The world of mental health therapy can be overwhelming with its vast array of therapeutic approaches. From psychodynamic and cognitive behavior therapy to narrative and systemic therapy, the options seem endless. In this blog post, we will explore the different types of therapy, their commonalities, and their unique perspectives. By shedding light on the complexities of therapy, we aim to help you make more informed decisions about the type of therapy that may best suit your needs.
There are many types of therapy which include but are not limited to: psychodynamic (or psychoanalytic) psychotherapy, cognitive analytic therapy (CAT), cognitive behaviour therapy (CBT), dialetical behaviour therapy (DBT), compassion-focussed therapy (CFT), acceptance and commitment therapy (ACT), transactional analysis (TA), family therapy (systemic, structural, problem-based, behavioural), multi-systemic therapy (MST), mentalisation based therapy (MBT), narrative therapy, rational emotive behaviour therapy (REBT), humanistic psychotherapy, Gestalt psychotherapy, interpersonal therapy (IPT).. and this isn’t even touching the surface.
The complexity of therapy encompasses various approaches, each with its own set of theories, techniques, and evidence base. It’s essential to recognize that therapy is not a one-size-fits-all solution. Rather, it is a multifaceted landscape that aims to address diverse mental health challenges and support individuals on their unique journeys to healing and growth.
Despite their differences, many therapeutic approaches share common themes and techniques. One such theme is the exploration of individuals’ cognitive processes, beliefs, and personal narratives. Therapies often delve into how our thoughts and interpretations influence our emotions and behaviors. Additionally, when working with multiple individuals, therapists may inquire about their perceptions of others and examine similarities and differences in opinions.
Therapy also looks at the things that we do. What we ‘do’ could mean something as simple as what we eat and when we go to bed, or as complex as how we deal with difficult interpersonal situations and ‘act out’ different feelings. Naturally, therapies also address how we feel. The aim, usually, is to try to support us to feel better. Sometimes (not as often) the focus may be how our feelings interact with others around us, and their feelings.
Therapies encompass a holistic perspective, focusing not only on thoughts and beliefs but also on behaviors and emotions. They encourage individuals to examine their actions, ranging from everyday habits to complex interpersonal dynamics. The ultimate goal is to foster self-awareness, promote emotional well-being, and help individuals develop healthier ways of coping with life’s challenges.
Most therapies aim to identify patterns or ways of being that contribute to distress. They seek to uncover and understand the underlying causes of these patterns, often exploring individuals’ personal histories and childhood experiences. By examining the roots of current challenges, therapy can help individuals gain insight into themselves and their current circumstances. In some cases, therapies may also consider broader social and cultural factors that shape an individual’s life.
One crucial aspect that sets therapies apart is their underlying values and their understanding of distress. Cognitive approaches, for example, emphasize changing unhelpful thinking patterns and assume a strong connection between thoughts and emotions. Psychodynamic approaches, on the other hand, delve into earlier life experiences and explore the unconscious through symbols and metaphors. Narrative approaches focus on reshaping self-stories by enriching them with positive elements alongside problematic ones. Existential and humanistic approaches prioritize leading a life aligned with one’s values and finding meaning in existence. Systemic and community approaches examine the social and cultural context in which distress occurs, emphasizing relationships and broader social factors.
However, as the late psychologist David Smail wrote about extensively, people are often pushed into having ‘insight’ rather than ‘outsight’. That is, people look inwards and (some argue) are therefore subtly blamed for the distress that is caused by distal factors such as economic depression, war, poverty, overconsumption of idealised media lifestyles, sexism, racism, homophobia, inequality, and so on.
Smail argued, essentially, that most people do the best they can with what has been given to them – and, if anything, we should appreciate the myriad of creative ways that people find to try to make their way in life rather than labelling them ‘dysfunctional’. He saw the (limited) role of therapists primarily as ‘being with’ people who are in distress and supporting them through this, rather than trying to change people who fundamentally have little power against huge outside forces.
Systemic and community approaches tend to see people as a product of, and part of, their social context and culture. It’s not just about what is wrong with ‘you’, but how people relate to each other in light of certain problems. This is important when we consider that distress is not necessarily an individual ‘mental illness’ but actually a social and cultural phenomenon.
While many therapies focus on the individual, it is essential to acknowledge the impact of context and relationships. The therapeutic alliance between the therapist and the client plays a vital role in the success of therapy. Research shows that the quality of the therapeutic relationship outweighs specific techniques or orientations. Understanding this emphasizes the importance of finding a therapist with whom you feel comfortable and aligned, ensuring a strong foundation for therapeutic work.
Even therapy is dependent on its relational context. We know that the biggest in-therapy factor that affects the outcome is one’s relationship with a therapist. Martin et al (2000) conducted a meta-analysis and found that the quality of the ‘therapeutic alliance’ is more important than the technique and orientation of the therapist. This can be seen as positive news. It implies that the most important thing is to have a therapist that one is able to work with – this may include taking part in a therapy that fits with your values.
So what might be helpful? The following are some questions to consider when beginning your therapeutic journey, and you can find the acronyms at the start of this article.
Do you feel your thinking patterns are especially problematic, or do you get stuck in cycles of reacting? Maybe go with CBT. Are you more concerned with finding feelings difficult to tolerate, or are you an ‘overthinker’ already? If so, DBT, CFT and ACT might prove helpful. Are your life stories primarily negative, and do you get ‘stuck’ in one aspect of yourself or your life? Narrative and humanistic approaches could support you. Are you concerned with repeating patterns of relationships in your life? Perhaps CAT or psychodynamic will be suitable.
Your ‘problem’ will no doubt be important to the people who care about you too, so if you’d like to group together to make meaning, come up with ideas, and create change, systemic approaches may well be for you (and for those close to you). Additionally, systemic approaches (alongside compassionate therapies) may help shift the self-blame that so many of us are burdened with.
Whilst therapy can be a confusing world, it may also be a hopeful world in that there will be ‘something for everybody’. If one type of therapy hasn’t ‘worked’ for you, that’s okay, and it’s certainly not something you should blame yourself for. There are plenty of ways of understanding distress and plenty of therapies (or communities) that are available to address different kinds of problems.
