Counsellors and psychotherapists come in many different shapes and sizes. This article seeks to outline some of the most important ways in which therapists differ from each other. The aim is to help anyone choosing a therapist to make a reasonable assessment, based in particular on the client’s character, and the client’s preferred methods of relating.
All therapists are capable of being friendly. The difference is at what stage, and how often, this friendliness shows itself. Therapists who come from a person-centred tradition (favouring a positive relationship from the start) will tend to be warm and welcoming from the moment you meet them. In contrast, some therapists offer more of a ‘blank slate’ at first, offering a more neutral, even formal, style, in order to see what emerges over time.
If a client wishes to experience warmth and closeness quite quickly, then a friendlier therapist may offer a better foundation. A friendly, welcoming therapist can also be suitable if a client is having trouble accepting a part of themselves. It’s usually easier to disclose to someone who welcomes you without judgement. Those with trust issues may also find that a welcoming therapist gives them the consistently positive response that encourages them to share.
However, there are some advantages to a more neutral, detached approach. If a client feels somehow distant from others, then they may be more comfortable with a therapist that doesn’t rush in with too much warmth. Also, if a client wants factual advice and techniques, a more scientific, expert approach might suit them. Some clients find too much warmth invasive, and are more at home with the relational side kept to a minimum.
There are a huge number of different methods on offer, and it can be overwhelming to try to understand them all, let alone choose. Broadly, methods divide into three. (The division is my informal one only.)
- Technical and educational methods. These treat the client as a person to be processed. Examples include EMDR, rational emotive behaviour therapy, and cognitive behavioural therapy (CBT).
- Relational methods. These treat the client as a relational being, and treat the therapist-client relationship as a big part of the process. Examples include person-centred therapy, psychodynamic therapy, relational-cultural therapy, and many forms of integrative therapy.
- Quasi-religious methods. These have strong cultural adherence, similar to a religion. Examples include psychoanalysis, mindfulness, therapies based on transpersonal psychology, and therapists who work from specific religious perspectives.
Roughly speaking, if the therapist presents themselves as a scientific, technical expert, it’s type 1; if they see therapy as an evolving relationship, it’s type 2; and if they have a particular philosophy of life to spread, it’s type 3.
Therapists often mix and match. For instance, I tend to work relationally with a person-centred approach (and sometimes psychodynamically), but also use aspects of the CBT process, and some quasi-Buddhist elements of mindfulness.
A good therapist can be flexible in method. For instance, a good CBT practitioner, while working from a scientific base, may well use relational practices, such as warmth, kindness and personal engagement, where appropriate.
GETTING ON WITH YOUR THERAPIST
Above all, pay close attention to how you are getting on with your therapist. Is the relationship consistently hostile, or consistently friendly? Hostility is OK sometimes, especially if it is part of the method to work through difficult feelings. Consistent friendliness is obviously helpful, but can backfire if the therapist ends up just agreeing with everything the client says, mollycoddling and potentially preventing any growth.
Whatever the ups and downs, research suggests that the ‘therapeutic alliance’ is particularly important. This term is used to describe the working relationship between client and therapist. A strong alliance means that, whatever the difficulties, both sides realise they are on the same side, helping the client towards happiness. Just like an Olympic athlete with their coach, there needs to be a strong alliance, involving trust, to get through the developmental journey.
From time to time, there will be relationship ruptures, times when client and therapist appear to be arguing or not getting on. These are not necessarily harmful. In any relationship, coming back together after a difference is an essential part of growth and resilience. Often, the client can use the therapeutic relationship as a model, or test, for behaviour they want to try in ‘real life’. The safe environment is a good place to practice new ways of relating.
For example, some clients have fallen into an appeasing, avoidant manner which prevents relationships deepening. By going through a process of uncomfortable intimate engagement with a therapist, learning to share more, a client can learn resilience and skills which they can then take to their family and friends, deepening those relationships in turn.
OVERALL QUESTIONS TO ASK YOURSELF
Here are a few summary questions we can ask ourselves about any therapeutic relationship, and in fact any relationship:
- What do I know about the other’s overall philosophy, and their approach to our work together?
- Do I feel the right balance of warmth and challenge?
- Do I feel that the therapist is attentive and responsive?
- Do I trust this person with my happiness?
- When we have a disagreement, are we able to negotiate it well?
The key factors of warmth, challenge, attention, trust and negotiation are ones to look for. If either or both of you is cold, bored, unconcerned and unengaged, that’s not generally a good sign. If you are both welcoming of each other, but also challenging of each other; attend to each other well; trust each other; and negotiate change effectively together… then you may be in business.