Comparison of Approaches to Therapy

Counselling is a relationship between a professional trained counsellor and a client which is designed to help resolve and understand their personal or psychological problems, helping them to reach their goals which are done through emotional or interpersonal nature. (McLeod 1996, pp. 63). Counsellors use different approaches or apply different models using talking therapies, depending on a person’s mental state or what the counsellor feels to be effective. The integrative model of counselling is useful for the counsellor as it allows for a clear breakdown of a mental state allowing the counselling process to be more successful. (Holm-Hadulla, Hofmann, & Sperth, 2011).

Before the humanistic therapies were introduced in the 1950s by Carl Rogers, the only real forms of therapy available were behavioural or psychodynamic (McLeod, 1996 2-3). These approaches focused on the subconscious or unconscious experience of clients and not what was on the surface. Personal Centred Therapy focuses on what is on the surface and is a positive theory which gives hope to everyone and encourages personal growth and change. Person-Centred Therapy was developed in the 1940s and 50s to develop a personal, more medical therapy encouraging self-growth in discussions allowing them to determine their own solutions and believes all humans are good and driven to making themselves be the best they can be. (Grant, 2007). The theory draws on respect for every person and values their needs making them responsible for their own growth and development. Personal centred therapy is non-directive talking therapy, so the client gets to lead the conversation at their own pace meaning the therapist does not have any input or direction. (McLeod, 2013).

Personal centred approach has three important concepts and values. The first one is the need for positive regard which is the need for respect from one another. Positive regard has two different needs which are unconditional and conditional positive regard. Unconditional positive regard means the therapist must not judge or label the client, providing acceptance. (Malik Bhanji, 2013), Conditional positive regard is the feeling of being accepted resulting in behavioural change so that conditions are met between the client and counsellor. (Wilkins, P. 2000). The second concept is congruence, which means a client should feel comfortable sharing any personal information as this helps to form a good relationship between the therapist and client, whilst also proving good communication showing the client that it’s okay to feel helpless allowing them to see themselves for who they really are. When a client starts personal centred therapy, they are known for being in a state of incongruence. The role of the therapist is to reverse this process. Goldman, R. N. (2017). The third concept is to have an empathetic understanding as this allows the therapist to gain empathetic feelings and transferee these onto themselves to allow the client to gain a better understanding of themselves. Rogers (McLeod, 1996, pp. 64-70) argued that to create growth and be able to take steps forward a person must find their true self. This involves using unconditional positive regard, congruence and being able to show an empathetic understanding, if all three values are present, positive change would occur.

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Personal centred counselling has many theories that fall under a humanistic umbrella. Three of the main approaches are personal centred therapy, Transactional analysis, and Gestalt therapy. Personal centred therapy the counsellor shows the client unconditional positive regard, empathy and congruence by taking the professional status away and expertise and not directing the therapy in any way to help the client come to terms with any negative feelings which are steps to changing and encouraging positive development. (Stiles et al., (2006). Transactional analysis integrates different process from the humanistic approach and also psychodynamic as it put our own personality into three stages, which are the parent, adult, and child and it looks at your own behaviour, not other peoples which can help you understand the way interacting with others can go wrong. (McLeod, 1996, pp. 85-86). Gestalt therapy looks at a person and the surroundings that could be contributing to the way they are feeling at present by gathering their immediate thoughts and behaviours and reversing the negative with positive thoughts which will help the client to see situations different for the future. (Yontef, G. 2007).

Psychodynamic Therapy was developed by Sigmund Freud between 1890-1930. Theories were developed to bring awareness to the inner emotional state and the forces that drive a person to behave the way they do. Freud believed these forces lay in the unconscious and different structures of behaviour, from early experiences which are critical in shaping a person later in life. The aim of psychodynamic is to bring back awareness by digging into the emotional state and finding out why the client feels the way they do. Only then will a person be able to move forward and completely improve the way they to relate to others and value them self. (Yakeley Jessica, 2014). To be successful in helping clients gain back control the therapist reviews certain life factors by going through emotion, thoughts, early-life experiences and beliefs, recognising certain patterns which then can help the client avoid future occurrences. (McLeod, 1996, pp. 64-70). To deal with conflict that keeps arising making it an occurring problem, Freud said we can develop a defence mechanism that stops unconscious thought from causing anxiety or being left in denial stopping us blocking external memories or thoughts bringing them to a state of awareness. (Cramer, 2015). Freud placed importance on five stages during our younger years, which were the oral stage, zero to one and half years where fixation starts. The anal stage one and half years to three which is developing toilet training. The phallic stage, three to five years where sexual attraction starts between a boy and girl. Latency stage five years to twelve years where the child develops sexual feelings for the opposite sex, and the genital stage twelve to adulthood where sexual urges and behaviours start. Freud said that if a child passes through one of the five stages with unresolved conflict, neurosis will start with abnormal behaviour which are shown patterns of anxiety or depression. (Comer, Furnham & Gould, 2013). 

These three stages are the Id, Ego, and superego. The Id is present from birth and is what characterises our desires which have demands to satisfy in our unconscious part of the mind. The Id is known to contain our selfish needs, fears, and unpleasant experiences and is developed as a child grows older. The ego is what tells the id that the desires cannot always be fulfilled. The ego is the peacemaker and decides that instead of demanding satisfaction, it will first be assessed. The ego is the reasoner and rational. The superego also forms during our childhood years and this is known as the good ego. The superego decides which desires are right and which are wrong, and we learn this from our families or from our culture. If all these three desires are at conflict, this is when psychological disorders can occur. (Comer, Furnham & Gould, 2013).

Psychodynamic therapy between the counsellor and patient is seen as a blank slate, so transference plays a major part in therapy allowing the counsellor to have an intervention. Psychodynamic is a therapy that digs deep so it diminishes any further occurrence in psychological problems by building defence mechanisms. (Bouchard, G., & Thériault, V. J. (2003) suggested that defence mechanisms can have an important effect in the physiological state and development of a patient. Although there are many positive points to psychodynamic therapy, it has also been highly criticised due to the long and negative painful process which the patient must go through to remove any buried thoughts. Another main factor to consider is the client’s defence mechanisms as it is ethically impossible to measure. Research cannot predict ahead which defence mechanisms will be used by a given individual. Freud said that a person who is exposed to anxiety develops a mechanism (Comer, Furnham & Gould, 2013). Predicting repression, denial intellectualisation or any other mechanism would be impossible making the theory and evidence ethically unacceptable.

In contrast to psychodynamic, personal centred approach focus on the conscious mind and what is going on here and now, rather than digging deep into the emotional state. Personal centred approach allows a person to actualise focusing on positive aspects in a self-directed way following all the core conditions. According to (Leontiev, 2016), personality progresses from people meeting their own needs. In personal centred therapy there is no attention paid on transference making therapy shorter than psychodynamic as there is no unconscious problem to be found so you are fully aware of problems.

In personal centred therapy ethical principles are followed on boundaries surrounding no questioning. Therapy does not dig deep so problems can reoccur in the future by ignoring the psychological dysfunctions by neglecting the role of evolutionary psychology regarding the belief that there is an evolutionary adaption to the root of human behaviour. (Human Behavior and Evolution Society., 1997). Personal centred therapy takes environmental influences into account, rather than focusing on past and internal thoughts.

All though both approaches where different in their goals, they still contributed to science in a positive way. Psychodynamic having a negative and gloomy view whereas humanistic has a positive happy approach. Science supports the idea that the conscious, here and now cannot function without the unconscious, memories shaping our future actions, but both have had positive influences on the health and wellbeing of psychological problems and contributed significantly to research. 

References

• Comer, R., Furnham, A., & Gould, E. (2013). Psychology. Hoboken, N.J.: Wiley. Chapter 15: Personality.
• Cramer, P. (2015). Defence Mechanisms: 40 Years of Empirical Research. https://doi.org/10.1080/00223891.2014.947997.
• Goldman, R. N. (2017). The emotion-focused therapeutic relationship: Genuineness, warmth, and acceptance are not neutral: Comment on Gelso and Kanninen (2017). Journal of Psychotherapy Integration, 27(3), 350–358. https://doi.org/10.1037/int0000096.
• Grant, A. (2007). Dryden’s handbook of individual therapy Dryden Windy 5th Dryden’s handbook of individual therapySage56614129223801412922380. Mental Health Practice, 11(1), 144. doi: 10.7748/mhp.11.1.20s18.   
• Holm-Hadulla, R. M., Hofmann, F.-H., & Sperth, M. (2011). An integrative model of counseling. Asia Pacific Journal of Counselling and Psychotherapy, 2(1), 3–24. https://doi.org/10.1080/21507686.2010.546864.
• Human Behavior and Evolution Society. (1997). Evolution and human behavior. Elsevier Science Inc. Retrieved from https://www.journals.elsevier.com/evolution-and-human-behavior
• Leontiev, D. (2016). Practices of Meaning-Changing Interventions: A Comprehensive Matrix. Clinical Perspectives On Meaning, 131-145. doi: 10.1007/978-3-319-41397-6_7.
• McLeod, John. (1996). An introduction to counselling (p. 1). Buckingham: Open Univ. Pr. 
• Mcleod, J. (2013). An Introduction to Counselling (5th ed., p. 167). Berkshire: Open University Press.
• Malik Bhanji, S. (2013). Respect and Unconditional Positive Regard as Mental Health Promotion Practice. Journal Of Clinical Research & Bioethics, 04(03). doi: 10.4172/2155-9627.1000147. 
• Paul Wilkins (2000) Unconditional positive regard reconsidered, British Journal of Guidance & Counselling,28:1, 23-36, doi: 10.1080/030698800109592.  
• Stiles, W., Barkham, M., Twigg, E., Mellor-Clark, J., & Cooper, M. (2006). Effectiveness of cognitive-behavioural, person-centred and psychodynamic therapies as practised in UK National Health Service settings. Psychological Medicine, 36(4), 555-566. doi:10.1017/S0033291706007136. 
• Cramer, P. (n.d.). Defense Mechanisms: 40 Years of Empirical Research. https://doi.org/10.1080/00223891.2014.947997
• Holm-Hadulla, R. M., Hofmann, F.-H., & Sperth, M. (2011). An integrative model of counseling. Asia Pacific Journal of Counselling and Psychotherapy, 2(1), 3–24. https://doi.org/10.1080/21507686.2010.546864
• Human Behavior and Evolution Society. (1997). Evolution and human behavior. Elsevier Science Inc. Retrieved from https://www.journals.elsevier.com/evolution-and-human-behavior
• Yakeley Jessica. (2014). Psychodynamic psychotherapy: developing the evidence base. Advances in Psychiatric Treatment, 20(269–279). https://doi.org/10.1192/apt.bp.113.012054
• Yontef, G. (2007). The power of the immediate moment in gestalt therapy. Journal of Contemporary Psychotherapy, 37(1), 17–23. https://doi.org/10.1007/s10879-006-9030-0