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There are many different approaches therapists use as forms of intervention and modalities of work. Oftentimes, therapists are eclectic and use a variety of different techniques and approaches to getting to healing and understanding.
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IAMAdoptee asked JaeHee Chung Sherman, LCSW to explain the various common modalities many clinicians use in their work. Remember, some therapists may specialize in using one particular modality, and others may use a combination of a few. All of these approaches can be helpful in the healing process.
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Psychodynamic Therapy
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Rooted in psychoanalytic therapy, this intervention is less intensive, and what most consider traditional talk therapy. The goal of psychodynamic therapy is gain insight into behavior and psychological patterns such as emotions, thoughts, beliefs, and early-life experiences and help clients recognize how these patterns, particularly early relational patterns, may contribute to presenting issues through representation and interpretation (Team, n.d.). The premise is that through self-awareness of patterns an individual can make beneficial changes into everyday life. It is considered one of the oldest models of therapy.
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Many therapists will utilize psychodynamic therapy in conjunction with other interventions (based on a client’s needs) such as EMDR, SE®, CBT, etc. Accessing the unconscious state of mind in an effort to make the unconscious, conscious. There are many different forms of psychodynamic therapy such as brief adaptive psychotherapy, dynamic supportive psychotherapy, and more (CSAT, 1999). Psychodynamic therapy can be beneficial for individuals who desire a long-term therapeutic intervention and “deep dive” into counseling with a trained psychodynamic therapist.
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This intervention can be useful for individuals who have been diagnosed with mild depression, generalized anxiety, and stress.
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To learn more about psychodynamic therapy, please visit the following:
https://www.apa.org/news/press/releases/2010/01/psychodynamic-therapy
https://www.goodtherapy.org/learn-about-therapy/types/psychodynamic
https://psychcentral.com/lib/psychodynamic-therapy#3
Risks of Psychodynamic Therapy:
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Psychodynamic therapy requires more in-depth discussion related to past experiences, particularly childhood, and memories. Traditionally, psychodynamic therapy is a lengthy process that can stretch up to 25 session to two years or more. Many times, insurance will not cover this specific therapy absent of specific treatments and goals.
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It is recommended that psychodynamic therapy be used when an individual does not present with multiple presenting concerns such as chronic trauma, active suicidality, homicidality, addictions (including process addictions such as gambling, shopping, pornography, etc.), eating disorders, self-harm, and acute depression and anxiety.
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The risk is continued exposure to traumatic events based on processing an incident to “experience” the trauma in order to make sense of how it may impede daily life (Linden & Schermuly-Haupt, 2014). Individuals who have complex, acute trauma may wish to seek alternative therapies that assist regulation, enhance coping skills, and mental health wellness/management prior to psychodynamic therapy first.
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EMDR (Eye Movement Desensitization and Reprocessing)
According to EMDRIA (2020), EMDR is “is an extensively researched, effective psychotherapy method proven to help people recover from trauma and other distressing life experiences, including PTSD, anxiety, depression, and panic disorders.” With the awareness that our brains and bodies are constantly moving towards healing, EMDR aids the process by allowing the brain to transform a memory, rather than just reframing it.
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EMDR is an established, evidence-based mental health intervention that has been endorsed and recommended by numerous international and governmental agencies such as the American Psychological Association (APA), U.S. Department of Veterans’ Affairs & Department of Defense, Substance Abuse and Mental Health Services of America (SAMHSA), and the World Health Organization (WHO).
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Benefits of EMDR
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The goal of EMDR is to resolve and integrate, or make sense of, unprocessed traumatic memories housed in the brain (EMDRIA, 2020). Dependent upon the nature of an individual’s presenting concern, EMDR may be completed in fewer sessions than other tradition psychotherapies. EMDR is client-driven with the belief that the therapist provides navigation through the session that may include lateral eye movements, tapping, and/or sound/light pulses. This guided intervention is based on a client’s level of comfort and led by the therapist.
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Unlike other therapeutic interventions, EMDR does not require extensive verbal discussion related to traumatic experiences but focuses on allowing the brain and body (somatic) to guide the healing process. Some individuals do not want to further disclose traumatic experiences and others who may be negatively impacted regarding mental health diagnosis and clinical note disclosure such as active military, police, medical professionals, etc., EMDR has been a more comfortable intervention and treatment option.
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EMDR can be used as a singular therapy intervention, in conjunction with traditional cognitive therapies, and/or adjunctive therapy with another therapist who has been trained. This can be decided between you and your therapist. EMDR is a formal mental health intervention that should only be used by trained and licensed mental health practitioners.
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For additional information about the specific process of EMDR therapy, please follow this link: https://www.emdria.org/about-emdr-therapy/experiencing-emdr-therapy/
What EMDR is Not
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EMDR is not meant to eradicate, cure, nor erase disturbing or traumatic memories. The EMDR process is to help integrate those memories by creating new connections in your brain between disturbing experiences and a new emotional awareness that will help guide you in the future.
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EMDR does not alter memory but reprocesses how your beliefs and perceptions are impacted. Even though EMDR may not require extensive talk therapy, like any therapeutic relationship, it is important to establish a trusting relationship for EMDR to be effective and sustainable which may require more sessions to build rapport and meet individual needs.
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EMDR is not hypnosis which induces clients into an “altered state of mental relaxation,” but requires dual focus between positive and negative experiences simultaneously to process them effectively (EMDR, n.d.).
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EMDR Risks
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Distressing and unresolved memories may emerge and some clients may experience reactions during a treatment session that neither they nor the administering clinician may have anticipated, including a high level of emotion or physical sensations after the treatment session, the processing of incidents/material may continue, and other dreams, memories feelings, etc., may emerge (EMDR, n.d.).
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Somatic Experiencing (SE®) Therapy
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The SE® (2020) approach “is a body-oriented approach to the healing of trauma and other stress disorders.” Developed by Dr. Peter Levine, Ph.D. to assist those impacted by complex trauma based the knowledge that the body houses stress that must be discharged or is stored as “thwarted survival energy” in the body. SE works to release the stress stored in the body following a traumatic, attachment wounds, and/or chronically stressful event. SE® focuses on internal resiliency, self-awareness, and our bodies capacity to heal, rather than the “pathology of trauma” (Winblad, Changaris, & Stein, 2018).
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Benefits of SE®
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SE® is meant to gently guide clients through the toleration of bodily sensations and responses connected to conscious and unconscious trauma memories. Through the subtle observations related to the body’s reactions during therapy, a trained SE® therapist, helps guide a client through body recognition, emotional awareness, and toleration of stressful events to build tolerance and regulation. This process does not necessarily require significant discussion, nor verbal processing related to the traumatic events unless an individual and therapist choose this. It is particularly beneficial for individuals who have experienced early childhood trauma experiences, medical trauma, anxiety, complex trauma (PTSD) and assault, vicarious (secondary) trauma impacts, and chronic health issues.
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To learn more about SE®, please visit the following:
https://traumahealing.org/about-us/
https://www.somaticexperiencing.com/somatic-experiencing
https://www.goodtherapy.org/learn-about-therapy/types/somatic-experiencing
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Risks of SE®
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Like any other intervention, there are potential risks such as unprocessed memories, sleep disturbances, eating pattern changes, and bodily sensations that may not be recognizable. It is important to maintain on-going communication with your therapist should any side effects occur.
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Adoptee-Centric Considerations
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The therapeutic modalities listed are typically utilized with adult clients (18+ years old and up). It is not uncommon for adoptees to have been exposed to outdated, attachment-based pediatric therapeutic interventions prior to seeking therapy as an adult such as holding therapy, rebirthing therapy, ABA (Applied Behavioral Analysis), TBRI© (Trust-Based Relational Intervention), and other therapies that required behavioral modifications on the part of an adoptee in order to be rewarded relationally.
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Psychotherapy has historically overlooked the identity-based stress and trauma that adoptees, particularly who hold marginalized identities such as race, LGBQ+, non-binary, religious minorities, disabled, immigrants, and individuals denied their human right to their DNA, social, and medical information. It is normal for adoptees, particularly adoptees of color, to mistrust therapists and therapeutic applications based on past experiences that have too often exposed adoptees to harmful and coercive treatments.
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Though, therapists may be formally trained in these modalities, we recognize there is a long way to go so that these interventions are also synthesized with adoption-competent and thoughtful therapeutic care when working with adoptees and their families through the lifespan.
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We strongly recommend that adoptees consider the following:
- Inquire about the training and supervision a therapist has sought to work with adoptees (beyond their lived experience or a few seminars).
- Research the membership a therapist may be linked to.
- Working with adoptees under the age of 17 years old, does not constitute “expert status.” We, as adoptees, grow up. Inquire about adoption lifespan experience and consult a therapist has sought.
- Read through their intake and contract paperwork: Is it adoption-sensitive? Identity-based inclusive? Who does it “cater” to?
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References
About Us. (2020). Somatic Experiencing Trauma Institute. https://traumahealing.org/about-us/
Center for Substance Abuse Treatment. Brief Interventions and Brief Therapies for Substance Abuse (1999). Rockville (MD): Substance Abuse and Mental Health Services Administration. (Treatment Improvement Protocol (TIP) Series, No. 34.) Chapter 7—Brief Psychodynamic Therapy. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64952/
EMDR International Association. (2020, July 15). About EMDR Therapy.
https://www.emdria.org/about-emdr-therapy/
EMDR. (n.d.). Frequently Asked Questions. https://www.emdr.com/frequent-questions/
Psychodynamic psychotherapy brings lasting benefits through self-knowledge. (n.d.). Retrieved December 26, 2020, from https://www.apa.org/news/press/releases/2010/01/psychodynamic-therapy
Linden, M., & Schermuly-Haupt, M. L. (2014). Definition, assessment and rate of psychotherapy side effects. World psychiatry : official journal of the World Psychiatric Association (WPA), 13(3), 306–309. https://doi.org/10.1002/wps.20153
Team, G. (n.d.). Psychodynamic Therapy. Retrieved December 26, 2020, from https://www.goodtherapy.org/learn-about-therapy/types/psychodynamic
Winblad, N. E., Changaris, M., & Stein, P. K. (2018). Effect of Somatic Experiencing Resiliency-Based Trauma Treatment Training on Quality of Life and Psychological Health as Potential Markers of Resilience in Treating Professionals. Frontiers in neuroscience, 12, 70.
