So here you are, looking for someone to talk to because, well, doing it all on your own just doesn’t work any more. Or perhaps it has never quite worked, but now you are ready to take that step to see someone who is not a friend, not family. A ‘professional’. A stranger. It can be a little daunting.
For those seeking psychological health or happiness, or even just a bit of relief, a space to pause and breathe, a chance to get in touch with themselves, there are plenty of options out there. In fact, there are so many options within the field of talking therapies that even the practitioners offering these options struggle to explain the differences between some of them. The end result is that many of those seeking help end up with someone more or less by chance, and it may take months or years of attending sessions for you to discover whether the background, approach and style of this particular professional works for you, or not.
There are some general differences, though, that are useful to be aware of:
Cognitive Behavioural Therapy (CBT)
For years now, CBT has been promoted aggressively as the cheapest and most effective form of treatment for a wide range of conditions, such as phobias and depression. However, there are limitations and criticism. This Guardian article does an excellent job at summing some of these developments. More on the effectiveness of CBT versus psychotherapy here.
From a client’s perspective, you can usually expect sessions that are quite structured. CBT can bring symptom relief and provide useful coping skills, for instance by identifying and correcting “irrational thoughts”. You may get homework in between sessions and monitor progress on your efforts to change behaviour. There is usually not much focus on engaging with the root causes of your difficulties, beyond the current symptoms – but then this may be all you want or need. The idea is, basically, that with enough willpower you will be able to change the way you feel and behave, no matter how long you have been feeling and behaving like that, and no matter, why. Unfortunately, sometimes things are not so straightforward, and you may find yourself looking for something different, deeper, and more suited to your subjective experience.
Counselling
Counselling is a broad field. Some counsellors have very little training and almost no experience of counselling themselves, some are amazing at what they do, and some are actually trained psychotherapists offering “counselling” because some clients prefer the idea of seeing a “counsellor” rather than a “psychotherapist”. Counsellors will generally have had a shorter and less intense training than psychotherapists or psychoanalysts. Some rely on one particular model or approach (e.g. person-centred, humanistic, Gestalt etc.), others work in an integrative way. Many are more “chatty” and involved than psychotherapists or psychoanalysts would allow themselves to be. Sessions are usually once a week or less frequently.
Psychoanalytic Psychotherapy
Psychoanalytic psychotherapy originates in the work of Sigmund Freud. Freud has had many colleagues and followers who have agreed with, questioned, developed and added to his ideas. Soon the field of psychoanalysis fragmented into a number of different schools, including Jungian (following C. G. Jung, called Analytical Psychology), Object Relations or Kleinian (following Melanie Klein, the school dominant in the UK), and Lacanian (following the French psychoanalyst Jacques Lacan). There is an independent tradition, ego psychology, self psychology, attachment theory and so on. They all work from the position that, as people, we are not as rational as we like to believe, and that much of what we feel, think and do is driven by unconscious processes. Without becoming aware of them and working through them we cannot change in a fundamental way.
The term “therapy” is an interesting one and worth thinking about for a moment. It implies that something is “wrong” and needs to be put “right”, that a patient who feels bad is helped to feel better, happier and so on. The therapist is someone who assists you along this journey. Sessions are unstructured, i.e. what you talk about is entirely your choice. You will not get homework and there is no expectation on you to do anything in order to be “a good patient”. It is a space to talk. Your therapist listens carefully and helps you gain a different perspective on what is going on in your unconscious, how this impacts on your life and how change may be possible.
By getting to know yourself better, and by using the relationship with your therapist as a kind of laboratory for relating to people, you may find that you gradually feel less controlled by your current symptoms, that they may even disappear completely, and that you are better able to cope with a whole range of other situations that life throws at you. Psychotherapy takes time (months or years) because it acknowledges that problems we have developed over a lifetime usually cannot be resolved in a few weeks, and that change at a fundamental level of our personality can be neither forced nor rushed. The pace and experience is different for everyone. You may not want to stop talking in the beginning, or you may struggle to find words that describe how you feel. A psychoanalytic psychotherapist will listen to you, explore your thoughts and feelings with you, challenge you – but will never tell you what you should do.
Psychoanalytic therapists, psychoanalysts, or Jungian analysts have undergone many years of intense personal therapy as part of their training, and the self-awareness gained through this is – hopefully – their most important professional tool. One could go as far as saying that you are paying a therapist not for her theoretical knowledge, but for her ability to be present – really present – with you because she has worked (and is working) on her own issues elsewhere.