Therapeutic Techniques

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is the most widely-used therapy for anxiety disorders. Research has shown it to be effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalized anxiety disorder, among many other conditions.

Cognitive behavioral therapy addresses negative patterns and distortions in the way we look at the world and ourselves. As the name suggests, this involves two main components:

Cognitive therapy examines how negative thoughts, or cognitions, contribute to anxiety.
Behavior therapy examines how you behave and react in situations that trigger anxiety.
The basic premise of cognitive behavioral therapy is that our thoughts–not external events–affect the way we feel. In other words, it’s not the situation you’re in that determines how you feel, but your perception of the situation. For example, imagine that you’ve just been invited to a big party. Consider three different ways of thinking about the invitation, and how those thoughts would affect your emotions.

Example situation of hearing about a party:

As you can see, the same event can lead to completely different emotions in different people. It all depends on our individual expectations, attitudes, and beliefs. For people with anxiety disorders, negative ways of thinking fuel the negative emotions of anxiety and fear. The goal of cognitive behavioral therapy for anxiety is to identify and correct these negative thoughts and beliefs. The idea is that if you change the way you think, you can change the way you feel.

Solution-Focused Brief Therapy

As the name suggests, solution-focused brief therapy is about being brief and focusing on solutions, rather than on problems. We learned a long time ago that when there is a problem, many professionals spend a great deal of time thinking, talking, and analyzing the problems, while the suffering goes on. So much time and energy, as well as many resources, are spent on talking about problems, rather than thinking about what might help us to get to solutions that would bring on realistic, reasonable relief as quickly as possible.

Problems do not happen all the time. Even the most chronic problems have periods or times when the difficulties do not occur or are less intense. By studying these times when problems are less severe or even absent, people do many positive things that they are not fully aware of. By bringing these small successes into their awareness and repeating the successful things they do when the problem is less severe, people improve their lives and become more confident about themselves.

And, of course, there is nothing like experiencing small successes to help a person become more hopeful about themselves and their life. When they are more hopeful, they become more interested in creating a better life for themselves and their families. They become more hopeful about their future and want to achieve more.

Because these solutions appear occasionally and are already within the person, repeating these successful behaviors is easier than learning a whole new set of solutions that may have worked for someone else. Thus, the brief part was born. Since it takes less effort, people can readily become more eager to repeat the successful behaviors and make further changes.

Client-Centered Therapy

Client-Centered Therapy was developed by Carl Rogers in the 1940’s and 50’s. It is a non-directive approach to therapy. “Directive” meaning any therapist behavior that deliberately steers the client in some way. Directive behaviors include asking questions, offering treatments, and making interpretations and diagnoses. Virtually all forms of therapy practiced in the US are directive.

A non-directive approach is very appealing on the face of it to many clients, because they get to keep control over the content and pace of the therapy. The therapist isn’t evaluating them in any way or trying to “figure them out”.

The foundational belief of CCT is that people tend to move toward growth and healing, and have the capacity to find their own answers. This tendency is helped along by an accepting and understanding climate, which the therapist seeks to provide above all else.

A Client-Centered Therapist conducts sessions in the following manner:

• Listen and try to understand how things are from the client’s point of view.
• Confirm that understanding with the client.
• Treat the client with unconditional regard.
• There is also a mandate for the therapist to be congruent or transparent – which means being self-aware, self-accepting, and having no mask between oneself and the client. The therapist knows themselves and is willing to be known.

CCT may sound simple or limited, because there is no particular structure that the therapist is trying to apply. But when I watch CCT in action I see a very rich and complicated process. People unravel their own stuff. They discover new things, take brave steps, and don’t have to cope with a therapist who is doing things to them in the meantime. The therapist strives to understand and accept the client’s stuff, which is no simple feat. Over time, the client increasingly seeks to understand and accept their stuff too.

That CCT is effective has been amply demonstrated by decades of research. Furthermore, recent research has shown that the most significant variables in the effectiveness of therapy are aspects of the relationship and the therapist’s personal development – not the particular discipline they practise or techniques they employ. C-C therapists focus more attention on these variables than therapists in any other discipline.

Group Therapy

Group therapy is a type of psychotherapy that involves one or more therapists working with several people at the same time. This type of therapy is widely available at a variety of locations, including private therapeutic practices, hospitals, mental health clinics and community centers. Group therapy is sometimes used alone, but it is also commonly integrated into a comprehensive treatment plan that also includes individual therapy and medication.

The Principles of Group Therapy

In The Theory and Practice of Group Psychotherapy, Irvin D. Yalom outlines the key therapeutic principles that have been derived from self-reports from individuals who have been involved in the group therapy process:

The instillation of hope: The group contains members at different stages of the treatment process. Seeing people who are coping or recovering gives hope to those at the beginning of the process.

Universality: Being in a group of people experiencing the same things helps people see that what they are going through is universal and that they are not alone.

Imparting information: Group members are able to help each other by sharing information.

Altruism: Group members are able to share their strengths and help others in the group, which can boost self-esteem and confidence.

The corrective recapitulation of the primary family group: The therapy group is much like a family in some ways. Within the group, each member can explore how childhood experiences contributed to personality and behaviors. They can also learn to avoid behaviors that are destructive or unhelpful in their real life.

Development of socialization techniques: The group setting is a great place to practice new behaviors. The setting is safe and supportive, allowing group members to experiment without the fear of failure.

Imitative behavior: Individuals can model the behavior of other members of the group or observe and imitate the behavior of the therapist.

Interpersonal learning: By interacting with other people and receiving feedback from the group and the therapist, each individual can gain a greater understanding of himself or herself.

Group cohesiveness: Because the group is united in a common goal, members gain a sense of belonging and acceptance.

Catharsis: Sharing feelings and experiences with a group of people can help relieve pain, guilt or stress.

Existential factors: While working within a group offers support and guidance, group therapy helps member realize that they are responsible for their own lives, action and choices.

How Does Group Therapy Work?

Groups can be as small as three or four people, but group therapy sessions generally involve around seven to twelve individuals (although it is possible to have more participants). The group typically meets once or twice each week for an hour or two. The group can be open or closed to new members, and can be on a large variety of topics.