Psychodynamic and cognitive–behavioural approaches to counselling – understanding and implementing the reciprocal nature of the counselling relationship.

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Psychodynamic psychotherapy and Cognitive-behavioral therapy are the most frequently applied methods of psychotherapy in clinical practice (John McLeod, 2008). Psychodynamic counselling focuses on counsellor-client relationship and exploration of immediate and unraveling feelings and relationship dilemmas that creates difficulties in everyday life (McLeod, 2008). The aim of psychodynamic counselling is to help the individual comprehend and understand the reasons for their problems, and interpret these insights so that the individual will have the competence to cope with any future difficulties if they happen to occur again (McLeod, 2008). Contrastingly, the Cognitive-Behavioural Approach – which evolved from behavioural psychology  – follows a more empirical approach based on three key features which are; problem-solving, change-focused approaches to working with clients; a respect for scientific values; and close attention to the cognitive processes through which people monitor and control their behaviour (McLeod, 2008). Looking at how these two different theoretical approaches are implemented in counseling will offer a better insight into the advantages and disadvantages of both approaches and how they have been adapted over the years to overcome such deficits in the field of counselling (McLeod, 2008).

 

Freud saw the human mind as divided into three regions. Firstly, is ‘The id’ (‘it’), a reservoir of primitive instincts and the ultimate motives for one’s behaviour (McLeod, 2008). Furthermore, the id has no time dimension, so it is through repression that powerful memories are stored and trapped there, powerful enough to invoke feelings as strong as when an event first happened (McLeod, 2008). The id is governed by the ‘pleasure principle’, and is irrational (McLeod, 2008). Secondly, is The ego (‘I’), the conscious, rational part of the mind, which makes decisions and deals with external reality (McLeod, 2008). And lastly, is The superego (‘above I’), the ‘conscience’, the store-house of rules and taboos about what one should and should not do (McLeod, 2008). The attitudes an individual has in the superego are mainly an internalization of ones’ parents’ attitudes (McLeod, 2008).

 

Freud’s psychoanalytic methods of treatment had become subject to change and modifications the more they were used by other practionioners of psychoanalytic methods of treatment (McLeod, 2008). Subsequently, due to the broad scope of subdivisions that stemmed from Freud’s work, psychotherapists had a predisposition to call themselves psychodynamic rather than psychoanalytic (McLeod, 2008). Psychodynamicism allowed for counsellors to make similar kinds of assumptions about the nature of the client’s problems and how best these problems could best be worked on (McLeod, 2008). However, the main distinctive features of the psychodynamic approach are that individuals’ difficulties have their fundamental origins in childhood experiences (McLeod, 2008). Subsequently, the individual may not be consciously aware of the true motives or compulsions behind their actions (McLeod, 2008).

 

Although subsequent theorists in the psychodynamic tradition moved the emphasis away from Freud’s focus on sexuality in childhood (i.e. the oral, anal and phallic stage) they would still agree that emotions and feelings that are triggered by childhood sexual experiences can have powerful effects on the child’s development (McLeod, 2008). However, the basic viewpoint that is shared by all psychoanalytic and psychodynamic counsellors is that to understand the personality of an adult client or patient it is necessary to understand the development of that personality through childhood, particularly with respect to how it has been shaped by its family environment (McLeod, 2008).

 

Constrastingly, behaviour modification uses the Skinnerian notion that the individual has repertoire of possible responses available at their disposal – and in any situation, or response to any stimulus, – emits the behaviour that is reinforced or rewarded (McLeod, 2008). This principle is known as operant conditioning (McLeod, 2008). For example, on being asked a question by someone, there are many possible ways of responding and an individual can answer the question, ignore the question, or run away (McLeod, 2008). Consequently, Skinner (1953) argued that the response emitted, is the one that was the most frequently reinforced in the past (McLeod, 2008). Thusly, most individuals will answer a question, because it has resulted in reinforcements such as attention, praise, or material rewards (McLeod, 2008). However, if an individual has been brought up in an environment where answering questions leads to physical abuse and running away leads to safety – then the individual will use previous reinforcement history and run off to safety (McLeod, 2008). Consequently, to help individuals with behavioural issues, this suggested that reinforcing desired or appropriate behaviour, and ignoring inappropriate behaviour, would be of benefit to the individual (McLeod, 2008). If a behaviour or response is not rewarded it will, according to Skinner, undergo a process of extinction, and fade out of the repertoire (McLeod, 2008).

 

Subsequently, both Ellis, the founder of rational emotive therapy, and Beck (1976), the founder of cognitive therapy, began their therapeutic careers as psychoanalysts (McLeod, 2008). Also, they both became dissatisfied with psychoanalytic methods, becoming more aware of the importance of the ways in which individuals thought about themselves (McLeod, 2008). Beck had been practising psychoanalysis and psychoanalytic psychotherapy for years before a patient’s cognitions had an enormous impact on his feelings and behavior (McLeod, 2008). Beck (1976) reported on a patient who had been engaging in free association, and had become angry, openly criticizing Beck (1976) (McLeod, 2008). When the individual was asked what he was feeling, he reported feeling very guilty (McLeod, 2008). Beck (1976) accepted this statement, on the grounds that, within psychoanalytic theory, anger causes guilt (McLeod, 2008). But then the patient went on to explain that while he had been expressing his criticism of Beck (1976), he had ‘also had continual thoughts of a self-critical nature’, which included statements such as ‘I’m wrong to criticize him … I’m bad … He won’t like me … I have no excuse for being so mean (McLeod, 2008). Beck concluded that ‘the patient felt guilty because he had been criticizing himself for his expressions of anger to me’ (McLeod, 2008).

 

Beck (1976) described these self-critical cognitions as ‘automatic thoughts’, and began to see them as one of the keys to successful therapy (McLeod, 2008). The emotional and behavioural difficulties that individuals’ experience in their lives are not caused directly by events but by the way they interpret and make sense of these events (McLeod, 2008). When individuals’ can be helped to pay attention to the ‘internal dialogue’, the stream of automatic thoughts that accompany and guide their actions, they can make choices about the appropriateness of these self-statements, and if necessary introduce new thoughts and ideas, which lead to a happier or more satisfied life (McLeod, 2008). Although Beck (1976) had been a psychoanalyst, he found that his growing interest in cognition was leading him away from psychoanalysis and in the direction of behaviour therapy (McLeod, 2008). He cites some of the commonalities between cognitive and behavioural approaches: both employ a structured, problem-solving or symptom reduction approach, with a highly active therapist style, and both stress the ‘here-and-now’ rather than making ‘speculative reconstructions of the patient’s childhood relationships and early family relationships’ (McLeod, 2008).

 

Similarly, Ellis, who also trained in psychoanalysis, evolved a much more active therapeutic style characterized by high levels of challenge and confrontation designed to enable the client to examine his or her ‘irrational beliefs’ (McLeod, 2008). Consequently, Ellis argued that emotional problems were caused by distorted thinking arising from viewing life in terms of ‘shoulds’ and ‘musts’ (McLeod, 2008). For example, when an individual experiences’ a relationship, in an full on, exaggerated manner, the individual may be acting upon an internalized, irrational belief, such as ‘I must have love or approval from all the significant people in my life (McLeod, 2008).’ Subsequently, for Ellis, a belief like the one above is irrational because it is exaggerated and overstated (McLeod, 2008). A rational belief system might include statements such as ‘I enjoy being loved by others’ or ‘I feel most secure when the majority of the people in my life care about me (McLeod, 2008).’ Thusly, irrational belief leads to feelings of anxiety or depression, if anything goes wrong in a relationship (McLeod, 2008). The more rational belief statements allow the person to cope with relationship difficulties in a more constructive and balanced fashion (McLeod, 2008).

 

To conclude, in practice, psychodynamic counselling involves a form of therapeutic helping that draws on the theories of psychoanalysis, as a means of deepening and enriching the relationship between counsellor and client (McLeod, 2008). Conversely, cognitive–behavioural theory is largely silent on child development, and lacks the person-centred approach of psychoanalysis, but it is historically the most recent of the major therapy orientations, and is perhaps in its most creative phase, with new ideas and techniques being added to it every year (McLeod, 2008).

 

 

 

 

Referencing

 

McLeod, J. (2008). ‘Themes and issues in the psychodynamic approach to counselling’, in Langdridge, D., (eds) Introduction to Counselling, McGraw Hill/Open University Press.

 

McLeod, J. (2008). ‘From behaviourism to constructivism: the cognitive– behavioural approach to counselling’, in Langdridge, D., (eds) Introduction to Counselling, McGraw Hill/Open University Press.

 

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