By Brian A Martin Counsellor, Mediator & Personal Coach
Face to face therapy is best, but telephone counselling is also available if for some reason you cannot visit a Counsellor.
It is important to have confidence in the Counsellor you choose. If, after the first session or two, or at any time later, you find that you do not have faith in the Counsellor's ability to help you, you should seriously consider changing. Research has shown that the most important single thing in successful therapy is the relationship between the therapist and the client. There are plenty of Counsellors to choose from – I suggest that you only stick with the same Counsellor if you have faith in that Counsellor.
If the Counsellor appears to resent any of these questions I suggest you look elsewhere.
There is a kind of magic in being able to open one's heart to another person and be listened to, understood, not judged; in being listened to by someone who will work hard to understand things from your point of view, and who will value you.
From the moment we are born we are learning how to survive and cope with life. Thousands of childhood incidents and experiences combine to build a sort of 'Map Of The World' which is imprinted in our subconscious mind. The content of this 'Map' is unique to each of us, our guide to responding and coping with life: a sort of personal view of reality made up of our personal beliefs about what's right, what's wrong, what's good, what's bad, what's allowed, what's not allowed, what's safe, what's not, and so on.
Our 'Map' holds all of our beliefs about ourselves, the world, and others. This 'Map' guides us in handling and experiencing every situation we are faced with. As we grow older the 'Map' gets added to by continuing experience of life. Sometimes the additions are helpful, sometimes unhelpful.
Unfortunately our 'Map' is always incomplete with key pieces of information missing and some incorrect conclusions drawn about ourselves, the world, and others. We are unaware of the flaws in our 'Map'.
The impact of trauma - When life's crises come along even a robust and helpful map may become damaged. Trauma shatters some of our assumptions, destroys part of our map, and leaves us needing professional help to recover and make sense of things.
The objectives of counselling - What all the recognised approaches to counselling do, in often diverse ways, is help us cope with our circumstances, deal with trauma, solve problems, overcome faulty and unhelpful thinking and complete 'unfinished business' from the past.
Why two people can suffer apparently similar experiences and one will need counselling help and the other not. - Some of us have a map of the world which is robust and helpful, holding mainly positive beliefs about self, others, and the world. A positive map helps us generate lots of options, gives the capability to generate lots of ways to resolve problems.
For others the map is self limiting and unhelpful, holding beliefs which damage self esteem, cause communication [and therefore relationship] problems, and provide low ability to cope and solve problems.
Although all counselling approaches have the same objectives, how they set out to achieve those objectives varies a lot. The difference in approaches ranges from the empowering therapeutic relationship of Person Centred counselling through to the confronting of unhelpful thinking by Cognitive therapists: from the analytical approach of the Psychodynamic counsellor through to the coaching of new behaviours used by Behavioural therapists.
Some approaches are low in intervention e.g. Person Centred Counselling whilst others, specifically Transactional Analysis [TA] and Neuro Linguistic Programming [NLP ] are high in intervention.
The story of Alan later in this chapter, illustrates some of the differences in approach.
Whatever kind of help you need there are plenty of people available to help you. Below is a list of helping organisations for different kinds of problems.
If you feel that you need counselling or psychotherapy it is a very good idea to consult your doctor first. Your doctor may be relied on to maintain confidentiality and will tell you about any free treatment which is available. He or she may not know a lot about counselling and psychotherapy but will be able to guide you towards local organisations with appropriate expertise.
Regrettably you may find that the waiting list for local NHS counselling/ psychotherapy treatment is long and the number of sessions limited. You may decide to face the costs of private treatment paying £25 - £50 for a one hour session. It would be good if a friend is able to recommend a therapist they have satisfactory personal experience of.
For a comprehensive list of Counsellors and Psychotherapists [and local organisations providing free counselling] look in Yellow Pages under 'Charitable & Voluntary Organisations' and 'Counselling & Advice'. Yell.com is also superb and very easy to use – just type Yell.com in the internet address box then follow the simple instructions on the screen.
When you look at Yellow Pages you will find a bewildering array of different sorts of therapists. This is because of the many different kinds of Counselling and Psychotherapy – all of which work best in some situations, but none of which work best in all situations. Some of the different types of approach are discussed later in this chapter.
Towards the end of this chapter you will find a list of some of the main professional bodies each of which will give you a list of therapists in your area.
Alan's story demonstrates how different kinds of problem are best dealt with by a blend of different kinds of response. The strict code of confidentiality which governs my work does not permit me to talk about a real client so I have composed Alan's Story using elements typical of many of my clients.
The first time I meet a new client the main thing I have to do is decide the best way of helping that client. There can be no 'One size fits all' approach since each client is a unique human being and no two clients present with exactly the same issues.
Alan is 47 years old. He is a quiet and private person. Beneath his passive mask he is angry about some things but does not know how to safely express and discharge his anger, so he keeps it buried. He has no appetite for work which he finds boring and where he is put on by people he works with and unappreciated by his boss. He finds it hard to get out of bed most mornings. He also gets very anxious about some situations at work, particularly where there is any possibility of conflict or embarrassment.
Alan is seriously stressed and finds it impossible to relax. The stress seems to be affecting his memory and is making him irritable which is damaging his family relationships. He and his wife are not getting on. He has memories from his childhood which lower his self esteem and self confidence. He had critical and controlling parents whom he could never please. His wife has taken over the role of his critical and controlling parents and berates him constantly. If he tries to argue back she talks over him. He usually finds it easier to keep quiet, say nothing.
Last year his mum died and he has not been able to feel grief for her, something he feels guilty about. His father is now very frail and showing early signs of Alzheimer's. Alan spends a lot of time meeting the needs of his father who is very demanding – often requiring Alan to do things he could do for himself. Alan's father never learned to say 'thank you' and Alan is hurt and resentful that what he does for his father does not seem to be appreciated. His wife criticises him constantly for letting himself be put on by his father and at work.
Not surprisingly, Alan is finding life a real struggle. His doctor says there is nothing physically wrong and wants to put him on tranquilisers but Alan wants to avoid this. Alan is pessimistic about the future He doesn’t have the confidence and self belief to make changes in his life. Even if he did have the confidence and self belief he has no idea how to set about achieving personal change, how to break out from a life scenario he finds so depressing and stressful.
Alan has a real mixture of therapeutic needs which would benefit from the use of several different types of therapeutic approach
Person Centred Counselling is a low intervention approach, high on empathetic listening, and would help Alan a great deal, including his worries about his father's decline in health and in working through the childhood experiences which have caused him to be so passive. Bereavement Counselling would help him handle his unexpressed grief about his mother's death and the guilty feelings he has about not mourning her loss.
Stress Therapy would help develop ways of coping with his stress. Anger Management Therapy would teach him how to deal with situations in which he gets angry and get rid of stored up anger from the past. He could learn deep relaxation and instant calming with Hypnotherapy/NLP. He could also use a Relaxation CD to lower his stress level and to get to sleep at night. Hypnotherapy/NLP could also be used to boost his confidence and help him tackle situations in which he gets anxious.
Assertiveness Skills training would teach him to communicate assertively with his wife and with his work colleagues and to handle specific situations where he finds it difficult to be assertive, to express himself, and to say 'NO'. This would also boost his self confidence and self esteem. Couples Counselling [even without his wife present] would help him learn how to handle his relationship with his partner better, or even decide if he wants to split. Family Counselling would help resolve family relationship problems.
Problems Solving Techniques Coaching could help him switch from worrying about his problems to deciding what to do about them. Life Coaching could be employed to bring hope and renewed enthusiasm for life by developing an inspiring Personal Vision of how the future could be made to be.
Your story, like Alan's, may have a number of different themes, or you may have only one very specific issue you want to deal with. Some therapists, including me, offer a free initial consultation which enables the client to get an idea of the approach likely to work best for them, and the number of sessions indicated. The free initial consultation is usually without any obligation on the client to book paid for sessions.
These are the most common approaches to counselling and psychotherapy
Its not as simple as just looking at the main approach used by the therapist since most therapists nowadays 'borrow' techniques from approaches other than their own main approach. A survey of therapists in America revealed over 400 combinations of approaches in use. However some elements of theory are increasingly accepted by most therapists e.g. the existence of a subconscious mind, the influence of early child development experience, and a self actualising tendency – the tendency to recover and to deliver one's potential.
A growing number of therapists use a combination of techniques from different approaches. For example, my main approach is Transactional Analysis. I blend in techniques drawn from Neuro Linguistic Programming [NLP], Eye Movement Rapid Desensitisation [EMDR], Cognitive Behavioural Therapy [CBT] and Hypnotherapy.
TA came into prominence as a result of the work of Eric Berne on Ego States in the 1950's and 60's. TA introduced the concept that we do not communicate from one fixed position, rather change the way we think, feel, and behave depending on our Ego State at any moment.
'The aim of TA therapy is to empower individuals to establish and maintain autonomy – that is, the ability to feel, act and live appropriately to the here and now, free from restrictive and sometimes dysfunctional beliefs, feeling, and patterns established in earlier life. It is also excellent in working with conflict and communication problems.
TA emphasises a partnership with the client in which both parties agree and clearly state the objectives and methods of the work. The client takes personal responsibility for the aims and outcomes of change.
TA can be used in any field where there is a need for understanding individuals, relationships, communications, and systems. TA is a theory about: Psychopathology, Personality, Communication, Relationships, and Child Development
The Ego States are – Parent, Adult, Child. Only the Adult Ego State relates to the 'Here and Now'. Parent Ego State is conditioned by archaic parental messages from parental figures in childhood. Child Ego State results in a display of archaic behaviours which we learned as children as a means of attempting to get our needs met. We move frequently and rapidly from one Ego State to another depending on the situation we are in and who else is involved.
NLP is the study of the structure of subjective experience: Its about Communication, Language, Modelling Excellence, a Theory of Internal Experience enabling us to understand our own map of the world and work out others Map Of The world so we can relate to them effectively. It was developed in the 1980's by Richard Bandler and John Grinder.
N Neuro - The mind and how we think
L Language - How we use language and how it affects us
P Programming - The strategies use to achieve goals [or not!]
EMDR was the creation of Francine Shapiro in 1987. Nobody knows exactly why it works but it has been proved many times in practice. A change in affect [feelings] about a past experience is achieved by passing two fingers rapidly to and fro about 15 inches in front of the clients face. The client follows the finger movement with his eyes without moving his head and simultaneously hold in mind the situation being worked on. After a number of passes, and sets of passes, the client experiences a change in affect [or regresses to an earlier linked scene which can then be processed]. EMDR has proved very effective in dealing with Post Traumatic Stress.
EFT [Emotional Field therapy] has much in common with EMDR Designated parts of the face and body are subject to tapping whilst repeating a positive affirmation. Eye movement whilst tapping is also a feature. The theory is that the tapping of acupuncture points and energy lines is what produces the changed affect.
'Freudian therapists concentrate on helping their clients to come to an understanding of previously unconscious aspects of themselves' The rest is up to the client!
There are three main Psychodynamic approaches: Freudian, Jungian, and Kleinian. I have concentrated on the Freudian approach, the brainchild of Sigmund Freud (1856 – 1939).
In Freudian theory the id is 'the biological bedrock of motivation containing raw sexual and aggressive impulses. The ego is seen as that part of the personality responsible for co-ordinating internal and external reality. Its main purpose is seen as trying to satisfy the selfish driving of the id whilst keeping us out of danger.
Later, as we grow up, the values of the ego become internalised, become 'reality', and shape the superego. This is the part of us that rewards us with good feelings when we are 'good' and reproaches us when we are 'bad'. Feelings of guilt and low self esteem are evoked when the values of the superego have been contravened'
Freudians believe that psychological disturbance comes from inner conflict between the different parts (force fields) of our personality. Psychological health is to be achieved by bringing the internal conflict into consciousness and learning to deal with it adaptively and creatively.
The main work in therapy is identifying the root causes of the emotional conflict. This is done by finding the hidden meanings in free association, dreams, symbols ' and by identifying avoidances (resistances) , and transferences.
Person Centred Therapy was created by Carl Rogers (1902 – 1987).
Person Centred counsellors believe that all human beings have the capacity for self recovery and that their role as therapist is to facilitate self healing process by providing that the 'right' environment . The 'right' environment is one where the client feels safe, feels that they are not being judged, feels that they are truly understood. The role of the person centered counsellor is to create these conditions in therapy by being empathetic, non-judgmental, and accepting. Unconditional Positive Regard by the counsellor of the client is a key feature of the successful Person Centred relationship.
The therapy is usually protracted The protraction permits the development of the 'right conditions' via the evolution of a trusting, therapeutic alliance between counsellor and client. In stark contrast to the Psychodynamic approaches the development of the relationship with the counsellor as a genuine and congruent partner in the therapeutic relationship becomes centrally important. 'Person Centred therapists do not hesitate to invest themselves freely and fully into the relationship with their clients'
No techniques, interventions, advice, behavioural 'homework' feature. The counselling is about helping release a natural healing tendency.
The term 'Behaviour therapy' was coined originally by Skinner and made popular by Lazarus in 1950. However, the approach of reducing anxiety by exposing the client to a feared situation was written about by Locke as long ago as 1693. Rewards were applied by a captain in the Royal Navy to control prisoner behaviour in 1800. Freud acknowledged the importance of behaviour therapy 'One can hardly master a phobia if one waits to let the psychoanalysis influence the client to give it up'.
Behaviourist believe that all human behaviour, both normal and abnormal is determined by learning, by conditioning. Symptoms are viewed as the product of faulty, distorted, inappropriate reasoning in response to a neutral stimulus i.e. one which would not normally result in such reasoning (such as a phobic reaction to spiders). The foundation of the therapeutic approach is to help the client unlearn the distorted reasoning and overcome the unhelpful behaviour by exposure. It focuses on what happens rather than analysis of internal processes.
Dissatisfaction with the explanation of learned behaviour as the sole cause of problems led Lazarus in 1971 to argue for an approach which introduced cognitive processes – addressing unhelpful ways of thinking. Cognitive approaches stress the importance of each persons perception of events rather than the reality of the event.
In stark contrast to Psychodynamic and Person Centred approaches Behaviour Therapy is focussed on the overt problem rather than trying to uncover the underpinning and unconscious processes leading to the problem/s. The aim is to directly work on behaviour change using homework and practice of changed behaviours. Goals are important. A family member or friend often acts a co-therapist.
The major tools are behavioural analysis, exposure, step by step reduction in unhelpful behaviours, and practice of new behaviours.
If you contact these organisations they will send you more details of their particular approach and a list of local qualified practitioners.
British Association of Behavioural and Cognitive Psychotherapists
tel: 01254 875277 email: info@babcp.com web: http://www.babcp.com
British Association for Counselling & Psychotherapy
tel: 0870 443 5252 fax: 0870 443 5160 email: bacp@bacp.co.uk web: http://www.counselling.org.uk
The Association of Neuro Linguistic Programming [NLP]
tel: 0870 870 4970 fax: 0870 444 0790 web: http://www.anlp.org
Institute of Transactional Analysis [ITA]
tel: 08165 728012 email: admin@ita.org.uk
National Council For Hypnotherapy
tel: 01509 881477 email: admin@hypnotherapists.org.uk
United Kingdom Council For Psychotherapy [UKCP]
tel: 020 7014 9955 web: http://www.psychotherapy.org.uk/find_a_therapist/
Feeling Suicidal - Samaritans O8457 909090 fax 01753 819004
24 hour confidential service for anyone feeling suicidal
e- mail: jo@samaritans.org web: http://www.samaritans.org.uk
Anxiety - Mind [free counselling plus information on mental health]
tel: 020 8519 2122 fax: 020 8522 1725 web: http://www.mind.org.uk
Alcohol - Alcoholics Anonymous
tel: 0845 769 7555 web: http://www.alcoholics-anonymous.org.uk
Bullying - Andrea Adams Trust [Anti Bullying Help line]
tel: 01273 704 900
Child Counselling - Young Minds
tel: 020 7336 8445 email: enquiries@youngminds.org.uk web: http://www.youngminds.org.uk
Childline [For children requiring counselling] tel: 0800 1111
Depression - Depression Alliance
tel: 020 7633 0557 fax 020 7633 0559 email: information@depressionalliance.org web: http://www.depressionalliance.org
Employment Problems - Employment Tribunals
tel: 0845 859 775
Information - Your local Council For Voluntary Service
Will provide a list of organisations providing free help
Panic - No Panic (Organisation for phobias, anxiety, and neurosis)
web: http://www.no-panic.co.uk
Trauma Support - Assist
Help line: 01788 560800 Office: 01788 551919
Four Approaches To Counselling & Psychotherapy - Windy Dryden & Jill Mytton ISBN0415139927
An introduction and overview of some of the main approaches to counselling & Psychotherapy [All quotes in asterisks in this chapter are drawn from this book]
Handbook of Individual Therapy - Windy Dryden ISBN080397843X
An authoritative overview of the twelve key approaches to individual therapy
Thoughts & Feelings - Mathew McKay, Martha Davis, Patrick Fanning ISBN09349860307
The cognitive approach to stress
Counselling For Stress Problems - ISBN080398863X
A multi-modal approach to stress counselling and stress management
Personality Adaptations - Ian Stewart & Vann Joines ISBN187024401X
A Guide To Human Understanding In Psychotherapy and Counselling
TA Today - Ian Stewart & Vann Joines ISBN1870244001
An introduction to Transactional Analysis
Person Centred Counselling In Action - Dave Mearns & Brian Thorne ISBN0761963710
Gives a real insight into Person Centred Counselling
Gestalt Therapy - Frederick Perls, Ralph Hefferline, Paul Goodman ISBN0285626655
A practical insight into one of the main approaches to psychotherapy
Introducing NLP - Joseph O'Connor & John Seymour ISBN1855383446
Psychological skills for understanding and influencing people
Hypnosis In Therapy - HB Gibson & M Heap ISBN 086377170X
A comprehensive range of applications used in conjunction with other therapeutic and medical approaches
The Feeling Good Handbook - David D Burns MD ISBN0-452-28132-6
A global best seller with advice on fears, phobias, panic, self defeating attitudes and much more.
A Therapist's Guide To EMDR Laurel Parnell ISBN – 13: 978 0 393 70481 5
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Email: brian@brianamartin.co.uk