Why are there different types of counselling?

There are many types of counselling and psychotherapy, which can be confusing to a newcomer to this field.

Counselling started with Sigmund Freud at the beginning of the 20th century. When treating patients with curious psychological ailments, he discovered a way of talking that brought about a sense of relief. One of Freud's patients called it ‘the talking cure'. Today, we take counselling for granted, but 100 years ago the idea that simply talking could help someone with serious problems was a radical concept.

Despite this new discovery, it was still unclear exactly how or why the talking cure worked. Freud had his ideas, many of which have remained as part of the profession (including concepts such as the unconscious and transference), while other of Freud's ideas have been put to one side or developed by those who followed him.

My view is that the different approaches to therapy offer different emphases. I call myself an ‘integrative' psychotherapist because I integrate different modalities into my practice. For me, each of the modalities has something different to offer, a different angle.

For example, for most counsellors being trained today, the first approach they are taught is the ‘person-centered approach'. In a nutshell, this approach describes a particular way of being with the client and suggests that this way of being is sufficient in itself to produce change. The person-centred counsellor is trained to listen attentively and offer empathy and acceptance. It might sound simple, but this type of listening and acceptance is relatively rare in ordinary life, and it can feel powerful and healing.

Another style of therapy is called psychodynamic. This refers to the idea that within our psyche there are intriguing dynamics at play, much of it unconscious. These dynamics were mostly set up in childhood. We know that children cannot survive by themselves: they need a caring adult to nurture them and teach them how to deal with life. But what if that adult is depressed or angry or disinterested in their child? In such circumstances, the child finds themselves in a dilemma: they need this adult, but this adult is also a source of frustration or worse. It can be imagined how such a child will grow up into a person who finds it difficult to know how to be with people. I'm over-simplifying, but the point remains: our childhood experience impacts on how we are as adults. Psychodynamic therapy takes a deep dive into this material to help people get unstuck from unhelpful patterns.

Existential therapy takes the view that, regardless of our childhood, the human condition is a challenging one: each of us is alone in the universe, we are each ultimately responsible for our own decisions (and we rarely know what's for the best), we struggle to find meaning in life, and, in the end, we die. This is a lot to deal with! Existential therapy explores these topics in depth to help the client come to terms with the human condition.

Cognitive Behavioural Therapy (CBT) takes the view that our problems are largely due to unhelpful ways of thinking about ourselves and the world. Accordingly, CBT seeks to help the client to think about their lives in more skillful ways.

Solution-focused therapy seeks to give the client a quick fix to a pressing issue, such as whether to leave a job or a relationship. This type of therapy will look at the dilemma in detail and support the client in deciding what to do.

Some forms of therapy - like Gestalt Therapy and Transactional Analysis - are in themselves integrative models, albeit with particular angles or slants. Gestalt, for example, has an emphasis on how we feel in the present moment and how our issues tend to be held in the body, so to speak: people are like pressure cookers holding different emotions and the therapist helps the client to let off steam. Transactional Analysis emphasises how a person is not a single thing but a collection of parts in dialogue with each other: for example, we each have within us a parental part, a child-like part and an adult decision-making part.

In some ways, each of the different modalities can be used to explore all of the issues I have highlighted here, albeit with different emphases. As an integrative therapist, I'm happy to borrow from any approach if I think it best fits the material the client is bringing in that moment.

By Mike Brooks, Counsellor & Psychotherapist