by Lee Jaffe, Ph.D.

When faced with an array of psychotherapies, it is difficult to know what’s right for you. Psychoanalysis? Psychodynamic Psychotherapy?  Cognitive-Behavioral Therapy (CBT)? Dialectical Behavior Therapy (DBT)? Gestalt Therapy?
They are all so very different, right?
In fact, all of these therapies are “talk therapy” and in many ways are more similar than not.  And what’s more, they all originated in the work of Sigmund Freud. That’s right! Freud invented “talk therapy”, and even behavioral therapies such as CBT and DBT are “talk therapies” based on Freud’s original model.
In my book “How Talking Cures” I illustrate the six most important elements of all talking cures. Like ingredients that vary in different recipes, their proportions will depend on the type of psychotherapy:

1. Direct support
2. Introjection
3. Catharsis
4. Insight
5. Identification
6. Working Through

Direct support is giving advice to a patient. For example, George was repeatedly in debt owing to his susceptibility to credit card offers. He came to treatment anxious and depressed about his unmanageable debt. In evaluating his difficulties, it became apparent that he could not understand the realities of the credit card offers. With referral to a debt management professional and ongoing support for the management of his finances, George gained financial stability.

Introjection occurs when the patient begins to internalize the voice of the therapist. Patients will report that when trying to cope with difficult situations they “hear” the words of the therapist helping them cope more effectively. For example, Alice has a habit of disagreeing with others. Without realizing it she is prone to saying “yes…but” rather than affirming. As this pattern was addressed in therapy, she came to hear the therapist’s voice pointing this out, and increasingly was able to stop herself and instead be more affirming of others. The result was a significant improvement in her relationships.

Catharsis is the when someone who has been unable to express emotion, cries, shouts, or in other ways “lets it out." Mary lost her baby last year to sudden infant death syndrome and refuses to change anything in the baby’s room.She cannot even consider accepting the idea of having another child. Through talk therapy she was helped toward expressing the painful emotions and grief. Now she is considering having another child and moving on with her life.

Insight is the ability to understand a feeling and where it came from. This helps the patient to manage the feeling. Barbara came to see me because she was worried that she was not a good mother when in fact she was quite capable. Through insight, she came to understand that her painful worries are the result of unconscious guilt about being a bad daughter, caused by refusing to have anything to do with her ailing mother.