How To Find a Therapist: Part III

June 25, 2012

In this last installment of the “How to Find a Therapist” Series, I will be addressing the issue of the types of psychotherapy available.

ORIENTATION

There are many kinds but I will stick with the main types.  In the biz we refer to these types as “Orientations”  An orientation is really just a group techniques a therapist will use that have their foundation in a certain philosophy of treatment.   Therapists are usually trained thoroughly in one orientation.  Some have training in more than one technique and my label themselves as “Eclectic”, but usually there is a primary area of orientation.

PSYCHODYNAMIC  APPROACH/INSIGHT-ORIENTED THERAPY

This orientation descends directly from Freud, who believed personalities are established during our childhoods (for him it was by age 5, for some others it is even earlier) and that everything we are now harkens back to everything that happened back then.  From the standpoint of this orientation, there are many things that may have happened to us in our childhoods that we try to block out or repress.  These repressed memories stand in the way of us knowing ourselves and setting ourselves free from any negative symptoms we experience that bring us to treatment.  We can illuminate these blocks by focusing on repressed material that breaks through in dreams or patterns of behavior in our current lives and with the therapist.  Once the repressed material reveals itself, we may have a catharsis and a “working through” of the issues, and hopefully feel unblocked so we can move on with our lives.

When Freud started out and for many decades thereafter, psychoanalysts practiced this type of treatment and sessions were four to five sessions per week.  The typical therapy now is once per week, and is done by psychiatrists, psychologists or social workers.  Psychoanalysts who may come from different backgrounds, still believe that treatment should be at least two times per week.

Some patients are in treatment on an every other week basis, but  I believe for this type of therapy to work,  at least weekly is the goal.  The relationship with the therapist is central to this approach and the more contact the better.

RATIONAL-EMOTIVE THERAPY AND OTHER COGNITIVE BEHAVIORAL THERAPIES

The goals for treatment in this broad area include changing the client’s ideas/cognitions (or in some cases irrational beliefs) that effect emotions and in turn affect behavior.  Big names associated with this approach are Ellis, Michenbaum and Beck.

Some examples of irrational beliefs are:

If I don’t get what I want, it’s terrible, and I can’t stand it.

I must perform all tasks perfectly well.

I must have love and approval from all the significant people in my life.

It’s easier to avoid facing life’s difficulties than to face them and perhaps get even greater rewards.

The treatment usually involves the therapist teaching the client to observe his own behavior so the client can begin to reduce the irrational beliefs that foster destructive ways of feeling and behaving.  Any piece of this triad of functioning (thinking, feeling, behaving) may be addressed since they are all considered to work together from this perspective.

Some techniques in this area involve giving homework to the client where the client’s track their thoughts feelings and behaviors in stressful or potentially stressful situations and then develop alternative scripts or thoughts for these situations.

Sometimes the intervention will be more focused on the behavior where the client is instructed to act “as if” they are not depressed, for example.  The assignment may be to become lessw isolated,  as in going out with friends even if the client doesn’t really feel like it.  The result may be having a good time and the client’s thoughts about the depression and the depression itself may change.

Insurance companies usually love cog-B, as we call it in the biz, because it usually means shorter term treatment.  In my experience, it is fine if you have specific symptoms such as anxiety, and I feel that it works well with couples and families.  If you are looking to go deeper into your relationships with people and discover patterns that you may have not recognized in yourself before, psychodynamic group or individual therapy is to me a better choice.  There is a greater investment of time and money in the second case.

I did not cover the multitude of other therapies out there but there are many:  Marital therapy, Family systems therapy, Existential therapy, Gestalt therapy, just to name a few. However, when it comes to down to individual therapy, insight oriented approaches and cognitive behavioral approaches have the most widespread use at this point.

Most research says that the orientation of the therapist is less important than the  is relationship with the therapist.  I think this is probably true, but an informed client is always a better consumer.

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2 Responses to “How To Find a Therapist: Part III”

  1. Hello. I think anybody who is interested in psychiatry should read an article about the lack of sleep as the factor, that might be cause of a brief but dangerous psychotic disorder. The article is available on the WP website: http://www.washingtonpost.com/lifestyle/travel/psychologist-lack-of-sleep-prompted-jetblue-pilots-brief-psychotic-disorder-during-flight/2012/07/11/gJQA7Wx4bW_story.html

    • Hello Weldon: This is a very interesting article. However, I think it does not make it plain that sleep deprivation probably does not cause psychotic behavior in the way that that it happened for this pilot. Sleep deprivation can cause hallucinations, but this kind of longer term psychotic break is not typical. What I imagine will emerge with a throrough evaluation is that the pilot may have had an underlying disturbance that was exacerbated by the sleep deprivation. Whatever the case, we should not have ANY sleep deprived pilots. This is a major problem.

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