Counseling/Therapy: So Many Types and Approaches…Which One Should I Choose?

By Dot Lucci, M.Ed., CAGS
Director of Consultation and Psychoeducational Services, NESCA

Many adults, teens and children struggle with a myriad of challenges from everyday stressors, feelings of worthlessness and insecurities to official diagnoses of anxiety, depression, PTSD, eating disorders, OCD, addiction, and more. Deciding how to grow and change and alleviate the pain and suffering can be daunting. There are so many different ways to address psychological pain. Psychological, medical, behavioral, psychopharmacological, complementary (e.g., acupuncture), and educational treatments, among others, are possible choices and can assist in lessening an individual’s anguish. How do I decide which one(s) to try? Usually, treatment involves more than one of these, so the decisions may not be as difficult as you think. The first step is recognizing that you, your child, your marriage or family needs help and taking a step to get help.

Psychological treatments include many options: psychotherapy (i.e., “talk therapy or insight-based therapy”), psychoeducational counseling, biofeedback, social training, behavior therapy, mindfulness, stress management, anger management and so many more. Therapy can be individual, group, family or couples work, and there is no single approach that works for everyone. It often depends on the referral question and complaint. Counseling is typically provided by a psychologist, social worker, mental health counselor, marriage and family counselor, expressive therapist, psychiatrist and/or psychiatric nurse. Many factors go into making psychological treatment decisions (i.e., referring question/complaint, cost, location, approach, etc.). When it comes to therapy, it is most important to have “goodness of fit” between the clinician and the client. The client needs to have a connection with and feel valued, supported and understood by their practitioner. This allows whatever treatment approach or method to be more readily accepted by the client.

Reviewing the differences between treatment approaches may help with the decision-making process beyond “the goodness of fit.” Psychotherapy involves talking with a clinician to address emotional, psychological and behavioral challenges that can be both conscious and unconscious. The client’s past experiences, perceptions and history may play an important role in psychotherapy. The client “tells a story” that helps the clinician understand their life experiences through their eyes, therefore allowing treatment to be tailored to that client’s personal experience. By working through one’s thoughts, past experiences and stressors with a caring clinician, the client is able to gain insight and perspective, reduce symptoms, change behavior, learn strategies to lighten the load and improve quality of life. Often psychotherapy is long-term and involves good communication/language skills as well as higher level of thinking, often abstractly, and insight capacity.

Psychoeducational treatment is somewhat different than psychotherapy. Education is central to treatment and is a more directive approach. It can have very specific goals and may be short-term. The past is not actively addressed; rather, the purpose is to teach the client to acknowledge, accept and understand their disability and/or mental health condition and provide ways to support growth, change and meet goals. Psychoeducational treatment can be provided to individuals, groups, families, couples, employers and others and may include reading informational text, video analysis, homework, data collection, biofeedback, journal writing and more.

Some of the goals of both treatment approaches may be to:

• connect how thoughts, feelings and behavior are intertwined;
• improve coping and problem-solving skills to better deal with life’s stressors;
• increase positive self-regard; and
• recognize and better deal with strong emotions.

Many clinicians have training in specific techniques and some use a combination of approaches and philosophies. Psychotherapy typically falls into broad categories: Psychoanalysis and psychodynamic, Behavior Therapy, Cognitive Therapy, Humanistic Therapy and Integrative or Holistic Therapy.  Sometimes a specific approach may be the best method of choice given a specific condition or specific goal of the client. Some techniques have been researched on large samples of people and proven to yield positive results with certain diagnoses; while others are newer, less researched (yet are still effective).

In determining what technique is most appropriate, consider the age, diagnosis, goal of treatment, efficacy of the treatment, as well as the personality, cognitive and language capacity, cultural/family background, location, cost, etc. Many treatment approaches share common techniques, but some techniques are better suited with certain conditions/diagnoses. There are upwards of 100 different types of psychotherapeutic approaches, so knowing which one works with what conditions, resonates with you as the client and can meet the needs/goals.

Another option is online treatment. In recent years, many in-person practices and newer standalone online treatment options have emerged. Often these are for mild depression and anxiety. As you search out any treatment, ask for references and reviews and assess treatment efficacy. Some online sites include Talkspace, TeenCounsleing and more. There are also online apps to help with stress management, anxiety, depression and more, such as Moodfit, HeadSpace for Kids, MindShift, Inner Balance, and so many more. Needless to say, online therapy and apps are not the same as in-person therapy but may augment and be helpful in some situations.

Many clients at NESCA present with learning differences, anxiety, OCD, depression, trauma, addiction, ASD, and more. The following partial list includes just some of the treatment approaches recommended by many of NESCA’s neuropsychologists. At NESCA, we currently offer a psychoeducational approach to psychological treatment and short-term pandemic related issues of anxiety and depression. If interested in learning more, please visit: https://nesca-newton.com/integrativetherapeutic/.

• Acceptance and Commitment Therapy (ACT)
• Attachment-based Therapy
• Animal-assisted Therapy
• Bibliotherapy
• Biofeedback
• Cognitive Behavior Therapy (CBT)
• Dialectic Behavior Therapy (DBT)
• Exposure & Response Prevention (ERP) Therapy
• Expressive Therapy (art, music, drama, etc.)
• Family Systems Therapy
• Hypnotherapy
• Mindfulness-Based Cognitive Therapy (MBCT)
• Motivational Interviewing
• Narrative Therapy
• Positive Psychology
• Parent-Child Interaction Therapy (PCIT)
• Play Therapy
• Psychoeducational Counseling
• Trauma-Focused Cognitive Behavioral Therapy

Additional information about treatment approaches can be found at: https://www.psychologytoday.com/us/types-of-therapy.

https://www.nami.org/learn-more/treatment/psychotherapy

https://apa.org/topics/psychotehrpay/approaches

https://talkspace.com/blog/different-types-therapy-psychotherapy-best/

https://verywellmind.com

 

About the Author

NESCA’s Director of Consultation and Psychoeducational Services Dot Lucci has been active in the fields of education, psychology, research and academia for over 30 years. She is a national consultant and speaker on program design and the inclusion of children and adolescents with special needs, especially those diagnosed with Autism Spectrum Disorder (ASD). Prior to joining NESCA, Ms. Lucci was the Principal of the Partners Program/EDCO Collaborative and previously the Program Director and Director of Consultation at MGH/Aspire for 13 years, where she built child, teen and young adult programs and established the 3-Ss (self-awareness, social competency and stress management) as the programming backbone. She also served as director of the Autism Support Center. Ms. Lucci was previously an elementary classroom teacher, special educator, researcher, school psychologist, college professor and director of public schools, a private special education school and an education collaborative.

Ms. Lucci directs NESCA’s consultation services to public and private schools, colleges and universities, businesses and community agencies. She also provides psychoeducational counseling directly to students and parents. Ms. Lucci’s clinical interests include mind-body practices, positive psychology, and the use of technology and biofeedback devices in the instruction of social and emotional learning, especially as they apply to neurodiverse individuals.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.