Sivene (Social Therapist)

1. #1Attachment-Based Therapy

   Keys: Attachment-Based Therapy

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   Overview: Attachment-Based Therapy looks at the connection between an infant’s early attachment experiences with primary caregivers, usually with parents, and the infant’s ability to develop normally and ultimately form healthy emotional and physical relationships as an adult. Attachment-based therapy aims to build or rebuild a trusting, supportive relationship that will help prevent or treat mental health conditions such as anxiety and depression.

   When it is Used: An attachment-based approach can be used in individual, family, couple, and group therapy, with both children and adults, to help clients mend or recover from fractured family relationships.

   What to Expect: Since the goal of attachment-based therapy extends to repairing the family relationship, the therapist will work with the individual adolescent client alone, and also with the family as a group. The therapist works with the family to build and strengthen the parent-child bond and help the child to develop into an independent, self-sufficient adult. With individual adults, the therapist aims to help the client overcome the effects of negative early attachment difficulties by establishing a secure bond between the client and the therapist. Once this relationship is solidified, the therapist can help the client communicate more openly and better explore and understand how their current feelings and behaviors are associated with earlier experiences.

   How it Works: It is believed that strong early attachment led to safety, security, and support, which then led children to develop healthy connections with others. Without a healthy foundation, babies may grow to be fearful, confused, and insecure, ultimately becoming depressed or even suicidal as adolescents. Theoretically, by forming a trusting relationship with parental figures or with the therapist, the client is better prepared to form strong bonds in other relationships. To do so, patients may explore their childhood in therapy. They may discuss their early relationship with their parent or caregiver, family dynamics as they grew up, and significant childhood experiences. They may explore connections between their childhood relationships and their adult relationships—how the past may have influenced the present. They may discuss skills to improve their current relationships, emotions, and behaviors. And they may work with their family members to improve together.

2. #2Couples Therapy

   Keys: Couples Therapy

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   Overview: Couples therapy is a type of therapy that aims to help romantic partners address relationship conflicts, improve communication, and increase affection and empathy for one another. Couples therapists may employ techniques from a variety of modalities, including emotionally focused therapy, the Gottman Method, cognitive-behavioral therapy (CBT) for couples, Imago relationship therapy, and others.

   When it is Used: Partners who seek couples therapy do so for a wide variety of reasons; often, these include communication challenges; frequent or intense conflicts; persistent disagreements about finances, child-rearing, the division of labor, or other quotidian concerns; or challenges related to sex and intimacy. Infidelity by one or both partners can also lead a couple to seek therapy. Many couples on the verge of splitting up seek therapy, either to determine whether the relationship can be saved or to navigate the breakup in the healthiest, least destructive way possible; the latter approach may be especially valuable for couples with children who wish to co-parent effectively. Entering couples therapy does not mean a couple is destined to break up, though couples may determine over the course of therapy that a peaceful dissolution would be best for both parties. Couples therapy may also be beneficial if one or both partners suffer from physical health problems, anxiety, depression, substance abuse, PTSD, or related challenges, as these issues can disrupt connection or drive a wedge between partners. In such cases, the affected partner(s) may also pursue individual therapy.

   What to Expect: Couples can expect to each spend time sharing their concerns, identifying the emotions they feel toward their partner and toward the relationship, exploring personal history (both the individual partners’ personal history and their shared history as a couple), and learning skills—such as anger management techniques, conflict resolution, and joint problem-solving skills—that can help them approach challenges more effectively going forward. It's common for one or both partners to have some desire to “win” at therapy—that is, they want the therapist to agree with them, take their side, and designate the other partner as the cause of the couple’s problems. This is, however, an unrealistic expectation. A competent, ethical couples therapist will not take sides, and their job is not to declare one partner guilty and the other innocent. Instead, the therapist will assist both partners in understanding how they may be contributing to the couple’s larger issues and encourage them to see things from their partner’s point of view.

   How it Works: Effective couples therapy, then, will guide partners through this challenging but often deeply rewarding process. The therapist, as an impartial third party, can help couples identify patterns that are keeping them stuck, and the “neutral” space of the therapy room can be a safe haven for each partner to express their emotions, hopes, and fears. Ideally, this process will promote greater compassion—both for one’s partner and for oneself—and help the couple learn more productive ways of managing conflict and navigating problems as they arise.

3. #3Emotionally Focused Therapy (EFT)

   Keys: Emotionally Focused Therapy, EFT

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   Overview: Emotionally Focused Therapy (EFT) is a form of short-term therapy that aims to improve couple relationships by rekindling the physical and emotional bond that can get sacrificed to disappointment in a partner and alienation from them, a common dynamic in distressed couples. Drawing on research supporting attachment theory, the therapy regards the security of partner connection as the best lever for change in a dysfunctional relationship and a necessary source of both couple and individual growth. Love, in short, is transformative. Restoration of the emotional ties enables partners to be physically and psychologically open and responsive to each other so that they can construct a mutually supportive and satisfying relationship in the moment and for the future. EFT operates on the evidence that emotions are not accessories to human experience but organizing principles of our lives. The expression of longing and sadness over isolation is a powerful tool for eliciting the lost contact and responsiveness of a partner. Once that contact is restored, it becomes a renewable source of mutual comfort, a buffer against life’s many stresses. Couples can then go on to solve their own problems.

   When it is Used: EFT is especially useful when couples arrive at counseling in emotional distress or feel so alienated they may believe that the relationship is irreparable. They may be displaying intense anger, fear, grief, loss of trust, or a sense of betrayal in their relationship. Such strong negative emotions are thought to be expressions of protest and despair over the loss of connection and the resulting feelings of physical and emotional abandonment. They are also believed to conceal feelings of fear, helplessness, and unlovability that result when bonds are ruptured. It is also useful for couples and individuals who have difficulty expressing emotions or who believe that doing so is a sign of weakness. At the other extreme, EFT is of help to those who have trouble regulating emotions; their intense reactivity is believed to result from emotional alarms set off by fears of abandonment. In individual therapy, the therapist forms a secure alliance with the patient that becomes a safe haven for emotional exploration and expression. EFT has many other applications because it directly targets the emotional isolation believed to be at the core of so many forms of mental distress. For example, the fears of loss and disconnection it addresses are thought to underlie many instances of depression and anxiety and experiences of trauma. The therapy is also used to repair family bonds in instances where parent-child relationships have become troubled.

   What to Expect: After taking a history from the couple, the therapist will observe their interaction patterns. Couples will be asked to identify their most pressing issues. Through observation, listening, and questioning, the therapist comes to understand the unspoken fears and insecurities that underlie negative interaction patterns. The first several sessions are typically devoted to de-escalating the emotional reactivity and distress couples experience, especially if their life outside the therapy office. Couples learn to expand their emotional response patterns so that they can recognize and be responsive to their partner’s needs. The second stage of therapy is devoted to restoring a deep emotional bond between partners. The goal is to create a sense of security that allows partners to share their vulnerabilities, provide comfort for each other, and serve as a secure base for exploration of the world and individual and partnership growth. An EFT therapist is not just an observer but an active participant in the therapy. A very important part of the therapy is reframing such distancing behavior as anger or withdrawal not as pathology but as misguided bids for connection. That allows partners to express their deep feelings for each other and what they need from their partner. The last few sessions consolidate the gains made in the previous sessions. For example, with their mutual support system now restored, couples are typically asked to discuss an old or ongoing problem so that they can develop new solutions. Patients get to practice comforting and connecting rather than disconnecting in the face of difficulty, as they understand the true emotional needs that formerly drove their negative patterns.

   How it Works: Emotionally Focused Therapy puts emotional experiences and reactions front and center in therapy. It is based on attachment theory and the importance it places on connection to others as a source of feelings of comfort and safety and a vehicle for growth and development. Those others may be flesh-and-blood partners, the mental representations the client has of important figures in their lives, or even parts of themselves. EFT explores the nature of our connections and the emotions they generate. It also helps people actively restructure those relationships so that they pave the way for new, more rewarding experiences. For all its roots in attachment theory, EFT works very much with the reality of existing relationships and the emotions they generate. Patients come to understand how their negative interaction patterns are typically related to attachment-related fears of loss. Under the direction of the therapist, they learn to openly discuss their fears, identify the attachment needs that their fears mask, and instead of distancing themselves, use their vulnerabilities to seek closeness. From that position, they can readily solve life’s problems together.

4. #4Family Systems Therapy

   Keys: Family Systems Therapy

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   Overview: Family systems therapy is a form of psychotherapy that helps individuals resolve their problems in the context of their family units, where many problems are likely to begin. Each family member works together with the others to better understand their group dynamic and how their individual actions affect each other and the family unit as a whole. One of the most important premises of family systems therapy is that what happens to one member of a family happens to everyone in the family.

   When it is Used: Many psychological difficulties begin early in life and stem from relationships within the family of origin, or the family one grows up in, even though these problems often surface later in life. Families in conflict, as well as couples and individuals with concerns related to their families of origin, can benefit from family systems therapy. In addition to family conflict, Family Systems Therapy can be useful for depression, anxiety, personality disorders, eating disorders, substance abuse, and more.

   What to Expect: Eight key principles underpin Family Systems Therapy. This therapeutic approach focuses on helping families recognize these eight principles in their own family relationships to support development of healthier relationships.

   Principles of Family Systems Therapy:

   1. The Differentiation of Self: The sense of individuality a person develops, rather than relying on others in their family or social groups)
   2. The Triangle: The relationship dynamic between three people, which may influence relationships with others in the family
   3. The Nuclear Family Emotional Process: Relational patterns that occur in the family, including marital conflict, dysfunction in a spouse, impairment of one or more children, and emotional distance.
   4. The Family Projection Process: Parents may displace their feelings or anxieties onto their children, who then may displace their own feelings or anxieties onto others.
   5. The Multi-Generational Transmission Process: Small differences in differentiation between children and parents can lead to large differences among extended family members over time.
   6. Sibling Positions: Birth order can affect the dynamics between children, siblings, and parents.
   7. The Emotional Cutoff: Family conflict with no resolution may lead some people to sever a relationship entirely.
   8. Emotional Processes in Society: Broader social and cultural forces can influence family relationships.

   How it Works: Based on family patterns and systems theory, which looks at the parts of a system (such as individual family members) in relation to the whole (the family), it is believed that the personalities, emotions, and behaviors of individuals are a result of their birth order, their role within their family of origin and the coping mechanisms they have developed for dealing with emotional family difficulties. To understand the family system, the family must be viewed as a whole, and that what defines a family is more than the people who make it up but also how they interact with each other to create a unique family dynamic. During family systems therapy, the family works individually and together to resolve a problem that directly affects one or more family members. Each family member has the opportunity to express their thoughts and feelings about how they are affected. Together, the family works to help the individual in distress and to help relieve the strain on the family. Family members explore their individual roles within the family, learn how to switch roles, if necessary, and learn ways to support and help each other with the goal of restoring family relationships and rebuilding a healthy family system.

5. #5Interpersonal Psychotherapy (IPT)

   Keys: Interpersonal Psychotherapy, IPT

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   Overview: Interpersonal Psychotherapy (IPT) is a focused therapeutic approach to treat mood disorders. The main goal of IPT is to improve the quality of a client’s interpersonal relationships and social functioning. It also aims to help reduce overall distress. IPT differs from other traditional psychodynamic approaches in that it examines current rather than past relationships, and recognizes (without focusing on) internal conflicts. IPT differs from cognitive and behavioral therapy approaches because IPT addresses maladaptive thoughts and behaviors only as they apply to interpersonal relationships. IPT aims to change relationship patterns rather than the associated depressive symptoms. IPT also seeks to target relationship difficulties that exacerbate depressive symptoms. IPT is less directive than cognitive-behavioral approaches as IPT focuses on the client’s specified target areas without dwelling on the client's personality traits. IPT can also be used to treat major depressive disorder as well as other mood-related conditions.

   When it is Used: IPT provides strategies to resolve problems in four key areas: Interpersonal deficits (e.g. social isolation, unfulfilling relationships), Unresolved grief (e.g. if the distress or depression is linked to the death of a loved one), Difficult life transitions (e.g. retirement, divorce, moving), and Interpersonal disputes(e.g. conflicting expectations between partners, family members, friends, or colleagues).

   What to Expect: The IPT therapist will begin by assessing the client's depressive symptoms and asking the client about their social history and close relationships, including any changes in relationship patterns and expectations. The IPT therapist then works with the patient to implement treatment strategies specific to identified problem areas.

   How it Works: It is believed that changes in the client's social environment is a key factor in the onset of depression as well as continued depression.

6. #6Relational Therapy

   Keys: Relational Therapy

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   Overview: Relational therapy, sometimes referred to as relational-cultural therapy, is a therapeutic approach based on the idea that mutually satisfying relationships with others are necessary for one’s emotional well-being. This type of psychotherapy takes into account the ways in which social and familial factors relate to the relationships in a person’s life. Relational therapy integrates cognitive-behavioral therapy, which is goal-oriented, focuses on faulty thinking, and promotes self-awareness and healthy behaviors. These principles are taught to the client for them to apply to your daily interactions with others. Relational Therapy also draws upon principles of other therapies approaches such as psychoanalytic and psychodynamic therapy.

   When it is Used: Relational Therapy can help clients experiencing distress from their relationships. Clients experiencing relationship problems from disorders or issues such as anxiety, depression, stress, addictions, low self-esteem, poor body image, trauma, or personality disorders may also benefit.

   What to Expect: In relational therapy, the client learns to identify how they may be pushing people away rather than attracting them. The client also learns how these behaviors may be related to past experiences. The goal of Relational Therapy is to help the client develop new ideas and thinking patterns about relationships, build a strong relationship with the therapist, and use both the new ideas and the therapeutic relationship as a model to create healthier, longer-lasting relationships with the people around them.

   How it Works: Relational therapy aims to build the client’s (1) sense of self, (2) sense of agency, (3) patience with others, and (4) trust in others. The client will learn about boundaries, compromise, and healthy balance in relationships. Through helping the client to strengthen their relationships, the client can then experience a more fulfilling life and improvements in overall well-being.

7. #7Social Recovery Therapy (SRT)

   Keys: Social Recovery Therapy, SRT

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   Overview: Social Recovery Therapy (SRT) is a cognitive-behavioral intervention designed to help restore a more capable mental state to clients with psychosis by improving social and vocational skills and encouraging more participation in social activities. SRT focuses on identifying the client’s social and/or occupational goals and the obstacles to achieving them, then uses behavioral and cognitive strategies to help clients overcome avoidance and develop a sense of hope about their future.

   When it is Used: SRT can be helpful for clients who struggle with social disability (isolation, withdrawal, difficulties communicating, and/or a reluctance to engage in structured activities or seek support) during or after an episode of psychosis.

   What to Expect: Social Recovery Therapy (SRT) rests in large part on a therapeutic relationship that is supportive, hopeful, and flexible. The SRT therapist should “walk alongside” the client by being encouraging, persistent, and assertive in helping the client to overcome their social challenges. Once a baseline level of trust is established, the client and SRT therapist work closely together to (1) identify challenges and obstacles to social functioning, (2) establish social goals and expectations, and (3) match those goals to relevant agencies and activities. This could include referrals to vocational counselors, participation in educational groups, or seeking out and joining community centers that host sports and other social activities. Successfully engaging in these activities and navigating problems as they arise can help clients develop a sense of agency and promote optimism about their ability to function in the world. In addition to helping clients adjust to work, education, and leisure activities by learning and practicing necessary skills in a safe environment, SRT aims to ease any feelings of anxiety or hopelessness that may interfere with social success. To this end, SRT therapists will help clients identify and connect with their values and recognize how reaching their social and occupational goals could help them better align with those values.

   Overview of Psychosis: Psychosis is a broad term describing some loss of contact with reality. While it can have various causes, it is often associated with schizophrenia, a serious mental disorder that can have lasting, negative consequences. Despite recent advances in treatment, full recovery from schizophrenia remains difficult for many to attain. While many clients do receive early intervention services (which, in some cases, can promote significant gains), some struggle to adhere to conventional interventions (sometimes because of unpleasant medication side effects or difficulty finding and affording care). Others may continue to have difficulty with social functioning even as they see improvement in other symptoms.

   Consequences of Psychosis: These early social difficulties often lead to long-term issues of isolation, alienation, or even a complete lack of integration into the community. Because motivation to change tends to be highest in the early stages of diagnosis, proponents of SRT suggest that intervening during the first episode of psychosis, and focusing on social functioning specifically, is critical for preventing the early social decline associated with a poor long-term prognosis.

   How it Works: The goal of SRT is to help clients increase the amount of time they spend actively involved in social settings so that they can thrive, rather than merely survive as 'outsiders', in their community. This helps prevent long-term social disability and the development of schizophrenia or other related psychiatric disorders.

8. #8Structural Family Therapy (SFT)

   Keys: Structural Family Therapy, SFT

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   Overview: Structural family therapy is a type of therapy that focuses on the interactions between family members. Looking at the family as a system, structural family therapists work to improve communication between members of the family and encourage adjustments in the rules that govern how the family functions (its structure). The treatment’s distinctive features are the conception of the family as a structural system, and the active engagement of the therapist in the process of restructuring the way the system works in order to adjust elements that cause dysfunction. This restructuring can include family boundaries, hierarchies of power, and reactions by family members to major life changes. Structural Family Therapy allows everyone in the family to hear the viewpoint of the others, and allows the therapist to observe how the family interacts in real life.

   When it is Used: Structural Family Therapy is often used to help families experiencing distress or tension, such as mood disorders in adolescent, substance abuse, eating disorders, divorce, blending families, families affected by illness of death, families where a parent suffers from a mental health condition, or significant changes in family life arising from loss of a job, moving cities, or a change in gender identity or sexual orientation of a family member.

   What to Expect: In Structural Family Therapy, the therapist actively participates in treatment through making suggestions and directing discussions or arguments. Therapists may, at times, change the format of sessions, by changing the position of family members seated in the room, asking some family members to leave the session temporarily while others stay, and even, in some cases, by bringing some members of the family on the other side of a one-way mirror to observe the conversation of other members of the family.

   Key Tenets of Structural Family Therapy: Joining: Joining is a process whereby the therapist gets to know the family and sets expectations for treatment. A therapist may ask questions about the family, show their support of the family, and explain the technique of the therapy. Mapping: Mapping is an effort to understand a family’s rules, structures, and patterns. A therapist may draw a diagram and write notes themselves, or may hand members of the family a pencil and paper and ask them to map these functions of the family themselves. Unbalancing: Unbalancing is the act of the therapist challenging family members. It is not meant to be confrontational, but to push family members to reconsider their perception of how the family operates. Reframing: Reframing is a method by which the therapist will present the family’s challenges or complaints. Therapists will often reframe the problem of an individual in the family as a problem that may be a result of the structure and patterns of family dynamics. Enactment: Enactment is the plan for the future. Once the family’s structure has been observed and examined, the therapist, with input from the family, will introduce ideas and practices for the family to execute.

   How it Works: The fundamental goal of Structural Family Therapy is to help a family reorganize the way its members interact with each other in order to work more happily and cohesively as a unit and be able to adapt to stressors that may pop up in the course of life. Therapists may recommend to parents alter their behavior towards their children depending on whether the children need more independence or more support and guidance. They may suggest strategies to parents or other caregivers that highlight the need to present a united front. Ultimately, the objective of the approach is to strengthen the family as a system.

9. #9Gottman Method

   Keys: Gottman Method

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   Overview: The Gottman Method for Healthy Relationships is a form of couples-based therapy and education. A major tenet of the Gottman Method is that couples require five times more positive interactions than negative interactions. This is because negative interactions and emotions (e.g. defensiveness and contempt) hurt a relationship more than positive ones heal. As a result, the therapy focuses on developing the skills and understanding necessary for partners to maintain fondness and admiration, turn toward each other to get their needs met, and manage conflict. It also focuses on how couples can react and repair relations when they do hurt each other. Based on a couple's patterns of interacting, the Gottman Method also teaches couples how to implement relationship-building and problem-solving skills together.

   When it is Used: The Gottman Method can be helpful for couples who are stuck in chronic conflict, coping with infidelity, struggling with communication, in a stagnant relationship, emotionally distanced from each other, or facing difficulties over specific issues such as money, parenting, and sex.

   What to Expect: The therapist first provides couples an overview of the Gottman Method before each partner shares their history, relationship philosophy, and goals for treatment with the therapist. The therapist also conducts a thorough inspection of the relationship, including discussing a topic in which the couple disagrees on. The couple is educated on components of healthy relationships, and reminded of their fondness and respect which first brought them together. Direct coaching on interaction skills and developing trust is also provided, following components of a healthy relationship in what is called the 'Sound Relationship House' model.

   Components of a Healthy Relationship in the 'Sound Relationship House' model: Building Love Maps: This involves the therapist helping the couple know each other's inner worlds - their hopes, dreams, worries, stressors, and desires. Sharing Fondness and Admiration: This involves the therapist helping the couple focus on the respect and tenderness they have for each other. It works well when contempt exists in the relationship. Turning Towards instead of Away: This involves the therapist helping the couple to be aware of each other and responding when they sense their partner needs something emotionally. The Positive Perspective: This involves the therapist helping the couple to adopt a positive attitude when approaching relationship problems and repairing relationship failures. Managing Conflict: This involves the therapist helping the couple realize that while some relationship conflicts can be resolved, others must simply be managed, and can be managed well. Making Life Dreams Come True: This involves the therapist helping the couple create an atmosphere that encourages each other to talk honestly about their hopes, values, convictions, and aspirations. Creating Shared Meaning: This involves the therapist helping the couple understand important narratives, myths, and metaphors that may exist in their relationship. Trust: This involves the therapist helping the couple to know what each other thinks, and acting in the best interests of each other. Commitment: This involves the therapist helping the couple to develop gratitude for each other, and helping them to be committed to each other even through difficulties in life.

   How it Works: The Gottman Method recognizes that negativity has a strong impact on people's brains, and that, unless couples take steps to counteract instances of negativity, they will grow apart emotionally. The Gottman Method identifies and addresses the states of mind and behaviors shown to underlie intimacy. It also helps couples maintain a positive orientation towards each other that can sustain them through upsetting circumstances.

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