Chapter 5: Psychotherapy Treatment Approaches
Narrative therapy teaches that your identity is shaped by the stories that you tell yourself and others, and a narrative therapist will encourage you to share these stories. By bringing these stories to light, you and your therapist can investigate the various influences that have shaped your difficulties.
The act of talking about your life in story form helps you get distance from your problems and see them as something outside of yourself, rather than as essential parts of your personality. Another powerful aspect of narrative therapy is “re-authoring” your stories to present a different point of view about your past and problems.
Narrative therapy tends to be short-term, and is available mostly in private practices.
Play therapy is similar to art therapy in that it provides a means to express feelings, memories, and ideas that might be hard to put into words.
Therapists can use play as a means of assessment and treatment. Certain play therapists teach parents to engage in modified play therapy sessions with their own children in the home.
As you might expect, play therapy is usually offered in settings that specialize in the treatment of children and families.
Psychoanalysis is a form of treatment in which problems such as phobias, compulsions, and depression are seen as symptoms of unconscious conflicts. The therapist (sometimes called an analyst) helps you (referred to as the analysand) bring this unconscious material into your normal state of awareness where you can acknowledge and work through it.
You express your unconscious material in a variety of ways: dreams, fantasies, jokes, and even your attitude toward your therapist. The therapist’s role is to interpret this material so that the you can gain insight into how it affects you.
Because psychoanalysis is traditionally delivered in multiple sessions per week over a long period of time, very few insurance companies or managed care organizations reimburse for these services. Many psychoanalysts are willing to negotiate reasonable out-of-pocket fees to make their services affordable for those who need it.
Psychodynamic therapy is built on many of the same ideas and techniques as psychoanalysis, but is typically delivered in a less-intensive and time-limited format. Psychodynamic therapists also borrow techniques from other approaches.
This form of treatment is available in many settings.
Because it is briefer than psychoanalysis, insurance companies
are more willing to reimburse for it.
Reality therapy is a present-oriented approach that holds that you are completely responsible for your own behavior.
The first step in making a change is recognizing that you have chosen your negative behaviors, and that because you have this power, you can choose positive and helpful behaviors instead.
Problems occur when you fail to successfully meet your needs for survival, power, freedom, belonging, and fun. The therapist begins by helping you clarify what you want out of life. Then both you and your therapist will look carefully at your actions, feelings, and self-talk to see if they can help you attain the goals you’ve chosen. If not, you consider new behaviors and make a plan.
Instead of focusing on genetic or environmental factors, your therapist will emphasize your autonomy. If you fail to carry out a plan, your therapist will not reprimand you or listen to excuses. Instead, you’ll work together to identify why the plan did not work and create a new, more effective plan to help you get what you want.
Reality therapy has proven to be particularly helpful in schools, prisons, and residential treatment settings, but can be found in hospitals, clinics, agencies, and private practices as well.
Since reality therapy is sometimes classified as a kind of cognitive-behavioral therapy, you’ll usually have no trouble getting insurance companies and managed care organizations to reimburse for services.
As its name suggests, this approach focuses on solutions rather than problems. A solution-focused therapist will not delve into the details of your problem or speculate about its origins. Instead, they’ll ask you about times when the problem seems to be less important, and ways in which you cope with the problem.
You’ll be asked to envision a better future, and then to begin taking small steps toward that future. The therapist will emphasize your strengths and resources.
Solution-focused therapy is usually brief and is available in many settings. This approach is also gaining popularity as a treatment for marital problems.
While most therapists look at what happens within people, systems therapists are more interested in what happens between people. Your problems are viewed in the context of your family system, so your therapist will probably want to get your family involved.
Therapists may work with individuals, entire families, or smaller subgroups within families. You may be asked to come to an office, or the therapist may come to your home. Some combination of the two is also possible.
Systems therapy is usually available in agencies and clinics that specialize in the treatment of families, couples, and children.
At the top of an index card or a small piece of paper, write Treatment Approaches. Below that, write down your top four choices of approach.
- Art Therapy
- Behavior Therapy
- Cognitive-Behavioral Therapy
- Humanistic Therapy
- Interpersonal Therapy
- Motivational Interviewing
- Narrative Therapy
- Play Therapy
- Psychodynamic Therapy
- Reality Therapy
- Solution Focused Therapy
- Systems Therapy