Research has shown that the quality of the relationship between the therapist and the client has a greater influence on client outcomes than the specific type of psychotherapy used by the therapist (this was first suggested by Saul Rosenzweig in 1936 [5]). Accordingly, most contemporary schools of psychotherapy focus on the healing power of the therapeutic relationship.

This research is extensively discussed (with many references) in Hubble, Duncan and Miller (1999)[6] (quotes in this section are from this book) and in Wampold (2001) .

A literature review by M. J. Lambert (1992) [8] estimated that 40% of client changes are due to extratherapeutic influences, 30% are due to the quality of the therapeutic relationship, 15% are due to expectancy (placebo) effects, and 15% are due to specific techniques. Extratherapeutic influences include client motivation and the severity of the problem:

For example, a withdrawn, alcoholic client, who is "dragged into therapy" by his or her spouse, possesses poor motivation for therapy, regards mental health professionals with suspicion, and harbors hostility toward others, is not nearly as likely to find relief as the client who is eager to discover how he or she has contributed to a failing marriage and expresses determination to make personal changes.

In one study, some highly motivated clients showed measurable improvement before their first session with the therapist, suggesting that just making the appointment can be an indicator of readiness to change.

Outside of therapy people rarely have a friend who will truly listen to them for more than 20 minutes (Stiles, 1995)[10]... Further, friends and relatives often are involved in the problem and therefore do not provide a "safe outside perspective" which may be required. Nonetheless, as noted above, people often solve their problems by talking to friends, relatives, co-workers, religious leaders, or some other confidant in their lives, or by thinking and exploring themselves.
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Labels: The therapeutic relationship

Counseling and psychotherapy must be adapted to meet the developmental needs of children. Many counseling preparation programs include a courses in human development. Since children often do not have the ability to articulate thoughts and feelings, counselors will use a variety of media such as crayons, paint, clay, puppets, bibliocounseling (books), toys, et cetera. The use of play therapy is often rooted in psychodynamic theory, but other approaches such as Solution Focused Brief Counseling may also employ the use of play in counseling. In many cases the counselor may prefer to work with the care taker of the child, especially if the child is younger than age four. Theraplay is an approach developed to facilitate a healthier relationship between parent and child that uses structured play. Children who have experienced chronic early maltreatment that results in Complex Post Traumatic Stress Disorder or reactive attachment disorder can be effectively treated with Dyadic Developmental Psychotherapy

Labels: Psychotherapy Adaptations for children

Integrative Psychotherapy involves the fusion of different schools of psychotherapy.

Initially, Sigmund Freud developed a talking cure called psychoanalysis; then he wrote about his therapy and popularized psychoanalysis. After Freud, many different disciplines splintered off. Some of the more common therapies include: psychoanalytic psychotherapy, counselling, co-counselling, analysis, transactional analysis, cognitive behavioural therapy, gestalt therapy, body psychotherapy, psychodynamic psychotherapy, family systems therapy, person centred counselling, and existential therapy. Over two hundred different acknowledged theories of psychotherapy are practiced.[citation needed]

A new therapy is born in several stages. After being trained in an existing school of psychotherapy, the therapist begins to practice. Then, after follow up training in other schools, the therapist may combine the different theories as a basis of a new practice. Then, some practitioners write about their new approach and label this approach with a new name. This overall pattern has been observed in numerous new therapies and is certain to form many future therapies.

A pragmatic or a theoretical approach can be taken when fusing schools of psychotherapy. Pragmatic practitioners blend a few strands of theory from a few schools as well as various techniques; such practitioners are sometimes called eclectic psychotherapists and are primarily concerned with what works. Alternatively, other therapists consider themselves to be more theoretically grounded as they blend their theories; they are called integrated psychotherapists and are not only concerned with what works, but why it works.

For example an eclectic therapist might experience a change in their client after administering a particular technique and be satisfied with a positive result. In contrast, an integrative therapist is curious about the “why and how” of the change as well. A theoretical emphasis is important; for example, the client may only have been trying to please the therapist and was adapting to the therapist rather than becoming more fully empowered in themselves.

Different Routes to Integrative Psychotherapy

The most recent edition of the Handbook of Psychotherapy Integration (Norcross & Goldfried, 2005) recognized four general routes to integration: (1) Common Factors, (2) Technical Eclecticism, (3) Theoretical Integration, and (4) Assimilative Integration (Norcross, 2005).

Common Factors. The first route to integration is called common factors and "seeks to determine the core ingredients that different therapies share in common" (Norcross, 2005, p. 9) The advantage of a common factors approach is the emphasis on therapeutic actions that have been demonstrated to be effective. The disadvantage is that common factors may overlook specific techniques that have been developed within particular theories. Common factors have been described by Jerome Frank (Frank & Frank, 1991), Bruce Wampold (2001), and Miller, Duncan and Hubble (2005).

Technical Eclecticism. The second route to integration is technical eclecticism which is designed "to improve our ability to select the best treatment for the person and the problem…guided primarily by data on what has worked best for others in the past" (Norcross, 2005, p. 8). The advantage of technical eclecticism is that it encourages the use of diverse strategies without being hindered by theoretical differences. A disadvantage is that there may not be a clear conceptual framework describing how techniques drawn from divergent theories might fit together. The most well known model of technical eclectic psychotherapy is Arnold Lazarus’ (2005) Multimodal Therapy. Larry E. Beutler’s model of Systematic Treatment Selection (Beutler, Consoli, & Lane, 2005) represents another model of technical eclecticism.

Theoretical Integration. The third route to integration commonly recognized in the literature is theoretical integration in which "two or more therapies are integrated in the hope that the result will be better than the constituent therapies alone" (Norcross, 2005, p. 8). Some models of theoretical integration focus on combining and synthesizing a small number of theories at a deep level, whereas others describe the relationship between several systems of psychotherapy. One prominent example of theoretical synthesis is Paul Wachtel's (Wachtel, Kruk, & McKinney, 2005) model of Cyclical Psychodynamics that integrates psychodynamic, behavioral, and family systems theories. Another example of synthesis is Anthony Ryle’s (2005) model of Cognitive Analytic Therapy, integrating ideas from psychoanalytic object-relations theory and cognitive psychotherapy. The most notable model describing the relationship between several different theories is Prochaska and DiClemente’s (2005) Transtheoretical Model.

Assimilative Integration. "This mode of integration favors a firm grounding in any one system of psychotherapy, but with a willingness to incorporate or assimilate, in a considered fashion, perspectives or practices from other schools" (Messer, 1992, p. 151). Assimilative integration is the fourth route and acknowledges that most psychotherapists select a theoretical orientation that serves as their foundation but, with experience, incorporate ideas and strategies from other sources into their practice. Increasingly, integrationists are acknowledging that most counselors will prefer the security of one foundational theory as they begin the process of integrative exploration. Formal models of assimilative integration have been described based on a psychodynamic foundation (Stricker & Gold, 2005) and based on cognitive-behavioral therapy (Castonguay, Newman, Borkovec, Holtforth, & Maramba, 2005).

Emerging Models that Combine Routes. In addition to well-established approaches that fit into one of four routes, there are newer models that combine aspects of the traditional routes. For example, Hill’s (2004) three-stage model of helping skills encourages counselors to emphasize skills from different theories during different stages of helping. Hill’s model might be considered a combination of theoretical integration and technical eclecticism. Good and Beitman (2006) described an integrative approach highlighting both core components of effective therapy and specific techniques designed to target clients’ particular areas of concern. This approach can be described as an integration of common factors and technical eclecticism. Multitheoretical Psychotherapy (Brooks-Harris, 2008) is a new integrative model that combines elements of technical eclecticism and theoretical integration. Therapists are encouraged to make intentional choices about combining theories and intervention strategies.

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Labels: Integrative Psychotherapy

Expressive therapy, also known as creative arts therapy, is the intentional use of the creative arts as a form of therapy. Unlike traditional art expression, the process of creation is emphasized rather than the final aesthetic product. Expressive therapy works under the assumption that through use of imagination and the various forms of creative expression, humans can heal. Most forms of creative expression have an equivalent therapeutic discipline:

* Art Therapy - The use of painting, drawing, sculpture and other forms of art as therapy.
* Dance Therapy - The use of kinesthetic expression as therapy.
* Drama Therapy - The use of theater tools and improvisation as therapy. Includes Psychodrama.
* Music Therapy - The use of listening, playing and personalizing music as therapy.
* Play Therapy - The use of playing with toys, observing play as therapy. Includes sandtray therapy.
* Writing therapy - The use of the written word, generated and historical as therapy. Includes poetry therapy and Bibliotherapy.

Expressive therapists are often known as dance therapists, art therapists, music therapists, drama therapists and as other names based on their choice of primary artistic expression, also known as their modality. Usually, being an expressive therapist is a masters level clinician, often coupled with other liscensure or certification. In common, all expressive therapists share the belief that it is through creative expression and the tapping of the imagination a person can examine the body, feelings, emotions and his or her thought process.

Although often separated by the form of creative art, some expressive therapists consider themselves intermodal, using expression in general, rather than a specific discipline to treat clients, altering their approach based on the clients' needs, or through using multiple forms of expression with the same client to aid with deeper exploration.

Expressive therapists work with a wide variety of populations in a wide variety of environments. They have worked in areas such as medical illness, grief, educational and behavioral problems, emotional issues, and even criminal behavior.

There is a certification process for the "Certified Expressive Therapist", and the "Certified Expressive Arts Therapist", and the "Expressive Therapist Registered", as well as certifications within each of the specific disciplines.

Significant contributors to this field include Shaun McNiff, Paolo Knill, Steve Ross, as well as Steven and Ellen Levine

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Labels: Expressive therapy

Psychoanalysis was the earliest form of psychotherapy, but many other theories and techniques are also now used by psychotherapists, psychologists, psychiatrists, personal growth facilitators and social workers. Techniques for group therapy have been developed.

While behaviour is often a target of the work, many approaches value working with feelings and thoughts. This is especially true of the psychodynamic schools of psychotherapy, which today include Jungian therapy and Psychodrama as well as the psychoanalytic schools. Other approaches focus on the link between the mind and body and try to access deeper levels of the psyche through manipulation of the physical body. Examples are Rolfing, Pulsing and postural integration.
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Labels: Psychoanalysis

Psychotherapy can be seen as an interpersonal invitation offered by (often trained and regulated) psychotherapists to aid clients in reaching their full potential or to cope better with problems of life. Psychotherapists usually receive a benefit or remuneration in some form in return for their time and skills. This is one way in which the relationship can be distinguished from an altruistic offer of assistance.

Psychotherapy often includes techniques to increase awareness for example, or to enable other choices of thought, feeling or action; to increase the sense of well-being and to better manage subjective discomfort or distress. Psychotherapy can be provided on a one to one basis or in group therapy. It can occur face to face, over the telephone or the internet. Its time frame may be a matter of weeks or over many years. It can be seen as ultimately about agency and the meaning of life. Psychotherapy can also be seen as a social construct that cannot occur in a power vacuum nor without reference to semiotics (meaning systems and symbols) - irrespective of how practitioners may describe their work or research its effects. Therapy may address specific forms of diagnosable mental illness, or everyday problems in relationships or meeting personal goals. Treatment of everyday problems is more often referred to as counseling (a distinction originally adopted by Carl Rogers) but the term is sometimes used interchangeably with "psychotherapy".

Psychotherapists employ a range of techniques to influence or pursuade the client to adapt or change in the direction the client has chosen. These can be based on clear thinking about their options; experiential relationship building; dialogue, communication and adoption of behavior change strategies. Each is designed to improve the mental health of a client or patient, or to improve group relationships (such as in a family). Most forms of psychotherapy use only spoken conversation, though some also use various other forms of communication such as the written word, artwork, drama, narrative story, or therapeutic touch. Psychotherapy occurs within a structured encounter between a trained therapist and client(s). Because sensitive topics are often discussed during psychotherapy, therapists are expected, and usually legally bound, to respect client or patient confidentiality.

Psychotherapists are often trained, certified, and licensed, with a range of different certifications and licensing requirements in every jurisdiction. Psychotherapy may be undertaken by clinical psychologists, social workers, marriage-family therapists, expressive therapists, trained nurses, psychiatrists, psychoanalysts, mental health counselors, school counselors, or professionals of other mental health disciplines. Psychiatrists have medical qualifications and may also administer prescription medication. The primary training of a psychiatrist focuses on the biological aspects of mental health conditions, with some training in psychotherapy. Psychologists have more training in psychological assessment and research and, in addition, a great deal of training in psychotherapy. Social workers have specialized training in linking patients to community and institutional resources, in addition to elements of psychological assessment and psychotherapy. Marriage-Family Therapists have training similar to the social worker, and also have specific training and experience working with relationships and family issues. Licensed professional counselors (LPCs) generally have special training in career, mental health, school, or rehabilitation counseling. Many of the wide variety of training programs are multiprofessional, that is, psychiatrists, psychologists, mental health nurses, and social workers may be found in the same training group. Consequently, specialized psychotherapeutic training in most countries requires a program of continuing education after the basic degree, or involve multiple certifications attached to one specific degree.

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Labels: Psychotherapy General issues

Cognitive Behavioral Therapy (CBT) is a psychotherapy based on modifying everyday thoughts and behaviors, with the aim of positively influencing emotions. The general approach developed out of behavior modification and Cognitive Therapy, and has become widely used to treat mental disorders. The particular therapeutic techniques vary according to the particular kind of client or issue, but commonly include keeping a diary of significant events and associated feelings, thoughts and behaviors; questioning and testing assumptions or habits of thoughts that might be unhelpful and unrealistic; gradually facing activities which may have been avoided; and trying out new ways of behaving and reacting. Relaxation and distraction techniques are also commonly included. CBT is widely accepted as an evidence-based, cost-effective psychotherapy for many disorders. It is sometimes used with groups of people as well as individuals, and the techniques are also commonly adapted for self-help manuals and, increasingly, for self-help software packages.

The basics

CBT is based on the idea that how we think (cognition), how we feel (emotion), and how we act (behavior) all interact together. Specifically, our thoughts influence our feelings and our behavior. Therefore, negative and unrealistic thoughts can cause us distress and result in problems.

An example will illustrate this process. Someone who, after making a mistake, thinks "I'm useless and can't do anything right." This impacts negatively on mood, making the person feel depressed; the problem may be worsened if the individual reacts by avoiding activities. As a result, a successful experience becomes more unlikely, which reinforces the original thought of being "useless." In therapy, the latter example could be identified as a self-fulfilling prophecy or "problem cycle," and the efforts of the therapist and client would be directed at working together to change this. This is done by addressing the way the client thinks in response to similar situations and by developing more flexible ways to think and respond, including reducing the avoidance of activities. If, as a result, the client escapes the negative thought pattern, the feelings of depression may be relieved. The client may then become more active, succeed more often, and further reduce feelings of depression

Cognitive Behavioral Therapy

CBT can be seen as an umbrella term for many different therapies that share some common elements. While similar views of emotion have existed for millennia, the earliest form of Cognitive Behavior Therapy was developed by Albert Ellis in the early 1950s. Ellis eventually called his approach Rational Emotive Behavioral Therapy, or REBT, as a reaction against popular psychoanalytic and increasingly humanistic methods at the time . Aaron T. Beck independently developed another CBT approach, called Cognitive Therapy, in the 1960s. Cognitive Therapy rapidly became a favorite intervention to study in psychotherapy research in academic settings. In initial studies, it was often contrasted with behavioral treatments to see which was most effective. However, in recent years, cognitive and behavioral techniques have often been combined into cognitive behavioral treatment. This is arguably the primary type of psychological treatment being studied in research today.

Concurrently with the pioneering contributions of Ellis and Beck, starting in the late 1950s and continuing through the 1970s, Arnold A. Lazarus developed what was arguably the first form of "Broad-Spectrum" Cognitive-Behavior Therapy. Indeed, in 1958, Arnold Lazarus was the first person to introduce the terms "behavior therapy" and "behavior therapist" into the professional literature. He later broadened the focus of behavioral treatment to incorporate cognitive aspects (e.g., see Arnold Lazarus' 1971 landmark book "Behavior Therapy and Beyond," perhaps the first clinical text on CBT). When it became clear that optimizing therapy's effective and effecting durable treatment outcomes often required transcending more narrow focused cognitive and behavioral methods, Arnold Lazarus expanded the scope of CBT to include physical sensations (as distinct from emotional states), visual images (as distinct from language-based thinking), interpersonal relationships, and biological factors. The final product of Arnold Lazarus' approach to psychotherapy is called Multimodal Therapy and is, perhaps, the most comprehensive form of CBT.

Cognitive Behavioral Group Therapy (CBGT) is a similar approach in treating mental illnesses, based on the protocol by Richard Heimberg. In this case, clients participate in a group and recognize they are not alone in suffering from their problems.

A sub-field of Cognitive Behavior Therapy used to treat Obsessive Compulsive Disorder makes use of classical conditioning through extinction (a type of conditioning) and habituation. (The specific technique, Exposure with Response Prevention (ERP) has been demonstrated to be more effective than the use of medication--typically SSRIs--alone.) CBT has also been successfully applied to the treatment of Generalized Anxiety Disorder, health anxiety, Social phobia and Panic Disorder. In recent years, CBT has been used to treat symptoms of schizophrenia, such as delusions and hallucinations. This use has been developed in the UK by Douglas Turkington and David Kingdon.

Other types of Cognitive Behavioral Therapy include Dialectical Behavior Therapy, Self-Instructional Training, Schema-Focused Therapy and many others.

CBT has a good evidence base in terms of its effectiveness in reducing symptoms and preventing relapse. It has been clinically demonstrated in over 400 studies to be effective for many psychiatric disorders and medical problems for both children and adolescents. It has been recommended in the UK by the National Institute for Health and Clinical Excellence as a treatment of choice for a number of mental health difficulties, including post-traumatic stress disorder, OCD, bulimia nervosa and clinical depression. Cognitive Behavioral Therapy most closely allies with the Scientist-Practitioner Model of Clinical Psychology, in which clinical practice and research is informed by a scientific perspective; clear operationalization of the "problem" or "issue;" an emphasis on measurement (and measurable changes in cognition and behavior); and measurable goal-attainment.

Labels: Cognitive behavioral therapy

psychotherapy can be said to have been practiced through the ages, as individuals received psychological counsel and reassurance from others. Purposeful, theoretically-based psychotherapy was probably first developed in the Middle East during the 9th century by the Persian physician Rhazes, who was at one time the chief physician of the Baghdad hospital. In the West, however, serious mental disorders were generally treated as demonic or medical conditions requiring punishment and confinement until the advent of moral treatment approaches in the 18th Century. This brought about a focus on the possibility of psychosocial intervention - including reasoning, moral encouragement and group activities - to rehabilitate the "insane".

Psychoanalysis was perhaps the first specific school of psychotherapy, developed by Sigmund Freud and others through the early 1900s. Trained as a neurologist, Freud began focusing on problems that appeared to have no discernible organic basis, and theorized that they had psychological causes originating in childhood experiences and the unconscious mind. Techniques such as dream interpretation, free association, transference and analysis of the id, ego and superego were developed.

Many theorists built upon Freud's fundamental ideas, including Anna Freud, Alfred Adler, Carl Jung, Karen Horney, Otto Rank, Erik Erikson, Melanie Klein, and Heinz Kohut and often formed their own differentiating systems of psychotherapy. These were all later termed under a more broad label of psychodynamic, meaning anything that involved the psyche's conscious/unconscious influence on external relationships and the self. Sessions tended to number into the hundreds over several years.

Behaviorism developed in the 1920s, and behavior modification as a therapy became popularized in the 1950s and 1960s. Notable contributors were Joseph Wolpe in South Africa, M.B. Shipiro and Hans Eysenck in Britain, and B.F. Skinner in the United States. Behavioral therapy approaches relied on principles of operant conditioning, classical conditioning and social learning theory to bring about therapeutic change in observable symptoms. The approach became commonly used for phobias, as well as other disorders.

Some therapeutic approaches developed out of the European school of existential philosophy. Concerned mainly with the individual's ability to develop and preserve a sense of meaning and purpose throughout life, major contributors to the field (e.g., Irvin Yalom, Rollo May) and Europe (Viktor Frankl, Ludwig Binswanger, Medard Boss, R.D.Laing, Emmy van Deurzen) attempted to create therapies sensitive to common 'life crises' springing from the essential bleakness of human self awareness, previously accessible only through the complex writings of existential philosophers (e.g., Søren Kierkegaard, Jean-Paul Sartre, Gabriel Marcel, Martin Heidegger, Friedrich Nietzsche). The uniqueness of the patient-therapist relationship thus also forms a vehicle for therapeutic enquiry.

A related body of thought in psychotherapy started in the 1950s with Carl Rogers. Based in existentialism and the works of Abraham Maslow and his hierarchy of human needs, Rogers brought person-centered psychotherapy into mainstream focus. Rogers' basic tenets were unconditional positive regard, genuineness, and empathic understanding, with each demonstrated by the counselor. The aim was to create a relationship conducive to enhancing the client's psychological well being, by enabling the client to fully experience and express themselves. Others developed the approach, like Fritz and Laura Perls in the creation of Gestalt therapy, as well as Marshall Rosenberg, founder of Nonviolent Communication, and Eric Berne, founder of Transactional Analysis. Later these fields of psychotherapy would become what is known as humanistic psychotherapy today. Self-help groups and books became widespread.

During the 1950s, Albert Ellis developed Rational Emotive Behavior Therapy (REBT). A few years later, psychiatrist Aaron T. Beck developed a form of psychotherapy known as cognitive therapy. Both of these included short, structured and present-focused therapy aimed at changing a person's distorted thinking, by contrast with the long-lasting insight-based approach of psychodynamic or humanistic therapies. Cognitive and behavioral therapy approaches were combined during the 1970s, resulting in Cognitive behavioral therapy. Being oriented towards symptom-relief, collaborative empiricism and modifying peoples core beliefs, the approach gained widespread acceptance as a primary treatment for numerous disorders. A "third wave" of cognitive and behavioral therapies developed, including Acceptance and Commitment Therapy and Dialectical behavior therapy, which expanded the concepts to other disorders and/or added novel components.

Counseling methods developed, including solution-focused therapy and systemic coaching. Postmodern psychotherapies such as Narrative Therapy and coherence therapy did not impose definitions of mental health and illness, but rather saw the goal of therapy as something constructed by the client and therapist in a social context. Systems Therapy also developed, which focuses on family and group dynamics—and Transpersonal psychology, which focuses on the spiritual facet of human experience. Other important orientations developed in the last three decades include Feminist therapy, Brief therapy, Somatic Psychology, Expressive therapy, and applied Positive Psychology.

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Labels: Psychotherapy History

Psychotherapy is an interpersonal, relational intervention used by trained psychotherapists to aid clients in problems of living. This usually includes increasing individual sense of well-being and reducing subjective discomforting experience. Psychotherapists employ a range of techniques based on experiential relationship building, dialogue, communication and behavior change and that are designed to improve the mental health of a client or patient, or to improve group relationships (such as in a family).

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Labels: Psychotherapy