Book: Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment

Book Title:

Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment.

Author(s): Peggy O’Brien, Erika Crable, Catherine Fullerton, and Lauren Hughey.

Year: March 2019.

Edition: First (1st).

Publisher: US Department of Health and Human Services.

Type(s): eBook.


In 2015, 20.8 million people aged 12 years or older (7.8% of the United States population) had a substance use disorder (SUD) in the previous year. Approximately 75% of this group, or 15.7 million Americans, had an alcohol use disorder,
2.0 million had a prescription opioid use disorder (OUD), and about 0.6 million had a heroin use disorder.

Since 1999, opioid-related overdose deaths in the United States have quadrupled, with more than 15,000 individuals experiencing prescription drug-related overdose deaths in 2015. Even though evidence-based SUD treatments are effective, rates of treatment receipt are quite low. In 2015, only 18% of the population with SUDs, or 3.7 million people, received SUD treatment – a number that has not increased significantly since 2002.

Only about 48% of patients who enter SUD treatment actually complete it.

You can access the book, for free, here.

Book: Approaches to Drug Abuse Counselling

Book Title:

Approaches to Drug Abuse Counselling.

Author(s): National Institute on Drug Abuse (NIDA).

Year: 2000.

Edition: First (1st).

Publisher: US Government Printing Office.

Type(s): eBook.


Dual disorders recovery counselling (DDRC) is an integrated approach to treatment of patients with drug use disorders and comorbid psychiatric disorders.

The DDRC model, which integrates individual and group addiction counselling approaches with psychiatric interventions, attempts to balance the focus of treatment so that both the patient’s addiction and psychiatric issues are addressed.

The DDRC model is based on the assumption that there are several treatment phases that patients may go through.

You can access the book, for free, here.

Book: Integrating Behavioural Therapies with Medications in the Treatment of Drug Dependence

Book Title:

Integrating Behavioural Therapies With Medications in the Treatment of Drug Dependence (National Institute on Drug Abuse Research Monograph Series).

Author(s): Lisa Simon Onken (PhD), Jack D. Blaine (MD), and John J. Boren (PhD.

Year: 1995.

Edition: First (1st).

Publisher: US Government Printing Office.

Type(s): eBook.


It is no revelation that drug dependence is a complex problem with behavioural, cognitive, psychosocial, and biological dimensions and may be treated with behavioural therapy (including behaviour therapy, psychotherapy, and counselling), and, where available, pharmacotherapy.

Drug use can be reduced behaviourally with appropriate manipulation of reinforcements within the environment (Higgins et al. 1993). Continued improvements over time in drug use can be initiated by cognitive behavioural psychotherapies to modify cognitions that perpetuate drug use (Carroll et al., submitted for publication), and a reduced likelihood of
relapse has been engendered by specialised training approaches (Rohsenow et al., in press).

Methadone, of course, has long been recognised as an effective pharmacotherapy to reduce opiate use, and its biological mechanism of action is well understood.

You can access the book, for free, here.

Book: Psychotherapy And Counselling In The Treatment Of Drug Abuse

Book Title:

Psychotherapy And Counselling In The Treatment Of Drug Abuse (National Institute on Drug Abuse Research Monograph Series).

Author(s): Lisa Simon Onken (PhD) and Jack D. Blaine (MD).

Year: 1990.

Edition: First (1st).

Publisher: US Government Printing Office.

Type(s): eBook.


Drug abuse treatment occurs in a multitude of forms. It may be provided in outpatient or inpatient settings, be publicly or privately funded, and mayor may not involve the administration of medication. The differences among the philosophies of, and the services provided in, various drug abuse treatment programmes may be enormous. What is remarkable is that some form of drug abuse counselling or psychotherapy is almost invariably a part of every type of comprehensive drug abuse treatment. Individual therapy or counselling is available in about 99% of the drug-free, methadone-maintenance, and multiple-modality drug abuse treatment units in this country (National Drug and Alcoholism Treatment Unit Survey 1982). It is also available in approximately 97% of the detoxification units.

You can access the book, for free, here.

Book: Therapy with a Map: A Cognitive Analytic Approach to Helping Relationships

Book Title:

Therapy with a Map: A Cognitive Analytic Approach to Helping Relationships.

Author(s): Steve Potter.

Year: 2020.

Edition: First (1st).

Publisher: Luminate.

Type(s): Paperback and Kindle.


A therapeutic relationship is a web of interactions, tasks and processes in space and time. It is not easy to stay aware of the relationship in the thick of talking and trying to help someone; but doing so boosts flexibility and enables deeper formulation. A therapist who can attend not only to a specific therapeutic model, but also to relational factors underlying all therapy, has a far greater chance of enabling change.

Therapy with a Map sets out a therapeutic process of talking accompanied by visual conversation maps set down in real time on paper. Like all maps, these help us to find our way, notice when we are lost, track our route and survey the wider landscape. The book uses mapping to introduce the tools and concepts of Cognitive Analytic Therapy (CAT), along with other relational, conversational and narrative approaches. By mapping patterns of thinking and relating, therapists can help clients to develop self-understanding, solve problems, and take away a freer, more self-aware relationship with themselves in the world.

What is Art Therapy?


Art therapy (not to be confused with arts therapy, which includes other creative therapies such as drama therapy and music therapy) is a distinct discipline that incorporates creative methods of expression through visual art media. Art therapy, as a creative arts therapy profession, originated in the fields of art and psychotherapy and may vary in definition.

There are three main ways that art therapy is employed:

  • The first one is called analytic art therapy. Analytic art therapy is based on the theories that come from analytical psychology, and in more cases, psychoanalysis.
    • Analytic art therapy focuses on the client, the therapist, and the ideas that are transferred between the both of them through art.
  • Another way that art therapy is utilised is art psychotherapy.
    • This approach focuses more on the psychotherapist and their analysis of their clients artwork verbally.
  • The last way art therapy is looked at is through the lens of art as therapy.
    • Some art therapists practicing art as therapy believe that analysing the client’s artwork verbally is not essential, therefore they stress the creation process of the art instead.

In all of these different approaches to art therapy, the art therapist’s client/service user goes on the journey to delve into their inner thoughts and emotions by the use of paint, paper and pen, or even clay.

Art therapy can be used to help people improve cognitive and sensory motor function, self-esteem, self awareness, emotional resilience. It may also aide in resolving conflicts and reduce distress.

Current art therapy includes a vast number of other approaches such as person-centred, cognitive, behaviour, Gestalt, narrative, Adlerian, and family. The tenets of art therapy involve humanism, creativity, reconciling emotional conflicts, fostering self-awareness, and personal growth.

Brief History

In the history of mental health treatment, art therapy (combining studies of psychology and art) emerged much later as a new field. This type of unconventional therapy is used to cultivate self-esteem and awareness, improve cognitive and motor abilities, resolve conflicts or stress, and inspire resilience in patients. It invites sensory, kinaesthetic, perceptual, and sensory symbolisation to address issues that verbal psychotherapy cannot reach. Although art therapy is a relatively young therapeutic discipline, its roots lie in the use of the arts in the ‘moral treatment’ of psychiatric patients in the late 18th century.

Art therapy as a profession began in the mid-20th century, arising independently in English-speaking and European countries. Art had been used at the time for various reasons: communication, inducing creativity in children, and in religious contexts. The early art therapists who published accounts of their work acknowledged the influence of aesthetics, psychiatry, psychoanalysis, rehabilitation, early childhood education, and art education, to varying degrees, on their practices.

The British artist Adrian Hill coined the term art therapy in 1942. Hill, recovering from tuberculosis in a sanatorium, discovered the therapeutic benefits of drawing and painting while convalescing. He wrote that the value of art therapy lay in “completely engrossing the mind (as well as the fingers)…releasing the creative energy of the frequently inhibited patient”, which enabled the patient to “build up a strong defence against his misfortunes”. He suggested artistic work to his fellow patients. That began his art therapy work, which was documented in 1945 in his book, Art Versus Illness.

The artist Edward Adamson, demobilised after WW2, joined Adrian Hill to extend Hill’s work to the British long stay mental hospitals. Other early proponents of art therapy in Britain include E.M. Lyddiatt, Michael Edwards, Diana Raphael-Halliday and Rita Simon. The British Association of Art Therapists was founded in 1964.

U.S. art therapy pioneers Margaret Naumburg and Edith Kramer began practicing at around the same time as Hill. Naumburg, an educator, asserted that “art therapy is psychoanalytically oriented” and that free art expression “becomes a form of symbolic speech which…leads to an increase in verbalisation in the course of therapy.” Edith Kramer, an artist, pointed out the importance of the creative process, psychological defences, and artistic quality, writing that “sublimation is attained when forms are created that successfully contain…anger, anxiety, or pain.” Other early proponents of art therapy in the United States include Elinor Ulman, Robert “Bob” Ault, and Judith Rubin. The American Art Therapy Association was founded in 1969.

National professional associations of art therapy exist in many countries, including Brazil, Canada, Finland, Lebanon, Israel, Japan, the Netherlands, Romania, South Korea, and Sweden. International networking contributes to the establishment of standards for education and practice.

Diverse perspectives exist on history of art therapy, which complement those that focus on the institutionalisation of art therapy as a profession in Britain and the United States.


There are various definitions of the term art therapy.

The British Association of Art Therapists defines art therapy as “a form of psychotherapy that uses art media as its primary mode of expression and communication.”

The American Art Therapy Association defines art therapy as: “an integrative mental health and human services profession that enriches the lives of individuals, families, and communities through active art-making, creative process, applied psychological theory, and human experience within a psychotherapeutic relationship.”

What is Art Therapy Used For?

As a regulated mental health profession, art therapy is employed in many clinical and other settings with diverse populations. It is increasingly recognised as a valid form of therapy. Art therapy can also be found in non-clinical settings, as well as in art studios and in creativity development workshops. Licensing for art therapists can vary from state to state with some recognising art therapy as a separate license and some licensing under a related field such a professional counselling, mental health counsellor. Art therapists must have a master’s degree that includes training on the creative process, psychological development, group therapy, and must complete a clinical internship. Art therapists may also pursue additional credentialing through the Art Therapy Credentials Board. Art therapists work with populations of all ages and with a wide variety of disorders and diseases. Art therapists provide services to children, adolescents, and adults, whether as individuals, couples, families, or groups.

Using their evaluative and psychotherapy skills, art therapists choose materials and interventions appropriate to their clients’ needs and design sessions to achieve therapeutic goals and objectives. They use the creative process to help their clients increase insight, cope with stress, work through traumatic experiences, increase cognitive, memory and neurosensory abilities, improve interpersonal relationships and achieve greater self-fulfilment. The activities an art therapist chooses to do with clients depend on a variety of factors such as their mental state or age. Art therapists may draw upon images from resources such as ARAS (Archive for Research in Archetypal Symbolism) to incorporate historical art and symbols into their work with patients. Depending on the state, province, or country, the term “art therapist” may be reserved for those who are professionals trained in both art and therapy and hold a master or doctoral degree in art therapy or certification in art therapy obtained after a graduate degree in a related field. Other professionals, such as mental health counsellors, social workers, psychologists, and play therapists optionally combine art-making with basic psychotherapeutic modalities in their treatment. Therapists may better understand a client’s absorption of information after assessing elements of their artwork.

A systemic literature review compiled and evaluated different research studies, some of which are listed below. Overall, this survey publication revealed that both the high level of variability (such as incorporating talk therapy) and limited number of studies done with certified art therapists made it difficult to generalise over findings. Despite these limitations, art therapy has, to an extent, proved its efficacy in relieving symptoms and improving quality of life.

General Illness

Art-making is a common activity used by many people to cope with illness. Art and the creative process can alleviate many illnesses (cancer, heart disease, influenza, etc.). This form of therapy helps benefit those who suffer from mental illnesses as well (chronic depression, anxiety disorders, bipolar disorders, etc.). It is difficult to measure the efficacy of art therapy as it treats various mental illnesses to different degrees; although, people can escape the emotional effects of various illness through art making and many creative methods. Sometimes people cannot express the way they feel, as it can be difficult to put into words, and art can help people express their experiences. “During art therapy, people can explore past, present and future experiences using art as a form of coping”. Art can be a refuge for the intense emotions associated with illness; there are no limits to the imagination in finding creative ways to express emotions.

Hospitals have started studying the influence of arts on patient care and found that participants in art programs have better vitals and fewer complications sleeping. Artistic influence does not need to be participation in a programme, but studies have found that a landscape picture in a hospital room had reduced need for narcotic pain killers and less time in recovery at the hospital. In addition, either looking at or creating art in hospitals helped stabilise vital signs, speed up the healing process, and in general, bring a sense of hope and soul to the patient. Family, care workers, doctors and nurses are also positively affected.

Cancer Diagnosis

Many studies have been conducted on the benefits of art therapy on cancer patients. Art therapy has been found to be useful to support patients during the stress of such things as chemotherapy treatment.

Art therapists have conducted studies to understand why some cancer patients turned to art making as a coping mechanism and a tool to creating a positive identity outside of being a cancer patient. Women in the study participated in different art programs ranging from pottery and card making to drawing and painting. The programmes helped them regain an identity outside of having cancer, lessened emotional pain of their on-going fight with cancer, and also giving them hope for the future.

In a study involving women facing cancer-related difficulties such as fear, pain, altered social relationships, etc., it was found that:

Engaging in different types of visual art (textiles, card making, collage, pottery, watercolour, acrylics) helped these women in 4 major ways. First, it helped them focus on positive life experiences, relieving their ongoing preoccupation with cancer. Second, it enhanced their self-worth and identity by providing them with opportunities to demonstrate continuity, challenge, and achievement. Third, it enabled them to maintain a social identity that resisted being defined by cancer. Finally, it allowed them to express their feelings in a symbolic manner, especially during chemotherapy.

Another study showed those who participated in these types of activities were discharged earlier than those who did not participate.

Furthermore, another study revealed the healing effects of art therapy on female breast cancer patients. Studies revealed that relatively short-term art therapy interventions significantly improved patients’ emotional states and perceived symptoms.

Studies have also shown how the emotional distress of cancer patients has been reduced when utilising the creative process. The women made drawings of themselves throughout the treatment process while also doing yoga and meditating; these actions combined helped to alleviate some symptoms.

Another study looked at the efficacy of mindfulness-based art therapy, combining meditation with art, on a large study with 111 participants. The study used measurements such as quality of life, physical symptoms, depression, and anxiety to evaluate the efficacy of the intervention. This yielded optimistic results that there was a significant decrease in distress and significant improvement in quality of life.

A review of 12 studies investigating the use of art therapy in cancer patients by Wood, Molassiotis, and Payne (2010) investigated the symptoms of emotional, social, physical, global functioning, and spiritual controls of cancer patients. They found that art therapy can improve the process of psychological readjustment to the change, loss, and uncertainty associated with surviving cancer. It was also suggested that art therapy can provide a sense of “meaning-making” because of the physical act of creating the art. When given five individual sessions of art therapy once per week, art therapy was shown to be useful for personal empowerment by helping the cancer patients understand their own boundaries in relation to the needs of other people. In turn, those who had art therapy treatment felt more connected to others and found social interaction more enjoyable than individuals who did not receive art therapy treatment. Furthermore, art therapy improved motivation levels, abilities to discuss emotional and physical health, general well-being, and increased global quality of life in cancer patients.

In sum, relatively short-term intervention of art therapy that is individualised to various patients has the potential to significantly improve emotional state and quality of life, while reducing perceived symptoms relating to the cancer diagnosis.

Disaster Relief

Art therapy has been used in a variety of traumatic experiences, including disaster relief and crisis intervention. Art therapists have worked with children, adolescents and adults after natural and manmade disasters, encouraging them to make art in response to their experiences. Some suggested strategies for working with victims of disaster include: assessing for distress or posttraumatic stress disorder (PTSD), normalising feelings, modelling coping skills, promoting relaxation skills, establishing a social support network, and increasing a sense of security and stability.


While art therapy helps with behavioural issues, it does not appear to affect worsening mental abilities. Tentative evidence supports benefits with respect to quality of life. Art therapy had no clear results on affecting memory or emotional well being scales. However, Alzheimer’s association states art and music can enrich people’s lives and allow for self expression.


Art therapy is increasingly recognised to help address challenges of people with autism, as evidenced through these sources. Art therapy may address core symptoms of the autism spectrum disorder by promoting sensory regulation, supporting psychomotor development and facilitating communication. Art therapy is also thought to promote emotional and mental growth by allowing self expression, visual communication, and creativity.


A 2005 systematic review of art therapy as an add on treatment for schizophrenia found unclear effects. Studies reveal that cognitive behavioural therapy has proven to be most effective for this disorder.

Geriatric Patients

Studies conducted by Regev reveal that geriatric art therapy has been significantly useful in helping depression for the elderly, although not particularly successful among dementia patients. Group therapy versus individual sessions proved to be more effective.

Trauma and Children

Art therapy may alleviate trauma-induced emotions, such as shame and anger. It is also likely to increase trauma survivors’ sense of empowerment and control by encouraging children to make choices in their artwork. Art therapy in addition to psychotherapy offered more reduction in trauma symptoms than just psychotherapy alone.

Because traumatic memories are encoded visually, creating art may be the most effective way to access them. Through art therapy, children may be able to make more sense of their traumatic experiences and form accurate trauma narratives. Gradual exposure to these narratives may reduce trauma-induced symptoms, such as flashbacks and nightmares. Repetition of directives reduces anxiety, and visually creating narratives help clients build coping skills and balanced nervous system responses. This only works in long-term art therapy interventions.

Children who have experienced trauma may benefit from group art therapy. The group format is effective in helping survivors develop relationships with others who have experienced similar situations. Group art therapy may also be beneficial in helping children with trauma regain trust and social self-esteem. Usually, participants who undergo art therapy through group interventions have positive experiences and give their internal feelings validation.

Veterans and Post-Traumatic Stress Disorder

Art therapy has an established history of being used to treat veterans, with the American Art Therapy Association documenting its use as early as 1945. As with other sources of trauma, combat veterans may benefit from art therapy to access memories and to engage with treatment. A 2016 randomised control trial found that art therapy in conjunction with cognitive processing therapy (CPT) was more beneficial than CPT alone. Walter Reed Army Medical Centre, the National Intrepid Centre of Excellence and other Veteran Association institutions use art therapy to help veterans with PTSD.

Eating Disorders

Art therapy may help people with anorexia with weight improvements and may help with depression level. Traumatic or negative childhood experiences can result in unintentionally harmful coping mechanisms, such as eating disorders. As a result, clients may be cut off from their emotions, self-rejecting, and detached from their strengths. Art therapy may provide an outlet for exploring these inaccessible strengths and emotions; this is important because persons with eating disorders may not know how to vocalise their emotions.

Art therapy may be beneficial for clients with eating disorders because clients can create visual representations with art material of progress made, represent alterations to the body, and provide a nonthreatening method of acting out impulses. Individuals with eating disorders tend to rely heavily on defence mechanisms to feel a sense of control; it is important that clients feel a sense of authority over their art products through freedom of expression and controllable art materials. Through controllable media, such as pencils, markers, and coloured pencils, along with freedom of choice with the media, clients with eating disorders can create boundaries around unsettling themes.

Another systematic literature review found conclusive evidence that art therapy resulted in significant weight loss in patients with obesity, as well as helping with a range of psychological symptoms.

Ongoing Daily Challenges

Those who do not suffer from a mental illness or physical disease were also tested, these patients have ongoing daily challenges such as high-intensity jobs, financial constraints, and other personal issues. Findings revealed that art therapy reduces levels of stress and burnout related to patients’ professions.


The term containment, within art therapy and other therapeutic settings, has been used to describe what the client/service user can experience within the safety and privacy of a trusting relationship between client and counsellor. This term has also been equated, within art therapy research, with the holding or confining of an issue within the boundaries of visual expression, like a border or the circumference of a mandala. The creation of mandalas for symptom regulation is not a new approach within the field of art therapy, and numerous studies have been conducted in order to assess their efficacy.[

What is the Purpose of Art Therapy?

The purpose of art therapy is essentially one of healing. Art therapy can be successfully applied to clients with physical, mental or emotional problems, diseases and disorders. Any type of visual art and art medium can be employed within the therapeutic process, including painting, drawing, sculpting, photography, and digital art. Art therapy may include creative exercises such as drawing or painting a certain emotion, creative journaling, or freestyle creation.

One proposed learning mechanism is through the increased excitation, and as a consequence, strengthening of neuronal connections.

Outline of a Typical Session

Art therapy can take place in a variety of different settings. Art therapists may vary the goals of art therapy and the way they provide art therapy, depending upon the institution’s or client’s/service user’s needs. After an assessment of the client’s strengths and needs, art therapy may be offered in either an individual or group format, according to which is better suited to the person. Art therapist Dr. Ellen G. Horovitz wrote, “My responsibilities vary from job to job. It is wholly different when one works as a consultant or in an agency as opposed to private practice. In private practice, it becomes more complex and far reaching. If you are the primary therapist then your responsibilities can swing from the spectrum of social work to the primary care of the patient. This includes dovetailing with physicians, judges, family members, and sometimes even community members that might be important in the caretaking of the individual.” Like other psychotherapists in private practice, some art therapists find it important to ensure, for the therapeutic relationship, that the sessions occur each week in the same space and at the same time.

Art therapy is often offered in schools as a form of therapy for children because of their creativity and interest in art as a means of expression. Art therapy can benefit children with a variety of issues, such as learning disabilities, speech and language disorders, behavioural disorders, and other emotional disturbances that might be hindering a child’s learning. Similar to other psychologists that work in schools, art therapists should be able to diagnose the problems facing their student clients, and individualize treatment and interventions. Art therapists work closely with teachers and parents in order to implement their therapy strategies.

Art-Based Assessments

Art therapists and other professionals use art-based assessments to evaluate emotional, cognitive, and developmental conditions. There are also many psychological assessments that utilise artmaking to analyse various types of mental functioning (Betts, 2005). Art therapists and other professionals are educated to administer and interpret these assessments, most of which rely on simple directives and a standardised array of art materials (Malchiodi 1998, 2003; Betts, 2005). The first drawing assessment for psychological purposes was created in 1906 by German psychiatrist Fritz Mohr (Malchiodi 1998). In 1926, researcher Florence Goodenough created a drawing test to measure the intelligence in children called the Draw-A-Man Test (Malchiodi 1998). The key to interpreting the Draw-A-Man Test was that the more details a child incorporated into the drawing, the MORE intelligent they were (Malchiodi, 1998). Goodenough and other researchers realised the test had just as much to do with personality as it did intelligence (Malchiodi, 1998). Several other psychiatric art assessments were created in the 1940s, and have been used ever since (Malchiodi 1998).

Notwithstanding, many art therapists eschew diagnostic testing and indeed some writers (Hogan 1997) question the validity of therapists making interpretative assumptions. More recent literature, however, highlights the utility of standardised approaches to treatment planning and clinical decision-making, such as is evidenced through this source. Below are some examples of art therapy assessments:

  • Mandala Assessment Research Instrument:
    • In this assessment, a person is asked to select a card from a deck with different mandalas (designs enclosed in a geometric shape) and then must choose a colour from a set of coloured cards.
    • The person is then asked to draw the mandala from the card they choose with an oil pastel of the colour of their choice.
    • The artist is then asked to explain if there were any meanings, experiences, or related information related to the mandala they drew.
    • This test is based on the beliefs of Joan Kellogg, who sees a recurring correlation between the images, pattern and shapes in the mandalas that people draw and the personalities of the artists.
    • This test assesses and gives clues to a person’s psychological progressions and their current psychological condition (Malchiodi 1998).
    • The mandala originates in Buddhism; its connections with spirituality help us to see links with transpersonal art.
  • House-Tree-Person:
    • In the house-tree-person test, the client/service user is asked to first draw a house, then a tree, then a person, and is asked several questions about each.
    • As of 2014, this test had not been well-validated.

Outsider Art

The relation between the fields of art therapy and outsider art has been widely debated. The term ‘art brut’ was first coined by French artist Jean Dubuffet to describe art created outside the boundaries of official culture. Dubuffet used the term ‘art brut’ to focus on artistic practice by insane-asylum patients. The English translation “outsider art” was first used by art critic Roger Cardinal in 1972.

Both terms have been criticized because of their social and personal impact on both patients and artists. Art therapy professionals have been accused of not putting enough emphasis on the artistic value and meaning of the artist’s works, considering them only from a medical perspective. This led to the misconception of the whole outsider art practice, while addressing therapeutical issues within the field of aesthetical discussion. Outsider Art, on the contrary, has been negatively judged because of the labelling of the artists’ work, i.e. the equation artist = genius = insane. Moreover, the business-related issues on the term outsider art carry some misunderstandings. While the outsider artist is part of a specific art system, which can add a positive value to both the artist’s work as well as his personal development, it can also imprison him within the boundaries of the system itself.

What is Therapy?


A therapy or medical treatment (often abbreviated tx, Tx, or Tx) is the attempted remediation of a health problem, usually following a medical diagnosis.

As a rule, each therapy has indications and contraindications. There are many different types of therapy. Not all therapies are effective. Many therapies can produce unwanted adverse effects.

Treatment and therapy are generally considered synonyms. However, in the context of mental health, the term therapy may refer specifically to psychotherapy.

Semantic Field

The words care, therapy, treatment, and intervention overlap in a semantic field, and thus they can be synonymous depending on context. Moving rightward through that order, the connotative level of holism decreases and the level of specificity (to concrete instances) increases. Thus, in health care contexts (where its senses are always noncount), the word care tends to imply a broad idea of everything done to protect or improve someone’s health (for example, as in the terms preventive care and primary care, which connote ongoing action), although it sometimes implies a narrower idea (for example, in the simplest cases of wound care or post-anaesthesia care, a few particular steps are sufficient, and the patient’s interaction with that provider is soon finished).

In contrast, the word intervention tends to be specific and concrete, and thus the word is often countable; for example, one instance of cardiac catheterisation is one intervention performed, and coronary care (noncount) can require a series of interventions (count). At the extreme, the piling on of such countable interventions amounts to interventionism, a flawed model of care lacking holistic circumspection – merely treating discrete problems (in billable increments) rather than maintaining health. Therapy and treatment, in the middle of the semantic field, can connote either the holism of care or the discreteness of intervention, with context conveying the intent in each use. Accordingly, they can be used in both noncount and count senses (for example, therapy for chronic kidney disease can involve several dialysis treatments per week).

The words aceology and iamatology are obscure and obsolete synonyms referring to the study of therapies.

The English word therapy comes via Latin therapīa from Greek: θεραπεία and literally means “curing” or “healing”.

Types of Therapies

By Chronology, Priority, or Intensity

Levels of Care

Levels of care classify health care into categories of chronology, priority, or intensity, as follows:

  • Emergency care handles medical emergencies and is a first point of contact or intake for less serious problems, which can be referred to other levels of care as appropriate.
  • Intensive care, also called critical care, is care for extremely ill or injured patients.
    • It thus requires high resource intensity, knowledge, and skill, as well as quick decision making.
  • Ambulatory care is care provided on an outpatient basis.
    • Typically patients can walk into and out of the clinic under their own power (hence “ambulatory”), usually on the same day.
  • Home care is care at home, including care from providers (such as physicians, nurses, and home health aides) making house calls, care from caregivers such as family members, and patient self-care.
  • Primary care is meant to be the main kind of care in general, and ideally a medical home that unifies care across referred providers.
  • Secondary care is care provided by medical specialists and other health professionals who generally do not have first contact with patients, for example, cardiologists, urologists and dermatologists.
    • A patient reaches secondary care as a next step from primary care, typically by provider referral although sometimes by patient self-initiative.
  • Tertiary care is specialised consultative care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital.
  • Follow-up care is additional care during or after convalescence.
    • Aftercare is generally synonymous with follow-up care.
  • End-of-life care is care near the end of one’s life. It often includes the following:
    • Palliative care is supportive care, most especially (but not necessarily) near the end of life.
    • Hospice care is palliative care very near the end of life when cure is very unlikely.
      • Its main goal is comfort, both physical and mental.

Lines of Therapy

Treatment decisions often follow formal or informal algorithmic guidelines. Treatment options can often be ranked or prioritised into lines of therapy: first-line therapy, second-line therapy, third-line therapy, and so on.

First-line therapy (sometimes called induction therapy, primary therapy, or front-line therapy) is the first therapy that will be tried. Its priority over other options is usually either:

  • Formally recommended on the basis of clinical trial evidence for its best-available combination of efficacy, safety, and tolerability; or
  • Chosen based on the clinical experience of the physician.

If a first-line therapy either fails to resolve the issue or produces intolerable side effects, additional (second-line) therapies may be substituted or added to the treatment regimen, followed by third-line therapies, and so on.

An example of a context in which the formalisation of treatment algorithms and the ranking of lines of therapy is very extensive is chemotherapy regimens. Because of the great difficulty in successfully treating some forms of cancer, one line after another may be tried. In oncology the count of therapy lines may reach 10 or even 20.

Often multiple therapies may be tried simultaneously (combination therapy or polytherapy). Thus combination chemotherapy is also called polychemotherapy, whereas chemotherapy with one agent at a time is called single-agent therapy or monotherapy.

Adjuvant therapy is therapy given in addition to the primary, main, or initial treatment, but simultaneously (as opposed to second-line therapy). Neoadjuvant therapy is therapy that is begun before the main therapy. Thus one can consider surgical excision of a tumour as the first-line therapy for a certain type and stage of cancer even though radiotherapy is used before it; the radiotherapy is neoadjuvant (chronologically first but not primary in the sense of the main event). Premedication is conceptually not far from this, but the words are not interchangeable; cytotoxic drugs to put a tumour “on the ropes” before surgery delivers the “knockout punch” are called neoadjuvant chemotherapy, not premedication, whereas things like anaesthetics or prophylactic antibiotics before dental surgery are called premedication.

Step therapy or stepladder therapy is a specific type of prioritisation by lines of therapy. It is controversial in American health care because unlike conventional decision-making about what constitutes first-line, second-line, and third-line therapy, which in the US reflects safety and efficacy first and cost only according to the patient’s wishes, step therapy attempts to mix cost containment by someone other than the patient (third-party payers) into the algorithm. Therapy freedom and the negotiation between individual and group rights are involved.

By Intent

Therapy TypeDescription
Abortive Therapy1. A therapy that is intended to stop a medical condition from progressing any further.
2. A medication taken at the earliest signs of a disease, such as an analgesic taken at the very first symptoms of a migraine headache to prevent it from getting worse, is an abortive therapy.
3. Compare abortifacients, which abort a pregnancy.
Bridge Therapy1. A therapy that figuratively provides a bridge to another step or phase, crossing over some immediate chasm (challenge).
2. In contrast with destination therapy (see below), which is the final therapy in cases where clinically appropriate.
Consolidation Therapy1. A therapy given to consolidate the gains from induction therapy. In cancer, this means chasing after any malignant cells that may be left.
Curative Therapy1. A therapy with curative intent, that is, one that seeks to cure the root cause of a disorder.
2. Also known as etiotropic therapy.
Definitive Therapy1. A therapy that may be final, superior to others, curative, or all of those.
Destination Therapy1. A therapy that is the final destination rather than a bridge to another therapy.
2. Usually refers to ventricular assist devices to keep the existing heart going, not just until a heart transplant can occur, but for the rest of the patient’s life expectancy.
Empiric Therapy1. A therapy given on an empiric basis; that is, one given according to a clinician’s educated guess despite uncertainty about the illness’s causative factors.
2. For example, empiric antibiotic therapy administers a broad-spectrum antibiotic immediately on the basis of a good chance (given the history, physical examination findings, and risk factors present) that the illness is bacterial and will respond to that drug (even though the bacterial species or variant is not yet known).
Gold Standard Therapy1. A therapy that is definitive, just as a gold standard diagnostic test is a definitive test.
Investigational Therapy1. An experimental therapy. Use of experimental therapies must be ethically justified, because by definition they raise the question of standard of care.
2. Physicians have autonomy to provide empirical care (such as off-label care) according to their experience and clinical judgment, but the autonomy has limits that preclude quackery.
3. Thus it may be necessary to design a clinical trial around the new therapy and to use the therapy only per a formal protocol.
4. Sometimes shorthand phrases such as “treated on protocol” imply not just “treated according to a plan” but specifically “treated with investigational therapy”.
Maintenance Therapy1. A therapy taken during disease remission to prevent relapse.
Palliative TherapySee supportive therapy (below) for connotative distinctions.
Preventive Therapy (Prophylactic Therapy)1. A therapy that is intended to prevent a medical condition from occurring (also known as prophylaxis).
2. For example, many vaccines prevent infectious diseases.
Salvage Therapy (Rescue Therapy)1. A therapy tried after others have failed; it may be a “last-line” therapy.
Stepdown Therapy1. Therapy that tapers the dosage gradually rather than abruptly cutting it off.
2. For example, a switch from intravenous to oral antibiotics as an infection is brought under control steps down the intensity of therapy.
Supportive Therapy1. A therapy that does not treat or improve the underlying condition, but instead increases the patient’s comfort, also called symptomatic treatment (see there for more information).
2. For example, supportive care for flu, colds, or gastrointestinal upset can include rest, fluids, and over the counter pain relievers; those things do not treat the cause, but they treat the symptoms and thus provide relief.
3. Supportive therapy may be palliative therapy (palliative care).
4. The two terms are sometimes synonymous, but palliative care often specifically refers to serious illness and end-of-life care.
5. Therapy may be categorised as having curative intent (when it is possible to eliminate the disease) or palliative intent (when eliminating the disease is impossible and the focus shifts to minimizing the distress that it causes).
6. The two are often contradistinguished (mutually exclusive) in some contexts (such as the management of some cancers), but they are not inherently mutually exclusive; often a therapy can be both curative and palliative simultaneously.
7. Supportive psychotherapy aims to support the patient by alleviating the worst of the symptoms, with the expectation that definitive therapy can follow later if possible.
Systemic Therapy1. A therapy that is systemic.
2. In the physiological sense, this means affecting the whole body (rather than being local or locoregional), whether via systemic administration, systemic effect, or both.
3. Systemic therapy in the psychotherapeutic sense seeks to address people not only on the individual level but also as people in relationships, dealing with the interactions of groups.

By Therapy Composition

Treatments can be classified according to the method of treatment:

  • By Matter:
    • By drugs: pharmacotherapy, chemotherapy (also, medical therapy often means specifically pharmacotherapy).
    • By medical devices: implantation.
      • Cardiac resynchronisation therapy.
    • By specific molecules: molecular therapy (although most drugs are specific molecules, molecular medicine refers in particular to medicine relying on molecular biology).
      • By specific biomolecular targets: targeted therapy.
        • Molecular chaperone therapy.
      • By chelation: chelation therapy
    • By specific chemical elements:
      • By metals:
        • By heavy metals:
        • By gold: chrysotherapy (aurotherapy).
        • By platinum-containing drugs: platin therapy.
        • By biometals:
          • By lithium: lithium therapy.
          • By potassium: potassium supplementation.
          • By magnesium: magnesium supplementation.
          • By chromium: chromium supplementation; phonemic neurological hypochromium therapy.
          • By copper: copper supplementation.
      • By non-metals:
        • By diatomic oxygen: oxygen therapy, hyperbaric oxygen therapy (hyperbaric medicine).
        • Transdermal continuous oxygen therapy.
        • By triatomic oxygen (ozone): ozone therapy.
        • By fluoride: fluoride therapy.
        • By other gases: medical gas therapy.
    • By water:
      • Hydrotherapy.
      • Aquatic therapy.
      • Rehydration therapy.
        • Oral rehydration therapy.
      • Water cure (therapy).
    • By biological materials (biogenic substances, biomolecules, biotic materials, natural products), including their synthetic equivalents: biotherapy.
      • By whole organisms.
        • By viruses: virotherapy.
        • By bacteriophages: phage therapy.
        • By animal interaction: see animal interaction section.
      • By constituents or products of organisms.
        • By plant parts or extracts (but many drugs are derived from plants, even when the term phytotherapy is not used).
          • Scientific type: phytotherapy.
          • Traditional (prescientific) type: herbalism.
        • By animal parts: quackery involving shark fins, tiger parts, and so on, often driving threat or endangerment of species.
        • By genes: gene therapy.
          • Gene therapy for epilepsy.
          • Gene therapy for osteoarthritis.
          • Gene therapy for colour blindness.
          • Gene therapy of the human retina.
          • Gene therapy in Parkinson’s disease.
        • By epigenetics: epigenetic therapy.
        • By proteins: protein therapy (but many drugs are proteins despite not being called protein therapy).
        • By enzymes: enzyme replacement therapy.
        • By hormones: hormone therapy.
          • Hormonal therapy (oncology).
          • Hormone replacement therapy.
            • Oestrogen replacement therapy.
            • Androgen replacement therapy.
            • Hormone replacement therapy (menopause).
            • Hormone replacement therapy (transgender).
              • Hormone replacement therapy (male-to-female).
              • Hormone replacement therapy (female-to-male).
          • Antihormone therapy.
            • Androgen deprivation therapy.
        • By whole cells: cell therapy (cytotherapy).
          • By stem cells: stem cell therapy.
          • By immune cells: see immune system products below.
        • By immune system products: immunotherapy, host modulatory therapy.
          • By immune cells:
            • T-cell vaccination.
            • Cell transfer therapy.
            • Autologous immune enhancement therapy.
            • TK cell therapy.
          • By humoral immune factors: antibody therapy.
            • By whole serum: serotherapy, including antiserum therapy.
            • By immunoglobulins: immunoglobulin therapy.
              • By monoclonal antibodies: monoclonal antibody therapy.
      • By urine: urine therapy (some scientific forms; many prescientific or pseudoscientific forms).
      • By food and dietary choices:
        • Medical nutrition therapy.
        • Grape therapy (quackery).
    • By salts (but many drugs are the salts of organic acids, even when drug therapy is not called by names reflecting that).
      • By salts in the air.
        • By natural dry salt air: “taking the cure” in desert locales (especially common in prescientific medicine; for example, one 19th-century way to treat tuberculosis).
        • By artificial dry salt air:
          • Low-humidity forms of speleotherapy.
          • Negative air ionisation therapy.
        • By moist salt air:
          • By natural moist salt air: seaside cure (especially common in prescientific medicine).
          • By artificial moist salt air: water vapor forms of speleotherapy.
        • By salts in the water.
          • By mineral water: spa cure (“taking the waters”) (especially common in prescientific medicine).
          • By seawater: seaside cure (especially common in prescientific medicine).
    • By aroma: aromatherapy.
    • By other materials with mechanism of action unknown.
      • By occlusion with duct tape: duct tape occlusion therapy.
  • By Energy:
    • By electric energy as electric current: electrotherapy, electroconvulsive therapy:
      • Transcranial magnetic stimulation.
    • By magnetic energy:
      • Magnet therapy.
      • Pulsed electromagnetic field therapy.
      • Magnetic resonance therapy.
    • By electromagnetic radiation (EMR):
      • By light: light therapy (phototherapy).
        • Ultraviolet light therapy.
          • PUVA therapy.
        • Photodynamic therapy.
          • Photothermal therapy.
          • Cytoluminescent therapy.
        • Blood irradiation therapy.
        • By darkness: dark therapy.
        • By lasers: laser therapy.
          • Low level laser therapy.
      • By gamma rays: radiosurgery.
        • Gamma Knife radiosurgery.
        • Stereotactic radiation therapy.
        • Cobalt therapy.
      • By radiation generally: radiation therapy (radiotherapy).
        • Intraoperative radiation therapy.
        • By EMR particles:
          • Particle therapy.
            • Proton therapy.
            • Electron therapy.
              • Intraoperative electron radiation therapy.
              • Auger therapy.
            • Neutron therapy.
              • Fast neutron therapy.
              • Neutron capture therapy of cancer.
        • By radioisotopes emitting EMR:
          • By nuclear medicine.
          • By brachytherapy.
      • Quackery type: electromagnetic therapy (alternative medicine).
    • By mechanical: manual therapy as massotherapy and therapy by exercise as in physiotherapy and exercise therapy.
      • Inversion therapy.
    • By sound:
      • By ultrasound:
        • Ultrasonic lithotripsy.
          • Extracorporeal shock wave lithotripsy.
          • Extracorporeal shockwave therapy.
        • Sonodynamic therapy.
      • By music: music therapy.
        • Neurologic music therapy.
    • By temperature.
      • By heat: heat therapy (thermotherapy).
        • By moderately elevated ambient temperatures: hyperthermia therapy.
          • By dry warm surroundings: Waon therapy.
          • By dry or humid warm surroundings: sauna, including infrared sauna, for sweat therapy
      • By cold:
        • By extreme cold to specific tissue volumes: cryotherapy.
        • By ice and compression: cold compression therapy.
        • By ambient cold: hypothermia therapy for neonatal encephalopathy.
      • By hot and cold alternation: contrast bath therapy.
  • By Procedure and Human Interaction:
    • Surgery.
    • By counselling, such as psychotherapy (refer to list of psychotherapies).
      • Systemic therapy.
      • By group psychotherapy.
    • By cognitive behavioural therapy.
      • By cognitive therapy.
      • By behaviour therapy.
        • By dialectical behaviour therapy.
      • By cognitive emotional behavioural therapy.
    • By cognitive rehabilitation therapy.
    • By family therapy.
    • By education.
      • By psychoeducation.
      • By information therapy.
    • By physical therapy/occupational therapy, vision therapy, massage therapy, chiropractic or acupuncture.
    • By lifestyle modifications, such as avoiding unhealthy food or maintaining a predictable sleep schedule.
    • By coaching.
  • By Animal Interaction:
    • By pets, assistance animals, or working animals: animal-assisted therapy.
      • By horses: equine therapy, hippotherapy.
      • By dogs: pet therapy with therapy dogs, including grief therapy dogs.
      • By cats: pet therapy with therapy cats.
    • By fish: ichthyotherapy (wading with fish), aquarium therapy (watching fish).
    • By maggots: maggot therapy.
    • By worms:
      • By internal worms: helminthic therapy.
      • By leeches: leech therapy.
    • By immersion: animal bath.
  • By Meditation:
    • By mindfulness: mindfulness-based cognitive therapy.
  • By Reading:
    • By bibliotherapy.
  • By Creativity:
    • By expression: expressive therapy.
      • By writing: writing therapy.
        • Journal therapy.
    • By play: play therapy.
    • By art: art therapy.
      • Sensory art therapy.
      • Comic book therapy.
    • By gardening: horticultural therapy.
    • By dance: dance therapy.
    • By drama: drama therapy.
    • By recreation: recreational therapy.
    • By music: music therapy.
  • By Sleeping and Waking:
    • By deep sleep: deep sleep therapy.
    • By waking: wake therapy.

Book: Acceptance and Commitment Therapy (A.C.T.)

Book Title:

Acceptance and Commitment Therapy (A.C.T.): Workbook to Get Out From Anxiety, Relieve Depression, and Break Free From Stress and Worry, for a Newfound Mental Health.

Author(s): Gerald Paul Clifford.

Year: 2020.

Edition: First (1st).

Publisher: Independently Published.

Type(s): Paperback and Kindle.


Life can present many challenges, some of which can be incredibly difficult to overcome. When these more troubling challenges arise, it can feel impossible to know how to navigate them and the many experiences they bring.

You may feel worried about your thoughts, emotions, behaviours, or all three. Especially when these parts of your experience seem hijacked by anxiety, anger, fear, frustration, depression, or other difficult emotions, it can be overwhelming to navigate them and the many behavioural experiences they bring.

Acceptance and Commitment Therapy (A.C.T) is a type of psychotherapy that relies on talk therapy techniques to assist you with achieving a more functional state in your life. By adjusting your perspective, increasing your awareness, and taking intentional action, you deepen your ability to recognise and navigate your emotions.

Book: Good Morning, Monster

Book Title:

Good Morning, Monster – A Therapist Shares Five Heroic Stories of Emotional Recovery.

Author(s): Catherine Gildiner.

Year: 2020.

Edition: First (1st).

Publisher: St. Martin’s Press.

Type(s): Hardcover, Paperback, Audiobook, and Kindle.


In this fascinating narrative, therapist Catherine Gildiner’s presents five of what she calls her most heroic and memorable patients. Among them: a successful, first generation Chinese immigrant musician suffering sexual dysfunction; a young woman whose father abandoned her at age nine with her younger siblings in an isolated cottage in the depth of winter; and a glamorous workaholic whose narcissistic, negligent mother greeted her each morning of her childhood with “Good morning, Monster.”

Each patient presents a mystery, one that will only be unpacked over years. They seek Gildiner’s help to overcome an immediate challenge in their lives, but discover that the source of their suffering has been long buried.

As in such recent classics as The Glass Castle and Educated, each patient embodies self-reflection, stoicism, perseverance, and forgiveness as they work unflinchingly to face the truth. Gildiner’s account of her journeys with them is moving, insightful, and sometimes very funny. Good Morning Monster offers an almost novelistic, behind-the-scenes look into the therapist’s office, illustrating how the process can heal even the most unimaginable wounds.

The Challenges & Opportunities for Counselling & Psychotherapy in the Aftermath of COIV-19.

Research Paper Title

Counselling and psychotherapy post-COVID-19.


The researchers consider how the prolonged, complex and uncertain aftermath of the COVID-19 crisis will present challenges and opportunities for counselling and psychotherapy.

Increased mental strain on populations, individuals and professionals is likely to be compounded by further constraints in therapeutic resources.

Nevertheless, emerging needs and priorities will offer ground for systems thinking in linking the application of a range of therapeutic frameworks, theories to address global challenges, integration of counselling and psychotherapy into new sectors, service models for the most vulnerable, use of digital approaches, support mechanisms for professionals and interdisciplinary research.


Vostanis, P & Bell, C.A. (2020) Counselling and psychotherapy post-COVID-19. Counselling and Psychotherapy Research. doi: 10.1002/capr.12325. Online ahead of print.