The different types of psychological treatments

Psychology

Our mental health is being challenged more than ever. The world is more competitive, social media dictates how we should look and what we should be doing, and social comparisons are in our awareness daily. Depression and anxiety are on the rise as well due to uncertainty about the future, worries about relationships and work, and of course, the Covid pandemic has certainly not helped.

Thankfully there are many psychological treatments that can be accessed should you require them. Below you will find a list of various psychological treatments available and how they might help your mental health:

Psychological Tools:

Psychological therapies fall into three general categories:

  1. Behavioural
  2. Humanistic
  3. Psychoanalytic

Behavioural therapies work with conscious processes and focus on cognitions and behaviours. Humanistic therapies seek to empower the client through self actualisation – working with the ‘here and now’

 

Acceptance and Commitment Therapy:

ACT differs from traditional cognitive behavioral therapy (CBT) in that rather than trying to teach people to better control their thoughts, feelings, sensations, memories and other private events, ACT teaches them to “just notice”, accept, and embrace their private events, especially previously unwanted ones. ACT helps the individual get in contact with a transcendent sense of self known as “self-as-context” — the you that is always there observing and experiencing and yet distinct from one’s thoughts, feelings, sensations, and memories. ACT aims to help the individual clarify their personal values and to take action on them, bringing more vitality and meaning to their life in the process, increasing their psychological flexibility.

While Western psychology has typically operated under the “healthy normality” assumption which states that by their nature, humans are psychologically healthy, ACT assumes, rather, that psychological processes of a normal human mind are often destructive. The core conception of ACT is that psychological suffering is usually caused by experiential avoidance, cognitive entanglement, and resulting psychological rigidity that leads to a failure to take needed behavioral steps in accord with core values. As a simple way to summarize the model, you can say that ACT views the core of many problems to be due to the acronym, FEAR:

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

And the healthy alternative is to ACT:

  • Accept your reactions and be present
  • Choose a valued direction
  • Take action

ACT commonly employs six core principles to help clients develop psychological flexibility:

  1. Cognitive defusion: Learning to perceive thoughts, images, emotions, and memories as what they are, not what they appear to be.
  2. Acceptance: Allowing them to come and go without struggling with them.
  3. Contact with the present moment: Awareness of the here and now, experienced with openness, interest, and receptiveness.
  4. Observing the self: Accessing a transcendent sense of self, a continuity of consciousness which is changing.
  5. Values: Discovering what is most important to one’s true self
  6. Committed action: Setting goals according to values and carrying them out responsibly.

ACT has been contrasted with Dialectical Behavior Therapy, since both are behavior therapies that focus on balancing acceptance and change . The major difference is ACT’s focus on direct research from relational frame theory. ACT has similarities to the mystical aspects of some of the major spiritual and religious traditions such as Buddhism

Psychodynamic Counselling

Psychodynamic counselling uses the therapeutic relationship to gain insight into unconscious relationship patterns that evolved since childhood. Memories and other evidence of early relationships are used to make sense of current concerns. The process of change occurs as clients become more aware of the power of the unconscious, including defence mechanisms, instincts and rules for life, to influence behaviour, and hence more able to control their actions and responses.

Psychodynamic therapy (or Psychoanalytic Psychotherapy as it is sometimes called) is a general name for therapeutic approaches which try to get the patient to bring to the surface their true feelings, so that they can experience them and understand them. Like Psychoanalysis, Psychodynamic Psychotherapy uses the basic assumption that everyone has an unconscious mind (this is sometimes called the subconscious), and that feelings held in the unconscious mind are often too painful to be faced. Thus we come up with defences to protect us knowing about these painful feelings. An example of one of these defences is called denial, which you may have already come across.

Psychodynamic therapy assumes that these defences have gone wrong and are causing more harm than good, that is why you have needed to seek help. It tries to unravel them, as once again, it is assumed that once you are aware of what is really going on in your mind the feelings will not be as painful.

Psychodynamic therapy takes as its roots the work of Freud (who most people have heard of) and Melanie Klien (who developed the work with children) and Jung (who was a pupil of Freud’s yet broke away to develop his own theories)

Psychodynamics takes the approach that our pasts effects our presents. Those who forget history are doomed to repeat it, and this is the same for an individual. Though we may repress our very early experiences (thus we don’t remember them) the theory is that the “ID” never forgets the experiences. If a child was always rewarded with sweets we may not know why we reach for the tub of ice cream whenever we are depressed and we want cheering up.

Psychodynamic therapists are taught many theories of child development (Oral stage, anal stage, latency period etc). The theory here is that if an adult has not properly progressed through all the child development stages, the therapist may identify the particular stage(s) that are missing.

Transference

If we go back to our own beginnings, we will see that all of us develop ways of relating to others based on experiences with those who cared for us in our formative years. This is something that everybody knows but rarely thinks about. Rather like the apple that fell to the ground causing Newton to ask why, Freud noticed that his patients seemed to develop particularly strong feelings towards him, and he too asked the question why. This was the beginning of his understanding of how, in the therapeutic setting, the therapist becomes a figure of overwhelming importance. Not because of any intrinsic wisdom or innate charm on his/her part but because, Freud realized, feelings previously felt in connection with parents or significant others were being transferred from the past into the present: the transference.

Why should this be so? Before I attempt to answer this question it is important to point out that all our relationships have an element of transference in them: into each new meeting both participants bring expectations and assumptions based on previous encounters. However, in most situations, particularly social ones, there is inter-action: exchange of opinion, agreement, argument, attraction, flirtation, aggression, repulsion, and so on. In this way, through interaction, our expectations and assumptions are either confirmed, contradicted or modified. We all know that after meeting someone for the first time we make a decision as to whether we will see that person again. Sometimes, consciously or unconsciously, we decide that we do not want to take the relationship further; on other occasions we seek every opportunity to renew the acquaintance.

If we move from social relations to professional ones we will again see how we bring expectations based on past experiences to these meetings. But now because there is less interaction there will not be so much room for maneuver, not so much scope for our assumptions to be altered. Two examples spring to mind: student and tutor, patient and doctor. The student who meets with a tutor will have expectations of that encounter, just as the patient will have expectations of the encounter with the doctor. In both cases, the object (tutor or doctor) is seen to possess knowledge that the subject (student or patient) lacks. I am introducing the term ‘object’ because it is one that is commonly used in the psychoanalytic literature, and although most of us think of objects as being things, inanimate things, the word object also refers to people.

This situation in which one person seeks something from another involves particular sorts of emotions: most of us feel small and powerless in relation to someone who has something, in these examples knowledge, that we do not think we possess. Because the object has the power to determine our future, the tutor to help or hinder our academic objectives, the doctor to heal our body, we may also feel anxiety. Will they share their knowledge with us; will the power they have over us be exercised in a way that respects our integrity? Thus we might say that certain professional contacts will tend to evoke transference feelings, particularly those which involve a relationship with someone who has knowledge that we do not, or real power to influence our lives for good or ill. In other words, the way in which our parents or caregivers have responded to our needs in the past will influence the way in which we approach those we perceive as being in positions of authority in relation to us.

It is also generally true that in these sorts of relations the subject knows little about the object. In the examples I have given, the tutor or doctor, the objects, will learn a great deal about their students or patients, the subjects. This is the nature of the relationship but it is not two-way traffic. Therefore projections (the way we assume people will react to us) although they may be modified the more contact there is, are less likely to be resolved in the way that they are in social situations where the emphasis is on interaction.

If we now move on to the specific relationship of therapist and client we can begin to see how transference feelings will he present even before the first meeting occurs. Clients will bring expectations and assumptions based on their experiences of life that will influence the way in which they perceive the therapist. We can begin to learn about these previous experiences not only in listening to what our clients tell us, but also in noticing how they relate to us, what expectations and assumptions they bring to the encounter. We do not seek to alter these perceptions but rather to try to understand them.

Countertransference

Some of our understanding will come through the feelings the therapist has about the clients, the emotions that are stirred up in the therapist in their affiliation with them: the countertransference. People all know that different people evoke different feelings, and most of us tend to avoid those who stir up unpleasant emotions, and seek the company of those who make us feel good. What is so different in the therapeutic situation is that therapists do not, or rather should not, decide to offer therapy only to those clients who elicit good feelings. They try to use their understanding of the countertransference, the feelings they have about their clients, in the service of all the individuals who seek their expertise. However, since there is a tendency to refer indiscriminately to all the feelings therapists have in their meetings with clients, and label them ‘counter-transference’, an area of confusion exists, that is as if the client were responsible for all feelings in the therapeutic setting. This confusion is hardly surprising since there is no agreement as to precisely what can be defined as countertransference. Some take it to include everything in the therapist’s personality liable to affect the treatment; others see it as only concerning the unconscious processes evoked by the client’s transference. It is somewhat reminiscent of what comes first, the chicken or the egg.

If we think about our ordinary everyday encounters we know that we have feelings about the people with whom we come into contact. We find ourselves saying things like this: ‘you really irritate me when you keep on agreeing with what I say. Don’t you have any opinions of your own?’ Or, ‘I do enjoy being with you because although we often differ we never seem to fall out over our differences.’ Depending on what sort of people we are, the first statement might be thought rather than spoken. However, both statements say as much about the person uttering them as they do about the person at whom they are directed. In the first example we might expect the subject to be upset by our comment; in the second to be flattered by the complementary nature of our words. Now it is unlikely that any therapist would interpret the countertransference in such subjective terms, but I have used these rather crass examples deliberately to emphasise the danger of using one’s own feelings unthinkingly.

How does the Therapist work?

The therapist normally takes an attitude of unconditional acceptance. This basically means that the therapist holds you in high regard because you are a person, no matter what your problem is.

The therapist tries to develop a relationship with you, to help you discover what is going on in your unconscious mind. They do this partly by theoretical knowledge (academic stuff!), partly by experience, and partly through their knowledge of themselves.

We know the last part must seem quite weird, but actually, it is critical. The therapist often uses how they feel in the room with you, as a guide to how you are feeling. They are, for lack of a better way of putting it, testing the relationship with you to discover more about you than you are aware of. The therapist uses interpretations, which are a way of making sense to you about what is going on, in order to help you become aware of your unconscious feelings.

So, in every session, the therapist is trying to judge, how much you are in touch with your own feelings, what feelings you are not aware of, how close are you to knowing the unconscious feelings, how painful these feelings are to you, and how well you can tolerate the pain that becoming aware of these feelings will bring.

How the therapist works is actually more complicated than I have presented here, but I hope this gives you a rough idea.

Psychodynamic Therapy

Psychodynamic counselling or psychotherapy evolved from psychoanalytic theory, however it tends to focus on more immediate problems, be more practically based and shorter term than psychoanalytic therapy. Carl Jung, Alfred Adler, Otto Rank and Melanie Klein are all widely recognised for further developing the concept and application of psychodynamics.

Psychodynamic therapy focuses on unconscious thought processes which manifest themselves in a client’s behaviour. The approach seeks to increase a client’s self-awareness and understanding of how the past has influenced present thoughts and behaviours, by exploring their unconscious patterns.

Clients are encouraged to explore unresolved issues and conflicts, and to talk about important people and relationships in their life. Transference (when clients transfer feelings they have toward important people in their life to the therapist) is encouraged during sessions.

Compared to psychoanalytic therapy, psychodynamic therapy seeks to provide a quicker solution for more immediate problems.

 

 

Psychoanalytic Counselling

Psychoanalytic therapy is based upon psychoanalysis but is less intensive, with clients only attending between one and three sessions a week. Psychoanalytic therapy is often beneficial for individuals who want to understand more about themselves. It is particularly helpful for those who feel their difficulties have affected them for a long period of time and need relief of mental and emotional distress.

Together, the therapist and the client try to understand the inner life of the client through deep exploration. Uncovering an individual’s unconscious needs and thoughts may help them to understand how past experiences have affected them, and how they can work through these to live a more fulfilling life.

Functional Analytic Psychotherapy

Functional analytic psychotherapy (FAP) is an approach to clinical psychotherapy that uses a radical behaviorist position informed by B.F. Skinner‘s analysis of verbal behavior.

Although sufficient for use alone, this approach is offered as something that may be practiced in addition to cognitive behavioral therapy (CBT). FAP focuses on in-session client-therapist interactions as the basis for clinical change.

Often FAP is lumped with behavioral activation, dialectical behavior therapy, integrative behavioral couples therapy, and acceptance and commitment therapy. Together these therapies are often referred to as third generation behavior therapy because the focus less on cognitive phenomena and more on functional analysis commonly found in applied behavior analysis and a behavioral theory of language and cognition.

Cognitive Behaviour Therapy

Cognitive behavioral therapy (or cognitive behavioral therapies or CBT) is a psychotherapeutic approach that aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure. The title is used in diverse ways to designate behavior therapy, cognitive therapy, and to refer to therapy based upon a combination of basic behavioral and cognitive research

CBT was primarily developed through a merging of behavior therapy with cognitive therapy. While rooted in rather different theories, these two traditions found common ground in focusing on the “here and now”, and on alleviating symptoms

The therapeutic approaches of Albert Ellis and Aaron T. Beck gained popularity among behavior therapists, despite the earlier behaviorist rejection of “mentalistic” concepts like thoughts and cognitions. Both these systems included behavioral elements and interventions and primarily concentrated on problems in the present. Albert Ellis’s system, originated in the early 1950s, was first called rational therapy, and can arguably be called one of the first forms of cognitive behavioral therapy. It was partly founded as a reaction against popular psychotherapeutic theories at the time, mainly psychoanalysis.] Aaron T. Beck, inspired by Albert Ellis, developed cognitive therapy in the 1960s

COMPUTERISED CBT:

There are cognitive behavioral therapy sessions in which the user interacts with computer software (either on a PC or sometimes via a voice-activated phone service), instead of face to face with a therapist. This can provide an option for patients, especially in light of the fact that there are not always therapists available, or the cost can be prohibitive. For people who are feeling depressed and withdrawn, the prospect of having to speak to someone about their innermost problems can be off-putting. In this respect, computerized CBT (especially if delivered online) can be a good option.

EMDR

What does EMDR therapy involve?

Therapy begins with the therapist seeking to understand the nature of the problems presented by the client, to determine whether EMDR is suitable, to establish the specific events from the past and/or present that need to be worked with and to orient the client to the process.

In an actual EMDR session, the client is asked to focus on a selected upsetting event with its associated thoughts and emotions. Then, bilateral stimulation with eye movements or alternating taps or sound beeps or music is begun. From time to time, the therapist stops the stimulation to ask about the client’s current state and to guide the process. The processing of the selected event or image ends when, after repeated viewing of the image, the client is able to do so with a positively enhanced sense of well being. The upsetting memory or emotion often seems to have faded into the past and to lost its power.

EMDR is a non-drug, non-hypnotic psychotherapy procedure. It is non-directive and does not require the therapist to know details of the events that have led the client to therapy, only what happens during the process. The EMDR process is client led and always remains within the control of the client.

Why bring up a painful memory?

When painful memories are avoided, they keep their disturbing power. They can unexpectedly and sometimes frighteningly affect our behaviour in the present.. With EMDR you can face the memory in a safe setting, so that you do not feel overwhelmed. From here, you can move on and allow the memory and emotions to fade into the past and lose their power.

How does it work?

At this point in the development of this therapy, we don’t really know how EMDR works. There are various theories, one of which compares the movement of the eyes in therapy with the movement that occurs naturally during dreaming, which seems to speed up the client’s ability to move through the healing process. Some websites describe alternative theories as to how it works.

 

EFT

Emotional Freedom Techniques (EFT) is a form of alternative psychotherapy aimed at alleviating a psychological problem, such as eliminating addictions or other unwanted thought or behavioural patterns.

It is administered through a ritual tapping on acupuncture points, sometimes humming while a specific traumatic memory is focused on. The theory behind this technique is aimed to manipulate the body’s energy field at the meridians.

These theories have been seen as pseudoscientific. It is suggested that any utility this technique has stems from its more traditional cognitive components, such as the placebo effect, distraction from negative thoughts by repetition, behavioural anchoring and others.

THOUGHT FIELD THERAPY

Thought Field Therapy, or TFT, is a fringe psychological treatment developed by an American psychologist, Roger Callahan. Its proponents say that it can heal a variety of mental and physical ailments through specialized “tapping” with the fingers at meridian points on the upper body and hands. There is no scientific evidence that TFT is effective, and the American Psychological Association has stated that it “lacks a scientific basis

MULTIMODAL THERAPY

Multimodal therapy is an approach to psychotherapy founded by Arnold Lazarus. It is based on the idea that humans are biological beings that think, feel, act, sense, imagine, and interact; and that each of these “modalities” should be addressed in psychological treatment. Multimodal assessment and treatment is built around the acronym BASIC I.D.: (i.e., seven interactive and reciprocally influential dimensions of personality/psychology or “modalities” which are Behavior, Affect, Sensation, Imagery, Cognition, Interpersonal relationships, and Drugs/biology, respectively).

Multimodal therapy originated within the context of behavior therapy and, later, the framework of cognitive behavioral therapy (“CBT”). Indeed, Arnold Lazarus introduced the terms “behavior therapy” and “behavior therapist” into the professional literature in 1958. During his pioneering work in the clinical arena of CBT, Arnold Lazarus realized that more areas of psychosocial functioning often needed to be addressed in therapy than merely actions and thoughts. This led him to expand the model of traditional CBT by incorporating additional modalities for assessment and treatment. This was briefly referred to as “broad-spectrum behavior therapy,” and ultimately became multimodal therapy.

 

RATIONAL EMOTIVE THERAPY

As explained, REBT is a therapeutic system of both theory and practices; generally one of the goals of REBT is to help clients see the ways in which they have learned how they often needlessly upset themselves, teach them how to un-upset themselves and then how to empower themselves to lead happier and more fulfilling lives.The emphasis in therapy is generally to establish a successful collaborative therapeutic working alliance based on the REBT educational model. Although REBT teaches that the therapist or counsellor had better demonstrate unconditional other-acceptance or unconditional positive regard, the therapist is not necessarily always encouraged to build a warm and caring relationship with the client. The tasks of the therapist or counsellor include understanding the client’s concerns from his point of reference and work as a facilitator, teacher and encourager.

In traditional REBT, the client together with the therapist, in a structured active-directive manner, often work through a set of target problems and establish a set of therapeutic goals. In these target problems, situational dysfunctional emotions, behaviors and beliefs are assessed in regards to the client’s values and goals. After working through these problems, the client learns to generalize insights to other relevant situations. In many cases after going through a client’s different target problems, the therapist is interested in examining possible core beliefs and more deep rooted philosophical evaluations and schemas that might account for a wider array of problematic emotions and behaviors. Although REBT much of the time is used as a brief therapy, in deeper and more complex problems, longer therapy is promoted.

In therapy, the first step often is that the client acknowledges the problems, accepts emotional responsibility for these and has willingness and determination to change. This normally requires a considerable amount of insight, but as originator Albert Ellis explains:

“Humans, unlike just about all the other animals on earth, create fairly sophisticated languages which not only enable them to think about their feeling, their actions, and the results they get from doing and not doing certain things, but they also are able to think about their thinking and even think about thinking about their thinking.”

 

Evolutionary Psychology

Evolutionary psychologists presume that all human behaviour is down to our innate responses that our human ancestors created in order to survive. This school of thought focuses on how our behaviour has been shaped through adapting to our environments.

Examples include how we learned the language, the ways in which monogamy came about, and why we socialise with others. The historic meaning behind modern behaviours can sometimes explain why certain patterns have developed. Charles Darwin is known as the father of evolutionary psychology and he believed that humans have social instincts that evolved through natural selection.

Positive Psychology

Martin Seligman is the founder of positive psychology and focused on strengths that allow people to build a life of meaning and purpose. As the name suggests, positive psychologists identify the elements of a good life. The science of positive psychology is based on three separate levels – these are the subjective, individual and group levels.

An example of positive psychology is the focus on gratitude, resilience, and compassion and how this can improve an individual’s quality of life as well as their mental health.

As you can see there are many varied treatments that can be used when our mental health is compromised. Humans are complex creatures and the more treatments we have, the more personalised the approach can be.

Mandy X

 

Photo by Markus Winkler on Unsplash

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