By Licia Ginne, LMFT
Psychotherapy is not easily described in general statements. There are different theories of psychotherapy and when you add the personality of the therapist and the client into the mix you always get some unique variation. Psychotherapy is a mixture of thinking, insight, discussion, understanding, emotions and in cognitive behavioral type therapy’s exercises. Psychotherapy should give you things to think about outside of the office visit.
Psychotherapy can have benefits and risks. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness and helplessness. Psychotherapy has also been shown to have benefits for people who go through it. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. But there are no guarantees to what you will experience.
Therapy involves a large commitment of time, money and energy, so you should be careful about the therapist you select.
I’ve written a separate article on in-depth psychotherapy which is a combination of contemporary psychoanalytic principles, object relation, and self-psychology.
Below is a brief outline of various theories and techniques. Often therapists will combine techniques and theories to find a therapeutic framework that works best for them. We all bring our personalities, beliefs and experiences to the therapy room. It is important to find a therapist that you feel comfortable with, one you feel understands you, one who provides clear boundaries and you believe has your best interests in mind.
Use of art and creativity as a way to get at deeper feelings and greater self-knowledge. Based on the belief that accessing the more creative or right-brain part of us is helpful in identifying what is going on emotionally and can be a part of the healing process.
Behavioral Founded on the belief that true change and movement towards goals is accomplished through action and that disorders are learned ways of behaving that are maladaptive. If we can learn to change our behavior, then our thoughts, feelings, and attitudes will also change. Common behavioral techniques include systematic desensitization (gradual exposure to an anxiety-provoking situation paired with relaxation), using reinforcements for desired behaviors, and aversion therapy to extinguish unwanted behaviors. The client learns new behaviors, the origin of the problem is not needed, and the relationship between therapist and client are not considered the focus is on the plan of change and behaviors.
Use of electronic systems to monitor internal processes such as heart rate, brain waves, or perspiration to help an individual become aware of their physiological responses and learn to have more control over them.
Counseling is founded on what is written in the Bible. Based on the belief that Scripture is the final authority for what kinds of decisions a person should make or how they should live their life.
Clients are believed to be in the best position to resolve their issues if the therapist can establish a warm, accepting, and safe environment in which the individual feels free to talk about his/her issues and can gain insight into them. This type of therapy is non-directive because the therapist typically does not give advice or make interpretations.
Therapy is based on the belief that faulty thinking patterns and belief systems cause psychological problems and that changing our thoughts improves our mental and emotional health and results in changes in behavior. Often cognitive therapy will work in conjunction with behavioral therapy and you may see the term Cognitive-Behavioral.
Interpretation of dreams, using symbols, myths, free association, and your memories. There are a variety of philosophies and approaches for analyzing dreams including Adler ian (dreams are projections of a person’s current concerns), Gestalt (every person and object in a dream represents an aspect of the dreamer), and psychoanalytic (dreams are a key to what is happening in a person’s unconscious).
EMDR (Eye Movement Desensitization Reprocessing)
Technique of restructuring thought patterns and associations related to traumatic events and memories and other sources of emotional distress. Francine Happier developed EMDR when she discovered that rapid-eye movements combined with focusing on disturbing thoughts and memories produced a calming effect.
Therapy which looks at the entire family as a complex system having its own language, roles, rules, beliefs, needs, and patterns. Each family member plays a part in the system and family systems therapy helps an individual discover how his or her family operated, that person’s role in the system, and how it affects the individual’s relationship with the current family and relationships outside the family. Within this category there are various theories and approaches to family therapy.
Experiential therapy emphasizing what is happening in the here and now to help individuals become more self-aware and learn responsibility for and integration of Thoughts, feelings, and actions. A goal is to develop more internal vs. external support. Techniques include confrontation, role-playing, and the empty-chair or dialogue between two parts of a personality. Founder: Frederick S. (Fritz) Perls (1893-1970) who believed that people must find their own way in life and accept responsibility for who they are to reach maturity.
Jungian (Analytical Psychology)
The focus of therapy is to help individuals access more of their inner world (unconscious) and develop greater self-realization and individuation. Carl. G. Jung’s theory is psychoanalytic, but differs from traditional Freudian theory in that Jung added the concepts of individuation (human potential), which includes transcendence and spirituality. People are seen in a positive light and therapy considers the soul, which seeks to be nurtured by something larger than the self.
Based on the belief that true change and growth comes from an individual becoming more self-aware by bringing unconscious thoughts, motivations, feelings, and experiences into the conscious so that behavior is based more on reality than instinct. Founder: Sigmund Freud (1856-1939). Key concepts are that behavior is determined by unconscious motivations, irrational forces, instinctual drives, and psychosexual events occurring during the first 6 years of life. Classical psychoanalysis is an intensive and long term process with a focus on transference (transferring feelings about and reactions to past significant others onto the therapist) and uncovering unconscious material.
RET (Rational Emotive Therapy)
Based on the belief that our emotions result from our beliefs, interpretations, and reactions to life events. A type of cognitive therapy based more on thinking and doing than with the expression of feelings. Founder: Albert Ellis (b.1913) is known as the father of RET and the grandfather of cognitive-behavioral therapy.
Based on the Freudian and Jungian depth psychology. Heinz Kohut, its founder, postulated that narcissism and grandiosity in the infant is healthily managed by selfobject experiences which can be idealizing, mirroring, or twinning experiences. The experience of the infant is the most important and it is the primary caretaker’s responsibility to respond to the infant in an affirming and validating manner. He felt that these selfobject experiences continue throughout development and life. The essence of therapy arises from empathic understanding within the therapeutic frame and that healing results from temporary disruptions in this empathic stance in the therapist. The relationship between client and therapist is most important, like that of mother and child, and the healing comes with the resolution, understanding and working through of that relationship.
Solution-focused treatment begins from the observation that most psychological problems are present only intermittently. People with panic disorder obviously do not spend every minute of every day in a panic; even depression fluctuates in severity. Solution-focused therapy tries to help the patient notice when symptoms are diminished or absent and use this knowledge as a foundation for recovery. If a patient insists that the symptoms are constant and unrelieved, the therapist works with him or her to find exceptions and make the exceptions more frequent, predictable, and controllable. In other words, therapy builds on working solutions already available to the patient.
TA (Transactional Analysis)
Interactions with others and communication styles are seen as coming from three states: the parent, adult, and child and the different types of ways those three parts of our personality communicate within ourselves and with other.
In finding a therapist it is important to know what their credentials mean, only a licensed therapist may bill insurance companies and identify themselves as a Psychologist, Psychiatrist, Licensed Clinical Social Worker or Marriage, Family Therapist. Those in training will be licensed as interns, residents or assistants and will work under the supervision and license of a currently licensed practioner.
Each person seeking a license has required courses and a certain amount of hours of supervised training before he or she is eligible to take the State-licensing exam. After passing the exam and becoming licensed, the individual required to take a certain amount of continuing education credits to keep the licenses.
No one of these is better than the rest and since therapy is such an individual and subjective experience, much of it depends on the individual counselor and client. Psychiatrists are the only practioners that can currently prescribe medication. Most therapists will have referrals to psychiatrists if medication seems like a viable option and will work with the psychiatrist to manage your treatment. Psychiatrists are usually the most expensive. Psychologists, MFT, and LCSW’s can charge anywhere between $75.00 – $300.00 an hour and many well known practioners may charge as high as $500.00 per hour. Figuring out how you will finance your therapy is an important step in finding the right person to talk to.
If you can afford it, paying out of your own pocket to see a therapist in private practice may be the most straightforward approach. You won’t have to deal with restrictions, insurance companies and you will not have to contend with releasing information about you and your treatment to insurance or managed care companies. Your treatment will remain completely confidential.
If you plan to use your insurance coverage you should call your insurer and find out what kind of coverage you have. You may have to choose from a particular panel of providers, or you may be able to use a therapist of your choosing. When you call you may consider the following:
- What are your in network, out-patient mental health benefits. (In network may be a selected panel of providers and your out of pocket costs may be less) this may include a specific number of sessions per year, your co-payment, or possibly the need for your Primary Care Physician’s referral. If you have already found a therapist you may ask if they are in network.
- What are your out-of-network benefits: Will they reimburse for you to see any therapist of your choosing. You may have to meet a deductible, your co-payment may be higher or most often it will be a percentage of what they consider reasonable and customary. You may have a set number of visits per year.