TYPES OF THERAPY
If you are considering counseling for yourself, a loved one, or family member we encourage you to become more knowledgeable about the kinds of therapy commonly used by professional therapists today. Below is a description of some of the types of therapy most frequently used by our practice. This list is not exhaustive. If you are looking for a particular type of treatment or therapy that you do not see here, please call our client relationship coordinator to see which of our counselors can meet your specific needs.
“CBT” is an evidence-based model currently enjoying a wave of popularity in the U.S. as the therapy of choice to get fast results. In plain terms it is an approach that rests on the idea that people can have better emotional, relational, and spiritual health if they utilize counseling to leverage changes in their habitual negative thinking and/or behavior patterns.
Practically speaking, if you are considering the CBT approach it is helpful to think of CBT and CBT counselors in two categories. The first category is an eclectic counselor’s use of CBT and the second is a CBT model that is more formal in terms of method and practice.
CBT from an eclectic therapist’s point of view means the therapist is frequently exploring and then jointly planning changes in the client’s thoughts and behaviors. Emotional and/or relationship changes will fall in place as one’s thinking and behavior choices are improved. The flow of the counseling is usually very straightforward, logical, conversational, and in many ways very natural.
The second CBT category is one which is more disciplined and structured. It involves written thought challenges, “stop behaviors,” use of ranking scales for monitoring change, and a lot of repetition or practice of a particular behavior.
Both of these approaches are effective and useful in the proper setting, but as a consumer of services you should be knowledgeable about the difference. Our practice has numerous therapists using cognitive behavioral techniques mixed with other approaches (see eclectic approach), but most of our counselors do not currently offer the more rigorous CBT approach typically found in in-patient settings. If you are interested in either CBT approach be sure to mention this when you speak to our client relationship coordinator for appropriate counselor selection. We’ll be happy to match you with a counselor who emphasizes this approach.
EMDR (Eye Movement Desensitization and Reprocessing)
EMDR is a form of integrative psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences. Research has established EMDR as effective for issues such as:
- Panic attacks
- Complicated grief
- Sexual and/or physical abuse
- Performance anxiety
- Disturbing memories that are not always identified as traumatic (death of loved one or excessive grief from other causes, abandonment, rejection, feeling powerless)
- Mental health issues that can be traced to earlier troubling events in life (e.g., a trauma related depression, certain anxiety disorders, and addictions)
- Low self-esteem and self-defeating beliefs (e.g., “I’m not worthwhile” or “I am out of control”)
- Anxiety produced by upcoming events
EMOTIONALLY FOCUSED THERAPY (Marriage Therapy)
Emotionally Focused Therapy (EFT) is a short-term form of therapy that focuses on adult relationships and attachment/bonding. The therapist and clients look at patterns in the relationship and take steps to create a more secure bond and develop more trust to move the relationship in a healthier, more positive direction. EFT focuses on the present time to makes changes in the here and now. There are three steps, or stages, of EFT. The first is to de-escalate the couple’s or family member’s negative cycle of interactions, and help them see and understand what is happening in their relationship. Clients come to see that the problems lie in insecurities and distance. The next stage is to restructure interactions, wherein the therapist helps clients discuss their fears in the relationship, using language that doesn’t push the other away. Clients learn to turn toward each other and discuss their needs and they become more open and responsive to each other. Consolidation is the third stage of EFT, wherein the therapist helps clients see how they got into negative patterns and points out how they were able to change those patterns and can continue these types of conversations in the future.
Instead of adhering to one particular approach or school of thought, a counselor with an eclectic approach has been trained in a variety of therapeutic techniques and employs elements from those that best meet the personal needs of the client. The goal is to personally tailor the course of treatment while enhancing the client’s progress. A successful eclectic therapist is competent and trained in several types of counseling. They will blend or shift between therapy modalities very purposefully, thoughtfully, and strategically for your benefit.
Together, you and the therapist can select an approach or mix of approaches that help you find solutions in a timely and practical manner. On the other hand, if you are searching for, or need a very specific type of therapy, our client relationship coordinator will help you find the counselor who specializes in that area of practice.
Professional counseling and therapy literature is packed with discussion about “evidence-based” treatment models. While this does not refer to one specific therapy type, the term means that the therapy model being applied has been found to be the “most effective” in clinical trials and research. Currently the types of counseling and therapy earning the title “evidence-based” are generally those which change behavior the fastest. CBT, ERP, and Brief Solution Focused treatments are generally the treatments being referred to wherever you find the term “evidence-based” being used. Our practice is very appreciative of clients, clinicians, and researchers participating in these outcome based studies. You can also learn by looking at our counselor bios that we have many clinicians well trained in evidence-based treatment modes.
On balance, we also encourage counselors and clients working together to assess and reassess client “outcomes” or results throughout the counseling process. Just because an evidence-based therapy may work for a percentage of the population in a brief period of time does not necessarily mean that same therapy is the one which will help you the most. Our philosophy is that good counseling is an art form as well as something that comes from diverse training and extensive clinical experience. The ultimate measurement of the effectiveness of any given therapy is whether or not that therapy type is producing positive emotional, behavioral, and mental health for you; not just for the population at large.
EXPOSURE AND RESPONSE PREVENTION THERAPY (ERP)
ERP is designed to help adults and children to overcome various forms of anxiety. Its classic use is with Obsessive Compulsive Disorder or “OCD.” This is a relatively easy therapy to understand because it simply helps a person build a gradual tolerance to the things they are having anxiety responses to. Common sense tells us that controlled practice or “exposure” to a troubling circumstance can help a person learn to cope with and eventually master the situation. While the concept is simple this is very difficult to successfully implement without skilled assistance. A trained counselor will help you set your practice exercises at an appropriate level – not too easy, but not overwhelming either. Exposure response therapy for treating difficult patterns of anxiety (such as OCD) is often more effective when used in conjunction with appropriate medication. Brain chemistry imbalance or deficiency is known to be a strong component of some anxiety disorders; therefore, the most effective treatment is often accomplished by a combination of ERP treatment along with appropriate medication. As with “CBT”, ERP is considered among the state of the art, evidence-based treatments.
Faith-based approaches to counseling and therapy incorporate one’s faith and spiritual beliefs into the process of personal growth, healing and change. In American culture, the term “faith-based” is usually used with specific reference to the Christian faith. Christians of various denominations look for faith-based counseling because they want to share a common foundation about life, relationships and mental health with their counselor.
We believe that the fields of counseling, psychology, psychiatry and social work have much in common with the principles of a Christian worldview. For clients specifically seeking faith-based counseling we offer an integrated approach that incorporates the client’s convictions and practices of their faith, current psychological research and professional ethical standards into the counseling and therapy experience.
While many clients from the local Christian community come to us specifically for faith-based reasons, we welcome people of all faiths and allow each person to determine how much their personal faith and beliefs enter into the therapy process.
If you have questions about how our counselors will work with you in reference to your faith, we encourage you to call and speak with our client relationship coordinator.
FAMILY SYSTEMS THERAPY
Family systems therapy is often a neglected treatment option in today’s short term results-oriented world. Ironically, because of the dynamics that happen when many family members get together, family therapy can actually be one of the fastest means to bring about meaningful behavioral and emotional changes for the whole family.
Many would cringe to think about bringing multiple family members together to discuss a problem. The “cringe” usually is evidence of the fact that the family is overwhelmed by the problem, lacks hope, and isn’t talking about the problem because discussion frequently turns into an emotionally charged event. Though it can be uncomfortable, most families are surprised by the rapid change in dynamics that can come from family sessions. The family therapist is trained to help alter the familiar communication, coping, and problem solving patterns – which often are being held onto even though they are not currently helping the problem.
Gestalt therapy relies greatly on client and counselor awareness of emotional states in real time in the session. It shares many of the basic assumptions of psychodynamic theory but seeks to help individuals live well in the “here-and-now” moment. Gestalt therapists believe that when one identifies and expresses what is going on inside them, change is initiated even though it is often an indirect process. Indeed, many people grow up in families or subcultures which discourage them from being self-aware or able to assert themselves when something is being experienced “on the inside.” In Gestalt counseling the client is learning the skill of identifying and articulating present states of thought and emotion. Likewise the counselor is also aware and noticing the experience of being with the client and honestly, sensitively, and constructively shares that experience with the client. This can become a powerful means of change for many individuals, especially if they have had few people give them honest feedback without being harsh or critical.
Couples begin therapy with a conjoint session, followed by individual interviews with each partner. Couples complete questionnaires and then receive detailed feedback on their relationship.
Interventions are designed to help couples strengthen their relationship in three primary areas: friendship, conflict management, and creation of shared meaning. Couples learn to replace negative conflict patterns with positive interactions and to repair past hurts. Interventions designed to increase closeness and intimacy are used to improve friendship, deepen emotional connection, and create changes which enhances the couples shared goals. Relapse prevention is also addressed.
Some of the relationship issues that may be addressed in therapy include:
- Frequent conflict and arguments
- Poor communication
- Emotionally distanced couples on the verge of separation
- Specific problems such as sexual difficulties, infidelity, money, and parenting
Even couples with “normal” levels of conflict may benefit from the Gottman Method Couples Therapy. Gottman-trained therapists aim to help couples build stronger relationships overall and healthier ways to cope with issues as they arise in the future.
This method of counseling is normally in reference to substance abuse counseling but the principles can be used in any setting. The “motivational” aspect of the counseling is the recognition that one must be internally or self-motivated if any lasting change is going to take place. (Ultimately self-motivation trumps the pressure, wishes, or thoughts of others.) The “interviewing” part of this therapy refers to the therapist being trained and skilled at asking questions in such a way that the client is helped to come to their own discovery of the need, desire and resources to change.
Unfortunately, mandated (court or employer for e.g.) alcohol/drug treatment programs are externally motivated. They are someone else’s idea that the client or offender needs to “cut back,” quit, or change certain behaviors. If change were only this easy! External motivation can be helpful in the short run for individuals, but problems often occur because the change may also only last as long as the person is being watched (probation, drug testing, etc.). Eventually the external motivation for change will be removed, at which time the moment of truth begins. Motivational Interviewing attempts to address problem behavior at the level of one’s internal motivation to encourage long-term, maintainable change.
Play Therapy is an alternative to talk therapy and is used to help children make the transition to verbalizing their problems and finding solutions. Play therapists receive special training so that they are equipped to use “play” in a very strategic and purposeful way. By utilizing things such as common toys, games, sandbox, art, or puppets, children tend to relax and be themselves. This encourages and expedites the communication of important information and often sheds new light on difficult subject matter. It also can give children a number of alternative means to express difficult emotions so they can reduce or eliminate destructive expressions of anger, frustration, sadness and so forth.
This type of counseling presumes that people have a “subconscious” and a personal history which deeply impacts the way that they think, feel, and act in the present moment. The early development of professional psychology and counseling comes from psychodynamic schools of thought. In psychotherapy, the therapist may dialogue extensively with you about early life experiences or long standing thinking/feeling/behavioral patterns that seem to be connected to unmet psychological and emotional needs.
This type of therapy can at times seem abstract, indirect, or impractical as it stands in contrast to more modern brief solution focused therapies or cognitive behavioral therapy. Strict cognitive behavioral therapists are critical of seemingly endless examinations of the past that don’t necessarily translate into behavioral change. Psychodynamic advocates argue that there is far more to mental, emotional, and spiritual health than thinking accurate thoughts and achieving predefined behavioral outcomes. Our practice strongly believes that either extreme can be counterproductive to the process of helping people. We tailor the counseling approach to the needs of the individual, which might involve the use of both types of therapy or a balance of the two at different points in the process.
SAND TRAY THERAPY
Sand tray therapy is a form of expressive therapy used with clients of all ages. Sand tray therapy allows a person to construct his or her own microcosm using miniature toys and colored sand. The scene created acts as a reflection of the person’s own life and allows him or her the opportunity to resolve conflicts, remove obstacles and gain acceptance of self.
Although sand tray therapy may look like child’s play, it is a highly therapeutic and multidimensional form of therapy that can provide emotional release and realization for a person in therapy. Adults who have been traumatized and show limited response to other forms of therapy may respond well to sand tray therapy. The environment presents an atmosphere free from threats, and the therapist works with the person in therapy to alter the positions of the miniature objects as representations of the true people and events. By beginning to facilitate change on a fictitious level, a person can gain the courage and ability to recognize that these same changes can be made in his or her own life. While the sand tray process involves creating a series of trays and might last for months or years, significant change may be experienced in just one sand tray session.
“Talk therapy” in the broadest sense refers to the notion that human communication has a healing and life-giving quality to it when done under the right conditions. Most people have experienced at one time or another that sense of “I just feel better after I talk about it.” On one level talk therapy isn’t really all that complicated and you can practice it with a good friend.
You might rightly wonder though, “how is talk therapy with a professional any different than a good long talk with my friend over a cup of coffee?” Three major differences exist. First, a good counselor is highly trained in the art and science of listening and giving feedback (as opposed to advice). Second, a professional is dedicated to be in this role in a safe place conducive to a private and intimate discussion. Finally, the correct counselor assignment means she or he has a wealth of experience relevant to your particular situation. This means they are skilled not only at identifying specific clinical diagnoses but they have talked to and helped dozens, if not hundreds of individuals who struggle with problems similar to yours. A wealth of experience combined with on-going education, training, and a caring heart usually translates into a very positive and life changing counseling experience.
One legitimate criticism of talk therapy is that the counselor and client may lapse into a “talking” relationship that is a replacement for regular relationships. While not all long term therapy is necessarily unhealthy, our practice strongly encourages clients to develop at least a few close and trusted friends who you can talk with openly and regularly. Good counselors are very skilled at talk therapy, but they are also skilled at helping you develop relationships where talking is part of a healthy life. For some, building a few successful relationships is a big part of the successful conclusion of their time in counseling.