Psychotherapy Approaches

Cognitive Behavioral Psychotherapy (CBT) examines the effect of thoughts and beliefs on emotions and behaviours. It is one of the psychotherapy approaches that gained momentum since the mid-1960s, a combination of cognitive therapy and behavioural therapy. The aim is to help the person find the thoughts that continue the problem, to gain skills to change these thoughts and to create change in behaviours.

Cognitive Behavioral Psychotherapy (CBT) aims to teach the person the skills he/she can use for life by focusing on the current problems in his/her life. The therapeutic relationship between the therapist and the client is provided with the cooperation of both parties. It provides an effective treatment to individuals of different age groups in many mental health problems such as depression, anxiety disorders, bipolar disorder, eating disorders, post-traumatic stress disorder, schizophrenia, alcohol and substance abuse, and sexual dysfunctions.

The first steps of psychoanalytic psychotherapy were taken by Freud’s studies a century ago. Freud’s technique has gone through many stages and has developed and undergone some changes since then. It has also contributed significantly to other therapeutic approaches over this time period.

Psychoanalytic psychotherapy is a study of explanation and interpretation. After the evaluation interview, if the psychoanalytic psychotherapy process has started, an explanation study is initiated by providing insight into unconscious conflicts that emerge as a symptom on the basis of past experiences. This explanation study is carried out with the analysis of free associations, which is the working material of analytical psychotherapy. The free association is that the analysand describes all that goes through his/her mind during the session without any limitation, censorship or concealment.

During psychotherapy, the analyst listens to with intense attention, engages where necessary, speaks little, and remains mostly silent. In addition, the analyst should have an empathetic and neutral stance. In fact, what determines the nature of psychotherapy here will be the therapeutic cooperation of the analyst and the analysand.

Psychoanalysis is a psychotherapy method in which analysand is generally accepted as extending on the couch within the weekly determined days. Dynamic psychotherapy uses the same principles and techniques as classical psychoanalysis, but unlike psychoanalysis, the number of weekly interviews may vary and the psychotherapist may take a much more active approach. In addition, unlike psychoanalysis, they sit on opposite seats.

EMDR means “eye movement desensitization and reprocessing ” and is one of the strongpsychotherapyapproaches of recent years. It is a physiologically based therapy that aims to re-process negative and traumatic memories that affect daily life and to look at the person from a healthier and new perspective.

The protocol applied in EMDR therapy is 8-stage and 3-way in the form of past, present, and future. The protocol aims to eliminate today’s symptoms by reprocessing and desensitizing the disturbing moment experienced in the past with two-way stimulation and to gain a new perspective in which positive beliefs and feelings about similar situations that may occur in the future are developed.

Schema Therapy is a psychotherapy method developed as a theoretical and practical model for the recognition and treatment of psychological disorders with significant origins in childhood and adolescence.

Schemas are patterns of thought, emotion and behavior that start from childhood and repeat throughout life. Since schemas are formed by childhood experiences and develop and progress throughout life, they have ossifying pattern structures. These patterns affect one’s thoughts and feelings in understanding every information coming from the environment and in the experiences gained; their relationship with those around them. Therefore, emerging behaviours vary depending on the developed scheme. Understanding and noticing where and how these structures are shaped is one of the most important steps to capture change.

The Schema Model developed by Young et al. focuses on creating changes in schema patterns by combining Cognitive-Behavioural Therapy techniques. According to the schema model, schemas that start to develop from childhood experiences turn into dysfunctional thought and behaviour patterns over time. It has been observed that these schemas, which help to cope with events and situations in childhood, are disruptive to one’s function at adulthood and may be associated with some chronic conditions. At this point, Schema Therapy is a psychotherapy method developed as a theoretical and practical model for the recognition and treatment of psychological disorders with significant origins in childhood and adolescence.

These diagrams are as follows:

• Abandonment/Instability,
• Mistrust / Abuse,
• Emotional Deprivation,
• Defectiveness / Shame
• Social Isolation/Alienation,
• Dependence / Incompetence
• Vulnerability to Harm Or Illness
• Enmeshment / Undeveloped Self
• Failure to Achieve,
• Entitlement / Grandiosity
• Insufficient Self-Control / Self-Discipline
• Subjugation,
• Self-Sacrifice
• Approval-Seeking /  Recognition-Seeking
• Negativity /  Pessimism
• Emotional Inhibition
• Unrelenting Standards / Hypercriticalness

Jeffrey Young defined 18 different schemas in the Schema Therapy model and divided these schemas under 5 schema areas.

Many have doubted hypnosis, which has been shrouded in mysteries and myths for centuries. At the same time, hypnosis has attracted the attention of many famous scientists interested in human behaviour. Sigmund Freud, Alfred Binet, William James, Wilhelm Wundt, Clark Hull, Ernest R. Hilgard and many of the most important scientists in psychology had seriously considered hypnosis. Nevertheless, hypnosis has only recently received the attention it deserves. In addition to being a subject of intensive research in experimental psychology laboratories all over the world, its effect is a clearly visible treatment component.

Hypnosis is a procedure in which a healthcare professional or researcher encourages the patient or client to experience feelings, perceptions, thoughts or behavioural changes at that time. The hypnotic state is usually created by an induction process. Although there are many different hypnotic inductions, many induce relaxation, calming and relief. Instructions for imagining or contemplating pleasant experiences are also common in hypnotic inductions.

With the relaxation and relief created by hypnosis, the person focuses on his/her own thoughts and the suggestions of the therapist.

As can be understood from the above definition, hypnosis is not a therapy method such as Cognitive Behavioural Therapy, Psychoanalysis. It is the state of consciousness that the person is prone to inculcation.

Hypnotherapy is the application of psychotherapy techniques to the person under hypnosis.

Although the state of consciousness of the brain under hypnosis continues, since the person focuses on his/her own thoughts and the inculcation of the hypnotherapist, there are no situations such as resistance encountered in classical therapies, incomplete, inappropriate fulfillment of assignments or not being applied at all.

Therapies performed under hypnosis are performed more easily, comfortably and promptly by the hypnotherapist. In addition, the obstacles that will be experienced during classical therapy are eliminated and the ability to cope with them is increased. For example, in cognitive behavioral therapies, the exposure technique is applied to patients with claustrophobia such as getting on elevators. In hypnotherapy, the person is encouraged to think about the location of the elevator, the conditions of the environment and to gradually revive getting on the elevator alone (imagination) while under hypnosis. With these inculcations, the reactions of the person in that environment are immediately learned, therapy techniques are applied and thus, the treatment response is accelerated. This whole process takes place under the supervision of a hypnotherapist and in an environment where the person feels relaxed and comfortable.

Contraindications to the Use of Hypnosis

Since hypnosis is a complement to therapy rather than a form of treatment, it should not be treated as a magical treatment of problems that the therapist cannot address without it. The traditional practical rule is as follows: If you are not qualified to treat without hypnosis, a condition cannot be treated with hypnosis. Nor should a therapist treat a condition with or without hypnosis in a way that goes beyond his/her own training, expertise or capacity. Such an attempt is unethical.

It is vital that clinical therapists strengthen their beliefs and expectations that patients will respond to hypnosis before, during and after a hypnosis session. For example, it is not uncommon to say “how did I get here”, “I missed the crossroads” or “I came home but I don’t remember the last few minutes” while driving in traffic. Those who concentrate on a book, newspaper and television do not hear and do not respond are frequently encountered situations. These are “natural hypnosis” situations that occur in life and are not directly related to a mental problem.

How Much Hypnotherapist Learns What I Know or What Can He/She Make Me Do?

People can react differently to hypnosis. Some describe the situation as a change in the state of consciousness. Others depict hypnosis as a normal state in which they feel very calm and relaxed, with attention focused. Regardless of how and to what extent people react, most people describe this experience as a very pleasant feeling. Most importantly, they remember what happened in the experience of hypnosis.

Sensitivity to hypnotic inculcations varies from person to person. One of the factors that make this sensitivity variable is the susceptibility to hypnosis as well as the positive-negative information learned from various sources related to hypnosis and the expectations related to it. Contrary to what is generally depicted in written and visual sources such as books, magazines, cinema, newspapers, people do not lose control under hypnosis. They usually know who they are and where they are and often remember what happens in the event of hypnosis, unless they are specifically amnesia with inculcation. Under hypnosis, there is no withdrawal from personality, no loss of conscientious values. If the person under hypnosis is given an inculcation (making him/her say something or have him/her do something) that he/she does not want or approve, the person rejects these suggestions. If these rejected inculcations are persistently repeated, the person exits hypnosis.

Hypnosis makes it easier for people to experience inculcatory experiences, but does not force them to experience them.

For example, if a person who is afraid of getting on the plane is given posthypnotic (post-hypnotic) inculcation during hypnosis that “you will never wear your seat belt on the plane despite all warnings and the risk of being thrown out of the plane”, what is the result? It is a social rule to wear a seat belt on an airplane. When an inculcation is given in this way, one does not forget that this has social and individual consequences and opposes this inculcation. If persisted, the person exits hypnosis after this opposition reaches a certain level.

The hypnotherapist’s posthypnotic inculcation in this way is incompatible with ethical values and laws.

It should be remembered that hypnotherapists are also mental health professionals.

Autohypnosis

Autohypnosis, which is taught to the person by the hypnotherapist, is the self-hypnosis by giving inculcations to the person. Here, the hypnotherapist teaches which inculcations will be given in which situation and which steps will be followed. The suggestion taught in autohypnosis can only be used for that complaint.

How many sessions does hypnotherapy take?

1. The duration of hypnotherapy varies in some conditions.
2. The number of therapy sessions may vary according to the sought solution mental problem,
3. The relationship of trust and adaptation established with the hypnotherapist,
4. The inculcation and treatment approach of the hypnotherapist,
5. Personality characteristics (hypnotic suggestions can be taken faster or slower depending on personality traits).

It is used in the treatment of many disorders such as trauma, phobia, anxiety disorders, panic attacks, addiction, eating disorders, lack of self-confidence, relationship problems.

Psychodrama is a method of psychotherapy developed by Jacop Levi Moreno in the 1920s. Experience groups are formed in psychodrama and when individuals want to animate something from the past or the future, they have the opportunity to question and re-stage in a time period we call now and now. Problems in psychodrama are not limited to time, they may be related to the past, the present and the future. It is not limited to a certain place; all universes, mythology and fairy tales, dreams can form the environment of psychodrama. The group plays a part of life through the eyes of the protogonist, the troublemaker. Understanding and being supported emotionally and physically by a group member with the roles and interaction of the group members can be a therapeutic experience. Psychodrama can be useful for a wide range of diseases including relational, neurotic, psychotic and psychosomatic problems. Psychodrama is used individually or in groups as a short psychotherapy method for long-term, ongoing groups and for treatment-oriented and crisis sharing many characteristics.

Motivational Therapy

Motivational therapy (motivational interview) is a client oriented, directive method used to increase intrinsic motivation for change and strengthen commitment by discovering and solving ambivalence.

Motivational interview is used as an important and effective method in the treatment of addiction. It has gained importance especially with the failure of forceful treatment methods. Important advantages of this method are that it is short-term and has permanent effects on the person in terms of quitting. It is also used to initiate change in patients who do not consider treatment.

Motivational interview is a treatment that helps people understand their problems and take action for change. This method is especially useful for addicts who are reluctant or ambivalent to quit. Understanding and solving the ambivalence plays an important role in the treatment. Some substance users need to resolve this ambivalence.

Motivation is the first step of treatment. Motivational interview sets the stage for people to move on to the next stages of treatment.

Interpersonal Psychotherapy (IPT) is a time-limited therapy method that can be applied to many mental disorders, especially depressive disorders, perinatal depression, mood disorders,eating disorders,anxiety disorders, from childhood and adolescents to old people.

History

Interpersonal Psychotherapy was developed by Gerald Klerman, Myrna Weissman, and Eugene Paykel at Yale University in the 1970s as a combination with antidepressants or monotherapy in major depression. In the development process, the aim was to create a rapidly applicable, modified treatment that could be compared with antidepressant treatments in major depression studies instead of finding a new therapy method. In the following periods, studies on IPT have increased and it has become a frequently used therapy method today.

Characteristics of Interpersonal Psychotherapy

1. The main focus is interpersonal relations and social support mechanisms of the person.
2. IPT evaluates psychology according to biopsychosocial/moral/cultural model.
3. It turns to interpersonal relations and social support mechanisms without directly targeting the therapist-patient relationship.
4. The duration of acute treatment is limited.
5. It can be applied from adolescents to the old people in a very wide age range.

Interpersonal Psychotherapy Method

Reactions to crises experienced in daily life vary from person to person. Genetic factors, childhood life events, attachment, social support, environmental factors and adulthood experiences are effective in these reactions. IPT aims to reduce clinical symptoms by causing a transformation in interpersonal relationships during troubled processes experienced by patients in crisis moments. Interpersonal relationships of the patient are emphasized during these crisis moments. During therapy, patients learn to improve their relationships, discover the social support networks around them, and politely request the emotional and concrete support they need. Although IPT has little in common with other psychotherapies; it does not directly use the main methods in psychodynamic psychotherapy that connects childhood, past life events and mental problems, cognitive behavioral therapy that gives assignments for mental problems or in other therapies. It does not place the relationship and transfer of the therapist and the patient at the center of the therapy.

The theories on which IPT is based are attachment theory, interpersonal relations theory and social theory. In IPT, grief and loss (loss of parents, spouses, children, friends, stillbirth, job loss, bankruptcy), role transitions (being a mother or father, job change, title change, divorce, retirement, leaving the family for education), interpersonal conflicts (domestic conflicts, conflicts in the work environment) are the main focal points. IPT is accepted as an effective treatment method by the American Psychiatric Association, England National Health and Clinical Excellence Essence (NICE).

Family Therapy

Family therapy aims to solve the problems that may be experienced among family members within a system by evaluating the whole family, not the individual. Within the framework of this system, the perspective of family members, the communication of family members with each other and what members experience in the face of problems are also listened to. Family therapists can sometimes work with all family members, sometimes with some of their family members, or sometimes with just one person.

It can be said that the objectives of family therapy include strengthening communication between family members, breaking unhealthy relationship cycles in the family, making the family stronger by recognizing its resources, and increasing their problem-solving skills by identifying conflicting situations in the family.

Couple Therapy

In couples therapy, the problems that married or unmarried couples have difficulty in coping with in their relationships and the issues they want to strengthen their relationships are studied. In couples therapy, it is aimed to open a healthy communication area for couples, with the help of their couples’ therapist, focusing on the correct understanding of each other and strengthening their communication pathways. In this therapy model, it is aimed that couples can produce solutions to the issues they experience problems, strengthen communication between couples, and make healthy decisions about the process or continuation of the relationship.

Topics studied in couples therapy include lack of communication between couples, conflicts in the relationship, and distrust. In addition to these; the effects of cheating on the relationship, the process of repairing the relationship after cheating, making a divorce decision, cooperating in the divorce process, getting support before marriage and reviving the relationship are among the topics studied.

Sexual Therapy

Sexual therapy is one of the psychotherapy methods applied to individuals or couples with sex-related problems by clinical psychologists and psychiatrists who are trained in this field. People from different age groups who are married, single, living together, divorced, separated, widowed, with children, who have previously had sexual intercourse or who have never had sexual intercourse can apply to therapy.

During sexual therapy, an environment is provided in which the person is not judged, can feel comfortable and what is spoken is based on confidentiality. In this environment, the person is expected to discover his/her physical and psychological processes, the reasons for the factors that cause the problem, and his/her relationship if he/she is in a relationship. However, psycho-education related to the concept of sexuality such as physiology of sexuality, cycle of sexual response, false beliefs about sexuality is provided. Therapy is made suitable for the client on a scientific basis. Sexual therapy may vary depending on sexual problem, severity and duration of complaint.