A facts and figures page about the different kinds of therapy — just as each of us sees our issues in different ways — therapists have different approaches.
Each of us responds to different therapies for different issues. As there are over 600 modalities therapists can call upon to use in therapy, it is worth looking for ones that will work well with you.
Making choices around these issues can help you in your path to understanding yourself and your motives and behaviours.
Which kind of therapy will suit you? Here are some modalities currently in use. If you want information on something not mentioned here —
“The person is pretty much what he says he is.” (Hall & Lindzey, 1966, p.498)
“For the client, this optimal therapy has meant an exploration of increasingly strange and unknown and dangerous feelings in himself; the exploration proving possible only because he is gradually realising that he is accepted unconditionally.” (Rogers, as cited by Hall & Lindzey, 1957, p.476)
Carl Rogers was the founder of person-centred, or client-centred counselling. It is exactly how it sounds: humanistic, phenomenological and puts the client centre-stage. Rogers rejected the psychoanalytical theory: paternalistic and therapist oriented. Client-centred therapists believe that awareness (a requirement for this kind of therapy) is intrinsically linked to the intellectual capability of the client and the therapist’s acceptance of the client’s ability and that the paternalistic, authoritarian attitude taken by psychoanalytical therapists has a negative influence on outcomes.
Attitude of the therapist
Many therapies have techniques vital to their philosophy; where Adlerian theory might suggest it is the attitude of the client, PC theory says it is the attitude of the therapist that counts most, using only a “…warm, empathic, acceptant, non-evaluative relationship…” (Stein, 1970, p172) to establish rapport that allows the client to not only feel in control but also be in control. The therapist is non-directive and only assists: by listening and responding to the client in a positive way; reflecting the client’s words and feelings; prompting responses where the client falters or becomes lost; tentatively interpreting where deemed useful; clarifying and responding warmly. Above all, it is just being there for the client that Roger’s believes works best.
Rapport between client and therapist
At the same time, the therapist does not become emotionally involved with the client and the therapist’s congruence is essential for the client to feel safe. If it is rapport between client and therapist that is essential for treatment, it might be said the passive stance of the therapist is the treatment. Rogers believed that the qualities desired of the therapist expressed earlier, were more important than formal training for the therapist.
Being in a relationship
As person-centred therapy is mostly about being in a relationship it is ideal for assisting in relationship improvement, skills development, self-understanding and self-awareness and mind/body awareness and integration. Focussing on the attitude of the therapist and allowing the client to become aware of feelings, the therapy is designed to nurture and enable the client’s growth, resulting in personal empowerment, actualising and fulfilling the client’s potential.
These positive outcomes all contribute to a wholeness of the person. While any psychotherapy is designed to effect change in behaviour, and PC can fairly quickly make the client aware of self and behaviour, which is vital information for the client to have, however, this will probably not allow the client to make permanent behaviour change without other more directive therapies. Insight leads to change but only after patterns of behaviour have altered: Rogers believed, according to a2zpsychology.com:
– “The resources all lie within the client. While this may be so, this type of therapy may not be effective for severe psychopathologies such as schizophrenia (which is today considered to have a strong biological element) or other disorders such as phobias, obsessive compulsive disorders or even depression…” (a2zpsychology.com, 2002)
Trust and cooperation
“There is no doubt that person-centred therapy is widely used today especially in marriage counselling and family therapy. Research suggests that a shortcoming in only person-centred therapy is that issues return for the client in the long-term.” (Stein, p.171)
“Transaction Analysis as a theory of psychotherapy … integrates intrapsychic dynamics with interpersonal behaviours in an innovative and reactive manner within a humanistic/existential framework of values. “(Clarkson, 1992, p.1)
Eric Berne – directive and dynamic
Transaction Analysis was founded by Eric Berne (1910-1970) and is seen as humanistic (like Adlerian and Client-centred) but far more directive, much more dynamic. TA sees essentially all people are born ‘OK’, individual and responsible. TA is often seen as an integrated approach which draws from various schools of psychoanalysis to enable an individual to effect change.
TA inevitably differs from Adlerian and Client-centred approaches because of Eric Berne’s preoccupation with the darker side of humankind. (Clarkson (1992, pp.4-6.) If Berne had such a black view of his clients (or their lives) it could mean he thinks humankind is primarily evil. Do the scripts he refers to and uses extensively in his theories spring from a rational and reasonable attempt to be good or free, or more a clamouring away from certain destruction and hell? The ‘Ok’ness which Berne refers to in his writings contrasts with his basic beliefs about mankind. To be fair, Clarkson later goes on to say:
“Throughout his life, Berne never minimised the destructive potential of people as individuals and nations, but he also adhered to his belief in the person’s inner drive to health and growth, which places him firmly in the humanistic tradition.” (Clarkson, 1992, p.10.)
An attempt to understand human beings but also to change them
TA attempts to provide a cure for maladaptive behaviour of the individual by involving the client and the therapist in a contract to change the way the client is acting. There are many aspects to this theory and integration is a key word (various contributions from other therapies appear in the actual therapy) but this ‘contract’ is central. The client agrees to work on the issues, with the therapist’s help. TA manages to not only attempt to understand human beings but also to change them.
A diagrammatic picture of attitudes and modes of behaviour known as ego states…
“Parent (controlling bossy and nurturing), Adult, (computer -like problem solver and storer of information), and Child (thinking feeling and behaving like the child we once were)” (Crichton, 2002)
…is used extensively in TA work, enabling the client to see where attitudes originate and why they are destructive or productive. With language and recognition of ‘scripts’ being used by clients, changing ways of seeing things facilitates change.
Self-understanding and self awareness
TA is an ideal therapy for changing behaviour, creating an environment for allowing a person self-understanding and self awareness, providing an atmosphere for skill development because TA and makes it easy for the client to understand past actions, make new and effective decisions for future behaviour changes… not only in the counselling environment —the client’s contract specifies future as well as current circumstances.
Nothing is new but that we discover it
Much of what is happening in TA today is hardly ever researched and if it is researched is only sustainable by quoting people who are usually devotees of the system. TA can often be seen as a “system” and used as an effective analysis tool. With out the beneficial insights, true behaviour change will just not occur. These limitations (un-researched, newly developed) can also be seen as exciting and stimulating ways of tackling age-old problems, which have faced human beings down the ages. Nothing is new but that we discover it.
Freud, Carl Jung …
Sigmund Freud established the psychoanalytical/psychodynamic theory from extensive clinical observation ofhis ‘patients’ in the 1890’s. PP is often referred to as the talking cure. Cathartic hypnosis was the initial method used (subsequently abandoned because Freud and Joseph Breuer’s patients kept coming back for more) but what was significant in this early work was not only the establishment of techniques such as hypnosis to cure psychological illness but that feelings were drawn from the unconscious.
Id, ego, super-ego
The id (unconscious and instinctual centre of being) and ego arbitrating and balancing) with the superego imposing a morality clause in the proceedings – all play their part in controlling the anxiety of the patient. By the use of various techniques – analysing and coercing transference feelings, encouraging free association, establishing rapport and dream analysis, psychoanalysis strives to dynamically influence the environment and effect change in the client’s personality.
Jung broke away from Freud’s ideas Jung broke away from Freud’s ideas, (around 1913) especially in the area of the unconscious. Jung believed that the mass of unconscious material humans can access is in the collective unconscious; these are universal truths and beliefs. He recognised, particularly, the ‘concepts of transference and countertransference in the psychotherapeutic relationship.
Interpretation of dreams
“Jung’s system of psychotherapy is based on the concept of bringing the patient into contact with the healing collective unconscious largely through the interpretation of dreams and thereby causing him to see his own problem more clearly. In carrying out the process of free-association the analyst as well as the patient produces associations, since the analysis is believed to be a cooperative procedure in which the patient cannot progress beyond the point the analyst has himself reached.” (Brown, 1964, p.50.)
On the negative, psychoanalytical/psychodynamic is a very directive therapy. The client is often seen a patient. It is extremely slow and clients can see a therapist for many years, (sometimes many times a week) which can prove extremely expensive to the client. Because of the time factor, therapists can easily become involved in the patient’s life. I see this is a very difficult way to treat patients. I prefer to see clients as partners and the relationship in a more cooperative stance. For me the client, not the therapist, is the reason for being there.
If a client’s problems require or the client is seeking deeper knowledge then a more psychodynamic approach is required. Various techniques like hypnosis, free association and analysis of slips of the tongue can provide much deeper understanding of self. This kind of therapy is almost mandatory for people dealing with other people in a professional therapeutic situation. It is long term, expensive and not without danger if inappropriately handled. However, human problems are invariably complexly interwoven and although
Psychodynamic/Psychoanalytical Psychoanalysis requires a long-term commitment on behalf of the client and the therapist it is good for healing and resolving the past. Analysis of this sort delves deep into the unconscious and can be helpful in spiritual development, self-understanding and self-awareness; accompanying these major changes the consequences frequently are personal empowerment and actualising potential.
Rational Emotive Behaviour Therapy – REBT
What you do and how you behave can be determined by what you believe or the way you think.
Therapy using this kind of modality is directive and structured. It usually is relatively short term and goal oriented. Tasks are often given to clients in the form of homework in order for them to effect changes in their behaviour which eventually become second nature to them.
Ultimately, what you believe is what you are and how you behave.
CBT attempts to change thought patterns, negative beliefs and through examination of past behaviours re-educate your attitudes and beliefs so you will feel comfortable acting differently.
“The focus is on working with thinking and acting rather than primarily with expressing feelings. Therapy is seen as an educational process. The therapist functions in may ways like a teacher, especially in collaborating with the client on homework assignments and in teaching strategies for straight thinking; and the client is learner, who practices the skills discussed in therapy in everyday life.” (Corey, 2001, p298.)
The founder of CBT, Aaron Beck, and the founder of Rational Emotive Therapy, Albert Ellis, were both psychoanalytically trained, but felt when they were seeing clients that there was something missing in the therapy. Beck discovered when working with depressed people that they often used a great deal of negative self-talk around their depression, their lives and their worldview.
If the client thinks someone is talking about him/her and if they have a predisposition to have low self esteem, these two factors could lead to a false assumption that people are talking about them behind their back, and further, they are saying bad things about therm. There is no empirical knowledge that this occurring. What happens is that a possible false assumption has been made and used as a basis for behaviour. It was from these insights, among others, that CBT was born.
“Things must be the way I want them”, and “People must be how I want them.”
Ellis’s contribution revolves round the awareness that some people process information in ways that are sometimes irrational, possibly harmful to their wellbeing. “Mustabatory” beliefs can seriously affect the way people act in the world: “I must be loved”, “Things must be the way I want them”, and “People must be how I want them.” These irrational beliefs will always leads to disappointment because there is no way other people can live up to these expectations.
These irrational beliefs are often the result of early childhood experiences and carried through the rest of their life. As adults, using modalities like CBT and REBT these experiences can be changed by learning new ways of thinking/behaving.
CBT can make real inroads in treating people who are suffering depression. On your first visit to a CBT therapist, you may be asked to stop worrying about your depression, for the next week. This often relieves the anxiety of clients and often they report back – “I felt a lot better in the past week. I was more relaxed.”
CBT works by empowering people to take some control of their lives, their feelings, and their thoughts. If you see a CBT therapist the client will be asked to make experiments in life by trying different ways of looking at things and doing things.
“Behaviour is an experiment… an attempt to anticipate the future, not merely in a response to the past. Although much of what happens to a person in life may be outside his (her) control. His (her) construction of those events will determine what he makes of life. States of mind such as anxiety, threat, hostility and guilt severe indicators of the need for change. Each person views the world from a unique standpoint, developing networks of meaning which are based on discrimination in his mind between similarities and differences of those things within his experience.” (Browning, 1988, p68)
A CBT Therapist will probably give client homework and asked to look at thought patterns and be shown alternatives ways of thinking. The client will be guided toward making more accurate assumptions and toward realising it is often not what is happening to them but more the way they view what is happening.
This is not to say that goals are not achievable. What often happens though is that people look at friends and relatives around them, or listen to their boss and expect to live up to other people’s expectations … that are often way off course. The client’s job is to find what is right for you, aim for those goals and then go about achieving them.
If we have right thinking attitudes about our lives we can overcome many psychological stumbling blocks. As illustrated above, often what we think and how we think can have massive repercussions on simple life issues. Depression I’ve mentioned above, panic disorders, obsessive-compulsive disorders (OCD), and anxieties are responsive to CBT, often in conjunction with other psychotherapies or counselling and sometimes with medication.
CBT is probably the most commonly used therapy for depression, but is also useful when dealing with relationship improvement, skills development, personal empowerment, behaviour change and symptom relief, parent training, relationship counselling, drug and alcohol misuse, stress management and child abusers.
CBT is often confused with therapies or modalities or systems that are simply positive thinking and thus is often misrepresented in the self-help industry. CBT is sometimes seen as a confrontational therapy and some clients may not be happy with such an experience. Often, after sometime in therapy, these clients can be introduced to some aspects of CBT, (homework for instance) and where it proves to be successful, these clients will often be very open to further behaviour modifications using these methods.
Some CBT therapists might misuse their authority and impose on clients their own worldview, which is akin to discounting the client’s worldview. This is detrimental to the client being in control or learning to be in control, which is surely the aim of all therapy.
One criticism of CBT is that client’s undergoing this therapy are seldom asked to consider the causes of their problems. While it is true CBT deals with the hear-and-now it is untrue to say that CBT does not employ reference to emotions and past experiences. These factors are usually known to be causes of current issues, and CBT prefers to utilise the here-and-now because it is relief from current behaviour the client needs and wants.
“The predominant models among cognitive scientists of how the mind processes information have lacked an acknowledgement that rationality is guided by – and can be swamped by – feeling. The cognitive model is, in this regard, and impoverished view of the mind, one that fails to explain the Sturm and Drang of feelings that bring flavour to the intellect.” (Goleman, 1996. p.41)
Good therapy employs many methods when dealing with a client, and in the case where it is deemed important to find the cause to eliminate reoccurrence of the problem an Existential or Gestalt element might be introduced to the sessions. In a multicultural perspective, CBT can be completely misunderstood; at least the client could think he/she is being misunderstood: take the case of an Asian client extolled to find his/her own realistically achievable goals, while at home the client is being exhorted to achieve great things by her family. When the client is torn between two irreconcilable goals it may be very difficult to grasp the concepts of CBT. Careful nurturing may eventually see some results, but at what cost?
“I think therefore I am” René Descartes
Existentialism derives from philosophical and religious thinkers (Soren Kiekegaard primarily, then Fredrich Nietzsche, Edmund Husserl and most famously Jean-Paul Satre) around the 1850’s. Believing that the vastness of the human dimension is extremely difficult to understand yet often the most influential in people’s behaviour and understanding of life, the argument went on to state that life couldn’t be understood simply in behavioural or emotional terms.
Existential Therapy developed from philosophical ideas and writings into a therapeutic model that aims to give clients knowledge of themselves. Knowledge in the sense that allows them to be truthful with themselves, have a wider worldview than their previous awareness and a way to know of the past events and move into the future with a positive attitude, understanding the limitations of the human dilemma. This dilemma comes about by the paradoxical limitations of the human condition versus the ultimate freedom this dilemma enlightens. A circular augment but that is part of the dilemma of explaining existentialism. Hence: ” I think, therefore I am.”
Liberate the client
Existential Therapy, like all counselling, aims to liberate the client from past, current and future fears and the resultant inhibiting thoughts and actions. Existential therapy is executed by establishing a dialogue where the therapist will ask “what” and “how” but never “why”, leading to an existential understanding. A task not often satisfactorily completed, given: (a) the complexity of the human condition; and (b) adequate layman’s language to explain.
Understanding It is believed that this “understanding” of the client’s world in this existential way will allow him/her to more fully take on responsibility (in existential terms “freedom”) for their beliefs and actions. This responsibility to their selves and the rest of humanity is the key if a client is to be in control (feel free) of their lives. It is the therapist’s task to demystify this complex philosophical model/therapy, as it is often perceived, and help the client come to an understanding.
“What is required is not formal explication: the task of philosopher, and of the therapist as well, is to de-repress, to reacquaint the individual with something he or she has known all along. This is precisely the reason that many of the leading existential thinkers (for example, Jean-Paul Satre, Albert Camus, Miguel de Unamuno, Martin Burber) prefer literary exposition rather than formal philosophical argument. Above all, the philosopher and the therapist must encourage the individual to look within and to attend to his or her existential situation.” (Yalom, 1980. p16.)
Existential Therapy is best suited for clients facing developmental issues, which can include adolescent struggles for identity, middle-aged crisis, relationship breakdowns, and where advancing toward old age. It is in the human being’s major life changes when existential questions are asked, so it is fitting that this philosophical and therapeutic modality should provide an effective way to tackle life issues.
Human problems can be helped by an existential approach
Self-understanding/self-awareness, relationship improvement, spiritual development, mind/body awareness and integration, and personal empowerment are all amenable to Existential Therapy. It is interesting to note that so many human problems can be helped by an existential approach and this attests to the belief of Yalom that the Existential Therapy founders aim was
“…that existential key concepts and themes will become integrated into all therapeutic schools rather than existential therapy be(ing) a separate school.” (Corey, 2001. p161.)
On the downside Existential therapy is often seen as mystifying rather than demystifying human behaviour due to its complex philosophical language:
“Both beginning and advanced practitioners who are not of a philosophical turn of mind tend to find many of the existential concepts lofty and elusive. And those counsellors who do find themselves close to this philosophy are often at a loss when they attempt to apply it to practice.” (Corey, 2001. p 162.)
I suggest that the main problem with Existential Therapy is that even when completely understood by a counsellor or therapist a problem might be that telling a client that “life is just plain bloody unfair” and that is “man’s lot” and that is the “dilemma you must face if you want to move on” might not be helpful. Most clients come to counselling in pain. They may not want a philosophical discussion right now thank you.
“Life is not a problem to be solved, but a reality to be experienced.” (Kierkegaard)
Frederick Salomon Perls and Lore Perls brought Gestalt Therapy to the world. It is present-centred approach to therapy. Being aware of the moment and where a person is in that moment is the key to Gestalt principles. What is happening now and where it is happening are seen as crucial to gestalt’s understanding of a client’s position in the world and in relation to the presenting problem. An awareness of the experience and how that experience is remembered is also very important.
Therapist who is very skilful, and a client who is equal…
For a client to appreciate Gestalt Therapy I believe there are two forces required: a therapist who is very skilful, and a client who is equal in skill and intellectual capacity. Gestalt Therapists work with clients experientially, holistically, including cognitive, emotional, spiritual, and interpersonal aspects of a client’s life. Within this parameter the therapist and client collaborate by looking at the moment. Exploring the meaning of what is happening here-and-now for the client in relation to what they are talking about.
Looking at feelings, thoughts, and memories.
If a client is talking about something that happened twenty years ago or feeling something or remembering something, that is the here-and-now. In this here-and-now is the recognition that everything experienced is in relation to the environment, “the field”. Environment or the field include the family, work place, etc … and these are all inter-related. These two basic tenets of Gestalt Therapy are joined by a third – phenomenology – “… how each of us sees the world, how each of us contributes to creating our own experience…” and “… a way of learning how to listen afresh by bracketing off as much as possible – our beliefs, values, theories, interpretations, ‘knowledge’ etc – so as to be touched a new by the nomena, the virgin experience…” (Parlett. 1995.)
Gestalt psychology is concerned with the nature and structure of perceptual experience mediated by our awareness, seen as five distinctive qualities: contact, the meeting of differences; sensing, close and far sensing determines how we become aware; excitement, is the emotional component; figure formation, determines how awareness is developed; and wholeness, meaning the whole is greater than the sum. Gestalt Therapists may employ homework, experimentation and dialogue with the client to enable the client to understand their working and appreciation of their selves in the environment. Therapy can depend greatly on the relationship between therapist and client.
Some see Gestalt Therapy as overly confrontational. My experience of Gestalt Therapy certainly shows this is an aspect that must be carefully monitored or it might put a client off therapy and leave the client in a no-man’s-land. Therapists who challenge too abruptly, without first gaining the clients trust may simply antagonise the situation.
Where Gestalt Therapy works best is when dealing with clients who have a need for mind/body awareness and integration, self-understanding and self-awareness, personal empowerment, actualising and potential. Again, good therapy utilises many modalities, and in its place, under careful application Gestalt Therapy can work well for some people.
Gestalt Therapy can result in some deep awareness and feelings leading to emotional catharsis. These clients must be cared for properly or they might be scarred. Attention to technique alone can be damaging.
Gestalt Therapy works well for some people because the techniques employed to affect change are practical and clients are able to participate in these techniques, directly seeing results. The empty chair or hot seat as Perls called when an audience was present, is suitable for client’s role playing and along with “games” the Gestalt Therapist will play with the client allowing the client to actually see and hear and “interpret” the experience themselves, leading to a greater understanding of their behaviour, hopefully leading to changes in behaviour. Clients take responsibility for their participation in the therapy, so when something cathartic happens it is with their permission. This makes gestalt Therapy a powerful tool for change in people’s lives.
Beginning with Freud early in the 20th Century individual psychotherapy has grown from an elite practice to one that is available to everyone. Couple and family therapy began to develop in the 1950’s and includes Salvador Minuchin who was concerned less with the individuals psychopathology and more with the client’s environment: his family and the structures encompassing him.
Murray Bowen Murray Bowen’s theory is derived from a biological model of instinctual and evolutionary concept. Bowen’s Family Therapy proposed a system that aimed to help each member of the family to identify his/her position within in the family relationship and the consequent anxiety caused somewhat by that position. The stresses and strains inextricably entwined within any living organism are the stuff of Bowen theory.
Bowen was concerned with de-triangling relationships and emotional situations; the differentiation of self- defusing relationships; the nuclear family emotional system – where people bring their childhood “role” into adulthood; family projection; emotional cut-off; multigenerational transmission process – Patterns and themes passed down through generations, how families begat “like” families; sibling position which determines one’s existential view of the world; and societal regression – how patterns in families reflect patterns in society.
Other family systems theories include: Cloe Madenes; Jay Haley; Virginia Satir; Gregory Bateson; C Whittaker.