Kenya Association of Professional Counsellors

Higher Diploma in Counselling Studies

Title

Compare and contrast the three major theories of counselling: Psychodynamic, Cognitive Behavioural and Person-Centred with reference to relevant literature (3000 words).

Facilitators: Beatrice Otieno

Briggid Muisyo

Student: Albert Muraya

Date: 16th June, 2011

Words: 3097

Final Copy
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Table of Contents

Introduction

This essay will present and contrast the workings of the three major theories of counselling psychology mainly psychodynamic, cognitive behavioural and personcentred. First I will describe what psychology is and what counselling entails, then I will explain why there are different schools of thought around counselling psychology, before introducing each in turn. My discussion will examine the three theories or approaches for a history of the founder and a rationale for why they were led to introducing a new therapy approach and a sketch of the key concepts. Further, I will look at methods and processes employed by each theory, the respective roles played by the therapist and the client and the various situations to which the theory can be applied. Finally I will examine the limitations of the theory and how well it integrates with other approaches. Throughout this paper I will

offer my own view of the issues at hand and in so doing attempt a synthesis of the three theories.

Counselling is a therapeutic and growth relationship process concerned with helping individuals make adjustments to themselves, significant others and the environment in which they live (Hansen et al, 1986). Through the process they are assisted to define goals, make decisions and solve problems related to personal, social, and vocational concerns. The British Association of Counsellors and Psychotherapists (1986) states that the purpose of counselling is have an individual live more fully and satisfyingly. Counselling involves talking with a person in a way that helps that person solve a problem or helps to create conditions that will cause the person to understand and/or improve his behaviour, character, values or life circumstances (Douglas Woods, 2011). This assistance is supplied in the context of a relationship which is structured, disciplined and deliberate, though it may take place informally.

Counselling theories have evolved out of a continuing need to explain and understand human behaviour and development. The different theories have alternative views of human nature and the development of the person stemming often from the early experiences of their founders or developers as well as the socio-cultural context in which they grew.

Key Figures

The most logical way to examine counselling theories is to first look at the various individuals who founded or contributed in the main, to them. The Psychodynamic Theory was first postulated by Sigmund Freud (1856-1939) as Psychoanalysis. In essence he learned, in overcoming his own emotional pain, the dynamics of personality development (Corey, 2000). He developed an interest in hypnosis which was an early precursor of psychotherapy. Born to a Viennese family, he graduated from medical school and became a psychiatrist. His early interest in the workings of the human personality was piqued by patients with physiological symptoms that had no organic cause and who had no conscious knowledge of the origin of their problems. He concluded the cause lay in their unconscious minds and sought to know more about this (Hough, 2000). This led him to develop techniques to delve into the subconscious which have wide application today. He is the seminal figure in the field of psychology and psychotherapy. Freud did not tolerate divergent views from himself and this led his contemporaries and students establishing their own theoretical approaches. These included Alfred Adler (1870-1937) who introduced what he call Individual Psychology in 1911. His primary difference with Freud was on emphasis. Carl Jung, postulated Analytical Psychology he sought a wider basis for development of the personality than Freud. Other figures in the psychodynamic school include Melanie Klein (1882-1960) who developed Object Relations Theory and Erik Erikson (1902-1994) who in devising ego psychology developed his of view of development through the lifespan the Psychosocial Stages of Development.

The Cognitive Behavioural Therapy (CBT) grew from academic psychology whose emphasis was on measurement and testing for vocational as well as educational purposes (Macleod, 2000, pg 31). The theory is really an amalgam of several individual approaches and whose towering figure is Albert Ellis (1913-2007). After practicing as a psychoanalyst for six years (Corey G, 2005), he concluded that it was superficial unscientific and he embarked on a series of experiments on the efficacy of his therapy in which he combined elements of humanistic and behavioural therapies. He called his therapy approach Rational-Emotive and later Rational Emotive Behaviour Therapy - REBT. He was motivated to develop his ideas in response to early challenges of fear of public speaking and fear of rejection by girls; he was able to overcome these fears.

Another central figure in the CBT group of therapies was Aaron Beck (1921). An American psychiatrist trained in psychoanalysis, Beck formed what is now known as Cognitive Therapy (CT) from a failed attempt at empirically validating Freuds notion of depression; that it was anger turned inward. He found distortions in the thinking of the patients under review rather than retroflected anger (turned inward) in their dreams and thoughts (Corsini, R. 1995). Beck overcame childhood illness and adversity and used his experience in overcoming generalised fears and anxiety to develop a natural empathy for others suffering from similar conditions (Corey, 2000).

Person-centred therapy is part of the Humanistic school of counselling. It was founded by Carl Rogers (1902-1987), an American clinical psychologist who found that he was influenced by experiences in his formative years to veer away from the directive

controlling stance of the psychoanalysis in which he had been trained to a more open questioning attitude when working with his clients initially children in an institution for troubled youth he headed. He was also influenced by the scientific validation of behaviourism to conduct his own experiments into the effectiveness of his methods, and was one of the first psychotherapists to record his sessions. The method that he evolved had the premise that the client had answers to their own problems and that he as therapist had to follow the lead of the client. His ideas like those of Freud before him have been adapted by other schools of counselling and are generally accepted as the basis for most therapeutic relationships.

Basic Assumptions and Key Concepts

The counselling theories in question all encompass therapeutic techniques as well as a model of the human personality. Freuds view of human nature was that the human being was controlled by irrational forces and instinctual drives established in childhood whereby people were products of their environment and innate unconscious forces. These instincts serve as a means of survival for the individual where the goal of life is to enhance pleasure and avoid pain. He viewed the human personality as comprising three elements the id, the primitive; the ego, refined by contact with the outside world; and the super ego, representing authority figures. Freud believed that for psychological health, all three had to

be in balance (Hough, 2002). The egos role was to balance the conflicting demands between the id and the superego that led to tension. In order to protect the ego from this negative energy, defence mechanisms develop; these include denial, repression, regression and others. He saw human development through stages denominated by changing awareness and attitudes towards the human sexual organs. Accordingly he devised the notion of libido which refers to the energy of all life instincts. This energy then is the motivation that drives us to the central goal of life which is to enhance pleasure and avoid pain. Later he came up with the death instinct that accounts for human aggression. In his view, these unconscious drives determine how people act (Corey, 2000).

Psychodynamics was further developed by refinements to this basic view of human nature Specifically Jung attributed other drives as being cultural and spiritual through which one found meaning in life. He developed the notion of individuation in which the conscious and the unconscious are harmonised into one whole. He went further and introduced the idea that we inherit elements of our ancestors unconscious the collective unconscious or archetypes which are interwoven with our very own. These different levels of unconscious are given expression in dreams. Melanie Klein developed Objectrelations theory in which psychological development is dependent on the process of separation and individuation (developing a distinct identity) from the primary care-giver. It explains the first three years of a childs life before giving way to orthodox psychosexual theories (Hough, 2002). Eriksons extended the notion of personality development through the lifespan where both sexual and social development happen concurrently in which there is a struggle for mastery and competence by the ego thus Ego Psychology; the

epigenetic principle in human development through which social considerations come into play in the development of the person.

Person-centred therapy is quite distinct from Psychodynamic therapy in that it views human beings as essentially trust-worthy and who have a capacity for solving their own problems, setting their own goals and working towards them with minimal supervision and direction. Rogers saw them as capable of self-directed growth in the right kind of enabling environment (Corey, 2005). The basis of his view is that all human beings (organisms) have a tendency to self-actualisation movement towards greater complexity, interrelatedness and order which leads to full potential and wholeness, what he termed as the fully functioning person. (Corsini and Wedding, 1995). This means that people will be free of anxiety and grow in a constructive way when their environments are supportive.

The third school of counselling psychology under consideration is the Cognitivebehavioural which is comprised of more than twenty distinct therapy methods that are grouped together as having a common approach to problem solving. These include Rational Emotive Behavioural therapy postulated by Albert Ellis and Cognitive therapy (CT) by Aaron Beck. They view human problems as stemming from disturbances in the thought or cognitive processes in which people are disturbed not by events themselves, but by their view of events. Emotions are derived from our beliefs, evaluations, interpretations and reactions to life situations and events, and that changing these will lead to a change in how we feel about things, and consequently how we behave or the actions we take (Corey, 2005).

In summary then, cognitive-behavioural therapy is centred on the present and views psychological difficulties as stemming from the cause and effect relationship between thoughts, feelings and actions whereas, the psychodynamic view of human emotional and relational difficulty is rooted in the past and specifically in childhood, and that achieving present catharsis requires correcting imbalances rooted in the very depths of out psyche our subconscious. Cognitive-behavioural therapy deals entirely with what is conscious and evident to the client. Person-centred therapy is also focused on the here and now, though it departs from the other two in that it regards the human being as self-directed and capable of setting his own goals. Psychodynamic and cognitive-behavioural therapy are both directive and the role of the client is more passive than in person-centred therapy. Finally cognitivebehavioural therapy does not really offer a thesis on the development of the human person, but rather accepts them as they are. Its view of human nature is limited to the immediate problem at hand. Both psychodynamic and person-centred therapy offer rich views of human nature the former sees the human being in developmental terms whilst the latter sees this more in growth terms.

Therapy goals, clinical relationship and techniques

It is useful now to look at the process of therapy offered by all three schools of counselling psychology for their contrasting features. Cognitive-behavioural therapy is directive and persuasive and even confrontive, though it can also be reflective and structured in its approach (Corsini & Wedding, 1995). It is didactic and the therapist takes

the role of a teacher pointing out distorted thinking, helping the client identify and process emotions and practicing new skills by way of role-play.

In cognitive-behavioural therapy there is a heavy reliance on homework assignments and it is very much a skills-based method. The aim of therapy is to distinguish the person from their behaviour and focus on the behaviour so that the client can acquire a more realistic and practical philosophy of life by minimising emotional disturbances and self-defeating behaviour. They learn how to turn dysfunctional emotions into healthy ones whilst achieving universal self-acceptance and universal other-acceptance and begin to see the relationship between their own wellbeing and others. The counsellor provides insight into the clients belief system and irrational or faulty thinking. They help the client modify their cognitions to more useful and sustainable ones, and teach coping skills for future selfmanagement.

Cognitive-behavioural therapy is also solution-focused rather than problem-focused implying that the duration of therapy is determined by the goals set at the beginning. Once achieved, therapy is terminated, and therefore can easily be for just one session.

In person-centred therapy, the client is very much in the drivers seat; they set the agenda, determine the goals of therapy and the therapist takes their cues from there. Therapy aims at bringing to the immediate awareness of the client their inner experiences similar to the psychodynamic which aims at bringing the unconscious to the conscious. Rogers devised core conditions for successful therapeutic interaction that are supplied by

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both the therapist and the client. The former are congruence or genuineness the counsellor being real; unconditional positive regard or acceptance of the client; empathy or understanding a profound interest in the clients world of meanings and feelings (Hough, 2002). There were also client-side attributes that contribute to successful therapy that were essentially feelings about self, namely; self-concept perception of self which improves therapy outcomes the more positive it is; locus of evaluation (or control) where the client get validation from, self or others; and experiencing - how open-minded and willing the client is to new opportunities. The theory states that the more available the six conditions are, the greater the chances that the client will become positive and realistic about self, become more expressive and self-directed, and become more free and open to try new things. Clients grow in maturity and stability which allows them to manage stress better. This is because the source of conflict and problems the divergence between experience and the self-concept narrows reducing anxiety and increasing the ability of the person to adjust healthily to their environment (Corsini and Wedding, 1995).

In person-centred therapy, the client is helped to come to a greater acceptance of those parts of self that they disapprove of, whilst helping them overcome any fear of the therapist they may have. Their view of the world moves from a rigid stance to a more open and fluid one that is flexible and malleable so that they become more accepting of lifes terms, and more resilient to disappointment (Hough, 2002). As self-acceptance grows, the client will shift to an internal locus of evaluation where they depend more on inner feelings and they can trust their instincts better. It is an open-ended therapeutic method in that just

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as with the agenda and goals, the duration is set by the client, and generally tends to run for longer than in cognitive-behavioural.

The aims of psychodynamic therapy are to bring the unconscious into the conscious and to strengthen the ego over the id and superego so that behaviour is based more on reality and less on instinctual cravings (Corey, 2005). Reconstruction of character is the ultimate aim; thus psychoanalysis tends to go on for years. The real distinction from the other therapies is in the role of the counsellor and the therapeutic process. The belief is that if the counsellor makes himself as unobtrusive as possible, then whatever feelings, notions, attitudes etc. that the client projects onto the therapist are the reflections of withheld subconscious material that will be the subject of analysis. A major task in psychodynamic therapy therefore is inferring meanings from what the client is providing and using the data to reconstruct the personality. It is less collaborative than either person-centred therapy or cognitive-behavioural, but there does need to be a therapeutic alliance, and the client needs to understand the process somewhat. The relationship between client and therapist is artificial as the counsellor needs to give as little as themselves as possible.

The contrast between these therapies is clear on the one extreme is person-centred therapy where the therapeutic relationship is the core of the therapy and any healing depends on the efficacy of this alliance. It is relationship as treatment. In psychodynamic therapy the relationship is also key but for different reasons the therapist needs to disappear from the clients radar for maximum effectiveness whereas with cognitivebehavioural therapy the relationship is less critical. The process of building the relationship

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and the significance of this process also differs; in person-centred therapy building insight and achieving catharsis can begin immediately, whereas with psychodynamic rapport must be built first.

Attached to the therapeutic relationship is the question of transference in psychodynamic it is crucial, whereas with person-centred therapy it can be a distraction as well as an important source of information; with cognitive-behavioural therapy it has no role, and when it arises it is dealt with as an irrational belief to be confronted.

Cognitive-behavioural therapy runs for the shortest duration whilst psychodynamic may run for years. Person-centred therapy can take place over a single session, but it more likely runs for a few months to a year or more.

The biggest difference for me is that both psychodynamic and person-centred therapy rely very much on the insight of the client that is he ability of the client to look at themselves as if from outside of themselves in order have an accurate perspective on their condition. This is not necessary in cognitive-behavioural therapy which is centred on the acquisition and application of skills.

Conclusion

These schools of psychotherapy and counselling come from very different persuasions and are inextricably linked to their founders struggles in youth to find

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meaning and purpose in their lives. They are largely contemporaries in that their founders lived in roughly similar decades, with psychoanalysis being the father of them all. Starting as the psychoanalytic, psychodynamic therapy grew out of the reaction to psychoanalysis and its perceived shortcomings that spawned person-centred and cognitive-behavioural therapies. My view is that all these methods are complementary and one can draw from each the concepts of the unconscious and ego defences of the psychodynamic, the relationship base and client respect of the person-centred and the skills and applications thrust of the cognitive-behavioural. My own interest and ambition to be a skilled helper has grown by studying these methods, as I can see that each offers a unique insight into understanding the whole person. None is truly complete by itself, nor can any be discarded as irrelevant or useless.

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Appendix A References

1. British Association of Counselling and Psychotherapy, 1986, Counselling-Definition of terms in use with expansion and rationale (Information Sheet 1), Rugby: British Association for Counselling. 2. Corey, G, (2005) Theory and Practice of Counselling and Psychotherapy, 7th Edition, Belmont: Brooks/Cole. 3. Corsini R.J. & Wedding D, eds, (1995) Current Psychotherapies, 5th Edition, Itasca: F.E.Peacock. 4. Douglas Woods, (2011) What is Counselling http://www.dougwoods.com/counselling.html 5. Hansen, J.C., Rossberg, R.H., Cramer, S.H (1994) Counselling Theory and Process, 5th Edition, Needham Heights: Allyn and Bacon.

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6. Hansen, J.C., Stevic, R.R, Warner Jr., R.W. (1986) Counselling Theory and Process, 4th Edition, Boston: Allyn and Bacon. 7. Hough M, 2002; A Practical Approach to Counselling, 2nd Edition, Harlow: Pearson. 8. Macleod J, 2003, An Introduction to Counselling, 3rd Edition, Buckingham: Open University Press.

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