Table of Contents
- Person-Centred Therapy
- Psychodynamic Approach
- What is Cognitive Behavioural Therapy (CBT)
- Integrative Psychotherapy
A person-centred approach is a way of engaging with somebody, supporting somebody in a way that is likely to work for them and that means avoiding things that are liable to make people fearful or anxious and focusing on things that make people happy, excited and anticipating what is next in a positive way. For example, if you were to try and provide me with some support it would be important to know some things about me that actually worked for me such as, in my case being in the open-air. You would perhaps organise an activity for me that takes place in the open air. What you wouldn’t do for me is take me to the DIY store as I don’t like DIY. It wouldn’t make me fearful or anxious but it would trigger my depression quite a bit. As you can see, it is a way of building up a picture of somebody’s wishes, somebody’s likes and dislikes and what they react well to or badly to in order to get it right for them and that’s particularly important for people who don’t communicate via speech for example who may have some greater difficulty in communicating to you what it is that they want so we have to build up a picture over-time.
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Carl Rogers was a humanist, he believed that we are all good and that we have a natural desire to grow. His view is that if you provide people with the right environment, growth will be the result. This ideal environment is composed of three conditions. Genuineness, unconditional positive regard and empathic understanding. Genuineness is when the therapist is expressing himself honestly. The client should perceive that there is congruence on the part of the therapist meaning that the therapist is saying what he/she truly feels. The therapist is being real with the client with unconditional positive regard. The therapist accepts the client as they are, which is unique human-beings with their own values, thoughts and feelings. Seeing people in a positive light involves recognising that people are essentially doing the best they can based on how they view the situation. It’s not that the client is a bad person or is sick, instead there are some mis-understandings that are obscuring the client’s good nature. In Roger’s view, if you respect the client’s individuality and accept the right to make their own decisions they will begin to grow. Acceptance also helps the clients feel comfortable when talking about their feelings. Empathic understanding is where the therapist seeks to understand the inner-world of the client. What does the client think? How does the client feel? This is empathy. Therapists listen very attentively to the client and they rephrase the client’s feelings back to them in their own words. This allows therapists to check if they have accurately understood what the client is feeling. The client also gains insight into hearing their feelings out loud. It helps to clarify things to hear it from the outside like looking into a mirror, for example. If a client said that they had recently lost their job and soon after learned their husband wanted a divorce the therapist might reflect back to her saying “So, you feel lately like things are falling apart. Like you’re losing control?” and she might respond back with “Yes, that’s exactly how I’ve been feeling.” and this way the therapist sees that he correctly understood what the client was saying and the client gains important insight into her underlying feelings. She also sees that the therapist is listening and genuinely cares about what she’s saying. In Roger’s view empathy was very important to the therapeutic relationship. In other styles of therapy, the therapist is seen as an expert. Person-centred therapy on the other hand is all about having a genuine relationship with the client. This relationship is non-directive, in other words. The client is the one who decided what to talk about and what decision are the best. In this way the client is directing the therapy, not the therapist. Therefore, the purpose of the therapist is to be a facilitator who provides the right conditions for the client to grow. The person is already programmed for growth so why should the therapist have to interfere. This choice to trust to the client is self-direct is one of the things that made Carl Rogers unique. We can contrast him with someone like Albert Ellis whose form of therapy is directive. He tells you exactly what is wrong with you and how to fix the problem. Meanwhile, Roger’s is attempting to empower you by trusting in your ability to choose your own path. In his view, you are the expert in who you are and what you’re meant to do with your life. Furthermore, Roger’s felt that telling people how they should feel and think undermines their autonomy. He wanted clients to become more independent, and free themselves from being controlled by others. Ultimately, the growth instinct expresses as the need to self-actualise which is a continuous process in becoming the best person you can be and the person-centred approach to therapy is all about providing a supportive environment for that process.
Psychodynamic therapy is a therapeutic approach and theory developed and recognised by theories such as Sigmund Freud, Carl Jung, Melanie Klein, Heinz Kohut, Alfred Adler and of course many others. Let’s name some of the Psychodynamic terminology and how it considers mental health. Words such as the unconscious process, transference, counter transference, defence mechanisms, denial, dreams, oedipus complex, repression, free association and the compulsion to repeat. These theories looked at how our feelings and behaviour are affected by unconscious motives that are rooted in our childhood experiences. These unconscious motives are called the ID and the SUPER-EGO and they’re in constant conflict with the conscious part of the mind and that conscious part of the mind is called the EGO and it is this conflict that creates anxiety which is dealt with the EGO’s use of defence mechanisms. The ID is like a child. Like when you want instant gratification for your needs and wants and when they are not met you become tense and anxious. The ego behaves like the reality checker, it is a mediator that deals with the desires and pressures from the instant gratification that the child wants and it’s the ego that recognises that other people have wants and needs too. This is called self-regulation. The other unconscious motive that develops last is called the super ego and this is based on the rights and wrongs like morals and judgements. For clarification, ID creates demands, the EGO gives a reality check and the SUPER EGO provides morality and these three made up parts are called a tripartite. Further dynamic therapy is a commonly used therapy to treat depression and anxiety disorders. Freud’s psycho analysis is a specific form of psychodynamic therapy and in its classic approach psycho analysis can be a lengthy process. You would be meeting a psycho analyst who would be typically a blank screen and a patient would visit anything from 2-5 sessions a week over a period of several years. Psychodynamic therapy aims to turn you inside-out and put you back together again. It’s the most complex of all the talking therapies and has had the most influence on most other popular theories.
Unlike psycho analysis, meeting several times per week modern psychodynamic therapists generally meet their clients once a week but if you’re in crisis you could be invited to meet more than once a week. The psychodynamic approach believes that people are cured by gaining insight, by bringing their unconscious thought and motivations into conscious awareness and picking up hidden meanings and patterns that are shared in each session. The aim is to also release repressed emotions and experiences, it’s widely used to help clients recognise and understand how unconscious factors affect their current relationships and their patterns of behaviour. This therapeutic process also helps you resolve and understand your problems with relationships, both past and present by increasing awareness of your inner-world. It’s different from other forms of therapy because its aim is for deep seated change in your personality and your emotional development. The goal is to help you understand serious psychological disorders and work towards changing deep routed complex distress, particularly feelings of loss. It also helps you to see the way in which you’ve developed defence mechanisms as a way of coping and this therapy helps to change those patterns. However, this theory is not just limited to those with extreme mental health problems. There are many people who experience a lot of meaning and are looking for more peace and contentment and this kind of therapy can be very useful for that. The therapeutic relationship is considered paramount to the process and in psychodynamic therapy the relationship helps to highlight how you interact in all your relationships by allowing you to transfer your feelings of significant others onto the therapist and it can illuminate how your early life relationships still affect you today. It’s this method of looking into your landscape and exploring with you your interpersonal relationships and how it supports you to see your part how patterns and dynamics, including games become acted out in your current life and through exploration you become empowered to transform these dynamics into healthier patterns of relating. Fundamentally, the goals of psychodynamic therapy are to encourage self-awareness and understanding of the influence of your past onto your present behaviour.
What is Cognitive Behavioural Therapy (CBT)
CBT therapy is a very different type of therapy because it’s short term and it is one of the only therapies that we can actually monitor and show through statistics improvement. CBT can be very powerful. Most therapies don’t work as they’re not quite as direct. Most therapies are very circular. CBT believes it isn’t so much what happens to us in our life but how we think about what has happened to us. CBT focuses on those beliefs and because of that the main things that we use are thought-tracking (Keep record of all those negative automatic thoughts) so we can notice they are un-noticed thoughts. Thought-stopping is a method used to stop the negative automatic thoughts. The main components to CBT are to bring awareness to the thoughts that we have every day whether they be automatic, figure out the underline core belief. They can have you do some roleplaying and you can get into it so that you can start verbalising NAT and you can start changing them and turning them into a more positive and healthier voice. The therapist's job is to help you think in a different way of your overview of situations you find yourself in from a different perspective of thinking. The therapist also encourages the client to practice new thought process and check thinking out against evidence. Once you practice, keep practicing like with any other skill it becomes second nature. It is a sub-conscious thought process that comes from practice. The more practice put in, the better you’ll get at any task including your life.
Integrative therapy is when several distinct models of counselling and psychotherapy are used together. Integrative Therapy is applied by blending the Person-Centred approach and the CBT approach. This creates the integrative approach. The integrative therapist may use the Person-Centred approach to build a therapeutic alliance with the client (Build a relation, gain a rapport and understanding) to develop a trusting, safe relationship which is important in bringing out a true, clear understanding with the client. The Person-Centred approach is also used to try and understand the client’s perception of reality and their unique view of the world as they see it. This is called empathy. The integrative therapist blends this with the CBT approach to challenge irrational thinking, give strategy and guidance helping clients to overcome their individual difficulties and also produce a measurable outcome. Another way of thinking about Integrative Therapy is making sure the blend of approaches suits the client. Some advantages of Integrative Therapy are that differing approaches may suit more clients, allowing a wider range of approaches to be used and also allowing the counsellor to tailor the approach for the individual clients. However, there are some disadvantages of Integration Therapy. Disadvantages include dilution of theoretical consistency (PCT and CBT differ in core modalities creating the dilution of theoretical consistency during IT through blending the two.) Therapists training and trust in the core model and integration therapy can also potentially be confusing for the client if the integrative models are not put together during treatment with care (Jumping from one treatment to the other.)