When contemplating therapy, the choice of which type of therapy and which therapist can seem overwhelming. However, with some time and research, it can become easier to make an informed decision.
There are many, many different therapies out there. Most therapeutic approaches can be broken into four categories.
(1) Behaviour therapy
Perhaps the most widely known therapy is Cognitive Behavior Therapy (CBT). It views mental health issues, such as anxiety and depression, as the result of faulty thinking and cognitive distortions. By correcting those distortions and by adapting our behaviour, symptoms will decrease and our goals can be achieved.
CBT does not prioritise the client, but rather the issue, which CBT would see as faulty thinking. CBT is often seen as the gold standard of treatment for anxiety and depression. During treatment, the therapist will take a very active role in achieving short-term goals, as agreed upon with the client, to prevent relapse and overall symptom management. This is done through a process of psychoeducation, regular homework tasks and goal setting.
However, CBT is far less effective for treating issues relating to emotional regulation, attachment, trauma, addiction and relationship issues, where a more in-depth approach is needed. An approach that prioritises the client-therapist relationship to create deeper level change.
Psychodynamic Therapy & Psychoanalysis
This therapeutic approach comes from the work of Sigmund Freud and other psychoanalysts. It is rooted in the unconscious and in understanding the past to manage more effectively with the present.
In psychodynamic therapy, the therapist takes on more of a role as an observer, rather than a facilitator. The work is long term and the relationship between the client and the therapist is emphasised. Psychodynamic and psychoanalysis is concerned with a deep rooted change in thoughts, feelings, and behaviour by linking into the unconscious and subconscious mind, rather than short-term goals and symptom reduction. It is therefore an appropriate therapy for longer-term concerns, including trauma, attachment and personality issues.
Humanistic Therapy (Person-Centered and Solution-Focused)
Humanistic therapy focuses on the positive attributes that a person has, including their personal characteristics, their strengths and their overall drive to self-actualisation. The therapy focuses on the here and now and on the client being able to take an active role in the therapy process. It is an approach that is heavily based on the work of Carl Rogers.
The most contemporary therapy approaches are integrative and combine elements of all or some of the above. By combining these elements, integrative approaches create a stronger whole and are effective treatments for more complex problems, including post-traumatic stress disorder (PTSD), borderline personality disorder, addictions, emotional regulation and attachment issues.
Eye Movement Desensitisation and Reprocessing (EMDR), Schema Therapy, Dialectical Behaviour Therapy (DBT) and Acceptance and Commitment Therapy (ACT) are integrative approaches.
Eye Movement Desensitisation and Reprocessing (EMDR)
Eye Movement Desensitisation and Reprocessing (EMDR) commonly involves the rapid movement of a client's eyes, taxing their working memory and enabling them to reprogram their brain. It is a form of psychotherapy that was recognised as an effective way to treat post-traumatic stress disorder (PTSD) but has since been adapted to treat a range of other concerns.
EMDR is a unique approach, as it uses bilateral stimulation. This is often achieved through the therapist using their fingers or a pointer to guide the client’s eye movements back and forth. Therapists may even utilise a light travelling side to side across a bar. As well as visual bilateral stimulation, EMDR can also use tactile and auditory stimulation. Clients may be facilitated to feel different sensations that bounce within their hands or hear different sounds that are bounced within their environment.
EMDR is an integrative approach that combines elements from CBT, humanistic and psychodynamic therapies in a unified whole. It focuses on the client as the centre of the process. Much like in psychoanalysis, there is also an element of free association. For example, during an EMDR session, the therapist will often ask the client, “What are you noticing now?”
The main idea behind EMDR is that when someone experiences trauma, that trauma memory goes into an isolated part of the brain and to a separate memory network. When a trauma memory is successfully processed in EMDR, it then becomes fully integrated and joins another memory bank network. In essence, the idea behind EMDR is that unprocessed and unintegrated memories can cause Post Traumatic Stress Disorder (PTSD).
Schema therapy is long-term psychotherapy that was created out of Cognitive Behavior Therapy (CBT) for the treatment of personality issues and borderline personality disorder (BPD).
Schema therapy combines elements from attachment theory, psychoanalysis, humanistic therapy, as well as CBT. The core idea behind schema therapy is that everyone has needs as a child and when those needs go unmet, often chronically, then ‘schemas’ develop. Schemas are a way in which we view the world and other people. They contain beliefs, feelings, thoughts, emotions and sensations.
In response to not wanting to feel the emotions that these schemas trigger, we develop coping styles or survival methods that are effective when we are a child but have become less effective as an adult. Schema coping is often most notable in relationships or in response to relationships and interpersonal situations.
Schema therapy, similarly to psychodynamic therapy, is focused on deep level change and a connection between understanding and working through the past to better cope with the present.
The therapy relationship in schema is central to the treatment and blends between humanistic and attachment. During schema therapy, the therapist meets the unmet needs of the client. This is achieved through the therapy relationship, as well as through a range of experiential techniques, including chair dialogues, parts work, imagery work and behaviour pattern-breaking.
Dialectical Behavior Therapy (DBT)
Dialectical Behavior Therapy or DBT is a treatment that was designed specifically for borderline personality disorder and highly suicidal clients. It is used in both group and individual therapy. DBT is a behaviour therapy, in that it works on the client having the skills and the tools to be able to deal more effectively with an environment that is triggering and often pulling them into crisis. DBT is a skills-based therapy and highly psychoeducational, as well as combining elements of Buddhism and existentialism. Two of its core principles include acceptance and change as principles that co-exist. DBT is a highly structured therapy, similar to CBT. It utilises an active and engaging therapist, similar to a teacher, and is split over four modules: distress tolerance, mindfulness, emotional regulation, and interpersonal effectiveness.
Acceptance and Commitment Therapy (ACT)
Acceptance and Commitment Therapy or ACT is an integrative Cognitive Behavior Therapy. One of the core ideas in ACT is building psychological flexibility. ACT in essence is about embracing our difficult thoughts and our feelings, instead of trying to get rid of them or feel guilty for experiencing them. ACT uses many elements of mindfulness, as well as cognitive techniques to illustrate how our thoughts only have meaning once we give them that. ACT uses six processes to build psychological flexibility: defusion, acceptance, contact with the present moment, the observing self, values and committed action.
When looking to start therapy, it can first help to understand a little about some of the main approaches that are out there and which ones you feel may be best suited for your needs. You may also consider whether you think therapy might be a long or a short term process and any barriers you might have that hamper your ability to commit to therapy. A typical length of therapy in Australia is for ten sessions with a Medicare subsidised Mental Health Care Plan. However, therapy will often extend beyond this in order to address deeper change. Create Balance utilises a range of therapeutic approaches to suit your needs and prioritises integrative treatments such as EMDR.