There are many different approaches to psychotherapy. Use of one method or another depends on the psychologist’s or therapist’s training, style and personality. Some psychologists use one approach with all patients; others are eclectic, and some tailor their approach based on particular patients’ needs, symptoms and personality.
Although the approaches are often seen as distinct, in the implementation and even theoretically there is often overlap. Rigidly adhering to one way of thinking or approaching therapy often limits results and misses the whole picture, and may result in an approach that feels foreign or false to the patient.
The psychodynamic approach focuses on understanding where the patient’s problems or symptoms came from. The therapist helps the patient recognize how the past is repeated in the present.
Attachment theories have become more popular recently as new research emerges. These approaches use empirically-based and neurobiological research to understand problematic relationship styles. Scientific studies on attachment have found that issues in adult relationships can be reliably predicted from objectively identifiable, early patterns of attachment between parents and children. Therapists using attachment-based approaches aim for healing unconscious psychological and biological processes in the brain and promoting the development of higher-level capacities. Such capacities include the ability to recognize and reflect upon what is happening in one’s own mind and the minds of others, and sort out one from the other.
This approach to therapy is also particularly helpful for teaching parents ways to react that optimize children’s psychological and brain development and improve parent-child relationships.
Cognitive-behavioral approaches emphasize learning to recognize and change maladaptive thought patterns and behaviors, improve how feelings and worries are handled, and break the cycle of dysfunctional habitual behaviors. This perspective helps people see the connection between how they think, what they tell themselves, and the feelings and actions that follow.
Interpersonal approaches emphasize identifying and understanding self-defeating patterns in relationships, figuring out why a particular situation is happening in a particular context, changing patterns that don’t work and developing healthier ones. In this approach, relationships and the here-and-now are the focus.
Systemic approaches understand problems in a contextual framework and focus on understanding and shifting the current dynamics of relationships, families, and even work settings. The roles and behaviors that people take on in a particular family or context are understood to be determined by the unspoken rules of that system and interaction among its members. Change in any part of the family system or group is the route to changing symptoms and dynamics, whether or not the “identified patient” is specifically involved in those changes. In this type of therapy, the “identified patient” in a family – the one seen by family members as having the problem — is viewed by the therapist as part of a larger system that is creating or sustaining this problem. This approach can be particularly useful when one member of a family seems resistant to therapy or to change; it opens up other avenues for intervention.
Other therapeutic approaches are centered around self-expression, with therapy providing a safe and private place to express feelings, confusion, worries, secrets and ideas.
In general, regardless of the therapist’s preferred way of working, people find therapy to be most useful when therapists are responsive, engaged, and offer feedback.
Many people who have been in therapy or have interviewed different therapists report better results when they like and feel comfortable with a therapist experienced in their particular issue. In addition, some of what makes a good match has to do with “chemistry.” Chemistry involves more subtle factors such as the therapist’s personality and whether he or she is someone in whom the client would want to talk and confide.