In this two-part special series we explore what different schools of psychology and counselling modalities tell us about how to help change happen. For the purpose of the series, we’ve divided the world of psychological therapies into 4 main classes: Cognitive and/or behavioural; Psychoanalysis/ psychodynamic/ analytical; Humanistic and; Transpersonal. In Part 1 we explore Cognitive and/or behavioural and Psychoanalysis/ psychodynamic/ analytical approaches.

Who or what is a human being? How we respond to that query has implications for almost everything we do, but in this two-part series, we examine what it means for us as counsellors and mental health practitioners helping clients to achieve desired changes in their lives. Specifically, given what we understand about the nature of human beings, what can the different schools of psychology and counselling modalities tell us about how to help change happen?

Are we human because we think? Descartes’ famous statement, “cogito ergo sum” – I think, therefore I am – would suggest that, if thinking is what sets us apart as human beings, then the psychologies that most greatly help clients change would be those that look at the way they think.
Then again, what about our emotions? If we look at cognition but fail to take feelings into account, are we not missing some vital clues to what is happening for the client, and what might therefore effect change? Yet other counselling modalities believe that they “cut to the chase” by not even attempting to focus on thoughts or feelings. Rather, they say, by changing maladaptive behaviours of clients, the rest will fall into line.

And we cannot ignore those psychologies which insist that we human beings are our behaviour, our emotions, our thoughts, and more. If we don’t look at who is choosing to act, feel, and think, such psychologies say, then we have failed to examine the most inclusive sense of human beingness, and our change efforts have missed the mark.

Not only that, but we must also take into account the capacity – and felt need – of human beings to change through connection to the “something more” or “something larger” than ourselves. That need has spawned the development of transpersonal psychologies which acknowledge that we will not truly understand ourselves until we comprehend our place in the universe: that is, among all other beings and with respect as well to a notion of the “spiritual” dimension.

So we set for ourselves an enormous task, but for the purpose of this two-part series, we’ll look briefly at some of the main therapies of psychology. Specifically,

1. What is it about a counselling or psychotherapy process that makes people change? In other words: what are the mechanisms of therapy?
2. What does the paradigm supporting a given school of psychology assume about the nature of human beings and therefore how they can change?
3. What are the main concepts of a given psychology?
4. Who were famous proponents of the psychology?
5. With what kinds of client issues does a given psychology naturally sit well?

Whether you are a counsellor, psychotherapist, psychologist, psychiatrist, social worker, or simply a lay person with an interest in mental health issues, it is helpful to be clear on what different psychologies assume and what, therefore, they can offer the client and the therapist.

Mechanisms of the therapy

Psychologist Raymond Corsini and psychiatrist colleague Gina Rosenberg searched through 300 articles to identify the critical elements for helping people achieve desired change. They found 220 statements about change and performed a factor analysis on them, identifying nine factors, three each under the umbrella categories of cognitive, affective, and behavioural factors.

1. Cognitive factors: Under the category of change by virtue of helping clients change how they think, there were the factors of:
   1. Universalisation. Clients improve when they realise that they are not alone, that others have similar problems, and that human suffering is universal.
   2. Insight. Growth occurs as clients increasingly come to understand themselves and others and gain different perspectives on their own motives and behaviour.
   3. Modelling. People benefit from watching other people. A client may model himself or herself on the therapist.
2. Affective factors:
   1. Acceptance. This factor reflects the sense of getting unconditional positive regard, especially from the therapist.
   2. Altruism. Change can result from recognising that one is the recipient of the love and care of the therapist or other members of the group or from being the one who provides love and care to others, as well as feeling that he or she is helping others.
   3. Transference. This factor identifies the emotional bond that occurs between the therapist and the client or between clients in a group setting.
3. Behavioural factors:
   1. Reality testing. Change becomes possible when clients experiment with new behaviours in the safety of the therapy session, receiving support and feedback from the therapist and other group members.
   2. Ventilation. This factor speaks to the value of “blowing off steam” through crying, shouting, or other catharsis in an environment in which the person can still feel accepted.
   3. Interaction. Clients improve when they are openly able to admit to the group that there is something wrong with themselves or their behaviour.

In the days when Corsini and Rosenberg did their study, transpersonal psychologies were not as popular as they now are, so they didn’t even have a separate category or factor for those types of change statements. For the purpose of this series, we’ll divide the world of psychological therapies – and there are over 400 known types – into four main classes:

1. Cognitive and/or behavioural
2. Psychoanalysis/psychodynamic/analytical
3. Humanistic
4. Transpersonal

In talking about the different schools, we’ll state who the main proponents or developers are (or were), what some of the chief assumptions and concepts are, and what types of client issues tend to sit well with the modality. We’ll move from relatively narrower paradigms to those which deal more in the fullness of the human being. Of course, not all psychologies fit nicely into these categories.

Cognitive and/or behavioural psychologies

In this group we can include the following:

1. Behaviourism (Ivan Pavlov, B. F. Skinner, and Albert Bandura)
2. Rational Emotive Behaviour Therapy, or REBT (Albert Ellis)
3. Cognitive therapy (Aaron Beck)
4. Cognitive Behaviour Therapy, or CBT (an offshoot of REBT and Cognitive therapy, by Beck and Ellis)
5. Reality therapy (William Glasser)

Counselling schools of the cognitive/behavioural sort tend to claim that how you behave and what you do can be determined by what you believe or the way you think. When clients think in negative, limited, or unhelpful ways, therefore, most of these modalities see it as the therapist’s job to spot irrational language or behaviour and help the client to exchange it for thoughts which are more helpful, less constraining to the client’s life, and more able to generate moderate emotions. Strict behaviourism works with conditioning through rewards and punishment to help the client increase helpful behaviours and beliefs and to extinguish maladaptive ones (through lack of reward).

Therapy using these psychologies is directive and structured. It usually is relatively short term and goal oriented. Tasks are often given to clients in the form of homework in order for them to effect changes in their behaviour which eventually become second nature to them. In the course of examining and changing negative thought patterns, beliefs, and behaviours, clients’ attitudes undergo a re-education. The counsellor is thus an educator, working in collaboration with clients to help them adopt “straight thinking” strategies. The focus is on working with thinking and acting rather than on expressing feelings.

The founder of REBT (Ellis) and the founder of CBT (Beck) were both trained in the tradition of psychoanalysis, but sensed that something was missing in that therapy. Beck went on to notice that his depressed clients used a lot of negative self-talk in reference to their depression and their world view. Thus a client might believe without any evidence, for example, that a particular friend said no to an invitation because she did not like the client, who might then act standoffish or cool toward the friend.

The client would in this case be using assumptions not backed up by truth as a basis for behaviour, which could very well then attract the presumed reality: the friend might – in response to the client’s behaviour – really come to have feelings of dislike. Ellis’ writing has described how clients tend to hold irrational belief patterns that generate strong emotions. “Shoulds” and “musts” were often the basis for these, such as “People should treat me with respect” or “I must have approvals from ____ in order to feel ok about myself.” Such irrational beliefs generally lead to disappointment because the world at large cannot live up to such expectations.

In a somewhat similar vein, reality therapy also seeks behavioural change, but here the reason for changing behaviour is to gain greater need satisfaction. Reality therapists assert that people enter counselling or therapy because something has gone wrong with their lives. They are not fulfilling their needs effectively and thus feel discomfort, anxiety, depression, guilt, fear, or shame. Reality therapy is based on control theory, a system of brain functioning, which states that the human brain functions like a thermostat in that it seeks to regulate its own behaviour (much like an air conditioner) in order to change the world around it.

Adapted to become useful in a clinical setting, reality therapy contends that all human behaviour is motivated by the fulfilment of the same four psychological needs: for belonging, power, fun (enjoyment), and freedom, as well as the physical need for survival. Effective satisfaction of the needs results in a sense of control referred to by other theories as self-actualisation or becoming a fully functioning person.

Reality therapy has been compared to REBT and CBT, and while there are significant differences, all three psychologies share the principle that outside forces do not cause stress, depression, anxiety or other disturbances. Rather, it is the reaction of people to events that causes strong emotion or distress. Too, the therapies overlap in their understanding that a focus on the client’s current life is crucial, and that too much emphasis on the past is not useful.

Cognitive and behavioural therapies are probably the most commonly used therapies for depression, but are also useful when dealing with relationship improvement, skills development, personal empowerment, behaviour change and symptom relief, parent training, relationship counselling, drug and alcohol misuse, stress management and child abusers.

Psychoanalytical/psychodynamic/analytical psychologies

While the behavioural/cognitive traditions have emphasised current thoughts and behaviour patterns as the best option for achieving change, the psychodynamic traditions of Freud, Jung, and the object relations people such as Melanie Klein focus on the importance of two things in order to understand what is happening for a client:

1. Looking beneath the surface of the conscious mind;
2. Examining the client’s early experiences in order to establish the relational template, or pattern, that the client then attempts to put into or onto most significant relationships as a way of healing.

In this stream of modalities, we include the chief psychodynamic therapies:

• Psychoanalysis (Sigmund Freud)
• Analytical psychotherapy (Carl Jung)
• Object relations psychotherapy (Melanie Klein)

(We’ll discuss Psychosynthesis, which is also psychodynamic, in Part Two of this series)

After much clinical observation of his “patients”, Freud established his psychoanalytical/ psychodynamic theory at the end of the 19th century. Often referred to as the “talking cure”, its initial method was cathartic hypnosis. Subsequent techniques included analysing transference, free association, establishing rapport, and dream analysis, through which the therapist hopes to effect change in the client’s personality.

Freud was revolutionary in looking to the unconscious for repressed feelings that needed to surface. His constructs of the three main parts of the psyche: the id (unconscious, instinctual centre of being), the ego (arbitrator and balancer), and the superego (guardian of the conscience, imposing morality onto the process) are core psychology understandings, and all have a role in controlling client anxiety.

Among the Freudian concepts which have maintained a high profile, not only with mental health practitioners but also in lay circles, have been those of the phases of libidinal drives. Before he ever postulated a separate drive for aggression, Freud talked about the Oral, Anal, and Phallic phases. The Oral phase (extending from birth to 18 months) centers on gratification connected with the mouth, orienting people toward taking in what is pleasurable and expelling what is not. The main “danger” in the period is loss of the need-satisfying “object” (meaning: mum and her breast).

The Anal phase, between 18 months and 3 years of age, sees the main source of pleasure from retaining and passing faeces. Thus, an individual comes to learn what is valuable and to be retained, and what should be expelled. The main “danger” here is the loss of love from those who matter. After three years of age, the Phallic phase is in progress, where the main area of libidinal gratification is around the genitals. Penis envy and sexual wishes and fantasies come into being at Phallic, so the chief “danger” of this period is fear of punishment for forbidden sexual and aggressive wishes.

Jung, originally a disciple of Freud, broke away around 1913 to establish a different understanding of the unconscious: specifically, that the mass of unconscious material that humans can access is in the collective unconscious: the universal truths and beliefs that are often seen as archetypes. This material could be accessed via interpretation of dreams, which would allow the client to see his or her problem more clearly, thus leading to healing.

Because Jung believed that opposites were a “precondition” for psychological life, he sought to understand the opposites in a person’s psyche which could only be transcended (and wholeness experienced) through increased awareness. This belief made it natural to posit the notion of psychological shadow – the hidden part of a person – that balanced the ego (the part of ourselves that we are aware of) in the personal consciousness. And there was a role for the persona, or public face of an individual in society. To accept that so much material lay in unconscious realms made it imperative to recognise the importance of transference and countertransference in the psychotherapeutic relationship. Finally, Jung believed that the process of free association (when the client just spoke whatever came into their mind) needed to be a cooperative procedure, with the analyst as well as the patient making interpretations.

Melanie Klein, another disciple of Freud who came to diverge from his thinking, developed what has been called object relations theory (not Klein’s term), the “object” being another person with whom a child is in relationship. The theory suggests that a person’s relationships – from childhood through to adult years – are shaped by family experiences during infancy. In Klein’s theory “objects” are usually internalised images of a primary caregiver, such as mother or father, and may even be parts of a person (such as the breast of a mother, which may be termed a “part-object”). A person’s conception of objects can be re-shaped by later experiences, but objects continue to exert a strong influence throughout life.

In fact, the infant-mother interactions are so intense that they form the focus of the infant’s drives, sometimes provoking anger and frustration, and other times provoking dependence. The infant’s reactions are powerful enough to overwhelm his or her individuality, said Klein, so the manner in which the conflicts are resolved is reflected in the adult’s personality.

Psychoanalytical or psychodynamic work is both directive and long-term. Its slow pace can mean that clients see their therapist, sometimes several times a week, for years; thus it also expensive. Although long-term commitment on behalf of both therapist and client is required, this stream of therapy is good for healing and resolving past issues. Delving deep into one’s unconscious can promote self-understanding and self-awareness, empowerment, and self-actualisation, and open the door to spiritual development.

The proponents of humanistic therapies say that their modalities can also do so – but without the psychoanalytical limitations. We explore humanistic approaches, as well as transpersonal modalities, in Part Two of this series (next edition).

Additional reading: AIPC’s Five Therapies e-Book (PDF)