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Ways of Working

CBT? Person centred? Psychodynamic? How do you choose between the many methods of counselling and psychotherapy that are out there? Sometimes you might feel that you are being expected to be an expert before you even embark on therapy.

All roads lead to Rome, and whatever theoretical approach your counsellor or psychotherapist uses, as you work together you may end up focussing on the same underlying issues. However, there are significant differences in approach, and these can make big differences to how wide-ranging the work is, how long it takes and how much it costs.

Many practitioners work integratively or eclectically which means that they draw on a variety of models of counselling and psychotherapy as appropriate to the situation. But even those who draw on a variety of models often have two or three core models that they mainly draw on, so it is useful to have some awareness of the different ways of working, and to be able to understand how your prospective practitioner is likely to work.

This page outlines a few of the more common approaches available. If your therapist uses an approach or approaches not listed here, they should at least be able to explain how their approach is similar or different from the approaches below, so if you are familiar with these you should be able to find out about your therapist's approach by asking questions like "how is that similar or different from such and such approach?".

Art Therapy

Cognitive Analytic Therapy

Cognitive Behavioural Therapy

Couples Counselling

Dramatherapy

EMDR

Existential Psychotherapy

Neuro-Linguistic Programming

Person-Centred Counselling

Play Therapy

Psychodynamic Counselling

Transactional Analysis

Art Therapy [back to list ]
Art therapy uses art materials as a way of expressing and exploring issues. Using painting, drawing and other techniques the client can explore the issues that in other forms of therapy are primarily expressed in words. Art therapy combines traditional ways of working psychotherapeutically with a way of expressing oneself that can be very powerful. The client is not expected to be an artist - the focus of the work is on using art forms to work with client issues and to enable change and growth on a personal level. Art therapy can be particularly helpful for people who find it hard to express their thoughts and feelings in words, and for those who are particularly skilled at using words to avoid working with feelings.
Cognitive Analytic Therapy [back to list ]
Cognitive Analytic Therapy is a focussed, time-limited therapy, typically from 4 to 24 sessions, with the focus being on discovering how problems have evolved and how the procedures devised to cope with them may be ineffective. Through working with your therapist to understand how your difficulties may be made worse by habitual coping mechanisms it gives you an opportunity to learn techniques to support change. It looks at your past history and life experience, how you learned to form relationships and the beliefs you hold about yourself and other people, with a focus on recognising how your coping mechanisms originated and how they can be improved and adapted. Client and therapist work in an active, collaborative way. Diagrams and written outlines are worked out together to help identify and revise old patterns that do not work well.
Cognitive Behavioural Therapy [back to list ]
CBT focusses on thinking and behaviour as a way of achieving therapeutic change. It tends to be short term. Although there is no strong evidence that CBT is more effective than other approaches to counselling and psychotherapy, more research has been undertaken to determine its effectiveness than most other approaches, and for this reason, and its short-term nature, it tends to be favoured by the NHS. CBT tends to include a teaching element, to aid client's understanding of their conditions and reactions, and to help develop techniques and skills for managing or transforming their situation and ways of thinking & responding.
Couples Counselling [back to list ]
Couples counselling is different from individual counselling because the relationship is the focus of attention, instead of one person's specific issues or problem. In couples counselling, the counsellor will help you and your partner identify the conflict issues within your relationship, and will help you decide what changes are needed in order for both of you to feel satisfied with the relationship. This is most often done as a couple but individual sessions can also be helpful. In the case where you and your partner decide to bring the relationship to an end, your counsellor can help you find ways of managing that process in a productive way.
Dramatherapy [back to list ]
Dramatherapy uses the performance arts within the therapeutic relationship. Dramatherapists are trained in both drama and therapy to work with clients to facilitate therapeutic change. Stories, myths, puppetry, masks and improvisation may be used. Clients do not need to be trained in drama.
EMDR [back to list ]
Eye Movement Densitisation and Reprocessing Therapy is based on the theory that traumatic or upsetting events can be locked or frozen into the nervous system, causing the person to re-experience sensations or perceptions that were experienced at the time of the event. The events remains unprocessed and continue to affect the person concerned, fixed in the body and mind.

EMDR seems to affect the memory networks storing the traumatic events, allowing them to be processed, so that the memory can begin to feel like a 'normal' one, rather than an overwhelming experience. Working with the therapist, the person focusses on the upsetting event and at the same time some form of stimulation is used. This can be following something visually, or using sounds, so that new images, thoughts, feelings and bodily sensations arise in ways that lead to a diminishing of the distress associated with the memory.
Existential Psychotherapy [back to list ]
The existential approach takes the viewpoint that many of the emotional issues that we deal with in life can be related to the problem of coming to terms with the basic conditions of existence - issues like freedom, aloneness, death and the meaning of life.

Existence, in this approach is not thought of as a static thing, but as a dynamic process of coming into being, of becoming what one fully can be.

An existential practitioner will work with their client to develop an awareness of the basic truths of existence and encourage them to face their anxieties about them. The orientation of the work tends be present and future focussed rather than looking at depth into the past.

The main goal of existential psychotherapy is to help clients experience their existence as more real, more authentic, and in doing so to develop their own sense of personal meaning in the world, and to become more aware of their own freedom of choice in a life-affirming way.
Family Therapy [back to list ]
Family therapy involves several family members all meeting with a therapist. Most family therapists will take a 'family' to mean any group of people who define themselves as such, who care about and care for each other. Family therapy can be helpful if a family is having problems getting along. It can also be used when one family member has a problem and family relationships are part of the reason why the problem persists. In many cases it can be a child who most obviously appears to have the problem, but this is not always the case. Family therapists avoid blaming any family member for the problems: instead they help the family interact in different ways that may solve the problem.

Family therapy is often recommended if a child has a problem with behaviour. The therapist will work to help the family see how the behaviour fits into larger patterns of behaviour and interaction within the family, and will help the family find ways of seeing the situation and different ways of acting and reacting that are likely to change the overall situation. Family therapists may also work with people individually or may suggest individual sessions in the context of a series of family meetings. They may also, if appropriate, work with the professional or social networks around the family.
Gestalt [back to list ]
The Gestalt approach has a tendency to focus on what is happening in the present, rather than going into the past. The practitioner works with the client to help them raise awareness of their own processes and interactions with others and the environment.

Gestalt practitioner work with spontaneity and present-centeredness and interactions tend to focus on:
- Being holistic: considering the whole person, with a focus on integration.
- How the client makes contact with and relates to others (family, work, school, friends, authority figures).
- How clients organize or manipulate their environment from moment to moment.
- Where the focus of interest lies for the client, as a way of providing insight into their needs.
- The here and now: what is what is being thought, done and felt presently, and not in the past or the future.
- Unexpressed feelings as "unfinished business".
Many therapeutic interventions, called "exercises" and "experiments", have been developed to enhance awareness and bring about client change.
Hypnotherapy [back to list ]
Although hypnosis has been recognised and used therapeutically for centuries, hypnotherapy (or more properly, hypno-psychotherapy, the branch of psychotherapy that uses hypnosis) was developed in its present form from the nineteen-thirties onwards by Milton Erickson, a US psychiatrist and medical practitioner. Most, if not all, modern hypno-psychotherapists draw on his techniques in one way or another.

Hypnotic states, or trances, are naturally occuring phenomena that we experience in our everyday lives, where our attention tends to be focussed inwards rather than on outer concerns (ever driven your car automatically on a familiar route when you actually intended to go somewhere else? You were probably in trance). Accessing our trance states can help "loosen up" our ways of thinking and behaving when we feel consciously stuck.

Hypno-psychotherapists are experts at helping induce such trance states and in helping people use those states to experience therapeutic change. Hypno-psychotherapy involves addressing the unconscious mind more directly than in some other forms of therapy, and that focus can help bypass resistance to change that a person may be holding onto mainly at a conscious level.

Hypnotherapy has been used to treat psychological and emotional problems, for pain management, anaesthesia and pain relief, for phobias and addictive behaviours, as well as to enhance performance creativity and mental prowess. Many practitioners combine elements of hypnosis with other forms of psychotherapy.

Training in hypnosis does not necessarily qualify someone to take on the role of counsellor or psychotherapist. If you are considering working with a practitioner who works with hypnosis, it is wise to make sure that they have appropriate qualifications in counselling, hypno-psychotherapy or other type of psychotherapy.
Integrative Therapy [back to list ]
A growing trend in counselling and psychotherapy is the integrative approach. This takes aspects from several different models and theories but unlike an eclectic approach which just takes bits and pieces of different approaches to make a "toolbox" from which the practitioner can draw for different ways of working, an integrative approach goes further and brings together two or more of these different ways of working into a single model or framework which itself is consistent, coherent and theoretically sound. If your practitioner works integratively, they should be able to explain which models or ways of working they integrate into the framework they are using.
Neuro-Linguistic Programming [back to list ]
When used in counselling and psychotherapy, Neuro-Linguistic Programming or NLP is characterised by its strong acknowledgement of and respect for the unconscious mind. NLP practitioners are trained in perceptual acuity which means that they are highly attuned to signals from the unconscious which are normally overlooked in day-to-day life. This can mean paying close attention to aspects such as the clients breathing, voice tone, choice of words, skin tone, posture, expression, eye movements and muscle tone.

Although other methods of counselling and psychotherapy acknowledge the importance of these, NLP puts a strong focus on these as ways of communicating with the unconscious, and may even rely on them as the main way of exploring the emotional life of the client. NLP techniques usually aim to work directly at an unconscious level without lengthy reflection on or exploration of feelings and issues. Because of this it is sometimes possible to facilitate change in the client quickly and painlessly, because it bypasses the resistances that would normally be encountered and might have to be painstakingly broken down if working with these issues at a conscious level.

As a result, clients can sometimes be puzzled to experience change without being aware of having done anything consciously in sessions that would explain why. The subtle communications that take place from and to the unconcious in sessions are easily missed by the untrained eye, and this sometimes leads to NLP being misperceived as a formulaic way of working.

Training as an NLP practitioner does not in itself qualify someone to take on the role of counsellor or psychotherapist. If you are considering working with a therapist who uses NLP techniques, it is wise to make sure that they have appropriate qualifications in counselling or psychotherapy.
Person-Centred Counselling [back to list ]
The person-centred approach is based on the belief that we all have a natural tendency towards growth and wholeness, but that often difficult life experiences lead us to have a negative concept of ourselves, in one way or another and that this can lead to difficult feelings or behaviour.

The idea is that when people have the opportunity to be in a relationship where they experience themselves as truly understood and fully accepted exactly as they are, by someone who interacts with them genuinely and honestly, they will naturally begin to grow and develop in therapeutic ways. These traits of genuineness, acceptance and empathic understanding are highly valued by the person-centred practitioner and are seen as the keystones of their practice.

A person-centred therapist aims to provide an experience of this type of relationship for their client, so that as the relationship develops the conditions that lead to the client's growth, change and personal development take place.

Introduced in the forties, the importance and power of this approach is now almost universally recognised and most methods of therapy will acknowledge the therapeutic value of genuineness, acceptance and empathy.

Because of the strong emphasis on acceptance, person-centred practitioners have sometimes had the reputation for being susceptible to overlooking suppressed anger, both in themselves and in their clients.
Play Therapy [back to list ]
In Play Therapy the therapist uses the power of play to work therapeutically with the client, normally a child. The therapist strategically uses play to help the child express what is troubling them when they do not have the verbal language to express their thoughts and feelings, with toys, and the way they are played-with forming a way of communicating or expressing what in other therapies would be done using words. The therapist is trained to be sensitive to the symbolism and meaning of the play, what it might be expressing, and how to work with play to therapeutic and healing ends. Since play is a very natural form of self-expression for children, this is a way of taking therapy to the child, rather than trying to fit the child to the therapy.
Psychodynamic Counselling [back to list ]
The psychodynamic approach has as its starting point that people are largely motivated by unconscious drives. Psychodynamic work attempts to help you increase your awareness of your unconscious motivations.

Where your conscious and your unconscious motivations are in conflict with each other, it can lead to unhappiness and difficulty in relationship with others, as well as to self-sabotage. Psychodynamic work aims to help you make these conflicting motives conscious, so that you can come to terms with them or resolve them, at which point the symptoms of these conflicts usually lessen or disappear and there is a tendency to experience greater freedom and joy in life.

Keeping conflicting emotions and bottled-up feelings out of our awareness takes a lot of emotional energy, and being able to work through and resolve these often results in the person having more reserves of energy and a greater sense of vitality.

Where you might have been keeping conflicting motivations out of your awareness as a way of coping with them, bringing them into focus can feel threatening and difficult, and the psychodynamic practitioner will usually work with you in parallel to helping you develop alternative, more life-affirming coping mechanisms. This is so that it can start to feel safe to let yourself become more aware of your existing, less productive ways of coping and then to let go of them.

The psychodynamic approach takes the view that apart from their particular constitutions, people's development is largely determined by circumstances in childhood, so the work can involve looking at the past, especially early years and family relationships, and exploring how those past experiences might be influencing or distorting the person's perceptions of what's going on here and now, in particular exploring how the relationship between the client and therapist is being experienced.
Transactional Analysis [back to list ]
Transactional Analysis, or TA, is an approach that focusses on how people interact with each other. It works with the idea of three "ego states" or ways of being in relationship, known as Parent, Adult and Child. In relationship you can adopt an attitude roughly similar to that of being like a Parent, Adult or Child, and likewise treat the other person as if they were either a Parent, Adult or Child. This gives rise to different styles of interacting with each other, such as like a parent towards a child, or as an adult towards an another adult. The fact that we can communicate on different levels (eg. sending both overt and covert messages) gives rise to rich and subtle combinations of these when we interact with others.

A TA practitioner will help you explore your preferred ways of interacting with others, and they with you, as a way of gaining more insight into what is going on in your relationships and as a way of becoming aware of choices and ways of relating to others that you may have been overlooking.

TA works with the idea of a "life script", the story we tell ourselves about how things are, how we are, and how things have to be. We run scripts because of some actual or perceived payoff, for example someone who complains a lot may at a deep level be hoping for some sympathic and warm reaction from others.

However often the scripts we run don't have the payoff we hope for, are highly inefficient at doing so, or cause us considerable pain and difficulty in their unintended side effects. Becoming aware of the scripts we are running, and why, empowers us to decide to change them and find more effective ways of finding fulfilment in life.

TA has a strong teaching element to it, so clients of TA practitioners should expect to become familiar with the psychological models used in TA, and to learn to think of themselves and other in terms of these models. This can both be empowering on the one hand as a way of gaining insight and understanding, and limiting on the other, by occasionally making it more difficult to see things from a perspective that doesn't fit the TA model.

© Copyright 2008. All our articles are written by practitioners in the field of counselling or psychotherapy. Articles on this site reflect only the views of the individual authors. Seek professional advice before engaging a practitioner.

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