Types of Talk Therapy

By Dr. Ari Zaretsky

In the April edition of alive&awake, I wrote a blog called Therapy FAQs, where I touched on the different types of therapy available.This month, I want to go into more detail and give you an overview of two major categories of therapy commonly used for depression or bipolar disorder, so that you and your family can be better informed and explore the best fit…

Interpersonal therapy (IPT) was originally developed to treat depression. It has since been adapted for bipolar and other disorders. It is time-limited and goal-oriented, and addresses a person’s symptoms, social relationships and roles. IPT focuses on what is happening “here and now” and attempts to help a person change, rather than just understand his or her actions and reactions. The patient and therapist examine current and past relationships. IPT does not focus on unconscious or subconscious motivations, wishes or dreams. It looks at conscious, outward action and social adjustment. It does not try to change the personality, but rather to teach new skills that can lessen symptoms.

An IPT therapist is an active supporter of the patient on the wellness journey. The therapist does not assign homework, but may encourage a patient to engage in social activities. The therapist helps the patient review his or her symptoms and relate these symptoms to one of four things: grief over a loss, conflicts with others, changes in life status such as moving or changing jobs or isolation/lack of social skills. The therapist and patient then work through specific situations, one by one, to relieve symptoms and stress.

Cognitive-behavioral therapy (CBT) combines cognitive therapy, which involves examining how thoughts affect emotions, and behavioral therapy, which involves changing a person’s reactions to challenging situations. CBT is goal-oriented and works best when the patient takes an active role. One aspect of CBT is that it helps a person recognize their situation-specific negative automatic thoughts or deeper beliefs that contribute to negative emotions. The therapist helps the person see that some of these thoughts and beliefs are false or don’t make sense and helps the person change them. Types of automatic thoughts may include focusing on one negative idea (E.g. an unkind person) and applying the negative quality to everything (E.g. the human race in general) – viewing things as “all good” or “all bad”, or applying labels such as “loser”, “no good”, or “worthless”. Types of deeper beliefs such as conditional assumptions and core beliefs may include, “I have to succeed at everything”, “Everyone has to love me”, “It’s a disaster if things don’t go the way I plan or expect,” or “I can’t change the miserable way I am.”

The behavioral aspect of CBT takes place after a person has a more calm state of mind. The person can then take actions that help him or her move closer to planned goals. For example, if depression has caused someone to withdraw from life, that person may be encouraged to participate in hobbies or spend time with friends. Or a person may be gently coached, under supervision, to confront situations, things or people that cause fear or panic. Through practice, a person learns new, healthier behaviors.

With CBT, the therapist assigns homework. It may include journaling, reviewing notes or tapes of the therapy session, or trying a new approach to an old problem. There may also be exercises to make a person more aware of his or her own thoughts and actions without judging them.

The most important parts of any type of therapy are partnership, communication, goals, collaboration, trust, understanding and action. Most mood disorders such as depression or bipolar disorder, require more than medication alone to achieve full remission and optimal functioning. Successful therapy can help a person change thoughts, beliefs, perceptions, actions, and moods, for the better.   

Ari Zaretsky Photo

Dr. Ari Zaretski is Psychiatrist-in-Chief at Sunnybrook Health Sciences Centre, as well as Associate Professor, Department of Psychiatry at the University of Toronto.


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