Therapeutic Orientations

Authors: Stefan G. Hofmann, Q. Jade Wu, Boston University

In the past century, numerous psychotherapeutic orientations have emerged to treat mental illnesses. This module discusses well-known therapeutic approaches and their histories, techniques, advantages, and disadvantages, with a focus on Cognitive Behavioral Therapy (CBT) as the most effective modern approach.

Learning Objectives

• Familiarize yourself with the most widely practiced psychotherapy approaches.
• Understand the history, goals, key techniques, and empirical support for each approach.
• Consider the impact of emerging treatment strategies in mental health.

Introduction

• Mental illness has been noted as far back as 1500 BCE.
• Nearly half of Americans will experience mental illness in their lifetime.
• Various psychotherapies exist, with CBT being the most effective.
• Other approaches: psychoanalytic therapy, person-centered therapy, and mindfulness-based therapies.

Psychoanalysis and Psychodynamic Therapy

History

• Founded by Sigmund Freud; focuses on unconscious conflicts and desires.
• Mental health problems arise from tension between the id, ego, and superego.
• Psychoanalysis aims to bring unconscious struggles into awareness.

Techniques

• Free association: patients share thoughts without censorship.
• Dream analysis to uncover latent content.
• Therapists interpret thoughts and behavior through transference and countertransference.

Advantages and Disadvantages

• Decreasing in practice due to lack of empirical support.
• Not suitable for severe psychopathology or intellectual disabilities.

Humanistic and Person-Centered Therapy (PCT)

History

• Developed by Carl Rogers; focuses on self-worth and identity.
• Encourages self-understanding in a supportive therapist-patient relationship.

Techniques

• Non-directive therapy: therapists guide patients towards self-discovery.
• Unconditional positive regard from therapists.

Advantages and Disadvantages

• Highly acceptable due to its supportive approach.
• Mixed effectiveness; uses unspecific treatment factors.

Cognitive Behavioral Therapy (CBT)

Overview

• Addresses thoughts and behaviors contributing to mental disorders.
• Present-focused with homework assignments between sessions.
• Empirically supported and effective for many psychiatric illnesses.

Techniques

• Reappraisal/Cognitive restructuring: changing maladaptive thoughts.
• Focuses on adaptive behavior development.
• Exposure therapy for anxiety disorders.

Advantages and Disadvantages

• Cost-effective and logically intuitive.
• Requires active patient effort with homework.

Mindfulness-Based Approaches

Overview

• Adapted from Buddhist and yoga practices.
• Focuses on nonjudgmental acceptance of thoughts and sensations.

Techniques

• Mindfulness-based stress reduction (MBSR) and cognitive therapy (MBCT).
• Encourages present-moment awareness and physical relaxation.

Advantages and Disadvantages

• High acceptability due to cultural familiarity.
• Evidence supports effectiveness for mood and anxiety disorders.

Emerging Treatment Strategies

• Technological advances enhance treatments (e.g., internet-based therapies).
• Cognitive bias modification and CBT-enhancing pharmaceuticals.

Pharmacological Treatments

• Psychiatric medications used alongside talk-based therapies.
• Effectiveness varies with disorder and individual factors.

Integrative and Eclectic Psychotherapy

• Combines techniques from multiple approaches.
• A significant number of therapists use integrative methods.

Conclusion

• Various therapies exist for treating mental illness, with CBT most empirically supported.
• Understanding therapies can guide people to seek mental health help effectively.

Discussion Questions

1. Does psychoanalysis still have a place in mental health treatment?
2. What are the advantages and disadvantages of technological advances in psychological treatment?
3. Are all therapies equally effective due to common factors?
4. What factors should be considered when choosing psychological treatment?

Vocabulary

• Acceptance and Commitment Therapy: Nonjudgmental observation of mental processes.
• Automatic Thoughts: Spontaneous, problematic thoughts.
• Cognitive Behavioral Therapy (CBT): Changing thoughts and behaviors influencing psychopathology.

References

A selection of key references and further readings on psychotherapies and their development.