Types of Therapy: An overview of common approaches
If you ask a therapist about their approach, you will probably hear a bunch of acronyms like DBT, CBT, MI, ACT, TLDP, AEDP. What do these acronyms stand for and what exactly are these different therapies? This blog post is designed to give you a brief overview of some of the major schools of thought and approaches in the psychology field.
What is Cognitive Behavioral Therapy (CBT)?
Cognitive Behavioral Therapy focuses on the relationship between thoughts, behaviors, and emotions and provides tools to evaluate and modify inaccurate or unhelpful thinking as well as to increase effective coping strategies.
Cognitive Behavior Therapy, or CBT, grew out of the work of Aaron Beck in the 1960s and remains an approach used by myriad therapists. Beck identified the intricate relationship between our thoughts, emotions, and behaviors. He argued that our interpretations of events are what impact how we feel and what we do, as opposed to the event itself. For example, let’s say that your boss ignores you in the hallway (in the days before remote work). If you have the thought, “wow, she must be busy,” you may experience the emotion of sympathy and go ahead with your day. However, if you had the thought, “she must hate me, I must have done a bad job,” you may feel sad or anxious and spend the day ruminating about the quality of your work.
CBT therapists work with clients to examine both the accuracy and utility of their thoughts in order to transform their behaviors and emotions. CBT therapists will first teach clients to identify their thoughts (which is much easier said than done). Therapists will then guide clients in examining the accuracy of their thoughts with the goal of modifying thoughts to be more effective and accurate. CBT therapists often use worksheets called thought logs to help clients with these processes. They may also identify characteristic patterns of thinking a client may use. Additionally, CBT therapists provide clients with effective behavioral tools and teach healthy coping skills. CBT therapy is highly practical and values concrete problem-solving strategies.
CBT emphasizes identifying solutions and, ultimately, helping clients become their own therapists. The therapy is highly interactive and often includes setting agendas in session and “homework” to complete between sessions. CBT has been demonstrated to be effective for many different presenting problems including depression, anxiety disorders, PTSD, chronic pain, and some substance use disorders.
What is Dialectical Behavior Therapy (DBT)?
DBT aims to help clients simultaneously accept where they are while also providing concrete skills to help clients develop the life they ultimately want to lead.
Dialectical Behavior Therapy was developed by Marsha Linnehan in the late 1970s (though her seminal book was published in 1993). It is what is called a third wave cognitive behavioral therapy; it is an extension of CBT that incorporates Eastern philosophy and practices of Zen Buddhism, such as mindfulness. While CBT therapists tend to empathize the import of thoughts, DBT therapists really target behaviors. Therapists work to clients to identify specific behaviors that are interfering with their quality of life, the series of events that lead to the use of those behaviors, and more effective behaviors clients use instead. DBT also focuses on identifying and accepting dialectics, which are two opposing ideas that can exist at the same time. In DBT, one of the most important dialectics is allowing for acceptance while working towards change simultaneously. DBT provides many different skills to help clients engage in both change and acceptance. These skills are broken up into four categories: mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation.
DBT in its full form is a comprehensive, multimodal approach that includes individual therapy, group skills training, 24-hour phone coaching on an as needed basis, and a weekly consultation team for providers . When delivered in this manner, DBT is highly structured approach. More commonly, DBT is adapted in individual and/or group therapy. Therapists may teach their clients the highly effective DBT skills, review DBT concepts such as dialectics, and help clients increase effective behaviors.
A significant body of research had demonstrated that DBT is highly effective both when provided in its full form and in modified forms that focus on the skills and key concepts. Linehan initially developed DBT for individuals with borderline personality disorder who engaged in self-harm or suicidal behaviors. However, in the past 30 years, DBT and DBT adaptations have been demonstrated to be effective with many different presenting problems including (to name a few) depression, bipolar disorder, bulimia, PTSD/ trauma, and ADHD.
What is Acceptance and Commitment Therapy (ACT)?
ACT is a therapy that aims to help patients reduce suffering by accepting their emotions and internal experiences so that they can live lives consistent with their core values.
Acceptance and Commitment Therapy (ACT) is another third wave cognitive behavioral therapy. ACT was developed by Steven Hayes in the early 1990s. It views psychological distress as stemming from problematic attempts to control unpleasant emotions, sensations, and thoughts. Hayes’ and Spenser’s book “Get Out of Your Mind and Into Your Life” succinctly sums up this approach. ACT focuses on changing the process with which clients react to their emotions and thoughts, promoting acceptance as opposed to trying to alter or avoid their experiences. It discourages the use of maladaptive emotion regulation strategies, particularly avoidance, denial, and suppression. To this end, therapists may teach clients mindfulness techniques and skills to help client’s distance themselves from the content of their thoughts (called cognitive defusion exercises). Another key part of ACT is helping clients find what is most important to them (their values) and take steps to move them towards these values. Therapists may lead clients in values clarification exercises and work with clients to identify concrete actions clients can take to add values-consistent behaviors into their life.
ACT has a been demonstrated to be highly effective. As of December 2016, there were 171 randomized control studies demonstrating the efficacy of ACT for a number of different presenting problems including depression, chronic pain, anxiety disorders, and PTSD.
What is Motivational Interviewing (MI)?
Motivational interviewing is a collaborative method to help clients explore normative ambivalence about change, enhance motivation, and help clients initiate change in a way that is inherently respectful and honors clients’ autonomy.
Motivational interviewing was developed by William Miller and Stephen Rollnick. In his work with folks with substance use disorders in the 1980s, Miller noticed that clients were often confronted and shamed and that this approach was not only dehumanizing, but also ineffective in promoting change. Miller felt that it is important to respect normative human ambivalence about change.
MI is an approach to helping clients explore their ambivalence about change in a manner that is collaborative, empathetic, respectful, and values individuals’ right to make their own choices. It normalizes the difficulty we experience motivating ourselves and committing to change. It also provides clients with support in enacting a change once clients feel ready to do so.
MI has been used across many settings in which individuals that may be experiencing low motivation or struggling with making changes related to their physical and/ or mental health. It is used extensively by health psychologists who work in hospitals or primary care settings and by therapists who work with substance use disorders. Therapists also utilize this approach in therapy when a client is evaluating if they would like to change other types of behavior in their lives. Many therapists use MI with clients to help them identify what they would like to focus on in therapy and to actualize these goals. MI has a tremendous amount of research supporting its efficacy.
What is psychodynamic therapy?
Psychodynamic therapy is an insight-oriented approach that focuses on helping clients identify unconscious processes and experince emotions to decrease psychic tension.
Psychodynamic therapy is the term for the modern version of classical psychoanalytic therapy. It stems from the work of the key figures in the psychology field including Sigmund Freud, Carl Jung, Alfred Adler, and Erik Erikson. Psychodynamic and psychoanalytic psychotherapists view our unconscious processes as underlying our personality. These frameworks also postulate that humans use defense mechanisms (such as intellectualization, denial, repression, and sublimation) to protect themselves from the disturbing, socially inappropriate urges and parts of their psyche. These approaches view unconscious processes as being informed significantly by early childhood experiences. There several different branches of psychodynamic therapy including object relations, self-psychology, and ego psychology.
The exact nature of psychodynamic therapy varies by the school of thought. Not many therapists provide classical psychoanalysis which is often depicted in popular media as clients laying on a couch three times a week for several years. More often, psychodynamic therapists will work with clients on a weekly basis for a shorter period of time. Psychodynamic therapy is an insight-oriented approach, wherein therapists help clients bring into consciousness those unconscious processes that they argue drive our personalities. There may be inquiry about early childhood experiences and therapists create space to experience and process emotions that come up. Therapists may also work with clients to identify defense mechanisms (e.g., denial, repression) that may be ineffective and work to strengthen mechanisms that promote psychological wellbeing. Psychodynamic therapists emphasize the import of the therapist-client relationship as a vehicle of healing.
What is attachment-based therapy?
Attachment-based therapy looks at the impact of early experiences on our expectations about relationships and sense of our own self-worth; it encourages clients to express their emotions and utilizes the therapy relationship to help clients develop healthy, supportive relationships with others and themselves.
Attachment-focused therapy focuses on the impact of our early relationships, particularly with our primary care providers, and the ways in which they have impacted our subsequent relationships and sense of self. This therapy is rooted in the work of researchers such as Henry Harlow, John Bowlbly, and Mary Ainsworth. Therapists who adopt an attachment framework argue that, through our experiences with our primary care givers, infants develop expectations of how others will treat them and how worthwhile they are, called the internal working model of attachment. These therapists will work with clients to identify the nature of their internal working models of attachment and how it has impacted relationships throughout their life, both with others and themselves. A goal of therapy is to shift a client’s internal working model of attachment so that clients can feel more secure in their relationships and feel a greater sense of self-worth. The therapist utilizes the relationship with the client to provide the client with a corrective experience in which the client knows that they can depend on the therapist and that the therapist finds the client inherently worthy. The hope is that this experience begins to translate to clients’ relationships outside of therapy and ultimately their sense of self.
