Therapeutic Approaches
This blog post is a continuation of the previous post. To go back and read that part first, click here!
Psychodynamic Theory. Psychodynamic theory is the oldest western talk therapy that is officially recognized. It encourages clients to delve into their past to help discover what early life attachments or lack thereof led them to become the person they are today. It operates from the understanding that your early life affects your unconscious mind in a way that leads you to develop your behavioral patterns as an adult, and that through discovering and processing those attachments you can be made aware of them and find a mechanism for change. This is a deeply personal type of therapy and it strongly relies on a therapeutic trust between yourself and the therapist. This theory also typically means a long term and rich relationship with your therapist, as trust needs to be built before the deep work can begin. Expect questions about your past, expect your therapist to say “Have you ever noticed that….” And “Can you tell me more about that” a lot. Also yes, it was founded by Freud and no, we do not believe in “penis envy” or “Oedipus complexes” anymore. Freud had many good ideas for the process of therapy and also many ridiculous fixations that the profession has left by the wayside.
Person-Centered Therapy aka Rogerian Therapy. Person-Centered Therapy operates from the understanding that you actually know exactly what is wrong and how to change it, you just haven’t been given the space and time to figure it out. Developed by Carl Rogers, person-centered therapy puts you, the client, in almost complete control. The therapist will ask some follow ups, but they will not offer suggestions or hypotheses in the way that some therapists will. You might be thinking to yourself “That doesn’t make any sense,” which is exactly what I thought when I started learning about it. However, when you see it in action it is quite remarkable and it has become a bedrock of my approach. The self reflection space created by person-centered therapy really creates a space for discovery of one's inner self and discovery of how to make change. In my personal experience, clients whose therapist uses these techniques will often make as many realizations outside of sessions as they do within them. As with psychodynamic therapy, expect to have a rich and deep relationship with your therapist.
Cognitive Behavioral Therapy (CBT). CBT is probably the most widely accepted therapy practice in America, and virtually every therapist will say they can practice some version of it. CBT is derived from the scientific method, and operates from the perspective that our thoughts cause us to have feelings which cause us to behave in certain ways, which then reinforces those initial thoughts which exacerbate those feelings and behaviors on and on and on until we find ourselves to be in a state of distress. The goal of CBT is to identify those negative thoughts, and actively rebut them in order to change our feelings and behaviors. A common example is the thought “Nobody likes me” leading one to feel very sad, which leads to them behaving in a withdrawn way, which reinforces the belief of “nobody likes me”, which then makes them feel worse so on and so forth until they develop clinical depression. In CBT you would be encouraged to actively rebut the thought of “nobody likes me” and replace it with “People like me” and see how that changes things, as well as to work to change your behavior to change how you think and feel about yourself, others, and the world around you.
A CBT therapist will also point out logical fallacies with your negative thoughts. To use the thought pattern from above, a CBT therapist might ask “If nobody likes you, why do so many people keep asking if you want to hang out?” It is also important to note that CBT often requires some trial and error in identifying the root maladaptive thought. It is also worth noting that CBT is largely unconcerned with why you are having that thought in the first place. While you might uncover the “why”, it is not considered necessary in CBT.
Dialectical Behavioral Therapy (DBT). DBT is a type of therapy wherein your therapist will try to help instill a type of radical acceptance within yourself. Specifically, it tries to help integrate distress tolerance, emotional regulation, mindfulness, and interpersonal effectiveness. It is a skills based therapy wherein you learn ways to best integrate the skills into your own functioning. It is a very common modality in group therapy, but can be applied individually, as well. I can already feel your eyes glazing over, so to put it more simply, in DBT you try to learn to love the things you dislike about yourself or others. It seeks to help resolve conflicts by accepting both sides of them as true (be they internal, or external). A very basic example would be learning to love yourself as you age. While many of us wish we looked like we did when we were younger, DBT would encourage you to treat that as valid while also finding ways to love your new body. To be clear, there is a reasonable limit to the “see and acknowledge all sides of an issue” concept. For example, a client experiencing discrimination on the basis of race would NEVER be told to try to see the issue from the perspective of the person or persons discriminating against them.
If you Google DBT, you will find that DBT was originally developed for the treatment of Borderline Personality Disorder (BPD). DBT is now used for a wide array of concerns and is not limited to BPD treatment.
Family Systems Therapy. Family Systems is a type of therapy that stresses the relationship between the person, the people around them, and their environment in order to best locate the source or sources of their distress. In this approach, your therapist will almost function as a kind investigator. You should be prepared to talk about your past, your family, and the system around you as well as how you interact with it. This theory will also deal a lot with the feedback loops that can be formed by families acting out the same patterns over and over again. A very basic example of this would be one person yelling at another, causing them to do a task worse, which then results in more yelling and worse performance over and over and over again. By identifying these patterns and breaking the habit, we can affect change.
Internal Family Systems (IFS). Not to be confused with Family Systems, IFS applies systems thinking to one person. In IFS, the therapist helps the client identify different parts of themself that cause inner conflict, distress, or functional difficulties. For example, most people can identify having an “inner critic” that comments negatively when we feel we have made an error or feel shame. Parts of ourselves can take the form of managers, who want everything to be in order, firefighters, who want to resolve a problem as quickly as possible, often without regard for consequences, and exiles, who are the most vulnerable parts of us that our other parts try to hide away. In this approach, all parts are considered good, even ones that seem self-destructive. All parts are trying to operate with the goal of protecting the person. In IFS therapy, the client learns to become “self-led” with one’s core self guiding behavior by soothing and reassigning parts to new “jobs.” For example, the inner critic can become a wise confidant and guide.
Acceptance and Commitment Therapy (ACT). ACT is a therapy model that almost functions in opposition to CBT. Much like DBT, it deals a lot with radical acceptance. While CBT specifically tries to locate maladaptive thought patterns, ACT operates from the perspective that all thoughts are normal and we should welcome them and healthily integrate them rather than attacking them. The idea is that by treating our thoughts as unhealthy, we make them so and thus worsen our anxiety, depression, or other presenting issues. In ACT you will learn how to normalize and welcome your thoughts, rather than being at war with them. ACT helps clients understand and make decisions from their personal values, making it a very grounding approach to therapy.
How do I know which modality is right for me?
This is a hard question to answer if I am being honest. Because of how unique people are, there is no one way to match modality to a person. There are some loose guidelines, such as the fact that CBT can see results on a shorter timeline, whereas psychodynamic therapy tends to be longer term. However, there is no golden rule here, it is more of a question of emotional fit than anything. If something sounds interesting, give it a try. If you know you will respond badly to one of these, try something new. There is no rule saying you have to keep using the same theory if it isn’t working for you.
It should be noted, this is not an exhaustive list. I have included some of the most common therapeutic modalities, but there are dozens more. If you come across one not listed here, the best thing you can do is ask the therapist what it means, and what treatment will look like. I understand all of this is daunting, and that it can be frustrating to find a therapist. Beyond that, it is difficult to know which type of therapy will work best for you. I hope these tools help, and a reminder to you that ultimately the best way to figure out if a theory is a good fit is to try it. If you start with a therapist and their theoretical orientation is a bad fit, tell them and they can almost certainly recommend someone who practices differently who may be a better fit for you.
How can I find a therapist who practices a modality I connect with?
In reading this, if any of these modalities seemed to connect with you, here’s how to find a therapist that utilizes them. First, Psychology Today allows you to filter by modality–however, that still leaves you with a long list. Calling or emailing a specific practice is often a better way. Most offices will ask you some version of the question “Is there a type of therapist you would like to see?” Some people may respond with a gender, race, ethnicity, or other identity factor they’d prefer their therapist to have. Many people will ask to see someone who works with their issue. Most people, however, will not know what to say. If you have a modality you would like to try, you can ask “I would like to see someone who practices from a psychodynamic orientation” and they should be able to match you.
If you would like to book with one of our providers, email connect@transcendchicago.com, and we will match you with a therapist who practices in the modality of your choice. We offer free 15-minute consultations, so you can ask your questions about the therapist’s approach before jumping all the way in.
