognitive therapy typically comprises 10-20 sessions, while a course of psychoanalytic therapy typically lasts between 1-2 years.
Many experience a kind of relief when they find out that their symptoms are caused by a well-described illness and that there are others with the same illness. It often reduces the feeling of shame that many experience.
What is cognitive therapy?
In cognitive therapy, you work with your therapist to understand and modify intrusive thoughts and inexpedient actions that can contribute to developing, aggravating or maintaining your illness. Cognitive therapy entails joint exploratory work between you and your therapist.
The cognitive therapy is based on your current problems. However, your therapist may ask about events from earlier in your life that may be of importance to your present situation. It differs how much you talk about experiences from the past. For some, this part of the therapy does not take up much space.
The cognitive diamond
The cognitive diamond is a model used in cognitive therapy. The model shows how thoughts, feelings, bodily sensations and behaviour affect each other in all situations.
Such interaction is usually expedient, but it may also cause problems, as in the example below:
A man with panic disorder is afraid of having a heart attack. The panic attacks especially occur in situations in which it is not easy for him to get away. One morning on the bus, he thinks, “What if I have a heart attack.” This thought gives him a feeling of anxiety and produces bodily symptoms such as sweating, palpitations and oppression in the chest. The man thinks that these are signs of a heart attack, which aggravates both his anxiety and physical symptoms, and, in turn, reinforces his thoughts that he may be having a heart attack. The episode ends with the man getting off the bus in a hurry several stops earlier than planned (behaviour). After this episode, he does not dare take the bus. There are many other things he avoids as they cause the same symptoms.
Working with the cognitive diamond
Based on the cognitive diamond, you work with your therapist to analyse current problem situations in your life.
The purpose of the analysis is to improve your ability to identify inexpedient (negative) thoughts and actions in specific situations. On this basis, you can then work towards making your thoughts more realistic and helpful (alternative thoughts) and making your actions more expedient.
When your thoughts and actions become more expedient, your mental and physical discomfort (symptoms) will become less pronounced. This happens automatically because thoughts, actions, feelings and bodily sensations are always closely connected – as seen in the cognitive diamond model.
How is cognitive therapy conducted?
Cognitive therapy can be conducted individually or in a group. When you start therapy, you will be assigned a regular therapist who will follow you throughout the process. He or she will typically use some of the methods described below.
Psychoeducation is usually the first part of your treatment. In psychoeducation, you learn about your illness. You learn about the causes of the illness, your symptoms, the course of your illness and your treatment options.
List of problems and goals
After psychoeducation, you will typically prepare a list of problems and goals together with your therapist. The list should contain your most serious problems and symptoms. Based on this list, you and your therapist will set some specific goals for your therapy. The goals must be realistic in relation to the time at your disposal, and they must result in your problems becoming significantly easier to cope with.
The main purpose of the list of problems and goals is that you and your therapist have a joint understanding of what you are working towards. When you have some specific goals, it is also easier to see the improvements that you achieve during the process.
Example: A man who suffers from PTSD after a traffic accident may have as his goal to be able to drive again.
When you start your therapy, you and your therapist will work together to form an overview of the extent of the problems you will be dealing with.
You can, for example, register the situations in which your problems occur and how you react in these situations. This provides a good basis for planning the further course of your therapy.
In connection with your therapy, you and your therapist typically work with forms, models and illustrations. This provides a good overview of the problems you are working with and the methods you are using. Once your therapy has been concluded, you can use the written material to continue to work with these methods yourself.
Analysis and restructuring
Analysis and restructuring is one of the fundamental methods in cognitive therapy. The purpose is that you are to learn to identify and distinguish between your thoughts, your behaviour, your bodily sensations and your feelings in specific situations.
It often turns out that your thoughts are excessively negative and pessimistic. You can therefore work to ‘restructure’ your negative thoughts into more realistic and helpful (alternative) thoughts.
If you change your way of thinking, you will – as shown in the cognitive diamond – also be able to change your behaviour. This means that you will have fewer unpleasant feelings and bodily sensations (symptoms).
Many of our thought and behavioural patterns have been present since childhood and are therefore very ingrained. You cannot change these patterns overnight. It often requires that you work intensively with them for an extended period of time.
Example: A young woman suffering from depression is convinced that her friends do not like her anymore. When she is with them, she only focuses on signs that they are tired of her. This focus means that she does not see her friends’ support and care for her at all. She becomes even sadder and begins to isolate herself. By restructuring her thoughts and by focusing on the fact that her friends want to help her, the woman can better see the signs of this. She can better accept help from her friends and avoid isolating herself. By changing her thought pattern in this way, the woman becomes less sad.
When you attend cognitive behavioural therapy, you will be given homework between the therapy sessions. The homework is usually related to the things you have worked with in your therapy. The homework gives you new knowledge that you can use in your next therapy session.
Example: A man suffering from social phobia may be given as a homework assignment to make a brief classroom presentation in his study programme between two therapy sessions.
Exposure and response prevention
Exposure and response prevention is a method that is especially used in connection with anxiety disorders and OCD. When you expose yourself to the harmless situations that trigger your anxiety, your body automatically responds so that the anxiety subsides if you remain in the situation. It also disproves your thoughts that this is a dangerous situation.
Example: A woman suffering from OCD is afraid of being infected with bacteria. When she has been out, she changes all her clothes and takes a long bath as soon as she gets home. Her homework assignment is that she must leave her home at least once every day (exposure). When she gets home, she must gradually learn not to change her clothes or take a bath (response prevention). This can be done in stages, so that she gradually shortens her bath and refrains from changing her clothes. She will gradually experience that her anxiety and discomfort of skipping her bath become less and less pronounced. It will also mean that she will be able to move about more freely outside her home.
This type of therapy is used in connection with PTSD. PTSD is a disorder that occurs as a delayed response to a traumatic event. In trauma-focused exposure therapy, the PTSD sufferer learns to confront his or her traumatic memories under controlled conditions. By repeatedly confronting the feared situation, whether imagined or in reality, the anxiety is reduced, and the PTSD sufferer gradually regains a sense of control.
On conclusion of your therapy, you and your therapist work to prevent a recurrence of symptoms. You make a summary of what you have worked on and the changes and goals you have achieved.
On this basis, you can prepare a plan for what you need to continue to work with on your own and what you can do to avoid a recurrence of symptoms.
What is psychoanalytic therapy?
Psychoanalytic therapy is talk therapy in which a free and open conversation between you and your therapist forms the basis for psychological change.
The purpose of the therapy is to create a foundation for psychological change through a deeper recognition of the emotional issues that stand in the way of your achievement of greater mental freedom in your life.
The therapeutic work involves both examining and dealing with your feelings and thoughts. It also focuses on how this manifests itself in your ways of relating to other people and in your behavioural patterns.
Who can receive psychoanalytic therapy?
You can be offered psychoanalytic therapy if you have a personality disorder. This means if, for example, you are characterised by pervasive emotional instability and impulsivity, or if you generally find it difficult to tolerate that others have other opinions than you and behave differently from you. Psychoanalytic therapy can also be helpful if, for example, you find it hard to accept that you or others make mistakes, etc., where these difficulties mean that you have problems making your life work.
Psychoanalytic therapy can also be used to treat anxiety, depression, bipolar disorder and various forms of psychosis.
The purpose of a course of psychoanalytic therapy may differ and will often depend on your underlying disorder and thus on the problems which prevent you from leading a satisfactory life.
The therapeutic work will often focus on understanding and accepting your own emotional life, so that contact with both others and yourself becomes easier and freer.
Did you know...
that a specialist in psychiatry or a psychologist assesses which therapy will be most effective for you?
Individual therapy or group therapy?
Psychoanalytic therapy can be offered as both individual therapy and group therapy, and psychoeducation will also be offered as part of the therapy. The therapy will typically last between 1-2 years, but this may vary.
In individual therapy, it is up to you to bring up what you think is causing you problems. Together with your therapist, you will try to examine and understand why and how a given problem arises. During the process, your therapist will be able to help you see some of the aspects to which you yourself are blind and which contribute to preventing you from dealing with the problem.
If you ‘change the subject’, and thus fail to confront what is causing you problems, you can examine together with your therapist how, in this way, you yourself end up contributing to maintaining a status quo.
You will typically work on getting to know your own emotional life better and become better at enduring and dealing with difficult and frustrating feelings.
Many mistakenly believe that individual psychoanalytic therapy is about focusing on childhood and trauma, but it is much more about how you live your life in the here and now and what problems this gives you.
Typical issues may be that you experience that you are not worth anything, that others are constantly ‘out to get you’ and/or do not understand you, that you do not fit in, that you are afraid of being left alone and therefore cling to others, or that you need to be able to control or manage yourself and your surroundings.
Group therapy focuses on how your own problems manifest themselves in the way you relate to other people.
In group therapy, you can meet other persons who have some of the same difficulties you have. It may therefore be a great help to you that you can use the group to talk about your difficulties and your feelings.
By listening to the other members of the group, and by discovering and examining the reactions that you trigger in others – and that they trigger in you – you may be able to discover something that you have not been aware of before.
The purpose of both group therapy and individual therapy is to give you an opportunity to learn more about yourself and your relations with others.
Psychoeducation is an important part of your therapy. In psychoeducation, you will have an opportunity to learn more about your diagnosis, the background of your difficulties and problems, and how they manifest themselves. You will also learn more about what psychoanalytic therapy entails.
How is psychoanalytic therapy conducted?
Before commencement of therapy
Before starting a psychotherapeutic course of treatment, it is important that you talk to your therapist about what problems and difficulties you are experiencing in your life. There will often be a need to establish how extensive your problems are and for how long they have persisted. A diagnostic interview will typically also be conducted with you to map and obtain a more precise picture of your diagnosis and your difficulties. This is done to ensure that psychoanalytic therapy is the right therapy offer for you. It is important that you decide whether you are ready to participate in this type of therapy.
For psychoanalytic therapy to be effective, it is important that you are motivated for working with yourself.
If you and your therapist find that you need to start a course of psychotherapy, you will usually also agree the frequency and duration of the therapy as well as the framework, i.e. the importance of attendance stability, cancellation of appointments, status consultations or the like.
First therapy session
It is natural if you are a little nervous ahead of your first therapy session, but try to show up with as open a mind as possible.
In the first sessions, you and your therapist will talk about the difficulties and problems you think that you have. Perhaps your therapist is the same person with whom you have had the initial consultations, and, in such case, you will both already have a shared picture of what your difficulties and problems are.
At the first therapy sessions, the purpose will be for you and your therapist to become more aware of how your difficulties and problems manifest themselves and how you can work with them.
Throughout the course of your therapy, you participate in exploring your problems and examining how you can work to resolve them. The therapist’s role is to help you see some of the aspects to which you are blind and that make it difficult for you to deal with your problems. If, for example, you are unable to meet with people you find do not understand you, your actions may then contribute to maintaining your difficulties.
At the start of the therapy, you will typically feel relief at being listened to and understood. But as the therapy progresses, it may become difficult or perhaps even frightening for you to have to work so much with yourself.
Together with your therapist, you may discover patterns within yourself which it may take time to accept, understand and change. This is hard work. But if you overcome the difficulties, it may, in turn, be a great liberation for you.
You will probably experience that energy and resources that you have previously spent on dealing with problems in your life can now finally be released.
This page has been updated in 2021 (version 1.02).
Most recently revised by: Mikkel Arendt, Psychologist specialising in psychiatry, Department for Depression and Anxiety Disorders, Aarhus University Hospital – Psychiatry (the cognitive therapeutic part)
Rikke Bøye, Senior Psychologist, Clinic for Personality Disorders and Suicide Prevention, Department for Depression and Anxiety Disorders, Aarhus University Hospital – Psychiatry (the psychoanalytic therapy part)
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