Demystifying Psychotherapy

These three terms are broad and can have their meaning shift from context to context. Humanistic / Person-Centered treatment is a therapist’s way of stating that they have a faith that clients have the capacity to change within themselves. The therapist minimizes their role as an authoritative expert, and while they bring special knowledge into play, the client ultimately is in charge of the direction that therapy goes and the therapist is providing support along the way.

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Attachment Theory is a perspective that seeks to explain much of a client’s social behavior through the perspective of their formative relationships growing up. The theory is that the quality of the caregiver relationship at birth and through childhood sets the template and tone for other significant relationships later in life. Poor quality caregiver-child relationships are seen as a source of much social struggle and the therapist works at trying to heal and build up a client’s internal concept of healthy social connections.

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Somatic Therapy is a fancy way of saying that the therapist is interested in what information a client’s body can bring into therapy; people don’t exist in reality exclusively from their neck up. A somatic therapist is interested in the connection between thoughts, emotions, sensations, and feelings that a client has, and how each of these types of information influences the other types of information. Think about how a stomach ache or a headache or a sore muscle can make you anxious or irritable. The reverse is true as well.

This is the lens with which I approach my learning towards providing therapy. I will undoubtedly be writing more about somatic therapy in other posts.

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Cognitive-Behavioral Therapy is the most well-known treatment orientation now. This is in part due to the fact that it is a coming together of Cognitive Therapy and Behavioral Therapy, two schools of therapy that have been around for over fifty years. Together, they are readily put into straight-forward manuals and are generally easy to teach and perceived as logical. Cognitive therapy focuses on identifying unhelpful thoughts and challenging them with more helpful thoughts. Behavioral therapy focuses on unhelpful behaviors and replacing them with helpful behaviors. It sounds simple, but putting it into practice takes both art and effort. There is much research to show that this is an effective form of therapy, and as such, many therapists will include it in their treatment orientations. Ten out of the fifteen therapists I sampled claimed to incorporate this therapy in their work.

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 Mindfulness is a relatively recent tool that many therapies are incorporating due to the widely recognized positive benefits it brings. In this case, traditional CBT is further enhanced by exercises that encourage an in-this-moment awareness for the client. Mindfulness as a whole means different things to different people and is both simple and complex to grasp. Many mindfulness practitioners attribute the heritage of ideas to practices common in Buddhist monasteries, though the typical CBT environment is often far removed from those roots. Mindfulness on its own is not innately spiritual, however, it can be used as a tool by people of many different faiths to enhance their spiritual discipline and awareness. Mindfulness, like much of therapy, is about suspending the normal patterns of thought you have and becoming very curious about your present experience. This new thought pattern allows you to be more creative and is often regarded as an excellent way to reduce absent-mindedness, overactive thoughts, and anxiety.

Further reading: Cognitive Behavioral Therapy and Depression

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 Narrative Therapy is a recent arrival in the field of therapy and owes much of its process to philosophy and literature. It is post-modern in that it places little emphasis on labels, diagnosis, or an exterior reality. Of ultimate concern is how a client perceives their role in their life’s story, and how that role is proving to be unhelpful to them. The therapist, in turn, emphasizes new ways of making sense of past events in life, and thus, the therapist and client re-interpret the client’s story in a way that empowers them. For example, a client can see themselves as a victim initially, and through therapy can reconstruct their self-identity to see how they are a survivor with the potential to make decisions for the better. While there are practitioners who focus solely on Narrative Therapy as a standalone therapy, it is most often used alongside other therapies.

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 Solution-Focused Brief Therapy has very little regard for a client’s past and is much more interested in the current moment and the current problems. The client and therapist work together to find solutions to problems and consult past experience to see where past tools and successes can inform current work. Childhood is rarely focused on, and as such, the therapy is often quite brief in the number of sessions. This is very successful for some problems, but clients may find that other problems are more enduring or deep-rooted.

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 Family / Marital Therapy, often known by one of its more prominent schools of thought as Systems Therapy, is ultimately about how relationships impact people. A client can come in with certain challenges, yet the maintaining issues or other supporting challenges might not be known until the therapist can work together with a couple or family group. Each relationship is known as a sub-group, and two parents together can be a subgroup called “Parents”, or siblings can be a subgroup called “Siblings” or “Children”, and Parents and Children have different relationships than mom and child or dad and child would. The therapy is rooted in finding out how relationships are helpful, unhelpful, and how they maintain their patterns. This can be done with just one person or a whole group. While a Psychologist can be trained in this kind of work, there is a separate field that specializes in this type of knowledge called Marriage and Family Therapists. Each professional comes with their own skills and tools, and both have their strengths and weaknesses.

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 Eye Movement Desensitization-Reprocessing Therapy, or EMDR for short, is a novel form of therapy geared specifically toward dealing with trauma on a body level. While no one is exactly sure how it works, it is one of the most widely trained forms of therapy and the results with clients for trauma are often quite successful. Put simply, it is a form of exposure therapy that uses body sensations to process what the nervous system seems otherwise unable to process on its own. A client recalls a traumatic experience, rates its intensity, and while recalling it, the therapist guides them through an exercise to stimulate the nervous system on both sides (bi-laterally). This can involve asking the client to follow a pen or a finger being waved past the client’s eyes rapidly and rhythmically, or having the therapist alternate in tapping a client’s knees. Some methods are more comfortable for some clients, and the therapist ultimately works within the client’s capacity. As the client recalls the traumatic experience and goes through the exercise at the same time, the perceived stressfulness of trauma often rapidly diminishes. At the end of the exercise, the therapist re-rates the client’s subjective distress, and if the threshold is low enough, the therapist moves backward through a client’s history to their earliest possible connected traumatic memory, reprocessing each memory along the way. Though controversial as a therapy in regards to the amount and quality of research being done, it nevertheless has staying power and revolutionized the field of trauma therapy. As with all therapies, many but not all clients find success here.

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 Trauma-Focused Therapy, in general, is a way of a practitioner saying that they’re familiar with working on traumas like accidents, sudden job losses, witnessing death or extreme suffering, etc. There are many different theories about how to best work with trauma, and working with trauma is qualitatively different than working with mood, developmental, or personality disorders. The theory here goes that the brain needs to be worked with on three levels: cognitive, emotional, and life support. These are loosely represented by primate, mammalian, and lizard brains in terms of how information is processed. A trauma will disrupt processing on all three levels, and a therapist who is trauma-focused is trained to recognize what state a client is in during a session, and how best to meet their needs at that moment to help a client best process their experiences to a point where they can cope well independently.

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Psychodynamic Therapy is one of the oldest forms of psychotherapy. It is a direct evolution from Sigmund Freud’s Psychoanalytic Therapy. Gone are the days of lounge chairs and a mysterious, blank-faced analyst sitting outside of your field of view (in most cases). As all things develop over time, Psychodynamic Therapy has refined its methods and theory, and in general is much more relational and personable than its roots once were. The main focus here is on how a person’s development has been either successful or unsuccessful in numerous tasks, and how a person develops defenses against challenging emotions when unsuccessful at a task. These defenses are seen by therapists as unhelpful beliefs and behaviors that at one time served a purpose, but are no longer functioning for a client. This form of therapy can be brief, or it can be long. Clients may come once a week for twelve weeks, or up to three times a week over the course of years. This form of therapy can also go very deep into a person’s self-concept and can be intensely challenging and vulnerable. Some people find it very healing, and some find it overwhelming.

The main focus here is on how a person’s development has been either successful or unsuccessful in numerous tasks, and how a person develops defenses against challenging emotions when unsuccessful at a task. These defenses are seen by therapists as unhelpful beliefs and behaviors that at one time served a purpose, but are no longer functioning for a client. This form of therapy can be brief, or it can be long. Clients may come once a week for twelve weeks, or up to three times a week over the course of years. This form of therapy can also go very deep into a person’s self-concept and can be intensely challenging and vulnerable. Some people find it very healing, and some find it overwhelming.

This form of therapy can be brief, or it can be long. Clients may come once a week for twelve weeks, or up to three times a week over the course of years. This form of therapy can also go very deep into a person’s self-concept and can be intensely challenging and vulnerable. Some people find it very healing, and some find it overwhelming.

Depending on which school of thought a psychodynamic therapist is interested in, extensive discussion of the unconscious, dream analysis, or even archetype work may be on the table. Not every psychodynamic therapist focuses on these areas, nor is it a part of each therapist’s practice. There is great diversity under the title of Psychodynamic therapy.

Further reading: Psychodynamic Therapy and Depression

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 Coaching is about helping someone problem solve and move toward goals. It is very similar in practice to Solution-Focused Brief Therapy, however, the main distinction to make is that anyone can call themselves a “coach”, but not everyone can call themselves a “psychologist.” Psychologists can do coaching, but life coaches cannot do therapy. This is because psychologists are held accountable to professional and disciplinary groups, and are licensed; coaches are not. This is due to the greater degree of responsibility a psychologist has in working to bring healing to vulnerable populations, whereas in general, coaches help people without necessarily focusing on healing. Coaching is about having someone come alongside you and solve problems, but not necessarily dig into your childhood, give you a diagnosis, or perform intensive therapeutic techniques. Having both professions helps spread the load of those seeking help, assuming they are appropriately filtered according to the intensity of their challenges.

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 Existential Therapy is less a form of therapy and more about a lens in which to understand a client’s problems. Stemming from philosophy and the work of writers such as Soren Kirkegaard, Jean Paul-Sartre, and Viktor Frankl (who wrote the famous book, ‘Man’s Search of Meaning’). Existential therapy is about helping client’s make meaning in the midst of their suffering, and not necessarily to find healing. To an existentialist, meaning is more important than comfort, as coined in the expression, “He who has a why to live for can bear almost any how.” by Friedrich Nietzsche. A client is ultimately held responsible for their meaning-making, for their choices, and for their actions. A therapist helps the client understand where they are unconsciously or otherwise making meaning and choices, and brings them to focus for intentional decisions to be made.

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 Gestalt Therapy, in brief, is an active, experience-focused form of therapy rooted in several philosophies including the above-mentioned Existentialism. As one of the oldest forms of therapy next to Psychoanalysis, it has a rich history and has developed in many ways since its founding father, Fritz Perls, first made it famous. Gestalt focuses on phenomenological inquiry, which means that the therapist is most interested in understanding a client’s experience and worldview through their own eyes as possible. The better a therapist ‘gets’ a client, the better they can provide experiments to shift the client’s experience. Experiments are (most often) spontaneous ways of trying a new experience out to learn something new. Gestalt is most famous for its two-chair exercise, in which a client sits in one chair and imagines another person/thing in the other chair. They then verbalize their thoughts to that person or thing, and in verbalizing their thoughts they pay attention to their own response, emotional and behavioral. The ‘thing’ in the other chair may be a symbolic representation of another ‘part’ of themselves. For example, I may speak of the “bold” part of me to the “shy” part of me, to better understand both the bold and the shy parts of me. Many of our thoughts and behaviors are reactive responses to life, and Gestalt is interested in suspending the ‘normal’ way of being to discover a new way of being; the normal way of being no longer works for a client, so therapy is creatively discovering new ways to function in life.

Further reading: Gestalt Therapy and Depression

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The Gottman Method is named after the foremost researching clinicians in relationship therapy, Dr. John M. Gottman, and Dr. Julie Gottman. Through a 9-part therapy method, clients work at restoring their relationship. Covering themes like building Love Maps, sharing fondness and admiration, turning towards (how we respond to connection attempts), positive perspective, managing conflict, aspirations and hopes, creating shared meaning, trust, and working on commitment, clients learn new skills and views to strengthen their relationship. Their work stemmed out of research with more than 3,000 couples and has proven to be highly effective.

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 Motivational Interviewing (MI) is a form of therapy based on connecting clients to their own forms of motivation and working with their own problems and skills in a way that is highly committed to change. This form of therapy is most often used alongside other forms of therapy and is considered to be highly person-centered, in that the client leads the pace and the therapist doesn’t push them beyond their own commitments. When executed well with proper training, this is considered a highly effective tool to compliment other forms of therapy.

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Strengths-Based Therapy is ultimately a lens of seeing clients and the therapeutic process. Whereas some forms of therapy focus on what you are doing wrong or not well enough and changing that, Strengths-Based is about finding what you do well and helping you to do better with it. Furthermore, this form of therapy helps with identifying what supports you have in place, such as family, church/community groups, etc, and how to best use these supports to your favor. It is not exclusively focused on your strengths, but it brings them up to help empower you to overcome your weaknesses knowing that you have internal resources to lean on.

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In our increasingly multicultural world, Culturally Sensitive Therapy is a mindset that therapists have in understanding how you function in relation to your culture. What might seem challenging to a German client might be commonplace to a Chinese client, or vice-versa. What strengths or weaknesses an LGBTQ client has can be further enhanced or further challenge them in light of their community support. This form of therapy is concerned with how you see yourself, how you create meaning, and what is/is not acceptable in your view of this world. This form of therapy further acknowledges that each client is entirely unique, and a mix of different cultures, as well as how much they identify with each culture. This sensitivity is about providing the best possible care to a client while respecting them.

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 Feminist Therapy is a way of identifying that a therapist is concerned about power dynamics on many levels for their clients. It goes far beyond merely gender-focused power dynamics. Feminist therapists are generally concerned about how a client is influenced by their family, workplace, significant relationships, forms of aggression against them for reasons such as culture, sex, or self-identification. Feminist therapists tend to see their role as advocates and activists on behalf of their clients.

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 Play Therapy is a fun, imaginative take on therapy in which clients–most often, but not exclusively kids–tackle big emotional and behavioral struggles through playing with toys, sand trays, and games. The imaginative play helps them overcome challenges by taking on roles to internalize the strengths of those roles. A kid suffering from fear due to the loss of their home in a fire may take great strength in pretend playing as a firefighter, or a kid that is bullied may benefit greatly from pretending to be a superhero. Play is often the most comprehensive way that kids learn about this world, and increasingly, research is showing that adults benefit greatly from engaging their imaginations in therapy to tackle real-world issues and learn new skills. This form of therapy is closely related to Drama Therapy and other expressive/art forms of therapy. [/show_less]

Hypnotherapy

 Hypnotherapy is an alternative form of therapy. It likely conjures wild thoughts or memories people have of seeing hypnotism done at carnivals, school talent shows, or on television. That is hypnosis for entertainment, although for some people it may seem much more sinister. While I have undergone no teaching or training in this method, it is worth describing at some level to provide some information. According to a release by the American Psychological Association, “Hypnosis can create a highly relaxed state of inner concentration and focused attention for patients, and the technique can be tailored to different treatment methods, such as cognitive-behavioral therapy.” Hypnosis in therapy follows the classical usage of latin, relating to hypno- for sleep and -osis for a state or condition. Essentially, hypnosis is an altered form of consciousness in which a client responds differently than they would otherwise. There are two primary forms used in therapy.

• Suggestion therapy: Working with the subconscious mind while a client is in a state of hypnosis, the theory is that they are more able to respond to suggestions, and this is sometimes used to treat things like smoking addictions or pain management.
• Analysis: Here, the theory is that a client in a state of hypnosis is more able to explore painful memories from the past and bring them to light in the present. These revelations are then worked on with a different form of psychotherapy.

Not everyone is easily hypnotized, and even those that are may be very uncomfortable with the concept for cultural or spiritual reasons. If you have concerns such as these, always discuss them with your therapist. Not all psychologists train in these methods and those that are, often use them in different ways.

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Acceptance and Commitment Therapy (ACT; pronounced as a word not an acronym) is a form of therapy, that, as its name implies, is about accepting life circumstances and committing to moving toward positive goals. The focus of ACT is to increase psychological flexibility, that is, to recognize your thought processes and thoughtfully consider and choose alternative thought processes, thus changing your behaviors. It can be seen as a form of mindfulness cognitive-behavioral therapy, though it does diverge in terminology and some methodology. It is a therapy that loves acronyms, for example, Fear is:

• Fusion with your thoughts
• Evaluation of experience
• Avoidance of your experience
• Reason-giving for your behavior

A core component of ACT is a concept called “experiential avoidance”, which can be summed up this way: you have a goal, but you’re afraid of the possible negative consequences of moving toward the goal. So what do you do? You decide not to move toward your goal. The end result is that your fear prevents you from ever knowing success. You’re rewarded for never knowing failure either, but at what cost? Experiential avoidance is essentially the opposite of psychological flexibility.

In discussion with a colleague who is more knowledgeable about ACT, I learned that ACT as a system focuses on six core processes. Four, in particular, are emphasized:

1) Acceptance, the opposite of experiential avoidance;
2) Cognitive defusion, in which negative thoughts are observed mindfully instead of avoided or reasoned away;
3) Chosen values, where emphasis is placed on living intentionally;
4) Committed action, where not only a value is chosen, but a plan is put in place to execute your chosen values.

Ultimately this therapy is–grossly oversimplified–about meeting an experience fully, accepting whatever outcome, and moving toward positive goals.

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Dialectical Behavior Therapy (DBT) is a tailor-made therapy for those suffering from chronic suicidality and borderline personality disorder or any form of extreme emotional regulation challenges. It is team-based, intensive, and highly structured. The term Dialectical comes from the holding of a both-and belief, of holding opposite views that get combined: accept life as you are, and move towards change (not to be confused with A.C.T.) DBT works with four main components:

• Skills training groups
• Individual therapy
• Phone coaching
• Consultation team

The consultation team is for the therapists, due to the demanding nature of the therapy. The therapy was founded by Marsha Linehan, who developed many of these skills alongside the patient and helpful care of staff in a hospital when she herself was struggling as a young woman with the issues that DBT addresses. This was born out of a CBT model with a heavy emphasis on behavioral training. This is countered by a large focus on mindfulness as well, to complete the ‘dialectic’ of DBT. Normally clients cannot get into DBT without a referral from a psychiatrist, and psychologists trained in this methodology are few in number. There is a large and ever-growing body of research supporting DBT as an effective form of psychotherapy.

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Christian counseling is a form of therapy that focuses on bringing God as well as biblical teaching and encouragement into the therapy room. Most Christian counselors will see any client that comes to them, not just Christian clients, and the degree to which they incorporate spiritual themes into therapy will vary from client to client. Spiritual disciplines such as prayer and scriptural meditation are encouraged in this form of therapy. Therapists in this particular model will often have received training from theological schools and received training in the form of pastoral counseling. Psychotherapy as a whole is shifting in its approach to spirituality, and therapists are receiving more training and awareness about client’s individual spiritual beliefs and sensitivities.

The term ‘Christian counseling’ is an umbrella term that covers a theme more so than a set of specific techniques. Therapists under this umbrella will vary by Christian denomination, by individual theological training, and by personal integration of these themes with their other unique blend of therapeutic lenses and tools, and as such one Christian counselor can look and behave dramatically different than the next.

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Next to Drs Gottman, Sue Johnson’s Emotionally Focused Therapy (EFT) is considered the premiere form of couples therapy. The therapy emerged from Johnson’s work with couples and observations on attachment theory and a theoretical understanding of how ‘love’ works. As a system, a therapist following EFT can help point out particular relational snags that a couple is going through, educate them on how to become more aware of these patterns, and give them tools to break through old ways of relating to re-establish a healthy relationship by building up a secure attachment.

The therapy follows nine treatment steps, broken into three stages. The first stage is ‘Cycle Deescalation’. The second step is ‘Changing Interaction Patterns’, and the third is ‘Consolidation and Integration’.

This therapy can be used for both couples and families, and there is a strong empirical base of evidence in its favor.

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 Hakomi is a mindfulness-based somatic psychotherapy. This means that it’s focused on slowing down your thought processes to allow you to become more aware of all your thoughts and to establish a more peaceful way of relating to yourself. The somatic focus is about working with your body – using the body’s senses and awareness of these senses to help focus your mind and emotions. It works on the level of experience, and through practical exercises, a client is able to more fully and truly experience their thoughts and emotions, thus being in a better place to process and master them rather than be mastered by them.

A client may be encouraged to remember a troubling experience they had, perhaps from childhood, and then mindfully notice the experience in its entirety. The crucial step here is to notice how recalling the experience is different on several levels than the initial experience was. Noticing that difference allows the client to transform an old memory into a less destructive or more meaningful experience.

Furthermore, a client is encouraged to recall experiences of emotional healing or restoration and use them as an internal resource in processing difficult past experiences. For example, a client may recall being humiliated in front of their classroom for giving a wrong answer and having their peers laugh at them; they may then recall how the teacher responded gracefully, and how a peer later came and gave them a hug. Or they may imagine having had that happen. An imagined experience can be almost as powerfully felt as a recalled experience can be. Whether real or imagined, re-experiencing a healing experience in close proximity to recalling a troubling experience can feel quite healing. This can work with visualizing a future event that a client may be anxious about.

That’s where the somatic element comes in. Your nervous system’s perception of pain and health linked to your mind’s constructions allows you to feel a shift, and combine the two. The next time you recall the troubling memory in question, your body is more inclined to remember the healing experience in therapy, and the memory (or future anxiety) will be less troubling to you.

In terms of the therapy room experience, perception is reality, and the person’s total mind-body perception is critical to therapeutic change.

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 Experiential Therapy is a lens or umbrella term for therapies like Gestalt, Play Therapy, Hakomi, etc that prioritize making experiences and not just speaking of thoughts within therapy. Having this list organized with a mix of lenses and models is a quirk of how I pulled information from PsyochologyToday.com – nevertheless, I understand it to be a fruitful exercise in defining key terms in the field of psychotherapy

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The Expressive Arts and Art Therapy are a novel approach to doing therapy in a multi-sensory fashion. Clients are encouraged to discuss their experiences, moods, feelings, or struggles through alternate methods like dance, construction, painting, making videos – really, any way they can find that functions as a creative outlet. The focus is on developing a client’s awareness of their internal experience and processing it while being involved in something creative. This therapy works well for those who have challenges speaking, understanding their problems at a deeper level, or with cognitive delays. This may be used when other methods of therapy are not producing results, and these methods can lead to new breakthroughs. The expressive arts are often used in tandem with other forms of therapy.

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Energy Psychology can be thought of as bringing together thoughts, emotions, sensations, behaviors, and concepts like acupuncture meridians (theoretical energy systems) and ‘the biofield’. As such, it could be classified as a somatic therapy system, however, it goes beyond the scope of body work and delves into theoretical fields inspired by forms of spirituality such as the Hindu Vedic chakras or extrapolations of bio-energetic fields. A bio-energetic field is theorized to exist around each person, generated by their cells and nervous systems. An analogy would be that like the earth has a magnetic field, each person has an energy field. There is anecdotal evidence that people can have a highly attuned sense of spatial awareness such that if a hand is held near them, even with their eyes closed, they have a higher-than-chance sense of awareness regarding the distance of the hand. This is akin to a personal boundary or ‘sixth sense’.

This form of therapy theory and practice goes far beyond my scope of experience and knowledge, and I hope to return to provide more accurate information over time as I encounter more knowledge.

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