Finding a counsellor that is right for you is not as easy as it ideally should be. Realising you need some support is already a big step, so being faced with the daunting task of finding someone you can trust to understand and help you, makes many of us put the whole thing off.
Recommendations are a good place to start. But, the counsellor that suits your friend may not be the best fit for you. Understanding a bit more about the different frameworks that counsellors apply, and what are important factors in successful counselling, can help you assess if a particular counsellor is right for you.
You might be surprised to hear – and the number depends on whom you ask – there are around thirty different approaches to psychotherapy (Wikipedia lists over a hundred). Each approach applies a theoretical framework to understand people’s problems and interventions to help solve them. Most approaches to individual psychotherapy can be grouped into five broad categories.
Psychodynamic or psychoanalytical therapies
Originating from Sigmund Freud, these approaches view unconscious meanings and motivations – influenced by early childhood experiences – as the driving force behind problematic personality traits and behaviours. These approaches emphasise the use of the therapeutic relationship to uncover and understand these unconscious processes, and subsequent shift these, with the goal of deeper characterological transformation rather than simply a reduction of symptoms. Psychodynamic therapy therefore tends to be longer-term, though some brief adaptations have been developed.
Behaviour therapies
These approaches focus on how learning influences our behaviour, and apply experiential interventions to help people “unlearn” problematic behaviours. An example is systematic desensitisation or exposure therapy for phobias, whereby people are gradually exposed to the feared stimulus in order to overcome their phobia.
Cognitive therapies
The premise behind cognitive therapies is that dysfunctional thinking (thoughts, assumptions, beliefs) leads to dysfunctional behaviours and negative feelings. These approaches seek to challenge and change people’s thinking, and therefore improve their behaviours and wellbeing. In CBT, the therapist has quite a teaching and directive stance and the relationship is not viewed as a mechanism of change. Like behaviour therapy, these approaches tend to be shorter-term and focussed on the specific issues people bring to therapy.
Humanistic-existential therapies
Therapists working with these approaches are influenced by humanistic-existential philosophy that values the capacity of individuals and the meanings they make. A common approach called “client-centred” therapy, views the client as the expert on their own experience and considers that the therapist’s genuine interest and “unconditional positive regard” is what enables change in the client.
Integrative approaches
While some therapists are loyal to a particular therapeutic approach, many draw from several theoretical frameworks to develop their own approach or tailor therapy to the needs of the individual. It’s a good idea to ask a potential counsellor what frameworks most influence their approach, and see if their approach feels right for you.
So, which approach is best?
There is quite a bit of argy-bargy between the different approaches. There is substantial evidence in fact, to support the efficacy of all these approaches, which begs the question – why? The answer may lie in the more recent “common factors” research that has found that the therapeutic relationship and the attributes that the client brings to therapy (including their hope for a positive outcome), account for over 70% of the successful outcomes of therapy.
This of course, doesn’t mean that a therapist’s training is irrelevant. Having a theoretically sound way of understanding a person’s problems, and a skilled approach that suits a client, is an important foundation for a strong therapeutic relationship and for maintaining focus and hope in therapy.
So in short, if you like your therapist, if you trust them and feel accepted by them, if their approach feels comfortable and makes sense to you, then you have a good starting point for successful counselling.