What kind of psychotherapy?

adult-psychometric-assessmentsIf you start to read about psychotherapy you may become confused about the many different approaches that seem to be out there. However, there are just a few basic ingredients to psychotherapy:

  • Behavioural: Here there is a focus on actively changing behaviour. For example, it can help depressed people to become more active, do more and sleep less. Fear and phobias can be overcome by gradually confronting them. Many people can benefit from learning to express themselves more clearly and act more assertively. People who are disorganized can learn to plan effectively and organize themselves.
  • Cognitive: Here there is a focus on negative or self-defeating thoughts or assumptions such as “I’m stupid,” “I’m not good enough,” “If I get close to people they will hurt me so its best to stay alone.” Therapists help you identify these kinds of thoughts and to re-evaluate them. This in turn can lead to experimenting with new ways of behaving. For some basic cognitive methods are described here (link to Cognitive therapy: Some basic principles and methods)
  • Cognitive-behavioural: Cognitive-Behaviour therapy (CBT) puts together cognitive and behavioural methods to provide a rich range of practical ways of working towards change.For more information from the British Association for Behavioural and Cognitive Psychotherapies click here.For extensive web resources and reports on the application of CBT http://mindovermood.com/news_press.htm.

    Many CBT methods can be used on a self-help basis (link to Self-help resources from CBT).

  • Psychodynamic/Relational: Psychodynamic/relational therapies are based on the theory that problematic emotions and behaviours arise from patterns (or schemas) that were learned in the family in response to difficult situations such as parental conflict, inconsistency, criticism, anger or neglect, painful losses such as the death of a parent or sibling or feeling abandoned because of hospitalisation or a parent leaving. These kinds of experiences set up a sense of self as threatened, defective or unlovable or a sense of self that is split up and inconsistent – the person sometimes feels loved and safe, but at other times may feel empty and lonely, or at other times helpless and victimized. People cope with these painful schemas in ways that may be ineffective or self defeating e.g. by cutting themselves off emotionally, being excessively perfectionistic, or competing and always trying to come out on top and be the best. Gaining an understanding of these patterns is the psychodynamic aspect of this approach. The relational aspect is that therapists form a relationship with their clients and as the different self-experiences emerge, they work to offer a balanced consistent caring response which provides a corrective experience. This changes the underlying problematic schemas. In all forms of psychotherapy, the relationship between client and therapist is central because psychotherapy depends on you trusting the therapist and feeling the two of you are working together. For the importance of this in CBT click here.
  • Experiential: Experiential therapists believe that meaningful change can only come through engaging with a person’s actual experience. They warn that cognitive and behavioural methods may bypass this, which is why attempts to use them to change sometimes fail. They help their clients focus on what they are actually feeling moment to moment both in relation to therapist and with respect to everyday events. They may also heighten clients’ experience by encouraging them to express themselves for example in drawing or painting or poetry or whatever expressive methods come naturally to them. In session they may use imagery techniques in conjunction with emotional focusing or activate dialogues between parts of the self using chair dialogues (different parts speak from two or more different chairs). They believe that in this way clients will get in touch and authentic sense of who they are and where they are going in life.
  • Integrative: Integrative therapies see value in all the approaches described above and do not see one as excluding the other. They draw on theory and methods from all of them in ways suited to the individual clients they are working with. For a good example of an integrative approach to post-traumatic stress disorder see the work of Bessel van der Kolk featured in this article in the New York Times in May 2014. http://mobile.nytimes.com/2014/05/25/magazine/a-revolutionary-approach-to-treating-ptsd.html?referrer=https%3A%2F%2Fm.facebook.com

Schema therapy is an example of an integrative therapy that draws on all the approaches described above and combines the strengths of each into a comprehensive and flexible process. Sometimes people start with a CBT approach and find it does not help them as much as they had hoped. Schema therapy can often address this by helping them become aware of deeper processes that are out of awareness but are contributing to their problems.

Next: Assessment and the therapy contract