Three of the main forms of counselling can sometimes be confusing.

In this article I hope to

unravel and clarify some of the mystery surrounding these three types of counselling
approaches by means of comparing and contrasting with reference to their differing
theoretical rationale, therapeutic interventions and processes of change.
The Person Centred Approach (Originator: Carl Rogers 1902 1987) focuses on the belief
that we are all born with an innate ability for psychological growth if external circumstances
allow us to do so. Clients become out of touch with this self-actualising tendency by means
of introjecting the evaluations of others and thereby treating them as if they were their own.
As well as being non-directive the counselling relationship is based on the core conditions of
empathy, congruence and unconditional positive regard. By clients being prized and valued,
they can learn to accept who they are and reconnect with their true selves.
The Psychodynamic Approach (Originator: Sigmund Freud 1856 1939) focuses on an
individuals unconscious thoughts that stem from childhood experiences and now affect their
current behaviour and thoughts. The urges that drive us emanate from our unconscious and
we are driven by them to repeat patterns of behaviour. Therapy includes free association, the
analysis of resistance and transference, dream analysis and interpretation and is usually long
term. The aim is to make the unconscious conscious in order for the client to gain insight.
Cognitive Behavioural Therapy (Contributors: Ellis 1913 - & Beck 1921 - ) focuses on how
an individuals thoughts and perceptions affect the way they feel (emotions) and behave. We
are reactive beings who respond to a variety of external stimuli and our behaviour is a result
of learning and conditioning. Because our behaviour is viewed as having being learned, it can
therefore be unlearned. By helping clients to recognise negative thought patterns they can
learn new positive ways of thinking which ultimately will affect their feelings and their
behaviour.
When comparing and contrasting these three major approaches in relation to their differing
theoretical rationale, I found the following similarities between the Person Centred Approach
and Cognitive Behavioural Therapy. Both deal with the conscious mind, the here and now
and focus on current problems and issues the client may have. They both have a positive view
of human nature and view the individual as not necessarily being a product of their past
experiences, but acknowledge that they are able to determine their own futures. They both
attempt to improve well-being by means of a collaborative therapeutic relationship that
enables and facilitates healthy coping mechanisms in clients who are experiencing
psychological pain and disharmony in their lives.
In comparing the similarities between the Person Centred Approach and the Psychodynamic
Approach, it is possible to see some similarities and parallels between the concepts of the
actualising tendency, the organismic self and the self-concept to Freuds theory on
personality structure. The id and the organismic self are both representative of that part of the
psyche that is often ignored or repressed. The super-ego and the self-concept, both describe
internalised rules and moral values which have been imposed upon us by significant others.
The ego is similar to the actualising tendency in that it is concerned with mediating between
the id and the super-ego and the actualising tendency seems to echo this.
In contrasting the Person Centred Approach with Cognitive Behaviour Therapy in relation to
their differing theoretical rationale Cognitive Behavioural Therapy sees behaviour as being a
learned response whereas the Person Centred view is that clients have not been able to have
previously self-actualised. From a Cognitive Behavioural perspective, human experience is
viewed as a product of the interacting elements of physiology, cognition, behaviour and
emotion. The Cognitive Behavioural Approach is based upon the theoretical rationale that the
way in which we feel and behave is determined by how we perceive and structure our
experience. In the Person Centred Approach, a person is viewed as having had various
experiences and developing a personality as a result of these subjective experiences.
In contrast to the Psychodynamic Approach, the Person Centred Approach focuses on the
conscious mind and what is going on in the here-and-now whereas the Psychodynamic
Approach focuses on the subconscious and looks to early childhood to examine unresolved
conflicts. Freud emphasized the need to modify defences, to reduce the pressures from the
superego so that the patient could become less frightened of the superego and to strengthen
the ego.[1] The aim of the Person Centred Approach is self-actualisation whilst the aim of
the Psychodynamic Approach is insight. The Person Centred Approach focuses on the
positive belief in the human ability to self-actualise whereas the Psychodynamic Approach
focuses largely on the negative aspects.
In highlighting the differences in theoretical rationale between the Psychodynamic Approach
and Cognitive Behavioural Therapy, the Psychodynamic Approach encourages the client to
uncover the past and early childhood in order to bring to memory significant events.
Cognitive Behavioural Therapy, however, focuses on the here and now and is goal orientated.
The Psychodynamic Approach sees us as being driven by unconscious urges whereas
Cognitive Behavioural Approach sees our behaviour as being a learned response.
Freuds structural model states that the human psyche is an interaction of the three forces: the
id, the ego and the superego and he also assumed that we are driven by inherent sexual and
aggressive drives. Cognitive Behavioural Therapy sees functioning or dysfunctioning as
being a learned response to external stimuli.
In looking at the similarities between the Person Centred Approach and Cognitive
Behavioural Therapy with regard to their therapeutic interventions both utilise the core
conditions of empathy, unconditional positive regard and congruence but in Cognitive
Behavioural Therapy it is used mainly in the establishing of the working alliance. The
creation of a relationship of safety and trust is an essential first step in CBT, as in any form
of therapy.[2] In both these approaches, the relationship between client and counsellor is
similar by means of the counsellor being congruent and both would use the skills of
reflection, paraphrasing and summarising. In both these approaches, the client is prepared for
the eventual ending a few sessions before the actual end of therapy. Both would use
awareness techniques.
The therapeutic intervention of immediacy used in the Person Centred Approach could be
compared to the technique of transference used in the Psychodynamic Approach however; in
the Person Centred Approach, the emphasis on the present replaces the investigative
perspective of the Psychodynamic Approach.
In comparison, the differences between the therapeutic interventions used in the Person
Centred Approach and the Cognitive Behavioural Approach, the Person Centred Approach is
non-directive whereas CBT is taught and is goal orientated. In Cognitive Behavioural
Therapy clients are taught skills which are needed and necessary for them to change which
would in turn reduce their emotional angst and change their behaviour. In the Person Centred
Approach growth is self-directed. The number of sessions in the Person Centred Approach
can be open ended whereas CBT has a set period.
When looking at the main differences between Person Centred Approach and the
Psychodynamic Approach the Person Centred counsellor would encourage the client to seek
the solution to their problem within themselves and would not attempt interpretation which is
the major therapeutic intervention of the Psychodynamic Approach. The Person Centred
Approach pays no attention to the issue of transference. The relationship between the client
and the counsellor is also different in that in the Person Centred Approach the core conditions
are a vital tool whereas in the Psychodynamic Approach the counsellor is a blank slate onto
which the client can project.
There are however some similarities between the Psychodynamic Approach and Cognitive
Behavioural Therapy. Many of our schemas were put in place when we were very young
and stem from childhood, this learned response and behavior could be linked to the
Psychodynamic intervention of linking childhood events and associated feelings to current
problems.
Looking at the differences in the therapeutic interventions between Psychodynamic Approach
and Cognitive Behavioural Therapy the key therapeutic interventions used in the
Psychodynamic Approach are free association, thematic apperception test / Rorschach inkblot
test, parapraxis, interpretation of transference, dream analysis, hypnosis and regression. In
Cognitive Behavioural Therapy, the techniques used could be systematic desensitisation,
reinforcement techniques, forceful disputing, reality testing and the identifying of automatic
thoughts. Cognitive Behavioural Therapy is directive and is goal orientated and does not look
at the clients past. In Psychodynamic Therapy, there is a danger that the client could become
dependent on their counsellor whereas in Cognitive Behavioural Therapy the client is taught
to be autonomous.
The similarities between the Person Centred Approach and Cognitive Behavioural Therapy in
relation to their process of change are that the core conditions used in both would bring about
change in the client by the building up of trust and rapport.
When comparing the differences in the process of change between the Person Centred
Approach and the Cognitive Behavioural Approach, change would occur for the client in
Cognitive Behavioural Therapy through guiding and assisting them into firstly identifying
negative thought patterns and then by changing their irrational beliefs. By changing thoughts,
we can change the way in which we react to situations and events. In Cognitive Behavioural
Therapy, this process of change occurs by means of education, and by bringing these thought
patterns into awareness behavioural change will occur. Change can also occur through reality
testing in which the clients negative beliefs will be challenged and their subsequent negative
emotions eliminated.
In the Person Centred Approach, change occurs with the core conditions of empathy,
congruence and unconditional positive regard being in place. This relationship is all that is
necessary to bring about change and with no threat of being judged, the client learns to
perceive their world from a new perspective and gains the ability to self-actualise with felt
senses connecting the different aspects of their particular issues.
In contrasting this to the Psychodynamic Approach, change occurs by means of uncovering
repressed or significant events and their associated feelings. By this process, change will
occur and the client will be better equipped to understand the connections between past
events and present behaviour. Change in the Psychodynamic Approach, occurs for the
individual through the strengthening the individuals ego whilst in the Person Centred
Approach the aim is to achieve growth through the individuals self-actualising tendency. In
the Person Centred Approach, it is a personal process for the client of being in a warm
relationship but in Psychodynamic counselling the counsellor is a blank slate on which the
client can project feelings. Transference is crucial in the process of change, requiring
understanding and interpreting but the Person Centred Approach ignores the past events in a
clients life unless these events affect the clients conditions of worth.
When comparing the similarities between the Psychodynamic Approach and Cognitive
Behavioural Therapy, change could occur through the uncovering of schemas, which is
similar to bringing the unconscious into conscious awareness.
In contrast, the differences in the process of change between the Psychodynamic Approach
and Cognitive Behavioural Therapy in the Psychodynamic Approach the process of change
would involve encouraging clients to look into their past with a view to uncovering repressed
or significant events and memories and their associated feelings. By gaining this insight the
client will achieve a new perspective which will form the basis for healing and change.
Cognitive Behavioural Therapy deals only with the here-and-now, it does not address the
past, deals only with presenting symptoms and could miss underlying problems. The
cognitive model assumes that emotional and behavioural change is mediated by changes in
beliefs and interpretations.[3]
Cognitive Behavioural Therapy sees the process of change as being a relatively short-term
process whereas Psychodynamic Therapy is a long term process of change. The aim of
Psychodynamic Therapy is for the client to gain insight and the aim of Cognitive Behavioural
Therapy is change. Cognitive Behavioural Therapy believes that change is possible and
focuses on behaviour rather than on emotions. A major difference between CBT and
psychodynamic therapies lies in the degree of importance given to exploring early childhood
experiences for the origins of maladaptive patterns of thinking and behaviour. In CBT it can
be helpful to explore early experiences to enable the client to place his problems in a
historical context, but this is not seen as a major part of the counselling.[4]
In conclusion, each model has its own strengths and weaknesses and individuals may find
one approach more appropriate than another, depending on their own personal preference or
on the severity and depth of their presenting problem. Time factors and costs would also need
to be taken into consideration.
Bibliography:
[1] Dryden, W (2002) Handbook of Individual Therapy Fourth Edition. Page 27.
[2] McLeod J, (2009) An Introduction to Counselling Fourth Edition. Page 148.
[3] Dryden W (2002) Handbook of Individual Therapy Fourth Edition. Page 304.
[4] Trower P, Casey A, Dryden W (1988) Cognitive Behavioral Counselling in Action. Page
7,8.