Introduction to individual therapy 

Individual therapyWhen people think of psychotherapy, more often than not they will imagine lying on a leather couch while an intimidating psychologist takes notes on everything they say in order to dig up “repressed” childhood experiences that will provide insight into their present psychological condition. This indeed was the way of psychotherapy back in the days of Sigmund Freud. These days, psychotherapy takes on a different form and the psychoanalytic approach just described is very rarely used. 

What is individual therapy?

Individual therapy is a psychotherapy implemented by a trained professional, usually a therapist or psychologist, to help a client work through a problem. The ways that individual therapy is implemented varies widely depending upon the psychological problem experienced by the client, the personal beliefs and practices of the therapist, and the individual needs of the client.

Below is a summary of the major forms that individual therapy can take and the mental illness or psychological problem they have been most successful in treating. Not all therapies described below will be offered by all psychologists.

A point to keep in mind is that the more you believe you can change and that therapy can make a difference, the more positive and successful your treatment will be. This concept of self efficacy will be discussed in more detail later in the article.

What is involved in individual therapy?

The overall length of time taken for individual therapy varies widely. Usually a minimum of eight sessions are needed to make sure all aspects of the illness have been touched upon. However, your therapist may recommend more or less sessions depending on your progress. An important part of therapy is making sure that you come back for follow up sessions after one month, six months and 12 months so your psychologist can monitor your condition and make sure it is under control. 

The first session will usually involve you and your psychologist “getting to know” one another. Your psychologist will ask questions about you and your past experiences, current situation, family, job and friends. Your psychologist will not push you to delve into private matters, but does need to obtain enough information about your individual needs in order to determine a course of treatment. In some cases, the problem will be quite evident to both you and your psychologist (e.g. if you are anorexic and are seeking help to fight it). However, in some cases there may be an underlying issue you are not aware of (e.g. you may be depressedanxious or angry without knowing why).

It is important for your psychologist to assess the problem and decide the best plan of action. The first step is to determine what the problem is. Once you and your psychologist have both developed an awareness of the situation, you can start to work together to determine why the problem is present. From here, your psychologist will implement a program to try to solve the problem.

Remember that, although your psychologist may be directing the sessions, you are the one in control. If you feel that the therapy should take a different direction, discuss this with your psychologist. He or she has selected a program to best suit your needs, but will still be very responsive to any feedback that you have. However, keep in mind that psychologists are highly trained professionals that have a lot of experience in their field. By trusting that your psychologist has your best intentions in mind, you will benefit more from the therapy.

Therapist-client relationship

Individual therapyOne of the key ingredients of success in psychotherapy is the strength and stability of the relationship between the client and the therapist. Therefore it is very important that you are comfortable and happy with your psychologist.

Therapists that are rigid, critical and uninvolved are less effective. As you can imagine, talking to someone who you dislike and who seems to be judgemental will not do you much good. You will not want to attend sessions and you will be less likely to follow advice.

Qualities to look for in a psychologist include warmth, empathy, patience, genuineness, honesty and the ability to be upfront yet caring at the same time. These qualities help the client achieve the important goal of self efficacy. Clients that have self efficacy are clients that believe in themselves, the therapy and the psychologist. When you trust that the therapy is helping, you are are more likely to actively work on therapy goals, and are therefore more likely to experience the benefits of the treatment.
 
One of the most important aspects of psychotherapy is communication. Choose a psychologist you feel very comfortable talking to. Obviously when you meet a person for the first time it is very hard to tell whether or not you are going to be able to communicate effectively with them, but if you focus on the qualities listed above, you are likely to open up to them as the sessions continue.

Therapy goals

In every type of psychotherapy, the psychologist will help you develop specific goals for the therapy. This will include a broad overall goal as well as more focused goals that may change from session to session. Breaking the overall goal into session-by-session objectives helps to focus on specific parts of the program and make sure all aspects are properly covered. It also makes it easy to identify which specific parts you are having difficulty with and what you need to work on more. Keeping the overall goal in mind will help you get past times when you feel like giving up on the therapy. To keep focused and consistent with the therapy, remember to keep visualising yourself overcoming your difficulty.

Your therapist will also help you to:

  • Identify coping strategies: These may be coping strategies that have helped you in the past. Your psychologist will teach you to adapt these strategies to your current situation. If your coping strategies have been unsuccessful in the past, your therapist will guide you in the development of new ones.
  • Rearrange life priorities: Sometimes people have psychological problems because they have an irrational expectation of themselves and others. This increases the pressure on everyone and can lead to stress, anxiety and depression. By rearranging your expectations and priorities you may be able to avoid unnecessary stress.
  • Focus on meaningful pursuits.
  • Identify personal strengths: Sometimes during times of psychological crisis it is easy to focus on your weaknesses and what you do not have, instead of your strengths and the wonderful things you do have. Psychologists will draw your attention to positive aspects about yourself, and help you rediscover and bring them out again. This will help you to believe in yourself.

Children and individual therapy

Play therapyPsychotherapy for children is quite different to psychotherapy for adults. Children do not understand the role of psychologists and can be threatened by being alone with them. Quite commonly, children will want their parents to be present before they trust psychologists enough to talk with them alone. It may help to give the psychologist a non-threatening name like “the talking doctor” so that children can better understand their role.

Psychologists commonly adopt play therapy when they are working with children. This allows them to develop a fun and comfortable relationship with the child, and can also give the psychologist an idea of how the child is coping.

Adolescents and individual therapy

Adolescence is a time when children learn to embrace independence and make decisions for themselves. However, with this new responsibility and freedom, many adolescents struggle psychologically. Peer pressure and sexuality can be very confusing and upsetting. Techniques used for adolescents are similar to those used for adults. Teenagers are more likely to be defiant towards the therapy. Therefore, more time and patience need to be adopted by both the psychologist and parents for for the psychologist to “get through” to the adolescent and for the therapy to be effective.

Therapeutic techniques

There are some common techniques used in individual psychotherapy:

Play therapy

Play therapy allows children to express their reality through imaginative play, and gives them the ability to approach and retreat from the intensity of their situation as they please. It also allows them to re-enter childhood during a period when they are faced with very adult demands  Play can indicate how children are coping with their condition and how much they understand about what is happening. For some children, the expression during play can be an indicator of how they are coping with their situation. Very constricted play often represents an overwhelmed child. More imaginative and lively play can be an indicator of emotional restoration.

Exercise therapy

Regular exercise is a cost-effective treatment for moderate depression. Studies have shown that people who exercise regularly report:

  • Less self reported pain
  • Less stress and anxiety
  • Improved body image

Relaxation/meditation therapy

Relaxation or meditation therapists guide you through a series of visualisation exercises that help you better understand the goals and possibilities of the treatment. There may also be some muscle relaxation through massage or yoga-type activities. Some psychological conditions that can benefit from relaxation therapy include:

Milieu therapy

Milieu therapy is a highly structured type of therapy based on support by the psychiatrist. The psychologist will try and interpret symptoms as a meaningful aspect of your personality or experience. The psychologist will give you constant feedback about your progress throughout the sessions. Milieu therapy is used to treat: 

  • PTSD

Laughter therapy

Humour in psychotherapy has positive consequences on mental health. Laughter provides relief and can decrease stress. Laughter also has positive physiological effects on the body. Laughing with people increases interpersonal skills. Your psychologist will encourage you to laugh as much as you like throughout the sessions.

A technique commonly used in group therapy is the formation of a circle, with each person lying face up on another person’s stomach. Once one person laughs, the trembling of the stomach causes the next person to laugh, then the next, until the whole group is cracking up together about nothing in particular!

Laughter therapy is used to treat:

  • Depression
  • Clinical health

Behavioural therapy

Behavioural therapists treat problem behaviours directly. Behaviour is changed through several classical conditioning, aversive and exposure exercises. Behaviour therapy can be used to treat:

Cognitive therapy

Cognitive therapists believe that one’s thoughts guide their emotions and psychology. By making changes to irrational thoughts and vicious self-blame cycles, many psychological disorders can be treated, including:

  • Eating disorders
  • Depression
  • PTSD

Cognitive behavioural therapy

Cognitive behavioural therapy is, as the name suggests, a mixture of cognitive and behavioural therapy. It is a very efficacious and wide spread treatment, mainly used for: 

  • Eating disorders

Manual based therapy

Manual based treatments have evolved through years of studies and research and have been refined to treatments that can be very successful. This is why manual based treatments tend to be more empirically supported. Manual based treatments are highly specific for the disorder they are treating, and are usually more successful in patients who do not display comorbid conditions. Manual based treatments are used for:

  • Eating disorders 

Individualised therapy

An individualised psychotherapy program has been developed by the psychologist specifically for you. This will usually involve a blend of many psychotherapies in order to address the many psychological aspects that tend to accompany a psychological disorder.

Biopsychosocial therapy

Biopsychosocial therapy is the therapy most commonly used to treat people who are suffering from clinical health problems and the psychological distress that comes with it. Biopsychosocial therapy focuses not only on the physical aspects of your condition, but also psychological factors (e.g. depression and anxiety) and your social situation (e.g. family and work). The biopsychosocial model is used as an alternative to biomedical models (based on the idea that biology is directed linked to symptoms). Many clinical conditions can be treated this way, such as:

Follow up

An important aspect of any psychotherapy is the follow up. It is easy to feel abandoned after therapy sessions have finished; you will be used to having an hour or so a week in which you can talk to a very supportive and empathetic objective person, and you may feel its abrupt end. It is therefore a good idea to “wean” yourself off psychotherapy. Perhaps have an extra session two weeks after the program has been completed, and another after a month. This will let you to discuss any concerns you have with your psychologist and it will also allow them to monitor your progress after the program.

Psychological changes do not happen over night. Very often, the psychological treatment is only the first step. The hard part starts once you have left therapy; you have to implement the changes yourself and work hard at all the skills and advice that you were given in therapy. It is quite natural to be intimidated by this, so follow up sessions can be a very comforting solution. Follow up sessions remind you that you are not completely alone. You can go back to your psychologist and receive more help. They will make sure you do not slip back into your old negative thinking or acting patterns.

Effectiveness

Psychotherapy is a highly effective treatment for a wide range of psychological conditions.

The effectiveness of the therapy depends on what you are willing to put into it in terms of time, effort and faith. Trying your best to take on board everything you have learnt from your psychologist will enable you to make changes to your life. There is only a certain amount the therapist can help you with. After that, your wellbeing comes down to your own determination and willingness.

References

  1. Myers DG. Chapter 17: Therapy. In: Brune C. Psychology 7th Edition. New York: Worth Publishers; 2003. 659-85.
  2. Grepmair. Promoting mindfulness in psychotherapists in training influences the treatment results of their patients: A randomized, double-blind, controlled study. Psychotherapy and psychosomatics. 2007; 76(6): 332-8.
  3. Vatne S, Hoem E. Acknowledging communication: A milieu-therapeutic approach in mental health care. Journal of Advanced Nursing. 2007; 61(6): 690-8.
  4. Maccormack T, Simonian J, Lim J, Remond L, Roets D, Dunn S, Butow P. “Someone who cares”: A qualitative investigation of cancer patients’ experiences of psychotherapy. Psycho-oncology. 2001; (10): 52-65.
  5. Nordhus. Brief dynamic psychotherapy with older adults. Journal of Clinical Psychology. 1999; 55(8): 935-47.
  6. Neron S, Lacroix D, Chaput Y. Group vs individual cognitive behaviour therapy in panic disorder: An open clinical trial with a six month follow-up. Canadian Journal of Behavioural Science. 1995; 27(4): 379.
  7. Delaney K. Top 10 milieu interventions for inpatient child/adolescent treatment. Journal of Child and Adult Psychiatric Nursing. 2007; 19(4): 203-14.
  8. McKay JR, Alterman AI, Cacciola JS, Rutherford MJ, O’Brien CP, Koppenhaver J. Group counseling versus individualized relapse prevention aftercare following intensive outpatient treatment for cocaine dependence: Initial results. Journal of Consulting and Clinical Psychiatry. 1997; 65(5): 778-88.
  9. Ghaderi. Does individualization matter? A randomized trial of standardized (focused) versus individualized (broad) cognitive behavior therapy for bulimia nervosa. Behaviour Research and Therapy. 2006; 44(2): 273-88.
  10. LeMay K, Wilson KG. Treatment of existential distress in life threatening illness: A review of manualized interventions. Clinical Psychology Review. 2008; 28(3): 472-93.
  11. Brown MR, Sourkes B. Psychotherapy in pediatric palliative care. Child and Adolescent Psychiatric Clinics of North America. 2006; 15(3): 585-96,viii.
  12. Tkachuk. Exercise therapy for patients with psychiatric disorders: Research and clinical implications. Professional Psychology, Research and Practice. 1999; 30(3): 275-82.
  13. McCreaddie M, Wiggins S. The purpose and function of humour in health, health care and nursing: A narrative review. Journal of Advanced Nursing. 2007; 61(6): 584-95.
  14. Compas BE, Keefe FJ, Williams DA, Haaga DAF, Leitenburg H. Sampling of empirically supported psychological treatments from health psychology. Journal of Consulting and Clinical Psychology. 1998; 66(1): 89-112.
  15. Bortolotti B, Menchetti M, Bellini F, Montaguti M, Berardi D. Psychological interventions for major depression in primary care: A meta-analytic review of randomized controlled trials. General Hospital Psychiatry. 2008; (30): 293-302.

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