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.