Mental Health Therapies - Therapy formats

After deciding that therapy fits one's needs, the next step is deciding what form of therapy is best. There are a few types, and their characteristics are featured below.

Individual Therapy

Often the first form of counseling encountered by first-time therapy seekers, individual therapy is made up of sessions between a therapist and patient. The sessions are usually held on a regular basis, and, depending on the kind of therapy chosen, sessions can occur anywhere from one to four times a week. Details of individual therapy sessions (that is, the positions of the patient and therapist in the room, the duration of a session, the nature of the therapist-patient relationship, etc.) vary across different therapy types.

Many patients prefer individual therapy to other forms of therapy because of the one-on-one attention received from the therapist. For others, it may be hard enough for them to express themselves with their therapist, but add a few more people in the room and the patient may feel very uncomfortable and not at all like talking.

Individual therapy is often suggested for first-time patients to fully introduce the therapy experience in a gentle, personal manner. The patient may then move on to other forms (discussed below) or even add a second therapy form to his or her initial therapy plan.

Couples Therapy/Family Therapy

Couples or marital (marriage) therapy is often paired with family therapy because of the similar topics discussed in both forms. Today, the term "couples" is used more often than "marital," however, to include the growing number of people who live together in a committed relationship but are not yet married or choose not to marry. Couples therapy and family therapy will be discussed together here because of their similarities.

In both couples and family therapy, the relationship between therapist and patient is not as important as the relationship and interaction between the couple or family members. The goal is to allow the patient to see the partner or family member as he or she really is and not as a product of the patient's repressed emotions about that person. Usually, a conflict between a couple or between family members is a sign of an emotional difficulty in one member of the couple or family; the therapist works to figure out what that conflict might be. Sex therapy, too, is often part of couples therapy, as sexual problems between partners are a common problem; when other conflicts arise within the relationship, a couple's sex life will likely be affected.

In couples and family sessions, patients are encouraged to listen to each other with empathy and to be clear in relaying what they think is being said by the other patient(s) and what feelings surround this. The therapist's awareness of which stage each patient is in in the relationship (at the beginning of a conflict versus being at a point where a partner or family member is considering leaving the relationship), is also important in planning the therapy strategy. Despite who in the relationship is suffering the most, it is the therapist's duty to be sensitive to the needs of all patients involved.

Group Therapy

Group therapy was first introduced in 1905 by American internist Joseph A. Pratt, who developed this therapy technique for patients suffering from tuberculosis (an infectious lung disease) so they could share concerns and support one another. The concept gained popularity through the 1930s, and in 1948 the American Group Psychotherapy Association was formed.

Before entering group therapy, the interested patient meets with the group therapist so the therapist can get to know the patient and learn his background, and the patient can get a feel for what the group sessions will be like. Groups usually meet once a week for one to two hours. (Groups meeting within a larger institution gather for shorter periods, however, because persons in these facilities are often severely disturbed and cannot focus for long periods of time.)

Once in the group meeting, the hour begins either with one person opening the conversation or with an opening from the therapist. Much less involved than in other therapy forms, the group therapist acts more as mediator, referee, and time clock than anything else. What is important is to get group members to interact among themselves in a constructive manner. Sometimes all members of the group participate, sometimes not, depending on the topic or group members' attitudes that session.

The dynamics of group therapy sessions are in themselves part of the healing process for a patient. Often patients can learn about themselves

through other patients' experiences. Also, social pressures are at their strongest in these sessions. For example, the therapist's suggesting that patient A is acting aggressive is more believable to that patient if patients B, C, and D agree with the therapist. It is also comforting for many patients to be engaged with those who are sharing their problems and life upheavals.

For many people, group therapy is just as effective as individual therapy. Researchers have found that since one's personality is based primarily on interactions with others, therapists can learn about the patients in a group therapy session by observing their interactions with other patients. Treatment, then, for one patient in the group can be based on the therapist's observations of that patient during the group session.

Support Groups

Created out of a need to educate and protect, a support group exists as a way to help people afflicted with the same or similar problems and conditions in a group setting. Countless support groups have surfaced in recent years. Some are not as serious as others, but many have enlightened and provided support for hundreds of thousands of people.

ALCOHOLICS ANONYMOUS (AA). Based partly on the studies of cognitive therapists and techniques of rationalemotive behavior therapy (REBT), Alcoholics Anonymous (AA) has provided help to millions of people who suffer from alcoholism. AA is based on a twelve-step program for restructuring one's life as an addict; in these twelve steps addicts admit to, come to terms with, and hopefully conquer their addictions. AA also acts as a comforting support network for alcoholics and recovering alcoholics in the effort to become, and stay, clean and sober.

AA and the twelve-step program paved the way for numerous substance-abuse or other kinds of support groups, such as Narcotics Anonymous, Gamblers Anonymous, Overeaters Anonymous, and Bulimics Anonymous. Offshoot support groups, such as Al-Anon, for alcoholics' loved ones, have also developed for the families, partners, and friends of addicts. (See Chapter 14: Habits and Behaviors, for more information on AA.)

Key ring with the inscription "A Day at A Time," given to recovering alcoholics at Alcoholics Anonymous as a symbol of their continuing recovery. (Photograph by

Robert J. Huffman. Field Mark Publications

. Reproduced by permission.)

Both the support and offshoot support groups can be very helpful for those battling addictive behaviors, whether it is the addicts or their families and friends. As with so many other therapy forms and techniques, joining a support group requires dedication, time and patience.