Therapeutic Modalities

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. Therapists help patients understand and accept that thought is an inherently messy process. DBT is itself an interplay of science and practice.

Internal Family Systems (IFS) is an approach to psychotherapy that identifies and addresses multiple sub-personalities or families within each person’s mental system. These sub-personalities consist of wounded parts and painful emotions such as anger and shame, and parts that try to control and protect the person from the pain of the wounded parts. The sub-personalities are often in conflict with each other and with one’s core Self, a concept that describes the confident, compassionate, whole person that is at the core of every individual. IFS focuses on healing the wounded parts and restoring mental balance and harmony by changing the dynamics that create discord among the sub-personalities and the Self.

IFS was developed by psychologist Richard Schwartz. In his work as a family therapist, Schwartz began to observe patterns in how people described their inner lives: “What I heard repeatedly were descriptions of what they often called their “parts”—the conflicted subpersonalities that resided within them,” Schwartz says. He began to conceive of the mind as a family, and the parts as family members interacting with one another. Exploring how these components functioned with one another was the foundation for IFS and the idea of the core Self.

Expressive arts therapy combines psychology and the creative process to promote emotional growth and healing. This multi-arts, or intermodal, approach to psychotherapy and counseling uses our inborn desire to create; such a therapeutic tool can help initiate change. For some people who have a hard time articulating what they are feeling, self-expression through art can be useful. Expressive arts therapy draws from a variety of art forms, and this integration of methods can help patients access their emotions. Meanwhile, art therapy tends to be based on one particular art form.

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.

Cognitive processing therapy (CPT) is a specific type of cognitive-behavioral therapy found to be effective for treating post-traumatic stress disorder (PTSD) in people who have experienced violence, abuse, natural disasters, or other traumatic events. CPT is short-term, typically conducted over the course of 12 sessions.

In CPT, the therapist will help a patient who has undergone significant trauma to evaluate his or her thoughts surrounding the trauma, particularly maladaptive or self-blaming thoughts that may be exacerbating PTSD symptoms, and conditions including anxiety and depression that set on in the wake of the experience. 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; for example, patients will likely be asked to write an account of their trauma between sessions, to be read aloud in a later session.

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.

The trauma-focused approach to therapy was first developed in the 1990s by psychiatrist Judith Cohen and psychologists Esther Deblinger and Anthony Mannarino, whose original intent was to better serve children and adolescents who had experienced sexual abuse. TF-CBT has expanded over the years to include services for youths who have experienced many forms of severe trauma or abuse.

Acceptance and commitment therapy (ACT) is an action-oriented approach to psychotherapy that stems from traditional behavior therapy and cognitive behavioral therapy. Clients learn to stop avoiding, denying, and struggling with their inner emotions and, instead, accept that these deeper feelings are appropriate responses to certain situations that should not prevent them from moving forward in their lives. With this understanding, clients begin to accept their hardships and commit to making necessary changes in their behavior, regardless of what is going on in their lives and how they feel about it.

ACT was developed in the 1980s by psychologist Steven C. Hayes, a professor at the University of Nevada. The ideas that coalesced into ACT emerged from Hayes’s own experience, particularly his history of panic attacks. Eventually, he vowed that he would no longer run from himself—he would accept himself and his experiences.

“We as a culture seem to be dedicated to the idea that ‘negative’ human emotions need to be fixed, managed, or changed—not experienced as part of a whole life. We are treating our own lives as problems to be solved as if we can sort through our experiences for the ones we like and throw out the rest,” Hayes writes in a Psychology Today post. “Acceptance, mindfulness, and values are key psychological tools needed for that transformative shift.”

Cognitive behavioral therapy (CBT) is a short-term form of psychotherapy based on the idea that the way someone thinks and feels affects the way he or she behaves. CBT aims to help clients resolve present-day challenges like depression or anxiety, relationship problems, anger issues, stress, or other common concerns that negatively affect mental health and quality of life. The goal of treatment is to help clients identify, challenge, and change maladaptive thought patterns in order to change their responses to difficult situations.

Originally called simply “cognitive therapy,” what is now CBT was developed in the 1960s and 1970s by psychiatrist Aaron Beck, who found that helping depressed patients recognize and challenge their automatic negative thoughts had a positive impact on their symptoms. Beck drew on theories developed by psychologist Albert Ellis, the creator of rational emotive behavior therapy (REBT), among others, to develop an approach that was short-term and goal-oriented, in contrast to the dominant modalities of the time. Though it was originally designed to treat depression, since its inception CBT has been found to be effective for a wide range of mental health conditions and day-to-day psychological challenges, and is recommended as the first-line treatment for disorders including depression, anxiety, and insomnia.

Psychodynamic therapy is derived from psychoanalytic therapy, and both are based on the work of Sigmund Freud. Psychodynamic therapy is an in-depth form of talk therapy based on the theories and principles of psychoanalysis. In effect, talking about problems in a therapeutic setting can be extremely valuable for the individual. Comparatively, psychodynamic therapy is less focused on the patient-therapist relationship and more focused on the patient’s relationship with their external world.

Psychoanalytic therapy is a form of in-depth talk therapy that aims to bring unconscious or deeply buried thoughts and feelings to the conscious mind so that repressed experiences and emotions, often from childhood, can be brought to the surface and examined. Working together, the therapist and client look at how these early hidden and stifled memories have affected the client’s thinking, behavior, and relationships in adulthood. This therapy is based on Sigmund Freud’s theories about psychoanalysis.

EMDR is a psychotherapy technique designed to relieve the distress associated with disturbing memories. Short for Eye Movement Desensitization and Reprocessing, it involves recalling a specific troublesome experience while following a side-to-side visual stimulus delivered by the therapist. The resulting lateral eye movements are thought to help reduce the emotional charge of the memory so that the experience can be safely discussed, digested, and stripped of the power to trigger anxiety and avoidance.

Despite numerous studies showing that the technique works for some patients, it has been highly controversial ever since it was introduced in 1987. No universally accepted theory has been put forth to explain how lateral eye movements are integral to the treatment. Further, the evidence is not clear that EMDR is superior to classic forms of exposure therapy, in which patients recall traumatic memories in the safe environment created by a therapist; repeated exposure to the aversive memory in the safe context diminishes fear and avoidance of the memory and any situation that might trigger it.