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December 1, 2021
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Psychotherapy Models
Our clinicians have advanced training in evidence-based psychotherapy models. Our team of psychologists and clinical associates generally work from an integrative framework. An integrative approach combines components of various effective psychotherapy models such as Cognitive Behaviour Therapy, Emotion Focused Therapy, Mindfulness Based Therapy, Psychodynamic and Dialectical Behaviour therapy so that therapy is optimized and customized to the client’s goals, needs and preferences. We recognize that a particular model of therapy is effective for certain types of issues, but everyone is different in terms of the type of therapy that would most benefit them.
Cognitive Behaviour Therapy (CBT)
Cognitive Behaviour Therapy (CBT) is a goal-oriented, problem-focused and structured approach to treating many psychological issues such as depression, anxiety disorders, eating disorders, relationship conflict, and psychosis. It is based on the idea that the way in which a person interprets events, situations and people influences their subsequent mood and behavior. These interpretations are based on certain beliefs, and if these beliefs are maladaptive or irrational, they will struggle with poor mood and behaviours that continue to exacerbate the issues. Our beliefs are maladaptive if they are based on certain assumptions and biases that are not true. Often people are not fully aware that they are operating on these assumptions and have never had the opportunity to challenge them.
How does CBT Work?
In CBT, we look at thoughts, feelings, physical experiences and behaviours as interconnected. If we can make some changes, starting with your thoughts and even your behaviours, you will experience improvements in your physical and emotional experiences.
In order to get there, clients are taught strategies and exercises to apply both within and outside of therapy that make them more aware of and challenge maladaptive beliefs, with the goal of developing more adaptive beliefs that improve their mood, behavior and overall well-being.
If you feel you have tried and been unsuccessful in changing some of your thoughts, you may wonder how can a therapist help. You may be concerned that you will be told that the way you think is wrong when you may not entirely agree. At Toronto Psychology Clinic, we don’t try to force you into adopting our belief system. In our approach to CBT, a belief is adaptive if it fits a clients’ personal value system which includes both personal and cultural values. In a CBT focused session, we use the collaborative, guided discovery method: your therapist walks you through a series of exercises meant to help you look at your thoughts from different perspectives so you see something you didn’t notice before. Think of it as being the person in the driver’s seat, with your therapist sitting alongside you, asking you to look in some directions you did not consider before and may want to steer towards. We facilitate and support you, but we will not steer the car for you. We believe real change happens when it comes from within the client.
CBT research has shown that 10-20 sessions can provide substantial benefit for clients. However, some people may require more.
A CBT approach includes:
- Tracking your thoughts and feelings in response to situations during the week
- Conducting exercises to weigh the evidence that supports or does not support a particular belief you have
- Challenging underlying assumptions that may be maladaptive
- Learning to define and understand an issue or event in more realistic ways
- Understanding how past experiences influenced your thoughts and feelings
- Trying new behaviours to see if that changes your thoughts and mood
Dialectical Behaviour Therapy (DBT)
Dialectical Behaviour Therapy (DBT) is a comprehensive therapy model developed by Marsha Linehan and colleagues to treat people with Borderline Personality Disorder (BPD). Borderline Personality Disorder is a disorder where a person struggles with an unstable sense of identity, instability in relationships and difficulty regulating emotions. Borderline Personality Disorder is challenging to treat because the characteristic emotional volatility and instability in a person’s sense of self and their relationships makes it hard to remain engaged in treatment unless a clinician is skilled in understanding the diagnosis and how to treat it. Dialectical Behaviour Therapy (DBT) is a widely used, scientifically proven to be a successful treatment program for people with Borderline Personality Disorder (BPD).
How does Dialectical Behaviour Therapy (DBT) Work?
Dialectical Behaviour Therapy (DBT) in its entirety involves individual therapy, group therapy, a DBT therapist consultation team and phone coaching. At the Toronto Psychology Clinic, we only provide the individual therapy with Dialectical Behaviour Therapy skills and techniques. The individual therapy involves teaching various strategies such as:
- Mindfulness: Learning to be present and noticing your thoughts, feelings and behaviour as they happen without trying to control them.
- Distress tolerance: Developing skills to tolerate and effectively cope during emotional crisis, especially when there is nothing one can change about a situation, and accepting a situation as it is, rather than how it is perceived it should be.
- Interpersonal effectiveness: The ability of a person to ask for what they need when necessary, while still maintaining self-respect and relationships with others.
- Emotion regulation: The ability to manage emotions so that they do not control thoughts and behaviours.
Emotion Focused Therapy (EFT)
Emotion-Focused Therapy (EFT) is an evidence-based treatment approach based on the idea that how we understand and use our emotions guides how we live. Some people develop unhealthy patterns of emotions that contribute to poor psychological and emotional well-being. From an EFT framework, emotions are adaptive or maladaptive. Whether or not an emotion is adaptive is not based on the type of emotion, but the context in which the emotion occurs. For instance, it is adaptive to feel fear if someone puts a gun to your head, to feel angry if someone violates or insults you, and to feel hurt if someone you love ignores you. Your emotions in these situations tell you what you need to protect yourself, giving you an opportunity to speak up against the violation or to let someone know what you need. Emotions signal what we need and what we should do in order to get what we need.
Emotions are maladaptive if they make us feel stuck, burdened, depressed, anxious, and/or behave in ways that move us further from our life goals, such as acting in hostile ways towards someone who did not appear to acknowledge you, or feeling paralyzed with fear prior to your exams. Maladaptive emotions develop for a number of different reasons that can be explored in therapy such as family role modeling, traumatic experiences or simply not having been in environments that supported exploration and accurate identification, verbalizing and use of our emotions.
How does EFT Work?
In Emotion-Focused Therapy (EFT) the therapist facilitates the client’s ability to process their emotions so that the emotions change and make way for other healthier emotions. They guide the client in connecting with and expressing all aspects of certain emotions they want to change. These components include thoughts, beliefs, metaphors, physical sensation, stories, needs, and motives. Such exploration leads to deeper insight about what one is struggling with and unveils new feelings. Processing of emotions also involves expressing some emotions that are difficult because they make one feel vulnerable and are hard to acknowledge, let alone feel — sadness, hurt, shame, etc. Being able to process and validate such feelings leads to building greater emotional resilience.
Several studies have found Emotion-Focused Therapy (EFT) is a highly effective treatment for many emotional and behavioural problems such as depression, anxiety, eating disorders, and PTSD.
Emotion Focused Couple Therapy
In Emotion-Focused Couple Therapy, each partner’s conflict is explored not simply as problems in communication, but as a product of different attachment and identity needs. Each partner has a certain emotional schema – or blueprint – through which they form and navigate their romantic relationships. If these emotional schemas are shaped in ways that are non-adaptive, or not fully compatible, the partners will experience a lot of distress. The form of distress for each partner depends upon what attachment and emotional needs are not met.
In Emotion-Focused Couple Therapy, the therapist guides the partners in identifying their respective attachment patterns and how these interact in a way that leads to a negative interaction cycle that they keep repeating. Greater awareness along with emotional activation and drawing out alternative responses to emotions by the therapist guides each partner to a place of healthy emotional attachment.
Mindfulness, Acceptance and Commitment Therapy (ACT)
Mindfulness
Today there is much research to support the benefits of mindfulness to a person’s physical and psychological health. Mindfulness refers to meditative ideas and practices that involve observing thoughts and feelings and letting go of the need to change or ruminate about things. Mindfulness-Based Therapies encompass mindfulness philosophies and techniques in their intervention approach. In a world that is becoming increasingly fast-paced and competitive with technology and social media, it’s hard not to feel the intensity of time, the demand to get things done and be the very best, to the point that one is not really paying attention to what is happening on the inside. This directing of awareness to one’s inner world in a way that is non-judgemental – thoughts are neither good nor bad but are just that, thoughts – and leads to greater contentment.
Mindfulness-based strategies and ideas are included in therapies such as Dialectical Behaviour Therapy (DBT) and Mindfulnes-Based Cognitive Therapy (MBCT). At our clinic we use mindfulness strategies within various models of therapy to help with anxiety, depression, eating disorders, borderline personality disorder, etc. Mindfulness techniques include breathing and relaxation exercises along with guided imagery to direct attention to one’s thoughts and feelings in a more mindful way.
The rationale underlying ACT is that it is counterproductive to try to control painful emotions or psychological experiences as such reactions lead to greater distress. The ACT therapist assists the client in adopting the view that there are valid alternatives to trying to change the way one thinks these include being mindful, attentive of one’s personal values and at the same time accepting one’s psychological experiences.
Acceptance and Commitment Therapy (ACT)
Acceptance and Commitment Therapy (ACT) is an evidence-based model of psychotherapy that combines important aspects of cognitive behaviour therapy and traditional models of behavioural therapy.
In ACT, client are encouraged to stop avoiding, denying, and struggling with their emotions and learn to accept such feelings as adaptive responses to situations. Such acceptance and giving up the fight against the emotions allows them to move forward in their life. Such acceptance along with evaluation and understanding of one’s values leads to commitment to making necessary changes in their behaviour.
The ACT therapist helps you listen to your inner dialogue, particularly about traumatic events, relationships, physical problems and other issues. You decide if the issue requires immediate action and change or if you need to accept it and make behaviour adjustments. You may examine past behaviours that did not work so that your therapist can help you stop repeating unproductive patterns of behaviour and identify ones that are more productive. Once you face and accept your issues, you can make a commitment to stop fighting your past and emotions and start engaging in constructive behaviours that are consistent with your personal values and goals.
Psychodynamic Therapy
Psychodynamic therapy refers to a group of approaches to psychotherapy that focuses on uncovering and understanding a person’s thoughts and feelings at a much deeper level than some other forms of therapy. It focuses on bringing one’s awareness to not-yet-fully-conscious ideas and feelings that are contributing to their unresolved symptoms.
Psychodynamic therapy often gets confused with psychoanalytic therapy. Some people think it involves putting a person on the couch, attempting to hypnotize them or telling them their problem boils down to being in love with their mother. This is not the case at all, although we do have a couch to make you feel more at home. Psychoanalysis is an older approach that was developed by Freud, where a person is asked to lie on a couch and say everything that comes to mind. We do not practice psychoanalysis at our clinic. We use the term “psychodynamic” to refer to a group of models that were developed over the years by clinicians after Freud who revised and built on his ideas to make them more relevant to people’s lives today. Psychodynamic models include object-relations, transference-focused (early attachment), self-psychology, and family systems. This is why we prefer to call it ‘contemporary psychodynamic’ approaches. In fact, approaches such as CBT, DBT and EFT include ideas based on psychodynamic principles.
In psychodynamic therapy, we collaborate with the client to explore and uncover deeper thoughts, ideas, and feelings and share observations about certain themes and patterns that repeat themselves in what a client is sharing. We don’t believe in pushing interpretations on people. Insight only helps a person if it comes from within their own frame of reference. The feedback we often get from clients working with this approach is that they didn’t know it, but now that it has been brought to their attention, it makes a lot of sense.
A psychodynamic approach can be very helpful for a number of issues including general distress, difficulty in relationships, depression, anxiety, trauma, and personality disorders. Often when clients feel other approaches didn’t help or helped for certain symptoms (e.g., reducing their OCD symptoms) but feel that they are still stuck in life and repeating unhealthy patterns in their life, a psychodynamic approach can help uncover something much deeper that can resolve the issue. Often a psychodynamic approach helps with more complex and hard-to-treat issues.
Contrary to what some believe, psychodynamic therapies are supported by rigorous scientific research. There are active research centres evaluating the effectiveness of psychodynamic psychotherapy models such as Transference-Focused Therapy for Borderline Personality Disorder. The Transference-Focused approach is based on the idea that the way you feel, think and react in relationships with important people in your life contributes to your problems. You will work together with your therapist to reflect on these feelings and reactions in a nonjudgmental and empathic manner, in an effort to change and try new ways of relating.
Individual Psychotherapy
Individual psychotherapy is the most common form of counseling. You’ll meet regularly one-on-one with a reliable and relatable therapist to explore your feelings, early life experiences, and any personal difficulties you are currently facing. Individual psychotherapy is a unique process that can support you in the areas of your life where you feel stuck and increase your understanding of the way you engage with the world and with yourself. Deeper self-knowledge promotes healing, self-esteem, professional development, and can help you move on from what’s been holding you back.
Family Therapy
Couples therapy is joint counseling for you and your romantic partner. The therapist sees both partners together in order to facilitate healthy communication and to identify harmful patterns of relating in the relationship. Working together with a therapist will help both of you gain a deeper understanding of what the other is going through and to learn to share responsibility for your relationship. If you are experiencing confusion and tension in your relationship, are having issues related to sex, intimacy and fidelity, or would like to deepen your connection to your partner, couples counseling might be right for you.
