What Type of Therapy Should I Choose?
It is much more important that you get on well with a counsellor or psychotherapist, and feel safe with them, than that you agree with their theoretical approach. However, for a brief overview of how the different approaches to counselling and psychotherapy fit together, and to understand a bit about the way I work, you might find the following useful.
Psychodynamic approaches believe that much of the mind does not lie under conscious control, but resides in a whole mass of rather murky and untamed emotions of which we are unconscious. The approach emphasises the circumstances of our early development, and regards our psychological base to be largely complete by the time we are about five years old. The theory was pioneered by people like Sigmund Freud, Melanie Klein and the "Object Relations" school.
Psychodynamic therapists and counsellors tend to be more interested in the individual than in their problems as such. They always have an eye to the past, and the way patterns from the past resurface, particularly under stress. They note that old ways of relating to people (such as our parents) often repeat themselves inappropriately in the present. To this end the relationship between client and therapist is examined very thoroughly. The unconscious mind is likely to express itself most clearly if it has the floor to itself, so psychodynamic therapists may adopt a “blank mirror” approach, saying very little and refusing to engage in “normal” social interplay, which they see as “gratification”. Such behaviour can seem cold and aloof. There is no doubt that psychodynamic techniques can bring the unconscious into play in double-quick time and its practitioners are real experts at interpreting its nuances, but the approach can appear hard and unyielding to someone who is having a bad time or who has had frightening early experiences of abandonment or trauma. Traditionalists would disagree, but I find it best used with a light touch.
Humanistic approaches are fundamentally more optimistic and upbeat, and their practitioners believe that we can find joy from within ourselves and the processes of life. They are likely to have little interest in the unconscious, but emphasise the presence of both therapist and client in the here-and-now, seeking to raise awareness of what is going on and promote the client’s taking responsibility for his or her own experience. Types of therapy that are generally regarded as humanistic are Rogerian, Client-Centred, Person-Centred, Gestalt, Existential, Transactional Analysis and Solution-Focused.
Strict behavioural approaches emphasise humans as members of the animal kingdom. They don’t pay much attention to ideas about mind and free will, but regard human experience as a battle for survival in a difficult environment, conditioned only by previous experiences. Behaviourists try to weaken and eliminate those habits which damage us or hold us back, and to create and strengthen the ones that assist us in life. The sorts of habits that behaviour therapy may seek to build up are those relating to reducing anxiety, aiding relaxation, assertiveness, self-control, social skills, and sexual functioning.
Behaviour therapy offers a range of techniques that are particularly good in dealing with issues around anxiety, such as specific phobias, obsessions or lack of assertiveness. Behavioural therapists may also apply themselves to group behaviour in specific settings, such as in schools and the workplace.
Cognitive-behaviour therapy (CBT) was partially derived from this behaviourist approach, but is much more interested in the way the mind is involved in how we learn and what we believe. Many different schools are all interested in the links between thinking, feeling and behaviour. They are generally considered very effective in dealing with depression, anxiety, and obsessive-compulsive behaviour, and are also a good way of engaging with personality problems.
The cognitive element in these approaches rests on the assumption that we all make mistakes when we process information as thoughts, and that by learning to think about things in new or different ways we can change the way we feel and behave. Pure cognitive therapy is generally highly-structured and short-term, challenging clients to test their own reality, and change it when they find ideas that will work better for them. Short-term bursts of cognitive work in a broader approach can also be very effective.
Systemic counselling is the basis of modern Relate training for couples, though Relate still draws heavily on a psychodynamic understanding of interrelationship. Systemic therapists seek to address people not on an individual level, but as people in relationship and as members of groups. They tend to approach problems practically rather than analytically, without making diagnoses or assigning blame. Theiy see their role as being to help relationships change themselves by introducing creative “nudges”.
Integrative practitioners generally try to draw together the most useful parts of the other approaches. They avoid a one-size-fits-all philosophy and are more likely to respond flexibly to the needs of different clients. A recent survey of British counsellors and psychotherapists showed that there are now more integratively-trained practitioners than any other group, but that they still only amount to 1 in 5 of the total.
Some attacks [on psychotherapy] have been downright silly; many have been quite ugly. Though frightening, these attacks are an implicit tribute to the power of the healing relationship.
- Judith Lewis Herman
Transpersonal approaches are grounded in the work of figures like Carl Gustav Jung, who suggested that that there is a “collective unconscious” – a sort of group memory to which we all have access through our own personal unconscious. Its core belief is that human beings are more than just the sum of their problems and that we all have experiences beyond normal everyday consciousness. The term "transpersonal" has become a general term for awareness extending beyond the individual. In some ways it is the link between psychology and spirituality, but it remains firmly grounded in an individual's direct experiences, and does not rest upon faith or belief in the unseen.
Transpersonal therapists work from a sound integrative base and have a deep respect for the way the inner world emerges through language, metaphor and symbol. The transpersonal approach works well for a variety of problems and is also useful for people who are reasonably happy but still feel something is missing. Perhaps they want to develop their creativity or spiritual life, or feel that they could put their intuition to better use. It is especially effective around life crises – such as bereavement or the traditional “mid-life crisis” – and there is an emphasis on looking forward, whilst not forgetting how we arrived at where we are.
Transpersonal psychotherapists work with a variety of ways to access the unconscious (though they might describe it differently). Working with dreams, body awareness, using artwork or objects, guided meditation, and drawing on stories and myths, may all be brought in. I am keen to use these as supplements to the traditional "talking cure", but only where clients are happy to work in this way.
EMDR (Eye Movement Densensitisation and Reprocessing) is a fairly new technique developed to deal with traumatic and disturbing memories. It is a type of adaptive information processing, and draws on the idea that memories of very difficult events can be badly stored in the brain, away from the networks that would help us to deal with them. In effect the memories get "stuck" so that they come up a lot, often very painfully, and never get neatly filed filed away. EMDR uses rapid eye movements (following the therapist's finger moving backwards and forwards) or alternate-side hand tapping to "unstick" the painful memory. It sounds odd, but it is only one of two specific psychological treatments approved for Post-Traumatic Stress Disorder by the National Institute for Health and Clinical Excellence, and it certainly helps people explore traumatic memories very deeply. For this reason only those with proper professional credentials are eligible for EMDR training.