There are many types of mental disorder – all of which require different forms of treatment. Psychotherapy is now, perhaps the most popular way to treat mental health issues. Mental disorders can be characterised as ‘possessing enduring and maladaptive cognitive organisations or “schemas” that have a strong impact upon affective and behavioural responses.’[1] Psychotherapy is all about resolving these issues, through therapeutic means. It was introduced as an alternative to diagnostic and medication-based treatment and has since been incredibly popular. Its popularity is largely to do with the stigma attached to prescribed medicine – like anti-depressants – and the fear of side-effects and possible dependency.[2] The most common trait behind any psychotherapy type is the role of discussion between patient and therapist. Talking is seen as the best way to get to the root of a problem, and let emotions and thoughts flow. It is essentially founded on the principle of: the more we talk, the more we understand the issue.

There are many types of psychotherapy – some more experimental and ‘out there’ than others. From music and dance, to equine-assisted and chess therapy, the range is vast to say the least. As more people experience mental health-related issues, and we discover different forms of illness, it is likely that therapy practices will continue to evolve. While all types of psychotherapy work for different people, there are four main categories: psychoanalysis, behavioural, cognitive and humanistic. These are the most popular and tested forms. Here, we take a look at each approach, outlining the core features and limitations.

Psychoanalysis/Psychodynamic

This particular type of psychotherapy focuses on changing problematic behaviours by discovering their unconscious meanings and motivations.[3] It is treatment that seeks out the root to a problem; often implying that mental health issues have stemmed from experiences during childhood.[4] This therapy can take place over several months or several years, depending on the nature of the issue.[5] This almost limitless time-frame is a key feature and the freedom from time constraint is something it and practitioners pride itself on.[6] Psychodynamic therapy is very similar to psychoanalysis and attempts to uncover the repressed experiences of childhood. It differs, however, in its level of intensity: sessions may take place one or twice a week and the extent to which practitioners try to unearth past experiences, is far less-intense.[7]

This type of therapy is hundreds of years old. It is strongly associated to Sigmund Freud – a strong indicator of just how long it has been practiced. While it has been around longer, its historical context is also a limiting factor. Psychoanalysis is a qualitative type of therapy, but critics have outlined its failure to recognise scientific progress. It is a therapy focused on the root to a problem, but is unfortunately rooted in its own past. Other forms of therapy have consistently urged psychoanalysis to open its doors to ‘data-gathering methods, now widely available in biological and social science.’ There is hope that this new evidence, ‘may help psychoanalysts to resolve their theoretical differences.’[8] There is an opportunity for psychoanalysis to collaborate with new science. Until then, may it continue to be branded stuck in the past.

Behavioural

Behavioural therapy emphasises learning. It believes that with learning, patients may develop both normal and abnormal behaviours; learning to manage and overcome these.[9] It has proven to be effective in many areas: intimacy in couples, forgiveness, relationships, chronic pain, distress, substance abuse, depression, anxiety, insomnia and obesity.[10] It is all about learning to cope. If patients feel uncomfortable with a situation, behavioural therapy helps them feel comfortable. It targets the reactions that make these situations so uncomfortable; teaches patients about them, and how to cope.

While there are many types of behaviour therapy and many success stories, like all types of psychotherapy, it receives plenty of scrutiny and ongoing assessment. Critics have argued that this particular type of therapy is too rigid in its approach. It has also been criticised for its heavy focus on the subconscious, and its failure to acknowledge ‘observable’ behaviours.[11] Finally, as it is learning-based therapy, one of its features is giving patients external rewards at certain stages. Critics have argued that these can make the patients too dependent on external factors rather than internal motivation – the major driving force of long-term change.[12]

Cognitive

This is all to do with how people think, rather than what they do. It shares many of the same characteristics as behavioural therapy and is a popular means of treatment for depression and anxiety.[13] In fact, cognitive behavioural therapy is the ‘most widely researched and empirically supported psychotherapeutic method.’[14] It emphasises the link between people’s emotions and behaviours, and their perception of events. It is formed on the basis of three levels of cognition: core beliefs, dysfunctional assumptions and negative automatic thoughts.[15] For instance, a core belief is the negative perception someone has of themselves, like ‘I’m useless.’ This influences dysfunctional assumptions: a patient may believe that because they are useless, it is better not to try, than to risk failing. Coupled together, these generate negative thoughts from the outset. Feelings of automatic and inevitable failure are promoted by low self-esteem and reduced self-confidence.[16] Cognitive behavioural therapy aims to address all three stages and help patients to deal with the emotions and thoughts associate with each one.

Despite being seen as a largely popular type of psychotherapy, a recent meta-analysis revealed that positive effects on depression from cognitive therapy had been declining since 1977. This is reinforced by the argument that Cognitive therapy has the highest drop-out rate – sometimes five times that of other therapy types.[17]

Humanistic

‘Humanistic therapies are based on the premise that people are self-actualising’ – everyone has an inherent tendency to develop their potential and better themselves.[18] The clue is in the name: it is all to do with empathy and care for that particular person. These therapies were introduced in the 1950s and 1960s as a counter treatment to prescriptive approaches.[19] Sessions are centred around positivity and that particular client. The practitioner will consult heavily with the individual and shape therapy around their particular needs and preferences. As mentioned, it is all about empathy.

Similarly, to psychoanalysis, it is a psychotherapy approach that dates back a while. Therefore, it is unsurprising that questions have been asked about the lack of empirical evidence used in research.[20] Critics also argue that because there is such a one-dimensional focus on the patient, there is little consideration for external factors. Such focus means practitioners often ignore or fail to acknowledge the impact of society on their patient’s personality and emotional development.[21] Like psychoanalysis, it is therapy that would benefit from opening the door to other types.

Of course, these all come under the broader treatment of psychotherapy. While there are conflicting arguments, critiques and tendencies to highlight failures, they are all motivated by the same outcome: understanding emotions and behaviours, and finding a solution. There are a number of practitioners who integrate different elements from each psychotherapy approach. This is known as holistic or integrated therapy. It is a more open-minded approach that will likely continue to grow in popularity as it combines the best parts, from each approach. As mental health becomes an increasingly greater issue, psychotherapy will be a more heavily relied upon treatment. It seems that collaboration is the best way to deal with the growing issue. Types of psychotherapy should complement each other, not compete.

Sources:

[1] Beck, A. T. and Greenberg, M.S. 1990. Cognitive Approaches to Psychotherapy: Theory And Therapy, in Emotion, Psychopathology, and Psychotherapy, [available online 2013], available at: https://www.sciencedirect.com/science/article/pii/B9780125587051500142 [accessed 14 June 2020].

[2] Churchill, R et. al. 2010. Humanistic therapies versus other psychological therapies for depression. [online], available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4179874/ [accessed 13 June 2020].

[3] American Psychological Association. Webpage. Different Approaches to Psychotherapy. [online], available at: https://www.apa.org/topics/therapy/psychotherapy-approaches [accessed 13 June 2020].

[4] Web Md. Article. Mental Health and Psychotherapy. [online], available at: https://www.webmd.com/mental-health/mental-health-psychotherapy#1 [accessed 14 June 2020].

[5] ibid.

[6] Fonagy, P. 2003. Psychoanalysis Today. [online], available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525087/ [accessed 14 June 2020].

[7] Lumen Learning. Webpage. Approaches to Psychotherapy. [online], available at: https://courses.lumenlearning.com/boundless-psychology/chapter/approaches-to-psychotherapy/ [accessed 13 June 2020].

[8] Fonagy, P. 2003. Psychoanalysis Today

[9] American Psychological Association. Webpage. Different Approaches to Psychotherapy.

[10] Lumen Learning. Webpage. Approaches to Psychotherapy.

[11] ibid.

[12] ibid.

[13] Beck, A. T. and Greenberg, M.S. 1990. Cognitive Approaches to Psychotherapy: Theory And Therapy, in Emotion, Psychopathology, and Psychotherapy

[14] Byrne, M. and Fenn K. 2013. The key principles of cognitive behavioural therapy. [online] available at: https://journals.sagepub.com/doi/full/10.1177/1755738012471029 [accessed 14 June 2020].

[15] ibid.

[16] ibid.

[17] Lumen Learning. Webpage. Approaches to Psychotherapy.

[18] Churchill, R et. al. 2010. Humanistic therapies versus other psychological therapies for depression.

[19] ibid.

[20] Lumen Learning. Webpage. Approaches to Psychotherapy.

[21] ibid.