What Does Therapy ACTUALLY Look Like? Understanding the Different Types of Therapy.
We’ve all seen how therapy is portrayed in the movies. You know the scene. An old man in a bow tie sitting opposite with his clipboard in hand, making secret notes on everything you say. He looks bored and tired, as if he might fall asleep right there in front of you. He occasionally offers a small piece of advice or raises an eyebrow in feigned concern. Then there’s the unspoken expectation that you’ll see him every week for years on end, just to sit and talk about the things that are troubling you.
Is that what therapy is truly like?
Well thankfully, the answer to that is no! Therapy is not, or should not, simply be a place where you have a one-sided monolog of a conversation that feels like a trail to nowhere. Psychologists work with you to understand your goals and plan a way forward, and they utilise an evidence-based therapeutic framework that best suits you. Below we touch on the most common forms of therapeutic intervention that your psychologist may draw upon, so that you can have a sneak peak into what therapy really looks like. Therapy is not a “one-size-fits-all” thing, and we encourage you to talk with your psychologist about the framework that they are recommending, so that you feel confident in the path forward.
Here are some of the most common forms of therapy:
Cognitive Behaviour Therapy (CBT)
This is a form of therapy based on the philosophy that our thoughts, emotions, physiology (e.g., what’s going on in our body) and our behaviour are all connected. In other words, what we think affects the way we feel and how we feel affects our body and all these things impact our subsequent behavioural choices. The impact is not linear and unidirectional, in fact our behavioural choices then impact our body and our feelings and our thoughts. They are linked and connected, and they all have an impact upon each other. CBT is often used to treat some of the most common mental health conditions such as anxiety and depression and research has demonstrated that it can be highly effective in doing so. CBT looks at identifying and addressing the factors that are maintaining the problem now, teaching people different strategies to help create more healthy thoughts and behaviours and to better manage their emotions and body responses. In turn, they create more positive connections between their thoughts, feelings, body reactions and choices, and start to better manage and move through the challenges that they are facing.
Acceptance and Commitment Therapy (ACT)
This is a form of psychological intervention that uses acceptance and mindfulness strategies along with commitment and behavioural change strategies to increase psychological flexibility. The term psychological flexibility refers to the ability to be present in the moment, to be mindful of our thoughts and feelings, and to make intentional choices that are aligned with what is important to us – our values. In our society, we spend a lot of time on autopilot and have learnt to avoid our uncomfortable thoughts and emotions. We might drink, excessively exercise, scroll through social media for long periods of time, or simply just stay “busy”. This “experiential avoidance” leads to secondary issues in our lives – burnout, fatigue, unhealthy coping strategies and so forth. ACT helps people create healthier relationships with their thoughts and feelings, to learn to be more present in the moment, and to make more intentional value-aligned decisions in order to help build a more meaningful and purposeful life for them.
Schema Therapy
One of the easiest ways to understand Schema therapy is to think of a tree. The fruit on the tree represent the symptoms that bring someone into therapy. It may be anxiety, depression, grief, relationship problems, etc. Many traditional forms of therapy assist people in learning strategies to keep the symptoms (the fruit) in check. While this is helpful and useful, schema therapy seeks to ask and answer the question – why is this fruit there in the first place? What is feeding this tree? Schema therapy looks at what’s beneath the surface. What building blocks created in childhood contributed to the foundation that the individual now stands upon? A “schema” refers to a particular framework or “lens” which has developed, through which people now view and interpret themselves and the world around them. Schemas can lie dormant and be “triggered” at different times – which can explain why you might feel fine in some areas of your life (e.g. confident making friends), but suddenly feel and behave very differently in other certain situations (e.g. anxious when getting closer to someone and withdrawing due to a fear of abandonment or an Abandonment Schema being activated). Schema Therapy not only seeks to bring awareness and healing to the schemas, though cognitive strategies and emotion-focused strategies, but it also helps people become more aware of maladaptive “coping modes” which they have developed over time. Schema then helps people create more healthy ways of responding to their own emotions and needs.
Whilst Schema Therapy has traditionally been used for the treatment of personality disorders and chronic DSM Axis I disorders that do not respond to other therapies, it has become more popular across the board in the last several years due to its success in helping people overcome chronic issues for a wider range of concerns.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is a form of therapy that was first developed in the 1980s to help alleviate the distress associated with traumatic memories as is common in those with Post Traumatic Stress Disorder (PTSD). As evidence for this form of therapy has grown, it has become increasingly commonplace in clinical practice. The client and therapist work together addressing specifically targeted memories and trauma associations, while at the same time engaging in a set of bilateral stimulations such as eye movements, sounds or tapping. The general philosophy behind EMDR is that it enables people to heal from the symptoms and emotional distress that they have experienced in a gentle and guided way by allowing new neural pathways/associations of old memories to develop. By facilitating the linking of trauma memories with associated memory networks, a different meaning is created.
Final Thoughts
Regardless of the type of therapy you use, one of the key predictors of therapeutic outcome is the quality and strength of the therapeutic relationship between the client and their psychologist. So be open and transparent with your psychologist about any questions that you may have about the therapy approach (no question is too small or silly!) so that you can feel comfortable and confident in the path forward and work better together as a team to navigate the difficulties you are facing.
