Five Major Approaches to Therapy

[David Baxter PhD]

Key Concepts of Five Theoretical Models
Australian Institute of Professional Counsellors

Some of the major techniques used in counselling and other disciplines (e.g. coaching) are based on the key theoretical models of Behaviour therapy, cognitive behaviour therapy, person-centered therapy (aka client-centered therapy), solution-focused therapy and gestalt.

Understanding each of these therapies' histories, concepts, applications, benefits, disadvantages and processes helps therapists to relate to clients and assist them to develop efficient models for positive change and to cope with life's challenges.

How much do you know about these mainstream therapies? This article provides an overview of the key concepts in each of the approaches.

Behaviour Therapy

• Classical Conditioning is a type of learning when an unconditioned stimulus (UCS) such as food produces an unconditioned response (UCR) such as salivation. If a neutral stimulus such as a bell is then paired with the UCS to get the UCR and this is repeated, the neutral stimulus will create the response of salivation.
  
• Operant Conditioning (or instrumental learning) is the process whereby learned responses are controlled by the consequences (Weiten, 2007). There are two main processes involved in operant conditioning:
  
• Reinforcement occurs when a response is strengthened by an outcome. There are two types of reinforcement, negative and positive reinforcement. Positive reinforcement occurs when a Behaviour is strengthened by a positive reward.
  
• Punishment occurs when a response to Behaviour decreases the likelihood of the Behaviour reoccurring (Weiten, 2007). There are also two types of punishment, negative and positive punishment:
• 1. Positive punishment occurs when an aversive response to Behaviour is used and therefore the Behaviour is less likely to occur.
  2. Negative punishment occurs when something is taken away and therefore decreases the likelihood of the Behaviour reoccurring.
• Social Learning (or modeling) occurs when an individual (or animal) responds a certain way due to having observed the behaviour previously. Social learning is an extension of classical and operant conditioning in that an individual is conditioned indirectly by observing another’s conditioning.

Cognitive-Behaviour Therapy

• Albert Ellis’s Rational Emotive Behaviour Therapy (REBT): Essential to Ellis’s theory is the A-B-C sequence. This sequence describes the relationship between experience, beliefs and reactions. According to Ellis, we experience Activating Events (A) everyday that prompts us to look at, interpret, or otherwise think about what is occurring. Our interpretation of these events results in specific Beliefs (B) about the event, the world and our role in the event. Once we develop this belief, we experience Consequences (C) based solely on our belief.
  
• The role of the counsellor is to dispute the irrational belief (B). Disputing has three parts: detecting, discriminating and debating irrational beliefs.
  
  • Detecting irrational beliefs: They can be detected through the examination of activating events (A) and consequences (C).
  • Discriminating between rational and irrational beliefs: It is deciding whether the belief is irrational or not. A clue to the rationality of a belief is the use of terms such as should, must and ought. Use of such terms often indicates that a belief is irrational.
  • Debating irrational beliefs is a large part of REBT. There are many techniques that can be used to debate irrational beliefs.
• Aaron Beck’s Cognitive Therapy teaches clients to identify faulty patterns of thinking. Clients are introduced to intervention strategies that assist in changing thought patterns and consequently changing Behaviour. Cognitive therapy is founded on the notion that our core-beliefs, thoughts, emotions and behaviours are all inter-connected.
  
• Regularly occurring cognitive distortions can create psychological distress and may lead to depression, anxiety or other difficulties. An examination of cognitive distortions is used in cognitive counselling to assist client in identifying and modifying their maladaptive thought patterns. The process of cognitive therapy is briefly outlined as:
  
  • Identify a client’s automatic thinking
  • Evaluate the automatic thought in terms of:
  • The feeling/emotion it generates
  • Its validity (Is it true?)
  • Apply strategies to modify the thinking pattern

Person-Centered Therapy
The humanistic influence on person-centered therapy: the humanistic approach has been a major influence on person-centered therapy. Person-centered therapists believe that clients are capable and trustworthy and they focus on clients’ ability to make changes for themselves.

• Actualization: People have the tendency to work toward self-actualization. Self-actualization refers to developing in a complete way. It occurs throughout the lifespan as the individual works toward “intrinsic goals, self-realization and fulfillment, involving autonomy and self-regulation” (Seligman, 2006).
  
• Conditions of Worth: these influence the way in which a person’s self-concept is shaped from important people in his or her life. Conditions of worth refer to judgemental and critical messages from important people that influence the way the individual acts and reacts to certain situations. When an individual has conditions of worth imposed on him or her, self-image is often low. Also, if the individual is exposed to overprotective or dominating environments, this can also have a negative impact on self-image (Seligman, 2006).
  
• The Fully Functioning Person is an individual who has “ideal emotional health” (Seligman, 2006). Generally, the fully functioning person will be open to experience, lives with a sense of meaning and purpose, and trusts in self and others. One of the main goals of person-centered therapy is to work toward becoming “fully functioning”.
  
• Phenomenological perspective: The phenomenological approach refers to the unique perception by each individual of his or her own world. The individual experiences and perceives own world and reacts in an individual way. Person-centered therapy focuses on the individual’s own experience informing how treatment will work.

Solution-Focused Therapy
Solution focused therapies are founded on the rationale that there are exceptions to every problem and through examining these exceptions and having a clear vision of a preferred future, client and counsellor, together, can generate ides for solutions. Therapists are competency and future focused. They highlight and utilize client strengths to enable a more effective future.

Solution focused practice emerged with the idea that solutions may rest within the individual and his or her social network. As postmodernism sparked questions about the superiority of the therapist’s position and the idea of a universal truth, the therapeutic relationship began to transform - the client now recognized as the expert in his or her own life. This created a more collaborative approach to counselling (Bertolino & O’Hanlon, 2002) and established a context in which solution focused practice could flourish.

Key concepts of Solution-Focused Therapy are illustrated by techniques, including: basic assumptions; the miracle question; exception questions; scaling questions and; presupposing change.

Gestalt Therapy
Several key concepts underlie Gestalt therapy, many of which are similar to that of person-centered and existential therapy. However, what does differentiate Gestalt therapy from these therapies are some of the ideas added by Perls and associates as well as distinctive therapeutic techniques that will be covered further down (Seligman, 2006). The following are the key concepts of Gestalt therapy:

• Wholeness and Integration: Wholeness refers to the whole person or the individual’s mind and body as a unit rather than as separate parts (Seligman, 2006). Integration refers to how these parts fit together and how the individual integrates into the environment.
  
  Often people who come to therapy do not have these parts fitting together in their environment, Gestalt therapy is about facilitating clients to integrate themselves as whole persons and help restore balance in their environment.
  
• Awareness: Awareness is one of the most important elements in Gestalt therapy as it is seen as a “hallmark of the healthy person and a goal of treatment” (Seligman, 2006). When individuals are “aware”, they are able to self-regulate in their environment. There are two main causes lacking awareness:
  
  • Preoccupation with one’s past, fantasies, flaws and strengths that the individual becomes unaware of the whole picture.
  • Low self-esteem.
• There are three ways people may achieve awareness through therapy:
  
  • Contact with the environment: This is through looking, listening, touching, talking, moving, smelling, and tasting. This enables the individual to grow in his or her environment through reacting to the environment and changing.
  • Here and now: This is the individual is to live in and be conscious at the present moment rather than worrying about the past or the future.
  • Responsibility: This refers to the individual taking responsibility for his or her own life rather than blaming others.
• Energy and blocks to energy: Gestalt therapists often focus on where energy is in the body, how it is used, and how it may be causing a blockage (Corey, 2005). Blocked energy is a form of resistance, for example, tension in a part of the body, not breathing deeply, or avoiding eye contact. Gestalt therapy is about finding and releasing the blockages that may be inhibiting awareness.
  
• Growth Disorders: Growth disorders refer to emotional problems that are caused by people who lack awareness and do not interact with their environment completely. In doing so, people are unable to cope with the changes in their lives successfully and, instead deal with the problems in a defensive manner (Seligman, 2006).
  
• Unfinished business: Unfinished business refers to people who do not finish things in their lives and is often related to people with a “growth disorder” (Seligman, 2006). People with unfinished business often resent the past and because of this are unable to focus on the here and now. One of the major goals of Gestalt therapy is to help people work through their unfinished business and bring about closure.

 

[Daniel E.]

Regarding "here and now" in therapy:

Here-and-now is based on the idea that the client's interpersonal issues will eventually emerge in the therapeutic relationship. A woman who feels betrayed by all her friends and family will probably feel betrayed by her therapist at some time. A man with anger issues will eventually feel angry in therapy. Addressing the material that emerges in the room becomes the focus. Therapy becomes less talking about issues and more working with them as they happen, in the here-and-now.

Yalom encourages therapists and patients alike to take the vulnerable risk of discussing what's happening in the moment, a noticeable shift that often bears fruit.

Yalom On the Here-and-Now - Psychology Today

 

[Daniel E.]

Source: Changing for Good (1994)