The Therapeutic Approach in Counselling

“Therapy or treatment is the attempted remediation of a health problem, usually following a diagnosis.” (extract from Wikipedia)

In the context of mental health, therapy has vastly changed over time. Long before the scientific approach to the treatment of mental health prevailed, attempts to discover the underpinnings of the human mind produced a wide range of therapies and theories. For many centuries, the therapeutic approach to the human mind was mostly based on supernatural and religious beliefs.

This approach began to change when Phillipe Pinel, in 1793, introduced his methods in Paris. Pinel believed that switching from a commonly violent and medicine-based treatment to a strictly non-violent and observational approach could produce a better outcome for patients. At this point, the history of the counselling therapy had begun to be shaped.

Therapy in Counselling

The general concept of therapy has its differentiations from the counselling approach to therapy. In counselling, providing therapy does not mean providing a cure to a patient’s illness. Counselling’s general objective is to help improve the client’s quality of life, and in many instances that could mean to simply explore a relationship issue or the perception towards oneself. The varied types of counselling therapies reflect many approaches to solve similar issues – and these approaches can work differently depending on the individual. In order to better understand this concept, we’ve gathered some information about some counselling treatments used nowadays.

Cognitive Behaviour Therapy (CBT)

CBT is an insight-focused therapy that emphasises recognising and changing negative thoughts and maladaptative beliefs. The approach is based on the theoretical rationale that the way people feel and behave is determined by how they perceive and structure their experience. CBT proposes that change comes about by changing the client’s thinking about the situation. Once the client has converted his/her point of view, the problem-perception switches to a clearer context. Some basic concepts within the CBT schools of thought include:

• Arbitrary Inferences: refers to making conclusions without supporting and relevant evidence. This includes “catastrophising”, or thinking of the absolute worst scenario and outcomes for most situations.
• Selective Abstraction: consists of forming conclusions based on isolated details of an event (and ignoring other information).
• Overgeneralisation: a process of holding extreme beliefs on the basis of a single incident and applying them inappropriately to dissimilar events or settings. Personalisation is a tendency for individuals to relate external events to themselves, even when there is no basis for making this connection.
• Labelling or mislabelling: involves portraying one’s identity on the basis of imperfections and mistakes made in the past and allowing them to define one’s true identity.

The Gestalt Therapy

An existential/phenomenological approach based on the premise that individuals must be understood in the context of their ongoing relationship with the environment. Gestalt proposes that change comes about by the client being aware of what he/she is experiencing and resolving the situation. Gestalt promotes direct experience and testing in order to adapt to the environment; express different behaviour; and instigate awareness of action and further responsible recognition of the results. Some basic concepts of the Gestalt approach include:

• Holism: all nature is seen as unified and as a coherent whole, and the whole is different from the sum of its parts.
• Field Theory: the organism must be seen in its environment, or in its context, a part of the constantly changing field.
• The Field-Formation Process: it describes how the individual organises the environment from moment to moment. The figure-formation process tracks how some aspect of the environmental field emerges from the background and becomes the focal point of the individual’s attention and interest.
• Organismic Self-Regulation: The figure-formation process is intertwined with the principle of ‘Organismic self-regulation’, a process by which equilibrium is ‘disturbed’ by the emergence of a need, a sensation, or an interest. Gestalt therapists direct the client’s awareness to the figures that emerge from the background during a therapy session and use the figure-formation process as a guide for the focus of the therapeutic work.

Person-Centred Therapy

Person-Centred Therapy is “an approach to helping individuals and groups in conflict. A clearly stated theory (developed by psychologist Carl R. Rogers), accompanied by the introduction of verbatim transcriptions of psychotherapy, stimulated a vast amount of research on a revolutionary hypothesis: that a self-directed growth process would follow the provision and reception of a particular kind of relationship characterised by genuineness, non-judgemental caring, and empathy.” (Corsini 1995).

In Person-Centred therapy, the focus is on the client. The objective is to achieve progress by self-directed growth, emphasizing on the ‘here-and-now’ of the individual’s life. This emphasis on the present replaces the diagnostic perspective in counselling. Here, individuals are not products of their past experiences – instead, they are able to determine what is right for them (self-diagnosis and remediation). The person-centred approach is intrinsic to most therapies as it aims to establish an affective relationship between client and counsellor.

Solution-Focused Therapy

This therapeutic focus is on exploring the client’s perspective towards a problem. The client is assisted to develop a different perspective towards the future, and through that perspective, work on their current situation. The goal-driven process is similar to coaching – the counsellor’s role is to build initial rapport and then use questioning techniques to direct the process of therapy (in order to enhance the client’s understanding of his/her strengths and successes in already overcoming his/her problems).

The solution-focused approach can be defined in five different stages: describing the problem, developing well-formed goals, exploring for exceptions, end-of-session feedback, and evaluating client progress.