There is no question that sound preparation and a thorough theoretical grounding is fundamental to anyone interested in a career in counseling. Though there are strong practical and emotional elements to mental health professions, it is also imperative to build up a broad knowledge of the various strategies, techniques and theories available to help treat patients. In this way, when faced with a new, unfamiliar or particularly difficult situation, counselors can draw on not just their own experience but also that of the many mental health professionals that have gone before them, not to mention the millions of hours of research that have been conducted to help ascertain the very best way to help people with their problems.
Psychotherapy may be a relatively young field — first developed in the 19th century — but today you can find a large number of theories available that offer varying approaches to issues of mental health and how to resolve them. This article examines the ideas behind four of the main branches of psychotherapy: psychoanalysis and psychodynamic therapy, cognitive behavioral therapy (CBT), humanistic therapy and interpersonal therapy, as well as their potential application in real-life scenarios. It also looks at how therapists typically use these approaches in practice, how to receive training in these areas, and what opportunities there are for further development over the course of a counselor’s career.
Psychoanalysis and psychodynamic therapy
Psychoanalysis could perhaps be described as the ‘classical’ form of mental health treatment, with its modern therapeutic form the closest to the ‘talking therapy’ pioneered by Sigmund Freud. Psychoanalysis makes a major distinction between the conscious and unconscious mind, and is underpinned by the assumption that all of us have unconscious mental processes and repressed or resisted experiences or memories that influence our current state of mind.
During therapy sessions, the patient, together with the psychoanalyst or counselor, explores past events and relationships in their life in relation to current issues. With this approach, it is hoped that by gaining a better understanding of their unconscious feelings and motivations, the patient will be able to process and move beyond them and eventually achieve a more balanced psychological and emotional state.
Psychodynamic therapy can arguably be seen as an evolution of psychoanalysis. Although it also focuses on the unconscious, therapists who specialize in this area also tend to explore the patient’s personality and mind, and will also examine the effects of the outside world on the individual in relation to the current issues in their life. Commonly used techniques include free association, the Rorschach Inkblot Test, transference and dream analysis.A counselor who specializes in psychodynamic therapy will encourage patients to speak about a wide range of issues that can be addressed internally.
Often, this kind of therapy can help people resolve inner conflict and differs from other approaches in the sense that it seeks to achieve a significant change in personality and emotional development. Both psychoanalysis and psychodynamic therapy are often used to treat patients with depression, though psychodynamic therapy has also proven to be an effective solution for a range of other issues, including anxiety, emotional struggles or trauma, grief and self-destructive behavior.
Cognitive and behavioral therapies
There are several forms of cognitive therapy and behavioral therapy. The different terms are often confusing and sometimes used interchangeably. Generally, the main focus of behavioral therapy is on manipulating both the internal physiological environment and the external environment in order to cause changes in behavior.
Though behavioral techniques are very often cited in education and parenting guides, behavioral therapy can also be applied in a wide number of other areas, including to treat stress or anxiety, and improve group or interpersonal dynamics. Cognitive therapy, on the other hand, sees thought processes, or cognition, as the main driver of change and seeks to achieve cognitive restructuring by examining and reassessing the client’s thoughts, beliefs and expectations.
In these wide and varied fields, the most widely used approach is probably cognitive behavioral therapy, or CBT. Here, the assumption is that your thoughts, feelings and actions are all interconnected and that having negative thoughts can trap you in a negative cycle. As the name suggests, CBT uses elements of cognitive and behavioral therapy, employing a combination of environmental manipulation and cognitive techniques to try and attain improvements in the client’s general state of mind.
CBT seeks to break larger problems down into smaller parts so that they are less overwhelming and disrupt negative patterns so that the patient can move to enjoying a more positive outlook and alter their behavior in a positive direction. One notable feature of cognitive behavioral therapy is that instead of focusing predominantly on issues from the patient’s past, like with psychotherapy, it instead focuses more on current issues and how they can be addressed.
Counselors who specialize in cognitive behavioral therapy or similar approaches are typically expected to have a detailed understanding of not just psychological phenomena, but also issues related to neuroscience and the workings of the brain, as well as verbal and rule-governed behavior. Cognitive behavioral therapy is typically used to treat anxiety and depression, though it also has a range of other clinical applications, including bipolar disorder, borderline personality disorder, eating disorders and psychosis.
At the same time, it has been suggested that in some cases it may not be suitable for treating certain conditions — for example, if someone has suffered significant childhood trauma that they need to process, it might mean that they also require further exploration of the events of their past. However, cognitive behavioral therapy can also be used to help people to address general emotional challenges, such as stress, managing emotions, coping with grief or loss and managing chronic medical symptoms.
Humanistic therapy
Humanistic therapy, which was developed partly to provide a more positive and proactive methodology compared to the above approaches, is more concerned with examining a person’s capacity to make rational choices and develop to their maximum potential. Strictly speaking, humanistic therapy is an umbrella term that describes a wider range of different therapeutic approaches. The common thread is that each of these theories or sub-theories attempts to focus on the patient as an individual, with their own specific issues and their own unique potential. They also tend to focus much more on everyday life than other therapies like psychoanalysis and CBT.
Some of the most well-known types of humanistic therapies include client-centered therapy, where the counselor takes a non-directive approach and the client is an equal partner in the exchange. For example, Gestalt therapy focuses on perception and looks at the person’s current life and experiences instead of the past. There is also logotherapy, which is primarily concerned with helping people to identify a sense of purpose in their lives and assisting them with dealing with any difficulties they might have by encouraging them to find meaning in their life and take positive forward steps.
Regardless of the specific approach, a counselor who practices humanistic therapy should be open, authentic and interactive, and should always try to empathize with the subject and treat them on a human level. Humanistic therapy can be used to treat a variety of different issues, including psychosis, trauma, relationship difficulties, depression and learning to cope with chronic health problems. In addition, it has also been applied in a range of other areas, including in educational settings and even corporate environments. Some aspects of humanistic therapy, such as providing active listening and unconditional support, have also been incorporated into other forms of therapy.
Interpersonal therapy
Interpersonal therapy focuses on interpersonal aspects of our relationships and the role our everyday interactions and habits play in our emotional wellbeing. It assumes that it is possible to aid someone’s emotional wellbeing by focusing on improving interpersonal functioning. Unlike most other therapies, interpersonal therapy is usually time-limited (typically 12–16 weeks) and focuses on current, rather than past, relationships. It typically examines four main areas: conflict in relationships, life changes such as changing jobs or having a baby that can induce stress or produce a wide range of emotions, the impact of grief and loss and how to cope with it, and difficulties in starting and maintaining relationships.
In this form of therapy, counselors are expected to be non-neutral, active, positive and supportive of the patient’s journey. Counselors are also required to have a sophisticated understanding of human behavior, interpersonal interaction and group dynamics, a high level of empathy and the ability to be proactive and actively seek out working solutions for the client or patient. Interpersonal therapy is typically used to treat acute depression, though it can also be used to treat eating disorders, chronic fatigue and bipolar disorder. In addition, it is also recommended as an effective way of treating interpersonal disputes between partners, family members, close friends or coworkers, where the therapy can be carried out in either one-to-one or group formats.
In addition to the above theories, many counselors also elect to follow an integrative or holistic approach, where they implement a blend of different approaches depending on the situation in front of them.
Acquiring knowledge and the right skillset
In terms of career paths, therapists or counselors typically study a range of different approaches and theories before deciding whether to specialize in one area. While there is plenty of information available online and in book form regarding the various types of therapies, most prospective counselors will usually learn about these theories in detail in their formal education. And though undergraduate degrees do often provide reasonably extensive information about different branches of psychology and psychiatry, it is in postgraduate education that counselors can expect to develop in-depth theoretical background knowledge, practical training and field experience in relation to different approaches to therapy, all of which will help them prepare them for a long career in the profession.
Indeed, postgraduate training is a crucial step in any counselor’s pathway, particularly as counselors in the US, for example, are required to complete a master’s degree or PhD degree before they can start practicing. While a PhD is popular with people more interested in an academic or potentially research-based career, most graduates who would like to embark on a practical career in counseling are more likely to complete a master’s degree. Fortunately, there are a wide range of courses available, many of them offering specialization in certain areas. Today, while some students continue to opt for attending a course on campus, mental health counseling online masters degrees are also increasingly popular and can provide students with the required skillset in a more convenient way than conventional campus-based courses.
A Master of Science in Clinical Mental Health Counseling at the St Bonaventure University in the US, for example, provides students with the chance to not only gain the qualifications necessary to become a fully-fledged counselor but also earn a wider understanding of their chosen profession, and gain practical experience in the field of counseling. In this course, students are introduced to the main methodologies and approaches implemented in counseling, as well as how to explore and conduct both qualitative and quantitative research.
In addition, the course examines the development and cognitive processes that influence learning, key definitions and distinctions in relation to the diagnosis of mental disorders, an overview of counseling as a profession, and training and theoretical knowledge in relation to multicultural counseling. Students are also expected to complete two internships that provide crucial practical experience in their chosen field through hundreds of hours of clinical experience. Indeed, it is often during these placements that future counselors gain true insight into the nature of their future career.
Putting it into practice
Of course, even if someone has completed their qualifications and is ready to practice as a certified counselor, their learning path is far from complete. Indeed, the first few years of work as a practicing counselor are likely to be just as formative and insightful — if not more so — than the years of theoretical education, as the counselor is exposed to a wide range of situations, patients and mental health issues.
While new research can often influence the use of applied methodologies in counseling, as the counselor’s career develops they also have the chance to see what works best with which issue and which patient. In these situations, while some counselors are more rigid and will try to stick to their principles of practice no matter what, others are more flexible. A nonjudgmental approach, for example, might seem to be suitable in one context but ineffective in another.
There is no question that the future path of a counselor is highly influenced by their work, not to mention their own personal experiences. In fact, it is not unusual for a counselor to favor one approach early on in their career before gravitating more towards a different form of therapy later in life. Indeed, as their career develops and their interests expand, many therapists go on to do further post-graduate specializations. A passion for lifelong learning is key, and there are also a whole host of additional training courses available. Most of the best counselors also make a concerted effort to educate themselves in their spare time, be it through informal discussions with colleagues, private reading and study, or by attending conferences related to their chosen area of expertise.
The right blend of theoretical knowledge and practical experience
There are few professions as wide-ranging as being a counselor. Not only do counselors tend to deal with a vast array of people suffering from various mental health issues and from many different backgrounds, but many of them also work in a wealth of different institutions, from state hospitals and clinics to private healthcare facilities, schools or even businesses. It should be no surprise, then, that there are also many different theories and approaches to dealing with mental health, each with its own philosophy, its own research background, and its own unique advantages and challenges.
For anyone interested in a career in counseling, it is essential to gain a detailed understanding of the broad spectrum of available therapies and their practical applications, as well as specialist knowledge in certain areas. It is also vital to stay flexible and remain open to new ideas. After all, counseling is a dynamic and constantly evolving area — just one of the reasons why it is one of the most challenging careers available. It is probably most important that any prospective counselor identify their own path by choosing the approach, or a blend of approaches, as well as the field of application that best suits their strengths as a counselor — their personality, their style and their future goals.
