In some ways this is a golden age of psychotherapy. There are treatments being developed that therapists are excited about, because we get to see clients more frequently transform their suffering into growth before our eyes.
No one of us can get trained in all of the promising developments. But a group of us try hard. The following is a list of treatments in which “I would if I could”, and in several cases I have, immersed myself. Most are psychotherapy models, and one is a related therapy that some psychotherapists also offer.
It is okay for clients not to know about any of these! Some people are curious, and if that is you (and you may be a therapist) read up! But it may be a good sign if your therapist has gone to the trouble of getting trained in one or more of these.
Accelerated Experiential Dynamic Psychotherapy
AEDP, developed by Diana Fosha, Ph.D., seeks to undo aloneness in the face of overwhelming emotional experience, which can be at the root of a myriad of emotional difficulties. AEDP is informed by attachment research, by new understandings of the brain’s neuroplasticity (or ability to change well into adulthood), and by Fosha’s desire to hone in specifically on what fosters transformance and healing across therapeutic methods. Did you know that clicks of recognition, a-ha moments, feelings of relief, lightness, warmth, openness, and other sometimes subtle signs, may show that a progression of healing is well underway? (Yes, this occurs sometimes after some of the painful emotions, so we work from the start to create a secure place for emotional exploration). I offer AEDP in my Concord practice, Level II certification. To find out more about AEDP, check out either its Wikipedia entry: https://en.wikipedia.org/wiki/Accelerated_experiential_dynamic_psychotherapy: or its institute’s website: https://www.aedpinstitute.org/, where a tab may also direct you to many AEDP trained therapists.
Affect Phobia Therapy
APT is a cousin to AEDP, both considered “short term dynamic psychotherapies”. They seek to make it safer and more secure to have a full emotional experience. Affect Phobia is about the fear of feelings. Through life experiences, we have all learned to get anxious or ashamed in the context of certain feelings, although which ones bother us differ from person to person, and we may not even be consciously aware that the core emotion was there in the first place. The anxiety or shame tamps us down, when the first or core emotion might add adaptive and enlivening capacities. Learning the patterns of which emotions get tamped down unnecessarily, how these blocks affect life today, how these avoidances patterns started initially for adaptive reasons, and ultimately how to regain access to full emotional life while keeping self-protective abilities, all may be goals in APT. I am not currently pursuing certification in APT, but am fortunate to participate in the regular Harvard Medical School Affect-Focused Psychodynamic Research Group. This group is led by international APT trainer and supervisor, Kristin Osborn, L.M.H.C., right in our Concord suite, and together we look at clinical work primarily through an APT lens and with APT research tools. To find out more about APT or to seek an APT therapist, check out: http://www.affectphobiatherapy.com/.
Eye Movement Desensitization and Reprocessing
EMDR was developed in 1989 by Francine Shapiro, Ph.D., initially for resolving traumatic material for clients with challenges such as PTSD. After taking a history, developing resources, preparing, and choosing which memories would be best to work on in light of current symptoms, a memory is “processed”. A protocol is used in which fairly standard questions are used (e.g. what is the emotion you are feeling right now as you think of the memory?) in combination with an unusual aspect: clients “visit” the memory while doing a task of bilateral eye movements, or similar “bilateral” or “dual attention” task. Distress may drain away, and then a person’s sense of self (for instance “I am safe now”) may become more adaptive, a body scan is also done to help shed lingering somatic effects of the experience. EMDR is a SAMHSA evidence based practice, also recommended by the VA. While at first the eye movement component was viewed with skepticism by most, at this point they have done studies to show this is actually an important component of the therapy. I offer EMDR in my Concord office. I have been Level II trained snce 2003, and continue with years of ongoing Consultation with Debbie Korn, Psy.D. Find out more about EMDR at http://www.emdr.com/ and at http://www.emdria.org/? Furthermore, Massachusetts clinician names may be sought at http://emdrreferrals.com/, organized by town and insurance.
Feeling State Addiction Protocol
FSAP is a variation of EMDR, developed by Robert Miller, Ph.D. It was created to work to lessen the pull of behavioral addictions, such as gambling, sexual addictions, food addictions, shopping, etc. It has since been used to lessen the pull or craving associated with cigarette smoking as well. Like EMDR, eye movements are involved with FSAP. Instead of draining the energy from a traumatic memory, however, with FSAP we are identifying a memory in which a “Positive” Feeling-State has been over-learned in a neural network. Discharging the energy associated with the “Positive Feeling-State” that was over-learned lets the mind do some adaptive processing and feel like it is now actively choosing instead of being pulled by the craving. I offer FSAP in my Concord office. Find out more at http://www.fsaprotocol.com/
Dialectical Behavioral Therapy
Marsha Linehan, Ph.D., developed DBT initially for individuals with Borderline Personality Disorder, or BPD. This diagnosis, associated often (not always) with multiple hospitalizations for self-harm behaviors, often employed in an attempt to manage severe emotional distress. This treatment has good results that are empirically validated, for a diagnosis that had been historically hard to treat. Several aspects of DBT remain important to me even when I am not working directly with a program. Firstly, everything is a skill. DBT has a skill listed and well-articulated for everything we might do to ride out an emotion without doing anything destructive, drain the energy of an emotion, learn from an emotion, build self-respect, ask for something, tend to a relationship, or become aware of something. Secondly, DBT is all about the “dialectic”, or the opposite of all-or-nothing thinking. It helps us see that truth is often best synthesized with drawing the best from two apparent opposites, such as acceptance and change. Thirdly, DBT is one of the first therapies that specifically named mindfulness as a component. It was a frontrunner in this regard. We now know that the mindfulness aspect of therapy is one of the most useful parts, and the neuroscientists are moving in to help us put language on this. Finally, DBT taught me to be an expert in validation. Marsha even wrote an article specifying six different types of validation. Marsha noted one reason CBT wasn’t palatable to this group of people, was that it could be way too invalidating! If I could help clients and their families learn one skill, it would be validation. (Validate the need or the emotion if you can’t validate the behavior). Things start to settle down this way. I was very involved with a DBT program from 2000-2005, coordinating the program for two of those years. I do not offer DBT in Concord, but am known to pull out a DBT skill on a regular basis. “DEAR MAN” anyone? (Get ready to build your tolerance for acronyms). http://behavioraltech.org/ is one site to check out for DBT resources. Want skills? Consider buying the skills book online – I use the book by Marsha Linehan herself, not a copycat (although many of those are good as well). It is called “DBT Skills Training, Handouts and Worksheets, 2nd Edition”, as opposed to the book that tells you how to run the skills groups. McLean’s hospital in Belmont MA has daytime skills groups.
Circle of Security
The same people who developed “Circle of Security – Parent”, a Parent Seminar, which I offer, also developed a whole therapy. I do not offer the intensive COS therapy itself, although I have read the manual and seek to be influenced by it. Like AEDP above, and like Child Parent Psychotherapy, described below, attachment research strongly informs Circle of Security. We are all born to form bonds with our caregivers, and as parents we are also designed to form bonds with our children. Sometimes subtle fears can get in the way of fully meeting children’s needs. For one parent, there may be an unthought fear that a child may need too much, and for another parent the fear may be that the child will be so independent that the parent will no longer be needed. Often these fears are encoded in “implicit memory” and we are not fully aware of them. We bring awareness to unneeded and not fully articulated fears. Please don’t worry, they seek to foster Good Enough parents, not Perfect Parents! They bring safety and security to building enjoyable relationships, and build confidence as we meet our children’s needs. COS has a great website, http://www.circleofsecurity.net/. They also work with animators and have some youtube clips to help illustrate their material. They seem to do more intensive training elsewhere than here, so if you are reading this from afar, perhaps you have a COS intensively trained therapist near you! I am happy to offer their COS-P parent seminars here in Concord as a registered COS-P parent educator.
Child Parent Psychotherapy
CPP is very similar in intent to Circle of Security described above, in that it is heavily based on attachment research. This therapy was originally developed more specifically for children who have already witnessed parental violence at a young age, and have traumatic reactions before they have the verbal abilities to engage in a traditional therapy. CPP is described further in this fact sheet: http://www.nctsn.org/nctsn_assets/pdfs/promising_practices/Child_Parent_Psychotherapy_CPP_fact_sheet_3-20-07.pdf.
SP originated from the work of Pat Ogden, Ph.D., and brings “somatic awareness” or awareness of the body, as a fundamental element of healing. Emotions begin in the body. The body can be an untapped resource in the healing process. To start with, it can hold information about what has gotten stuck. Using sensation as guidance, the healing process can be facilitated. I am not trained in SP, although my work has been influenced by ongoing consultations with colleagues who do specialize in this modality. Their work can be amazing. Find a clinician at: https://www.sensorimotorpsychotherapy.org/home/index.html
SE and SP are often thought of similarly by those of us that aren’t very trained in either one. That includes me. Somatic Experiencing is from the groundbreaking work of Peter Levine, Ph.D. I hear it is currently harder, but not impossible, to find SE on the East Coast. A website to check out is http://traumahealing.org/.
Internal Family Systems
Developed by Richard Schwartz, Ph.D., IFS uses family systems theory to understand how various “parts” of ourselves interrelate. We are encouraged to “step back” into a resource called “Self” which is noted for qualities such as calm, curious, compassionate, courageous, connected, clear, creative, and confident. I abbreviate the “8 C’s” into the idea of our “warm curious stance” as we observe our inner experience from Self. From this place, we might note one part of self might want a donut, while another part might Scorn the thought. Scorn feels bad, hence the need for another donut. Which part is “the real me?” Perhaps both, one trying to achieve comfort, one trying to achieve health or fitness. The goals (comfort, health) aren’t bad, but neither binges nor scorn-fests ultimately work ideally. The resource of Self can help build a new spaciousness to observe that the underlying goals are worth working towards, and that new collaborations are possible. I have a notable IFS influence in my practice, but am not pursuing certification. One of many IFS certified therapists in this area can be located at http://selfleadership.org/.
Emotion Focused Therapy
There are two EFT’s, and I am talking specifically about Emotion Focused Therapy, which Les Greenberg and Sue Johnson developed for couples. I have not even been able to make it to a one-day training for this method, but give me a chance and I might! See this site: http://www.iceeft.com/ or the Wikipedia entry here: https://en.wikipedia.org/wiki/Emotionally_focused_therapy .
Neurofeedback is not psychotherapy. But a few psychotherapists (and some other clinicians) offer it. Psychotherapy works with the mind. Really good psychotherapy, we now know, can actually help the brain. It now can be shown on brain scans, that good psychotherapy can help settle certain sections of the brain down, activate others, and increase brain connectivity in important ways. (Hint: other things can do this too, such as mindfulness practices). However, it tends to take very carefully honed and paced psychotherapy work to help the brain learn to self-regulate. When the brain has been through way too much (for instance with PTSD), neurofeedback can sometimes help self-regulate much more quickly than even advanced psychotherapies can. What is neurofeedback? It is a specialized form of biofeedback. The feedback means we give the brain information it normally wouldn’t have, so that it can begin to influence biological processes that would normally be going on automatically in the background. One kind of biofeedback is learning to warm the temperature of the hands, by attaching a sensitive thermometer to the fingertip. Just giving that instant info (or feedback) and a little coaching (i.e. don’t try too hard – that’s counterproductive) and the brain can learn to warm the hands. Well, with neurofeedback, the biological process the brain learns to influence is its own brainwave pattern. Our brainwaves (to oversimplify) are very slow when we sleep, less slow when drowsy, less slow when alert, faster still when anxious. These days, software can fit in a laptop to filter the brainwaves (electrodes on the head make the brainwaves visible to the computer, no electricity goes in the brain, at least in the kind of neurofeedback I’m describing). The software then selectively rewards, for instance, the alert focused brainwaves, through a video game with rocket ships, beeps, diamonds, or the like. You might be surprised how brilliantly many brains are willing to organize themselves for beeps. In Sebern Fisher’s “Neurofeedback for Developmental Trauma: Calming the Fear-Driven Brain”, case studies were presented involving Dissociative Identity Disorder, Autistic Spectrum, Eating Disorder, and Attachment Disorders, making progress in ways that would not be expected with even advanced psychotherapeutic techniques. I offer neurofeedback combined with psychotherapy in my Concord practice, and I am able to consult with Sebern Fisher in complex situations. This addition has led to important breakthroughs when “issues” from childhood had become “stuck” in a brain-based way. Find out more about neurofeedback here: http://bcia.org/i4a/pages/index.cfm?pageid=1 , here: http://www.aboutneurofeedback.com/ and here: http://www.eegspectrum.com/.
What’s not on my list of faves: Cognitive Behavioral Therapy. CBT works for many. Find out about CBT here https://www.beckinstitute.org/get-informed/what-is-cognitive-therapy/. Here is my biased opinion. It’s partly that many people with complex issues are screened out of some of the studies that helped catapult CBT to the premier “evidence based” reputation it enjoys. Once any serious attachment issues, for example, have been well-addressed, CBT is likely to proceed smoothly (maybe even with a self-help book). Also, working with the C part of CBT, we are sometimes working “top down” using the frontal cortex to try to calm the limbic or emotional brain. Sometimes some of the above approaches work “bottom up”, calming the fight or flight response first, and then the thoughts make sense more readily. But yes, I agree, if you have horrible self-talk, it needs to be gentled, and if you are using avoidance as your primary strategy with anxiety it needs to be approached. In my experience, some people may benefit from one of the above ways of approaching emotions or sensations or their “fear-driven brain” in addition to cognitions and behaviors. The CBT greats are likely to be doing things that overlap with some of the methods above, and practitioners of the methods above inevitably know a thing or two about CBT. But I’d be remiss if I didn’t mention CBT, and for instance Boston University’s internationally renowned Center for Anxiety and Related Disorders https://www.bu.edu/card/ is right nearby, and has greatly helped many people.
How to choose? Personal preference. Particular situation. Availability. Fit (feeling secure enough, heard enough, to be doing something enough?) with a particular therapist. Try one of these methods and if after giving it a good try, there isn’t movement, talk with your therapist about other ideas, perhaps one of these other modalities above. And I’m sure there are more. Ask others! Don’t give up!