The course of psychotherapy – contracts, goals, methodology, duration

Proven content

Psychotherapy is a complex process based on a contract between the patient and the therapist. This kind of agreement allows you to plan the course of therapy, set priorities and goals that we want to achieve before its completion. How long can psychotherapy last? What is talking to a psychotherapist, problem solving and developing new behavior patterns?

Psychotherapy – a complex therapeutic process

Psychotherapy comes in many different forms, and its course is dictated by the patient’s needs and the methodology proposed by the specialist. We can work on a specific difficulty in the short term or plan long-term actions to solve deep-seated problems. Individual work or in the form of group psychotherapy is also used.

Each therapeutic process has a different course, but it is possible to outline a general scheme of action on which the effectiveness of the treatment depends. The main issue is to diagnose the patient. Once the specialist has determined the type of disorder or the category of the problem, this will facilitate the initial targeting of therapy to more closely investigate the causes of its development. However, it takes time to discover the essence of the problem and develop a mechanism of dealing with ailments or destructive reactions.

After the diagnosis is made, a therapeutic contract is developed. This means that we set goals and time to achieve them. In some cases, the exact number of visits is not specified – this is mainly the case long-term psychotherapy. The method used during therapeutic sessions depends on the specificity of the problem, but its main element is a conversation with a psychotherapist.

The course of psychotherapy – contracts

assumptions psychotherapeutic contract is established on the basis of a diagnosis, which nevertheless remains only a starting point. Establishing a diagnosis usually requires at least several consultations. Only then the further course of therapy is planned and the contract is formulated – orally or in writing. Subsequent sessions allow the specialist and the patient to gradually explore the nature of the problem.

The main assumption of the contract between the patient and the psychotherapist is to define the goals that we want to achieve during the session. The patient comes to a psychological or psychiatric consultation for specific reasons. When he comes to psychotherapy, he sometimes knows exactly what ailments make it difficult for him to function in specific spheres of life. Then it is easier to determine to which the effects of therapy one should strive. There are times, however, where the patient’s current status makes it impossible to determine the nature of the problem – then general goals can be set and then modified over time.

Terms of the psychotherapeutic contract they depend on the type of therapy, but some elements are essential regardless of the circumstances. We are talking about consent to cooperation, issues related to confidentiality, working methods or rules for termination of cooperation. Formal issues are always determined, including the duration of each session, the frequency of meetings and the terms of their cancellation, as well as the price of the visits. For group meetings, it is important to keep any information about other meeting participants to yourself and not to socialize with them.

Psychotherapy always requires the involvement of the patient and the therapist. A person attending psychotherapy must also be aware that during the sessions they will receive help and support, but the vast majority of mental work belongs to them. The psychotherapist should inform the psychotherapist about the possible effects of the treatment process and other important issues.

The course of psychotherapy – goals

As part of the therapeutic contract, certain goals are outlined to which we pursue during subsequent meetings. It is they that give direction to psychotherapeutic sessions and form the overall framework of the session. In practice, it may be necessary to modify the goals during the treatment process. Aims of psychotherapy is determined on the basis of:

1. patient expectations;
2. patient’s motivation that led to the decision to start treatment;
3. current psychophysical state;
4. the nature of the disorders (e.g., addiction, depression, PTSD, psychotic disorders);
5. patient’s environmental and cultural conditions;
6. the patient’s ability to analyze their own feelings, mental states and thoughts;
7. the chosen method of psychotherapy.

As for the specific goals depending on the method of treatment, they may look like this:

1. psychodynamic psychotherapy – improving well-being and getting rid of symptoms by releasing suppressed emotions, learning about their sources, understanding your needs and impulses driving behavior, developing new defense mechanisms and greater self-awareness;
2. cognitive-behavioral psychotherapy – understanding patterns of thinking and perceiving reality that are irrational and contribute to the appearance of symptoms that are burdensome for the patient; becoming aware of the influence of the environment and experiences on behavior, learning to solve problems and adapt to different life situations;
3. Gestalt psychotherapy – becoming aware of and reacting to emotions, changing the way of thinking about the future, reducing anxiety and acquiring the skills needed to deal with uncertainty and face problems;
4. systemic therapy (family therapy) – working on emotional relations between family members, changing the way of communication, marking boundaries between family members and their roles, modifying the functioning of the family as a whole.

The course of psychotherapy – methodology

In practice, the basis for the course of psychotherapy is a conversation, but the methods of conducting the sessions depend on the type of psychotherapy. Possible actions and activities can be discussed by the psychotherapist with the patient. The conversation during the meetings takes place in different ways, because different dialogue techniques are used (e.g. the empty chair technique), sometimes the therapist is active, other times passive and is limited to asking questions. An additional element of psychotherapy There are also homework assignments, thanks to which the patient learns how to break certain behavior patterns or trains certain skills to react in social situations.

During psychotherapy, we can come across techniques aimed at learning to solve problems, new ways of reacting or a different way of thinking. The therapist can also implement assertiveness training or relaxation training, as well as propose other types of therapeutic activities, e.g. art therapy or therapy with animals (dog therapy, hippotherapy).

The course of psychotherapy – duration

The duration of psychotherapy depends on the complexity of the problem. If the patient wants to deal with a specific problem, the proposed solution is short-term therapy involving a minimum of several sessions. Already when formulating the contract, it is possible to arrange a specific number of meetings (often from 10 to 40), which motivates to work and implement the action plan. In the case of deeply rooted problems and behavior patterns that are difficult to break, long-term therapy, which may last up to several years, turns out to be more effective. Then it is not agreed on a specific one the date of completion of psychotherapybut focuses on current work and in line with current needs.

Appropriately selected type and duration of psychotherapy therapy allow for the effective implementation of the set goals and the achievement of long-term effects. Each psychotherapy has its limitations, so you should approach this form of treatment with realistic expectations, so as not to be disappointed.

References:

1. Aleksandrowicz J., Czabała C., J. Fundamentals of psychotherapy, [In:] Psychiatria. T. 3, Treatment methods, ethical, legal, public and social issues, Wciórka J., Pużyński S., Rybakowski J. (eds), Elsavier, Wrocław 2012, 256-265.

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