Therapy Approaches
With literally hundreds of different types of psychotherapies practiced today, sorting them out can be very confusing for those seeking services.
If you're seeking to address a mental health or relationship issue with the help of a professional, it's important that you choose a therapist who has an approach that makes sense for you. If you find yourself disagreeing with the ideas and approach that the therapist uses, you'll be much less likely to make progress in therapy.
One essential prerequisite for a good treatment outcome is establishing rapport with your counselor. Rapport refers to the comfort level that you feel in working with him or her. This includes feeling that your counselor cares for you, understands what is going on in your life, and is working with you to help you achieve your goals. If this sense of teamwork or rapport is not there, ask to be transferred to another counselor or look for a better fit for yourself. You'll make much more progress if you have strong rapport with your counselor than if you don't, regardless of the type of therapy being used.
The Most Common Styles of Psychotherapy
Cognitive Behavioral Therapy (CBT)
The most widely used therapeutic approach in North America, CBT is based on the premise that a person develops distorted or negative thoughts about themselves, others, or their future. These distorted thoughts ("I am so stupid"; "They deserve everything they get") lead to negative emotions or actions. If a depressed person thinks they are stupid, then they will feel ashamed and helpless, because stupidity is a permanent trait, which no one wants. If they think others deserve punishment, then they will act out aggressively.
CBT helps people identify their distorted thoughts, and then challenge them. The person learns to replace them with more realistic thoughts: e.g., "I made a small mistake, but overall my work is very good." This results in a more positive emotion, a bit of disappointment over the mistake, and optimism over the general quality of their work.
CBT was originally developed to treat depression and anxiety, and has repeatedly been shown to effectively address those disorders. Today, it's also used to treat anger management, eating disorders, addictions, and many other mental-health issues.
Interpersonal Psychotherapy (IPT)
IPT is a short-term (16 to 20 sessions) form of therapy that has proven effective in treating depression. It focuses on interpersonal events that seem to have been catalysts in the onset and/or continuance of the depression, such as a recent transition (e.g., graduation, marriage, moving), dispute (e.g., marital conflict, problems on the job), or loss (e.g., divorce, job loss). The first few sessions of IPT are devoted to assessing and identifying which specific interpersonal issue to focus on through the remainder of treatment.
IPT also examines the client's number and quality of relationships, since people with mental-health issues frequently have few people who are close to them. In their sessions, the therapist works with the client to help them understand life changes, explore options, and widen the scope of their social life.
Research has shown IPT to be as effective as anti-depressant medications for short-term treatment of depression. In addition to treating depression, IPT can also be used to address other disorders, such as bulimia and substance abuse.
Solution-Focused Therapy (SFT)
A therapist who uses SFT invites the client to create a vision of what they want their future to look like. In their sessions, therapist and client explore ways to move toward the ideal future that the client desires. For example, the therapist may delve into when the client's current problem did not present itself, and what was different about those times. This creates an awareness in the client that the problem comes and goes, and that there can be times when it is gone entirely. The therapist may also work with the client to determine small steps or large changes that will bring the client closer to their ideal future.
By helping the client pay attention to the times positive change occurs, the therapist helps them move forward in their journey to their preferred future. The therapist also draws attention to the different ways in which the client copes with their problems, and the resources the client has, or uses. This increases awareness in the client that they do cope with their problem, and have resources available to them. The client then feels more confident that they can learn to cope better, and use their resources to improve.
SFT is designed to be brief, and focuses very much on the present, rather than the client's past. Research is still pending on its effectiveness for a variety of problems.
Psychodynamic
The oldest of the psychotherapies, psychodynamic therapy is the "talking cure" originally developed by Sigmund Freud. It holds that mental disorders arise from unconscious conflicts among the three elements of an individual's psychological makeup: the id, ego, and superego. Psychodynamic therapy helps people work through these conflicts over the course of a lengthy therapeutic process.
Brief psychodynamic therapy has also been developed. It assumes that people have a core conflict that shapes their other relationships. Brief psychodynamic therapy helps people to understand this core conflict and to resolve it through therapy.
Humanistic
Psychotherapists who work with a humanistic approach assume that the person is not controlled by unconscious conflicts but has an inherent desire to self-actualize -- that is, to realize their full potential. The therapist gives the client positive regard, no matter where the client is in life. The therapist reflects back to the client what they are feeling, and acknowledges the feelings that may be just below the surface. There is no attempt to move the client in a particular direction, as it is assumed that, within this non-judgmental, empathic atmosphere, the client will naturally choose their own best path to take and move along forward.
Effectiveness
Besides the therapeutic approaches outlined here, dozens of others also exist, such as systemic and existential therapies.
Regardless of the type of therapy employed, an overwhelming body of evidence suggests that all therapeutic approaches can be equally effective. (One exception is phobias, for which behavioral therapy is widely considered to be the most effective treatment option.)
What remains far more important than the mode of therapy is the relationship between the client and the counselor. If the client feels accepted, understood, and cared for by the counselor, and if the client believes that the counselor is helping them to achieve their goals, then the client is far more likely to improve than if these conditions are not met.
If you're considering therapy, you need to select a counselor whom you feel comfortable working with. In fact, it's wise to interview two to four counselors to find the one who is the best fit for you. This will increase the likelihood that you'll improve through therapy and find relief for your problem.