At ABS, our therapeutic approach is initiated in the context of the person-centered plan with its problem orientation, focused on difficulties and goals devised by the consumer in conjunction with his/her treatment team. The psychotherapy that follows is predicated upon this plan, and as such, should be problem-focused as well.
Although there are many “evidenced-based” psychotherapies identified in the literature, it is important to clarify that each individual seeking help has unique issues and styles of interacting. As such, every attempt to provide psychotherapy will, by necessity, need to be a “new” therapy based on the client’s needs and the array of skills/techniques/approaches available to the counselors or psychotherapists.
MOTIVATIONAL INTERVIEWING
Of course, almost all forms of psychotherapy or counseling involve empathic and supportive approaches. In this regard, motivational interviewing training provides a basis for using reflective listening, goal identification, and client-oriented interactions which can be applied universally. A good tool, especially for neophyte therapists, motivational interviewing is not, in and of itself, a treatment modality (except for the treatment of adult alcoholics where there is a significant evidence base). Nonetheless, a good grounding in motivational interviewing skills is expected of therapists at ABS.
SUPPORTIVE PSYCHOTHERAPY
Like motivational interviewing, supportive psychotherapy is a commonly used approach that can be integrated into all forms of psychotherapy and counseling. It uses principles of active and reflective listening, emphasizing empathic skills, and avoids confrontation, interpretation, value judgments, behavioral, or cognitive interventions. By providing an accepting environment, it helps individuals gain trust and creates an environment of positive regard which facilitates sharing and open discussions. Unlike motivational interviewing, there is evidence showing that this form of psychotherapy is as effective as other (manually based) psychotherapies such as CBT or Interpersonal Psychotherapy. Supportive Psychotherapy is frequently used in a brief therapy approach, and is often enough, in conjunction with other therapeutic modalities and interventions (e.g., pharmacotherapy, family therapy, and group therapy) to help individuals get better and recover from their psychiatric problems.
Cognitive Behavioral Therapy (CBT)
This form of psychotherapy fits nicely into a person-centered approach, identifying problems and developing goals to deal with these. By identifying and modifying problematic cognitions, perceptions, attitudes, opinions, and beliefs, CBT tries to adjust and improve subsequent emotions and behaviors. CBT tends to occur over a range of 10-12 sessions, and the nature of the therapeutic interaction tends to be structured and focused on the identified problems. Cognitive interventions, such as education about problems or cognitive restructuring, are combined with behavioral exercises like approaching avoided situations or trying out new behaviors, with the resulting resolution of identified problems/symptoms.
FAMILY PSYCHOTHERAPY
Often, individual psychotherapy approaches are inadequate to address the problems that individuals identify. Frequently, family structures or processes are problematic and perpetuate the individual’s problems. Although there are several schools or theories about family systems and associated therapeutic approaches, with some evidence-based data supporting the same, there are no clear-cut techniques that stand out. In general, family therapy utilizes problem identification and develops family-based interventions (behavioral plans, exercises, and activities) for the family members to pursue. In doing so, family system problems are often identified and provide further opportunity for changes, which eventually benefit the identified client. Therapeutic interventions include exploration of negative feelings/conflicts, having family members try out new communication approaches, re-establishing hierarchies, and creating new ways of reacting to problems. Family therapy usually occurs over weeks or months and is often used in conjunction with individual and group psychotherapies. Family therapy typically involves members of the nuclear family (parents, siblings, children, and/or spouses) but may be expanded or contracted based on the actual family dynamics (e.g., focusing on marital counseling or involving grandparents).
GROUP PSYCHOTHERAPY
Perhaps one of the least appreciated and most frequently used forms of psychotherapy, Group Psychotherapy utilizes the beneficial effects of using others with similar problems to help with healing. Here, the therapist is often less focused on the individual’s problems and is more focused on helping group members learn better ways of interacting. Groups may be theme-oriented (e.g., sex offenders and substance abusers) or generalized and tend to be long-term. Many CBT approaches for theme-based groups have been developed and have been proven effective and efficient. Although techniques such as motivational interviewing, CBT, and supportive psychotherapy can be used in a group setting, the basic role of the therapist in group settings is to facilitate improvement by clients helping each other.
INSIGHT-ORIENTED/PSYCHODYNAMIC PSYCHOTHERAPY
Growing out of psychoanalytic tradition, this individual therapy approach utilizes techniques of historical/developmental exploration, clarification, and interpretation. It is based on the theory that problems and difficult emotional and behavioral difficulties stem from developmental problems (trauma, parental neglect, sibling conflict, etc.) which remain active in derivative symptoms and problems. There is significant evidence base that this approach works for individuals with depression, post-traumatic stress disorder, panic disorder, and personality disorders; however, clients must possess adequate verbal and intellectual capacities to engage in this form of therapy. Often considered long-term therapy, this technique can be used in a brief therapy format as well.