Chapter 5: Psychotherapy Treatment Approaches
A treatment approach, or theoretical orientation as they’re sometimes called, is nothing more than a set of ideas about what makes people tick and how they change, and a set of techniques for helping people make those changes.
The last time anyone bothered counting them, there were more than 250 treatment approaches in all. By now, there are certainly many more. In fact, there are almost as many treatment approaches as there are therapists. This chapter will explore some of the most commonly available approaches available today.
Art therapy is based on the idea that the creative process can help you express emotions, work through traumatic experiences, manage stress, gain insight into how you interact with others, and enhance your self-awareness.
In this form of treatment, you are encouraged to engage in drawing, painting, sculpting, or photography. Your therapist guides you through the process and helps you explore the thoughts and feelings expressed through the art you create.
Art therapists believe that people can share ideas through visual art that they may find difficult to share in words. For this reason, you may be asked to complete art-based assessments designed to help your therapist learn about your feelings, problems, and personality.
In addition to what you learn about yourself through art, you may find the act of expressing yourself creatively therapeutic in itself.
Don’t avoid art therapy because you think you lack talent. Art therapy is not an art class. Your therapist works with people of all skill levels, and is not concerned with judging the technical merit of your work.
People of all ages can benefit from art therapy. Some art therapists report great success in using these techniques with older adults and even entire families.
Art therapy is most commonly practiced in agency settings, but can occasionally be found in hospitals, clinics, nursing homes, schools, and private practices.
You probably won’t be surprised to learn that this kind of therapy focuses on your behaviors. According to the behavioral approach, the best way to change your thoughts and feelings is by changing your behaviors.
Suppose you were seeking therapy because you have a crippling fear of dogs. Your therapist won’t ask you about your early experiences with dogs or probe for the unconscious roots of the problem. Instead, you’ll start gathering data and applying techniques to extinguish the fear.
Behavior therapy emphasizes the use of proven techniques designed to break the chain between unwanted behaviors and the triggers and reinforcers that maintain them.
In the example mentioned above, your therapist may begin by asking you to rate a variety of dog-related experiences in terms of how anxious they make you feel. You will then be taught relaxation techniques and asked to practice them while you’re exposed to increasingly anxiety-provoking situations until eventually, you can pet a dog without much anxiety.
This approach adopts a scientific viewpoint, but don’t make the mistake of assuming that all behavior therapists are cold, uncaring people in white lab coats.
Behavior therapy is practiced in hospitals, clinics, community agencies, school-based programs, and private practices. Because it is highly structured and time-limited, you may find that your insurance company is especially willing to reimburse for behavior therapy.
You’ll find that the cognitive-behavioral approach shares certain ideas and techniques with behavior therapy, but its primary focus is on thinking rather than behavior. This approach holds that your feelings are not caused by external events, but by your thoughts about those events.
Suppose a friend compliments you on your appearance. If you think, “That was nice of her. I guess I do look pretty good today,” you’ll probably feel happy and grateful. On the other hand, if you think, “She’s just saying that because she’s my friend. I look terrible,” you’re likely to feel sad and resentful.
Since your thoughts influence your feelings, persistent patterns of negative thinking can cause emotional and psychological problems. Cognitive-behavioral therapy teaches you to take charge of your feelings by taking charge of your thoughts.
Your therapist will start by helping you identify your thoughts and explore how they influence your feelings. Eventually you’ll learn to dispute negative thoughts and replace them with more helpful ones.
Cognitive-behavioral therapy is currently one of the most popular forms of treatment available and is commonly practiced in almost any setting.
You might also hear about rational-emotive behavior therapy, cognitive therapy, or dialectical behavior therapy. These are different “flavors” of cognitive-behavioral therapy, but they are all based on the same core ideas.
You’ll find that some therapists don’t identify with any single theory. Instead, they pick and choose ideas and techniques from multiple approaches. They may identify themselves as eclectic or integrative.
This can be a very effective approach, but it creates a challenge for potential clients. You may appreciate a therapist’s eclecticism but still want to get some idea of what therapy will be like before you make a decision.
Fortunately, most eclectic therapists are more than willing to share their ideas and talk to you about how they work. Just ask.
Eye movement desensitization and reprocessing (EMDR) is based on an information processing model. If you undergo a traumatic or stressful experience, your brain may not process information correctly. Instead, your negative feelings and distorted thoughts will be stored just as they were experienced during the event.
During EMDR therapy, you will be asked to recall these disturbing events while simultaneously focusing on external stimuli designed to help your brain reprocess the information correctly.
You can find EMDR being practiced in many settings, but it’s particularly popular in clinics that specialize in the treatment of post-traumatic stress disorder and phobias.
Humanistic therapy is an umbrella term for a wide variety of approaches. What they all have in common, however, is a rejection of scientific or medical models in favor of an emphasis on personal experience.
In client-centered therapy, you’ll have an opportunity to explore your thoughts and feelings in a warm, open, and nonjudgmental environment. By helping you gain insight, your therapist will give you the tools you need to promote your own growth.
Gestalt therapy holds that when you try to be someone you’re not, you get stuck and can’t change. Being honest about who you are and how you feel in the present moment, on the other hand, creates the right conditions for growth. By taking responsibility for yourself, you gain the power to change.
Existential therapy teaches that you alone make your own choices and create your own values. Existential therapists believe that this responsibility can create feelings of anxiety and loneliness, but that therapy can help you face these possibilities with a sense of freedom and power.
Humanistic therapy is found in many settings, and gestalt techniques are particularly popular in the group therapy format.
Because humanistic therapies are not time-limited and do not focus on gathering data or measuring outcomes, you may have difficulty convincing your insurance company or managed care organization to reimburse for these services.
Interpersonal therapy is a highly-structured therapeutic approach originally designed to treat depression, though it’s since been modified to help with a number of other problems.
This approach holds that psychological difficulties are the result of relationship problems and faulty patterns of communication.
Interpersonal therapy will help you focus on four areas: unresolved grief, role disputes, role transitions, and interpersonal deficits.
Because interpersonal therapy takes a medical view of psychological problems, you can typically find it being practiced in hospitals and clinics. Insurance companies and managed care organizations approve of this approach because it is time-limited.
Motivational interviewing will assist you in thinking through the consequences of your behaviors. By helping you see the gap between the life you’d like to live and the life you’re living right now, your therapist hopes to increase your sense of motivation and desire to change.
Motivational interviewing stresses your autonomy and respects the choices you make, even if they are self-destructive.
Motivational interviewing has been particularly successful in substance abuse counseling, but it can be found in other settings as well.
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