Counselling London provide several different counselling modalities for patient treatment.What comes to mind when you think of the words counselling or counsellor? Do you picture a room where one person tells another their deepest secrets and problems hoping for magical advice that will whisk the trouble away? The fact is the word counselling is much more then that and actually encompasses several different counselling modalities or types. Understanding what they are can help you to choose the system which may work best for your individual needs.
There are two types of counselling, directive and non-directive. A directive counsellor is one who will tell you things that you can do and may request that you do “homework” assignments to help you each your goals, while a non-directive counsellor will allow you, the client, to decide what topics are discussed and where to go with the information with a nudge here and there. Both “types” work using some sort of modality, here is a short list of the different types of counselling modalities that you may come across and a short description of each.
The modality of behavioural therapy is built on the belief that any learned behaviour can be changed or unlearned without drawing attention to reasons or origin of the behaviour. Those who suffer from phobias, fears, addictions or obsessive compulsive behaviour often benefit from therapy modality.
Behavioral therapy, in general, is believed to have three separate and distinct points of origin, South Africa led by Wolpe’s group, the United States led by Skinner, and the U.K with both Rachman and Eysenk as lead. All three offer their own approach to looking at behaviour issues.
Eysenck’s group focused on behaviour issues as interplay between environment, behaviour and personality characteristics. Skinner’s group located in the U.S tended more towards an operant conditioning where the main focus created a useful approach to interventions and assessment focused toward contingency management like the token economy and behavioural activation.
One of Skinner’s group, a student by the name of Ogden Lindsey is said to have formed a movement called precision teaching. Precision teaching is a type of graphical chart known as the Standard Celeration Chart which monitors the progress of clients.
Skinner was interested in individualizing programs to improve learning for those without learning disabilities and spent time working with Fred S. Keller to develop programmed instruction toward that end. These programmed instructions offered up some clinical successes in aphasia rehabilitation. In fact Gerald Patterson used programmed instructions as a way to help create his parenting guide for kids with behavioural problems. Respondent condition appears slow, depending upon age, but operant conditioning remains relativity stable.
Although many practitioners of behavioural therapy remain solidly committed to the basic operant and respondent paradigm, the second portion of the twentieth century saw more therapists combining behavioural therapy and the cognitive therapy pioneered by Aaron Beck and Albert Ellis, to form cognitive behavioural therapy.
In some practises adding the component of cognitive therapy added to the effect such as the collected evidence which suggests cognitive interventions vould improve social phobia treatments, while in other sections the treatment was not enhanced, which brought about Third Generation Behaviour Therapies.
Third generation behaviour therapy makes use of the basic principals of operant and respondent psychologies but adds usable analysis and clinical formulation or case conceptualization of verbal behaviour which is more inline with the view of the behavioural therapist. Although some research papers suggest the effectiveness of these therapies for some cases of cognitive therapy, the overall question has yet to be answered.
Cognitive Analytical Therapy (CAT)
Cognitive analysis therapy or CAT explores a client’s thinking and language as well as links between cultural, historical and social ideals of how we operate. This type of therapy helps the client to learn and develop new skills with which to change undesirable patterns of behaviour including negative thought patterns and actions. The therapy modality comparatively short, lasting on average only around 16 weeks and is directive and strictly structured with the number of sessions agreed upon at the outset of the program.
During the first part known as the Reformulation phrase the analysit collects relevant information such as current issues and past life experiences to write a reformulation letter to the patient. The letter summarizes the therapist’s understanding of the problem with particular emphasis given to comprehending the link between childhood patterns of behaviour the way they impact o adult life. The document is then agreed between therapist and client and is then used to form the base for the rest of the sessions.
Once this summery letter has been agreed a client may then be requested to complete a series of rating sheets or diaries to record the occurrences of issues and their context. This period is known as the Recognition phase and during it the patient and the analyst will then work to create a diagrammatic formula which illustrates any unhelpful habits that remain problematic for the client. The purpose of this section is to help the client to see how and when problems happen.
During the 2nd part of the therapy the client and therapist move toward the Revision phase where “exits” are identified and practised from the diagram which was established during the earlier phase. For example; a troublesome procedure involving a client who may choose to overdose due to anger may include an “exit” strategy that involves expressing that anger in a way that is not self-harming behaviour.
At the end of the program both the client and the therapist write “goodbye” documents which summarize what they feel has been accomplished in the program and what still needs to be done which they exchange. Once the agreed upon amount of weekly sessions is complete a follow up session or sessions may occur to keep an eye on and support the client with any changes that have been managed Typically a 16 week course of therapy is followed by a single meeting approximately one month following the last session with a final session around three months later.
Cognitive Behavioral Therapy (CBT)
CBT or cognitive behavioural therapy seeks to change a person’s destructive emotions that stem from an incorrect view of past events. By helping a client to explore their thoughts beliefs, and behaviours CBT can help them to learn new ways of reacting and behaving. This type of therapy is often used with both individuals and groups and can include a number of therapeutic systems and approaches including well known systems such as cognitive therapy, rational emotive behavioural therapy and multimodal therapy. One difficulty which has persisted through out the development of CBT is defining the range of what make up cognitive–behavioural therapy.
Although the specific therapeutic method may vary somewhat within the various methods of cognitive behavioural therapy sessions ,depending on the specific type of difficulty or issues they will commonly include writing a journal of any significant events which will include associated thoughts, behaviours and feelings that question and test assumptions, cognitions, evaluations and beliefs that may be unhelpful or unrealistic. The therapist will then help the client to gradually confront activities which have been shunned and to try out new methods of acting and reacting. Mindfulness, relaxation and disruption methods are often used.
Cognitive behavioural therapy is often used in conjunction with some type of mood stabilizing medication to treat any conditions such as bipolar disorder. The application of cognitive behavioural therapy is recognized by the NICE guidelines within the British NHS as a way, along with medication and family therapy of treating schizophrenia.
Generally going through a course of CBT is not a walk in the park for clients, a typical course is 12 sixteen hour long sessions and even once a client begins to distinguish where and when their thoughts go awry it can continue to take a lot of time and attempt to a replace non-working cognitive-affective-behavioural process or habit with a more realistic and adaptive one.
CBT is very problem structured and focused towards the patient. This type of therapy requires that both patient and therapist are open and honest with each other so that the therapist can help develop strategies that allow the client to manage problems that can guide him or her to a better life.
Family therapy investigates the relationships within a family group by focusing on the family as a whole, instead of dealing with a individual person from within the family. The focus of this therapy is on how the family interacts together with the therapist’s aim to connect the entire family system in finding helpful solutions for any problems. Although the amount of session depends entirely on the family and its problems the average is usually between 5 and 20 sessions.
A family therapist will often meet with a couple of members of a family concurrently which has the benefit of being able to see the different ways in which family members see shared relations as well as interaction patterns which may become obvious to the analyst and the family during sessions. These patterns generally mirror habitual contact patterns seen at home even with the therapist incorporated into the family group.
Family therapy interventions generally focus more on association patterns then analysing impulses of the unconscious or early childhood traumas of individuals the way a Freudian therapist would, although some teachings for family therapy such as psychodynamic and intergenerational consider such historic and individual factors and might use tools such as a genogram to help clarify the patterns of relationships across the generations.
The most individual feature of a family therapy is the analytical framework and perception instead of the number of people who are present in any given therapy session. In other words family analysts are relational therapists, so they are usually much more involved in what occurs between people rather then what may be occurring within an individual, although some tend are as involved in individuals within the system those human beings and their interactions constitute, especially those who identify as psychodynamic, object relations, intergenerational, EFT, or experiential family therapists. Depending on current conflicts and the advancement of the therapy thus far, a therapist may choose to focus on examining a previous conflict, whereby reviewing the past event and proposing an alternative way in which the family could have dealt with each other during it instead or the therapist may instead proceed directly to addressing the source or sources of tension in a more abstract way by bringing attention to patterns of behaviour which the family may not have noticed.
The focus of family therapists is more toward the maintenance or solving of issues instead of attempting to recognize a particular cause. Although some family may see the cause-effect analysis as an attempt to focus blame to one of more human beings with the result that for these families to concentrate on the reason is of little or no value.
Neuro-linguistic programming (NLP)
The theory behind neuro-linguistic programming is divided into three levels:
Neuro: the establishment of our individual mental “map” of our environment.
Linguistic: The way in which we assign personal meaning to information
Programming: the way in which be behave or respond to our personal meaning of the information we receive from our environment
This type of therapy is most often used as a way to instigate changes to enhance our development, personal growth, and performance.
One a bond of trust has been established the therapist will gather information about the client’s present state and help the client to define the desired goal or state for the interplay often by using the meta model questions. The counsellor will then pay particular care to both verbal and non-verbal hints as the patient answers questions which define the current state and the desired state as well as any resources which may be used between them.
The client will then be encouraged to consider all of the consequences that the wanted outcome may have over his or her life, both professional and personal taking into strict account any positive goal toward any problems which may arise.
The client is then assisted in gaining the wanted outcome via the use of any tools or techniques designed to change the internal responses and representations to motivations in the environment. Other techniques and tools which may be used include indirect suggestion from the Milton model, reframing, and sub modalities.
Finally, the client is helped to “future pace” the changes by learning to mentally enact and incorporate the changes into the patient’s life. For instance; a client may be requested to project themselves into the future to see, feel and hear what it is like to have achieved the desired outcome in their own mind.
Psychoanalysis is a form of therapy that uses an understanding of human behaviour to explore the mind. With this type of therapy negative unconscious behaviours can be taken out into the open with the goal of changing them into something positive or at least removing any power they may hold over the client. Every aspect of your behaviour may be scrutinized including your relationship with your therapist as it can emphasise your pattern of behaviour within any relationships with others.
Psychoanalysis at its most basic is the understanding of the client’s unconscious conflicts which may be causing a problem with current functioning. Often these conflicts will cause a painful symptom such as a phobia, depression, anxiety, and compulsive behaviours.
According to Strachey in 1936 discovering the client’s distorted observations about the therapist can lead to an understanding of what may have been forgotten. In other words unconscious hostile emotions toward the therapist could prove to be symbolic negative behaviours toward what is known as the “frame” of the therapy. According to Robert Langs the frame of the treatment includes the necessity of speaking, fees and the times of the sessions. In other words If the client makes errors, forgot or exhibits other oddities over times, costs and talking the therapist can often find diverse unconscious “resistance” toward the stream of thoughts or free association.
Reclining on a sofa with the therapist hidden from view seems to allow the client to remember more, experience more resistance and transference and reorganize thoughts after an insight occurs from the translative work of the therapist.
When delving into a client’s fantasy life it is understood through the examination of dreams, including masturbation fantasies. (cf. Marcus, I. and Francis, J. (1975), Masturbation from Infancy to Senescence) Generally an therapist is iengrossed in how the client avoids or responds to these kinds of fantasies (cf. Paul Gray (1994), The Ego and the Analysis of Defence)
Any recollections of early life may be imprecise, Freud called these distortions “screen memories” and very early memories from before the age of two tend to be inaccessible.
Psychodynamic psychotherapy examines the unconscious mind as well as past occurrences and studies the influences of both on current responses and behaviours. With this type of therapy you will be supported to speak out about your childhood relationships with both your parents and other important people and it is encouraged for you to transfer or project deep feelings about yourself, your parents or any significant others onto the analyst.
Psychodynamic psychotherapy is a type of depth therapy where the main focus is to reveal things within the client’s unconscious psyche with the goal of alleviating any psychic tensions. Although it is comparable to psychoanalysis in this way it relies much heavier on the interpersonal relationship between client and therapist more then any other type of in depth therapy.
The approach for this type of therapy tends to be a bit more eclectic then others and takes form from a number of places instead of relying on a particular modality. It has been used in conjunction with individual psychotherapy, group psychotherapy, family therapy, and to comprehend and work with organizational and institutional contexts.
Most of the approaches to psychodynamic psychotherapy are cantered around the assumption that there is a maladaptive functioning leftover from childhood and this unconscious conflict is causing a dissonance in current day to day life. The role of the psychodynamic therapist is to uncover and help to resolve these unconscious problems by first intervening to alleviate the discomfort caused by them, then bringing them forward for the patient to recognize their existence and finally by helping the patient to develop tactics for change.
Some major procedures used by therapists in the psychodynamic psychotherapy modality includes distinguishing resistance and transference, free association, working through painful recollections and stressful issues, catharsis, and creating a strong therapeutic alliance.
The aim of relationship counselling is to enable people to recognize and manage negative patterns and differences within their relations. With the help of your therapist you will study your emotions and how you communicate so that you can find new ways to adapt for a positive future.
Before any kind of relations between people can be comprehended it is important to understand and recognize that each person has their own unique perceptions, personality, values and history, including the therapist.In fact, each individual within a relationship will adhere to a potentially different and unexamined value system, societal and institutional variables all of which can and do shape a person’s behaviour and nature and are considered during the process of therapy.
One principal of relationship counselling is that it is fundamentally beneficial that all participants interact with each other as well as with society with best possible amounts of conflict. To this end a couple’s conflict resolution skills predicts the instance of divorce.
All relationships, even the most balanced and best matched will go through periods of conflict known as negative interaction cycles which will result in self-reinforcing negative patterns due to various reasons including insecure attachment, ego, arrogance, jealousy, anger, poor, greed, understanding/communicationm or problem solving, third parties, ill health and so on.
Often changes in situation such as physical health, finances and the pressures of other family members can have a important effect on a couple and influence responses, the conduct and actions of those involved with the relationship.
Usually it is the interaction of two or more factors which cause the trouble and generally both parties involved exhibit such traits. This is because the influences within a relationship are reciprocal and it takes both to create and deal with problems.
Solution-Focused Brief Therapy
Solution-focused brief therapy is a type of therapy which centres on a specific problem and works to promote a positive change instead of focusing on the problem at hand or any past problems. Within this type of therapy you are expected to concentrate on the your positive attributes such as your resources and strengths to set goals and gain the changes that you wish to make.
Focused on social constructionist philosophy Solution focused brief therapy (SFBT),is a type of talking therapy which is often referenced as simply as ‘brief therapy ‘or ‘solution focused therapy’ This type of therapy points the focus toward what the client wants through treatment instead of on whatever problem or issue brought them to seek help. It does not utilize or draw attention to the past but rather today and in the future.
The way this type of therapy works is the analyst will ask the client to first envision their goal or wanted future then both will begin making the necessary changes both large and small which can make this envisioned future a reality for the client. To this end the therapist will ask questions about the client’s strengths and resources, story, and any exceptions to the issue.
Solution focused analysts tend to think that change is a constant SFB therapist works with their clients by helping them to identify those things which they want to change about their lives while also helping them to hold on to and encourage the things which are currently occurring that they want to keep. To this end the counsellor will help the client to build a solid vision of a wanted future in their mind that is convincing and possible and helps the patient to recognize those times within their current life when this “future” is close to examine what is dissimilar about those occasions so that the client can learn to identify and emulate the behaviour which brought about the successes.
Solution based therapy can be looked at as working predominantly or exclusively on two things, helping clients to discover a preferred future and discovering where, when, how and with whom parts of that wanted future are currently happening.
While this modality is often achieved using a social constructionist outlook it is realistic and can be realized without any specific theoretical framework beyond an intention toward these two things.
Person Centered Counselling
Person or client centred counselling is established on the idea that the therapist provides three essential features that are therapeutic in and of themselves.
Empathy: the skill to picture oneself in another person’s position
Unconditional positive regard: friendly, warm and positive emotions regardless of the other person’s behaviour
Congruence: openness and honesty
The counsellor works to develop a relationship with the patient and uses this relationship to help the client heal and change.
Formally begun by Carl Roberts, person centred therapy is now judged to be the basic work in the humanistic school of psychotherapies. Also known as Rogerian psychotherapy it is seen as one of the major scholastic groups along side psychodynamic, psychoanalytic and Existential therapy, pioneered by Sigmund Freud and Rollo May respectively.
According to Rogers individual experience is the basis for both therapeutic effect and for living. He was able to identify six separate circumstances which are necessary before a client can affect personality differences in a relationship during therapy. These six aspects are a vulnerability toward stress on the part of the patient, genuineness on the part of the therapist in that the therapist is really herself or himself with aspects of self disclosure, the clients awareness of the therapist’s genuineness, unconditional good regard on the part of the therapist for the patient, and an truthful empathy, all of which is in sharp contrast to the detached position of other therapies, especially the more severe behavioural therapies.
Other hallmarks of Roger’s Person centred therapy include, naturalistic faith in your own beliefs and the accuracy of feelings, living in the present rather than the past or future, contributing to other peoples’ lives, and a accountable recognition of your freedom, with a view toward involving yourself fully in our world
Psychosynthesis is an modality of psychology created by Roberto Assagioli M.D which at its most basic is simply a name for the process of personal growth. This process is the natural tendency or evolutionary drive in all of us to harmonize our various aspects at a higher level of organization which then becomes conscious making it possible for us to cooperate with and facilitate the process by broader use of our human abilities, such as will, imagination, and intuition. He included even our spiritual side, our higher aspirations, and our centre, which he called the Self.
Dr. Assagioli compared psychosynthesis to the most prevalent schools of thought of the day including Sigmund Fraud’s existential psychology where one contrasting belief is that psychosynthesis does not consider loneliness to be either essential or ultimate.
According to Assagioli “the direct experience of the self, of pure self-awareness… – is true. Other central ideals to his theory include, “Spiritual goals of “Self-Realization”, and the “interindividual psychosynthesis” – of ‘social integration…the harmonious integration of the individual into ever larger groups up to the “one humanity”
The modality of Psychosynthesis was never supposed to be an exclusive method or an school of thought by the 1960s many publications, centres and conferences around Italy and the United States offered it as a central theme.
The main way that Psychosynthesis broke off from the empirical base of psychology is that it discovered a person as both a soul and a personality which was considered to be spiritual but Assagioli continuously maintained it was scientific.
Although Assagiolicreated therapeutic methodologies that were beyond those to be found in other psychoanalysis modalities of the day with the unconscious playing an important role he was cautious to preserve a balance with the “rational” conscious therapeutic work.
The word psychosynthesis was not coined by Assagioli, in fact it was used by Bezzoli and even Freud who used it to define the aim for the client in psychoanalysis, : “As we analyse…the great unity which we call his ego fits into itself all the instinctual impulses which before had been split off and held apart from it. The psycho-synthesis is thus achieved in analytic treatment without our intervention, automatically and inevitably’
Although some of the main points of psychosynthesis are different from other modalities of the time, Assagioli did agree with Freud that repairing childhood traumas and the development of a healthy ego were needed goals, but he held on the point that growth could not be limited to only these goals. Assagioli, who was a student of both Eastern and Western spiritual philosophical traditions attempted to address human growth as it progressed beyond the well working ego, he wanted to encourage the growth of human potential that Abraham Maslow termed to be self actualization. He also wished to support the spiritual aspects of the human experience as well.
In short, Assagioli wanted to develop a way that a patient could consider both the mind and its personal growth which includes personality incorporation and self actualization and the spirit or transpersonal growth which includes spiritual insight, unitive states of consciousness and inspired creativity. Psychosynthesis also identifies the route of self realization such as the contact and response of the deepest directions or callings in life.
The Transactional analysis modality, which is also known as TA is considered to be an integral approach to psychology and psychotherapy due to elements within its framework of psychoanalytic, humanist and cognitive approaches.
Developed during the 1950s by Canadian-born US psychiatrist, Eric Berne transactional analysis counselling stresses a person’s personal responsibility toward their own feelings, behaviour and thoughts and believes that people change if they want to replace their normal or customary behaviour with different ones.
When entering into a transactional analysis session the therapist will offer:
Permission: for you to give out a new message about yourself and the world around you
Protection: because when making changes some behaviours and thoughts may seem risky
Potency: the power to actually deliver on is promised
Planning: planning goals is a part of the modality
The main focus of this modality is to uncover a person’s life script or plan that he or she was given as a child. The counselling will teach the client how to discover which of the following operations that he or she is working from at all times.
The Child: replaying actions and responses from childhood
The Parent: actions and reactions copied from parental figures
The Adult: appropriate to the current situation
According to its founder’s wishes, TA is not only post-Freudian but extra-Freudian. In other words although it has its basis in psychoanalysis it was specifically designed to be a unorthodox branch of the modality that places importance on transactional instead of psycho-analysis.
Because of its focus on the transactional, TA transferred notice from the inner psychological dynamics to those contained within people’s interactions. In other words rather then feel that raising the awareness of ideas held unconsciously was the best route, TA concentrates more on the way people interact with each other. Changing these interactions is the path that TA transverses to fixing emotional troubles
Berne also believed in making a promise toward “curing” his clients instead of simply attempting to understand them. To do so he introduced the most important aspect, the contract, a specific agreement between patient and analyst to pursue the specific changes a client wants.
By revising Freud’s concept that the human psyche is composed solely of the id, ego and super ego Berne suggested the addition of three additional ego states, the adult, the child and the parent which are shaped during childhood experiences and combine within Freud’s ego but not the id or super ego.
Accordingly unhappy childhood experiences could lead to these becoming pathologically fixated within the Child Parent ego states and bring discomfort to a client and those around him or her in a variety of ways including mental illnesses.
Berne took into consideration how people act with each other as well as how the different ego states influence each interaction. Counterproductive or unproductive interactions were believed to be signs signalling ego state issues. By studying these interactions according to an individual’s developmental history it would allow that individual to “get better.” Berne believed that each of us has something causing a problem within our ego states and that bad behaviours could be addressed by only treating the problematic person.
Berne was able to identify a typology of counterproductive social behaviours which he identified as “games.”
Berne wrote two popular books which showed his theories, : Games People Play (1964) and What Do You Say After You Say Hello? (1975). Berne’s long time friend Thomas Anthony Harris wrote I’m OK, You’re OK (1969), which is the most popular book about TA.
Existential counselling is the modality that helps people to illuminate, consider and understand life so that they can live to the best of their ability by encouraging them to pay close attention to any basic beliefs that they make about themselves and life so that they ma come to terms with life the way that it is helping them to understand their existence.
This type of counselling focuses on encouraging the client to take control of their own life and not focus on what they may be doing wrong while concurrently it takes note of limitations so that choices can be made based on the options which are available.
Gestalt counselling is a directive type of therapy which focuses on gestalten which is the patterns of thought, activity and feeling. This modality works by pushing the client into an active awareness of their present situation and incorporates communication that goes beyond the spoken.
One important aspect of gestalt counselling is acting out of or dramatisation of any conflicts within a client’s life. This could include the use of props such as several chairs so that the client may physically act out different positions to show various aspects of themselves.
Existential Counselling is a philosophical modality which addresses each aspect of a person’s life and places that person solidly within the predictable though challenging aspects of the human experience
According to existential counselling theory human living takes place within four separate dimensions, psychological and spiritual, physical, social and it shows that each of these aspects operate under which predictable paradoxes, dilemmas and tensions are played out. Accordingly people can learn to cope with these stresses and conflicts much more successfully by confronting the negatives as well as the positives including theproblems of life and death, strength and weakness, love and hate and absurdity and meaning.