In the beginning…
Since Sigmund Freud put therapy on the map with his psychoanalytic approach, there has been an exponential growth in the different approaches to counselling and psychotherapy. Many of today’s modalities bear little resemblance to the clichéd image of a patient lying on a couch being analysed by a white man in a white coat. For a start, the word ‘patient’ has been replaced by the less medicalised term ‘client’. Furthermore, the advent of Carl Rogers’ Person Centred approach paved the way for a more equal, collaborative therapeutic relationship, with a central belief that although a therapist may be an expert in their field, the client is the expert on his or herself (1)
Spoilt for choice?
For people seeking some form of psychological help, it can be confusing looking at the array of options. For some, their starting point might be topic-based, e.g. anxiety, depression, grief, trauma etc. This makes sense, particularly if you are suffering from a defined common mental health problem. For this reason, many counselling directories and individual websites will list the thematic areas that therapists are trained to work within.
However, another way of approaching it would be from the ‘modality’ – i.e. a particular theoretical model, which will have a rationale that underpins and characterises a certain way of working with the same range of topics, such as anxiety, depression etc. Some popular modes of talk therapy are Person Centred Counselling, Gestalt therapy, TA (Transactional Analysis) and CBT (Cognitive Behavioural Therapy). Even more vogue is the term ‘Integrative’ therapy, which is being widely used by therapists.
A word of caution
At its best, an integrative approach is a knowledgeable and purposeful blend of theories and methods, whereby the therapist would be able to give a rationale for why and how they were working in a particular way. At its worst, the term ‘integrative counsellor’ is a foil for an eclectic or haphazard ‘pic ‘n mix’ approach to therapy, crucially, without the underpinning of a sound theoretical or conceptual base. This can be unsafe. Skilled integrative counsellors, however, can work safely and adaptively with a broad range of presenting issues and mental health topics.
The International Integrative Psychotherapy Association is a professional body, founded by Richard G Erskine and associates (2). It teaches, practises and promotes a model of integrative psychotherapy. Eight philosophical principles form the foundation for the model, which places at its core the importance of relationship. This includes the relationship we have with ourselves, with others and with our therapist. Difficulties in relationships might cause us to adapt in ways that are limiting, and ultimately can cause us to loose sight of our true and spontaneous selves. Integrative psychotherapy in this sense is about a process of self-discovery and becoming whole.
The centrality of relationship
We have seen there is a potentially bewildering array of common mental health problems, and an equally numerous range of therapies. How to make the right match and the right choice?
Clinical and research evidence would suggest the quality of the therapeutic relationship, irrespective of which type of therapy is being practised, is one of the key factors in promoting change, healing and growth. (3)
For sure, it is also generally accepted that certain therapeutic approaches are particularly suited to particular problems, and have an evidence base to support that. Common examples include CBT for depression and anxiety disorders, EMDR for PTSD (4).
However, within any and all of such couplings, the rapport and trust built between client and therapist will outweigh a toolbox of techniques and interventions in influencing the beneficial effects and ultimate success of any therapy.
As a client, therefore, feel free to ask any potential therapist about their trainings and approach. Feel free also, to consult your gut about whether the therapeutic relationship feels like the right fit for you, and your particular needs. There is no one-size-fits-all for therapy, and it is a client’s prerogative to research and select their therapy and therapist with care and discretion.
(1) Rogers, C.R., 2004. On becoming a person: A therapist’s view of psychotherapy. Robinson
(3) CPCAB. 2015. Last updated 12/02/2016. The CPCAB model of helping work and counselling practice. Available from: http://www.cpcab.co.uk/public_docs/cpcab_model (accessed 2018.02.14)
(4) www.nice.org.uk: Common mental health problems: identification and pathways to care. Clinical guideline (CG123) Published date: May 2011. (accessed 2018.02.14)
Loraine is a Certified Integrative Psychotherapist with the International Integrative Psychotherapy Association (IIPA).