ABC Counselling ConceptsWeek 6

Therapeutic Models of Counselling

Session Aims

• To introduce and explore three major therapeutic models

• Psychodynamic

• Cognitive Behavioural

• Person-centred

Session Objectives

• Check-in and reflect - speaking and listening• Identify and share some personal philosophies about

helping• Recognise the nature and importance of counselling

theories• Identify the key features of at least 3 major therapeutic

models (unit 1:2.1)• Describe the client issues which could be helped by

the models chosen (unit 1:2.2) • Outline potential barriers to the models chosen (unit

1:2.3)

• Homework: complete the work sheet provided

Personal Philosophies about helping

• Share your answers in small groups.

Personal philosophies about helping

• Where do human thoughts, feelings, behaviours and personalities come from?

• What are causes of human distress?

• How can/do people change?

• What is the best way to help someone?

Counselling Theories

• “All people who counsel operate from theoretical frameworks about how clients become the way they are, how they maintain their problems and how they are helped to change”

• Richard Nelson-Jones• Theory and Practice of Counselling

Why are Counselling Theories Important?

• Providing conceptual frameworks• Providing languages• Generating research• Support the counsellor and client from unsafe or

unhelpful practise

Theories as lenses

• Allport (1962) described working with different counselling theories as like seeing the world through different coloured lenses

Psychodynamic

• In the context of counselling and therapy, the word ‘psychodynamic’ refers to a Freudian approach or to an approach whose origins are firmly rooted in Freudian theory (Hough 2002:13)

The Big Idea

• The main concept which underpins psychodynamic approaches is that our thoughts, feelings and behaviours are governed by processes which are out of our awareness.

• Problems are caused by things which are happening in our unconscious mind.

Some key features, ideas and practices associated with the Psychodynamic Approach

• An analytical approach• Unconscious motivation• Id, ego and superego• Psychosexual (and other) stages of development.• The significance of childhood experience• Connecting the past and the present• Anxiety and ego defence mechanisms• Transference and counter-transference• Working with dreams and symbols• Free Association• Interpretation

The role of the counsellor in psychodynamic counselling is to help the client to recover and interpret significant experience

“If I were to single out one feature which underpins all the method and the theory… …it is the quietly reflective but persistent question: What does it – (this word, that action, this memory, that feeling, this aspect of our relationship, that symbol, this defence, that explanation) – what does it all mean?”

• Michael Jacobs in Psychodynamic Counselling in Action, p.126

Cognitive Behavioural Therapy• A directive and structured approach• The origins of CBT are in behavioural and cognitive

psychology• Behavioural psychology is about actions and responses

and about how behaviour is learned and unlearned.• Cognitive Psychology is about how our minds work and

how we think about things.• Aaron Beck and Albert Ellis are usually credited with

founding CBT.

Cognitive Behavioural TherapyThe Big Idea

The theoretical origins of CBTs can be traced back to the Stoic Philosopher, Epictetus, who in the first century AD noted that:

“People are disturbed not so much by events as by the views which people take of them.”

More Big Ideas - CBT

• People’s problems are caused not by the things which happen to them, but by how they think about, or process, things which happen to them.

• The role of the CBT, therefore, is to help clients by helping them to identify and change their unhelpful thoughts, beliefs and behaviours.

CBT – A Structured Intervention

1. Identify and describe the problem (e.g. a phobia, depression or anger issue) in some detail (e.g. when, where, how often , for how long, in what way, since when…)

2. Identify and challenge the irrational or illogical thoughts or beliefs which cause, justify or prolong negative feelings of behaviours

3. Learning, practicing and maintaining new and more positive ways of thinking and behaving.

Some Irrational Beliefs

• I should always be loved and approved of by everyone

• In order to be a worth while person, I need to be good at everything

• Bad people, including myself, should be severely punished.

• If things are not the way I want them to be, then it’s a disaster.

ABC and CBT

• A = Activating event (something happens)

• B = Beliefs about what happened (rational or irrational)

• C = Consequences (emotional and behavioural responses.

ABC, an example

Sue invites her friend to the cinema.

A – Activating EventSue’s friend says that she wants to spend some time alone

with her sister and her sister’s family.B – Belief and InferenceSue thinks, ‘she’s not really the friend I thought she was –

she has rejected my offer. This always happens to me. I am not likeable.’

C - Emotional and Behavioural ConsequencesSue becomes depressed and avoids her friend.

ABC, an example continued

Sue invites her friend to the cinema:

A – Activating Event

Sue’s friend says that she wants to spend some time alone with her sister and her sister’s family.

B – Beliefs and Inference

Sue thinks: ‘I would really like to see the film with Jane and spend lots of time together, but what Jane says is reasonable, she has her family to think of too’

C – Emotional and Behavioural Consequences

Sue suggests that she and Jane see the film together later in the week and uses her free evening to catch up with college work and to spend time with her mum. Sue feels good.

Other practices associated with CBT’s

• Homework• Keeping a diary• Rating scales • Systematic de-sensitization• Self-talk• Rehearsing• Relaxation exercises • Mindfulness

Person-centred Approach

• A non-directive approach

• Origins are in humanist psychology and philosophy

• Main founder, Carl R Rogers

The Actualizing Tendency

• Rogers suggested that human beings (and everything else in the universe) are subject to a growth force or “actualizing tendency”.

• In favourable conditions people grow and become their true selves.

• In unfavourable conditions, (internal or external) this growth or actualising tendency is inhibited.

More Big Ideas - PCA

• We each experience the world uniquely

• We are experts in our own lives – we know best how we feel

• The best way to understand how someone else is feeling is to listen.

• Our behaviour represents our best effort to achieve fulfilment at any given time.

The role of the counsellor in the PCA

To create an environment in which the client feels safe to experience and share difficult thoughts and feelings

This relationship is based on the three Core Conditions of Congruence, Unconditional Positive Regard and Empathy.

Which Therapy?

Sometimes particular therapies are considered to be most helpful for particular problems e.g.

• Psychodynamic – relationship issues, childhood abuse• CBT – Phobias, anxiety, anger• Person-centred – loss, bereavement, personal

development

However, it is also argued that most therapies can help with a wide range of issues – anxiety, worry, depression, sadness, relationship issues, bereavement, addiction…

Which client?

Sometimes is argued that certain therapies suit different kinds of clients? e.g.

• Psychodynamic – may suit those who are analytical, interested in the past and in the unconscious

• CBT - may suit those who are practical, scientific, methodical, solution focussed

• Person-centred – may suit those who are interested in feelings and in exploring responses with the counsellor as a companion.

Barriers – what gets in the way?

On your own (or in small groups) consider things which might prevent clients from accessing counselling or particular models of counselling.

E.g. lack of commitment might make it hard for a client to use CBT as they could struggle to do the homework.

Homework(see worksheets)

• Complete the crossword provided, using information given during the power point presentation.

• Identify three issues which may be helped by each of the three approaches.

• Write down some barriers which may prevent clients form accessing each of the three therapies discussed.

Additional Reading (optional)

Tutor notes on CBT and Psychodynamic Counselling

Dr Mulhauser on Person-centred counselling. Available at http://counsellingresource.com/lib/therapy/types/person-centred/

Patient UK on Cognitive Behaviour Therapy. Available at: http://www.patient.co.uk/health/Cognitive-Behaviour-Therapy-(CBT).htm