Therapy Approaches
1-1 / Couples / Families
The Technical Definition – “Clinical psychology is an integration of psychological science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development.”
But what do we actually do? Well, when you come in you tell me about a particular problem you are having currently in your day-to day life. This might be in the form of physical or behavioural ‘symptoms’ you are experiencing. It might be problems you are having in your relationships with friends, family colleagues. It could be about how you feel about yourself or your life in general. It might also be about things that have happened to you in the past and still cause you distress. I will ask you some questions so I can try to really understand how these issues affect you.
We will then spend a session or two talking about your life history, from birth to now. This helps me to understand together what has shaped you, your psychological, emotional and relational development so we can come to understand how you see and experience the world, and how that affects your current problems. I might even give you a questionnaire or two to help us with this understanding.
I bring the clinician’s psychological knowledge and your life story together to develop your psychological formulation. This synthesis will help us to identify the areas we need to work on and select the best therapeutic approaches for you. This may involve learning new skills or techniques to manage symptoms. We may look at your early experience and try to reframe it so that it doesn’t negatively affect you in the here and now. We might discuss how you have related to other people over the past week and explore different interpretations and ways to respond to others. These are just some examples of what therapy might look like. You can see descriptions of different therapies on the therapy approaches page.
Mentalization Based Therapy (MBT)
Mentalizing is defined as implicitly and explicitly interpreting the actions of oneself and other as meaningful on the basis of intentional mental states (e.g., desires, needs, feelings, beliefs, and reasons). It is the process of understanding the thoughts and feelings of ourselves and others. We all do this every day of our lives from thinking about why we feel the way we do about an event to wondering why our loved one or colleague appears to be in a bad mood or said a certain thing. We often do this automatically and switch to a controlled, effortful mentalizing when we need to. Some people can find it difficult to switch to controlled mentalizing and their automatic mentalizing leads them to assumptions and responses that cause more problems. This can lead to feeling like nobody understands you and that you don’t understand yourself.
MBT was developed through working with people who have a diagnosis of Borderline Personality Disorder however it has been used successfully for many different problems and client groups. The major goals of MBT are: (1) better behavioral control, (2) increased affect regulation, (3) more intimate and gratifying relationships and (4) the ability to pursue life goals. This is believed to be accomplished through increasing the patient's capacity for mentalization in order to stabilize the client's sense of self and to enhance stability in emotions and relationships.
MBT services usually run as weekly group and individual sessions for 12-18 months. MBT can also be used in individual therapy where clients experience difficulty with extreme emotions and problems in relating others. The therapy works through building a safe attachment relationship with the therapist which provides a relational context in which it is safe for the patient to explore the mind of the self and other. The development the therapeutic relationship, together with a persistent focus on mentalizing in therapy, facilitate change by leaving people more open to learning outside of therapy, in the social interactions of their day-to-day lives.
Therapy for Trauma (EMDR)
Eye movement desensitization and reprocessing (EMDR) is a fairly new, non-traditional type of psychotherapy. It's growing in popularity, particularly for treating post-traumatic stress disorder (PTSD). PTSD often occurs after experiences such as military combat, physical or sexual assault, or car accidents.
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We do know that when a person is very upset, their brain cannot process information as it does ordinarily due the high levels of distress causing the pre-frontal cortex to ‘shut down’. One moment becomes "frozen in time", and remembering a trauma may feel as bad as going through it the first time because the images, sounds, smells, and feelings haven’t changed. Such memories have a lasting negative effect that interferes with the way a person sees the world and the way they relate to other people.
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EMDR seems to have a direct effect on the way that the brain processes information. It allows the prefrontal cortex to remain ‘online’ so that normal information processing is resumed. Following a successful EMDR session, a person no longer relives the images, sounds, and feelings when the event is brought to mind. They still remember what happened, but it is less upsetting. Many types of therapy have similar goals. However, EMDR appears to be similar to what occurs naturally during dreaming or REM (rapid eye movement) sleep. Therefore, EMDR can be thought of as a physiologically based therapy that helps a person see disturbing material in a new and less distressing way.
Schema Focused Therapy
Young (1990) developed Schema Therapy to work with clients who are diagnosed with a personality disordered, or characterological difficulties, who cannot be adequately helped by standard Cognitive Behavioural Therapy (CBT). Schema Therapy is an integrative therapy, combining aspects of cognitive, behavioural, psychodynamic, attachment and Gestalt models. It sees the cognitive and behavioural aspects as vital to treatment, as in standard CBT, but gives equal weight to emotional change, experiential techniques and the therapeutic relationship. Like CBT, it is structured, systematic and specific. It follows a sequence of assessment and treatment procedures. The model outlines specific schemas, coping styles and modes. Perhaps most importantly, it normalises rather than pathologises personality disorders in its assumption that everyone has schemas, coping styles and modes, however, in the people we treat they are more rigid and extreme.
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Schema Therapy places a greater emphasis on the childhood origins of psychological problems which is particularly relevant in this context. Young (1990) defines Early Maladaptive Schemas (EMS) as self-defeating emotional and cognitive patterns that develop early in childhood and are strengthened and elaborated throughout life. Maladaptive behaviours are thought to be driven by schemas. According to the model, schemas are dimensional, meaning that they have different levels of severity and pervasiveness. The more entrenched the schema, the greater number of situations that activate it, the more intense the negative affect and the longer it lasts. Offending behaviour can be understood as an extreme consequence of schema activation.
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Young has identified 18 schemas, all of which are maladaptive and he postulates that the person develops coping strategies in order to cope with the emotional distress associated with the schema. These coping styles take the form of Schema Surrender (giving in to the schema and accepting that the resulting negative consequences are unavoidable); Schema Avoidance (avoiding triggers internally and externally that may activate the schema); and Schema Overcompensation (acting as though the opposite was true) (Young , 1990).
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Schema Therapy can be done as a combination of group and individual therapy sessions, or individual only session. I currently use schema therapy in individual therapy sessions, usually where there are difficulties relating to others and problems arise in your day-to-day functioning as a result. Firstly, you and your therapist will identify what schemas are currently active and causing you difficulties and then help you to spot them in real life situations. Secondly, cognitive and experiential techniques such as imagery are used to undermine and heal the schemas reducing their impact. Finally, the development of new, healthy and adaptive behavioural responses help to improve your current functioning.
Dialectical Behaviour Therapy
Dialectical Behaviour Therapy (DBT) integrates Cognitive Behavioural Therapy (CBT) with Eastern mindfulness practices. It is an evidence-based therapy that has proven effective in helping people develop coping skills, reduce self-harm behaviours and improve negative patterns of thinking. DBT encompasses four modules of therapy:
Existential Therapy
The existential approach is first and foremost philosophical. It is concerned with the understanding of people’s position in the world and with the clarification of what it means to be alive. It is also committed to exploring these questions with a receptive attitude, rather than a dogmatic one: the search for truth with an open mind and an attitude of wonder is the aim, not the fitting of the client into pre-established categories and interpretations.
The existential approach considers human nature to be open-ended, flexible and capable of an enormous range of experience. The person is in a constant process of becoming. I create myself as I exist. There is no essential, solid self, no given definition of one’s personality and abilities.