There are hundreds of psychotherapy approaches or schools of thought. By 1980 there were more than 250; by 1996 more than 450; and at the start of the 21st century there were over a thousand different named psychotherapies—some being minor variations while others are based on very different conceptions of psychology, ethics (how to live) or technique. In practice therapy is often not of one pure type but draws from a number of perspectives and schools—known as an
integrative or
eclectic approach. Contemporary integrative models increasingly emphasize identifying and modifying recurrent cognitive, emotional, and interpersonal patterns, combining techniques from cognitive-behavioral, psychodynamic, and attachment-based frameworks. The importance of the
therapeutic relationship, also known as therapeutic alliance, between client and therapist is often regarded as crucial to psychotherapy.
Common factors theory addresses this and other core aspects thought to be responsible for effective psychotherapy. Sigmund Freud (1856–1939), a Viennese neurologist who studied with
Jean-Martin Charcot in 1885, is often considered the father of modern psychotherapy. His methods included analyzing his patient's dreams in search of important hidden insights into their unconscious minds. Other major elements of his methods, which changed throughout the years, included identification of childhood sexuality, the role of anxiety as a manifestation of inner conflict, the differentiation of parts of the psyche (id, ego, superego), transference and countertransference (the patient's projections onto the therapist, and the therapist's emotional responses to that). Some of his concepts were too broad to be amenable to empirical testing and invalidation, and he was critiqued for this by Jaspers. Numerous major figures elaborated and refined Freud's therapeutic techniques including Melanie Klein, Donald Winnicott, and others. Since the 1960s, however, the use of Freudian-based analysis for the treatment of
mental disorders has declined substantially. Different types of psychotherapy have been created along with the advent of clinical trials to test them scientifically. These incorporate subjective treatments (after Beck), behavioral treatments (after Skinner and Wolpe) and additional time-constrained and centered structures, for example, interpersonal psychotherapy. In youth issue and in schizophrenia, the systems of family treatment hold esteem. A portion of the thoughts emerging from therapy are presently pervasive and some are a piece of the tool set of ordinary clinical practice. They are not just medications, they additionally help to understand complex conduct. Therapy may address specific forms of diagnosable
mental illness, or everyday problems in managing or maintaining
interpersonal relationships or meeting personal goals. A course of therapy may happen before, during or after
pharmacotherapy (e.g. taking
psychiatric medication). Psychotherapies are categorized in several different ways. A distinction can be made between those based on a
medical model and those based on a
humanistic model. In the medical model, the client is seen as unwell and the therapist employs their skill to help the client back to health. The extensive use of the
DSM-IV, the diagnostic and statistical manual of mental disorders in the United States is an example of a medically exclusive model. The humanistic or non-medical model in contrast strives to depathologise the human condition. The therapist attempts to create a relational environment conducive to experiential learning and help build the client's confidence in their own natural process resulting in a deeper understanding of themselves. The therapist may see themselves as a facilitator/helper. Another distinction is between individual one-to-one therapy sessions, and
group psychotherapy, including
couples therapy and
family therapy. Therapies are sometimes classified according to their duration; a small number of sessions over a few weeks or months may be classified as
brief therapy (or short-term therapy), others, where regular sessions take place for years, may be classified as long-term. Some practitioners distinguish between more "uncovering" (or "
depth") approaches and more "supportive" psychotherapy. Uncovering psychotherapy emphasizes facilitating the client's insight into the roots of their difficulties. The best-known example is classical psychoanalysis.
Supportive psychotherapy by contrast stresses strengthening the client's coping mechanisms and often providing encouragement and advice, as well as reality-testing and limit-setting where necessary. Depending on the client's issues and situation, a more supportive or more uncovering approach may be optimal.
Humanistic These psychotherapies, also known as "
experiential", are based on
humanistic psychology and emerged in reaction to both behaviorism and psychoanalysis, being dubbed the "third force". They are primarily concerned with the human development and needs of the individual, with an emphasis on
subjective meaning, a rejection of
determinism, and a concern for positive growth rather than
pathology. Some posit an inherent human capacity to maximize potential, "the
self-actualizing tendency"; the task of therapy is to create a relational environment where this tendency might flourish. Humanistic psychology can, in turn, be rooted in
existentialism—the belief that human beings can only find meaning by creating it. This is the goal of
existential therapy. Existential therapy is in turn philosophically associated with
phenomenology.
Person-centered therapy, also known as client-centered, focuses on the therapist showing openness, empathy and "unconditional positive regard", to help clients express and develop their own
self. Humanistic
Psychodrama (HPD) is based on the human image of humanistic psychology. So all rules and methods follow the axioms of humanistic psychology. The HPD sees itself as development-oriented psychotherapy and has completely moved away from the psychoanalytic catharsis theory. Self-awareness and self-realization are essential aspects in the therapeutic process. Subjective experiences, feelings and thoughts and one's own experiences are the starting point for a change or reorientation in experience and behavior in the direction of more self-acceptance and satisfaction. Dealing with the biography of the individual is closely related to the sociometry of the group.
Gestalt therapy, originally called "concentration therapy", is an existential/experiential form that facilitates awareness in the various contexts of life, by moving from talking about relatively remote situations to action and direct current experience. Derived from various influences, including an overhaul of psychoanalysis, it stands on top of essentially four load-bearing theoretical walls:
phenomenological method, dialogical relationship, field-theoretical strategies, and experimental freedom. A briefer form of humanistic therapy is the
human givens approach, introduced in 199899. It is a solution-focused intervention based on identifying emotional needs—such as for security, autonomy and social connection—and using various educational and psychological methods to help people meet those needs more fully or appropriately.
Insight-oriented Insight-oriented psychotherapies focus on revealing or interpreting
unconscious processes. Most commonly referring to
psychodynamic therapy, of which
psychoanalysis is the oldest and most intensive form, these applications of
depth psychology encourage the verbalization of all the patient's thoughts, including
free associations, fantasies, and dreams, from which the analyst formulates the nature of the past and present unconscious conflicts which are causing the patient's symptoms and character problems. There are six main schools of psychoanalysis, which all influenced psychodynamic theory: Freudian,
ego psychology,
object relations theory,
self psychology,
interpersonal psychoanalysis, and
relational psychoanalysis. Techniques for analytic
group therapy have also developed.
Cognitive-behavioral Behavior therapies use
behavioral techniques, including
applied behavior analysis (also known as
behavior modification), to change maladaptive patterns of behavior to improve emotional responses, cognitions, and interactions with others.
Functional analytic psychotherapy is one form of this approach. By nature, behavioral therapies are empirical (data-driven), contextual (focused on the environment and context), functional (interested in the effect or consequence a behavior ultimately has), probabilistic (viewing behavior as statistically predictable),
monistic (rejecting mind-body dualism and treating the person as a unit), and relational (analyzing bidirectional interactions).
Cognitive therapy focuses directly on changing the thoughts, in order to improve the emotions and behaviors.
Cognitive behavioral therapy attempts to combine the above two approaches, focused on the construction and reconstruction of people's
cognitions,
emotions and
behaviors. Generally in CBT, the therapist, through a wide array of modalities, helps clients assess, recognize and deal with problematic and dysfunctional ways of thinking, emoting and behaving. The concept of "third wave" psychotherapies reflects an influence of
Eastern philosophy in clinical psychology, incorporating principles such as
meditation into interventions such as
mindfulness-based cognitive therapy,
acceptance and commitment therapy, and
dialectical behavior therapy for
borderline personality disorder. It aims to foster adaptation to current interpersonal roles and situations.
Exposure and response prevention (ERP) is primarily deployed by therapists in the treatment of
OCD. The
American Psychiatric Association (APA) state that CBT drawing primarily on behavioral techniques (such as ERP) has the "strongest evidence base" among psychosocial interventions. By confronting feared scenarios (i.e., exposure) and refraining from performing rituals (i.e., responsive prevention), patients may gradually feel less distress in confronting feared stimuli, while also feeling less inclination to use rituals to relieve that distress. Typically, ERP is delivered in "hierarchical fashion", meaning patients confront increasingly anxiety-provoking stimuli as they progress through a course of treatment. Other types include
reality therapy/
choice theory,
multimodal therapy, and therapies for specific disorders including
PTSD therapies such as
cognitive processing therapy,
substance abuse therapies such as
relapse prevention and
contingency management; and
co-occurring disorders therapies such as Seeking Safety.
Systemic Systemic therapy seeks to address people not just individually, as is often the focus of other forms of therapy, but in relationship, dealing with the interactions of groups, their patterns and dynamics (includes
family therapy and
marriage counseling).
Community psychology is a type of systemic psychology. The term
group therapy was first used around 1920 by
Jacob L. Moreno, whose main contribution was the development of
psychodrama, in which groups were used as both cast and audience for the exploration of individual problems by reenactment under the direction of the leader. The more analytic and exploratory use of groups in both hospital and out-patient settings was pioneered by a few European psychoanalysts who emigrated to the US, such as
Paul Schilder, who treated severely neurotic and mildly psychotic out-patients in small groups at Bellevue Hospital, New York. The power of groups was most influentially demonstrated in Britain during the Second World War, when several psychoanalysts and psychiatrists proved the value of group methods for officer selection in the War Office Selection Boards. A chance to run an Army psychiatric unit on group lines was then given to several of these pioneers, notably
Wilfred Bion and Rickman, followed by
S. H. Foulkes, Main, and Bridger. The
Northfield Hospital in Birmingham gave its name to what came to be called the two "Northfield Experiments", which provided the impetus for the development since the war of both social therapy, that is, the
therapeutic community movement, and the use of small groups for the treatment of neurotic and personality disorders. Today group therapy is used in clinical settings and in private practice settings.
Expressive Expressive psychotherapy is a form of therapy that utilizes artistic expression (via improvisational, compositional, re-creative, and receptive experiences) as its core means of treating clients. Expressive psychotherapists use the different disciplines of the creative arts as therapeutic interventions. This includes the modalities
dance therapy,
drama therapy,
art therapy,
music therapy,
writing therapy, among others. This may include techniques such as
affect labeling. Expressive psychotherapists believe that often the most effective way of treating a client is through the expression of imagination in creative work and integrating and processing what issues are raised in the act.
Postmodernist Also known as
post-structuralist or
constructivist.
Narrative therapy gives attention to each person's "dominant story" through therapeutic conversations, which also may involve exploring unhelpful ideas and how they came to prominence. Possible social and cultural influences may be explored if the client deems it helpful.
Coherence therapy posits multiple levels of mental constructs that create symptoms as a way to strive for self-protection or self-realization.
Feminist therapy does not accept that there is one single or correct way of looking at reality and therefore is considered a postmodernist approach.
Other Transpersonal psychology addresses the client in the context of a spiritual understanding of consciousness.
Positive psychotherapy (PPT) (since 1968) is a method in the field of humanistic and psychodynamic psychotherapy and is based on a positive image of humans, with a health-promoting, resource-oriented and conflict-centered approach.
Hypnotherapy is undertaken while a subject is in a state of
hypnosis. Hypnotherapy is often applied in order to modify a subject's behavior, emotional content, and attitudes, as well as a wide range of conditions including: dysfunctional habits, anxiety, stress-related illness, pain management, and personal development.
Psychedelic therapy are therapeutic practices involving
psychedelic drugs, such as
LSD,
psilocybin,
DMT, and
MDMA. In psychedelic therapy, in contrast to conventional
psychiatric medication taken by the patient regularly or as needed, patients generally remain in an extended psychotherapy session during the acute psychedelic activity with additional sessions both before and after in order to help integrate experiences with the psychedelics. Psychedelic therapy has been compared with the
shamanic healing rituals of indigenous people. Researchers identified two main differences: the first is the shamanic belief that multiple realities exist and can be explored through altered states of consciousness, and second the belief that spirits encountered in dreams and visions are real.
Body psychotherapy, part of the field of
somatic psychology, focuses on the link between the mind and the body and tries to access deeper levels of the psyche through greater awareness of the
physical body and
emotions. There are various
body-oriented approaches, such as Reichian (
Wilhelm Reich) character-analytic
vegetotherapy and orgonomy; neo-Reichian
bioenergetic analysis;
somatic experiencing;
integrative body psychotherapy; Ron Kurtz's
Hakomi psychotherapy; sensorimotor psychotherapy; Biosynthesis psychotherapy; and Biodynamic psychotherapy. These approaches are not to be confused with
body work or body-therapies that seek to improve primarily physical health through direct work (touch and manipulation) on the body, rather than through directly psychological methods. Some non-Western
indigenous therapies have been developed. In African countries this includes harmony restoration therapy, meseron therapy and systemic therapies based on the
Ubuntu philosophy.
Integrative psychotherapy is an attempt to combine ideas and strategies from more than one theoretical approach. These approaches include mixing core beliefs and combining proven techniques. Forms of integrative psychotherapy include
multimodal therapy, the
transtheoretical model, cyclical psychodynamics, systematic treatment selection,
cognitive analytic therapy,
internal family systems model,
multitheoretical psychotherapy and conceptual interaction. In practice, most experienced psychotherapists develop their own integrative approach over time.
Child Psychotherapy needs to be adapted to meet the developmental needs of children. Depending on age, it is generally held to be one part of an effective strategy to help the needs of a child within the family setting. Child psychotherapy training programs necessarily include courses in
human development. Since children often do not have the ability to articulate thoughts and feelings, psychotherapists will use a variety of media such as musical instruments, sand and toys, crayons, paint, clay, puppets, bibliocounseling (books), or board games. The use of
play therapy is often rooted in
psychodynamic theory, but other approaches also exist. In addition to therapy for the child, sometimes instead of it, children may benefit if their parents work with a therapist, take parenting classes, attend
grief counseling, or take other action to resolve stressful situations that affect the child.
Parent management training is a highly effective form of psychotherapy that teaches parenting skills to reduce their child's behavior problems. In many cases a different psychotherapist will work with the care taker of the child, while a colleague works with the child. Therefore, contemporary thinking on working with the younger age group has leaned towards working with parent and child simultaneously, as well as individually as needed. == Computer-supported ==