You probably can think of a time when you were helped by “Working something out” with a friend. Psychotherapy is based on the same principle – the idea that an understanding, receptive, nonjudgmental listener can help you work through a problem.
Unlike most friends, however, psychotherapists use a tool kit of techniques called “interventions,” which are designed to help change self-defeating behavior or thinking. There are many approaches to psychotherapy. They seem to vary in success rate from person to person, but most studies have shown that any therapy at all is better than none.
Psychoanalysis, developed by Sigmund Freud, was the first kind of psychotherapy. Some still practice it, but since Freud’s time several other major approaches have been developed. The three most common are behavior therapy, cognitive-behavioral therapy, and humanistic-experiential therapy.
The success of these therapeutic approaches depends on the needs of the individual client. For this reason, many therapists use elements of several approaches. The “match” between you and the therapist may be as important as the strategy he or she uses. Your therapy should feel comfortable to you; understanding how different therapies operate will help you determine whether your own needs are being met.
Traditional psychoanalysis is an intensive and long-term probing to understand unconscious memories, thoughts, fears, and conflicts rooted in the earliest years of development. Understanding these repressed conflicts helps you to break away from them. Instead of dwelling on the past, you can put energy into a healthier present.
To get at these hidden anxieties, therapists may use such traditional techniques as dream analysis and free association, in which you follow seemingly unconnected chains of thought and the therapist looks for connected ideas. He or she also may see the therapist-client relationship as reflecting how you reacted to a critical earlier figure, such as a parent.
Classical psychoanalysis often included hundreds of sessions and lasted for several years, but today many analysts have modified it to shorter term treatment.
Behavior therapy addresses specific behavior in the present rather than inner conflicts or past traumatic events. Following are some common tools of behavior therapy:
- Extinction and systematic desensitization frequently are used for anxiety disorders. The therapist may increase your exposure, in a safe setting, to the object of your fear, or may ask you to imagine the source of your anxiety while consciously trying to relax. In this way, you learn to overcome your fear.
- Aversion therapy discourages undesirable behavior by punishment, such as an electric shock. At the same time, the therapist works on reinforcing more effective behavior. For example, to treat alcoholism your therapist might prescribe a drug that reacts negatively with alcohol, causing stomach upset. But you are unlikely to quit permanently unless being sober has its own incentives.
- Systematic use of reinforcement develops and shapes effective behaviors. By continually increasing reinforcement and making you do more to receive it, therapists can shape your behavior. Another example of this approach is behavioral contracting, in which you and someone closely involved with the therapy (for example, a teacher, parent, or spouse) agree on set responsibilities and appropriate behaviors.
- Biofeedback teaches you to learn to control physical responses that we normally think of as automatic, such as the panic related responses of increased heart rate and heightened blood pressure.
Rather than dismissing thoughts and emotions as irrelevant, cognitive-behavioral therapy views them as “internal events” and incorporates them into behavioral techniques. Cognitive-behavioral therapy has developed into several branches, but all see thoughts as closely related to behavior and motivation, and all use behavior changing techniques. Two examples of this approach are:
- Rational-Emotive Therapy (RET), which assumes that self-defeating thoughts shape behavior. It attempts to change the thoughts rather than the behavior itself. RET holds that all well functioning people should act rationally. If they don’t, it’s because they have faulty conceptions of reality that need to be altered. For example, if you believe that you always should make everyone happy or that everything you do should be perfect, you are likely to be disappointed. If you see these disappointments as your own fault, you may develop a negative self-image. RET aims to reshape these beliefs and self-evaluations.
- Cognitive-behavioral therapy for depression, which tries to identify self-defeating beliefs and works on disproving them experimentally. We often look for evidence that supports our faulty assumptions (“I got laid off from work, so it’s true that I am always incompetent.”) and ignore evidence that should challenge them (“People always ask me for advice, but it’s just because they don’t know any better”). Learning to look at all evidence will help you to “disprove” these beliefs.
Humanistic-experiential therapy sees Psychological illness as a result of the alienation, lack of genuine meaning, and loneliness of the modern world. The therapist acts mostly as a guide, letting you be primarily responsible for directing the therapy.
There are several branches within this general area. Two of these are:
- Client-centered therapy, which – although rarely practiced in its pure form – influenced the humanistic-experiential approach. This approach lets you, rather than your therapist, direct the treatment. The therapist provides warmth and understanding, and, by reflecting back to you what you say, helps you identify your feelings and accept them.
- Gestalt therapy, which looks at the unity of mind and body and the need to integrate thought and action. The focus is becoming fully aware of yourself and accepting responsibility for your own behavior. A key concept of Gestalt therapy is identifying “unfinished business” from the past that takes energy away from the present.
Although these approaches are distinct schools, many therapists use techniques from more than one of them. For example, relationship therapy may come from any of these perspectives.
Therapy for interpersonal relationships sees individual behavior as a symptom of a larger unit. Therapists work with groups, such as families or couples. They watch interactions and identify patterns and sources of conflict. Often all members of the unit need to change their behavior to satisfy other members and make the group function more smoothly.
Ask your therapist about his or her own approach, and make sure that you are comfortable with it. Being aware of your options will help ensure that your therapy is right for you.