Psychotherapy has been referred to as the treatment of emotional and personality problems and disorders by psychological means. Many different techniques may be used to treat problems and disorders and to help the client become a mature, satisfied, and independent person. However, an important factor common to all of the techniques is the client–therapist relationship with its interpersonal experiences (Kolb, 1982).

Sigmund Freud (1856–1939) introduced the concept of psychoanalysis, the original talking therapy, which involved analyzing the root causes of behavior and feeling by exploring the unconscious mind and the conscious mind’s relation to it. He was the first to understand and describe the psychotherapeutic process as an interpersonal experience between client and therapist. He thought that our relationships with other people, including clients, are patterned by early infant and childhood relationships with significant people in our environment. These patterns of relationships are repeated later in our lives and may interfere with client–therapist relationships because of transference, or the client’s unconscious assignment to the therapist of feelings and attitudes originally associated with important figures in his or her early life. Transference can be positive (affectionate) or negative (hostile). The therapist, in turn, may exhibit countertransference, or an emotional reaction to the client based on the therapist’s unconscious needs and conflicts. Such a response could interfere with therapeutic interventions during the course of treatment. Resistance, the conscious or unconscious psychological defense against bringing repressed thoughts into conscious awareness, may also occur and interfere with the client’s ability to benefit from psychotherapy. Examples of resistance include remaining silent for a long period of time, being late for a therapy session, or missing appointments (Shahrokh & Hales, 2003; Sadock & Sadock, 2003).

Harry Stack Sullivan, a psychiatrist and psychoanalyst known for his research on the psychotherapy of schizophrenia and for his view of complex interpersonal relationships as the basis of personality development, introduced the term parataxis. It refers to the presence of distorted perception or judgment exhibited by the client during therapy. Parataxis is thought to be the result of earlier experiences in interpersonal relationships and occurs as a defense against anxiety (Shahrokh & Hales, 2003; Fromm-Reichmann, 1960).

According to the American Nurses Association (ANA; 2000), psychotherapy may be performed by the certified specialist in psychiatric–mental health nursing. Psychotherapy may also be performed by licensed clinical social workers, clinical psychologists, and psychiatrists. Psychotherapy is a process in which a person who wishes to relieve symptoms, resolve problems in living, or seek personal growth enters into a contract to interact in a prescribed way with the psychotherapist (Shahrokh & Hales, 2003). Counseling is a form of supportive psychotherapy in which the nurse and other qualified professionals, such as licensed mental health counselors, offer guidance or assist the client in viewing options to problems that are discussed by the client in the context of the nurse–client relationship (ANA, 2000). The psychiatric–mental health nurse must understand these dynamics while using counseling interventions or providing care to clients involved in psychotherapy. Chapter 3 focused on the development of theory-based psychiatric nursing practice and the various roles the nurse serves, including those of therapist and counselor. This chapter focuses on the application of individual therapy and counseling as they relate to the psychological needs of clients, including children and adolescents. Family, couple, and group therapy are addressed in Chapter 15.