So what is counselling and therapy

counselling

So I recently did a bit of a deep dive on a few common psychotherapy approaches.   I thought I would share some of that info to give people an idea about what counselling actually is.  In particular this article will focus on CBT, which is provided via Medicare here in Australia and is quite popular in general.  There are some options to keep in mind but will save providing more info on those for another post.

I recently read a brilliant article written by a young lady on her experiences with therapy, informative and a good read (https://www.vice.com/en_uk/article/8xxyj3/everything-i-wish-id-been-told-before-starting-therapy).   While UK based, it sounds like her experience is somewhat similar to what you could expect in Australia.

 

Medicare here in Australia provides access and rebates for only a small number of psychotherapy approaches (http://www.health.gov.au/internet/main/publishing.nsf/content/health-pcd-programs-amhpm-pdf-QAs#1_2).   The key one you will come across is Cognitive Behavioural Therapy (CBT).   There are two key reasons it has gone mainstream in my opinion;

– It has had proven success in the treatment of depression and anxiety, with better results that medication (see boring study with lots of big words here – http://ebm.bmj.com/content/ebmed/4/1/20.full.pdf)

– It has fairly standard treatment timelines – approximately 20 sessions for depression for example.

Unfortunately the latter is both a positive and a negative.  For people looking to understand how therapy works then CBT is able to set some rough expectations on timeline which is good.  However, what if it takes longer?  It seems to be a common criticism of government provided CBT schemes that the one size fits all approach rarely fits all, and they struggle to adapt.

While Medicare mentions Interpersonal Therapy (IPT) and Narrative Therapy,  the latter seems to be for select cultural groups and you will be lucky to find anyone that knows IPT in Australia.   I did find this somewhat dated article covering IPT if your interested – http://www.psychotherapy.com.au/fileadmin/site_files/pdfs/InterpersonalPsychotherapy.pdf

 

So what the heck is Cognitive Behavioural Therapy (CBT)

 

I am going to let you go find the history and origins yourself, for this article I wanted to share some short and sharp information about the CBT approach.

Safe to say you will rarely find the same approach between two CBT practitioners.  How therapists integrate a method into who they are and how they operate translates to different emphasis and commonly inclusions from other therapy styles.   CBT also has a lot of different subtle flavours and evolutions which I think also contributes to variances in practitioners.

So, CBT is used to describe several related approaches you may here about including rational emotive behaviour therapy (REBT), cognitive therapy (CT) and emerging variants such as mindfulness-based cognitive therapy (MBCT).   It uses directly observable behaviour, indicators/determinants of behaviour, learnings that will assist change, client tailored approaches and thorough assessments.

While diverse, the key tethering point for all the CBT variants is a focus on measurable/observable behavioural, belief, emotive and physical information, which are all linked to each other.  Rather than focusing on philosophical searches for value or purpose like in existential therapy, or the concepts of mind used in traditional psychoanalytic therapy (Freud) , CBT focuses on the here and now thoughts and beliefs.

The differences between the various CBT disciplines, and BT before it, varies in where initial queues are taken from and focus of change is placed; either behaviours, emotions or thoughts/beliefs.   REBT for example explores all three areas and their interactions whereas CT focuses more around ‘cognitive distortions’ and has a far more thinking focus in general.

The role the therapist takes on can also vary in CBT variants – REBT is a rather direct and confrontational style in which the therapist challenges the client on what they think.  As opposed to CT which leads the client but offers open ended questions the client can explore and test.   CT also encourages clients to explore the ways in which they think, and the resulting beliefs this creates, versus REBT that focuses mainly on the beliefs themselves and validating or dispelling them.

Perhaps the last key difference to note is that REBT applies a generic approach to all scenarios whereas CT uses specific plans or protocols per diagnoses.

As mentioned above, the CBT based modalities all target behavioural change by exploring, testing and changing thinking and beliefs.  This is done via review and developing techniques to avoid the thinking.

There isn’t any focus on a client’s long passed history or trying to link it to current behaviour. There is also no strong emphasis on the client-therapist relationship; the therapist is challenging thought processes and it is the conflict style that drives clients to test and alter their thinking.

CBT methods can use the following methods across cognitive, emotional and behavioural modes such as;

– cognitive homework in which clients make lists of problems and then note and challenge the held beliefs underpinning them,

– reframing or changing language can also alter beliefs,

– bibliography to assist with education and reinforcement,

– rational emotive imagery in which clients imagine bad/upsetting situations and are educated on developing rational thought process for dealing with them,

– role playing,

– relaxation, and

– modelling.

How those are used can vary a lot though from client led with the therapist supporting (CT), through to therapist driving and challenging (REBT).

 

And why might you want to explore something else?

Freud

In your searching you may come across people who offer traditional Psychoanalytic Therapy which is perhaps the original from Freud.  As opposed to a focus on current thoughts, behaviours and emotions, it instead looks to understand childhood development issues or events to address and work with.   I guess in talking with people, many click with the concept of unpacking the source for their challenges as the mechanism to manage them and change.

 

Existential and Humanistic

You may also come across people who refer to their style as existential and/or humanistic.   This is a collection of therapies that all supports and trusts the client to understand themselves, the world and resolving their own problems.  They all focus on areas such as freedom, choice, values, purpose and responsibility.  They differ in where they focus; either towards the anxiety arising from life and a search for meaning (existentialists), versus the potential available to us all that we can actualise and in doing so find meaning (humanists).

The humanistic approaches in particular I really connect with.  They are the first to flick the ‘expert’ role in therapy by making it the client rather than the therapist.  And they also emphasise the client-therapist relationship as THE determining factor in success or failure of therapy.   There is a value base to the humanistic approaches where honesty and integrity is paramount.  Some clients can find it a little directionless, so at times kicking in some other approaches helps the client move around a sticking point.

Hope that shed some light…  and please reach out if you have any questions.

 

Warm Regards

Jason

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