Although we may behave in complex and sophisticated ways, Freud believed that we are still animals, and consequently that our behaviour is governed by the same drives as any other animal. Therefore, at the roots of our behaviour are drives like hunger, thirst, aggression and sex. Sexual motives he considered especially important. Freud proposed that the unconscious mind expresses itself through dreams, and that the content of a person’s dreams can therefore reveal what is in their unconscious. Dream analysis is the process of assigning meaning to dreams.
One strength of the psychodynamic approach is that it takes into account both sides of the nature–nurture debate. Freud claimed that adult personality is the product of innate drives (nature) and childhood experiences (nurture). These drives include the structures of the personality (id, ego and superego), as well as the psychosexual stages that every child passes through. In each of these stages, frustration or overindulgence may lead to a fixation on that stage and predictable adult personality characteristics. Freud’s theory therefore considers the influence of nature (things we are born with) and nurture (things that develop through experience). The interaction of these two approaches is a key strength.
The psychodynamic approach has proved to be useful in several ways. It highlights the fact that childhood is a critical period in development; who we are and become is greatly influenced by our childhood experiences. Ideas put forward by Freud have greatly influenced the therapies used to treat mental disorders. Freud was the first person to recognise that psychological factors could be used to explain physical symptoms such as paralysis. Psychoanalysis has been widely used to help people overcome psychological problems. Generally, this is a useful approach for helping to understand mental health problems that can be caused by childhood trauma or unconscious conflicts.
Freud’s explanations reflect the complexity of human behaviour and experience. This can be seen in the ways the different approaches treat mental disorder. For example, the behaviourist approach proposes that recovery from mental disorder can be achieved through re-learning, and does not require any consideration of what may have caused the disorder in the first place. The problem with this approach is that the original symptoms may simply reappear again because the actual cause has been ignored. Freud’s method of psychoanalysis seeks to uncover deep meanings and acknowledges that understanding behaviour is a lengthy process.
PERSON-CENTRED THEORY
Developed in the 1930s by the American psychologist Carl Rogers, client-centred therapy departed from the typically formal, detached role of the therapist emphasized in psychoanalysis and other forms of treatment. Rogers believed that therapy should take place in a supportive environment created by a close personal relationship between client and therapist. Rogers's introduction of the term "client" rather than "patient" expresses his rejection of the traditionally relationship between therapist and client and views them as equals. In person-centred therapy, the client determines the general direction of therapy, while the therapist seeks to increase the client's insight and self-understanding through informal clarifying questions. Rogers trusted in people and believed that, if a safe psychological environment existed then all people would naturally move towards greater awareness and a better fulfilment of their potentials.
The following potentials, he believed, are within all of us:
- Sociability: the need to be with other human beings and a desire to know and be known by other people
- Being trusting and trustworthy.
- Being curious about the world, and open to experience.
- Being creative and compassionate.
The psychological setting which helps us realise these potentials is one where we feel free from threat, both physically and psychologically. Rogers said counsellors could create this safe setting with clients and therefore help to bring about change. Much of his work was in understanding and defining the disciplines and conditions to be followed by counsellors so that they can create a safe therapeutic relationship with people who came to see them. He describes the "core conditions" that are needed by a counsellor in order to bring about therapeutic change.
The main three are:
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Empathy - Rogers said that if this condition is in place the counsellor can have an accurate, empathic understanding of the client’s awareness of his own experience. He stressed the importance of the counsellor showing this understanding to the client.
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Unconditional Positive Regard - This means that the counsellor is accepting and absolutely non-judgemental of the client. The counsellor accepts all the parts of the client. It is completely unconditional in that there is no element of “I only like you if you are like this or do that”.
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Congruence - means that the counsellor is authentic and genuine. The counsellor does not present an aloof professional facade, but is present and transparent to the client. There is no air of authority or hidden knowledge, and the client does not have to speculate about what the counsellor is ‘really like’.
As a result, person-centred theory takes these core conditions as both necessary and sufficient for therapeutic movement to occur — i.e., that if these core conditions are provided, then the client will experience therapeutic change. The person-centred approach takes clients as their own best authorities. The focus of person-centred therapy is always on the client’s own feelings and thoughts, not on those of the therapist — and certainly not on diagnosis or categorization. The person-centred therapist makes every attempt to foster an environment in which clients can encounter themselves and become more intimate with their own thoughts, feelings and meanings.
Together, these three core conditions are believed to enable the client to develop and grow in their own way — to strengthen and expand their own identity and to become the person that they ‘really’ are outside of the pressures of others to act or think in particular ways. There are no strict guidelines regarding the length or frequency of person-centred therapy. True to the spirit of person-centred therapy, however, scheduling may be adjusted according to the client's expressed needs. The client also decides when to terminate therapy. Termination usually occurs when he or she feels able to better cope with life's difficulties.
Many people agree that, keeping to these principles in our lives and using these disciplines as a person-centred counsellor, can be exciting and very challenging.
COGNITIVE-BEHAVIOURAL THEORY (CBT)
Developed by Dr. Aaron T. Beck, is a form of psychotherapy in which the therapist and the client work together as a team to identify and solve problems.
It is a way of talking about:
- How you think about yourself, the world and other people
- How what you do affects your thoughts and feelings.
CBT can help you to change how you think (Cognitive) and what you do (Behaviour). These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the 'here and now' problems and difficulties. Instead of focusing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.
Therapists use the Cognitive Model to help clients overcome their difficulties by changing their thinking, behaviour, and emotional responses. Cognitive therapy has been found to be effective for a myriad of psychiatric disorders, including depression, anxiety disorders, eating disorders, and substance abuse, among others.
Cognitive therapy has been a means of help for adolescents and children, couples, and families. Its efficacy has also been established in the treatment of certain medical disorders, such as irritable bowel syndrome, chronic fatigue syndrome, hypertension, fibromyalgia, post-myocardial infarction depression, noncardiac chest pain, cancer, diabetes, migraine, and other chronic pain disorders.
The cognitive model describes how peoples’ perceptions of, or spontaneous thoughts about, situations influence their emotional, behavioural (and often physiological) reactions. Individuals’ perceptions are often distorted and dysfunctional when they are distressed. They can learn to identify and evaluate their automatic thoughts and to correct their thinking so that it more closely resembles reality. When they do so, their distress usually decreases; they are able to behave more functionally. Individuals also learn to identify and modify their distorted beliefs: their basic understanding of themselves, their worlds, and other people. These distorted beliefs influence their processing of information, and give rise to their distorted thoughts. Thus, the cognitive model explains individuals’ emotional, physiological, and behavioural responses as mediated by their perceptions of experience, which are influenced by their beliefs and by their characteristic ways of interacting with the world, as well as by the experiences themselves.
Therapists use a gentle questioning process to help patients evaluate and respond to their automatic thoughts and beliefs—and they also teach them to engage in this evaluation process themselves. Clients are encouraged to keep mood diaries and record responses to set exercises. Therapists may also help patients design behavioural experiments to carry out between sessions to test cognitions that are in the form of predictions. When patients’ thoughts are valid, therapists do problem solving, evaluate patients’ conclusions, and work with them to accept their difficulties.
The goals of cognitive therapy are to help individuals achieve a remission of their disorder and to prevent relapse. Much of the work in sessions involves aiding individuals in solving their real-life problems and teaching them to modify their distorted thinking, dysfunctional behaviour, and distressing affect.
Therapists select techniques based on their on-going concept of the patient and their problems and their specific goals for the session. They continually ask themselves, “How can I help this patient feel better by the end of the session and how can I help the patient have a better week?” A developmental framework is used to understand how life events and experiences led to the development of core beliefs, underlying assumptions, and coping strategies.
CHANGE VIEW: 10 key facts about CBT:
Change: your thoughts and actions
Homework: practice makes perfect
Action: don't just talk, do!
Need: pinpoint the problem
Goals: move towards them
Evidence: shows CBT can work
View: events from another angle
I can do it: self-help approach
Experience: test out your beliefs
Write it down: to remember progress
NATs - Negative Automatic Thoughts.
They’re “Negative” in that they hinder the person’s motivation and ability to engage, and contribute to emotional problems. They are “Automatic” in that they seem to happen “just like that”, popping into the person’s head as if from nowhere. Therapy is to help people identify, understand, and modify their belief systems and also their self-defeating behaviours in order to function more effectively and happily.
Clients are helped to achieve this by using an ABC system:
A – Activating event
B – Belief (rational and irrational)
C – Consequence (emotional and behavioural)
KEY DIFFERENCES BETWEEN THESE THEORIES
Psychodynamic Theory –
- The therapist is the expert and using their knowledge and skill, they interpret our experiences and behaviour (e.g. dreams) to unveil our unconscious motives, giving us an opportunity to be free of those unconscious controls.
- Believes there will always be a conflict and compromises between the 3 parts of the personality (the id, ego and super ego)
- Deals with a person’s psyche (emotions, feelings, thoughts)
- Inborn Instincts are the foundations upon which childhood experiences build our personality.
- Our true motives are unconscious and hidden from us because the instincts and urges are taboo.
- A psychodynamic approach might explore how people develop an early model of relationships which then forms the foundation for all future relationships.
Person-Centred Theory –
- The client is the centre of the helping process and has the resources within to heal themselves in a safe environment.
- Uses 3 core conditions (UPR, Empathy and Congruence) to let the client direct the self- healing process.
- Counsellors incorporate the core conditions into their way of being as people.
- Conditions of Worth – cause blocks to self-actualisation.
- Therapist will support client in removing these blocks to enable the healing process.
- A person-centred approach might explore the concept of “conditions of worth” and how this effects the development of the self-concept and loss of contact with the organismic self.
Cognitive-Behavioural Theory –
- Clients are taught ways to change thoughts and expectations
- Highlights that it is our beliefs, interpretations and perceptions of life events that determine our feelings, moods and ultimately, our actions.
- Clients are helped to identify, understand and modify their belief systems and behaviours in order to function more effectively
- The therapist helps us identify our irrational beliefs by arguing with us, putting forward logical reasons showing us how to change.
- Clients can unlearn these irrational ways of thinking and learn rational beliefs which will lead to pleasant feelings and help them achieve a goal of fulfilment.
- A cognitive/behavioural approach might look at the individual’s development of irrational beliefs or early conditioning which directly affect an individual’s emotional response.
Each approach has its own language and framework for describing “change” within the therapeutic relationship and how this can be facilitated. Integrating theory into practice is a lifelong process of change and development as counsellors develop their own unique style and understanding of their work. Knowledge of basic counselling skills and the ability to apply them is of proven value to people from many personal and employment related walks of life.
Large organisations such as local authorities, health authorities and voluntary support organisations use counselling skills to underpin their worker development programmes and training courses. Counselling and communication skills are used every day to build such relationships in order for the work to happen.
Health professionals can use counselling skills to modify how they give information according to individual needs by paying attention to the patient's reactions. This approach allows patients' reactions to be explored, helping to achieve the best outcome for them by reinforcing their self-worth and helping to retain some control of their situation. It is also appropriate for use in encouraging user involvement in care delivery.
Therefore, no matter in which counselling field a person works, one must be aware of the psychological theories since successful practice is impossible without theory. If a counsellor doesn’t know why one is applying certain practical methods, one cannot be sure that he or she is applying them effectively and correctly. Counselling practice involves constant working and communicating with people.
So, in order to be able to help others, a counsellor should know the psychological theories that support practical methods to be applied.
BIBLIOGRAPHY
• Psychodynamic Approach by Saul McLeod, published 2007
• Folens Publishers LTD, 2009, Online Classroom
• holah.co.uk
• An Introduction to Person-Centred Counselling by Dr Greg Mulhauser
• RCPsych Public Education: Dr Paul Blenkiron
• Beck Institute for Cognitive Behaviour Therapy