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10 Of The Strangest Psychotherapy Techniques

by Samantha Popp
fact checked by Jamie Frater

When most people think of psychotherapy, they picture patients relaxing on a sofa and spilling all of their emotions. “Tell me about your childhood,” the therapist says, taking a drag of his cigar. In reality, therapy takes place in all kinds of settings.

10 Sexual Surrogacy Therapy

Sexual Surrogacy Therapy
Your therapist looks deeply into your eyes, holds your hand, and kisses you passionately on the lips. This isn’t a violation of the American Psychological Association’s code of ethics. Kissing, and sometimes even more, is just part of the job as a sexual surrogate. Sexual surrogates are trained professionals that work with sex therapists to help people work through intimacy issues. Surrogacy goes beyond regular talk therapy; it includes activities to model appropriate romantic and sexual relationships.

People may choose sexual surrogacy for many reasons, including anxiety about relationships or general sexual dysfunction. A newly widowed person struggling with dating or a war veteran returning as an amputee might practice flirting or body confidence with a surrogate. Sessions can include everything from social skills training to actual genital-to-genital contact. Surrogacy might sound like prostitution, but its therapeutic benefit seems to give it a free legal pass. The focus is not on pleasure, but on learning what appropriate sexual or relationship behavior feels like. Surrogates aim to get patients to the point where they can end therapy and forge connections on their own.

9 Equine Therapy

Equine Therapy
Horseback riding is no longer a luxury for the rich. The impressive size and emotionally intelligent nature of the horse makes it an excellent therapy partner for troubled youth, drug addicts, and people with disabilities. Learning to care for and ride these gentle giants can be a way to develop important coping skills like self-confidence and patience. Therapy with a horse feels more like fun than work, so patients may feel more open to growth as they learn to take care of both themselves and of their animal friend.

Because horses can weigh up to 900 kilograms (2,000 lb) and are easily frightened, patients get a hands-on education in overcoming fears. Anger and anxiety have no place in the saddle, so troubled youth and others struggling with those emotions may find that working with a horse helps to form new patterns of positive behavior. Caring for the horse and its equipment, or even learning to conquer the fear of riding, can be a powerful metaphor for other challenges in life.

Horses aren’t the only animals helping people figure out their feelings; elephants, dolphins, monkeys, and many other animals have been used in therapeutic or service settings.

8 Nude Psychotherapy

Nude Psychotherapy
While now a forgotten art, baring bodies and souls in nude therapy sessions was all the rage in the late 1960s. At the forefront of this movement was Paul Bindrim, an offbeat psychologist who believed nakedness allowed people to shake off the social expectations created by clothing and to deal directly with their most private emotions. During group therapy events, Bindrim preached that by shedding shirts and ties, people could explore repressed thoughts, heal marriage troubles, and achieve “peak experiences,” a euphoric state of being attained only through self-actualization.

Nude truth-seekers would delight in spending several days revealing their deepest secrets in facilitated exercises designed by Bindrim to promote trust and openness. Activities included everything from deeply gazing into a partner’s eyes to scrutinizing each others’ genitals in an exercise called “crotch eyeballing.” Bindrim taught that true freedom from negative thoughts could only be achieved once a person could expose her most private motivations and parts. Staring directly into what he believed was the root of all repression was a means to do this. Groups of participants swam, meditated, hugged, and expressed rage, all in their birthday suits.

As the socially liberal climate of the 1960s dwindled, so did the popularity of nude therapy. Bindrim felt the sting of conservative critics, but his naked marathon programs seemed to fall out of favor due to changing times as opposed to any wrongdoing. Those seeking nude therapy today aren’t out of luck. The Human Awareness Institute in California offers participants courses in intimacy and sexuality, some with the option of ditching clothes in search of personal purpose.

7 Chess Therapy

Chess Therapy
Sometimes healing is best done in the company of kings and queens. Patients get clear about their feelings in chess therapy, a technique used to reach patients who have trouble communicating verbally. The idea of using board games to help patients learn problem-solving skills was first used by Persian scholar Rhazes (AD 852–932) during his tenure as chief physician at a Baghdad hospital. Since then, the game of chess has been used to represent real-life problems, allowing patients to explore skills like conflict resolution and decision making.

One case study reports that chess was an excellent outlet for a 16-year-old boy with schizoid personality disorder who felt emotionally isolated from other people. While he struggled to form relationships, playing chess helped him see his therapist as a partner and confidant. As therapy went on, he felt safe sharing his feelings, all during the banter of discussing his next move.

Rooks and pawns allow patients to act out fantasies and explore impulses. Simply questioning why the patient has decided to move a piece in a certain way might give way to conversation about a bigger issue.

6 Wilderness Therapy

Wilderness Therapy
When the campsite is set up and the fire is lit, the doctor is in. Wilderness therapy is a successful, and sometimes controversial, way to help troubled youth by teaching life and social skills on the hiking trail. Intensive group therapy and one-on-one sessions are coupled with outdoor activities like mountain climbing and fly-fishing to teach self-reliance and responsibility. Programs promise to reform even the most wayward of offenders, including juvenile delinquents and teens with depression, anger management issues, or eating disorders.

While wilderness therapy can be effective, certain methods have come under fire for using unethical, and sometimes downright abusive, techniques to help struggling youth. Wilderness programs are loosely regulated, so not all programs are staffed by qualified professionals. Upon closer examination, some “therapy” groups seemed to be just military-style boot camps with little mental health benefit.

Most famous for his controversial wilderness therapy programs is Steve Cartisano, founder of the Challenger Foundation and several other programs throughout the US and South America. Cartisano faced negligent homicide charges when two teens died during excursions that he was supervising. Although he has been acquitted of that charge, a string of abuse allegations have followed him wherever he sets up shop. He maintains his innocence and his dedication to helping youth, but his whereabouts are currently unknown.

Even legitimate wilderness therapy groups have been criticized for partnering with teen escort companies to forcibly remove unwilling participants from their homes to attend the program. While controversy and risk exist, wilderness therapy might be a creative way to teach life skills when other methods have failed.

5 Hypnotherapy

Hypnotism might seem like a magic trick, but it actually has the power to help people break into their subconscious to get to the cause of their problems, like smoking or overeating. Hypnotherapy helps patients change unwanted behaviors with suggestions of new behavior patterns during guided meditation sessions.

The feeling of “zoning out,” such as while driving long distance or lying on the beach, is what a hypnotic state feels like. While hypnotized, the patient is not asleep, but rather extremely relaxed and sensitive to suggestion. Psychotherapists who use this method believe that while hypnotized, a patient can uncover subconscious negativity and replace it with new ways of thinking or feeling.

Skilled hypnotherapists begin the process with a relaxation exercise to clear the mind and to release tension. (Think of the classic line, “You’re getting very sleepy.”) From there, the hypnotist expertly guides the patient through suggestions to solve the problem, like choosing healthier snacks or eating smaller portions to lose weight. The brain, much like a sponge in this moment, will supposedly start to incorporate those recommendations into new patterns of thought.

Hypnotherapy is meant to be used alongside regular talk therapy and not just on its own. Patients can even learn to hypnotize themselves to find stress relief on their own.

4 Sandplay Therapy

Sandplay Therapy
Building sand castles is fun in the summertime and may have therapeutic value, too. Much like chess therapy, sandplay therapy offers those with trouble communicating the chance to share their feelings by designing scenarios with figurines in sand trays. Children, and sometimes adults, relay their feelings through expressive creations without ever having to speak a word.

Inspired by the teachings of Carl Jung, Swiss psychologist Dora Kalff developed the sandplay technique to communicate with patients who might have difficulty sharing their feelings as a result of trauma or abuse. Patients are provided with trays of sand and a variety of figurines. They are instructed to create stories about the toys and the patterns of play that emerge can often mirror real problems in the patient’s life.

Therapists are trained to pick up on those symbols. When a child makes adult figures act aggressively while child figures behave anxiously, the therapist might ask the child to explain why older people are mean to little kids. A conversation about the toys might give way to sharing details of an abusive parent. While discussing trauma or abuse can be difficult, the playfulness of the sand sets the stage for healing conversation to take place.

3 Flooding Therapy

Phobias, extreme and irrational fears, can cause much anxiety and pain. But never fear; anxiety caused by spiders, dogs, and even elevators can all be alleviated through flooding, an intense form of exposure therapy that requires patients to face their fears.

Irrational fears are cured by exposing the patient to the fear-inducing object over a long period of time. For example, a person looking to get rid of his fear of dogs may start by just looking at photos of dogs under the supervision of a trained professional. Therapy continues with an “exposure” to dogs in person and eventually working up the courage to pet actual puppies. The slow pace of learning to manage fear has proven to have high success rates in gently treating anxiety, phobias, and post-traumatic stress disorder.

Flooding therapy works just like exposure therapy, except there is nothing slow about it. Patients will be asked to face full-on fear in the first visit. There is no gradual introduction to the feared object, and flooding can be quite intense. Dog-phobic individuals will be asked to play with puppies right away and elevator-hating people will spend their first flooding session riding the lift without breaks. Flooding therapy evokes a strong anxiety response that in theory, will exhaust the patient into letting go of the irrational fear.

However, critics say that intense exposures may not be therapeutic but instead traumatic to people already struggling with extreme fear. In some cases, flooding actually makes the phobia worse. There is no way to know if a patient will respond well to flooding therapy, so the general consensus is that slow and steady wins the race.

2 Puppet Therapy

Hand puppet
Dragons, pigs, and puppies can help you learn to deal with an overbearing boss, an annoying neighbor, or a troublesome child. Puppets play an important role in therapy by helping patients express emotions and practice difficult conversations in the safe company of a stuffed animal. As they practice being assertive with a toothy tiger puppet, patients might feel freer to stand up for themselves outside of therapy. Puppets make it easier for patients, especially children, to practice expressing difficult emotions, discuss abuse, or practice social skills in a playful way.

Puppets create a safe distance between the therapist and patient, so it feels more comfortable speaking through the puppet. Trained therapists can creatively mirror the child’s problems, which makes introducing difficult topics easier. For example, a girl struggling with moving to a new town is told that the puppet has just moved, too.

The therapist interviews the puppet, rather than the patient, which gives the patient license to say whatever they feel. Puppets, and other forms of play therapy, have proven to be excellent ways to teach autistic children social skills or to practice imaginative thought.

1 Horticulture Therapy

Horticulture Therapy
Imagine the patience and knowledge it takes to grow a tiny seed into a strong tree. In horticulture therapy, therapists combine their love for nature with their expertise in mental health to teach those skills. Much like equine therapy uses the horse to teach skills, horticulture therapists use plants to convey different lessons and skills. Working in prisons, hospitals, and nursing homes, therapists initiate conversation while gardening or crafting pinecone bird feeders.

As groups work together to plant flowers or grow gardens, therapists lead conversations on confidence and teamwork. Horticulture therapy is especially useful for people with disabilities. Activities can be designed for people in wheelchairs or with other special needs. Anyone can delight in the happiness of watching a flower grow. It can be a great source of pride to watch a planted seed grow and be instrumental in its care. By connecting with nature, patients find calmness to bring into their own lives.

Samantha Popp uses her extensive background in education and behavioral modification to teach professionals how to play nicely with each other. You can learn more about her work at and you can follow her on Twitter.

fact checked by Jamie Frater