Comparing Approaches to Therapy Part l - Counselling Explained
Throughout this essay I use the term 'Counselling' to refer to Person Centred Counselling and other approaches where empathic listening and response is the very essence of the treatment approach. I use the term 'Psychotherapy' as a collective term to include all those approaches which are not based on counselling and where the therapist uses interventions and techniques to direct the treatment approach. In Part II - Psychotherapy Explained you can read more about some of the psychotherapeutic approaches I refer to in this essay including:
- Transactional Analysis [TA]
- Neuro Linguistic Programming [NLP]
- Eye Movement Desensitisation Reprocessing [EMDR]
- Emotional Field Therapy [EFT]
- Psychodynamic Psychotherapy
- Cognitive Behavioural Therapy [CBT]
A clear distinction between Counselling and Psychotherapy is to some extent artificial
- because there is overlap between Counselling practice and Psychotherapy practice. However they are also very different in many respects and some types of problem respond better to an approach which is primarily Counselling [which has empathic listening at its heart], whilst other issues respond better to a more structured [psychotherapeutic] approach led by the therapist. However it is my opinion that to be a good psychotherapist you have to have good counselling skills in addition to your psychotherapy expertise.
Sometimes Psychotherapy is definitely not the preferred approach [initially at least]. For example, it would be inappropriate [in my opinion] to use hypnosis or psychotherapy to attempt to speed up a 'normal' grieving process. Bereavement counselling would be the preferred approach. On the other hand, if the grieving process becomes blocked, some combination of Hypnotherapy and Psychotherapy [Hypno-psychotherapy] may be needed.
An example of when Counselling would not be the preferred approach is phobia. Freud, the grandfather of psychotherapy, expressed the view that it would take a very long time for empathic listening to cure a phobia. I have no doubt that phobia requires one of the psychotherapeutic approaches not a Counselling approach [see my essay 'Phobia Cure']
The Aims of Counselling
The aims of counselling are broadly similar for most therapists. In compiling the list below I have included only those kinds of problem where I believe that Counselling is likely to be the most beneficial therapeutic approach [initially at least]. Those kinds of problems where I feel that Psychotherapy might be more effective more quickly are listed in Part II - Psychotherapy Explained
When Counselling is an appropriate therapeutic response in helping clients: some examples
- Coping with bereavement & loss
- Coping with family problems
- Coping with life crisis
- Coping with relationship break up
- Coping with stressful circumstances
- Incurable health problems and injury
- Trauma including childhood abuse
- Problem solving
- Relationship problems
- When there is 'unfinished business' from the past [e.g. anger, sadness, guilt, trauma]
- When the person feels alone in the world " When there is no-one else who can listen, hear, and support
I have absolutely no doubt that Counselling is the appropriate response when the clients difficulties are a natural response to life's problems.
A good example of what I mean by this is bereavement and loss. Grief is a natural human emotion - it does not need to be 'cured' by psychotherapeutic techniques. What the client needs is a trusted, empathic, non judgmental, companion to provide support and reassurance during the grieving process. If however, the natural grieving process becomes blocked psychotherapeutic interventions may become appropriate in addition to the counselling approach.
I would recommend Person Centred Counselling as the main approach when the client is stuck with circumstances in their life which they are finding difficult to cope with even though they are otherwise functioning 'normally'. Often the core of this work is to help clients to accept their predicament and to learn to live with it.
In my opinion none of the recognised approaches is 'right' or 'wrong' or 'best'
Each of the recognised approaches to counselling and psychotherapy is effective, but not always. None of the approaches works all the time for all clients and all types of problem. What is 'right' 'wrong' or 'best' depends on the presenting issues, the profile of the client, and the competency of the therapist in any particular approach.
The 'Integrative' or 'Multi Modal' approach.
Because no particular therapeutic approach is appropriate in all circumstances many of us practice in what is called an 'integrative' way. This means selecting therapeutic techniques from different bodies of theory according to the specific needs and profile of the client. This approach is the opposite to a 'one size fits all' approach where the client gets a fixed approach based on a single theory or therapeutic model. The integrative approach to Counselling and Psychotherapy is described in Part II - Psychotherapy Explained
Ethical Counselling is confidential and practiced by a qualified person who receives regular professional supervision and is a member of appropriate professional bodies. Its about:-
- Listening in an empathic and non-judgemental way
- Helping the client to explore and express their feelings
- Helping the client to clarify issues; helping them 'think aloud'
- Allowing the client to become aware of, and explore, various options
- Asking questions which encourage the client to develop their thoughts.
- Helping the client take responsibility for their own life and own actions
- Recognising the limits of one's abilities to help and referring the client to another practitioner where appropriate
Counselling is significantly different to most of the other approaches
which [for convenience] I have labelled as 'Psychotherapy' and some of which I have written about in Part II - Psychotherapy Explained. A big difference is that Counselling relies mainly on the development of a healing relationship between client and therapist. This takes time. In most of the approaches I have identified as Psychotherapy, the relationship between client and therapist is of secondary importance to the use of techniques, 'interventions' by the therapist.
Even in psychotherapy the relationship with the client is very important.
The difference is that in Counselling the relationship is overwhelmingly important, is the core of the therapy. In Psychotherapy it is the techniques which dominate the treatment.
Why do some people need therapy when other can cope without?
From the moment we are born we are learning how to survive and cope with life. Thousands of childhood incidents and experiences combine to build a sort of 'Map Of The World' which drives our adult way of thinking, feeling, and behaving. The content of this 'Map' is unique to each of us, our personal guide to responding and coping with life: a sort of personal view of reality made up of our personal beliefs about what's right, what's wrong, what's good, what's bad, what's allowed, what's not allowed, what's safe, what's not, and so on.
Our 'Map' holds all of our beliefs about ourselves, the world, and others. This 'Map' guides us in handling and experiencing every situation we are faced with. As we grow older the 'Map' gets added to by continuing experience of life. Sometimes the additions are helpful, sometimes unhelpful.
Unfortunately our 'Map' is always incomplete
with key pieces of information missing and some incorrect conclusions drawn about ourselves, the world, and others. We are not aware of the unhelpful flaws and gaps in our 'Map', unaware that some things which we believe to be reality are not. Fortunately, since we have constructed our 'reality', we can reconstruct unhelpful aspects of it in therapy - but to do this we need awareness of the defects in our map. Counselling and Psychotherapy help us to be aware of the defects in our map and to reconstruct parts of our map minus the defects.
The impact of trauma
When life's crises come along even a robust and helpful map may become damaged. Trauma shatters some of our beliefs, destroys part of our map, and leaves us needing professional help to recover and make sense of things.
Two people can suffer apparently similar experiences and one will need therapy help and the other not.
Some of us have a map of the world which is robust and helpful, holding mainly helpful beliefs about self, others, and the world. A positive map helps us generate lots of options, gives us the capability to generate ways to resolve problems.
For others the map is self limiting and unhelpful, holding beliefs which damage self esteem, cause communication [and therefore relationship] problems, and provide low ability to cope with and solve problems.
Person Centred Counselling
The concept of Person Centred Counselling was developed by Carl Rogers in the 1950's and 60's. The legend about his 'eureka' moment of insight helps a great deal in understanding the Person Centred Counselling approach. The story is that one day he went down to the cellar of his home and noticed that a potato which had fallen from a sack of potatoes had thrown out shoots and was growing despite the lack of natural light, nutrient, or water. His thought, which was to led to the development of Person Centre counselling, was 'If even a potato can survive and grow in so hostile circumstances then surely a human being can grow and recover given the 'right' environment. The 'right' therapeutic environment being one where the client feels safe, feels that they are not being judged, feels that they are truly understood. Achieving the right environment for recovery and growth is the central aim of Person Centred Counselling.
Person Centred counsellors believe that human beings have the capacity for self recovery and that their role as therapist is to facilitate the self healing process by providing that the 'right' environment. The role of the Person Centred counsellor is to create these conditions in therapy by being empathic, non-judgemental, and unconditionally accepting of the client. Unconditional positive regard of the client by the counsellor is a key feature of the successful Person Centred relationship. As a result of this approach the relationship with the counsellor is sometimes the best non-sexual relationship the client has ever, or will ever, experience.
There is a kind of magic in being able to open one's heart to another person who will listen, understand, not judge, and not shower you with advice.
Although it takes time to develop a 'therapeutic alliance' between counsellor and client, the client often experiences an immediate sense of relief as a result of sharing their story, their thoughts, and feelings, often for the first time. It is the counselling relationship not techniques, directive interventions, advice, or cognitive behavioural 'homework' which leads to recovery. Person Centred counselling helps release the natural healing tendency and capacity for personal growth.
When the counselling approachis not enough
Despite my absolute belief in the appropriateness and effectiveness of Person Centred Counselling in many situations I also recognise many other situations where it is not the best approach. Often a more focussed approach led by the therapist using directive psychotherapeutic interventions may be more appropriate. Why?
Because the Person Centred process is not structured, directive, or brief. Mainly, the client talks and the therapist listens and responds empathically helping the client work things out for themselves. There is not normally a shared diagnosis, contracted for outcome, or treatment plan. It was this lack of structure and direction which led to my choosing to qualify in Transactional Analysis after three years of Person Centred Training. I was drawn to a more 'integrative' approach which would allow me to use a wide range of interventions in helping solve some kinds of problems more quickly.
Which approach/s will best help you - Counselling or Psychotherapy?
Alan's story demonstrates how different kinds of problem are best dealt with by different kinds of response. I have composed Alan's Story using elements typical of many of my clients. It would be an extremely unfortunate person to simultaneously suffer all of the problems that beset Alan!
Alan is 47 years old. Alan has felt alone all his life. He is a quiet and private person who feels anxious in social situations. His social anxiety assumes phobic proportions in some situations. He says he has 'always' felt the need to please others and becomes anxious when he thinks he might have upset someone. As a result he is not at all assertive and never takes the risk of upsetting others by disagreeing even when he is not getting his needs met.
Beneath his passive mask he is angry about some things but does not know how to safely express and discharge his anger, so he keeps it buried. He has no appetite for his job which he finds boring and where he is put on by people he works with and unappreciated by his boss. He finds it hard to get out of bed most mornings. He also gets very anxious about some situations at work, particularly where there is any possibility of conflict or embarrassment.
Alan is seriously stressed and finds it impossible to relax. The stress seems to be affecting his memory and is making him irritable which is damaging to his family relationships. He and his wife are not getting on. He has memories from his childhood which lower his self esteem and self confidence: he remembers he has 'always' been like that and feels sure that there are childhood factors which he is repressing. He had critical and controlling parents whom he could never please. His wife has taken over the role of his parents and seems to him to be constantly criticising. If he tries to argue back she talks over him. He usually finds it easier to keep quiet, say nothing.
Last year his mum died and he has not been able to feel grief for her, something he feels guilty about. His father is now very frail and showing early signs of Alzheimer's. Alan spends a lot of time meeting the needs of his father who is very demanding - often requiring Alan to do things he could do for himself. Alan's father never learned to say 'thank you' and Alan is hurt and resentful that what he does for his father does not seem to be appreciated. His wife criticises him constantly for letting himself be put on by his father and at work.
Not surprisingly, Alan is finding life a real struggle. His doctor says there is nothing physically wrong and has suggested anti depressants but Alan wants to avoid this. Alan is pessimistic about the future. He doesn't have the confidence and self belief to make changes in his life. Even if he did have the confidence and self belief he has no idea how to set about achieving personal change, how to break out from a life scenario he finds so depressing and stressful. As a result of his difficulties he is increasingly withdrawing from any activity which he can avoid and is becoming increasingly agoraphobic, not going out or mixing with other people unless he feels he has no choice.
Alan has a real mixture of therapeutic needs which would benefit from the integrative use of several different types of therapeutic approach
Person Centred Counselling would help Alan a great deal in coping with various aspects of his situation, including his worries about his father's decline in health and his pessimism about the future. Bereavement Counselling would help him handle his unexpressed grief about his mother's death and the guilty feelings he has about not mourning her loss.
TA Psychotherapy would help him to overcome his early life experience, his compulsion to please others, his low self esteem, his passivity, his social anxiety, his communication problems, and to feel OK about himself. Cognitive Behavioural Therapy would help him with some aspects of the way he is by helping him to change some of his self limiting behaviours and some of his unhelpful ways of thinking.
Stress Therapy would help develop ways of coping with his stress. He could learn deep relaxation and self calming with Hypnotherapy and use a customised Relaxation CD prepared in Hypnotherapy to lower his stress level and to get to sleep at night. Hypnotherapy/NLP/ Phobia Cure Techniques could also be used to boost his confidence and help him tackle situations in which he gets anxious. Anger Management would help him learn to release his stressful anger in safe ways and put the past to rest.
Assertiveness Skills Training would help him to communicate assertively with his wife and with his work colleagues and to handle specific situations where he finds it difficult to be assertive, to express himself, and to say 'NO'. This would also boost his self confidence and self esteem. Couples Counselling would help him learn how to handle his relationship with his partner better, or even decide if he wants to split. Family Counselling would help resolve family relationship problems.
Problems Solving Techniques Coaching could help him switch from worrying about his problems to deciding what to do about them. Life Coaching could be employed to bring hope and renewed enthusiasm for life by developing an inspiring Personal Vision of how the future could be made to be.
Medication Although Alan is resistant to the idea of medication it would probably be helpful for the time being at least, not as an alternative to therapy but as an aid, by helping him to be calmer and able to think more clearly about what his therapist is imparting.
Alan's Story illustrates why I believe integrative Counselling and Psychotherapy is best. Alan's mixture of therapeutic needs would benefit from the integrative use of several different types of therapeutic approach and could not, in my opinion, be comprehensively addressed by a single theoretical approach.
Your story, like Alan's, may have a number of different themes, or you may have only one very specific issue you want to deal with. Many reputable therapists offer a free initial consultation which enables the prospective client to find out if they feel comfortable with that therapist and get an idea of the approach likely to work best for them. The free initial consultation is often without any obligation on the client to book paid for sessions.
Counselling & Psychotherapy - Some Of The Main Professional Bodies
These are some of the professional bodies of which I am a member.
British Association for Counselling & Psychotherapy [BACP]
United Kingdom Council for Psychotherapy [UKCP]
National Council For Hypnotherapy [NCH]
United Kingdom Assosiation for Transactional Analysys [UKATA]
European Institute of Transactional Analysis [EATA]
Selected Reading List
|Mearns & Thorne||||Person Centred Counselling In Action|
|Palmer S||||Handbook of Counselling|
|Rogers C R||||
A Way of Being
By the originator of Person Centred Counselling
|Windy Dryden||||Handbook of Individual Therapy|
|Windy Dryden||||Four Approaches to Counselling & Psychotherapy|