This section is intended to provide a general overview of the various approaches to psychotherapy. Beyond a pedagogical function, this overview may serve as a reminder of the diversity of the field and the many areas in which a student may seek specific training and clinical experience. Note that this review is intended to be merely descriptive and does not discuss empirical support for these therapies. Furthermore, we do not advocate any one particular approach.
There are inherent difficulties in any attempt to classify types of psychotherapy. In actual practice, therapists often incorporate elements from several theoretical frameworks, complicating efforts at classification. In fact, eclectic and integrative approaches are becoming increasingly common and popular among therapists of all persuasions. Even well known therapies may resist simple classification. Nonetheless, a basic grouping of the various approaches to psychotherapy can be useful. The following summaries, which were adapted from reference sources listed at the bottom of this page, are intended to serve as very basic starting points. Interested readers are suggested to seek additional sources.
Cognitive/Cognitive Behavioral Therapy
Behavior Therapy (return to top)
Behavior therapy grew out of the early behaviorist view that psychology should study observable acts rather than intrapsychic processes. However, modern behavior therapy does recognize the importance of cognitive constructs such as thoughts and feelings. A basic premise of behavior therapies is the idea that empirical research and principles should guide both assessment, which is an ongoing part of therapy, and treatment. As such, behavior therapies typically involve systematic application of experimentally based principles of learning to aid in behavior modification. These principles include classical conditioning, operant conditioning, and modeling (or social learning). The general goals of therapy are to identify problem behaviors, to generate new opportunities for learning, and to expand the array of alternative behavioral responses available to the client. The client plays an active role, in determining goals for example, and must be motivated to effect changes. The therapist focuses on contextual antecedents, characteristics of the problem behavior, and consequences. A positive therapist-client relationship, characterized by warmth, empathy, and genuineness, is viewed as a key ingredient in therapy, but it is not considered sufficient for behavior modification to take place. Common techniques and tools used in behavior therapy include relaxation training, systematic desensitization, modeling, role-playing, activity scheduling, and homework. Behavior therapy may also take the form of self-management programs, which often involve teaching coping skills, or eclectic approaches (such as Lazarus’ multimodal therapy), which often “borrow” various techniques.
Cognitive (or Cognitive-Behavioral) Therapy (return to top)
Over the past 20-30 years, cognitive therapies have developed considerably, and efficacy studies have proliferated. Because “cognitive” therapies often incorporate behavioral techniques (and vice versa), it is increasingly difficult to classify many therapies into one domain or the other. Having emerged out of the empirical era, many cognitive therapies, like behavior therapies, stress the importance of systematic assessment. A fundamental concept of almost all cognitive therapies is the A- B-C theory of personality. This theory postulates that the effect of activating events (A) on emotional and behavioral responses/ consequences (C) is mediated by cognitions or beliefs (B). Thus, problematic behavior can be changed by modifying maladaptive beliefs. In rational-emotive therapy (RET), a form of cognitive therapy developed by Albert Ellis, the therapist employs various cognitive, emotive, and behavioral techniques in an effort to challenge irrational beliefs and to foster development of new patterns of thinking. Beck developed perhaps the most well-known form of cognitive therapy, which was designed initially as a treatment for depression. It stresses the role of automatic thoughts and cognitive distortions, such as arbitrary inference, overgeneralization, and polarized thinking, in maintaining negative thinking or negative schema. Many different cognitive therapies have been developed following Ellis and Beck, and they often target specific problems. Given this diversity, the nature of the therapeutic process varies between individual therapies. In RET, the therapist adopts a more didactic stance and often directly challenges the client’s irrational beliefs. In Beck’s CT, the therapist and the client collaborate to test hypotheses based on the client’s beliefs. As in behavior therapy, the client must be committed to modifying their maladaptive beliefs. Cognitive therapists often employ a variety of techniques to assist in cognitive restructuring. These techniques may include education, examination of thoughts and cognitions, self-monitoring, problem solving, role-playing, teaching coping skills, assigning homework, mood ratings, and activity scheduling.
Experiential Therapy (return to top)
The experiential therapies include client-centered, Gestalt, and existential psychotherapies. These therapies were developed separately and are based on the work of Rogers, Perls, May, Yalom, and others. Although they may use different methods and stress different issues, they share several important elements, including a core belief in human beings’ inner potential for growth and development. Furthermore, as the name suggests, experiential therapies focus on in-therapy experiencing. As such, general goals of therapy may be to elicit emotional experience, to provide an empathic therapeutic relationship, and to facilitate the creation of meaning and awareness. With regard to the therapist’s role, the various experiential approaches differ in the acceptable level of directiveness, but they generally emphasize “process directiveness”, which involves suggesting productive ways to work on a particular type of issue. Finally, the experiential therapies stress the essential benefit offered by the therapist-client relationship and adopt a client-centered approach. As mentioned above, the way in which these ideas are applied varies among the experiential psychotherapies. In existential psychotherapy, for example, awareness develops through detailed exploration of issues such as death, freedom, isolation, and search for meaning within the setting of a trusting bond between therapist and client. During this exploration, existential therapists may employ techniques from various approaches. In client-centered therapy, the client’s growth and awareness are attained based on a warm, accepting, genuine, and empathic therapeutic relationship, and the therapist may use skills such as “listening, accepting, respecting, understanding, and sharing” (Corey, p. 215). Gestalt therapy maintains that a client must accept responsibility for his/her life to achieve maturity and addresses issues such as unexpressed feelings (guilt, resentment, abandonment, etc.), avoidance, and neuroses with a distinct emphasis on the here-and-now. Although Gestalt methods are often somewhat confrontational, they are not necessarily harsh. They may be used in group or individual therapy and consist of unconventional “experiments”, dialogue exercises (“empty chair technique”), role playing, and several other techniques.
Psychodynamic Therapies (return to top)
Although they differ in important ways, traditional psychoanalysis and more modern psychodynamic therapies share a common Freudian origin. Basic elements of Freudian theory include the id/ego/superego structure of personality, the tension between the conscious and unconscious, the use of ego-defense mechanisms, and the psychosexual stages of development. Furthermore, both camps view psychopathology as rooted in unconscious conflict and emphasize the need for insight. Other important contributors to the development of psychodynamic therapy include Jung, Horney, Fromm, Sullivan, Erikson, and Adler. Many of these theorists departed from Freud’s views and incorporated the influence of social and cultural factors into personality development. Modern psychodynamic therapy often draws from self-psychology and object relations theories, which focus on attachment and the process of individuation. Traditional psychoanalysis relies heavily on the development of a transference relationship between the therapist and the client and, in its strict form, advocates a cool, objective stance on the part of the therapist. In modern psychodynamic therapy, this view has been loosened in favor of a collaborative relationship between the client and a therapist who validates the client’s expressions and communicates understanding. Because psychodynamic therapy continues to focus primarily on childhood experiences and exploration of the past, it may require long-term therapy. However, modern psychodynamic interventions that are short-term have been developed and are being applied with greater frequency. Although these contemporary approaches also view psychopathology as rooted in unconscious beliefs and childhood experiences, the focus of therapy is alleviation of current problems. Techniques traditionally used by psychoanalytic or psychodynamic therapists include free association and interpretation of dreams, resistance, and transference. However, other common therapeutic techniques may be used as well, and Adlerian therapists avail themselves of a wide variety of methods to aid clients in modifying mistaken beliefs and to promote growth and insight.
References: (return to top)
Corey, G. (1991). Theory and practice of counseling and psychotherapy. Pacific Grove, CA: Brooks/Cole.
Lambert, M.J. (2004). Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (5th ed.). New York: Wiley.