Almost everything has been described as psychotherapy from orthodox psychoanalysis in which a person lies on a couch for several days a week for many years to shorter forms of once weekly psychotherapy, group therapy, activity therapy, and adventure-based therapy. We sometimes call our daily activities "driving" therapy, "garden" therapy, and even "work" therapy. Psychiatrists tend to have a narrower definition of psychotherapy and see it as a series of meetings between a therapist and a client in which they work together to help the client to overcome a psychological problem. There are several forms of psychotherapy that can be of enormous benefit to people with different psychiatric problems.
Unfortunately many insurance companies limit the amount of money that they will pay for any form of psychotherapy. They discriminate against people with psychological problems and the treatments they will cover and hide behind a maze of double talk and regulations that will prevent you from getting the treatment you need. As a result you may not be able to engage in any beneficial form of therapy except meeting a therapist a few times to go over your problems and discuss ways of managing them.
Don't be bullied by insurance companies and HMOs to restrict your treatment to the use of medications when psychotherapy can be far more effective and result in long lasting changes. Persistence with an insurance company can pay off. Under threats to complain to a state regulating industry, they may agree to fund appropriate treatment.
Consider paying for psychotherapy out of your own pocket. Although this may seem like a large expense, consider what you are paying for discretionary spending such as smoking, clothes, restaurants, and entertainment. Most people can afford psychotherapy if they put their minds to it.
Behavioral Behavioral therapy focuses specifically on your behavior and seeks to change it through a series of exercises. There are several kinds of specific behavioral techniques that may help you.
Systematic Desensitization This is a process in which you and your therapist establish a hierarchy of situations ranging from those that you handle easily to those that are most difficult. You practice the easiest ones first. When fully comfortable with the initial situation, you progress to the next situation in the hierarchy. You practice at each stage in the hierarchy until the difficulty is mastered before moving to the next stage. Systematic desensitization is a slow process in which the problem is gradually mastered step by step. If you become overwhelmed at any step, you scale back the difficulty of each task by breaking it up into smaller increments and increasing the frequency of practice.
Flooding This is essentially the opposite sequence. One imagines the most difficult experience possible and seeks it out. The experience is purposely overwhelming. With regular practice however, similar experiences in life become much more tolerable. For example, if you panic in crowds and stores, three to four times a week you go to the most crowded large space you can find, such as a downtown shopping district or a mall. Regular practice gives you the confidence to go to a less crowded place as well, and makes it relatively easy by comparison. Many therapists accompany their clients to begin flooding and gradually reduce their involvement as proficiency is gained.
Relaxation Techniques Relaxation techniques are mental and physical exercises to induce a state of calm and relaxation. The goal of a relaxation technique is to achieve that sense of relaxation in a calm situation and gradually gain proficiency in achieving that same state of calmness and relaxation in anxiety-provoking situations.
There are many different forms of relaxation techniques. Relaxation tapes provide soothing sounds such as the waves of the ocean. These are often a good way to begin learning how to relax. In progressive muscular relaxation a person slowly clenches and relaxes each of the body's muscle groups, in sequence, one after the other. Each clenching and unclenching should be gradual and take roughly ten to fifteen seconds. As the exercise proceeds, most people notice that they are physically much calmer. In using the breathing technique one sits quietly and comfortably breathing slowly in and out and saying "in ... out ... in ... out..." with each breath. As thoughts come to your mind, you let them pass through and refocus your attention on your breathing. With meditation, one develops a sense of relaxation by concentrating on a word or phrase while simultaneously letting the body relax deeply. Attention is paid not so much to breathing or to the muscles, but rather to the word itself. Focusing on the word itself helps you to maintain a state of relaxation by overriding any thoughts that do come to mind. In self-hypnosis, you learn to imagine yourself in a calm place and embroider it with as many details as possible. Regular practice at hypnosis then allows you to recall this image and the sense of relaxation it brings when you are feeling distressed. It is best learned by working with somebody who is an expert at hypnosis and can teach it to you.
Cognitive Therapy Cognition is the mental process of thinking and knowing. Aaron Beck, a professor of psychiatry at the University of Pennsylvania School of Medicine, has written a number of books exploring the element of cognition in both anxiety and depression. Although he acknowledges that there are many root causes for these disorders, he has written widely about his research demonstrating that these disorders are maintained in part by mistaken or dysfunctional cognitive appraisal of a situation. For example, one type of dysfunctional thinking is called "catastrophic thinking," which occurs when people lose their perspective on a situation and dwell on the worst possible outcome.
He developed cognitive therapy to help people correct their dysfunctional appraisal of situations. Cognitive therapy is short-term, problem-oriented, and primarily educational. Some techniques commonly used in cognitive therapy include homework between sessions and role-playing in the session itself.
Psychodynamic Psychotherapy Psychodynamic psychotherapy shares with psychoanalysis the belief that much of your psychological distress is due to unconscious conflicts about people and events in the past. The process of therapy involves meeting with a therapist once or twice a week.
Psychodynamic psychotherapy has profoundly helped many people. It can be slow going at first, and you may need months of treatment to notice substantial benefits. Full resolution of old conflicts can take years.
Interpersonal Therapy This form of therapy was pioneered by psychiatrist Gerald Klerman. You meet with a therapist weekly, usually for no more than a few months. You focus on your current relationships with others and how they contribute to your distress. You work on one or two current problems, rather than unconscious feelings, with the goal of coping better with interpersonal situations.
Group Therapy While the treatments listed above generally involve a therapist and an individual, there are advantages to treatment in a group setting led by a therapist. Groups commonly meet weekly and focus on issues common to the group members. These issues could include disorders such as depression or anxiety, or life problems such as cancer or divorce. Sometimes groups are made up of people in similar situations, such as single adults, teenagers at school, or women who have been sexually abused. Group therapy is an enormously powerful tool that can significantly aid in your recovery from psychiatric problems.
Many people avoid group therapy because they dislike having to share their problems with strangers. Although some initial hesitancy is reasonable, it is unfortunate when the normal reticence to share private experiences with others interferes with the use of such a powerful aid.
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