Have you ever been curious about talking therapies but when you flip through The Spark listings you don't know where to start? What's the difference between a humanistic approach and an existential one, or between a counsellor and a psychotherapist? What is Gestalt therapy? Or body psychotherapy? Or CBT? NLP? EFT??
It's no wonder we're confused. According to the British Association of Counselling and Psychotherapy (BACP) there are 366 methods of talking therapies. The distinction between them can be slim at times, and there are conflicting views about the definitions and whether they should be separated at all.
Part of the problem is that this work is not legally regulated and despite attempts and discussions within the government nothing has been put in place as yet. Organisations such as BACP and the UK Council for Psychotherapy (UKCP) aim to bring professional standards and accountability into the industry. BACP has 36,000 members worldwide, UKCP has 7,000 members, (psychotherapists and counsellors, despite their name). You can be confident that a therapist who is a member of either of these organisations will be working to an acceptable level of professional capability. If you consult someone and feel their skills are questionable, you can file a complaint with their membership organisation.
However, many skilled therapists work independently, choosing not to belong to either the UKCP or the BACP for personal or political reasons. There are many routes to becoming a good therapist that may not meet the standards set out by these two organisations; for example, a therapist might have extensive background experience in a specific fi eld such as mental health, palliative care, addictions or domestic abuse.
Another membership organisation – the Independent Practitioners Network – aims for professional standards and accountability through human relationships rather than qualification levels. Individual members become part of a local group who work together through supervision or therapeutic practice. The group supports the individuals within it and stands by each member professionally. The group makes links with other groups and needs to have two links to become members of the IPN.
You can also find a list of Bristol-based practitioners who are working privately through another organisation: Counsellors And Psychotherapists in Private Practice, but be aware that this is a membership body for peer support and there are no accreditation requirements.
When looking, don't be afraid to ask what qualifications and experience a therapist or counsellor has and if you don't understand ask them to explain in more detail. A therapist recommended by someone you know is worth talking to. Speak to a few and get a feel for them. It is worth meeting in person and talking through how they work and your expectations. Some will offer a free initial consultation. Don't feel you have to commit to sessions with someone and don't be afraid to tell them why if you choose not to. The same goes if you try a few sessions and really feel it is not working. However, be aware that it can take a while to feel comfortable when you're talking about personal or troubling issues.
Private one-to-one sessions cost anything from £30-75 an hour, depending on the therapist's qualifications, skills and experience.
But what is the difference between counselling and psychotherapy? It depends who you ask. “We actually make no distinction,” says Phillip Hodson, BACP's media consultant and a psychotherapist, author and broadcaster. “We are much more interested in whether our members are competent, reliable practitioners than what they are called.”
The UKCP see it differently: to them the distinction is important. For a start, the levels of training can be very different. Psychotherapists train for five years, during which time they have extensive therapy themselves. Some counselling courses are relatively short, part-time and do not require you to do personal therapy.
Counsellors who are members of BACP or UKCP will have gone into therapy themselves and done case studies under supervision, bringing their depth of training more in line with that of psychotherapists. So UKCP introduced the title Psychotherapeutic Counsellors. “We did this to distinguish counsellors whose training and depth of clinical practice was more closely aligned with psychotherapeutic practice and its relational quality (meaning that the treatment's effectiveness is achieved through the medium of the therapeutic relationship) than with counselling trainings for which this is not the case,” says Katy Rose, a counsellor with UKCP.
To place this in context, we need to look at the main approaches. Broadly speaking there are three main types of therapy: psychodynamic, humanistic and cognitive behavioural.
Psychodynamic is interested in your childhood and past experiences, which may play out in your relationship with your therapist. This is called 'transference'. So, for example, say you were a self-centred, attention-seeking, brattish child and you're now 25 and in therapy, you revert to that behaviour. “The therapist, instead of taking it personally, knows it's good stuff to work with; it's present in the room and you can look at it and try and change it,” says Phillip. There is also a term called countertransference where the therapist makes use of the feelings they have towards you in response to your behaviour. “So if you're incredibly difficult and brattish,” Phillip continues, “they then might want to say to themselves 'I wish I could smack this person around'. A trained therapist knows how to use that so they say, 'if I'm feeling this maybe this is what most people feel with this person. Maybe I can work with that and get some adjustment there'.” This is all about our unconscious mind driving our behaviour, those hidden motivations we aren't able to put into words.
Humanistic – also described as person-centred or person-driven – is about an authentic relationship between the client and the therapist. The therapist, whatever their personal misgivings, tries to accept the client wholeheartedly regardless of how they are behaving or feeling. A humanistic psychotherapist will be aware of transference and counter-transference dynamics but will not necessarily work with it directly. Humanistic therapy isn't concerned with childhood much although it may look at that. It's more concerned with what's in the room - the 'Gestalt' - which is a German word meaning 'the reality between us'. It's about how you feel about your therapist and accessing the here and now. The humanistic approach is used a lot in marriage guidance and relationship counselling.
Cognitive Behavioural Therapy (CBT) is very distinct from the other two approaches. It isn't concerned with what caused your problem, your history, your childhood or your unconscious mind. It looks at what you do to maintain your problems. Your 'cognition' is literally what you think and it drives your behaviour. So, for example, a client might say “my boyfriend dumped me, nobody can love me,” and she doesn't go out, so she never meets new people, removing any potential of having another relationship. The therapist would challenge that belief to see what evidence there is for its truth. She would then only have to fi nd one person who loves her to prove it is not true. The truth is that one person has left her and that has made her feel terrible. It doesn't change her potential to have other relationships. CBT therapists may use a method of trying to measure your feelings by getting you to record on a scale of one to ten how strongly you are feeling them. The government loves CBT because it claims to be 'evidence-based'. It is very measurable and works well at combating the negative patterns of thinking in depression. It is available on the NHS (because it's also cheap and quick) although only if your symptoms are not too severe and you're not too old. The depth of CBT you get can be limited, however, and it doesn't always fi x the problem on its own. Many therapists find it useful in conjunction with other techniques. “Common sense says that every therapist, whatever their approach, would use some aspect of CBT,” says Phillip.
The reasons for seeing a therapist may determine whether you see a counsellor or a psychotherapist. Traditionally, counselling is aimed at a specific problem or crisis point: relationship issues, a bereavement, a drug or alcohol problem or an eating disorder, for example. The therapy can be brief with weekly or fortnightly sessions over a period of weeks or months. Psychotherapy looks at the patterns and behaviours underneath that make up the whole person. It's an in-depth way to address your whole life. The relationship between the therapist and client is paramount: change relies on a deep level of trust built up over time. It continues for years and can be several times a week.
However - yet again - there are exceptions to this distinction. It stands to reason that if you find your counsellor helpful then you will want to go back to them because you have a relationship with them and they know some of your history. Or you may find that the issue you started with uncovers deeper-rooted issues. “Counsellors are just as good at looking at fundamental causes of problems as anybody else,” says Phillip. Some psychotherapists also work short-term and less intensively.
There are many different schools and methods of counselling and psychotherapy. The broad definitions below are of the most common types of therapy practised in the UK today.
• Body/Biodynamic Psychotherapy
A holistic approach that pays attention to what the client feels in their body which could be through posture, gestures, breathing, pain etc. Uses massage, emotional expression, breathwork and body awareness exercises.
This is a transpersonal therapy; working with the concept of a 'higher self'. Meditation and visualisation are often used for self-discovery and it is often offered alongside hypnotherapy, dreamwork, breathwork and soul retrieval.
• Transactional Analysis
A model for understanding our personality, how we relate and our patterns of behaviour. Interested in how we replay childhood strategies that are causing us pain: games we play and parent-child relationships. Integrates psychoanalytical, humanistic and cognitive approaches.
This is based in philosophy and looks at everyday problems in the context of the individual within their relationships and the world. By looking at challenges from these contexts you uncover new choices to overcome them. Some humanistic approaches have roots in existential practice.
• Mindfulness / Core Process
Developed from Buddhist practice, this simple meditative practice focusses on thoughts, breathing and stretching, teaching inner stillness and being in the present by acknowledging your thoughts and letting them go. Can be practised by anyone, anywhere, in as little as three minutes. Excellent for stress management, anxiety and depression. Improves memory and concentration. You may come across cognitive therapies that use mindfulness or Core Process.
A popular existential/humanistic approach, focuses on what you have brought into the room. Looks at the patterns you are following or communicating in the moment - often through your body language - and how they relate to your past. Conflicts can be addressed through direct dialogue to a cushion or chair. representing other people
Meaning 'beyond the personal', this evolved out of the humanistic approach. Strips away definitions of 'self' such as age, gender, culture, appearance etc and looks at the person at the centre. Working from a holistic, spiritual point of view, beyond the ego.
• Dance Movement Therapy (DMT)
This approach assumes that we express our inner feelings in how we hold and move our bodies. The client explores their feelings through physical movement, with expert support and creative input from trained dance movement psychotherapists. No dance experience necessary! The process is used to facilitate emotional, physical, social, mental and spiritual growth.
• Art, Drama & Music Therapy
The client uses art media – drawing, painting, sculpting etc – to express their emotions. Good for those who find verbalising their emotions difficult. Drama therapy and music therapy are related types of creative psychotherapy which enable clients to experience insight, healing and growth through playing and exploring their imagination. All dramatherapists, art and music therapists must register with the Health Professions Council.
• Equine Assisted Psychotherapy
Horses do not respond well when you're carrying emotional baggage. The client develops an authentic relationship with a horse, and releases their baggage. It's good for trauma, addiction, eating disorders, social exclusion. Works well with teenagers, groups, learning difficulties and those who have not found solutions with talking therapies.
LEAP www.leap-etc.co.uk 0776 0776500
For more info on definitions or to search for a therapist near you, visit:
• British Association of Psychotherapists: 0208 4529823, www.bap-psychotherapy.org
• The Harbour: offers psychodynamic therapy for people suffering from or affected by life-threatening illness. www.the-harbour.co.uk
• Rightsteps Bristol: 0117 943 1111. NHS. Basic CBT therapy, referral through GP or self-referral.
Written by Hannah Latham, illustration by Kate Evans
First published issue 68, spring, mar-may 2012
Disclaimer: Details correct at time of printing but may now have changed.
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