Compare and Contrast Two Approaches to Counselling
Advanced Diploma in Integrative Counselling
Course code: ADC- G301
Compare and Contrast Two Approaches to Counselling
Compare and Contrast Two Approaches to Counselling
Personality can be defined as a dynamic and organised set of characteristics possessed by a person that uniquely influences his or her , , , and in various situations. It refers to the patterns of thoughts, feelings and behaviours consistently exhibited by an individual over time that strongly influence our expectations, self-perceptions, values and attitudes, and predicts our reactions to people, problems and stress. The study of personality therefore has a broad and varied history in psychology, with an abundance of theoretical traditions.
Humanistic and Psychoanalytical theory can be seen as two main dispositional perspectives derived through the field of Psychology. theory explains human behaviour in terms of the interaction of various components of personality for example the and believes that personality is based on the dynamic interactions of these three components. In contrast to it is emphasised that people have and that they play an active role in determining how they behave. Accordingly, humanistic theory focuses on subjective experiences of a person as opposed to forced, definitive factors that determine behaviour. With this fundamental difference in mind this essay will therefore compare and contrast psychoanalytical and humanistic traditions in terms of their application to counselling and psychotherapy, looking categorically at the shifts and changes within both traditions and therefore how both are used within today’s society.
Psychoanalytic theory was an extremely influential force during the first half of the twentieth century. It focused on understanding of the unconscious motivations that drive behaviour. Psychoanalytic theory originated with the work of Sigmund Freud. Through his clinical work with patients suffering from mental illness (Freud and Breuer 1955 [1893-5]) Freud came to believe that childhood experiences and unconscious desires influenced behaviour. Based on his observations, he developed a theory that described development in terms of a series of psychosexual stages. According to Freud, conflicts that occur during each of these stages can have a lifelong influence on personality and behaviour and through free associations, dreams or fantasies; clients can learn how to interpret deeply buried unconscious memories or experiences that may be causing them distress. (Freud, 1924d)
He believed that neurosis stemmed from early sexual traumas and therefore his ‘hysterical’ female patients had been subjected to pre-pubescent ‘seduction’- that is, in most cases, sexual abuse by the father, reprocessed memories of such assaults later surfaced, he concluded, in otherwise baffling hysterical symptoms. Freud spent a number of years developing this theory until 1896 when he finally went public with his findings. The next year however he confessed ‘I no longer believe in my ‘neurotica’- the seduction theory. By then Freud, deep in richly autobiographical dreams and self analysis, had convinced himself that his patients’ seduction stories were fantasies, originating not in the perverse deeds of the adults but in the erotic wishes of infants. The collapse of the seduction theory therefore brought about the idea of infantile sexuality and without the abandonment of the seduction theory, psychoanalysis as a theoretical structure built upon unconscious desires and there repossessions would not exist today.
However to explain this decisive switch remains hotly contested in the world of counselling and psychotherapy. Orthodox Freudians, notable Freud’s disciple and biographer Ernest Jones, have cast it as the ‘Eureka-moment’ in which he saw the light. Some critics allege, by contrast, a loss of nerve, and hold that it was the abandonment of the seduction theory that was his error, perhaps even a ‘betrayal’ both of psycho-sexual truth and of his patients. If they had indeed been sexually abused, their stories were now discounted, as were those of future patients on the couch. However I personally believe the Freud’s seduction theory has a lot to account for, as there are many trauma related psychosis found in today’s society that are primarily related to rape and sexual abuse (Gerald, 1998).
As already mentioned Freud’s work was both controversial and inspiring to many therefore his followers and competitors went on to expand upon his ideas to develop theories of their own. Much like , Erik Erikson (also a psychoanalyst) believed that personality develops in a series of stages but with dissimilarity to , Erikson’s theory describes the impact of social experience across the whole lifespan. Erikson's eight-stage theory of psychosocial development describes growth and change, focusing on social interaction and conflicts that arise during different stages of development and therefore was greatly influential to the humanistic movement (Erikson, 1997). Thus there are many threads and interconnection within these formulations of psychoanalytic thinking also known as Neo- Freudianism, which credit its roots in the work of Otto and Karen Horne. It is their research amongst others that can now be categorised into three main modality of humanistic therapy; Gestalt, Transactional Analysis and Person Centred Theory.
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Humanistic therapy therefore began as a reaction to psychoanalytical theory and derives from ‘humanistic psychology’ a term which originally flagged up a concern about dehumanisation within the therapeutic relationship. The approach therefore claimed to be more humane, warmer and relational then psychoanalytical traditions. It was coined the ‘third wave’ movement (Maslow, 1962) and many humanistic pioneers believed that they were forming a revolutionary movement which overturned the orthodoxies of the past which dominated psychology at the time. It appeared in the USA in 1940s and 1950s becoming more defined at the Old Saybrook Conference of 1964 (Bugental, 1965) where many of the best know figures came together. They agreed that topics such as self-actualization, creativity and individuality were the central theme of this new approach and in 1961, the American Association for Humanistic Psychology was officially established.
Humanist thinkers felt that psychoanalysis was preoccupied with psychology as a form of science, failing to take into consideration the role of personal choice. Alternatively, movements and waves could be seen as cultural and artistic and there is a strong link between humanistic therapy and creative expression. It was instead focused on each individual's potential and stressed the importance of growth and self-actualization. Therefore the fundamental belief of humanistic theory is that people are innately good and that psychological problems result from deviations from this natural tendency (Maslow, 1943).
As well as believing that people have an unlimited potential for growth, humanistic therapy also believes that, just as we are now, we are basically and fundamentally OK (Harris, 1967). Transactional analysis founded by Eric Berne takes these concepts into consideration where it is essentially described via three ego state, parent, adult and child (Berne, 1968) similarly to Freud theory of psychosexual stages in terms of super ego, ego and I. However Transactional Analysis is very much an operational tool rather than a metapsychological entity.
Berne defined an ego -state as a system of feelings accompanied by a related set of behavioural patterns that is not hugely interested in the existential status or in concepts like the unconscious but rather in the usefulness of learning to recognise different ego-sates in one self and in others (Berne, 1968). Therefore one of the fundamental parts to Transactional Analysis is to educate the client to recognise their own shifts between ego-states and the advantages and drawbacks to each state depending on the situation. Transactional Analysis also extensively explores what it calls ‘crossed transactions’ and therefore the interpersonal difficulties that arise when people are communicating from different ego states, for example parent to child and vice versa (Stewart and Jones 1987).
Berne also believed that life scripts are written in childhood again similar to aspects of Freudian thinking. Bern proposed that having written our infant life story we are likely to go ahead and live it out for at least some of the time in our adult life. Thus a life script is based on inadequate or out- dated information and the more rigidly followed, the less good the results are likely to be. Situations like suicide, drug addictions or psychosis all result from scripts and hence in TA language- are capable of being ‘changed’ and therefore ‘free’ from our life script. This consequently suggests a definition of autonomy: behaviour, thinking or feeling which is a response to the here and now reality rather than a response to a script belief (Berne 1961).
In terms of humanistic theory there is a clear distinction from models like psychoanalytical theory that perhaps thus focus on ‘mental illnesses’ as a diagnosis which may exclude the client’s internal world. As a result humanistic therapy dismiss ideas relating to prognosis and treatment- traditionally rejecting this as ‘dehumanisation of clients’ (Clarkson, 1989) They believe that labelling people can strip clients of the unique ways in which they have chosen to give meaning to their existence (Kelly 1989). Rowan argues that ‘labelling does harm to clients even when the labels are correct’. In other words, one does not even have to validate diagnostic categories in order to argue that they are unhelpful, simply because they block the therapeutic relationship by suggesting that the therapist, rather than the client is the expert on the client’s problems and therefore unable to speak the clients language (Rowen, 1998).
Some current therapies therefore employ methods that are not entirely composed of ‘client language’ for the treatment of problems which were originally part of the traditional province of psychoanalysis. If we take Freud’s ‘traumatic neurosis’ (porter, 2002) as an example, we find that this has a number of current labels. One of the most common is Post Traumatic stress Disorder (PTSD) and one of the most novel methods of treatment is Eye Movement Desensitisation and Reprocessing (EMDR). PTSD is often diagnosed in soldiers returning from war and EMDR is a treatment specifically developed for those suffering from it. It is a collection of integrated therapy involving concepts derived from psychodynamic therapy and cognitive behavioural therapy (CBT) amongst others. Its distinguished feature is that it requires suffers to learn to focus their thoughts on traumatic topics and then control their eye movements thus a progressive reduction in the experience of trauma ensues.
The language used by those who employ concepts such as PTSD and treatments such as EMDR is very different from that used by Freud. An interesting question therefore arises: to what extent are modern day developments different from the type of talking cure offered by Freud and his early followers? One key element remains identical- the client is engaged in the first instance through the use of words. Therapist may employ a different mode of speaking, that is the type of language and the stated aims of the treatment may differ, but in each case, what is sought is the reduction or elimination of the client’s symptoms (Hall et al, 2010).
It is interesting to note that there is currently a suggestion among practitioners of EMDR that it achieves its results not through training of eye movements but because of the desensitisation. The precise cause of symptom change is difficult to characterised, distinguish and chart, no matter how many trails are carried out. Human thinking is evanescent, individual and by its very nature indefinable. EMDR exhibits the same problem as Freud’s observation of nightmares, night sweats and so forth, indicate dream disturbances and are one of ‘the masochistic trends of the ego’ in that they are not open to straightforward verification (Freud, 1920).
Psychoanalysis is therefore viewed as problematic because words are so elusive, with approaches labelling certain types of mental illness with a new extended label, and since Freud’s time a new vocabulary has been generated. For example neurasthenia is now known as depression and psychasthenia is more commonly known as obsessive compulsive disorder (Freud, 1926 and Wikipedia). Much ongoing work has taken place in psychiatry and psychology to redefine the complaints originally listed by Freud. The most well known classification systems are the Diagnostic Statistical Manual of Mental Disorder and the international Classification of Diseases and Related Health Problems.
If we were to add a list of treatments available for these ailments in 1926 and compare them to those available today, the outcome would look remarkably similar, nowadays however, the term ‘psychoanalysis’ in its general application would not be used, many variants of the talking cure thus are still available, in terms of the counselling world- the most common being psychodynamic. The problem with classification in relation to psychoanalysis therefore persists- a definition of illness provides no pointers to a potential cure.
Many humanistic practitioners would therefore argue that while symptoms do often lesson or disappear during therapy, this is a by product of the work rather than its primary goal. They thus acknowledge that recognition of repeated patterns in human behaviour (whether momentarily or long term) is intrinsic to the humanistic approach (Clarkson, 1989). This is, to increase overall wellbeing and quality of life by reconnecting the client to the sources of their own growth, differing greatly from the psychoanalysis in practise if not in theory. Analytically influenced work thus tends to stress compromise and realism, accepting difficulty and ambiguity and therefore can perhaps lack the openness to joy, creativity and optimism found in humanistic work.
Hence, albeit Freud’s desire to think of himself as a ‘natural scientist’, a frequent criticism directed at psychoanalytical theory is; there is no supporting scientific evidence for its claim to efficiency. Though Freud was still in principle committed to the scientific biology in which he had been trained, in actuality Freud’s psychodynamic proceeded without reference to neurological substrates (Porter, 2002). As a result the evidence based psychotherapies, CBT and interpersonal therapy and its variants have become much more popular in recent years, often at the expense of both humanistic and longer term psychoanalytical psychotherapies (Hall et al, 2010).
Subsequently there now appears to be a lot more assessment and diagnoses happening. This could be primarily because of external pressures which are ultimately financial. Both the NHS and insurance companies demand diagnoses of pathology in order to approve (pay for) therapeutic work, and this is also becoming the norm in voluntary organisations (Sanders, 2005). Since they, alongside voluntary organisations who’s funders have largely adopted the same approach and are the main sources of subsidy for therapy, this demand for a medical definition has largely been accepted and therapy’s heritage of medico-pathological labels has been dusted off. The difficulty for humanistic therapist is thus consequently finding a comfortable balance between acknowledging that practitioners of course recognise patterns to the issues that clients bring whilst being able to maintain as a core position that each person is unique and that the authority about a person rests in the person rather than the outside experience (Bozarth, 1998).
As a result many humanistic therapists are developing their own versions of conventional diagnostic categories, primarily those used in DMS IV (American Psychiatric Associations, 1994). For example; A System of Gestalt Diagnoses of Borderline, Narcissistic and Schizoid Adaptations (Greenberg, 2003) and not forgetting another very influential paper which discusses how the traditional pathologies- schizophrenia, hysteria etc can be understood in terms of Transactional Analysis (Ware, 1983). But it is the Rogerians Person Centred Theory (PCT) - also highly criticised for its lack of empirical research and scientific findings, that has held out most strongly against pathology and diagnoses since such concepts are directly inimical to their whole approach (Sanders, 2006).
Person centred theory has therefore been criticised for being ‘profoundly simple’ (Totten, 2010) and that is concerned with presence rather the theology and therefore lacking in skill. But interestingly there has been a strong emphasis in humanistic therapies on the use of experiential groups (Berne, 1966, Perls, 1971; Rogers 1973; Whitton 2003 and Berkow 2005). Carl Rogers was the originator of the encounter group model and both TA and Gestalt have traditionally done a lot of work in groups rather than one to one and continue to do so. Of course other modalities use groups and in contrast within psychodynamic traditions they tend to perceive groups as specialism requiring separate training; while in humanistic circles practitioners have spent a significant amount of time in groups and therefore will often be regarded as inherently competent to lead them.
Consequently it is rarely possible to make absolute distinction and oppositions between modality. Unlike most CBT and medical model therapies, humanistic practise is orientated towards growth not cure and unlike most psychoanalytical therapies; humanistic practise is actively relational and unrestricted. These differences are basis to the unique identity of humanistic therapy. If humanistic, psychoanalytical and CBT theory was to be subsumed into a generic version of therapeutic practise then the essence of individual practise would be lost.
The existence of different modalities and approaches therefore benefit not only the client, but also the practitioner. Certainly clients need different approaches which best suit their needs, issues, life situation and personality. But it is also important for the practitioner to work in a style that suits their personality and hence enables them to give their best. If modality was therefore integrated without careful care or consideration given to the core concepts of each, then it is possible that either practitioner or their clients would be dissatisfied with the result. Give this, there is still an authentic need to strengthen the interconnection between modalities and for each to learn from the others so as to improve overall practise, while still recognising and preserving the real differences of approach. (Lapworth and Sills, 2010).
Thus, one can sometimes feel that psychoanalytical practitioners at times convey behaviour which suggests that they don’t like their clients, often treating their clients as patients, a specimen of theology perhaps. Humanistic therapy therefore offers a style which is rooted in an appreciation of human beings and there innate tendency to heal and grow- a style which fosters the valuing, the individual quirks and foibles, a principled willingness to follow where the client leads and an optimism which is itself conducive to therapeutic success. The finest practitioners in each modality I believe have therefore already incorporated all or much or what they need from other modality. However I believe at times practitioners can be ignorant, perhaps believing that they are staying ‘true’ to their theoretical background, but none the less, possibly secluding themselves from what is going on elsewhere in the world of counselling and psychotherapy and consequently are not equipped to invent for themselves what is missing or underemphasised in their own training.
In conclusion it may not pay to think of psychoanalytical and humanistic as competing schools of thought- but to consider that each branch of theory has contributed to our understanding of the human mind and behaviour. Humanistic theory added yet another dimension that takes a more holistic view of the individual and there are many groups of individual practitioners that working with a combination of some or all modality often including psychodynamic input. This comes to no surprise as although heavily criticised- both Freud’s seduction theory and work relating to traumatic neurosis have heavily influenced all fields of counselling and psychotherapy today. I may even argue that his work is the fundamental basis of theoretical thinking. Although differences still stand with both schools of thought, where humanistic theory gives way to the potential for growth and psychoanalytical theory offers insight into our unconscious thoughts, I feel that when both these elements are brought together, true therapeutic change can take place. Consequently, regardless of the chosen theoretical background, when engage in therapeutic relation, the main focus should be the client and their interest alone. Therefore to avoid labelling and to work within the context of the client I believe working via a humanistic approach which is therefore integrated with other modality can provide a harmonious blend of both presence and theology.
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Compare and Contrast Two Approaches to Counselling