What I Am Learning About Psychotherapy

First, some Questions and Answers (click or tap to expand):

Thoughts About Psychotherapy

By psychotherapy I mean treatment or therapy by a trained licensed therapist. It is aimed at changing or stabilizing psychiatric or psychological symptoms and behaviors in a patient. (Psychiatrists and other physicians usually prefer the traditional word “patient”; many other practitioners prefer “client”.)

There are hundreds of different labels applied to types and theories of psychotherapy. Therapists are often proficient in more than one style. The various psychotherapies usually overlap and should not be considered absolutely separate. If getting results (outcome) is the bottom line, evidence suggests that you should be more interested in how you relate to a therapist regardless of the label or brand of therapy. Therapy can be with individuals, couples, groups, families and can have various formats: in person, online, texting.

In Georgia, therapists may be licensed as:

• LPCs (licensed professional counselors with Masters degrees)
• Marriage and Family Therapists (Masters degree)
• Social Workers (Masters degree)
• Psychologists (PhD and PsyD)
• Nurses
• Physicians

The following is a partial list of some common types of psychotherapy with ultra brief comments and some theorist names:

1. CBT (cognitive behavioral therapy; Aaron Beck) which examines how automatic habitual thoughts and reasoning relate to emotions;
2. Psychodynamic therapy (Freud, Jung, Adler, Horney, Kohut, psychoanalysis, etc.) which looks at psychological conflicts, defense mechanisms, life history and development, unconscious events, dreams, relationship of therapist to patient;
3. DBT (dialectical behavior therapy- Marsha Linehan), usually considered a form of CBT, which aims to help improve skills of self/impulse control, prevent self harm, often in a group setting;
4. Mindfulness therapies, which involve skills of being aware/stepping back and observing one’s own mental activities, using meditation (Jon Kabat-Zinn);
5. Trauma Focused Therapies aimed at PTSD (post traumatic stress disorder- Bessel van der Kolk) symptoms such as recurrent panic attacks, flashbacks, nightmares;
6. I like a particular type of mindfulness-CBT called ACT (acceptance and commitment therapy- Steven Hayes); Also Solution Focused Brief Therapy; anger management training; mentalization therapy stresses awareness of how others think
7. Motivational Enhancement/Interviewing (Miller and Rollnick), often used with habits like addictions, which systematically assists decision making.
8. There is a group of “active” therapies involving physical actions including EMDR (eye movement desensitization and reprocessing-Francine Shapiro), brainspotting, EFT and tapping; biofeedback
9. Supportive and psychoeducational therapies involve advice, guidance, teaching about risks and benefits; and art/music/literature therapy approaches;
10. Existential psychotherapy (Victor Frankl, Irvin Yalom) which helps people identify meaning in their lives; related to religious and spiritual counseling.
11. Applied Behavioral Analysis, Behavior Therapy, contingency management, and other reward based treatments (B.F. Skinner)
12. Prescribing medication (psychopharmacology) is associated with brief therapies; more on this in another post.

The above is a small sample of the types of therapy one might find in Atlanta. See Good Therapy website for a much longer list and descriptions. Most therapists have developed their own unique style which can be adapted to different kinds of people, personalities, and diagnoses.

The good news is that research on psychotherapy shows that people who are in therapy do better than matched people with similar problems who are not in therapy.

Therefore it is definitely worth considering psychotherapy to help with psychological and psychiatric problems. How to choose which type of therapy? Research has not shown the superiority of any particular therapy when therapies are matched against each other (called the Dodo Verdict: “All have won and therefore all deserve prizes”). But some therapists are more effective than others. The research of Dr. Scott Miller and his group indicates that therapists who use measured feedback from patients can have improved results. FIT (feedback informed treatment) is a general concept that can be applied to any type of psychotherapy. It involves getting some measured response back from the patient (feedback) which allows the therapist to continuously, at each session, assess how the patient is functioning and how the patient assesses the therapeutic relationship and the therapy session. It makes sense to measure things such as outcomes in order to improve and find mistakes. If you measure at each visit, you can find early warning signs of problems or dropping out. People who don’t drop out of therapy generally benefit significantly. Whatever therapy theory or technique is being used, this feedback improves the effectiveness of the treatment. It permits the therapist to quickly adjust or modify the treatment and develop accurate empathy.

My take on all this: psychotherapy at its essence is the use of our basic social qualities to share, to learn, to cooperate, to empathize, to bond with each other.

A therapist has evidence and training and a theory that makes sense to the therapist and is acceptable to the patient. There are many different acceptable theories which are associated with good outcomes. Feedback metrics allow the therapist to more clearly and quickly identify any problem, and problems are inevitable in human relationships. It’s not that it doesn’t matter what type of therapy we subscribe to. It’s that we don’t have objective outcome evidence of which theories or procedures are better with particular problems or people. It is important to be trained and to believe in what you are doing, so that you can professionally engage the patient in a scientifically acceptable type of treatment.  Consider asking the therapist if it is OK to give feedback each session about how you are doing and how she or he is doing.  Professionals (athletes most obviously) need to know their statistics in order to improve their outcomes. Of course, knowing your foul shot percentage can cause some healthy anxiety and curiosity, but that anxiety signal is OK since it triggers strategies for improvement.

Image by Gerd Altmann from Pixabay