Psychotherapy and counselling give us a way to think and talk together about both current difficulties and the life experiences that may have helped to form them. Exploring these aspects of your life together can be very enlightening and helpful in terms of challenging thinking patterns – both conscious and unconscious - that may have become entrenched over time, and can fuel anxiety, depression, relationship difficulties and other maladaptive behaviour.
These thinking patterns can become exhausting, and therapy offers an unhurried space to begin making sense of yourself and your world at your own pace in a quiet, confidential environment. Sometimes when emotions run high it can be difficult to understand our feelings, let alone manage them, making everything feel overwhelming. Having another mind to think alongside our own at these times can feel calming and give us the needed space to begin challenging our fears.
Different therapists can take different approaches to the way they practise. Here are a couple of the most common approaches to be found, some brief explanations of them and how they relate to my own practise:
Dynamic Psychotherapy / Psychoanalysis
My background is in dynamic psychotherapy, which is a more analytical type of therapy. The word ‘dynamic’ relates to how the unconscious mind interacts with and influences the conscious mind – a relationship that is always flowing and changing. Another important dynamic is in the relationship between the client and the therapist, which can reflect the significant interpersonal relationships in the life of the client - particularly (but not exclusively) in his or her early years.
Traditionally, the psychotherapist in this mode of practice will keep her or his personality in the background, presenting as a kind of ‘blank canvas’ onto which the client can project their thoughts and feelings. From here, the therapist and client can begin to make sense of, and explore the conscious and unconscious, sometimes entrenched patterns of thinking shaped by past events and relationships that might cause pain, trauma, dissociative and hurt feelings in the present.
A drawback of a purely psychoanalytical approach is that sometimes a blank canvas can just be a blank canvas - there is a risk that a therapist might come across as cold and detached, and either alienate a client or create an unhelpful sense of superiority. Many people seeking therapy will have experienced a great deal of rejection and detachment, both in themselves and in their relationships to others. While this is an important thing to explore in itself, a therapist who appears aloof and unsympathetic can risk doing more harm than good. I believe that genuine care and empathy is a vital part of the therapeutic process, and that one of the most important roles of a therapist is to listen, and not just to analyse.
Cognitive Behavioural Therapy
You may have heard of, or experienced Cognitive Behavioural Therapy (CBT). Therapists practising CBT aim to help clients by examining patterns of ‘negative’ thought and behaviour which may be causing difficulties, and breaking them down into smaller parts that might be more manageable. They will then explore ways to change these patterns with the view that thoughts, physical sensations and behaviour are all interlinked, and conscious modification (if it can become habitual), can help to alleviate difficulties and improve mood. CBT is often favoured as a form of short-term therapy and can be effective in helping with specific difficulties such as acute depression and anxiety, obsessive behaviour, panic disorders, phobias, sleeping problems and eating disorders.
One criticism of CBT is that while it can be very useful in challenging thinking patterns that might cause specific difficulties in life - particularly in the short term - it can fail to address the underlying causes of these difficulties, which can continue to rumble on and cause distress. It can also give the impression that there is a ‘wrong’ way to feel and to think, and leave less room for acceptance of real and valid feelings. Accompanying this, there is a risk of a sense of failure, especially where a client is unable to modify their thinking. When this is the case it will be for good reasons, which more analytical types of therapy can help bring into the light. In my view, an open acceptance of feelings, thought patterns and behaviour is the first step towards understanding them. In this way, change towards happier, more contented or peaceful ways of being can happen over time in a more natural and lasting way.
Because of its more short term nature and perceived cost-effectiveness, many local authorities are increasingly keen to offer patients a course of CBT based therapy as part of the NHS ‘Improving Access to Psychological Therapies (IAPT) programme. This article by integrative counsellor Helen Hadfield in the BACP’s Therapy Today magazine explores her experience of a CBT approach.
Others
Some other psychotherapeutic approaches such as Gestalt, Humanistic and Behavioural therapy involve more of a focus on the ‘here and now’ in the life of the client, and less of a focus on subconscious drives and past experiences. However, it is important to bear in mind that no psychotherapeutic approach is mutually exclusive, and they will all share common elements and goals.
Most people looking for therapy want something that is cost effective and works for them. However, research suggests that it is the relationship between client and therapist which results in a long lasting therapeutic change, not necessarily the modality of the therapy. Change occurs when we feel safe enough to begin thinking through our difficulties, challenge entrenched maladaptive behavior and begin exploring better more effective ways of coping. Therefore, finding a therapist and an environment that feels right for us seems to be the first most important step to taking control of our lives in a healthy productive way.
While I come from a psychodynamic background, I take more of an integrative approach in my private practice, combining and adapting what I see as the most helpful aspects of different therapeutic modes - along with simple common sense - in a way that will hold the most benefit for each client I see. Every person is unique, individual and important, and I believe that any approach taken by a therapist should reflect this. Above anything else, I believe that a therapist, regardless of their mode of practice, should create a sense of safety and trust, free of any prejudice or judgment - a calm space in which to help a client explore and come to terms with their difficulties.
