TYPES OF THERAPY:

Interpersonal Therapy or IPT:

This is a treatment designed originally for depression and empirically validated in research as equivalent to imipramine (a psychotropic drug) for moderate to severe depressive disorders. It has also been shown to be effective for a wide range of anxiety, adjustment, eating, developmental concerns as well as for work with couples, substance abuse and with those coping with chronic and exacerbated illness.  It is time limited, and the person being treated is expected to participate equally in session with the therapist who advocates for the patient and uses supportive interventions to improve social and relationship functioning, communication skills and a better understanding of diagnosis and treatment. The relationship with the therapist is used as an example of how the person being treated interacts with those in his/her world and as a result, the therapist encourages the person in treatment to be clear in letting the therapist know how the things said and done in therapy impact them.  The therapist will, likewise, reflect to the person treated, the impact of their behaviors and communication with the therapist as a person receiving them. This builds very real relationship with the therapist and assists the patient in understanding how they are likely to be perceived by others. It clarifies what is likely to be unsaid by others in a safe environment, allowing the person in treatment to make changes that will have a positive impact on the way they relate to others. Clear goals for how you wish to improve your relationships, communication and self-esteem are set to focus your treatment. The result is reduced anxiety, depression, stress and poor ways of coping.  While all therapies target your emotions, thoughts and behaviors, (and some target insight, or changing personality) each theory emphasizes one area more frequently. This theory focuses on EMOTION and RELATIONSHIP as primary mechanisms for change

Cognitive-Behavioral Therapy or CBT:

This is a treatment that was also designed originally for depression and empirically validated in research as equivalent to imipramine (a psychotropic drug) for moderate to severe depressive disorders, though less effective for very severe depression than IPT. It has also been shown to be effective for a wide range of anxiety, traumatic, adjustment, eating, developmental concerns as well as for work with couples and with those coping with chronic and exacerbated illness, psychosis, substance abuse, in fact almost every mental illness.  It is time limited, and the person being treated is expected to participate very similarly to a student with a teacher in therapy, although treatment is seen as a collaborative process. The person being treated sets an agenda with the therapist, is given behavioral homework (often symptoms are tracked on handouts and brought to session for discussion) and is taught methods for analyzing how their thoughts impact their mood and views of themselves. Goals are set, reviewed and measured by you and your therapist. The therapist will assist you in discovering your primary beliefs about yourself and the way you see the world and others and will challenge any areas that are having a negative impact on your life. While all therapies target your emotions, thoughts and behaviors, (and some target personality) each theory emphasizes one area more frequently. This theory focuses on THOUGHTS and BEHAVIORS as primary mechanisms for change.

Psychodynamic Therapy:

This therapy is what might be called a “relaxed or modern psychoanalysis”. In fact, all other therapies (except perhaps for the very strict behavioral therapies) originated from psychoanalysis, so keep this in mind when thinking about therapy. They all come from the same source, but have changed forms to accommodate specific diagnoses and our busy lives. The psychodynamic therapist is interested in helping you to understand your unconscious motivations for your behaviors so that you can more fully comprehend your personality structure, and cope with areas that hinder your goals and relationships. While there are brief, time limited models of psychodynamic therapy (IPT above, is one of these), if your needs indicate psychodynamic work, chances are that you will not contract for a specific number of sessions. Rather, you will contract for a goal in treatment that is likely to require a great deal of change and time to effect that change. Many people interested in very deep self development opt for this work, while those who suffer from multiple traumatic experiences or losses, or have some form of more severe mental illness while still functioning well in the world also find it to be of benefit. This is due to the committed, long term relationship to the therapist to work on complex concerns. This therapy requires deeply investigating your family and social history, patterns of emotional response to situations, dream analysis, explorations of how you relate to your therapist in ways similar to those in your history, and relating the way you interact in venues with which you are struggling to your therapist in an effort to gain insight into why you reacted in the ways that you did. While all therapies target your emotions, thoughts and behaviors, (and some target personality) each theory emphasizes one area more frequently. This theory focuses on UNCONSCIOUS MOTIVATIONS and PERSONALITY as primary mechanisms for change.

Acceptance/Commitment Therapy

This therapy is considered a cognitive or thinking therapy (some feel that it is a behavioral/functional theory) that emphasizes the use of mindfulness of each moment and acceptance of yourself. It provides you with exercises to help you to become more flexible in your response to yourself and, thus to others. By committing to your own values, and accepting what occurs for you, you are free to make choices about the directions you wish to take when responding to various situations. This assists you in changing unhelpful behaviors. For a Buddhist, this therapy feels like sitting in a room with another Buddhist that is guiding you through your passage to yourself. In my opinion, this therapy has empirically validated Buddhist principles, and trains you in being fully present, moment to moment. For a non-Buddhist, this therapy will feel very different from other treatments you might have received as the objective is to help you to get beyond your usual way of ignoring your patterns by refocusing your mind on what is actually happening. Techniques include the use of paradox, metaphor, and experiential exercises to get you to understand how the way that you choose to label anything often gets in the way of you experiencing it just the way that it is. I do not tend to work with this therapy in exactly the way that it was designed, nevertheless, it is inevitable that my values system and many of the ways that I interact with you as a person will align with the ideal of this therapy. While all therapies target your emotions, thoughts and behaviors, (and some target personality) each theory emphasizes one area more frequently. This theory focuses on THOUGHTS and BEHAVIORS as primary mechanisms for change.

HYPNOSIS:

Myths and Realities of Clinical Hypnosis

Most people think of stage hypnotists when they think about hypnosis and therefore are under the mistaken impression that they will be controlled by the hypnotist and made to do things that are ridiculous, unpredictable and embarrassing. Nothing could be further from the truth.

Hypnosis is just a relaxed state of focused attention that accesses an unconscious part of your brain. What occurs is something you have likely experienced in everyday life. My favorite examples of natural experiences of hypnosis are the following:

• You have argued with a loved one and set off to go to the grocery store, but end up at work instead because you were so focused on the argument.

This is perhaps the best example because it provides you with the following reality checks: You still stop at red lights, notice pedestrians, etc, and are engaged with the world. You don’t go off to some bizarre unknown territory. In other words, you are safe, although you are driving and will come out of your hypnotic trance instantly if need be to put on the brakes, make a hard turn, etc. If you found yourself to be too distracted by focusing on your argument, you would be able to instantly reorient yourself and come out of the hypnotic state. If all else failed, when you ended up at the office instead of the grocery, you would likely right yourself and concentrate on getting to the grocery. Finally, there is clear evidence of what is known by clinical hypnotists as the “hidden observer.” In other words, while in trance, there is a part of your brain actively engaged with the world that reacts if needed, much the same as how you can wake from sleep to attend to things if needed. (although the brain waves in sleep are different than those in the hypnotic state).

• You are reading a novel or watching a film and become so absorbed that you feel as if you are actually participating in the story, and even have to be physically roused by a loved one because you failed to respond to a call for dinner!
  This is evidence of a deeper trance wherein you no longer hear, see, in some cases don’t even smell the current reality as you have transported yourself elsewhere. People who can do this well enough and have known allergies to anesthesia have sometimes been hypnotized for surgery!
   
• You are doing something athletic and lose yourself in it similarly to the driving experience listed above.
  This experience can either be hypnotic or meditative depending upon the level of concentration, the type of absorption and the brain wave.

In short, YOU are in control, not me as your hypnotist during any session we devise together. There is no danger that you will go so far into trance that you will never come out, all people come out eventually. There are few, if any side effects from this treatment (some people experience mild headaches or drowsiness temporarily) and most people come out of hypnosis more relaxed for a longer period of time and able to function much better as a result. I use hypnosis to create a safe space for you if you have been traumatized and to remit dissociation as a result of training you in this technique. I also use it for chronic pain, deep relaxation and stress reduction. While hypnosis is effective for other areas, I generally do not use this technique to remit smoking or weight loss for example; especially not without other therapeutic techniques. I actually did my dissertation on hypnosis and smoking cessation, so I feel I have greater understanding of how to integrate hypnosis with other therapies. Hypnosis is NEVER used with someone who has ever experienced a psychotic episode. Finally, I do not use hypnosis for past life or memory regression.

My tendency is to work from a psychodynamic perspective using techniques from the other therapies listed on this page along with a devotional practice for what is called an integrative therapy. I will clearly discuss with you any therapies I intend to use with you, and the reasons for my choices.

COMMUNICATION:

Three Ways of Relating (Karen Horney) and when these might be useful:

This psychodynamic therapist illustrated communication in a way that I have found particularly useful. She discussed how each of us approaches other people by moving toward them, moving away from them, or moving against them. All three approaches have merit at different times in our daily lives, however, most of us tend to use a primary mode of interacting with others and need to develop greater flexibility in our approach by choosing the way of relating that makes more sense for the situation in which we find ourselves.

A Communication Structure for Approaching Others Assertively:

Assertion is considered moving against others in a way that is similar to the Tai Chi method of moving against someone. In other words, the goal is not to be so forceful as to throw yourself off balance, or to aggressively push the other person.  Generally, it is for a win-win in relationship; however, assertion is a risky strategy as it challenges the other person. Therefore, the results are unpredictable. Sometimes, even if you are completely appropriate in your challenge of another’s assertions, a rupture in relationship will be the result. This is the reason to carefully consider whether or not to interact by “moving against” another. Sometimes, in an effort to be helpful, or just plain honest, we share with others a challenging opinion, when in fact, this might not have been either necessary or worth the risk to the relationship. The adage: Pick your battles, is relevant here.

A good example of an assertive request to another would be one that focused on requesting that a specific behavior be changed and actually suggested a method that would be acceptable to you. It is important to include how the annoying behavior has impacted you emotionally to give the person the idea that you are open for discussion and are vulnerable in the situation as well. This vulnerability to them moving against you creates greater balance, and you are more likely to be heard. Of course, timing and history between you play a role in this matter and must be considered. However, take a look at the following statement, and see if you would respond favorably to this assertive request:

“When you leave your clothes on the floor, I feel unappreciated since I usually take care of the laundry. If you wouldn’t mind putting them into the hamper if they are dirty, or hanging them up on the back of the door if you plan to use them again, it would really help me.”

Notice how there are no “hot” words like always, never, must, should, that have an accusatory tone. Notice how there is no name calling and how it is the behavior, not the person who is emphasized.

A Communication Structure for Approaching Others With a Heart of Understanding
(Listening Well, Pleasing):

Pleasing is considered moving towards another, and is very useful as an implied conversational tool, even when you feel the need to move against another. What I mean by this is that if you keep in mind that the other person wants happiness and their own needs to be met, even when there is difficulty between you, you are likely to communicate well.  In this example, however, we are actually talking about doing something for another to please them outright, often at the expense of getting our own needs met. When used in moderation, this approach can be very helpful. Be sure to rephrase what has been said to show that you are listening, and then say something agreeable.

“I know I tend to leave my clothes everywhere. I feel lazy when I get home from work and it feels good not to have so many rules at home. I am sorry I wasn’t thinking about how it looks to you. It wouldn’t be a big deal at all for me to hang them on the door or put them into the hamper. No problem.”

Notice how you still have the opportunity to explain yourself and be understood on some level here. Here there is an explicit apology. A shorter version of this might be to just say “Sure, I can do that. No problem.” Either way, the other person is likely to be very satisfied.

By the way, if you are the recipient of a pleasing remark, be gracious and end the requests at that point. Pleasing well is hard to maintain if another becomes demanding with requests. Again, consider if your request is well timed, and if it is worthwhile to you, knowing that too many requests will be unwelcome.

A Communication Structure for Deferring Your Approach of Others 
(Appropriate Avoidance):

Sometimes we go forward, when a retreat would be wiser. This is a place where timing is everything. Avoidance of conflict is wise when it means you are waiting for the proper time to address a concern, or when you are unlikely to be heard because of how the other party perceives the situation. Notice that I call this a deferred approach, and appropriate avoidance. In other words, eventually, if you thought you needed to walk around a problem, you are likely to have to come back to it again. Avoidance is a poor choice when it means you sacrifice communication entirely. When another is angry, it is appropriate to request you discuss things later and to remove yourself. When your boss makes a request that is unreasonable, it is better to wait until you have considered all of the reasons for the request and measured your words carefully before approaching with a challenge to the authority. It is the rare situation that calls for avoidance of it entirely and permanently. Although most of us would avoid danger unless it meant we were unable to save a loved one.

Keep in mind that the three strategies are to be used flexibly. More communication strategies specific to your situation will be discussed in session.

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Copyright © 2008 Pollyanna V. Casmar, Ph.D. All materials contained on this site are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without prior written permission.

Last modified: 09/23/08