Overview of therapeutic approaches
This guide gives a brief overview of therapeutic approaches and provides a description of some of the most popular therapeutic approaches.
The guide is not a recommendation of any therapy approach. It is intended to give clients an overview of what different therapy types are, the theory behind them and what a client could expect.
This is not an exhaustive list and other therapies are available, some requiring experts or specialists who work with a particular therapeutic approach.
Attachment Theory, originating from Psychologist John Bowlby, is centred on the type of emotional bond we create as children with our primary caregivers, such as parents. This type of emotional bond guides how we behave, particularly in relationships with others. There are four main attachment styles: secure attachment, ambivalent-insecure attachment, avoidant-insecure attachment, and disorganized-insecure attachment. The counsellor will help the client explore attachment styles and which is applicable to them and then support them in making changes they want to make.
Counsellors use attachment theory to help clients identify strengths and weaknesses within relationships and how these play out in relationships. Then, for instance, the Counsellor may work with a client to help them feel more secure in their relationships.
Behavioural therapy focuses on stopping unwanted behaviours. For example: addictions, phobias and obsessive-compulsive disorder (OCD). Counsellors believe that behaviour is learned and can be unlearned or changed with therapy. As well as helping clients to acknowledge the behaviour itself, counsellors help to them to raise their awareness of the thoughts and feelings that lead to the behaviour, or those that occur as a result of the behaviour, in order to help them better understand it.
Behavioural Therapy is often ‘action based’ which means that the Counsellor will ask the client to complete tasks and record how they feel whilst carrying the tasks out.
Cognitive Behavioural Therapy (CBT)
Cognitive behavioural therapy (CBT) can help manage problems by exploring how thoughts can affect feelings and in turn our behaviour. CBT combines a cognitive approach (examining thoughts) with a behavioural approach (the actions we take). It aims to break down issues and problems into smaller, more manageable parts.
CBT can help with a wide range of emotional difficulties and conditions such as depression and anxiety. The counsellor helps the client to focus their attention on the “here and now”. This can help clients to understand how past events may have shaped thier thinking and behaviours and help them to adapt their thoughts and manage them. Sometimes clients are asked to keep mood diaries or complete tasks at home to later discuss in their therapy sessions.
Compassion Focussed Therapy
This approach was founded by Paul Gilbert, a clinical psychologist. It is an integrative approach as it utilises other forms of psychotherapies. It also uses concepts and techniques from Buddhism, neuroscience and evolutionary therapy.
Compassion-focused therapy looks at evolution theory and the two parts of the brain. The ‘old’ part which protects our survival, for instance, food, shelter, love and safety. This part is also responsible for the fight, flight and freeze stress responses and can be the driving force behind issues like anxiety. The ‘new’ part of the brain has evolved over time and this part allows us to have a sense of self and lets us imagine, visualise have ideas and make choices, such as how we want to live.
Compassion focussed therapy believes that the new part and old part of the brain can often be in conflict and when this happens, the old part takes over creating protective emotions, such as anxiety. Compassion-focused therapy helps by bringing our focus towards consciously developing our ability and willingness to be more compassionate towards both ourselves and others.
Eye movement desensitisation reprocessing (EMDR)
EMDR is a form of psychotherapy developed by American psychologist Francine Shapiro in the 1980s.
When something traumatic has happened, for some people the memory of their experience flashes back into their mind and the intensity of feeling is like it’s taking place again in the present moment. They may also experience nightmares. This is thought to happen due to the mind being too overwhelmed during the actual event to process what was going on.
These memories cannot be erased but it is believed that EMDR can alter the way that these traumatic memories are stored within the brain, which can make them easier to manage.
The Counsellor uses bilateral (side to side) eye movements, or taps, or sounds in a series of ‘sets’ lasting around 25 seconds. After each set, the counsellor may also ask you to recall the original memory and ask you how it seems to you now, before starting the bilateral eye movements process again.
This will continue until the client’s feelings of distress have reduced and they are experiencing more positive thoughts and feelings.
Developed in the late 1940s by Fritz Perls, Gestalt therapy is guided by the principle that every individual is a whole including mind, body and soul and that the client is best understood in relation to their current situation as they experience it.
The Counsellor focuses strongly on self-awareness and the ‘here and now’ as it is believed that this is key to personal growth and developing full potential. The approach recognises that sometimes this self-awareness can become blocked by negative thought patterns and behaviours that can leave people feeling dissatisfied and unhappy.
It is the aim of a Gestalt therapist to promote a non-judgemental self-awareness that enables clients to develop a unique perspective on life. By helping an individual to become more aware of how they think, feel and act in the present moment, Gestalt therapy provides an insight into ways in which a person can alleviate any current issues and distress they are experiencing in order to aspire to their maximum potential.
Counsellors may use role play, and open chair technique or place attention on body language to support the client in raising self-awareness.
Human Givens psychotherapy is based on the belief that human beings have a set of innate needs (or ‘givens’), which determine our sense of well-being. It is believed that these needs have evolved and refined over thousands of years and that we have in-built resources to help fulfil our needs.
However, if our resources fail to work, our needs are unfulfilled resulting in psychological difficulties. Counsellors work with clients to identify which needs are not being met and then identify ways in which the client can satisfy them using their own resources.
Integrative counselling is a combined approach to psychotherapy that brings together different elements of specific therapies. Integrative counsellors believe that there is no single approach that can treat each client in all situations. Each client is considered as a whole, and counselling techniques are blended to meet their individual needs and unique circumstances.
Integrative Counsellors may work with clients to explore what helps and why it helps. They often integrate behavioural, cognitive, and physiological approaches with each client, such as Person-Centred, Attachment Theory and Cognitive Behavioural Therapy (see separate sections in this guide). These therapies are combined to suit a client’s preferences of working and support needs.
We can all tend to be on autopilot a lot of the time. We do things without really thinking about what we are doing. For instance, when we are driving we can arrive at our destination with no recollection of the junctions, traffic lights or roundabouts we’ve manoeuvred. Our minds have taken us off with other thoughts and we have gone through the motions of driving without really thinking about it.
Mindfulness is a way of reconnecting and bringing together our mind and body. Often stress, anxiety and worry can be focussed on the past or the future and mindfulness aims to bring us in to the present moment. It can involve working with the breath, the senses and with meditation to help calm the mind and help us relax to be better able to cope with life’s stresses and demands.
Mindfulness can also help to sooth the physical sensations of stress and anxiety by working with the breath to release tension, relax the muscles, reduce the pace of a racing heart and help to deepen shallow breathing.
Created in the 1950s by psychologist Carl Rogers, the person-centred approach regards humans as having an innate drive to develop towards their full potential. However, this drive can become blocked by certain life experiences, particularly those which affect our sense of value.
The Counsellor works to understand the client’s view of their world and their experiences from their perspective. The Counsellor creates an environment that is non-judgemental, safe and unconditional for the client to feel able to open up. The client can then explore and utilise their own resources and strengths. The Counsellor facilitates the client in learning about themselves and identifying their own solutions with little intervention.
Relationship counselling is often attended by both people in the relationship; however, one person may attend alone to discuss their relationship issues. Sometimes, after the initial coupe of individual sessions, the other person joins for counselling as a couple.
The Counsellor will support the discussion of issues that are challenging, focussing on communication and enabling each person to speak and be heard by the other. The counsellor will support the couple in identifying their own solutions and this can then lead to making the changes the client or clients want to happen.
The Counsellor will not tell clients what to do or advise you whether couples should stay together or separate, neither will they take sides.
Solution Focussed Therapy
Developed in America in the 1980s by Shazer and Berg, Solution Focused Therapy is an approach to psychotherapy based on solution-building rather than problem-solving. Although it acknowledges present problems and past causes, it predominantly explores an individual’s current resources and future hopes. This can help them to look forward and use their own strengths to achieve their goals.
Counsellors believe that the clients are the experts and they will support the client to outline their own goals, identify their strengths to solve and overcome their problems.
Dr Jeff Young developed the schema-focused approach which combines parts of cognitive, behavioural, attachment, psychodynamic and gestalt models, making it an integrative approach.
Schema therapy focusses on changing negative patterns or beliefs that people have lived with for a long time. These patterns are called schemas.
Schemas usually start in our early years, but they can develop in adulthood. For example, believing that others will leave you, that people are unreliable or that the world is a dangerous place where disaster is likely to strike. Or feeling that the negatives outweigh the positives in life, resulting in a pessimistic outlook.
The Counsellor works with the client to identify the client’s schemas and explore their meaning and usefulness. The Counsellor will support the client to raise their awareness of what is accurate and inaccurate thinking and help them to change their thought patterns for healthier alternatives
Founded by Eric Berne in the late 1950s, TA therapy is based on the belief human beings have three ego-states: parent-like, adult-like and child-like. It is believed that these ego-states determine how we express ourselves as individuals, interact with others and form relationships.
This concept is used with techniques to explore how a client communicates with others and to identify alternative approaches of interaction to result in more preferred outcomes.
The Counsellor will help the client to explore their personality and how it has been moulded by past experiences, particularly experiences from childhood. The Counsellor will also help the client to focus on problem-solving behaviours, support them to identify solutions, assist them in recognising how they can implement the solutions in their day to day interactions with others and explore how this could affect their relationships.