The 4 stages of Psychotherapy (and their characteristics)

A summary of the different stages of psychological therapy, and the activities they contain.

The purpose of therapy is to enable patients to enjoy a happier life by developing cognitive skills. The process of psychotherapy can be really long, but it is almost always productive and beneficial for the patient.

This process is basically in four phases: assessment, explanation of the diagnosis, treatment and completion of therapy.

In the following we will see, in detail, the 4 phases of psychotherapyIn addition to certain factors that influence in how long it can end up being.

• Article related: "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 at the conclusion of the therapy. Although there are discrepancies among manuals, the phases of psychotherapy are, fundamentally, these:

• Evaluation and orientation
• Explanation of diagnostic hypotheses
• Treatment
• Completion of therapy (conclusion and follow-up).

The duration of the first two stages is usually short, comprising at most three sessions in total.. However, the actual treatment and completion stage of psychotherapy may vary in length, as each person is unique and so is the therapy applied to him or her.

Among the factors that influence the duration and how the therapy is given we can find:

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

As for the frequency of sessions, this is determined by the specific case. As a general rule, the first sessions of the therapy usually have a weekly frequency of visits.. This is preferred so that the patient can reflect and apply the lessons learned during the treatment stage. In case 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. Evaluation and orientation

The first phase is the evaluation and orientation phase. In this phase, the patient and therapist establish the first contact, in which the therapeutic alliance begins to be built. That is, it is the beginning of the psychotherapy itself, although 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 worries him/her.

This part of the therapy can be an uncomfortable situation for both the professional and the client. This is normal, given that, on the patient's side, it implies meeting someone new, opening up to someone who, even though he/she knows he/she is a professional, is still an unknown person.. On the other hand, this situation is not comfortable for the psychologist either, since it implies deciding whether or not to treat the patient or to refer him/her.

It should be noted that the patient's first impression can determine many aspects of the psychotherapy. In fact, the way in which the contact is made can either move the therapeutic process forward or, if not, ruin it as soon as it begins. 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 session.and about 30% drop out after the first or second session.

In case the patient does come, the psychologist determines whether the psychotherapist considers the psychotherapy to be adequate or not. It is here that the patient's motivation can be observed. Although it may be strange, there are times when the patient refuses to see his or her problems and is therefore not in favor of change. This may occur if it is a child or adolescent forced by their parents or a person pressured by someone close to them.

In making contact, the patient is free to ask the therapist about anything he/she wants to know.The psychologist's approach to the patient's problem, first diagnostic idea of the problem, experience with people with the same problem, psychodiagnostic skills...

If the psychologist considers that the problem referred by the patient is within his diagnostic skills and competences, he proceeds to sign the contract by which he will start providing his services.

In addition, he/she will also take the opportunity to administer diagnostic tests in order to get a more precise idea of what is wrong with the patient.. Questionnaires of personality, intelligence, psychopathology or those that pertain depending on the problem that the patient has referred can be applied.

2. Explanation of the hypotheses

Once the first part of the psychotherapy has been completed, that is, the contact and evaluation, we proceed to the explanation of the diagnostic hypotheses. This phase is brief, usually lasting one session.

The psychologist, on the basis of the information obtained in the previous phase, presents to the patient his or her idea of what is really happening to him or her, what possible causes may be behind the problem in question and how it should be addressed.What possible causes may be behind the problem in question and how they should be addressed. 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 conscience allows it, that a decision is made as to what aspect will be worked on during the psychotherapy.

3. Completion of the therapy

The two previous phases are designed to lay a good foundation for this third phase, i.e. the treatment. This is where the patient's progress and improvement will occur, and it is the fundamental part of psychotherapy, as well as the most difficult one.and at the same time the most difficult. It is during this phase that the professional will demonstrate his technical skills in the treatment of 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, making the patient change his or her belief system, acquire adaptive behaviors and functional ways of relating to others.

It should be noted that during the treatment phase new problems may come to light, which will require a reformulation of 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 be aware of more phenomena that have damaged the patient's mental stability.

As new problems come to light, it is possible that the patient may feel worse than he/she did at the beginning of the psychotherapy. This is not a bad thing; 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 him to have a better capacity to manage them. In this way, the patient will acquire greater control of his life.

It is frequent that during the treatment phase the therapist makes the patient dramatize the behaviors taught in the consultation, with the intention of seeing if he/she has really acquired them. In addition, the therapist will give homework to do at home, will give homework to do at home or in problem situations.. The intention is that the patient manages to activate, in a natural and adaptive way, the new learning in the real world, allowing him/her to relate adaptively with the environment and other people.

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

However, on the other hand, it must be said that, even when treatment is started, there is a risk of abandonment.. When no improvement is noted at the beginning of therapy, or even when there is a feeling of worsening after the third session, about half of the patients drop out of therapy prematurely.

4. Termination

Once the objectives 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 the therapy should be done in a gradual way.otherwise it can be a traumatic and counterproductive event. Traumatic should be understood in the sense that ending such a deep process of self-knowledge suddenly leaves many unknowns. In addition, the patient is someone who has organized the week in order to be able to go to the consultation, practice the new learning acquired there and dramatize it at home. He needs someone to reassure him that he has made sufficient progress to be able to live on his own.

Ideally, the end of therapy should be planned in the same way that it has been planned in the past.The ideal is to have the end of therapy planned in the same way that the entire psychotherapeutic process has been planned. Therapy should never end in the same session in which the idea arose. It is very difficult to have a clear idea at the beginning of psychotherapy when it will end, but when the time comes, the end of therapy will be harmonious and beneficial for the patient, organizing it properly.

It is important to understand that one should not be thinking throughout the therapy about when this final moment will come, since although it may occur, it is not necessarily recommended. As we have already mentioned, each person is unique and so is the therapy that is applied. In the same way that some may require a few months to see great improvements, others will need several years to achieve wellness and some, due to their psychopathology, will require lifelong treatment.

Also it may be that the completion of therapy with a psychologist is not the end of psychotherapy.. Sometimes patients find it necessary to change therapists when they feel they have reached a limit with one. This may be either because they are not comfortable with the therapist or the therapist has already done all they can with the patient. There is also the option of ending therapy with a professional and, in the future, returning to the same practice.

In order to be considered the right time to end therapy, the following points must be met:

• The patient has improved and satisfied the stated goals.
• The patient has acquired skills that he/she knows how to use outside therapy.
• Changes in the patient's relational patterns are noted.

If these points are considered to have been satisfied, the conclusion of therapy will be initiated. This does not mean that, once concluded, the patient and the psychologist cannot re-establish contact in the future.. There will always be a follow-up period, in which the therapist makes sure that the patient is doing well, but giving him/her more and more autonomy. Follow-up will be discontinued if there is sufficient reason to believe that the patient has achieved full autonomy and a fully healthy relational form.

Bibliographical references:

• de Rivera, J. (1992). The Stages of Psychotherapy. Eur. J. Psychiat. 6(1), 51-58.