Psychotherapy
© 2009
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There are hundreds of different types of psychotherapy and it is almost impossible to discuss all of them in one chapter. However, we can divide these many different kinds of Psychotherapy into four general categories. These four categories are Psychoanalysis (or Psychodynamic therapy), Humanistic, Behavioral, and Cognitive Therapy. Below is a brief description of these four types of treatment categories.
Psychoanalysis (Psychodynamic Therapy) - 1 hour sessions 3-5 times a week (12 weeks - many years)
Psychoanalysis is a form of therapy originally developed by Sigmund Freud (1963). Since Freud's time there have been many theorists and therapists who have made new discoveries and have modified this form of therapy in a variety of ways. Because of this, there are many modern variations of this form of therapy. They are commonly referred to as "Psychodynamic Therapy." They form a large variety of different types of therapy using the psychodynamic approach to gain insight into our unconscious conflicts and cognitive/emotional/behavioral patterns.
In Freud's classic form of psychoanalysis (and some of its modern variations), there are a number of commonly used techniques. One is known as "free association." To learn about the client's unconscious mind, the therapist will often ask the client to engage in free association. This means that the client says out loud whatever comes to mind from moment to moment. This provides the therapist important clues about what may be going on in the client's unconscious mind. The therapist may notice changes in emotional tone, patterns in how one concept is associated with another, patterns in the timing of the moments of silence in the clients speech, etc. These types of clues allow the therapist to understand what makes the client emotional and how the client's structures his/her world in his/her unconscious mind.
Another common technique used in psychoanalysis (and some of its modern variations) is dream analysis. This is when the client reports his/her dreams and the therapist tries to detect patterns in the multiple dreams that are reported. Freud had a unique theory about dreams. He differentiated between the manifest and latent content of dreams. The manifest content is the actual storyline of the dream. This is usually what the client directly reports in the therapy session. The latent content is the underlying meaning of dream. It is often considered to be an expression of the unconscious mind. These are often considered to be expressions of unacceptable feelings coming from our unconscious mind. Dreams are a safe place to express our unacceptable feelings because nobody else sees our dreams. However, these unacceptable feelings are not only unacceptable to the world around us but also to ourselves. Therefore, the expressions of our feelings do not come out directly in our dreams. They are expressed as symbolic representations of our true feelings. With dream analysis, the therapist and client work together to explore the symbolic representations of our unacceptable and unconscious concerns, feelings, and desires in our dreams. This allows them to slowly uncover the content of the client's unconscious mind.
In Freud's original form of Psychoanalysis, the client would lie down on a couch while the therapist sits outside of the client's view so that the therapist does not influence what the client says. Many of the more modern forms of Psychodynamic therapies tend to have the therapist and client sit face to face with each other. This is because some modern therapists believe that the therapist can never be a completely objective observer of the client. The idea is that the client is in a relationship with the therapist just like any other relationship the client has with other people in his/her life. For these therapists, what happens in the relationship between the client and the therapist provides many clues about what happens in the client's other relationships (much more so than when the therapist tries to be an objective observer).
There are a number of important concepts relating to the relationship between the client and the therapist in Psychodynamic therapy (and Psychoanalysis). One is known as transference. This occurs when the client expresses feelings they have toward significant other individuals in their lives to the therapist as if the client feels this way towards the therapist. Sometimes this is interpreted as a defense mechanism known as displacement. In other cases it is interpreted as an unconscious behavioral pattern that we have to make us feel better about ourselves. For example, a client might have a pattern of getting what s/he wants by expressing anger and intimidating others. Another client might have a pattern of receiving pity from others by complaining about their lives. These patterns are often unconscious but provide the therapist with very important information about the client's belief about how the world works.
Another important concept is the "talking cure." Freud found that in many cases, his clients felt better after having the therapist listen to him/her talk about his/her concerns. Although the overall goal of Psychoanalysis and Psychodynamic therapy is much more ambitious than this, the fact that someone shows that they care and is there to listen to us can be therapeutic in itself. It temporarily relieves us of the tremendous anxiety we feel. However, because the "talking cure" is not directly related to dealing with the core issues of the client this is only considered to be a temporary cure.
Humanistic Therapy - meet 1 or 2 times a week (6 weeks ~ )
There are many types of Humanistic Therapies. One of the most commonly used forms of Humanistic Therapy is Client-centered Therapy, a form of therapy developed by Carl Rogers (1959).
Rogers believed that everyone has an actualizing tendency, a natural motivation to maintain and enhance life (both our own and others). But he believed that difficult experiences in life often took us away from this positive motivation. As we get hurt, we lose our ability to trust humanity and stop trusting and caring for others. Because all of us have many difficult experiences, we all lose touch with our actualizing tendency to some extent. This, according to Rogers, is the main cause of our emotional and behavioral problems. The purpose of Client-centered Therapy is to get back in touch with this actualizing tendency.
As the name "Client-centered" implies, the Client-centered therapist neither tells the cleint what his/her problem is nor what to do about it. It is up to the client to discover the root of their problem and what to do about it. Rogers believed that if we provide people the right kind of environment, people will naturally grow as human beings. Therefore the therapist's job is to provide the right kind of environment for the client.
Client-centered therapy focuses on providing a safe, accepting, caring, and respectful environment so that the client feels safe and courageous enough to face his or her own difficult experiences and learn to use those experiences to change in a positive way. Rogers states that there are three important ingredients in providing the safe and caring environment necessary for client-centered therapy. The first is that the therapist must provide the client with unconditional positive regard. Unconditional positive regard is the idea that we love, accept, and respect others for just being themselves regardless of who they are and what they do. The second ingredient is that the therapist must provide the client with empathic understanding. Empathic understanding is showing that the therapist is interested in the client and understands how the client feels. Empathic understanding is different from plain old listening. We often feel frustrated when others are listening to us halfheartedly while they are watching television or reading the newspaper and say, "You are not listening to me!" In many cases, they have heard what we have said but they are not showing that they care and understand how we feel. In this case, they are listening but there is a lack of empathic understanding. As you can imagine, we are much more likely to feel comfortable and be courageous to face our own difficult experiences when the other person is empathically understanding us rather than listening halfheartedly. The third and final ingredient in client-centered therapy is that the therapist must be in a state of congruence. Congruence is a state in which who we are matches who we want to be. This means that, in order for client-centered therapists to be effective, they must feel relatively secure emotionally and have learned to use difficult experiences to change in a positive way. As you can imagine, it would be very difficult for an insecure person who has not made their difficult experiences into a postive learning experience to provide an environment of unconditional positive regard for others.
Behavior(al) Therapy - 1 - 7 times a week ( 1 day - multiple years)
Behavior Therapy (or Behavioral Therapy) is a form of therapy focusing in changing problematic behaviors and symptoms using the principles of classical and operant conditioning (Miltenberger, 1997). It is also referred to as Behavior Modification (or B-mod).
Some of the common therapy techniques in Behavior Therapy are systematic desensitization, token economy, and aversive conditioning.
Systematic desensitization is a technique developed by a behavioral therapist called Joseph Wolpe. It is a technique to that uses the principles of classical conditioning to help the client associate relaxation and other positive emotions with a fear inducing stimulus. This way the client gradually becomes less afraid and anxious of a stimulus that used to induce fear and anxiety in them. It is mostly used to treat phobias and other anxiety disorders. For a detailed explanation of this treatment method, please refer to the last section of Dr. Boeree's website on Psychotherapy.
Token economy is a form of treatment developed from B. F. Skinner's theory of operant conditioning. It is a technique that uses tokens for rewards and punishments to change behavior. Token economies are commonly used in inpatient clinics such as psychiatric wards, homes for children and adolescents with behavior problems, and prisons. When an individual behaves in positive ways, s/he is rewarded with tokens (plastic poker chips are often used as tokens). When an individual behaves in negative ways, these tokens are taken away (like a speeding or parking ticket). When a client has collected enough tokens, they may be able to buy various types of goods or privileges such as candy, time to play games, time to watch TV/movies, trips to places outside of the institution and so on. This method seems to be effective in institutions dealing with individuals with behavioral problems.
Aversive Conditioning is another form of treatment using B. F. Skinner's theory of operant conditioning. This technique involves the use of positive punishment to stop problematic behaviors. It is often used to treat individuals with severe behavioral problems such as people with serious alcoholism and sex offenders. The therapist sets up a system so that the client is severely punished when they engage in the undesirable behavior. In the case of alcoholism, the client takes some medication that makes them severely nauseous whenever they consume alcohol. In the case of sex offenders, the client is hooked onto a device that administers an electric shock whenever they become sexually aroused in the presence of inappropriate stimuli. Because the administration of positive punishment can have negative side effects (this is why Skinner was not enthusiastic about using positive punishment to change behavior), this form of treatment is only used when an individual is considered to be a serious threat to themselves or other people in society.
Cognitive Therapy - 1 or 2 times a week (6 weeks ~ )
Cognitive Therapy is a form of therapy focusing on how our thoughts influence our emotions and behavior. The two most common forms of cognitive therapy are the ones developed by Aaron T. Beck and Albert Ellis. Since, the form of therapy developed by Albert Ellis is described in Dr. Boeree's website on Psychotherapy, this chapter will focus on Cognitive Therapy developed by Aaron T. Beck (1976).
The goal of Beck's Cognitive therapy is to change maladaptive thought patterns that cause negative moods and behavior into adaptive thought patterns that cause positive moods and behavior. In this form of therapy, the therapist's first task is to detects the client's maladaptive thought patterns. For example, some of us may receive a "B" on your paper and think, "Great! I am very proud of myself" while others may think, "This is horrible! I am worthless and people will never respect me!" Even though the same thing happened to these people, the way we interpret the event greatly influences how we feel and behave afterwards. After the therapist figures out what the maladaptive thought patterns are, they must help us become aware of those thought patterns that may have negative effects on our emotions and behaviors. This is necessary because thought patterns are often automatic and occur below our level of awareness. If we insist on using the maladaptive thought patterns, the therapist will often provide us with homework assignments to help us understand how those thought patterns lead us to the wrong conclusions about ourselves or the world around us.
Finally, after we have become aware of our maladaptive thought patterns, the therapist helps us replace these maladaptive thought patterns with more adaptive ones. Like learning how to play a musical instrument, we must practice using the new and more adaptive thought patterns over and over again. At this point, the therapist becomes almost like a coach who oversees our performance as we practice. In recent years, Cognitive Therapy has incorporated many techniques of Behavioral Therapy and is now often referred to as Cognitive-Behavioral therapy.
References
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. Oxford, England: International Universities Press.
Freud, S. (1963). Introductory lectures on psychoanalysis. In The standard edition of the complete psychological works of Sigmund Freud (Vols. 15-16, pp. 9-496). Ed. and trans. by J. Strachey, in collaboration with Anna Freud, assisted by A. Strachey and A. Tyson. London: Hogarth. (Original work published 1916-1917).
Miltenberger, R. G. (1997). Behavior modification: Principles and procedures. Monterey, CA: Brooks Cole.
Rogers, C. (1959). A theory of therapy, personality and interpersonal relationships as developed in the client-centered framework. In (ed.) S. Koch, Psychology: A study of a science. Vol. 3: Formulations of the person and the social context. New York: McGraw Hill.
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