What are the Main Therapy Approaches? How Do They Work?

Today, approximately 8 billion people are living in the world. Now, think about yourself… Your life, the things that are important and unimportant to you. The details you have forgotten. The color of your favorite pen. The bitterness left by your ex-lover. The smell of your grandfather’s house. The excitement of shouting “simitçiii” to the street vendor passing by in your childhood. The entirety of your inner world that makes up your entire life and that you can only share a part of with other people. Your pains, your fears. The feelings you experienced while overcoming them… Your uniqueness… There are approximately 8 billion of these uniquenesses. I kindly ask you to take a brief pause to imagine what this means.

Psychology is a relatively new field of science, and therefore, new therapy approaches emerge every day. In fact, considering that there are 8 billion people in the world and taking into account everyone’s uniqueness, having so many therapy approaches is a very good thing! On the other hand, having so many options can cause confusion for patients…

When you decide to start therapy, what are the approaches you may encounter? Now, let’s examine the main ones and their working styles together.

Psychoanalysis

Psychoanalysis is actually the source from which all therapy approaches emerged. Developed by Sigmund Freud, this approach places a primary emphasis on the unconscious. The unconscious is where we store the data we gather from the world since infancy, which is beyond our awareness and inaccessible at will. According to psychoanalysis, this is also the source of our psychological issues. Psychoanalysis states that if we behave “this way” today, it’s because of the data stored here. In this therapy approach, efforts are made to uncover and thoroughly examine what these data are: relationships with parents, events in early childhood, and experiences during adolescence. It’s a significant approach in the development of psychology, primarily due to its introduction of the concept of the unconscious. Psychoanalysis has served as a foundation for many subsequent therapy approaches. In this approach, the client reclines on a couch while the therapist sits behind them. It’s a therapy approach where therapist guidance is minimal; instead, it’s based on the client freely associating their thoughts. To practice psychoanalysis, a therapist must undergo their own analysis. This approach is not as preferred by therapists today as it used to be due to its requirement for long-term commitment (analyses can last for years, with sessions typically held 3-4 times a week) for healing.

Psychodynamic

Psychodynamic therapy is a continuation of psychoanalysis. This approach, which applies Sigmund Freud’s views by adapting them to the present day, is one of the most likely approaches you will encounter if you decide to start therapy today.

In the psychodynamic approach, which is based on the fundamental assumption that the source of today’s problems lies in past experiences, the aim is to delve into the origins of these issues rather than focusing on current problems, in order to create lasting solutions. This approach places emphasis on the layered structure of the human mind, namely the subconscious, and relationships play a significant role. Particularly, like in psychoanalysis, a considerable space is dedicated to early relationships. The concepts introduced by psychoanalysis such as id, ego, and superego are also important terms in the repertoire of a practitioner working with psychodynamic therapy.

Put simply, id represents our instincts, superego our connection to societal/cultural norms, and ego serves as the bridge between these two.

In the psychodynamic approach, the aim is to bring repressed emotions and thoughts from the subconscious to the conscious level. Revealing the desires that the client is unaware of and confronting them with these desires is an important step in psychodynamic therapy. Then, time is allocated to coping strategies to integrate these desires into life.

A significant difference that sets the psychodynamic approach apart from psychoanalysis is the level of therapist activity. While the therapist may not be as active as in Cognitive Behavioral Therapy, occasionally, they can guide the client with non-directive, open-ended questions. For example, they may help the client by establishing a connection between a current issue and a problem experienced during childhood.

Another significant aspect of psychodynamic therapy is the anticipation that the client will bring their everyday life issues into the microcosm of therapy and reflect them onto the therapist (referred to as “transference” in psychological jargon). This transference is worked on in the therapy room, in the here and now, serving as a rehearsal for relationships outside therapy with the therapist. Through this process, resolutions can occur.

Cognitive Behavioural Therapy

Cognitive Behavioral Therapy (CBT) is the most widely used and goal-oriented therapy approach today. In this approach, three important concepts come into play: thought, emotion, and behavior. These three components, which influence each other, are worked on at the conscious level. The subject of each session is determined jointly by the therapist and the client. In CBT, which is a relatively active approach on the part of the therapist, the therapist highlights important points in the client’s stories to help the client become aware of them. Questions such as “What did you feel at that moment?” and “What thought came to your mind?” are aimed at reaching the client’s emotions and thoughts. The therapist and the client together test the alignment of negative emotional patterns with reality, and the client’s cognitive distortions are addressed. Cognitive distortion is a phenomenon where the client believes in their own thoughts regardless of their alignment with reality. For example, “He didn’t answer the phone, he must have had a car accident,” or “He’s avoiding eye contact, he must be hiding something from me.” Questions like “What advice would you give to your closest friend if they were in this situation?” aim to help the client gain an objective perspective on their own life and to take a holistic view of events.

Cognitive Behavioral Therapy (CBT) does not reject the unconscious but does not work with the unconscious. The goal in this approach is to reduce symptoms, so cases where problems are solved quickly are observed. The rapid resolution of issues makes CBT an economical choice for clients. Working with CBT for long periods is also possible if it is suitable for the client’s personality and progress is being made in therapy.

In summary, those considering starting therapy will likely encounter these approaches. I believe awareness is crucial for healing, both for my colleagues and for anyone seeking our help. Apart from the three approaches detailed in this article, there are many others in the field, such as schema therapy, logotherapy, existential analysis, brief solution-focused therapy, and many more. Additionally, many psychotherapists, including myself, use an eclectic approach, incorporating multiple approaches into our practice. Moreover, while techniques and approaches are essential for therapists to know what to do, the cornerstone of therapy is “rapport,” which is independent of the approach. If you need help and have decided to seek therapy, forming a connection and trust with your therapist is more important than which approach they use. Wishing you a healthy life both mentally and physically.