Types of counseling and psychotherapy

Types of counseling and psychotherapy

The most common question I get asked from people making an initial consultation request is, “What type of consulting do you do?”

This usually means: “What type of problem do you offer advice for?” Most counselors and psychotherapists, including myself, do not specialize in one type of problem, as all problems or difficulties involving feelings and thinking share similarities and tend to respond to therapy in similar ways.

The answer to the question “What type of problem do you offer advice for?” This would be something like “difficulty with feelings and thinking,” rather than specific issues like “low self-esteem” or “fear of failure.” Most counseling and psychotherapy deals with the whole person and usually does not separate one thing that they think, feel, or do.

However, this is just a general rule. There are some therapies that specialize in specific types of problems, often those that use a specific solution-based approach. Addiction counseling is an obvious example, a specialty that typically involves a progressive, guided program. Others could be grief or eating disorders. A certain part of the population, such as young people or women, could also be identified as groups requiring a specific approach to some extent, but by and large these use the same techniques as any other psychological counseling. The main difference might be that the agency was set up to address this specific problem or group, received funding for it, and therefore focuses its resources on that area. An individual counselor or psychothearpist may become involved in a particular area because of a particular interest in it, or because he or she has undertaken additional training in it, or perhaps has had particular experience with the subject himself.

What counselors and psychotherapists mean when they talk about different types of therapy is the differencetheoretical orientation of the therapist, not in the types of problems in which they specialize. There are a number or approaches that can be broadly divided into the three areas of humanistic, psychodynamic and cognitive behavior. Even a brief description of all types of approaches and their subdivisions is beyond the scope of this article. I will therefore limit it to the two main approaches that I use myself: person-centered (a “humanistic” approach) and psychodynamic.

Person-centered counseling and psychotherapy

At the heart of the person-centered approach is the idea that the advisor is a “guest” in the world of customer experience, with all that this implies in terms of respect and trust.

The customer is seen as essentially trustworthy, that somewhere somehow they know what they need and that they have the desire to grow. The counselor can help bring these into awareness and help the client use them.

Another key concept is “conditions of value.” Early in life, conditions are imposed by which a person measures their own worth, how acceptable or unacceptable they are. A simple example might be: “Never be evil, or you will be an ugly, shameful person and you will not be loved.” The message this carries could be something like "If I'm angry, it means I'm worthless, so I must never be angry." The person will inevitably feel angry, perhaps frequently, and conclude that they must therefore be worthless, ugly, and shameful. Another might be, “If you don’t do well academically, it means you are stupid and will be a failure in life.” This type of condition tends to stay with the person indefinitely, and he or she may have struggled for years to live up to the potentially impossible conditions of value. When this type of inner belief is brought to light and its roots are fully understood, the person may see that it is not really true, that it was put there by others, and that I can move away from it.

The person-centered counselor tries to be with the client as a kind of companion. The counselor respecting and accepting the person, whatever they are, will result in the person themselves coming to feel that they are actually acceptable and coming into contact with a more real, "organismic" self that has always been there in some way but has been hidden. They could then become more real, less concerned with appearances and facades, or living up to the expectations of others. They may value their own feelings more, positive or negative. They can begin to enjoy their experience of the moment. You may appreciate others more and enjoy relating to them rather than feeling oppressed, shy and inferior.

The counselor achieves this by creating a climate of acceptance in which the client can identify. Certain therapeutic conditions facilitate this, conditions established by the founder of this approach, Carl Rogers. These include:

The genuineness or authenticity of the therapist. Not only can this be done, it must be real or it will be worthless.

Complete acceptance of the customer and positive consideration for him, no matter what he appears to be.

“Empathic understanding”, the therapist truly understands what the client is saying and also shows the client that their feelings have been understood.

Psychodynamic counseling and psychotherapy

Psychodynamic or psychoanalytic therapy attempts to promote interaction that includes unconscious elements of the client. A lifetime of experience, most notably what the person has learned from his or her first relationships in early childhood, will determine the way the client interacts with others. This will also be noticeable in the therapeutic relationship in some form, and the therapist must be aware of the forces and influences that can affect the client.

This approach does not include the idea of ​​“free will”. It sees our thinking, feeling and decision-making not as the result of conscious awareness, but as the result of many forces that operate under conscious awareness. The person acts and relates to others primarily as a result of the instincts they were born with, along with what they have learned about themselves, primarily due to the nature of their close relationships in early life.

The particular “personality” is formed in the crucible of this early experience. For example, if the child's primary caregiver did not feed him or her properly, this is put down as anxiety. This can be as simple as being fed, getting enough to eat, or it can be extended by the infant to include related things such as trust (they have learned not to trust that food or the caregiver will be there when needed). or uncertainty about life in general or feeling like something is always missing. A result might be overeating, say, or greed in other ways, for goods or neediness, anxious need for the presence of others or another. This is an example. There are countless types of operations of this kind in the psyche, which form from birth with all kinds of subtleties and variations. They are almost all laid down at a level of the person not accessible to consciousness and are played unconsciously.

The therapist must be aware of the nature of these unconscious networks and how they function in the session and in the person's life. The client's thoughts, actions, and feelings can be “interpreted” by the therapist as how their unconscious mind might direct them. Or, perhaps less controversially, how early experiences might have led to who he or she is now. By talking about this, the client can gain self-knowledge, acceptance and more control over their life.

In relation to the psychotherapist, the client may see the therapist partly as “like” someone else, for example as a father or mother. This is called “transference” because feelings originally evoked by the parent are “transferred” to the therapist, where they can be brought to awareness and addressed in therapy.

Integrative counseling and psychotherapy

As the name suggests, an integrative approach attempts to integrate one or more theories into a unified method.

I believe that it is difficult to integrate person-centered and psychodynamic orientations into one because they are opposite in many ways. The concept of “expert” for example. Person-centered counseling seeks to avoid a situation in which one person plays the role of “expert” and the other is the passive recipient of wisdom. In psychodynamic counseling or psychotherapy it can seem difficult to avoid this. The practitioner is the holder of a seemingly arcane knowledge, particularly of the workings of the unconscious, which is translated into interpretations of what the client says. This is in contrast to a simple but “appreciated” acceptance of the customer and anything they might say without interpretation, as is the case with the person-centered approach.

Despite these difficulties, however, I believe it is possible to incorporate elements of both into a style that is more effective than either alone. That it is possible to operate in a largely person-centered manner, accepting and appreciating the person and their statements and still being aware of the influences of the past on the way a person is now. This includes the therapist being aware of the psychodynamic possibilities underlying the interaction between therapist and client. I believe that there will inevitably be some “transference” and at least some expectation that the therapist has knowledge and skills that the client does not have, which will lead to certain feelings in the client. Transference is often seen in person-centred counseling as an obstacle that needs to be overcome as quickly as possible and although I believe it should be brought into awareness, I believe it can be a valuable tool in avoiding being discharged too soon and not being underestimated.

The consultant must strive to be aware of all the elements that may arise at any given time in the relationship and how these may vary at different times, and be able to decide which of them to share with the client for his benefit. I believe that it is possible to tentatively share some “psychodynamic” possibilities without losing the basic “person-centered” conditions of respect and authenticity. This integration of two approaches by an experienced psychotherapist who not only relies on putting a learned theory into action but also meets the client as real and completely as two real people has remarkable power to help people become fuller and more satisfying ways to experience themselves and their lives.

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