Types of Therapy

 

Therapies

Each year, millions of people seek therapy and receive real help for just as vast a number of problems and issues! Therapy can address a wide range of concerns such as depression, relationship crises, parenting problems, emotional distress, career issues, substance abuse, significant loss, and clinical disorders or conditions. You can also look to therapy for life-enhancing help in fulfilling aspirations for personal growth or self-improvement.

Through the course of their training and practice, mental health professionals often develop expertise in specific areas and establish preferred modes of therapy. As you’ll see when you review therapists’ profiles in the Therapist Locator, there are many types of therapy or orientations. It may be that the nature of your particular problem will clearly define the type of therapy that would be the best for you and can then help you determine which therapist(s) to consider. For example, if you are experiencing difficulties in your relationships with family members, a therapist who specializes in Family/Marital Therapy would be a good choice.

Most therapists work with their clients to determine the most effective treatment plan even when it does not include their preferred orientation or just one specific technique. This can sometimes involve elements of several different types of therapy, for example, a combination of behavioral therapeutic techniques and psychodynamic therapeutic techniques, becoming what is referred to as an eclectic approach to therapy.

Art Therapy

In art therapy, the client uses clay, paint, and another art medium to create images that explore their feelings, dreams, memories or ideas. People come to art therapy for a variety of reasons. For example, individuals suffering from depression, facing loss, coping with trauma, dealing with addiction, recovering from sexual abuse, or seeking means to overcome anxiety have often found relief, courage, and strengthening insight through art therapy. Creativity can provide a means of expression for that which has no words, or is not yet fully understood. Using the client’s art as an interpretive reference point, the art therapist helps the client further explore their feelings, experiences, and perceptions and claim renewed clarity and meaning in their life.

Behavioral Therapy

Behavioral therapies use learning principles (examples given below) to eliminate or reduce unwanted reactions to external situations, one’s thought and feelings, and bodily sensations or functions. Rather than dealing with unconscious conflicts, this therapeutic approach deals with events of which people are aware or can readily become aware. The therapist teaches the client to replace undesirable responses (groundless fears, for example) in their day-to-day living. Learning-based techniques include the following:

Exposure Therapy
Instead of trying to avoid or escape upsetting experiences which can bring short-term relief, but in the longer run usually prolong or worsen one’s vulnerability clients voluntarily expose themselves to the experiences while in a relaxed state. Exposures may be to the actual situation (in vivo exposure) or to an imagined version of it (in vitro exposure). As a result, they form associations between the formerly upsetting experiences and feeling relatively untroubled, which leads to clearer thinking and better decisions. With practice, the new associations progressively take over from the old ones that were causing difficulty.

Contingency Management
Here, desirable actions are selectively reinforced (rewarded), and undesirable actions are ignored whenever possible. (At times, undesirable actions may be penalized instead of ignored, but this tactic is regarded as a last resort, since it produces distress and tends to yield unpredictable results.)

Behavioral activation
This is a method commonly used in treating depression. It involves developing a list of activities the client is likely to enjoy or needs to engage in as part of a normal and satisfying life. Then, beginning with the easiest (or sometimes, the most indispensable) activities on the list, the client agrees to carry them out in an organized manner. This reinstates contact with the naturally-occurring rewards of the chosen activities, which in turn helps overcome the depressed mood.

Modeling
The client observes another person perform the desired behavior (for instance, doing something he has been afraid to do). Then, having seen how someone else’s performance did not meet with negative repercussions, with the therapist’s encouragement and guidance the client learns to successfully copy the performance.

Biofeedback
A bodily function (such as heart rate or muscle tension) is monitored and the amplified information is fed back to the client. Through this process, the client becomes better able to control the function. For example, they learn to relax to slow their heart rate or decrease muscle tension more effectively than they could rely on normal, un-amplified feedback about these functions.

Cognitive Therapy

Cognitive therapies rely on other, largely verbal, learning principles namely, those that involve cognition (perception, thinking, reasoning, attention, and judgment). The basic strategy is to change the thoughts, beliefs, assumptions and attitudes that are contributing to the client’s emotional or behavioral problems. Two of the best known cognitive therapies are:

Cognitive therapy
This approach assumes that people who are suffering, for example, from depression view themselves and the world around them negatively because of distortions in thinking. Some of these distortions include all-or-none thinking (a tendency to see events or situations as either entirely good or entirely bad), overgeneralization (allowing one unfortunate event to support a negative interpretation of all events), and selective perception (focusing only on discouraging events). The therapist helps the client to first recognize and then change these maladaptive cognitive behaviors.

Rational-emotive therapy (RET)
RET is based on the premise that many problems are the result of irrational thinking. For example, an individual can become unhappy and develop self-defeating habits because of faulty beliefs. Another example would be a person who has developed the need to be perfect in all their actions and feels devastated after even the smallest failure. RET (recently renamed REBT, for rational-emotive behavior therapy) helps the client understand the irrationality and the consequences of such a way of thinking, to then reduce their feelings of anxiety in stressful situations, and finally to learn how to substitute more effective problem-solving methods.

Cognitive behavior therapy (CBT)
This is what most behavior therapists and cognitive therapists today actually do in practice. It combines the methods and underlying theories of BT with those of CT. For most clients and conditions, it is generally believed that the combination is more effective than either BT or CT alone.

Existential Therapy

Existential therapy is based on developing a client’s insight, or self-understanding, and focuses on problems of living such as choice, meaning, responsibility, and death. This therapeutic approach emphasizes free will the ability to make choices that are not dictated by heredity or past conditioning, through which an individual can become the person that he or she wants to be. Existential therapy attempts to restore meaning to life so that the client is inspired to have the courage to make choices that are both rewarding and socially constructive.

Following his experiences in a Nazi concentration camp, Victor Frankl developed a kind of existential therapy he called logotherapy. Frankl believed that one of the major factors that contributed to the prisoners who survived was their ability to maintain a sense of meaning. Logotherapy is directed towards helping clients reappraise what is really important (most meaningful) in their life.

Family Therapy

Family can influence our perceptions, our modes of interacting, and our styles of communicating. In Family Therapy, the therapist applies therapeutic principles while engaging the participation of family members, individually and as a group. The process recognizes and reinforces constructive aspects of the family’s relationships while also allowing destructive elements and counter-productive interaction styles to be identified, acknowledged, and changed. A family is considered to be any group of individuals who are committed to one another’s well-being (usually for life).

Marital therapy assists couples in working more effectively as a couple and in cultivating mutually acceptable problem-solving strategies. A marriage is similar in its development to individual and family development in that there is a marital life cycle that has fairly predictable stages. At each stage, there are interpersonal skills to be mastered and the therapist helps the couple deal with their current issues.

Typical marital problems that couples seek treatment for include:

  • Inability to compromise
  • Sexual difficulties
  • Financial disputes
  • Child-rearing conflicts
  • Extended family issues (e.g., dealing with in-laws)

Marriage as a whole is different from the sum of its parts. For example, to describe the husband as an individual and the wife as an individual is not the same as describing the pair of them in relationship and interaction. The therapist helps the couple pay attention to the patterns which connect them as a means of appreciating the overall structure of their marriage.

Gestalt Therapy

In Gestalt therapy, therapists challenge clients with questions so that the client increases their awareness of feelings and develops a stronger ability to face daily living situations and problems. Gestalt therapists can use a variety of other techniques, such as role playing and confrontation, to help the client learn more effective means of coping and to assume more responsibility for the activities of their life. The emphasis is on what is being done, thought, and felt at the moment, rather than on what occurred in the past, or what might be, could be, or even what should be. The therapist teaches the client that what is directly experienced and felt is more reliable than explanations or interpretations based on pre-existing experiences or attitudes. The goal of Gestalt therapy is for the client to become aware of what they are doing, how they are doing it, and how they can change themselves and, at the same time, to learn to accept and value.

Humanistic Therapy

Humanistic psychology acknowledges that an individual’s mind is strongly influenced by ongoing determining forces in both their unconscious and in the world around them, specifically the society in which they live. Humanistic therapy holds a hopeful, constructive view of human beings and the individual’s substantial capacity to be self-determining. By and large, this therapeutic approach works with present (rather than past) occurrences and attitudes with a goal of client growth and fulfillment.

Play Therapy

Play therapy is a therapeutic technique most often used when working with children. While a child may not be developmentally able to articulate their feelings, a therapist can help them express what’s going on through engaging them in play. The sessions take place in a room that is specially furnished with toys, games, and equipment a child can use as tools for the dramatic scenes they direct while working with the therapist. Through play therapy, a child can create the world they can master, practice social skills, overcome frightening feelings and/or experiences, and symbolically triumph over traumas or upsets that have threatened their well-being. The therapist meets regularly with the child’s parents to share their observations, learn more about what is happening in the child’s life from the parents’  perspective, and to offer suggestions for how the parents can support their child’s therapy.

Postmodern Therapy

Postmodern psychotherapists believe that it is difficult at best, and often impossible, for a mental health expert to be able to determine what is psychologically healthy  since there is no truly objective measurement of mental health. As in postmodern philosophy, art, architecture, and music, deconstruction is a dominant theme in postmodern psychotherapy. In psychological terms, deconstructing means to regard the givens we take for granted as true (for example, adolescence is a time for teens to separate from their parents, or if you don’t earn a good living you’re not successful) and carefully examine their usefulness/appropriateness from the client’s point of view.

Practitioners of postmodern therapy even question the givens of their own profession (e.g. the concept of transference and its relevance to working with clients), and try to pay particular attention to minimizing the unavoidable power of authority granted to the therapist by the client who comes seeking expert advice. This is done through working hard to be as collaborative with the client as possible.

The are three main types of postmodern therapies:

  • Narrative Therapy rests on two underlying principles: a) all human thought and behavior exist in cultural contexts that give them particular meaning and significance, and b) people’s view of the world is shaped through a complex, generally unconscious process of sifting through experiences and selecting those that are most consistent with the story one holds of oneself.
  • Solution-Focused Therapy emphasizes the construction of solutions to problems, rather than an examination of their causes or how they are maintained. This approach is inherently brief compared with traditional psychotherapy and rests on the belief that clients can solve their problems by doing more of what has been successful for them in the past.
  • Collaborative Language Systems is a type of postmodern therapy that dissolves problems through conversation and emphasizes a collaborative conversational partnership between therapist and client.

Psychoanalytic Therapy

Clients interested in psychoanalysis must be willing to commit to an intensive and long-term therapy process. The intent of psychoanalytic therapy is to allow access to the unconscious as a source of conflicts and motivations. The therapist uses techniques such as free association (the client reports anything that comes to mind) and dreams analysis (the interpretation of the client’s dreams) to find commonalities in the client’s thoughts and behaviors and to then interpret them in terms of the client’s problems.

The treatment process can, at times, become blocked by the client’s resistance (their unwillingness to provide information). Transference is a condition in which the client begins to consider their therapist in the same emotional way they would consider a person in their lives, such as a parent or sibling. Working with interpretation, resistance, and transference is sometimes called working through, a therapeutic technique in which the therapist helps the client better understand their conflicts and how to resolve them.

Rational Emotive Behavioral Therapy (REBT)

When thinking about getting addiction treatment, it’s important to understand what types of therapies are offered at different treatment centers, so that you can select a program that best meets your needs.

Here is an overview of Rational Emotive Behavioral Therapy (REBT), a form of cognitive-behavioral therapy (CBT) that is sometimes offered as a part of a comprehensive substance abuse treatment program.

Rational Emotive Behavioral Therapy is a counseling technique that is sometimes offered to help people increase life satisfaction, to reduce the symptoms of disorders such as anxiety or panic, or to avoid negative emotions that increase the odds of addiction relapse.

REBT was developed in the 1950s and was groundbreaking in its day as the counseling technique that pioneered cognitive-behavioral therapy. REBT is still widely practiced and respected today.

REBT as Drug or Alcohol Addiction Treatment

REBT strives to help people achieve greater happiness in life. It is used in addiction treatment to help people understand how they control their negative feelings. It teaches people new to recovery techniques to use in real-world situations that increase happiness and life satisfaction, and in doing so, reduces the odds of relapse.

A REBT counselor would advise that we are responsible for much of our happiness (or unhappiness) and that our beliefs influence our well-being far more than outside events do.

REBT – Changing Your Beliefs to Increase Your Happiness

While asking someone to change their beliefs may sound like some form of indoctrination, a REBT therapist asks patients to explore and change only certain negative and rigidly held beliefs that may contribute to unhappiness.

For example:

  1. My professor gave me a “D” on my term paper.
  2. He hates me because I disagree with him.
  3. I give up, I’ll never pass.

Or:

  1. My professor gave me a “D” on my term paper.
  2. He didn’t agree with my arguments.
  3. It’s too bad, I’ll have to work extra hard next time to keep my GPA up.

It’s all in the ABC’s! Actions produce Beliefs which produce Consequences. Importantly, it is not, in many cases, the action or adverse event that produces the emotional consequence; it is the belief you have about the action that does.

This is good, because you can’t very well stop anything bad from ever happening to you again, but you can change the way you think or believe, which changes how tough events make you feel.

In the first scenario, the person’s rigid belief (he hates me) led to despondent feelings and self-defeating behaviors.

In the second scenario, a more realistic belief led to a mild negative but healthier reaction and a plan to move on toward continuing happiness and success.

What Are Negative Beliefs?

A REBT therapist will argue that it is our negative beliefs that cause much of our unhappiness, and that if we practice, we can change these beliefs and start living happier more satisfactory lives – which for someone in recovery from substance abuse is a very important thing. It’s hard to stay sober over the long haul when you’re unhappy.

Unhealthy negative beliefs share certain elements, including:

  • Rigidity
  • Lack of acceptance for who you really are
  • Demand a high level of perfection from you
  • Prioritize what others think about you
  • What you think about yourself depends on what others think of you

Some examples of unhealthy beliefs include:

  • Those close to me must love and approve of me.
  • I must succeed at what I do.
  • Other people must behave correctly, or they must be punished.
  • I can’t control my happiness since the things that make me unhappy are not under my control.
  • If I don’t achieve my goals, things will be terrible.

In reality, we may prefer it if those close to us love and accept us, but they don’t have to, and the world won’t end if they don’t.

Other people don’t have to behave the way you think they should, and it’s not up to you to worry about punishing anyone.

You can’t control what happens to you but you can control the way you feel and respond – you can control your happiness!

Tolerance – The Path to Happiness

Accepting yourself, others and the world in general as it is, and not as it should be, is the path to greater happiness.

According to Albert Ellis, the father of REBT counseling, to live a happier life you must:

  • Accept yourself unconditionally – I want to succeed at work, but I don’t have to, and if I fail to do well, I can still like myself and have fun. I want to be a better husband, but I am not perfect. I will try to do better while accepting that my few negative traits do not define me as a “bad person.”
  • Accept others unconditionally – You accept every other person as a worthy person. You do not have to accept the self-defeating or antisocial actions of others, but no person’s few negative actions define that person completely.
  • Accept the world unconditionally – The world is not fair and you can’t control it. You do your best to help yourself and to help others but you acknowledge that you cannot change the world and so you must not get irrationally upset about the state of the world.

As Dr. Ellis would say, you aren’t perfect, others aren’t perfect and the world isn’t perfect – accept it, and then go out and have some fun!

Advantages of REBT

  • REBT therapy doesn’t require the months or years of counseling that some psychodynamic methods do; a typical course of REBT treatment ranges from 5 to 30 sessions in total.
  • REBT can induce lasting change and offers clients a real-world technique that can be practiced to increase life satisfaction; once learned, REBT becomes a self-help modality.
  • REBT does not strive to help people change their negative environmental conditions; rather, patients learn to accept imperfections in the self, others and the world, which can lead to greater happiness and personal freedom and frequently to positive environmental changes down the road.