Psychotherapy, talk therapy, and counseling are terms used to describe interventions with mental health providers. Professionals who commonly treat patients with psychotherapy include Social Workers (LCSW), Professional Counselors (LPC, MFT), Psychologists (PhD or PsyD), and, less commonly, psychiatrists (MD, DO). Professional liscenses are required to practice psychotherapy.
What happens in psychotherapy?
Psychotherapy typically begins with assessment of the presenting problem. The assessment includes an evaluation of symptoms and behaviors, the way those symptoms and behaviors impact the child's life and the lives of those around the child, and the way those around the child respond to the child's symptoms and behaviors.
During psychotherapy children and families gain insight into behaviors, emotions, and thinking, learn new skills, and practice new behaviors. Progress throughout treatment should be tracked.
While there are many types of psychotherapy with variations in the approach, the objective is the same: Remission of symptoms and improved youth and family functioning.
Types of psychotherapy
It is important to attempt to match therapeutic technique for which there is the most evidence of treating the presenting concern. Commonly used therapies for children and families include:
- Cognitive Behavioral Therapy (CBT) is a time-limited, goal-oriented therapy that focuses on the link between thoughts (cognition) and actions (behavior). It is the therapy of choice for anxiety disorders and typically the first line treatment option for depressive disorders. It is intended to help people change thought patterns and actions that cause unhealthy or unproductive behavior.
- Parent-Management Therapy (PMT) is a behavioral treatment for youth with challenging behaviors, often as related to ADHD or ODD. PMT is structured and works to establish a more positive environment for the youth to be successful and improve family communication.
- Parent-Child Interaction Therapy (PCIT) is similar to PMT and addresses behavioral problems in young (2-8) children through parent coaching sessions. The parent and child engage in a playroom while the therapist observes through a one-way mirror and provides real-time guidance to the parent via an earbud or other communication device. The PCIT therapist helps the parent to create a positive relationship.
- Dialectical Behavioral Therapy (DBT) is a form of cognitive behavior therapy. DBT started as a treatment for suicidal thoughts and behaviors but is often used with disorder of mood regulation, including bipolar disorder. DBT aims to give people the skills to regulate their emotions, handle stress in a healthy manner, and improve relationships, and live mindfully. It is particularly helpful for people who struggle with intense, uncontrollable negative emotions or those who engage in self-harm.
- Acceptance Commitment Therapy (ACT) is an action-focused form of cognitive behavior therapy. There is evidence for the use of ACT with anxiety disorders, OCD, depressive disorders, and substance use. ACT share principles of CBT with the goal of understanding the context in which negative outcomes occur and trying new behavior patterns. Mindfulness activities are often part of ACT programming.
- Applied Behavior Analysis (ABA) is a treatment commonly used for Autism Spectrum Disorder. The treatment uses behavioral learning principles to teach socially important and desired behaviors in real-life settings. ABA is an intervention that addresses communication, social skills, and self-management.
- Motivational Interviewing (MI) is an approach to therapy that seeks to elicit motivation to engage in treatment or health behavior with individuals who have previously expressed ambivalence. This approach is commonly implemented medical treatment adherence, substance use disorders, and eating disorders.
- Interpersonal Psychotherapy (IPT) is a short-term treatment that is effective in treating depression in adolescents and children. The basis is that depression occurs because of difficulties with grief/loss, conflict in relationships, difficulties adapting to changing relationships, and social isolation. Treatment focuses on skill building and improving social communication.
- Psychodynamic Psychotherapy emphasizes how certain life events and relationships, both past and present, affect one's current feelings, relationships, and choices. Psychodynamic therapy is often used for depression in adults.
Supportive Therapy is often talked about but not a specific evidence-based treatment. Supportive therapy may be sought with a host of life challenges, including adjustment disroders. While supportive therapy can take many forms it typically includes empathic listening, encouragement, and help with problem-solving.
Psychotherapy techniques can be completed with patients individually, with families, and in groups. Acuity and disorder specific treatments may warrant a combination of approaches to treatment (e.g. weekly individual and group therapy sessions).
Patients with specific disorders or with more severe symptoms may be treated in therapeutic environments including alternative schools, residential treatment centers, inpatient/partial/and intensive outpatient treatment settings.
Getting the most out of therapy
Before inititing treatment patients should be clear on the challenge(s) that are intended to be addressed in psychotherapy and how psychotherapy may help. Psychoeducation about disorders is helpful in orienting families to care.
Parents should be prepared to ask the following questions with prospective therapy provider:
- What types of therapy to be used, is it a match for their specific challenge?
- What are the objectives of therapy treatment for this challenge?
- How will we monitor progress and outcomes from treatment?
- What is the expected length of treatment?
- What are the fees and policies?
To get the most out of therapy:
- The child and parent should be comfortable with the approach to treatment and person providing care.
- It is OK to find another provider.
- A therapist is part of the treatment team. Releases of information should be completed to communicate across providers.
- Children and families should follow the therapy schedule.
- Homework between therapy sessions is essential to progress.