Different Types of Therapy
By Licia Ginne, LMFT
Psychotherapy
is not easily described in general statements. There are different
theories of psychotherapy and when you add the personality
of the therapist and the client into the mix you always get
some unique variation. Psychotherapy is a mixture of thinking,
insight, discussion, understanding, emotions and in cognitive
behavioral type therapy's exercises. Psychotherapy should
give you things to think about outside of the office visit.
Psychotherapy can have benefits and risks. Since therapy often
involves discussing unpleasant aspects of your life, you may
experience uncomfortable feelings like sadness, guilt, anger,
frustration, loneliness and helplessness. Psychotherapy has also
been shown to have benefits for people who go through it. Therapy
often leads to better relationships, solutions to specific problems,
and significant reductions in feelings of distress. But there
are no guarantees to what you will experience.
Therapy involves a large commitment of time, money and energy,
so you should be careful about the therapist you select.
I've written a separate article on in-depth
psychotherapy which
is a combination of contemporary psychoanalytic principles, object
relation, and self-psychology.
Below is a brief outline of various theories and techniques.
Often therapists will combine techniques and theories to find
a therapeutic framework that works best for them. We all bring
our personalities, beliefs and experiences to the therapy room.
It is important to find a therapist that you feel comfortable
with, one you feel understands you, one who provides clear boundaries
and you believe has your best interests in mind.
Art Therapy
Use of art and creativity as a way to get at deeper feelings
and greater self-knowledge. Based on the belief that accessing
the more creative or right-brain part of us is helpful in identifying
what is going on emotionally and can be a part of the healing
process.
Behavioral Founded on the belief that true change and movement
towards goals is accomplished through action and that disorders
are learned ways of behaving that are maladaptive. If we can
learn to change our behavior, then our thoughts, feelings,
and attitudes will also change. Common behavioral techniques
include systematic desensitization (gradual exposure to an anxiety-provoking
situation paired with relaxation), using reinforcements for
desired behaviors, and aversion therapy to extinguish unwanted
behaviors. The client learns new behaviors, the origin of the
problem is not needed, and the relationship between therapist
and client are not considered the focus is on the plan of change
and behaviors.
Biofeedback
Use of electronic systems to monitor internal processes such
as heart rate, brain waves, or perspiration to help an individual
become aware of their physiological responses and learn to have
more control over them.
Christian/Bible-Based
Counseling is founded on what is written in the Bible. Based
on the belief that Scripture is the final authority for what
kinds of decisions a person should make or how they should live
their life.
Client-Centered
Clients are believed to be in the best position to resolve their
issues if the therapist can establish a warm, accepting, and
safe environment in which the individual feels free to talk about
his/her issues and can gain insight into them. This type of therapy
is non-directive because the therapist typically does not give
advice or make interpretations.
Cognitive
Therapy is based on the belief that faulty thinking patterns
and belief systems cause psychological problems and that changing
our thoughts improves our mental and emotional health and results
in changes in behavior. Often cognitive therapy will work in
conjunction with behavioral therapy and you may see the term
Cognitive-Behavioral.
Dream Analysis
Interpretation of dreams, using symbols, myths, free association,
and your memories. There are a variety of philosophies and
approaches for analyzing dreams including Adler ian (dreams
are projections of a person's current concerns), Gestalt (every
person and object in a dream represents an aspect of the dreamer),
and psychoanalytic (dreams are a key to what is happening
in a person's unconscious).
EMDR (Eye Movement Desensitization Reprocessing)
Technique of restructuring thought patterns and associations
related to traumatic events and memories and other sources
of emotional distress. Francine Happier developed EMDR when
she discovered that rapid-eye movements combined with focusing
on disturbing thoughts and memories produced a calming effect.
Family Systems
Therapy which looks at the entire family as a complex system
having its own language, roles, rules, beliefs, needs, and patterns.
Each family member plays a part in the system and family systems
therapy helps an individual discover how his or her family operated,
that person’s role in the system, and how it affects the
individual’s relationship with the current family and relationships
outside the family. Within this category there are various theories
and approaches to family therapy.
Gestalt
Experiential therapy emphasizing what is happening in the here
and now to help individuals become more self-aware and learn
responsibility for and integration of Thoughts, feelings, and
actions. A goal is to develop more internal vs. external support.
Techniques include confrontation, role-playing, and the empty-chair
or dialogue between two parts of a personality. Founder: Frederick
S. (Fritz) Perls (1893-1970) who believed that people must find
their own way in life and accept responsibility for who they
are to reach maturity.
Jungian (Analytical Psychology)
The focus of therapy is to help individuals access more of their
inner world (unconscious) and develop greater self-realization
and individuation. Carl. G. Jung's theory is psychoanalytic,
but differs from traditional Freudian theory in that Jung added
the concepts of individuation (human potential), which includes
transcendence and spirituality. People are seen in a positive
light and therapy considers the soul, which seeks to be nurtured
by something larger than the self.
Psychoanalytic
Based on the belief that true change and growth comes from an
individual becoming more self-aware by bringing unconscious thoughts,
motivations, feelings, and experiences into the conscious so
that behavior is based more on reality than instinct. Founder:
Sigmund Freud (1856-1939). Key concepts are that behavior is
determined by unconscious motivations, irrational forces, instinctual
drives, and psychosexual events occurring during the first 6
years of life. Classical psychoanalysis is an intensive and long
term process with a focus on transference (transferring feelings
about and reactions to past significant others onto the therapist)
and uncovering unconscious material.
RET (Rational Emotive Therapy)
Based on the belief that our emotions result from our beliefs,
interpretations, and reactions to life events. A type of cognitive
therapy based more on thinking and doing than with the expression
of feelings. Founder: Albert Ellis (b.1913) is known as the father
of RET and the grandfather of cognitive-behavioral therapy.
Self Psychology
Based on the Freudian and Jungian depth psychology. Heinz Kohut,
its founder, postulated that narcissism and grandiosity in the
infant is healthily managed by selfobject experiences which can
be idealizing, mirroring, or twinning experiences. The experience
of the infant is the most important and it is the primary caretaker’s
responsibility to respond to the infant in an affirming and validating
manner. He felt that these selfobject experiences continue throughout
development and life. The essence of therapy arises from empathic
understanding within the therapeutic frame and that healing results
from temporary disruptions in this empathic stance in the therapist.
The relationship between client and therapist is most important,
like that of mother and child, and the healing comes with the
resolution, understanding and working through of that relationship.
Solution-Focused
Solution-focused treatment begins from the observation that
most psychological problems are present only intermittently.
People with panic disorder obviously do not spend every minute
of every day in a panic; even depression fluctuates in severity.
Solution-focused therapy tries to help the patient notice when
symptoms are diminished or absent and use this knowledge as a
foundation for recovery. If a patient insists that the symptoms
are constant and unrelieved, the therapist works with him or
her to find exceptions and make the exceptions more frequent,
predictable, and controllable. In other words, therapy builds
on working solutions already available to the patient.
TA (Transactional Analysis)
Interactions with others and communication styles are seen as
coming from three states: the parent, adult, and child and the
different types of ways those three parts of our personality
communicate within ourselves and with other.
In finding a therapist it is important to know what their credentials
mean, only a licensed therapist may bill insurance companies
and identify themselves as a Psychologist, Psychiatrist, Licensed
Clinical Social Worker or Marriage, Family Therapist. Those in
training will be licensed as interns, residents or assistants
and will work under the supervision and license of a currently
licensed practioner.
Each person seeking a license has required courses and a certain
amount of hours of supervised training before he or she is eligible
to take the State-licensing exam. After passing the exam and
becoming licensed, the individual required to take a certain
amount of continuing education credits to keep the licenses.
No one of these is better than the rest and since therapy is
such an individual and subjective experience, much of it depends
on the individual counselor and client. Psychiatrists are the
only practioners that can currently prescribe medication. Most
therapists will have referrals to psychiatrists if medication
seems like a viable option and will work with the psychiatrist
to manage your treatment. Psychiatrists are usually the most
expensive. Psychologists, MFT, and LCSW’s can charge anywhere
between $75.00 - $300.00 an hour and many well known practioners
may charge as high as $500.00 per hour. Figuring out how you
will finance your therapy is an important step in finding the
right person to talk to.
If you can afford it, paying out of your own pocket to see a
therapist in private practice may be the most straightforward
approach. You won't have to deal with restrictions, insurance
companies and you will not have to contend with releasing information
about you and your treatment to insurance or managed care companies.
Your treatment will remain completely confidential.
If you plan to use your insurance coverage you should call your
insurer and find out what kind of coverage you have. You may
have to choose from a particular panel of providers, or you may
be able to use a therapist of your choosing. When you call you
may consider the following:
- What are your in network, out-patient mental health benefits.
(In network may be a selected panel of providers and your
out of pocket costs may be less) this may include a specific
number of sessions per year, your co-payment, or possibly the
need for your Primary Care Physician’s referral. If you
have already found a therapist you may ask if they are in network.
- What are your out-of-network benefits: Will they reimburse
for you to see any therapist of your choosing. You may have
to meet a deductible, your co-payment may be higher or most
often it will be a percentage of what they consider reasonable
and customary. You may have a set number of visits per year.
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