When most people think about psychotherapy, they imagine discussing their innermost feelings in a caring, supportive environment. This is reasonably accurate for some forms of therapy. It can be helpful to many people who face difficult, and confusing situations in their lives. It's just not a good way to quickly and effectively deal with a debilitating problem.My practice is based on Cognitive Behavioral Therapy (CBT). Cognitive behavioral therapy uses clinically tested methods to get rid of patients' specific symptoms. Every intervention is specific to the problem and the patient's diagnosis. The goal is to efficiently restore the person's ability to function, usually in less than six months.
The methods used in cognitive behavioral therapy are grouped into protocols designed to treat patients with a specific diagnosis. Protocols exist for treating disorders like major depression, generalized anxiety, obsessive compulsive disorder (OCD), generalized anxiety, panic disorder, and post-traumatic stress disorder (PTSD). Each protocol tells the therapist just what to do for a typical patient on a session by session basis.
Using protocols isn't very creative, but it has advantages. Every protocol has been rigorously tested in clinical trials, just like the drug testing done for the FDA. When a patient comes in with a clear diagnosis and a typical set of problems, we can tell them how long therapy will last and what percentage of patients benefit from it. When someone comes into my office with a case of panic disorder with agoraphobia, for example, I usually know that they have a better than 75% of getting better in 20 weeks of treatment.
Of course, people are individuals. Even when they come in with the same diagnosis, patients can come in with widely varying symptoms. Their family and work situations are different. They also vary in their ability to work on problems and their preferences for how to work on them. The art of therapy, for a short-term, cognitive behavioral therapist, lies in tailoring a general purpose protocol into the treatment for a specific patient. When this is done well, treatment is even more effective than the figures given in clinical studies.
Many patients decide to go on past the point where they can function again. They want to deal with the underlying causes and all the more subtle forms of distress they may feel. I think this is a great idea. Our strategy is to first deal with the symptoms, get them back on their feet, and then work on the causes.
To work on underlying causes, I use a combination of Beck's cognitive therapy and Young's schema therapy. Both are based on a learning theory model. People are presumed to have come by their problems through exposure to difficult situations they've been exposed to, mainly in childhood. We learn from these situations, forming ideas about ourselves and others. Unfortunately, we form them with all the experience and wisdom of children, and we usually don't correct them as adults. Therapy is based on changing maladaptive core beliefs and emotional reactions.
Schema therapy is an effective way to help people change patterns of thinking, emotional reactions, and behavioral patterns that have been present throughout adult life. Obviously, it takes longer than just getting rid of major symptoms. Therapy for some people lasts as long as two years. Still, this is short-term compared to most other forms of psychotherapy.