Pluralistic Counselling and Psychotherapy

Mick Cooper,John McLeod

• Publisher: SAGE Publications Ltd
• Year: 2010
• ISBN:
  9781446259818
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

Mick Cooper and John McLeod pioneer a major new framework for counselling theory, practice and research - the ?pluralistic? approach. This model breaks away from the orientation-specific way in which counselling has traditionally been taught, reflecting and responding to shifts in counselling and psychotherapy training.

As accessible and engaging as ever, Cooper and McLeod argue that there is no one right way of doing therapy and that different clients need different things at different times. By identifying and demonstrating the application of a range of therapeutic methods, the book outlines a flexible framework for practice within which appropriate methods can be selected depending on the client?s individual needs and the therapist?s knowledge and experience.

This is a must-read for anybody training or practising in the counselling or helping professions - it should not be missed!

1	Introducing the Pluralistic Approach

This chapter discusses:

• The rationale for the development of a pluralistic approach to counselling and psychotherapy.
• The development of ‘schoolism’ in the counselling and psychotherapy field and its limitations.
• The development of integrative and eclectic approaches.
• The basic assumptions and framework underpinning the pluralistic approach.

From Schools to Schoolism

Since the first days of psychoanalysis, the psychotherapy and counselling world has been characterised by the emergence of divergent schools of thought and practice. ‘Over the years’, write Duncan, Miller, and Sparks (2004: 31), ‘new schools of therapy arrived with the regularity of the Book-of-the-Month Club’s main selection.’ Today, it is estimated that there are more than 400 different types of therapy (Norcross, 2005), offering a vast array of practices, techniques, and understandings of mental distress.

Within the United Kingdom, most practitioners adhere to one or other of these schools, and single orientation approaches remain the predominant way of practising, commissioning and thinking about the therapeutic field. In the British Association for Counselling and Psychotherapy (BACP), for instance, less than 25% of therapists are trained in an integrative approach (Couchman, 2006, personal communication), and the UK Council for Psychotherapy (UKCP) has recently restructured along orientation-specific lines. An orientation-based conceptualisation of counselling and psychotherapy is also evident in recent moves – both within the UK and internationally – towards ‘evidence-based practices’, in which highly specific, manualised forms of therapeutic intervention are recommended for specific psychological ‘disorders’ (e.g., Department of Health, 2001). As a consequence of this, trainings for such initiatives as the Improving Access to Psychological Therapies programme in the UK are almost entirely orientation-based, with trainees schooled in very specific manualised treatments for specific psychological problems.

Exercise 1.1: Therapeutic attitudes

For each of the following therapies, write down a number from 1 to 7 in the box after it indicating how much you like or dislike it. Try to respond with your immediate gut feeling and try and to be as honest as you can – don’t think too much about it. If you haven’t heard of the orientation, just leave the box blank. Scoring is as follows:

1 = Strongly dislike, 2 = Moderately dislike, 3 = Slightly dislike, 4 = Neither like or dislike, 5 = Slightly like, 6 = Moderately like, 7 = Strongly like

Psychodynamic therapy
Person-centred therapy
Cognitive-behavioural therapy
Gestalt therapy
Integrative therapy
Hypnotherapy
Arts therapy
Classical/Freudian psychoanalysis
Pharmacological/drug therapies

Please write down any other therapies that you have a gut feeling of like towards:

Please write down any other therapies that you have a gut feeling of dislike towards:

If there are any therapies that you have given a score of 3 or less to, or stated that you dislike, spend some time (maybe 10 minutes) thinking why you have come to feel that way towards them. Is it something to do, for instance, with your personal experiences of that therapy, the practitioners of that therapy you have met, or what you have come to associate that therapy with?

Now take some time (maybe 10 minutes) thinking about why you like the therapies that you do.

Finally, ask yourself the following questions (maybe 10 minutes):

• Can you think of ways in which the therapies that you dislike may be helpful to some people?
• Can you think of ways in which the therapies that you like may be unhelpful to some people?

Without doubt, the emergence of specific schools within the psychotherapy and counselling field has done much to foster growth and creativity within the field (see Samuels, 1997). We are now in a position where clients have a vast diversity of practices to choose from, and where forms of therapy are constantly developed and refined to be of as much benefit as possible to clients. And yet, there is also the danger that the existence of schools can tip over into an unproductive ‘schoolism’: ‘characterized by binary thinking (i.e. “This”, against “That”),’ where, ‘those immersed in schoolistic attitudes are likely to defend passionately the “truth” of their own school and attack with vigour the “error” of rival schools’ (Hollanders, 2003: 277–278). In other words, rather than practitioners of different orientations respecting and valuing the others’ work – as a heart surgeon might do to a paediatrician – a tribalism emerges that is more akin to rivalries between supporters of different football teams.

Such schoolism can be highly destructive, and this is for a number of reasons. First, such a ‘battle of the brands’ (Duncan et al., 2004: 31) makes it difficult for adherents of any one orientation to learn from, and develop their practice in response to, adherents of other orientations. Second, schoolism can degrade further into an ‘ideological cold war’, with ‘Mutual antipathy and exchange of puerile insults between adherents of rival orientations’ (Norcross, 2005: 3). This can then create a professional environment that is experienced as hostile, unsafe and unproductive by all. Third, and perhaps most importantly, schoolism can lead practitioners to be ‘blind to alternative conceptualizations and potentially superior interventions’ (Norcross, 2005: 3), such that they can end up imposing upon clients less helpful – or actively unhelpful – practices. Ultimately, then, it is clients who are most likely to lose out as a result of schoolism – people who, as the research shows, do not tend to be particularly interested in the therapist’s ‘brand’ (Binder, Holgersen & Nielsen, 2009). As the philosopher William James writes (1996: 219), ‘It is but an old story, of a useful practice first becoming a method, then a habit, and finally a tyranny that defeats the end it was used for.’

Box 1.1: Pathways to schoolism

Why is it that schools of therapy can, so easily, deteriorate into schoolisms? Interestingly, perhaps, many of the theories developed in these schools, themselves, can help us to understand this transition. For instance, in person-centred theory (Rogers, 1951, 1959), it is hypothesised that people tend to form, and then defend, fixed concepts of self (e.g., ‘I am a person-centred therapist’), out of a desire to maintain self-consistency, and out of a fear of how they might be judged by themselves and those around them if they relinquished that identity. Similarly, at the core of CBT is the belief that people tend towards absolutist, black-or-white thinking (Beck, John, Shaw & Emery, 1979), in which all experiences are placed in one of two opposite categories – e.g., ‘This therapy is effective’, ‘That therapy is ineffective’ – rather than acknowledging ‘the complexity, variability and diversity of human experiences and behavior’ (Beck et al., 1979: 15). This emphasis on the tendency to split between ‘good’ and ‘bad’ ‘objects’ is also evident in the psychodynamic theory of Klein (Cooper, 1996). Another way of thinking about the emergence of schoolism comes from an existential perspective, which holds that one of our most fundamental needs is to feel that our lives are of meaning (Frankl, 1986). From this stance, it might be argued that we need to feel that our approach is ‘better’ than others to give ourselves a sense of significance and purpose in the work that we do. To face the possibility that other therapists’ work may actually be more valuable and helpful might be decidedly anxiety-evoking.

Social psychological theories can also be very valuable in helping us understand this shift from schools to schoolism. ‘Social identity theory’, for instance, highlights the way that we instinctively tend to favour our in-group because, by feeling positive about a group we are part of, we feel better about ourselves (Tajfel & Turner, 1979). Research around ‘cognitive dissonance’ (e.g., Festinger, 1957) has also highlighted the fact that, once we make a choice (for instance, to train in a particular orientation), we then tend to feel more positive towards that standpoint, as a means of justifying to ourselves why we made that choice in the first place.

What may also fuel schoolism is a desire – perhaps a basic human one – to have simple, neat, definitive answers to complex questions. In other words, it may be much more satisfying and reassuring for people to believe that the answer to the question: ‘What is of help to people?’ is ‘X’ rather than ‘X and Y and a bit of Z… though for some people it is U and P and possibly Z… but we are not sure…’ As William James (1996: 45) states, this latter, pluralistic worldview – the belief in a ‘messy universe’ – is by no means appealing: ‘It is a turbid, muddled, gothic sort of affair, without a sweeping outline and with little pictorial nobility.’

In discussing this tendency towards schoolism, it is probably important to emphasise also that we are not just talking about cognitive processes here, but about deeply affective and emotional ones. ‘When your faith is disturbed your being is rattled,’ writes Connolly (2005: 93). ‘You react bodily through the roiling [churning] of your gut, the hunching of your shoulders, the pursing of your lips, and the tightening of your skin.’

At the heart of many of these issues, however, may be the fact that the field of psychotherapy and counselling is, in essence, still in a ‘pre-paradigmatic’ state (Kuhn, 1970; Norcross, 2005). The philosopher Thomas Kuhn uses this term to refer to a period in the development of a scientific discipline in which a shared understanding has yet to be reached, and is characterised by ‘competing schools of thought’ that ‘possess differing procedures, theories, even metaphysical presuppositions’ (Bird, 2009). Here, in the absence of any agreed-upon evidence, dogmas are likely to flourish. Moreover, without such certainty, psychotherapists and counsellors may be more likely to experience anxiety and defensiveness in the face of alternative viewpoints and practices.

Integrative and Eclectic Approaches

Since the 1930s, psychotherapists and counsellors have attempted to overcome the problems associated with single orientation therapies by developing more integrative and eclectic approaches (Goldfried, Pachanakis, & Bell, 2005). Growth in this field has been particularly marked from the 1970s onwards (Nuttall, 2008), such that it can now be claimed that an integrative or eclectic stance is currently the most common theoretical orientation of English-speaking psychotherapists (Norcross, 2005), with around 25–50% of American clinicians identifying in this way (Norcross, 2005; Orlinsky & Rønnestad, 2005d). Furthermore, research indicates that many practitioners identified with specific orientations, in reality, tend to integrate into their practice methods from other orientations (see Box 6.1 on page 99). For instance, psychodynamic therapists, on average, have been found to strongly endorse the CBT practice of challenging maladaptive beliefs, while cognitive-behavioural therapists have been found to prioritise the person-centred stance of empathy (Thoma & Cecero, 2009).

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