Cognitive-Behavioural Therapy (CBT)

Cognitive behavioural therapy directs attention to a person's thoughts and beliefs as key sources of the problems they are experiencing. For the CBT psychotherapist, how we explain events will cause us to feel particular emotions and to act in certain ways.

A good thing about CBT is the view that if you help someone change their thinking, you will help them to feel and act differently.

Therapists who use CBT tend to listen carefully to how someone explains their understanding ofof events. These therapists want to know what you think and believe about other people and yourself. CBT therapists examine an individual's self-talk to see what kinds of messages they tell themselves.

For the CBT therapist, this kind of internal dialogue often becomes the focus for how they can help (e.g., how can I help the client think differently about these issues?). an individual makes progress as they start to apply new collections of thoughts and beliefs, replacing ones that have caused problems.

We know from decades of research that particular kinds of thought patterns are associated with various mental health problems. There are characteristic thinking styles associated with depression, anxiety, abusiveness and addiction. Often, these thinking styles have been learned and practiced over so many years they become automatic. These are areas where CBT can be very helpful and effective.

While CBT inevitably focuses on thoughts and beliefs, emotions and feelings are also extremely significant to therapists using this form of psychotherapy. Unpleasant emotions are often a driving motivation for clients to seek therapy. CBT therapists are particularly sensitive to the powerful nature of emotions.

For the individual, CBT can feel like a chance to learn a whole new way of making sense of their inner - psychological - world and emotions. Both client and therapist can find that opportunity very rewarding.

Interpersonal Therapy (IPT)

Many therapists view relationships as a basic and important need for each of us. Relationships help give meaning to our lives and help us develop social skills.  Good relationships with our friends and loved ones tend to have some mix of affection, assertiveness and dependency involved.

Relationships can become difficult or unhealthy when people lose the ability to be flexible.  This is especially true if they become more rigid and limited in how they connect with others. This is the kind of situation that is of particular interest to the IPT psychotherapist.

IT Therapists tend to view personal problems as a result of a person's difficulty fitting well into their social world. Rather than being able to create truly new relationships, for example, the IPT therapist sees how a client may be carrying old and unhelpful relationship patterns into their new relationships. This in turn creates problems, often the same old kinds of interpersonal problems that we have experienced in important relationships in our past.

IPT psychotherapists are particularly interested in several dimensions of relationships. These include the tensions between love and independence and dominance and passivity. IPT therapists are curious to see which kinds of relationships result in particular patterns of difficulty for someone. It may be, for example, that an individual tends to get along with with co-workers, but not with their children or their spouse or parents. Perhaps they have trouble generating new friendships. Or, perhaps that person has had good relationships with particular people for years, but now experiences those relationships in negative ways for reasons they don not yet fully understand.

Similar to some of the ideas in CBT, the IPT therapist looks to patterns of behaviour or thinking in an individual's past to understand ways problems they're experiencing now. For example, IPT therapists may work to understand how a client may be in some way copying some aspects of past relationship dynamics (e.g., passivity, hostility) into a current situation.

Good IPT work typically involves helping an individual uncover and understand the roots of current relationship problems. Sometimes this happens with exploring how an individual is responding to the therapist. This relationship can trigger some familiar but unhelpful relationship patterns. Ideally, individuals able to experience a more full and enriching set of relationships by avoiding relationship patterns adopted in their past for survival value. Instead, they  can learn to experience exciting and empowering new ways to carry themselves into their relationships.

Intensive Short-Term Dynamic Psychotherapy (ISTDP)

Intensive Short-Term Dynamic Psychotherapy or ISTDP is a form of brief emotion-focused psychotherapy developed by Habib Davanloo of McGill University. It is taught in several international training programs.

ISTDP is used to treat people at the Centre for Emotions and Health at Capital Health where staff also does research into this treatment.

The basic ISTDP understanding of many psychological problems is that interruptions to human relationships or attachments may cause a series of mixed feelings. These feelings may become blocked and avoided. When life events like getting married, having children, or the death of a loved one stirs up these feelings, an individual's anxiety and defences may be activated. If the individual is unaware of this anxiety and the defences they are using, this causes relationship problems, physical symptoms and a range of psychiatric symptoms. This accounts for a significant proportion of people with anxiety, depression, somatic health problems and interpersonal problems.

The treatment approach ISTDP uses is first to help the person see the link between past and present feelings of anxiety and their defences. This is to help them learn how to stop blocking off of their feelings.

The therapist will often focus on the feelings the person is experiencing during their session. They will point out the ways the individual's feelings become blocked and interrupt the connection with the therapist in treatment. When these feelings are experienced there is an abrupt drop in tension, anxiety and other physical symptoms and defences. The patient and therapist can then see the driving emotional forces that were being defended. This may start a healing process in which the old avoided feelings are experienced and worked through.

Often one of these breakthroughs is enough to improve the symptoms an individual is experiencing. In most cases a series of these events are required to bring about major behavioral changes. If the person has very high anxiety, a treatment approach in group or individual therapy may be needed first to improve anxiety tolerance before the emotions can be experienced.

At the end of a successful therapy session or sessions, there is an absence of somatic anxiety and major defences. An individual's health improves, and their relationships develop and grow as they were meant to before the original trauma.

This treatment and related approaches have been extensively researched and shown effective with patients experiecing depression, anxiety, somatic health problems, substance abuse, eating disorders and personality problems.

For more information vist the Centre for Emotions and Health

Ch...ch...ch...changing. Motivational Interviewing and Change

When was the last time you made a lasting change in your life?

We all make changes – some small, some big.  We change our minds on where to eat lunch.  We take a different route to work.  We change our spending habits in hard times.  We cut back on snacks in the evening.  Change is a part of growth.  Without change there is no improvement.

But sometimes we get stuck.

Sometimes we want to change but we don’t.  We can’t.

That’s what Motivational Interviewing is all about.  Motivational Interviewing, or MI, is an approach that psychologists use to help people get unstuck.  It is based on decades of research around the question of HOW people make lasting changes.  When the research began, psychologists were asking questions about how people stopped smoking. MI has since been applied to many, many other areas of change including weight loss, drug abuse,
health-care decisions, depression and anxiety.

There are two main ideas that drive the work of MI.

There are a number of identifiable conditions that are present in order for people to change.  They are:

  •  Concern – a person has to be aware of the need for change
  • Convinced – a person needs to believe that the change would be for the best
  • Commitment – the person needs to have a firm plan of action
  • Change – the person needs to follow through on the plan

Sounds simple, right?

At the heart of it, MI is simple.  It is about gently guiding a person through the stages of change so they can reach the goal.

The journey towards the goal is often rocky. This is the second main idea of MI.

People frequently take two steps forward and three steps back.  Change is hard.  People are psychologically programmed to resist change (especially if we think the change will be tough).  So a psychologist working with MI principles will be helping people with issues around:

  • Confidence
  • Commitment
  • Resistance
  • Reassurance

When you work with a psychologist, MI provides a framework for approaching a problem to maximize the likelihood of sustained change.  It is about finding and encouraging your own motivation and commitment while developing a solid plan of action.  It’s about real change for a better tomorrow.