Theories of Counselling and Psychotherapy

An Introduction to the Different Approaches

Stephen Joseph

• Publisher: Bloomsbury Academic
• Year: 2010
• ISBN:
  9781350305670
• Edition: 2
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

This authoritative overview of the main approaches to counselling and psychotherapy offers a uniquely concise and systematic framework for understanding and comparing different models of working. Bringing together the philosophical and practical elements of a wide range of psychological therapies, Stephen Joseph examines the assumptions and values that unerpin different understandings of mental distress and the various approaches to psychological assessment and treatment. He sets his discussion in the context of the contemporary drive towards evidence-based practice. This book will be essential reading for students of psychology and all newcomers to counselling and psychotherapy. New to this Edition:
- Offers a uniquely clear and simple framework for students to compare and contrast different therapeutic approaches
- Up-to-date research and new developments in theory discussed throughout
- Strong pedagogy, including examples, tabulated summaries, summarypointsand glossary, makes this a versatileresource for teaching and study purposes

Chapter 1

Introduction

Helen walks into the therapist’s office. The therapist smiles and offers her a seat. Helen sits down and within seconds she bursts into floods of tears. The therapist hands Helen a tissue which Helen uses to wipe away her tears. Slowly, Helen begins to tell her story, and the therapist begins to build up a picture of how Helen feels so tired all of the time, finds it difficult to get out of bed in the morning, is unable to take an interest in things, has lost interest in her appearance, constantly feels like crying, wonders what is the point of it all and has thoughts of taking her own life. Socially, Helen has withdrawn from her family and friends, rarely accepting invitations to go out, behaviour which seems so out of character for Helen. Her friends have always thought of Helen as outgoing and gregarious and are now worried about her, wondering what has caused Helen to behave so differently to the way she usually is with them. Helen’s employers have also warned her about persistent lateness and she is now at risk of losing her job. How should we, as therapists, go about helping Helen with her problems?

Alex tells the therapist of how he finds himself exploding in a rage at the slightest provocation. His behaviour, he says, has cost him his marriage and several friendships. In the latest episode he had been out drinking with his work colleagues to celebrate a birthday, but as the evening wore on he became increasingly irritable and towards the end of the night attacked one of his colleagues, beating him to the ground and kicking him until he was pulled away by the others. Now even his job is at risk as a result of his temper. How can the therapist help Alex to understand his rage and help him find ways to deal with his feelings more effectively?

Tom was driving home one winter evening with his fiancée Sharon. They had been out Christmas shopping in the nearby town. Tom reached down, only for a second, to change the CD that was playing. He looked up just in time to see that the traffic in front of him had slowed. He slammed on the brakes and swerved to avoid the car in front. He remembers thinking how slow everything seemed to be happening. His car rolled over several times, before slamming into a barrier. Other cars behind Tom skidded to a halt, some of them crashing into the back of the cars in front. This was a horrific accident in which Sharon died. That was one year ago. As the anniversary looms, Tom is in a state of high distress. As he tells the story of what happened that night he begins to talk more slowly. His memories and feelings come flooding back. Tom feels like his life has been turned upside down. Every time he hears the music that was playing in the car he is catapulted back to that night. He wakes up in the morning with thoughts of Sharon and he describes himself as crippled by the feelings of guilt that he killed her. How can we help Tom?

Matt is a young man who has worked since leaving school and has several close friends whom he sees regularly. All of Matt’s friends would agree that he has always been someone who seems happy with life, content with himself, and who has a bright career ahead of him. However, in the last few months, Matt’s friends have noticed that he is acting very strangely compared to the way he used to be with them. Matt has taken to spending more time by himself, refusing invitations, and saying that he has important work to do for the benefit of the world. His parents too have noticed that they often hear voices coming from Matt’s room as if he is talking with someone but they know that he is alone in his room. They are becoming increasingly concerned about him. Matt’s parents have suggested that he visits the doctor but Matt refuses to go along, saying that nothing is the matter with him.

Sarah has been working for fifteen years in her job as an estate agent. Although she has enjoyed her work over the years, she has recently turned forty and has begun to long for a more restful and fulfilling way of life. At school Sarah loved art, and always wanted to go to art school. She looks back on her life and wonders where it has gone. She longs to do something different and more personally fulfilling with her life now. She would love to just be able to paint and be more creative but she feels trapped in her job. Sarah desperately wants to find a way to live a life in which she feels free to pursue her creative passions. She is dissatisfied with her life, feels trapped in her job and hates the commute to work every day. She daydreams about just walking away from it all and not going back.

Different therapists will give different answers to the question of how they might help Helen, Alex, Tom, Matt, and Sarah. In this first chapter, the nature of counselling and psychotherapy will be discussed. What is it that counsellors and psychotherapists do that is different from the support we get from family and friends? What is the definition of counselling and of psychotherapy? What are the different approaches to therapy?

The nature of counselling and psychotherapy

Helen, Tom, Alex, Matt, and Sarah are all people whose difficulties in living might lead them to seek help. Of course, the types of problems seen by counsellors and psychotherapists will vary depending on a number of factors, such as whether they are in private practice, work in a hospital, or in a general health practice. Some counsellors and psychotherapists will specialize in seeing clients with particular difficulties. Some will specialize in people who have experienced trauma, others with clients who have problems with eating, or young people in a university setting, for example. In recent years the range of client difficulties seen by counsellors has greatly diversified as the profession has developed. Compared to the late 1990s, more counsellors and psychotherapists now work in psychiatric settings, primary care settings such as General Practitioners’ surgeries, workplaces, schools, and agencies specializing in crisis counselling (Barnes et al., 2008). Also, it is becoming increasingly common for counsellors and psychotherapists to work with clients with more extreme difficulties who would traditionally have been seen by psychiatrists and psychologists.

Of course, often when we are troubled in some way our first port of call will actually be friends or family and not a professional therapist. Friends and family can provide very important resources for us in times of need. Before going on to look at the roles of counsellors and psychotherapists, I’d like to say a little more about this and what makes social support from family and friends different from what professional therapists do.

Social support

In times of crisis we will often turn to our family and friends for help. Barker et al. (1990) carried out a survey of over 1000 adults who were representative of the UK population with respect to age, sex, and social class. They asked: if you had a personal problem, who would you talk to about it? The most frequent answer was partner (68 per cent), followed by a close relative (54 per cent), a friend or neighbour (43 per cent), the family doctor (41 per cent), a workmate (20 per cent), and finally, a religious adviser (17 per cent). Some interesting differences were found between men and women. Men were more likely to seek help from their partner (71 per cent) compared to women (64 per cent). Women were more likely to seek help from a close relative (61 per cent) compared to men (45 per cent), and more likely to seek help from a friend or neighbour (52 per cent) compared to men (34 per cent). Men were more likely to seek help from a workmate (23 per cent) compared to women (18 per cent). But can social support from our friends and family really help?

Depending on the relationship between the people involved and the nature of the problem, social support from family or friends might indeed be sufficient in helping a person overcome his or her difficulties. Certainly, there is now a substantial body of research showing that people who have high levels of social support from friends and family are psychologically healthier than those who have low levels of social support. By social support, what is meant is the provision of emotional or practical aid to a person from others in their social network. Family and friends who are able to provide emotional reassurance, who can help us see things differently, or help us feel valued and esteemed, who are able to provide a loan of money or other practical help if needed, and who are able to offer advice on how to deal with a situation can help us cope with the most upsetting and stressful experiences in life. We know this, not only from accounts of what people tell us, but also from the numerous research studies that have been carried out. In these studies, the researchers have found ways of measuring social support and psychological health, through the use of questionnaires, interviews, or observing interactions between people. They then go on to test statistically whether or not there is an association between social support and psychological health. The results of the numerous studies show that greater levels of social support are associated with lower levels of psychological distress (Cohen and Wills, 1985).

Indeed, social support from family and friends has even been shown to be associated with better adjustment following the most horrific and traumatic events. After the Herald of Free Enterprise disaster – the ferry capsize which took place off the coast of Zeebrugge in 1987 – my colleagues and I asked survivors to complete a questionnaire, the Crisis Support Scale, which measured the amount of support received from family and friends. We found that those survivors who reported having higher levels of social support in the immediate aftermath of the Zeebrugge and similar disasters subsequently fared better than those who reported having lower levels of social support (Joseph et al., 1992; Joseph et al., 1993; Dalgleish et al., 1996). So, if social support from family and friends is so important, why might we need counsellors and psychotherapists? What is it that counsellors and psychotherapists are able to provide that our family and friends can’t?

When our friends and family are not enough

Alex feels that he has alienated his friends through his aggressive behaviour and that he has no one that he can turn to for support. Helen has withdrawn from her family and friends who, although they want to help, feel shut out by her. Furthermore, family and friends are often unable to provide us with the support we need. They might not have the emotional or practical resources themselves to help us deal with our problems. Matt’s family and friends would like to be able to help, but they just don’t know what to do.

Not everyone has people around him or her to provide support. This is most evident, for example, in the case of people who have lost loved ones. Not only have they been bereaved and are in need of social support to help them cope with their grief, but they have also lost their main source of social support. This is the case for Tom. He also feels such shame as he was the driver on the night of the accident and that stops him seeking help from others. He feels others judge him and so he keeps his thoughts and feelings to himself. For those who have lost loved ones, bereavement counselling might provide a very valuable emotional resource which will help them to work through and accept their loss, and to find ways of dealing with their painful feelings.

Furthermore, family and friends might offer us support that we actually find unhelpful. For example, they might offer us advice when all we want is to be listened to. They might encourage us to talk when all we want to do is sit in silence. They might try to stop us crying when all we want to do is cry. In their attempts to be supportive, family and...