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Types of Psychotherapy (Approaches)

 

 

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Introduction

A professional's approach to therapy or "psychotherapeutic orientation" can be as unique as that therapist him or herself.  Most therapists learn about and receive training in several approaches and specialize later in their professional development.  This training interacts with the therapist's personality and the cultural and professional environment within which he or she practices to determine that unique style that develops.  Still, there are a number of recognized approaches with new ones developed all the time.  Most new approaches add a small amount that is truly new while expanding on existing approaches or combining elements of several approaches.  Most approaches therefore have considerable overlap in theory and practice.

There is also a school of thought, with some research to back it up, that there are common elements in all effective therapies that are responsible for the bulk of positive outcome.  For example, the quality of the therapeutic relationship, regardless of therapeutic orientation, is one factor that has been shown as necessary and sufficient for postive outcome.  There is also focus on common therapist skills such as empathic listening, reflection, and teaching that are relatively neutral in theory, as necessary components, as well as client factors such as motivation, application of learning outside of appointments, and nature of the difficulty to be addressed.  Unfortunately, psychotherapy and human change is incredibly difficult to research in a manner that can conclusively answer the question of which approach is best.  The research that has provided meaningful results has most often focused on very limited, easily defined problems that can be measured objectively.  This hardly addresses the human condition and the conflicts and struggles that people often bring to psychotherapists.

We have chosen to briefly present four major categories to help understand the most commonly identified psychotherapeutic approaches:  Psychodynamic, Humanistic-Existential, Cognitive-Behavioral, and Transpersonal.  If you are interested in pursuing these topics further, you can click on the links provided in the text, search Amazon.com, the Internet, libraries and bookstores using the terms and authors discussed and find a wealth of information.

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Psychodynamic Psychotherapy

Sigmund Freud is credited as the founder of psychoanalysis and psychoanalytic theory, if not modern psychology.  There have been a multitude of variations that have evolved and the term most often used to broadly encompass these approaches is "Psychodynamic."  Terms such as: neurosis, conflict, attachment, object relations, unconscious, defense mechanisms, id, ego, superego, drives, libido, transference, countertransference, and countless more have emerged from this approach.  Some of the major approaches within the psychodynamic category are: Psychoanalysis (Sigmund Freud), Adlerian Psychotherapy (Alfred Adler), Analytical Psychotherapy (Carl Jung), Object Relations (Mahler, Winnicott, Fairbairn, Klein, Gutrip, Kernberg and others), and Self Psychology (Heinz Kohut).

Freud's original theories were based on the conflicts that he believed were at the core of human existance.  These conflicts emerge from attempts to reconcile our biological selves with our social selves.  Aspects of these conflicts are unconscious and influence our behavior without our awareness.  Psychodynamic therapies work to make the unconscious conscious so that we can have greater insight into our needs and behavior and therefore more control over how we allow these conflicts to affect us.

In Adlerian psychotherapy, clients are encouraged to overcome their feelings of insecurity, develop deeper feelings of connectedness, and to redirect their striving for significance into more socially beneficial directions.  Through a respectful Socratic dialogue, they are challenged to correct mistaken assumptions, attitudes, behaviors and feelings about themselves and the world.  Constant encouragement stimulates clients to attempt what was previously felt as impossible.  The growth of confidence, pride, and gratification leads to a greater desire and ability to cooperate.  The objective of therapy is to replace exaggerated self-protection, self-enhancement, and self-indulgence with courageous social contribution.

Carl Jung was a student of Freuds and eventually developed his own theory called "Analytical Psychology."  While still based on the reconciliation between the consious and unconsious, Jung broaded Freud's work to include concepts of culture, mythology, and spirituality.  For Jung the most important and lifelong task imposed upon any person is fulfillment through the process of individuation, achievement of harmony of conscious and unconscious, which makes a person one and whole.

The term "object-relations" refers to the self-structure we internalize in early childhood, which functions as a blueprint for establishing and maintaining future relationships.  Psychopathology is an expression of traumatic self-object internalizations from childhood acted-out in our current relationships.  Psychotherapy is the resolution of these self-destructive patterns of relating so that we can mature and self-actualize.  Self psychology is Heinz Kohut's variation of object relations theory that recognizes the central importance of people's needs for relationships critical in providing necessary experiences during growth and development. These experiences are called self-object experiences.  Sufficient positive self-object experiences when the infant and child are developing facilitate the formation of a strong, cohesive self -- the core of one's personality and character.  Kohut is credited with adding the concept of "empathy" to the every day discourse of psychotherapy.

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Humanistic-Existential Psychotherapy

Humanistic psychotherapy is an approach which tries to do justice to the whole person including mind, body and spirit. It represents a broad range of therapeutic methods. Each method recognizes the self-healing capacities of the client. The humanistic psychotherapist works towards an authentic meeting of equals in the therapy relationship.  Abraham Maslow is perhaps the best know theorist associated with Humanistic Psychology and Carl Rogers (Client Centered Psychotherapy) the best know therapist, though many have followed including Fritz Perls and his Gestalt Therapy.

Existential psychotherapy is closely related to humanistic psychotherapy, though different historical figures are usually associated with the two models.  Many therapists today will identify themselves as "humanistic-existential" in approach due to the common roots and perspectives. 

Existential psychotherapy aims at enabling clients to find constructive ways of coming to terms with the challenges of everyday living. The focus is on the client’s concrete, individual experience of anxiety and distress leading to an exploration of their personal beliefs and value system, in order to clarify and understand these in relation to the specific physical, psychological and socio-cultural context. The experience and influences of the past, present and future are given equal emphasis. The questioning of assumptions and facing up to the possibilities and limitations of living is an important part of this interactive, dynamic and direct approach.  Four "existential problems" are cited as the core of the existential struggle that is the primary focus in this therapy and considered to be at the root of most psychological difficulties: death, freedom vs. responsibility, isolation, and meaninglessness.  There are no absolute solutions to the existential problems yet all of us have to come to terms with them.  The names most associated with Existential Psychotherapy (not Existential Philosophers like Sartre and Kierkegaard) are Rollo May, James Bugental, and Irvin Yalom.

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Cognitive-Behavioral Psychotherapy

Cognitive-Behavioral Therapy (CBT) is a practical approach that seeks to define concrete goals and uses active techniques to reach them.  The cognitive-behavioral therapist looks at patterns of thinking and behavior and how these patterns are reinforced and maintained by the person within his or her environment.  A functional analysis of thinking and behavior is performed, often using log sheets and graphs to better understand thought and behavior patterns in the context of daily routines.  Once an understanding of symptoms and behavior is achieved, the therapist and client together devise changes in the patterns and continue tracking.  This process is repeated until the original goals are met.  Attention to irrational thinking patterns (e.g., automatic thoughts, catastrophic thinking) is central to the approach as well. 

Some of the techniques and programs that are usually associated with CBT are relaxation training, systematic desensitization, assertiveness training, and social skills training.  

Historically, Cognitive-Behavior Therapy (CBT) has its roots in the work of behaviorists such as Ivan Pavlov, John Watson, Joseph Wolpe, and B.F. Skinner.  Skinner, in particular, developed theories of operant conditioning that were the basis of behavior therapy, which views the consequences of behavior as shaping future behavior.  Associated with Skinner are terms such as stimulus-response, positive reinforcement, and contingencies of behavior. 

Skinner's emphasis was on observable behavior.  It was theorists such as Albert Bandura (Social Learning Theory) and cognitive therapy and cognitive-behavioral therapy originators such as Albert Ellis (Rational Emotive Behavior Therapy), Aaron Beck (Cognitive Therapy), William Glasser (Reality Therapy) and Donald Meichenbaum (Cognitive-Behavioral Therapy) that brought thought and emotion into this approach.

CBT is considered the "second wave" of behavior therapy.  In the 1990's approches evolved that incorporated mindfulness and acceptance into the cognitive-behavioral perspective.  Some consider this a fundamental change as CBT emphasized control and reduction of problematic thinking, while the third wave approaches emphasized acceptance and moving on.  Further, advocates for the third wave approaches consider attempts to control or reduce these symptoms as counter productive and as potentially worsening them.  Adopting mindfulness and acceptance from eastern thinking, third wave theorists embrace paradox.  In this case, symptom reduction will often occur when symptoms are accepted and fighting against them ceases.  Some of these third wave approaches are Steven Hayes, Kirk Strosahl, Kelly Wilson's Acceptance and Commitment Therapy (ACT), Marsha Linehan's Dialectical Behavior Therapy (DBT), Jon Kabat-Zinn's Mindfulness Based Stress Reduction (MBSR), and Zindel Segal, Mark Williams and John Teasdale's Mindfulness Based Cognitive Therapy (MBCT).

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Transpersonal Psychotherapy

Transpersonal/Psychospiritual psychotherapy can be defined by its orientation which includes the spiritual dimension rather than the content of therapy. It views the human psyche as having a central core Self or Soul as the centre of identity as well as a personal ego. Psychotherapists draw on a wide range of therapeutic methods towards the uncovering of past psychological material within a context of the individuals potential based on spiritual insight and experience. Within this perspective there is both a movement of the personal centre to the Self and a movement of the Self to manifest its nature through and in the personal centre. Thus therapy includes both repair and individuation.

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