Understanding Different Approaches to Psychotherapy

By Lynn Margolies, Ph.D. Last updated: 8 Oct 2018

There are many different approaches to psychotherapy. Use of one method or another depends on the therapist’s training, style and personality. Some use one approach with all patients; others are eclectic, and some tailor their approach based on particular patients’ needs, symptoms and personality.

Although the approaches are often seen as distinct, in the implementation and even theoretically there is often overlap. Rigidly adhering to one way of thinking or approaching therapy often limits results and misses the whole picture, and may result in an approach that feels foreign or false to the patient.

The psychodynamic approach focuses on understanding where the patient’s problems or symptoms came from. The therapist helps the patient recognize how the past is repeated in the present.

Attachment theories approaches use empirically-based and neurobiological research to understand problematic relationship styles. Scientific studies on attachment have found that issues in adult relationships can be reliably predicted from objectively identifiable, early patterns of attachment between parents and children. Therapists using attachment-based approaches aim for healing unconscious psychological and biological processes in the brain and promoting the development of higher-level capacities. Such capacities include the ability to recognize and reflect upon what is happening in one’s own mind and the minds of others, and sort out one from the other. This approach to therapy is also particularly helpful for teaching parents ways to react that optimize children’s psychological and brain development and improve parent-child relationships.

Cognitive-behavioral approaches emphasize learning to recognize and change maladaptive thought patterns and behaviors, improve how feelings and worries are handled, and break the cycle of dysfunctional habitual behaviors. This perspective helps people see the connection between how they think, what they tell themselves, and the feelings and actions that follow.

Interpersonal approaches emphasize identifying and understanding self-defeating patterns in relationships, figuring out why a particular situation is happening in a particular context, changing patterns that don’t work and developing healthier ones. In this approach, relationships and the here-and-now are the focus.

Systemic approaches understand problems in a contextual framework and focus on understanding and shifting the current dynamics of relationships, families, and even work settings. The roles and behaviors that people take on in a particular family or context are understood to be determined by the unspoken rules of that system and interaction among its members. Change in any part of the family system or group is the route to changing symptoms and dynamics, whether or not the “identified patient” is specifically involved in those changes. In this type of therapy, the “identified patient” in a family – the one seen by family members as having the problem — is viewed by the therapist as part of a larger system that is creating or sustaining this problem. This approach can be particularly useful when one member of a family seems resistant to therapy or to change; it opens up other avenues for intervention.

Other therapeutic approaches are centered around self-expression, with therapy providing a safe and private place to express feelings, confusion, worries, secrets and ideas.

In general, regardless of the therapist’s preferred way of working, people find therapy to be most useful when therapists are responsive, engaged, and offer feedback.

Many people who have been in therapy or have interviewed different therapists report better results when they like and feel comfortable with a therapist experienced in their particular issue. In addition, some of what makes a good match has to do with “chemistry.” Chemistry involves more subtle factors such as the therapist’s personality and whether he or she is someone in whom the client would want to talk and confide.

5 Sure Signs It’s Time to See a Therapist

By John M. Grohol, Psy.D.
Last updated: 8 Jul 2018

Psychotherapy is a wonderful treatment for many of life’s problems, with thousands of studies backing up its use as an evidence-based treatment. But sometimes a person doesn’t know when to go see a therapist. How bad should you let things get before you seek out help?

Psychologists know a secret that the research has shown —The sooner you seek out treatment, the faster you’ll feel better. It may sound obvious, but far too often people let their problems overwhelm them before getting help.

So here are 5 sure signs that it may be time to see a therapist.

1. It causes significant distress in your life.

   Nearly every diagnosis listed in the DSM-5, the mental health diagnostic manual, has a requirement that a problem cause significant problems in your everyday life functioning, whether it be at work, at home, at school, or someplace else. Maybe your concentration is shot, or your enthusiasm and drive for getting things done is simply not there anymore. Maybe you avoid any interaction with your classmates or coworkers. Or maybe you’re just feeling plain overwhelmed.

   If your anxiety, depression, mania, or whatever is causing you to function poorly in one of these environments, for weeks on end, that’s a sure sign it’s time to seek out help.

2. Nothing you’ve done seems to have helped.

   Few people feel anxious for weeks on end and do nothing to try and help calm their anxiety. Few people suffer from the symptoms of depression without having tried to reverse the lethargy, sadness, or hopelessness feelings.

   Sometimes our own coping skills fail us. They simply stop working, or become far less effective than they were in the past. If you’ve tried a half dozen different things already — talk to a friend, exercise more, seek out support online, read up on various self-help techniques online — and nothing has made much of a difference, that may be a sign it’s time to talk to a therapist.

3. Your friends (or family) are tired of listening to you.

   Friends and family members are usually pretty great. They are there for us when times are good, and they are there for us when times are bad. If you need to bend someone’s ear about the feelings or thoughts you’re having, a friend is often close at hand.

   But sometimes a friend can also feel overwhelmed by your problems. They start to pull away from seeing you. They don’t answer your texts or don’t take your call. They stop returning emails, or spend days before you hear a reply (with no explanation).

   These may be signs that you’ve overwhelmed your own social support system. It’s time to reach out and talk to someone whose job it is to listen, and offer tools and techniques to improve your life.

   We risk adding another disorder to our existing problems in an effort to self-medicate.

4. You start overusing or abusing something (or someone) to try and help alleviate your symptoms.

When the going gets tough, many people turn to their trusted mood-altering substance of choice — such as alcohol, cigarettes, or some drug. There’s nothing wrong with that when done in moderation.

But when we’re feeling overwhelmed, sometimes we look to one of those helpers and start over-using it. We risk adding another disorder to our existing problems in an effort to self-medicate.

And it’s not just drugs that people will abuse to help alleviate their symptoms. Spending all of your free time online, engaging in non-stop pornography or gambling, or constantly checking your Facebook updates may all be efforts to block out your other problems.

Worse is when we turn our angst or anger toward another person in our lives, such as a loved one. Some people lash out or make their loved one’s life miserable as a way of trying to feel better about themselves.

5. People have noticed and said something to you.

This one is obvious — but sometimes we simply ignore the most obvious signs in our lives. Maybe it was a friend who pulled you aside one day and said, “Hey, is everything okay? I notice you seem to be really struggling lately… maybe you should talk to someone?” Or a partner who’s said, “Look, you need help. You haven’t been yourself in weeks. Nothing I do seems to help, and in fact, we just seem to be getting worse.”

Even coworkers and classmates may have noticed and made a small attempt to let you know they think you may need someone to talk to.

Therapists Spill: 10 Tips for Making the Most of Therapy

By Margarita Tartakovsky, M.S.
Last updated: 8 Oct 2018

Can you really be honest? How do you know if you’re getting better?

Before you even walk through the door, you also may have certain preconceived notions, which can stifle your progress: Being a good client means being polite and rarely asking questions. Being a good client means never disagreeing with your therapist.

Below, clinicians spill 10 important ways you can make the most of therapy.

1. Choose carefully.

   “You may be in a hurry to find answers for your problems, but it’s a good idea to take the time to carefully choose your therapist,” said Ryan Howes, Ph.D, a clinical psychologist in Pasadena, Calif.

   He suggested researching different types of therapists and approaches, selecting several clinicians who seem to offer what you seek, and talking over the phone with each one, or trying out a single session.

   “Evaluate them not just on their credentials, but on how comfortable you feel talking with each of them. Then pick one, and dive in.”

   If you’re not sure about your new therapist or the process overall, psychotherapist Bridget Levy, LCPC, suggested giving it at least three sessions — “unless it is very clear after the first or second session that the therapist is not a fit.”

2. View therapy as a collaboration.

   According to Susan Lager, LICSW, a psychotherapist and relationship coach in Portsmouth, New Hampshire, therapy is an interactive process. Express your needs, ask questions, read books, and do the “homework assignments,” she said.

   For instance, this may involve telling your therapist what you’d like to discuss during a session, informing them that a certain appointment time doesn’t work for you or asking for clarification, she said.

   Couples may do homework assignments that include taking turns brainstorming ideas for quality time and creating a plan of action, she said.

3. Schedule sessions at a good time.

   This means scheduling your appointments when you can give them full attention, Lager said. For instance, avoid scheduling a session in “the middle of a work day when you have to be ‘on’ right afterward. Give yourself time and space to process and reflect around the therapy hour.”

4. Say anything in therapy.

   “Some people censor themselves in therapy for fear of judgment or appearing impolite,” said Howes. However, he encourages clients to say whatever they want, because doing so is what really leads to progress.

   He gave this example: A client discloses that they didn’t want to come to therapy today. This opens the door to honestly discussing how they feel about therapy, making adjustments that’ll help or clarifying what makes today feel so difficult.

   Mentioning seemingly unrelated points also can be helpful. For instance, “a discussion about their work brings to mind a memory from their childhood that doesn’t seem to fit, and we work to find the connection.”

   Even a client saying that Howes looks tired or might be frustrated because of something the client said can uncover important insights.

   “Being a ‘good client’ doesn’t mean being on your very best behavior, it means being the most authentic, unfiltered version of yourself.”

5. Talk about therapy in therapy.

   “To use an academic analogy, therapy is both a lecture and a laboratory,” Howes said. In other words, the issues you have outside of therapy often show up in session, he said. This is helpful since it gives you an opportunity to practice healthy coping and relational skills in a safe environment with your clinician.

   Howes gave these examples: If you’re passive, you can practice being assertive. If you’re afraid of seeming “too needy” or you feel like you need to be strong for others, you can discuss just how tough your days have been.

6. Set markers for change.

   “Establish markers with your therapist for positive change, so that you’ll be better able to track your progress and stay motivated,” Lager said. These markers include anything behavioral, emotional or attitudinal, which you can observe, she said.

   For instance, this may include feeling happier or more energized, letting go of toxic people in your life, planning social dates or communicating to your boss about workplace issues, she said.

   “Markers are like signposts, positive or negative, telling you what direction you’re moving toward.”

7. Have an order of operations.

   Howes suggested handling “business first,” which includes “payment, scheduling, insurance and any other logistics.” (This is “much easier than trying to rush through it on your way out the door or after having a big emotional breakthrough.”)

   Next, talk about any issues you have with your therapist. This is vital “because problems you have with her may have an impact on any other work you want to do.”

   For instance, maybe your therapist angered you last week. Maybe you’d like to end therapy. Maybe you have a question about what you talked about last session. Raise these concerns in the beginning of your session, so you have plenty of time to process them, Howes said.

   “Oftentimes, confronting your therapist can strengthen the therapeutic alliance and thus the therapy in general,” said Levy, director of business development at Urban Balance, a counseling practice in the Chicago area.

8. Do the work outside your sessions.

   A therapy session typically lasts 50 minutes; however, in order to get the most out of it, it’s important to think of therapy as 24/7, Howes said.

   “Keep a journal, reflect on your last session, prepare for your next one, and generally pay attention to your thoughts and feelings throughout the week. You’ll have much more material for your sessions, and you’ll find that you are applying the work to your everyday life.”

9. Set boundaries around therapy.

   Create boundaries around who you talk to about your therapy, Lager said. This might mean not sharing details of your sessions with people who gossip or give unsolicited advice, she said.

   When setting boundaries, the key is avoid “creating social pressure or unhelpful spheres of influence which might undermine your own self-trust, and confuse you.”

   If you’re not selective about what you share, according to Lager, you’ll “unwittingly create a ‘peanut gallery,’ which can become opinionated, loud and an intrusive presence in the therapy work.”

10. Savor the process.

    According to Howes, “Therapy is like taking a course where you are the topic. Enjoy the journey and soak in every tidbit you can; you never know when it might come in handy.”

    “Therapy … can be an amazing, transformative process toward living a conscious life,” Lager said.