Tag Archives: cognitive behaviour therapy

Really – they study for 6 years? What for?

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I thought a nice follow on to the last post (What actually happens in therapy?) would be to look at the different models / theories that are used to guide the therapy. Yes, folks, this is where the “work” lies and the bits that keep psychologists studying for 6 years!!! As mentioned, we’re not all about the “chatting” in therapy – there is some very real work that happens, some deep talking that occurs, but just what you talk about is very much informed and guided by the therapist’s choice of theory.

So here is the breakdown.

There are many methods / models of therapy. To name a few, Cognitive Behavioural Therapy, Psychodynamic Psychotherapy, Interpersonal Therapy, Emotion Focused Therapy, Strategic Therapy, Narrative Therapy and many more. For the purposes here, I am really only going to discuss the ones that I use most often, but you would be well within your rights to find out what your psychologist uses and how it all works!

(Disclaimer: what follows is a very simplified version of what actually goes down in the session)

CBT = Cognitive Behavioural Therapy:

This is a very common form of therapy and extremely useful in treating conditions such as Anxiety, Social Phobia, Specific Phobias, Depression, Obsessive Compulsive Disorder, Stress Management and many many more. It is a far more directive form of therapy that includes homework assignments and ‘experiments’. In fact, CBT is a time limited form of therapy that has a very specific goal and definite steps in attaining this goal.  The focus here is on your thoughts (the “cognitive” part of the name) and how these affect your feelings and in turn your behaviour (the “behavioural” part of the name).  It all looks something like this:The Cognitive TriangleSo, if our conditions such as Anxiety, Depression, Phobias, Panic attacks etc all manifest behaviourally, then it would make sense for us to target our thoughts first, right? Need an example?

OK, let give an example of Depression… some thoughts you may have had could be: “Im not coping in my job” “I’m a useless mother”, “Im a useless father / wife / husband etc”, “No one likes me”, “I cant do this” etc etc etc. Feelings that would automatically follow thoughts like these would include loneliness, sadness, feeling useless and unloved etc. As a result, your behaviour would not be one of prouncing joy – no, you would probably stay in bed, cry, not want to go out and see people, not try very hard at work, become demotivated etc. Now, here is the important part – this behaviour CONFIRMS your thoughts – i.e.: not trying hard at work would probably lead to you not getting everything done and, therefore, feeling like you cant cope. Not getting out of bed, crying a lot and not wanting to see people would lead to you isolating yourself, not looking your best and essentially feed back into thoughts such as “no one likes me”, “I am a useless mother / father / wife / husband”… AND THUS THE CYCLE BEGINS! CBT therefore focuses on breaking this cycle by examining your thoughts and exploring how these are affecting your feelings and behaviour! Your psychologist will give you homework assignments designed to train you in “catching” your thoughts and challenging your beliefs, as well as relaxation training excercises, thought/worry stopping techniques and stress management methods.

So the next big one is Psychodynamic Therapy – yes, the father here is Freud, but he lost favour years ago and the theory is now informed by more recent theorists that do not place all that much emphasis on the Oedipus Complex 🙂 Where CBT  is a more goal directed form of therapy, Psychodynamic therapy is less time-limited and guided more by the client and his/her associations (this is a fancy word for “talking about whatever comes to mind”). The aim of this model is to uncover how early childhood and formative experiences have shaped how we react and feel about current situations. So the therapy here would require you to talk as freely and openly about your current circumstances, while your psychologist tries to link these experiences with earlier ones and places an emphasis on how you have been shaped by those experiences. Essentially, by uncovering the source of our frustrations, we are often able to think differently about them and, ultimately change the way we feel and react to current ‘curve balls’.psychodynamic cartoon

This is a great form of therapy if you are wanting insight into why you feel or behave in certain ways, insight into your relationship dynamics with your partner, insight into why you keep having the same sort of experiences (you know the case of getting involved with the wrong kind of partner over and over and over again?), or just want some personal growth experiences. Psychodynamic therapy is very explorative and while it has moved on from the “lying on the couch” experience, it still aims to probe the deeper recesses of the mind and uncover the anxieties and defenses we have hidden there.

I think this gives you a pretty good idea of what lies behind the practice of therapy and I certainly don’t want to bombard you with any more information… as usual, however, please feel free to post questions if you are interested in other forms of therapy, or have any comments you would like to make…

Great chatting to ya, until next time remember:

There is only one meaning of life: the act of living itself.” (Erich Fromme)

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So, what actually happens in therapy??

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This is a good question, really. It seems the whole concept of “therapy” is shrouded in mystery – not very much information out there regarding what actually happens when you see a psychologist, and those that are in therapy are not likely to discuss it in much detail. I have often been told by others that they would love to have my job as a psychologist – “you get to sit around and chat all day!”

Well, for the most part, there isn’t much “chatting” going on in a therapy session. And it certainly isn’t about making friends! – not for the client and not for the psychologist. In fact the relationship between the client and the therapist is a tricky one, quite different from all other relationships. Firstly, it is a pretty intimate relationship, one where the psychologist gets to be part of a very personal journey of self discovery that is often not shared with others in the client’s life. Very personal thoughts and feelings are explored with the therapist in an entirely confidential and non-judgmental space. As a result, the therapist often gets to know the client in a far more intimate way than others have done in the past. Secondly, it is not a reciprocated relationship. The therapist does not share their own personal stories with the client – in fact in most cases, the client actually knows precious little about the therapist and his/her life. As a result, the relationship can feel quite  one-sided.

So, what actually happens in the therapy session if we are not “chatting” and making friends?

Well, as you can see, the relationship is a very important one, so a large part of the first few sessions is about establishing this relationship. Forming a “working alliance” we call it. Basically the psychologist gets to know the client, while making every effort to leave the client feeling well understood and accepted. This is possibly one of the most important factors in establishing whether therapy will be effective or not. Many great theorists have surmised that the success of therapy is based entirely on the therapeutic relationship and whether or not the client and therapist have made a connection. So, folk, this is important to remember – its no use continuing with a psychologist if you dont feel you can establish a “working alliance” with them.

OK, so now we have the relationship – what else happens?

We TALK! Psychotherapy is known as the “talking cure” and as such, talking forms the basis of what you “do” in therapy. Its what you talk about that makes the difference and this depends largely on the type of therapy being used. (I will deal with different therapy models in more detail in future posts). For now it is suffice to say that the therapy model often depicts the focus of the therapy and what is spoken about. Having said that, however, there is no right and wrong regarding what may and may not be spoken about during therapy. This is YOUR time, an hour that is dedicated solely to you and, consequently, you get to be the leader here. Your therapist might guide you in certain directions, but you have the power to talk about as much or as little as you like. And NO! Your psychologist cannot mind read, or magically pull out your deepest darkest secrets. No, therapy is based on honesty and trust – a space where you come be as honest as you can about things, and in the process learn to trust again… and isn’t that what we all want?

I guess its in the talking, the being honest and the forming of a really important relationship that the details are sorted out. This is where the problems find solutions, the significant relationships with others are restored, the wounds of the past are healed and new coping skills are learnt.

Hopefully this has de-mystified the therapy process a bit for you and given you some encouragment in taking the next step and getting involved…

Till my next post, remember

“A journey of a thousand miles must begin with a single step”