WHAT IS THERAPY?
All counselling and psychotherapy starts from a core set of basic principles and processes. A clear set of boundaries fundamentally creates a sense of safety and security.
These core conditions predominantly come from the person-centred theory of Carl Rogers. He claims that these conditions are sufficient alone for a therapeutic process to occur. Being Client-centred enables the client to feel accepted and genuinely understood in order to develop self-empowerment and work towards self-actualisation.
Therapy with SPECTRUM
Peace and security with a qualified and experienced therapist .
50 minutes a week to talk through the difficulties you are experiencing.
Brief or long term process
Shaped by your therapists theoretical stance.
Pure approach or integrative.
Fundamental strong therapeutic alliance.
Empathy, unconditional, congruence and non-judgemental
Safe place for client to explore their inner world
Secure place for emotional expression and catharsis
Creation of long-term and positive change.
GENERIC MODEL OF THERAPY
THERAPY AS A WHOLE
Establishing a relationship
- Information gathering
- Getting to know each other
- Understanding where the client is in
themselves at this time
- Establishing a relationship
- Therapeutic work
- Engaged in an issue
- Accessing the pain and the resources
- Creating some shift
- Preparing to go it alone
- Building on new skills.
- Consolidating change's made.
GENERIC MODEL OF THERAPY
Formal; therapeutic contract
Technical; theoretical orientation
Interpersonal; Therapeutic bond
Clinical aspect; in-session impact
Temporal aspect; sequential flow
Orlinsky et al. (1994)
GENERIC CORE CONDITIONS FOR CREATING A THERAPEUTIC ALLIANCE
Unconditional positive regard
GENERIC PROCESS OF THERAPY
Assessment of clients presenting issues and case formulation.
Build a therapeutic alliance
Ending (this may in itself bring about the main core therapeutic work)
Therapists abide by a strict code of ethics set by a governing body in which they are accredited to. Ethical practice include strict rules around confidentiality and boundary setting, particularly regarding dual relationships. This enables the client to feel contained and secure enough to reach full cathartic release of emotional expression.
From this core basis each therapist works from chosen theoretical models, either integratively, eclectically or purallistically. They will also bring their own personality, values and principles (frame of reference) which they are constantly negotiating so as to stay on the client's journey without judgement or direction.
Therapy works on many levels in which the therapists years of training enables them to observe and work with.
Even though therapy may be experienced as chaotic and fragmented, as complex and not following a straight path, the underlying process in which therapy occurs remains the same.
What makes a Counselling Psychologist different to other therapists and clinicians?
"Counselling psychologists deal with a wide range of mental health problems concerning life issues, including bereavement, domestic violence, sexual abuse, traumas and relationship issues.
They understand diagnosis and the medical context to mental health problems and work with the individual’s unique subjective psychological experience to empower their recovery and alleviate distress.
Counselling psychologists are a relatively new breed of professional applied psychologists concerned with the integration of psychological theory and research with therapeutic practice.
The practice of counselling psychology requires a high level of self-awareness and competence in relating the skills and knowledge of personal and interpersonal dynamics to the therapeutic context."
Training and accreditation
Counselling Psychologists are chartered with the British Psychological Association (BPS) and HPC (Health professionals Council).
To achieve this status therapists would have gained a good degree in Psychology or similar training background followed by a Post-graduate diploma and Masters in Counselling Psychology which entails a large research project. In the last 3 years standards have increased and students now have to train at a doctorate level only.
This training is a balance between practical and academic emphasis, unlike Clinical Psychology that has a stronger stance towards academic and medical. However, Counselling Psycholgists are increasingly being recognised as equally credible within the NHS.
Training as a Counselling Psychologist requires many direct counselling hours with clients as well as their own mandatory personal therapy. An equal emphasis is however placed on a high academic level of learning and applying key theoretical stances.
Due to the Psychological and therefore medical nature of the role it is important for trainees to understand the need for evidence based practice and how this is achieved. They therefore have to complete their own research dissertation to enable them to consider issues around assessing outcome measures. This has implications on the provision of different counselling models within the public and private sectors.
Other therapists may have the same level of training, but have focused on a more specialised area such as psychotherapy or integrative therapy. They may then be registered to a different governing body such as United Kingdom Council for Psychotherapy (UKCP).
Counsellors will have also had a similar level of intense practical training, but would not need to reach masters level. They would gain recognition and be registered with the British Association for Counselling and Psychotherapy (BACP).
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Evidence based practice
Research plays a key part in recognising and validating Counselling Psychology as a credible profession in the medical world. However, some of the approaches typically taken by a CP is hard to measure objectively.
NICE guidelines in the NHS place an emphasis on the use of Cognitive Behavioural Therapy (CBT) as it's primary 'talking therapy' treatment for most issues. This is because CBT is brief and stays focused on a specific, target goal. Therefore outcome can be measured easily through various ongoing questionnaires (Becks inventory of depression, CORE etc). However, a CP can work with various issues and the complexities of the human being, making it hard to measure in terms of efficacy (outcome measure and cost effectiveness).
Therefore smaller cases of qualiative research becomes crucial in building a picture of effectiveness.
As my research shows a CP will consider various elements of the clients world to understand and work with their presenting issue ie; their current social and environmental context, their past history, any medical issues etc. A CP sees a client as a whole made up of seperate parts that all interact and affect each other, influencing and being influenced by their unconscious processes.
Integrative vs pure
Some therapist and counsellors may train under a specific theory, such as being person-centred or a psychotherapist. Others may train as an integrative therapist where their overall style incorporates elements of different theories.
A CP trains in specific orientations in their pure form before considering their use in an integrative way. Some therapists may opt to be specific about the orientation they are applying at a given time, or may subtly shift elements in response to the clients needs and complex process. This in itself is a complex issue and debated heavily.
As their career and experience develops individual CP's may choose to learn about other and newer, theories which they may start to incorporate into their practice.
Assessment and diagnosis
Whilst a CP cannot make a formal diagnose of any mental illness they are trained in giving a full assessment of a clients needs. From this assessment they will create a case formulation utilising their knowledge of the psychological orientations they are trained in.
They may use various questionnaires or measures which will depend on the individual CP and the bias of orientation they work with. They may be more directive in the initial sessions as they try to gain a picture of the clients internal and external world. However, formulation will be mainly based on their first interactions with the client and what they present.
They may refer to DSM-IV if they suspect mental illness, but if they suspect this to be the case they would refer the client for a formal assessment and diagnosis.
It is debated as to whether a diagnosis is helpful for some people and a CP will focus more on whether they can work with what the client presents rather than the label they are given.