Understanding the Main Approaches to Psychotherapy

There are different approaches to psychotherapy and many psychotherapists integrate different models into their practice. In contrast, other therapists prefer to use one particular approach.

Below you will find a description of the main approaches to psychotherapy. This article was created to help you select a psychotherapeutic approach that is most effective for your needs and relates to your values, philosophy of life, and beliefs.

1. Psychoanalysis and Psychodynamic Therapy

By the end of the 19th century, the physician and neurologist Sigmund Freud developed a new psychotherapeutic method. He called it psychoanalysis or depth psychology. Psychoanalysis gave rise to modern psychotherapy and was based on the scientific method.

Psychoanalytic therapy is usually a long healing process, often lasting several years. This approach assumes that the origin of emotional problems is found in unconscious conflicts that occurred during childhood.

Talking with the therapist, you will have a better understanding of your emotions, attitudes, and intrapsychic conflicts. You will also analyze how the projection of your mental states can affect your life and current relationships.

Psychodynamic therapy uses interventions similar to psychoanalysis, but it is a much shorter therapeutic process. The key to treatment is in the therapeutic alliance that is created between the patient and the psychoanalyst. This alliance allows the analysis of the within the patient’s life.

Related link: American Psychoanalytic Association

2. Behavioral Approach to Psychotherapy

This approach emerged in the late 19th in opposition to psychoanalysis and other psychotherapeutic methods of the time. It assumes that behaviors are reflex acts conditioned by certain stimuli. Behavior is also the product of personal history, created through positive reinforcements or punishments.

At the beginning of the 20th century, the Russian psychologist Ivan Pavlov showed that it is possible to learn new reflex behaviors after having associated external stimuli to these behaviors. This method was called “classical conditioning.” The desensitization technique is based on this type of conditioning.

Around 1913, B.F. Watson established the psychological school of behaviorism and popularized the use of the scientific method with this approach.

Later, the psychologists Edward Thorndike and B.F. Skinner were pioneers in investigating operant conditioning. They discovered that by positively reinforcing a certain behavior it increased while applying negative reinforcements (punishments) the same behavior was reduced. On the other hand, that same behavior was extinguished, that is, it disappeared, when it was not reinforced (neither positively nor negatively).

These principles, initially discovered in animal studies, are the basis of behavioral psychotherapy. This therapy begins by identifying behavioral problems and the factors that cause or affect these behaviors. The goals of the treatment are defined later and alternative behaviors to the problem behaviors are identified.

Besides, you can evaluate the skills and resources you have, and learn strategies to learn useful behaviors that can be applied successfully to other areas of your life.

3. Humanistic and Transpersonal Approaches to Psychotherapy

Humanistic and transpersonal psychotherapy emerged in the 1950s as a third wave in psychotherapy. It responded to the limitations of psychoanalysis and behaviorism.

Three types of humanistic psychotherapies have been important:

Client-centered therapy (Carl Rogers);
Gestalt therapy (Fritz Perls);
Existential therapy, also called logotherapy (Viktor Frankl).

Humanistic psychotherapy focuses on knowing yourself and the search for meaning and purpose in life. One of its fundamental questions is: “What does it mean to be and to exist as a human being?”

When you know yourself better and have clarity about what you want, you can develop your potentials, and carry out your aspirations and life purpose.

This type of psychotherapy emphasizes the ability to empathically listen and reflect the client’s inner world. Empathy is a resource that is always present in this therapeutic approach.

As other psychotherapies, humanistic and transpersonal psychotherapy also operate within the psychological states that impede functioning and well-being. It relies on the intrinsic value of the human experience and the unique aspects and capacities of each person. This allows the client to go beyond their problems, trauma, and personal history, achieving a happier life.

Within transpersonal psychotherapy, the spiritual aspects of the person, whether called soul, spirit or higher mind, are also considered. It is assumed that within yourself lies this spiritual aspect, without associating it with a certain religion or spiritual tradition.

Viktor Frankl Institute of Logotherapy

Association for Transpersonal Psychology

4. Cognitive-Behavioral Approaches to Psychotherapy

This approach to psychotherapy aims to help people identify their negative automatic beliefs and inadequate behaviors. The goal is to replace them with more objective beliefs and beneficial behaviors that generate a better perception of themselves and life in general.

The focus of this therapy is the patient’s current experience and problems. One of its basic principles is that there is a reciprocal relationship between what you think, feel (your emotions), your physiology (how your body reacts), and your behaviors.

For example, this type of psychotherapy can help a person with depression to become aware of the negative thoughts and specific behaviors that are contributing to create and maintain their depressive state.

Cognitive-behavioral therapy incorporates principles derived from theories of learning and information processing. By changing beliefs and behaviors, the patients’ problems decrease and their performance improves in different areas of life.

The therapist also assumes the role of educator, working as a team with the patient, teaching different techniques that can alleviate problems and assigning tasks to perform between sessions.

The purpose of applying these strategies outside the therapy session is to help patients utilize them in solving their daily problems, in a way that requires less guidance. This will help maintain the changes and progress accomplished after the therapy ends.

5. Somatic Approaches to Psychotherapy

This psychotherapy is based on what the person is experiencing in the body. Becoming aware of the sensations and perceptions you experience in your body (somatic experience) is the starting point to understand what is happening currently in your inner world

At the same time, the therapist will help you relate these perceptions (body awareness) to important events – traumatic or not – that have occurred in the past and will help you associate them with your current difficulties.

This therapeutic approach assumes that the emotions, beliefs, and inner world of the person are reflected in the body through posture, degree of muscular tension, development of a certain body structure, or repetitive pains and sensations.

Its main objective is to help you achieve an adequate integration between your mind and body, and a presence of increased vitality, rooted in your body and daily experiences. Psychotherapists using this therapy modality may also integrate other body techniques such as physical exercises, breathing, movement, dance, yoga, Tai Chi, and Chi Kung.

Some pioneers of this psychotherapy approach were Pierre Janet in the late 19th century, Wilhelm Reich in the early 1930s and later, Alexander Lowen and John Pierrakos. Current exponents of this movement are Peter Levine, creator of Somatic Experiencing, and Pat Ogden, founder of Sensorimotor psychotherapy.

Somatic Experiencing Trauma Institute

Sensorimotor Psychotherapy Institute

6. Psychotherapy based on Neuroscience and Theory of Secure Attachment

This psychotherapy is based on the most recent advances in neuroscience which have shown that the brain is capable of changing under the action of the different life experiences. This ability is called “neuroplasticity.”

Creating new circuits in the brain and autonomic nervous system makes it possible to change negative beliefs and emotions, learn new skills and behaviors, and develop strength and resilience. It also helps us process the effect of recent traumatic experiences or those that occurred during childhood.

Advances in interpersonal neurobiology have demonstrated that we all need to relate to each other for our brain and mind to develop healthily. In this regard, the theory of secure attachment states that we are biologically programmed to build affective bonds with other people.

Our parents are the main figures of attachment, who provide support and affection during childhood. Depending on our parents’ attachment styles we develop a secure or insecure manner of relating to people.

Psychotherapists who use this approach seek to heal psychological conflicts or trauma that occurred during childhood, as well as deficiencies within personal relationships. These conditions are frequently the product of abandonment, rejection, and physical or psychological abuse experienced during early childhood.

The mind and brain are utilized to acquire new skills and achieve a more fulfilled and happier life, while restoring trust and connection with other people.

Scientific studies have shown the validity of the secure attachment theory, proposed in the 1960s by John Bowlby, psychologist, psychoanalyst, and British psychiatrist.

This approach is also valuable in teaching parents new behaviors and ways to communicate with their children that facilitate optimal psychological development and healthy relationships between parents and children.

7. Acceptance and Commitment Therapy (ACT)

This therapy was created by Steven C. Hayes in 1982 and integrates strategies to develop acceptance and flexibility using a cognitive-behavioral approach. Called ACT, for its acronym in English “Acceptance and Commitment Therapy.”

One of the objectives of this type of psychotherapy is that the person accepts his/her emotions, reactions, and life as they are, without avoiding or trying to control difficult situations that may arise.

ACT invites you to accept reality as it is and work with what you have now. Based on your current situation you can develop the ability to find purpose and meaning in your life.

This therapy suggests that it is possible to achieve a state of greater well-being by overcoming negative emotions and thoughts, and adopting behaviors that help achieve valuable changes in life. Consequently, within this approach to psychotherapy you need to establish a commitment that helps in the achievement of your proposed goals with concrete actions.

ACT uses various mindfulness exercises that can increase awareness of your thoughts and emotions, helping to choose new behaviors that are related to your values and purposes.

Related link: Steven C. Hayes, PHD

8. Internal Family Systems Therapy (IFS)

This psychotherapy approach was created by Richard Schwartz. It assumes that the psychological system of every person contains various sub-personalities that are generally in conflict with each other.

These sub-personalities are parts within the person that usually are affected by or laden with painful emotions. Examples of such emotions are sadness, shame, frustration, and anger. These painful emotions are generally caused by abuse or trauma during childhood.

The goal of this therapy is to heal those wounded parts, achieving balance and harmony among them while reestablishing contact with your real Self. The Self is the essence within you that always remains undamaged, intact, and complete, beyond the difficulties and traumas you might have experienced. The Self contains aspects such as compassion, confidence, relaxation, and security.

This psychotherapy uses the following techniques:

Dialogue between the parts (sub-personalities);
Locating where a certain part feels in the body:
Visualization and diagrams to identify the sub-personalities;
Understanding how these parts relate to each other;
Releasing the emotions contained in the sub-personalities.

Gradually, your real Self will direct these sub-personalities within you. As a result, the unique qualities of your Self will be more fully expressed. This psychotherapy approach explicitly assumes the spiritual nature of the Self.

Related link: IFS Institute

9. Dialectical Behavior Therapy (DBT)

This modality of cognitive-behavioral therapy was originally developed by Marsha Linehan to treat patients with suicidal tendencies. It has also proven its effectiveness for the treatment of borderline personality disorder. This psychotherapy approach also integrates mindfulness practices to generate acceptance of things that can’t be changed.

This therapy seeks to solve the patient’s problems with the support of dialectical philosophy. Reaching a balance between acceptance and change – two seemingly opposing aspects – can be achieved through this therapy.

An essential goal of this approach is helping patients reduce the onset of polarized and extreme thoughts, emotions, and behaviors. Learning to react in a more balanced way within the situation of the present moment is another key target.

Related link: The Linehan Institute

10. Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is a structured form of psychotherapy that uses eye movements or other type of bilateral stimulation. It helps reduce or eliminate the effects of traumatic experiences.

The therapist will ask you to focus on the traumatic memories. At the same time, he/she will move the fingers from side to side or diagonally. Several sessions are necessary which usually makes the traumatic memories and emotions less vivid and intense.

This therapy can integrate into the treatment elements from other approaches such as psychoanalytic therapy, cognitive-behavioral therapy, or somatic psychotherapy.

EMDR focuses on the perceptual aspects of memories (cognitive, affective, and somatic) which creates new links with other memory networks in the brain. This reprocessing helps the patient desensitize from the traumatic memory.

Consequently, stimuli that previously triggered states of anxiety, fear or panic, don’t generate these effects anymore. The autonomic nervous system has been regulated through the therapy.

The person can also become aware of new aspects that may help solve their difficulties. This occurs because the mind can generate new connections and process information differently. Beyond the effects of trauma, constructive behavior and personal growth can arise more easily.

Related link: EMDR Institute

References

American Psychological Association. Different approaches to psychotherapy. Retrieved from https://www.apa.org/topics/therapy/psychotherapy-approaches

Hersen, M. & Sledge, W., Eds. (2002). Encyclopedia of psychotherapy. Academic Press.