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Almost everyone has an innate tendency for good health and many people recover  naturally from functional mental disorders.   This has been reported to occur among about one in three psychiatric patients suffering the milder forms of disorder while they are waiting for a first appointment.    Possible reasons include a determination to recover and the right kind of support from family,  friends, colleagues and so on.    An unexpected change of circumstances may also help.   

But the other two of the three may need more dedicated help from someone who specialises in helping people with mental disorders by means of psychotherapy, a word derived from the ancient Greek (psyche = mind; therapeia = service) and a holistic approach to functional mental disorders.

Partly because of its association with Sigmund Freud and psychoanalysis, psychotherapy is often regarded as a medical treatment, but the the function of  psychotherapy practicians differs from that of their medical counterparts because it does not comprise systematic diagnoses, categorisation and standardised treatments.   Instead, their function comprises helping clients unravel the causes of their disorder so that they, the clients, can decide how best to deal with them.
'Psychotherapy facilitates the remission of symptoms.   It not only speeds up the natural healing process but also often provides additional coping strategies and methods for dealing with future problems.'

M.J. Lambert & A.E. Bergin 'The effectiveness of psychotherapy' in Handbook of psychotherapy and behavior change. A.E. Bergin & S.L. Garfield (eds) 4th Edn, Wiley, New York 1994

Psychotherapy is not an easy option and, because it is not based on a universally acknowledged body of knowledge, it cannot legitimately be described as a 'learned profession' with a career structure.   Moreover, it is not a mysterious or magic cure and (pace Freud) it is not a science, but a craft!    Simply, it involves one or more structured conversations during which client and practician explore the client's mental, psychological, emotional, spiritual or existential difficulties and possible ways of resolving them.

Confusion tends to arise because psychotherapy is sometimes called 'counselling' which, although similar in some ways, consists largely of offering advice and/or consolation and comfort, whereas psychotherapy only offers solace when clients are deeply distressed and rarely includes casual conversation because its main aim is to help clients determine the best way of dealing with their difficulties by learning more about themselves and their circumstances as a basis for  self-help;  perhaps also, as part of that process to search for their real personality instead of the false version with which their culture may have invested them.

Psychotherapy practicians attach little or no significance to the mental illness categories used by many psychiatrists.   Instead, they encourage clients to concentrate on their reasons for seeking help — such as unwanted addictive or anti-social behaviour; chronic depression; self-harm or suicidal thoughts; anxiety; breathlessness; poor concentration; difficult relationships; emotional isolation; forgetfulness; frequent headaches, indigestion, infection or skin problems;  hearing voices; irritability; lack of confidence; nightmares;  panic attacks; poor appetite, poor sleep or sleep terrors ...

'... life itself is the best therapist.   What (psycho) analysis can do is to make one able to accept the help that life offers
and to profit from it.’
(Karen Horney,  p. 211 Self-Analysis.  W.W. Norton & Co., New York & London 1968)

When client and practician have established the reason(s) why the client needs help, the practician is likely to suggest that they decide which needs to be addressed first, while allowing for the fact that the client may later wish to change the order of priority.

Once these or other symptoms of disorder have been clearly identified, client and practician behave as fellow workers and  try to tease out  the underlying causes so that they can then discuss possible ways  of removing or modifying them — and even perhaps in the most difficult cases of learning to adapt to them!   The practician's main function is then to try to see the client's situation as the client sees it and to feel as the client feels about it.   S/he may then be better able to understand  and perhaps challenge any fixed way of thinking that the client seems .to have developed as a result of incidents and circumstances that the client either imagined or truly experienced.

Karen Horney once compared psychoanalysis to climbing a difficult mountain, guided by someone who is not too certain of the way because, although experienced in mountain climbing, s/he has not climbed this particular mountain before.  
Another analogy would be that of a research project in which the main topic of enquiry is the client's confused state.

 p. 14 Self-Analysis. W.W. Norton & Co., New York & London 1968

As Sol L. Garfield pointed out, the efficacy of psychotherapy does not depend only or even primarily on what practician and client discuss in their meetings, but on what the client does or perhaps fails to achieve between their meetings, because the purpose of their meetings is mainly to provide opportunities to discuss what the client has found or thought about since the previous meeting, thus comparable to seminars or tutorials.
'Whoever acquires knowledge  and does not practise it resembles him who ploughs his land  and leaves it unsown.'  

'Eclectic Psychotherapy' p.177 in Handbook of Psychotherapy Integration. John C. Norcross & Marvin R. Goldfried (eds)] Basic Books, New York 1992

Sa'di Gulstan, 1258 CE

During the psychotherapeutic process, clients may discover some unwelcome truths about themselves and thereby incur distress that they had not anticipated!   For example, the practician may suggest that progress towards a solution is being obstructed by one or more of the client's firmly-held beliefs; or s/he may question whether the client's plan of action will achieve its objective, thus prompting the client to feel resentment or, at best, extreme disappointment. 
Such risks cannot be avoided if the psychotherapeutic process is to have a positive outcome.   The practician will probably have warned the client of  the possibility and, if it arises, do what s/he can to soften the impact so that it can be more easily absorbed.   Even if it strains their relationship, the practician's moral duty entails upholding their contract.

Psychotherapy will not relieve the symptoms of mental disorder if there is any reason to suppose that the underlying cause is physical.   In such cases, intending clients should seek medical advice before considering psychotherapy.   They can reasonably assume that their disorder is mental only if no physical cause has been established; but  the doctor, like the patient, should distinguish clearly between physical and non-physical symptoms.    Depression, anxiety, morbid thoughts, irritability, phobias and nightmares, for example, are mental, not physical, symptoms.   

Because it is based on the principle of self-help, psychotherapy is unlikely to help people who want relief from their suffering without incurring real effort or risk.   For the process to be worthwhile, clients must be prepared to question their beliefs and try out new ideas.  
If they falter and question whether it is worth continuing, the practician will probably try to encourage them by pointing out any progress they have already made, but s/he will not subject them to undue pressure to continue. 

The efficacy of psychotherapy has often, and rightly, been questioned.   Measurement is difficult because the cases of people who have found it helpful and the cases of those who have not found it helpful are seldom recorded by public health services.  
Also, because the objectives of medical intervention and psychotherapy differ, attempts to measure their comparative efficacy are unrealistic.    In medicine, for example, efficacy is usually measured by a reduction of patients' symptoms.   Such factors as the ability to maintain a steady job and/or a network of personal relationships tend to be overlooked.   

Another factor limiting accurate measurement is that the meaning of the word 'efficacy' varies from person to person and from situation to situation.   What, for instance, was  the therapy intended to achieve?   Was the objective realistic?   Who decided the objective: the client, the consultant, or the client's advisers?

All we can realistically do is compare the proportion of people who we know have been helped by psychotherapy with the proportion of those who we know were not!    On this crude criterion, reviews of many reported studies, such as the following, suggest that psychotherapy works at least as well as other remedies.

For more information, without obligation, telephone: 01773 833267 (24 hours). All calls are confidential.