What Type of Therapy Do I Want ?

It depends on your initial preferences and your therapists recommendations.

This is Part 3 of a 12-Part Series: The Hardest Things in Psychotherapy

💡Every clinician and patient who begins therapy should ask a fundamental question:

• How does our therapy begin and with what kind of therapy? Which door should I enter to get the help I need?

The answer is not obvious. Clinicians who get this wrong for their patients can incorrectly shape months of future psychotherapy work.

Classic Mistake: Wrong Entry Point Without Listening to the Patient First

Example #1: The clinicians who begin every treatment through the same door enter therapy by asking emotional questions (ex: “How do you feel?”) regardless of the patient’s emotional availability.

Example #2: Clinicians who focuses on the patient thoughts (ex: “What do you think about yourself?”) regardless of the patient’s readiness for cognitive work.

Example #3: Those or who ask for bodily sensations (ex: “Where do you hold your panic?”) may do this when the body is not yet safe territory.

All of these are missing the mark: they are not meeting the patient where they live. Instead, the clinician is just tapping their modality of choice, not necessarily what the patient needs. And there is a real difference between those two things.

The most important questions for patient is to ask themselves when considering therapy is what do they want to change. Do they want to change something internal about themselves or impact their environment.

Internally focused therapies will focus on emotions, thought, behaviors or biology. Externally focused treatments will focus of interpersonal relationships, families, or organizational systems. If as a patient, you are internally focused then ask yourself this: Do you want to feel more or differently… than choose an emotion focused therapy. Do you want to change your thinking, obsessions, or beliefs than choose a cognitive therapy. Are you seeking to modify a compulsion or addiction than choose a behavioral or biological therapies. If your therapy goal is to change something outside of yourself than ask— “Do you want to change a relationship?” than interpersonal or couples therapy is the better fit. Want to help to change a family member or a dysfunctional organization than systemic therapies are a good way to proceed.

No single entry point in to therapy is universally superior. The clinician who has only one preferred entry point to therapy will inevitably try to fit every patient through it. Some will fit. Many will not.

Patient don’t need to know the answer to these question before they seek help. However, when they pick a therapist who does CBT or psychodynamic therapy they can expect therapy will begin focusing on troubling thought or behaviors (CBT) or complex emotions (PDP).

The deeper framework beneath this is that all therapy is about a need or a want to change something. One way to think about this further is to recognize that all therapy approaches define themselves by one of six entry point encapsulated in the acronym ECIBSS-B.

Both patient and clinicians often choose their favorite or most comfortable therapy entrance point, will let the alliance develop, before opening more threatening material using other channels. While each therapy modality has a main entry point, which is sometime all that they do, the more complex therapies work to influence change in multiple domains, sooner or later.

A sampling of Different Types of Therapy Include:

• Therapies Focused on Emotions: Emotion Focused Therapy (EFT), Psychodynamic Therapy (PDP), Gestalt herapy (GT) .
• Therapies Focused on Thoughts and/or Beliefs: Cognitive Behavioral Therapy (CBT), Schema Therapy (ST), Acceptance and Commitment Therapy (ACT).
• Therapies Focused on Changing Behaviors: Motivational Interviewing (MI), Behavioral Activation (BA), Exposure and Response Prevention (ERP), Systems of Change (SOC).
• Therapies Focused on Relationships: Couple Therapy, Interpersonal Psychotherapy (ITP), or Psychodrama.
• Therapies Focused on the Body: Somatic Experiencing (SE), Sensorimotor Psychotherapy (SP), Eye Movement Desensitization and Reprocessing (EMDR), and Gestalt(GT).
• Therapies Focused on a Family or Dysfunctional Organizations: Structural, Strategic, and Bowenian Family Therapy, Internal Family System (IFS) therapy.
• Therapies Beginning with a Biologic Focus: Psychopharmacology, Ketamine, Psychedelics, Transcranial Magnetic Stimulation (TMS), Electric Convulsive Therapy(ECT).

Some of the more complex therapies are trying to help people change many things. For example, DBT focuses on both behavioral and interpersonal issues; Mentalization-Based Treatment (MBT) focuses on emotions, interpersonal, and systems domains; Transference focused psychotherapy (TFP) focuses on emotions, interpersonal, and cognitions; This list could be a lot longer.

All therapy is about change. The entry point is where change becomes possible for each patient at that moment. Choosing the right entry point is crucial; it can mean the difference between a treatment that meets needs and one that misses the mark. The door matters.

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Robert E. Feinstein, MD Professor of Clinical Psychiatry, Zucker School of Medicine at Hofstra/Northwell

Psychiatrist, Psychoanalyst, Educator, and Supervisor Contact: Feinster@RobFeinsteinMD.com

Owner & Founder Empathian LLC ( An Online Mental Health Education Company) Empathian.com

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