Counselling is a common form of therapy to help people deal with distress, unhappiness and life difficulties. Counselling is the chance to talk in-depth about your difficulties, along with your thoughts and feelings. You will be able to do so in a safe, non-judgmental and supportive environment. Your therapist will not tell you what to do but rather they will support you to further understand your difficulties. You will also be helped to find ways to work through your existing and future difficulties.
Sometimes the term ‘counselling’ is also used as an umbrella term for all talking therapies.
Cognitive Behavioural Therapy (CBT) is a therapy approach commonly drawn upon for people experiencing various problems. Research suggests it can be helpful for many people with a range of difficulties. CBT is based upon the idea that in all situations three aspects come into play; thoughts, behaviours and feelings and they are all interconnected. If we have difficulties in one of these aspects this can have a knock on negative effect on the other areas. We may then experience a vicious cycle that can become difficult to break.
Together with your therapist you will learn CBT tools to help you to make positive changes to your thinking patterns and behavioural patterns which, in turn, will lead to improvements to the way you feel.
The therapy mainly focuses on problems in the here and now, however, it can be fruitful to explore how past experiences have shaped your thinking and behavioural patterns. For example, a child brought up in an environment where they received little praise from their parents may develop the belief that they are not good enough. The thought “I’m not good enough” may enter their minds frequently in the here and now and may lead to unhelpful behavioural patterns, such as working very hard and allowing themselves little time to rest and enjoy themselves. This can contribute to high stress and anxiety levels.
The guidelines of the National Institute for Health and Care Excellence (NICE Guidelines) recommend Cognitive Behavioral Therapy (CBT) to deal with the following issues:
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CBT References and useful links:
Acceptance and Commitment Therapy (ACT)
Acceptance and Commitment Therapy (ACT) is based on the idea that it is a natural human tendency to want to control and get rid of things that are unpleasant. For example, if you do not like the unpleasant bright orange colour of your living room wall you could just paint it a different colour! As controlling and getting rid of unpleasant things outside of our bodies works seemingly well we tend to apply this same strategy to our inner experiences, such as, unpleasant thoughts, memories, feelings and physical sensations. However, this doesn’t work as well when we try to do this to our inner experiences and it can even have the opposite effect by making things worse. The initial unpleasant thoughts, memories, feelings and physical sensations that we were trying to get away from may come back more frequently and with more intensity. A short exercise can show this paradox in action….
Over the next 30 seconds do your absolute best to NOT think about a pink elephant. Ok…GO!
How did you get on? Often people say that the image of the pink elephant kept popping up in their minds and it is hard to not think about it. On the odd occasion someone may find that they successfully didn’t think about the pink elephant as they perhaps distracted themselves by thinking of something else. BUT if this happened for you, you only know you weren’t thinking about the pink elephant because you were thinking about the pink elephant!
Now, this exercise just involved a pink elephant which most likely has no particular importance in your life. However, imagine if instead of a pink elephant you were trying to get rid of the thought “I’m a failure” or the memory of being criticised as a child or feelings of anxiety or physical pain. These internal experiences are of more importance to us and, therefore, would be even harder to try to push away and get rid of. This paradox is thought to contribute to our emotional struggles.
One way we may try to get away from unpleasant internal experiences is to avoid situations where these may arise. For example, if we feel anxious about meeting new people we may choose to avoid situations where there is pressure to socialise with new people. This may provide some temporary relief as you get away from worrying thoughts and feelings of anxiety. However, did this action help move you closer to what’s important to you in life and make your life richer or has it done the opposite? If we make this decision time and time again – avoid difficult situations to get away from unpleasant internal experiences – life becomes narrower. We get further away from where we want to be in life. This leads to life becoming less fulfilling. ACT suggests that choosing to avoid, leading us to take steps away from things that are important to us, also contributes to our emotional struggles.
ACT proposes that the relationship we have with our thoughts is also key to understanding our emotional struggles. We have a tendency to believe our thoughts and to let them guide our actions. But what if these thoughts are unhelpful and have little grounding, such as “I’m no good” and “others think I’m boring?” Obviously this wouldn’t make us feel great about ourselves. It may contribute to us taking actions that may, again, move us away from where we want to be in life, thus leading to a less satisfying life.
Your therapist will firstly help you to make sense of your struggles by drawing upon the concepts outlined above. They will then help you to learn various concepts and tools to address the things that are keeping your difficulties going.
- You can be helped to identify the things that are important to you in life and goals that can help you take steps towards these. You will learn how to address the obstacles that may get in the way of this. The more you take steps towards things that are important to you the more fulfilling life will be
- Learn to focus your energy on things that you have control of and to let go of trying to control things that you have little or no control of
- Mindfulness/meditation to help you become more present focussed (and give your mind a break from future worries and past regrets), to let go of judgements and to gain more enjoyment from the here and now
- Change your relationship with thoughts, see them for what they are, just thoughts. Learn that they do not need to dictate what you do
- Learn to sit with unpleasant internal experiences by being open to them, give them space and not try to get away from them (which we know would only make them worse!)
These are just some of the concepts and tools that can be introduced in therapy based upon ACT. Therapy will be very much tailored to your needs. ACT is mainly focused on the present, however, you and your therapist may decide it would be helpful to also explore your past and how this has shaped your struggles in the present.
Dialectical Behaviour Therapy (DBT)
Dialectical Behaviour Therapy (DBT) evolved from Cognitive Behavioural Therapy. DBT was initially developed to help people who experience intense emotions, such as those diagnosed with Borderline Personality Disorder. However, research also suggests DBT can be helpful for a range of mental health difficulties.
Dialectics is the main theory that underpins DBT. Dialectics is the theory that opposites, such as change and acceptance, balance each other and co-exist. In DBT the therapist and individual explore ways to make good changes to improve situations and relationships. You will be helped to find ways to manage difficult emotions whilst also accepting situations and tolerating difficult emotions.
In DBT four key areas are focussed on:
Emotional Regulation: This involves learning various strategies to manage difficult emotions.
Distress Tolerance: This involves learning to accept difficult emotions by sitting with and tolerating them as opposed to trying to get rid of them.
Mindfulness: This involves being more present focussed and letting go of judgements which can help foster acceptance.
Interpersonal Effectiveness: This involves understanding difficulties individuals have in interpersonal interactions and learning ways to improve these interactions to improve relationships.
Cognitive Analytic Therapy (CAT)
Cognitive Analytic Therapy (CAT) integrates elements of cognitive therapy and psychoanalytical therapy. CAT is highly collaborative and encourages you to take an active role in therapy.
CAT explores how chain of events, thinking, feelings and motivations lead to the development of problems and how they are maintained. Together with your therapist you will explore how early experiences are influencing current problems. For example, a child who has been neglected and abandoned may in their adult life be vulnerable to feelings of abandonment and may even come to neglect themselves. You will then be helped to understand the implications of such experiences and the impact that they have on current problems. It is beneficial to reflect upon your current coping strategies to such problems, to learn new coping strategies, problem solve and make changes to address current and future problems.
Psychoanalytic or psychodynamic therapy is based on the premise that problems are rooted in thoughts and feelings in the unconscious mind. Therapy involves an in-depth exploration of past experiences and emotions with the aim of bringing them to the surface of the conscious mind. It is believed that this can help alleviate symptoms and distress. Additionally, becoming more aware of internal drives that influence thoughts and feelings in the present moment can facilitate change in destructive behaviours.
On some occasions psychoanalytic or psychodynamic therapy can be delivered over a short duration, however it is usually delivered over a longer period of time. It is well suited for individuals who are interested in exploration during therapy rather than wishing to learn coping strategies.
Schema-Focused Therapy (SFT)
Schema Therapy is a form of therapy that integrates theories and techniques from several therapy approaches, including Cognitive Behavioural Therapy, Psychoanalytic Therapy, Gestalt Therapy and Attachment Theory. It was originally developed to help people with Borderline Personality Disorder. However, Schema Therapy can be helpful for anyone, particularly those with entrenched difficulties.
Schema Therapy is focussed on maladaptive schemas. Maladaptive schemas are self-defeating and long standing thinking and emotional patterns that develop early on in our lives. They contribute to behaviours and ways of relating to others that may be unhelpful and may serve to maintain the schemas. Therapy aims to address maladaptive schemas and replace them with healthier alternatives.
The first stage of therapy is to identify maladaptive schemas. A questionnaire may be conducted to help identify these. Then you are encouraged to spot when the schemas come into action. Lastly, you will be helped to find ways to address unhelpful thinking and behavioural patterns and replace them with healthier ones.
Compassion Focused Therapy (CFT)
Compassion Focused Therapy (CFT) is a form of therapy that draws upon Cognitive Behavioural Therapy as well as elements from other fields, such as neuroscience, Buddhism and developmental psychology. CFT is aimed at those who are often self-critical which involves putting themselves down and being overly hard on themselves. It is believed that self-criticalness underlies many emotional problems, such as anxiety and depression. CFT helps individuals learn to build upon their self-compassion as well as compassion towards others.
The Human Mind
CFT is based upon how the mind works and how it has evolved. It is believed that there are three systems which help us to regulate our emotions:
- Threat and Protection
- Drive or Resource Focused
- Contentment and Soothing
It is believed that if we have faced difficult early experiences we are more likely to activate the Threat and Protection system. This leads our thoughts, feelings and behaviour to be focused on threat, fear and aims to keep us safe. Many years ago when there were lots of real dangers in the world, for example, the threat of being eaten alive by an animal, the Threat and Protection system served us well and helped us to survive. However, we no longer face the same dangers as we did many years ago, yet our brains continue to work hard to look out for and protect ourselves from threat. But this system is activated more than is necessary and this is why humans face emotional difficulties compared to other animals whose brains are less evolved!
The main aim of CFT is to help build self-compassion and compassion for others which can help to develop the Contentment and Soothing system.
Person-centred therapy is based on the premise that all individuals have the ability to reach their potential and to lead a more fulfilling life. The therapist avoids taking the lead in directing the course of the discussions but rather you take the lead in the process of self-discovery. The therapist helps you to understand your experiences and to find your own solutions whilst adopting a compassionate, non-judgmental and empathic approach.
Person-centred therapy suggests that there are three key factors that are needed to facilitate growth within individuals:
- Unconditional positive regard: this means the therapist will be accepting, respectful and non-judgmental of individuals particularly in how they respond to situations and recognise they are doing their best
- Empathy: the therapist will show empathetic understanding of individuals’ difficulties from the individuals’ perspective
- Congruence: this means the therapist does not hold authority but instead is genuine, honest and transparent
Who is Person-Centred Therapy For?
Person-centred therapy can be helpful for anyone who wants to gain a deeper understanding of themselves, who wants to develop their confidence and wishes to work towards their potential. It is well suited for individuals who prefer the freedom to talk in a supportive environment rather than to be introduced to specific coping strategies.