Karuna Psychotherapy and Counselling Harrogate

1. Home
2. Client Info
3. Fees
4. Therapy Contract
5. Articles
6. Downloads
7. Qualifications
8. Contact
9. Room Rentals

The Different Approaches in Psychotherapy and Counselling

Understanding something about the different therapy approaches is perhaps as equally as important as understanding the different discipline names in terms of you deciding whom you wish to see. This is because whilst there is an overlap amongst the approaches, with many using similar techniques or terminology to alleviate your problems, there are also several differences. There are literally hundreds of therapeutic approaches, however, it is not necessary for you to understand them all in order to weigh up the sort of person who would best suit you and meet your needs. This article outlines four of the most popular approaches which therapists and counsellors use. There is also a table which attempts to simplify some of the major differences between them.

Client / Person-Centred Approach

For the purpose of this account, I will use the term client-centred to refer to both client and person-centred psychotherapy. The main difference between the two, is simply that the former refers to therapy for people with emotional problems, whereas the term person-centred may be used more widely for people outside the field of emotional health.

In client-centred therapy, individual sessions usually run for about an hour, the total number is left up to you to decide, or may be negotiated between you and your therapist. Client-centred psychotherapy was traditionally seen as a non-directive therapy, that is one in which your therapist did not lead you to a specific topic of conversation but left this entirely up to you. However, today, many client-centred therapists would argue that it is not possible to be totally non-directive and this may not always be desirable (dwelling on problems may exacerbate rather than alleviate them). Hence, an attitude of non-controlling of the therapeutic process may better describe the therapy. This means that the therapist takes your lead in what you wish to look at in therapy and keeps this central. However, if your therapist felt that you were continuously avoiding something, they may challenge you by speaking honestly about it. For example, they may say something along the lines of "I note that you came to see me about your drug problem but have spent your session talking about your new kitchen".

Your therapist brings their own essential qualities to therapy (known as the core conditions); empathy, genuineness (congruence) and acceptance (unconditional positive regard). Your willingness to talk about your problems relates to your level of safety or comfort with your therapist, whose qualities promote the ideal climate for you to feel safe. People often have problems which they feel ashamed or embarrassed about. Your account will be sensitively listened to and aims to be accurately reflected back to you by your therapist in a non-judgemental way. In so doing, the aim is for you to come to listen to your fears, thoughts and feelings without denial or distortion until you reach a stage of self-acceptance where change and growth are possible.

Some client-centred therapists will leave decisions over what you wish to do about your problems up to you. However, the therapist will nonetheless share their understanding of your problems (be congruent) and may offer insight into how behaviour patterns sometimes evolve. Some client-centred therapists do not offer advice or interpretation, others do, but many will openly express how they see your problems from their perspective and therefore in this way your beliefs are empathically challenged.

Client-centred therapy attributes more importance to the therapist's attitudes than to their technical training or skills. This doesn’t mean that client-centred therapists are untrained, moreover, there is a strong emphasis on the therapeutic relationship as being paramount. The adoption of strategies or techniques may or may not be used; this is dependent upon you and your therapist. Working as a client-centred therapist, I personally take your lead. If you appear to ask for information, strategies, advice, life skills support, then I believe I would not be being client-centred if I didn’t offer it. This attitude varies from therapist to therapist and therefore if you want these aspects included in your therapy and have found a client-centred therapist whom you like, share this concern with them and find out from the start whether you will receive the support you need.

Cognitive Behaviour Therapy (CBT)

Cognitive behaviour therapy or CBT techniques may be learned through computer programmes, self help books, through individual, or group therapy. Individual sessions typically run for fifty minutes to an hour and comprise between 6 and 20 sessions in total. CBT works on the assumption that how we evaluate events, determines how we respond to them both emotionally and behaviourally. Whilst the cognitive element examines cognitive processes; your thoughts, attitudes, and beliefs; behavioural therapy, focuses on how you behave in response to these.

CBT attempts to identify and explore your ways of thinking, how these influence your feelings and how you behave as a consequence to these. It is argued that the way you think about something, leads you to respond to it in a given way. For example, if I haven’t received an expected phone call from a friend I may make a number of assumptions as to why, this will influence how I feel and behave. For example, my thought processes (cognitions) may include; the friend no longer wants to see me, I have upset them or angered them in some way, they were always a bit sensitive anyway, I’m better off without them. These types of thoughts are likely to make me feel upset, annoyed or both and I am less likely to call the friend, that is I will behave according to these beliefs whether or not they are correct. However, if I concluded the friend was very busy at the moment, that their not phoning was out of character, or that maybe they had been poorly, I am more likely to feel differently about them not telephoning and more likely to behave differently by calling them again. CBT aims to identify your self talk thought patterns (called negative automatic thoughts or NAT’s) whereby you learn to challenge the thoughts and respond based more on evidence than on presumption.

Learning to stop such thoughts in their tracks, prevents the thoughts becoming more and more distorted which occurs as the person projects all sorts of their own ideas onto the other person to explain why they may be behaving as they are. CBT therefore aims to stop you jumping to conclusions when these may be incorrect. This prevents some of the unpleasant feelings and behaviours occurring. Unlike some of the other talking treatments, which may focus on past experiences in conjunction with what is happening currently, CBT mainly focuses on the "here and now" problems rather than on the causes of your problems.

Core beliefs develop as we grow up, out of a need to understand and make sense of the world. They are used as a heuristic rule of thumb, a method to navigate a way around the environment. Like stereotypes, they can be useful in terms of our not having to test everything out anew but unhelpful when assumed correct because we make assumptions based on limited information and behave as if the assumption were true. When people become depressed, they are more likely to see things which confirm their negative automatic beliefs and miss events which disconfirm or challenge the belief. In this way the depression may be reinforced and a cyclical pattern emerges, negative thought leads to negative feeling which in turn leads to negative behaviour. This encourages further negativity, greater sadness and depression and increases the likelihood of the person behaving in ways which will reinforce their negative beliefs.

CBT therapists often give homework to be carried out in-between sessions. This may involve completing daily records which monitor your thoughts, feelings and behaviours and how they are interacting. This may be followed by you actively doing practical tasks with the support either of your therapist, a friend, or on your own.

Psychoanalysis & Psychodynamic Psychotherapy

Both psychoanalysis and psychodynamic therapy are similar in so far as they attribute emotional problems to your unconscious motives. However, unlike classical psychoanalysis, psychodynamic psychotherapists do not necessarily accept Freud's view that these unconscious motives and conflicts are sexual. A further common difference between the two approaches is the length of therapy and its depth. Psychodynamic psychotherapy may be useful for more recent milder problems, it can be fairly brief, taking approximately 8 weekly sessions. However, psychoanalysis may involve three visits a week for several years and is perhaps more suited for problems of a more long standing nature tending to try and influence more of your personality and is more in depth.

Both psychoanalysis and psychodynamic therapy carry the underlying assumption that we have an unconscious mind which sometimes holds feelings too painful for us to face. Therefore, usually in childhood, we develop a defence against these feelings in order to protect us from them. An example of a defence is denial. Therapy assumes that your defences are causing more problems than they are solving. The therapist therefore uses the therapeutic relationship in order to gain a greater understanding of your unconscious feelings and processes making interpretations of them and sharing them with you in order to increase your awareness. The understanding gained through this exploration aims to arm you with knowledge about how you are behaving and allow you to make choices about how you wish to behave in the future, rather than you acting on the basis of unconscious impulses or behaviours formed out of custom or habit.

Therapy assumes the difficulties you are experiencing as an adult originated from your childhood experiences. As a child, you didn’t have the same level of understanding and awareness that you now have as an adult. As a consequence, your thought processes will have been naïve. Also as children we are highly influenced by other people’s beliefs and take these on as our own without thinking for ourselves. Sometimes as adults we continue to respond to our current environment based upon these old thoughts feelings and experiences and in ways which may not be relevant, may be ineffective or harmful to us now. Therapy aims to explore your awareness of your thoughts and feelings and learn how some of the current ways you are coping may no longer be adaptive. In addition, therapy aims to help you discover new more effective ways of dealing with problems now.

Psychodynamic therapy also focuses on the feelings we have about people, particularly our family. It may therefore be helpful if you are having difficulties with past or present relationships. Like client-centred therapy, although it is used to treat a wide variety of conditions, it carries the opportunity for you to focus on aspects of your personality and therefore may be particularly suited for personality problems. The therapist develops a therapeutic relationship with you. This relationship is unique because the therapist maintains a uniform, neutral and accepting stance. The neutrality of the therapists facial expression allows you to project onto them unconscious feelings held towards others. In this projection the therapist learns about how you behave towards others based upon how you are behaving towards them.

In summary, therapy aims to explore feelings; bring to light those you are unaware of and explore your level of understanding of painful feelings and how well you cope with them. Once these have been unearthed, you can choose to respond to your current environment in ways more suited to your current needs.

Systemic / Family Therapy

Systemic therapy looks at relationships between people and therefore is particularly useful for working with families, couples or groups, although you can attend as an individual. Therapy has been argued suitable for people with serious problems (e.g. schizophrenia, addictions and eating disorders) and for families experiencing parental separation, individual crises or divorce.

Rather than seeing the problem as residing within one person and focussing upon them, therapy looks at the interactions between people in their environment. Problems, it is argued, arise within a given context. Therefore, it maybe that the situation needs changing, rather than the individual. Some psychological problems are exacerbated by societal problems, for example there are strong links between unemployment, poverty, poor housing and depression. Also people entering therapy because of being battered or abused are not the cause of their problem.

A systemic therapeutic approach suggests problems may more easily be altered than if faulty biological makeup is seen as the cause, as is the case in the medical approach. If the problem is in the environment, then it may be more easily changed, whereas changing your biology is more problematic. The assumption is therefore that therapy can change behaviour by changing the context within which you’re living rather than by changing you as an individual.

Systemic therapy also focuses upon the function of behaviours rather than the cause. Hence family interactions whether viewed as good or bad are seen to develop from having a function or purpose. What is it about the actions that people have undertaken that makes them the best that they could manage under the circumstances? In family therapy the attribution of blame on one person is challenged. The therapeutic aim is to shift your perception of the problem from blaming yourself or an individual family member, to seeing problems as arising out of interactions between the family members / group members / or society in general. This approach acknowledges that if you introduce something new into a system (family) then this can have unexpected consequences on the rest of the system (family). Anything that changes one aspect, will have consequences for all others. This is important when thinking about the introduction of new family members into the family, through birth, or marriage for example.

Therapy uses a narrative or story telling approach, with each family member (who wishes to attend) recounting their own story. It looks at how and what you communicate with one another; how you influence one another’s thoughts, actions and behaviours; who has been ascribed what role in the family or group and the influence this behaviour may have upon you, a couple or the family’s behaviour.

Whilst the precise number of sessions used in systemic therapy depends upon the problem, the therapy tends to be fairly short term, the average being between 5 and 20 sessions. Whilst I have talked mainly of family or group therapy, therapy may be individual, couple, or include part or whole of a family, or a group of people who are close to one another. It is not necessary therefore for all family members to attend and individuals can be helped if they attend alone.

In family therapy, the aim is to make visible the family’s problems. Therapy aims to uncover family secrets that are a potential source of unsolvable problems. It also aims to gain an understanding of the family’s shared beliefs and ways of behaving with one another. Family myths are integrated beliefs that are maintained by all family members and typically go unchallenged. A family myth may be that only father goes out to work. If father becomes hospitalised the children may be concerned about bills. Other issues relate to what can be talked about in the family and what is never discussed? How are needs expressed and to whom? Do rules apply to all family members or just one or two?

In family therapy, the therapeutic process often takes place in a room with a one-way screen where the family are observed by a team of therapists in an adjoining room. The team along with the therapist and family seek to develop multiple explanations for the presenting problems. Like client-centred therapy, you are seen as expert in your own life and the therapist’s use of power is minimised. Systemic therapists act in the belief that it's important that those involved take the work into their own lives rather than keeping it in the therapy room. Therefore what happens between sessions is as important as what happens in them.

While a systemic therapist will consider it desirable for individuals to claim responsibility for their own actions, they will attempt to establish connections between your experiences and points of view and those of others with whom you are close. Through the exploration of your accounts, the aim is for you to be able to make new connections between yourself and others based upon a new co-constructed story.

Summary Table of Approaches

*Generally speaking the longer you’ve had your problem, the longer the therapy