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What approaches exist in psychotherapy?
Psychotherapy is not a unified discipline, but an umbrella term for a wide range of approaches that differ in philosophy, methodology and the therapist's style of work. In this article, we will take a closer look at four prominent approaches: cognitive behavioural therapy (CBT), Gestalt therapy, SUR (group psychotherapy according to Skála, Urban and Rubeš) and systemic family therapy.
We will explain not only the basic principles, but also how these approaches work with clients and what situations they typically address.
Cognitive-behavioural therapy (CBT)
CBT is one of the most scientifically proven psychotherapeutic approaches. It was created by combining two schools of thought: behaviourism, which focuses on observable behaviour, and cognitive psychology, which tracks thought patterns.
Basic principles of CBT
Thoughts, emotions and behaviour are interconnected. A change in one of these links can affect the entire chain.
Mental health issues are often perpetuated by faulty thinking patterns (known as cognitive errors) and dysfunctional habits.
Clients learn new ways of thinking and behaving.
The course of treatment using CBT
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The therapy is structured and time-limited (often 10 to 20 sessions).
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Homework assignments, which the client tries out between sessions, play an important role.
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The therapist helps the client identify negative automatic thoughts (e.g., ‘I can never do anything right’) and works with them using methods such as cognitive restructuring.
Example of CBT
A client with panic disorder learns to recognise the first signs of an attack, challenges catastrophic thoughts (‘I'm definitely going to die.’) and practises breathing and physical exercises to manage anxiety.
Gestalt therapy
Gestalt therapy emerged in the mid-20th century as a reaction to the cold, rational style of psychotherapy. It emphasises the experience of the ‘here and now’, bodily perception and authenticity.
Basic principles of Gestalt therapy
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Emphasis on the holistic perception of the person – Gestalt means shape, whole.
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The client is responsible for their own life and choices.
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Working with unconscious patterns that influence behaviour (so-called unfinished business).
The course of Gestalt therapy
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Experiencing the present moment plays an important role – the therapist often guides the client to describe what they are feeling in their body at that moment.
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Working with experimentation – for example, using an empty chair to conduct a dialogue with inner parts of oneself.
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Strong involvement of physical reactions, emotions and non-verbal expressions.
Example of Gestalt therapy
A client who has difficulty expressing anger ‘sits’ the person they are angry with on an empty chair and tries to have a conversation with them. This releases pent-up emotions and provides a new experience of self-expression.
SUR – Group psychotherapy in real events
SUR is an abbreviation for the System of Training in Psychotherapy, which was established in the 1960s as a specific model of psychotherapeutic education in Czechoslovakia. Its founders were Doc. MUDr. Jaroslav Skála, PhDr. Eduard Urban and MUDr. Jaromír Rubeš. SUR was unique in that it built on the principles of the therapeutic community and developed outside official structures as a spontaneous school of personality-oriented psychotherapy.
Basic principles of SUR
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SUR is primarily group therapy, where participants reflect on their experiences and reactions to ‘real events’ – that is, actual relational or emotional situations that arise in the group.
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The therapist is not directive, but rather acts as a facilitator – the group itself is the driving force behind change.
The course of SUR therapy
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The work usually takes place in a permanent group that meets regularly (e.g. once a week or during intensive weekends).
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The group serves as a living social microcosm that reflects the interpersonal patterns of its individual members.
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Reflection and feedback are of fundamental importance.
An example processed using SUR therapy
During a weekend meeting, participant Lenka expresses that she often submits to others in her life and is unable to say no. In response, another group member tells her that she feels as if Lenka does not respect her boundaries. In a safe, guided environment, both have the opportunity to talk openly about their emotions. The group helps them see the connections with their childhood and relationships outside of therapy. The whole process encourages self-reflection, a deeper understanding of one's own behaviour patterns, and creates space for personal growth while maintaining a safe environment in which this skill training is possible.
Systemic family therapy
Systemic therapy (especially in its family form) views people as part of relational systems – family, work, community. A change in one member affects the entire system.
Basic principles of systemic family therapy
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The family is perceived as a system with its own rules, roles and structure.
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The symptoms of one member (e.g. a child) may be an expression of a dysfunction in the system.
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The aim is not to find someone to blame, but to find ways in which the whole system can function better.
The course of systemic family therapy
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Several family members often attend the sessions and the therapist leads a dialogue between them.
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Questions such as ‘What do you think your brother would say if he were here?’ or ‘How would things change if this problem disappeared?’ are frequently used.
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Working with metaphors, genograms, or so-called circular questions.
An example processed using systemic family therapy:
A child has behavioural problems at school. During therapy, it becomes apparent that the parents are in a long-term conflict and the child is attracting attention to himself in order to divert attention from the tension between them. The therapy focuses on changing the communication between the parents, not primarily on the child's behaviour.
Each therapeutic approach offers a different perspective on the human psyche and a different way of guiding a person towards change. There is no better or worse approach; the important thing is to find an approach that resonates with the specific client, their personality and the problem they are presenting. CBT offers structured solutions for specific difficulties, Gestalt enables deep experience and awareness, SUR supports self-knowledge, and systemic therapy brings change to relationship networks.
At Psymed, we have experts in these approaches and we will be happy to help you choose the one that will be most useful for you. Just get in touch using our simple form.
Sources:
https://app.terapie.cz/gestalt
Kalina K. a kol.: Mezioborový glosář pojmů z oblasti drog a drogových závislostí. Filia Nova/Úřad vlády ČR, Praha, 2001
https://app.terapie.cz/systemicka-terapie
https://is.muni.cz/el/1423/podzim2015/PST433/um/Soucasna_RT_update_2015.pdf