The 4 phases of Psychotherapy (and their characteristics)
Jul 16, 2021
The purpose of therapy is to ensure that patients enjoy a happier life, developing cognitive skills. The psychotherapy process can be really long, but almost always productive and beneficial for the patient.
This process occurs, fundamentally, in four phases: evaluation, explanation of the diagnosis, treatment and completion of therapy.
Then we will see, in detail, the 4 phases of psychotherapy, in addition to certain factors that influence how long it can end up being.
- Related article: "The 8 benefits of going to psychological therapy"
The 4 phases of psychotherapy, described and summarized
The psychotherapeutic process begins when the patient contacts the therapist, and ends when the therapy is concluded. Although there are discrepancies between manuals, the phases of psychotherapy are, fundamentally, these:
- Assessment and orientation
- Explanation of the diagnostic hypotheses
- Completion of therapy (conclusion and follow-up)
The duration of the first two stages is usually short, comprising at most three sessions in total
Among the factors that influence the duration and how the therapy is given we can find:
- Have received prior therapy.
- Start therapy with a new therapist or start with one you already know.
- The psychological problem to be treated.
- Whether there is a mental disorder and the severity of its symptoms.
- If the person receiving therapy is an individual, a couple, a group, a family ...
- The method and psychotherapeutic approach applied by the professional.
As for the frequency of the sessions, this is given by the specific case. As a general rule, the first sessions of therapy usually have a weekly visit frequency. It is preferred this way so that the patient can reflect and apply the lessons learned in the treatment stage. In the event of a higher frequency of sessions, more than one a week, it would be somewhat unnecessary because it would not accelerate the therapeutic process. These sessions last, on average, about 45 to 50 minutes.
1. Assessment and orientation
The first phase is that of evaluation and orientation. In this, patient and therapist establish the first contact, in which the therapeutic alliance begins to be built. That is to say, it is the beginning of psychotherapy itself, although not of the therapeutic action itself. Here, the psychologist tries to collect as much information as possible about the patient, in order to conceptualize the problem that concerns him.
This part of therapy can be an uncomfortable situation for both the practitioner and the client. This is normal since, on the patient's side, it implies meeting someone new, opening up to someone who, even knowing that he is a professional, does not stop being a stranger. On the other hand, this situation is not comfortable for the psychologist either, since it implies deciding whether or not he can treat the patient, or will have to refer him.
It should be noted that the first impression on the part of the patient can determine many aspects of psychotherapy. In fact, the way in which the contact takes place can keep the therapeutic process going or, if not, ruin it right away. According to research, after the first psychotherapeutic interview, between 15 and 17% of patients do not go to the first session, and about 30% drop out after the first or second session.
In case the patient does come, the psychologist determines if he considers that psychotherapy is adequate or not. This is when you can see what the patient's motivation is. Although it may be strange, there are times when the patient refuses to see her problems and, therefore, is not favorable to change. This can happen if it is a child or adolescent forced by her parents or a person pressured by someone close.
In making contact, the patient has total freedom to ask the therapist about everything he wants to know: therapeutic approach, first diagnostic idea of your problem, experience with people with the same problem, psychodiagnostic skills ...
If the psychologist considers that the problem referred to by the patient is within her capabilities and diagnostic skills, the contract is signed by which he will begin to provide his services.
In addition, he will also take advantage of administer diagnostic tests with the intention of having a more accurate idea of what is happening to the patient. Personality, intelligence, psychopathology questionnaires or those that pertain to the problem that the patient has referred can be applied.
- You may be interested: "What is a psychological evaluation?"
2. Explanation of the hypotheses
Once the first part of the psychotherapy has been passed, that is, the contact and evaluation, we proceed to the explanation of the diagnostic hypotheses. This phase is short, normally lasting one session.
The psychologist, based on the information obtained in the previous phase, presents to the patient his idea of what really happens to him, what possible causes may be behind the problem in question and how they should be worked on. In other words, the patient's problem has been conceptualized and translated into psychological language. It is at this point, as long as the patient's consciousness allows it, that it is decided on what aspect to work on throughout psychotherapy.
3. Completion of therapy
The two previous phases are designed to lay a good foundation for this third phase, that is, the treatment. This is where the progress and improvement of the patient will occur, and it is the fundamental part of psychotherapy, as well as the most difficult. It is during this phase that the professional will demonstrate his technical capabilities in treating psychological problems.
The intention of this phase is to make the patient improve significantly with the passing of the sessions. Here we will work on what has been evaluated in the previous phases, causing the patient to change their belief system, acquire adaptive behaviors and ways of relating to others functional.
It should be said that During the treatment phase, new problems may come to light, which will require reformulating the original conceptualization of the problem.. Also, with the discovery of these new problems, the effectiveness of the treatment may be greater, since the therapist will have knowledge of more phenomena that have impaired the mental stability of the patient.
As new problems come to light, the patient may feel worse than he did at the start of psychotherapy. This is not bad, on the contrary, it is a sign that he is becoming aware of what his problems are, of their origin. Having them in the space of consciousness will allow you to have a better ability to handle them. In this way, the patient will acquire greater control of her life.
Often during the treatment phase the therapist has the patient dramatize the behaviors taught in the consultation, with the intention of seeing if he has actually acquired them. What's more, put homework to do at home or in problem situations. The intention is for the patient to be able to activate, in a natural and adaptive way, the new learning in the real world, allowing him to adaptively relate to the environment and other people.
On average, the treatment phase can last between 10 and 15 sessions, especially in treatments cognitive-behavioral, with 65% of patients beginning to notice improvement after the seventh session.
However, on the other hand, it can be said that, even when treatment is started, there is a risk of abandonment. When no improvement is noticed at the beginning of therapy or, even, there is a feeling of worsening After the third session, about half of the patients abandon therapy before weather.
Once the objectives set in the hypothesis explanation phase have been achieved, or at least most of them, the time has come to end the therapy.
The end of therapy should be done gradually, since, otherwise, it can be a traumatic and counterproductive event. It should be understood as traumatic in the sense that ending such a profound process of self-knowledge suddenly leaves many unknowns. In addition, the patient is someone who has organized the week to be able to go to the consultation, practice the new learnings acquired in it and dramatize them at home. It requires someone to assure him that he has advanced far enough to be able to live on his own.
Ideally, plan the completion of therapy, in the same way that has been done with the entire psychotherapeutic process. Therapy should never be finished in the same session in which the idea arose. It is very difficult to have a clear idea of when psychotherapy will end when starting psychotherapy, but once the moment, the end of the therapy will be something harmonious and beneficial for the patient, organizing it duly.
It is important to understand that you should not be thinking throughout the therapy about when this final moment will arrive, since although it may happen, it is not necessarily recommended. As we have already mentioned, each person is unique and so is the therapy that is applied to them. In the same way that some may require a few months to see great improvements, others will need several years to achieve well-being and, some, due to their psychopathology, will require treatment of for life.
Also the termination of therapy with a psychologist may not be the end of psychotherapy. Sometimes patients find it necessary to change therapists when they think they have reached a limit with one. This may be because you are not comfortable with the therapist or the therapist has already done all he could with the patient. There is also the option of ending therapy with a professional and, in the future, returning to the same consultation.
For it to be considered that the right time has come to end therapy, the following points must be met:
- The patient has improved and satisfied the objectives set.
- The patient has acquired skills that she knows how to use outside of therapy.
- Changes are noted in the patient's relational patterns.
If these points are deemed to have been satisfied, completion of therapy will begin. This does not mean that, once concluded, the patient and the psychologist cannot reestablish contact in the future.. There will always be a follow-up period, in which the therapist makes sure that the patient is well, but giving him more and more autonomy. The follow-up will cease to be carried out if there are sufficient reasons to think that the patient has achieved full autonomy and a fully healthy relational form.
- de Rivera, J. (1992). The Stages of Psychotherapy. Eur. J. Psychiat. 6(1), 51-58.