Psychotherapy Definition, Goals and Stages of Psychotherapy Essential Process in

Psychotherapy Models of Psychotherapy: Individual Therapy, Group Therapy, Couples

Therapy, Family Therapy

Psychotherapy is the informed and intentional application of clinical methods and

interpersonal stances derived from established principles for the purpose of assisting people
to modify their behaviour, cognitions, emotions and/or other personal characteristics in
directions that the participants deem desirable. Psychotherapy is a unilateral professional
relationship that is circumscribed by limits on time, frequency of contact, content of
discussions, and level of intimacy in which a person may talk over problems with a specialist
in human behavior. Confidentiality is assured in a professional relationship, so that a client
or patient can express whatever is on his or her mind without concern that the information
will be disclosed to others.

Goals
Kleinke (1994) described six fundamental therapeutic goals common to almost all
psychotherapies:
(1) Overcoming demoralization and gaining hope- Common concerns that bring many to
psychotherapy (e.g., anxiety, depression, loneliness, low self-esteem, problematic
symptoms and/or relationships) often lead to the patient’s feeling hopeless and
demoralized. Psychotherapy usually seeks to return or develop a sense of hope or optimism.
(2) Enhancing mastery and self-efficacy- Increasing one’s sense of mastery, efficacy, and
control can also heighten one’s sense of hope.
(3) overcoming avoidance- Avoidance of issues can lead to more serious problems. Denying,
avoiding, and minimizing problems prevent a person from dealing directly with them.
Psychotherapy often seeks ways to help patients confront problems and concerns in order
to deal more effectively with them.
(4) becoming aware of one’s misconceptions -
(5) accepting life’s realities- Psychotherapy often seeks ways to help patients confront
problems and concerns in order to deal more effectively with them.
(6) achieving insight- Insight into the intrapsychic, interpersonal, biological, and social
factors that lead to symptoms and problems are likely to assist a person in coping more
effectively with their concerns.
The goal of psychotherapy may include changing very specific problem behaviors. For
example, the goal might be to reduce or minimize temper tantrums, fear while speaking in
public, nail biting, binge eating, or smoking. Other goals might include improving certain
target behaviors such as attention in class, performance on examinations, polite behavior,
exercise, and healthy food consumption etc. Goals of treatment might also involve careful
management of a crisis (e.g., trauma, suicidal or homicidal threats). The objectives of
psychotherapy may change several times during the course of the therapy experience.
Sometimes the goals are difficult to define and articulate until the psychologist evaluates or
gets to know the patient. Overall, the ultimate objective is to improve quality of life through
self-understanding, behavioral and lifestyle change, improved coping and adaptation,
and/or enhanced relationships.

Stages of Psychotherapy
1. Initial Consultation
These are the type of questions that must be asked and answered. Why the patient has
decided to seek help? What the patient hopes to gain from psychotherapy? Whether there
is a good fit b/w goals, needs, & interests of the patient and the skills of the psychologist?
Terms of professional services discussed by psychologist – limits of confidentiality, fees,
available appointment times, therapeutic approach. Am I likely to be able to work with this
person successfully? Whether or not to schedule a second appointment? Patient is able to
assess if the psychologist has an appealing &professional manner. The patient may evaluate
how adequately his or her needs can be met by working with the psychologist, and whether
the practical terms of the therapy are acceptable (e.g., session availability, fees, office
location, psychologist approach). The patient may also consider whether the psychologist
has an appealing personality or professional manner. Psychologist determined if he is
equipped to work effectively with the patient. The psychologist may also refuse to provide
continued services for several reasons. For example, the patient may reveal an alcohol
problem, and the psychologist might wish to refer him or her to a specialist in the
assessment and treatment of substance use. During this phase the therapist learns about
the patient and more importantly, the patient learns, what will happen and what is
expected of him.
2. Assessment
Clinical assessment is a way of diagnosing and planning treatment for a patient that involves
evaluating someone in order to figure out what is wrong. In this stage, there are formal
psychological testing & extended interviews. Some psychologists perform formal
assessments for each new patient in their practice. Many clinics, hospitals, prisons, and
other facilities use a standard battery of tests for all persons undergoing psychotherapy. For
example, each adult patient might be asked to complete the Minnesota Multiphasic
Personality Inventory-2 (MMPI-2), Symptom Checklist90-Revised (SCL-90-R), and Projective
Drawings no matter what the presenting problem(s) might be. The gaining insight into
factors that: Led to the development of the problem, Maintenance of problem, Appropriate
strategies for helping the patient obtain relief from problem. The therapist needs to
understand of the nature of problem as well as figure out the diagnosis & direction of
treatment.
3. Development of Treatment Goals
It is important, however, for both patient and psychologist to have some understanding of
the goals that each has in mind so that both parties can work toward the same ends. The
goal set varies from one approach to another. For example, behavioural approach would
focus on the behaviour to be fixed. Once treatment goals are developed then the treatment
plan is outlined to attain the goals. The clinician must integrate information about the
particular person with knowledge of general principles of personality functioning and
psychotherapy and temper his judgements by reasonable expectations as to probable
situations. The goals should be open to change as new understandings emerge or
conditions change. Some psychologists explicitly detail treatment goals with their patients
and use formal instruments to complete this process, others are much more informal about
the development of treatment goals.
4. Implementation of Treatment
Actual treatment provided with the hope of reaching treatment goals. There are Individual,
couple, group, family or group psychotherapy which can weekly, biweekly, or daily sessions.
It differs for Inpatient, outpatient, partial hospitalization. They are different theoretical
orientations & biological, psychological, & social interventions are carried out. Treatment
might include homework, self-help reading, consultation with other professionals.

5. Evaluation of Treatment
It is regularly done during the course of treatment which is to to assess if the treatment is
working effectively or needs to be altered. There are 2 types- Formal (using checklists,
questionnaires, etc.) versus informal assessment (discuss progress of treatment informally
during periodic sessions). Termination or alteration in treatment is determined based on
evaluation.

6. Termination
Psychotherapy is usually terminated once therapy goals are attained. The premature
termination of therapy due to patient’s time or financial constraints, resistance to change,
Job change/move (or even psychologist’s), Change in insurance coverage. A discussion
concerning relapse strategies and a review of psychotherapy progress usually occur during
termination.
7. Follow-Up
Often, follow-up sessions are scheduled or at least offered to the patient to ensure that the
changes achieved during the course of therapy are maintained after treatment is
terminated. Periodical booster sessions might be scheduled to review progress and to work
on problems that emerge later. Follow-up can provide a sense of continuity for patients, and
alleviate the abruptness of termination after an intensive therapy.
Essential Process in Psychotherapy Models of Psychotherapy: Individual Therapy, Group
Therapy, Couples Therapy, Family Therapy

Individual psychotherapy is the most commonly practiced and researched mode of

psychotherapy. Individual psychotherapy involves conversations between a psychologist
and patient who work as a team to help the patient overcome problems, improve insight
and/or behavior, and enhance his or her quality of life. The discussion can focus on the
development of techniques to cope with symptoms (e.g., thought stopping, relaxation),
feelings associated with symptoms (e.g., alienation, fear) or on the actual relationship
between the psychologist and patient (e.g., the transference and counter transference).
Whereas individual psychotherapy for adults involves discussions with a psychologist, for
young children it often incorporates play activities. Play therapy includes activities that are
observed and interpreted by a psychologist. It is assumed that children work though
emotional conflicts in their play, and that themes that develop and become re-enacted
during play sessions assist in the healing process. Play is also used with children to aid
communication and as a distraction to assist children in feeling less self-conscious when
talking about sensitive topics.
Group psychotherapy comes in many shapes and sizes with various goals, techniques, and
objectives. Some groups are conducted in hospital settings and meet daily or several times
per week. Outpatient groups generally meet once per week or every other week. Some
groups are homogeneous, specializing in the treatment of people who share a common
clinical problem (e.g., bulimia, social phobia, alcoholism), whereas other groups are
heterogeneous, with patients experiencing a wide range of concerns and diagnoses. Groups
that are psychoeducational in orientation provide both useful information for patients
experiencing similar problems and an opportunity for group support (e.g., sharing and
expressing feelings and concerns and obtaining feedback from group members). Recently,
much attention has been given to forgiveness groups. These groups include people who may
experience both mental and physical health problems associated with chronic feelings of
anger and bitterness associated with the inability to forgive themselves or others.
The curative factors are- Instilling hope: Other learning and dealing with concerns enhances
hope. Universality: Others share same problems and concerns. Altruism: Helping others
enhances self-esteem and confidence. Interpersonal learning: Learning from others in open
and honest manner. Corrective recapitulation of the Group often takes on a family-like
quality. New ways of primary family: interacting with others helps to improve ways of
dealing with others. Catharsis: Expressing emotions in a safe and trusting manner. Group
cohesion: Feeling connected and close to the group. Development of socializing techniques:
Group provides chance to develop and improve social skills. Imitative behavior: Group
members learning by observing and modeling other group members as well as the group
leader. Existential factors: Group members learn about meaning in life, that life is not always
as you plan, and that feelings of loneliness are common.
Couples psychotherapy is often useful for those experiencing marital or couples discord.
Rather than meeting with one person to discuss problems in the relationship, both parties
meet with the psychologist to work on in vivo issues pertaining specifically to the
relationship (e.g., communication problems, sexual concerns, commitment issues). Couples
therapy includes unmarried as well as married partners; heterosexual as well as homosexual
partners.
Family psychotherapy involves the entire family—parents and children, and sometimes also
grandparents, aunts and uncles, or various subsets of the family (e.g., mother and child dyad
or pair). The goals of family psychotherapy often include improving both communication
between family members and problem-solving strategies. There is often an “identified
patient” (e.g., an adolescent who is acting out), yet treatment focuses on how each family
member is contributing to the maintenance of disharmony within the entire family system.