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Understanding Therapy Part 2: Approaches to Therapy

On the page about thoughts, emotions, and behaviors, I discussed how these can all potentially influence each other.  On this page, I will discuss how that translates into the approach the therapist might take.  Basically, a therapist might prefer to conceptualize certain connections going from one of those three to the other as more important or powerful than the others.  It could also be that it just fits with how they think about how one thing causes another to happen.


I want to emphasize that I will be giving the briefest possible overviews of several types of therapy.  The purpose is to show how they are related to the three components of well-being and the logic of the treatment strategy.  But due to space considerations, these descriptions leave out many nuances and do not capture the full extent of them.  I also don't intend to trivialize any of the example issues presented below.  What we think and feel is our real experience, and the reason I am a therapist is that I know it sometimes takes help from another person to overcome the difficulties.  There are many internet resources that go into more depth about each of these if you are interested in following up.

Therapies that focus on Thoughts

Cognitive Behavioral Therapy (CBT)

This is one of the most common types of psychotherapy.  It is often interspersed throughout therapy even if a therapist is primarily using a different mode of therapy.  There are many different components to CBT, but one of the primary ways of using it is exploring the thoughts a client is having.  It turns out that sometimes these thoughts are biased or inaccurate.  By gently pointing out these thoughts or having the client make the realization themself, the client can adjust them so they do not cause as much distress.


Another way CBT can be used is by diving into the belief structure that someone has that support the thoughts they are having in the moment.  By identifying problematic beliefs (often, a client will have a negative view of themselves, or an overly pessimistic view of how the world works), a discussion can ensue and a new belief structure can be formed.  By changing the thoughts and beliefs one has, it can reduce negative emotions, and give people more confidence to engage in behaviors that may bring them more happiness.


Narrative Therapy

As discussed on the previous page, beliefs form the foundation for our thoughts, through which you filter new and past experiences.  How the beliefs fit together with new information can have profound effects on emotional reactions.  Narrative Therapy focuses on beliefs that people have about the story of their lives.  For example, if a client believes their life has shown that they are unable to handle the challenges that come along, they might feel like they are a ‘loser’, and will be more likely to feel hopeless about the future.  If a therapist helps the client see that they have in fact been able to do many things successfully in their life that they’ve overlooked because they’ve been focused on the negative, it can promote a positive view of the self and more optimism about the future.  This in turn can allow the client to move forward, alleviating the burden of the negative emotions they have been feeling,  and promoting engaging in new rewarding behaviors such as building personal relationships or taking on professional challenges.

Therapies that focus on Emotions

Dialectical Behavioral Therapy (DBT)

One of the most critical parts of DBT is that it recognizes emotions can be so powerful that they overwhelm our ability to think through our problems.  Therefore, the way to achieve progress is to get those emotional responses under control.  This therapy provides many strategies for doing this.  Say someone is extremely sensitive to social rejection.  By working on evening out the emotional responses, this will allow the client to have the opportunity to think about the thoughts and beliefs they have that might not be useful, or let them think about how to change their behavior.


Emotion-Focused Therapy for couples (EFT)

EFT is one type of therapy that is considered ‘experiential’.  This means it prioritizes emotional experiences within the therapy session itself.  Specifically, having partners really listen to each other and have emotional experiences in the therapy session can be a powerful force to re-organize our thoughts around our partners and our attitudes towards the relationship.  By understanding that their behavior is driven by their motivations to want to be loved and cared for, and to want a good relationship, instead of by a mean spirit, we can understand our partner in a different way.  (In other words, by re-orienting our emotional responses, it changes our thoughts about them.)


This works the best when clients are forced to sit in the emotions they are feeling in response to what their partner is saying.  What I mean is: It can be easy to hear something new and possibly dismiss it or forget about it later.  But to really feel that emotion will let the new viewpoint sink in.  I will add that like all good couples therapies, this model of therapy facilitates learning new things about your partner so it changes beliefs too, which change thoughts.

Therapies that place emphasis on Behaviors

Solution-focused Brief Therapy

In a nutshell, this therapy espouses the idea that the behaviors we engage in shape the experience of our lives.  The answers to our problems are there, if we have the courage to take the actions towards our ideal life (this isn’t to say that it’s always easy!).  By enacting these changes, we will find our emotional responses will change as well.  For example, by taking the big step and moving to the city with the dream job, we will find our environment is different, we have new experiences that we want to have, and our everyday emotional experiences will be vastly improved on the whole.

Exposure Therapy for Phobias and Anxiety

One of the most proven effective therapies for phobias and anxiety is exposure to the source of the worry.  For example, if we have a fear of public speaking or talking to strangers, we can take baby steps towards those goals, and take it as slow as the client needs to go.  For example, just saying hi to someone new and that’s it for the moment.  The idea is that we will see that nothing bad really happens, or at least, the fears we have magnified in our minds over some amorphous disaster happening, don’t materialize in real life.  This will change the associations we have between the situation and our emotional responses.  Because of this, in the future the worry will not arise as severely.  Through a set of steps that progressively allow the client to go a bit farther each time, the client can make significant progress in overcoming their fears.


Behavioral Activation for Depression

It turns out that physical activity has an effect on our emotional state.  It is also the case that acting to get things done makes us feel more accomplished and useful.  One of the most useful ways to tame depression is by ensuring that clients don’t get stuck in a trap of inaction: to help them get out of the cycle where depression leads to inaction which leads to more depression and so forth.  The mere physical activity has been shown to act more directly on our mood, and accomplishing tasks acts more through our thoughts about ourselves.  So in this way taking action really does change the state of the world, and changes our thoughts and emotions about ourselves. 



The takeaway from all of this is that because thoughts, behaviors, and emotions are all able to influence each other, there are many paths through which positive change can be achieved that affects the totality of a person's well-being.  However, for some people, a therapist might recognize that one of these three areas is the primary stumbling block.  Therefore that one area might be a good entry point into creating positive changes.

Keep in mind that the therapies listed are just some of the many models of therapy that are used by therapists today.  A therapist might prefer to stick to one of the models above, or they may feel comfortable with a few different modes of therapy.

A therapist that you choose to engage should feel comfortable answering plenty of questions you have about the process.  Most people haven't been to therapy before and don't know what to expect!  It is one of the therapist's most important jobs to make you feel comfortable.  If you don't feel comfortable talking to them, you are likely not to improve as much throughout the process.

If you'd like to talk to me about starting therapy, please don't hesitate to call or email me today.

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