Modalities
While I pick up ideas and techniques from clinical experiences, readings, and trainings, I have a number of therapeutic modalities that I rely on in my counseling sessions. Rather than strictly using only one modality in a session, I often dance from one modality to another throughout a session. Here is a list of some of the therapy models I use most often:
Dialectical Behavioral Therapy
Dialectical Behavioral Therapy (DBT) is a comprehensive therapy that focuses on building skills to improve one’s ability to be mindful, to have healthy relationships, to manage emotions, and to get through intense emotions in healthy ways. DBT is specifically for borderline personality disorder and suicidal thinking; however, I find this therapy applicable to nearly everyone and use it to some degree with most of my clients. An assumption behind DBT is that healthy behaviors can be learned with practice, just as any other type of skill can. I don’t know how to change oil on a vehicle, but if someone taught me, and I practiced enough, I bet I could learn how to do it well enough. We all have skills related to mental health and relationships that we didn’t learn growing up, for whatever reason. I use DBT to teach client’s skills that are relevant to their struggles, helping them feel more competent to handle what life brings. DBT also emphasizes finding balance between extremes. For example, this particular spectrum often comes up with my clients during our sessions: one side of the spectrum is focusing on only our own needs. The other side of the spectrum is focusing on only the needs of others. If we get caught at either end of the spectrum, we will run into difficulty. Our goal is to be in the middle range where both our needs and the needs of others matter and to have some flexibility to adjust in situations that come up, rather than being stuck at one spot.
Motivational Interviewing
Motivational Interviewing (MI) is a therapy that focuses on helping people gain the motivation and confidence they need to make important changes in their lives. We all know what it’s like to try to make a change but then to find ourselves losing motivation and giving up prematurely. MI techniques allow me to help clients identify if and what they want to change, which can be anything from reducing substance use to attempting to trust another human being again. MI techniques also help clients identify their specific reasons for whether and how to change, plan ahead for a change, and implement the change at a pace at which they feel confident and comfortable. MI is not about me telling someone else how to live—it’s about empowering people who decide they want to change to recognize that change is possible.
Person-Centered Therapy
Person-Centered Therapy, as its name implies, is all about the client. In this therapy model, the client does most of the talking. My role as the therapist is to actively listen, summarize, clarify, and reflect what the client is saying. My job is to be a mirror to the client, allowing them to understand themselves and their thoughts in a new way. An assumption of person-centered therapy is that the client has all of the wisdom that they need already inside of them. In this open, less-directive therapy, the client is able to take the session wherever they need to, to hear themselves think out loud, and to access their inner clarity and insight.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is one of the most well researched and most often used psychotherapy modalities. CBT can help with a variety of issues including social anxiety, panic attacks, depression, and PTSD. CBT, just as the name implies, focuses on how our thoughts (“cognitions”) are tied to our emotions and actions (“behaviors”). For example, someone having a panic attack might experience the emotion of panic, which could then lead to a thought such as “I am going to die.” This thought would likely lead the person to experience even more intense panic, which would then probably intensify the person’s belief that they are going to die and could eventually lead to a panic attack. We all get caught up in unhelpful thinking patterns, such as in this example. CBT helps increase awareness of these unhelpful patterns and empowers people to find healthier ways of thinking and acting.
Acceptance and Commitment Therapy
Acceptance and Commitment Therapy (ACT) incorporates concepts of mindfulness, acceptance, and commitment to taking action that aligns with one’s values. Mindfulness is defined as present moment awareness with acceptance. Acceptance is learning to see reality as it is, even when it is painful, rather than denying reality. ACT focuses heavily on asking if our responses and behaviors are “working” or not. For example, a person who feels sad may deal with that painful feeling by spending hours getting lost in a social media news feed. ACT would lead me as a therapist to ask that person whether this type of social media consumption is accomplishing the person’s desired goal—in other words, to ask if this behavior is “working” for them. We all at times get caught up in actions and habits that end up working against us. The concept of committed action entails taking steps towards what matters most to someone (i.e., what that person values), rather than getting swept away in emotions or thoughts that lead them away from what they want. For example, if a person values human connection but does not go to social gatherings due to fear, ACT techniques may help that person “de-fuse” themselves from that fear. The fear doesn’t necessary disappear, but the person learns to distinguish themselves and what they want from the fear that they are experiencing. ACT shows that someone doesn’t have to be happy all of the time in order to have a good life, because living life in alignment with one’s deep values leads to a life of meaning and fulfillment.
Eye Movement Desensitization and Reprocessing
Eye Movement Desensitization and Reprocessing (EMDR) is often used to treat post-traumatic stress disorder (PTSD), but EMDR has also been used to address a variety of other challenges, such as anxiety. One of the distinguishing features of EMDR is its use of bilateral stimulation, such as eye movement, to process memories, emotions, and body sensations. I have been trained in EMDR and have completed my required EMDR consultation hours through the EMDR Institute. Some therapists consider themselves EMDR therapists in that EMDR is a primary modality that they use with clients. I tend to be more eclectic in my therapy approach in that I use EMDR but also rely on a number of other modalities and approaches. More information about EMDR can be found at https://www.emdria.org/about-emdr-therapy/
Collaborative Assessment and Management of Suicidality
Collaborative Assessment and Management of Suicidality (CAMS) helps people who face suicidal thinking address the issues that are causing them to be suicidal, enabling them to work toward a life worth living. A key component of CAMS, as its name shows, is collaboration between the therapist and client. When I use CAMS, I work hard to show empathy to the person who is considering taking their own life, rather than chastise them for their suicidal thoughts. Everyone is different in what drives them to be suicidal. In CAMS, we identify the unique “drivers” that cause that person to be being suicidal, and we together create a plan for how to address them. People often find a sense of relief at being able to articulate both what is causing them to be suicidal and what they need to change in their life for them to no longer be suicidal. Once we have clearly established this, we take action to make these changes happen.
Written Exposure Therapy
Written Exposure Therapy (WET) is an evidence-based therapy for treating post-traumatic stress disorder (PTSD). WET is a therapy I can use with those who are interested in processing past trauma. It is a brief therapy, intended to last about five sessions. During these sessions, the client spends 30 minutes per session writing about a traumatic experience that they want to work through. During the 30 minutes of writing, I am in the room and available if the client needs me, but I typically don’t initiate conversation with the client while they are writing as not to disrupt their work. After the writing portion of the session has finished, I talk with the client about their writing experience and work with the client to feel calm and present before they leave the session. Some people prefer this therapy over other PTSD therapies due to being able to write about the trauma rather than describe it out loud. Many people find relief from completing WET and find that they feel more in control of their lives, rather than feeling as if the traumatic memories control them. Many people also experience a reduction in PTSD symptoms after completing this therapy.