Types of Counselling and Psychotherapy

The most common question I am asked by people making a first enquiry about counselling is ‘What type of counselling do you do?’

What is usually meant by this is, ‘What kinds of problem do you offer counselling for?’ Most counsellors and psychotherapists, myself included, do not specialise in one type of problem, as all problems or difficulties affecting feelings and thinking have similarities, and mostly respond to therapy in similar ways

So the answer to the question ‘What kinds of problem do you offer counselling for?’ would be something like ‘Difficulties with feelings and thinking’, rather than specific single issues like, say, ‘low self esteem’, or ‘fear of failure’. Most counselling and psychotherapy deals with the whole person, and doesn’t usually separate off one thing they’re thinking or feeling or doing.

This is only a general rule, however. There are some therapies which do specialise in particular types of issue, often ones which employ a particular solution-based approach. Counselling for addictions is an obvious example, a specialism which usually involves a progressive, guided programme. Others might be bereavement or eating problems. Particular section of the population, such as young people or women, might also be identified as groups needing a specialist approach to some extent, but on the whole these use the same techniques as any other psychological counselling. The main difference might be that the agency has been set up to deal with that particular issue or group, has received funding for it, and so focuses it’s resources in that area. An individual counsellor or psychothearpist may deal in a particlar area because it has especially interested them, or they’ve done extra training in it, or possibly had particular experience of the issue themselves.

What counsellors and psychotherapists mean when they speak of different types of therapy is the difference in the theoretical orientation of the therapist, not in the types of problem in which they specialise. There are a number or appraoches, broadly divisible into the three areas of Humanistic, Psychodynamic and Cognitve-Behavioural. Even a short description of every type of approach and it’s subdivisions is beyond the scope of this article. I will therefore limit it to the two main approaches which I employ myself, Person Centred (a ‘humanistic’ approach) and Psychodynamic.

Person Centred Counselling and Psychotherapy

At the centre of the Person Centred approach is the idea that the Counsellor is a ‘guest’ in the world of the client’s experience, with all that this implies regarding respect and trust.

The client is considered to be essentially trustworthy, that he or she knows somewhere, somehow, what they need, and that they have a desire for growth. The counsellor can help bring these into awareness and help the client to utilise them.

Another central concept is ‘conditions of worth’. Conditions are imposed early in life by which a person measures their own value, how acceptable or unacceptable they are. A simple example might be ‘Don’t ever be angry, or you will be an ugly, shameful person, and you will not be loved.’ The message this carries might be something like ‘If I’m angry it means I’m worthless, therefore I must never be angry.’ The person will inevitably feel angry, possibly frequently, and conclude from this that they must therefore be worthless, ugly, shameful. Another might be ‘If you don’t do well academically, it means you are stupid and you will be a failure in life’. This kind of condition will tend to stay with the person indefinitely, and he or she might have been struggling for years to live up to what might be impossible conditions of worth. If this kind of inner conviction is brought to light, and it’s roots understood fully, it might be that the person can see that it’s not actually true, it’s been put there by others, and my be able to move away from it.

The Person Centred Counsellor attempts to be ‘with’ the client as a kind of companion. The Counsellor respecting and accepting the person, whatever they are like, will lead to the person him or herself coming to feel that he or she actually is acceptable, and coming into contact with a more genuine, ‘organismic’ self which has always been there in some way, but been hidden. They might then become more genuine, less preoccupied with appearances and facades, or living up to the expectations of others.They may value their own feelings more, positive or negative. They may begin to enjoy their experience of the moment. They may value others more, and enjoy relating to them, rather than feeling opressed, shy, inferior.

The Counsellor acheives this by creating a climate of acceptance within which the client can find him or herself. Certain therapeutic conditons facilitate this, conditions laid down by the founder of this approach, Carl Rogers. These include:

The therapist’s genuineness, or authenticity. This can not be just acted, it has to be real or it will be worthless.

Total acceptance of the client, and positive regard for them, no matter how they appear to be.

‘Empathic understanding’, the therapist really understanding what the client is saying, and, further, showing the client that their feelings have been understood.

Psychodynamic Counselling and Psychotherapy

Psychodynamic, or Psychoanalytic, therapy attempts to foster an interaction which includes unconscious elements of the client. An entire lifetime’s experience, most powerfully what the person has learned from his or her first relationships in early childhood, will determine the way the client relates to others. This will come out in some form in the therapeutic relationship too, and the therapist needs to be aware of what forces and influences may be at work in the client.

This approach does not include that idea of ‘free will’. It does not see our thinking, feeling and decision making as the result of conscious awareness, but as the results of many forces which are operating beneath conscious awareness. The person is acting and relating to others largely as the outcome of the instincts they are born with, together with what they have learned about themselves, largely through the nature of their close relationships in early life.

The particlar ‘personality’ is formed in the crucible of this early experience. If, for example, the main carer of the child has not fed her properly, this will be laid down in as an anxiety. This may be simply about being fed, about getting enough to eat, or it may be extended by the infant into related things, such as trust (they have learned not to trust that food, or the carer, will be there when needed), or insecurity about life in general, or a feeling of there always being something lacking. A result might be overeating, say, or greed in other ways, for goods, or neediness, anxious need for the presence of others, or one other. This is one example. There are myriad kinds of operations of this kind in the psyche, forming from birth, with all kinds of subleties and variations. They are almost all laid down in a level of the person which is not accessible to the conscious mind, and are acted out unconsciously.

The therapist needs to be aware of the nature of these unconscious networks, and how they are working in the session and in the person’s life. The client’s thoughts and actions and feelings may be ‘interpreted’ by the therapist, in terms of how their unconscious might be directing them. Or, perhaps less controversially, how early experience might have resulted in the way she or he is now. In discussing this, the client may gain self knowledge, acceptance and more control of his or her life.

In relating to the psychotherapist, the client may see the therapist partly as ‘like’ someone else, say a father or mother. This is called ‘transference’, because feelings originally evoked by the parent are ‘transferrred’ onto the therapist, where they can be made conscious and dealt with in therapy.

Integrative Counselling and Psychotherapy

As the name implies, an integrative approach attempts to integrate one or more theories into one unified method.

I believe that it is difficult to integrate Person Centred and Psychodynamic orientations into one, as they are in many ways antithetical. The notion of the ‘expert’ for example. Person Centred Counselling tries to avoid a situation where one person is in the role of ‘expert’ and the other is the passive receiver of wisdom. In Psychodynamic counselling or psychotherapy it can seem hard to avoid this. The practitioner is the holder of what can seem like an arcane knowledge, primarily of the workings of the unconscious, knowledge which is transmitted in interpretations of what the client says. This contrasts with a simple but ‘prized’ acceptance of the client and whatever they might say, without interpretation, as is the case with the Person Centred approach.

Despite this kind of difficulty, however, I do believe that it is possible to integrate elements of both in a style which is more effective than either alone. That it’s possible to operate in a largely person centred way, accepting and valuing the person and whatever they say, and yet be aware of past influences on the way a person is now. This includes the therapist being aware of the psychodynamic possiblities underlying the interaction between therapist and the client. I believe that there will inevitably be some ‘transference’, and at least some expectation that the therapist holds knowledge and skills which the client does not have, which will lead to certain feelings in the client. Transference is often seen in Person Centred Counselling as an obstacle to be overcome as soon as possible, and while I agree that it should be be brought into awareness, I believe that it can be a valuable tool, not to be dismissed too soon, and not to be undervalued.

The counsellor must strive to be aware of all elements which might be operating in the relationship at any time, and how these might vary at different times, and be able to decide which of these should be shared with the client for their benefit. I believe that it is possible to share, tentatively, some ‘psychodynamic’ possibilites without losing the basic ‘Person Centred’ conditions of respect and genuineness. This integration of two approaches in an experienced psychotherapist, who is not relying simply on putting into operation a learned theory but is also meeting the client as genuinely and fully as possible as two real people, has remarkable power to help people find fuller and more satisfying ways of experiencing themselves and their lives.