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Summary of Psychotherapies

A fairly comprehensive listing of the types of psychotherapy available. The list includes basic tenets and execution.

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redball.gif (1055 bytes) Psychoanalytic Psychotherapy: In its purest form, two types of problems bring an individual to a psychologist's office: Problems emerging from a patient's past life (the patient's developmental trauma and experiences) and problems which appear to arise from current internal and external stressors. It is rarely, if ever, that this separation of problems is that pure. In reality, current problems are superimposed on old and chronic problems which the patient has carried for an extended period. The skilled doctor is able to see the impact of the past upon the response to present stressors. An initial means of conceiving of psychotherapy is understanding that it is a means of creating a professional atmosphere in which old feelings and fantasies can be brought to the surface so that they may be studied, understood and resolved.

Psychotherapist believe that the unconscious motives along with unresolved conflicts lead to maladapted behavior.  They believe that to develop a normal personality,  a person successful go through five psychosexual stages:

  • Oral - Birth to 1 year:  Sucking.
  • Anal - 1 to 3 years:  Holding and releasing urine and feces.
  • Phallic - 3 to 6 years:  Pleasure in genital stimulation.
  • Latency - 6 to 11 years:  Sexual instincts develop.
  • Genital - Adolescence:  Sexual impulses return.

Inadequate resolution of any of these stages lead to flawed personality development.  

redball.gif (1055 bytes) Behavior therapy is a combination of the systematic application of principles of learning theory to to the analysis and treatment of behavior. It involves more than principles of learning and conditioning, however, and uses the empirical findings of social and experimental psychology. The emphasis is placed upon the observable and confrontable and not inferred mental states or constructs. The doctors seeks to relate problematic behaviors (symptoms) to other observable physiological and environmental events. This involves behavioral analysis of what is occurring (and has occurred) and means of altering the behavior. 

The early development of behavior therapies occurred in the 1960s and 1970s and at that time, this mode of psychological care was defined as the systematic application of learning theory to the analysis and treatment of behavioral disorders. This is too narrow of a definition and today, behavior therapy draws not only upon principles of learning theory and conditioning but upon empirical findings from experimental and social psychology. The doctor relates that patients and their disorders to to observable events from physiological or environmental factors rather than inferring that they arise as a result of unseen/unrecognized/unconscious conflicts or trauma. Behavioral analysis, noting the events which lead to motor or verbal behaviors, is used to assist the patient in understanding cause-effect relationships and means of disrupting/discontinuing the maladaptive or counterproductive behaviors. Behavior Therapies have a wide range of application in phobic, maladaptive habit, and compulsive behaviors.

In systematic desensitization, the patient can overcome maladaptive anticipatory anxiety that is evoked by situations or objects by approaching the feared situations gradually and in a psychophysiologic state that inhibits the experience of anxiety. A variety of deep muscle relaxation procedures induces a psychophysiological state that counterconditions the anxiety response. A graded list or hierarchy of anxiety-provoking scenes which are associated with the patient fears is prepared. The patient then approaches the deconditioning of anxiety by beginning, in fantasy (mental imagery), with the least anxiety provoking scene and progressing up the hierarchy. The clinical goal is for the patient to be able to vividly imagine the previously most anxiety-evoking scene with equanimity. This capacity translates to real life situations but is most successful when real life situations are also used during the course of resolving each scene in the hierarchy.

redball.gif (1055 bytes) Clinical Hypnosis is an attentive, receptive, focal concentration while the individual has a concurrent awareness but a constriction of peripheral events. It is very similar to visual focus and peripheral vision. Those items in the center are sharp, detailed and colorful while those in the periphery are less noticeable. It is very similar to being so absorbed in that which a person is reading that they enter the world of the book and often fail to note things occurring around them. There are psychological, sensory, and motor/behavioral changes during hypnosis. The individual may have the ability to alter perceptions, dissociate from events and have amnesia for part of the hypnotic experience. The patient has the tendency to comply with the doctor, but this suggestibility and willingness has limitations. EEG (electroencephalographic) studies suggest that the brain is experiencing resting arousal and that they are not asleep. Unfortunately, clinical hypnosis as performed by your doctor can become confused with mythology and stage performers who use similar approaches to entertain an audience. See Hypnotherapy Pages

redball.gif (1055 bytes) Group psychotherapy is effective and appeals to many patients and doctors. The same number of doctors can treat more patients, and it may be combined with individual psychotherapy. In some countries, the group psychotherapeutic approach has exceeded the individual approach. As the nuclear family and religion has become diverse, and in some instances, fragmented, the psychotherapy group may meet the strong need to belong, affiliate and assist others. Many doctors see a group size of 8 to 10 patients as optimal, but groups may vary in size from 3 to 15. Weekly or twice monthly sessions of 1-2 (1 most common) hours seems to be the average. Groups of differing ("heterogenous") patient needs may be helpful, but there are some group psychotherapy where all share the same expressed need or disorder. In some instances the group is thought of as a doctor who is expressed through other group members: as each group member grows stronger, he/she provides assistance in interpretation, insight and decision making to other group members.

redball.gif (1055 bytes) Clinical biofeedback instrumentation provides information (data) to a patient about normally involuntary physical processes that are below threshold (outside of awareness). The patient, with these data, can adjust behavioral, cognitive (mental) and affective (emotional) processes and learn to control these physical processes. The term was first employed during WWII and the term behavioral medicine was first utilized in 1973 to describe integration of behavioral and biomedical sciences for the diagnosis, treatment, rehabilitation and prevention of illness as well as promotion of health. Not only can biobehavioral methods be effective in the management of specific symptoms and rehabilitation, but these approaches are often useful for patients who are resistant to other forms of treatment.

redball.gif (1055 bytes) Dialectical behaviour therapy (DBT) is a longer term cognitive behavioural treatment devised for borderline personality disorder which teaches patients skills for regulating and accepting emotions and increasing interpersonal effectiveness.

redball.gif (1055 bytes) Eclectic therapies Many NHS therapists formulate the patient's difficulties using more than one theoretical framework and choose a mix of techniques from more than one therapy approach. The resulting therapy is pragmatic, tailored to the individual. These generic therapies often emphasise important non-specific factors (such as building the therapeutic alliance and engendering hope). By their nature, they are more idiosyncratic and difficult to standardise for the purposed of randomsied controlled trials research.

redball.gif (1055 bytes) Eye movement desensitisation and reprocessing (EMDR) is a form of imaginal exposure treatment for post-traumatic conditions where the traumatic event is recalled whilst the client makes specific voluntary eye movements.

redball.gif (1055 bytes) Focal psychodynamic therapy identifies a central conflict arising from early experience that is being re-enacted in adult life producing mental health problems. It aims to resolve this through the vehicle of the relationship with the therapist giving new opportunities for emotional assimilation and insight. This form of therapy may be offered in a time-limited format, with anxiety aroused by the ending of therapy being used to illustrate how re-awakened feelings about earlier losses, separations and disappointments may be experienced differently.

redball.gif (1055 bytes) Psychopharmacotherapies are based upon the realization that the brain is not chemically responding in a functional fashion. This has to do with chemicals within the brain and central nervous system called neurotransmitters which must not only exist but exist in balance for thought, emotion and behavior to have regulation. Vigorous research on these chemical agents have existed since the mid 1950s. As a result of this research, we better understand how the brain's function is regulated and how best to assist those who suffer from dysregulation of these neurotransmitters. Acetylcholine and norepinephrine were among the first investigated followed by dopamine (dihydoxyphenylethylamine) and indoleamine serotonin. Quantitatively, these are only minor transmitters in the brian but they serve major roles in emotional behavior. The anticonvulsants, neuroleptics, antidepressants and anxiolytic agents are ever being refined. They are not addictive agents although some patients become dependent upon the anti-anxiety (anxiolytic agents) when they are not prescribed in an appropriate schedule. Non-medical abuse of the anti-anxiety drugs is actually uncommon. These anxiolytic agents were excessively prescribed in the past, and some clinicians became hesitant to prescribe them. Appropriately used, the drugs are both safe and beneficial. See Psychopharmacology Pages

redball.gif (1055 bytes) Marital and Sexual Psychotherapies deal with not only environmental, situational and phase of life problems which confront relationships but deal with concurrent problems in communication and conflict. Problems that occur within a relationship often emerge from interactional problems, the nature of feedback which couples provide each other, the difficulties in maintaining functional balance within the relationship, and the struggles for power and control which emerge. While interactional problems within a marital system may result in, and sometimes from, sexual conflicts, these are not the sole causes, nor even necessarily the primary causes. It is quite possible for a couple to have a functional sexual relationship and a dysfunctional emotional relationship. Relationship problems may emerge or worsen as a result of sexual dysfunction. By the time the couple consults a doctors, it is questionable as to whether sole resolution of the sexual problem, via medication for example, will make the marriage again functional unless other intervention (e.g. marital psychotherapy) is concurrently provided.  See Counselling Pages

redball.gif (1055 bytes) Short-term dynamic psychotherapies (STDP) work well for nonresistant patients whose resolution of problems do not become steeped in long term transferential problems relating to the doctor and for whom problems are significant but not overwhelmingly complex. Such patients often have some beginning insight or awareness of potential causes of their problems. Treatment begins with a comprehensive diagnostic examination which determines whether the problems/disorder can be appropriately treated by a particular psychotherapeutic technique. The doctor also determines whether the patient has the strength to confront the underlying causes for their problems and that there is the potential for positive response to short term intervention. As in psychoanalysis or psychoanalytic psychotherapies, STDP does involve examination of of the means by which unconscious needs and drives influence a patient's behavior and functional capacity.

redball.gif (1055 bytes) Client-centered psychotherapy arose during the period of 1938-1950 and broadened the scope of patients treated by this approach in the 60s and 70s. The characteristics that distinguished this form of patient care included the belief that specific characteristics of the doctor were necessary and sufficient for effective treatment; rejection of the medical/disease model and focus upon the growth model of patient change; the immediate (rather than emotionally distant) accessibility of the doctor; focus upon the experiences of the patient; focus upon the patient's ability to live within the moment; concern for personality change rather than personality structure; and belief that the process applies to all patients rather than a select group; application of all knowledge of the impact of psychotherapy upon the interpersonal process. Many patients reported significant gains after only brief treatment exposure in contrast to the greater time period perceived required by other modes of treatment.

redball.gif (1055 bytes) Cognitive Behavioral Psychotherapy is based upon a theory of psychopathology, set of psychotherapeutic principles,  and knowledge based upon empirical investigation. It is based upon information-processing theory and social psychology. Aside from being effective with a wide range of disorders, it appears to enhance the impact of medications used to treat such disorders and has appeal in that it is active, structured and time-limited. Pain, phobias, and mood disorders as well as psychophysiologic (psychosomatic) disorders have been treated successfully with this treatment approach. Errors in our thinking leading to self-defeating assumptions, incorrect interpretation of information, and lack of adequate problem solving planning are believed to be at the heart of our problems. Treatment assist the patient in identifying, testing the reality of, and correcting dysfunctional beliefs underlying our thinking and to assist the patient in modifying the thoughts and behaviors which emerge.

redball.gif (1055 bytes) Relaxation Techniques in this form of therapy the patient is helped to resolve stresses that can contribute to the particular disorder. Breathing re-training and other skills are taught in which the patient is actively involved in developing skills that are useful for a lifetime. Can take time to achieve results and treatment benefits are limited to active use of the techniques.

redball.gif (1055 bytes) Adlerian Therapy   Adlerian Therapy is a growth model.  It stresses a positive view of human nature and that we are in control of our own fate and not a victim to it.  We start at an early age in creating our own unique style of life and that style stays relatively constant through the remained of our life.  That we are motivated by our setting of goals,  how we deal with the tasks we face in life,  and our social interest.  The therapist will gather as much family history as they can.  They will use this data to help set goals for the client and to get an idea of the clients' past performance.  This will help make certain the goal is not to low or high,    and that the client has the means to reach it.  The goal of Adlerian Therapy is to challenge and encourage the clients' premises and goals.  To encourage goals that are useful socially and to help them feel equal.  These goals maybe from any component of life including,  parenting skills,  marital skills,   ending substance-abuse,   and most anything else.  The therapist will focus on and examine the clients' lifestyle and the therapist will try to form a mutual respect and trust for each other.  They will then mutually set goals and the therapist will provided encouragement to the client in reaching their goals.  The therapist may also assign homework,   setup contracts between them and the client,  and make suggestions on how the client can reach their goals.

redball.gif (1055 bytes) Existential Therapy Focuses on freedom of choice in shaping one's own life.  Teaches one is responsible to shape his / her own life and a need for self-determination and self-awareness.  The uniqueness of each individual forms his / her own unique personality,  starting from infancy. Existential therapy focuses on the present and on the future.  The therapist try's to help the client see they are free and to see the possibilities for their future.   They will challenge the client to recognize that he / she themselves were responsible for the events in their life. This type of therapy is well suited in helping the client to make good choices or in dealing with life.

redball.gif (1055 bytes) Gestalt Therapy  Gestalt therapy integrates the body and mind factors,  by stressing awareness and integration.  Integration of behaving,  feelings,  and thinking is the main goal in Gestalt therapy.   Client's are viewed as having the ability to recognize how earlier life influences may have changed their life's. The client is is made aware of personal responsibility,  how to avoid problems,  to finish unfinished matters,  to experience thing in a positive light,  and in the awareness of now.   It is up to the therapist to help lead the client to awareness of moment by moment experiencing of life.  Then to challenge the client to accept the responsibility of taking care of themselves rather then excepting others to do it.  The therapist may use confrontation,   dream analysis,  dialogue with polarities,  or role playing to reach their goals.  This may include treatment of crisis intervention,  marital / family therapy,  problem in children's behavior,   psychosomatic disorders,   or the training of mental health professionals.

redball.gif (1055 bytes) Rational-emotive and Cognitive-behavioral Therapy  Rational-emotive therapy is a highly action-oriented and deals with the client's cognitive and moral state.  This therapy stresses the clients ability of thinking on their own and in their ability to change.   The rational-emotive therapist believes that we are born with the ability of rational thinking but that my fall victim to irrational thinking.  They stress the clients ability to think,  in making good judgments,  and in taking action.    The therapist will use directed therapy.  The therapist believes that a neurosis is a result of irrational behavior and irrational thinking.  The Rational-emotive and Cognitive-behavioral therapist believe the clients problems are rooted in childhood and in their belief system,  that was formed in childhood.   Therapy will include method is solving and dealing with emotional or behavior problems.  The therapist will help the client to eliminate any self-defeating outlooks they may have and to view life in a rational way.  The therapist will never have a personal relationship with the client.  The therapist will think of the client as a student and themselves as the teacher.

redball.gif (1055 bytes) Reality Therapy   The reality therapist teaches the client ways to control the world around them and how to meet their personal needs.   They believe that the client can and will change their life for the better.   The reality therapist focuses on the what and the why of the clients actions.   They point out what the client doing and in getting them to evaluate it.  A behavioral or emotional problem is a direct result of the clients believe and feelings about themselves. The therapist will help the client evaluate their behaviors and feelings,  to challenge them to become more effective at meeting their needs.

redball.gif (1055 bytes) Transactional Analysis  Transactional analysis focus on the clients cognitive and behavior functioning.  The therapist helps the client evaluate their past decisions and how those decisions affect their present life.   They believe self-defeating behavior and feelings can be overcome by an awareness of them.  The therapist believes that the clients personality is made up of the parent,  adult,  and child.  They believe that it is important for the client to examine past decisions to help their make new and better decisions.

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