Theoretical Approaches to Counselling: CBT, Person-Centred, and Psychodynamic

Counselling Studies Level 3

Learning Journal for Week 2: Wednesday 3rd October, 2012

In my last learning journal I examined why theory is important in counselling work.  In this journal, I would like to expand on that by describing some of the main theoretical approaches to counselling.

There are a variety of theoretical approaches that counsellors can adopt within their practice, many of which are briefly described by the BACP (2010). There are far too many to discuss within a single learning journal, thus I will be focusing on three approaches I feel are most prevalent in the field: Cognitive Behavioural Therapy, Person-Centred Counselling, and Psychodynamic Therapy.

 

Cognitive Behavioural Therapy (CBT)

Cognitive-behavioural therapy (CBT) was founded in the 1960s by Aaron Beck when he observed that his counselling clients tended to have an ‘internal dialogue’ that was often negative and self-defeating (Beck, 1979). This internal dialogue was observed to influence behaviour, leading to the hypothesis that changing internal dialogues would lead to changes in behaviour. Thus, CBT focuses on the thoughts, images, beliefs and attitudes held by the client and how these relate to the clients behaviour or way of dealing with emotional problems. In particular, CBT focuses on two specific elements: cognitive restructuring (of negative thinking patterns) and behavioural activation (where the client overcomes barriers to participating in activities) (Nathan and Gorman, 2002). As a result, CBT is now seen as one of the major orientations of psychotherapy due to its unique focus on both cognitive and behavioural psychological models of human behaviour (Roth and Fonagy, 2005). The ‘cognitive’ aspect of this approach is based on how cognitions influence the development and maintenance of emotional issues, while the ‘behavioural’ aspect draws on early research on learning theory (i.e. operant and classical conditioning – the belief that behaviours can be learnt and conditioned).

 

Person-Centred Counselling (PCC)

PCC is a humanistic approach to counselling founded by Carl Rogers in the 1950s, based on the assumption that human beings are experts of themselves and that they have access to their own innate expert resources of self-understanding and self-direction (Rogers, 1951). The role of the counsellor is thus to provide a facilitative environment, comprising six necessary and sufficient conditions, for the client to find these resources within themselves (Rogers, 1959):[1]

  • Psychological contact (i.e. rapport and mutual understanding) between client and counsellor.

  • Client incongruence or vulnerability, which prompts them to continue counselling.

  • Counsellor congruency (genuineness), showing their own human traits through appropriate personal disclosure.

  • Unconditional positive regard (UPR), even if a client divulges something that the counsellor disagrees with; the counsellor remains accepting and caring of the client.

  • Empathic understanding (i.e. the ability to understand what the client is feeling), thus validating the client’s feelings.

  • The client recognises the UPR, congruence, and empathic understanding of the counsellor, at least to a minimal degree.

 

These core conditions are proposed to demonstrate an appreciation of personhood and individuality, which encapsulates the theoretical notion of ‘self-concept.’ Self-concept refers to the perceptions and beliefs the client holds about themselves and comprises three components: 1) Self-worth (self-esteem) – thoughts about the self, which develop in early childhood and from experiences with parents or guardians; 2) Self-image – perceptions of the self, including body image, which can influence personality; 3) Ideal self – the self a person would like to be, including goals and ambitions. Rogers based PCC on the assumption that all human beings are seeking a positive self-concept (self-actualisation), and it is this innate motivation towards self-fulfilment that is nurtured during PCC.

 

Psychodynamic Therapy

The theoretical approach of psychodynamic therapy, developed by Sigmund Freud, focuses on ways in which the unconscious impacts how people function (Freud, 1933). Freud believed that the unconscious is a component of the mind that the individual is unaware of, but which manifests through behaviour: “infantile wishes, desires, demands and needs that are hidden from consciousness awareness because of the conflicts and pain they would cause if they were part of everyday life” (Feldman, 1993, p. 381). The goal of psychoanalysis is to locate and release powerful emotional thoughts and feelings trapped or ‘repressed’ in the unconscious, with the most frequently utilised technique being ‘free association’ (i.e. verbalising everything that comes to mind without censorship). In order to use this method, an essential component of psychodynamic therapy is the creation of a safe place for the recalling of repressed childhood memories (Bergmann, 2010). A strong client-counsellor relationship is required, but the relationship is less about encouraging client authenticity and more about developing a dependent relationship that is based on transference (i.e. the unconscious redirection of feelings from one person to another). The theory is that this analytic experience of acceptance in a non-judgmental, neutral environment can help the client resolve and heal repressed thoughts and feelings.

 

References

Beck, A. T. (1979). Cognitive therapy of depression. New York: Guilford Press.

Bergmann, M. (2010). The Oedipus Complex and Psychoanalytic Technique. Psychoanalytic Enquiry, 30(6), 535-540.

Feldman, M. (1993). The dynamics of reassurance.  International Journal of Psycho-analysis, 74, 275-284.

Freud, S. (1933). New introductory lectures on psychoanalysis. Lecture 33: Femininity. Standard Edition, v. 22. pp. 136-157.

Nathan, P.E. and Gorman, J.M. (2002). A Guide to Treatments that Work. 2nd edition. New York: Oxford University Press.

 Rogers, C. (1951). Client-cantered Therapy: Its Current Practice, Implications and Theory. London: Constable.

Rogers, C. (1959). A theory of therapy, personality, and interpersonal relationships, as developed in the client-centred framework. In S. Koch (ed) Psychology: A Study of a Science, Vol 3. New York: Penguin.

Roth A. and Fonagy P. (2005) What Works for Whom: A critical review of psychotherapy research. Second Edition. The Guildford Press, London.


[1] Rogers believed that three of these conditions were core to facilitating change within the client: congruence; UPR, and empathic understanding.

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Categories: Counselling, Personal/Professional Development, Psychology

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4 replies

  1. Great post Nicola, and I agree that one of the most important part of the therapy is the transference. It’s interesting to see how a client has a problem, shares the problem, then the problem is with the therapist. Client leaves happy feelilng sorry for the therapist who now has their problem. (In a nutshell) That’s why it’s so important for the therapist to have their own councelling regularly and also to have mentors who they speak to often.

  2. That is so true, Susan. I am learning just how important the supervision process is too. Transference is a therapeutic tool that is a lot for a counsellor to take on without support.

  3. how do these then work together as one model?

  4. Good question, Kate. They are distinct models, but a counsellor who uses them all might call themselves Integrative.

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