ABCs of Mental Health Care

Treatment Types

print Types of Psychotherapy

In family therapy, a person's symptoms are viewed in the larger context of the family. Just as a certain department in a business can suffer due to problems in another department, a person with depression might be responding to larger family issues. For example, a depressed adolescent's symptoms might be related to her parents' marital problems.

Special techniques of family therapy include:

  • A genogram is a family tree constructed by the therapist. It looks at past relationships and events and what impact these have on the person's current emotional state.
  • Systemic interpretation views depression as a symptom of a problem in the larger family. For example, 16-year-old Billy's getting into trouble in school and staying out at night are viewed as unconscious attempts to shore-up his parent's failing marriage. It is noted in the sessions that his parents only get along and work together as a team when they are dealing with Billy's problems.
  • Communication training helps families identify and correct dysfunctional communication patterns. People are taught how to listen, ask questions and respond non-defensively.

Interpersonal Therapy

Interpersonal therapy focuses on the relationships of the client and attempts to improve communication patterns and how people relate to others to lead to positive outcomes. This type of therapy is similar to psychodynamic psychotherapy, which focuses on the individual, including the unconscious, and uses the therapeutic relationship as an instrument of change and growth.

Techniques of interpersonal therapy include:

  • Identification of emotion. The therapist helps the person identify his emotions and why he feels the way he does. For example, Roger is upset and fighting with his wife. Careful analysis in therapy reveals that he has begun to feel neglected since his wife started working outside the home. Knowing that the relevant emotion is hurt and not anger, Roger can begin to address the problem.
  • Expression of emotion. This involves helping the person express their emotions in a healthy way. For example, when Roger feels neglected by his wife he responds with anger and sarcasm. This, in turn, leads his wife to react negatively. By expressing his hurt and anxiety in a calm manner, Roger can make it easier for his wife to react with nurturance and reassurance.
  • Dealing with emotional baggage. Often, people bring unresolved issues from past relationships to their present relationships. Looking at how these relationships affect a person's mood and behavior help him gain objectivity in present relationships.

For example, growing up, Roger's mother was not a nurturing woman. She was very involved in community affairs and often neglected Roger's needs. When choosing a wife, Roger chose a woman who was attentive and nurturing. However, when it was necessary for her to work outside their home, old feelings of hurt and rejection were rekindled in Roger, feelings originally experienced in relation to his mother. Therapy helped him to recognize how his relationship with his own mother affected his reaction to his wife working outside the home.

Group Therapy

Group therapy provides treatment in a format where there is one therapist and six to eight participants with related problems. The participants improve not only from the interventions of the therapist, but also from observing others in the group and receiving feedback from group members. The group format, while not providing the one-on-one attention of individual formats, has several advantages.

Similar to family therapy, group therapy is a style that can incorporate any of the psychotherapy schools. The advantages of group therapy include:

  • Less expense. Treating several persons simultaneously enables the therapist to reduce the usual fee. In most cases, the cost of group therapy is less than one-third that of individual therapy.
  • Increased feedback. Group therapy can provide the person with feedback from peers who are struggling with similar issues. Getting different perspectives can help promote growth and change.
  • Modeling. By seeing how others handle similar problems, the patient can add new coping methods to her behaviors. This can give the patient a variety of perspectives on what seems to work and when. For example, Mary listens to Joan talk about how productive it felt to tell her husband that he hurt her feelings, rather than simply getting angry with him and not speaking. As she listens, Mary thinks of how she might try this same strategy with her husband. She can then try out this new behavior by practicing with the men in the group.

Behavioral therapy

Behavioral therapy is sometimes referred to as cognitive-behavioral therapy. In this approach, problems are believed to stem from changes in thinking and behavior. The goal is to increase the person's engagement in positive or socially reinforcing activities. Behavior therapy is a structured approach that carefully measures what the person is doing and then seeks to increase chances for positive experience. Common techniques include:

  • Self-monitoring. This is the first stage of treatment. The person is asked to keep a detailed log of his or her activities during the day. By looking at the list, the therapist can determine exactly what the person is doing. For example, Bill, who is being seen for depression, returns with his self-monitoring list for the past week. His therapist notices that Bill goes to work in the morning, returns home at 5:30 p.m. and watches television uninterrupted until 11 p.m. before going to bed.
  • Schedule of weekly activities. This is where the person and therapist work together to develop new activities that will provide chances for positive experience. For example, looking at his self-monitoring sheet, Bill and his therapist determine that watching so much television alone gives Bill little opportunity for positive social interaction. Therefore, they decide that Bill will have dinner out with a friend once a week and join a bowling league.
  • Role playing. This helps the person develop new skills and anticipate issues that might come up in social interactions. For example, one of the reasons that Bill stays home so much is that he is shy. He does not know how to start a conversation with strangers. Bill and his therapist work on this by practicing with each other on how to start a conversation.
  • Behavior modification. In this technique, the person will receive a reward for engaging in positive behavior. For example, Bill wants a new fishing rod. He and his therapist set up a contract where he will reward himself with a new fishing rod when he reduces his TV watching to one hour a day and becomes involved in three new activities.

Play therapy

Play therapy uses various play modalities (e.g., action figures, dolls, pretend play, fingerpaints, coloring, etc.) to help children (usually younger children) physically and symbolically express emotional states and beliefs that may be hard to put into words. This technique views play as an essential part of children's cognitive, social and emotional development, particularly with regard to representational skills (of situations and scripts for interactive patterns in certain situations). Play modalities help children alter their forms of expression and/or develop more effective interactive patterns. This is particularly helpful with younger, pre-verbal children and/or with children for whom social/emotional situations are particularly distressing and threatening (e.g., victims of abuse, neglect, trauma), and for whom intimacy and/or verbal disclosure may be difficult.

Marital therapy

In marital therapy, the therapist often assumes the role of "facilitator" to help couples specify areas of conflict and develop more effective problem-solving and communication skills. Prescribed exercises can be used to help couples improve skills in the areas of intimacy and conducting family life development (e.g., redefining the relationship in the wake of "empty nest" syndrome).

Adult vs. child therapy (adolescents)

Depending on the age of the child and the nature of the issues to be addressed, therapy with children and adolescents will usually include the parents. For younger children, parents are essential members of the therapy team, as they spend the majority of time with the child and will therefore be the strongest agents of change.

In these situations, the therapist will often spend time helping the parents to understand the factors influencing their child's emotional and/or behavioral problems, and then help them develop more effective ways of interacting with their child (e.g., communication skills, behavior management). Individual sessions with the child will often occur in addition to sessions that include the parents to help the child feel less threatened by the experience and to work on individual change issues.

For older children and adolescents, whether the therapist meets primarily with the child alone, the parents alone, or the child and parents together will usually depend on the nature of the issues involved. Family members will typically be involved in the therapy when children's problems are strongly related to family conflict or changes, or where family members will play crucial roles in reinforcing a child's efforts to address a problem. On the other hand, an older adolescent who is experiencing fears of normal developmental transitions (e.g., from home to college) may benefit more from individual therapy to address these issues.

By Michael Herkov
© 2000 University of Florida Brain Institute


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