The definitive counselling & psychotherapy guide. Part 1: Types of therapy

Types of therapy

At Relationships in Mind I see both people who have had previous experiences of therapy and total newbies who have never had therapy before. I have come to appreciate how difficult this first step is and how daunting it can be to choose a therapist, especially in London, where there are so many different options.

The fist part in these series will focus on different types of therapies on order to give an idea of how therapies can be different from each other.

**Types of therapy**

It probably makes sense to divide therapies into two categories:

**Skills-based therapies:**

These are based on the idea that the best way to help people is to identify their difficulties and then help them apply certain procedures to resolve them. Cognitive Behavioural Therapy (CBT) is the most characteristic approach here. CBT is based on the idea that thinking errors lead to painful feelings, which in turn lead to unhelpful behaviours that create vicious cycles. In these models, the therapist is more like a teacher, conveying tools and strategies to help clients manage their symptoms better.
For example:

Jon has been diagnosed with social anxiety. When he approaches social situations he thinks “I am not going to be interesting”, “people will think I am weird”. He feels anxious. His behaviour is that he avoids eye contact, overthinks what to say etc.

Thoughts lead to Feelings lead to Behaviours. Behaviours have an impact on what we are going to think and feel next.

Without realising, John comes across as aloof and people find it hard to engage with him. Not to mention that the process of putting so much effort to control how he comes across is anxiety provoking in itself. Because people do not know how ot engage, they keep their distance and John can see that (self-fulfilling prophecy).

CBT has a protocol which is based on the focus of attention. CBT researchers have worked out that this is likely where social anxiety starts; people focus too much on how they come across (behaviour). CBT for social anxiety starts by helping Jon to notice the impact of that behaviour: He gets more anxious when he focuses so much on himself the expense of the environment and other people. Jon employs a number of “safety behaviours” to secure how he comes across. Avoids eye contact, overthinks what to say etc.

The therapist invites him to conduct an experiment: Jon talks about something for a minute, employing all his usual “safety” behaviours. Following that, he tries talking about the same subject again, but now focuses all of his attention on the therapist rather than on himself. Jon will likely realise that he feels less anxious when he doesn’t focus on himself. He can now see the impact his behaviour has on his thinking and feeling (there is a lot more to the protocol than that).

**Relational therapies:**

These include approaches where the “curative” factor is the relationship with the therapist. Examples are psychodynamic or psychoanalytic therapy, humanistic therapy, and existential-phenomenological therapy. These models address the whole person, and the therapist aims to offer a professional partnership that involves careful listening, dialogue, reflection, and interpretation. More importantly the therapist tries to respond in ways that promote understanding and insight. The result is that the client can expand who they are in the therapy situation. Thinking expands and they can share that. Feeling expands and they can share that.

Babies require a relationship to develop. They need another mind that is able to recognize their feelings, respond appropriately, and proportionately. Imagine an infant that is furious, crying, screaming. The “good enough” parent can think about the infant’s mind, and respond in a way that conveys to the baby that they are understood and tolerated. Some babies have had an experience of being abandoned, or punished when they get angry. Human beings never stop needing supportive relationships to help them continue their path to growth and development.

Social anxiety clients like Jon are likely to be understood in a different way from therapists of this tradition. A client like John might be someone who has had experiences where their expansiveness, assertiveness, aggression were shut down. As a result they suppress ordinary human feelings of anger and rage and when they detect the presence of any angry feelings they switch to a hyper-vigilant, self-protective mode o9f thinking that you put one foot wrong and you’ve destroyed he relationship. Because the baby who assesses, with her baby mind, that all this screaming has driven the mother away, will have to suppress her feelings in some way.

A relational therapist will be attempting to provide a relationship in which John can expand. In time, if Jon trusts the therapist, he will show the therapist how afraid he is of his anger, how worried he is that it may drive the therapist away. Eventually he will show you his anger. The good enough therapist will welcome that as any other expression of Jon’s feelings.

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As a Counselling Psychologist I have trained and practiced within both traditions. I believe that there is no size fits all approach. What research appears to indicate is that it is the relationship between the two therapist and client that matters. The therapist’s role is to provide a coherent framework within which the client’s difficulties can be understood. This experience also alone appears to empower clients to revisit their social relationships with a renewed confidence that they will have more experiences of being accepted and understood (Google “epistemic trust” for the geeks).

In conclusion, you may not have to worry too much about therapeutic approach, although it is a good idea to see more than one therapists and get a feel for what approach is more immediately compatible with you are in the world. Then you will expand. I promise.

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In the meantime if you are thinking how wonderfully neutral and even handed this therapist is, I want to see him, get in touch by emailing me at nikos.tsigaras@kensintgoncounselling.com (if you can access High Street Kensington). 07805945233 if you’re old fashioned.