Therapy Modalities @ TPC

Psychotherapy is often a term many of us are familiar with yet unsure about. With a myriad of different modes of therapy out there, which one is best suited for us? The answer is: There is no one unique form of psychotherapy that is administered exclusively for anyone. Instead, psychologists tend to utilise a combination of therapy modalities to further aid you in your mental health journey. 


What is Psychotherapy? 
Psychotherapy is a broad umbrella term that encompasses a wide selection of different therapy modalities, ranging from the more prototypical talk therapies - cognitive-behavioural, interpersonal - to other uncommon forms therapy such as hypnotherapy (The American Psychological Association, 2020). More importantly, the core feature of psychotherapy is the concept of collaborative treatment based on the relationship between the client and the psychologist. Through such scientifically validated procedures, psychotherapy aims to provide clients with a supportive environment so as to aid individuals in developing healthier mindsets and habits.


Different Types of Psychotherapy:

While psychotherapy is usually grounded in dialogue, there are other unconventional modes of psychotherapy available. Here is a list of different types of psychotherapy offered by our clinic. 

• Cognitive-Behavioural Techniques
  
• Mindfulness 
  
• Play and Art as Therapy 
  
• Life Coaching
  
• Family and Relationship Counselling
  
• Applied Behavioural Analysis Techniques 
  
• Eye Movement Desensitization and Reprocessing (EMDR) 
  
• Hypnotherapy
  
  

Cognitive-Behavioural Technique (CBT):

Cognitive-Behavioural Therapy, the “archetype” of psychotherapy, is one of the most well-known forms of therapy. In a nutshell, this therapy aims to modify unhealthy thinking patterns and change perceptions. It has been found to be especially effective for patients facing depression, anxiety, eating disorders, drug use problems, relationship issues and severe mental illnesses. Additionally, there has been empirical evidence demonstrating the effectiveness of CBT.

CBT treatment usually involves strategies that attempt to alter thinking patterns as well as behavioural patterns. Not all strategies would be utilised, rather each treatment strategy would depend on the client as well as the psychologist.

Thinking Pattern Strategies include: 

• Learning to recognize one’s distortions in thinking that are creating problems, and then to re-evaluate them in light of reality. 
  
  
• Gaining a better understanding of the behavior and motivation of others. 
  
  
• Using problem-solving skills to cope with difficult situations. 
  
• Learning to develop a greater sense of confidence is one’s own abilities. 
  
  

Behavioural Pattern Strategies include: 

• Facing one’s fears instead of avoiding them 
  
• Using role playing to prepare for potentially problematic interactions with others. 
  
• Learning to calm one’s mind and relax one’s body
  
  

As the name suggests, in CBT there is an interaction between the psychological triad of Cognition, Behaviour and Affect.

The first aspect of the triad, Affect refers to a person’s temperament, conditioning and personality. While Behaviour refers to one’s reinforcement history and previous consistencies. Lastly, Cognition refers to a person’s selective perceptions, thinking styles, available beliefs, self-concepts, attributions and information (Sheldon, 2011)

CBT thus encourages clients to empirically test out their fears or avoidance reactions and promotes an analysis of emotions, their circumstantial triggers, and the various consequences on thinking and behavioural patterns (Sheldon, 2011).

Mindfulness:
Mindfulness simply put, is the attempt to incorporate skills into clients which allow them to be aware of any physical, mental and emotional condition in the present moment without becoming judgemental. Although bearing some links to Zen Buddhism and Roman Catholicism, Mindfulness in a clinical setting is usually free from any kind of religious connotations (IMH, 2021). 

While psychology tends to be concerned with the content of consciousness, mindfulness on the other hand is more concerned with consciousness itself. Being mindful allows well-used thought patterns, beliefs and behaviours to become much more salient. This allows us to be more conscious of our thoughts and emotions - be it comfortable or uncomfortable - as well as enable us to gain an awareness that we are given the choice to choose an action that is perhaps more in line with our values.

Through Mindfulness training, we are thus paying more confident and thorough attention to the lifeworld (mindfulness and clinic). We are also increasing awareness of any thoughts, feelings and actions that hinder our mental health progress. Consequently, this would enable us with the ability to better engage those aspects of ourselves. 
 The Institute of Mental Health has also provided some steps for individuals who wish to engage in mindfulness without the help of a trained therapist. The following steps would guide you in practicing mindfulness of your breath. Do consult a specialist if you experience any discomfort of distress (IMH, 2021).

Play and Art as Therapy: 
   
Play and Art Therapy is often used amongst psychologists to help facilitate the exploration of emotions, development of awareness and to help cope with stressors. This form of therapy is usually differentiated amongst children and adults. Although stereotypically defined as a form of therapy that caters specifically to children, play and art also serves a medium for older individuals to express themselves in a more comprehensive manner. 

Play and Art for Children
Play during therapy is a more natural medium of communication for children than verbal communication. It is a healing and growth process that children are able to use naturally and independently. Through Play and toys, a symbolic connection is established between the child’s sensory-motor handling of concrete objects and something else the child might have experienced directly or indirectly (Landreth, 2002). This familiar medium would thus greatly aid in the child’s therapeutic self-expression, allowing them to express themselves more fully and directly through self-initiated, spontaneous play. (Cochran, 1996).

In contrast, Art therapy utilises art materials to help a child symbolically work through confusions, anxieties and conflicts. While Play therapy uses a variety of toys and other materials, Art therapy like its namesake, uses art materials instead. By integrating visual arts into psychotherapy, one can dilate the rational conceptions we typically harbour with regards to the human experience. Like play therapy, it probes the child to communicate through mediums they may be more familiar with as opposed to the conventional method of talking.

The utilisation of verbal therapy would restrict the child’s ability to communicate. Thus Play and Art would allow the therapist to go to a child’s level of communication and interact with them, rather than the child accommodating the adult. A therapeutic working relationship through Play and Art would thus aid the child in expressing feelings and attitudes that might have been inaccessible at a verbal level (Landreth, 2002).


Play and Art for Adults

While Play Therapy is primarily used for children, through the use of creative techniques such as drawing, painting, collage, coloring or sculpting in Art Therapy, adults are also provided with a medium to better communicate and understand their emotions. It may also help in improving self-esteem, managing addictions, relieving stress, improving symptoms of anxiety and depression, as well as coping with a physical illness or disability (Psychology Today, n.d.). Other than being used as a stand-alone form of therapy, art therapy can also be used in combination with other types of therapy based on the psychologist’s discretion.


   
Life Coaching:

Life Coaching is where the therapist encourages clients to be the best version of themselves. This can entail improvements in one’s personal lives as well as working lives. According to the IGCP of the Australian Psychological Society, coaching psychology is “the systematic application of behavioural science to the enhancement of life experience, work performance and well-being for individuals, groups and organizations who do not have significant mental health issues or abnormal levels of stress” (Nelson-Jones, 2007). Life coaching can thus help in developing personal goals, adjusting into a major life transition, and seeking professional advice. 

Life Coaching is a technique that can be applied to anyone of all ages and from all walks of life. It can be administered at various stages of life, and coaching can cover all dimensions of life, such as career/life purpose, family and friends, finances, romance/intimacy, health/self care, social/fun, personal/spiritual development and physical environment.

Life Coaching has its roots in Cognitive-Behavioural Psychology and Humanistic Psychology. Its methods and strategies may vary from client-to-client depending on each individual’s circumstance. It can involve helping a person to learn a skill for the first time, helping them maintain and improve existing skills and assisting them to weaken and possibly stop exhibiting unwanted skills. It can be conducted in various settings, with individuals, couples, groups and in classrooms. It is imperative we realise that life-coaching focuses on seeking mental-wellness rather than overcoming a specific mental illness (Nelson-Jones, 2007).

Family and Relationship Counselling:
This form of therapy aims to help correct or address any behaviours that may be affecting the family. This usually involves addressing relationships between family members and the family unit as a whole (Psychology Today, n.d.). It also aims to address a broad range of clinical issues and relational problems.

Here therapists can help clients to understand issues and conflicts in relationships, providing your family with a safe and open environment to air your concerns, consequently enhancing your communication skills and familial bond. Compared to the predominant individualistic approach in most fields of clinical psychology, family and relationship therapy adopts a systemic relational approach (American Psychological Association, n.d.) .
In Marriage or Couple counselling, the therapist will meet both partners together before meeting with each individual separately. The same goes for Family counselling where the session would start off with meeting the entire family before meeting separately with individual family members. Therefore during the first session,  the therapist would aim to get a sense of the family/relationship dynamics (Psychology Today, n.d.). 


Applied Behavioural Analysis Techniques (ABA):

ABA (also known as behaviour modification and learning theory) is an approach to early intervention treatment which systematically applies a range of interventions based on learning theory principles (Maglione et al., 2016). It aims to improve specific behaviours such as social skills, communication, reading, and academics as well as adaptive learning skills, such as fine motor dexterity, hygiene, grooming, domestic capabilities, punctuality and job competence. It is also commonly used as a therapeutic intervention for individuals with autism (Psychology Today, n.d.).

ABA seeks to help clients identify self-destructive and unhealthy behaviours. This form of therapy may help children with attention/disciplinary issues as well as adults who exhibit any unhealthy behaviours. It has been shown to increase useful behaviours such as communication and social skills through various reinforcement procedures. It has also helped to reduce negative behaviours such as self-harm (Maglione et al., 2016).

By evaluating a client’s behaviour, the therapist develops treatment plans to help improve the communication and behaviour necessary for clients to function and achieve success in their personal and professional lives. The length of time ABA is administered differs for each individual and depends on the severity of the problem as well as individual rate of improvement (Psychology Today, n.d.).

Listed below is what one can typically expect in an ABA session:
1. Determine what behaviours require change
2. Set goals and expected outcomes
3. Establish ways to measure changes and improvements
4. Evaluate where you are now
5. Learn new skills and/or learn how to avoid negative behaviours
6. Regularly review your progress
7.Decide whether or not further behaviour modification is necessary 


Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is another psychotherapy treatment  that differs from conventional talk therapy which aims to alleviate distress associated with traumatic memories. This is done by attempting to activate the client’s own natural healing processes by recalling distressing events without being invasive. Through EMDR therapy, affective stress is relieved, negative beliefs are reformulated and physiological arousal is reduced. It has proven to be effective for clients suffering from Trauma, anxiety and panic.


EMDR therapy is conducted in Eight Phases. By focusing on past disturbing memories and related events, current distressing situations, one hopes to develop the skills and attitudes needed for positive future actions. EMDR therefore involves dealing with 3 time periods: the past, present and future. Each individual’s treatment length differs according to the number of traumas as well as the age of PTSD onset.

Listed below is a brief summary of how the eight phase treatment approach is conducted:

Phase 1: The client and therapist would first work together to identify possible distressing memories and current situations that cause emotional distress. This may also include related incidents in the past.

Phase 2: The therapist then imparts certain techniques such as a variety of imagery and stress reduction techniques to help the client handle emotional distress. This is to ensure that the client maintains equilibrium during and between sessions.

Phase 3 - 6: During these phases, the client is required to identify 

1. The vivid visual image related to the memory 
   
2. A negative belief about self 
   
3. Related emotions and body sensations 
   

Through bilateral stimulation (eye movements, taps, or tones) the therapist would then assess how distressed the client is. If there is no distress related to the target memory, the client would then attempt to focus on a positive belief during the next set of distressing events.

Phase 7: In this phase, a log is given to the client to document any related material that may arise. This serves as a reminder for the different self-calming activities mastered in phase 2.

Phase 8: In this phase, the progress made thus far would be examined.

If you would like to find out more about EMDR in detail, contact us and let's talk about it!

Hypnotherapy: 

If one were to come across the terms Hypnotherapy of hypnosis, one might automatically be inclined to think of the gentle swaying of a pocket watch and the snapping of fingers which would cause one to fall asleep immediately. These fallacies and misconceptions can be traced back to hypnosis as portrayed in popular culture. Hypnotherapy however, can be simply summarised into an intervention technique to tap into an individual's subconscious mind. Through the use of hypnosis - a state of relaxation, confusion or concentration in which the conscious mind becomes remote or detached from everyday care and concerns - one is able to focus on different aspects of their personal self that they wish to change. This induced state of relaxation also makes one more receptive to suggestion.

Contrary to popular belief, trance induction is induced by the individual rather than the hypnotist, this makes it impossible for a trance to be induced against a person’s will. Thus the therapist here acts as a facilitator more than anything. The aim is to gently pinpoint problems the patient may be facing and to employ behavioural modification via hypnosis to elicit beneficial and therapeutic resolutions. It is important to note that the effectiveness of hypnotherapy is largely dependent on the client’s own willingness and motivation to alter any unhealthy behaviours (Mackereth, 2010).

Listed below are just some of the issues hypnotherapy can help with:

• Phobias
  
• Anxiety 
  
• Addiction 
  
• Obsessive-Compulsive Disorder
  
• Trauma
  
• Depression
  
  

Other non-mental health benefits include (Mackereth, 2010): 

• Reduced Heart Rate Variability
  
• Increased Quality of Life
  
  
• Feasible intervention for acute and chronic pain
  
• Better irritable bowel syndrome (IBS) management 
  
  

There are therefore a wide array of psychotherapies available depending on each client’s situation and need. Despite the negative stigma surrounding psychotherapies and clinical help, these interventions have proven effective in alleviating distress, unhealthy behaviours and mindsets. Thus, if you ever feel the need to seek help, do not hesitate. Regardless of what society propagates, mental health should be a priority.

References

American Psychological Association. (n.d.). Couple and Family Psychology. American Psychological Association. Retrieved May 6, 2021, from https://www.apa.org/ed/graduate/specialize/family
American Psychological Association. (2020, July 31). Understanding psychotherapy and how it works. American Psychological Association. https://www.apa.org/topics/psychotherapy/understanding
Childs, D. (2011). Mindfulness and clinical psychology. Psychology and Psychotherapy, 84(3), 288-298. https://doi.org/10.1348/147608310X530048 
Cochran, J. L. (1996, March). Using Play and Art Therapy to Help Culturally Diverse Students Overcome Barriers to School Success. The School Counselor, 43(4), 287-298. https://www-jstor-org.libproxy1.nus.edu.sg/stable/23900917?seq=1#metadata_info_tab_contents
Landreth, G. L. (2002). Play Therapy: The Art Of The Relationship. Brunner-Routledge.
Mackereth, P. A. (2010). Integrative Hypnotherapy: Complementary Approaches in Clinical Care (A. Cawthorn, Ed.). Churchill Livingstone Elsevier.
Maglione, M. A., Kadiyala, S., Kress, A. M., Hastings, J. L., & O'Hanlon, C. E. (2016). TRICARE Applied Behavioural Analysis (ABA) Benefit: Comparison with Medicaid and Commercial Benefits. RAND Corporation. https://www.jstor.org/stable/10.7249/j.ctt1b67wmj
Nelson-Jones, R. (2007). Life Coaching Skills: How to Develop Skilled Clients. SAGE Publications Ltd. http://sk.sagepub.com.libproxy1.nus.edu.sg/books/life-coaching-skills
Psychology Today. (n.d.). Applied Behavior Analysis. Psychology Today. Retrieved May 6, 2021, from https://www.psychologytoday.com/sg/therapy-types/applied-behavior-analysis#:~:text=Applied%20Behavior%20Analysis%20(ABA)%20is,%2C%20punctuality%2C%20and%20job%20competence.
Psychology Today. (n.d.). Art Therapy. Psychology Today. Retrieved May 5, 2021, from https://www.psychologytoday.com/sg/therapy-types/art-therapy
Psychology Today. (n.d.). Marriage and Family Therapy. Psychology Today. Retrieved May 6, 2021, from https://www.psychologytoday.com/sg/therapy-types/marriage-and-family-therapy
Sheldon, B. (2011). Cognitive-Behavioural Therapy: Research and practice in health and social care. Routledge.