3 MAIN SCHOOLS OF THERAPY

I believe other therapists might be able to explain the 3 main branches of therapy better than I can but I'll give it a go for the clients who might come across these blogs.

Although there are broadly speaking three main schools within therapy, in practice most clients will have a choice of two: person-centred and CBT. The third choice, psychodynamic therapy, from the Freudian school, although once prominent is now far less common. It is worth noting that the differences between models can often be over-stated. They all have the same basic destination, even if they chose a different path to get there and there can be common overlap between models.

That is not to say there aren’t differences in their respective approaches, and it can be useful to have a knowledge of the main models. The following guide should give you a very brief overview.

Person-Centred / Humanistic

This approach pioneered by Carl Rogers was in many ways a reaction against the doctor / patient dynamic of the earlier approaches, in which the doctor was the expert and replaced this with a more collaborative approach. This model is good for when you want to explore in a non-judgemental manner why are you feeling the way you are feeling. So for example with a client experiencing depression there will be an emphasis on clarifying the initial goal (which may develop and change) and then exploring the feelings associated with the presenting condition.  This approach facilitates the relationship between the client and therapist and taps into the resources and creativity of the client.  Carl Rogers' research taught him that it was the client who knew what hurt the most and what direction to go in.   This empowerment of the client does not suit everyone - especially those looking to the Counsellor for all the answers.  However the approach, handled with skill by the therapist produces a very strong client/therapist relationship; one where the best lessons learned are the ones learned by the client themselves.  This contrasts with the CBT approach which would be more focused on goal setting and reporting back on tasks set. The key thing about humanistic approach is therefore the relationship.  It is a commonly understood that whatever the approach this is perhaps the key ingredient.  Personally I feel that the person-centred approach suits my personality (which I have researched) and enables me to create an excellent working relationship.

Psychodynamic

The psychodynamic view is that we are controlled by unconscious motivations and beliefs shaped from childhood, imprints from our parents throughout our infancy and childhood shape our conscious and unconscious thoughts, affecting our choice of relationships, creating coping mechanisms and defences, and influencing how we behave with others. Furthermore it argues these forces are blocked from our everyday awareness and only through prolonged therapy can with bring this out into the open.

Although once prominent for many years, the influence of psychodynamic approach, at least as far as therapists are concerned, has all but disappeared. Indeed it can be a challenge to find a purely psychodynamic therapist at all, with only 1500 members the British Psychoanalytical Society.

That’s not to say these theories are no longer relevant however it’s that the other models have incorporated aspects of this approach without more challenging baggage that can be associated with Freud (fixation with past, sexuality, dreams, emotionally distant therapist)

Cognitve Behavioural Therapy

The final approach, CBT, puts how we think at the centre of the process. So it is not what happens to us, but how we think about what has happened that is key to our emotional wellbeing. Derived from Stoicism (philosophy of ancient Greece), it has recently become very popular and is indeed the main approach implemented by the NHS although in recent years the Person Centred Approach has gained ground.

It’s focus is not unlike that of psychodynamic, identifying unconscious thoughts that are preventing us living a normal life and thus the focus of therapy is observing and recording these thoughts which are then explored in therapy. For example with depression the client will often have a very negative, self-critical voice (‘I’m useless’, ‘no-one would ever want to be with me’) and these thoughts will be then challenged in therapy. One aspect of CBT is self-evaluation forms which will often be repeated every couple of weeks. The criticism of CBT is that by prioritising the role of our conscious mind, our rational thought processes, it under-estimates the role of our emotional and historic patterns of thinking and behaving.

Partly to counter these criticisms, there has been a move away from the more cognitive aspects towards a focus on both the relationship and the past (humanistic and psychodynamic models), as evidenced by the so-called Third Wave CBT.

CBT is useful if you are looking more to develop coping strategies, or practical solutions to the issue you are feeling, it will normally involve setting clears goals and regular reviews of progress.

Conclusion

It should be said that recently many therapists and organisations have adopted an integrative or pluralistic stance, in that they have a number of approaches that they tailor to the issues of the client, at different times, depending on the client. The belief is that there can be a natural movement between models.  My view is not optimistic that therapists can successfully operate at the required level of the different skills in order to do this.  And the therapist will almost certainly prefer and therefore practise the approach that suits them more than any another.   In other words, I feel it is better to develop real expertise in one model than being average in many.   I fully recognise that this is not the opinion of many organisations looking to appeal to a wide range of clients.  Time will tell.