With hundreds of therapy approaches described on online therapy sites like eTherapi or PsychologyToday, it can be hard to decide what’s best for us and to schedule that first appointment with a therapist.
In this article we mean to explain the “fundamental” types of therapy from which pretty much all the others derived, and to explore how online therapy can support therapists and patients.
Psychoanalysis is a rigorous and long-term probing to understand unconscious memories, thoughts and fears having their origins in our earliest years of development. Understanding these repressed internal clashes helps us break away from them. Instead of living the past again and again, we are free to put our energy into a healthier present.
To get at these hidden painful thoughts, therapists may use techniques as dream tracking and free association of thoughts. He or she also may use the therapist-client relationship to surface patterns around how we reacted to a critical earlier figure, such as a parent.
Behavior therapy addresses specific behavior in the present rather than inner conflicts or past traumatic events.
The therapist may help us safely increase our exposure to the cause of our fear. This doesn’t have to be the actual object of the fear right away, but may include imagining such object. The therapist then helps the patient relax. In this way, we gradually learn to overcome our fear.
This approach discourages undesirable behavior by “punishment”. At the same time, the therapist works on reinforcing more effective behavior. For example, to help with their habit of biting their fingernails the therapist might prescribe a hand lotion that is particularly distasteful and causes stomach upset. But we are unlikely to stop permanently unless the new behavior has its own incentives.
An example of this approach is behavioral contracting, in which someone closely involved with the therapy (e.g., a teacher, parent, or spouse) and we agree on new behaviors and goals to achieve. The other party’s positive reinforcement helps us shape the new behavior.
This is a technique that trains people to improve their health by controlling, mostly through relaxation and mindfulness techniques, certain bodily processes that normally happen involuntarily, such as heart rate, blood pressure, muscle tension, and skin temperature. Sensors are attached to our body, or in some cases just held in our hands, and measure these processes and display via a monitor. With help from a biofeedback therapist, we can learn to change them.
Cognitive Behavioral Therapy (CBT)
Rather than considering thoughts irrelevant, cognitive-behavioral therapy sees them as “behaviors” and includes them in the process.
CBT is a short-term, goal-oriented therapy modality whose goal is to identify and modify patterns of thinking or behaving that are behind people’s difficulties, so that they change the way they feel. In other words, CBT works by changing our deeper beliefs or attitudes about the world around us.
Humanistic-experiential therapy sees mental health issues as the result of the alienation, lack of purpose, and loneliness that can derive from living in our modern society. The therapist acts mostly as a guide, letting us mainly direct the therapy process.
What Therapy is Right for Me?
Most therapists use a combination of the techniques above and a variety of variations to adapt the the particular circumstances. Today there are tens if not hundreds of therapy “techniques” that the therapist community is proud of.
However, research suggests that the “match” between the therapist and the patient is ultimately more important than the particular strategy used. In fact, studies have shown that the particular approach used in psychotherapy is not as big a factor as the “therapeutic alliance” we form with our therapist. Therapy should feel comfortable to us. And the resulting relationship is what heals.
Studies conducted on online therapy have shown that online therapy can be as effective if not more effective than in person therapy. Most of these studies currently have focused on techniques based on CBT, however experts are optimistic that this applies to other types of therapy as well.
In conclusion, with an increasing amount of research being done on the effectiveness of various online therapy channels (e.g., live video, simultaneous or asynchronous messaging) we don’t see reasons why most of the approaches used by therapists today should not be at least as effective online as they are in person.