The 4 Phases of Psychotherapy (and Their Characteristics)

The purpose of therapy is to help patients enjoy a happier life by developing cognitive skills. The psychotherapy process can be really long, but it is 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.

Next We will see, in detail, the 4 phases of psychotherapy in addition to certain factors that influence how long it may end up being.

Table of Contents

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:

The duration of the first two stages is usually brief, comprising, at most, three sessions in total However, the treatment itself and the completion stage of psychotherapy can vary in duration, since each person is unique and so is the therapy applied to them.

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

Regarding the frequency of the sessions, this is determined by the specific case. As a general rule, The first therapy sessions usually have a weekly visit frequency This is preferred so that the patient can reflect and apply the learning learned in the treatment stage. If there were more frequent sessions, more than one a week, it would be somewhat unnecessary because it would not speed up the therapeutic process. These sessions last, on average, about 45 to 50 minutes.

1. Evaluation and orientation

The first phase is evaluation and orientation. In this, patient and therapist establish the first contact, in which the therapeutic alliance begins to be built That is, 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 or her.

This part of therapy can be an uncomfortable situation for both the professional 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, is still a stranger On the other hand, this situation is not comfortable for the psychologist either, since it involves deciding whether or not he can treat the patient, or will have to refer him.

It should be noted that the patient’s first impression can determine many aspects of psychotherapy. In fact, the way in which contact is made can make the therapeutic process continue or, otherwise, 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% quit after the first or second session.

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If the patient does come, the psychologist determines whether he or she considers psychotherapy appropriate 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 their parents or a person pressured by someone close to them.

At the time of contact, The patient has complete freedom to ask the therapist about anything they want 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 that the patient refers to is within his or her diagnostic capabilities and competencies, he or she proceeds to sign the contract by which he or she will begin to provide his or her services.

In addition, it will also take advantage of administer diagnostic tests with the intention of having a more precise idea of what is happening to the patient Personality, intelligence, psychopathology questionnaires or those that pertain to the problem that the patient has mentioned can be applied.

2. Explanation of the hypotheses

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

The psychologist, based on the information obtained in the previous phase, presents to the patient his idea of what is really happening to him, what possible causes may be behind the problem in question and how they should be worked on. That is, 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 which aspect will be worked on throughout the 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 patient’s progress and improvement will occur, and is the fundamental part of psychotherapy, at the same time the most difficult. It is during this phase that the professional will demonstrate his technical capabilities in the treatment of psychological problems.

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The intention of this phase is to make the patient improve significantly as the sessions progress. Here what has been evaluated in the previous phases will be worked on, making the patient change their belief system, acquire adaptive behaviors and functional ways of relating to others.

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, given that the therapist will be aware of more phenomena that have harmed the patient’s mental stability.

As new problems come to light, the patient may feel worse than he or she did at the beginning 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 manage them. In this way, the patient will acquire greater control of her life.

It is common that during the treatment phase the therapist has the patient dramatize the behaviors taught in the consultation, with the intention of seeing if they have really acquired them. Besides, 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, new learning in the real world, allowing him 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 after starting treatment, there is a risk of abandonment When no improvement is noted at the beginning of therapy or there is even a feeling of worsening after the third session, about half of the patients abandon therapy prematurely.

4. Termination

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 could 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. Furthermore, the patient is someone who has organized the week to be able to go to the consultation, practice the new learning acquired there and dramatize it at home. He requires someone to assure him that he has made enough progress to be able to live on his own.

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

It is important to understand that you should not be thinking throughout the therapy about when this final moment will come, given that although it may occur, it is not necessarily recommended. As we have already mentioned, each person is unique and so is the therapy 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 lifelong treatment.

Also It may be that the termination of therapy with a psychologist is not the end of psychotherapy Sometimes patients find it necessary to change therapists when they believe they have reached a limit with one. This may be because you are not comfortable with the therapist or the therapist has already done everything he could with the patient. There is also the option of finishing therapy with a professional and, in the future, returning to the same office.

For it to be considered that the right time has arrived to end therapy, the following points must be met:

If it is considered that these points have been satisfied, the conclusion of the therapy will begin. 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 well, but giving him/her more and more autonomy. Follow-up will stop if there are sufficient reasons to believe that the patient has achieved full autonomy and a fully healthy relational form.