Psychotherapy Definition and Objectives - Treatment Modalities

Psychotherapy - Definition

Generally speaking, Psychotherapy is a process through which individuals in states of distress, or different forms of dysfunction attempt to mitigate, or eliminate symptoms, or conditions thought to be related to their discomfort, or anguish, or failure to adapt and relate to others.

Having said that, one may consider that there may be individuals that are "Ego-Syntonic"; that is, their signs and symptoms are not recognized by them, nor do they think they have any problems; e.g. some alcoholics, those suffering serious thought disorders, narcissists, etc.

Thought these individuals may cause adversity, and even harm to others, they are oblivious of their actions and contributions.

So, to state that Psychotherapy addresses individual suffering, may not be inclusive.

We need to expand our definition of what "Psychotherapy" is, to include the objective of "assisting individuals in recognizing and mitigating characterological defects, or deficits, that may cause, or contribute adversely to the wellbeing of others.

We need to also consider that there are individuals who though capable of certain levels of success and achievement, are underperforming, and/or underachieving due to characterological quirks that adversely impact on their self-esteem, confidence, and self-regard.

Finally, we may be remiss in not addressing Dysfunctions in family, and or group units in need of exploring underying causes and reasons that adversely impact on the quality of their relationships

"Psychoanalysis", unlike its sister "Psychotherapy", is a very long and tedious process through which the primary objective is a complete restructuring of an individual's character, and personality.

Psychotherapy Delivery and Service Types

• Face to Face - In Office
• Face to Face - In Home
• Face to Face - On Line Skype, Video Conference
• Face to Face - In Agencies
• Face to Face - In Hospital, Residencies
• Face to Face - In Group - Conference Rooms
• Face to Face - In Group - Community Settings
• Via Telephone
• Via Email - Chat

Individual Psychotherapy - Subtypes and Differences

Psychodynamic psychotherapy

Most essential to this treatment process is an acceptance of the premise that mental health issues neither exist in a vacuum, nor are they caused by a single event.

Absent any physiological, medical, or neurological conditions, this approach is with an understanding that a multiplicity of factors, through a dynamic interplay, stand at the foundation of every condition.

Genetic predispositions, characterological constellations, medial issues, early developmental experiences, social and family dynamics; all blend into an amorphous mass that is at the core of every condition.

Through a very close relationship between the client and the therapist, a process begins and focuses on exploring the client’s past as it relates to their present condition, their thoughts, actions, and reactions.

Under this regiment, a well trained and experienced professional, refrains from a strict adherence to single theories, or blind adherence to singular techniques such as CBT, DBT, or BM, or ...

The primary aim is not to identify destructive thoughts, states, or behavioral patterns, but rather the restructuring of one's personality dynamics.

This is done in a tedious and progressive fashion, identifying the transductive nature of the evolution of the personality, its traits, and its processes; That is, the 'how' thoughts, feelings, and/or actions are being mentally transported and/or transformed into psycho-physiological and/or behavioral events and/or processes.

What is the associative process of sensors in the body or mind, that leads up to the conversion of either conscious, or unconscious experiences into cognitive, behavioral, or affective states?

The therapist begins with a typological evaluatory process, and sets a theoretical basis within which behavioral manifestations and congruence of thoughts and affects are followed for oddities, or variations. Exceptional attention is given to how the individual moves from one thought to another, and whether there exists a need to view client's product in a symbolic, or metaphorical fashion.

Themes related to resistance, transference, and defense mechanisms are noted for levels of maturity and the emergence of introjects.

When appropriate, Ego Functions are assessed and client's insight is encouraged through retrospective analysis of content and behavioral signs.

Psychoeducational Psychotherapy

As Introduced by Kasdaglis, M in the mid-nineties, its aim went beyond families and children.

It's usefulness is not merely to educate the patient and families about conditions, or disorders, or symptoms, or their course, prognosis, and other relevant information.

Properly used it is a distinct treatment technique that may be viewed as a highly effective adjunct to other therapeutic modalities, and especially to psycho-dynamic approaches.

It focuses on providing the patient and his, or her family with a "dynamic formulation" of the condition and its sympoms; doing so the patient, as well as the family become integrated into the treatment process.

A dynamic formulation articulates the patient's condition and symptoms from an "Object Relations" perspective based on their history and dynamics. It proposes the ideas of "behavioral determinism", where no behavior is accidental, even if the disorder may have some genetic origins.

To understand this, we might resort to a rather trivial example. Someone born and raised in a remote village of Antarctica, never having the privilege or modern communication, or travel, has inherited a gene for Obsessive-Compulsive-Disorder. ... Eventually, his condition includes brushing his foot-prints on the snow every time he takes a step... His condition may never manifest in coconuts falling on his head as his Florida-born OCD counterpart; and neither will he ever be found to suffer from "bacterio-phobia" followed by compulsions to wash their hands a few times a day...

Object relations, and especially parental introjects, may have set the stage for this Antarctica man each time some event serves as a symbol, a metaphor, or a trigger, if you will... Once the therapist has some understanding of this, the therapist may formulate the dynamic correlate, wait for the patient to enter into a state filled with a reasonable replica of the initial affective experiences, and then proceed to share this with their client...

Laughable as it may sound, the CBT therapist will suggest breathing techniques, meditation, exposure, or implosion techniques ! - Band-Aids to a hemophiliac !

Ego-Functions (Ego-Psychology) psychotherapy

In this approach, rather than looking at the label, or the condition, a well-trained Ego-Functions practitioner, makes an assessment of the level of operational adequacy of a dozen or so, “Ego-Functions”.

Examples include, though not limited to: Insight, Judgment, Self-observing ego, sense of reality, reality testing, object relations, etc. (For a complete annotated list please go to Ego-Functions.html).

Having done so, and using parts of a psycho-educational approach, a treatment plan is designed that will address the strengthening of each function in need of mitigation.

Psychoanalytic therapy.

A rather well-known treatment process, as well as rejected and misunderstood by contemporary mental health professionals. Practitioners are required to have undergone 4 to 10 years (3 times weekly) post-graduate psychoanalysis themselves.

It is based on theories and postulations of Sigmund Freud, who described the unconscious as the reservoir of desires, thoughts, and memories that are below the surface of conscious awareness.

He believed that it was these unconscious forces that could often lead to psychological distress and disturbances.

Early childhood experiences have shaped the individual and they are at the core of psychopathology.

The aim is to explore these experiences as a cathartic venue and to gain insight and awareness of unconscious forces causing, or contributing to their current state.

Family Psychotherapy - Subtypes and Differences

Conjoint Family Therapy

Introduced by Virginia Satir who many consider as the "Mother of Family Therapy, it focuses on family reconstruction.
It does so through 3 primary approaches.

Collaborative treatment: 1 or more members of the patient's family are simultaneously treated by 2 different therapist sharing in the same treatment objective.

Concomitant treatment approach :the identified patient, and at least one more family member, are treated by the same therapist. and

Conjoint sessions: All family members are seen simultaneously.

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While treating a single individual within a family system, well seasoned psychotherapists will 'always' insert and utilize Dr. Satir's techniques and postulates, especially in reference to communication patterns, 'self-esteem' issues, and 'triangulations'.

Family - Marital - Couples

Family therapy, also referred to as couple and family therapy, marriage and family therapy, family systems therapy, and family counseling, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of interaction between family members. It emphasizes family relationships as an important factor in psychological health.

This type of therapy helps spouses and partners understand why their loved one has a mental disorder, what changes in communication and behaviors can help, and what they can do to cope.

This type of therapy can also be used to help a couple that is struggling with aspects of their relationship.

Family: Because family is a key part of the team that helps people with mental illness get better, it is sometimes helpful for family members to understand what their loved one is going through, how they themselves can cope, and what they can do to help.

Psychodynamic Family Psychotherapy

Introduced by the 'father of Family Therapy', Dr. Nathan Ackerman, it adheres to a belief that a patient's condition, and/or disposition is both the cause, as well as the result of an interplay between the patient and other family members.

There is a proposition that people that we are related to may either enhance, or inhibit the probability of what is innate to become manifest.

Implied under these premises is Dr. N's conviction that patients be treated within the context of their family.

His techniques are based on psychodynamics

Where psychoanalytic theory focuses on the internal manifestations of a mental health condition, Psychodynamics seek to identify, unravel, and deal with, both, internal as well as external and family dynamics.

The Kasdaglis Variant Model (KVM)

Under this regiment, a well trained and experienced professional, refrains from a strict adherence to single theories, or blind adherence to singular techniques such as CBT, or BM, or ...

Depending on the diagnosis, client's intellectual capacity, symptomatic presentation, client's objectives, and a host of other considerations, the Therapist may vary techniques from one session to another, and even within the same session.

To be effective, there is a definite requisite for the professional to be exceptionally well versed in all known theoretical backgrounds, familiar with applied treatment modalities, and last, but not least, hold a minimal bias in favor, or against particular approaches.

Especially crucial is advanced knowledge of Family Dynamics and techniques as per Satir, Bateson, Ackerman, and Minchin.

MFT (Marriage and Family Therapy) (Couples and Family Therapy)

This type of treatment is delivered by practitioners licensed and/or certified in Family Therapy. It focuses on dysfunctional patterns of family relations by addressing issues of communication, and/or family structure and dynamics.

SFBT (Solution-Focused Brief Therapy.)

The focus of this approach is finding solutions, rather than exploring the basis of the underlying issues, or pathology.

In this treatment approach understanding of the problem is irrelevant, in as much as the solution is always the same :

Almost like a robot, a questions is posited to every client : Imagine you woke up this morning and your problem was gone. What would your life be like ? …

CBT, RET, BMT
(Cognitive Behavioral therapy), (Rational Emotive Therapy), (Behavior Modification Therapy)

These therapies depend on the presumption that individuals have developed ill-conceived themes, or behavioral patterns, through which they view the world and its vicissitudes.

In that sense, the focus is neither the individual, nor their condition. Rather it is in convincing the patient of their error in thinking and “teaching” them new and more innovating ideas that lead to the development of personal coping strategies that target solving current problems and changing unhelpful patterns.

Unbelievable as it may sound, CBT claims to be effective in all areas of need from acne to schizophrenia. It is dysfunctional thinking that leads to dysfunctional emotions or behaviors.

By changing their thought process, they can change how they feel, and behave.

Dialectical Behavioral Therapy (DBT)

This is a variant of CBT; its objective to identify negative thinking patterns and replace them wwith morepositive behaviors.

It is claimed that DBT may be effective in treating destructive behavioral patterns, and suicidality.

TMS (Trans-cranial magnetic stimulation)

This is an intensive treatment technique minimally for a total of 10 sessions, 5 days weekly each session lasting ap 45 minutes.

Please note that TMS is less likely to be effective with patients that had unsuccessfully tried a plethora of different medications for prolonged periods of time.

About 40% of veterans with treatment-resistant major depression achieved remission following treatment with sham or active repetitive transcranial magnetic stimulation (rTMS), reported a clinical trial in JAMA Psychiatry.

TMS is a none invasive technique utilizing magnetic coils to stimulate the brain through electrical currents.

TMS is totally painless, and does not require the patient to be under anesthesia or muscle relaxants;

ECT (Electro-Convulsive Therapy)

Individuals with severe major depression, or bipolar type II disorder, who have not appeared to respond to medications, may benefit from Electroconvulsive therapy (ECT)

This procedure entails brief electrical stimulations of the brain while the patient has been given muscle relaxants, and is under general anesthesia.

It's administration is handled by a psychiatrist, an anesthesiologist, and a nurse. more often than not, the first 3 sessions are on 'inpatient' basis

NLP (Neurolinguistics programming.).

Developed by Richard Bandler and John Grinder, it aims at changing your thoughts and actions, by emulating successful people's patterns of thoughts and behaviors.

The primary technique is reframing problems in a manner that alters the perception of symptoms, or events.

EMDR (Eye Movement Desensitization and Reprocessing.)

Introduced by Shapiro in 1989 a psychotherapeutic approach originally designed to alleviate distress associated with traumatic memories.

Aka “Adaptive Information Processing model” is supposed to facilitate accessing and processing of traumatic memories and other adverse life experiences.

An interactive technique facilitating the reduction of psychological stress through reliving traumatic experiences from the past by the therapist directing your eye movements.