'The question is not how to be cured; the question is how to live.' (Joseph Conrad)

The holistic approach

Because of their innate tendency for good health, many people recover spontaneously from functional mental illness.   This has been reported to occur among about one in three psychiatric patients suffering from milder forms of the illness while waiting for their first appointment with a consultant; mainly perhaps because they are determined  to recover.⁽¹⁾     Perhaps also because they have the right kind of support from family and friends, from books, audio tapes, magazines and so on.   An unexpected change of circumstances may also help.   
But they may recover more quickly and lastingly if they engage the services of a consultant who specialises in helping people with mental illness.

Psychotherapy

* For an explanation of the term 'mind', see the page Mental Illness. 

The word 'psychotherapy' is often misunderstood.   It derives from ancient Greek (psyche=mind; therapeia=service).   Partly because of its association with Sigmund Freud and psychoanalysis, it is often regarded as a medical treatment.   For  that reason, many people refer to it as  'counselling' which, although in many ways similar, actually means advising.   
True psychotherapy, by contrast, consists of a joint study by the client and consultant, or 'therapist', of the client's mind.   It could more accurately, therefore, be called 'mind consultancy'.*   It is thus a a form of self-help by one or more dialogues aimed at increasing clients' knowledge of themselves and their mental/emotional perplexity.   

Not a medical consultation

‘... life itself is the best therapist.   What (psycho) analysis can do is to make one able to accept the help that life offers and to profit from it.’ Karen Horney ⁽²⁾

Psychotherapy consultants attach little or no significance to the mental illness categories used by many medical practicians.   Instead, they encourage their clients to concentrate on their reasons for seeking help, with a view to discovering what is really troubling them.    
Unlike medicine, psychotherapy does not consist of a standard series of steps intended to help the consultant determine the cause(s) of the disorder and prescribe treatment.   Diagnosis and treatment are determined by the client(s) and the consultant acting as co-workers.

Psychotherapy is not an easy option.   It does not comprise consoling or comforting, although support of that kind may be offered as part of the process, especially at first.    It involves one or more structured conversations during which client and consultant explore the client's mental, psychological, emotional, spiritual or existential difficulties and discuss possible ways of resolving them.
The consultant, or 'psychotherapist', may begin the process by suggesting that they decide which areas of their joint study they need to examine in detail.    By careful listening and reflection, s/he tries to see the difficulties as the client sees them.   Only then, can s/he suggest explanations that may have been overlooked and possible ways of dealing with them. 
This continues until clients decide they have acquired all the information and skill they need to continue alone.

Analogies

(I believe) that significant change in the client occurs or is achieved in the client's actual social environment and not in the consulting room.' Sol L. Garfield ⁽³⁾

Karen Horney compared psychotherapy to climbing a difficult mountain, guided by someone ‘who is not too certain of the way,  because, although experienced in mountain climbing, s/he has not climbed this particular mountain (before).’ (4)

Another analogy is that of a research project in which the main topic of enquiry is the client's confused state.   What clients do between the consultations is more important than the consultations, because these are intended mainly as opportunities to discuss what clients have discovered and thought about since the previous meeting.

Limitations

During the process, clients may discover some unwelcome truths about themselves; thus incurring some unanticipated distress!   For example, the consultant may suggest that the clients’ long-term interests might be better served by questioning their firmly-held beliefs, or perhaps by doubting whether the action they intend will achieve their objective.  This can lead to resentment or severe disappointment. 
Although such risks cannot be avoided in the interest of a successful outcome, their impact can be softened and absorbed.   Conscientious consultants warn clients of this possibility and, even if strains the relationship, they do not abandon the client.

Other disadvantages

Psychotherapy will not relieve the symptoms of mental disorder if a physical cause is possible.   If so, intending clients should seek medical advice before considering psychotherapy.   They can reasonably assume that their illness is mental, only if no physical cause can be established. 
None the less, when potential clients seek medical advice, the doctor should distinguish clearly between physical and non-physical symptoms .    Depression, anxiety, morbid thoughts, irritability, phobias and nightmares, for example, are mental, not physical, symptoms.   

Self-help essential

Efficacy

The efficacy of psychotherapy has often, rightly, been questioned.   Measurement is difficult because many people who find it helps them do not come to the attention of public health services.   Another reason is that the objectives of medical intervention and psychotherapy differ, so that attempts to measure their comparative efficacy are unrealistic.    In medicine, for example, efficacy is usually measured by a reduction of patients' symptoms.   Such factors as the ability to maintain a steady job and/or a network of personal relationships are largely overlooked.   
Another factor affecting measurement is that what we mean by 'efficacy' varies from person to person and from situation to situation.   What was the therapy intended to achieve?   Was the objective realistic?   Who determined the objective: the client, the consultant, or the client's advisers?

None the less, two separate studies of people who were 'clinically-depressed' showed that 'the changes in functional brain activity following pharmacotherapy and psychotherapy were remarkably similar.' (5)

All we can realistically do is compare the proportion of people helped by psychotherapy with the proportion of those who were not!   On this crude criterion, it seems from reviews of many reported studies that psychotherapy works at least as well as other remedies!(6)

Mental Illness

^{How Psychotherapy
Works}

 ^{Experiencing Psychotherapy}

Choosing a
Psychotherapist