To this point we have considered the different approaches to psychotherapy under the assumption that a therapist will use only one approach with a given patient. But this is not the case; as you saw in Figure 13.1, the most commonly practiced approach to therapy is an eclectic therapy, an approach to treatment in which the therapist uses whichever techniques seem most useful and relevant for a given patient. For bipolar disorder, for instance, the therapist may use both psychological skills training to help the patient cope with the severe highs and lows, but may also suggest that the patient consider biomedical drug therapies (Newman, Leahy, Beck, Reilly-Harrington, & Gyulai, 2002). 1 Treatment for major depressive disorder usually involves antidepressant drugs as well as CBT to help the patient deal with particular problems (McBride, Farvolden, & Swallow, 2007). 2
As we have seen in Defining Psychological Disorders , one of the most commonly diagnosed disorders is borderline personality disorder (BPD). Consider this description, typical of the type of borderline patient who arrives at a therapist’s office:
Even as an infant, it seemed that there was something different about Bethany. She was an intense baby, easily upset and difficult to comfort.She had very severe separation anxiety—if her mother left the room, Bethany would scream until she returned. In her early teens, Bethany became increasingly sullen and angry. She started acting out more and more—yelling at her parents and teachers and engaging in impulsive behavior such as promiscuity and running away from home. At times Bethany would havea close friend at school, but some conflict always developed and the friendship would end.
By the time Bethany turned 17, her mood changes were totally unpredictable. She was fighting with her parents almost daily, and the fights often included violent behavior on Bethany’s part. At times she seemed terrified to be without her mother, but at other times she would leave the house in a fit of rage and not return for a few days. One day, Bethany’s mother noticed scars on Bethany’s arms.When confronted about them, Bethany said that one night she just got more and more lonely and nervous about a recent breakup until she finally stuck a lit cigarette into her arm. She said “I didn’t really care for him that much, but I had to do something dramatic.”
When she was 18 Bethany rented a motel room where she took an overdose of sleeping pills. Her suicide attempt was not successful, but the authorities required that she seek psychological help.
Most therapists will deal with a case such as Bethany’s using an eclectic approach. First, because her negative mood states are so severe, they will likely recommend that she start taking antidepressant medications. These drugs are likely to help her feel better and will reduce the possibility of another suicide attempt, but they will not change the underlying psychological problems. Therefore, the therapist will also provide psychotherapy.
The first sessions of the therapy will likely be based primarily on creating trust. Person-centered approaches will be used in which the therapist attempts to create a therapeutic alliance conducive to a frank and open exchange of information.
If the therapist is trained in a psychodynamic approach, he or she will probably begin intensive face-to-face psychotherapy sessions at least three times a week. The therapist may focus on childhood experiences related to Bethany’s attachment difficulties but will also focus in large part on the causes of the present behavior. The therapist will understand that because Bethany does not have good relationships with other people, she will likely seek a close bond with the therapist, but the therapist will probably not allow the transference relationship to develop fully. The therapist will also realize that Bethany will probably try to resist the work of the therapist.
Most likely the therapist will also use principles of CBT. For one, cognitive therapy will likely be used in an attempt to change Bethany’s distortions of reality. She feels that people are rejecting her, but she is probably bringing these rejections on herself. If she can learn to better understand the meaning of other people’s actions, she may feel better. And the therapist will likely begin using some techniques of behavior therapy, for instance, by rewarding Bethany for successful social interactions and progress toward meeting her important goals.
The eclectic therapist will continue to monitor Bethany’s behavior as the therapy continues, bringing into play whatever therapeutic tools seem most beneficial. Hopefully, Bethany will stay in treatment long enough to make some real progress in repairing her broken life.
One example of a n eclectic treatment approach that has been shown to be successful in treating BPD is dialectical behavioral therapy(DBT; Linehan & Dimeff, 2001). 3 DBT is essentially a cognitive therapy, but it includes a particular emphasis on attempting to enlist the help of the patient in his or her own treatment. A dialectical behavioral therapist begins by attempting to develop a positive therapeutic alliance with the client, and then tries to encourage the patient to become part of the treament process. In DBT the therapist aims to accept and validate the client’s feelings at any given time while nonetheless informing the client that some feelings and behaviors are maladaptive, and showing the client better alternatives. The therapist will use both individual and group therapy, helping the patient work toward improving interpersonal effectiveness, emotion regulation, and distress tolerance skills.
- Psychoanalysis is based on the principles of Freudian and neo-Freudian personality theories. The goal is to explore the unconscious dynamics of personality.
- Humanist therapy, derived from the personality theory of Carl Rogers, is based on the idea that people experience psychological problems when they are burdened by limits and expectations placed on them by themselves and others. Its focus is on helping people reach their life goals.
- Behavior therapy applies the principles of classical and operant conditioning, as well as observational learning, to the elimination of maladaptive behaviors and their replacement with more adaptive responses.
- Albert Ellis and Aaron Beck developed cognitive-based therapies to help clients stop negative thoughts and replace them with more objective thoughts.
- Eclectic therapy is the most common approach to treatment. In eclectic therapy, the therapist uses whatever treatment approaches seem most likely to be effective for the client.
EXERCISES AND CRITICAL THINKING
- Imagine that your friend has been feeling depressed for several months but refuses to consider therapy as an option. What might you tell her that might help her feel more comfortable about seeking treatment?
- Imagine that you have developed a debilitating fear of bees after recently being attacked by a swarm of them. What type of therapy do you think would be best for your disorder?
- Imagine that your friend has a serious drug abuse problem. Based on what you’ve learned in this section, what treatment options would you explore in your attempt to provide him with the best help available? Which combination of therapies might work best?