| Types of Psychotherapy |
Introduction
A professional's approach to therapy or "psychotherapeutic orientation" can
be as unique as that therapist him or herself. Most therapists learn about and
receive training in several approaches and specialize later in their
professional development. This training interacts with the therapist's
personality and the cultural and professional environment within which he or she
practices to determine that unique style that develops. Still, there are a
number of recognized approaches with new ones developed all the time. Most new
approaches add a small amount that is truly new while expanding on existing
approaches or combining elements of several approaches. Most approaches
therefore have considerable overlap in theory and practice.
There is also a school of thought, with some research to back it up, that there
are common elements in all effective therapies that are responsible for the bulk
of positive outcome. For example, the quality of the therapeutic relationship,
regardless of therapeutic orientation, is one factor that has been shown as
necessary and sufficient for postive outcome. There is also focus on common
therapist skills such as empathic listening, reflection, and teaching that are
relatively neutral in theory, as necessary components, as well as client factors
such as motivation, application of learning outside of appointments, and nature
of the difficulty to be addressed. Unfortunately, psychotherapy and human change
is incredibly difficult to research in a manner that can conclusively answer the
question of which approach is best. The research that has provided meaningful
results has most often focused on very limited, easily defined problems that can
be measured objectively. This hardly addresses the human condition and the
conflicts and struggles that people often bring to psychotherapists.
We have chosen to briefly present five major categories to help understand the
most commonly identified psychotherapeutic approaches: Psychodynamic, Humanistic-Existential,
Cognitive-Behavioral, Transpersonal, and Systems Theory & Therapy. If you are
interested in pursuing these topics further, you can click on the links provided
in the text, search Amazon.com, the Internet, libraries and bookstores using the
terms and authors discussed and find a wealth of information.
Art
Therapy:
In this form of therapy the individual uses clay, paint and other art medium to
create images that explore their feelings, dreams, fears, or memories.
Creativity can provide a means of expression for that which has no words, and is
often used with both children and adults suffering from depression, facing loss,
or recovering from trauma or sexual abuse.
Behavioral Therapy:
This type of therapy helps weaken the connections an individual has made between
situations and the automatic reactions to them. It also teaches the individual
ways to calm his/her mind and body so that they are able to feel better and
think more clearly.
Biofeedback:
Biofeedback involves the use of electronic systems to monitor internal processes
such as heart rate, brain waves, or perspiration to help an individual become
aware of their physiological responses and learn to have more control over them.
This therapy seems particularly effective in treating anxiety disorders.
Cognitive Therapy:
This therapy type teaches individuals how certain thinking patterns are causing
their symptoms by distorting the way they view life. It encourages new, healthy
and realistic thinking patterns to emerge.
Cognitive-Behavioral Therapy (CBT):
Cognitive-Behavioral Therapy (CBT) is a practical approach that seeks to define
concrete goals and uses active techniques to reach them. The cognitive-behavioral
therapist looks at patterns of thinking and behavior and how these patterns are
reinforced and maintained by the person within his or her environment. A
functional analysis of thinking and behavior is performed, often using log
sheets and graphs to better understand thought and behavior patterns in the
context of daily routines. Once an understanding of symptoms and behavior is
achieved, the therapist and client together devise changes in the patterns and
continue tracking. This process is repeated until the original goals are met.
Attention to irrational thinking patterns (e.g., automatic thoughts,
catastrophic thinking) is central to the approach as well.
Some of the techniques and programs that are usually associated with CBT are
relaxation training, systematic desensitization, assertiveness training, and
social skills training.
Historically, Cognitive-Behavior Therapy (CBT) has its roots in the work of
behaviorists such as Ivan Pavlov, John Watson, Joseph Wolpe, and B.F. Skinner.
Skinner, in particular, developed theories of operant conditioning that were the
basis of behavior therapy, which views the consequences of behavior as shaping
future behavior. Associated with Skinner are terms such as stimulus-response,
positive reinforcement, and contingencies of behavior.
Skinner's emphasis was on observable behavior. It was theorists such as Albert
Bandura (Social Learning Theory) and cognitive therapy and cognitive-behavioral
therapy originators such as Albert Ellis (Rational Emotive Behavior Therapy),
Aaron Beck (Cognitive Therapy), William Glasser (Reality Therapy) and Donald
Meichenbaum (Cognitive-Behavioral Therapy) that brought thought and emotion into
this approach.
Dialectical Behavioral Therapy (DBT):
This type of therapy was created for those suffering from borderline personality
disorder, and seems to be one of the most effective treatments available for
this disorder. DBT teaches the individual behavioral skills for interpersonal
relationships and ways to effectively cope with sudden surges of emotion. It
focuses on distress tolerance and emotional regulation, and usually targets
behaviors in a descending heirarchy:
* decreasing high-risk suicidal behavior
* decreasing responses that interfere with therapy
* decreasing behavior that interferes with quality of life
* dealing with PTSD responses
* enhancing respect for self
* acquisition of behavioral skills taught in the group
Those involved in this type of therapy generally meet with a therapist once a week and participate in a group session once a week.
Eye Movement Desensitization and Reprocessing (EMDR):
EMDR focuses on restructuring thought patterns and associations related to
traumatic events and memories.
Existential Therapy:
Humanistic psychotherapy is an approach which tries to do justice to the whole
person including mind, body and spirit. It represents a broad range of
therapeutic methods. Each method recognizes the self-healing capacities of the
client. The humanistic psychotherapist works towards an authentic meeting of
equals in the therapy relationship.
Existential psychotherapy aims at enabling clients to find constructive ways of
coming to terms with the challenges of everyday living. The focus is on the
client’s concrete, individual experience of anxiety and distress leading to an
exploration of their personal beliefs and value system, in order to clarify and
understand these in relation to the specific physical, psychological and socio-cultural
context. The experience and influences of the past, present and future are given
equal emphasis. The questioning of assumptions and facing up to the
possibilities and limitations of living is an important part of this interactive,
dynamic and direct approach.
Family/Marital Therapy:
The therapist applies therapeutic principles while engaging the participation of
family members. Constructive aspects of the family's relationships are
reinforced, while destructive elements are identified and altered. Family
members are taught better communication skills, and ways of coping outside of
the therapist's office.
Gestalt Therapy:
Gestalt therapy emphasizes what is happening in the here and now to help
individuals become more self-aware and learn responsibility for and integration
of thoughts, feelings, and actions. The goal of this therapy is to develop more
internal vs. external support.
Play Therapy:
This is a therapeutic technique most often used when working with children.
Through play therapy a child can create a world they can master, practice social
skills, overcome frightening feelings and/or experiences, and symbolically
triumph over traumas. This therapy works well for children that may not have the
verbal skills needed for other types of therapy, and lets them express
themselves in a safe and fun way.
Psychoanalytical Therapy:
Sigmund Freud is credited as the founder of psychoanalysis and psychoanalytic
theory, if not modern psychology. There have been a multitude of variations that
have evolved and the term most often used to broadly encompass these approaches
is "Psychodynamic." Terms such as: neurosis, conflict, attachment, object
relations, unconscious, defense mechanisms, id, ego, superego, drives, libido,
transference, countertransference, and countless more have emerged from this
approach. Some of the major approaches within the psychodynamic category are:
Psychoanalysis (Sigmund Freud), Adlerian Psychotherapy (Alfred Adler),
Analytical Psychotherapy (Carl Jung), Object Relations (Mahler, Winnicott,
Fairbairn, Klein, Gutrip, Kernberg and others), and Self Psychology (Heinz Kohut).
Freud's original theories were based on the conflicts that he believed were at
the core of human existance. These conflicts emerge from attempts to reconcile
our biological selves with our social selves. Aspects of these conflicts are
unconscious and influence our behavior without our awareness. Psychodynamic
therapies work to make the unconscious conscious so that we can have greater
insight into our needs and behavior and therefore more control over how we allow
these conflicts to affect us.
In Adlerian psychotherapy, clients are encouraged to overcome their feelings of
insecurity, develop deeper feelings of connectedness, and to redirect their
striving for significance into more socially beneficial directions. Through a
respectful Socratic dialogue, they are challenged to correct mistaken
assumptions, attitudes, behaviors and feelings about themselves and the world.
Constant encouragement stimulates clients to attempt what was previously felt as
impossible. The growth of confidence, pride, and gratification leads to a
greater desire and ability to cooperate. The objective of therapy is to replace
exaggerated self-protection, self-enhancement, and self-indulgence with
courageous social contribution.
Carl Jung was a student of Freuds and eventually developed his own theory called
"Analytical Psychology." While still based on the reconciliation between the
consious and unconsious, Jung broaded Freud's work to include concepts of
culture, mythology, and spirituality. For Jung the most important and lifelong
task imposed upon any person is fulfillment through the process of individuation,
achievement of harmony of conscious and unconscious, which makes a person one
and whole.
The term "object-relations" refers to the self-structure we internalize in early
childhood, which functions as a blueprint for establishing and maintaining
future relationships. Psychopathology is an expression of traumatic self-object
internalizations from childhood acted-out in our current relationships.
Psychotherapy is the resolution of these self-destructive patterns of relating
so that we can mature and self-actualize. Self psychology is Heinz Kohut's
variation of object relations theory that recognizes the central importance of
people's needs for relationships critical in providing necessary experiences
during growth and development. These experiences are called self-object
experiences. Sufficient positive self-object experiences when the infant and
child are developing facilitate the formation of a strong, cohesive self -- the
core of one's personality and character. Kohut is credited with adding the
concept of "empathy" to the every day discourse of psychotherapy.
Transpersonal Psychotherapy
Transpersonal/Psychospiritual psychotherapy can be defined by its orientation
which includes the spiritual dimension rather than the content of therapy. It
views the human psyche as having a central core Self or Soul as the centre of
identity as well as a personal ego. Psychotherapists draw on a wide range of
therapeutic methods towards the uncovering of past psychological material within
a context of the individuals potential based on spiritual insight and experience.
Within this perspective there is both a movement of the personal centre to the
Self and a movement of the Self to manifest its nature through and in the
personal centre. Thus therapy includes both repair and individuation.
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