Why Are There So Many Types of Therapy?

When it comes to mental health, there is a wide variety of treatment options available.  Practically any combination of three or four letters will render an acronym for a particular brand of talk therapy you can undergo with a certified practitioner eager to help - CBT, DBT, EFT, ACT, EMDR, REBT, etc. Not only that, but there's a whole world of psychiatric medications and newer hallucinogenic drugs on the market and under research, each designed to treat mental health issues. How do you ultimately decide what kind of approach is best? Before undertaking such a serious and important question, I want to help explain some preliminary concepts that underlie the diversity of approaches to helping people with mental health conditions.  What makes mental health so unique?  Why are there so many types of therapy for mental health conditions?  Why is this not the case in other areas of medicine?  

Clinical Psychology Differs from other Medical Disciplines

The fundamental difference between psychology and other disciplines relates to the difference between the mind and the body - an infamous distinction that has been the topic of debate in the history of philosophy for centuries.  The reason there are so many types of treatment approaches when it comes to mental health has to do with the fact clinical psychology studies the mind, and the mind has properties that differ from the body.  ​In this article, I'll explain what distinguishes the mind from the body/brain by looking more closely at what it means for something to be "objective" versus "subjective."  While not without its limitations, this general distinction has important implications for the study of mental activity and helps explain why there are so many treatment approaches when it comes to mental health conditions compared to other maladies.  
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Generally speaking, bodily processes are "objective," meaning they occur independent of our mental activity.  This is where the mind differs....

The Body is "Objective"

Generally speaking, bodily processes are objective, meaning that they occur independent of our mental activity.  They don't require our participation, we can't will them to act differently, they don't change based on how we feel or think about them, etc.  When a person has biological indicators signaling cancer, for instance, the person's experience of cancer - his or her thoughts and feelings about the disease - make relatively little difference to the pathophysiology of cancer (although it should be noted more and more research is demonstrating the influence of the mind and mental states on numerous physical diseases, including cancer).  Biological and physiological markers are objective facts, independent of our thoughts and feelings.  These facts directly dictate diagnosis in many areas of medicine.  As a result, medical treatments for the body are often unified across physicians.  Physicians might vary from one another with regard to treatment details, but the variability of approach is more limited because the thing being treated is fundamentally objective.  

The Mind is "Subjective"

Treatment approaches differ widely among mental health professionals because the "thing" being treated is not only the body, but the mind - and the mind has properties that are distinct from the body.  The mind is fundamentally subjective instead of objective.  Psychology uniquely explores our subjective experience - the way the world feels and presents itself to us from the first-person perspective.  By definition, the subjective qualities of an experience are more variable across individuals because they are comprised of the particular experiences of each person.  While this might make the scientific study of subjectivity more difficult, it's also what makes psychology so explanatorily rich and fascinating.

Consider the difference between objective and subjective aspects of something like depression.  An objective, bodily-based (and radically over-simplified) view of depression might be "a below average quantity of serotonin in the brain," while a fundamentally subjective view of depression might be "the debilitating feeling that 'I mean nothing in the world' and 'I would be better off if I never existed.'"  The first definition focuses on the objective properties of depression - something that can be measured, counted, and quantified.  This is conducive to empirical methods of investigation but yields a more mechanical description and fails to address what it actually "feels like" to be depressed.  The second is less conducive to the same quantitative methods of study (though, by no means, not all), but it renders a definition of depression that is much richer and "experience-near" [1].   ​Neither definition is wrong; rather, they each address mental functioning from different levels of explanation.  

A "Science" of Subjectivity (a brief interlude)

Because subjectivity is so fundamentally different from objectivity, some branches of psychology have departed from quantitative methods of inquiry altogether.  Hermeneutic, qualitative, and some psychoanalytic approaches to inquiry arose to study precisely the subjective facets of our experience.  These approaches utilize in-depth case studies and interviews that yield insights into human functioning that give rise to incredibly rich and interesting methods of treatment.  Treatment approaches arising from these methods, such as some approaches to psychoanalysis, are often not only clinically meaningful, but demonstrably effective in helping people make desirable changes in their lives.  These approaches consider the following kinds of questions: What does it actually feel like to be "depressed?"  What relation might one emotional experience (such as hate) have to do with alternative emotional experiences (such as sadness or love) within the same person?  Why is it that we seem to repeat the very same behaviors we most avidly denounce?  These are important questions about our subjective experience that can't as easily be studied quantitatively.  

​When new areas of inquiry arise that can't easily be studied according to current methods, new branches of science are born.  The history of science bears this out.  Cell biology, for instance, came into existence only after the technological innovation of the microscope.  This made possible the observation of an entirely new realm of inquiry, and cell biology became a new discipline.  This is similar to the development of psychoanalysis within the field of neurology and psychology.  Freud examined more closely the subjective experiences of hysterical female patients otherwise largely neglected by the methods of treatment available at the time, and he discovered the operation of unconscious processes.  In doing so, Freud ushered in an entirely new way of conceptualizing mental activity, and, ultimately, a new discipline and area of inquiry was born: psychoanalysis.

Psychoanalysis might be considered, in essence, the science of subjective experience.  The hallmark of psychoanalysis is that there are unconscious processes at work in our mind, and these processes direct the flow of thought, feeling, and behavior and form the foundation of our personalities.  Freud’s innovation/discovery of psychoanalysis pioneered the very concept of talk therapy.  All major branches of therapy stem from this foundation in some way.  
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What about the brain?

With the progress of science, the distinction between the mind and brain became somewhat artificial compared to what it was in the history of philosophy.  Now, we understand the brain as the physical "place" where the activity we call our "mind" resides or emerges.  The electrochemical interactions among the highly intricate neural architecture comprising our physical "brain" constitute the objective properties of our brain that give rise to the mind and mental activity.  The mind is not a physical thing somehow located in the brain; rather, we use "mind" to refer to the various mental activities constituting our subjective experience (such as our feeling sad or our thinking about the beauty of a flower).  In other words, our mind is the subjective “thing” that emerges from the physiological interactions within our brain.  

Our mental functioning thus represents the culmination of the intricate interplay between our brains and our minds.  It is the frontier between the objective and the subjective - a bodily organ possessing properties that are both objective and subjective.  As a result, it would perhaps be more accurate to refer to the "mind/brain" when trying to describe mental activity.  When we describe something like depression as a deficit of serotonin and the feeling of sadness/despair, we are describing the same phenomenon from alternate levels of explanation. 

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The distinction between treating mental suffering as either objective or subjective has implications for the kinds of treatment approaches we take.  Psychiatrists who tend to examine depression from a more objective body-based perspective, for example, will emphasize organic and physiological factors.  Medication and other physical interventions become predominant modes of intervention in psychiatry because the brain is more the focus of inquiry.  Modifying its chemistry yields changes that are often helpful from this perspective.  When the problem is viewed through an objective, brain-based lens, the treatment approach will tend to be fairly uniform.  

Psychological approaches emphasize the exploration of depression from the perspective of subjectivity.  Because subjective facts, by their nature, differ according to the experience of the particular person, they admit a wider variety of possible conceptualizations and treatments.  Some approaches emphasize thought processes, while others emphasize emotional experience, the mental experience of physiological processes, or unconscious processes.     

So, why are there so many types of therapy?

There are many types of therapy for mental health conditions because mental health conditions pertain to the mind/brain, which possesses properties that are not only objective but fundamentally subjective.  The mind/brain is comprised of objective and subjective qualities.  Subjective qualities, by definition, are concerned with the way things feel to us from the first-person perspective.  Whichever qualities are emphasized will differ according to the areas emphasized by different theorists.  Subjective qualities thus intrinsically admit a wider variety of approaches than objective qualities.

Conclusion

Theoretical perspectives among psychologists vary widely in direct proportion to the wide variability in perspective about subjectivity among individual theorists.  Different theorists have selected different aspects of subjective experience to explore, rendering differing ideas abut the nature and origin of complex mental problems.  Instead of examining something like depression through the lens of neurotransmitters and chemical re-uptake inhibitors, psychology examines depression through the lens of what it feels like to be a depressed person - the realm of the subjective.  Differing views of these subjective properties render different theoretical treatment orientations.  As long as there are differences between people, there will likely be different ways of understanding subjectivity. 

About the Author

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Tyson Davis, Psy.D. is a clinical psychologist and psychoanalyst at Glen Forest Psychological Services, PLLC.  He specializes in helping individuals and couples dig deeper to make lasting transformation in their lives.  Tyson has a special interest in the study of personality development and psychoanalytic psychotherapy for individuals and couples.

Footnotes:
[1] It should be noted that psychology is a large umbrella encompassing many branches.  Not all areas focus on the subjective.  Some areas focus on the more biologically-based aspects of brain functioning, including such branches as experimental psychology, neuropsychology, and neurobiology to name a few.