Psychotherapy

Cognitive Behavioral Therapy (CBT)

What is Cognitive Behavioral Therapy (CBT)?

Cognitive behavioral therapy (CBT) is a model of psychotherapy that originated in the United States and has developed over several decades. Firstly, CBT depends upon a belief that psychological suffering and dysfunctionality can be alleviated by purely psychological intervention. Secondly, the medium used to understand and address the suffering is language.

CBT involves interactive sessions during which the therapist detects the so-called cognitive distortions or unhelpful thoughts, that is to say the beliefs that the individual displays on a conscious and unconscious level, as well as the associated behaviors. For example people who are known as “perfectionist” are constantly judging themselves and typically have unhelpful thoughts such as “I are dumb!”, which they will try to compensate with behaviors that avoid failures at all cost. These cognitive distortions or unhelpful thoughts are very deep beliefs that patients struggle to change on an emotional level even if they make them suffer.

The goal of cognitive behavioral therapy (CBT) is to relieve the individual by helping them identify and understand their unhelpful thoughts and behaviors, and bring them more in tune with their environment. How? One of the means used by cognitive behavioral therapy (CBT) is the so-called “action tasks”, whereby the psychotherapist proposes to the individual to perform a task that challenges their schemas. For example such a task might entail asking the perfectionist to produce a document that would include a typo.

This “action task” generally takes place outside of the individual’s comfort zone: it is therefore expected that they will worry and resist performing it. But the trained psychotherapist will usually choose tasks that are feasible, and the interpretation of resistance is part of the therapeutic process.

I try to prescribe “action tasks” that will foster lasting changes in people’s daily lives by taking into account their resources and potentialities. One patient recently said: “Dr. Adam is awesome. He listens to you and has a great sense of style as a therapist. He’s never snotty, rarely late, and takes every emotion into consideration. He’s a class act. ”

Cognitive behavioral therapy (CBT) also uses the cognitive restructuring which aims to challenge certain patterns of thinking in the here-and-now, but also through EMDR.

How do I practice Cognitive Behavioral Therapy (CBT)?

I practice CBT, emphasizing the reduction of symptoms as my main aim. For example I could possibly help a person who wants only to quickly reduce their fear of public places (agoraphobia). CBT is based on a theory that it is not events in themselves that upset us, but the meanings we give them. However, CBT believes that this meaning is conscious, can be accessed, and is not ambiguous. If someone says that they feel sorry for a person, they do feel sorry and it is possible that their problem is that they should not; the therapist then tries to help the person to see that they are thinking about something in the “wrong way”. The concept of unconscious, a central freudian discovery, renders the picture instantly more complex: if you say you are sorry for someone it might indeed mean that you are sorry, but could also mean that you can’t face your own aggressiveness and the fact that you are delighted at what happened to the other. The question of the existence of the unconscious is crucial, because if CBT starts to take into account the possibility of unconscious meanings and logic, then it would become another branch of psychoanalysis.

Cognitive Behavioral Therapy (CBT) is evidence-based and has scientifically demonstrated efficacy, which has brought about a revival of interest in psychological therapies.

BRIEF Psychotherapy and Strategic Family Therapy

What is a BRIEF therapy and strategic family therapy?

Brief psychotherapy and strategic family therapy refer to therapy models that were developed since the 1960s at the Mental Research Institute (MRI) in Palo Alto. These models are associated with Richard Fisch, John Weakland, Jay Haley, Paul Watzlawick, and Eileen Bobrow, whose work has permanently influenced the world of therapies but also communication.

These brief therapies are called exactly “short problem solving therapies”: they are based on a simple model but require the definition of the problem and identification of ineffective solutions (the solutions that become the problem) in order to move towards a resolution.

These strategic family therapies imply a direct intervention of therapists to influence participants to resolve their issues.

How I practice BRIEF psychotherapy and BRIEF strategic family therapy?

I do not practice the brief therapies and strategic family therapy in the strict sense: it seems difficult to develop such a practice outside of a specialized institute and it can have a provocative aspect of it that does not really fit with the vision of certain patients of what therapy should be.

Nevertheless I am very influenced by this model, which can give me an interventionist attitude during crisis situations. Some of my core questions for any new patient are: “What are you willing to do to solve this problem?”. Or, “if this problem were resolved today, how would that change your situation”?

EMDR

What is EMDR?

EMDR (Eye Movement Desensitization and Reprocessing) is a therapy that was developed in the late 1980s by Francine Shapiro. This American psychologist discovers and confirms in the psychology laboratory the therapeutic effect of bilateral stimulations (initially eyes movement) to decrease the emotional charge related to traumatic events.

She then created a care protocol (EMDR) that she validated with combat veterans suffering from post-traumatic stress. Not only does this approach help alleviate their emotional reactions and desensitize them (this is the “Desensitization” or “D” of EMDR) but it also empowers them to perform a reinterpretation of the event (the “Reprocessing” or “R” EMDR). A former combat veteran who has been traumatized may present, in addition to nightmares and panic attacks, cognitive distortions such as “I am guilty of having survived”. EMDR can act on this cognitive distortion.

EMDR has become a powerful tool of “cognitive restructuring”: it can be administered as a supplement to cognitive behavior therapy (CBT).

Let’s take for example the perfectionist who has anticipatory anxiety about making mistakes or struggles with fears of being stupid or dumb. It suffices for them to recall the memories that are associated to the cognitive dysfunction “I am dumb”. They substitute a positive experience for the trauma in an EMDR protocol. So the individual and the psychotherapist can work together to alleviate this belief. For in order to perform EMDR there must be a care protocol with “memory targets” and “cognitive distortions” on which one wishes to work.

If EMDR can mitigate relatively quickly the effects of a single traumatic event, therapeutic follow-up often lasts several months. EMDR cannot be fulfilled on the first visit.

EMDR can never be performed on a person who is too psychologically decompensated: their condition needs to be stabilized first, possibly with psychopharmacology, then EMDR can begin. EMDR requires at least a one-hour consultation.