Licensed Psychologist and Psychoanalyst

Types of Therapy

There are many different approaches to psychotherapy.  Each approach emphasizes different things.  Each has it's own strengths and weaknesses.  Each has it's own presumptions about how the mind is structured and how the psyche works. 

Lynne Harkless, Ph.D.  4601 Ponce de Leon Blvd.  Ste 310    Coral Gables, FL  33146   305.926.1133    LHarkless1@aol.com

Definitions: 

"Psychotherapy" refers to any form of talk therapy.  There are many forms of

psychotherapy - Behavioral, Gestalt, Cognitive (or CBT), Existential, Psychoanalytic,

and many more.  Different therapists do different forms of therapy. Some therapists

use a mixture of more than one form.

"Psychoanalytic psychotherapy" is the form of therapy I practice.  I will explain more

about how it works below.

Examples of How Some of the Different Types of Therapy Work:  .

Behavioral Therapy:  .

• If a person has a phobia, for example, a behavioral therapist might expose the person to the feared stimulus in small doses.  This is in order to desensitize them to the feared stimulus.  Behavioral techniques tend to work in the realm of conditioned responses and behavior rather than deeper meanings.
  

Gestalt Therapy:

• An example of a Gestalt technique might be to have the patient pretend their spouse or boss or some other important person is sitting in a chair next to them and to express to that person whatever they feel toward them in a role played conversation.  Gestalt techniques tend to be experiential and emotive in this way,
  

Cognitive or Cognitive-Behavioral Therapy (CBT):

• CBT treatments try to uncover what they call irrational thoughts that cause problematic emotional reactions.  They then tend to dispute or “reframe” those thoughts with less upsetting types of thoughts or cognitions. 
  

• For example if someone is denied a raise they might feel like a failure.  A CBT therapist might counteract this thought by reframing it into alternative ways to interpret what happened.  They might say “just because you didn't get one raise does that really mean you are a total failure?”   The idea is that reframing this irrational “catastrophizing” thought (or other types of irrational thoughts) into a more rational one can relieve the distress of feeling that you are a total failure.
  

Psychoanalytic Psychotherapy:  

• Psychoanalytic therapists are interested in underlying meanings.  If someone quickly feels like a total failure after being denied a raise (as in the above example), a psychoanalytic therapist might point that out to the person just like a CBT therapist would, but unlike CBT, the psychoanalytic therapist will not dispute or reframe it.  They will try to understand the person's tendency to feel so worthless.  They will look into how and why this person has become so self condemning and into the other ways this might play out in that person's life. 
  

• The psychoanalytic belief is that conscious, visible symptoms like catastrophizing or phobias or panic have to do with other less conscious, less easily visible problems.  Psychoanalytic therapy is designed to address the less conscious problems that underlie the conscious ones.  
  

• Psychoanalytic therapists believe that focusing on the surface level of symptoms might help a person to get better at putting out the fires inside them, but it is not so good for getting rid of the fires altogether  The psychoanalytic approach is geared toward getting at the cause of those fires so that they are no longer there to be coped with. 
  

• I am not saying that developing good coping skills is not a goal of psychoanalytic treatment.  It is.  It is simply not the only goal.  Deeper relief, deeper self understanding, and increased capacity to lead a happy life are also goals.
  

How Long Do the Different Kinds of Therapy Take?

The length of any therapy depends on the goals of the therapy.  Therapy can be very brief or it can be longer term.

• “Short Term” or “Brief" Therapy refers to 12 sessions or less. 
  

Any of the above therapies can be done in a short term way, including psychoanalytic

therapy.  Brief therapy is usually highly structured and has specified target goals. 

Goals usually involve reduction of some symptom such as panic attacks, sleep

disturbance, fear of flying, or something of that nature.  When the symptom resolves or

becomes less acute, the therapy is ended.

• “Long Term” or “Open-Ended" Therapy refers to 12 sessions or more. 
  

The length depends on the individual person's issues and desires.  It could be 6 months

or it could be some years.  Therapy might last longer because the problems are more

complex and require a longer time to get resolved.  Or it might last longer because there

are profound positive life changes going on and the person wants to continue to improve.

What is the Appeal of Short Term Structured Therapy?

• Therapies that are designed as short-term therapies promise relief from symptoms with minimal time and without having to dig up one's entire childhood.  This can be very appealing and can make a lot of intuitive sense.  Insurance companies like it because it is structured to be quicker and therefore cheaper.  Individual people also often like the idea of quick relief at lower expense.
  

• Some people fear what they will open up if they engage in a deeper therapy.  Sometimes a person with these kinds of fears wants to treat just the surface if at all possible.  Structured therapy approaches can feel safer to someone who has such fears. 
  

Why Isn’t Short Term Therapy Always the Best Form of Therapy?

There are some issues for which short term, structured therapies are very helpful and some for which they are not. 

• For example, if a person has just been diagnosed with a serious medical problem, they might best be helped by structured techniques to manage fear, or guided imagery to boost immune functioning, or techniques to reframe panic-inducing perceptions.  These are short term goals.
  

• On the other hand, if that same person wants to reevaluate how they've lived their life so far, or if unresolved feelings from the loss of a parent have been opened up, or if they want to grieve the losses of health and safety and future that they might be feeling, a short-term therapy that targets surface thoughts or behaviors is not well suited for those goals.  Goals like this involve self exploration, and self exploration requires a longer and more organic (less structured) inner process.
  

What is the Appeal of Longer Term Therapy?

• Longer term psychoanalytic therapy offers a context in which complicated or lifelong difficulties can be addressed in a deep enough way to create meaningful changes.  It offers a chance to deal with things that, in my view, short term therapy cannot be very effective for.
  

• Some difficulties are complex enough that they cannot be resolved in a few sessions of therapy.  Some examples of the types of problems that are more complex are:
  

Inability to find or keep a committed relationship

Fear of anger

Mild to extreme self destructiveness

Fears of closeness to others

Intense emotional reactions that cause problems either internally or in relating to

others

Not living up to one’s potential

Fear of conflict

Anger problems

Abusive childhood history

A life that feels lacking in meaning

Sexual problems

Problems that remain despite working on them in other forms of therapy

• A major appeal of longer term therapy is that it offers a depth of change that nothing else can.   For people who feel ready to deal with things they haven't been able to overcome themselves or in other ways, psychoanalytic therapy offers them a chance to do that.
  

Is Psychoanalytic Therapy Short Term or Long Term?

• Psychoanalytic therapy can be done in a short term way and frequently is done in a short term way . Couples therapy, for example, is often shorter term.  If the relationship is basically solid and the two people love each other and wish to stay together, areas of difficulty can often be worked through in a relatively brief time.
  

• Similarly if an individual is pretty satisfied in their lives overall but has one area that trips them up or causes pain, a brief psychoanalytic approach is often sufficient.
  

• In short term psychoanalytic therapy, there is a more narrow focus on one or two specific goals.  The therapist will only do this however, if they believe the goal issues are not too interwoven with other issues.  If they believe the surface problems are connected to other issues that must be addressed as well, they can explain this to you.  You can then decide for yourself.
  

• Although it can be short term, psychoanalytic therapy is often longer term.  Other therapy approaches are almost always short term.   The possibility of longer term deeper work if needed is one of the advantages of a psychoanalytic approach.
  

What is the Potential Reward of Psychoanalytic Therapy?

• In my view, of all the therapy approaches, the psychoanalytic approach is the most powerful for dealing with human complexities and contradictions.   It can be a very meaningful and life changing experience to find someone who is interested in and trained in helping you get into sealed off areas of your psyche and helping you to understand them. 
  

Special Note About Therapists:

• Not all therapists are interested in delving deeply into the psyche.  Many, if not most these days, prefer or value working in other ways.  It takes special training to know how to handle deeper therapeutic work and special interest in hearing about the deeply held secrets that most human beings carry in them in some form.  The ability to help people delve into secret areas of themselves is one of the ways in which psychoanalytic therapists excel in their training and their personalities.  These areas of the psyche are where many of the problems that cause people deep pain for years of their life are rooted. 
  

• A good psychoanalytic psychotherapy experience can change your life in ways you might think unimaginable or impossible.  You can become freer to flourish in all areas of your life. Love, family, friendships, physical health, financial security, occupational satisfaction, and all areas of living can become more fulfilling.   
  

• A longer term analytic therapy is not so different in some ways from getting a college degree.  They both require time, effort, and expense to get something that can change the course of the rest of your life.