Introduction
A professional's approach to therapy or "psychotherapeutic orientation"
can be as unique as that therapist him or herself. Most therapists
learn about and receive training in several approaches and specialize later
in their professional development. This training
interacts with the therapist's personality and the cultural and professional
environment within which he or she practices to determine that unique style
that develops. Still, there are a number of recognized approaches with
new ones developed all the time. Most new approaches add a small
amount that is truly new while expanding on existing approaches or combining
elements of several approaches. Most approaches therefore have
considerable overlap in theory and practice.
There is also a school of thought, with some research to back it up,
that there are common elements in all effective therapies that are
responsible for the bulk of positive outcome. For example, the quality
of the therapeutic relationship, regardless of therapeutic orientation, is
one factor that has been shown as necessary and sufficient for postive
outcome. There is also focus on common therapist skills such as empathic
listening, reflection, and teaching that are relatively neutral in theory,
as necessary components, as well as client factors such as motivation,
application of learning outside of appointments, and nature of the
difficulty to be addressed. Unfortunately, psychotherapy and human change
is incredibly difficult to research in a manner that can conclusively answer
the question of which approach is best. The research that has provided
meaningful results has most often focused on very limited, easily defined
problems that can be measured objectively. This hardly addresses the
human condition and the conflicts and struggles that people often bring to
psychotherapists.
We have chosen to briefly present four major categories to help
understand the most commonly identified psychotherapeutic approaches:
Psychodynamic, Humanistic-Existential, Cognitive-Behavioral, and Transpersonal.
If you are interested in pursuing these topics further, you can click on the
links provided in the text, search
Amazon.com, the
Internet, libraries and bookstores using the terms and authors discussed and find a wealth of information.
Top  Psychodynamic Psychotherapy
Sigmund Freud is credited as the founder of psychoanalysis
and psychoanalytic theory, if not modern psychology. There have been a
multitude of variations that have evolved and the term most often used to
broadly encompass these approaches is "Psychodynamic." Terms such as:
neurosis, conflict, attachment, object relations, unconscious,
defense
mechanisms, id, ego, superego, drives, libido, transference, countertransference, and countless more have emerged from this approach.
Some of the major approaches within the psychodynamic category are:
Psychoanalysis (Sigmund Freud),
Adlerian Psychotherapy (Alfred Adler),
Analytical Psychotherapy (Carl Jung),
Object Relations (Mahler, Winnicott, Fairbairn, Klein, Gutrip, Kernberg and others), and
Self Psychology
(Heinz Kohut).
Freud's original theories were based on the conflicts that he
believed were at the core of human existance. These conflicts emerge
from attempts to reconcile our biological selves with our social selves.
Aspects of these conflicts are unconscious and influence our behavior
without our awareness. Psychodynamic therapies work to make the
unconscious conscious so that we can have greater insight into our needs and
behavior and therefore more control over how we allow these conflicts to
affect us.
In Adlerian psychotherapy, clients are
encouraged to overcome their feelings of insecurity, develop deeper
feelings of connectedness, and to redirect their striving for
significance into more socially beneficial directions. Through a
respectful Socratic dialogue, they are challenged to correct mistaken
assumptions, attitudes, behaviors and feelings about themselves and the
world. Constant encouragement stimulates clients to attempt what
was previously felt as impossible. The growth of confidence,
pride, and gratification leads to a greater desire and ability to
cooperate. The objective of therapy is to replace exaggerated
self-protection, self-enhancement, and self-indulgence with courageous
social contribution.
Carl Jung was a student of Freuds and eventually developed
his own theory called "Analytical Psychology." While still based on
the reconciliation between the consious and unconsious, Jung broaded Freud's
work to include concepts of culture, mythology, and spirituality. For
Jung the most important and lifelong task imposed upon any person is
fulfillment through the process of individuation, achievement of harmony of
conscious and unconscious, which makes a person one and whole.
The term "object-relations" refers to the self-structure we
internalize in early childhood, which functions as a blueprint for
establishing and maintaining future relationships. Psychopathology is
an expression of traumatic self-object internalizations from childhood
acted-out in our current relationships. Psychotherapy is the
resolution of these self-destructive patterns of relating so that we can
mature and self-actualize. Self psychology is Heinz Kohut's variation
of object relations theory that recognizes the central importance of
people's needs for relationships critical in providing necessary experiences
during growth and development. These experiences are called self-object
experiences. Sufficient positive self-object experiences when the
infant and child are developing facilitate the formation of a strong,
cohesive self -- the core of one's personality and character. Kohut is
credited with adding the concept of "empathy" to the every day discourse of
psychotherapy.
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Humanistic-Existential Psychotherapy
Humanistic psychotherapy is an approach which tries to do
justice to the whole person including mind, body and spirit. It represents a
broad range of therapeutic methods. Each method recognizes the self-healing
capacities of the client. The humanistic psychotherapist works towards an
authentic meeting of equals in the therapy relationship.
Abraham
Maslow is perhaps the best know theorist associated with Humanistic
Psychology and
Carl
Rogers (Client Centered Psychotherapy) the best know therapist, though
many have followed including Fritz Perls and his
Gestalt Therapy.
Existential psychotherapy is closely related
to humanistic psychotherapy, though different historical figures are usually
associated with the two models. Many therapists today will identify
themselves as "humanistic-existential" in approach due to the common roots
and perspectives.
Existential psychotherapy aims at enabling clients to find
constructive ways of coming to terms with the challenges of everyday living.
The focus is on the client’s concrete, individual experience of anxiety and
distress leading to an exploration of their personal beliefs and value
system, in order to clarify and understand these in relation to the specific
physical, psychological and socio-cultural context. The experience and
influences of the past, present and future are given equal emphasis. The
questioning of assumptions and facing up to the possibilities and
limitations of living is an important part of this interactive, dynamic and
direct approach. Four "existential problems" are cited as the core of
the existential struggle that is the primary focus in this therapy and
considered to be at the root of most psychological difficulties: death,
freedom vs. responsibility, isolation, and meaninglessness. There are
no absolute solutions to the existential problems yet all of us have to come
to terms with them. The names most associated with Existential
Psychotherapy (not Existential Philosophers like Sartre and Kierkegaard) are
Rollo May, James Bugental, and Irvin Yalom.
Cognitive-Behavioral Psychotherapy
Cognitive-Behavioral Therapy (CBT) is a practical approach that seeks to
define concrete goals and uses active techniques to reach them. The
cognitive-behavioral therapist looks at patterns of thinking and behavior
and how these patterns are reinforced and maintained by the person within
his or her environment. A functional analysis of thinking and behavior
is performed, often using log sheets and graphs to better understand thought
and behavior patterns in the context of daily routines. Once an
understanding of symptoms and behavior is achieved, the therapist and client
together devise changes in the patterns and continue tracking. This
process is repeated until the original goals are met. Attention to
irrational thinking patterns (e.g., automatic thoughts, catastrophic
thinking) is central to the approach as well.
Some of the techniques and programs that are usually associated with CBT
are relaxation training, systematic desensitization, assertiveness training,
and social skills training.
Historically, Cognitive-Behavior Therapy (CBT) has its roots in the work
of behaviorists such as Ivan Pavlov, John Watson, Joseph Wolpe, and B.F.
Skinner. Skinner, in particular, developed theories of operant
conditioning that were the basis of behavior therapy, which views the
consequences of behavior as shaping future behavior. Associated with
Skinner are terms such as stimulus-response, positive reinforcement, and
contingencies of behavior.
Skinner's emphasis was on observable behavior. It was theorists
such as Albert Bandura (Social
Learning Theory) and cognitive therapy and cognitive-behavioral therapy
originators such as Albert Ellis (Rational
Emotive Behavior Therapy), Aaron Beck (Cognitive
Therapy), William Glasser (Reality
Therapy) and Donald Meichenbaum (Cognitive-Behavioral
Therapy) that brought thought and emotion into this approach.
CBT is considered the "second wave" of
behavior therapy. In the 1990's approches evolved that incorporated
mindfulness and acceptance into the cognitive-behavioral perspective.
Some consider this a fundamental change as CBT emphasized control and
reduction of problematic thinking, while the third wave approaches
emphasized acceptance and moving on. Further, advocates for the third
wave approaches consider attempts to control or reduce these symptoms as
counter productive and as potentially worsening them. Adopting
mindfulness and acceptance from eastern thinking, third wave theorists
embrace paradox. In this case, symptom reduction will often occur when
symptoms are accepted and fighting against them ceases. Some of these
third wave approaches are Steven Hayes, Kirk Strosahl, Kelly Wilson's
Acceptance and
Commitment Therapy (ACT), Marsha Linehan's
Dialectical Behavior Therapy (DBT), Jon Kabat-Zinn's
Mindfulness Based Stress Reduction (MBSR), and Zindel Segal, Mark
Williams and John Teasdale's
Mindfulness Based Cognitive Therapy (MBCT).
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Transpersonal Psychotherapy
Transpersonal/Psychospiritual psychotherapy can be defined
by its orientation which includes the spiritual dimension rather than the
content of therapy. It views the human psyche as having a central core Self
or Soul as the centre of identity as well as a personal ego.
Psychotherapists draw on a wide range of therapeutic methods towards the
uncovering of past psychological material within a context of the
individuals potential based on spiritual insight and experience. Within this
perspective there is both a movement of the personal centre to the Self and
a movement of the Self to manifest its nature through and in the personal
centre. Thus therapy includes both repair and individuation.
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