How is psychological therapy affected by the direction led by the therapist?

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belarafon eNotes educator| Certified Educator

Psychological Therapy, or Psychotherapy, is a form of counseling for patients which focuses on moods, inner thoughts, past events, and goal-oriented exercises. The main aim of all therapy is to lead the patient from a damaged place to a healthy place, whether that be mentally or physically; Psychotherapy tries to bring a patient to a healthy mental state using the therapist's knowledge of human nature, typical and atypical mental issues, and techniques for understanding and acceptance.

Therapies can be doctor-directed or patient-directed. Each method has its own merits and drawbacks, depending on the mental state of the patient and the doctor's field. If the therapy is doctor-directed, the patient will be led through exercises and discussion chosen mainly by the doctor, with the intent of drawing out specific topics or memories for the patient to accept or reject; this type of therapy usually has a specific goal in mind. If the therapy is patient-directed, the doctor will take a more passive approach, allowing the patient to control the flow and nature of each session, which can allow the patient to feel more comfortable and so open up more; this type of therapy is usually more long-term, with no defined goals. Although there are many different schools of psychotherapy, most in practice fall into one of these two types.

Doctor-directed therapy will usually follow a set procedure based on the doctor's expertise and past records of similar cases. By comparing a case to others, and conducting similar techniques, many issues can be dealt with in a sort of "standardised" procedure; a technique that works on Problem A will probably work on the same Problem A in a different patient. This gives the doctor a methodology to work from, and it can be adapted on the fly based on patient reactions while still maintaining a set procedure. Additionally, a case can be studied by multiple doctors and their understanding of the standardised procedures will allow a better understanding of the patient.

Patient-directed therapy is longer-term and relies on the patient's willingness to be counseled and helped. Patients who are not cooperative will often be allowed to lead the direction of the therapy, since they will not follow the doctor's lead; instead, the doctor must probe with careful questioning to find the source of the problem. In this case, methodology is more about allowing the patient to feel comfortable and safe, and so be willing to open their inner thoughts. The course of the therapy may take much longer and be more organic in nature, with breakthroughs coming at random. Case studies of this nature are normally the exception, and will not be helpful in a broader sense to future cases.

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