How does psychotherapy work?

There are two different levels at which this question must be answered: the mental level and the neurological level.

At the mental level we observe that as patients acquire deep emotional understanding of themselves they have more mental instruments to modify their way of being, feeling and behaving so that these may be beneficial to their quality of life. Knowing oneself implies undoing sterile behavioral patterns, dissolving chronic symptom formations, discovering new potentialities, allowing oneself to satisfy deep needs, and knowing how to take care of the more vulnerable aspects of the self.

At the neurological level recent investigations in neuropsychiatry using computerized axial tomography (CAT) and nuclear magnetic resonance (NMR) have shown that the synaptic structure, the density of certain neuron bundles and the prevalence of particular neurotransmitters in the brain change during psychotherapy. These results were to be expected since a person’s mind is not an abstract entity separated from the body, but rather the result of the extraordinarily complex interaction between physical parts of the brain.

For the moment, the exact mechanisms that mediate between the self-knowing process of psychotherapy and the structural changes in the brain’s inner architecture are unknown, but the empirical data indicate that they exist. As research continues we will learn more.

How many sessions a week are necessary?

Psychotherapy can take place one, two, three, four or five times a week. There exist various clinical situations in which a high frequency of sessions per week is counter-indicated, but, in general, psychotherapy is quite like any other discipline: the more one works, the better the possibilities of achieving important change.


Face to face or couch?

The couch can be a useful work instrument in order to give the patient more freedom to be in contact with herself or himself instead of paying attention to the therapist.

However, couch work is not always indicated, and in many cases it is more beneficial for the patient to be able to physically see the therapist.


How long does psychotherapy last?

The human mind is one of the most hyper-complex, and idiosyncratic, objects of study that exist; thus, its careful exploration cannot be fast. The time needed to understand oneself, to comprehend where emotional problems come from, to recognize counter-developmental relational patterns and bring about the necessary changes usually implies some years.


When does psychotherapy finish?

Adult psychotherapy finishes when both the patient and the therapist agree that the patient enjoys a quality of life that is good for him or her.

Child and adolescent psychotherapy finish under the same conditions as that of adults except that three parties must agree: the patient, the parents and the therapist.


Medication: what is it and why use it?

The development of psychotropic drugs in the fifties meant an enormous advance in psychiatry, and allowed many patients to go back to a decent quality of life. Since then, research in the field has developed considerably and the new generations of drugs are more effective and have fewer side effects.

Psychotropic drugs act on brain chemistry, modifying the intensity, the transmission frequency and the interaction of neurotransmitters in order for the patient’s affective state to improve. They are the fastest remedy that exists to reduce symptom intensity, but they do no have long-term effects. If they are the patient’s only therapeutic means, it is probable that when he or she stops taking them the old symptoms will reappear, unmodified. With certain exceptions, every pharmacological treatment must be secondary to a psychotherapy whose goal is to produce stable long-term change.

The use of medication is indicated when the intensity of the symptoms is such that the patient cannot take on his or her minimum obligations, such as work or family life. A psychiatrist or a psychologist can assess the need for medication, but only a psychiatrist can prescribe. If a psychologist should consider that medication is indicated he will refer the patient to a psychiatrist. Efforts will be made for medication use to be limited in time until the patient is well enough to be able to take on her or his life without it.


Is the origin of emotional problems organic or environmental?

Current research with monozygotic twins that have been separated at birth suggests that the answer lies in an extremely complex interaction between certain organic ––genetic or epigenetic–– factors, and the environment. The more serious the emotional problems, the more it seems that there may exist certain predispositions towards that pathology. A predisposition is not determining and only results in pathological development if it is combined with an unfavorable environment.


What is the difference between a psychiatrist, a clinical psychologist, a psychotherapist and a psychoanalyst?

Psychiatrist: This is a person who has undertaken higher studies in medicine, specializing in psychiatry, the discipline that is geared towards the prevention, evaluation, diagnostic, treatment and rehabilitation of mental disorders. In order to be a clinical specialist, a psychiatrist in Spain will have done the MIR residency training program in the Public Mental Health sector. The fundamental difference between a psychologist and a psychiatrist is that the latter has been trained to recognize medical conditions that could be affecting the patient’s mental state, and, as a doctor she or he can prescribe medication if necessary. If a psychiatrist should also practice as a psychotherapist, he or she will have undergone long and exacting training in one of the schools of psychotherapy.

Clinical Psychologist: This is a person who has undertaken higher studies in psychology, the discipline that studies the behavior and the mental processes of human beings and animals. She or he will have specialized in the clinical branch of psychology, which is the field that directs the study, diagnosis and treatment of psychological problems or disorders in order to increase the patient’s wellbeing, emphasizing the search for knowledge. A psychologist in Spain will also have done a PIR residency training program in the Public Health sector, or an equivalent program in the private mental health sector. He or she will also have undergone long and exacting training in one of the schools of psychotherapy.

Psychotherapist: This is a person that has undertaken higher studies in psychiatry, psychology, or, sometimes, social work, and who works to alleviate the emotional suffering of patients. He or she will also have undergone long and exacting training in one of the schools of psychotherapy. There currently exist many branches of psychotherapy, though they all spring from five main schools: psychoanalysis, systemic therapy, humanistic therapy, behaviorism and cognitivism. These schools have training programs of differing intensity and depth.
           
Psychoanalyst: This is a person who has undertaken higher studies in psychiatry, psychology, or sometimes, adjacent disciplines, and that has undergone long and exacting training in the psychotherapeutic modality called psychoanalysis. Psychoanalysis is a discipline that was created by Sigmund Freud (1856-1939) in order to help patients discover the unconscious reasons for their difficulties and, thus, free themselves of them. Psychoanalysis has developed enormously since its creation, and there currently exist many schools specialized in extremely precise aspects of mental functioning.          

                       
What are the ethical principals of psychologists?

The following page of the American Psychological Association contains complete information on the matter: http://www.apa.org/ethics/code2002.html