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Today is the International Day of Happiness and the theme this year is ‘Happier Together’. The focus is on what we have in common, rather than what divides us.
Indeed, research has shown that relationships are essential to our happiness and well-being. Loneliness increases the risk of dying from a stroke, the risk of a heart attack and the risk of developing Alzheimer’s, and there is higher mortality among individuals who are lonely.
When I talk about relationships, I do not refer only to romantic ones; our social network includes friends, family, colleagues, neighbours, teammates and so on.
A special type of relationship is the so-called therapeutic (in the context of psychotherapy). But, what exactly is this therapeutic approach? Or, therapeutic approaches rather, since there’s a large number of psychological therapies; these therapies differ both in their theory and the therapeutic approach used. Although they’re collectively known as ‘talking therapies’, some therapies encourage ‘doing’ and learning practical skills, and not just ‘talking’; this is particularly true for CBT, mindfulness-based therapies and art therapy.
Psychoanalysis and psychodynamic psychotherapy
Psychoanalysis is the most archetypal psychotherapy. Established by Sigmund Freud, there is a group of (psychoanalytic) theories and therapeutic techniques (‘Freudian’ being one of them). Psychodynamic (or psychoanalytic) psychotherapy differs from psychoanalysis in that it is less intensive and briefer than the latter.
These therapies can be particularly helpful for longstanding problems, especially when these problems affect our relationships. They can also be helpful for those of us struggling with personal fulfilment. Unconscious patterns can be brought into awareness and explored through the intervention of the therapist, who makes ‘interpretations’ rather than provide direct advice on how to change.
The therapist acts like a mirror, and can help us see and understand ourselves better by shedding light on aspects of our personalities and internal world that we may be oblivious to. Needless to say that this process takes time; psychoanalysis is far from a quick fix.
Cognitive behavioural therapy
CBT is usually delivered in much shorter time and follows a totally different approach. CBT focuses on a specific problem (such as low mood, anxiety, anger, low self-esteem, or even chronic pain), and on the here-and-now. It is not as holistic as psychoanalysis or psychodynamic psychotherapy; however, there’s strong research evidence about its effectiveness in the management of a number of psychological problems, mental illnesses and long-term physical conditions.
According to the underpinning theory, our feelings, thoughts, behaviours and physical symptoms are closely linked to each other. The therapist helps us identify vicious cycles involving unhelpful thinking styles (cognitive distortions, thinking biases, traps or errors, as they are also called) and behaviours. By breaking these vicious cycles we can change the way we think and behave. By doing so, our feelings and physical symptoms can also change.
Mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) use mindfulness as the main therapeutic approach. Derived from Buddhist traditions, this is a psychological process of bringing our attention to experiences occurring in the present moment.
Acceptance and commitment therapy (ACT) is another mindfulness-based therapy; it differs from CBT in that it teaches us to notice, accept and embrace distressing experiences (such as feelings or physical symptoms) rather than trying to change them. This does not mean resigning to these experiences, but acknowledging that they can be outside our control.
ACT encourages us to rather change the way we perceive and view them. Essentially, a mindfulness approach can help us become less reactive to stress, build resilience, cope better with health problems (including long-term physical illnesses) and reduce psychological distress.
Other psychological approaches
Art therapy combines talking therapy with creative exploration through the arts. It can help explore and communicate feelings that may be too difficult or distressing to express in words.
Counselling involves a therapist listening and helping us find ways to deal with emotional issues. It is less structured than CBT, and may be particularly helpful when going through a change in life circumstances (for instance, bereavement).
Life coaching is not a type of therapy, but a collaborative approach to support an individual achieve their personal or professional goals.
Benefits and challenges
Despite their different therapeutic approaches, different psychotherapies have a very important element in common: the relationship with the therapist (often called therapeutic relationship or alliance). Research shows that this plays a very important role in the outcome of therapy (whether it is successful or not) no matter what therapeutic approach has been used.
Another benefit (again irrespective of the type of psychotherapy) is that they encourage us to pay close attention to our internal world (feelings and thoughts) and this alone can often be therapeutic. Psychotherapies provide a space where this internal world can be acknowledged, validated, understood and explored – and I strongly believe that this is where one of their greatest benefits lie.
A challenge, however, is that psychotherapies do not provide a quick fix. Improving our well-being and mental health is a skill that can be learned and developed over the rest of one’s life. It is a skill that takes consistent daily practice just like learning a musical instrument, or a foreign language. It therefore requires time, effort, persistence and patience.
Dr Alex Chatziagorakis is a London-based consultant psychiatrist and a member of the Royal College of Psychiatrists.
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