Treatment Approaches
Psychoanalysis/Psychodynamic Psychotherapy
As you have probably learned, there are many “schools” of psychoanalysis, Freudian, Jungian, Sullivanian, etc. Each expresses a different theoretical view point as to the underlying source for the development of personal characteristics and behavior. However, no matter the theoretic school, there are two primary concepts which form the basis of all of the psychoanalytic approaches.
The first is based on the observation that individuals are often unaware of many of the factors that determine their emotional reactions and behavior. These unconscious factors may create troubling personality traits, difficulties in work or in love relationships, or disturbances in mood and self-esteem. The psychoanalytic (long-term/intensive) or psychodynamic (short-term/limited) approach to treatment helps the individual know how these unconscious factors affect current relationships and patterns of behavior and how they can be changed.
The second critical underpinning of the psychoanalytic approach is often identified as “the transference relationship.” The concept of transference is the notion that all of the unconscious factors that play out in the individual’s relationships, personal and professional, will also play out in the relationship the individual has with the analyst. Because it is at-the-moment, the analyst can use these interactions to illustrate how specific unconscious factors influence the individual’s behavior and reactions, as well as suggesting how those reactions might be modified to improve all relationships.
Short-Term Therapy
Short-term therapy is most effective when a well-defined therapeutic goal can be established by patient and therapist. This criterion applies to a wide range of situations.
For example, a patient who has previously been in long-term therapy finds herself unable to decide how to deal with a specific issue in an ongoing relationship. In short-term, focused therapy the therapist might help her to see more clearly which aspects of her own personality contribute to the problem or prevent her from behaving in a constructive fashion, and also discuss with her various practical solutions or communication techniques to consider.
A different approach would be used for a patient with a fear of flying. This person could be taught a self-hypnosis exercise for entering into a trance - state in which fear is reduced, and flight time used effectively. For example, a documentary producer now uses trance while traveling to create scenes for her movies. A single session is typically all that is required to learn the technique - which would subsequently be practiced for 90 seconds eight or ten times a day until mastery is achieved.
The common goal of all forms of short-term therapy is to overcome the flawed assumptions about ourselves and the world that we all hold to various degrees. Challenging those assumptions and putting them to the test behaviorally forms the basis for cognitive and behavioral approaches to change.
Multiple short-term techniques are frequently used together. A patient learning self-hypnosis in preparation for surgery expresses her distress at the thought of being alone in the hospital, but feels that she cannot ask her friends to visit. She assumes that “people don’t want to be bothered" and might feel angry or refuse. The therapist will help her to evaluate and provide evidence for her assumptions through a series of questions, and may also encourage her to test the assumptions by inviting someone she doesn't particularly care about to visit. Patients are frequently surprised to discover the extent to which their assumptions are incorrect. Many times when a person is feeling anxious, thinking becomes exclusively focused on imagining the most negatives outcomes possible, and simply challenging the assumptions brings great relief.
Hypnosis
The hypnotic state - often called trance - can be described as a plateau of heightened awareness with external vigilance subdued, or as a relaxed state of focused concentration. What is powerful (and therefore seems magical) is the access the hypnotic state provides to feelings, memories, and the systems of the body. The hypnotic state can be induced by an external source, a hypnotist or even a tape, - or often without awareness, by the individuals themselves. Have you ever wondered where the two-hour stretch of time went while you were driving on the freeway? Have you ever watched lovers walking down the street, arm in arm, so involved in each other the rest of the world does not exist for them? These are a few examples of the many spontaneous, self-induced, trance experiences.
For most of us, the hypnotic state is a safe and comfortable place in which our conscious awareness of the external world fades away; a state in which we have an enhanced capacity for creative imagery and for communication with both body and mind.
You can learn to consciously and voluntarily invoke this mental setting - this state of heightened awareness - which is the technique of self hypnosis. I like to think of it as a pathway to a very special place: a room within us. Once in the room, you can experience suggestions and ideas in a vivid matter; while relaxed and open. Once in this state of focused concentration and inner communication you can employ a strategy to restructure your thoughts, beliefs, feelings and reactions. Through self-hypnosis, you have the means of stepping forward in your life and achieving your optimal potential.
Cognitive Behavioral Therapy
Our thought-patterns are so habitual that we hardly notice them, and that is efficient for daily living. During your first cognitive therapy sessions, you will practice noticing and evaluating your thoughts - the running mental commentary that influences your behavior and emotions. Very rapidly, you will become more aware of deeper, underlying beliefs that shape the individual thoughts.
CBT is collaborative, problem-focused, and can produce rapid symptom relief and a sense of accomplishment. It can be used for a broad range of problems: all types of anxiety, phobias, compulsions, depression, communication problems, and more.
Because a lifetime of learning is expressed in day-to-day thoughts and behaviors, working with current issues is not a superficial approach. It can bring lasting changes.
While some people will be content to have reached an initial goal, such as overcoming one type of social anxiety, others will stay to work on other issues, or to work in a more exploratory fashion.
People suffering from anxiety, headache, tinnitus, lower back pain, or insomnia may also benefit from relaxation training with biofeedback.
Biofeedback
Relaxing (turning off the fight-flight-freeze response) is a skill that can be taught in just a few sessions - when biofeedback is used to accelerate the learning process. Patients are taught simple techniques that can be practiced anywhere. The biofeedback equipment gives measures of muscle tension and blood flow changes that inform the person learning when the body is responding in the desired way. This skill is very useful for people experiencing anxiety, stress-related hypertension, insomnia, tinnitus, headaches, facial and back pain. Very popular with patients.
Eclectic
“Eclectic” highlights the need for the therapist and patient to keep an “open door” to a variety of therapeutic approaches during the course of treatment. It is an acknowledgement that multiple psychological strategies might be appropriately applied during the course of a patient’s treatment in order to most effectively deal with an individual’s problems.
A patient may have started therapy to overcome a fear of public speaking and find, in the course of examining his inner commentary on performance, that he has a deep belief that people are punitive, critical and uncaring. He comes to suspect that this underlying attitude is responsible for many of his longstanding relationship difficulties. He masters his performance anxiety through self-hypnosis or CBT, but continues with a new focus on understanding how he has “destructed” his life to accommodate his fears of others.
Or, a patient who comes for biofeedback training to manage chronic pain finds that she is unable to decrease her hyper vigilance as she realizes that the effort to achieve relaxation triggers a memory of abuse that she will then wish to address.
Or, a patient in analysis develops a checking compulsion that interferes with her work. CBT might be used to keep her from losing her job, while she continues her ongoing treatment.
Psychological Solutions is an eclectic practice in that we hope to make available to patients the best resources for working with a wide range of issues.
