Finding the right therapy can sometimes feel like a task overwhelming enough to trigger a nervous breakdown. There are almost 440 proven and distinct therapies currently listed in the National Registry of Evidence-based Programs and Practices. How do these therapies work and why? What do they treat? How effective are they? What, in short, am I in for when I step into a therapist’s office? Having seen my parents crisscross from therapist to therapist in attempt to find the solution for my dad’s obsessive compulsive disorder, and having had my own unique brew of physical and mental demons, these questions have meant much to my life.
This article will provide quick answers to these questions, for three of the most common types of therapy: Cognitive Behavioral Therapy (CBT, which aims to make you aware of your habits of thought), Psychodynamic Therapy (think Freud and the couch), and Family Counseling (therapy with mom, dad, brothers and sisters). For a more extensive list and in-depth descriptions of modern therapeutic schools, see here.
Cognitive Behavioral Therapy (CBT)
Ever see the bumper sticker:
This is the anthem of CBT, in a nutshell (or in the cranial cavity, more accurately).
In the CBT world, our cognitions—our thoughts, beliefs, our most fundamental assumptions—drive our emotions, which perpetuates a cycle, like this:
CBT targets the “thoughts” point of the cognitive triangle, using exercises to correct illogical thinking and create a virtuous circle of realistic emotions and positive behaviors. Too abstract? Let’s get concrete.
Right now, I’m thinking that you will find this article silly and worthless. Truly. I’m also thinking that my editor will find it worthless, and that my mother, in many ways my most critical reader, will find it worthless. Fundamentally, there is a part me that believes I am incapable of producing anything of worth. Given my disposition towards rumination, I am likely to wallow in this part of myself, eat cereal, Netflix, more cereal, do things to avoid writing this article and triggering these thougths, proving to my editor, my mother, to you, to myself that I am incapable of producing anything of worth because I never spend enough time on anything to produce or improve, and so and on and so forth, blah, blah blah, etcetera, etcetera.
But, CBT reminds us:
A CBT therapist would ask: Now that you’ve identified them, how realistic are these thoughts? The therapist would help me point out several distortions: jumping to conclusions, mind reading, discounting previous and positive receptions of my writing (see here for a list of cognitive distortions). The therapist may suggest that I ask these thoughts to “prove themselves;” write a draft and show it to my editor and mom; see what they really think. Through these exercises, I check back into reality, get moving on a project, and connect again to my human network.
The Mayo Clinic says CBT “can be a very helpful tool in treating depression, post-traumatic stress disorder (PTSD) or an eating disorder;” in addition, “it can be an effective tool to help anyone learn how to better manage stressful life situations.” But “thinking is just one part of human functioning.” The Mayo Clinic drops some realistic truths about CBT:
Cognitive behavioral therapy may not cure your condition or make an unpleasant situation go away. But it can give you the power to cope with your situation in a healthy way and to feel better about yourself and your life.
CBT is generally short term and goal oriented. Expect to tackle take-home worksheets and journal exercises to help you identify and correct errors in thinking. (See here for an example of a CBT exercise.) You can discuss your homework with your therapist, who will aid you in sharpening your CBT skills.
Look at the inkblot above. What do you see?
The inkblot test, along with the couch and bespectacled psychiatrist, has become almost a parody of the psychodynamic method.
But the inkblot test represents just one attempt at creating a tool to access your subconscious, the primal landscape of childhood-shaped fears and desires which, according to psychodynamic therapy, impact the decisions you make every day.
Me? I see two long-sleeved hands tearing a small animal apart. A trained psychotherapist could interpret this image for me, which is my brain’s personal expression of a fear or desire. Perhaps I desire to strangle my father. Perhaps I have denied this impulse for years, and it has haunted me and caused me to act in ways that I don’t understand. A trained psychotherapist, using tools like dream analysis, free association exercises, simple and attentive conversation, would help me access the root cause of my craving to strangle my father, to confront, understand, and overcome the events that first precipitated it.
Okay, this is all getting a little weird and speculative. Let’s just say Psychodynamic Therapy is a process for becoming aware of and understanding what experiences and people made you the person you are today, and what patterns of behavior you acquired over the years—with a trained expert to guide you and help you change. (For more information about Psychodynamic Therapy see here.)
Clinical reviews show that Psychodynamic therapy is effective for treating general (“free-floating”) anxiety disorders, generalized fear, and (depending on the patient) depression. Psychodynamic therapy is NOT effective for treating specific anxiety disorders, such as phobias or Obsessive Compulsive Disorder.
Be prepared for lots of talk. A good relationship with your therapist is key. Over years or even decades, you will go on an extensive journey through your mental landscape, examining unconscious memories, childhood events, and primal impulses, which may be joyful, painful, or embarrassing.
You’ve made it this far into your therapy journey with just your therapist and your inner life for companionship. But that doesn’t even begin to touch the kaleidoscopic complex (or clusterfuck) of your personality. Time to bring in the whole family!
In the Family Therapy world, your mental health in many ways depends on and is determined by your network of people.
You as well as your family members meet with the therapist. Among other things, this allows the therapy to draw on the mental and emotional resources of everyone in the group, which can be especially useful in helping a family to support a member with mental health or addiction problems (see here for a more detailed and theoretical definition). My mom, dad and I never saw a family therapist. But given the torqued nature of our emotional triangle, I believe it would (and still may) have helped us to understand our interactions, and helped us to draw on our inner resources to invent and practice healthier behaviors.
For example, the therapist may meet with a teen who has a drinking problem and then invite an older sibling who may have gone through his own problems with drinking to the sessions, says Anthony Siracusa, PhD, a psychologist in Williamstown, MA and a spokesperson for the American Psychological Association. “The older sibling might offer guidance, which might be more powerful than a therapist’s words.”
Family counseling “may address specific issues such as marital or financial problems, conflict between parents and children, or the impact of substance abuse or a mental illness on the entire family,” according to the Mayo Clinic. It is also useful for coping with major life transitions.
So what does all this mean?
I can’t tell you which therapy is best. I’m not a professional psychologist; I’m a former English major. And to tell the truth, your mental health, your well-being is so individual, there is no one right answer. But we are in a renaissance of evidence based therapies. Keep reading. Keep talking — to friends, doctors, family, therapists, professionals. Schedule an appointment. Keep searching for solutions. You might find a few that work.
This post was written by Isaac Weil as a part of the Therapy 101 collection. Please send any questions or concerns to email@example.com.
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