The 4 phases of psychotherapy (and its characteristics)

The goal of therapy is to lead patients to live happier lives by developing their cognitive skills. The process of psychotherapy can be very long, but almost always productive and beneficial for the patient.

This process essentially takes place in four phases: assessment, explanation of diagnosis, treatment and completion of therapy.

Then we will see, in detail, the 4 phases of psychotherapyIn addition to some factors that influence how long it can last.

    The 4 phases of psychotherapy, described and summarized

    The psychotherapeutic process begins when the patient contacts the therapist, And ends when the end of therapy is given. Although there are discrepancies between the textbooks, the phases of psychotherapy are basically as follows:

    • Assessment and advice
    • Explanation of diagnostic hypotheses
    • treatment
    • Completion of treatment (conclusion and follow-up)

    The duration of the first two stages is generally short, comprising a maximum of three sessions in total. However, the treatment itself and the stage of completion of psychotherapy may vary in duration, as each person is unique, and so is the therapy applied to them.

    Among the factors that influence the duration and the way in which the therapy is administered, we can find:

    • Having received prior therapy.
    • Start therapy with a new therapist or start it with an already experienced therapist.
    • The psychological problem to be treated.
    • Whether there is a mental disorder and the severity of its symptoms.
    • If the person receiving the therapy is an individual, a couple, a group, a family …
    • The psychotherapeutic method and approach applied by the professional.

    As for the frequency of the sessions, it is given by the specific case. Generally, the first therapy sessions usually have a frequency of weekly visits. It is therefore preferable that the patient can reflect and apply the learnings achieved at the treatment stage. In the case of a higher frequency of sessions, more than one per week, this would be somewhat unnecessary as it would not speed up the therapeutic process. These sessions last on average about 45 to 50 minutes.

    1. Assessment and advice

    The first phase is assessment and orientation. In this, the patient and the therapist establish the first contact, in which the therapeutic alliance begins to be built. In other words, it is the beginning of the psychotherapy itself, but not of the therapeutic action itself. Here, the psychologist tries to gather as much information as possible about the patient, in order to conceptualize the problem that concerns him.

    This part of the therapy can be a difficult situation for both the professional and the client. This is normal, since, on the patient’s side it’s about meeting someone new, opening up to someone who, although he knows he is a professional, is still a stranger. On the other hand, this situation is not comfortable for the psychologist either, because it involves deciding whether or not to treat the patient or to be referred to him.

    It should be noted that the patient’s first impression can determine many aspects of psychotherapy. In fact, the way that contact is made can cause you to continue the therapeutic process or, alternatively, ruin it as soon as you start. According to research, after the first psychotherapeutic interview, between 15 and 17% of patients do not attend the first session, And about 30% drop out after the first or second session.

    In the event that the patient comes, the psychologist determines whether he considers psychotherapy to be appropriate or not. This is where you can observe the patient’s motivation. Although it may sound strange, there are times when the patient refuses to see their problems and therefore is not in favor of change. This can happen if it is a child or adolescent forced by their parents or a person under pressure from a loved one.

    By making contact, the patient is free to ask the therapist anything 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 the problem with the patient to be within his diagnostic abilities and skills, the contract is signed to begin providing his services.

    In addition, it will also benefit from administer diagnostic tests with the intention of getting a better idea of ​​what is happening to the patient. Personality, intelligence, psychopathology or related questionnaires can be applied depending on the problem referred to by the patient.

      2. Explanation of assumptions

      After the first part of psychotherapy is completed, i.e. contact and assessment, the diagnostic hypotheses are explained. This phase is short, usually during a session.

      The psychologist, according to the information obtained in the previous phase, presents the patient with his idea of ​​what is really happening to him., What are the possible causes of the problem in question and how to resolve them. In other words, the patient’s problem has been conceptualized and translated into psychological language. It is at this stage, whenever the patient’s consciousness allows it, that one decides on which aspect to work on throughout psychotherapy.

      3. End of therapy

      It is believed that the previous two phases lay a good foundation for this third phase i.e. treatment. This is where the progress and improvement of the patient will go, and this is the fundamental part of psychotherapy., At the same time, the more difficult. It is during this phase that the professional will demonstrate his technical capacities in the treatment of psychological problems.

      The intention of this phase is to get the patient to improve significantly over the course of the sessions. We will work here on what has been evaluated in the previous phases, by changing the patient’s belief system, by acquiring adaptive behaviors and ways of relating to other functional ones.

      It goes without saying during the treatment phase, new problems may appear, which will require reformulating the original conceptualization of the problem. In addition, with the discovery of these new problems, the effectiveness of the treatment may be greater, as the therapist will be aware of more phenomena which have altered the mental stability of the patient.

      As new problems appear, the patient may feel worse than he did when he started psychotherapy. This is not a bad thing, in turn it is a sign that they are realizing what their problems are, where they come from. Having them in the space of consciousness will allow you to have a better ability to deal with them. In this way, the patient will have better control over his life.

      It is common for the therapist to ask the patient to dramatize the behaviors taught during the consultation during the treatment phase, with the intention of seeing if he has actually acquired them. Outraged, do homework at home or in problematic situations. The intention is that the patient is able to activate, in a natural and adaptive way, new learning in the real world, allowing him to adapt adaptively to the environment and to other people.

      On average, the treatment phase can last between 10 and 15 sessions, especially in cognitive-behavioral treatments, with 65% of patients starting to notice improvement from the seventh session.

      However, on the other hand, it must be said that, even if treatment is started, there is a risk of abandonment. When no improvement is noted at the start of treatment or even a feeling of worsening from the third session, approximately half of the patients leave the treatment prematurely.

      4. Termination

      Once the goals set in the hypothesis explanation phase have been achieved, or at least most of them, it is time to end the therapy.

      The end of treatment should be done graduallyBecause otherwise it can be a traumatic and counterproductive event. It must be understood with traumatic in the sense of putting an end to such a deep process of self-knowledge which 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 learning that she has acquired and dramatize at home. Someone needs to assure you that you are advanced enough to be able to live alone.

      Ideally, the completion of treatment should be planned, In the same way as for the whole psychotherapeutic process. Therapy should never end with the same session in which the idea was born. It is very difficult to have a clear idea of ​​when psychotherapy will start when it ends, but when the time comes, the end of therapy will be a little harmonious and beneficial for the patient, organizing himself well.

      It is important to understand that one should not think throughout therapy when that last moment will come, because while it can happen, it is not necessarily the recommended one. As we have already mentioned, each person is unique, as is the therapy applied to them. Just as some may take a few months to see major improvements, others will take several years to achieve well-being, and some, due to their psychopathology, will require lifelong treatment.

      too much stopping therapy with a psychologist may not be the end of psychotherapy. Sometimes patients believe it is necessary to change therapists when they believe they have reached a limit with one. This could be either because you are uncomfortable with the therapist or because the therapist has already done all he can with the patient. There is also the possibility of ending the therapy with a professional and, in the future, returning to your same consultation.

      In order for it to be considered that the right time has come to end therapy, the following points must be observed:

      • The patient improved and achieved the set goals.
      • The patient has acquired skills that he knows how to use outside of therapy.
      • Changes in the patient’s relational patterns are noticed.

      If it is considered that these points have been fulfilled, the conclusion of the treatment will be initiated. This does not mean that once concluded, the patient and the psychologist will not be able to reconnect in the future.. There will always be a follow-up period, during which the therapist makes sure that the patient is well, but giving him more and more autonomy. Follow-up will no longer be carried out if there are sufficient reasons to believe that the patient has reached full autonomy and a fully healthy relationship.

      Bibliographical references:

      • de Rivera, J. (1992). The stages of psychotherapy. EUR. J. Psychiat. 6 (1), 51-58.

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