Is the stereotype of therapy still “lie down on my couch
and tell me about your childhood / mother / dreams”? If so, we’ve come a long
way from Freud at the end of the 19th century. I’d like to explain some
of the body of research that sits behind what I do everyday in my office.
In the first few decades of the 20th century psychological research and therapy focused on behavioural psychology. With ideas about training behaviour – think Pavlov and his dogs – being applied to human behaviour. In the 1950’s and 1960’s Psychologists such as Aaron Beck said: hey, we humans also do this thing we call thinking. This led to the development of the cognitive-behavioural therapy (CBT) model which states that way we interpret situations (our thinking) influences how we feel and behave. Initially this model was applied to the treatment of depression (Beck et al, 1979). Since then this model has been applied to a wide range of mental health disorders and other behaviours and research has shown CBT to be a significant improvement on previous therapeutic approaches (Butler et al., 2006).
CBT is vastly different from the earlier models of psychotherapy in several ways. It is focused in the present, on what the problem is today. It is collaborative, with the emphasis being on the client and therapist working together, on mutually agreed goals. It is active, absolutely no lying down on a couch! You are far more likely to be writing, practicing strategies, role-playing and coming up with stuff to do between the therapy sessions which will help move you towards your goals.
Since the conceptualisation of CBT psychologists have continue to think about and explore other avenues for helping people. This led to many newer therapies which still use these characteristics of CBT although have different models. Dialectical Behaviour Therapy (DBT, Linehan, 1993) focuses on the importance of regulating your emotions. Acceptance and Commitment Therapy (ACT, Hayes et al. 2002) has its base in language acquisition and processing and emphasises the importance of engaging in meaningful activities. Metacognitive Therapy (MCT, Wells, 2009) explores our thinking about thinking. Each of these models also includes a mindfulness component. Research has shown us that these new models are about as effective as traditional CBT (Dimijdjian, 2016). Meanwhile, there are other factors at play which determine the effectiveness of therapy, such as characteristics of the therapist (Novotney, 2013) and the relationship formed between therapist and client (Horvath, 2001).
So, what does this mean when I work with someone? Following
an assessment, I provide you some sort of explanatory model for what’s
happening for you, based on one of these therapy types. The model will talk
about the interaction between your thinking, emotions and behaviour. Equally important
though, is how we work together through therapy. To be effective, therapy needs
to be an active process set in a warm and collaborative relationship.
Beck, A. T., Rush, A. J., Shaw, B. F., Emery G. (1979) Cognitive Therapy of Depression . The Guildford Press.
Butler, A. C., Chapman, J. E., Forman, E. M. & Beck, A. T. (2006) The empirical status of cognitive behaviour therapy: a review of meta-analyses. Clinical Psychology Review, 26.
Dimidjian, S., Arch, J. J., Schneider, R. L., Desormeau, P., Felder, J. N., & Segal, Z. V. (2016) Considering meta-analysis, meaning and metaphor: A systematic review and critical examination of “third wave” cognitive and behavioural therapies. Behavior Therapy 47 (6).
Hayes, S. C., Strosahl, K. D., Wilson, K. G. (2002) Acceptance
and Commitment Therapy: The Process and Practice of Mindful Change. The
Horvath, A. O. (2001) The Alliance Psychotherapy: Theory, Research, Practice, Training, Vol 38(4), 365-372.
Linehan, M. M. (1993) Cognitive Behavioral Treatment
of Borderline Personality Disorder. The Guildford Press.
Novotney, A. (2013) The Therapist Effect. Monitor on Psychology Vol 44, No. 2.
Wells, A. (2009) Metacognitive Therapy for Anxiety and Depression. The Guildford Press.