Psychotherapy. Helping you gain a better understanding of the issues troubling you.
There are many different types of psychotherapy. Here, we give a general overview of psychotherapy and look at three of their main apporaches.
What is psychotherapy?
Psychotherapy is an umbrella term that includes many techniques designed to help deal with aspects of our emotions or behaviour that we wish to change.
Modern psychotherapy has evolved since Freud.
Techniques – including those used in counselling and hypnotherapy – help bring about new perceptions that lead to beneficial changes in how we feel and how we act. Put simply: how you think is how you feel.
So the aim of a psychotherapist is to challenge, and ultimately change, negative and destructive thoughts, allowing the client to lead a more productive and satisfying life.
By changing how you think you can also change how you feel.
Simple to learn strategies provide clients with practical and powerful ‘life-skills’. An individual may act or react in a certain way that is not healthy but may be as a result of events that may have happened previously.
A psychotherapist will help a client to see this situation and develop more effective techniques for dealing with it in the future.
Techniques that may be used are training in assertiveness and relaxation and gradual desensitisation to feared objects. Psychotherapy has been proven to be highly successful in a broad range of specific problems such as phobias, repetitive habits (nail biting, bed wetting, etc.) as well as anxiety and depression. Ultimately the psychotherapist will seek to effect positive and lasting change by working with the client to modify his or her unhealthy thoughts and/or behaviours.
Psychotherapy offers new ideas and possibilities, new ways to behave and new directions to follow. It offers new choices in the way we deal with situations, and provides us with the resources we need to make those changes possible.
Each of us is a unique person in our own right. Your psychotherapist will utilise the techniques that are most appropriate and integrate them in the best way for each individual client
Humanistic counselling and psychotherapy is often referred to as the ‘third way’ (the first being psychodynamic and the second cognitive behavioural). Humanistic theory is eclectic and holistic and does not focus on symptomatic diagnosis. Humanism considers each person to have a core authentic ‘self’, which can be disturbed, masked or hidden by the difficulties encountered in life. Thus humanistic therapy is a journey of self discovery and getting in touch with the ‘authentic self’.
Humanistic psychotherapy, including person centred therapy, is often recommended for mental health conditions by NICE as ‘counselling’. Counselling is recommended by NICE (2009) for a depression where cognitive behavioural and other NHS preferred treatments have been declined by the patient. Rather than addressing the ‘symptom’ of depression for example, the therapist will look to address the deeper cause, thus relieving the depression.
A key concept in humanistic psychotherapy is ‘unconditional positive regard’, encouraging the client to accept themselves by demonstrating acceptance in the human relationship of the therapy environment. This environment itself is a safe and healing space.
A variation of humanistic theory is Gestalt therapy, which has certain key elements such as; the idea of issues being ‘incomplete’ and needing to be worked through to enable ‘closure’, and ‘fields’ which refers to the overlap between the actions and attitudes of people, groups and the environment. This concept of being part of something greater in an active way is a vital difference to non-humanistic therapies, which tend to ‘treat’ the ‘individual’ in isolation (although more broadly this is now shared within the ‘critical psychotherapy’ movement).
Another popular and well known version of humanistic psychotherapy is known as Person Centred Therapy, and this again works with the safe space and unconditional positive regard models. It is also very focused on avoiding evaluation by the therapist of the client, and often uses methods of feedback such as mirroring, reflection and summarising to feedback to the client what the client themselves has said for deeper consideration.
A third very common method within the many variations of humanistic therapy available is mindfulness therapy. This is a little misleading because mindfulness therapy has become synonymous with eastern psychology. In fact eastern psychology is as broad in scope (if not broader due to its existence since 4500 BCE) as western psychology. Also Mindfulness therapy when applied humanistically and holistically actually contains what are often known separately as acceptance therapy and compassion based therapy.
These are essentially eastern psychology variants of unconditional positive regard in the western psychology model. Mindfulness therapy often includes mindful practices, meditation, self acceptance exercises, and self reflection. Ethical mindfulness uses a theory similar to Gestalt field theories to look at interaction between the person and the group and the environment.
Versions or sub-groupings of Mindfulness are associated with CBT in particular, but are more humanistic in origin. These include MBCT (mindfulness based cognitive therapy), MBSR (mindfulness based stress reduction), teaching mindfulness (psycho-education), acceptance therapy and compassion based therapy. MBCT and MBSR in particular are recommended by NICE for the treatment of anxiety and depression related conditions. Mindfulness based change processes and meditations lend themselves well to hypnotherapy based work.
Mindfulness is well recommended and evidence based: Specifically NICE (2009) recommend MBCT for depression self help and relapse prevention. Also Studies at the Oxford Mindfulness Centre (part of Oxford University) have indicated measurable improvements from practising mindfulness in a range of conditions, and these are updated online.
Psychoanalysis refers to the psychotherapy practice of psychological analysis. Whereas counselling is a talking therapy model where the trainee is reminded that they have two ears and one mouth and should use them in proportion, analysis is far more proactive.
Whatever the underpinning theory model, the analyst will proactively focus in on areas of the client’s presentation, using the appropriate theory or theories to encourage the client to gain self awareness through far deeper analysis and insight.
Although this sounds very logic based, one of the challenges of analysis is to gain insight into knowledge held in the unconscious mind, and bring it into consciousness.
This addresses neurosis (psychological problems) in the client’s unconscious, thus relieving the ‘symptoms’ presenting as mental health conditions like depression or anxiety. The analyst will often ask the client to focus on topics, themes, choice of language, emotions or bodily feelings as an access route to greater knowledge.
This may be applied to situations as in situational analysis, or more holistically as in more traditional analysis methods.
The most commonly referred to form of psychoanalysis is from the psychodynamic school. Sigmund Freud developed his form of psychoanalysis, initially using hypnosis.
Freud later changed his approach to free association (conversational/relaxed state). Some therapists trained in hypnotherapy still use the initial approach and modern variations on it, and this is known as hypno-analysis.
Other great modern psychotherapists including Jung, Lacan and Klein have developed their own variations on psychological analysis and have added to the wealth of theories and models. Traditional psychoanalysis can be twice weekly, although in current times there is a great deal of variance.
Deeper work psychoanalysis can be spread out over months or years as a process of positive personal discovery. When dealing specifically with diagnosed mental health conditions, short term psychoanalysis is recommended by NICE (2009) for a depression where cognitive behavioural and other NHS preferred treatments have been declined by the patient.
Another school of psychological analysis is the cognitive behavioural school, which contains a range of variations using the cognitive behavioural theories of psychology. These include CAT (cognitive analytic therapy), Applied Behaviour Analysis and CBASP (cognitive behavioural analysis system of psychotherapy).
Each of these are applied to different forms of mental health condition, and NICE recommend both overall cognitive behavioural psychological therapies and individual variations for a range of mental health issues.
Other less common forms of psychological analysis include the use of linguistic analysis (such as Lacanian style analysis), systems analysis (such as that based on SSADM systems modelling), and Mindfulness based analysis which examines and analyses feedback from mindful reflection in the eastern psychology school of psychology.
CBT is short for ‘Cognitive Behavioural Therapy’, a particular type of psychotherapy that is the NHS choice of treatment for a variety of problems we experience.
In particular, CBT can help you to change how you think (‘Cognitive’) and what these thoughts may lead to (‘Behaviour’). These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the ‘here and now’ problems and difficulties. Instead of focusing on the causes of your distress or symptoms in the past, CBT looks for ways to improve your state of mind now. It has been found to be helpful in:
- Agoraphobia and other phobias
- Social phobia
- Obsessive compulsive disorder
- Post traumatic stress disorder
CBT can help you to make sense of overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you. These parts are:
- A Situation – a problem, event or difficult situation. From this can follow:
- Physical feelings
Each of these areas can affect the others. How you think about a problem can affect how you feel physically and emotionally. It can also alter what you do about it.
When you work with a CBT psychotherapist, the problem will be broken down into its separate parts. To help this process, the CBT psychotherapist may ask you to keep a diary. This will help you to identify your individual patterns of thoughts, emotions, bodily feelings and actions.
Together you will look at your thoughts, feelings and behaviours to work out if they are unrealistic or unhelpful, and how they affect each other – and you.
The therapist will then help you to work out how to change the unhelpful thoughts and behaviours you may have.
CBT is considered by the NHS to be the most effective psychological treatment for moderate and severe depression. Studies have shown that it can be as effective as antidepressant medication for many types of depression presented.
CBT has developed over time with the latest developments being referred to as the ‘third wave’ of CBT. This third wave has incorporated elements of Mindfulness, acceptance and compassion based therapy from eastern psychology. The effects of this development include a ‘softer’ and more humanistic element, additional change methods being taught to the client, and more positive self care such as meditation and mindful practice.
NICE recommend Mindfulness Based Cognitive Therapy and Mindfulness Based Stress Reduction for a range of issues including anxiety.
Mindfulness based cognitive and behavioural therapies are well recommended and evidence based: Specifically NICE (2009) recommend MBCT for depression self help and relapse prevention. Also Studies at the Oxford Mindfulness Centre (part of Oxford University) have indicated: measurable improvements from practising mindfulness in a range of conditions and these are updated online.
NICE recommend cognitive based psychological therapies generally as well as sub-types, and an interesting variation of CBT is CBH (Cognitive Behavioural Hypnotherapy). CBH uses very similar methods to traditional CBT, but reinforces the change process and visualisation processes using the natural state of hypnotic trance. Studies including Shoenberger et al 1997, Bryant et al 2005, and Kirsh et al 1995, cited in *Robertson 2013 p16) all indicate a better efficiency or effectiveness combining hypnosis and CBT (cognitive behavioural hypnotherapy) than CBT alone.
*Robertson, D (2013) ‘The Practice of Cognitive Behavioural Hypnotherapy. A manual for Evidence Based Clinical Hypnosis’. Karnac Books.
For more information on CBT, visit the NHS website for CBT at: www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt