Therapeutic Orientations

Therapeutic Orientations

• The aim is to help clients understand that much of their distress stems from their thoughts about a situation, and not the situation itself
• A cognitive therapist may help the client identify negative or irrational thoughts, challenge unhelpful thinking traps, and reframe these into more positive thoughts
• As many cognitive therapists also use techniques to modify a client's behaviour, this approach is often called Cognitive-Behavioural Therapy
• Example (Social Anxiety Disorder): a cognitive therapist may ask the client to identify specific negative thoughts they have when in social settings (I'm unbearable to be around or talk to), highlight irrational thinking patterns ("If people really thought you were unbearable, would they keep inviting you to social events?"), and reframe their thoughts (I can't expect everyone I meet to think I'm awesome, but plenty of people seem to enjoy spending time with me)

• The aim is to use the principles of classical and operant conditioning to reduce a person's distress and modify their behaviour
• Classical conditioning: if something that is a neutral stimulus for most people (i.e. a dog) has been conditioned to elicit a negative conditioned response (i.e. fear), then that response must be made extinct
• Client may be exposed to the conditioned stimulus (dog) in real-life and instructed to prevent the fear response in a technique called flooding, or instructed to imagine or experience progressively more distressing scenarios involving the stimulus in a technique called systematic desensitization
• Operant conditioning: positive reinforcement may be used to reward productive behaviour that reduces the client's distress
• Example (Social Anxiety Disorder): a behavioural therapist may instruct the client to experience a slightly more challenging social scenario every week (i.e. go for a walk in a public park, spend an hour in a grocery store, spend time with a few close acquaintances, etc.)

• Largely rooted in Freudian psychoanalysis; the aim is to have clients gain insight into the unconscious and repressed processes that may be causing their distress
• Psychodynamic therapists may use techniques such as: dream interpretation, free association (asking the client to state anything that enters their mind), and transference (when the client projects their feelings towards people from their life onto the therapist)
• Example (Social Anxiety Disorder): a psychodynamic therapist may use free recall to help the client discover that their social anxiety stems from a childhood that was made unstable due to frequent moving between cities. As a result, the child never felt fully comfortable at their new schools and always felt judgement from others due to being the "new student".

• The aim is to create a safe environment for clients and show them that they are capable of personal growth and of overcoming their challenges
• Carl Rogers' Client-Centred Therapy is the most common approach and involves:
• Unconditional positive regard: complete acceptance of the client by the therapist without judgement or evaluation
• Active listening: the therapist empathetically listens to the client and tries to understand the world through their eyes
• Honesty & genuineness: the therapist openly expresses their feelings to the client — even negative ones — but without any judgement
• Example (Social Anxiety Disorder): a humanistic therapist may actively listen to the client's worries, help them feel secure and not judged, then reflect some of their anxieties back to the client to help them understand that they are capable of successfully navigating social situations

• The aim is to use drug treatments to address a client's problems and reduce their distress
• More details can be found in the "Biological Treatments" subchapter
• Example (Social Anxiety Disorder): a biological therapist (i.e. psychiatrist) may prescribe an anti-anxiety medication for the client if their anxiety in social situations is causing them severe distress and impairing their daily functioning