While “therapy” of one sort or another is a mainstay treatment for many, if not most, mental health conditions, there is such a plethora of models and methods of psychotherapy that it can be a significant challenge for referring primary care providers to determine where to direct their patients to seek care most suited to their or their children’s behavioral health condition(s). While there is a significant amount of professional and scientific literature that seeks to clarify this issue and define what resources will work best for an individual or family with a specific set of problems, matching patients with a provider skilled in an optimal treatment approach remains a bit of an art— this made more complicated by the challenges of finding an accessible provider, by the constraints of insurance coverage, and by the ineffable issue of patient-provider fit.
Given these challenges, this week SmartCare newsletter seeks to provide a summary of a number of therapeutic modalities of relevance for the children and families they see who may seek referrals for behavioral health care. SmartCare’s family support service phone line 858 956-5900 is an additional resource available to your patients to assist them in identifying care that is targeted to their clinical needs and accessible by them geographically and financially.
In an extensive, but not exhaustive, discussion of the types of therapies provided on the Psychology Today website (see references for link, the list of distinct therapies identified describes 65 different types of psychotherapeutic treatment. In practice, most providers integrate elements of several techniques into their interventions with patients and it is good practice to advise patients to discuss their needs and preferences regarding treatment with a prospective psychotherapist at the outset of their seeking care.
This week’s newsletter offers a review of some of the therapeutic modalities and their indications to assist the primary care provider in their efforts to guide their patients in the right direction in seeking care for themselves or loved ones.
- Cognitive Behavioral Therapy (CBT): This is one of the most common types of psychotherapy and is used in a wide variety of clinical situations. It is typically a short-term, structured, present-oriented therapy that aims to help with problem solving by changing a person’s unhelpful and often automatic thinking that adversely impacts his/her emotional reaction and behavioral response to a situation. It has been found to be an effective treatment for depression, anxiety and insomnia. CBT is based on the cognitive model, which states that the way that individuals perceive a situation is more closely connected to their internalized ideas than to the presenting situation itself. A goal of CBT is to help the individual more clearly identify and become aware of the linkages between their thoughts, emotions and behaviors, with the aim of being able to respond to situations more objectively and less automatically. Cognitive Behavioral Therapy
- Trauma-focused CBT (TF-CBT): This is a specific CBT framework to help children and adults with trauma. Core components include: psycho-education, emotional regulation and cognitive re-processing of the trauma. Some therapists have special certification in TF-CBT. Trauma-focused CBT
- Exposure Response Prevention (ERP): This is a CBT model that is primarily used for OCD (obsessive compulsive disorder) and individuals with phobic behaviors. It involves helping the person facing his/her fears and then refraining from doing the ritual linked to that fear. It can be anxiety provoking at first but the goal is for the anxiety to wane over time. Exposure Response Prevention
- Habit Reversal: – This is a CBT model that is used for tic disorders. It involves helping the patient develop awareness of a premonitory urge of a tic coming on and creating competing response training. Habit Reversal CBT
- Dialectical Behavioral Therapy (DBT): This is a CBT-model that is useful for borderline personality disorder and chronic suicidal ideation/non-suicidal self-injury. It combines elements of CBT with mindfulness and improving distress tolerance. Dialectical Behavior Therapy (DBT)
- Psychodynamic therapy: This is a more long-term and in-depth form of therapy which relies more heavily on the relationship between the client and therapist. The goal is to unveil and/or reveal the internalized unconscious content of a client’s thoughts and interpersonal dynamics. Psychodynamic Therapy
- Family therapy: This is a form of psychotherapy that works with couples and families to foster change and development, viewing change in terms of the system of interactions among family members. Family Therapy
- Applied Behavioral Analysis (ABA): This is a model that is used specifically for individuals with Autism Spectrum Disorder. It is based on rewarding desired behavior and not rewarding undesired behavior. It seeks to teach individuals new more complex skills but breaking them down into smaller steps. Applied Behavioral Analysis
- Relationship Development Intervention (RDI): This is a newer model that is used for Autism Spectrum Disorder that uses a guide-apprentice relationship between a parent and child, where the parent is trained to help the child learn desired developmental and social skills. Relationship Development Intervention (RDI)
- Parent training (includes parent-child interaction therapy or PCIT): This primarily involves parent education to change parenting practices and increase positive reinforcement to help with symptoms of ADHD and ODD (disruptive behavior, aggression, tantrums) and is utilized most often with younger children. PCIT
- Eye Movement Desensitization and Reprocessing (EMDR): This is a therapy used for PTSD that uses an eye movement component to help reduce the distressing memories after a trauma by engaging the brain’s natural coping mechanisms. EMDR
- In-home behavioral therapy (ex. Therapeutic Behavioral Services-TBS): In-home behavior therapy can be used in conjunction with individual or family therapy to help generalize concepts learned in therapy into the home setting. This is particularly helpful when a child presents with more challenging behaviors in the home setting. TBS SD County
- Wraparound services: This is an even more intensive service that involves a combination of therapy, family partner, case management and team meetings. This is a service often used to help avoid hospitalization or out of home placement for children with complex emotional, behavioral and psychosocial problems. Wraparound Service
As primary care providers, if you have patients (adult and pediatric) who could benefit from psychotherapy, it is helpful to be able to guide them in an appropriate direction for what specific type of therapy to pursue. Feel free to refer patients to our SmartCare BHCS Patient/Parent Line for more individualized support and guidance in obtaining appropriate referrals.
- Psychology Today: Types of Therapy (https://www.psychologytoday.com/us/types-of-therapy)
- Jeppesen P, Wolf RT, Nielsen SM, et al. Effectiveness of Transdiagnostic Cognitive-Behavioral Psychotherapy Compared With Management as Usual for Youth With Common Mental Health Problems: A Randomized Clinical Trial. JAMA Psychiatry.2021;78(3):250–260. doi:10.1001/jamapsychiatry.2020.4045