Approaches to Therapy

Insight Therapies | Cognitive Therapies | Humanistic Therapies | Other Approaches

There is a wide variety of theoretical approaches or orientations to psychotherapy. The choice of approach is usually determined both by the training and experience of the therapist and the needs and desires of the patient. Almost all psychotherapy models are based on the idea that "talking" about one's behavior, thoughts, and feelings with a therapist can lead to healing and growth. Some of the more widely used approaches are described below. Not included in this list are other forms of intervention (psychopharmacology, biofeedback, healing touch, hypnotherapy, drama therapy, music therapy, dance and movement therapy, Reiki and yoga therapies) that may be used in conjunction with the "verbal" therapies.

Insight Therapies

Psychodynamic (Psychoanalytic) Therapy

The primary focus of psychodynamic therapy is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension. Although it has its roots in psychoanalysis, psychodynamic therapy tends to be briefer and less intensive than traditional psychoanalysis.

The theory and practice of psychoanalysis and psychoanalytic psychotherapy as developed by Sigmund Freud, is based on his vast theory and research on personality and psychic life dating back to the early 1900's. Psychoanalysis is a therapeutic method, which investigates the interaction of conscious and unconscious elements in the patient's mind and using techniques such as dream interpretation and free association works to bring repressed fears and conflicts into conscious awareness. According to Freud, all behavior is motivated by the desire to feel pleasure and anxiety is a direct result of the repression of conflicts. The psychoanalytic therapist helps clients ‘work through' their conflicts and find ways to resolve them by interpreting the ‘resistance' and ‘transference' operating in the therapeutic relationship. Psychodynamic Therapists are trained to interpret an individual's present responses to relationships, including the relationship with the therapist, and link these responses to the way the clients have come to see themselves and the world.

Adlerian Therapy

Alfred Adler was the first major figure to break away from Freudian psychoanalysis to form an independent school of psychotherapy and personality theory. His most famous concept is the inferiority complex that speaks to the problem of self-esteem and its negative compensations. His emphasis on power dynamics is rooted in the philosophy of Nietzsche. Adler viewed the individual holistically rather than reductively. Adlerian Therapy is a growth model. It stresses a positive view of human nature and that we are in control of our own fate and not a victim to it. The goal of Adlerian Therapy is to challenge the clients' premises and to encourage goals that are socially useful and that help clients overcome feelings of inadequacy.

Cognitive Therapies

Cognitive-Behavioral Therapy (CBT)

Cognitive-Behavioral Therapy (CBT) is a form of psychotherapy that emphasizes the important role of thoughts and perception in shaping feelings and behaviors. CBT uses a problem-solving approach that teaches people skills to change their thinking and manage their reactions to stressful people and situations. Developed out of Behavior Modification, CBT makes use of assignments, homework and trying out new ways of behaving and reacting to identify and change "distorted" or "unrealistic" ways of thinking, and therefore to influence emotion and behavior.

Dialectical Behavioral Therapy (DBT)

Dialectical Behavioral Therapy (DBT) is a psychosocial treatment developed by Marsha M. Linehan. Due to invalidating environments during a person's upbringing and due to biological factors as yet unknown, some people, react in erratic and unmanageable ways to emotional stimulation. The DBT therapist actively teaches patients how to manage emotional trauma rather than reducing it or taking them out of crises. The main treatment combines behaviorist theory along side training and practice in the Buddhist technique of mindfulness. DBT treatment will always include two components: weekly individual psychotherapy sessions with the aim to manage self-injurious and suicidal behaviors, discussion of current concerns and development of the client's coping skills. The purpose of the DBT is to help the client stabilize their own experience of the middle ground between rational and emotional mind states.

Rational Emotive Behavior Therapy (REBT)

Inspired by modern and ancient philosophical discourses, Albert Ellis, an American psychotherapist and psychologist, created Rational Emotive Behavior Therapy in the mid 1950's. The REBT framework assumes that humans are born with the ability of rational thinking and constructive behavior but fall victim to irrational thinking and self-defeating behavior. REBT attributes a client's problems to the irrational aspects of their belief system, which were formed in childhood. The REBT therapist engages the client in an educational process that directly teaches the client how to identify and replace irrational and self-defeating beliefs with more rational and self-helping ones. One of the main objectives in REBT is to show clients that how they perceive and interpret the events in their lives has a direct impact on how they will feel. The central aim of REBT is to increase the clients' adaptability with the introduction of a more rational and constructive philosophy of themselves, others and the world.

Humanistic Therapies

Gestalt Therapy

Gestalt therapy focuses on the client's 'here and now' experience (rather than on the past) and uses a variety of techniques to promote awareness of and contact with aspects of experience and of the self which have been suppressed. Developed by Fritz Perls' and others in the 1940's, the basic premise of Gestalt is that "life happens in the present – not in the past or the future – and that when we are dwelling on the past or fantasizing about the future we are not living fully." Perls, originally a Freudian analyst, was influenced by the principles of Gestalt psychology and existential philosophy. The Gestalt process assumes that what is "directly experienced and felt" is more reliable than are the explanations or interpretations based on pre-existing experiences or attitudes. It is a therapy that takes into account the whole individual and is concerned with both mind and body. The role of the Gestalt therapist is to bring the more obvious discrepancies in the client's presentation of themselves and their responses to others to the client's attention. Out of this material the therapist develops creative ways to challenge clients to accept the responsibility of taking care of themselves rather then excepting others to do so. As a process, Gestalt facilitates the client's awareness of personal responsibility, how to avoid problems, to finish unfinished matters and experience life with moment-by-moment awareness.

Person-Centered Therapy

Founded by Carl Rogers in the 1930's, Person-centered therapy departed from the typically formal, detached role of the therapist emphasized in psychoanalysis to promote a close personal relationship between client and therapist in a supportive environment. Person-centered therapy, which is also known as client-centered, non-directive, or Rogerian therapy, is an approach that places much of the responsibility for the treatment process on the client, with the therapist taking a nondirective role. Associated with the aims of the human potential movement, which defined human nature as inherently good, Person-centered therapy posits that human behavior is motivated by a drive to achieve one's fullest potential. Person-centered therapy focuses on human strengths rather than human deficiencies. In this process good mental health is reflected in the balance between the ideal self and real self. The Person-centered therapist creates a space in which clients can discover a more whole understanding of who they are and can develop greater self-esteem and an increased capacity to experience and express feelings at the moment they occur.

Existential Analysis

Existential Analysis is based on the existential belief that human beings are alone in the world. This aloneness leads to feelings of meaninglessness which can be overcome only by creating one's own values and meanings.

Existential Analysis originated in the work of psychiatrists who were influenced by existential philosophers such as Kierkegaard, Nietzsche, and Heidegger. Existentialist philosophy examines the essential aloneness of human beings in the world. By looking deeply into the issues of our aloneness, meaninglessness, and mortality, the client's self-awareness is enhanced. Clients who are overburdened by the anxieties of aloneness and meaninglessness become better able to find ways to manage these anxieties, to make new and healthy choices, and to take responsibility for their freedom.

Other Approaches

Interpersonal Psychotherapy (IPT)

Interpersonal Psychotherapy (IPT) is a time-limited psychotherapy that was developed in the 1970s and 80s as an outpatient treatment for adults who were diagnosed with moderate or severe clinical depression. The IPT framework considers clinical depression as having three components: the development of symptoms, which arise from biological, genetic and/or psychodynamic processes; social interactions with other people, which are learned over the course of one's life; and personality, made up of the more enduring traits and behaviors that may predispose a person to depressive symptoms. IPT has been modified for use with adolescents and older adults, bipolar disorder, bulimia, post-partum depression and couples counseling. Interpersonal therapy descended from psychodynamic therapy and like psychoanalysis emphasizes the unconscious and childhood experiences. However, IPT is structured more like cognitive behavioral approaches both in that it is time-limited and also in its use of homework, structured interviews and assessment tools.

Family Systems Therapy

Family Systems therapy is a form of psychotherapy that considers a family as an organism or system with its own internal rules, patterns of functioning, and tendency to resist change. The treatment involves all the members of a nuclear or extended family and may be conducted by a pair or team of therapists of both genders for a short-term treatment. Family Systems therapy uses ‘systems theory' to evaluate family members in terms of their position or role within the system as a whole. Rather than focusing on traits or symptoms in individuals, Family Systems emphasizes the importance of changing the way the system works. The aim of Family Systems Therapy is for family members to understand and accept their individual responsibility in the emotional functioning of the family unit. By learning to recognize the emotional relationship patterns and how anxiety is handled in the family, individual family members can manage themselves in more functional ways

Mindfulness

Mindfulness is a technique that can be applied with just about any therapeutic approach. Mindfulness is an awareness that intentionally observes the field of immediate experience. The early proponents of a mindfulness approach saw its main benefit as being for the therapist who would be more effective if they were to be mindful in their therapeutic work. More recent work has emphasized the benefit for the client in learning and practicing Mindfulness. In the therapeutic process, Mindfulness facilitates staying present with experiences a little longer. Looking at our experiences from the vantage point of mindful non-judgment enables us to stay present rather than attempting to fix or run away from whatever arises ~ especially where there is pain or difficulty. When we can stay present and allow experience to deepen without alteration, change naturally unfolds. This technique is especially helpful for stress reduction and work with physical and energetic symptoms.

Narrative Therapy

Drawing upon postmodern theory, Narrative Therapy was initially developed during the 1970s and 1980s, largely by Michael White and David Epston. Two underlying principles that guide treatment in Narrative Therapy are that reality and identity are social constructions, and that the problems people experience are within the story, not the person. Acting as an investigator, the Narrative Therapist uses deconstructive questioning to challenge the assumed realities within a client's story and to assist the client in the creation of a new story, thereby solving the problems inherent in the original story. The Narrative Therapy process encourages clients to see how their problems are fed by societal constructs that are much larger than themselves; this offers a way for clients to empower themselves in the creative authorship of their own lives.

Anger Management

The goal of anger management is not to eliminate the anger as a feeling, but rather to use anger as a signal of an underlying problem or issue that needs to be addressed. Clients are taught how to recognize the "triggers" of their anger, how to 'diffuse' their arousal and control it at appropriate levels, and how to accept other emotions so that the arousal can be processed and managed without the negative consequences when the anger is "uncontrolled."

Reality Therapy

Reality Therapy takes an educational approach in which clients are taught skills and knowledge that will enable them to take control of their lives. Reality Therapy places emphasis on the actions a person can realistically take rather than focusing on changing thoughts and feelings. The main principle of Reality therapy is to re-align the client's actions with awareness of basic psychological needs. The Reality Therapy methodology involves asking questions such as; What do you want? What are you doing to get what you want? Is it working? The therapist then draws upon this information to created workable plans that will assist clients in meeting their own needs.

Sources

Much of this information is gleaned from the following sources:

1. Corey, G. (1991). Theory and practice of counseling and psychotherapy. Pacific Grove, CA: Brooks/Cole.
2. Lambert, M.J. (2004). Bergin and Garfield's Handbook of Psychotherapy and Behavior Change (5th ed.). New York: Wiley.
3. http://www.counselingbook.com
4. http://www.planetpsych.com
5. http://www.goodtherapy.org
6. http://en.wikipedia.org/wiki/Psychotherapy