Psychotherapy is the treatment of mental disorders through a structured, professional relationship using psychological methods. It changes thoughts, emotions, behavior, and relationships and, over time, produces measurable changes in brain function. For many conditions (depression, anxiety disorders, PTSD, eating disorders, personality disorders), psychotherapy is as effective as medication, and the combination is often better than either alone.

Who provides it: psychiatrists, psychologists, clinical social workers, counselors, and advanced practice psychiatric nurses. Generalist registered nurses use supportive counseling, psychoeducation, and therapeutic communication, reinforce skills taught in therapy, and help run structured groups.

Common factor: across all approaches, the strength of the therapeutic alliance (trust, agreed goals, agreed tasks) is one of the strongest predictors of outcome.

Before referral or during therapy, the nurse assesses:

• Presenting problem, goals, and motivation for change (stage of change)
• Safety — suicide and violence risk take priority over any therapy
• Cognitive capacity and ability to reflect on thoughts and feelings
• Trauma history (to guide trauma-informed approaches)
• Supports, cultural beliefs about help-seeking, and practical barriers (cost, transport, time)
• Response to therapy: symptoms, function, homework completion, missed sessions (possible resistance)

Key psychodynamic phenomena

Major forms of psychotherapy

Family therapy

In all family systems approaches, the family is treated as a unit and the symptomatic member is often called the identified patient.

Group therapy offers universality, hope, altruism, and interpersonal learning; it is cost-effective and central to substance use and inpatient programs.

Listed in priority order.

1. Assess and monitor safety throughout therapy; exploring painful topics can temporarily increase distress and suicide risk
2. Refer appropriately — match the therapy to the diagnosis (e.g., DBT for recurrent self-harm with borderline personality disorder; trauma-focused therapy for PTSD; IPT or CBT for depression)
3. Support the therapeutic alliance — encourage attendance, explore missed sessions or reluctance without judgment
4. Reinforce skills learned in therapy on the unit or at visits (thought records, DBT skills, relaxation)
5. Recognize transference and countertransference in nursing relationships and seek supervision
6. Psychoeducation about the chosen therapy, expected duration, and the need for active participation
7. Coordinate care — share relevant observations with the therapist within confidentiality rules; combine psychotherapy with medication management when both are prescribed

• Therapy is active work; improvement usually takes several weeks and often requires homework
• Symptoms can feel worse briefly when difficult topics are explored — this is expected; report any suicidal thoughts right away
• Therapy sessions are confidential, with legal limits (danger to self or others, abuse of a child or vulnerable adult)
• Choose a licensed therapist; ask about the approach used and the evidence for your condition
• Online and video therapy can be effective and improves access

• Transference = client's feelings about a past significant person directed toward the therapist; central in psychoanalysis
• Psychoanalysis targets unconscious conflict and insight; CBT targets present thoughts and behavior with homework and shared goals — resolving unconscious conflict is not a CBT goal
• IPT = current interpersonal problems: grief, role disputes, role transitions, interpersonal deficits
• REBT A–B–C: B = belief (irrational belief about the activating event)
• Gestalt empty chair = express and integrate inner conflict
• Reality therapy WDEP: P = plan
• Solution-focused miracle question = imagine the problem solved and describe the difference
• Brief psychodynamic therapy identifies a central conflict early and works within a limited number of sessions
• DBT was developed for borderline personality disorder (Linehan)
• Family therapy: Bowen = differentiation and triangles; structural = boundaries and subsystems; strategic = symptom serves a function, directives
• The therapeutic alliance predicts outcome across all therapies