What Makes A Conversation “Psychotherapy?”

Years ago I had a student who repeatedly asked me how psychotherapy works. “How is it different than a conversation?”

When I think of psychotherapy, I think in terms of the talking itself as being the aspect that helps — and yes, of course it can be used in conjunction with medications. I think of it as being structured — in terms of time and place and frequency — and being all about the patient. And whether or not it’s actually discussed, some of what works is about the relationship — most people don’t get better talking to someone they despise, and the warmth, empathy, feeling listened to and cared for, well, they’re all important. And I also think of it as being a process over time. These are all parts of my definition, however, and they may not be parts of yours.

So what about about a one-time event? If someone meets with a therapist once, has wonderful insights and feels better, is that psychotherapy???If someone meets with their priest/hairdresser/auto mechanic once or twice or 57 times and feels better, is that psychotherapy? If someone talks to a friend over coffee every morning while the dogs play, is that psychotherapy? (Clearly it’s “therapy,” because most things involving either chocolate or coffee have some therapeutic value.) If a patient meets with a therapist every week for an hour-long session for years on end but never utters a single word, is that psychotherapy?

Some psychiatrists include education about illness and medication as part of their definition of psychotherapy. Others measure it by time—if it’s 20 minutes it’s a med check, if it’s 45 minutes it’s psychotherapy.

So what makes it “psychotherapy?” There’s no “right” answer.