12/02/2023
Types of Psychotherapy - Treatment Modalities
Psychotherapeutic techniques; Art, or Science ?
Psychotherapeutic techniques abound with diversity and innovation. Though they all focus on the amelioration of mental health conditions and consequent distress, their relevance to etiology, cause if you will, is highly dependent on theoretical postulates, rather than on an axiomatic basis.
One might even say that therapy is more of an art or a practice of ‘convenience’ rather than an empirical science.
What is especially significant in the 21st century, is that “Treatment Techniques” are primarily dependent on the following:
- The efficacy and veracity of the educational requisites for degrees related to mental health diagnosis and treatment.
- The efficacy and veracity of State licensure requisites.
- Dictates by the Diagnostic and Statistical Manual of the American Psychiatric Association.
- Insurance requisites, mandated timeframes, and reimbursement rates.
- The medicalization of mental health conditions.
It is imperative that those seeking psychotherapy exercise due diligence while bearing in mind that errors in ‘diagnoses, or the utilization of inept, or inappropriate techniques, can do more harm than good.
Finally, be aware that a single word or utterance by a poorly trained psychotherapist can result in the exacerbation of a condition or its symptoms.
Conditions that are poorly treated result in becoming intractable and/or chronic.
Psychotherapy - Definition
Generally speaking, Psychotherapy is a process through which individuals in states of distress, or different forms of dysfunction, attempt to mitigate, or ameliorate symptoms, or conditions thought to be related to their discomfort, anguish, or failure to adapt and relate to others.
Having said that, one may consider that there may be individuals who are "Ego-Syntonic"; that is, their signs and symptoms are not recognized by them, nor do they think they have any problems, e.g., some alcoholics, those suffering from serious thought disorders, narcissists, etc.
Though these individuals may cause adversity, and even harm to others, they are oblivious of their actions and contributions.
So, to state that Psychotherapy addresses individual suffering, may not be inclusive.
We need to expand our definition of what "Psychotherapy is" to include the objective of "assisting individuals in recognizing and mitigating characterological defects, or deficits, that may cause, or contribute adversely to the wellbeing of others.
We need to also consider that there are individuals who though capable of certain levels of success and achievement, are underperforming, and/or underachieving. due to characterological quirks that adversely impact their self-esteem, confidence, and self-regard.
Finally, we may be remiss in not addressing Dysfunctions in family, and or group units in need of exploring underlying causes and reasons that adversely impact the quality of their relationships.
"Psychoanalysis", unlike its sister "Psychotherapy", is a very long and tedious process through which the primary objective is a complete restructuring of an individual's character, and personality.
Psychotherapy Delivery and Service Types
- Face to Face - In Office
- Face to Face - In Home
- Face to Face - Online Skype, Video Conference
- Face to Face - In Agencies
- Face to Face - In Hospital, Residencies
- Face to Face - In Group - Conference Rooms
- Face to Face - In Group - Community Settings
- Via Telephone
- Via Email - Chat
Individual Psychotherapy - Subtypes and Differences
Psychodynamic psychotherapy
Most essential to this treatment process is an acceptance of the premise that mental health issues neither exist in a vacuum nor are they caused by a single event.
Absent any physiological, medical, or neurological conditions, this approach is with an understanding that a multiplicity of factors, through a dynamic interplay, stand at the foundation of every condition.
Genetic predispositions, characterological constellations, medical issues, early developmental experiences, and social and family dynamics; all blend into an amorphous mass that is at the core of every condition.
Through a very close relationship between the client and the therapist, a process begins and focuses on exploring the client’s past as it relates to their present condition, their thoughts, actions, and reactions.
Under this regiment, a well-trained and experienced professional, refrains from a strict adherence to single theories, or blind adherence to singular techniques such as CBT, DBT, BM, or ...
The primary aim is not to identify destructive thoughts, states, or behavioral patterns, but rather the restructure one's personality dynamics.
This is done tediously and progressively, identifying the transductive nature of the evolution of the personality, its traits, and its processes; That is, the 'how' thoughts, feelings, and/or actions are being mentally transported and/or transformed into psycho-physiological and/or behavioral events and/or processes.
What is the associative process of sensors in the body or mind, that leads up to the conversion of either conscious, or unconscious experiences into cognitive, behavioral, or affective states?
The therapist begins with a typological evaluatory process and sets a theoretical basis within which behavioral manifestations and congruence of thoughts and effects are followed for oddities or variations. Exceptional attention is given to how the individual moves from one thought to another, and whether there exists a need to view the client's product in a symbolic, or metaphorical fashion.
Themes related to resistance, transference, and defense mechanisms are noted for levels of maturity and the emergence of introjects.
When appropriate, Ego Functions are assessed, and the client's insight is encouraged through retrospective analysis of content and behavioral signs.
Psychoeducational Psychotherapy
As Introduced by Kasdaglis, M in the mid-nineties, its aim went beyond families and children.
Its usefulness is not merely to educate the patient and families about conditions, disorders, or symptoms, or their course, prognosis, and other relevant information.
Properly used it is a distinct treatment technique that may be viewed as a highly effective adjunct to other therapeutic modalities, and especially to psycho-dynamic approaches.
It focuses on providing the patient and his, or her family with an honest and simple translation of the psychiatric 'label', its consituent signs and symptoms, along with a "dynamic formulation"; in doing so the patient, as well as the family, become integrated into the treatment process.
A dynamic formulation articulates the patient's condition and symptoms from an "Intrapersonal" and Object Relations" perspective based on history and dynamics. It proposes the idea of "behavioral determinism", where no behavior is ever accidental, ... even if the disorder may have some genetic origins.
To understand this, we might resort to a rather trivial example. Someone born and raised in a remote village in Antarctica, never having the privilege of modern communication, or travel, has inherited a gene for Obsessive-Compulsive-Disorder. ... Eventually, his condition includes brushing his footprints on the snow every time he takes a step... His condition may never manifest in coconuts falling on his head as his Florida-born OCD counterpart; and neither will he ever be found to suffer from "bacterio-phobia" followed by compulsions to wash their hands a few times a day...
In the context of the Antarctica man with OCD, Object relations, and especially parental introjects, may have set the stage for how endogenous biogenetics might have unfolded over the years. These environmental influences may provide us with a glimpse of a myriad of metaphors, or triggers, if you will... Once the therapist has some understanding of this, the therapist may formulate the dynamic correlate, ... wait for the patient to enter into a state filled with a reasonable replica of the initial affective experiences, and then proceed to share this with their client...
Laughable as it may sound, the CBT therapist will suggest breathing techniques, meditation, exposure, or implosion techniques! - Band-Aids to a hemophiliac !
Ego-Functions (Ego-Psychology) psychotherapy
In this approach, rather than looking at the label, or the condition, a well-trained Ego-Functions practitioner, assesses the level of operational adequacy of a dozen or so, “Ego-Functions”.
Examples include, though not limited to Insight, Judgment, Self-observing ego, sense of reality, reality testing, object relations, etc. (For a complete annotated list please go to Ego-Functions.html).
Having done so, and using parts of a psycho-educational approach, a treatment plan is designed that will address the strengthening of each function in need of mitigation.
Psychoanalytic therapy.
A rather well-known treatment process, as well as rejected and misunderstood by contemporary mental health professionals. Practitioners are required to have undergone 4 to 10 years (3 times weekly) post-graduate psychoanalysis themselves.
It is based on theories and postulations of Sigmund Freud, who described the unconscious as the reservoir of desires, thoughts, and memories that are below the surface of conscious awareness.
He believed that it was these unconscious forces that could often lead to psychological distress and disturbances.
Early childhood experiences have shaped the individual and they are at the core of psychopathology.
The aim is to explore these experiences as a cathartic venue and to gain insight and awareness of unconscious forces causing or contributing to their current state.
Mindfulness
This is a form of meditation where the objective is to focus on becoming aware of the entirety of your being resisting the temptation to interpret or critique your thoughts, or feelings.
SFBT (Solution-Focused Brief Therapy.)
The focus of this approach is finding solutions, rather than exploring the basis of the underlying issues, or pathology.
In this treatment approach understanding of the problem is irrelevant, in as much as the solution is always the same:
Almost like a robot, a question is posited to every client: "Imagine you woke up this morning and your problem was gone. What would your life be like?" …
CBT, RET, BMT
(Cognitive Behavioral Therapy), (Rational Emotive Therapy), (Behavior Modification Therapy)
These therapies depend on the presumption that individuals have developed ill-conceived themes, or behavioral patterns, through which they view the world and its vicissitudes.
In that sense, the focus is neither the individual nor their condition. Rather it is in convincing the patient of their error in thinking and “teaching.” The new and more innovative ideas introduced by the therapist lead to the development of personal coping strategies. The target is to resolve current responses and change unhelpful patterns.
Unbelievable as it may sound, CBT claims to be effective in all areas of need, from acne to schizophrenia. It is dysfunctional thinking that leads to dysfunctional emotions or behaviors.
By changing their thought process, they can change how they feel, and behave.
Dialectical Behavioral Therapy (DBT)
This is a variant of CBT; its objective to identify negative thinking patterns and replace them with more positive behaviors.
It is claimed that DBT may be effective in treating destructive behavioral patterns, and suicidality.
The Kasdaglis Variant Model (KVM)
Under this regiment, a well-trained and experienced professional, refrains from strict adherence to single theories, or blind adherence to singular techniques such as CBT, BM, or ...
Depending on the diagnosis, client's intellectual capacity, symptomatic presentation, client's objectives, and a host of other considerations, the Therapist may vary techniques from one session to another, and even within the same session.
To be effective, there is a definite requisite for the professional to be exceptionally well versed in all known theoretical backgrounds, familiar with applied treatment modalities, and last, but not least, hold a minimal bias in favor, or against particular approaches.
Especially crucial is advanced knowledge of Family Dynamics and techniques as per Satir, Bateson, Ackerman, and Minchin.
TMS (Trans-cranial magnetic stimulation)
This is an intensive treatment technique minimally for a total of 10 sessions, 5 days weekly each session lasting ap 45 minutes.
Please note that TMS is less likely to be effective with patients that had unsuccessfully tried a plethora of different medications for prolonged. periods.
About 40% of veterans with treatment-resistant major depression achieved remission following treatment with sham or active repetitive transcranial. magnetic stimulation (rTMS), reported a clinical trial in JAMA Psychiatry.
TMS is a noninvasive technique utilizing magnetic coils to stimulate the brain through electrical currents.
TMS is totally painless, and does not require the patient to be under anesthesia or muscle relaxants;
ECT (Electro-Convulsive Therapy)
Individuals with severe major depression, or bipolar type II disorder, who have not appeared to respond to medications, may benefit from Electroconvulsive therapy (ECT)
This procedure entails brief electrical stimulations of the brain while the patient has been given muscle relaxants and is under general anesthesia.
It's administration is handled by a psychiatrist, an anesthesiologist, and a nurse. more often than not, the first 3 sessions are on 'inpatient' basis
NLP (Neurolinguistics programming.).
Developed by Richard Bandler and John Grinder, it aims at changing your thoughts and actions, by emulating successful people's patterns of thoughts and behaviors.
The primary technique is reframing problems in a manner that alters the perception of symptoms, or events.
EMDR (Eye Movement Desensitization and Reprocessing.)
Introduced by Shapiro in 1989 a psychotherapeutic approach originally designed to alleviate distress associated with traumatic memories.
Aka “Adaptive Information Processing model” is supposed to facilitate accessing and processing of traumatic memories and other adverse life experiences.
An interactive technique facilitating the reduction of psychological stress through reliving traumatic experiences from the past by the therapist directing your eye movements.
Family Psychotherapy - Subtypes and Differences
Conjoint Family Therapy
Introduced by Virginia Satir who many consider as the "Mother of Family Therapy, it focuses on family reconstruction.
It does so through 3 primary approaches.
Collaborative treatment: 1 or more members of the patient's family are simultaneously treated by 2 different therapist sharing in the same treatment objective.
Concomitant treatment approach: the identified patient, and at least one more family member, are treated by the same therapist. and
Conjoint sessions: All family members are seen simultaneously.
While treating a single individual within a family system, well-seasoned psychotherapists will 'always' insert and utilize Dr. Satir's techniques and postulates, especially about communication patterns, 'self-esteem' issues, and 'triangulations'.
Family - Marital - Couples
Family therapy, also referred to as 'couples and family therapy', 'marriage and family therapy', 'family systems therapy', and 'family counseling', is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to change in terms of the systems of interaction between family members. It reemphasizes family relationships as an important factor in psychological health.
This type of therapy helps spouses and partners understand why their loved one has a mental disorder, what changes in communication and behaviors can help, and what they can do to cope.
This type of therapy can also be used to help a couple that is struggling with aspects of their relationship.
Family: Because family is a key part of the team that helps people with mental illness get better, it is sometimes helpful for family members to understand what their loved one is going through, how they can cope, and what they can do to help.
Psychodynamic Family Psychotherapy
Introduced by the 'father of Family Therapy', Dr. Nathan Ackerman, it adheres to a belief that a patient's condition, and/or disposition is both the cause, as well as the result of an interplay between the patient and other family members.
There is a proposition that people that we are related to may either enhance or inhibit the probability of what is innate becoming manifest.
Implied under these premises is Dr. N's conviction that patients be treated within the context of their family.
His techniques are based on psychodynamics
Where psychoanalytic theory focuses on the internal manifestations of a mental health condition, Psychodynamics seeks to identify, unravel, and deal. with, both, internal as well as external and family dynamics.
MFT (Marriage and Family Therapy) (Couples and Family Therapy)
This type of treatment is delivered by practitioners licensed and/or certified in Family Therapy. It focuses on dysfunctional patterns of family relations. by addressing issues of communication, and/or family structure and dynamics.