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Deborah L. Cabaniss, M.D. Headshot

Choosing Psychotherapy Today: One Size No Longer Fits All

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Chances are that if you went to a doctor in the Middle Ages, you had a leech applied for bloodletting. That was about all there was. And chances are that if you went to a psychotherapist in the 1950s, you started psychoanalysis. That was also about all there was.

But if you go to a psychotherapist today, there are many options and each is different. Some are better suited for certain kinds of problems, and some are better suited for others. So if you're considering therapy, how do you decide what's best for you?

First, you need to know what's available. Here's some information about the major types of psychotherapy that are commonly used today:

Cognitive behavioral therapy: (CBT) is based on the idea that many of our problems are the result of how we think. It is well suited to treat anxiety, depression and eating disorders. The focus is on conscious thoughts, rather than on thoughts of which we are not aware. It is generally short term -- say, a few months -- but can be longer. Sessions are focused on the problem at hand. CBT therapists often give homework to help people practice new ways of thinking or behaving.

Dialectical behavior therapy: (DBT) was originally developed to help reduce suicidal and self-injurious behavior in people with borderline personality disorder. It also helps people with depression, anxiety and other behavioral problems to manage feelings, impulses and behaviors that feel out of control. DBT therapists are generally available by phone to provide coaching and support to handle situations that arise between therapy sessions. DBT generally lasts from six months to a year or longer, and patients often attend both individual and group sessions.

Interpersonal psychotherapy: (IPT) is a time-limited treatment originally designed to treat depression. It is based on the idea that depression may be caused by problems between people, and that resolving those problems can help people feel better. The treatment generally lasts for about 12 to 18 sessions. IPT is now being used for problems with anxiety and eating disorders as well.

Psychodynamic psychotherapy: (Sometimes called psychoanalytic psychotherapy) is based on the idea that thoughts and feelings that are out of our awareness (unconscious) may cause difficulties, including anxiety and mood problems. In this therapy, people are asked to speak as freely as possible, as well as to talk about dreams and fantasies, in order to become aware of unconscious thoughts and feelings. Understanding feelings about one's therapist can help people in this type of treatment to improve their relationships with people in general. Although psychodynamic psychotherapy may be time-limited, it often lasts a year or more.

Psychoanalysis: is an intensive form of psychodynamic psychotherapy that aims for change of long-standing problematic character patterns. While psychodynamic psychotherapy is generally conducted once or twice a week with the patient sitting up, psychoanalysis is generally conducted with the patient lying on a couch three or four times a week over a period of several years. As with psychodynamic psychotherapy, speaking freely in sessions, discussing dreams and fantasies, and focusing on the relationship with the therapist are used to uncover unconscious thoughts and feelings.

Combined therapy: Psychotherapy and medication are often used together. If the therapist is a psychiatrist, he or she might be able to prescribe the medication and conduct the psychotherapy. Otherwise the therapist can work with another medical provider (such as a pharmacologist or primary care doctor) who will prescribe and monitor the medication. For many people with problems that impair their functioning at home, at work, and in relationships, a combination of medication and psychotherapy is the best treatment.

There are other types of therapy, but this should give you a start. Some types of psychotherapy are short-term, lasting a few weeks, while others are long-term, lasting months or years. Some focus mostly on the problem at hand, while others encourage people to speak freely about whatever comes to mind in order to uncover unconscious thoughts and feelings.

So if you're thinking that psychotherapy might help you, get some referrals from people you trust, such as your doctor, or friends and family members who have had good therapy experiences. Then make an appointment for a consultation, which is a chance to tell the therapist about the issues with which you'd like help, to find our what the therapist recommends, and to see if it's a good fit. You might want to meet with more than one therapist to find the person and therapy approach that seems best for you. Here are some questions you might want to ask the therapist to help you figure this out:

1. What type of psychotherapy do you recommend for me and why?
2. In your opinion, how would we set the goals for this psychotherapy?
3. How long do you think that this psychotherapy will last?
4. How will we know if the psychotherapy is working? By when? What will we do if it's not working?
5. Do you think that my family should be involved in the psychotherapy?
6. Do you recommend that the psychotherapy be combined with medication? If so, will you or someone else prescribe?

Be informed, ask questions, and think about what's best for you, since today, when it comes to psychotherapy, one size no longer fits all!

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Here are some websites that can give you more information about the psychotherapies mentioned in this post:

CBT: beckinstitute.org
DBT: behavioraltech.org
IPT: interpersonalpsychotherapy.org
Psychodynamic Psychotherapy: apsa.org
Psychoanalysis: apsa.org

Deborah L. Cabaniss, M.D., is Director of Psychotherapy Training and Clinical Professor of Psychiatry at the New York State Psychiatric Institute/Columbia University Department of Psychiatry. She is the lead author of "Psychodynamic Psychotherapy: A Clinical Manual" and "Psychodynamic Formulation."

Cross reference:
"The Therapeutic Alliance: The Essential Ingredient for Psychology"

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