Different models of psychotherapy

The psychotherapy model refers to the theoretical background or to the way the psychotherapist conceives human cognition, emotion and behavior. There are several explanations for psychological functioning. These models supply us with handles to treat psychological suffering or enhance the life quality.

Usually four main models are distinguished:

Psychotherapists follow a certain training. When people search a psychotherapist, they are often directed in function of the psychotherapists theoretical therapy school. The therapy school is on the first place important for the psychotherapist. It offers him or her a framework within which he can think about the complaint and the person. The way of working of a therapist can only partly be lead back to his theoretical training. Especially young psychotherapists work according to a school. Experienced psychotherapists also depart from a certain theoretical framework, but especially, they handle interventions which fit with their personality and which have proven to be successful in the past (psychotherapists also discover interventions by ‘trial and error’, and integrate interventions from different schools). 

In the practice, psychotherapists handle different styles, which can be brought back to their personal preference and personality, more than to the theoretical background of the therapist. Psychotherapists work more and more integrative. They integrate notions, explanations and interventions from various origins in their personal style. Attention goes to understanding the origin of a problem, as well as to searching for solutions to lighten the suffering and enhance the quality of life.

Psychoanalytic psychotherapy

Like psychoanalysis, psychoanalytic psychotherapy assumes that we act on unconscious motives. Sometimes we are anxious, insecure, depressed… but do not understand where these feelings come from. Or one tries to engage in a relationship, but it doesn’t work, no matter how hard he wants it. It also happens that we have wishes, feelings and thoughts that we do not accept for ourselves.

During psychoanalytical therapy, your personal story unfolds, or you are confronted with gaps or contradictions in your story. Therapist and patient will identify together how unconscious patterns influence relationships, behaviors and feelings. They also try to understand how these patterns have developed. Patient and therapist try to listen to hidden meanings and to underlying patterns that shape thoughts, feelings, and behaviors. Psychological suffering is understood as a more or less conflicting ensemble of inner forces. During the sessions, elements that play a decisive role in psychic suffering will find their expression.

Psychological suffering is understood in the light of the personal (also early) history, in which patterns are often repeated. The inner images someone has of himself and of others steer the way in which someone deals with others. These images can play an important role in different forms of psychological problems.

We try to think and speak about frightening, painful, guilty, ashaming and/or unbearable tendencies, thoughts or feelings instead of trying to get them out of the way in all sorts of manners. The therapy aims to achieve a genuine insight in particular repetitive patterns and sensitivities. When insight is genuine, one can understand himself better, verbalize and make conscious choices in different areas.

The course of a psychoanalytical psychotherapy

Therapist and patient discern and analyse together how unconscious patterns influence relationships, behaviour and feelings of the patient. They also try to understand how these patterns have developed. During sessions, mainly the patient is speaking. The therapist asks the patient to try to say everything that comes to his mind. By surrendering to the inner flow of thoughts, feelings and fantasies, the patient turns away from the external world and directs his thoughts and perceptions more to the inner side. All sorts of thoughts and feelings, where he is ashamed of or rejects as being unimportant or silly (in daily life), can receive more attention.

As unconscious patterns in feelings and thoughts get clarified, complaints and symptoms diminish, but more important, one deals in another way with oneself. The patient takes his inner world more seriously and understands it better. This means that the feeling of self-esteem can increase, as well as inner freedom. This creates possibilities to stand firmer in life. Someone who dares to look inside also knows better where he stands and why he makes certain choices. The patient can understand his problems not only intellectually, but also emotionally.

(text based on a publication of the Nederlandse Vereniging voor Psychotherapie and Nederlands Psychoanalytisch Instituut)

Compared to psychoanalysis, the therapist is more active. He asks more targeted questions and sometimes concentrates on certain hypotheses, which may have been discussed with the patient previously. Usually the duration of the therapy is shorter than in psychoanalysis.

Client-centered psychotherapy

This school assumes that people are able to solve their own problems, i.e. the client-centered psychotherapist has faith in the client’s abilities for growth and development. The client learns to experience his own, unique thoughts and feelings and to relate with himself. If someone can experience and accept himself, the person will be able to deal with difficult situations in life. The aim of therapy is not so much to solve a particular problem, but rather to help the client to get a view on the impediments that seem to have banned satisfactory solutions to his problem.

The way in which the therapist tunes himself to the experiences of the client is characteristic for client-centered psychotherapy. The therapist tries to form a precise image of the client’s experiences and reflect this back to the client. He tries to initiate a process of self-exploration, self-acceptance and self-confrontation in the client. The attention is mainly directed on the present and the future, not so much on the past. An exploration of the past is only considered useful when that past is tangibly present in the here and now.

Finally the client-centered therapist endeavors an equivalent relation with the client. He will get along with the client in a respectful, congruent and empathic manner, to enhance the process of self-exploration for the client. The client is seen as the expert for his or her own psychic functioning; the therapist is the 'process-expert'.

Client-centered psychotherapy, also called experiential or person-centered psychotherapy (previously also known as 'non-directive'), was developed by the American psychologist Carl Rogers (1902-1987).

Behavior therapy

In behavior therapy, the behavior of the client is central. How one acts determines to an important extent how one feels. In the course of our lives, we have learnt many behaviors. Behavior therapy assumes that it also possible to unlearn behavior. Who is inclined to avoid some things from fear, will often reinforce his fear more than diminishing it. Who doesn’t know well how to bring over his opinion, will rather become uncertain or just irritated. Who has not learnt how to get a grip on himself, will easily become a victim of his own impulsivity.

In the therapy, one is working on a concrete problem or on a particular complaint. Stepwise the client works at an initially formulated target. In a behavior therapy the client can learn how to deal with things differently, so that he has lesser burden from the problem that is central in the therapy. A behavior therapist often works with exercises and tasks.

In an initial phase of behavior therapy, all the problematical behaviors and the circumstances in which they appear, are mapped. Then the client is helped to react with more adaptive behavior patterns to these circumstances. Before various exercises become and homework done. The listing of problem behavior as well as the finding and practicing of new, more fitting behavior, are a joint enterprise of client and psychotherapist.

Systemic therapy

The systems approach can be distinguished from others by its attempt to understand interpersonal human relationships. The individual is not analysed in isolation. The psychotherapist also attaches importance to the different levels of influence that operate simultaneously and of which the individual is part (family, professional, social, etc).

The individual is influenced both by his intentions, those of others, as well as the possibilities (options) within the environment and system. By evolving/developing in these different contexts, difficulties in relating may appear and may cause tensions, anxiety, depression, conflict, illness/malaise.

The psychotherapist is interested in the rules and models for living, in the process of feed-back, in the sought-after objectives, as well as the relevant coping mechanisms and the pressures to change. He observes the methods of communication, the conditions or fact of being congruent, the level of differentiation and commitment at the heart of the system. He is interested in the degree of self questioning which is tolerated, the flexibility of roles and their degree of adaptation to the actual state of the system.

The family history affects the individual. The individual carries with him values, emotions and behaviour which are determined by the family often across several generations. The psychotherapist’s aim is to facilitate a process in which each individual is invited to revisit their story or history, allow new meanings to emerge and live new experiences, so ,as to open new horizons and gain different perspectives. The psychotherapist will favour the expression of emotions, desires/wishes, constructive intentions and the effort involved/employed. He will provide the members of the system the opportunity to experience different ways of being, feeling, and interacting with the aim to reduce suffering or free oneself from the problem which led to the request for the consultation, in a way that will reactivate the evolutionary process.