Person-centred therapy, CBT, psychoanalysis… there’s over 450 different therapies out there, and often we focus on the differences between them. But how different are they really?
Of course, the specific methods that different therapies use can be very different (interpretation, for instance, vs two chair work vs behavioural experiments). But, in this blog, I want to suggest that where they are trying to help clients get to, and the underlying principles by which they are trying to do that, are actually pretty similar.
What I think all the therapies are trying to do, in a nutshell, is to help clients find better ways of getting from where they are towards where they want to be.
Yup, ‘better’. That’s something of a taboo word in the therapy field. But, of course, I don’t mean ‘better’ as defined by the therapist, or by society more widely; but in terms of what is most helpful for the client on their journey. So that might include more positive self-talk, or trying to see friends more, or mindfulness exercises. In every therapy, however implicit, there’s always some hope for change—even if the change is a move towards greater acceptance of where they are at.
Some therapies, like CBT, do that by providing a lot of structure and guidance. Others, like non-directive approaches, do it by providing clients with space to work out for themselves where they’re at and where they want to go. How different is that? Well, some teachers do a lot of standing up and delivering content. Others prefer to provide pupils with time and space for self-learning. There’s certainly variations in these methods, but that doesn’t mean that they’re trying to do different thing. All teachers want to help pupils learn (I’d hope) , and all therapists want to help clients find positive ways forward in their lives. At least, I’d hope that was the case.
But what about real theoretical differences in how well-being, distress, and change are conceptualised? In my latest book, Integrating counselling and psychotherapy (Sage, 2019), what I suggest is that, in fact, there’s a set of common principles that underlie all the different models, methods, and understandings. These can be summarised as follows:
Human beings are directional: that is, we act towards our worlds in meaningful, intelligible ways. We do things for reasons, not just randomly—striving towards the things that we most deeply want in our lives, like safety, love, or closeness with others.
A ‘good life’ is one in which we can get towards those things. This is not just about achieving them, but feeling like we are oriented towards them and progressing at sufficient pace.
Sometimes we experience problems because the way we try and get one of these thing can make it more difficult for us to get another. For instance, a client really wants intimacy in their life, but they’re also afraid of being un-safe by opening out to others. These conflicts (or what I call ‘dysergies’) might be a consequence of what we’ve learnt from our pasts about how to get the things we want, our environments, or because of ‘biases’ in the ways that we think.
And, sometimes, we can experience problems because we just haven’t learnt the best ways of getting the things that we really want. For instance, we haven’t learnt the communication skills that we need to get closer to others.
So what all therapies do is one of two things, and generally both:
They help clients find more synergetic ways of getting what they want: e.g., getting both safety and love. So, for instance, a therapist works with a client to help them realise that they’re avoiding intimacy because they’re scared of getting hurt, and then helps them think about ways of maybe bearing some of that hurt so that they can, ultimately, experience love in relationships and feel safer at the same time.
They help clients find more effective ways of getting what they want: for instance, learning that they can experience more intimacy by being more honest about themselves, or that the best way of overcoming a fear is to face it.
So what does this mean? One implication of seeing a common set of principles underlying all the different therapies is that it can then make us more open to the many different methods and understandings that are out there: less ‘schoolist’ and ‘tribalist’ in our approach. Supposing, for instance, that I am trying to help my client find answers to their relational problems by providing an empathic and accepting non-directional environment. Great. And maybe that’s what I’ll keep on doing. But perhaps I’ll also help them through some psychoeducation in effective communication, or perhaps also by interpreting some deep-seated fears they have of intimacy. Of course, I need appropriate training in any method or set of ideas that I am going to use, but a common framework helps me see other approaches as resources and possibilities, not as competition. There’s been far too much sabre-rattling for years between the different therapeutic schools. Articulating a common set of principles can help us break down some of the walls and meet each other as friends rather than enemies.
Yes, integrative and eclectic approaches have been doing that for years. But, even for these approaches, it can be difficult to articulate the principles on which an integration is based: why it’s a coherent—rather than mish-mashy—approach to therapy. So what’s described here can still be of value in working out the common underlying threads behind an integrative or eclectic form of practice. But, importantly, the inference here is not that we should all be practising in multi-method ways (and that’s something we also emphasised strongly in our pluralistic approach). The fact that there is a common thread underlying the different therapeutic approaches doesn’t make a purely psychoanalytic practice, or a purely person-centred one, any less valuable.
If you’re interested in these ideas, do have a look at my latest book. It starts by introducing this idea of directionality and how it relates to wellbeing and distress, and then goes on to talk about the way in which the main therapeutic approaches (psychodynamic, humanistic, existential, and CBT) can be aligned with it. The final part then talks about some common practices that come out of it, like helping clients to identify the things that they want most in life. The book covers a lot of ground (maybe too much), but it’s part of a pluralistic striving to bring lots of different therapies together and to find what is common amongst us. That’s not, in any way, to minimise the unique contribution that each of our different therapeutic approaches can make. But to help establish some common touchstones that can bring us further into dialogue with each other.
