Healing Therapies

There are as many types of therapy as there are approaches to psychology. Matching the therapy to the individual’s particular experience of a disorder is central to restoring peace of mind.

Psychologists working in the area of health aim to improve the mental and associated physical health of individuals, specific groups, and the wider population. This involves devising and delivering therapies to prevent and treat mental disorders, and to promote general wellness. They also play a role in evaluating how therapies improve health and which are the most effective. This influences the way psychological treatments are delivered at both the individual and public level.

Statistical evidence suggests that 84% of GP appointments in the UK are attributed to issues related to stress and anxiety.

Health and therapy

Roles of a psychologist

Whether working independently, as part of an interdisciplinary health care team, or in a research institution, psychologists are concerned with improving mental health and general wellbeing. Their different roles reflect the varied ways of achieving this goal for individuals or groups.

Who can provide treatment?

Many mental health specialists can deliver psychological assessments, therapies, and counselling, but only some can prescribe medications to treat disorders.

Psychologists These professionals perform psychological assessments and deliver a range of talking or behavioural therapies, depending on the needs of the individual or group.

Psychiatrists These are medical doctors who specialise in the treatment of mental disorders. They are licensed to prescribe psychiatric drugs as part of a patient’s treatment.

General medical professionals Doctors (GPs and hospital consultants), and advanced psychiatric nurses can prescribe drugs or other therapies.

Other mental health specialists Social workers, psychiatric nurses, and counsellors may deliver therapy alone as part of a supervised mental health team.

[1] Health psychologist – These specialists look at how people deal with illness and the psychological factors that influence their health. They may research and deliver strategies to improve health and prevent disease, such as promoting weight loss or stopping smoking. They may help individuals manage specific illnesses such as cancer.

Who would benefit from their help?

. Chronically ill patients needing help adjusting to a serious illness or managing pain.

. Population groups needing lifestyle advice to prevent disease.

. Health care providers wanting to know how to improve their services.

. Patient groups such as diabetics, who need advice to help them manage their condition.

– A health psychologist is educated to doctoral level, has followed practical training, and continues with professional development. They are located in hospitals, community health settings, public health departments, local authorities, and research institutions.

[2] Clinical psychologist – These psychologists help people to deal with mental and physical health issues such as anxiety, addiction, depression, and relationship issues. After clinically assessing an individual using tests, discussion, or observation, they will provide appropriate therapy.

Who would benefit from their help?

. People with anxiety or depression in need of individual or group therapy sessions.

. Children with learning difficulties or behavioural problems.

. Substance abusers who need help to tackle their addiction.

. PTSD sufferers in need of therapy to overcome post traumatic events and experiences.  

– These professionals hold a doctorate in clinical psychology. They are located in hospitals, are part of community mental health teams, health centres, social services, schools, and can be found in private practice.

[3] Counselling psychologist – These specialists help people facing difficult life issues, such as bereavement or domestic violence, as well as those with mental health disorders. They build a strong client relationship to effect change.

Who would benefit from their help?

. Families experiencing relationship difficulties.

. Children experiencing social, emotional, or behavioural problems, or who have suffered any type of abuse.

. Sufferers of stress who can be helped to address underlying problems.

. Bereaved individuals needing emotional support and guidance.

– A counselling psychologist is educated to doctoral level, has followed practical training, and continues with professional development. They are located within hospitals, are part of community health teams, health centres, social services, industry, prisons, and schools.

Psychoeducation

Increasing people’s awareness of living with mental health issues has become a key part of the therapeutic process. Whether delivered individually, in groups, or electronically via the Internet, psychoeducation helps those with mental disorders better understand their condition and the treatments on offer and should also offer help and effective support to their families, friends, and carers. Having detailed information allows people to take better control of their lives and take positive steps to deal with their symptoms. It also improves a person’s compliance with treatment and can play a role in reducing the stigma often associated with mental health disorders.

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Physical and psychological health

Scientific research increasingly links our mental health with physical health, and psychologists in the field have developed and introduced tools for assessing, and improving, our mind-body connection.

Making the connection

Health psychologists explore how a person’s state of mind (someone, for example, suffering from the day-to-day experience of stress) affects their body, and they find ways to improve a person’s physical health by helping them change the way they think. This may involve changing their lifestyle, social network, and attitude and perceptions. Health psychologists work in a variety of roles – in the community to help vulnerable and sick people, advising public authorities on health policy, and in hospitals.  

When assessing an individual, the psychologist looks at all the factors that may contribute to an illness or problem and devises a strategy for change. This might include identifying behaviours that damage a person’s health, such as smoking or poor diet; encouraging positive behaviour such as exercise, a healthy diet, oral hygiene, health checks, and self-examination; improving sleep practices; and scheduling preventative medical screenings. Health psychologists may also promote cognitive behaviour changes that give the person more control over their life.

Managing health conditions

Health psychologists can help when people are diagnosed with conditions that require hospitalisation or prolonged treatment, such as cancer, or alcohol or drug addiction. The psychologist will assess what can be changed to help improve the person’s ability to cope mentally with physical pain or discomfort and the potentially life-changing impact of their condition.

A diverse range of strategies are also employed to aid rehabilitation. On the psychological front, health psychologists work to build and maintain a patient’s self-esteem and motivation, training them to think more positively. Rallying the support of friends, family, and other health professionals is part of this process. On the physical side, they may implement alternative therapies, such as yoga and acupuncture, to enhance the patient’s wellbeing, help control cravings, or overcome depression. They may also recommend regular exercise, a nutrition programme, or vitamin therapy.

RATING MENTAL HEALTH

When a formal clinical assessment is needed, psychologists use a questionnaire to rate or measure an individual’s state of mind, differentiating between psychological health and emotional wellbeing.

Psychological health questions

. Mood Is your mood generally positive?

. Positive relationships Do you have friends or positive emotional ties?

. Cognitive function Can you properly think and process information?

Emotional wellbeing questions

. Anxiety Do you suffer from anxiety?

. Depression Are you depressed?

. Control Do you feel you have lost control or cannot control your feelings?

Biopsychosocial model

Health psychologists use this model to assess three different forces. Sometimes it is described as the differing forces meshing like a honeycomb in a person’s life: biological – the impact of physical traits; psychological – thought patterns and attitudes; and social – the influence of life events and other people. Psychologists recognise that these three forces can have either a positive effect or negative effect on health and wellbeing.

HOW STRESS AFFECTS THE BODY

Stress is nature’s way of alerting people to danger, putting their bodies into primitive “fight-or-flight” mode. The brain produces a cocktail of chemicals in response to stress, triggering changes throughout the body.

_{Nervous system – Headaches, irritability, nervousness, heightened sensitivity.}

_{Respiratory system – Rapid, shallow breathing as muscles tense.}

_{Musculoskeletal system – Muscle aches and pains, especially in neck, shoulders, and back.}

_{Cardiovascular system – Fast heartbeat, raised blood pressure.}

_{Gastrointestinal System – Diarrhoea, nausea, constipation, stomach pain, heartburn.}

_{Reproductive System – In women: irregular periods, reduced libido; in men: impotence.}

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The role of therapy

Psychotherapies use a range of strategies to help people modify the thoughts, actions, and emotions that are harmful to their physical or mental health, and also to promote improved self-awareness.

Therapeutic action

Psychotherapies are often referred to as “talking therapies” because communication with a therapist is the key agent for change. The aim is to manage adversity; maximise potential; clarify thought; provide support, encouragement, and accountability; and to cultivate peace of mind and depth of consciousness. Therapy seeks to improve a patient’s understanding of themselves, others, and their relational dynamics. It may also be used to define personal goals and organise behaviour into achievable systems.

Psychotherapy can uncover old wounds and help a patient understand how past negative experiences currently affect them in unhealthy ways. It can also help them change the ways they react to external stimuli, and how they internally process and interpret experiences, allowing them to move beyond current states of thought and behaviour. Therapy can empower a patient to explore their psyche and spiritual self and to achieve more satisfaction in their lives. It is designed to increase self-acceptance and self-confidence, and to diminish unhelpful negative or critical thinking.

Types of therapy

Therapeutic approaches and methods are as diverse and creative as the mind itself, and psychological progress can be achieved in many ways. The main types of therapy are categorised according to the philosophy on which they are based. Methods of delivery vary and might comprise individual sessions, group therapy, or online guidance and task completion.

. Psychoanalytical and psychodynamic

These approaches are based on the concept that unconscious beliefs underlie maladaptive thoughts and behaviours. Gaining an insight into these beliefs can explain and relieve problems. The therapist and patient also work to develop healthier ways of dealing with these previously repressed feelings, and to foster the patient’s inner resources and capability to manage their troubles.

. Cognitive and behavioural

These therapies stem from the belief that it is not the things that happen to a person that upsets them, it is the way they think about the things that happen to them that upsets them, and the meaning that they assign to their experience. Cognitive and behavioural therapies show people that they hold the power to change the way they think about things, and the way they react and behave as a result of these thoughts.

. Humanistic

This approach prioritises listening over observing. To this end, therapists use open-ended questions and qualitative tools to study personality and encourage the patient to explore their own thoughts, emotions, and feelings. The therapist sees the patient as inherently capable of and responsible for achieving personal growth, and not as a set of flawed unconscious drives.  

. Systemic

The “systems” approach enables people to work out issues arising from the interplay of relationships. Therapists can gain deeper understanding of problems by working with everyone in a system (family or group), hearing different points of view, and watching people interact. This allows people to explore their identity as part of a larger group, and also has the advantage of strengthening their community network – useful for issues that worsen with isolation, such as addiction.  

. Group therapies

. 12-step programme: The 12-step model is a group therapy approach specifically used to tackle addictions (such as to drugs, alcohol, or sex), and compulsive behaviours like eating disorders. An essential part of overcoming addictions or compulsions is support from and connection to a community. Group therapy reduces isolation and associated shame, shows people that they are not alone in their struggle, and provides a network for support and accountability.

. Self-help groups: These support groups focus on self-disclosure. While some groups have a professional lead, others are peer-led. Shared experience is valued over professional knowledge.

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Psychodynamic therapies

An umbrella term for all analytic therapies, psychodynamic therapy is also a method in itself. Analytic therapies follow the root aim of Sigmund Freud – to bring the unconscious mind into consciousness.

What are they?

The principle behind the psychodynamic approach is that the unconscious mind harbours feelings and memories, particularly from childhood, that shape thought patterns and behaviour in adulthood. The therapist helps the patient to talk about these, often unwanted, feelings and so draw them into the conscious mind. Burying unpleasant memories results in anxiety, depression, and phobias, and bringing them into the light of day gives the patient the tools to resolve their psychological problems as an adult.

Acknowledging buried memories helps the patient to identify, confront, and ultimately change the defence mechanisms they have developed to avoid experiencing painful realities, or facing unpleasant facts and unwanted thoughts. These (usually unconscious) mental strategies include denial (refusal to accept reality); repression (burying an unwanted thought or feeling); compartmentalisation (mentally separating conflicting emotions or beliefs); reaction formation (acting contrarily to how the person feels); and rationalisation (self-justifying an unacceptable behaviour).

In all psychodynamic therapies, the therapist listens to the patient talking about their conscious problems while looking for patterns, behaviours, and emotions that hint at their subconscious feelings. The goal is to enable the patient to deal positively with inner conflicts.

Psychoanalysis

The purpose of psychoanalysis and psychodynamic theory as a specific method is similar – to integrate the unconscious and conscious mind – but the depth of the process differs.

What is it?

The founder of psychoanalysis, Sigmund Freud, developed his “talking therapy” after working in Paris with Jean-Martin Charcot, a neurologist who discovered that his patients’ symptoms lessened after they talked about past traumas.

In the early 1900s, Freud established techniques such as free association, dream analysis, and resistance analysis, still widely used today. Silences in therapy are often as meaningful as what is said. All psychoanalysis assumes that psychological problems stem from the unconscious; that unresolved issues or repressed trauma hidden in the unconscious mind cause symptoms such as anxiety and depression; and that treatment can raise these conflicts to the surface so the patient can resolve them.

Psychoanalysis often takes years, deconstructing and rebuilding the patient’s entire belief system. It benefits those who are of robust mind, with an outwardly successful life, but aware of long-term niggles or torments, such as an inability to stay in a relationship. Psychodynamic therapy is less intense and focuses on present-day problems, such as a phobia or anxiety.  

The session

All forms of psychodynamic therapy take place in a familiar, safe, respectful, non-judgmental environment. Sessions are usually one to one and last 50-60 minutes.

(The Patient) In a traditional Freudian analysis, the patient lies on a couch and cannot see the therapist. In more interactive forms, the patient can see the therapist.

(Free association) The client talks spontaneously about whatever comes to mind, without editing what they say or attempting to give a linear structure. True thoughts and feelings emerge.

(Transference) The patient’s unconscious conflicting thoughts and feelings surface in their relationship with the therapist. They redirect emotions and feelings, often from childhood, from themselves to the therapist.

(The Therapist) The analyst listens but does not judge so that the patient need not fear saying something shocking, illogical, or silly.

(Interpretation) The therapist stays relatively quiet, reading between the lines of what the patient says to help them overcome subconscious limitations.

. Dream analysis A means of accessing the unconscious, analysing dreams can reveal hidden emotions, motivations, and associations.

. Resistance analysis Showing the patient what, how, and why they are resisting in thoughts, ideas or emotions can explain defence mechanisms.

. Freudian slip The patient reveals what is really on their mind (their unconscious thought) by saying something they did not intend to.

	PSYCHOANALYSIS	PSYCHODYNAMIC THERAPY
Time	2-5 sessions a week	1-2 sessions a week
Duration	Long term – several years	Short to mid-term – weeks, months
Delivery	The patient usually lies on a couch with the therapist behind, out of sight	The patient usually faces the therapist, who remains in sight
Relationship with therapist	The therapist is the expert – neutral and detached	The therapist is more interactive and acts as an agent for change
Focus	To promote deeper long-term change and happiness	To provide solutions for immediate problems

Jungian therapy

Carl Jung expanded Freud’s ideas – he thought the unconscious mind went far deeper than the merely personal and was at the core of behaviour patterns.

What is it?

Like his colleague Sigmund Freud, Jung considered that psychological distress occurs when the conscious and unconscious parts of the mind are unbalanced. But Jung thought that personal memories were part of a much larger whole.

Jung noticed that the same myths and symbols occur across the world, whatever the culture. He thought these must be the result of shared experience and knowledge of the human species, remembered by everyone as what he called the collective unconscious. These memories, in the deepest layer of the unconscious mind, take the form of archetypes – instantly recognisable symbols that shape behavioural patterns. The conscious ego is the public image that a person presents to the world. Its archetype is the persona, identifiable as a person being on their best behaviour. The darker aspects of the mind that most people hide Jung called the shadow. Further archetypes are the anima (female traits in men) and the animus (male traits in women), which often clash with the conscious ego and the shadow. To find the true self, all the layers of a person’s personality need to work in harmony.

While psychoanalysis delves into the top layer of the patient’s unconscious, Jungian therapists explore all the layers. Their role is to help the patient use the archetypes to understand and change their own behaviour.

Jungian therapists use techniques such as dream analysis (see above) and word association (the patient says whatever comes into their mind when the therapist presents them with a word) to reveal where the inner archetypes collide with outer-world experiences. This process of analysis enables the patient to understand which layers of their mind are in conflict, and then make positive changes to restore the balance. Like psychoanalysis, this therapy can be a fascinating journey into the mind and can take many years.

Self psychology and object relations  

Both of these therapies are offshoots of Freudian psychoanalysis. The therapist uses empathy to understand the patient’s unique perspective of life and create patterns of behaviour that improve relationships.

What are they?

Both self psychology and object relations focus on experiences in a patient’s early life as a way to understand and improve their adult relationships. The premise of self psychology is that children deprived of empathy and support in their early years cannot develop self-sufficiency and self-love as adults. The therapist fulfils the patient’s urge to look to others to meet their needs, giving them the self-worth and self-awareness to carry into their own relationships. In object relations – the name for childhood relationships that the adult is repeating inappropriately – the aim is to use the empathy with the therapist as a platform for analysing past interactions and emotions and applying new positive models of behaviour.

Transactional analysis

Instead of exploring the unconscious to shed light on the conscious mind, transactional analysis focuses on the three “ego states” of an individual’s personality.

What is it?

Rather than asking the patient questions about themselves, the therapist observes and analyses how they interact. Then they help the patient develop a strategy for operating from the adult ego state, rather than copying how their caregiver treated them when they were young (the parent ego state) or acting out how that treatment made them feel and behave as a child (the child ego state).

Conflict occurs when a person operates simultaneously from different states, for instance one part of their personality giving orders from their parent state and another part reacting defensively from their child state.

Transactional analysis helps the patient to recognise these three states and guides them towards using their adult state in all interactions. It helps the patient communicate as they wish to, unhindered by patterns formed in childhood. The adult state is based in the present and evaluates data from the child and parent states to draw a logical, intelligent conclusion that directs behaviour.

EGO STATES (components of a single personality)

. PARENT Can be controlling and critical or nurturing and supportive.

. ADULT Makes rational choices in response to the present time.  

. CHILD Uses feelings and behaviour from childhood.

Cognitive and behavioural therapies

What an individual thinks affects how they feel and behave. This group of therapies focuses on how thoughts affect behaviour and aims to help people change negative patterns.

What are they?

These therapies stem from the belief that it is not what happens to people but how they think about what happens to them that upsets them. These thoughts can lead an individual to behaviour based on a false premise. Cognitive-based therapy seeks to change patterns of negative thought. Behaviour-based therapy aims to replace unhelpful behaviours with positive actions that then change underlying feelings. Therapists often take elements from both cognitive and behavioural theories. The therapist helps the patient challenge automatic thoughts and practise new ways of reacting. Once the patient can change their viewpoint, they can alter how they feel and behave.

Collaborative approach

Cognitive and behavioural therapies require patients to be actively involved in the therapeutic process. Rather than the therapist taking a leadership role, the patient and therapist work in partnership to resolve issues. Honesty is integral to progress.

In many types of psychotherapy, the therapist leads the process, actively diagnosing the patient and directing the course of sessions and dialogues. This authoritarian approach can feel alienating to some patients, especially those who do not respond well to feeling directed or controlled, those who are sensitive to being judged or evaluated, those with issues around medical or authority figures, and those who have had negative past experiences in therapy.

In collaborative therapy, however, the relationship between patient and therapist is equal, reciprocal, and flexible. Both the patient and therapist make observations, direct conversations, and evaluate progress. Discussion helps the patient to view their problems from a new perspective, and then encourages them to take actions that change their patterns of behaviour. The process is one of trial and error, so if one course of action only serves to increase the patient’s distress, patient and therapist can discuss alternative behaviours and reinforce those that work for the individual. The patient remains actively engaged and equally responsible for their part in the healing process throughout the therapy sessions.

IRRATIONAL THOUGHTS AND BEHAVIOUR

While reality feels absolute, it is subjective and influenced by individual thought patterns – two people in the same situation may feel and react very differently. Many people automatically make incorrect assumptions and act on them. Therapy helps people to challenge these assumptions.

Let’s consider two individuals A and B:

A is outgoing, capable, and confident with a strong social network.

B is unconfident, shy with low self-esteem and a poor support network.  

[1] Emotional stimuli

A and B find out that a mutual friend is having a party but has not invited either of them. Despite the identical emotional stimuli, A and B process the information in vastly different ways based on their respective cognitive patterns. Person A might analyse the rational possibilities why she has not been invited or diplomatically confront the friend, whereas person B automatically jumps to the conclusion that she has been deliberately excluded.

[2] Thoughts and behaviours

A has rational thoughts

. Technical error Perhaps the invitation went astray.

. Work function Perhaps it is a party only for work colleagues and limited to those in the same industry.

. Limited guestlist Perhaps it is just a small gathering for an old group of friends she is not part of who have not seen each other for a while.

B has irrational thoughts

. Negative personal feelings The lack of an invitation reflects what the friend feels towards her.

. Deliberate exclusion The friend did not want to invite her because she is bad at socialising in groups.

. Self-destructive patterns She deserves not to be invited because good things do not happen to her.

A displays rational behaviours

. Make contact Phones or meets the friend having the party to have a casual conversation.

. Collect answers Asks thoughtful and diplomatic questions, without making assumptions, to ascertain the real reason for not being invited.

B displays irrational behaviours  

. Avoid Does not confront the friend or situation because it is too difficult.

. Confront angrily Feels overly defensive, engages the friend in an angry confrontation and accuses her of being thoughtless, not caring, or being deliberately unkind.

. Act defensively Treats the friend badly in retaliation.

Behavioural therapy

If behaviour can be learned, it can also be unlearned. Based on this idea, this action-based approach aims to replace unwanted behaviours with positive ones.

What is it?

This approach is based on the concepts of classical conditioning [learning by association] and operant conditioning [learning through reinforcement].

Classical conditioning works by linking a neutral stimulus with an unconditioned response to modify a person’s behaviour. Over time, the stimulus invokes a new conditioned response. For example, a child who falls over and hurts themself at the same time as hearing a dog bark [the neutral stimulus] may develop a fear of dogs. Behavioural therapy can reverse the process and desensitise the child. Operant conditioning uses reward-based systems that develop and reinforce desirable behaviours and discourage and punish unwanted ones. Strategies include issuing tokens for good behaviour or giving a child “time out” to defuse a tantrum.

Repeating tasks that invoke positive behaviours allows a patient to relearn responses. Behavioural therapy is particularly useful for overcoming phobias, OCD, ADHD, and substance abuse disorder.

Cognitive therapy

Developed in the 1960s by psychiatrist Aaron Beck, this therapy aims to change the negative thought processes and beliefs that lead to problematic behaviours.

What is it?

Beck proposed that negative or inaccurate thoughts and beliefs about ourselves, others, or the world have an adverse effect on our emotions and behaviours. This can create a vicious circle whereby behaviours reinforce an individual’s distorted thought processes.

Therapy focuses on breaking this pattern by helping people identify and replace negative thoughts with more flexible and positive ways of thinking. The therapist teaches the person how to observe and monitor their own thoughts and to evaluate whether they represent reality or are irrational. Setting tasks to be completed at home, such as diary keeping, can help the patient to identify their negative beliefs and then prove them wrong. Changing the underlying beliefs leads to changes in connected behaviours. Cognitive therapy is especially suitable for depression and anxiety.

CBT (cognitive behavioural therapy)

This therapy helps people to identify, understand, and correct the distorted thoughts that can have a negative effect on feelings and behaviour.

What is it?

This practical, structured, problem-solving approach employs theories first used in cognitive therapy (above) to reshape how a patient thinks, and strategies from behavioural therapy (above) to alter how they act. The aim is to change the negative thought and behavioural cycles that make the patient unhappy.

In order to understand the link between thoughts and behaviours, the therapist breaks problems down into separate parts, analysing the person’s actions, thoughts, feelings, and physical sensations. The therapist can then understand how the patient’s internal dialogue, their automatic thoughts [usually negative and unrealistic], affect their behaviour. The therapist helps the patient to recognise what experiences or situations trigger these unhelpful thoughts and gives them the skills to change their automatic reactions. 

Learning and practising these skills is key to the effectiveness of the therapy. The therapist sets tasks for the patient to practise at home. By implementing new strategies repeatedly in their daily life, the patient creates new patterns of positive behaviour and realistic thinking and learns to apply them in future.

An action plan is given where tasks are completed between sessions. This might include a thought log, recording anxiety levels, or a diary of enjoyable activities. The road to change involves the therapist helping the patient to follow and practise small, structured steps and gain the skills to tackle new problems independently.

THERAPY IN PRACTICE

With a disorder such as OCD, which has both cognitive and behavioural elements, therapy that aims to change either the thoughts that lead to the disorder or what the person does in response to those thoughts, or both, can help.

A comparison is now given of the three forms of therapy:

Behavioural therapy

Suitable for those who carry out compulsive behaviour to reduce fear.

[a] Helps the patient break the link between a certain object or situation and fear.

[b] Patient learns to confront their anxiety without performing rituals.

[c] This decreases their anxiety so unhealthy behaviours can stop.

Cognitive therapy

Suitable for those who carry out internal checks, practising avoidance and rituals in the mind and physically.

[a] Helps patient unlearn beliefs and restructure their thought patterns.

[b] Challenging the meaning the patient assigns to these thoughts makes them lose their power.

[c] Patient has no need to perform rituals.

CBT

Suitable for those who link situations with fear and exaggerate thoughts.

[a] Helps patient stop their compulsions in the mind and in behaviour.

[b] Patient learns nothing bad happens if they stop performing compulsions.

[c] Their anxiety decreases, and they break the thought cycle, so the behaviours can stop.

Third wave CBT

This group of evolving methods both extend CBT approaches and change the aim. Rather than focusing on reducing symptoms – though this is a benefit – they help the patient step away from unhelpful thoughts.

What are they?

Two therapies that come under the third wave CBT umbrella are ACT (acceptance and commitment therapy) and DBT (dialectical behaviour therapy).

ACT aims to change the patient’s relationship with their thoughts. Rather than trying to alter or stop unwanted thoughts, the patient learns to accept and observe them. Instead of thinking, “I never do anything right”, the patient switches to: “I am having the thought that I never do anything right”. Becoming an observer of their thoughts diminishes the power that the thought has over their state of mind and being. The thought no longer has to guide reaction or behaviour, and the person can instead choose actions based on their values.

Some people experience intense emotional reactions and have little ability to cope with their strong feelings. This may lead to damaging behaviours such as self-harm or substance abuse. DBT teaches the skills to accept and tolerate distress and to manage disturbing or provocative emotional stimulation. The process involves gaining behavioural control, then experiencing rather than silencing emotional stress – discussing and accepting past traumatic experiences and tackling self-blame and dysfunctional thoughts.

Mindfulness skills such as visualisation help the patient to maintain emotional regularity in everyday life, to build confidence to deal with problems calmly, and to expand their capacity for joy.

THE ACT METHOD

ACT therapists teach the patient to defuse the power of their negative self-judgments.

. Values Define what is most important to you.

. Acceptance Instead of trying to control or change thoughts, accept them without judgement.

. Cognitive defusion Distance yourself from the interpretations of your mind – just observe.

. The observing self Maintain a stable state of inner consciousness and awareness regardless of external stimuli.

. Commitment Set goals for behavioural change and commit to them, regardless of any sabotaging thoughts or emotions.

THE FOUR SKILLS OF DBT

Skills training teaches people who feel at the mercy of their emotions to accept themselves and their thoughts and to replace dysfunctional behaviours with positive actions.

[1] Mindfulness Become aware of the emotional experience – observe rather than react.

[2] Interpersonal effectiveness Stay calm and pay respectful attention to other people.

[3] Distress tolerance Use self-soothing encouragement in stressful situations.

[4] Emotional regulation Choose to behave in a positive way despite negative emotions.

CPT (cognitive processing therapy)

This therapy helps people to address and change negative, fear-based thoughts – referred to as stuck points – that recur after traumatic events so that they feel calmer and safer.

What is it?

CPT is particularly effective for people with PTSD. Sufferers often experience biased, upsetting thoughts that delay recovery, including feelings of helplessness; loss of trust, control, and self-worth or deservedness; blame; and guilt. These “stuck points” keep the person stuck with the symptoms of PTSD and are usually not based on what actually happened.

CPT aims to help the individual evaluate these stuck points by asking the question: “Do the facts support my thoughts?”. Patients re-examine the trauma and are helped to recognise acquired distortions and to re-write their negative post-traumatic view. This cognitive restructuring helps them to accurately differentiate between what is truly dangerous and what is safe, and to modify unhelpful thoughts in the future.

STAGES

The stages of CPT are designed to help the individual understand how trauma has affected their brain.

[1] Psycho-education – Discuss symptoms of PTSD, thoughts, and emotions.

[2] Formal processing of trauma – Recall trauma to gain awareness of thoughts.

[3] Using new skills – Learn and practise skills to challenge thoughts and modify behaviours.

REBT (rational emotive behaviour therapy)

Through this therapy patients come to understand that how they think about events is more significant than the events themselves.

What is it?

REBT works to replace the irrational beliefs that cause misery and self-defeating behaviours with more productive, rational thoughts. It breaks a patient’s rigid thought patterns – often governed by words like “should”, “ought”, and “must” – such as dwelling harshly and solely on the negative, thinking in black-and-white absolutisms, especially about themselves, and global-rating (“total idiot”). Understanding the ABC framework, patients learn to accept themselves and other people, to distinguish an irritation from a crisis, and to meet the challenges of life with tolerance and assertiveness. REBT is useful for anxiety, shyness disorders, and phobias.

ABC Framework

Activating Event – The event that triggers irrational thoughts, for example, being passed over for a promotion.

Belief – “I am a terrible, worthless person who never does anything right and will never be happy or successful.”

Consequence – Unhealthy emotions, such as depression, anger, blame, self-loathing, and low self-esteem.

Therapy

Disputes – “Nothing is that awful, life will have challenges; I can deal with this frustration and disappointment.”

Effective Emotions – “I would have loved that promotion, but I am a worthy and capable person regardless of the outcome.”

Methods used in CBTs

People often make their stress or fear worse through poor coping mechanisms. Two methods that offer practical strategies are SIT (stress inoculation therapy) and exposure therapy.

What are they?

SIT helps people to recognise the triggers and distorted thought processes that incite a stress response. Many patients overestimate the threat level of a situation and underestimate their ability to deal with it.

The therapist presents anxiety-provoking situations that cue stress through role play, visualisation, or recordings of stressors. In response, the patient learns and practises new coping mechanisms, such as relaxation and mindfulness techniques and assertiveness. Gradually the patient learns how to change their reaction to stress and cope with it instead of engaging the previous unhelpful response. People who have undergone traumatic experiences, or who have phobias, tend to avoid exposure to situations, objects, or places [“triggers”] that might cause fear. This avoidance often makes the problem worse, allowing the fear to grow. In exposure therapy, the therapist deliberately exposes the patient to anxiety-provoking stimuli to erode their fears.

Exposure is incremental and starts with “imaginal” exposure – imagining the feared thing or recollecting the traumatic memory. The intensity of exposure increases with “in vivo” exposure – real exposure in settings that provoke anxiety but are not truly dangerous. Various models can be used:

EXPOSURE METHODS

. Flooding Intense exposure to the person’s worst fears to extinguish the fear response.

. Systematic desensitisation Gradual exposure to fears to eliminate them.

. Graded exposure Grading anxiety-provoking situations to create a hierarchy of fears; the person progresses up the list, tackling the most feared last.

. Exposure and response prevention Exposing OCD sufferers to a trigger, while not letting them engage in their usual rituals; for example, a compulsive hand-washer is not allowed to wash their hands in an impeccably clean environment and finds there are no disastrous consequences, so the compulsion subsides.

. Aversion therapy Pairing an unpleasant stimulus with the unwanted behaviour to change it.

Mindfulness

Learning to focus awareness on the present – to observe what their thoughts, feelings, and body are experiencing at any one moment – can help people understand and manage unhelpful responses.

What is it?

Mindfulness techniques help people to give their full attention to what is happening around them and to them. Observing and accepting these experiences and sensations in a detached and non-judgmental way gives people the space to evaluate whether or not thoughts and behaviours are dysfunctional, and then to modify their responses. Practices to promote mindfulness include breathing, visualisation, and listening exercises, yoga, Tai Chi, and meditation.

Benefits of mindfulness

Learning to observe rather than be controlled by their thoughts allows people to anticipate and deal more effectively with stressful experiences and anxiety, and to replace negative thought patterns. Mindfulness exercises also have a calming effect – switching off the regions of the brain that stress turns on, and activating the parts that deal with awareness and decision-making. This allows people to focus on positive actions to promote wellbeing.

STRATEGIES FOR MINDFULNESS

Mindful Walking – Focusing your awareness on what you see, hear, and smell, your thoughts, and the physical sensation of walking allows you to connect with the present.

Mindful Eating – Slowing down, taking the time to bring full attention to the process and sensation of eating, focuses your mind and can change your responses.

Mindful Body Awareness – Practising yoga or doing a “body scan” – bringing your attention to each part of the body in turn, and noting how it feels – focuses mind and body.

Mindful Breathing – Learning to concentrate on the flow of your breath is a useful, calming meditation technique to relieve stress, anxiety, and negative emotions.

POSITIVE PSYCHOLOGY

Traditional psychotherapy concentrates on tackling disorders and problem behaviours; positive psychology, like humanistic therapies, focuses on the goals of self-fulfilment and wellbeing as a catalyst for change. Learning to think positively and to focus on what brings happiness encourages people to pursue positive actions – to develop their strengths, improve their relationships, and to achieve goals – on a personal and societal level. Mindfulness techniques are often used to help people focus their mind and behaviours on positive action.

PERMA model

Developed by psychologist Martin Seligman, this model for change defines the elements that promote wellbeing:

See also: Positive Psychology

(P) Positive emotion; (E) engagement; (R) positive relationships; (M) meaning; and (A) accomplishments. Understanding the importance of these elements and then taking steps to pursue them through everyday thoughts and actions allows people to build on their own strengths and resources to achieve future happiness (the desired outcome).

Positive Emotions Learning what brings happiness; positive emotions leading to positive outcomes.

Engagement Complete immersion or “flow” in a satisfying activity.

Positive Relationships Fostering a feeling of wellbeing and promoting positive emotions.

Meaning Having a sense of purpose to give context to all aspects of life.

Accomplishments Pursuing goals for a sense of purpose; success promoting self-esteem.

More on Mindfulness can be found here.

Humanistic therapies

This group of therapies encourages an individual to resolve their problems and issues and achieve greater fulfilment by recognising, understanding, and using their own capacity to develop.

What are they?

Before humanism developed in the late 1950s, psychological issues were viewed as flaws within a person that required intensive behavioural or psychoanalytic treatment. Psychological theories relied on a measurement of behaviour and other scientific, quantitative (statistical) studies to evaluate and categorise people. Humanists viewed these concrete, methodical approaches as too limited in scope to capture the broad, colourful, and individualistic human experience. In contrast with psychoanalysis, humanistic therapies view the person as a whole being able to exercise free will and make active choices, rather than as a set of predetermined drives, urges, and behaviours. Therapists emphasise the individual’s inner strengths, resources, and potential as the foundation for working through issues. Life may be filled with challenges and heartbreak, but humans are essentially good, resilient, and capable of enduring and overcoming difficulties.

Humanists also expanded the concept of therapy as a treatment for severe neuroses to a broadly applicable approach for anyone wanting to self-improve. They recognised people’s natural desire to overcome problems, seek happiness, improve the world, and live a satisfying and fulfilling life as the primary, central human motivation. An individual’s need to realise their potential and fulfil their goals and dreams is called self-actualisation.

Humanists believe that not only is a person capable of making changes and achieving personal growth but also that it is their responsibility to do so. This idea places the individual fully in control of their choices and goals.

Humanistic approaches for getting to know a patient are as creative and diverse as people themselves, but all are based on talking and trust. In a session, rather than relying on their own observations the therapist asks open-ended questions and listens to what the patient makes of their own behaviour and personality. All humanistic therapists use their empathy and understanding to help the patient accept themselves.

Therapeutic relationship

Humanistic therapies aim to cultivate a positive and constructive relationship by valuing their patient, and showing genuine, unconditional, positive regard. This environment nurtures the patient’s self-knowledge, confidence in their own choices, and emotional development, so that they can self-actualise (fulfil their own potential).

Therapist promotes:

. Self-awareness Aims to enable patient to acknowledge the personal choices available to them, and to understand their own motivation and goals.

. Self-acceptance Values the patient to allow them to accept themselves, and promotes self-regard and self-belief.

. Self-fulfilment and growth Helps the patient to harness their innate abilities and resources for self-development and improvement.

With a nurturing environment and constructive atmosphere, the patient is helped towards positive growth by putting down roots to flourish.

The patient engages with the process and takes responsibility for making the changes needed for personal growth. This is aided by the therapist who helps the individual take responsibility for their choices, behaviours, and self-development.

“[A person is] a continuing constellation of potentialities, not a fixed quantity of traits.” – Carl Rogers, Humanistic psychologist

Person-centred therapy

In this approach, the accepting, supportive relationship between therapist and patient promotes self-belief, confidence, and personal growth.

What is it?

True to humanism, person-centred therapy holds that all people possess the resources they need to gain insight, experience personal growth, and change their attitudes and behaviours to reach their full potential – self-actualisation.

Therapy sessions focus on the present and future, rather than on the past, and the patient leads the conversation. The therapist listens intently to the patient’s experiences responding without judgment.

The authenticity and depth (congruence) of this relationship encourages patients to express their thoughts and emotions freely. The therapist’s unconditional positive regard validates the patient’s feelings, attitudes, and perspective, and the therapist’s acceptance allows the patient to truly accept themselves. Self-esteem, self-understanding, and confidence improve; guilt and defensive reactions lessen.

Self-acceptance allows patients to have more faith in their abilities, express themselves better, improve their relationships, and can also help with body perception in people with dysmorphic disorders.

Patient-Therapist Relationship The therapist is the vehicle for the patient’s self-improvement.

The Therapist

. Congruence The therapist is positive, optimistic, and genuine.

. Unconditional Regard The therapist sees the patient in a positive light, enabling the patient to do the same.

. Empathy The therapist understands and experiences the world through the eyes of the patient.

These values allow the therapist to create a climate to facilitate change.

The patient then uses their inherent capacity and desire for personal growth and change. Self-actualisation can then be acquired.

Reality therapy

This problem-solving therapy seeks to help the patient evaluate and change their current behaviours and thought processes. It is especially useful for relationship issues.

What is it?

In reality therapy, the therapist helps a patient change how they act, then how they think, as both behaviours are easier to control than how they feel or react. The therapy holds that the only behaviour an individual can control is their own, which is motivated by five basic needs. The therapist discourages criticising, blaming, complaining, and excuses, all of which harm relationships. Instead, patient and therapist together identify and monitor behaviour and create a workable plan of change.

Five basic needs

[1] Physiological (survival) Food, shelter, and safety.

[2] Love and belonging Part of a family, network of friends, or community.

[3] Power To succeed, provide, feel competent, and be recognised for accomplishments.

[4] Freedom Autonomy and control over own life.

[5] Fun Pleasure, fulfilment, and joy.

Existential therapy

This philosophical theory helps people comes to terms with the specific, inherent challenges of simply existing by making choices and taking responsibility for their actions.

What is it?

Existential therapy is based on the premise that if people make peace with the givens of existence, they can lead a more fulfilling and enjoyable life, free from anxiety. Existentialism holds that people have free will and are active participants in their own lives. Therapy focuses on increasing self-awareness by exploring the meaning, purpose, and value in the patient’s life, and by helping them understand that they are in charge and not just a passive victim of drives and impulses. A session may address questions such as: “Why are we here?”, “How can life be good if it involves suffering?”, and “Why do I feel so alone?”.

By learning to accept responsibility for decisions in the past that led to emotional disruption, the patient gains the power to take control of their experiences. The therapist helps the patient find individual, nuanced solutions; and acceptance, growth, and welcoming future possibilities are key themes.

THE GIVENS OF EXISTENCE

. The inevitability of death The natural drive to exist conflicts with awareness that death is inevitable.

. Existential isolation Everyone enters the world alone and leaves it alone. Regardless of any relationships or connections, people are innately alone.

. Attendant isolation People are alone, yet seek connection.

. Meaninglessness People seek purpose, yet finding a path and understanding the meaning of existence often eludes them.

. Freedom and responsibility All have a responsibility to create their own purpose and structure, as existence inherently has none.

Gestalt therapy

This lively and spontaneous therapy liberates patients and helps them become more aware of their thoughts, feelings, behaviour, and their effect on their surroundings.

What is it?

The German word gestalt roughly translates as “whole”, reflecting the belief that the individual is more than the sum of their parts and has a unique experience of the external world. Gestalt therapies believe that discussion alone cannot alleviate guilt, unresolved anger, resentment, or sadness. The patient must evoke and experience negative feelings in the present to resolve them. The therapist may use role play, fantasy, visualisation, or other stimuli to arouse negative feelings from the past, so that the patient gains insight into how they react to certain situations. This increased self-awareness allows the patient to identify patterns and see the true, rather than perceived, effect of their behaviour. Gestalt was developed to treat addiction but helps depression, grief, trauma, and bipolar disorder too.

EMPTY CHAIR TECHNIQUE

The patient addresses an empty chair as if it is an important figure in their life, then changes roles to understand the opposing view. Releasing feelings and emotions through enactment increases self-awareness.

Emotion-focused therapy

This approach attempts to help people understand their emotions better and acknowledge them, and to use this new-found self-awareness to guide their behaviour.

What is it?

This therapy is based on the premise that emotions form the foundation of people’s identity and govern their decision-making and behaviour. With this approach, the patient is encouraged to discuss and analyse how they feel or have felt in past situations to identify which emotions are helpful or unhelpful to them and to make sense of their emotional responses.

Increasing awareness allows the patient to describe their emotions more clearly, to assess whether the feelings are appropriate to the situation, and to learn to use positive emotions to guide their actions. Recognising how unhelpful emotions, including those linked to traumatic experiences, negatively impact choices and behaviour also helps the patient to regulate these feelings and to develop strategies to change their emotional state.

Strategies may include using breathing techniques, imagery and visualisation, repeating positive phrases, or using new experiences to elicit positive emotions.

EMOTIONALLY FOCUSED THERAPY

Although its title is similar, emotionally focused therapy is different from emotion-focused therapy. It is a relationship therapy for couples and families to help them understand the emotions that govern their interactions. As negative patterns of behaviour and conflict can occur when emotional needs are not met, the therapist helps patients recognise their own feelings and acknowledge those of family members or partners. Learning how to express and regulate emotions, listen to others, and use emotion positively tightens bonds with partners or family members, resolves past issues, and offers strategies for the future.

Solution-focused brief therapy

This forward-looking therapy encourages individuals to focus on their strengths and to work positively towards achievable goals rather than dwelling on or analysing the past.

What is it?

This therapy is based on the belief that everyone has the resources to improve their lives but may need help in structuring plans. The so-called miracle question [“How is life different if…?”] is often asked so the person envisions what life will be like when their issue is resolved. From here, the individual can define a goal, create possible solutions, and outline specific steps to achieve their goal. Coping questions, such as, “How have you handled this in the past?” also encourage the person to focus on previous successes, showing them that they already have the skills, resourcefulness, and resilience to achieve a positive outcome.

Therapy usually involves about five sessions. While the therapist provides accountability and support, the patient is always considered to be the expert on their own problems. It is a particularly effective method for young people, who may prefer a short, structured approach rather than a probing analysis of their past.

Steps (similar to climbing a summit):

[1] Decide on a clear and realistic goal

[2] Describe the goal in detail and picture a solution

[3] Scale how close the goal is and decide on small realistic steps

[4] Assess what has already been achieved

[5] Reach goal or desired situation

Somatic therapies

These therapies – based on the idea that unresolved emotional issues are stored physiologically as well as psychologically – act on the body to release negative tension and restore mental health.

What are they?

Sometimes psychological healing occurs through methods that cannot be entirely explained yet are still effective. This is true of many mind-body healing therapies, sometimes called energy psychology, which deal holistically with the body and mind.

Somatic therapies consider that the integration of mind and body is essential for mental health. Massage, body work, breath work, yoga, Tai Chi, and the use of essential oils or flower essences are all examples of somatic therapies that may relieve physical and emotional tension.

Certain body parts are associated with psychological issues. Many people carry stress in their shoulders, for instance, and emotional trauma may create physical pain or digestive problems. Changing body posture can change the psychological experience – a broken heart, for example, often leads to a shoulders-forward, heart-protected slouch, and a sense of defeat results in a downward gaze. Encouraging the patient to thrust their shoulders back, sit up straight, and lift their chin to the sky can help them to feel powerful, more optimistic, and more open to facing the world.

Trauma destabilises the automatic nervous system. Psychological issues are stored in body and mind.

Yoga and other somatic therapies restore balance by releasing negative emotions held in the body.

The healing power improves the person’s state of mind and reduces physical symptoms of pain.

EMOTIONAL FREEDOM TECHNIQUE

This holistic therapy works on the same meridians (energy channels) as acupuncture and acupressure. The theory is that traumatic experiences can block these channels, causing continuing distress. The therapist uses their fingertips to tap meridian points on the body, while the patient thinks about a specific problem, image, or negative feeling, and voices positive affirmations.

Tapping these points appears to calm the amygdala – the part of the brain that processes emotions and controls the fight-or-flight response. Over time, this process reprogrammes the individual’s thoughts, removing negative emotions and replacing them with new, positive feelings and behaviours. Individuals can also learn to perform the tapping sequence themselves.

Tapping Points

Research suggests that 80% of individuals who participate report a positive effect when engaging EFT as a form of therapy.

EMDR (eye movement desensitisation and reprocessing)

This therapy stimulates the brain using eye movement, reprocesses traumatic memories so that they lose their power to disturb, and teaches the patient techniques to deal with emotional disturbances.

What is it?

In this therapy, the patient recalls a picture, scene, or feeling from a past trauma while tracking bilateral stimulation, such as the therapist’s hand moving back and forth across their field of vision. The patient thinks of a negative statement linked to the trauma (for example, “I am unworthy,” from a childhood marred by a disapproving parent) and replaces it with a positive, preferred self-statement.

Based on the idea that the negative belief system has been trapped in the patient’s nervous system, even though the actual danger has long since passed, the combination of eye movement and psychological recall neurologically releases the traumatic memory and its negative effects. This allows the memory to be stored neutrally and helps install a new healthy belief system.

The process mimics the memory processing and physical movement thought to occur during REM (Rapid Eye Movement) dream sleep. The therapy is particularly effective in treating individuals with PTSD. Symptoms can be significantly reduced in as few as three 90-minute sessions.

Hypnotherapy

During hypnotherapy, the patient enters a deep, trance-like state of relaxation that suppresses the conscious mind, allowing the subconscious to become more alert and receptive.

What is it?

The therapist uses the power of hypnotic suggestion to quiet the analytical parts of the brain and fully focus the patient’s attention on the subconscious mind. Once the patient is deeply relaxed, the therapist makes suggestions that instil different brain patterns, so changing the patient’s perceptions, thought processes, and behaviour.

Hypnotherapy is particularly useful for helping patients to overcome unwanted habits such as smoking or overeating. It can also be used to reduce pain in future situations that the patient anticipates will be painful such as childbirth or surgical or dental procedures. Another use is to allow suppressed or hidden memories to surface, so that the related issues and emotions can be addressed.

Patients practise deep relaxation, often using a recording taped by the therapist, between sessions to consolidate the work.

Arts-based therapies

These approaches use the alternative languages of art and music to promote self-discovery, self-expression, and wellbeing. They can help people articulate thoughts and feelings, and regulate their emotions.

What are they?

It can be difficult for some people to find wordsto express emotions and perceptions. Art therapy provides a way for them to describe their inner life, investigate and validate thoughts and feelings, and increase self-awareness. The physical act of producing art can be therapeutic in itself too, as it concentrates body and mind on a single creative goal.

The focus in art therapy is on the creative process as a form of communication rather than on the skill of the artist. Displaying their art in public can help individuals overcome their self-consciousness and self-criticism and lead to greater acceptance of themselves and improved self-esteem.

Music therapy plays a different role. When music stimulates the brain, it activates a myriad of sensory connections, which can change the individual’s physical and emotional states. Music acts on neural pathways throughout the brain to alter how a person processes information, experiences and expresses emotions, uses language, relates to others, and moves.

Music can promote long-term behavioural and emotional changes, including decreasing symptoms of depression and anxiety. Its physiological effects include triggering the release of mood-enhancing chemicals, such as dopamine, and lowering heart rate.

All styles of music can be used, and sessions may involve listening to music, using instruments, singing, improvising, or composing.

Animal-assisted therapy

This approach uses the bond between people and animals to improve communication skills, emotional control, and independence. It also helps to decrease feelings of loneliness and isolation.

What is it?

Interacting with animals increases levels of oxytocin, a hormone that promotes intimacy and trust, and mood-enhancing endorphins. Learning how to handle animals also improves behavioural and social skills and boosts self-esteem.

Stroking cats, looking after dogs or horses on a regular basis, and swimming with dolphins are some of the ways vulnerable people can learn about boundaries, respect, and trust and develop self-reliance and independence.

In anger management and substance abuse group therapy, the presence of animals can encourage participants to open up and talk about lost innocence and violent pasts, leading to greater self-acceptance and forgiveness.

“A pet is a medication without side effects.” – Dr Edward Creagan, American oncologist

Systemic therapies

These approaches recognise that people are part of a network of relationships that shape their behaviours, feelings, and beliefs. The therapies seek to influence the whole system, not just the individual.

What are they?

Systemic therapies make use of the concepts of systems theory, which hold that any individual object is just one part of a larger and more complex system. In human terms, this might be a family, workplace, organisation, or social community.

Disruption in one part of the system may affect or unbalance other parts of the network. For example, a person experiencing depression may find that it disrupts their relationships with family members, but it may also affect interactions with work colleagues and friends. Rather than treating the problems of the individual in isolation, systemic therapies therefore tackle them in the context of the system as a whole – looking for solutions that work for everybody. Making a change to one part of the system – such as providing better support for the individual at work – can benefit all members of the network.

As well as viewing the system as a whole, these therapies address system dynamics, attempting to identify deeply entrenched patterns and trends. The dynamics of many families, for example, are governed by a series of unwritten rules and unconscious behaviours.

By making individuals aware of the ways in which they interact and influence one another, these therapies help people to make positive changes that benefit the dynamics of the group. This involves considering the perspectives, expectations, needs, and personalities of all the people involved, and encouraging dialogue to enable each person to gain an insight into the roles and needs of others in the group.

Looking at problems systematically also reveals how seemingly unrelated issues can be closely linked. Solving one issue may therefore bring the bonus of a beneficial effect on other parts of the system.

Balancing relationships

When conflict occurs between two people, they may focus on a third person as a way to stabilise their relationship, rather than resolving the issue between themselves, so emotional relationships can be seen to be triangular. Adding a third person into an existing relationship (for example, the arrival of a baby) is not always beneficial and may cause friction between the original two.  

Family systems therapy

Relationships within the family unit are regarded as both the underlying cause of issues and the means by which they can be solved in this therapeutic approach that focuses on group dynamics.

What is it?

This therapy is based on the theories of psychiatrist Murray Bowen. Bowen used eight interlocking concepts to find out how birth order, a person’s role within the family, personality, and inherited traits all affect how individuals relate to each other in a family system. He defined the family both by the people within it and the way in which they interact.

Viewing the family as an emotional unit in this way enables individuals to work together to solve problems – these might be emotional issues affecting the whole family, such as death or divorce, or specific issues related to an individual member that have an impact on the rest of the unit.

Therapists explore how family members see their roles and express them. This exploration allows each person to understand better how their actions affect other members of the group, and how they are affected in turn.

Understanding how external factors impact relationships within the family, and how patterns can be repeated over generations, is also key. For example, children with a poorly defined sense of their own individuality (perhaps due to overbearing parents) may seek out a partner with a similarly low level of differentiation. The two of them then pass on conflicts or problems associated with these traits to their own children. Improving communication, self-awareness, and empathy, can help individuals break these generational patterns, and enable the family unit to build on its strengths and to use its interdependence to make positive changes.  

[1] Differentiation of self How a person maintains their own sense of individuality, while still functioning in the group.

[2] Emotional triangle How the smallest network in a human relations system, in many cases formed by two parents and a child, operates.

[3] Nuclear family emotional process How any tensions in the family affect the relationship patterns within the unit.

[4] Family projection process How parents’ emotions, conflict, or difficulties are passed on to their children.

[5] Emotional cut-off How individuals manage conflict within the family network by distancing themselves.  

[6] Multigenerational transmission How people seek partners with similar differentiation, so patterns repeat down the generations.

[7] Societal emotional process and regression How family emotional systems go on to influence wider systems in society, like the workplace.

[8] Sibling position How birth order influences the way children are treated – differences in expectation lead them to take on different roles.  

Strategic family therapy

The therapist plays a key role in this approach, helping families to identify the problems affecting their relationships and to develop structured plans and targeted interventions to solve them.

What is it?

This solution-focused technique, based on the theories of therapist Jay Haley, uses strategies specific to each family’s structure and dynamics to achieve an agreed outcome. The focus is always on current problems and solutions rather than analysing past causes and events.

The therapist plays an active role in helping the family to identify their problems. Together they agree on a goal achievable in a relatively short timeframe. The therapist develops a strategic plan to help family members adopt new ways of interacting that they might not have considered before. Individuals might be encouraged to replay common family interactions or conversations, with the aim of increasing the family’s awareness of how they operate and how problems arise.

Strategies for change are based on the strengths of family members. This allows the family to use their own resources to support each other in making positive changes to behaviour, and to successfully achieve their goal as a unit.

“In strategic therapy, the therapist takes responsibility for directly influencing people.” – Jay Haley, American psychotherapist

STRATEGIC ROLE OF THERAPIST

. Identify solvable problem Observes the family and identifies a problem, such as a teenage son John not communicating.

. Goal setting Helps the family decide on a clear goal – John must tell parents where he is.

. Designing an intervention Develops a plan that targets the problem within the family – John will phone in regularly.

. Implement plan Devises and reviews role-playing, discussions, and homework, to help the family understand why John is reluctant to keep in touch.

. Examine the outcome Ensures parents as well as John have made positive changes.

This type of interventionist therapy can help with aggressive behaviours, conduct problems, delinquency, to be part of conflict resolution plans, and helps to resolve and repair damaging behaviours.

Dyadic developmental theory

This theory aims to give children who have experienced emotional trauma a firm base from which they can form stable attachments and loving relationships with parents or carers.

What is it?

Children who are neglected, abused, or not properly cared for may be prone to rule-breaking and aggressive behaviour; thought, attention, and personality disorders; anxiety; depression; and difficulties in forming healthy attachments.

Dyadic therapy aims to establish a safe, empathetic, and protective environment for children with such a background, where they can learn new patterns of communication and behaviour. The therapist needs to build a collaborative relationship with both the child and caregiver as a basis for promoting a strong bond between the child and parent or carer. They use the principles of PACE – a Playful, Accepting, Curious, and Empathetic approach – to govern interactions with the child. This allows the child to feel valued, safe, and understood, and to be open to receiving nurture and support in their relationships.

Therapist is: Playful, accepting, curious, and empathetic

Patient feels: Safe, included, healthy, active, nurtured, responsible, and respected

Contextual therapy

The aim of this approach is to restore balance within a family, so that everyone’s emotional needs are met fully, fairly, and in a reciprocal manner.

What is it?

Imbalances in family relationships can occur when members feel others are treating them unfairly, ignoring their needs, or not reciprocating feelings.

Contextual therapy uses a concept of fairness and equal rights and responsibilities, called relational ethics, as a starting point for understanding the problems in family relationships. Relational ethics is also the basis for developing strategies to restore balance and harmony. The ages, background, and psychological characteristics of the members in the family unit provide context for grievances. The therapist encourages each member to express their side of the conflict, and to listen to the views of others in the family group. They are helped to acknowledge the positive efforts made by others in the family, and also to accept responsibility for their own behaviours.

Understanding that each person in the family deserves to have their needs met, and learning to take mutual responsibility for this, allows families to develop new patterns of behaviour that balance give and take.

FACTORS GOVERNING FAMILY DYNAMICS

. Background Age, social and cultural factors, and experiences that make each person individual.

. Individual psychology The personality and psychological make-up of each person.

. Systemic transactions How family members relate to one another – the emotional triangles, alignments, and power struggles, including relationships across generations and inherited patterns of behaviour.

. Relational ethics The balance of give and take and the emotional need and fulfilment that governs family dynamics; to be balanced, everyone must take responsibility for their actions and transactions with other family members.

Biotherapies

These therapies are based around the idea that biological or physical factors strongly influence mental disorders. They aim to change the structure of the brain, or how it functions, in order to alleviate symptoms.

What are they?

Unlike psychotherapies, which focus on environmental and behavioural factors and use the patient-psychologist relationship as an agent for treatment, biotherapies are prescribed by a psychiatrist and target how the brain functions mechanically. They are usually delivered in the form of medication or, in extreme cases, with interventions such as ECT (electroconvulsive therapy), TMS (transcranial magnetic stimulation), or psychosurgery. Some of these therapies attempt to correct the biological irregularities that are linked with the symptoms of mental illnesses such as bipolar disorder and schizophrenia. These irregularities may result from genetics, abnormalities in brain structure, or dysfunction in how parts of the brain interact.

Biotherapies are often used to bring symptoms under control and work alongside non-biological approaches, such as behavioural or cognitive therapies, which help people manage their symptoms and the factors that contribute to their condition.

Treatments

Psychiatric drug therapies act on neurotransmitters, such as dopamine and noradrenaline (both associated with reward and pleasure), and serotonin (which regulates mood and anxiety). They can be very effective in reducing symptoms but may have side effects, including drowsiness, nausea, or headaches.

Treatments that physically disrupt or stimulate the brain’s electrical signals are sometimes used when drug therapy has been ineffective. In ECT and TMS, low electrical currents are passed through the brain. Very occasionally, psychosurgery is used to alter brain functioning. This involves making small lesions in the brain to disrupt connections in the limbic system [see Applied Psychology (1)].

According to the US Centres for Disease Control and Prevention, antidepressant use increased nearly 65% from 1999 to 2014.

DRUG THERAPY

Medication can be used to reduce specific symptoms such as hallucinations, low mood, anxiety, or mood swings. While psychiatric drugs do not change the underlying mental health problem, they can help people to cope better and function more effectively:

[1] Antidepressants – These are used for treating depression, including despondent mood; anhedonia (inability to experience pleasure); hopelessness. They are sometimes given for anxiety.

Drug types – SSRIs (selective serotonin reuptake inhibitors); monoamine oxidase inhibitors; serotonin-norepinephrine reuptake inhibitors; tricyclics.

How they work – The “Feel-good” neurotransmitters (serotonin, dopamine, and noradrenaline) are made increasingly available for the brain to absorb.

Effect on person taking them – Improves mood and sense of wellbeing; increases motivation and optimism; raises energy levels; improves sleep patterns.

Side effects – Weight gain; drowsiness; inhibited libido and ability to achieve orgasm; sleep disturbance; dry mouth; nausea; headaches.

[2] Antipsychotics – Used for treating bipolar disorder; schizophrenia; and for symptoms such as hallucinations, delusions, difficulty with thinking clearly, and mood swings.

Drug types – A group of drugs that block dopamine. Older versions are called “typical”; newer drugs “atypical”.

How they work – They work by blocking the uptake of dopamine by the brain, as overactivity of the dopamine system causes psychotic symptoms.

Effect on person taking them – A decrease in auditory and visual hallucinations; stabilises mood; improves clarity of thought.

Side effects – Emotional effects are likely to emerge such as irritability and moodiness; neuromuscular effects; body temperature problems; dizziness.

[3] Anti-Anxiety drugs – Used for the treatment of GAD (generalised anxiety disorder); panic disorder; social anxiety disorder; PTSD; OCD; and phobias.

Drug types – Benzodiazepines; buspirone; beta blockers; SSRIs; serotonin-norepinephrine reuptake inhibitors.

How they work – They vary greatly in their action: some modify neurotransmitters; others (such as beta blockers) address physical symptoms.

Effect on person taking them – They improve the ability of the person taking them to manage stress and to face challenges; decreases muscle tension; lowers reaction to psychological triggers.

Side effects – Dizziness; poor balance or coordination; slurred speech; memory issues, difficulty concentrating; withdrawal symptoms.

[4] Mood stabilisers – These are used for the treatment of bipolar disorder; they may also be used to treat mood issues related to schizophrenia, depression, and seizure disorders.

Drug types – Lithium (for mania); anticonvulsants (such as carbamazepine, used for depression); antipsychotics (such as asenapine).

How they work – They vary in their action: some modify neurotransmitters, such as dopamine; others increase calming chemicals.

Effect on person taking them – These drugs reduce mania; they prevent cycles of manic and depressive episodes; alleviate depression.

Side effects – Weight gain; flat affect (little emotional reaction); dry mouth; acne; restlessness; sexual dysfunction; sun sensitivity.

[5] Stimulants – Used in the treatment of narcolepsy and ADHD.

Drug types – Amphetamines; caffeine; nicotine.

How they work – Stimulants increase the availability of neurotransmitters such as dopamine and noradrenaline to the brain, enhancing activity.

Effect on person taking them – Stimulants improve alertness and concentration levels; they are also increase clarity and the organisation of thoughts; energy levels raised.

Side effects – Anxiety; insomnia; loss of appetite; weight loss; increased heart rate; jaw tremors.

[6] Sleeping drugs – Used for treating sleep disorders.

Drug types – Antihistamines; sedative hypnotics; benzodiazepines; sleep-wake cycle modifiers.

How they work – They block histamines (antihistamines); enhance GABA (hypnotics; benzodiazepines); act on melatonin (cycle modifiers).

Effect on person taking them – Induces ability to fall asleep and/or remain asleep.

Side effects – Memory loss; daytime drowsiness; an increased risk of falling; risks of tolerance and dependence.

[7] Drugs for dementia – These are used for improving the associated symptoms of dementia and slowing progression of the disease (there is no cure for the underlying cause).

Drug types – Cholinesterase inhibitors.

How they work – The drugs inhibit the action of cholinesterases, enzymes that break down acetylcholine (a neurotransmitter important for memory).

Effect on person taking them – The drugs prevent successive strokes; the also delay further decline of cognitive function.

Side effects – Weight loss; nausea; vomiting; diarrhoea.

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_{This concludes the narrative for the page ‘Applied Psychology (3)’. Amendments to the above entries may be made in the future.}