In my previous post I talked about finding the right word to label what we are feeling. This is a useful skill. I will refer to it again when I discuss cognitive-behavioral therapy (CBT) and related exercises, starting next week.
But before I do that, it might be helpful to talk a little about the main kinds of therapy that are available for fear and anxiety. CBT is certainly one of the more common ones but there are others.
So today’s post is an overview of three of the most popular forms of psychotherapy: psychodynamic therapy, behavior therapy, and cognitive therapy. These therapies are quite complex so I present a simplified version for the purposes of this overview.
This type of therapy assumes that our unconscious motivations and dynamics are the source of many of our emotional difficulties.
Aside from the unconscious, past experiences, interpersonal relations, and the therapeutic relationship itself (e.g., transference), are also analyzed in psychodynamic therapy.
Transference refers to a client’s tendency to unconsciously enact old patterns of relatedness. For example, a female patient who constantly seeks reassurance from her male therapist might be fearing rejection by her therapist in the same way she once feared rejection from another authority figure, her authoritarian father.
One of the goals of psychodynamic therapy is to help the client develop insight. In the above scenario, the therapist expects that the client will gain insight into her behavior and realize how her past continues to influence her present relationships.
This insight could eventually loosen the hold of the old patterns on her present behavior.
The main area of focus for this kind of therapy is learning.
Let us examine the case of a man who is deadly afraid of dogs.
How can he unlearn the association between dogs and fear? What is needed, according to a behaviorist, is repeated pairings of dogs with stimuli (meaning objects or events) that are incompatible with fear.
But what sort of stimuli would be incompatible with fear? How about a state of relaxation?
To unlearn the association between fear and dogs, the young man is encouraged to practice relaxation while in the presence of a dog. Over time, as he feels more and more relaxed, he would be able to spend more time in the presence of the dog, get closer to the animal, and eventually even touch or pet it, all while remaining relaxed.
Then the next time that he comes across a dog in the street, he is likely to be more relaxed and less frightened.
Cognitive therapy assumes that thoughts are the source of emotional difficulties and problematic behaviors. If we change our thoughts, we will change our feelings and behaviors.
To illustrate, I will use the case of Oisha and her cognitive therapist, Mary.
Oisha feels quite anxious whenever she attends a formal gathering.
Mary asks Oisha to pay attention to her thoughts in those social situations, and to write them down. At first Oisha is not aware of what she is thinking when she is feeling particularly anxious, but slowly she gains greater awareness.
Consider some of Oisha’s common thoughts in social situations:
- My makeup, clothing, etc, have to be flawless
- I must come across as interesting and smart
- I have to be self-assured and confident
- I must not sweat, blush, tremble, etc.
Given that Oisha has set such impossible standards of appearance and conduct for herself in formal social gatherings, Mary thinks it is not surprising that Oisha becomes highly anxious in such situations.
In therapy, Oisha’s beliefs will need to be explored. Mary would ask Oisha to consider modifying some of her beliefs and replacing them with less demanding ones. For example, replacing “I must come across as smart,” with “I prefer to come across as smart.”
Mary hopes that a change in her client’s thinking will allow her to feel more relaxed in formal gatherings.
As already mentioned, I will spend the next couple of weeks discussing CBT (which combines behavioral and cognitive approaches mentioned above).
p.s. As usual, feel free to leave a comment if anything I have talked about is unclear, if you would like me to discuss a particular issue in more detail, or if something in today’s post resonated with you.