Models of Therapy
Feedback Informed Treatment – FIT (also known as Client Directed Outcome Informed Therapy – CDOI).
FIT was born out of therapy outcome research in which researchers examined what really works in therapy. Therapy outcome research reveals that the alliance between you and your therapist is more important to a positive therapy outcome than any particular kind of therapy. There are many different models, techniques and approaches to therapy such as Cognitive Behavior Therapy (CBT), reality therapy, and interpersonal therapy. FIT (or CDOI) encompasses many different kinds of therapy within one overarching philosophy. FIT allows your therapist to modify his/her approach to therapy as directed by you. If your therapist is out of sync with you (or worse, is annoying, patronizing, etc.) then there’s little chance that he/she can help. You probably won’t even come back after a session or two! Keeping an open dialogue about what does and does not help, informs your therapist about how best to help you.Scientifically validated, FIT maintains that you are the best judge of whether your therapy is effective and helpful. ApaCenter therapists embrace this idea. Think of it this way – If you go to a fine restaurant, does the chef tell you what you must order? Does he get to tell you how much you liked it? Of course not! Similarly, research shows that you benefit most from an on-going dialogue with your therapist (chef) about what is or is not helpful (tasty). Like having your own personal chef, an ApaCenter therapist actually checks in with you every session to get your input on how things are progressing. Your ideas and preferences are used to modify and enhance our approaches and techniques. This allows you to take an active role in your therapy because you are central to your own process of change. So, with FIT, one or more therapy models (described below) could be used in your sessions – depending on what works best for you.
Cognitive Behavior Therapy (CBT)
CBT is a form of therapy that has gained much attention within the last few decades. According to the cognitive behavioral therapy model, your thoughts, emotions, and behaviors are inextricably linked. The way that you perceive situations influences your physiological, emotional, and behavioral responses. As William Shakespeare wrote in Hamlet, “ …for there is nothing either good or bad, but thinking makes it so.” According to the CBT model, dysfunctional or inaccurate thoughts often underlie chronic and severe emotional and behavioral problems. Through various techniques, thoughts and behaviors are examined and modified. With practice, you learn these techniques so that you can effectively deal with your challenges on your own. In contrast to some other forms of psychotherapy, CBT tends to be more problem-solving oriented, shorter term, and focused on the present. CBT is also known as cognitive therapy and cognitive behavioral therapy.
Mindfulness is the idea that you are not your thoughts. When you are mindful, you turn toward the present moment. Regretting the past may cause you to feel down. Glorifying the past may diminish the importance of the present. Likewise, too much focus on great things yet to come may pull you away from what is happening now. And worrying about your future, about what might happen, can cause you distress in the present. Being more mindful helps you stop getting caught up in the continuous cycle of judging situations as bad or good and start accepting them as they are.
Mindfulness has the power to liberate you, to unshackle you, from a life lived in the past or future. This does not mean that you should not reflect on the past or plan for the future, but there are times to do that, and there are times when you should be fully present and soak up the experiences of the moment. For many people, anxiety and depressive feelings stem from dwelling on negative past experiences or worrying about future negative possibilities. A cycle of distressing thoughts, in turn, prevents us from accessing and experiencing positive events in the here-and-now. Becoming more mindful has the power to improve mood, decrease psychological distress, and support a fuller life in the only moment we ever truly live – Now.
Strength-Based, Solution-Focused Therapy
You probably posses all the tools you need to overcome most of life’s obstacles. In Solution-Focused therapy, your therapist will help you identify times in your life when you successfully resolved problems similar to those you now find overwhelming. Once you better understand your own strengths and resources, your therapist can help you rediscover ways in which you can overcome difficult challenges. Your therapist may ask you to try some short-term experiments between sessions. By noticing your progress toward these short-term goals, you (like most clients) will likely experience progress toward your greater goals. The obstacles that brought you to therapy will seem less like obstacles and more like surmountable challenges. Solution-Focused therapy is primarily present and future focused. Because it is usually short-term, perhaps 3-10 sessions, it is often referred to as, “Solution Oriented Brief Therapy” or simply, “Brief Therapy.”
Choice Theory / Reality Therapy
Choice Theory, as formulated by psychiatrist Dr. William Glasser, posits that all humans have 5 basic needs. The first need includes all of our physiological/survival needs (air, food, water). The other four needs are psychological. They include freedom, fun, power, and love/belonging. We attempt to satisfy our 5 needs through our behavioral choices. According to choice theory, almost all behavior is chosen, and we are all ultimately responsible for our own behavioral choices. Of the 4 psychological needs, the need for love and belongingness tends to be the most important. According to choice theory, it is through the development of close, caring relationships that we can most effectively fulfill our other needs and achieve happiness.
Unfortunately, we often “kill the golden goose” in our interpersonal relationships. That is, in our efforts to fulfill our own needs for power, freedom, and fun, we often inadvertently harm our relationships. We frequently use external control (i.e., various types of coercive force such as criticizing, threatening, and nagging) in attempts to get others to do what we want them to do. We misguidedly believe that controlling others will help us satisfy our own needs or their needs. However, this practice tends to result in conflict, frustration, and disconnected relationships. For example, think of how “micromanaging” or being a “helicopter parent” creates friction and resentment in relationships. In turn, disconnected relationships ultimately produce unhappy people that may manifest mental health problems such as depression and anxiety.
Reality therapy is Dr. Glasser’s counseling approach using choice theory. Within reality therapy there is a lot of emphasis on learning to develop a strong internal locus of control. Reality therapy supports a strong sense of responsibility for your behavior and the belief that you can attain desired results through your choices. Like CBT, reality therapy tends to be focused on the present, is problem and solution oriented, and tends to be short-term. Importantly, like CBT, a main goal in reality therapy is to aid you in gaining new perspectives and techniques that will help you manage challenges on your own. Although you may never have heard of Dr. Glasser’s choice theory and reality therapy, he has had a huge impact on modern psychology. He rarely gets his due credit.
Until about the 1990s, psychology and psychiatry tended to focus on pathology – What is going wrong with you and why? However, there is a new movement (spearheaded by psychologists such as Dr. Martin Seligman and Dr. Mihaly Csikszentmihalyi) that focuses on what makes people happy and why. Research within the field of positive psychology provides a wealth of data on strategies and behaviors (e.g., exercise, charitable deeds, learning to forgive, savoring, mindfulness) that tend to elicit a sense of fulfillment and positive emotional states. In therapy, you learn how to choose behaviors that tend to engender happiness, peace, and well-being. Oftentimes, these are activities that you used to do or still do occasionally but you are not aware of how beneficial they are. By learning to incorporate more positive behaviors and ways of thinking into your lifestyle, you can directly combat negative moods such as depression and anxiety. As you engage in practices that enhance happiness and well-being, negative feelings will naturally diminish.
Positive psychology DOES NOT mean that we should just “think happy thoughts” and plaster fake smiles on our faces. It is about learning to incorporate beneficial strategies within our lives that improve mood, provide a sense of peace, and enhance well-being. Within therapy, positive psychology practices can be woven in so that your negative moods and emotions also receive their due attention. Therapists using positive psychology practices merely try to correct the imbalance of always focusing upon the negative.
Many people are struggling emotionally because of difficulties in their interpersonal relationships. For instance, they may have painful interaction patterns they repeat over and over again with the important people in their lives. In interpersonal therapy the goal is to develop a safe and trusting relationship between you and your therapist. Within the context of this relationship you can safely explore and discover issues that are troubling you. Then you can experiment with new approaches to better address these issues. For example, if you are stuck in a pattern of unhealthy interactions with someone in your life, within the security of the relationship with your therapist, you can discover new and healthier interactions. As you experience success with your therapist, you can then try out these new ways of relating with other people. Improvements in your relationships will reduce symptoms of emotional distress and increase feelings of happiness and well-being.
Narrative therapy is based on the notion that we all create meaning out of our life experiences through the stories we tell ourselves and share with others. There are many different ways to interpret the events that happen in our life. Sometimes the stories we tell ourselves can constrict us and contribute to our suffering. In narrative therapy, you and your therapist will explore the stories that have dominated your life. These stories may be causing you distress. By examining these stories together, working to give them new meaning and exploring other, more empowering stories, you can learn to change how you think and feel about yourself and your life.
Children often experience emotional and behavioral difficulties when there is tension in the family. In this case, the best way to help your child is to bring your entire family to therapy. In family therapy your child’s difficulties are viewed as a symptom of a problem in the child’s family system. The family system is regarded as a whole, where all the parts (i.e., family members and subgroups of family members, including parents, siblings, etc.) influence one another. Your therapist’s goal is to find the sources of tension and conflict within your family system and assist you in resolving that tension by engaging in new, more positive interaction patterns. Also, your therapist will highlight past and present positive family interaction patterns to build upon.
Children, especially young children, often communicate best by playing, rather than talking. In play therapy, the medium of communication is play. This includes play with toys (e.g., dolls and doll houses, animal figures, common objects) and also artistic expression, such as drawing, painting, or working with Play-Doh. The role of your therapist is to offer a safe, accepting, supportive, attentive, and responsive environment where your child can explore issues that are painful and troubling. Through the medium of play, your therapist gently guides your child toward discovering new and healthier ways of coping, giving painful experiences a new and more positive meaning. Children are amazingly resilient and are often, with the safety and acceptance your therapist provides, able to “work through” what is bothering them.
Life coaching is different from other kinds of therapy because most clients who have a life coach are not suffering from significant psychological or emotional distress. Thus, it is generally not considered “therapy” or “counseling” per se. Unlike being a Licensed Psychologist, being a “life coach” does not require any kind of license, credential, or training. In effect, anyone can call him/herself a life coach and set up a practice. However, being a licensed mental health professional certainly provides a strong foundation for a person to serve as a life coach.
Life coaches generally serve as a sounding board and motivator for you. They most commonly address issues you face in your personal life, professional life, or relationships. Life coaches are skilled at asking purposeful questions that allow you to find answers within yourself, thereby achieving greater personal or professional growth. If you seek life coaching you are probably high functioning and generally happy with your life, but you may have specific goals that you have been unable to reach or certain questions about your life that you want help exploring in-depth. If this describes you, life coaching could help you take your life to the next level.