What are psychotherapeutic modalities?
I recently had a conversation with someone and I was reminded of common knowledge in game theory—believing that because I know something, I presume others also know the same thing. In particular, I remembered that others may not know about psychotherapeutic modalities.
Per one source, “Psychotherapy is a form of talking therapy, which can be conducted with individuals, groups, couples and families.” Often, psychotherapy is referred to as therapy, talk therapy, or counseling.
Per another source, “Modalities are approaches or methods that a therapist will use to help you reach your goals.” Sometimes, modalities are referred to as models, approaches, or techniques.
According to another source:
There are hundreds of psychotherapy approaches or schools of thought. By 1980 there were more than 250; by 1996 more than 450; and at the start of the 21st century there were over a thousand different named psychotherapies—some being minor variations while others are based on very different conceptions of psychology, ethics (how to live) or technique.
My psychotherapeutic modality of choice is Rational Emotive Behavior Therapy (REBT) which is said to be “the pioneering form of cognitive behavior therapy [CBT] developed by Dr. Albert Ellis in 1955.” For this, in 2021, I received advanced practicum training from the Albert Ellis Institute.
Per one source, approaches to psychotherapy fall into five broad categories: Psychoanalysis and psychodynamic therapies, behavior therapy, cognitive therapy, humanistic therapy, and integrative or holistic therapy. REBT uses cognitive, behavior, and humanistic techniques.
Years ago, a highly successful mentor within the field of mental, emotional, and behavioral health told me something I was surprised to hear. In reference to psychotherapeutic modalities, he said, “This is all made-up.”
In the most literal sense, he was correct. Even though CBT is considered the “gold standard of psychotherapy,” it, too, is a human-concocted therapy—as are all forms of psychotherapy.
When recently discussing this matter with an individual, I thought about a humorous anecdote that may help people understand how some psychotherapeutic modalities are formed, studied, and consequently practiced. Therefore, I present the reader with the Gallagher effect.
The Gallagher effect
Based on a Saturday Night Live skit, the 1999 comedy film Superstar featured fictional character Mary Katherine Gallagher. During moments of stress, Gallagher sticks her hands underneath her armpits and smells them as a means of self-soothing.
I suppose that Gallagher’s technique is a means of achieving catharsis—the process of releasing, and thereby providing relief from, strong or unpleasant emotions and bodily sensations. Imagine a psychotherapeutic modality being based on this practice, known as the Gallagher effect.
Although there are many psychotherapeutic modalities, not all of them adhere to the scientific method—observation, question, research topic area, hypothesis, prediction, experimental design, analysis of results, and reporting of conclusions. Some modalities bypass this process altogether.
Still, those techniques which have been scientifically evaluated are known as evidence-based methods. For the most part, these modalities are considered efficacious—successful in producing a desired or intended result; effective.
In regards to recognition of psychotherapeutic effectiveness, one source states that “many people prefer psychotherapy to pharmacological treatments because of medication side-effects and individual differences and people tend to be more adherent if the treatment modality is preferred.”
Let’s say that when watching Superstar, I suspect that the Gallagher effect may help other people. Observation is the first step of employing the scientific method.
I then form a question. I ask, “Even though the technique of sticking one’s hands underneath one’s own armpits and smelling them as a means of self-soothing is presented as fictional, could this approach actually work for other people?”
Having a proposal in mind, I set out to research this topic area. Are there subjective reports of people who sniff odor of armpits as a means of coping with the effects of stress?
After researching this matter, I form a hypothesis by explaining what I expect to happen—as clearly, testable, and measurable as possible. Preferably, I include an independent and dependent variable. Within my hypothesis, I make a prediction.
As simplistic as possible, I propose that if sniffing one’s own armpit odor in-session with a psychotherapy practitioner leads to a clinically significant and measurable reduction in symptoms of stress, then a client who practices this method outside of a session will experience a similar reduction in symptoms.
To test my hypothesis and prediction, I construct and experimental design through use of control and experimental (treatment) groups. Using randomization, I assign people who will not receive the treatment to a control group and people who will use the Gallagher effect to a treatment group.
For the sake of expediency herein, I stipulate that the experiment group will pair talking therapy and armpit sniffing in-sessions with homework related to self-talk and armpit sniffing outside of sessions during periods of significant stress. This will take place over a three-month period.
The control group will receive only the prescription of in-session talk therapy and self-talk outside of session, absent the Gallagher effect. At the end of three months, I analyze the results.
Suppose that at the completion of the experiment data reveal the experimental group had a higher rate of reduced symptoms than the control group. I conclude that I have failed to reject the hypothesis—that is that what I predicted would happen actually occurred.
Clients who practice the Gallagher effect in the presence of a trained practitioner and who then use this psychotherapeutic technique on their own outside of session, paired with self-talk, report fewer symptoms of stress than those who used only talk therapy and self-talk.
I report these findings and provide other people with the data so that the hypothesis may be tested in other settings. With enough testing, and pretending that other people deem my hypothesis as valid and reliable, the Gallagher effect would develop a theoretical framework.
It may then be brought forward as an evidence-based psychotherapeutic modality, perhaps as a form of CBT. Indeed, “This is all made-up.”
Conclusion
During a recent conversation with someone, I was reminded of psychotherapeutic modalities and how at the end of the day, each of these models is made-up. Though some of these techniques are scientifically tested and receive an evidence base, there is no be-all, end-all approach that works for all people.
I practice REBT, because it makes sense to me and it’s been a significant practice for achieving a higher level of functioning and improved quality of life in both my personal and professional experience. Nevertheless, this technique isn’t without its limitations—as no modality is perfect.
Over the years, I’ve examined a number of the leading psychotherapeutic modalities in common practice. I appreciate some and suspect a number of them are little more than a glorified Gallagher effect. I suppose even a placebo effect is still a treatment response nonetheless.
Far be it for me, an REBT practitioner, to tell others what they should, must, or ought to practice or receive as treatment. If sticking your hands underneath your armpits and smelling them provides comfort during periods of distress, it’s not my place to demand that you stop behaving in such a manner.
For those who choose something other than a Superstar approach to getting better rather than merely feeling better, I remain available. I’ve been coaching in one capacity or another since the ‘90s and I began clinical practice in 2011.
If you’re looking for a provider who works to help you understand how thinking impacts physical, mental, emotional, and behavioral elements of your life—helping you to sharpen your critical thinking skills, I invite you to reach out today by using the contact widget on my website.
As a psychotherapist, I’m pleased to help people with an assortment of issues ranging from anger (hostility, rage, and aggression) to relational issues, adjustment matters, trauma experience, justice involvement, attention-deficit hyperactivity disorder, anxiety and depression, and other mood or personality-related matters.
At Hollings Therapy, LLC, serving all of Texas, I aim to treat clients with dignity and respect while offering a multi-lensed approach to the practice of psychotherapy and life coaching. My mission includes: Prioritizing the cognitive and emotive needs of clients, an overall reduction in client suffering, and supporting sustainable growth for the clients I serve. Rather than simply helping you to feel better, I want to help you get better!
Deric Hollings, LPC, LCSW
References:
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