The Alphabet Soup of Therapy
- E
- Jul 24, 2019
- 6 min read
Updated: Aug 9, 2019
WARNING: This article briefly discusses issues such as suicide, self-harm, and abuse.
Going to therapy can be a hard step to take and not knowing what type of therapy works (or doesn’t) for you may make it harder. There are many schools of psychological thought, each with their own approach to therapy. It can be confusing to know what is involved with each and what their specific goals are.
Before we get into that, allow me to introduce myself and give you a little background. My name is E, I graduated from university with a degree in psychology and sociology, and I’ve been working in mental health care for going on 7 years now. As someone who takes care of people living with mental health illnesses and has lived personally with my own for over a decade, people having access to quality mental health care is deeply important to me. A significant part of that is being able to be informed.
So I want to provide a run down of some of the most common forms of evidence based therapies that are currently available including: what each focuses on, what their goals are, and the methods through which they achieve those goals. There are dozens of types of therapies including: talk, group, activity, and behavioral. Each school of psychological thought (e.g. Freudian, Jungian, Gestalt) has their own approaches to each. For the sake of brevity I will be focusing on only three therapeutic approaches.
Part of my intent in explaining just a few of the approaches out there is to encourage you to consider that just because one form of therapy does not work for you does not mean that none of them will. Sometimes the issue is finding a therapist that you feel comfortable with. It is common knowledge with mental health professionals that the client may not form a therapeutic relationship. It’s not necessarily the fault of the provider or of the client. Much like any other relationship, sometimes it just doesn’t click. Don’t be afraid or feel guilty about parting ways and finding a different health care provider if things don’t seem to be working out. While it can be frustrating to find the right fit, the benefits of doing so can make it all worth it.
All that being said, let’s make some soup!
CBT - Cognitive Behavior Therapy
As Jake discussed in Therapy, CBT is a therapeutic approach that involves something called cognitive restructuring. It involves recognizing when you are having harmful thought patterns, logically addressing the accuracy of the concern, and then working replacing that pattern with one that is both grounded in reality and emotionally helpful to you. For example, if you find yourself engaging in constant negative self-speak (e.g. “I’m just being stupid”, “I can’t do anything right”, “If I go, I’ll just embarrass myself”) - that’s considered a negative cognitive loop in that the more you think those kinds of thoughts, the more you believe them, and the more of them you think. The cycle then continues. Often, we aren’t aware how many mean comments we make towards ourselves in a day.
CBT can help you identify the ways and extent in which those anxieties are inaccurate as well as teach you how to practice self-compassion. Let’s take the example of “If I go, I’ll just embarrass myself.” A CBT therapist would ask you to identify when and why you feel that way, gently guide you to consider whether or not that’s accurate (“what happened last time you went to an event like this?”) and then encourage you to think in a more positive manner. Something I often practice when I get anxious about something and start 'catastrophizing' is to think about the situation in three ways: what’s the absolute worst thing I fear about this situation? If the situation was to go perfectly, even beyond what you expect what would that look like? And lastly, what is actually the most likely thing to happen?
Often, this therapy will involve workbooks that provide guided exercises to help. They can include small challenges to help change your behaviors while also reshaping the way that you think about yourself and the environment around you. Those living with anxiety, depression, and certain other mood disorders often benefit the most from this type of therapy.
DBT - Dialectical Behavior Therapy
A sister school to CBT, DBT uses very similar methods but is focused specifically on managing emotions and behaviors that are particularly self-destructive. This includes those who: suffer with frequent and active thoughts of suicide or to self harm, find it difficult to maintain healthy relationships or forms of communication, and feel intense negative emotions particularly when interacting with others.
DBT utilizes mindfulness which is a tool to help you feel present and aware in the current moment. It also focuses on emotion regulation, with the goal of reducing the extent to which the emotions feel overwhelming, and bring them down to a level that the individual is able to cope with and address. Partnered with emotion regulation is the idea of distress tolerance, which focuses on increasing an individual’s resilience to experiencing distressing situations. This often involves identifying different positive coping skills to replace the negative coping methods such as self harm. Lastly, DBT focuses heavily on something called interpersonal therapy (IPT - more letters for the soup!). When feeling negative emotions to the extent that they are constantly overwhelming, it can be hard to convey them to other people in a way that is constructive to both you and the other person. IPT is used to develop effective and healthy forms of communication that empowers you to cultivate relationships built on trust and understanding in contrast to frequent feelings of frustration, isolation, or disappointment.
Unlike CBT, DBT typically includes both individual one-on-one therapy sessions as well as DBT skills groups where you process and practice the skills DBT teaches with others who are also experiencing similar struggles. DBT is most often used for treating Borderline Personality Disorder, but has been shown to be effective in helping to treat different eating disorders, severe depression, bipolar, PTSD, and substance abuse issues.
EMDR - Eye Movement Desensitization and Reprocessing
EMDR is a newer form of trauma based processing therapy, which involves processing and addressing the certain feelings associated with a traumatic event rather than focusing on the event itself. It works to replace those feelings with more positive beliefs about yourself. The goal of EMDR is to understand: the framework of understanding that a traumatic event created, how it is affecting your current perceptions of self and others, and create a more desirable outcome for future events. For example, a traumatic event may have you feeling powerless and out of control in your daily life now and through processing it, the goal might be to replace negative beliefs about yourself. This replacement could take the form of something along the lines of: “I have power over things that happen to me”, which will embolden you to change how you feel and behave in the future.
Your therapist guides your eyes back and forth in a similar fashion to what naturally happens during REM sleep while also prompting you to discuss the feelings or beliefs related to the trauma. The later stage of EMDR involves the same process but with holding the positive idea that you would rather believe and working to integrate it into your self-image. Unlike other forms of talk therapy, a large portion of EMDR is based around the client and provides a feeling of just facilitating the healing an individual would eventually reach on their own, but at a faster rate. In other words, rather than have a therapist tell you how you should feel, you are able to reach your own conclusions and create the image of yourself that you want.
This is still, of course, all under the supervision and input of a mental health professional who may draw your attention to certain ideas or concepts that would be useful to consider further. EMDR is best suited for those who have experienced trauma, whether it be a single traumatic event or extended trauma over a period of time (e.g. abuse, war, etc.).
I firmly believe that everyone, if able, should seek out some form of therapy. Even if you don’t feel as though you are struggling with anything in particular, seeing a therapist gives you access to someone who truly only wants to see you become a better version of yourself. A lot of times we rely, as we should, on those closest to us in our lives to provide advice. While your best mates, your parents, or your partner all may care deeply for you and want good things, their input is not entirely objective. Don’t get me wrong, therapy is not about becoming a selfish version of yourself who only cares about your own opinion on things; it encourages us to find a sense of agency and awareness in our lives and to feel like active and willing participants.
Hopefully, this gives you a brief introduction into a couple of options out there. Please consider sitting down with a therapist/counselor to discuss what might work best for you in further detail. You have so little to lose, and so much to gain.
Be kind to yourself,
E
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