I am often asked by new patients which type of psychotherapy I practice. This is an understandable question since people want to get the best therapy possible. Since I have been studying and practicing psychotherapy for over 30 years, the truth is that I use many different forms of psychotherapy. This is called an eclectic approach. It includes the following schools: traditional talk therapy, psychodynamic, Cognitive Behavioral Therapy (CBT), and Dialectical Behavioral Therapy (DBT). I try to tailor the therapy to the patient since each person is different.
Each type of therapy is suited for a different situation. Cognitive Behavioral Therapy is useful for reducing mood and anxiety disorders that are caused by faulty thinking. It is a structured form of therapy with specific treatment goals determined at the start of therapy. Homework is assigned between sessions and is reviewed at the next session. This is a good form of therapy for structured people who are not comfortable entering into a traditional therapy relationship which often has relatively undefined goals. The disadvantage of CBT is that it is primarily used for symptom removal and is not geared toward transformational change like traditional talk or psychodynamic psychotherapy.
CBT has developed over time and has been tailored to specific populations. For a person who has obsessive-compulsive disorder, the gold standard of therapy is a specific form of CBT is called Exposure and Response Prevention (ERP). When combined with a specific anti-anxiety medication called Clomipramine, ERP therapy has been shown to be effective at reducing the symptoms of obsessive-compulsive disorder.
Another development of CBT is Dialectical Behavioral Therapy. This therapy was developed by Marsha Linehan, Ph.D., who suffered from a personality disorder and was treated with traditional psychotherapy and medications, both of which did not help her. She created a new form of therapy which combined her experiences in Eastern meditation with skills regarding mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. These skills are taught in modules focusing on each of these four areas so that patients can learn to cope on their own. It is an educational approach, not an insight-based approach like traditional talk or psychodynamic therapy.
Until 30 years ago, most therapists were primarily trained in psychodynamic therapy, which was an outgrowth of Freud’s findings. As society has become more technological and scientific and less humanistic there has been a greater demand for evidence-based treatments. Evidence-based treatments are treatments which are backed by scientific research. Each type of therapy treatment usually starts as a way of treating a certain illness. After it is shown to be effective with one illness, researchers investigate its effectiveness with other illnesses, much as drug companies do with pharmaceuticals. For example, recent research has shown that DBT, which was created to treat personality disorders, has also been shown to be effective for anger, emotional control and in the treatment of adolescents.
It is not only important to research what type of therapy you want but also what kind of therapist you need. An older, more experienced therapist is usually better. Also, a therapist who has been through their own intensive personal therapy (three-four times a week) is best no matter what type of therapy they practice. Many therapists today do not have this intensive personal training. Even if you are getting nontraditional forms of therapy such as CBT or DBT, it is best that the treating therapist underwent this rigorous training because it provides an understanding of human psychology that can’t be achieved any other way. Ask your therapist questions before starting treatment with them.
Jonathan Bellin is in private teletherapy practice and is accepting new patients. He treats adolescents and adults with the full range of mental health challenges. He received his MSW from Yeshiva University in 1993. He can be reached at [email protected].
