“Growing up, I was always intrigued by how people change. My mother, a clinical psychotherapist, would occasionally see patients at home in the evening. She would shut the door to the living room, and I imagined magical things happened in that room.” — Daniel Reisel, neuroscientist
Magical. The word strikes me because that’s precisely how I’ve felt about the concept of psychotherapy. To me, it is some sort of magic.
Psychotherapy is the psychological treatment of any mental, emotional, or behavioral disorder. Being essentially a psychological intervention, psychotherapy is distinguished from biological interventions such as the giving of medicines or the carrying out of medical and surgical procedures to treat illness. Mostly dealing with the intangible, psychotherapy thus makes a lot of room for fascination and wonder, but also for controversy and debate. The therapist doesn’t have objective lab results indicating blood profiles or X-rays to refer to, no medical/surgical tools to try and treat the client with.
What does the psychotherapist have in his arsenal, really?
Observation skills—keenly noting behavior, demeanor, body language, everything the client is not saying but is showing.
Communication skills—how to listen, how to phrase questions, how to phrase responses, what to say, what not to say, when to use silence.
Knowledge of psychotherapeutic techniques.
Experience, if he has been doing it for quite some time.
A capacity for correlating all the bits and pieces from various sources, from the explicit to the non-obvious.
A good grasp of human nature itself.
Discretion. Patience. Insight.
So how does the psychotherapist use those stuff he has in his toolbox to craft out the approach for therapy that will help the client best? Well, it depends on the school of psychology the psychotherapist bases his practice on.
See, not all psychotherapy is the same. There are different kinds, each with its own underlying theory about what causes psychological distress, behavioral problems, or mental illness in general. Each kind of psychotherapy also has its own set of strengths, weaknesses, and circumstances where it is considered most effective. Let’s consider its 5 major forms:
1. Psychodynamic Therapy
“Look into the depths of your own soul and learn first to know yourself, then you will understand why this illness was bound to come upon you and perhaps you will thenceforth avoid falling ill.”—Sigmund Freud
One of the oldest and probably the most well-known image of psychotherapy among the general public is psychodynamic therapy. In its most traditional form, Freudian psychoanalysis, you lie down on a couch and talk and talk and talk, as an analyst listens but rarely comments (although, newer forms of psychodynamic therapy have analysts take a more active and directive approach).
The goal is to uncover the unconscious motivations that make you behave and feel the way you do. The idea is that once you are aware of those unconscious motivations, you are in a better position to resolve internal conflicts and experience a degree of liberation from symptoms, owing to improved insight and emotional release.
2. Behavior Therapy
“Reward and punishment…are the spur and reins whereby all mankind are set on work, and guided.”—John Locke
Another form of psychotherapy, known as behavior therapy, aims to change problematic or self-defeating behaviors by applying the principles and techniques of conditioning. Maybe you’ve heard of people with phobias being gradually exposed to their feared object or situation until they eventually lose their fear of it. Or, maybe you’ve heard of children with conduct problems being managed by “rewarding” good behavior and “punishing” bad behavior. Those are examples of behavior therapy.
While psychodynamic therapy primarily aims to understand, behavior therapy essentially aims to change (which is why it is also referred to as behavior modification therapy). As mentioned above, this technique has been known to help best in managing cases of phobia and conduct problems.
3. Cognitive Therapy
“The soul becomes dyed with the colour of its thoughts.” — Marcus Aurelius
Another kind of psychotherapy, cognitive therapy, is based on the premise that negative emotions and problematic behaviors arise mainly out of “wrong” ways of thinking. Thus, instead of primarily targeting to change behaviors or emotions, cognitive therapy instead targets to change the thoughts that are supposedly underlying or causing those negative emotions and behaviors to surface.
In this form of therapy, irrational beliefs are challenged, erroneous reasoning is corrected, and self-defeating thoughts are modified to be more realistic (e.g. addressing the tendency to exaggerate the negative connotations of an event). Cognitive therapy is often used to help treat depressive and anxiety disorders, both of which are believed by many psychologists to be largely instigated by negative and irrational thoughts.
Since most contemporary psychologists believe that “thoughts and behavior influence each other,” cognitive therapy is often combined with behavior therapy in what is known as cognitive-behavioral therapy (CBT). CBT is one of the most widely practiced kinds of psychotherapy at the present time, because of empirical data supporting its efficacy in managing a good range of mental health disorders.
4. Humanist Therapy
“If I can provide a certain type of relationship, the other person will discover within himself the capacity to use that relationship for growth, and change and personal development will occur.”—Carl Rogers
Humanist therapies are rooted in the principle that all people are inherently motivated towards self-fulfillment and self-actualization. In contrast to traditional Freudian psychoanalysis that emphasizes the role of past conflicts in determining present behavior, humanist therapies explore what is going on in the present—in the “here and now”—and underscores people’s free will to change.
Carl Rogers, a pioneering humanist psychologist, proposed a client-centered therapy where the role of the therapist is to provide a safe, nonjudgmental setting in which the client can be freely and genuinely himself, fully accepted by the therapist with no conditions attached. The idea is that by offering such unconditional positive regard and practicing empathy, the therapist can help the client build a sense of self-acceptance and find more productive ways of seeing and dealing with problems.
Nowadays, the idea of treating the client with respect, empathy, and acceptance is not pigeonholed as exclusively the domain of humanist therapy. Applicable across all other therapies, these humanist principles are now endorsed by virtually all therapists as fundamental guiding principles for dealing with and relating to the client.
5. Existential Therapy
“He who has a why to live for can bear almost any how.”—Nietzsche
Existential therapy, like humanist therapy, emphasizes the human capacity for free will—the capacity to choose the attitude and perspective he will take in any given circumstance, and to choose his destiny. The existential therapist assists clients towards accepting responsibility for their current predicament, coping with the struggle for meaning amidst inescapable suffering, and exploring the meaning of existence.
Viktor Frankl, a psychiatrist who survived captivity in several Nazi concentration camps during WWII, developed a form of existential therapy known as logotherapy (“logos” = meaning). In his book Man’s Search for Meaning, in which he also chronicled his experiences in the concentration camps, Frankl identified logotherapy as “a meaning-centered psychotherapy” where the client is “confronted with and reoriented toward the meaning of his life.” According to Frankl, the key to retaining sanity is to recognize that “life holds a potential meaning under any conditions, even the most miserable ones.” It is this meaning that the existential therapist strives to help the client find in his life, as a way of coping with the harsh realities of life and death.
Again, different circumstances each call for a form of psychotherapy that would work best for it. Some contemporary psychologists even combine two or more types of psychotherapy in their practice. I myself am yet to practice psychotherapy in the clinical setting, although I have heard real-life stories and recollections about client cases and what goes on during therapy sessions. Client cases range from the mildly bizarre to the downright disturbing. Would I, faced with especially challenging clients and situations, be able to respond in helpful—or at least appropriate—ways?
“Helping to heal others contributes to your own healing process.” — mandaray.wordpress.com
One of the first things I ever learned about psychotherapy is that the very relationship between the therapist and the client is the therapy. That therapeutic relationship — or therapeutic alliance, as some call it — is the special thread that connects all forms of psychotherapy. And that particular bit of thread makes me smile. I think it is a gift—a simple but precious, precious thing—to be able to bring about healing and hope and positive change in the lives of others just by establishing a relationship with them, something that’s essentially a very human thing to do anyway.
Going back to what I said at the beginning of this post, for me psychotherapy is a form of magic. Not because I see it as unreal or a kind of illusion, but because in capable hands, it accomplishes more than what seemingly goes into it. It is truly a marvel to me that just by taking a little more time to listen, managing to say the right words at the right time, and offering the really basic things we each need and likewise can all give to others — presence, respect, warmth, acceptance — individuals with very real struggles, pains, and disturbances in behavior can be helped to heal, regain hope, change for the better, and restore balance.
Of course, the irony is that like medicine, psychotherapy too “labours incessantly to destroy the reason for its own existence (James Bryce).” Some cases of mental illness may require psychotherapy forever, but whenever it can, psychotherapy ultimately aims to render the client well enough to once again stand and go on living, without needing the touch of its magic to face reality again. ♦
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- Frankl, V.E. (1984). Man’s search for meaning. Boston, MA: Beacon Press.
- Kahn, M. (1997). Between therapist and client: The new relationship. New York, NY: A W.H. Freeman/Holt Paperback.
- Wade, C., Tavris, C., Saucier, D. & Elias, L. (2004). Psychology. Toronto, Canada: Pearson Education Canada Inc.