What Is It?
Cognitive behavioral therapy or CBT is a short-term form of therapy based on the idea that the way someone thinks and feels affects the way they behave. CBT aims to resolve the client's present-day challenges. The goal is to help clients identify, challenge, and change patterns to change their response to difficult situations. CBT is widely used and is recommended as the first-line treatment for disorders including depression, anxiety, and insomnia.
When Is It Used?
CBT is used for children, adolescents, and adults for individuals, families, and couples. Research has been found to show CBT is effective in the treatment of depression, anxiety, post-traumatic stress disorder, general stress, anger issues, panic disorders, social phobia, eating disorders, marital differences, obsessive-compulsive disorders, and childhood anxiety and depressive disorders. CBT can be used alone or in conjunction with medications. There are specialized forms of CBT that are used for specific disorders.
What Should I Expect?
CBT is a structured form of psychotherapy that occurs in relatively short periods of time. This usually lasts between 5 and 20 weeks, generally the sessions last 45-50 minutes each. The first few sessions will focus on assessment to identify the behavior patterns and set goals for treatment. In the following sessions, the client will identify the negative thoughts they have about their current problems, decide what they deem realistic, and come up with more realistic solutions. Once the client's perspective is more realistic the therapist can help come up with goals to reshape the negative emotions and reactions to problems. The last couple of sessions usually focus on recapping and reinforcing what they've learned. Clients will typically be sent home with "homework" to do between sessions. These will typically include exercises that will help them learn to apply the skills they came up with in therapy to their day-to-day life. While CBT may seem simple, it is all about breaking patterns and habits which can be a lot of work.
How does it work?
CBT often targets irrational patterns of thought that can negatively affect behavior. Common cognitive distortions include all-or-nothing thinking, catastrophizing, and personalization (believing that the individual is responsible for everything that happens around them). CBT is rooted in the present, so the therapist will initially ask clients to identify life situations, thoughts, and feelings that cause acute or chronic distress; and then explore whether or not these thoughts and feelings are productive. The goal of CBT is to get clients actively involved in their treatment plans so that they understand that the way to improve their lives is to adjust their thinking and their approach to everyday situations.
What Is It?
Cognitive Processing therapy or CPT is a specific type of CBT found to be effective in treating post-traumatic stress disorder (PTSD). CPT is short-term, typically conducted throughout 12 sessions. In CPT, the therapist will help a patient who has undergone significant trauma to evaluate his or her thoughts surrounding the trauma that may be exacerbating PTSD symptoms, and conditions including anxiety and depression that occur from the situation. The patient will then learn to challenge those thoughts and take a new perspective when appropriate. Like some other forms of CBT, at-home work is important for CPT.
When Is It Used?
CPT is a viable treatment option for most adults who have received a diagnosis of PTSD; it may also be used to treat older adolescents. CPT is not recommended for those who have not received a diagnosis of PTSD or those with literacy difficulties, as it involves written homework. It may also not be an ideal treatment for individuals struggling with substance abuse or suicidal ideation, or individuals with comorbid bipolar disorder.
What Should I Expect?
CPT can be conducted in individual or group therapy sessions or a combination. A full course of CPT typically involves 12 weekly sessions, each about 60 to 90 minutes long, though this can vary slightly depending on needs. Initial sessions typically focus on education that helps the patient learn about PTSD and what they can expect. In the next sessions, the client will work to identify and explore the ways that trauma may have altered their thoughts and beliefs. The therapist will help the client pick out thoughts that create barriers to recovery. Clients will then learn a set of strategies to these challenges and modify inaccurate or harmful thoughts. Patients will often be sent home with "homework" that may focus on writing about specific events, writing broadly about experiences, and writing about how they are feeling at different times.
How does it work?
Someone with PTSD may notice they think very differently about themselves and their environment than they did before the trauma. It typically affects their feeling of safety, trust, control, esteem, and intimacy. These thoughts can lead to fear, anxiety, guilt, and anger which can hinder their recovery from PTSD. CPT focuses on teaching a set of skills that will help the person challenge these negative thoughts. CPT focuses on repairing the damage done by a traumatic event to someone’s beliefs about themselves and the world. By offering specific cognitive restructuring skills, CPT allows an individual to challenge these negative thoughts and interpretations, gain a healthier perspective about the trauma, cope better with any future trauma, and move forward with their lives.
What Is It?
Trauma-focused cognitive behavioral therapy (TF-CBT) addresses the mental health needs of children, adolescents, and families suffering from the destructive effects of early trauma. The treatment is particularly sensitive to the unique problems of youth with post-traumatic stress and mood disorders resulting from sexual abuse, as well as from physical abuse, violence, or grief. Because the client is usually a child, TF-CBT often brings non-offending parents or other caregivers into treatment and incorporates principles of family therapy.
When Is It Used?
TF-CBT was originally geared toward helping children who were the victims of sexual abuse, but its scope has widened to include children and adolescents who have experienced a single or repeated experience of sexual, physical, or mental abuse or who have developed post-traumatic symptoms, depression, or anxiety.
What Should I Expect?
TF-CBT is a short-term intervention that generally lasts anywhere from eight to 25 sessions and can take place in an outpatient mental health clinic, group home, community center, hospital, school, or in-home setting. Treatment takes place with a non-offending parent or caregiver. Often, the treatment will begin where the child and non-offending caregiver have separate therapy sessions and advance to engaging in joint sessions. Cognitive behavioral techniques are used to help modify distorted or unhelpful thinking and negative reactions and behaviors. Learning to challenge invasive thoughts of guilt and fear can help a patient to reorganize their thinking more healthily and happily. The family therapy aspect of trauma-focused CBT attends to the problems family members may have in dealing with the trauma suffered by the child, including the use of various stress management, communication, and parenting skills.
How does it work?
Early trauma can lead to guilt, anger, feelings of powerlessness, self-harm, acting out, depression, and anxiety. Post-traumatic stress disorder, which affects children and adults, can manifest in several ways, such as negative recurring thoughts about the traumatic experience, emotional numbness, sleep problems, difficulty concentrating, and extreme physical and emotional responses to anything that triggers a memory of the trauma. TF-CBT can address and improve the symptoms of post-traumatic stress in youth. The goal of the treatment is to help the patient develop a sense of safety and security, to repair or develop healthy social skills, and for the caregiver to feel more confident in their ability to help the child productively.
What Is It?
Imago relationship therapy is a form of couples counseling and coaching designed to help relationship partners work out misunderstandings, reduce conflict, and rediscover ways to bond, communicate, and generally find common ground. A primary goal of the Imago approach is to help partners stop blaming, criticizing, and negatively reacting to each other and instead become more understanding and empathetic. Much of the work that takes place in Imago workshops and private therapy sessions involves learning to recognize how early childhood relationship experiences have affected how we relate, behave, and respond within committed relationships.
When Is It Used?
Couples dealing with communication struggles, consistent conflict, intimacy challenges, and trust issues may want to work with an Imago therapist but couples that are not in crisis may also benefit from the approach, learning how to manage conflict and enhance their dynamic. Dating partners, newlyweds, and long-term spouses may all seek Imago therapy to shore up their connection. Imago relationship therapy can benefit partners trying to become closer or bolster their relationship, as well as individuals who need to develop stronger communication skills to improve their relationships in general.
Imago therapy may not be the best approach for partners experiencing domestic abuse, or dealing with a partner’s substance abuse or addiction. Imago therapy can also be used for individuals hoping to find ways to make better choices in their dating life and gain perspective to recognize the traits they desire in future partners.
What Should I Expect?
The Imago technique is focused on 5 core principles that play out throughout therapy. An Imago therapist is likely to ask clients to re-imagine their partner as a wounded child; to re-romanticize their relationship through signs of appreciation, pleasant surprises, and even gift-giving; to restructure disappointments or frustrations by transforming complaints into requests and eliminating negative, hostile language from interactions; to resolve lingering feelings of anger; and finally to re-envision the relationship as a source of safety and happiness in their lives. Imago coaching can take place in group workshops, private counseling, or both, depending on the needs and preferences of the couple. Couples may be asked to role-play different dialogues to work on ways to communicate in difficult situations.
How does it work?
By understanding how negative experiences and feelings from childhood carry over into adult relationships and form your particular image, it is believed, that you can better understand your reactions to your partner, and vice versa, and develop the skills and empathy necessary to transform yourself and your relationship.
What Is It?
Dialectical behavior therapy (DBT) is a structured program of psychotherapy with a strong educational component designed to provide skills for managing intense emotions and negotiating social relationships. Originally developed to curb the self-destructive impulses of chronic suicidal patients, it is also the treatment of choice for borderline personality disorder, emotion dysregulation, and a growing array of psychiatric conditions. It consists of group instruction and individual therapy sessions, both conducted weekly for six months to a year,
The “dialectic” in dialectical behavior therapy is an acknowledgment that real life is complex, and health is not a static thing but an ongoing process hammered out through a continuous Socratic dialogue with the self and others. It is continually aimed at balancing opposing forces and investigating the truth of powerful negative emotions.
DBT acknowledges the need for change in a context of acceptance of situations and recognizes the constant flux of feelings—many of them contradictory—without having to get caught up in them. Therapist-teachers help patients understand and accept that thought is an inherently messy process. DBT is itself an interplay of science and practice.
When Is It Used?
With its strong emphasis on emotion regulation skills, DBT is finding application as a treatment for a wide range of mental health conditions. They include:
Personality disorders, including borderline personality disorder
Self-harm
Post-traumatic stress disorder
Bulimia
Binge-eating disorder
Depression
Anxiety
Substance use disorder
Bipolar disorder
What Should I Expect?
Expect a course of treatment that typically consists of weekly group, skill-focused instructional meetings as well as individual therapy sessions. Individual sessions usually last an hour; group meetings, usually consisting of four to 10 people, are designed to run for an hour and a half to two hours. DBT is present-oriented and skills-based, and patients are asked to practice their skills between sessions. Patients can expect homework assignments, which might, for example, focus on taking specific, concrete steps to master relationship challenges.
DBT specifically focuses on providing therapeutic skills in four key areas.
Mindfulness enables individuals to accept and be present in the current moment by noting the fleeting nature of emotions, which diminishes the power of emotions to direct their actions.
DBT also inculcates distress tolerance, the ability to tolerate negative emotion rather than needing to escape from it or acting in ways that make difficult situations worse.
Emotion regulation strategies give individuals the power to manage and change intense emotions that are causing problems in their life.
Last but not least, DBT teaches techniques of interpersonal effectiveness, allowing a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships; a core principle is that learning how to ask directly for what you want diminishes resentment and hurt feelings.
DBT incorporates many of the techniques of cognitive behavioral therapy (CBT). It helps patients recognize and challenge the varieties of distorted thinking that underlie negative feelings and prompt unproductive behavior. For example, patients learn to identify when they are catastrophizing—assuming the worst will happen—in order to avoid acting as if it were the case. They review their own past and present experience for instances of all-or-nothing thinking, seeing everything in extremes of black or white, devoid of the nuance that is more generally the nature of life.
Mindfulness training is an important part of DBT. In addition to keeping patients present-focused, it slows down emotional reactivity, affording people time to summon healthy coping skills in the midst of distressing situations.
Patients are asked to keep a diary tracking their emotions and impulses, a tool that helps them gain awareness of their feelings, understand which situations are especially problematic for them, and use the information to gain control over their own behavior. In individual sessions, patients review difficult situations and feelings they faced the prior week and engage in problem-solving by actively discussing ways of behaving that might have delivered a positive outcome. In addition, patients typically have access to therapists between sessions for skills coaching if they are in a crisis.
How does it work?
In seeing many mental health conditions as disorders of emotion dysregulation, DBT is focused on emotions and how they feed ineffectual action patterns. Many elements of the therapy are aimed at teaching patients how to recognize, understand, label, and regulate their emotions and how to handle interpersonal situations that give rise to negative or painful emotions.
Each week, for individual therapy sessions, patients complete a diary “card” (often done via an app), a self-monitoring form that tracks individualized treatment targets relating to moods, behavior, and skills. Patients identify and rate the intensity of emotions they experience each day—fear, shame, sadness, anger, pain, suicide attempts, and more—and space is provided to discuss emotional experience in more detail if needed. In addition, using a checklist of skills—which also serves as a handy reminder to deploy them—patients note the frequency with which they engaged in positive practices, from self-soothing and radical acceptance to reducing vulnerability and acting in ways contrary to how they felt.
The information on the diary card lets the therapist know how to allocate session time. Life-threatening or self-injurious behavior takes priority, not surprisingly. After identifying the behavioral targets for a session, the therapist helps the patient engage in behavioral analysis, figuring out what led to a specific problem situation the patient encountered, including any underlying beliefs or attitudes that surreptitiously reinforce the behavior, and discussing the consequences of the patient’s actions. The therapist and patient discuss more skillful ways to solve emotional and life problems.
Because DBT is a demanding therapy to deliver even for experienced therapists, therapists typically work in consultation with a treatment team and regularly meet with a team. The team’s recommendations are often applied in individual therapy sessions.
What Is It?
The Gottman Method for Healthy Relationships is a form of couples-based therapy and education that derives from the relationship research of psychologist John Gottman. For more than 40 years, Gottman identified and tested the elements of an enduring relationship. Gottman and his wife, psychologist Julie Schwartz Gottman, created the clinical treatment framework known as the Gottman Method and launched the Gottman Institute, a center for training, research, and education.
One of the major tenets of the Gottman Method is that couples require five times more positive interactions than negative, as negative emotions, like defensiveness and contempt, hurt a relationship more than positive ones heal. As a result, the therapy focuses on developing the skills and understanding necessary for partners to maintain fondness and admiration, turn toward each other to get their needs met, and manage conflict. It also focuses on how couples can react and repair relations when they do hurt each other.
When Is It Used?
The Gottman Method is a broad-based treatment that serves all couples, at any age, and in any stage of a relationship.
A 12-year study conducted by Gottman found that while gay and lesbian couples have some distinct dynamics, they are comparable to heterosexual couples in many ways, and would benefit similarly from the Gottman Method.
The method can be applied to many relationship problems but may be particularly useful for couples who are:
Stuck in chronic conflict
Coping with infidelity
Struggling with communication
In a stagnant relationship or emotionally distanced
Facing difficulties over specific issues, such as money, parenting, or sex
All Gottman Method therapy is based on a couple’s patterns of interacting, and partners learn and implement relationship-building and problem-solving skills together.
What Should I Expect?
Couples begin treatment with an assessment process and an overview of what the Gottman Method is. It continues with:
Each partner establishing a relationship with the therapist by sharing their history, their relationship philosophy, and their goals for treatment.
Undergoing a thorough inspection of the union, including engaging in discussion of a topic on which partners disagree.
Learning the research-derived components of healthy relationships.
Bolstering the fondness and respect that first brought the partners together.
Direct coaching from the therapist on interaction skills and developing trust.
Acquiring tools for checking and maintaining relationship health beyond therapy.
The Gottman Method focuses not only on providing practical skills for managing relationships, but on delivering deeper insight into how the relationship dynamics developed.
The length of treatment depends on the severity of a couple’s challenges. Researchers have studied it using ten sessions as a benchmark, but the duration is ultimately a decision made by the couple and the therapist. In some cases, such as a couple in crisis, treatment is employed intensively over the course of two to four days.
How does it work?
The Gottman Method is built on decades of research and observation into how couples interact. Gottman found that negativity has a strong impact on our brains, and that, unless couples take steps to counteract instances of negativity, they grow apart emotionally. The method identifies and addresses the states of mind and behaviors shown to underlie intimacy and helps partners maintain a positive orientation to each other that can sustain them through upsetting circumstances.
The resulting treatment focuses on the nine components of a healthy relationship, what Gottman calls “The Sound Relationship House.” It includes the following:
Build Love Maps: Assessing how well partners know each other’s inner world: their hopes, stressors, worries, and desires.
Share Fondness and Admiration: A focus on the level of respect and tenderness that exists between the couple. Gottman calls this level “the antidote for contempt.”
Turn Towards Instead of Away: Being aware of your partner and responding when you can sense they need something emotionally.
The Positive Perspective: Approaching problems and repairing relationship failures with a positive attitude.
Manage Conflict: While conflict in a relationship is inevitable, and can even sometimes be beneficial, Gottman says, managing it is different from resolving it. Some problems can be fixed, but many relationship conflicts must simply be managed.
Make Life Dreams Come True: Creating an atmosphere that encourages each person to talk honestly about their hopes, values, convictions and aspirations.
Create Shared Meaning: Understanding important narratives, myths, and metaphors about the relationship.
Trust: Gottman defines trust as partners knowing that each will think and act in the best interest of the other.
Commitment: Knowing that your partner will stick with you through the rough patches and work to get through them. It involves a focus on gratitude for who your partner is and what they do in the relationship.
Although individual perspectives and wishes are addressed, all therapy sessions in the Gottman Method are conducted with both partners together, and therapists do not privilege secrets.
What Is It?
Person-centered therapy, also known as Rogerian therapy or client-based therapy, employs a non-authoritative approach that allows clients to take more of a lead in sessions such that, in the process, they discover their own solutions.
The approach originated in the work of American psychologist Carl Rogers, who believed that every person is unique and, therefore, everyone’s view of his or her own world, and their ability to manage it, should be trusted. Rogers was a proponent of self-actualization, or the idea that each of us has the power to find the best solutions for ourselves and the ability to make appropriate changes in our lives. He initially referred to this approach as non-directive therapy, since it required the therapist to follow the client’s lead and not direct discussion. It was a concept that turned upside-down established notions of therapeutic practice of the time, such as psychoanalysis and behaviorism.
During person-centered therapy, a therapist acts as a compassionate facilitator, listening without judgment and acknowledging the client’s experience without shifting the conversation in another direction. The therapist is there to encourage and support the client without interrupting or interfering with their process of self-discovery, as they uncover what hurts and what is needed to repair it.
When Is It Used?
Person-centered therapists work with individuals or groups, and both adults and adolescents; the therapy can be long-term or short-term. The approach can benefit people who seek to gain more self-confidence, a stronger sense of identity or authenticity, greater success in establishing interpersonal relationships, and more trust in their own decisions. The approach, alone or in combination with other types of therapy, can help those dealing with anxiety and depression as well as grief or other difficult circumstances, such as abuse, breakups, professional anxiety, or family stressors.
Since the client must take initiative in person-centered therapy, those who are more motivated are likely to be more successful.
What Should I Expect?
Person-centered therapy is talk therapy in which the client does most of the talking. The therapist will not actively direct conversation in sessions, or judge or interpret what you say, but they may restate your words in an effort to fully understand your thoughts and feelings (and to help you do the same). When you hear your own words repeated back to you in this way, you may then wish to self-edit and clarify your meaning. This can actually happen several times until you decide that you have expressed exactly what you are thinking and how you feel.
There may be moments of silence in person-centered therapy, to allow your thoughts to sink in. This client-focused process is intended to facilitate self-discovery and self-acceptance and provide a means of healing and positive growth.
How does it work?
Person-centered therapy, as envisioned by Rogers, was a movement away from the therapist’s traditional role as an expert and leader, and toward a process that allowed clients to use their own understanding of their experiences as a platform for healing.
The success of person-centered therapy generally relies on three conditions:
Unconditional positive regard, which means therapists must be empathetic and non-judgmental as they accept the client’s words and convey feelings of understanding, trust, and confidence that encourage clients to feel valued and to make their own (better) decisions and choices.
Empathetic understanding, which means therapists completely understand and accept their clients’ thoughts and feelings, in a way that can help reshape an individual’s sense of their experiences.
Congruence, or genuineness, which means therapists carry no air of authority or superiority but instead present a true and accessible self that clients can see is honest and transparent.
When therapy is working well, clients experience themselves as better understood in their sessions, which often leads them to feel better understood in other areas of their lives as well. Research supports this idea: Studies have found that when clients perceive these three qualities to be present in their therapists—and particularly when they recognize the professional’s unconditional positive regard for them—they are more likely to report achieving positive outcomes; in other words, the relationship established between client and therapist is itself therapeutic
A person-focused professional should have the ability to remain calm in sessions, even if a client expresses negative thoughts about the therapist. A trained therapist should allow a client to verbalize that they are frustrated or disappointed by them and help the individual discover what insights can be gained by exploring those feelings.
What Is It?
Affirmative therapy, or LGBTQ+ affirmative therapy, is a therapeutic approach that validates and advocates for the needs of sexual and gender minority individuals.
Affirmative therapy employs a positive and informed lens when working with LGBTQ+ clients, as it celebrates and validates their identities, as well as acknowledges the stigma and obstacles that these clients may face.
The opposite of affirmative therapy would be any therapeutic practice that aims to “fix” or change sexual and gender-diverse clients, or that judges or shames them.
Affirmative therapy is distinct from gender-affirming care. Gender-affirming care encompasses psychological, social, and medical care that supports an individual's gender identity. This involves a wide range of interventions, such as changing one’s name or pronouns, talk therapy, or hormone replacement therapy. Gender-affirming care has been shown to be effective and help improve well-being and life satisfaction.
When Is It Used?
Affirmative therapy is primarily used to treat LGBTQ+ individuals, who benefit from therapy that takes into account a thoughtful, supportive understanding of gender and sexuality. Affirmative therapy involves an awareness of societal challenges like stigma and bias—which can result in stress, anxiety, and depression—and helps clients process and cope with those challenges, as well as mental health challenges not directly related to gender and sexuality, such as relationships, self-esteem, career, etc.
What Should I Expect?
Sexual and gender minority individuals often face challenges of prejudice and bias, which can lead to a unique experience of stress, anxiety, avoidance, and other mental health issues. Affirmative therapy provides a supportive environment for patients to process those experiences while feeling confident that the therapist validates their identity. For example, a patient in affirmative therapy may discuss personal growth and exploration of their gender identity, or how external or internalized homophobia may have influenced them.
How does it work?
Patients should expect to discuss their experiences and address their mental health challenges with a therapist who is informed about LGBTQ+ issues and celebrates their identity. Validating their identity may take the form of using gender-neutral language, or being educated about homophobia or transphobia, among other elements.
What Is It?
When Is It Used?
What Should I Expect?
How does it work?
What Is It?
Because play is a major outlet through which children demonstrate what is on their mind, whether they have words or not, a branch of therapy has developed around understanding children and their needs by observing their play and helping solve problems through play. Play therapy is typically targeted to children ages 3 to 11 who have social, emotional, or behavioral difficulties. Play therapy is real therapy conducted in the medium of play.
Play therapy takes place in a comfortable playroom where few rules are imposed on a child, allowing the child free and spontaneous expression of feelings. The therapist, schooled in child psychology, usually has an array of toys that children can use to act out their feelings. In addition, the therapist may ask children questions about the toys they’re using that reveal hidden worries and concerns.
Play therapists pay special attention to the child’s choice of play objects, the types of play the child engages in, and well as the style of play. In addition, the therapist and child set up a trusting relationship between them that has therapeutic value. Through play therapy, children learn to express their thoughts and feelings in appropriate ways, learn about the feelings of others, learn ways of controlling their own behavior, and learn how to solve problems they encounter.
When Is It Used?
Parents sometimes think that play therapy is “just play.” But play is important to children. Not only can play be a window into their inner world, but a lot can happen that is therapeutic and should not be dismissed just because it is conducted through the medium of play. Children can come to discover ways of thinking and behaving that help them flourish.
Play therapy is helpful for children who are in distress for some reason, who display overt behavioral problems, or who have experienced a dramatic upset in their life, such as the death of a parent or parental divorce. It’s often used when children are facing serious medical procedures or struggling with chronic illness, and many children’s hospitals offer play therapy.
Play therapy is considered helpful for children who have experienced physical or emotional abuse or for those who have been bullied. It has been shown to be of help to children who have experienced war and other atrocities. Children who are persistently sad or anxious can find play therapy a safe and confidential way to work out their problems, as can those who are angry or have trouble adjusting to change.
Play therapy is also sometimes used with adults. Role-playing, for example, is a technique widely used in play therapy that is also incorporated into such standard adult therapies as cognitive behavioral therapy. Creative writing, music, and art may all be adapted for therapeutic purposes.
What Should I Expect?
Parents play an important role in play therapy for children. The therapist usually starts by conducting an interview with one or both parents or caregivers to gather information about the child and learn what the presenting problem is.
The therapist may then interview the child separately and watch the child play on his or her own. Simply observing how parents and child interact at this juncture can provide the therapist with information about the parent-child relationship, the nature of the child’s attachment, and how well the child and parents manage a separation.
The therapist may also ask the child and parent (or caregiver) to play together in order to observe how they interact. Based on the information and observations, the therapist discusses their findings with the parent and decides on an approach to the treatment of the child.
Play therapy usually occurs in weekly sessions for an average of 20 sessions lasting 30 to 45 minutes each. The therapy will be tailored to the individual child and the nature of the problems they are struggling with. Over time, the child typically comes to trust the play experience and the therapist, and a supportive relationship develops that fosters progress.
In addition to watching how children play with objects in the playroom, therapists notice whether there are any changes in play from session to session. Highly repetitive play may be an important indicator of a problem that requires exploration. Some therapists have playrooms equipped with one-way mirrors so that they can observe the child at play without being intrusive. They may also videotape one or more sessions for later review and detailed observation.
How does it work?
Play is used to understand what is on a child’s mind because play is children’s natural medium of expression. While play therapy, like all therapy, is conducted by way of appointment, few rules may be imposed on the child’s play, and it is the choice of play objects and how they are used that often provide clues to a child’s developmental level, their family and social relationships, the difficulties they are experiencing in life, and their inner world. A child may be given access to trucks and phones and other toys, to drawing and painting materials, to dolls and action figures, to puppets, to stuffed animals, to masks and costumes, to sand play, and more. A child may be asked to tell a story about their family through the use of puppets. Or a child may be given a magic wand and asked to make a few wishes.
Sometimes play therapy is more directed, and a therapist might engage with the child in a play situation. For example, the therapist and child might role-play an experience the child finds overwhelmingly stressful, such as the first day of school, allowing the child to express their anxieties while discovering that their worst fears do not materialize. During the role-play, the child might be asked to play out a variety of scenarios and to come up with ideas for making them turn out as they wish.
Or the therapist may construct play activities the therapist believes will help a child heal from emotional injuries. As a play partner, the therapist can help children with social or emotional deficits learn to communicate and interact more skillfully.
Unlike many other forms of therapy, play therapy is directed by the child. Yet children typically draw or play out scenarios that mirror problems in their real lives. The play therapist might engage in a narrative that articulates and interprets the inner experience of the child.
The freedom to direct the therapy helps children in many additional ways: It communicates complete acceptance, it helps children discover themselves, it helps them develop a sense of self-mastery, and it is a stimulus to learning new ways of behaving. Both directive play and nondirective play have their uses. Play therapists may use both approaches depending on the circumstances.
What Is It?
Solution-Focused Brief Therapy (SFBT) is one of the world's most widely used therapeutic treatments (De Shazer, 2007, Hsu, 2011). Unlike traditional forms of therapy that take time to analyze problems, pathology, and past life events, SFBT concentrates on finding solutions in the present and exploring one’s hope for the future in order to find a quick and pragmatic resolution of one’s problems. This method takes the approach that you know what you need to do to improve your own life and, with the appropriate coaching and questioning, are capable of finding the best solutions.
SFBT was developed by Insoo Kim Berg, Steve de Shazer, and their colleagues in the late 1970s. Disillusioned by the results of traditional psychoanalysis, Berg and de Shazer wanted to create a new type of therapy that dealt less with the “why” behind challenges patients face, and more with the “how” of treating them. Originally begun out of Berg’s living room, the group went on to found the Milwaukee Brief Family Therapy Center in the early 1980s.
A review of 43 studies on SFBT found that there was “strong evidence that Solution-Focused Brief Therapy was an effective treatment for a wide variety of behavioral and psychological outcomes.”
SFBT has become particularly popular in non-Western countries, another study showed. Though the treatment started in North America, since 2013 the amount of research on SFBT in non-Western countries is twice that of Western countries.
The approach is particularly popular in Asia. In the 1980s, Berg was invited to speak and give workshops on the technique in Hong Kong. The treatment received attention and study, and soon after reached Mainland China.
Researchers suggest that the efficacy, practicality, and optimistic nature of the treatment translate well across cultures, and that the approach allows patients to maintain familial relations and personal dignity while addressing mental health issues.
When Is It Used?
Solution-Focused Brief Therapy can stand alone as a therapeutic intervention, or it can be used along with other therapy styles and treatments. It is not geared toward a particular population, but aims to treat patients of all ages and a variety of issues, including child behavioral problems, family dysfunction, domestic or child abuse, addiction, and relationship problems. Though not a cure for psychiatric disorders such as depression or schizophrenia, SFBT may help improve quality of life for those who suffer from these conditions.
What Should I Expect?
Goal-setting is the foundation of Solution-Focused Brief Therapy. One of the first questions a therapist asks is called the “miracle question”: “If a miracle occurred while you were asleep tonight, what changes would you notice in your life tomorrow?” This opens up your mind to creating a plan to reach your goal. Along with your therapist, you will begin to chart small, pragmatic ways to make changes in your life to achieve your goals.
One of the tenets of SFBT is a positive, respectful, and hopeful outlook on the part of the clinician. Practitioners maintain the assumption that people have the strength, wisdom, experience, and resilience to effect change. What other models view as "resistance" is viewed in SFBT as people's natural protective mechanisms or a previous therapist’s error that does not fit the client's situation. These assumptions make for sessions that tend to feel collegial rather than hierarchical.
Solution-Focused Brief Therapy may vary for a given patient, treatment is typically complete after four to eight sessions.
How does it work?
One of the original beliefs of Solution-Focused Brief Therapy practitioners was that the solution to a problem is found in the “exceptions,” or those times when one is free of the problem or taking steps to manage the problem. Working from the theory that all individuals are at least somewhat motivated to find solutions, SFBT begins with what the individual is currently doing to initiate behavioral and lifestyle changes. The therapist uses interventions such as specific questioning techniques, 0-10 scales, empathic support, and compliments to help a person recognize the virtues and strengths that have previously gotten the patient through hard times and are likely to work in the future. Individuals learn to focus on what they can do, rather than what they can’t do.
For example, a solution-focused approach would be to question the parents of a child exhibiting behavioral problems about when the child acts out and ask the parents to spot the exceptions—the occasions when the child shows good behavior—and would invite the parents to figure out how they contributed to these exceptions. Once parents discover what may be causing the exceptions, the therapists focuses them on continuing and amplifying what works.
Alternately, if parents have been taught a solution that therapists hold in high regard, but that isn’t working for them or for their child, they are invited to disregard the plan. Solution-Focused Brief Therapy suggests that no matter how good a solution might seem, if it does not work, it is not a solution.
What Is It?
Humanistic therapy, also known as humanism, is a form of talk therapy that focuses on a person’s individual nature, rather than assuming that groups of people with similar characteristics have the same concerns. Humanistic therapists aim to consider the whole person, especially their positive characteristics and potential for growth, not only from their professional viewpoint but from a client’s own personal sense of their behavior. The emphasis in sessions is on a person’s positive traits and behaviors and developing their ability to use their instincts to find wisdom, growth, healing, and fulfillment.
When Is It Used?
Humanistic therapy can be used to treat people with depression, anxiety, panic disorders, personality disorders, schizophrenia, addiction, and interpersonal and familial relationship concerns. The approach can also benefit people who have low self-esteem, who are struggling with finding a purpose or reaching their potential, who lack feelings of “wholeness,” who are searching for personal meaning, or who are not comfortable with themselves as they are.
What Should I Expect?
Humanistic therapy sessions encompass a gestalt approach—exploring how a person feels in the here and now—rather than trying to identify past events that led to these feelings. A humanistic therapist seeks to provide an atmosphere of support, empathy, and trust in which an individual can share their feelings without fear of judgment. The therapist does not assume the role of an authority figure with clients; the relationship is one of equals and wherever possible, the direction of sessions is determined by the client and their concerns in the moment as the expert on their own life and challenges.
How does it work?
Humanistic therapy emerged in the late 1950s, out of a perceived need to address what some psychologists saw as the limitations and negative emphases of behavioral and psychoanalytic schools of therapy. They developed humanism as a new, more holistic approach less focused on pathology, past experiences, and environmental influences on behavior, and more on the positive side of human nature.
Around this time, Abraham Maslow developed his hierarchy of human needs and motivations, and Carl Rogers developed his person-centered approach to therapy. Both of these thinkers and their theories influenced the development of humanistic therapy. A core tenet of humanistic therapy is that people are inherently motivated to fulfill their internal needs—and that each of us has the power to find the best solutions for ourselves and the ability to make appropriate changes in our lives, a concept known as self-actualization.
What Is It?
Somatic therapy is a form of body-centered therapy that looks at the connection of mind and body and uses both psychotherapy and physical therapies for holistic healing. In addition to talk therapy, somatic therapy practitioners use mind-body exercises and other physical techniques to help release the pent-up tension that negatively affects a patient’s physical and emotional wellbeing.
Practitioners of somatic therapy address what they see as a split between the body. Instead, they believe mind and body are intimately connected, though not always in apparent ways. Thought, emotions, and sensations are all believed to be interconnected and influence one another.
If talk therapy has reached its limits for a patient, somatic therapy holds that the body is a largely untapped resource for psychotherapy. These resources include what can be learned from one’s gestures, posture, facial expressions, eye gaze, and movement.
Somatic therapies of different kinds have been practiced for centuries. Fundamentally, yoga and meditation can be considered somatic therapies, and both are often incorporated into guided treatments.
When Is It Used?
Somatic therapy can help patients who suffer from a range of ailments, including:
Trauma and post-trauma
Stress
Anxiety
Depression
Grief
Addiction
Sexual function
Somatic therapy is also used in the treatment of some physical conditions, including:
Chronic pain
Digestive disorders
Sexual dysfunction
What Should I Expect?
omatic therapy sessions can vary widely among practitioners, but fundamentally, somatic therapy combines mindfulness, talk therapy, and what can be considered alternative forms of physical therapy. The therapist helps you focus on your body or revive memories of traumatic experiences and pays attention to any physical responses you have once the emotion is experienced or the memory is recovered.
Treatment techniques include deep breathing, relaxation exercises, and meditation, each used to help relieve symptoms. Some of the adjunctive physical techniques that may be used with somatic therapy include dance, exercise, yoga, vocal work, and “bodywork” akin to massage or physical therapy. Treatment techniques can be used in individual or in group therapy settings.
You may have strong emotional and physical sensations arise during somatic therapy as a result of working through memories of experiences that were painful for you.
How does it work?
Somatic therapy emphasizes helping patients develop resources within themselves in order to self-regulate their emotions, or to move out of the fight/flight/freeze response and into a higher-functioning mode where they can think more clearly. Through developing awareness of the mind-body connection and using specific interventions, somatic therapy helps to release the tension, anger, frustration, and other emotions that remain in a patient’s body from these past negative experiences. The goal is to help free the patient from what is preventing them from fully engaging in their lives.
Physical awareness is a key part of somatic therapy. A therapist might help the patient get into a mindful state by asking them to notice certain things: If they are upset, what is it in their body that tells them they are upset? Is it a tightening in the stomach? Or a dark feeling in the chest? Then the therapist asks the client to focus on those sensations, and by observing the client’s gestures and postures, find out what movement the client would have liked to have made, but couldn’t.
Centering is a foundational practice in somatic therapy in which a patient develops a calm home base in the body. It is achieved through building awareness of one’s muscles, breath, and mood. By slowing down one’s breathing, patients are able to “feel” more of what’s going on around and inside them.
Bodywork is also a part of somatic therapy. Bodywork involves a practitioner working with the motion of a patient’s body or face and can involve the therapist manipulating a patient’s tissue. Bodywork can also involve breathing patterns and guided meditation.
What Is It?
When Is It Used?
What Should I Expect?
How does it work?
What Is It?
When Is It Used?
What Should I Expect?
How does it work?
What Is It?
Mindfulness-based cognitive therapy, MBCT, is a modified form of cognitive therapy that incorporates mindfulness practices that include present moment awareness, meditation, and breathing exercises. This therapy was formulated to address depression. Using these tools, the mindfulness-based therapist teaches a client to be in the here and now as well as break away from negative thought patterns that can cause a decline into a mood-disordered state; this therapy can help a person fight off a difficult frame of mind before it takes hold.
MBCT is derived from the work of Jon Kabat-Zinn, a professor of medicine and creator of the mindfulness-based stress reduction technique, which is often used in meditation and yoga practices. Psychologists Philip Barnard and John Teasdale contributed to this work; and later, Teasdale along with psychologists Zindel Segal and Mark Williams combined this stress reduction strategy with cognitive behavioral therapy.
When Is It Used?
MBCT was developed for people to prevent relapse from recurring episodes of depression or deep unhappiness. It has been proven effective in patients with major depressive disorder who have experienced at least three episodes of depression. Mindfulness-based relapse prevention may also be helpful in treating:
Generalized anxiety disorders
Bipolar disorder
General emotional distress
Addictions
MBCT has also been shown to improve symptoms of depression in some people with physical health conditions as well, including:
Vascular disease
Traumatic brain injury
Chronic pain
In addition, MBCT has been studied in women with fibromyalgia, showing its effectiveness in reducing the impact of this chronic condition.
What Should I Expect?
MBCT is normally conducted within a group setting, and the weekly sessions are led by a therapist. In about eight meetings, you will learn meditation techniques as well as basic principles of cognition, such as the relationship between the way you think and how you feel. You will also have the opportunity to learn more about your depressive condition. On the days when there is no session, there is homework, which includes practicing breathing exercises and mindful meditation. You will also be encouraged to bring this present-moment awareness into your everyday routines, when you prepare a meal, as you eat, while you shower, or when you are walking.
How does it work?
For a person who has recovered from a depressive state, sometimes normal sadness is a powerful trigger for relapse of depression. Rather than trying to avoid or eliminate sadness or other negative emotions, one learns to change their relationship with these emotions. Accepting sadness, for example, can be executed by practicing meditation and other mindfulness exercises. These activities rebalance neural networks, allowing the client to move away from automatic negative responses toward an understanding that there are other ways to respond to difficult situations. In effect, you will learn that you are not your thought patterns.
By developing a routine meditation practice, clients can use the technique whenever they start to feel overwhelmed by negative thoughts. When sadness occurs and starts to bring up the usual negative associations that can trigger a relapse of depression, the client is equipped with tools that will help them replace their negative thinking with calmness, compassion, and positive action. A study from the University of Oxford showed that such mindfulness-based therapy is just as effective as antidepressant medication.
To read more about each of these therapies, explore these sites below.