Finding your path out of pain

A guide to help you understand psychotherapy systems and to help you choose ones that might fit you best

By Kathleen Wells, PhD

So much of our lives are focused on physical health. We spend hours in the gym, count fat grams and get regular checkups. Meanwhile, our minds and emotions may not be getting the same level of attention. But mental health is at least as important as physical health: We can't be healthy physically if we're not healthy mentally, since many psychological problems manifest in physiological symptoms. Even so, many people still don't seek psychotherapy or psychological counseling, often because therapy still carries a stigma. And that's a shame, when so many treatment modalities are available today. 

Here, Nexus  reviews some of the various psychotherapies available to help address a broad range of mental health issues. Many of the therapies are effective for similar issues. The efficacy of the treatment modality depends on the therapist's effectiveness, and on your receptiveness. See what fits your world view and spiritual beliefs, and use your intuition. You can soon be on your way to optimal mental health.  

Take a seat on the couch: Freud and traditional psychoanalysis Consciousness, purpose and control: Adlerian therapy Personal choice: Existential psychology We're all good: Person-centered psychotherapy Playing it out: Gestalt therapy Get real: William Glasser and reality therapy Changing thoughts and actions: Behavior therapy A family affair: Family systems therapy Back to the past: Hypnotherapy   Naturally: Eric Riss and natural psychotherapy   Taking action: Morita Shenku   Bringing it all together: Integrative psychosynthesis

Take a seat on the couch: Freud and traditional psychoanalysis

Perhaps every study of psychotherapy should begin with Sigmund Freud, the father of traditional psychoanalysis. Many of the treatments that followed his work are based in principle on his theories. Although controversial, the work of Sigmund Freud led the way to much research and development of modern day treatments. From the work of Freud, let's look at the more traditional therapies and then move on to some newer and less mainstream treatments.

Psychoanalytic therapy is based on the premise that the personality is determined by early experiences. These experiences create unconscious motives for behavior. For example, early childhood abuse can lead to distrust of oneself and others later in life. This could manifest in broken relationships or low self-esteem. Freud believed these early experiences to be primarily sexual and aggressive in nature. One of his greatest gifts to modern psychotherapy is the recognition that early childhood development is critical, and that children must be given every opportunity for appropriate health and development in their early years.

Eyeing For Change: EMDR A relatively new treatment came into being in the past 10 to 15 years. Francine Shapiro, PhD developed eye movement desensitization and reprocessing (EMDR). EMDR is designed to integrate many of the successful elements of various psychotherapies with rapid eye movement. The process activates the information-processing centers of the brain allowing clients to achieve therapeutic goals very quickly. Studies have shown the effects to be long lasting. This is particularly effective therapy for post traumatic stress disorder (PTSD), both for military veterans and civilians who have experienced natural disasters, assaults and other sudden trauma. It has also proven effective for victims of crimes, sexual abuse, and those with phobias and panic disorders.

This kind of therapy is based on seeking to resolve and integrate psychosexual stages of development. As people pass through various stages of early childhood development, they can get stuck at any of these stages, creating issues later in life. For example, middle childhood is seen as a time for developing a "sense of industry," creating personal goals that are meaningful and achieving them. If children fail to achieve the goals they set during this stage, it can create a feeling of being stuck in that mode of failure. A child can develop a sense of inadequacy, and the personality stages that follow won't develop as they should. 

The primary goal of psychoanalytical therapy is to make the unconscious conscious. In this way, clients can work through and resolve issues from early childhood development. The techniques used in this field are suitable for individual as well as group work. This treatment is useful for anxiety disorders and phobias. If you're thinking about seeking psychoanalytic therapy, find a therapist who looks at the past as a key to the future and assists you in resolving conflicts.

 

Consciousness, purpose and control: Adlerian therapy

Alfred Adler was a contemporary of Freud and was a major contributor to the psychodynamic approach to therapy. While Adler also believes the first six years of childhood development are critical, he didn't focus only on exploring past events. Rather, he felt that one's perception and interpretation of early events was more crucial to therapy than the events themselves. Adler felt people were motivated more by social urges than sexual urges. For him, the conscious mind was more critical than the unconscious, and he viewed humans as purposeful and goal-directed. While Freud's views were negative and deterministic, Adlerian therapists have a positive view of human nature and believe humans are in control of their fate, not victims of it. This therapy focuses on encouraging and assisting clients in changing their cognitive perspectives.

The goal of Adlerian therapy is to challenge the client's goals and basic premises while helping them to develop socially useful goals. Therapists attempt to establish trust and a sense of mutual equality. In this therapy, the client's lifestyle will be examined based on his or her actions. The way we choose to behave is considered a reflection of inner turmoil or conflict. A detailed questionnaire brings out details of childhood experiences and behavior patterns.

One method of this therapy is for clients to identify and work on unfinished past experiences by experiencing them as though they are occurring in the present. For example, a person who is overly aggressive and rage-filled will be asked to recount early experiences. These might include being a victim of a beating by the local bully. The experience is relived in as much detail as possible, as though it is happening right then. Only this time, as an adult, they can experience the beating and clear the misperceptions they had about that event. For instance, do they feel anger at themselves for allowing it, anger at the perpetrator after all these years, or some other emotion causing them to act out in rage now?

Adlerian therapy is for a broad spectrum of issues, like marriage and family problems, individual anxieties, relationship problems, substance abuse and issues related to aging. The benefit of Adler's work is in his broadly applicable therapy and its emphasis on social and psychological factors. His work, like Freud's, became a foundation for many of the other modern therapies.

 

Personal choice: Existential psychology

Students of Adlerian psychotherapy expanded his work by seeking to balance the individual's concerns with social concerns. This philosophical approach is known as existential psychology. It rejects the deterministic view of what creates personality and focuses clients on the choices they make. This psychotherapeutic approach was developed from the work of Viktor Frankl and Rollo May in the mid-20th century.

The basic existential theory is that we are what we choose to be. Therefore, the focus of therapy is to get clients to review their lives and to see where they have surrendered their control to others or to circumstance. When clients recognize these points, they are able to consciously shape their own lives, rather than allowing others or circumstances to do it for them. Self-awareness improves, as does accepting responsibility for one's choices and actions.

Existential therapy is particularly useful to those facing a developmental crisis or life transition. It's also helpful for clients who have problems accepting responsibility, making choices, coping with guilt or anxiety, or seeking value in their lives. This is a very effective therapy for those seeking personal enhancement and growth. Those with immediate problems and long-term issues can be helped by this approach.

 

We're all good: Person-centered psychotherapy

The person-centered approach to therapy grew from the existentialist view and was primarily the brainchild of Carl Rogers. He had a positive view of people as essentially trustworthy and capable of self-understanding, resolving their own problems and self-directed growth. He emphasized the need for non-judgmental listening and acceptance to help clients change. Through therapy, clients realize their potential and move toward increased awareness and trust in self. Maladjustment comes when there is a discrepancy between what the client wants to be and what he or she is. The focus of this therapy is on being in the present moment and experiencing and expressing feelings.

Rogers focused on providing a specific kind of therapeutic environment. He felt the therapist/client relationship had to provide a warm, empathetic, supportive relationship. The attitude of the therapist in this modality is critical to success. There is a wide application for person-centered therapy in both individual and group sessions. It is well suited to crisis intervention, marital and family therapy, and human relations training.

 

Playing it out: Gestalt therapy

Gestalt is another existentially based therapy. Gestalt, meaning "whole," is based on the idea that the whole is different from the sum of its parts. Founded by Fritz and Laura Perls, Gestalt believes that people must find their own way in life and accept responsibility for their actions if they are to become mature. Gestalt therapy focuses on helping clients achieve awareness of what they're doing or experiencing in order to gain self-understanding and knowledge by which change can occur. In addition, Gestalt also focuses on the client's perceptions of reality. For example, a client may perceive a vindictive divorce as a personal attack. His perception may be that the person he once loved now hates him and is treating him cruelly because he is not worthy of love. Gestalt therapy would help him shift his perception to accept that he is worthy of love and the other person's actions are a result of a much more complex dynamic.

Gestalt therapy emphasizes feelings and the unfinished business of personality development. It is widely used for group and individual concerns, marriage and family, behavior problems in children, and organizational development. The therapy draws on a variety of techniques such as role-playing, confrontation, reliving and re-experiencing resentment and guilt, and dialogues. Also included is dream analysis and dream work done by the client. These techniques are designed to be catalysts for getting clients into contact with their present experiences.

 

Get real: William Glasser and reality therapy

In the 1960s, William Glasser developed a new psychotherapy that paralleled existential, person-centered and Gestalt therapy. Reality therapy is similar to the other three in that it takes into consideration the client's perception of his or her world and how that client responds to the world as they see it. Glasser believes we respond to our world as it relates to us, not to the world as it really is. Our behavior is our attempt to control our perceptions of the world so they fit our reality.

This therapy model is effective in helping clients evaluate whether their present behavior and lifestyle are working for them or not. It doesn't focus on the past, but rather on the choices people have made and how they might change those choices to affect change in their lives. The goal of reality therapy is to challenge clients to do a serious evaluation and to help them more effectively meet their needs.

Reality therapy is an active and directive process, which guides clients in their evaluations. The therapist helps clients set and achieve goals for change. Part of this therapy includes a commitment on the part of the client to make the necessary changes in lifestyle or behavior to elicit the desired response. This type of therapy has been beneficial to youthful law offenders as well as individuals and families seeking to change behavior patterns. It is well suited for brief therapy and crisis intervention.

 

Changing thoughts and actions: Behavior therapy

Behavior therapy is a broad category of treatment modalities using a wide variety of techniques. This is action-oriented therapy that helps people change what they're thinking and doing. Arnold Lazarus was one of the pioneers of this field in the 1960s. Behavior is viewed as the result of our learning or conditioning. Where normal behavior is learned through reinforcement of appropriate behavior, abnormal behavior is the result of faulty learning processes. A teenage mother of a premature infant, for instance, might learn to fear germs as a result of being taught how to deal in a sterile manner with her baby. While the nursing staff may be telling her it is important to be as sanitary as possible, she might interpret that information to mean that if she is not sanitary, she will kill her premature infant. As a result of this faulty learning, a phobia of germs can manifest and create obsessive compulsive behavior where the young mother washes her hands repeatedly and is unable to touch anything she believes to be "germy."

The focus of this therapy is to assist clients in learning appropriate behavior, while eliminating inappropriate behavior. The focus is on factors that influence behavior, with the clients playing an active part in determining changes they want to make and establishing treatment goals. For the young mother above, the therapist would probably focus attention on the client's fear of killing her young child and possibly on the fear of death for herself. Together, they would set goals for new behavior. These might include being able to stop washing her hands in an inappropriate way, being able to touch the carts at the grocery and being able to hug her own child. The therapist would then assist her in relearning behaviors that will meet these goals.

Behavior therapy is useful for a wide range of problematic behavior such as phobias, depression, sexual and behavioral disorders, and stress management.

 

A family affair: Family systems therapy

Family systems therapy is an integrated method of looking at the whole family as a dynamic unit. When an individual is having problems, the diagnosis very often can be traced to difficulties that lie within the family structure. This being the case, it is not as effective to treat the individual as it is to treat the family. The symptoms with which the client presents are many times an expression of dysfunction within their family unit. For example, a teenager who runs away from home is brought to a therapist. The parents may blame her for running away. But the girl may be responding to dysfunction in the home. Arguments and the threat of impending divorce, for example, may have unsettled her and prompted her to act out. Actions by one family member will impact the rest of the members of the group, and the group's actions will have a reciprocal effect on the individual in question.

In family systems therapy the focus is on the communication patterns used within the family. The present behavior of the family is more important than past history. The goal is to help the family see patterns of behavior that are not serving the family well and to help the family develop new ones. Family systems approaches are useful for dealing with marital distress, communication problems, power struggles and crisis situations, and to enhance the overall functioning of the family. The entire process of improving family relationships is empowering to the family and may also lead to resolving issues with the larger extended family.

 

Back to the past: Hypnotherapy

Hypnotherapy has long been a tool used occasionally by some of these other psychotherapy models and by a few hypnotherapists. In the last 10 to 15 years, the field of hypnotherapy, and more specifically regression therapy, has grown, thanks to the work of Brian Weiss, MD and others like him. Weiss is a psychiatrist who uses hypnotherapy in order to regress patients to childhood and what he believes are past lives in order to speed up the therapeutic process. Weiss considers psychoanalysis and psychoanalytically oriented therapies to be "outmoded, slow and ineffective." Certainly his work supports the claim that hypnotherapy can result in cathartic sessions that produce long-lasting and life-changing results.

Hypnotherapy allows the patient to reach a focused yet relaxed state. In this state, the unconscious mind can be reached by the therapist in order to gain information and insight into what's causing the client's current problems. As soon as the unconscious mind of the client allows the conscious mind access to the information, healing begins. The therapy is useful for many psychological disorders, particularly phobias, depression and anxiety from childhood or "past-life" experiences. Hypnotherapy is also an excellent treatment for eliminating addictions to drugs, tobacco, food and alcohol, and to alleviate pain during childbirth, chronic illness and surgery.

If a client's religious world view does not fit with the ideology of past lives, he or she can think of past lives as the mind working metaphorically to get information from the unconscious to the conscious mind. Whether the client believes in past lives or not is irrelevant to the efficacy of the treatment.

 

Naturally: Eric Riss and natural psychotherapy

Natural psychotherapy is both a philosophy and a therapeutic modality created by Eric Riss, PhD. In this treatment, the use of all drugs is discouraged in dealing with psychological stress. "Mental illnesses" are viewed as bio-psycho-social reactions rather than strictly biological illnesses. Therapists assist clients in resolving and "unlearning" self-defeating patterns of behavior, thoughts and feelings. Natural psychotherapy seeks to teach clients new ways to deal with everyday problems as well as crises. This is a medication-free, empowering treatment.

Natural psychotherapy is successful in treating anxiety, depression, obsessive-compulsive disorders, and marital and family problems. It is also used for more severe problems such as addictions, alcoholism, bipolar and dissociative disorders. The primary premise of these therapists is that problems are easiest to resolve when the client nurtures his or her creative nature and develops his or her true self-rather than some idea of what he or she "should" be.

 

Taking action: Morita Shenku

In the early 20th century Shoma Morita established a treatment based on Zen Buddhism. Called Morita Shenku, it is most useful for procrastination and the anxiety that results when we procrastinate. Clients who are especially suited to this psychotherapy are nervous, introspective, perfectionist, hypochondriac, hypersensitive and preoccupied.

The therapy focuses on the external environment and behavior. Clients are taught how to take concrete action and then how to deal with the way they feel as they do so. While it is relatively new to the United States, a Western model has developed based on empathetic, confrontational and action-based instruction.

 

Bringing it all together: Integrative psychosynthesis 

Many of the above treatments would work well together. Integrative psychosynthesis believes that therapists should be able to use more than one therapy in a complementary way to best help clients heal. Integrative psychosynthesis also encourages therapists and clients to include a spiritual philosophy component to treatment. There is no single method that leads to a solution for many clients. The therapist you choose needs to be flexible and willing to integrate therapies to match your personal needs.

According to Robert Assagioli, the founder of this philosophy, the heart of psychotherapy is the therapeutic relationship. He believes it is not so much what happens between therapist and client as what happens through the therapist that is critical. So choose carefully. Read and study the therapies. Use your intuition to decide which is best for you. Find a reputable therapist, preferably through a personal reference, and then try that relationship out. If it's not working for you or if you outgrow a particular therapist, don't hesitate to move on to another.

With such a wide range of psychotherapies available to us, there is no excuse to continue being unhappy or unfulfilled. Value your mental health as much-or more-than you do your physical health. The mind is a powerful part of us. Taking care of it will produce physical, emotional and spiritual well-being.  

For more information... Want to know more about a certain kind of therapy? Lots of internet sites are great sources of information. Most of the sites have lists of links to numerous other sites dealing with mental health issues. Try the following: . The National Mental Health Association: www.nmha.org . The Mental Help Net: http://mentalhelp.net . The Emory University web site: www.medweb.emory.edu/MedWeb . The Mental-Health-Matters.com web site: www.mental-health-matters.com/society.htm Or try the following private resource site with a large list of resources: http://ourworld.compuserve.com/homepages/selfheal/nonmain.htm. Kathleen Wells, PhD, teaches Family Studies for the University of Arizona South in Sierra Vista, Arizona. She divides her time between writing, teaching and private practice.