The word modalities is a medical term used to describe the methods, approach, or process a therapist uses when working with a client who is seeking mental health treatment. There are several different treatment modalities in use at Therapeutic Health Services, and you will find a brief introduction to each of them below. All of them have been in use over many years in mental health practices all over the world, and are therefore tried and tested for their effectiveness and successful outcomes.
But not all modalities are effective for all clients. Some methods work well for some clients, while others need a different approach. At Therapeutic Health Services, the therapist will determine the best course of action for each individual we treat.
The act of knowing or perceiving a fact by the human brain is called cognition. Therefore the concept of cognitive behavioral therapy draws on the idea that it is our thoughts that determine our behaviors. However, what we think or believe about ourselves is often not true, as when a client generally perceives him or herself in a negative fashion. These inaccurate negative beliefs can be unlearned in therapy, and replaced with more precise thoughts and positive feelings. Once the client knowingly dispels these negative thoughts as inaccurate, then healing and new ways of thinking positively about oneself can begin. You may sometimes see the acronym CBT to describe this modality.
In Cognitive behavioral therapy, the client works with a mental health counselor or therapist to become aware of his or her negative thought processes. By identifying, isolating, and understanding them, harmful thought patterns that influence behavior can be avoided, as new, more positive ones take their place.
Many people have heard the saying “he can’t get out of his own way” to describe an individual who cannot seem to harness his emotions or handle the stress of everyday life in ways that will result in positive outcomes for him or herself, and those around them. This self-sabotaging behavior needs to be understood before it can be unlearned and treated as harmful. Dialectical behavior therapy can be very effective in helping clients realize they can learn to be mindful of their actions, positively manage the stress of everyday life, and deal with their emotions in ways that will help them improve their interpersonal relationships.
It differs from cognitive behavioral therapy in that it deals with one’s real life reactions to events, as opposed to the paralyzing thoughts of cognitive behavior that lead to inaction or poor choices of action. Once learned, these concepts greatly improve one’s interpersonal relationships. Dialectical behavioral therapy gives people the tools to accept the realities of life that they cannot control, the idea being that they do have control over their reactions to them. Clients realize this by learning how to think logically as the best way to manage their emotions. It is sometimes abbreviated DBT.
Solution-focused brief therapy (abbreviated as SFBT) is a strength-based approach to psychotherapy based on solution-building rather than problem-solving. Unlike other forms of therapy that focus on present problems rooted in past causes, solution-focused therapy concentrates on how one’s current circumstances and future hopes can lead one to practical, realistic outcomes to present difficulties and show one how to create a better life.
At the outset, the therapist determines if the client is capable of building solutions for him or herself by actively using his or her own intellect, strengths, resourcefulness, and creativity. An emphasis on current reality is essential, as well as any steps that may be taken to create the new one that is desired, in a relatively short period of time
Not based on any one theory, SFBT falls within the category of what are called constructive therapies, in which clients learn to create their own reality that is better than the one they are currently living in. Because changing for the better is the goal, once the client accepts that life changes are inevitable, he or she can start working to make positive changes quickly.
A skilled clinician can draw out clients’ thoughts by asking them about hopes and dreams and a realistic path to achieving them. Shifting focus to what already works in a client's life, and how other things can be made better, the client creates a path to achieve the solution.
You’ve no doubt heard the common expression used today to, “think outside the box.” In SFBT, what is known as the “miracle question” is a technique that therapists use to encourage clients to think beyond their present circumstances toward a desired outcome, by imagining that their current problem is miraculously gone. Considered this way, life without the problem can be envisioned, and thus, it is hoped, realistically achieved. The future possible solution may involve different ways of interacting with others, thinking in different ways and altering one’s behaviors when necessary. Put colloquially, clients might be asked to rate certain outcomes “on a scale of one to ten,” to see how important or unimportant the change would be if it were to occur. This is really what the client wants to know in any case, so it is a valuable technique when therapist and client are working on problem solving together.
SFBT results have been studied and found to be consistently effective cross-culturally in many mental health therapy scenarios, particularly the treatment of depression. This occurs as the client participates in creating the life he or she wants to live. A skilled therapist and willing client can use SFBT to achieve rapid, lasting results.
In instances of substance abuse, if a client does not want to change his or her behavior, the change will not occur. This is how motivational interviewing can benefit a client. Motivational interviewing helps identify the reasons a client wants to become sober, even if the client believes he or she does not. Behavioral change comes from within the client, not external forces.
The therapist encourages the client to find reasons that changing his or her behavior is a good thing. The power of drugs and alcohol pull a client into negative behavior, but motivational interviewing can get a client to discover his or her deepest goals and what the client really wants for the future. This realization is the incentive to achieve positive behavioral change.
The motivational interviewing approach is client centered and works best for people who are ambivalent about changing their behavior to get and stay sober. It is possible to want both to change but not feel ready to change. Eliminating this ambivalence can lead a person to make behavioral changes. But to work, motivational interviewing must be collaborative and stress that it is the client that makes the decision to change. Therapist and client collaborate on how this can be achieved, but the therapy centers around the client’s experience and point of view, not that of the therapist. There is no confrontation, which breeds mistrust. Collaboration leads to partnership and trust and eventually, recovery.
When the client can finally identify his or her motivations for change, these can be called upon every day, especially when the client feels he or she can’t continue and wants to give up the process. They are the incentive to keep up progress and move forward.
The counselor can best help by expressing empathy for the individual. There is no judgement in motivational interviewing, but viewing the problem from the client’s vantage point is key. The client must be understood and feel comfortable sharing thoughts with the therapist.
Once clients see the difference between who he or she is now, and the person they would like to be, this discrepancy can be a strong motivator for behavioral change. Gradually, the individual realizes he or she has become confident in their ability to change and finds that they have.
Meditation and mindfulness are achieved by learning to live in the present moment. By combining the workings of the mind and body to focus on the present, well-being, a sense of calm and mental focus can result. This is a very different mindset to the way many people live today. Modern life forces us to think about everything but the present. We worry about what we did yesterday, what we must still accomplish today, and think about what we need to do the next day, or next week, or next month.
The techniques of meditation and mindfulness can be taught to receptive clients as a way to help them manage anxiety and stress and improve concentration. No drugs or exercises are involved in performing meditation or achieving mindfulness. Primarily, deep, slow breathing is all that is necessary to bring the benefits of meditation into effect. Results achieved by many people from this practice have been shown to induce relaxation, reduce stress, improve sleep, and generally improve one’s quality of life. Meditation can also help with substance withdrawal, including nicotine. Physically lowering one’s blood pressure can also be achieved. Learning to live in the present through meditation and mindfulness has also been shown to relieve depression in some people.
It is helpful to have a teacher or therapist to guide one through the introductory steps in the practice of meditation and mindfulness, but these are quickly learned and can be practiced at will at any time. The key word is practice. Meditation and mindfulness training does not need to be perfect. The important thing is to practice regularly. The capability is always with you once you have learned how to slow down the racing thoughts of your mind and achieve calm. It is a practice you can always use.
Children express themselves through the act of play because they do not yet have the use of words or language to do so. The well-studied technique of play therapy allows a child to show his or her feelings through the creativity and self-expression of using toys and playing games. Doing so helps the child develop social skills, learn how to communicate with others, and express his or her own personal and behavioral problems to the therapist without the use of words.
Essentially, the child takes the lead in the initial play therapy sessions, which can be free form and non-intrusive for a period of time. The child is free to play as he or she wishes without input from the therapist. At other times, play can be therapist-led to encourage display of the child’s specific issues, thinking and social skills, decision making, and how to communicate his or her own concerns or problems. These activities will help children learn how to take personal responsibility for their actions, find new creative ways to solve problems, learn respect and acceptance of themselves and others, and develop interpersonal skills.
When children are first offered the opportunity for play therapy, they spend from 30-45 minutes in a safe, comfortable environment playing with a specially selected wide range of toys such as dolls, puppets, costumes, art materials, clay, finger paint, building toys like Legos and sandboxes, doll houses or stuffed animals to express themselves given their limited vocabularies. Music and dance activities may also be part of play therapy. Observing these activities can illustrate to the therapist the child’s various thoughts, emotions and conflicts, and encourages the development of healthy behaviors a child may need to learn.
At various stages, the therapist will offer adjunct services to the child’s parent or guardian by coordinating treatment with additional doctors or other professionals to make sure the child’s needs and welfare are addressed as the priority of play therapy.
Although designed at first for children under twelve, play therapy has been shown to benefit all ages. Just as the child advances and learns from play therapy, teenagers and adults can use the non-threatening activities of play to communicate their deeper, more serious feelings. For adults, play therapy has been shown to help with the behaviors of dementia patients; issues of grief and loss; post-traumatic stress; autism spectrum; abuse, anxiety and depression, among others. Adults may also benefit from play therapy in instances where limited social contacts and slow emotional development inhibit their release of feelings so that they can be expressed and addressed.
Only a licensed mental health counselor with advanced training and supervision in play therapy can provide this special treatment and is available at Therapeutic Health Services.
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