Psychotherapy is an intentional interpersonal relationship used by trained psychotherapists to aid a patient in problems of living. It aims to increase the individual’s sense of well-being and reduce their subjective sense of discomfort. Psychotherapists employ a range of techniques based on experiential relationship building, dialogue, communication and behaviour change and that are designed to improve the mental health of a client or patient, or to improve group relationships (such as in a family). Psychotherapy may be performed by practitioners with a number of different qualifications, including psychologists, marriage and family therapists, licenced clinical social workers, counsellors, psychiatric nurses, and psychiatrists.

Most forms of psychotherapy use spoken conversation. Some also use various other forms of communication such as the written word, artwork, drama, narrative story or music. Psychotherapy occurs within a structured encounter between a trained therapist and client(s). Purposeful, theoretically based psychotherapy began in the 19th century with psychoanalysis; since then, scores of other approaches have been developed and continue to be created.

Therapy is generally employed in response to a variety of specific or non-specific manifestations of clinically diagnosable and/or existential crises. Treatment of everyday problems is more often referred to as councelling. However, the term counselling is sometimes used interchangeably with “psychotherapy”.

Whilst some psychotherapeutic interventions are designed to treat the patient employing the medical model, many psychotherapeutic approaches do not adhere to the symptom-based model of “illness/cure”. Some practitioners, such as humanistic therapists, see themselves more in a facilitative/helper role. As sensitive and deeply personal topics are often discussed during psychotherapy, therapists are expected, and usually legally bound, to respect client or patient confidentiality. The critical importance of confidentiality is enshrined in the regulatory psychotherapeutic organisations’ codes of ethical practice.

There are several main broad systems of psychotherapy:

• Psychoanalysis – the first practice to be called a psychotherapy. It encourages the verbalisation of all the patient’s thoughts, including free associations, fantasies, and dreams, from which the analyst formulates the nature of the unconscious conflicts which are causing the patient’s symptoms and character problems.
• Cognitive Behavioural – generally seeks by different methodologies to identify and transcend maladaptive cognitions, appraisal, beliefs and reactions with the aim of influencing destructive negative emotions and problematic dysfunctional behaviors.
• Psychodynamic – is a form of depth psychology, the primary focus of which is to reveal the unconscious content of a client’s psyche in an effort to alleviate psychic tension. Although it has its roots in psychoanalysis, psychodynamic therapy tends to be briefer and less intensive than traditional psychoanalysis.
• Existential – is based on the existential belief that human beings are alone in the world. This aloneness leads to feelings of meaninglessness which can be overcome only by creating one’s own values and meanings.
• Humanistic – emerged in reaction to both behaviourism and psychoanalysis and is therefore known as the Third Force in the development of psychology. It is explicitly concerned with the human context of the development of the individual with an emphasis on subjective meaning, a rejection of determinism, and a concern for positive growth rather than pathology. It posits an inherent human capacity to maximise potential, ‘the self-actualing tendency’. The task of Humanistic therapy is to create a relational environment where this tendency might flourish.
• Brief Therapy – is an umbrella term for a variety of approaches to psychotherapy. It differs from other schools of therapy in that it emphasizes (1) a focus on a specific problem and (2) direct intervention. It is solution-based rather than problem-oriented. It is less concerned with how a problem arose than with the current factors sustaining it and preventing change.
• Systemic Therapy – seeks to address people not at an individual level, as is often the focus of other forms of therapy, but as people in relationship, dealing with the interactions of groups, their patterns and dynamics (includes family therapy and marriage counselling).
• Transpersonal Therapy – addresses the client in the context of a spiritual understanding of consciousness.

There are hundreds of psychotherapeutic approaches or schools of thought. By 1980 there were more than 250. By 1996 there were more than 450. The development of new and hybrid approaches continues around the wide variety of theoretical backgrounds. Many practitioners use several approaches in their work and alter their approach based on client need.

Mental health can also be defined as an absence of a major mental health condition (for example, one of the diagnoses in the Diagnostic and Statistical Manual, IV) though recent evidence stemming from positive psychology suggests mental health is more than the mere absence of a mental disorder or illness. Therefore the impact of social, cultural, physical and education can all affect someone’s mental health.

Mental health can be socially constructed and socially defined; that is, different professions, communities, societies and cultures have very different ways of conceptualizing its nature and causes, determining what is mentally healthy, and deciding what interventions are appropriate. Thus, different professionals will have different cultural and religious backgrounds and experiences, which may impact the methodology applied during treatment.

Many mental health professionals are beginning to, or already understand, the importance of competency in religious diversity and spirituality. A person is the sum of all his/her experiences as well as their biological inheritence. Therefore, psychotherapy should look at all these aspects of a persons life in order to understand the background to the issues that a patient presents.