“Talk therapy” is a common term used to refer to psychotherapy or counseling in general. Many types of psychotherapy exist, and they can be combined and alternated to meet specific needs as they arise. For example, you may be receiving cognitive behavioral therapy (CBT) when a crisis erupts in your life, such as the sudden loss of a loved one or your job, or the onset of a serious health issue. In this case, the therapist might suspend CBT and switch to supportive therapies such grief therapy and/or interpersonal therapies to bring about a role change and foster the adjustments needed to cope with the loss. When you gain more confidence and psychological strength, he or she may resume CBT.
If you are receiving therapy, you should ask your counselor what type or types of therapy you’re receiving and the goal and length of the therapy. Your therapy should result in some improvement within four to six sessions. If you do not see improvement with this period, you should switch to another therapist or at least seek a second opinion.
To help you understand the nature of most types of psychotherapy in use today, we have prepared this brief summary:
Supportive Psychotherapy
With this type of psychotherapy, defenses, adaptation, and positive transference are supported rather than analyzed.
Mechanisms of Supportive Psychotherapy
- Education and instruction
- Reality orientation
- Suggestion and advice
- Clarification and reassurance
- Catharsis
- Self-disclosure
Goals of Supportive Psychotherapy
- Control anxiety
- Improve self-esteem
- Structure to the environment
- Elicit positive transference
- Maintain or reestablish usual level of functioning
- Minimize self-destructive behaviors or prevent it
Psychodynamic Therapy
This therapy focuses on unconscious conflicts related to childhood experiences. The conflicts give rise to symptoms affecting the way the person interacts and behaves.
Criteria for Use of Psychodynamic Therapy
The individual is psychologically minded and exhibits a high tolerance to frustration. Impulse control, abstract thinking, and self-reflection are also strong characteristics of this person.
Mechanisms of Psychodynamic Therapy
Involves analyzing all positive and negative transference, resistance, and defensive mechanisms. Defensive mechanisms include the following:
Denial. Avoiding the awareness of some painful aspects of reality by negating sensory data.
Projection. Perceiving and reacting to unacceptable inner impulses and their derivatives as though they were outside self.
Acting Out. Expressing an unconscious wish or impulse through action that avoids consciousness of the accompanying affect.
Displacement. Shifting an emotion from one object or person to another.
Isolation. Separating the idea from the affect.
Grief Therapy
Definition of Pathological Grief
Denial of the loss, maladjustment to life without the lost one, inability to form a new relationship
Phases of Grief (According to the Bowlby Model)
Bereavement (numbness, yearning,) disorganization, despair, and reorganization
Goals of Grief Therapy
- To acknowledge the reality of the lost one, and to clarify attachment issues.
- To work through the pain of the grief caused by sadness, anger, guilt, withdrawal. and avoidance.
- To adjust to a changed environment and ease feelings of inadequacy and helplessness.
- To emotionally relocate the deceased and move on with life if the bonds are not broken.
Note: Getting into a new relationship doesn’t mean giving up your deceased/ lost person or object. Loving another person doesn’t mean that you love the deceased person less.
Interpersonal Therapy (IPT)
Basic Characteristics of IPT
IPT helps patients to “change rather than simply understand and accept their current life situation.” It focuses on what is not working in a person’s life and actions that will make it work for him or her.
The therapy intervenes in the formation of symptoms, and it aids social adjustment and interpersonal relationships. It works predominately on current problems at conscious and pre-conscious levels. IPT focuses on the Here and Now!
The overall treatment goals are to encourage mastery of current social roles and adaptation to interpersonal situations.
IPT largely based on the medical model, viewing depression as a clinical disorder, that is, it focuses on the “Limited Sick Role.”
Theoretical Foundations of IPT
Adolf Meyer placed emphasis on current psychosocial and interpersonal experiences in psychiatric disorders (vs intrapsychic and past focus from psychoanalytic theories).
Harry Stack Sullivan viewed psychiatry as the scientific study of people and the processes that go on among them, rather than exclusively on the study of the mind.
IPT also draws on Froman-Reichmann, Cohen et at., Arieti & Bemporad, Becker, Chodoff – all of whom emphasized the interpersonal context or aspects of depression.
The therapy has dual focus: one is to reduce depressive symptomatology, and the second is to deal with social and interpersonal problems. Four areas that contribute to depression are:
- Grief
- Interpersonal role dispute with spouse or children
- Role transition, such as a new job, divorce, or having a baby
- Interpersonal deficits. That is, difficulty initiating and maintaining relationships
An outline of Interpersonal Psychotherapy for Major Depression follows
Initial Sessions of IPT for Depression
Dealing with Depression
- Review depressive symptoms.
- Give the syndrome a name.
- Explain depression as a medical illness; and explain the treatment.
- Give the patient the “sick role.”
- Evaluate the need for medication.
Relating Depression to the Interpersonal Context
Review current and past interpersonal relationships as they relate to current depressive symptoms and determine with the patient the
- Nature of interactions with significant persons
- Expectations of the patient and significant persons and whether or not these expectations were fulfilled
- Changes that the patient wants in these relationships
Intermediate Sessions of ITP for Depression: Working on Problem Areas of Depression
The problem areas involved include grief, interpersonal role disputes, role transitions, and interpersonal deficits. Each area is briefly discussed below:
Grief
Dealing with grief in the intermediate sessions focuses on the following goals:
- Facilitating the mourning process
- Helping the patient reestablish interest and relationships to substitute for his or her losses
- Describing the sequence and consequences of events just prior to, during, and after the death
- Exploring both negative and positive associated feelings
- Considering possible ways of becoming involved with others
Interpersonal Role Disputes
The strategies for dealing with interpersonal role disputes involve understanding the following:
1. How nonreciprocal role expectations relate to the dispute:
- What are the issues in the dispute?
- What are the differences in expectations and values?
- What are the options?
- What is the likelihood of finding alternatives?
- What resources are available to bring about change in the relationship?
2. What parallels exist in other relationships?
- What is the patient gaining?
- What unspoken assumptions lie behind the patient’s behavior?
- How is the dispute perpetuated?
Role Transitions
1. The goals of dealing role transition are to
- Help with mourning and the acceptance of the loss of the old role.
- Help the patient to regard the new role as more positive.
- Restore self-esteem by developing a sense of mastery regarding demands of new role.
2. The strategies for role transitioning are to
- Review positive and negative aspects of the old and new roles.
- Explore feelings about what is lost.
- Explore feelings about the change itself.
- Explore opportunities in the new role.
- Realistically evaluate what is lost.
- Encourage the appropriate release of affect.
- Encourage the development of a social support system and of the new skills that are called for in new role.
Interpersonal Deficits
The goals of this last portion of the intermediate IPT sessions, which deal with interpersonal deficits, are to
- Reduce the patient’s social isolation.
- Encourage the formation of new relationships.
The strategies employed are to
- Relate depressive symptoms to problems of social isolation or un-fulfillment.
- Review past significant relationships including their negative and positive aspects.
- Explore repetitive patterns in relationships.
- Discuss the patient’s positive and negative feelings about therapist and to seek parallels in other relationships.
Cognitive Behavioral Therapy (CBT)
Theory of CBT
Maladaptive behaviors are secondary to ingrained, stereotyped negative thoughts that can lead to distortions in thinking, feeling, and perception.
Goals of CBT
The goals of CBT are to create rational responses to the distorted thinking that will help correct them and reduce the maladaptive behaviors associated with them.
Mechanism of CBT
The mechanism involves
- Eliciting the distorted thinking
- Exposing the schema at work, for instance, “I’m worthless if I’m not busy,” or “I’m not pretty if I’m overweight.”
- Making decisions and problem solving (pros and cons)
- Providing social skills training
Group Therapy
Group therapy is a learning process that takes place through interaction with other group members. The mechanisms of learning include establishing hope, universality, altruism, catharsis, transference, and cohesiveness, while enabling social learning by imparting information and imitating behaviors.
Dilactical Behavioral Therapy
This therapy looks at two opposing thoughts and one behavior. For example, do I want to lie? The answer is yes and no depending on the day, the time, and the circumstances. Such thoughts between two thoughts and one behavior are ongoing throughout life.
Specific Goals of Dilactical Behavior Therapy
The specific goals of this therapy are to turn
- Interpersonal chaos to interpersonal effectiveness.
- Labile emotions and mood to emotion regulation.
- Impulsiveness to distress tolerance.
- Confusion about self and cognitive dysregulation to mindfulness.
These goals are broken down further below:
Interpersonal Effectiveness
Here we focus on
- Balancing priorities versus demands in life and relationships, that is, to put off low priorities and ask for help. In other words, it means adding structure to your life.
- Balancing your wants to should ratio. For example, learn to say “no.”
- Building mastery and self respect.
Emotion Regulation
The goal here is to identify and label emotions, reduce vulnerability of the emotional mind, and amplify positive emotional events that have a beneficial effect.
Distress Tolerance
By developing distress tolerance, the patient can better survive crises and accept life as it is for the moment by distraction.
Confusion About Self and Cognitive Dysregulation
Self-soothing is the key to turning these properties to mindfulness.
Psychosocial Therapy
The goals here are (1) to satisfy the need for acceptance and emotional support within the self and among others and (2) to increase the level of enjoyment through social skill training and by planning activities and through problem solving. The following elements are important to psychosocial therapy:
- Patient and family education.
- Social skills training to establish and maintain a socially rewarding relationship.
- Vocational therapy, which aims at acquiring new skills or refreshing old ones to gain satisfactory employment.
- Milieu therapy, which results from living and working in a learning environment. It emphasizes the patient’s rights to goals, freedom of movement, and an informal relationship with staff. Additionally, it emphasizes interdisciplinary participation and clear communication, such as residential and inpatient treatment environments for psychiatric disorders and chemical dependency problems.