There can be many questions people have about what it’s like to work with a psychologist. One of these can be how will they actually help me to improve the difficulty I wish to address with them? Although this answer may have many facets, one aspect is related to the therapy approach or treatment modality that they will help you to understand as a tool to work through your difficulties.

Psychologists and Clinical Psychologists as part of their training and registration requirements have to meet competencies related to best practice and evidence based treatment approaches.  But what does that mean & why is it important? Essentially, evidence based treatment approaches have had a high level of research and review which indicates that they are effective in treating certain conditions and psychological difficulties. This means that your psychologist will be knowledgable about, and trained in, treatments which have been tried and tested with lots of people, across different difficulties, and found to have an impact in a positive way.

As we keep working on trying to understand what makes us human, and researching different treatment modalities, we have seen some change over the past decades which means that psychologists today have access to a broad spectrum of treatment approaches and strategies, some of which you may have heard of.

The Three Waves of Therapy Explained

The first wave of therapy

The first wave of cognitive therapy focused heavily on behaviourist approaches to change, such as classical conditioning (Pavlov), and operant conditioning (Skinner). With these approaches there was a focus on behaviour, and methods to change behaviours, without focussing on thoughts or emotions related to these behaviours.

The second wave of therapy

The second wave came in the 1960s, with the arrival of cognitive therapy, and later cognitive behavioural therapy (CBT). CBT is based on the idea that thoughts lead to feelings, which lead to behaviours, and therefore the emphasis in therapy switched to changing how we think. Fundamental to CBT was identifying your errors in thinking, or maladaptive thought patterns, and developing more realistic thought patterns, so as to change how you therefore feel, and subsequently what you do. 

CBT also utilises behavioural experiments to test the reality of our thoughts and beliefs, structured problem solving techniques, thought monitoring forms, and chain analysis strategies to assist in recognising unhelpful patterns of thoughts, feelings and behaviours. CBT has an abundance of research demonstrating its effectiveness in supporting people make positive changes in their lives. 

The third wave of therapy

More recently, we are now in the era of third wave psychotherapy. Interestingly, the focus of the third wave isn’t on changing thoughts or feelings themselves. Instead, these approaches aim to change our relationship to our thoughts and feelings, so we can enjoy greater wellbeing in our day to day life.

Third wave approaches integrate techniques from CBT, with concepts from neuroscience, mindfulness, evolutionary theory, and the science of compassion.

With practice, they can help us recognise how we become entangled in streams of worry, self-criticism and ruminative thinking, and find ways to break free from these patterns to improve our wellbeing. Third wave approaches don’t only strive to help someone eliminate the symptoms that are bothering them, they also strive to help people live the most satisfying and mentally healthy life possible.

Two of these third waves approaches are Dialectical Behavioural Therapy (DBT), and Acceptance & Commitment Therapy (ACT).

Dialectical Behavioural Therapy (DBT)

Dialectical Behavioural Therapy is a structured and skills based approach focusing on 4 modules: Distress Tolerance, Affect Regulation, Mindfulness, & Interpersonal Effectiveness. The main aim of DBT is to help people cope better with distress, manage and express their emotions better, improve their communication skills, and to help manage any relationship difficulties. Originally DBT was designed to be a group therapy treatment, however, now it has also been adapted to individual therapy, and each module can stand alone depending on what is individually required. DBT now has a wealth of research supporting its efficacy, and in particular has been shown to be helpful for someone experiencing Borderline Personality Disorder, and Bulimia Nervosa.

Acceptance & Commitment Therapy (ACT)

Acceptance & Commitment Therapy is a mindfulness based treatment approach that explores how our emotions, thoughts, and beliefs can take us away from leading a satisfying life based on our individual values. Through the practice of mindfulness meditation we can learn to stay present in our here and now, and to accept our feelings, situations and ultimately ourselves. In contrast to CBT, the focus with ACT is how we relate to our inner experiences, rather than correcting the thoughts we are having. There are six core principles of ACT - cognitive defusion, acceptance, being in the present moment, observing the self, values, and committed action. ACT now has a growing evidence base for its assistance in reducing anxiety difficulties, improving depression, managing pain and chronic illness.

My final thoughts

Although these are all slightly different therapy approaches, at times they can be complimentary, meaning that your psychologist may choose to explore more than one therapy approach and range of strategies with you.  You may also have heard of, are interested in, or have experienced a particular approach already, and therefore we may choose a certain approach also based on your preference.  Overall, however, your psychologist will always consider how your particular range of symptoms and experiences is best addressed by the different therapy approaches, and formulate a treatment plan for you with this in mind.