Mental health awareness is on the rise, and more and more people are becoming comfortable with psychotherapy. In fact, research shows that nearly half of Americans have visited a mental health professional in the past year.
It’s no secret that talk therapy is one of the best methods for treating mental illness, transitional stressors, or other emotional disturbances. With that in mind, there are many different kinds of talk therapy options to consider. Each has pros and cons, and what works well for one client may not be the best strategy for someone else. Let’s explore the different kinds of methods available.
Example: Client A
Client A is a woman in her mid-thirties who spends most weekends cruising bars, drinking too much alcohol, and sleeping with random men for validation. She assumes that she needs to have sex with people to feel desired and special. She believes she drinks too much and often says she’ll make a change, but once Friday rolls around, she’s back in the same routine.
As a result of her actions, she experiences profound shame, guilt, and embarrassment. She withdraws from others and hides this part of her life. Unfortunately, to cope with these intense feelings, she continues to numb and escape herself with alcohol and sex.
Let’s discuss what Client A can expect from each type of therapy.
Cognitive Behavioral Therapy (CBT)
CBT is one of the most well-known and studied therapy modalities, and it is one of the gold standard treatment methods for a variety of mental health conditions. The overarching premise of CBT is that thoughts, feelings, and behaviors are connected. CBT practitioners argue that mental illness can stem from unhelpful or unhealthy thoughts (known as cognitive distortions), which result in negative feelings and maladaptive behaviors.
A CBT therapist may help her examine Client A’s promiscuous behavior, where it originated from, and how it continues to both harm and benefit her. Her therapist may help her pinpoint that she holds a deeply-rooted belief that she’s unlovable or unworthy of love. In therapy, this client may work on developing healthier frameworks for thinking (i.e., I’m worthy of love just as I am) and cultivating more appropriate coping skills (going to a movie instead of the bars).
Interpersonal Therapy (IPT)
Interpersonal therapy focuses on an individual’s relationships and social dynamics. Interpersonal therapists theorize that, because humans are social creatures, relationship disturbances can create enormous stress in individual functioning. Interpersonal therapy may include work on role disputes, role transitions, unresolved grief, and interpersonal deficits. Therapists work with clients to strengthen communication by identifying and asserting feelings in healthier ways.
A therapist who practices interpersonal therapy may explore Client A and her feelings of acceptance and comfort around others. The therapist may utilize behavioral interventions, like role-playing, to help the woman better articulate her needs to others. The therapist may also encourage Client A to identify reasonable solutions for improving intimacy in her existing relationships.
Eye Movement Desensitization and Reprocessing (EMDR)
Originally used to treat traumatic memories, EMDR has become a popular treatment method for individuals struggling with symptoms of depression, anxiety, and compulsive issues. EMDR practitioners work with clients to reduce or eliminate the distress associated with traumatic or otherwise sensitive material. In this therapy, clients recount difficult memories or topics while receiving a series of bilateral stimulations.
For Client A, an EMDR therapist might explore her childhood to screen for any emotional, physical, or sexual trauma attributing to her current behavior. Likewise, the therapist will work with the client to reduce the symptoms of shame and fear she feels about herself.
Dialectical Behavior Therapy (DBT)
DBT is another branch of CBT that derives from the concept of dialectics. Dialectics are essentially opposites, and DBT practitioners believe that “living with a middle ground” is far more realistic than living in extremes. DBT consists of strengthening core mindfulness and enhancing skills rooted in distress tolerance, emotional regulation, and interpersonal effectiveness.
A DBT therapist would work with Client A to help her develop healthier coping skills when she feels anxious, ashamed, or unlovable. Client A would ideally learn how to find peace in her current reality- even when it feels uncomfortable, and she would learn skills rooted in self-soothing and radical acceptance. This therapist might also work with the client to boost her self-esteem to break her pattern of compulsive drinking and sex.
Psychodynamic therapy is rooted in the notion of exploring unconscious feelings and patterns. Psychodynamic therapists identify how past patterns, relationships, and defense mechanisms contribute to current distress. They also value the therapeutic relationship, and they might note how a client’s reactions to both therapy and the therapist relate to other patterns in their life.
For Client A, a psychodynamic therapist might explore how and where a client felt unloved or unworthy in childhood. The therapist may also confront how specific relationship patterns manifest in therapy (i.e., Client A seeking the therapist’s approval or Client A shutting down at confrontation because she perceives it as a rejection).
Attachment-based therapy focuses on the attachment between people. These therapists speculate that attachment, which develops in infancy, refers to the ability for people to be vulnerable and safe with others. People who have a healthy sense of attachment feel safe with themselves and with others. People with unhealthy attachment bonds, however, may be distrustful, guarded, or overly clingy. These therapists work with clients to model a secure attachment with the notion that this modeling can help clients build healthier relationships with others.
This therapist might work with Client A to teach her about her unhealthy attachment patterns and how they continue to unfold due to her behaviors. The therapist would ideally model secure attachment, in the sense that he or she would balance nurturing and compassion with firm boundaries and confrontation as needed.
Solution-focused therapy focuses on identifying present problems to provide quick and adaptive solutions. The model is future-focused and goal-oriented, and it differs from many other models because it doesn’t focus on a deep exploration of the problems. Instead, it focuses on concrete solutions for productive and sustainable change. At its core, solution-focused therapists believe that clients already have all the inherent strengths, knowledge, and resources needed for growth.
A solution-focused therapist would examine the exceptions in Client A’s behavior. For example, this therapist would focus on the times Client A doesn’t respond to her anxiety or sadness with drinking or compulsive sex. They would explore the alternative coping skills and behavioral patterns the client already exhibits. They would also ask future-oriented questions like, If you woke up tomorrow and everything was better, what would be the first changes you noticed?
Final Thoughts on Talk Therapy
Talk therapy can be a valuable resource for individuals who need support with their current distress. Clients may need to meet with a few different therapists to find what best works for them. Likewise, while some practitioners exclusively focus on using one model for treatment, therapy can be much more fluid. It’s not uncommon for therapists to blend interventions from a variety of different theories to provide the best care.