Counselling Methods

The following descriptions are my personal and specific understanding of a number of different therapy models and are not intended to be definitive. This is just a sample of the many therapeutic models currently used to understand and work with individuals in therapy, and many have common threads.

Many therapies assume that we learn about the world when we are very young, that we learn beliefs and strategies for how to engage with and be in the world in our childhood, and how to survive. These beliefs and strategies can be constructive or maladaptive. When adults are traumatised they can also develop certain responses, beliefs and strategies to survive the event. Therapy can be a way of understanding the strategies you learned to adapt yourself to the situation then, and enable you to update and adapt your beliefs and feelings based on your resources and information now.

Neurobiology explains that you have a part of the brain that is based on instinct, whose main purpose is to protect you from harm. If for whatever reason aspects of your childhood were not safe, your instinctual protective responses can be triggered in the present by something even quite small that reminds you of that lack of safety. This means you are sometimes responding to the past instead of the present, and this can be out of your awareness. Through a process of learning how this is working for you specifically, and learning to engage that part of your brain that can both listen to your feelings and your body responses but also assess reality and problem solve, you can override and change those instinctual responses and update them. You are literally retraining your brain and body to respond differently, increasing your choices so you can improve the quality of your life instead of running on automatic and responding to old alerts with limited resources.

Transactional analysis looks at relationships (transactions), both within ourselves and with others. In particular transactional analysis looks at ‘scripts’: the inner dialogue within an individual, internalised in childhood. These ways of being in the world and thinking about yourself and others have been internalised in your relationships in childhood, when you form a view of the world. This has an impact on your relationships with others and on how you manage your life. The aim of transactional analysis is to unravel these beliefs, internal conflicts and patterns of relating and behaving that are hurting you and help you examine the reality and usefulness of these beliefs and ways of being, updating the strategies for managing life and relationships which you developed in childhood when you had limited resources. The goal is the achievement of autonomy, awareness and the capacity for spontaneity and intimacy: changing both your relationship to yourself and how you relate to others. Part of this process is the growth of the Adult aspect, who can manage all the other ego states, curtail criticism and judgement, and allow spontaneity and authenticity.

Cognitive Behavioural analysis is usually an aspect of any therapy. However CBT focuses its attention on how the way you think leads to specific feelings and then behaviours. It suggests that it is not the situation but one’s thoughts about it that are the problem. CBT suggests you can interrupt unhelpful patterns by interrupting the process at any point: thoughts, feelings, behaviours, but most particularly by changing unhelpful beliefs. CBT also examines faulty and repetitive thinking patterns such as black and white thinking, catastrophizing, all or nothing, which can lead to intense feeling states and make it difficult to make good choices. The aim of CBT is identifying key unhelpful or distressing thoughts and beliefs (perceptions) and their impact on your feelings and learning to interrupt and challenge them in order to change your feelings and resultant non adaptive behaviours and coping strategies. The emphasis is on problem solving and making changes in your thinking and actions, making even small changes in how you think and what you do.

It has to be said, that any therapy has an expectation that you do this and that insight will lead to changes in feelings and behaviours.

However, the latest scientific research suggests it is not possible to ascertain which comes first: thoughts or feelings, although there is no doubt that they are interconnected. Changing the way you feel can enable your thinking to change, changing the way you think can enable your feelings to change. However, you have set up this way of thinking and behaving to help you in some way. Particularly in the case of trauma, if you have symptoms and not memories, it can be harder to change thoughts, feelings and behaviours because of their important adaptive and survival value, and this can require more work on learning to address bodily symptoms and coping strategies.

Dr Marcia Linehan developed DBT which is to provide individuals with more skills and strategies including to manage their feeling states. DBT is used both with individuals on their own and with groups with some different emphases to CBT including focusing on interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, and mindfulness skills. In particular Dr Linehan found that some people’s emotional responses happen faster and at a much more intense level, making it more difficult to interrupt and also to calm oneself so additional skills are needed than those offered by CBT. Building this ability to soothe oneself and regulate one’s emotions is central to healing and being able to understand any thoughts and behaviours that may result.

Somatic therapies have been developing for many years. Some focus on how posture reveals or reinforces patterns of being or interacting such as in the work of Alexander Lowen. Some work with physical catharsis which may enable people to release traumas laid down in the body and being constantly triggered in a body-mind circuit. More recent therapies such as Hakomi or sensorimotor psychotherapy focus on the client’s experience of their body in the present.

In trauma therapy, for example, physical sensations are seen as memories that have not been connected, which is similar to the basis of other, earlier body work therapies although leading to a different method. Sensorimotor strategies work to enable the client to experience being present in their body in sessions, to locate how distress is being experienced and maintained in their body and to learn how to use their mind and body to understand, interrupt and soothe their specific symptoms of distress, so they can then feel safe to process the cause of distress and to build alternative coping strategies.

The aim is to bring into awareness and to integrate your mind and your body experience, to build mindfulness, resilience and the ability to soothe yourself so you can feel safe in your own body. Being present in the body, feeling a sense of mastery in your body instead of feeling out of control, is a necessary step to becoming conscious and leading a conscious, intentional life.

Gestalt therapy focuses on internal conflicts, and also on your relationships. The basic belief is that external conflicts and difficulties in general can also reflect internal conflicts. Gestalt externalises the internal conflict by identifying the different aspects of the conflict and facilitating a dialogue between the two (or more). Therapy is a way to externalise internal conflicts so that the conflicting positions can be examined and understood. The aim is for the person to identify and resolve those conflicts holding them back in their lives and relationships.

Mindfulness is used as an adjunct to many therapies and all good therapists approach therapy mindfully. This means that they are in the present and focused with all their senses on the client and the client’s experience. For the client, mindfulness can be profoundly healing. The experience of being present to oneself and fully aware, at the same time building your ability to step outside of worries and concerns and gain perspective, is something that can be learned with practice, and can lead to a more calm and purposeful life. It is a tool that can be used to regulate emotions, lower stress and build self-understanding and acceptance.

The aim is to bring the attitude of mindfulness into your everyday life, so you can be less reactive and also can be fully present to yourself, your feelings and thoughts.

An infant’s or small child’s world is a world defined by attachment to a significant other(s). Attachments are of life and death importance for the infant, as their survival literally depends on this other. Because of this, early attachments are seen as formative in a child’s world view and their way of relating to others even though such attachments begin before the child acquires language. Other experiences either go some way to repairing or reinforce the early learnings of attachment.

All behaviours have survival value, and as such if they have been laid down in the body through trauma or early disruptions in attachment a person cannot be simply talked out of them. The survival value needs to be explored, respected and understood, before other choices can be made.

Psychodynamic looks at both conscious and unconscious motivations. These are seen to be formed in the family of origin, shaping personality, thoughts, feelings and behaviours and leading to patterns of behaviour and relationships. Psychodynamic therapy uses the client’s history, current difficulties and the therapeutic relationship as a means to enable these conscious and unconscious motivations to be examined and brought to the surface with the aim that they can be understood and examined and that through insight and the resolution of inner conflicts new choices can be made.

The latest neuroscience research tells us how the mind and body work and it is important to include these understandings in methods of therapy so both the brain and body are attended to. This is even more essential in the case of trauma.

The body and emotions can hold trauma (and its impact) without words, even if the events themselves are in memory. It is therefore important to use talking techniques alongside an understanding on how to become aware of and work with the body’s responses, which are often operating out of awareness and need to be brought into awareness to effect change.

Treatment must address the here and now experience of the … past. Thus in the moment, trauma related emotional reactions, thoughts, images, body sensations and movements that emerge spontaneously in the therapy hour become the focal points of exploration and change – Pat Ogden.

Copyright © 2017 All rights reserved.