Some approaches are perhaps better suited to certain types of issue or difficulty. This is backed up by research, however, there are still many areas of therapy that have yet to be studied and so we cannot yet say for definite that one approach is 'best' at dealing with something.
My own view is that some approaches are indicated over others according to the circumstances. It seems to me that it is a question of matching the problem/issue and the client's 'preferred way of being' with the therapeutic approach. I'll now try to explain what I mean by this!
Clearly, we are all individuals and we are all different yet, in general, we all tend to prefer one of three main ways of communicating.
Whilst this is a massive oversimplification of the myriad of ways in which we can understand how we relate to the world, there is some truth in the idea that we generally are either a cognitive (thinking) type, an emotional type or a 'do-er'. This simplistic view concerns how we each respond to a situation or, if you like, our preferred way of being. Let's take an anxiety-provoking situation as an example.
Clearly, we all are a mixture of the three yet one 'mode' is normally our preferred 'way of being'.
I'm not saying that I categorise people, yet I recognise that I can engage more readily with a thinker, especially initially, if I communicate on the basis of what they are thinking. Similarly, I can best engage with an emotional person if I empathise with their feelings and with a do-er by talking about what they have done or want to do, or maybe by involving them in an activity within the session.
Matching the Person to the Therapy
There are obviously implications here for therapy to be optimally effective. Psychological therapies likewise tend to divide into cognitive (thinking-orientated) therapies, humanistic (feeling-orientated) therapies and behavioural (doing) therapies. Again, this is a generalisation and of course each therapy will have elements of all three. The client always has to think about things in therapy for example, but thinking about your thoughts and analysing your feelings to see how rational they are might, for example, be emphasised in a cognitive approach whereas giving full expression to your feelings might be emphasised in some humanistic approaches, whilst 'being what you feel' might be emphasised in others.
In response to anxiety, for example, a cognitive therapist might explore with their client the rational basis for their fears. They may invite the client to identify their beliefs about the situation and then subject them to rational scrutiny. They may also look at what beliefs or assumptions the client is bringing to the situation that are adding to their anxiety. There will be an emphasis on gently challenging irrational or unhelpful beliefs. The aim is to help the client to develop greater insight together with more manageable approaches and ways of thinking and acting.
In the same situation, a behavioural therapist might work with the client to develop a gradual approach to facing the anxiety. Slowly, the client learns to be less afraid because they gradually experience more and more of the feared situation until they can cope with it. This is called 'graded exposure'. They also may also help the client to learn new strategies, including behaviours, for coping with fear.
Finally, a feeling-orientated counsellor would perhaps work more broadly with the client to examine their fears in the context of who they are as a whole, perhaps exploring how their whole approach to life, their previous experiences, their own expectations or their relationship with their Self (including expectations 'internalised' from others) was leading them to become fearful. They may also help the client to become more confident by helping them become aware of the full range of their personal resources. Sometimes, fear is experienced when a client is trying to be someone they are not. By being true to themselves and their feelings, clients often learn to approach fearful situations in a completely different way and the anxiety is either removed or made more manageable.
Just as 'thinking orientated people' can arguably be matched to 'cognitive' therapies, 'feeling orientated people' to feeling therapies and so on, it is perhaps also arguable that the 'problems' or issues that clients present with therapy might be categorised into thinking problems, issues with feelings and behavioural problems.
Again, each individual presentation will have an element of all three. Few, if any, problems are purely about thinking or feeling or behaviour by itself. This probably explains why any therapeutic approach, suitably practiced, can be expected to offer some benefits to the client. However, it seems to me that some presentations (problems/issues) are orientated to one of the three 'ways of being' and so might best be helped by a complementary approach.
Obsessive Compulsive Disorder (OCD), for example, is typified by rigid thinking and a compulsion to carry out certain patterns of behaviour, often with a high frequency. Research suggests that a cognitive or cognitive-behavioural approach is most effective - a matching of disorder with solution.
Similarly, in morbid or atypical grief - characterised as an individual being 'stuck' in their grieving process - it is important that the feelings of the client towards the deceased (or lost person/situation) are allowed full expression. My experience suggests that honouring all these feelings and giving expression even to seemingly 'contradictory' or 'inappropriate' feelings helps the client resolve their 'stuckness' and move on.
Honouring your feelings and giving them full expression helps you move towards acceptance of loss. Feeling oriented therapies are often more appropriate here than, say, CBT. Photo: Imagery Majestic
Bereavement counselling can on occasions be a lengthy process in which the client needs to 'work through' their feelings. Analysing the thoughts behind those feelings, irrational and unhelpful as some of them may be, isn't necessarily helpful. Thus, feeling-orientated approaches like person-centred counselling and insight-orientated humanistic therapies like psychodynamic psychotherapy are frequently most helpful here.
These are just two examples. I could cite many more, though I hope these are sufficient to illustrate the point about matching the preferred 'way of being' and the nature of the issue, to the therapeutic approach.
At this point you may be thinking that the best therapy for you is the one suited to your preferred way of being, for example, "I know I can be terribly emotional about anything and everything so I need some of that feeling-orientated therapy."
In part I would agree with you, however, the picture is not complete and your choice is perhaps not fully clear until you have also considered the areas in which you may need to develop, change or grow. To use this same example, an extremely emotional person might feel comfortable in a feeling-orientated therapy like (say) person-centred counselling, because its mode of operation suits their preferred way of being. However, their 'growing edges' (the areas in which growth or change will prove fruitful to them) involve developing a greater capacity for rational thought at times of crisis. This is because highly emotional people may sometimes become so overwhelmed by emotions as to be incapacitated by them. Learning in therapy to deal with problems and cope with difficulties in more rational ways might be more useful to them than knowing exactly how they feel and perhaps even why they feel it. In this example then, some element of cognitive work may be useful, even though the presenting problem and the person may involve great emphasis on feelings. Awareness or insight may be a first step towards useful change but it not enough unless it also leads to some action that leaves us better adapted to live our lives.
The psychotherapist Paul Ware talks about 'Doors to Therapy'. He describes clients as having an 'open door' (the mode they prefer to be in) and a 'target door' (the mode they could perhaps benefit from using more often). In this example, the 'open door' leads to feelings but the 'target door' is thoughts and thinking.
Of course, most clients are unaware of all this when they make their choice of counsellor. This is, in part, one reason for this web site! Even so, it can be hard to gain this insight until you have worked with a therapist for a number of sessions.
It is partly for this reason that a number of therapists will often use an approach which mixes together different types of therapy according to the situation. This is sometimes called 'eclectic therapy' or an 'eclectic approach'. I believe this is certainly a useful approach, however, it is sometimes criticised by therapists who work purely according to one model of therapy and who may feel that their approach, suitably practiced, will get the job done. Purists may also argue that it is important to maintain consistency so that the client can 'navigate' through the work, arguing that different approaches may sometimes contradict each other. Clearly, if the therapist uses one approach one week, tries that for a bit and then changes tack, this can be disorientating for the client. This would be extreme but critics argue that it can happen.
My own view is that to be eclectic as a therapist requires you have to have a good depth of training in each of the approaches you will use and considerable experience overall. Eclecticism is not, in my view, an option for the newly-qualified therapist. The counsellor needs to be experienced to recognise what will be most helpful to the client, at what point. Also, this same experience helps the counsellor to know that therapy often requires time and patience. If the client isn't reporting benefits, this doesn't necessarily indicate a change of approach is needed. Indeed, in some cases, the client may not yet be secure in the therapeutic relationship or feel safe enough to explore what needs to be explored or do what needs to be done.
My own approach to therapy is called integrative. This means that, like an eclectic practitioner, I have brought together a number of approaches to therapy, moulding them into a single working model, but with due regard for any tensions or conflicts between differing approaches.
Over the years, I have studied two theoretical orientations in detail (person centred and psychodynamic) and a number of other types of therapy (cognitive behavioural therapy and gestalt, for example) at a level sufficient to give me a broad-based approach to my work. This enables me to work flexibly, engaging with the client in a way that feels comfortable for them and which will be effective, whilst being able to offer therapeutic options to meet my client's needs. It also enables me to recognise when a referral to a specialist therapist working in a different way to me might be useful. For example, I have undertaken a basic level of training in drama therapy and hypnotherapy. This training does not qualify me to practice this type of therapy yet I know sufficient about the approaches to recognise when they may be useful and I can suggest a referral with the confidence that it will be helpful to them.
Dr Alan Priest, UKCP Registered Psychotherapist provides therapy for anxiety in Huddersfield and Halifax. Contact Me.
Page updated 12 April 2013.