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.
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 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:
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.
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.)
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.
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.
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 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:
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 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 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.
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 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 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 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.
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.