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Finding the right style of therapy is key to effective treatment

  • Asks ...

    I have depression and anxiety and I want to get some therapy. The whole idea of talking about my mother and my childhood and my ego and all that just seems kind of ridiculous to me. I know that some kinds of therapy aren’t really into this but I am confused by all the terms. What kind of therapy do I want if I don’t want to sit on a couch and talk about bogus repressed memories of my childhood?

  • Mary Ellen Brayton Says ...
    Mary Ellen Brayton

    You pose an excellent question. You are right when you state that not all theories are in to this style of counseling. The theory you are referring to is Psychoanalysis where Sigmund Freud stresses the importance of inborn drives, as you stated, in the ego, id, and superego, in determining later personality development. Later, others who followed this theory emphasized early relationships between child and mother. This is one of many theories utilized in counseling, but by no means the only theory. If you don’t want to “sit on a couch” and talk about repressed childhood memories there are plenty of other effective styles of counseling.

    A few of the other options helpful for treating both depression and anxiety include the following:

    Person-Centered Therapy: Developed by Carl Rogers emphasized understanding and caring for the client, as opposed to diagnosis, advice, or persuasion. Unconditional acceptance of the client for who they are is central to this theory. Person-Centered therapists are concerned about understanding the client's experience and communicating their understanding to the client so that an atmosphere of trust can be developed that fosters change on the part of the client. Clients are given responsibility for making positive changes in their lives.

    Rational Emotive Behavior Therapy: Developed by Albert Ellis focuses on Irrational beliefs that individuals develop that lead to problems related to emotions like fears and anxieties and to behaviors such as avoiding social interactions or giving speeches. By disputing these irrational beliefs the client can be taught to challenge their own irrational thoughts so that they can reduce anxiety and develop a full range of ways to interact with others.

    Cognitive Therapy: Aaron Beck developed Cognitive Therapy, an approach that helps individuals look at maladaptive thinking and how it may affect their feelings and actions. Belief systems and thinking are seen as important in determining and affecting behaviors and actions. Cognitive therapists use a structured method to help clients understand their own belief systems by recording dysfunctional thoughts and using questions to determine maladaptive thinking. I borrow from a number of theories.

    I find Cognitive Behavioral Therapy to be the theory that works best in treating both depression and anxiety because it is based on the fact that how we think can have a large effect on how we feel and therefore how we behave. This is a combination of Cognitive Therapy and Behavior Therapy. By looking at triggers to depression and anxiety we can look at the event that is causing the depression and/or anxiety. I explain it to my clients as the ABC’s of counseling.

    1. There is an Activating Event (A) – say you get a poor grade on a test.
    2. The Behavior (B) is a thought that you tell yourself – maybe you say I’m stupid, or no matter how hard I try I always fail,
    3. this causes a Consequence (C) – you quit trying, feel bad about yourself, or worse yet, drop out of school.

    The thought that you jump to the conclusion that you are stupid is a form of Black and White Thinking. This style of thinking will lead to low self-esteem and the thought that failing is inevitable can lead to a sense of helplessness. Both thoughts will keep the person "stuck" in depression. You can’t always change bad things happening (the “A”) but you can change your response (the “B”).

    Cognitive Behavioral Therapy would look at your Behavior, the (B) in order to change the Consequence, the (C).

    Typically there are irrational thoughts in our thinking when we are depressed. Here are a few examples of the irrational type thoughts we would look to change:

    Black or White Thinking: Viewing situations, people, or self as entirely bad or entirely good—nothing in between. Such thoughts almost always lead to harsh judgments and alienation from others. Example: “My supervisor is never fair and he has always hated me.”

    Helplessness: Refusing to acknowledge that he/she has any ability to impact his/her world in a positive fashion, but consistently believes that bad things just happen to him/her. This results in discounting all positive traits, abilities, and successes and refusing to put forth effort to change his/her environment, becoming dependent on others to do it for him/her. Example: “There is nothing I can do to change the situation, so I might as well just give up and let what happens happen.”

    Hopelessness: Consistently viewing situations as having no possible positive or even neutral resolution in the future. This leads to despair and refusal to search for solutions to problems. Example: “I’ll never make any new friends who accept me and enjoy me.”Worthlessness: Viewing self as not worthy of other people’s time, interest, or acceptance. This leads to making self-critical remarks in anticipation of rejection from others. Example: “I don’t blame them for not liking me because I’m not worth it anyway.”

    Catastrophizing: Blowing expected consequences out of proportion in a very negative direction. This results in withdrawal of effort to change things for the better and reacting to a situation as if the negative consequence has already happened. Example: “I’ll never be able to get another job. This layoff is the end of the line for me.”

    Negative Forecasting: Predicting events will turn out badly without any basis in reality. This type of thinking results in pessimism, depression, and withdrawal of effort. Example: “I’ll never get hired, so there’s no sense in even going for the interview.”What can be helpful is logging triggers to anxiety and/or depression, tracking how who we were with, what we told ourselves, how we thought, and then what we did can be used as a basis for change.

    Negative and fearful thoughts can hold us back from doing things. By doing a “reality check” of the fearful thought, we can begin to put maladaptive thinking in perspective. Then learning coping skills and alternative behaviors becomes key. Changing our thinking is dependent on us wanting to change our outcome. If we change what we tell ourselves, we can change how we feel, and eventually change how we react. Changing our negative thinking to rational, positive thoughts can have a huge effect on how we feel. Sometimes some of the thoughts we have may be real and not irrational at all. When this happens, therapists can help the client to grow in positive ways. For the example above, getting support, a tutor, decreasing distractions, improving time management skills can all help.

    The first step is asking for help which is a true sign of strength. Eventually putting these newly learned skills will indeed provide the person a new self-fulfilling prophecy. It’s hard to answer your question in a short answer. I hope this gives you a brief idea of the other forms of therapy out there that have been proven helpful for both depression and anxiety. And the best part is, they do not require a lifetime of therapy. Depending on the client, a few sessions may be adequate in order to shed light on a new way of thinking and, therefore, living.

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