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.
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 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 exploring your feelings, sitting with the emotional distress, as opposed to a CBT approach which would be more focused on goal setting; for example by next week I will phone at least one friend. The key thing about humanistic approach is you set the agenda. You talk about whatever you want to talk about, if you spend the whole session in general conversation and avoiding talking about your problems, that is your concern. This approach views you as an autonomous adult who is capable of shaping therapy and determining what you want.
Of course one of the main criticism of this model, it that for clients who have difficulty voicing their concerns or asserting want they want therapy can easy drift into a repeated discussion of the same old topics. Equally for clients who are unwilling or unable to explore what can be difficult and painful emotions person-centred counselling might not be the best fit.
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 has 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 member 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)
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.
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.
It should be said that most therapist tend to be integrative or pluralistic, in that they have a number of approaches that they tailor to the issues of the client, at different times, depending on the client. And indeed there can be a natural movement between models, which can be very effective. However not all therapist operate and this way it’s good to have a clear idea of what you prefer.
The following articles are written to help you understand what is this process of
therapy, what actually happens in the room, from finding a therapist to leaving one,
from understanding what a counsellor can help you with and what they can't.
It includes topics on the different types of therapy, to couples therapy, and about the role of diagnosis in mental health.