Navigating Therapy: On Types and Relationships
By Stella O'Malley
When a person tells me that they tried psychotherapy but it didn’t work for them, my response is always ‘Yes, but what happened? Did you connect with the therapist? What type of therapy was it, anyway?’
Some Types of Therapy
‘Psychotherapy’ is a generic term to describe any version of the ‘talking cure.’ That means it can come in many different guises. Psychoanalysis might suit one person, while another person might be all about Solution-Focused Brief Therapy. These days, many prefer specialist therapies such as addiction counselling, couples counselling, family therapy, or any of the acronyms—ACT, DBT, CBT, CFT, EFT, EMDR. The list goes on and on as theorists constantly try to reinvent the wheel.
One popular form of therapy today is Cognitive Behavioral Therapy (CBT). CBT tends to focus on the reduction of symptoms, so it can produce results in the short term. It’s based on the notion that our thoughts, feelings, and behaviour are interconnected and that we can manage our problems by changing the way we think and behave. Many people really benefit from CBT, especially those who have a very specific problem such as a phobia or new physical symptoms that could benefit from reframing in terms of language and behaviour. It often depends on the bounce of the ball: if the right CBT therapist meets the right client at the right time, then some magic can occur. If, however, the CBT therapist meets an individual who is going to therapy looking for a deeper, more authentic experience, then the individual can become frustrated and alienated by what they perceive as linguistic tricks on the mind.
For those patients, perhaps psychoanalysis or in-depth psychodynamic therapy would be a better choice. It’s so different to the likes of CBT that it feels disingenuous to frame them as similar experiences. Psychoanalysis offers a long and demanding therapeutic process that is grounded in complex psychological theory. It is common for people undergoing psychoanalysis to see their analyst multiple times a week – a scenario that is almost unheard of in other counselling disciplines unless the patient is in deep crisis. Psychoanalysis also tends to be expensive, as it can be a long process that typically lasts some years.
Humanistic or person-centred counselling is another form of psychotherapy. This counselling was made popular by Dr Carl Rogers who promulgated his notion that the client is the expert on their own life. In this context, the client leads and the therapist follows. The safety offered by a therapist who is unlikely to challenge you can be very empowering for some clients – especially those who have felt silenced by other people. However, critics of person-centred counselling have called it ‘the nodding dog’ approach to therapy as the process can go on for years without any change happening. Advocates of person-centred counselling find this offensive – and rightfully so. This counselling process offers a deep and thoughtful experience that can be utterly life-changing. I should know – I’ve had it and it was transformative. But, as with all types of therapy, the skill of the therapist and the relationship between the therapist and the client is crucial.
On Going Deeper
Many people today prefer to view their therapist as an equal partner, so the collaborative processes offered by CBT or the client-led approach of humanistic counselling are often favoured over psychoanalysis. Many feel uneasy with the ‘on-high’ position of the expert psychoanalyst who interprets the thoughts and behaviour of the patient in a world where we’re taught to value an equal relationship more than the insight of an expert—but it’s precisely this insight that makes the process valuable. Within the psychoanalytic process, the nature of the therapist-patient relationship is precious, and the psychoanalyst will not allow any intrusion into this relationship. It’s also legally mandated that no therapist may divulge any details of therapy to parents of children over 18. These days, however, many young adults are willing to give their therapist permission to discuss their situation with the parents, who are often paying for the service. The situation where parents are paying for their adult children’s therapy is becoming a larger issue, and it is often not a very healthy dynamic. It can create a triangulation where the therapist is the saviour, the client is the victim and the parent is categorised as the persecutor. None of this is healthy for the client. For this reason, I believe parents of adult children should avoid paying for a long-term therapeutic process if at all possible.
CBT is often attractive because it promises to deal with our current problems rather than focusing on our past experiences. But we must be careful when we seek a simple solution to a complex problem. If you have lived any length of time in this maddening world, you will know that we can end up in much deeper trouble if we seek a quick-fix to a problem that has been brewing for many years.
As an integrative therapist, I combine elements of all types of therapy, without favouring one school of training over another. Many people dislike more generalised therapy – they believe we must be a jack of all trades, master of none. And perhaps we are! On the other hand, integrative therapists are able to employ different approaches according to the needs of the client, and this can be worth its weight in gold. There is also value in being able to compare and contrast different mental health difficulties rather than always seeing the same type of problem. For example, it can be helpful to compare the mindset of the anorexic to the gender dysphoric individual. Another worthwhile comparison is the exhaustion of the trans person who comes to the decision that they need to detransition and the yielding of the addict who comes to realise that their drinking days are over.
What Matters Most in Therapy
Research shows us that measuring outcomes in counselling and psychotherapy is complicated and often unreliable. Indeed not many people know that seeking an evidence-base to argue the benefits of psychotherapy is not a particularly productive approach. Psychotherapy is not like antibiotics: it’s not a case of being sick one day and hale and hearty again the next. As Carl Jung pointed out, “the right way to wholeness is made up, unfortunately, of fateful detours and wrong turnings. It is the longissima via [longest path], not straight but snakelike, a path that unites the opposites in the manner of the guiding caduceus, a path whose labyrinthine twists and turns are not lacking in terrors.”
This is further complicated because some types of therapy are more easily measured than others. CBT’s structured process and goal of symptom reduction means that the success or failure of this process is easier to quantify than that of a deeper, more reflective process aimed not directly at symptoms but at developing a more authentic relationship with yourself and the world. Some people attend therapy for the first time and come to realise that they were living a lie. Such people might leave their partners or toxic friendships behind and confront the realities of their pasts; their lives might become immeasurably more difficult and yet, in a weird way, they could also be more satisfying. It is very difficult to ascertain any of this within research—just like it is difficult to measure how a favourite song that always makes you cry or much-loved novel or a particularly beautiful picture might have added to the sum of your life’s happiness.
What people should know is that, in many ways, it doesn’t really matter what type of therapy you go for. Research does show us again and again that when measuring for positive outcomes of therapy, the quality of the client-therapist relationship is by far the most significant factor in counselling and psychotherapy.
But psychotherapy has its limits – as Samuel Beckett tells us in his tragicomic play Endgame, “You’re on earth. There’s no cure for that!”
Header image by Priscilla Du Preez on Unsplash