Psychoanalysis

In behavioral therapies, therapists play a more directive role. The emphasis is on changing the patient's behavior, using positive reinforcement, and increasing self-efficacy. More recently, cognitive therapies such as those of A. T. Beck have tended to be combined with behavioral emphases. The cognitive-behavioral therapies have focused on changing dysfunctional attitudes into more realistic and positive ones and providing new information-processing skills. See also Cognition.

Most of the developments in interpersonal therapy have occurred in work with depressed patients. The goal of interpersonal therapy (a brief form of therapy) is centered on increasing the quality of the patient's interpersonal interactions. Emphasis is placed on enhancing the patient's ability to cope with stresses, improving interpersonal communications, increasing morale, and helping the patient deal with the effects of the depressive disorder. See also Personality theory.

Eclectic and integrative therapies

The largest number of psychotherapists consider themselves to be eclectics. They do not adhere strictly to one theoretical orientation or school but use any procedures that they believe will be helpful for the individual patient. Eclecticism has been linked with the development of a movement for integration in psychotherapy. The emphasis in this new development is on openness to the views of other approaches, a less doctrinaire approach to psychotherapy, and an attempt to integrate two or more different theoretical views or systems of psychotherapy.

Group, family, and marital therapy

Most psychotherapy is conducted on a one-to-one basis—one therapist for one patient—and the confidentiality of these sessions is extremely important. However, there are other instances where more than one patient is involved because of particular goals. These include marital, family, and group therapy. Outpatient groups have been used for smoking cessation, weight loss, binge eating, and similar problems as well as for what were traditionally viewed as psychoneurotic problems. Inpatient group therapy was frequently employed in mental hospital settings.

There has been research on the combined use of medication and psychotherapy. In general, where two highly successful treatments are combined in cases with depressive or anxiety disorders, there appears to be little gain in effectiveness. However, in several studies of hospitalized patients with schizophrenia where individual psychotherapy has been ineffective, a combination of psychotherapy and medication has produced better results than medication alone. See also Affective disorders; Psychopharmacology; Schizophrenia.

Psychoanalysis

Psychoanalysis

Psychoanalysis was the earliest form of psychotherapy, but many other theories and techniques are also now used by psychotherapists, psychologists, psychiatrists, personal growth facilitators and social workers. Techniques for group therapy have been developed.

While behaviour is often a target of the work, many approaches value working with feelings and thoughts. This is especially true of the psychodynamic schools of psychotherapy, which today include Jungian therapy and Psychodrama as well as the psychoanalytic schools. Other approaches focus on the link between the mind and body and try to access deeper levels of the psyche through manipulation of the physical body. Examples are Rolfing, Pulsing and postural integration.

Medical and non-medical models

A distinction can also be made between those psychotherapies that employ a medical model and those that employ a humanistic model. In the medical model the client is seen as unwell and the therapist employs their skill to help them back to health. The extensive use of the DSM-IV, the diagnostic and statistical manual of mental disorders in the United States, is an example of a medically-exclusive model.

In the humanistic model, the therapist facilitates learning in the individual and the clients own natural process draws them to a fuller understanding of themselves. An example would be gestalt therapy.

Some psychodynamic practitioners distinguish between more uncovering and more supportive psychotherapy. Uncovering psychotherapy emphasizes facilitating clients' insight into the roots of their difficulties. The best-known example of an uncovering psychotherapy is classical psychoanalysis. Supportive psychotherapy, by contrast, stresses strengthening clients' defenses and often providing encouragement and advice. Depending on the client's personality, a more supportive or more uncovering approach may be optimal. Most psychotherapists utilize a combination of uncovering and supportive approaches.

Cognitive therapy

Cognitive behavioural therapy is a kind of psychotherapy used to treat depression, anxiety disorders, phobias, and other forms of mental disorder. It involves recognising distorted thinking and learning to replace it with more realistic substitute ideas.

Expressive therapy

Expressive therapy is a form of therapy that utilizes artistic expression as its core means of treating clients. Expressive therapists use the different disciplines of the creative arts as therapuetic interventions. This includes the modalities dance therapy, drama therapy, art therapy, music therapy among others. Expressive therapists believe that often the most effective way of treating a client is through the expression of imagination in a creative work and integrating and processing what issues are raised in the act.

Adaptations for children

Counseling and psychotherapy must be adapted to meet the developmental needs of children. Many counseling preparation programs include a courses in human development. Since children often do not have the ability to articulate thoughts and feelings, counselors will use a variety of media such as crayons, paint, clay, puppets, bibliocounseling (books), toys, et cetera. The use of play therapy is often rooted in psychodynamic theory, but other approaches such as Solution Focused Brief Counseling may also employ the use of play in counseling. In many cases the counselor may prefer to work with the care taker of the child, especially if the child is younger than age four. Theraplay is an approach developed to facilitate a healthier relationship between parent and child that uses structured play. Children who have experienced chronic early maltreatment that results in Complex Post Traumatic Stress Disorder or reactive attachment disorder can be effectively treated with Dyadic Developmental Psychotherapy ^[1][2][3], which is an evidence-based family-based treatment approach.

The therapeutic relationship

Research has shown that the quality of the relationship between the therapist and the client has a greater influence on client outcomes than the specific type of psychotherapy used by the therapist (this was first suggested by Saul Rosenzweig in 1936 ^[4]). Accordingly, most contemporary schools of psychotherapy focus on the healing power of the therapeutic relationship.

This research is extensively discussed (with many references) in Hubble, Duncan and Miller (1999)^[5] (quotes in this section are from this book) and in Wampold (2001) ^[6].

A literature review by M. J. Lambert (1992) ^[7] estimated that 40% of client changes are due to extratherapeutic influences, 30% are due to the quality of the therapeutic relationship, 15% are due to expectancy (placebo) effects, and 15% are due to specific techniques.

Psychoterapy

Psychotherapy

Any treatment or therapy that is primarily psychological in nature. In recent years, counseling also has been included in this categorization.

Psychodynamic therapies

Historically, psychoanalysis—created by Sigmund Freud—has played an important role in the growth and development of psychotherapy. Central to Freud's theories was the importance of unconscious conflicts in producing the symptoms and defenses of the patient. The goal of therapy is to help the patient attain insight into the repressed conflicts which are the source of difficulty. Since patients resist these attempts bring to consciousness the painful repressed material, therapy must proceed slowly. Consequently, psychoanalysis is a long-term therapy requiring several years for completion and almost daily visits. Since Freud's time, there have been important modifications associated with former disciples such as Alfred Adler and Carl Jung. Self psychology and ego psychology are among more recent emphases. However, the popularity of psychoanalysis has waned. See also Psychoanalysis.

Experiential therapies

A number of related therapies are included in this group. Probably best known was the patient-centered therapy of Carl Rogers appearing in the 1940s. In Rogers' therapy, a major emphasis is placed on the ability of the patient to change when the therapist is empathic and genuine and conveys nonpossessive warmth. The therapist is nondirective in the interaction with the patient and attempts to facilitate the growth potential of the patient. Other therapeutic approaches considered as experiential include Gestalt therapy, existential approaches, and transpersonal approaches. The facilitation of experiencing is emphasized as the basic therapeutic task, and the therapeutic relationship is viewed as a significant potentially curative factor.

Cognitive, behavioral, and interpersonal therapies

In behavioral therapies, therapists play a more directive role. The emphasis is on changing the patient's behavior, using positive reinforcement, and increasing self-efficacy. More recently, cognitive therapies such as those of A. T. Beck have tended to be combined with behavioral emphases. The cognitive-behavioral therapies have focused on changing dysfunctional attitudes into more realistic and positive ones and providing new information-processing skills. See also Cognition.

Most of the developments in interpersonal therapy have occurred in work with depressed patients. The goal of interpersonal therapy (a brief form of therapy) is centered on increasing the quality of the patient's interpersonal interactions. Emphasis is placed on enhancing the patient's ability to cope with stresses, improving interpersonal communications, increasing morale, and helping the patient deal with the effects of the depressive disorder. See also Personality theory.

Eclectic and integrative therapies

The largest number of psychotherapists consider themselves to be eclectics. They do not adhere strictly to one theoretical orientation or school but use any procedures that they believe will be helpful for the individual patient. Eclecticism has been linked with the development of a movement for integration in psychotherapy. The emphasis in this new development is on openness to the views of other approaches, a less doctrinaire approach to psychotherapy, and an attempt to integrate two or more different theoretical views or systems of psychotherapy.

Group, family, and marital therapy

Most psychotherapy is conducted on a one-to-one basis—one therapist for one patient—and the confidentiality of these sessions is extremely important. However, there are other instances where more than one patient is involved because of particular goals. These include marital, family, and group therapy. Outpatient groups have been used for smoking cessation, weight loss, binge eating, and similar problems as well as for what were traditionally viewed as psychoneurotic problems. Inpatient group therapy was frequently employed in mental hospital settings.

There has been research on the combined use of medication and psychotherapy. In general, where two highly successful treatments are combined in cases with depressive or anxiety disorders, there appears to be little gain in effectiveness. However, in several studies of hospitalized patients with schizophrenia where individual psychotherapy has been ineffective, a combination of psychotherapy and medication has produced better results than medication alone. See also Affective disorders; Psychopharmacology; Schizophrenia.

You Can be Healty

Journal writing and other forms of writing therapy are based on the premise that the mind and the body are inseparably joined in the healing process. Although there are many methods of conducting journal writing therapy depending on the therapeutic technique of the psychologist or psychiatrist, the therapist often instructs the participant to write about a distressing or traumatic event or thought in one or more sessions.

Although researchers are uncertain about exactly how writing about traumas produces improvements in psychological well-being, traumatic stress researchers have pointed out that ordinary memories are qualitatively different from traumatic memories. Traumatic memories are more emotional and perceptual in nature. The memory is stored as a sensory perception, obsessional thought, or behavioral reenactment. It is associated with persistent, intrusive, and distressing symptoms, avoidance, and intense anxiety that results in observed psychological and biological dysfunction. Thus, one goal in treating traumatic memories is to find a means of processing them.

A narrative that becomes more focused and coherent over a number of writing sessions is often associated with increased improvement, according to several research studies. The memories become deconditioned and restructured into a personal, integrated narrative. Changes in psychological well-being after writing therapy may result from cognitive shifts about the trauma either during or after the writing process.