Most of us make the decision to go for therapy when there is something in our lives we want to address, whether that is a recent experience or a more long-standing difficulty. However, finding a therapist can be a daunting experience. Quite often the search involves a number of parameters, like distance, cost, availability and potentially previous experiences of therapy, either positive or negative, that might inform what it is we are looking for.
In addition to all the above, when looking for therapy there is a plethora of options to choose from in terms of modalities, or ways of practice. I will try to briefly outline some major streams in counselling and psychotherapy in order to help decipher what can sometimes seem like random letters put together.
The focus is on affect and expression of emotion as well as the exploration of attempts to avoid distressing thoughts and feelings. The therapy aims towards the identification of recurring themes and patterns and includes discussion of past experience (developmental focus). Unconscious drives are acknowledged, identified and explored. Additionally, interpersonal relations, as well as the therapeutic relationship, are addressed. There are time-limited therapies, such as BPT (Brief Psychodynamic) however they tend to be open-ended, meaning that the therapist and the client decide together when it is the right time to end. The therapeutic space is non-directive and unstructured and wishes and fantasies are explored.
Cognitive behavioural therapies
The focus is mainly on the present and they do not address the unconscious. Therapies such as CBT are goal oriented and fairly often short-term or time limited. The often called “Third Wave” therapies, such as ACT (Acceptance and Commitment), Mindfulness or CFT (Compassion Focused) are informed by Eastern traditions which promote the importance of accepting and tolerating distress and having compassion for the self and others. There is an educational element (controlling thoughts/actions) and the therapy often includes homework to support skills acquisition. The therapist tends to be directive and the therapeutic space is highly structured.
Humanistic (person-centred) therapies
The focus is on the present and future and mainly on conscious thoughts. The key ingredients are regarding the therapeutic relationship, they promote congruence, unconditional positive regards and empathic understanding. The direction of the therapy is to facilitate each client to reach self-actualisation through a safe and empathic relationship. The therapeutic space is unstructured, non-directive and they are usually open ended. Many therapies often employ a person-centred stance, meaning that the therapist actively embodies these principles.
The above categories briefly address some of the major theoretical streams in counselling and psychotherapy, however in practice many therapists offer what is called an integrative approach. This means that a therapist will use a combination of approaches, based on their interests and training, to make sense of what we bring to them and to inform their stance. An integrative approach can also evolve over time to address life changes or events that might come up in the course of therapy.
The most important ingredient in every therapy is the relationship with the counsellor or therapist. Whilst some approaches might suit our needs or current goals better than others, psychotherapy is a relationship, trust and safety in that relationship is key. Hopefully this article can help anyone looking for a therapist to feel more comfortable navigating the options available and have confidence in finding the right match for them.
Therapy can be a rich and life-changing experience and it is as unique as the match of client-therapist.
(Originally published in Counselling Directory 16/03/17 )