One of my colleagues asked me the other day to describe the different types of psychotherapeutic disciples endorsed by the majority of mental health practitioners. I was also reminded of the other thread offering free therapy. BTW, whatever happened to CityCowboy, did we scare him off with our plethora of problems...or maybe we are just a bunch of CountryExecutives...just joking (and a bad joke at that).

Here is a quick and dirty outline of the major style of therapy. Not all treatments are suitable for every person or all disorders. It's best to find a good match between you,the clinician, and the clinician's style.

I'm listing the different treatments in order of clinical effectiveness. Of course I'm a little biases so that will be apparent in my descriptions.


1. Cognitive Behavioral Therapy (CBT)

Targeted Clients: Adults and Adolescents

Targeted Problems: Couples/family therapy, sex therapy, all mood disorders (i.e. depression), personality disorders (i.e. Avoidant Personality Disorder), prevention of risky health behaviors

Method: Using the methods of Behavioral Therapy (read below) but incorporates techniques to target mood and/or cognition. Also, incorporates a wide range of other techniques such as Deep Muscle Relaxation, Self-monitoring of thoughts and behaviors, psychoeducation (reading articles or books to become informed about our problems), practicing effective communication, and reanalyzing irrational beliefs. This is only a small fraction of the techniques available.

Pros: very effective

Cons: hasn't reached its full potential because "cognition" and "mood" is still not fully understood. (Although, I predict Behavioral Economics Analysis will be the future of therapy...you can say you heard it here first!)


2. Behavioral Therapy

Targeted Clients: children and certain adults

Targeted Issues: drug/alcohol/nicotine addiction, behavioral problems in children (such as ADD/ADHD), autism, post-traumatic stress disorder (PTSD), specific-phobias, anxiety disorders (panic disorder, social phobia, and GAD), and OCD. Most of the problems are behaviorally based and does not include the more cognitively related problems such as depression.

Method: Treatment concentrates on the manipulation of the patient's behavior in order to treat the presenting problem. Treatment centers around the ABCs: Antecedents, Behavior, and Consequences (also called contingencies). The 'A' is any event that occurs before a behavior that helps to increase or prevent a certain behavior ('B') from happening. The 'C' is the reinforcer (i.e. reward) or punisher that increase or decrease 'B' (the behavior). Treatment focusses on identifying and shaping the As and Cs to decrease bad behavior and to increase good behavior.

Pros: provides concrete goals, treatment is relatively brief yet highly effective, the risk of relapse is reduced.

Cons: doesn't target cognition (or mood) directly

3. Client-Centered Therapy (also called Humanistic Therapy or Existential Therapy)

Targeted Clients: Adults

Targeted Issues: lack of social support

Method: The therapist acts like a friend rather than a doctor. The role of the therapist is very very passive and doesn't entail any direct guidance or advice. The main purpose is for the patient to feel as though they are being listened to. The idea is that patients can learn by themselves simply by talking out loud how to change. Goal of treatment is to strive to be a better person, one who is self-actualized.

Disadvantage: not very effective, most patients get very frustrated without any concrete goals or constructive criticism

Advantage: a patient feels like they have gained a friend.

4. Psychoanalytic Therapy

Targeted Clients: Adults

Targeted Problems: Relationship issues

Method: The patient re-experiences problems that occurred during childhood in an attempt to correct problems that have manifested in adulthood. The therapist helps to interpret the meaning of a patient's actions and describe them in terms of childhood dysfunction (e.g. you are trying to seek the love from many men because your father withheld true affection from you as a child.)

Disadvantage: requires years of treatment and isn't very affective. Patients easily get caught up in blaming others primarily their parents for their own problems.

Advantage: you can gain a lot of insight into your motives

The take home message is that when choosing a therapist, choose one that fits you best. Some people like passive therapist and just want someone to listen to them as in client-centered therapy. For me, I really dislike like that and need something constructive like CBT or BT depending on the issue at hand. You can also ask the therapist over the phone before you actually see them in person about what style they endorse. If they say they are eclectic, ask again because they is a far too easy answer. They will tell you which one of the 4 major disciples above if you just ask which discipline they identify with.

If anything isn't clear or if you have further questions just ask me.

~Poo

Well, I have at least 26 questions after reading through your post there Poo!!

I wouldn't even know where to start though, so I guess I'll just try and keep it short as possible.

I sat here for AT LEAST... a good 20 minutes after reading your post thinking of all the therapists I have seen over the years. Trying to concentrate on how each one differed and in what ways some were similar, in their approach to my therapy. Now my brain hurts..thanks buddy!!

Just teasing you buddy..but you really have caught my attention here. Long day here today..actually I have been up since around 4AM TUESDAY morning...well I did catch a 2 hour nap today..so I guess I should stop whining..

Maybe just one question for now.
Quote from your post..

"Not all treatments are suitable for every person or all disorders."

OK..so what happens if you come to find that you might have say.. 3-4 disorders, but they fit under 2..maybe even 3 different suggested therapies???

Hopefully I made some sense in my post/question. I'm really interested in hearing more.

Hey guys-I thought the article in forbes was very interesting. The info you put out there was also informative PooMonk. Here's my thing. When you break it down to the nitty gritty, it is about changing behaviours and habits. Sometimes even environments. While it is a great idea, for people wo could benefit most from it, it is rather unrealistic. IMHO I posted that article originaly to see what others thought. I'm no stranger to the proverbial couch myself. I am educated. I can take what I am told and apply it, or attempt to apply it, and realize how I failed to apply a certain method when I shoulda/coulda/woulda. My thing is this. How do you bring this to the middle(used to be me), and lower (me, now) class people in a way where they won't be sitting there looking at you like you are speaking a foreign language? How do you implement this type of therapy(which I do think has it's merits) to a group of people who are So accustomed to the "couch"? I think that is where it is needed the most, but probably used the least. I've only had one cup of coffee...does that make sense?? ANd do you think it will replace traditional therapies ?? Just curious........
Marley

Hi Mcshaun,
Most comorbid diagnoses (2 or more disorders) is best treated with CBT. Psychoanalytic therapy is pretty much outdated and not very effective. It's interesting but not effective. Client-centered therapy for is not very effective (especially with someone with more than 1 disorder). I would have to say that client-centered therapy are really for people who just need a friend to talk to. I'm a little biased here but research does indicate that it is not as effective as other forms of treatment. Most therapists using behavioral techniques to treat adults utilize CBT. It's actually kind of rare for a therapist to be a pure behaviorist. Most therapists today utilize CBT in one way or another. However, you have your die hard psychanalysist and client-centered therapists. CBT really gives therapists an arsonal of techniques to treat either behavioral problems such as anxiety disorder or cognitive problems such as depression. CBT use widely with adults and is effective in treating single and comorbid disorders. A skilled therapist whether they take a more cognitive approach or behavioral approach will usually know how to deal with a dual diagnosis. Remember it's not only the approach that the therapist used to treat patients, it is also the skill of the therapist. It's just like taking your car to a mechanic, he may either specialize in fixing foreign made cars or work on all makes and models, but what is most import is if he can do the job and do the job well. It doesn't mean much if a mechanic says he can fix your car and the only tools he has is a half empty roll of duct tape and a bent coat hanger. Plus, you wouldn't want to take your jaguar to a mechanic that only knows how to fix late model Ford pickups.

Let me know if you have any more questions,
Poo

Hi Marley, I'll have to read your article carefully. I just breezed through it. To give you a quick answer about how to treat people who do not speak the psych lingo, I really would have to say that a skilled therapist or speaker of any kind can communicate anything to anyone. Not everyone can do this though. Those therapists are able to speak the language of their patients on the patient's level and not try to talk in a way that expects patients to catch up in the process. So, really any technique can be implemented but it is the delivery which is very critical. If a patient doesn't understand what is being said then no matter what the technique that is being utilized then it will simply not help.

I do have to say that Behavior Therapy doesn't require the same sort of dialog as you will find in psychoanalytic therapy. BT is often used with individual with lower cognitive functioning than the average adult, such as people with autism and very young children. In this case you have to bypass verbal communication for the most part and treat the behavior directly. So in short, BT is equally effective with patients from variety of backgrounds or "classes".

I'll post something again after I read your article fully,
Poo