Health & Fitness

Psychotherapy is not one size fits all … Or is it?

Psychotherapy involves the application of clinical methods and interpersonal interactions to help people modify their behaviors, thinking patterns and emotions, in order to achieve a desired level of function and quality of life. It is a collaborative treatment based on the relationship between an individual and their therapist, and research has repeatedly demonstrated that it is an effective treatment for a broad variety of mental illnesses and emotional difficulties.

Every individual’s reason for seeking psychotherapy is unique, but common themes exist: a profound sense of helplessness, hopelessness, sadness, challenges carrying out responsibilities at work, worrying excessively, always expecting the worst and relationship difficulties. Additionally, individuals may choose psychotherapy for purposes such as loving and accepting oneself more, understanding one’s purpose in life, and for an opportunity to explore and get to know oneself at a deeper level.

Stefania Prendes-Alvarez, M.D., MPH, is a fellow in psychiatry at University of Miami Health System. Photo provided to the Miami Herald

Different psychotherapies propose a variety of theories for helping patients reach their treatment goals. Cognitive behavioral therapy is based on the theory that how an individual perceives a situation is more closely connected to their reaction than the situation itself. Thus, the therapist works closely with the patient on changing his or her unhelpful thinking patterns and behaviors, to achieve subsequent improvement in mood and functioning.

Interpersonal therapy is grounded on the notion that interpersonal factors are underlying the patient’s psychological distress. It deals primarily with the way the patient interacts with others around him or her by helping the patient identify and express emotions. Psychodynamic psychotherapy, also known as insight-oriented therapy, focuses on revealing unconscious processes as they are manifested in the present. A primary goal is for the patient to gain self-awareness and an understanding of the influence of the past on present behavior. Lastly, supportive therapy aims at helping patients maintain their level of function via listening, advising, encouraging and reassuring.

Saveanu Radu
Radu V. Saveanu, M.D., is professor and executive vice chair in the Department of Psychiatry at UHealth, the University of Miami Health System. Photo provided to the Miami Herald

Even though there are many psychotherapies, research suggests that all therapies may be equally effective, suggesting that there are common factors among them. The most widely reported common factor is the therapeutic alliance, defined as the working relationship between patient and therapist during treatment. The quality of this therapist-patient relationship is arguably the strongest predictor of how effective any form of psychotherapy will be. A good therapist will facilitate the development of this alliance by creating a safe, reflective space for the patient to open up about his/her internal state, while simultaneously offering realistic optimism. Furthermore, a strong therapeutic alliance will support the patient’s journey through the different stages of change: from symptoms with vague awareness, to understanding/insight, to ultimate symptom resolution with a deeper understanding of oneself.

Psychotherapy, like medications, affects the brain. Recent advances in brain imaging further support the idea of common factors among different psychotherapies. Brain imaging studies, performed at the completion of several different psychotherapy treatments, show that the brain is similarly altered in patients.

So perhaps one should not only ask “what psychotherapy is best for me?” but also “which therapist is best for me?” For when a strong therapist-patient relationship can facilitate curiosity and self-reflection, insight and understanding follow, with subsequent resolution of symptoms and increased life satisfaction. To schedule an appointment with a mental health professional at the University of Miami Health System, call 305-243-6400.

Radu V. Saveanu, M.D., is professor and executive vice chair in the Department of Psychiatry at UHealth – the University of Miami Health System, and Stefania Prendes-Alvarez, M.D., MPH, is a fellow in psychiatry.