If you’ve ever typed “types of therapy” into a search tool and felt more confused after reading the results, you’re not alone. Terms like cognitive behavioral therapy, dialectical behavior therapy, and EMDR can sound clinical and intimidating, but this guide helps you understand these approaches with definitions written for real people like you.

Whether you’re considering therapy for the first time, exploring options for a loved one, or simply trying to ask better questions when working with a therapist, we can help you through it all.

Why Knowing Your Therapy Options Matters

The beauty of therapy is that there is no one approach: it looks different for everyone, depending on their needs. The right treatment for someone navigating grief may look very different from what works for someone managing borderline personality disorder or processing childhood trauma. You may have heard of cognitive-behavioral therapy (CBT), which is very effective for many people, but it’s just one of many therapy approaches that trained professionals can use.

Knowing what’s available and which modalities address different needs empowers you to have informed, meaningful conversations with potential therapists or current therapists. It also helps you trust the process once you begin the healing journey.

The Most Common Types of Therapy, Explained

How Do You Know Which Type of Therapy Is Right for You?

The truth is: You don’t always know in advance, and that’s okay. Most skilled therapists are trained in multiple modalities and will tailor their approach to your specific needs, history, and goals. The most skilled therapists have a diverse toolkit of methods they can draw from, adapting their approach to match each person’s unique needs, interests, and developmental stage.

That said, going in with some knowledge gives you the ability to ask meaningful questions. When looking for the right therapist, or during your next session, try asking your therapist these questions:

Asking these questions will help you find the right fit for your healing journey, and a good therapist will welcome them.

A Quick Reference: Therapy Types and What They Address

There are so many therapeutic approaches out there, and we’ve only covered a few. Still, here’s a breakdown of the theories we discussed and what they can help support:

Taking the Next Step

Understanding these approaches is the first step in building a better you. Finding the right therapist is a significant part of improving your mental health, but you don’t have to do it alone. GoodTherapy’s therapist directory allows you to filter by therapy type, specialization, location, and more, so you can find someone who truly fits your needs.

If you’re still exploring whether therapy is right for you, our blog on what to expect in your first therapy session can help you get started.

Remember, reaching out is not a sign that something is irreparably wrong with you. It’s a sign that you know your well-being is worth investing in.

Many therapists, myself included, feel that the most potent work in psychodynamic treatment is in what’s called “working with the here-and-now.” Addressing what’s going on in the therapy room—and by that I mean what’s coming up between the person in therapy and the therapist—means we’re really cookin’! It puts the “dynamic” in psychodynamic therapy.

If you are at a place with your therapist where you feel okay about talking about your therapeutic relationship, it likely indicates a healthy level of trust between the two of you. You’ve moved from talking “about” issues (such as describing the latest negative interaction with your boss, the last argument with your wife, or the most recent bout of passive aggressiveness with that annoying neighbor) toward experiencing an issue together.

It can be scary. It takes guts. And it’s where so much amazing work happens.

[fat_widget_right]

So if the here-and-now is so important, why do therapists ask so many questions about the past? Why are there so many stereotypes about therapists asking about, say, your mother or father? Heck, why does your therapist want to know about your parents at all? After all, it’s you in therapy, not them, right?

Looking for Patterns

Early on in treatment, many therapists try to get a sense of your early history—questions about where and how you grew up, the family members who were (or weren’t) around, and much, much more. Was Dad down all the time? Did Mom never let you see her cry? Were you the oldest and thus “in charge” of your siblings? Were you always compared to another family member?

Therapists are often looking to suss out patterns, many of which tend to be dutifully followed in a less-than-conscious way. Emotional patterns could be strong feelings that come up for you seemingly out of nowhere. A therapist may ask you if a feeling is familiar. It may lead you to a memory of something small or large, but trusting it and seeing where it takes you can lead to uncovering and healing a long-held wound you didn’t know was still there.

Therapists are also attuned to relationship patterns and how they may be affecting you now. These may be recurring types of relationships (“Why am I always dating the same type of person who treats me this way?”) as well as patterns in your family’s history. For example, a man who feels he needs to hold the family together without showing emotion may have been modeled that by his father, who may have been modeled that by his father, perhaps instilling an unconscious limitation regarding what a father can be.

Using Patterns to Promote Change

In this way we are moving back and forth, examining how your past was the forerunner to who you are now. It dictates nothing. Someone else with your exact past wouldn’t necessarily be in the same place you are now, but we can often connect dots that led to the issues you may be struggling with.

Someone else with your exact past wouldn’t necessarily be in the same place you are now, but we can often connect dots that led to the issues you may be struggling with.

The past can provide some insight. It’s a reminder that your mental health is not all about “you” because there’s a larger picture of you in an environment, a greater context. The past can help put all of this together to better understand who you are. When you look at a pattern that has led to “you” and realize you’ve been using what you were given the best you could, you invite room for self-compassion. Positive change is very difficult without allowing yourself some of that.

It’s not about the insight, though. Insight-only therapy would make treatment an interesting intellectual exercise, but one that led to little actual transformation. Once we connect with past issues, uncover patterns, and unpack how strong emotions elicited by passing thoughts are actually learned responses to old hurts, we can finally heal those hurts.

That’s what we do when we work with the here-and-now.

We can finally let out anger that previously found its voice as depression.

We can finally cry about something that had been manifesting as resentment in every power dynamic we were on the less empowered side of.

We can truly, deeply laugh at something we once held as morbidly sacred.

Using the present to connect with the past, and then the past to connect back to the present, is how we move forward.

Many people who frequently procrastinate don’t endorse their own behavior or speak about it proudly. Many who experience repeated procrastination want to change. This desire and motivation to change is most acute when time is running out and the person procrastinating is in the throes of an emotional storm of anxiety.

The procrastinator often repents during his or her peak time of displeasure. For example, the academic or executive preparing for a big meeting, after staying up past 4 a.m., vows never again to put himself or herself through this self-inflicted, sleep-deprived, caffeine-infused pain. “Next time, I won’t wait until the last minute,” he or she says. However, when the next time comes, the vow is broken and boundaries of time are again played with dangerously.

It’s estimated that about 50% of college students and 20% of older adults procrastinate chronically (Harriet and Ferrari, 1996; Day, Mesnick, and O’Sullivan, 2000). But if it’s so painful, why do so many procrastinate? Are they masochistic or lazy? Let’s take a look at different reasons why people procrastinate and identify some tips to help those who do.

1. The Masochistic Procrastinator

[fat_widget_right]Bringing yourself to despair and surviving it can create a feeling of triumph and exhilaration. “I did it,” says the masochistic procrastinator. The excitement of just making it to class or to a plane in the nick of time can be a joyous rush or regressive return to adolescent rebellion. For others, the joy or pleasure of procrastination is less apparent (or more disguised). Unresolved Oedipal issues leading to guilt or ambivalence about success may drive these procrastinators to get in the way of themselves.

A tip for breaking the cycle: A deep dive with a psychodynamically informed therapist may help the masochistic procrastinator examine unconscious self-sabotaging behaviors. Understanding the motivations behind taking risks and how to sublimate this desire can help. Letting go of feelings of guilt about success or other similar feelings can help a person become more comfortable with assertiveness and embrace healthy aggression to move toward goals.

2. The Hedonistic/Self-Regulation Procrastinator

The hedonistic type of procrastinator, who often experiences self-regulation issues, may not have low self-esteem or confusion about goals. Instead, this procrastinator may struggle because he or she cannot delay gratification. Recent research suggests that this may be the most influential variable contributing to procrastination (Sirois, 2014).

People who experience self-regulation procrastination are drawn to what interests them in the moment. Facebook, fantasy football, Instagram, or Twitter may simply feel a better than working on a paper, prepping for a meeting, or calling back a client.People who experience self-regulation procrastination are drawn to what interests them in the moment. Facebook, fantasy football, Instagram, or Twitter may simply feel better than working on a paper, prepping for a meeting, or calling back a client. The hedonistic type of procrastinator often pushes away the negative feelings and consequences by instead indulging their immediate desires.

A tip for breaking the cycle: Think about your desired future self. Focus on the consequences that will result if you engage right now in what your priorities are. For example, fill in the blanks in this statement:

If I start now, the benefit will be _______ and I will feel _______. If I wait and procrastinate, I will feel _______ and the consequences will be _______.

3. The Sense of Self Procrastinator

Research (Shanahan and Pychl, 2007) indicates when you have an unstable sense of self, you may be more prone to procrastinate. In other words, if you do not feel connected to who you are, it often makes it difficult to feel connected to a task. For example, taking the steps to apply for a job in computer programming is less motivating and something you may avoid if you are unsure this is a career you want. Having a good sense of self can make tasks more meaningful and increase your motivation to engage in them. If you are passionate and have a sense of who you are, it may be easier to harness energy to complete tasks with more fervor and dedication.

A tip for breaking the cycle: Spend more time on thorough self-exploration to determine what you really want rather than what other people expect from you. Some individuals out of desperation pick a path or tasks in an attempt to free themselves from the existential anxiety of not knowing where to go in life. Being able to tolerate the unknown and discover what ultimately matches your personality and life goals, although time consuming, can help foster passion and success.

4. The Fear and Self-Esteem Procrastinator

Self-doubt and low self-esteem can sometimes make ordinary tasks appear daunting. When you doubt yourself, tasks at hand may be more difficult as you imagine trying to conquer an unbeatable opponent. This may lead you to engage in more pleasurable activities that have a short-term payoff. Unfortunately, avoidance of important tasks can also lead to self-loathing and feelings of guilt.

A tip for breaking the cycle: When climbing a mountain, it’s helpful not to look up. Instead, focus on what is in front of you. Focusing on subcomponents of a task rather than the end result can help people who feel overwhelmed or experience self-doubt.

5. The Self-Handicapping Procrastinator

By putting things off until the last minute and performing below their capabilities, many self-handicapping procrastinators protect themselves against negative feelings by saying, “I could have done better if I worked harder.” Living in a world of “what they could potentially accomplish if they worked hard” may be more comfortable than discovering strengths and weaknesses.

A tip for breaking the cycle: Reframing failure or success can be helpful. Try to view success as confronting a task and putting effort in regardless of whether you obtain the goal. Facing struggles in this way and learning from mistakes throughout the process will also help build strengths.

6. The Successful Rationalizing Procrastinator

This type of procrastinator has been doing it for years and, on the surface, has gotten away with it. A major rationalization such a person may rely on for his or her behavior is his or her success. Despite procrastinating, this individual may have received promotions at work, obtained excellent grades, and may be perceived by others as competent.

Relative success often leads this person to continue procrastinating, since he or she is able to function and achieve despite the behavior. Although successful, this type of procrastinator may not be living up to his or her true potential. Furthermore, the ghosts of uncompleted assignments often haunt the rationalizer. Although they may be confident they can get things done at the last minute, doing so has a psychological cost. Anxiety and feelings of emptiness can result from this type of procrastination.

A tip for breaking the cycle: Viktor Frankl, the renowned psychiatrist who wrote Man’s Search for Meaning, advocates making meaning regardless of your situation. Engaging tasks with all your energy and in a way that is meaningful to your environment makes life richer and fills it with purpose.

References:

1. Day, V., Mensink, D., & O’Sullivan, M. (2000). Patterns of academic procrastination. Journal of College Reading and Learning, 30, 120-134.
2. Harriott, J., & Ferrari, J. R. (1996). Prevalence of procrastination among samples of adults. Psychological Reports, 78, 611-616.
3. Shanahan, J.M., & Pychl, A.T. (2007). An ego identity perspective on volition action: status, agency and procrastination. Personality and Individual Differences, 43 901-911.
4. Sirois, F (2014). Out of sight, out of time? A meta-analytic investigation of procrastination and time perspective. European Journal of Personality, 511-520.

Cognitive behavioral therapy (CBT) seeks to help people identify negative or unhealthy thoughts, replace those thoughts with healthier thoughts, and in so doing, change their behavior and feelings. People don’t have to spend endless sessions discussing painful childhood memories, and the formulaic nature of CBT offers some people reassurance.

Preliminary studies of CBT showed impressive improvements in symptoms of conditions ranging from depression to personality disorders, leading to a surge in therapists who offered CBT. This type of therapy continues to be one of the most widely used evidence-based treatments available.

According to famed British psychologist Oliver James, though, CBT is a “scam” that does little to address underlying psychological issues. James, a psychodynamic therapist, argues that until people understand what led to their psychological troubles, those troubles are likely to reoccur.

GoodTherapy.org CEO and founder Noah Rubinstein, LMFT, LMHC, takes a similar stance with regards to addressing underlying issues in therapy.

“I am certainly not an expert on what research has shown about the efficacy of CBT, and I certainly don’t want to throw the baby out with the bathwater. CBT is an evidence-based, short-term therapy that has helped many people. However, on a theoretical level, I’ve always considered CBT to be a surface-level treatment rather than a method for lasting changes,” Rubinstein said. “In my experience, the only way to make lasting change is to help people tend compassionately to the more vulnerable feelings that protective functions, or defense mechanisms—such as depression, anxiety, self-criticism, anger, or addiction—are shielding us from.”

CBT’s Short-Term Effectiveness

There’s no question about CBT’s short-term effectiveness; even James admits that people receiving CBT can see remarkable improvements in a short period of time. So effective is CBT in the short term, in fact, that CBT self-help manuals such as David Burns’s The Feeling Good Handbook have become bestsellers. Because CBT teaches people how to detect and stop automatic negative thoughts, it’s especially popular for treating depression and anxiety. Some therapists, regardless of therapeutic modality, even insist that their clients use CBT principles to treat these conditions. 

Can Short-Term Behavioral Interventions Provide Lasting Results?

When researchers evaluate the long-term effects of CBT, the treatment looks less promising. James points out that psychodynamic psychotherapy yields better results in the long term because it helps people address the root causes of their distress. Several studies support this claim. For example, a 2003 meta-analysis that compared CBT and psychodynamic therapy for depression across several studies found that people who used psychodynamic therapy had larger improvements. Another study of marriage therapy evaluated the effects of behavioral versus insight-oriented marital interventions. CBT relies on behavioral interventions, while psychodynamic therapy is built on insight. Thirty-eight percent of couples who used the behavioral strategies were divorced four years later, compared to just 3% of couples who relied on insight-based approaches.

Rubinstein takes the view that conditions such as depression and anxiety protect us from the vulnerable feelings associated with the true source of our distress.

“For example,” Rubinstein said, “the man with depression who’s shut down, can’t get out of the bed in the morning, and has given up might be protecting himself from trying, failing, and once again feeling that terrible worthlessness he’s felt in the past.” Like James, Rubinstein sees CBT as a short-term fix that “helps to eliminate the problematic, surface-level protective behavior.”

Indeed, one of the selling points of CBT is that it doesn’t require a long-term commitment to therapy. Many CBT programs take only a few months, and some promise near-immediate results. A study published in Psychological Medicine in 2008, though, found that long-term approaches may be preferable. That study compared long-term psychodynamic therapy to two short-term therapies: short-term psychodynamic therapy and solution-focused therapy. While the short-term approaches produced more immediate results, those results faded over time. At the three-year mark, people who had undergone long-term therapy saw more improvements. Although this study didn’t evaluate CBT, it does suggest that dedicating more time to gaining insight can be valuable. [fat_widget_left]

Laura Reagan, LCSW-C, a GoodTherapy.org Topic Expert on trauma and posttraumatic stress, blends CBT with a variety of other techniques. She sees CBT techniques as effective and essential, though she acknowledges that CBT may not be best for addressing long-term issues.

“In my practice with trauma survivors, focusing only on changing thoughts and behaviors through CBT without using a more depth-oriented approach will result in only temporary improvement of symptoms which are likely to return, as the underlying problem has not been addressed. I use CBT skills as part of my work with clients to challenge negative cognitions about the traumatic events experienced.”

Rubinstein agrees that underlying problems need to be addressed for lasting change, “I don’t agree with everything Freud postulated, but he did believe that if you eliminate a defense mechanism, another will take its place, and I think that is the problem with CBT in terms of its long-term effectiveness. Therapies that help people to resolve the deeper and more vulnerable feelings that fuel defense mechanisms offer potential for long-lasting change.”

Is It a Scam?

While CBT doesn’t work for everyone, it’s far from a scam. James is a well-respected therapist, but he’s also a practitioner of psychodynamic therapy, so his opinion is by no means free of bias. While some studies have shown that psychodynamic therapy is more effective in the long term, others show that the two approaches are equally effective. Few studies show that CBT doesn’t work at all, and several studies suggest that CBT can work in the long term. A study that evaluated people who had been treated with CBT for social anxiety found that, even three years later, they were able to use what they had learned in CBT to more effectively cope with anxiety. A 2006 review of recent studies found that CBT may help reduce depression relapse rates, particularly when researchers compare the effects of CBT to the effects of medication alone.

Carey Heller, PsyD, a GoodTherapy.org ADHD Topic Expert who uses CBT as well as other forms of therapy in his practice, highlights the importance of a strong therapeutic alliance. He explains, “Many studies have shown that the quality of the relationship between the therapist and the patient/client is one of the best predictors of treatment outcome. Thus, the specific type of treatment, whether it is CBT, psychodynamic, or an integrative approach, is not the only determining factor in whether treatment will be successful for a specific individual. I feel it is more important to find a clinician who you feel comfortable with and can look at your unique needs in determining the best treatment approach to help you rather than just seeking out a specific type of treatment on your own.”

References:

1. Hope, Jenny. (2014, November 10). ‘CBT is a scam and a waste of money’: Popular talking therapy is not a long-term solution, says leading psychologist. Retrieved from http://www.dailymail.co.uk/health/article-2828509/CBT-scam-waste-money-Popular-talking-therapy-not-long-term-solution-says-leading-psychologist.html
2. Kendall, P. C., & Southam-Gerow, M. A. (1996). Long-term follow-up of a cognitive–behavioral therapy for anxiety-disordered youth. Journal of Consulting and Clinical Psychology, 64. Retrieved from http://dx.doi.org/10.1037/0022-006X.64.4.724
3. Knekt, P., Lindfors, O., Härkänen, T., Välikoski, M., Virtala, E., Laaksonen, M., . . . Renlund, C. (2008). Randomized trial on the effectiveness of long-and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up. Psychological Medicine, 38(05). doi: 10.1017/S003329170700164X
4. Leichsenring, F. (2003). The Effectiveness of Psychodynamic Therapy and Cognitive Behavior Therapy in the Treatment of Personality Disorders: A Meta-Analysis. American Journal of Psychiatry, 160(7), 1223-1232. doi: 10.1176/appi.ajp.160.7.1223
5. Snyder, D. K., Wills, R. M., & Grady-Fletcher, A. (1991). Long-term effectiveness of behavioral versus insight-oriented marital therapy: A 4-year follow-up study. Journal of Consulting and Clinical Psychology,59(1), 138-141. doi: 10.1037//0022-006X.59.1.138

Thank you for your letter. I’m sorry to hear that you aren’t experiencing the therapy you’re receiving as helpful, and I hope that I can provide some assistance. I’m going to start by offering a brief description of psychodynamic therapy and how it works.

Psychodynamic therapy is one of many “depth” psychotherapy processes. It is insight oriented, and a lot of the work is based on free association, where the client simply talks about whatever is on his or her mind at the moment. Eventually, patterns and processes stemming from past experiences and unconscious drives become apparent. The focus of the therapy then goes to the client becoming aware of how these patterns and drives are affecting his or her life. The goal of psychodynamic therapy is not simply to make symptoms go away but to improve one’s life in general. Those are lofty and worthwhile goals that often require some amount of time to accomplish. The experiences one has in life, including trauma, abuse, and neglect, become embedded in the way that person interacts later in life, and it may take some time to work through these more complex aspects of being. There is really no set time that anyone can give on how long one would be in psychodynamic therapy, as it is all dependent on many individual factors that are specific to the client, his or her needs, and the therapeutic relationship.

Now for the specifics of your question: It sounds as if your therapist is well credentialed and doing well by engaging in her own therapy. That indicates that she is a responsible professional, but, of course, without knowing her personally, I can’t say with any certainty one way or another.

What I can tell you with some measure of certainty is that one of the necessary conditions for optimal therapy is that there is a relationship between the therapist and the client. This means a relationship of trust, honesty, respect, healthy boundaries, and mutual willingness to work together. If any of those conditions aren’t present, the therapy process will not go as well as it could. Without knowing you, the therapist, or the relationship between the two of you, it’s hard to say what could be slowing down the process. However, as you reflect on your relationship with your therapist, I would invite you to explore the ways in which you engage in the therapy. Is there a part of you that withholds in therapy? Do you feel like you have allowed yourself to trust the therapist? You mentioned that you haven’t allowed yourself to “go there” with your therapist, and I’m curious if that is holding back the process in any way.

Because one of the most important pieces of a therapeutic relationship is mutual honesty and trust, I would suggest that you start with speaking openly and honestly about your concerns with your therapist, if you feel comfortable. If you can raise your concerns to your therapist, even when it might be a bit uncomfortable, you will be taking another step in trust and vulnerability with the therapist, which can serve to help the relationship. If you do so and you feel as though your concerns are still not resolved, the relationship hasn’t improved, and you don’t feel some sense of resolution, then it may be time to consider moving in a new direction.

If you do decide to go another direction with therapy and your therapist is not able to recommend anyone, GoodTherapy.org’s search engine can help. If you decide to go that route, I suggest that you take your time in finding someone new to work with and that you interview the therapist on how he or she works, what he or she expects, and how he or she anticipates the therapy progressing. If you decide to go with another therapist, take your time and make sure that it is the right fit for you, your needs, and your goals.

I applaud your willingness to seek out therapy and to ask for help when you need it. I trust that you will continue your journey with courage.

Yours truly,
Lisa

In recent years, support of psychodynamic psychotherapy for the treatment of schizophrenia spectrum and other forms of psychosis has diminished. This is not entirely a result of lack of validity or efficacy, but rather an investigative shift from traditional methods of therapy to more novel approaches. However, according to a recent study led by Bent Rosenbaum of the Department of Psychology at the University of Copenhagen in Denmark, psychodynamic therapy is still one of the most effective forms of treatment.

Rosenbaum compared treatment as usual (TaU) to TaU with supportive psychodynamic psychotherapy (SPP) in a sample of 269 adults admitted for psychosis. The participants were measured for global functioning and symptom severity before, during, and after the two-year treatment period. Rosenbaum found that the SPP group improved far more than the TaU group with respect to all levels of functioning and symptoms of psychosis. Over the course of two years of treatment, there were significant gains on social functioning and significant decreases on maladaptive symptoms for the participants in the SPP group.

These findings demonstrate that psychodynamic therapy and the core elements associated with that approach can still adequately serve the needs of many individuals with schizophrenia and other psychotic issues. Rosenbaum believes that when working with psychotic clients, clinicians should focus on the fundamental aspects of psychodynamic therapy. This includes overcoming obstacles to emotional processing, mental functioning relating to sense of self, and the development and maintenance of relational bonds. Cognitive development and attention to the present should also be incorporated to ensure maximum benefits for clients who struggle with these issues.

Rosenbaum hopes that this research will bring clinicians back to SPP and approaches of that kind. “It furthers recovery when it is used as a supplement to medical and social treatment modalities.” He added, “SPP should thus be taken into account as a modality in future research and treatment.” Doing so will open avenues of treatment for clients with varying levels of mental illness.

Reference:
Rosenbaum, Bent, Susanne Harder, Per Knudsen, Anne Koster, Anne Lindhardt, Matilde Lajer, Kristian Valbak, and Gerda Winther. Supportive psychodynamic psychotherapy versus treatment as usual for first-episode psychosis: Two-year outcome. Psychiatry: Interpersonal & Biological Processes 75.4 (2012): 331-41. Print

A client that drops out of therapy is one who does not complete the recommended course of treatment. Many therapeutic approaches, such as cognitive behavioral therapy, do not have a specific treatment deadline, and clients are considered dropouts when they have voluntarily stopped therapy prior to resolving the issues and symptoms that brought them there to begin with. Dropout is a serious concern for the medical community and the general population. Individuals who drop out of therapy are more likely to have future psychological complications and seek services multiple times, which places an economic burden on society. Because they do not learn adaptive coping strategies and fail to address the issues that plague them most seriously, they are likely to be less than productive in their careers, families, and communities. Additionally, therapists who experience client dropout may begin to question their ability to help clients and their own adequacy.

Understanding the factors that contribute to dropout can provide clinicians with the information they need to address the problem. Joshua K. Swift of the Department of Psychology at the University of Alaska in Anchorage wanted to explore this problem further and made it the focus of his most recent study. Swift analyzed over 650 studies that included more than 83,000 clients and looked at factors such as client age, therapy setting, therapist experience, type of therapy, issues addressed in therapy, and clinician definition of dropout.

Swift found that nearly 20% of all the clients in the studies ended their treatment early. He found that some variables, such as therapy setting, influenced the rates of dropout. He also discovered that rates of dropout were highest among the youngest participants and those seeking treatment for personality or eating problems. Swift believes that more work is needed to determine specific nuances that effect retention. He hopes efforts will be aimed at isolating psychological issues, such as anxiety or depression, and approaches, such as psychodynamic or behavioral therapy, in order to get a clearer idea of the different dimensions affecting treatment completion. Swift said, “By paying attention to these variables and making adaptations where needed, clinicians may be able to reduce rates of premature discontinuation in their work with clients.”

Reference:
Swift, J. K., Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology80.4: 547-559.

Psychotherapy is the first form of treatment for depression or anxiety and involves a variety of treatment techniques. During psychotherapy, the person experiencing depression or anxiety speaks with a licensed psychologist or therapist who helps him or her to identify and work on the causative factors. These factors trigger depression or anxiety by working in combination with chemical imbalances in the brain or heredity factors.

Psychotherapy helps people with depression or anxiety in the following ways:

• Understanding the behaviors, ideas, and emotions that contribute to depression or anxiety
• Identifying the problems or events that contribute to depression or anxiety and understanding which aspects of the problem they can solve
• Helping to regain a sense of control and pleasure in their lives
• Teaching them problem solving skills and coping techniques

Although psychotherapy can be performed in different ways, such as individual, family, and group therapy, there are also different approaches that psychotherapists can use to provide therapy. After having a brief talk with the client, the therapist will decide on the approach to use based on the underlying factors that contribute to the person’s depression. Many therapists specialize in one or more specific techniques or approaches. These different approaches to psychotherapy include psychodynamic therapy, interpersonal therapy, cognitive behavioral therapy, and solution focused therapy.

Psychodynamic Therapy
This therapy assumes that the person is depressed due to unresolved, unconscious conflicts that often stem from childhood. The goal of this therapy is for the person to understand and cope better with these feelings by talking about such experiences. Psychodynamic therapy usually takes place over several months and can produce excellent results.

Interpersonal Therapy
Interpersonal therapy mainly focuses on the person’s behaviors and interactions with family and friends. The goal of this therapy is to enhance self-esteem and improve communication skills during a short period of time. This therapy usually lasts for 3 to 4 months and works well for depression caused by social isolation, mourning, major life events, and relationship conflicts.

Psychodynamic therapy and interpersonal therapy help people resolve depression or anxiety caused by loss or grief, role transitions (like becoming a parent or caregiver), and relationship conflicts.

Cognitive Behavioral Therapy
Cognitive behavioral therapy helps people experiencing depression or anxiety to identify and change inaccurate perceptions they have about themselves and the world around them. The psychotherapist helps the client to think differently by directing attention to both the accurate and inaccurate assumptions they have about themselves and others.

This therapy is recommended for the following types of persons:

• People who think and behave in ways that trigger and perpetuate depression
• People who experience disability or interpersonal problems due to depression

Solution Focused Therapy
Solution focused therapy is a symptom-specific approach, which means it targets one or two stressors that are causing problems. The result might be helping the person find a better way to handle the boss at work or children at home. A person may simply learn techniques to handle anxiety. One therapist commented that solution focused therapy is like getting new tools in your toolbox to use immediately in your life, therefore helping you feel better quicker.

For an individual living with depression or anxiety, psychotherapy can promote better understanding of the condition and associated symptoms. For a person with depression, being able to talk with a psychologist or therapist who is there to listen, inquire, and help can be comforting as well as rewarding. After just a few sessions of psychotherapy, clients may feel a difference. Research suggests that three to five sessions often cause significant change. Talking through the issues can help identify behaviors and detrimental reactions or circumstances. Coping techniques can also be investigated during therapy sessions, and progress reports can be used to keep track of how these techniques work. For individuals experiencing anxiety or depression, being surrounded by loved ones or being encouraged to attend therapy sessions can provide immense support.

Learning about the stages of healing can be distressing, motivating, upsetting, or uplifting. No matter how you feel, your reaction is not wrong. Acknowledging your emotional response to the stages of healing can allow you to harness your emotions’ energy and reach out to a trained therapist.

When looking for a therapist, it is vital to keep in mind that, regardless of what type of psychotherapy you pursue, your therapist should empower you and welcome you as a collaborator in your therapy, not attempt to impose control over you. Studies have found that individuals who are active participants in their therapy are more satisfied with the therapy. In addition, it is crucial that you feel safe in your therapeutic relationship.

There is no magical treatment that will heal you overnight, nor is there one form of psychotherapy that is right for everyone, but you should be able to find a therapist, as well as a therapeutic approach, that works for you. Healing is like a marathon. It requires preparation, repeated practice, courage, determination, and the support of others—including that of a professional coach or therapist.

While there are numerous therapy approaches, the purpose of all trauma-focused therapy is to integrate the traumatic event into your life, not subtract it. This article discusses the most common forms of trauma therapy. Each approach is described in its most pure form, but keep in mind that many therapists combine different types of therapies.

Pharmacotherapy

Pharmacotherapy is the use of medications to manage disruptive trauma reactions. Medications have been shown to be helpful with the following classes of reactions/symptoms:

• Intrusive symptoms [fat_widget_right]
• Hyperarousal
• Emotional reactivity
• Heightened arousal
• Irritability
• Depression

Taking medication does not make one’s trauma reactions and pain evaporate. Medications can only help make the symptoms less intense and more manageable.

If you decide to use medications, consult a psychiatrist and continue working with that psychiatrist for as long as you take the medications. Inform the psychiatrist of how the medications are impacting you. Some medications have side effects that may or may not be tolerable to you, and some people do not respond favorably to medications. Medications are most effective when individuals pursue therapy concurrently.

Behavior Therapy

The most common form of behavior therapy is exposure. In exposure therapy, one gradually faces one’s fears–for example, the memories of a traumatic event–without the feared consequence occurring. Often, this exposure results in the individual learning that the fear or negative emotion is unwarranted, which in turn allows the fear to decrease.

Exposure therapy has been found to reduce anxiety and depression, improve social adjustment, and organize the trauma memory. There are various forms of exposure therapy:

• Imaginal exposure: An individual imagines the feared event as vividly as possible.
• In vivo exposure: The exposure occurs in the therapy.
• Systematic desensitization: The individual is exposed to successively more fear-inducing situations. This exposure is paired with relaxation.

Exposure therapy is a highly effective treatment for posttraumatic stress (PTSD).

Another form of behavior therapy is Stress Inoculation Training (SIT), also known as relaxation training. Stress Inoculation Training teaches individuals to manage stress and anxiety.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is grounded in the idea that an individual must correct and change incorrect thoughts and increase knowledge and skills. Common elements of cognitive behavioral therapy trauma therapy include:

• Teaching individuals how to breathe in order to manage anxiety and stress
• Educating individuals on normal reactions to trauma
• Exposure therapy
• Identifying and evaluating negative, incorrect, and irrational thoughts and replacing them with more accurate and less negative thoughts

Eye Movement Desensitization and Reprocessing (EMDR)

Therapists who perform EMDR first receive specialized training from an association such as the EMDR Institute or the EMDR International Association. An EMDR session follows a preset sequence of 8 steps, or phases. Treatment involves the person in therapy mentally focusing on the traumatic experience or negative thought while visually tracking a moving light or the therapist’s moving finger. Auditory tones may also be used in some cases. Debate regarding whether eye movements are truly necessary exists within the field of psychology, but the treatment has been shown to be highly effective for the alleviation and elimination of symptoms of trauma and other distress.

Hypnotherapy

There is no one guiding principal for hypnotherapy. In general, a hypnotherapist guides the individual in therapy into a hypnotic state, then engages the person in conversation or speaks to the person about certain key issue. Most hypnotherapists believe that the emotions and thoughts that an individual comes into contact with while under hypnosis are crucial to healing.

Psychodynamic Therapy

The goal of psychodynamic trauma therapy is to identify which phase of the traumatic response the individual is stuck in. Once this is discerned, the therapist can determine which aspects of the traumatic event interfere with the processing and integration of the trauma. Common elements of psychodynamic therapy include:

• Taking the individual’s developmental history and childhood into account
• Placing emphasis understanding the meaning of the trauma
• Looking at how the trauma has impacted the individual’s sense of self and relationships, as well as what has been lost due to the traumatic event

Group Therapy

There are a variety of different groups for trauma survivors. Some groups are led by therapists, others by peers. Some are educational, some focus on giving support, and other groups are therapeutic in nature. Groups are most effective when they occur in addition to individual therapy. It is important for a trauma survivor to choose a group that is in line with where one is in the healing journey:

• Safety/victim phase: Choose a group focused on self-care and coping skills.
• Remembering and mourning/survivor phase: Pick a group focused on telling the trauma story.
• Reconnection/thriver phase: Join a group that aims to create connection with people.
• Educational groups are appropriate during all phases.

Any therapist, regardless of which type of therapy she or he works from, desires to help you grow and heal through your traumatic experience.

Together, you and your therapist will strive to acknowledge and identify:

• Where you are at in your healing journey
• Who you would like to be and what you would like to be doing when you enter into the thriver stage
• How you can get to that place from where you are now
• How to guide you through this healing work

As always, reach out for help and know that you do not need to go it alone.

Reference:

1. What is the actual EMDR Therapy session like? (n.d.). Retrieved from http://www.emdrresearchfoundation.org/for-the-public/what-is-the-actual-emdr-therapy-session-like