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Whether you’re new to therapy, or feeling like you need to make a change in your therapy, learning about different therapeutic modalities is helpful information to guide you in choosing the kind of therapeutic intervention that would best help you on your journey.
What is a Modality?
A modality is a technique, or particular set of tools, used by a therapist to help clients reach their goals. Some of the most trusted modalities are those which are evidence-based, meaning the theory behind the modality is backed by rigorous scientific research that shows consistent outcomes. Let’s take a look at some of the most widely-used evidence based modalities.
Cognitive- Behavioral Therapy:
Cognitive-Behavioral Therapy or CBT is a modality that focuses on the relationship between thoughts, feelings and behaviors. A CBT therapist will be interested in effecting behavioral change through reframing thoughts and correcting “cognitive errors” and “distortions.” In other words, a CBT therapist is going to challenge you to not always believe that your feelings are reflecting reality. A CBT therapist will ask you to question your thoughts about a given situation, which will in turn change your feelings about the situation, and ultimately your reaction to the situation. An easy example of this is road rage: when someone cuts us off, we may feel intruded upon, and deliberately maligned by the other driver. This is called cognitive distortion. Because we believe our thoughts to be true, we feel angry and aggressive toward the other driver, and make a rude gesture to them or angrily tailgate them for a few miles. Using CBT, we would recognize our feelings about being cut-off feel very real–we may still feel angry and scared. However, we could challenge the idea that the other driver cut us off on purpose. There are a lot of other reasons people make mistakes while driving, including just carelessness. If we don’t accept the story our mind has created that the other driver is out to get us, we can pause before we react in an aggressive, retaliatory way. This kind of behavioral change is the goal of CBT. It focuses on the present, has concrete strategies and exercises to practice and is a therapy that can be completed short-term. CBT has been shown to be an effective therapy for substance-use disorder, anxiety, depression and other disorders like social phobias and eating disorders.
Psychodynamic Therapy:
Psychodynamic therapy is a modality that focuses on the ways insight into our past can help us make changes in our present. Understanding the map of our early childhood and how our first relationships shaped our experiences of love, trust and safety can help us understand the unconscious motivations or fears that guide our behavior and decisions as adults. Where CBT focuses on managing symptoms like depression and anxiety through behavioral change that is brief and solution-focused, psychodynamic therapy aims to help clients examine the roots of their symptoms. Psychodynamic therapy often is more long-term, as it can take time to examine your whole past. The therapist will help you to identify patterns in your relationships and help you trace the cause of those patterns to its original source. For instance, a client who has gone through several painful romantic break-ups and is unhappy in their single life, may choose psychodynamic therapy in order to gain insight into why their relationships are not successful and how to overcome those obstacles that may have been unconsciously preventing them from finding a lasting relationship. A psychodynamic therapist will help guide the patient through their past emotions that may be affecting their current situation. Dream analysis, emotional exploration, and deep reflection on how negative emotional experiences in our past affect our current relationships are all tools to help use insight to improve our current relationships. Psychodynamic therapy is often used to treat depression and anxiety, social phobias and relationship difficulties.
Dialectical Behavior Therapy:
Dialectical Behavior Therapy or DBT is a modality that has roots in CBT. But where CBT asks the client to identify their cognitive distortions or errors in thinking to change their behavior, DBT asks the client to learn mindfulness. Through awareness of our thoughts and feelings, we can be aware of how these states affect our behavior, we can change our responses. DBT therapy then teaches the client to increase their distress tolerance, interpersonal effectiveness, and build emotional regulation skills. For example, one skill taught in DBT is “opposite action.” So, if you’re in a fight with your partner and you have the urge to yell at them, recognize that urge and then do the opposite of that action, such as choosing not to yell at them and going for a cool down walk instead. DBT tends to offer pretty specific strategies that offer clients tangible actions to take with psychological goals in mind. It’s been shown to be effective with anxiety, depression, chronic suicidality and personality disorders like Borderline Personality.
Eye Movement Desensitization and Reprocessing (EMDR):
EMDR is a relatively new therapy technique developed with the specific aim of treating trauma. You may have heard about it connected to Prince Harry, who did a televised EMDR session in order to show how EMDR has helped him process the trauma of losing his mother at a young age. The process involves working with a trained therapist who will guide you through distressing memories while teaching you to engage in eye movements or other bi-lateral movements during the memory. The theory behind EMDR is that the brain actually stores traumatic memories differently than other memories. Because many parts of the brain shut down in order to protect the person from the trauma of the experience, the experience cannot be stored as a memory, but rather stays in the eternal present for the client. This explains why people can be “triggered” by certain sights, sounds, smells in their immediate environment that cause a flashback in which the brain believes the danger is still at hand. Think about the war veteran who screams at the sound of a car backfiring, convinced there is a fatal explosion happening. During EMDR, these memories are revisited while the therapist engages both sides of the client’s brain through bilateral stimulation, thus allowing the memory to be “reprocessed” as memory instead of a re-living of the event. EMDR is commonly used to treat PTSD of all kinds, as well as other mental disorders such as anxiety and depression. It does not require the client to explore the distressing event in detail, but rather goes straight to the repair process. It’s a relatively short therapy as well, with clients often completing treatment in weeks or months. If you’ve experienced a trauma that continues to disturb your present, EMDR therapy could be an effective choice for you.
Play Therapy:
Yes, play is therapy! Especially for children, for whom play is an expression of their emotional world. During a session of play therapy, the clinician will offer toys, games, art supplies, etc. to help engage the child and get to know them through their play. Unlike adults, who primarily use words to describe their feelings, children often need another medium in order to explore and understand their reactions and emotional responses. For instance, if a child is having an issue at home, instead of the therapist asking the child directly to tell about the problem, they may offer a dollhouse and dolls and ask the child to act out how the dolls feel in their house. By watching how the child positions the dolls and how they interact, the therapist can learn a lot indirectly about what the child is experiencing. During play therapy, the therapist lets the child take the lead in how they would like to play with the toys, rather than directing the play. Play therapy can help children identify emotions, explore a sense of self and practice social skills. It can als be used for more serious issues such as trauma and abuse. In any play therapy situation, building rapport and trust with the child is key. You will notice many play therapists literally get down to the child’s level and play on the floor. This is a strategy to ease the power dynamic between adult and child, and let the child lead the way. Adults too can tap into their inner child and do important healing work through play therapy. Therapeutic tools like sand trays and art supplies can help clients work through difficult feelings and memories. Alternative therapies like music, poetry and dance/movement therapy are other examples of accessing our more child-like, creative side to cope with life stresses, grief and past trauma.
These are just a few of the many therapeutic modalities that clinicians use, and many therapists tend to pull from a few modalities rather than strictly adhere to one method. Whatever modality you choose, remember it’s always the relationship between you and the therapist that matters most! A solid, supportive alliance with your therapist is the greatest tool for developing and enacting change in your life.
By: Alison Napolean, MSW Intern