4. Which kinds of psychotherapy do we know?

This question is similar to the question “which colours do we know?” Actually a great deal – however all of them are derived from several basic types. Similarly, there are several hundred different psychotherapies with their own name, but in fact they all are based on three main streams, which are deeply rooted in both theory and practice. Here is a short summary: 

  • Psychodynamic therapies

    • These include especially: Psychoanalysis (S. Freud), Psychodynamic psychotherapy, Individual psychology (A. Adler), Analytical psychotherapy (C. G. Jung), Katathym-imaginative psychotherapy.

    • These therapies study inner emotional conflicts, which we often are not aware of, and therefore cannot control. Emphasis is on awareness of emotions and fantasies, processing and expressing them, and also how we avoid this work in our life. Psychodynamic therapy believes that our relationships with loved ones had a major impact on us since childhood, and that they manifest themselves with the therapist as well. It makes sense to engage with the client for months or even years, as an understanding and a permanent change of problematic behaviour and experience patterns needs time. 

    • From client’s perspective, traditional psychoanalysis includes laying on a sofa, while the analyst stays out of visual field of the client, who says anything which comes to his mind. The analyst does not react (so not to disturb the client), but after some time he offers his view of the problem. The sessions take place several times a week over several years. Probably the most widespread version of this form of therapy (psychodynamic psychotherapy) is no longer so intense (rather once a week), nor does it lasts so long (one or two years on average). The principles are preserved, but the therapist sits face to face with the client and interacts with him more.

    • Psychoanalysis may not be convenient for some clients as it is demanding financially and in terms of time, or because of the therapist who acts from the position of an major expert.

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  • Cognitive-behavioural therapies

    • These include especially: Cognitive-behavioural therapy (CBT, A. Beck), dialectic-behavioural therapy (DBT, M. Linehan), multimodal therapy (A. Lazarus), and rational-emotive therapy (REBT, A. Ellis).

    • The human mind, emotions and behaviour are connected. If psychodynamic therapies enter this circle through the emotions, CBT does it through mind (or behaviour). In particular, it examines and questions thinking distortions (such as exaggeration or illogicality) and focuses on solving concrete problems through a systematic skill training (such as training of relaxation or assertivity). A person’s behaviour and experience are seen as learned, therefore a change requires relearning – whether through a principle of rewarding, or by automatic linking of stimuli which appear together, or by observing others.

    • CBT therapies are highly structured, which means that they have a clear program from beginning to end. A standard procedure includes creating a list of negative thoughts and feared situations, then organizing them according to their difficulty and gradually overcoming them. The client is encouraged not to avoid what he is afraid of, but to confront it. He or she can write a diary about his progress or fill a workbook as his homework assignments. This process of education and training is finished after about ten sessions.

    • Some clients may feel that CBT focuses more on symptoms than causes, or that logical approach in dealing with mental problems is incomplete.

  • Humanistic therapies

    • Sometimes these are called experiential, and include especially: Person-Centered Approach (PCA, C. R. Rogers), and Logotherapy / Existential analysis (V. E. Frankl, A. Längle).

    • This form of therapy is based on examining the individuality of each person rather than on searching for universal problems and their solutions. The emphasis here lies with the therapeutic relationship and restoring natural self-development. This striving to develop oneself is instrinsic to all people according to humanism, and an authentic self-realisation is considered beneficial for both the person and society. Experiential therapies also highlight the need for meaning in life, and the fact, that we can find meaning even in the most difficult situations. It admits the existence of paradoxes in the human psyche, and highlights the free will and responsibility of the individual.

    • Humanistic therapist is usually perceived as substantially empathetic, accepting and supportive. The therapist lets the client’s experience determine the course of therapy. He does not judge the client or his experience, nor tries to change it, but examines it impartially together with the client. At the same time, he provides the client with sincere feedback (“he sticks his neck out”).

    • Relational, exploratory and experiential sessions do not agree with some clients, who prefer concrete instructions.

If during the reading you got the impression that each form of therapy "is right about something" and brings some benefits, you are not alone. The process of integration has been going on for more than half a century, whether by “borrowing of techniques” between schools, or by a deeper integration of different forms of therapy. One of the examples of integration is also my style of work, Gestalt therapy, which is, roughly said, composed 40% of the humanistic school, 40% of psychodynamic therapy and 20% of CBT.

  • Gestalt psychoterapie

    • In German, der Gestalt means "a whole" or "a shape". Gestalt psychotherapy was found mainly by Friedrich (Frederick, Fritz) Salomon Perls (1893 – 1970) and his wife Laura Perls (1905 – 1990) in the 1940s and 1950s. Besides the three above-mentioned traditional forms of therapy, Gestalt therapy is also inspired by philosophy (existentialism, phenomenology), scientific principles (field theory), the eastern concept of awareness (mindfulness) and biological rules of perception ("gestalt psychology"). The important thing is, that these principles are not only mixed together, but they constitute a well integrated theory.

    • The humanistic foundations of the Gestalt therapy are reflected in its three main principles:

      • exploring what the client experiences and how he interprets it (phenomenology)

      • emphasis on the life context of the client (field theory)

      • equal and open therapeutic relationship (dialogical aspect)

    • Psychodynamic therapies as well as Gestalt examine the mechanisms, by which we modify contact with ourselves and outer environment, thereby preventing the full awareness of our emotions. Among CBT concepts, “schemes” equal to "fixed gestalts", while recent CBT focus on “mindfulness” and "acceptance" is well established in Gestalt as "work with awareness" and "paradoxical theory of change". By the way, nowadays CBT is rather more inspired by Gestalt than the other way around – for example, popular dialectical-behaviour therapy (DBT) is sometimes described as an attempt to translate Gestalt into technical language (also, the author of DBT has been in lively contact with the Gestalt community). 

    • From the client’s point of view Gestalt therapy appears to be quite “normal”. The therapist guides, supports, but also challenges the client. He does not have an agenda prepared in advance, does not talk too much or too little, and shares his real feelings with the client thoughtfully. Emotional experience, rationality and physical sensations are seen as equally important. The point is that a lively, creative human interaction in a safe space “here and now”, is the prerequisite for the client to realise fully his usual ways of behaviour and experience, and possibly try new ones.

    • Relational, exploratory and experiential sessions do not agree with some clients, who prefer concrete instructions.

There are also therapies, which are a direction of it's own (like family therapy, or meditation based therapy). However, it is interesting how with growing experience the psychotherapists from different schools converge in their style of work. And because the efficiency of the individual forms of therapy is comparable (see the next part of the series), both the therapist and the client can choose their preferred style of therapy. The important thing is for any particular therapy to respect general principles of good therapies, which are:

  • Non-pathologization (not to reduce the client to the problem he comes with)

  • The belief that people can grow, change and heal

  • Recognition of the importance of the therapeutic relationship

  • A certain deepness of the entire process

  • The awareness that no psychotherapy is perfect, and that the particular psychotherapist is not always able to help the particular client

I offer my psychological services as a self-employed therapist in the sense of the law no. 89/2012 Sb., Civil Code, § 2636 and following. I don’t provide healthcare in the sense of law no. 372/2011 Sb., about healtcare services. For more info click here.

© 2019 by Vladimír Marček, Ph.D

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