What if I Hated Therapy? Pt 2.

Part 2.

In my first entry of this blog, I discussed how normal it is to have a bad counseling experience and the many different ways the therapeutic relationship can suffer as a result.

There is probably something in you that is still curious about exploring therapy, otherwise you wouldn’t be reading this blog. Remember that there are thousands of therapists out there, and finding a match that suits your needs is possible.

One of the major factors that is often discussed in the professional counseling world but somehow remains a mystery to potential clients (AKA you) is that of theoretical orientation. Yes, there are different ways to conceptualize problems of living in the world. Some of these types focus on behavior, some on thoughts, others on feelings, some more on development, and still others on culture. The way the therapist conceptualizes personal problems is important because it affects the way they will relate to you as well as the type of concerns that you’ll focus on during treatment. In other words, every therapist you go to will pretty much have a different opinion on how they explain your behavior based on their theoretical orientation. In this entry, I attempt to cover the major styles that most counselors here in the U.S. practice by.

For the most part, theories that counselors draw upon can be divided into 5 categories:

1. Humanistic

2. Cognitive

3. Behavioral

4. Psychoanalytic

5. Integrative (Eclectic)

(1)

1. In humanistic theories, the common underlying belief is that people will move towards self-actualization (or the state at which people are their best selves) naturally and have the answers to improve their lives within themselves. (2)

Common theories within this category are person-centered/Rogerian, transpersonal, Adlerian/individual, gestalt, and existential orientations. . (3)

Because these theories generally agree upon the conceptualization that people will work towards what they need on their own, directive techniques are not the norm for therapists using these orientations. One exception is Adlerian therapy; these therapists generally incorporate a lot of education about mental health in session. This means that, in general, the humanistic therapist will not lead you in session but will allow you to lead. For the most part, these therapists believe that the counseling relationship itself is enough to produce change in people! The focus and overall goal in therapy is typically insight, and mostly lasts months to years.

2. Cognitive theories are categorized together because the theorists generally believe that people can have erroneous or distorted thoughts that inhibit their ability to live life healthily. (4)

Commonly used types within this category are cognitive theory, rational emotive behavior therapy (REBT), cognitive-behavioral therapy (CBT), reality therapy/choice theory, and solution-focused brief therapy.

Some common techniques in cognitive-based theories are reality testing and brainstorming. Cognitive therapists may assign homework. Typically, the consensus is that cognitive therapy should be brief (1 to 8 sessions). Most of the time spent in session will be focused on the present and little to no attention is paid to what has happened to you in the past. The overall goal in this type of therapy is typically problem-solving related to specific issues. (5)

3. Behavioral theories are categorized together because these practitioners share the belief that behavior is all learned and, therefore, that maladaptive behavior can be unlearned through therapy.

Common types of behavioral therapy are acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and mindfulness-based cognitive therapy. (4)

Common techniques you may find with behavioral therapy are rehearsal/role-play, learning skills to change behavioral patterns, homework assignments to help apply those skills, and systematic desensitization (learning to relax while gradually being exposed to your targeted anxiety or fear). The focus is always on current behavior, so sessions stay present-oriented and do not focus on your past. Behavioral therapy is brief (1 to 8 sessions) and the overall goal is to change specific behaviors. (4)

4. Psychoanalytic theory started with Sigmund Freud, and these theorists view people as having unconscious forces that drive everyday behavior.

Common techniques within psychoanalysis/psychodynamic theory are free association, dream analysis, and transference (or the redirection of emotions felt towards someone in childhood to your therapist). The focus in session is generally on the past and on the unconscious. Psychoanalysis is typically very long-term and can last years. The overall goal in this type of therapy is to uncover hidden meanings of behavior to produce insight that will help with your current problems. (4)

5. Integrative (Eclectic) theory is actually just a combination of two or more types of psychological theory. These therapists usually have one core theory mentioned above but integrate elements from multiple theories into their practice. Typically, these changes are made based on clients’ individual needs. (5)

Ponder for a moment what you’d like to see in a counselor’s style, and assess the quality of a previous counselor’s theory in relation to your treatment.

So how do you know which method would best fit your needs? This is where your gut reaction to reading about the theories comes in handy. Do structured therapy directives get your heart racing, or do you just want a safe relationship to experiment with being open? Unfortunately, there is no assessment that matches you perfectly to one theory or another (hint: if you were thinking that you wish there were such an assessment, you may look into cognitive/behavioral styles).

In the next blog, I will get less philosophical and more practical as I cover different therapeutic treatment modalities such as individual, couples, family, etc. Hang tight for those differences as we come a step closer to identifying what your individual counseling needs are!

References

(1) American Psychological Association. (n.d.). Different approaches to psychotherapy. Retrieved from http://www.apa.org/topics/therapy/psychotherapy-approaches.aspx

(2)  Association for Humanistic Counseling. (n.d.). Humanistic philosophy. Retreived from http://afhc.camp9.org/Philosophy

(3) Society for Humanistic Psychology. (n.d.). Historic review of humanistic psychology. Retrieved from https://www.ahpweb.org/

(4) Fall, K. A. Holden, J. M., & Marquis, A. (2010). Theoretical models of counseling and psychotherapy. (2^nd ed). New York, NY: Taylor & Francis Group, LLC.

(5) Northwestern. (2015). Five counseling theories and approaches. Retrieved from https://counseling.northwestern.edu/five-counseling-theories-and-approaches/