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Types of Therapy

The well-accepted definition of psychotherapy today is

"an interpersonal process designed to bring about modifications of feelings, cognitions, attitudes and behaviour which have proved troublesome to the person seeking help from a trained professional" (Strupp, 1978)

Within this broad definition, over 400 different therapies have been identified. Of these, the major classes include psychodynamic, behavioral and cognitive-behavioral, interpersonal, dialectical, family systems, and supportive psychotherapy. I am trained and experienced in all of these approaches to therapy. How I work with any individual client depends on the presenting problems.

Cognitive-Behavior Therapy (CBT) - CBT focuses on identifying problems and alleviating symptoms quickly and effectively. CBT helps you learn specific skills to deal with problems that concern you. Although gathering developmental history is often important, CBT does not dwell of family history and unconscious impulses. CBT helps you to learn skills that you can use for the rest of your life. These skills involve identifying automatic thoughts that cause emotional distress, interpretation biases that influence your thinking, and beliefs that contribute to problems. CBT helps you change habits and behaviors that you need for more successful relationships and for creating a healthier and happier life. CBT helps you learn how to manage emotions and use them adaptively.

Interpersonal Psychotherapy (IPT) - IPT starts by identifying and explaining the source or cause of your discomfort. The focus is on the ways in which your current functioning, social relationships, and expectations within these relationships may be contributing to the current upset. Usually the distress comes from one of four interpersonal areas: grief, interpersonal role disputes, role transitions, or interpersonal deficits. Treatment focus depends on which of these four areas is involved. For example, you may need to mourn a lost relationship and get assistance in finding new relationships and activities to compensate for the loss. Role disputes involve arguments and conflict about role responsibilities and fulfillment of these. Treatment involves helping you explore the source of the conflict and consider options to resolve the conflict. Treatment for a role transition, such as retiring or coping with a job loss, involves learning new coping skills and developing a plan for the future. Helping someone with interpersonal deficits may mean working on areas such as assertiveness training, anger management, or social skills training. Though originally intended for countering depressive symptoms, IPT has more recently been adapted for use with a wider range of disorders.

Dialectical Behavioral Therapy (DBT) - This therapy approach was originated by Marsha Linehan, Ph.D., at the University of Washington, who has done over 30 years of research demonstrating its efficacy. DBT is especially helpful for the client who experiences frequent crises, tends to act impulsively, and frequently feels overcome by emotions. The basis of DBT is learning the skill of mindfulness. From this foundation, clients learn how to tolerate distress and manage emotions more effectively. Skills for improving interpersonal relationships are also part of the focus of DBT.

Systemic or Family Systems Therapy - The Family Systems approach to therapy looks at how each person in a family, group, or organization plays (or played) a role in the system as a whole. This approach assumes that each element of the system is interconnected, and each element influences all others in significant ways. One element cannot change without the whole system changing. In a family systems model, psychological distress is assumed to be the result of the way the whole system interacts, and is not just one person's problem or difficulty. Although systemic thinking includes consideration of the entire family, working with the entire family is not necessary to bring about systemic change. Family systems thinking is a non-blaming approach to understanding and changing emotional distress. A family systems approach is especially useful with couples and families, although family systems thinking can help inform individual therapy as well.

Psychodynamic Psychotherapy - Unlike classical psychoanalysis, modern psychodynamic psychotherapy is relatively brief, focused therapy. Psychodynamic psychotherapy strives to help you identify and understand the historical influences that have contributed to current distress and to help you work through this distress. This therapy is an insight-oriented approach that assumes insight and understanding can lead to change. Psychodynamic psychotherapy may be a good choice if you have trauma issues or when you have difficulty articulating your goals in therapy. The therapist's job is to make connections and bring to consciousness that which was not in awareness. Sometimes the therapist's job is simply to bear witness so that the client can find his own strength and healing.

Dr. Joyce Nash, PhD    (650) 329-1000