What follows in this third post of ‘So you realy want to be a therapist?’ is a review of some of the popular therapies but it is by no means a definitive list. In making this list I simply wanted to inform newcomers to the professions that there are many ways towards their goal of being a therapist, some better than others in today’s world of politically expedient therapies- important for career advancement!
Cognitive Behavioural Therapy
Two influential pioneers in the development of CBT are Albert Ellis and Aaron Beck. Ellis used the Stoics (Philosophers) in developing Rational Emotive Behavioural Therapy while Beck developed Cognitive Therapy through scientific experiment. I believe Beck became more important (unfortunately) as he was the scientific face of the developing therapy, while Ellis swore a lot to explain his ideas.
Ellis said in an interview that it was not their past that upset people ‘It’s how [he or she] philosophized about it that made them disturbed.’ He was asked if he felt depression was self indulgent to which he replied ‘Yes, it’s “I run the fucking universe and it should do my bidding.” That’s arrogant and indulgent.’ Beck turned to science and an evidence based approach to therapy designing a lot of the tests himself. He was a pioneer in producing replicable date to validate his theories. Some say CBT is proven. I consider that more a political statement about any therapy currently in favour. It is effective but not the last word, no one can claim that!
CBT is a focus on behaviour and thoughts in the here and now. It is not overly concerned with your past. Basically, in the functional analysis (assessment) a therapist might help a client identify his or her cognitive distortions (intrusive, negative thoughts). Together they may identify the thought ‘I am worthless.’ The therapist and client then work together to interrupt this pattern of thinking with a positive one of the client’s choosing like ‘I have value.’
Evidence for the effectiveness of CBT has not surpassed that of other therapies as expected it would. In the UK talking therapies have been found to be as effective. My own thoughts are that CBT is scientific in application because it is evidence based. People should expect no less scientific rigour in a therapist’s approach to mental health as they have come to expect from their Doctors. That does not mean the system is perfect by any means, but it is now on the right track – research, studies, evidence.
Existential Psychotherapy
Existential therapy is not a set of techniques, it is more a philosophical approach. Some key figures in its development are Soren Kierkegaard, Jean Paul Sartre, Rollo May, Victor Frankl, Irvin Yalom. There is, of course, no unified theory of existential psychotherapy for existential philosophers and existential psychologists alike. I say ‘of course’ because like all theories they develop, and development is always through theoretical argument and scientific evidence.
Existential therapy ( in a nutshell) says that conflicts within a person arise due to that person’s confrontation with the givens of existence (basic truths). They are death, freedom ( and responsibility), isolation (or relationship) and meaninglessness (or meaning). This is the framework whereby a therapist will conceptualize a person’s problem and treatment.
‘Being and Nothingness’ by Jean Paul Sartre is a difficult book to read and argues for existentialism from a philosophical perspective. Emmy Van Deurzen has written far more accessible books for the average reader on existential psychotherapy.
Meta-Cognitive Therapy
The following is an extract from the Metacognitive Therapy Institute [link} .
[Metacognitive Therapy (MCT) is a recent development in understanding the causes of mental health problems and in treating them. The approach is based on a specific theory proposed by Wells and Matthews (1994), initially used to treat Generalised Anxiety and subsequently expanded as a general treatment approach (Wells, 1995, 2000). The approach is backed by scientific evidence from a wide range of studies.
Metacognition is the aspect of cognition that controls mental processes and thinking. Most people have some direct conscious experience of metacognition. For instance, when unable to remember a name a person may feel sure that the name is stored in memory. This gives rise to a metacognitive state that occurs as a strong feeling called the ‘tip-of the tongue-effect.• This is an example of metacognition working to inform the person that an item of information is somewhere in memory even though the person is unable to remember it. Metacognition can even go further by retrieving this name and pushing into consciousness often when least expected. Although we are aware of some metacognition operating like in this example, most of the metacognitions that control our thinking and conscious experience operate in the background.
One of the features of psychological disorders such as anxiety or depression is that thinking becomes difficult to control and biased in particular ways that lead to a worsening and maintenance of emotional suffering. Many patients report that they feel that they have lost control over their thoughts and behaviours. Another important feature is that the persons thinking and attention becomes fixed in patterns of brooding and dwelling on the self and threatening information.
Metacognitive therapy recognises this change in thinking patterns and believes it is very important. It gives it a name: the Cognitive-Attentional Syndrome (CAS). This pattern consists of worry, rumination, fixation of attention on threat, and coping behaviours that the person believes are helpful but many of which backfire and keep emotional problems going. The CAS is controlled by metacognitions and it is necessary to remove the CAS by helping patients develop new ways of controlling their attention, new ways of relating to negative thoughts and beliefs, and by modifying metacognitive beliefs that give rise to unhelpful thinking patterns.]
Blog: I have seen some very quick results using this approach and I have seen some clients unwiling to engage, as with all therapies.
