The approach to therapy is also known as the ‘modality’. Many different modalities exist including:
Cognitive Behavioural Therapy
Differences exist in terms of the role of the therapist, for example a person-centred therapist is seen as a partner, a psychodynamic therapist is seen as an interpreter and a cognitive behavioural therapist is seen as a teacher. All approaches depend on establishing a working relationship with the client and fostering trust.
Much research has been carried out to determine which type of therapy is most effective. Recent research indicates that counselling, problem solving therapy and cognitive behavioural therapy are equal in terms of effectiveness when helping people suffering from depression and anxiety (therapy today, 2010).
However, many researchers, academics and therapists believe that it is not the type of therapy which is important but the therapeutic relationship. It is thought that change and healing are made possible through the experience of creating a positive therapeutic relationship. For some people the therapeutic relationship may be their only experience of a relationship where it is safe to say exactly what they are feeling and thinking and to be accepted. This acceptance enables the client to experiment and take some risks in the therapeutic relationship. This learning can then be applied to other relationships.
The following offers a brief description of these therapies. For a fuller account please refer to ‘Theory and Practice of Counselling and Therapy’, Richard Nelson-Jones, 2006, Sage Publications, London.
The following are included under humanistic-existential therapy:
Underpinning the humanistic therapies is the belief that clients have the ability to develop their potential. The person-centred approach relies on the relationship between client and therapist to activate the client’s self-healing capacities. Essentially the relationship focuses on the ‘here and now’. This type of therapy is non-directive and focuses on what the client wants to discuss.
Counselling does not suit everyone and some clients prefer a directive approach such as cognitive behavioural therapy. However, it is important to note that change does not occur just because we know something. Lasting change can occur when we feel differently and have come to a deeper understanding of ourselves. Person-centred therapy can be a powerful way of achieving this.
Psychoanalysis originates from the work of Sigmund Freud and is concerned with exploring the unconscious and the levels of consciousness. Ego-defences, such as repression, denial, reaction formation and projection, are considered to be ways of coping with anxiety. Therapy tends to be for a long term period and may involve multiple sessions weekly. Central to this type of therapy is the development and ‘working through’ of the ‘transference’ which occurs when the client perceives the therapist as a significant other from their past.
Psychodynamic therapy has its roots in psychoanalytic thinking and the emphasis is on looking how past relationships inform current relationships. This involves working with ‘resistance’. Resistance is a defence against anxiety and impedes change. It is seen as a pathway to the client’s unconscious. The therapeutic frame is used to both elicit and contain resistance. Throughout the process of therapy the client becomes able to confront defences.
Cognitive Behavioural Therapy (CBT)
The cognitive behavioural approach is a problem focussed approach to psychological therapy and emerged from the behaviourist school which takes a mechanistic view of the person as one who can be ‘fixed’. The focus is on the ‘here and now’. CBT recognises unhelpful thinking patterns as contributing to psychological problems.
At the heart of CBT is learning and the therapist may be viewed as a teacher. Psycho-education is a key element of CBT. It is a collaborative and goal driven therapy. The client identifies the behaviour which needs changing and the therapist determines how it will be changed. CBT usually requires the completion of ‘between session’ work (or homework) by the client. It is considered to be an effective intervention for presenting problems such as panic disorder, obsessive-compulsive disorder and post-traumatic stress disorder.
Copyright 2010 Christine Bonsmann. All rights reserved.