Therapeutic Modalities

Therapeutic Modalities

For anyone interested in knowing more about some of the therapeutic modalities I use, I provide the following brief summaries.

Cognitive-behavioral therapy, psychodynamic therapy, and humanistic therapy are three broad therapy traditions that encompass many specific approaches and modalities. Cognitive-behavioral therapy works with maladaptive thought patterns that contribute to emotional distress and dysfunctional behaviors. By identifying negative, inaccurate or unhelpful thought patterns – ranging from surface thoughts to deep beliefs about oneself or the world – and transforming them into more positive and adaptive perspectives, a person’s mood and behavior both improve. While cognitive-behavioral therapy can be a powerful method of relieving many psychological symptoms, I find that it works best when combined with other methods. Psychodynamic therapy aims to identify and explore thoughts, feelings, meanings and motivations – often rooted in childhood experiences and often unconscious – that underlie presenting problems, and to resolve conflicts among those motivations. It also includes a focus on the interpersonal relationship between client and therapist. Humanistic therapy differs from cognitive-behavioral and psychodynamic approaches by a focus on the here-and-now of the client’s experience, a belief in the client’s inherent capacity and drive to heal and grow, and an emphasis on the client’s free will, self-determination, search for meaning, and fundamental goodness. The specific therapeutic modalities summarized below are all humanistic therapies.

Hakomi Experiential Therapy

Hakomi is an experiential and somatic approach to psychotherapy. Through the study of present-moment experience in mindfulness, conflicts organically resolve, maladaptive patterns shift, and resources are identified and strengthened.

The Hakomi experiential approach helps bring about awareness of “core material”. Core material are beliefs, emotions, memories, images and action tendencies, often formed in childhood, that shape us, organize our experience, and define our way of relating to ourselves and the world. Core material may relate to deep existential themes such as safety, self-worth, feeling loved, belonging, power and freedom. Hakomi often works somatically, by focusing on sensations, tensions, movements and gestures, and using those bodily events as access routes to core material. However, Hakomi can easily be adapted work with non-somatic channels of experience, for clients who are less drawn to a somatic approach.

Re-Creation of Self

Re-Creation of Self (R-CS) is both an innovative a model of the self, and a method for finding relief from painful feelings, negative thought patterns and limiting behaviors by shifting into preferred states of consciousness. R-CS is premised on the idea that each person has an “ideal self” that perfectly expresses that person’s unique individuality. When connected with this ideal self, one feels whole, solid, confident and capable, clear about one’s wants and needs, free to pursue those wants and needs, connected to others, fulfilled and alive.

On the other hand, according to the R-CS model, we often lose access to our ideal self and instead come to embody more limiting self-states – states in which we may feel anxious, depressed, hurt, upset or troubled in a myriad of ways, or engage in rigid and self-defeating behavioral patterns. The R-CS model holds that these limiting self-states developed when our genuine self-expression was blocked in some way, typically during childhood. For example, a child who is repeatedly criticized by his parents, may develop a wounded self-state that carries the pain of rejection. In addition, the child may develop a protective self-state that engages in behavioral strategies intended to prevent a re-occurrence of the original pain of rejection – for example, avoiding challenging situations or becoming overly critical of others.

R-CS offers effective and easily learned techniques for shifting out of these limiting self-states and back into one’s ideal self. This involves developing moment-to-moment awareness of one’s various self-states, noting one’s preference for some states over others, making a conscious choice to shift into the preferred states, and practicing making that shift until solidly anchored in one’s ideal self. Unlike many other psychotherapeutic approaches, R-CS focuses less on exploring and healing old wounds and more on developing the capacity to shift directly into one’s preferred self-states. Doing so is easier than one might at first expect because the ideal self already exists within – although it may take some time and practice to stabilize this new experience.

EMDR

Eye movement desensitization and reprocessing (EMDR) is a psychotherapeutic method for treating symptoms resulting from traumatic experiences. Traumas include life threatening and other severely stressful events such as accidents, assaults and physical or sexual abuse. Traumas also include less severe events that nonetheless undermine a person’s sense of effectiveness, confidence and self-esteem – such as being teased and humiliated, or ignored and neglected. Traumas may give rise to symptoms including flashbacks, nightmares, dissociation, anxiety, depression, distressing emotions, loss of self-esteem and self-confidence, and many others.

The theory behind EMDR is that traumatic events overwhelm the brain’s normal ways of coping, such that the memories of the events are not adequately processed. As a result, unprocessed memories of traumas get locked in their own “memory networks,” which are activated by present-time reminders of the traumatic events. When this happens, the emotions, sensations and beliefs associated with the original traumas are re-experienced as if they were happening in the present.

During EMDR treatment, the client is invited to focus on a traumatic memory, or on a present-time situation that activates the trauma, and then to free associate, under the therapist’s guidance, to other memories, thoughts, feelings and images. At the same time, the therapist applies “bilateral stimulation” by directing the client to move his or her eyes from side to side, by gently tapping on the client’s knees, or by using a device with headphones and paddles that emit tones and vibrations bilaterally.

EMDR works by activating and enhancing the person’s natural information processing system, which forms associations between traumatic memories and more adaptive information contained in other memory networks. Once traumas have been processed and integrated in this way, the person is able to recall traumas without experiencing distress, to make sense of the past, and to develop a positive view of the self and a positive expectation of the future. While EMDR was originally developed to treat post-traumatic stress disorder, it has been shown effective with a wide range of issues and problems.

Brainspotting

Brainspotting is a newer psychotherapeutic method for treating trauma that evolved out of EMDR, and is based on the discovery of a relationship between where we focus our eyes and what happens inside our brain.

During Brainspotting, like EMDR, the client is invited to free associate, under the therapist’s guidance, while a trauma is activated. “Bilateral stimulation” may also be used. Unlike EMDR, Brainspotting uses one or more specific eye positions (also referred to as “brainspots”) to help access traumas and make them available for processing. The therapist and client work together to discover these eye positions, by scanning the visual field and noticing eye positions that carry a stronger emotional charge.

Some therapists find that Brainspotting is more flexible in its use and relies more on the therapist’s attunement to the client. I find both EMDR and Brainspotting highly effective in working with trauma, and I help each client choose the method that works best for him or her.

Somatic Psychotherapy

Somatic psychotherapy refers to a wide range of therapeutic modalities that share a common belief that our embodied self is an integral part of who we are, and that our sense of identity and our emotions, motivations and ways of being in the world all have somatic counterparts. We experience our embodied self subjectively when we pay attention to sensations in our bodies, and we express our embodied self outwardly through our posture, gestures and movement patterns.

I integrate somatic work with the other modalities I use, in a way that is tailored to the particular needs of each client. For some clients, their embodied experience is an important channel of experience that both provides access to deeper material, and also helps identify, strengthen and create resources for change. For other clients, different channels of experience (for example, visual imagery, or emotions not felt in the body) are more important, and with those clients I work less somatically. When I do work somatically, I guide clients to become aware of their internal bodily experience, and I also track what clients communicate non-verbally through their bodily expressions.

Emotion-Focused Therapy

Emotion-Focused Therapy (EFT) is an approach that recognizes and makes use of the intelligence and adaptive function of emotions. For those with difficulty accessing emotions, EFT can help deepen the awareness and expression of emotions, and to tap their inherent wisdom. For those bothered by distressing emotions, EFT can help one learn to regulate and transform emotions.

EFT distinguishes between adaptive and maladaptive emotions. Adaptive emotions are those that help one assess and make sense out of a present situation and to guide action. Maladaptive emotions, by contrast, are old and repetitive emotions rooted in painful or traumatic experiences that make one feel helpless, inferior, unworthy, overwhelmed or wounded. The beauty of EFT is that it changes emotion with emotion – the person’s own adaptive emotions are evoked and tapped in order to undo, replace or transform maladaptive emotions. For example, maladaptive fear may be transformed by accessing and expressing empowering anger, or maladaptive shame may be transformed by healthy pride.

Emotionally Focused Couple Therapy 

Like EFT for individuals (with which it shares theoretical roots), Emotionally Focused Couple Therapy is experientially based and recognizes the positive adaptive function of emotional responses and needs. It also recognizes that couple conflicts often result from unmet attachment needs.

Emotionally Focused Couple Therapy helps resolve couple conflict and dissatisfaction in two key ways – first, by accessing and reprocessing the emotional experience of each partner; and, second, by identifying negative interactional patterns and creating new interactional patterns that reinforce a secure attachment bond, increase trust, and allow the partners to rely on each other as a source of comfort, protection and connection.

Character Theory

Character theory is a model for understanding how a person’s sense of self and basic way of coping in the world are formed through a complex interplay between one’s instinctual and existential needs and the environment’s response to those needs. Becoming aware of one’s character strategies can facilitate deeper self-understanding and increased freedom and choice.

In this model, each person has one or more dominant character styles, formed in early childhood and often representing creative and adaptive strategies for dealing with challenging environments. Different character theories posit different character styles – in the psychoanalytic tradition they include schizoid, depressive, histrionic and obsessive-compulsive styles, among others; and in Hakomi’s depathologized classification they include containing, self-relying, expanding, attracting and several other styles. A person’s character strategies are important resources that often serve one well, but at times psychological or interpersonal problems may result when a character style becomes rigid or overgeneralized.

When working clinically, focusing attention on character strategies can sometimes be helpful. An “aha” moment may happen when a person first becomes aware of a dominant character style. This self-awareness entails more choice, particularly if a character style has become rigid in its application.

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