What are the different approaches to individual therapy? In this lesson, we’ll watch as Mary tries to find the type of individual therapy that works best for her. Will she be able to overcome her problems? Let’s find out! Mary just started college. She’s been feeling sad and anxious because she’s been doing really badly in a class that was her best subject in high school – chemistry.
She hasn’t made as many friends as she’d hoped she would, and staying in touch with friends from home has been harder than she thought it would be. She knows she just needs to keep trying, but she’s having trouble finding the energy and motivation to do it; her mother suggests that she might be depressed, and that she should try some individual therapy to figure out how to feel better.If this was a realistic story, someone like Mary would probably head over to the student health center and be recommended to a therapist from there; but in our story, she searches for therapists online and is attracted to a simple website promising ‘traditional Viennese methods with outstanding results’ and featuring a photograph of a single, enigmatic cigar. She takes down the address and gets on her bike; soon she arrives at a solid brick building and is greeted by an old, bearded man in a suit. The therapist invites her into his office, invites her to lie down on a musty couch, and declares, in a thick Germanic accent: ‘Tell me about your dreams!‘Mary has stumbled upon the psychodynamic approach to therapy, pioneered by the Austrian psychologist Sigmund Freud. This approach rests on the assumption that psychological problems are caused by the interaction between the three parts of the personality: the id, the impulsive, childish part; the superego, the mature part concerned with long-term decision-making; and the ego, which works as a kind of mediator between the two. Imagine three friends, one who’s really cautious, one who’s really impulsive and a third who takes both suggestions and comes up with a compromise; that’s basically the superego, the id and the ego.
Freud asks Mary about her dreams in order to figure out what kinds of internal conflicts are going on in her unconscious mind. This is known as dream analysis. She replies hesitantly, ‘I;dreamed I woke up in my bed at home because our cat had licked my face. But then I walked out in the hallway and I was in the dorm again, but then I got to the bathroom and my mom was in there brushing her teeth and the cat was watching.‘Freud strokes his beard thoughtfully. ‘And tell me vat you sink of ven you hear zese vords?‘ This is a technique called free association.
He begins barking words: ‘Apple!‘Mary hesitates before replying tentatively, ‘Pie?‘Freud continues: ‘Hammer!‘‘Father.‘‘Cat!‘‘Home.‘‘Square!‘‘Peg?‘Freud frowns at this.
‘;square peg in a round hole?‘ Mary clarifies.‘Ah!‘ he announces. ‘Your dreams and your free associations lead me to interpret that the problem is you are ambivalent about leaving home! You miss your family! You miss your cat!‘ He encourages Mary to talk about this, and during the conversation she realizes that she’s talking to Freud as if he were her father; this is a process known as transference, or beginning to think of the therapist as someone important in your life.Other terms associated with the therapeutic process are resistance and catharsis. When Mary suggests at the end of their session that she may try out a few therapists before settling on a particular method, Freud accuses her of showing resistance, or interfering with treatment just as it gets close to revealing a hidden inner conflict.‘You’ll never reach catharsis if you quit now!‘ Freud calls as she leaves, referring to the release of tension a patient undergoes when they identify and solve inner conflicts.
Next, Mary goes to see an old, friendly-looking man wearing a red bow tie. This particular psychologist, Aaron Beck, developed cognitive therapy with the specific goal of treating depression, so Mary thinks he might be a perfect match.‘It sounds like you’re worried about making friends,‘ Beck says after listening to Mary for a while.‘Yes!‘ Mary says. ‘And it makes me feel bad about myself, like I’m not likable.
I leave my door open and only a few people come to see me.‘Beck nods sympathetically, then says, ‘You seem to have some self-defeating assumptions about what it means to have trouble making friends in college. You assume that your difficulties mean something negative about you as a person, which you are focusing on instead of working to improve the situation.”It just seems like it’s going to go on forever,’ Mary says sadly.Beck replies, ‘I have a colleague, Albert Ellis, who would call that an irrational belief. He practices a variant of cognitive therapy called rational emotive therapy, and he’d say that your irrational belief that your friendless state will go on forever makes you much more worried about it than if you accepted that eventually, things will get better.
‘Mary’s feeling a little overwhelmed. She thinks Beck has made some valuable points, but thinks she’ll still get another opinion.Mary’s not sure behavioral therapy is for her. She’s researched Joseph Wolpe, its founder, and it seems like he mainly intends it for people with specific negative behaviors like phobias. She doesn’t think she would benefit from exposure therapy, in which a specific stressful object – like a spider to someone who was really afraid of them – is approached in slow steps. First, the patient would think about a spider, then see one, then let one crawl on his sleeve; these are all stages of systematic desensitization.
A therapist might also try a less gradual method called flooding, in which the patient is suddenly exposed to the stressful object while in the controlled, calm environment of therapy where the therapist can help with relaxation techniques. She’s pretty sure that aversion therapy isn’t for her either; she doesn’t think she has any specific inappropriate behaviors that need to be discouraged. Aversion therapy is usually used for behaviors like substance abuse and overeating, as well as sexual deviance. The therapist pairs unpleasant stimuli, like violent images or bad smells, with the behavior he’s trying to eliminate in an effort to make the patient no longer enjoy that behavior. Though aversion therapy is still used successfully to treat addictions, its use for other behavior modification has been questioned due to its association with attempts to ‘cure’ homosexuality.
Mary is attracted to one aspect of behavioral therapy: social skills training. During her session with Wolpe, he role-plays social situations like dorm meetings and frat parties to help Mary build confidence in her ability to make friends. He also gives her specific social goals – some easy, like striking up a conversation while waiting for food in the dining hall, and others more difficult, like asking someone from class out to lunch.Having seen Freud, Beck, Ellis and Wolpe, Mary is starting to feel better about her situation. But she still feels like she’s missing something from therapy, so she goes to see a final therapist: Carl Rogers, who practices a humanistic approach.
Rogers makes a point of referring to her as a client rather than a patient, and uses active listening to try and help her reach self-awareness. Most importantly, he gives her unconditional positive regard; he makes it clear that he’s on her side. This helps her to feel comfortable discussing problems and solutions.Mary found that each of the four approaches to individual therapy brought out a different side of her problems and helped her come to terms with her situation so she could make specific plans about how to improve her situation. Freud’s psychodynamics held that Mary’s problems rested with her unconscious worry about leaving home; Beck’s and Ellis‘s cognitive therapies sought to change her assumptions and beliefs about social interaction. Wolpe’s behavioral approach tried to improve specific behaviors.
Rogers’s humanistic approach helped Mary come to terms with herself by supporting her and giving her room to grow.