When many people think of going to therapy, they picture laying down on a couch and talking to a therapist sitting in a chair and avidly taking notes on a clipboard. While this may be a somewhat accurate depiction of what happens during a therapy session, there is much more actually happening below the surface.
Psychotherapy, more commonly referred to simply as “therapy”, is the name given to the practice of spending time with a licensed mental health professional in order to seek advice or treatment. Depending on the nature of your condition, there are different ways a therapy session may be approached.
What happens during your therapy session, and how it affects you, can largely be determined by the type of therapy being used. There are several different types of therapy approaches that can be used. Among the more popularly used approaches are cognitive behavioral therapy, neurofeedback, and group therapy.
Cognitive Behavioral Therapy:
This approach to therapy is based on the idea that thoughts and feelings directly affect actions and moods. It primarily deals with identifying negative thought patterns and then changing these into more positive thought patterns.
Cognitive Behavioral Therapy (CBT) entered the psychology world in the 1960s with Dr. Aaron T. Beck. At that time, Dr. Beck was a psychiatrist at the University of Pennsylvania who was trying to conceptualize depression. During his research, he began to notice that people with depression were experiencing spontaneous, negative thoughts pertaining to themselves, the world, and/or their future.
Once he identified these patterns, he then began to work with patients by having them identify and explore these thought patterns. What he found was that by having patients identify and explore their negative thought patterns, they were able to see things more realistically. As a result, their emotional state improved, as well as their ability to function.
Since its introduction in the 1960s, CBT, also called simply cognitive therapy, has been proven to be an effective approach to psychotherapy. Over 1,000 different studies have detailed several benefits in treating a large variety of mental health concerns.
CBT can be used to treat:
- Generalized anxiety disorder
- Post-traumatic stress disorder (PTSD)
- General stress
- Anger issues
- Panic disorders
- Certain phobias
- Eating disorders
- Marital difficulties
- Obsessive-compulsive disorder (OCD)
Many modern therapists use CBT during their sessions. If this is the case, then the session will often begin with them asking what is going on in your mind at that moment. CBT works by identifying moods, thoughts, and feelings that occur in the present moment, and then evaluating the reasons behind them. It is not concerned with the past and is purely concerned with moving forward.
Depending on what the individual wants to work on, a number of strategies can be employed within the CBT model. Often, developing problem-solving strategies are a large part of CBT. To strengthen an individual’s ability to solve problems on their own, role-playing situations or relaxation techniques may be taught. These techniques can then be used during problematic situations that occur outside therapy.
The end goal with CBT is to teach individuals to essentially become their own therapist. This means that individuals will learn how to identify and evaluate their own thought patterns, change their own thinking, learn healthy coping skills, and manage problematic behaviors.
There are also subtypes of CBT including:
- Mindfulness-based CBT: additional focus on mindfulness, meditation, and breathing exercises
- Cognitive Processing Therapy: used in the treatment of PTSD, and is focused on the specific negative thought patterns associated with PTSD
- Rational Emotive Behavior Therapy (REBT): focused on irrational, negative thought patterns
- Dialectical Behavior Therapy (DBT): develops skills in four main areas 1) mindfulness 2) tolerating distress 3) emotional regulation 4) interpersonal effectiveness
This approach, also known as electroencephalogram (EEG) or neurofeedback, uses feedback from an individual’s brainwave activity to teach regulation strategies. With biofeedback, computers and electronic sensors measure physical symptoms such as muscle tension, blood volume pulse, heart rate, skin conductance, hand temperature, and respiration, in addition to brainwave activity.
Not only does the correlation between the two show how the mind and body are connected, but it shows individuals how to recognize signs of psychological stress. Once people are aware of how their body is reacting, it makes it easier to start gaining control of these reactions. Eventually, this allows them to decrease symptoms and increase their mood.
Biofeedback was developed around the late 1950s and early 1960s by Dr. Joe Kamiya of the University of Chicago and Dr. Barry Sterman of UCLA. Dr. Kamiya was using EEG to find that people’s brain activity could change based on rewards, while Dr. Sterman worked with cats to increase their sensory-motor rhythm by rewarding a change in brainwaves.
However, biofeedback wasn’t used in psychology until about the late 1980s and early 1990s. More recently, the concept of neuroplasticity has begun to gain traction in the medical field. Neuroplasticity refers to changes in the brain-derived from experiences, education, and adaptation. In simple terms, it means that our brain is constantly changing and can be altered from the things that happen to us.
Biofeedback can be used to treat:
- Seizure conditions
- Behavior disorders
- Attention deficit disorders
- Ongoing developmental delays
- Acquired brain injuries
- Birth trauma
- Post-traumatic stress disorder
- Stress related problems
Treatment with biofeedback is generally carried out as a once a week session, and most treatment courses last for about 20 weeks. The session will begin with you sitting in a chair and having electric sensors attached to your scalp. You will then listen to music or watch certain images that will improve your brain activity. As your brain essentially learns how to function better, you will begin to notice a decrease in symptoms.
This approach consists of more than one individual receiving psychotherapy at the same time. Group therapy can take the form of couples therapy, family therapy, or specialized support groups. The main thing that sets group therapy apart from individual therapy is that it is composed of multiple individuals working towards a common goal.
Group therapy has been around for quite some time and can be traced back to the early 1900s. At that point, it was used as a treatment for those with Tuberculosis. It was then used again during WWII to help soldiers suffering from PTSD and war-related emotional problems. After WWII, psychologist Irvin Yalom, along with others, further developed the approach of group therapy.
Yalom’s notion of group therapy became a popular model for psychotherapists in the United States and around the world. Yalom noted that there were 11 specific characteristics that enabled group therapy to be successful:
- Universality (I am not alone)
- Group cohesiveness
- Instillation of hope
- Imparting information
- Interpersonal learning
- Development of socializing techniques
- Intimate behavior
- Corrective recapitulation of the primary family group
- Existential factors
Group therapy sessions differ based on the type of group therapy being performed. This means that couples therapy, family therapy, and specialized support group sessions will all be different because they have different participants and goals.
For example, a couple’s therapy is generally based on establishing effective communication strategies. Often times, relationships can be negatively affected by life changes. When relationships become strained, “negative interaction cycles” become more prominent as a result of possible insecure attachment, ego, arrogance, jealousy, anger, greed, poor communication, and a lack of problem-solving. Relationships can also be strained by an individual’s mental health concerns as well.
Because of this, the ultimate goal of couple’s therapy is to teach both parties better ways of communicating with each other. During sessions, the couple may discuss certain aspects of their relationship that have caused trouble and they will also learn strategies about how to relate to one another. Overall, couple’s therapy works to identify and eliminate negative interaction cycles, while also promoting communication and positive interaction cycles.
With family therapy, the approach is similar, however, it is based on the family unit as a whole and how everyone is interacting together. During a family therapy session, members of the family explore how their family functions as a whole and how their individual actions contribute to this. A common idea expressed in family therapy is that what happens to one person actually happens to the entire family.
Finally, specialized support groups will focus on the topic the group is based on. There are a range of topics that a group therapy session can be based on, but some common ones are addiction, grief, LGBTQ, or sexual abuse. Within a specialized group therapy session, the focus is often about sharing experiences, getting advice, and creating a sense of community.
Most group therapy sessions are made up of about ten people, but there can also be larger or smaller groups, that sit in a circle facing each other. A licensed therapist will also participate as needed, facilitate discussions, and moderate or interject if things become heated. On average, most groups will meet about once or twice a week for about 1-2 hours. Often times, the cohesiveness of the group can also lead to outside activities as well.
Overall, there are many different approaches to therapy. If you are considering therapy, it is important to keep an open mind and be open to trying a few different approaches until you find the one that works best for you. As mentioned before, each type of therapy offers different strategies and theories on how to decrease your symptoms and increase your mood. In some cases, it may also be beneficial to try a hybrid approach using one or more types of therapy. Ultimately, the end goal is to find the best approach that works for you.
To get more information about the types of therapy or to get started with your therapy journey, schedule a consultation with NJ Family Psychiatry & Therapy today!