What is Psychotherapy?

Types of Psychotherapy (Approaches)


A professional's approach to therapy or "psychotherapeutic orientation" can be as unique as that therapist him or herself. Most therapists learn about and receive education in several approaches and specialize later in their professional evolution. This preparation interacts with the therapist's personality and the social and professional surroundings within which he or she practices to determine that particular fashion that develops. Nevertheless, there are a number of recognized approaches with new ones developed all the time. Most original approaches contribute a modest amount that is truly new while extending on existing approaches or combining components of several approaches. Most approaches therefore have significant convergence in theory and practice.

There is likewise a school of thought, with some research to back it up, that there are common elements in all efficient therapies that are contributive for the bulk of beneficial outcome. For instance, the character of the therapeutic relationship, irrespective of therapeutic orientation, is one factor that has been shown as essential and sufficient for postive outcome. There is likewise focus on common therapist skills such as empathetic listening, contemplation, and education that are relatively neutral in theory, as needed factors, as well as client components such as motivation, application of learning outside of appointments, and nature of the difficulty to be treated. Regrettably, psychotherapy and human modification is incredibly troublesome to research in a manner that can once and for all answer the question of which plan of attack is optimal. The research that has rendered meaningful outcomes has most frequently concentrated on very limited, easily defined problems that can be evaluated objectively. This scarcely covers the human condition and the disputes and struggles that people often convey to psychotherapists.

We have opted to briefly portray 4 major categories to help interpret the most commonly described psychotherapeutic approaches: Psychodynamic, Humanistic-Existential, Cognitive-Behavioral, and Transpersonal. If you are interested in surveying these matters further, you can click on the links provided in the text, search Amazon.com, the Internet, libraries and bookshops applying the terms and authors talked about and discover a wealth of information.

Psychodynamic Psychotherapy

Sigmund Freud is credited as the founder of psychoanalysis and psychoanalytic theory, if not modern psychology. There have been a multitude of variants that have developed and the term most frequently employed to generally encompass these approaches is "Psychodynamic." Terms such as: neurosis, conflict, attachment, object relations, unconscious, defense mechanisms, id, ego, superego, drives, libido, transference, countertransference, and innumerable more have emerged from this approach. Some of the major approaches within the psychodynamic category are: Psychoanalysis (Sigmund Freud), Adlerian Psychotherapy (Alfred Adler), Analytical Psychotherapy (Carl Jung), Object Relations (Mahler, Winnicott, Fairbairn, Klein, Gutrip, Kernberg and others), and Self Psychology (Heinz Kohut).

Freud's original theories were founded on the struggles that he thought were at the core of human existance. These conflicts emerge from attempts to harmonize our natural selves with our societal selves. Facets of these conflicts are involuntary and shape our behavior without our knowingness. Psychodynamic therapies function to make the unconscious conscious so that we can have better perceptiveness into our needs and behavior and therefore more control over how we allow these conflicts to affect us.

In Adlerian psychotherapy, clients are encouraged to master their feelings of insecurity, acquire deeper feelings of connectedness, and to redirect their endeavoring for import into more socially advantageous directions. Through a respectful Socratic dialogue, they are challenged to rectify mistaken assumptions, attitudes, behaviors and feelings about themselves and the world. Continuous encouragement stimulates clients to undertake what was previously felt as impossible. The development of self-confidence, pride, and gratification leads to a deeper desire and power to collaborate. The target of therapy is to replace exaggerated self-defence, self-enhancement, and self-indulgence with valiant social contribution.

Carl Jung was a pupil of Freuds and eventually developed his own theory called "Analytical Psychology." While still based on the balancing between the consious and unconsious, Jung broaded Freud's work to include concepts of civilization, mythology, and spiritualism. For Jung the most fundamental and long-term undertaking imposed upon any individual is fulfillment through the procedure of individuation, achievement of concordance of conscious and unconscious, which makes a mortal one and whole.

The term "object-relations" refers to the self-structure we internalize in early childhood, which functions as a blueprint for establishing and maintaining future relationships. Psychopathology is an expression of traumatic self-object internalizations from childhood acted-out in our present-day relationships. Psychotherapy is the resolving of these self-destructive patterns of relating so that we can grow and self-actualize. Self psychology is Heinz Kohut's variation of object relations theory that acknowledges the fundamental importance of people's needs for relationships vital in providing needed experiences during development and development. These experiences are called self-object experiences. Sufficient positive self-object experiences when the infant and child are growing facilitate the establishment of a strong, cohesive self -- the core of one's personality and character. Kohut is credited with contributing the conception of "empathy" to the every day discourse of psychotherapy.

Humanistic-Existential Psychotherapy

Humanistic psychotherapy is an approach which tries to do justice to the whole person including mind, body and spirit. It represents a broad range of healing methods. Each method acknowledges the self-healing capabilities of the client. The humanistic psychotherapist works towards an authentic meeting of equals in the therapy relationship. Abraham Maslow is perhaps the best known theorist affiliated with Humanistic Psychology and Carl Rogers (Client Centered Psychotherapy) the best know therapist, though many have followed including Fritz Perls and his Gestalt Therapy.

Existential psychotherapy is intimately related to humanistic psychotherapy, though diverse historical figures are usually related with the two models. Some therapists today will describe themselves as "humanistic-existential" in approach due to the standard antecedents and views.

Existential psychotherapy aims at enabling clients to discover constructive ways of coming to terms with the challenges of daily living. The focal point is on the client’s concrete, individual experience of anxiety and distress contributing to an exploration of their personal impressions and value system, in order to clarify and interpret these in relation to the particular physical, psychological and socio-cultural setting. The experience and influences of the past, present and future are rendered equivalent stress. The questioning of presumptions and facing up to the possibilities and limitations of living is an essential component of this correlative, dynamic and direct approach. Four "existential problems" are referenced as the core of the existential conflict that is the direct focus in this therapy and considered to be at the root of most psychological difficulties: death, freedom vs. responsibility, isolation, and meaninglessness. There are no thorough solutions to the existential problems yet all of us have to come to terms with them. The names most related with Existential Psychotherapy (not Existential Philosophers like Sartre and Kierkegaard) are Rollo May, James Bugental, and Irvin Yalom.

Cognitive-Behavioral Psychotherapy

Cognitive-Behavioral Therapy (CBT) is a practical approach that seeks to define concrete goals and uses active techniques to accomplish them. The cognitive-behavioral therapist looks at patterns of thinking and behavior and how these patterns are reinforced and retained by the person within his or her surroundings. A functional analysis of thinking and conduct is performed, frequently using log sheets and charts to better understand thought and behavior models in the context of daily routines. Once an understanding of symptoms and behavior is achieved, the therapist and client in concert formulate modifications in the patterns and persist in tracking. This procedure is replicated until the primary goals are satisfied. Attention to irrational thinking patterns (e.g., automatic thoughts, catastrophic thinking) is central to the approach as well.

Many of the techniques and programs that are usually affiliated with CBT are relaxation coaching, systematic desensitization, assertiveness preparation, and social skills training.

Historically, Cognitive-Behavior Therapy (CBT) has its roots in the work of behaviorists such as Ivan Pavlov, John Watson, Joseph Wolpe, and B.F. Skinner. Skinner, in particular, developed hypotheses of operant conditioning that were the cornerstone of behavior therapy, which sees the consequences of behavior as moulding future behavior. Associated with Skinner are terms such as stimulus-response, positive reinforcement, and contingencies of behavior.

Skinner's emphasis was on discernible behavior. It was theorists such as Albert Bandura (Social Learning Theory) and cognitive therapy and cognitive-behavioral therapy originators such as Albert Ellis (Rational Emotive Behavior Therapy), Aaron Beck (Cognitive Therapy), William Glasser (Reality Therapy) and Donald Meichenbaum (Cognitive-Behavioral Therapy) that instituted thought and emotion into this approach.

CBT is considered the "second wave" of behavior therapy. In the 1990's approches developed that integrated mindfulness and acceptance into the cognitive-behavioral position. Some view this as a fundamental change as CBT emphasized control and reduction of problematic thought, while the third wave approaches emphasized acceptance and moving on. Further, advocates for the third wave approaches view attempts to control or reduce these symptoms as counter productive and as potentially worsening them. Adopting mindfulness and acceptance from eastern thinking, third wave theorists espouse paradox. In this instance, symptom decrease will frequently occur when symptoms are accepted and struggling against them ends. Many of these third wave approaches are Steven Hayes, Kirk Strosahl, Kelly Wilson's Acceptance and Commitment Therapy (ACT), Marsha Linehan's Dialectical Behavior Therapy (DBT), Jon Kabat-Zinn's Mindfulness Based Stress Reduction (MBSR), and Zindel Segal, Mark Williams and John Teasdale's Mindfulness Based Cognitive Therapy (MBCT).

Transpersonal Psychotherapy

Transpersonal/Psychospiritual psychotherapy can be defined by its predilection which includes the spiritual dimension rather than the content of therapy. It sees the human psyche as having a central core Self or Soul as the centre of identity as well as a personal ego. Psychotherapists draw on a broad range of preventive methods towards the uncovering of past psychological material within a setting of the individuals potential based on spiritual perceptivity and experience. Within this perspective there is both a trend of the individual centre to the Self and a movement of the Self to manifest its nature through and in the personal center. Thus therapy includes both recompense and individuation.




“Under the care of Leo J. Borrell, M.D. since December 2001, I have seen a remarkable improvement in my mother’s condition. She is responding dramatically to the new regiment Dr. Borrell has prescribed”

- Beth Rose


Feb 3, 2008

The Interdisciplinary Team; The Role of the Psychiatrist

by Dr. Leo J. Borrell, featured in Assisted Living Consult for November/December 2006. A HealthCom Media Publication