Archive for February 2011

Different Types of Therapy   Leave a comment

There is quite a variety of therapeutic styles out there.

There are some therapists who’s clinical focus is primarily on the client’s relationships with others and how the behavior of others is contributing to the person’s well being (Interpersonal therapy) as opposed to intra-psychic conflicts within the person themselves. Here, the client and therapist work on building ones interpersonal skills which include; voice tone and body language in regards to communicating with others, patience with others, recognition of ones own emotional reactions to others, as well as appreciation for the people in ones life and expression of this appreciation to them. They will identify maladaptive relationships and work to strengthen or eliminate them as well as improve upon already strong relationships. In short, by improving ones social skills and in turn their relationships with other people one will improve their overall well-being.

There are therapists who focus primarily on ones actions. Again, setting aside internal processes and working solely with ones actions and how they impact ones life (Behavioral therapy). Take for example someone who has a fear of elevators. The behavioral therapist is not so much concerned with why the person fears elevators (what thought processes or early life experiences may have contributed to the fear) rather, the behavioral therapist wants to desensitize the person to the feared stimulus (elevators) through actual exposure to it, create a safe environment for the person to experience the elevator, and in turn not fear it. A client working with a behavioral therapist would likely take a gradual approach (although some therapists may expose the person all at once).

First, the therapist may have the client simply visualize the step by step process of entering the elevator and riding up and down on it in their mind, doing so repeatedly. Then, accompanied by the therapist, the client would actually walk up to an elevator, all the while both client and therapist taking note of and discussing the client’s responses to the stimulus (i.e. rapid breathing, sweating, verbal and visual expression of fear). Eventually, when the client is in a suitable mindset to enter the elevator he or she would do so. If the fear becomes overwhelming the therapist might employ relaxation techniques such as controlled breathing to calm the client down, then try again. Hopefully, through enough exposure and several experiences of safely riding an elevator this client would overcome this fear as the environment is simply not frightening and the client will not respond with fear, at least in theory.

But what of the past? What about early life experiences and their contributions to ones present state of mind? What about inner psychic and thought processes contributing to someones well being?

Well, the earliest forms of modern therapy are based on this model and still hold validity today. Insight oriented therapies have existed for quite sometime starting with Freud’s Psychoanalysis evolving to modern day Psychodynamic Therapy. The idea is that the mind is composed of different constructs that develop from early life experiences. (Freud’s concept of the conscious, subconscious, unconscious/ego, superego, id) If these experiences are traumatic or unhealthy a person’s psyche can develop conflicts within itself and lead to the person to suffer and display behaviors which further contribute to their suffering, many times outside of one’s conscious awareness. Such a therapist will work with a client to uncover these conflicts and learn how someone’s particular life experiences may be affecting them. For example, a man who is having trouble with relationships with women may become aware that his primary female role model, his mother, was quite domineering and emotionally abusive in the form of manipulation in her effort to control him and in a maladaptive manner, retain his affections. This hypothetical man now finds himself in relationships with emotionally abusive manipulative women and suffers because of it. However, now being aware that he had unconsciously sought out these traits in the women he engages relationships with because he had modeled his “ideal” woman from the influence of his early experiences with his mother, he can now choose instead with full awareness to seek out more adaptive relationships with more emotionally stable, unabusive women.

By gaining insight and becoming aware of ones inner psychic processes and early life experiences the idea is that one achieves the power to recognize these conflicts at play in their life and take actions to change them.

The most thoroughly empirically validated therapeutic process to date is Cognitive-Behavioral Therapy. A relatively modern form of therapy that takes some of the behavioral concepts mentioned above and bridges them with a person’s thought processes. CBT presents the mind as having a feedback loop between ones thoughts, beliefs, feelings, and behaviors. A feedback loop is a concept where each aspect of something effects the other.

For example, if a person truly believes that he or she is unworthy of love then such a person may also have self-defeating thoughts such as; (“nobody loves me”, “I’m a despicable person”, or “who would want to love me?”) in turn the person’s behavior may be to withdraw from social interaction and not seek out and foster relationships with other people. This can ultimately lead the person to feel depressed. As the person continues to feel depressed he or she will continue to withdraw from social interaction and continue to have self-defeating thoughts,. Therefore the underlying belief of not being worthy of love is continuously reinforced.

The CBT therapist is not so much focused on the person’s early life experiences and thus will not have the client analyze his or her past, rather the CBT therapist focuses on the present moment and asks the question “How are these processes effecting the person NOW?” Through the use of work assignments, which, for this hypothetical person would be to start off with the simple task of introducing ones self to another person. The therapist assesses the client in regards to their thoughts, feelings, beliefs, and behaviors in these moments. The therapist and client address; self-defeating or catastrophic thoughts (i.e. “This person doesn’t care about what I have to say”) and recognize adaptive rational thoughts as a result of the assigned task(s) (i.e. “this person seems interested in what I have to say”), identifying and challenging irrational beliefs (i.e. “Human beings are not loving beings”WHY?) while promoting more adaptive ones (i.e. “I’m a human being, all human beings desire and deserve love”/”All human beings are capable of love”), and highlighting maladaptive behaviors (i.e. lack of eye contact, pessimistic tone of voice) while promoting more adaptive ones (i.e. complimenting the other person, positive body language). By examining each aspect of the person’s cognitive-behavioral feedback loop and presenting alternatives a person can become better equipped to change how they feel and attain increased levels of social interaction. Furthermore, after this hypothetical person has more and more positive and rewarding experiences interacting with others he or she may change their beliefs about themselves completely (i.e. “I am worthy of love”). He or she will also be able to recognize and renounce negative thinking that still may arise and continue utilize the therapist’s assignments (i.e. the therapist has the client offer to take a new acquaintance to a social event). It is all in the moment and the process goes on without having to spend time digging deeply into the past. CBT is a pro-active approach and is very popular.

Some therapists utilize concepts from multiple theoretical approaches. For example, a therapist could gain insight into a client’s current interpersonal troubles by examining past relationships. Then present the client with pro-active assignments to allow the client to work with the particular stimulus (people). The insight provides closure and acceptance for the person in that his or her troubles were indeed influenced by his experiences as a child, thereby eliminating unwarranted or irrational thoughts (possibly guilt) and beliefs in regards to relationships. He or she is then directed by behavioral methods to improve social skills and provide positive experiences to learn and grow from. These therapies are known as; Eclective Therapy, the use of a distinct and separate approach to an individual case, and Integrative Therapy, the fusion of multiple approaches to a single case. To simplify this think of an ecclective therapist as one who uses behavioral techniques for one client, cognitive techniques for another, interpersonal for another, and so on. The integrative therapist, meanwhile, will utilize multiple approaches for each individual case the therapist works with (insight, behavioral, and cognitive approaches for a single client’s problems). A little confusing but there is a difference.

Integrative therapy is the orientation I identify with and I employ various approaches to each case depending on the person’s particular presenting problems. I believe the integrative approach prevents a therapist from taking an excessively dogmatic approach to therapy and become close-minded to alternative possibilities regarding the cause and resolution of clients problems. It allows the therapist to recognize problems from different angles and guide the therapy in a manner most suited for different clients. I believe integrative therapy allows for greater success as it allows a therapist to work with a greater variety of people who come seeking treatment with an even greater variety of issues.

However, I suppose the most pertinent question in all this is…..Which one is the best approach!

Well, actually, every therapeutic style has about the same level of effectiveness. A lot has to do with the interpersonal abilities of the therapist, their level of training and experience, and the level of rapport between client and therapist.

There is no universally agreed upon ultimate theory of psychology and human behavior nor is their one for therapy. However, all of these theoretical styles (and this article is simply scratching the surface, there many other types of therapies like Existential, Rational-Emotive, etc) have got at least a piece of it right which means the true answer is likely somewhere near the center with all these concepts playing a role in the totality of human psychology.

For the prospective client I would suggest researching these various approaches further. If you are considering seeking out therapy you would be well off to educate yourself and find the style you believe you would be best suited for and then find a therapist who works with that particular orientation.

Good luck and stay peaceful