Do You Know Your CBT from Your ACT? New York's Many Flavours of Therapy.

Do You Know Your CBT from Your ACT?

 New York's Many Flavours of Therapy

 In places such as New York, where psychotherapy is relatively mainstream and people may see a therapist for anything from a specific problem to personal growth, there is a very broad range of therapeutic approaches. The main differences are in how they understand psychological problems and what happens during sessions.

Main psychotherapy methods

Method	Basic idea	What sessions tend to involve	Particularly associated with
CBT – Cognitive Behavioural Therapy	Thoughts, feelings and behaviours reinforce each other	Identifying unhelpful thinking patterns and changing behaviours; often includes exercises/homework	Anxiety, depression, phobias, OCD, insomnia
Psychodynamic therapy	Current difficulties can be influenced by unconscious patterns and earlier relationships	Talking openly about relationships, emotions, recurring patterns and the therapeutic relationship	Relationship problems, depression, self-understanding
Psychoanalysis	A deeper exploration of unconscious processes and formative experiences	Frequent, often long-term sessions; free association and exploration of dreams/relationships	Long-standing emotional and personality patterns
Humanistic / Person-Centred therapy	People have an inherent capacity for growth when given an accepting environment	Therapist provides empathy, acceptance and non-judgmental listening	Self-esteem, life transitions, personal development
Gestalt therapy	Greater awareness of one's present experience can produce change	Exploring emotions, bodily sensations and interactions in the "here and now"	Emotional awareness, relationships, personal growth
ACT – Acceptance & Commitment Therapy	Psychological flexibility is more useful than trying to eliminate uncomfortable thoughts	Learning to accept difficult internal experiences while acting according to personal values	Anxiety, depression, chronic stress, behavioural difficulties
DBT – Dialectical Behaviour Therapy	Emotional regulation and acceptance can be developed as practical skills	Skills training in mindfulness, distress tolerance, emotional regulation and relationships	Severe emotional dysregulation, self-harm, borderline personality disorder
EMDR	Distressing memories can be processed differently so they become less emotionally disruptive	Therapist guides attention while the client recalls traumatic material, often using bilateral stimulation	PTSD and trauma
Trauma-focused therapy	Psychological symptoms may be consequences of traumatic experiences	Processing traumatic memories and developing safety/emotional-regulation skills	PTSD, abuse, accidents and other trauma
Schema therapy	Deeply established emotional/behavioural patterns ("schemas") can originate in childhood	Identifying and changing persistent patterns in relationships and self-image	Personality difficulties and long-standing problems
Internal Family Systems (IFS)	The mind can be understood as containing different "parts" with different roles	Exploring different internal parts and developing a more compassionate relationship with them	Trauma, anxiety, self-criticism and personal development
Interpersonal Therapy (IPT)	Psychological symptoms are closely connected to relationships and life changes	Working on grief, conflict, role transitions and interpersonal relationships	Particularly depression
Couples / relationship therapy	Relationship dynamics can be changed rather than treating one individual in isolation	Structured communication, conflict resolution and exploration of relationship patterns	Couples and long-term relationships
Family therapy	Problems can be maintained by patterns within a family system	Family members work together to change communication and interaction patterns	Family conflict, children/adolescents
Mindfulness-based therapies	Developing non-reactive awareness can change one's relationship with thoughts and emotions	Meditation, attention exercises and cognitive/behavioural techniques	Stress, anxiety, depression and relapse prevention
Existential therapy	Psychological distress can arise from questions of meaning, freedom, responsibility, mortality and identity	Philosophical and personal exploration rather than a highly structured treatment programme	Life transitions, meaning, identity and existential concerns

A useful way of understanding the New York model

The important point is that "seeing a therapist" doesn't necessarily mean receiving one particular type of treatment.

A New Yorker might see a:

• CBT therapist for anxiety or panic attacks.

• Psychodynamic therapist once a week for several years to understand recurring relationship patterns.

• Psychoanalyst several times a week for intensive long-term work.

• Trauma therapist following a traumatic experience.

• Couples therapist to deal with relationship difficulties.

• Executive/life therapist to deal with career, relationships, stress and major life decisions.

• Psychiatrist if medication or formal psychiatric assessment is required.

• Therapist who combines several approaches, which is extremely common.

There is also a significant distinction between psychotherapy and psychiatry. A psychotherapist generally provides talking/behavioural therapy, whereas a psychiatrist is a medical doctor who can diagnose psychiatric conditions and prescribe medication. Some psychiatrists also provide psychotherapy.

The "New York therapy culture"

New York is an interesting example because therapy has become relatively normalised as part of ordinary life, rather than being seen exclusively as treatment for serious mental illness.

Consequently, people may seek therapy for:

Clinical problems

• Depression

• Anxiety

• Panic

• OCD

• PTSD

• Eating disorders

• Addiction

• Personality disorders

Life problems

• Divorce

• Bereavement

• Career problems

• Family conflict

• Dating and relationships

• Parenting

• Relocation

• Burnout

Personal development

• Self-confidence

• Understanding one's behaviour

• Improving relationships

• Finding meaning

• Managing ambition and stress

• Understanding childhood experiences

• Becoming more emotionally self-aware

That produces an important spectrum:

Medical/clinical treatment ←→ psychological problem-solving ←→ self-understanding ←→ personal growth

And different therapeutic schools occupy different positions along that spectrum.

One particularly important distinction

The approaches can broadly be divided into three styles of intervention:

1. "Let's change the problem."
CBT, DBT, ACT and some behavioural therapies tend to be relatively practical and skills-oriented.

2. "Let's understand the problem."
Psychodynamic therapy, psychoanalysis and schema therapy spend considerably more time investigating why someone thinks, feels and behaves as they do.

3. "Let's develop a different relationship with the problem."
Humanistic, existential, mindfulness-based, ACT and some IFS approaches may focus less on eliminating an unwanted thought or emotion and more on developing awareness, acceptance and psychological flexibility.

In practice, modern therapists frequently integrate several of these approaches rather than adhering rigidly to one school.

From a business/market perspective, the New York model is also interesting because it has effectively created a large consumer market around psychotherapy—ranging from conventional clinical treatment through to relationship therapy, executive coaching and personal development.