Compare and contrast the different counselling approaches
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Counselling is a relatively recent phenomenon and is currently enjoying enormous popularity (Dryden and Mytton, 1999) It is a method of talking treatment that offers people a chance to change how they feel and to live better.
Counselling is about understanding the human condition riddled with contradictions. “We live in a constant tension between opposites: moving between wakefulness and sleep, confidence and doubt, belonging and isolation, sickness and health, life and death.” (Deurzen 1998 pg1) Exposure to these contradictions creates emotions that can easily shift us out of control. Counsellors are here to help clients to get better at managing these life problems. There are three main models: Psycho Dynamic, Humanistic and CBT. Each model has its own theory (scientific or philosophical basis) of human development and consequently its own way of working. Theoretical models have their origins in the values and beliefs of persons who, in turn, have converted these into a philosophy and theoretical model of counselling. “These values and beliefs form rationale for what one does, how one does it, and under what circumstances. It also predicts outcomes for different set of conditions” (Gibson and Mitchell, 1999, pg 123) They are different in their approach but the aim in more of less the same; to help clients with their problems/conflicts.
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2. Major theoretical approaches
2.1. Psycho Dynamic Approach (PD)
2.1.1. Theory and Theorists of PD Model
The Psycho Dynamic model is the oldest model based on the psycho analytic theories and practice of Sigmund Freud (1856-1939).
It focuses on the belief that a large part of our mental functioning is unconscious.
Freud was not the first to suggest the unconscious but was the first to attempt to find out its role in human emotions and behaviour. Although Freud tried to find access to the unconscious by hypnosis he was more successful using his technique of “free association”. “Freud believed he was able painstakingly to arrive at the kernel of the individual’s conflict – often some idea, memory, or emotional event too painful or unacceptable to be allowed freely into consciousness, and which had been repressed into unconscious.” (Brookes and Wanigarante; 2003 pg 43) Later Freud added the use of slips of the tongue, jokes and dreams as tools to access the unconscious.
Freud believed that our main issue is conflict caused by our primitive drives. The primitive drives of the unconscious are conflict with the rules, structures and prohibitions that the infant acquired from parents, teachers and society. To avoid the conflict, “unacceptable” ideas and impulses are repressed out of consciousness (and memory), but the pressure from the unconscious to discharge these unacceptable thoughts remains. The part of the mind from which these primitive drives arose is called the id; the-super ego is a part of the mind which follows the rules and prohibition. Somewhere between these two is ego: caught in conflict between the drives and censorship of super-ego.
PD counselling attempts to help the client develop insight into deep-rooted problems that are often thought to stem from childhood. PD works through defences which are seen as strategies that a person employs to avoid facing aspects of the self which are felt to be threatening (Jacobs, 2010).
PD counselling aims to bring the unconscious into conscious awareness so that the client may gain insight and understanding (Dryden and Mytton, 1999).
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There is one less obvious level of relating, which is a vital aspect for PD model – transference. “We bring to every relationship patterns of feeling and expectation which spring from our past experience and relationship. These patterns influence the way we perceive and make sense of present relationships. The transference from past to present is by definition unconscious. The transference is most likely to be used by many counsellors as a source of clues about the underlying patterns of thoughts, feelings, and behaviour.” (Potter, 1997, pg 69)
The counsellor will have their own response towards the transference, this is called counter-transference. The counsellors are not without any personal problems, but the counsellors recognise their limitations and throughout their own therapy they are able to see these. The counter transference is an important part of the counselling process; the counsellor is encouraged to explore this process in supervision.
PD model includes many different schools evolved from Freud original theory: Attachment Theory, Psycho-Analytic Theory, and Object Relations Theory. Carl Jung, Alfred Adler and Melanie Klein are all widely recognised for further development of the concept and application of psychodynamics.
2.2. CBT Model
2.2.1. Theory and Theorists of CBT Model
The CBT model links thinking and behaviour. It originated as a response to the Psycho Dynamic model which was looking for focused, quick and effective progress. The theory behind this model was formed in the 1950s as a result of merging the works of Aaron Beck and Albert Ellis (RET).
Ellis believed that although most approaches to counselling help clients with their difficulties, they lack efficiency, taking too long to achieve results. CBT aims to establish what the client’s problems are and to start working with them as quickly as possible (Dryden and Mytton 1999).
While PD explains emotional disturbance as unresolved traumas from childhood, CBT states that clients problems do not originate directly from the events but in how the individuals interprets and creates a meaning for them. (Milne 2007).
The central focus of the therapy is the individual’s thought process and beliefs and how these can be adapted. The client is helped to change the way he/she thinks: from negative and irrational to more realistic and helpful thoughts.
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The interaction between client and counsellor is controlled and structured. The role of the CBT counsellor has a strong teaching element, teaching clients to unlearn unhelpful habits of behaviour and to gain more useful patterns of thinking. The client creates plans of action and works on them between sessions. CBT concentrates on particular aspects of the client’s life.
As a non-dogmatic model, CBT does not insist on one particular relationship (as PD does) However, an active-directive style is encouraged since it is regarded as the most effective and efficient. The counsellor is less active once the client is taught about the ABC model and begin to teach himself.
2.3. Humanistic model
2.3.1. Humanistic model Theories and theorists
Just as behaviourism was a response to PD thinking, humanism was a response to limited ideas of pure behaviourism. The Humanistic model is based on a belief in the uniqueness of the individual. The most important early humanistic theorists are Abraham Maslow (1908-1970) and Carl Rogers (1902-1987).
They believed that personal problems were the result of distress rather than illness and developed talking treatments based on gentle questioning and positive feedback.
While the PD process will concentrate on repeat failure, disappointments, anger, hate and other negative feelings which arise from separation and loss Jacobs (2010), the humanistic approach puts considerable stress upon love and has more positive opinion about human nature and potential. We could take charge of our lives; we are not pawns under the control of either the unconscious or the environment. (Dryden and Mytton 1999)
The Humanistic model advocates that the individual is basically good, working towards positive aims, even if he or she is frustrated in achieving them. He/she can make huge changes and only needs to be encouraged. “Human beings are seen not as static victims or villains, but people in a process of growth which is natural and needful.” (Rowan, 2005 pg 5) Maslow said that we grow through five main levels of developments (Hierarchy of needs).
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The Humanistic model operates under: Empathy (Advanced Empathy), Unconditional Positive Regard and Congruence (genuineness) to motivate the client to reach self-actualisation at the highest level of development.
Roger believed that attitudes, rather than techniques alone are important for the counselling process. If the right environment is provided the client would let go of his/hers anxieties and fears and begin to see his/her situation in a more realistic way.
The Humanistic model includes several approaches to counselling: among the earliest are Maslow’s Pyramid, Existentialism and Person-Centred approach (Rogers).
Other interesting and available are: Gestalt, TA, Psycho Synthesis, various Play Therapies and others.
As a thinker I would chose PD counselling for myself, though I have some doubts in practicing it: I do not see the clear link between “being aware” and “a change”. The client might not feel stuck about the original issue but the process might awaken some other issues. The Humanistic model is a bit too vague, optimistic and a naïve for me. Val Potters (1997) says that CBT is likely to suit counsellors who like to work in a structured and focused way, with identified goals. As such it comes naturally to me and I like it. However, as a short process that does not go to the bottom of the problem, it appears to be superficial to me. I would probably like to see it combined with other approaches most likely with Psycho-Dynamic model.