Methods

The following descriptions are my personal and specific understanding of a number of different therapy models and are not intended to be definitive. This is just a sample of the many therapeutic models currently used to understand and work with individuals in therapy, and many have common threads.

The basic underpinnings of many therapy models

Many therapies assume that we learn about the world when we are very young, that we learn beliefs and strategies for how to engage with and be in the world, and how to survive, in our childhood. These beliefs and strategies can be constructive or maladaptive.
When adults are traumatised they can also develop certain responses, beliefs and strategies to survive the event.
Therapy can be a way of understanding the strategies you learned to adapt yourself to the situation then, and enable you to update and adapt your beliefs and feelings based on your resources and information now.

Neurobiology & Rewiring the Brain

Neurobiology focuses on how experiences impact and can rewire our neurobiology, such as the way our nervous system, our neurotransmitters and stress hormones work. This is important in therapy for many reasons, including the fact that we all have a part of the brain that is based on instinct, whose main purpose is to protect you from harm. If for whatever reason aspects of your childhood, or even later, were not safe, your instinctual protective responses can continue to be triggered in the present, by something that reminds you of that lack of safety. This means you are sometimes responding to the past instead of the present, and this can be out of your awareness.
Through a process of learning how this is working for you specifically, and learning to engage that part of your brain that can both listen to your feelings and your body responses but also assess reality and problem solve, you can override and change those rewired instinctual responses and update them. You are literally retraining your brain and body to respond differently, increasing your choices so you can improve the quality of your life instead of running on automatic and responding to old alerts with limited resources.

Transactional analysis

Transactional analysis looks at ‘scripts’: the inner dialogue within an individual, based on the child-adult relationship internalised in childhood. This impacts your relationship with yourself and how you manage your life, and your relationships with others. That is, these ways of being in the world and thinking about yourself and others have been learnt in your relationships in childhood, when you formed a view of the world at a time when you had limited resources.

The aim of transactional analysis is to unravel these beliefs, internal conflicts and patterns of relating and behaving that may be hurting you and your relationships. It helps you examine the reality and usefulness of these beliefs and ways of being, so you can update them for your present life. The goal is the achievement of autonomy, awareness and the capacity for spontaneity and intimacy: changing both your relationship to yourself and how you relate to others. Part of this process is the growth of the Adult aspect, who can manage all the other ego states, curtail criticism and judgement, and allow spontaneity and authenticity.

Cognitive Behavioural Therapies (CBT)

Understanding the relation between thinking, feeling and behaviour, and your responses to difficulties is an aspect of many therapies. However cognitive behaviour therapy focuses its attention on how the way you think leads to specific feelings and then behaviours, and how cognitive distortions or faulty thinking works to influence this.
CBT examines faulty and repetitive thinking patterns such as black and white thinking, catastrophizing and all or nothing thinking. These thinking patterns can lead to intense feeling states and make it difficult to make good choices. The aim of CBT is to identify key unhelpful or distressing patterns of thoughts and beliefs (perceptions) and their impact on your feelings and behaviours. The goal is to learn to interrupt and challenge these patterns of thinking and feeling in order to change your feelings and resultant non-adaptive behaviours and coping strategies.

However, another way of seeing these patterns of thinking and behaving that you have developed is that you have done so to protect yourself in some way. Particularly in the case of trauma, it can be harder to change thoughts, feelings and behaviours because of their important adaptive and survival value. This can require more work on learning to address somatic symptoms and learnt coping strategies, and also focusing on thinking as adaptive and serving a purpose rather than as simply distorted.

Dialectical Behaviour Therapy (DBT)

Dr Marcia Linehan developed DBT in order to provide individuals with more skills and strategies including to manage their feeling states. DBT is used both with individuals on their own and with groups, with some different emphases to CBT including focusing on interpersonal effectiveness, distress tolerance/reality acceptance skills, emotional regulation, and mindfulness skills. In particular, Dr Linehan found that some people’s emotional responses happen faster and at a much more intense level, making it more difficult to interrupt and also to calm oneself, so additional skills are needed than those offered by CBT. Building this ability to soothe oneself and regulate one’s emotions is central to healing and being able to understand the thoughts and behaviours that result from your intense feelings.

Body or Somatic Therapies

Somatic therapies have been developing for many years. Some focus on how posture reveals or reinforces patterns of being or interacting such as in the work of Alexander Lowen. Some work with physical catharsis which may enable people to release trauma that has been laid down in the body and is being constantly triggered in a body-mind circuit. More recent therapies such as Hakomi or sensorimotor psychotherapy focus on the client’s experience of their body in the present.

With trauma, for example, being physiologically triggered can happen without distinct memories in the moment, because the memories and sensations, although they both are accessible, have not been connected, and this disconnection is part of the function of dissociation. Sensorimotor strategies work to counter this disconnection, by enabling the client to experience being present in their body in sessions, and, in small steps, to connect to how distress is being experienced and maintained in their body. Through this process the client can learn how to use their mind and body to understand, interrupt and soothe their specific symptoms of distress, so they can then feel safe to process the cause of distress and to build alternative coping strategies.

The aim is to build awareness of, and to integrate, your mind and your body experience, and in doing so to build mindfulness, resilience and the ability to soothe yourself so you can feel safe in your own body. Being present in the body, feeling a sense of mastery in your body instead of feeling out of control, is a necessary step to becoming connected, and to leading a conscious, intentional life.

Gestalt Therapy

Gestalt therapy focuses on internal conflicts, and also on your relationships. It works on the basis that external conflicts and difficulties can sometimes also reflect internal conflicts. Gestalt therapy is a process of externalising the internal conflict, and one way to do this is by identifying the different aspects of the conflict and facilitating a dialogue between them. In this way the conflicting positions can be examined and understood. The aim is for the person to identify and resolve those conflicts holding them back in their lives and relationships.

Mindfulness

Mindfulness is used as an adjunct to many therapies and all good therapists approach therapy mindfully. This means that they are in the present and focused with all their senses on the client and the client’s experience. For the client, the practice of mindfulness can be profoundly healing. The experience of being present to oneself and fully aware, at the same time building your ability to step outside of worries and concerns and gain perspective, is something that can be learned with practice. This practice can lead to a more calm and purposeful life. It is a tool that can be used to regulate emotions, lower stress and build self-understanding and acceptance.

The aim is to bring the attitude of mindfulness into your everyday life, so you can be less reactive and also can be fully present to yourself, your feelings and thoughts.

Attachment Theory

An infant’s or small child’s world is a world defined by attachment to a significant other(s). Attachments are of life and death importance for the infant, as their survival literally depends on this other. Because of this, early attachments are seen as formative in a child’s world view and their way of relating to others even though such attachments begin before the child acquires language. Other experiences either go some way to repair or reinforce the early learnings of attachment.

All learnt behaviours have survival value, and as such if they have been laid down in the body through trauma or early disruptions in attachment a person cannot be simply talked out of them. The survival value of your particular attachment style needs to be explored, respected and understood, before other choices can be made.

Psychodynamic therapy

Psychodynamic therapy includes looking at attachment styles and at both conscious and unconscious motivations. These are seen to be formed in the family of origin: shaping personality, thoughts, feelings and behaviours and leading to patterns of behaviour and relationships. Psychodynamic therapy uses the client’s history, current difficulties and the therapeutic relationship as a means to enable these conscious and unconscious motivations to be examined and brought to the surface. This is so that they can be understood and examined and that through insight and the resolution of inner conflicts new choices can be made.

Research and Therapy

The latest neuroscience research continues to inform us about how the mind and body work and it is important to include these understandings in methods of therapy so that the influence of the brain and body in symptoms are both attended to. This is even more essential in the case of trauma.

It is therefore important to use talking techniques alongside an understanding of how to become aware of and work with the body’s responses, which are often operating out of awareness and need to be brought into awareness to effect change.