Which therapy?


There are many schools of therapy out there, and the key point is that not every type of therapy will suit every client. Sometimes, a therapist is so attached to their chosen mode of practice that they will subconsciously attempt to make the client fit into the therapy, as opposed to tailoring the therapy to fit the client.

You will know soon enough if something is the right solution for you – simply trust your instincts and don’t be afraid to shop around. What can be truly tragic is when a client has a bad experience with one therapist (remember, there are more and less competent practitioners out there, just like in every other profession) and it stops them from seeking help in the future. Don’t let this happen to you: as well as many counselling approaches there are many different personalities out there too and you may not necessarily take to one counsellor as much as you will to another.

Here is a little help with understanding what may be involved when you are making your choices:

Psychodynamic counselling

This is based on the idea that past experiences have a bearing on experiences and feelings in the present, and that important relationships, perhaps from early childhood, may be replayed with other people later in life. It translates the principles and insights of psychoanalysis and psychoanalytic psychotherapy into once-a-week counselling.

The counsellor usually aims to be as neutral a figure as possible, giving little information about him- or herself, making it more likely that important relationships (past or present) will be reflected in the relationship between the client and the counsellor. This relationship is therefore an important source of insight for both parties, and helps the client to ‘work through’ their difficulties. Developing a trusting and reliable relationship with the counsellor is essential for this work.

Pros and cons: some people feel that this type of therapy is too detached and does not offer enough empathy. Clients often tell me that they feel left very alone within that experience and would welcome more engagement from the counsellor. On the other hand, the idea is that your experience is not contaminated by other agendas and the therapist is just a blank screen onto which your experience is projected. Your interaction with your therapist may help you identify the behaviours you want to change in relation to others.

Client-centred or person-centred counselling

Person-centred approaches stem from Carl Rogers, a “humanistic therapist” in the 1940-1950s – the founder of client-centred approach, who believed that we all have internal resources to draw our own conclusions and make positive changes, without someone else telling us what to do. Carl Rogers believed that people are able to reach their own potential given the right environment.

Key elements are that the therapist is “empathic”; “non-judgemental”, “genuine” and “self-aware”. In other words, the therapist treats the client with the utmost respect, tries to really understand where they are coming from and is conscious of how they are behaving and responding in the session. It is “non-directive”, which means that the therapist allows the client to direct the session, and simply reflects on what they are saying or doing. The entire focus is on providing a space where the client is treated with an “unconditional positive regard”.

Although it sounds simple, it is in fact really intense for both the client and the therapist. The therapist is highly aware of everything that is occurring in the session, and reflecting on it as appropriate.

Pros and cons: in this type of counselling, you will really feel valued for who you are and allowed to truly be yourself without the fear of being judged. The therapist will guide you, but also trust your ability to draw your own conclusions. Sometimes, this may take longer than more solution-focused therapies and you may occasionally feel “stuck” –  then other interventions may be need to be added to help you move on more effectively.

Transactional analysis counselling

The therapeutic applications of TA focus on providing opportunity for individuals to change repetitive patterns. These patterns, the result of early childhood decisions which in TA are referred to as ‘script’ limit an individual’s potential. TA focuses on how script manifests itself in day-to-day life and how we can move beyond it to improve the quality of our lives. TA will help you understand the nature of your relationships with others, and recognise certain repetitive behaviours which may need to be acknowledged or altered.

Pros and cons: TA may really help you make sense of the world around you and may prove to be a lightbulb moment when suddenly your actions and others’ motives become clear. But, depending on the therapist’s approach, it may not be a platform to really heal and explore your feelings in great depth in a nurturing environment. .

Existential counselling 

Existential therapy starts with the belief that although humans are essentially alone in the world, they long to be connected to others. People want to have meaning in one another’s lives, but ultimately they must come to realize that they cannot depend on others for validation, and with that realization they finally acknowledge and understand that they are fundamentally alone. The result of this revelation is anxiety in the knowledge that our validation must come from within and not from others.

This helps people to clarify, think about and understand life, so that they can live it well. It encourages them to focus on the basic assumptions they make about it, and about themselves, so they can come to terms with life as it is. It allows them to make sense of their existence.

The counselling focuses the client on how much they already take charge of their life, and not on what they are doing wrong. At the same time, it takes note of any real limitations, so that they can make choices based on a true view of the options available.

Pros and cons: Clients are asked to ponder questions such as why they exist, why they suffer, what is the point of their lives, and whether they are alone or part of a larger whole. The advantage of focusing on these types of questions is that it empowers the individual to make choices and take responsibility for her actions. Existential counselling has been criticized as being overly “intellectual.” There has been criticism that existential counselling is in essence atheistic, ostracising people of religious faith.

Gestalt counselling

This is a directive type of counselling, focusing on gestalten (patterns of thought, feeling and activity). It encourages people to have an active awareness of their present situation, and also incorporates communication that goes beyond words. A key part of gestalt counselling is the dramatisation, or acting out, of important conflicts in a person’s life. This could involve using two or more chairs, for instance, so that they can physically take up different positions to represent different aspects of themselves.

It aims to help clients become aware of their current feelings and old conflicts and helps them become complete, and it also helps expand conscious awareness.

Pros and cons: Some of the criticisms of Gestalt therapy have been that it focuses too much on individual’s happiness and growth at the expense of other goals, too much on feelings and not enough on thought and decision making and that it is not effective with more disturbed individuals.

Cognitive behaviour therapy

This therapy is concerned with the way people’s beliefs about themselves shape how they interpret experiences. The objective is to change self-defeating or irrational beliefs and behaviours by altering negative ways of thinking.

Clients learn to monitor their emotional upsets and what triggers them, to identify self-defeating thoughts, to see the connections between their beliefs, feelings and behaviour, to look at the evidence for and against these thoughts and beliefs, and to think in a way that is more realistic and less negative.

The counsellor usually gives the client tasks or homework to do between sessions. This could mean recording thoughts and feelings, or doing something that tests out a basic assumption about themselves. This might mean, for instance, going to the shops when their fear is that they might panic.

Pros and cons: CBT is particularly good for specific goals and it works more effectively with clients who can appreciate more directive as well as self-investigative style of the therapy, particularly outside of the session. Some clients find this helpful, others dislike it, feeling they are being talked out of their emotions. Some find that CBT’s focus on rational thinking feels too inhuman to them, minimizing the importance of their personal history.

Rational-emotive behavioural counselling

Rational Emotive Behaviour Therapy (REBT) is a form of CBT therapy which takes into consideration a client’s healthy and unhealthy emotions and the focus is not so much on a more positive way of thinking, but rather on a more rational/flexible outlook, which in turn will lead to healthier emotions.

This takes the view that people have two main goals in life: to stay alive and to be happy. It aims to remove the obstacles that people place in their own way, and also to achieve a healthy balance between short-term and long-term goals.

REBT addresses the problem of unhelpful or unrealistic and addresses those beliefs by replacing them with unconditional self-acceptance, unconditional other-acceptance, and unconditional life-acceptance.

Pros and cons: REBT is known to be effective for the treatment a variety of anxiety disorders. The cognitive and behavioural techniques used in REBT have demonstrated effectiveness in treating panic disorder.  One criticism is the claim that it was too rational and not dealing sufficiently enough with emotions. It can be tough to have your beliefs challenged, and clients who prefer to “vent” or share worries with a therapist, without getting corrected, would be happier with a nondirective therapist.

With so many approaches around, it will be hard to choose. One size does not fit all, but the most important aspect of your therapy will be the quality of the rapport you have with your counsellor. Only you will know how you feel being in the room with them and if you want to trust them with your feelings and vulnerabilities. Have faith in own judgement and you will find what is best for you.

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