Tharapeutic Approaches and Applications
Most therapists utilise an integrative approach towards counselling that combines approaches and methods from a broad range of theoretical orientations as they assist clients through the various challenges of life. To help counsellors come to a better place of integration in being able to “pick” the right approach at the right time, we’ll overview four widely used therapies — and their typical application within the counselling process.
Cognitive Behaviour Therapy
Cognitive-behaviour therapy involves a specific focus on identifying and modifying faulty patterns of thinking through the use of cognitive intervention strategies. Further focus is on behavioural strategies that are designed to activate clients in the environment with a view to effect desired behaviour change.
Distinctive features of CBT:
- Use of homework and outside-of-session activities
- Direction of session activities
- Teaching of skills used by clients to cope with problems
- Emphasis on clients’ future experiences
- Providing clients with information about the course of treatment
- An intrapersonal/cognitive focus
CBT has its origin in behavioural theories however contemporary CBT focuses more on the individual’s cognitive (thought) processes. There are two main contributors to contemporary CBT, Albert Ellis and Aaron Beck.
Applications of CBT: Cognitive approaches have been applied as means of treatment across a variety of presenting concerns and psychological conditions. Cognitive approaches emphasise the role of thought in the development and maintenance of unhelpful or distressing patterns of emotion or behaviour.
Beck originally applied his cognitive approach to the treatment of depression. Cognitive therapy has also been successfully used to treat such conditions as anxiety disorders, obsessive disorders, substance abuse, post-traumatic stress, eating disorders, dissociative identity disorder, chronic pain and many other clinical conditions. In addition, it has been widely utilised to assist clients in enhancing their coping skills and moderating extremes in unhelpful thinking.
According to Seligman (2006) Behavioural Therapy focuses on the present not the past, observable behaviours rather than unconscious forces and short-term treatment, clear goals, and rapid change.
Behavioural therapy had its beginnings in the early 1900’s and became established as a psychological approach in the 1950s and 1960s. At this time, it received much resistance from the current school of thought, psychoanalysis.
The traditional behavioural approach is generally not used as it once was. It has moved towards a more collaborative treatment with other therapies and as such this has meant a more applicable approach (Seligman, 2006). Seligman (2006) has identified five models incorporating the behavioural approach. These models have some similar principles:
- Applied behavioural analysis — Focuses on how environmental events affect behaviour.
- Neo-behaviourism — Focuses on conditioning and learning.
- Social Learning theory — Focuses on the interaction of cognitive, behavioural and environmental factors that affect behaviour.
- Cognitive-behavioural theory — Focuses on how cognitions affect behaviour and implements both cognitive and behavioural techniques.
- Multimodal therapy — Integrates strategies from a wide range of approaches including behaviour therapy.
Applications of the behavioural approach: The behavioural approach can be used in the counselling process to help “clients acquire new coping skills, improve communication, or learn to break maladaptive habits and overcome self-defeating emotional conflicts” (Corsini & Wedding, 2000).
The focus of the approach should be on setting goals in relation to target behaviours (Sharf, 2004). Target behaviours can be anything from stopping smoking, decreasing anxiety provoking situations, learning how to act in a social setting, other interpersonal and marital problems, and prevention and treatment of cardiovascular disease.
Dependent on your qualifications and skill level, behavioural therapy may also be used in the treatment of many psychological disorders including anxiety disorders, sexual disorders, depression, chronic mental conditions, childhood disorders as well as eating and weight disorders (Corsini & Wedding, 2000).
Person Centred Therapy
The person-centred approach was developed from the concepts of humanistic psychology. The humanistic approach “views people as capable and autonomous, with the ability to resolve their difficulties, realize their potential, and change their lives in positive ways” (Seligman, 2006). Carl Rogers (a major contributor of the client-centred approach) emphasized the humanistic perspective as well as ensuring therapeutic relationships with clients promote self-esteem, authenticity and actualisation in their life, and help them to use their strengths (Seligman, 2006).
The person-centred approach was originally focused on the client being in charge of the therapy which led to the client developing a greater understanding of self, self-exploration, and improved self-concepts. The focus then shifted to the client’s frame of reference and the core conditions required for successful therapy such as ensuring the therapist demonstrates empathic understanding in a non-judgemental way.
Currently, the person-centred approach focuses on the client being able to develop a greater understanding of self in an environment which allows the client to resolve his or her own problems without direct intervention by the therapist. The therapist should keep a questioning stance which is open to change as well as demonstrating courage to face the unknown.
Applications of the Person Centred approach: The person-centred approach can be applied to working with individuals, groups and families (Corey, 2005). The person-centred approach has been successful in treating problems including anxiety disorders, alcoholism, psychosomatic problems, agoraphobia, interpersonal difficulties, depression, and personality disorders (Bozrath, Zimring & Tausch, as cited in Corey, 2005). Person-centred therapy has been shown to be as effective as the more goal-focused therapies (Corey, 2005).
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. Solution focused therapists are competency and future focused. They highlight and utilise client strengths to enable a more effective future.
Historically, psychotherapeutic approaches of the early-mid 1900s focused primarily on client pathology and problems. By the late 1950s a moderate shift in practitioner direction was occurring. Therapists were shifting from a focus on the past to a ‘here and now’ approach. Nonetheless the focus on client pathology and problems remained.
By the late 1970s, practitioners, particularly family therapists, were taking note of their own biases. Contextual factors became the focus as clinicians began to challenge traditional pathologizing and power-orientated practices (Bertolino & O’Hanlon, 2002).
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 recognised 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.
Applications of the Solution Focused approach: Solution focused counsellors are more concerned with solutions than how or why a problem originated. For this reason, solution focused practice has a broad application. The solution focused approach can be brief due to its focus on ‘what works’ and its emphasis on action as a significant factor in change. This makes it an approach that can be well integrated into the typically fast-paced lifestyle of the contemporary client.
As such, solution focused therapy has been successfully applied to a variety of client concerns, including drug and alcohol abuse, depression, relationship difficulties, relationship breakdown, eating disorders, anger management, communication difficulties and crisis intervention to name but a few.
In addition, solution focused approaches have been effectively applied to a vast array of client groups, including children, families, couples and mandated clients.