There are over 450 recognised talk therapy methods in this world so if you don't know what I'm talking about, safe to say, that's OK! It's rather confusing, to be honest. Or, if you've only ever heard of Cognitive Behaviour Therapy (CBT) and thought that was the only method, that's also totally understandable, considering the attention and widespread use of CBT. And safe to say, that I can't possibly cover all 450+ here but I'll mention a few - so you know how I work but also so you get an idea of what's meant by talk therapy/counselling/psychotherapy and by methods/approaches/framework (because apparently, my industry likes to make everything super complicated and confusing for outsiders, which I don't find entirely ethical and, definitely, not helpful). Let's see if I can make things clear as mud here ;-)
Let's start with some definitions...
In short, whether a practitioner is talking about a method or an approach or a framework, we're talking about a structured way and a system of working. As it says under 'approaches' - it's a way of dealing with a problem. And throughout the decades, different practitioners have found different ways to work with people. Some of them have had profound insights into the human psyche and have had access to an enormous amount of knowledge, while others have been busy projecting their own issues onto their clients or patients and drawing conclusions based on all sorts of unhelp biases.
That’s how we end up with more than 450 methods/approaches/frameworks out there. And nothing wrong with that (except for the fact it’s a bit overwhelming and confusing to navigate around all the options). I’m, myself, working on my own framework called the Curious Questions Framework (CQF) of how to use curiosity as our superpower to be more compassionate and resolve our own internal issues, relationship issues and issues at the workplace (but, let’s not get into that now).
In other words, different practitioners will work in different ways. They’ll apply different methods/approaches/frameworks to their way of working and with their clients. These methods can be both practical, structured ways of working like Cognitive Behaviour Therapy (CBT) which is based on the concept of identifying your thoughts, your feelings and your behaviours and by becoming aware of which thoughts, feelings and behaviours aren’t helpful and which you’d like to change, the practitioner will start to work towards having more helpful thoughts by, perhaps, challenging your existing thinking and perspective.
Others will use CBT but also have a philosophical framework added to their practice, so for example, in Denmark it’s still a widespread thought method to think of mentally ill people as being broken and they might ask and talk about ‘what’s wrong with you’. Whereas, there’s a different (thankfully, growing) way of thinking when it comes to working with mental illness and disorders which is to say ‘what happened to you?’ and examine which external factors impacted your mental health. So, the focus is no longer on you being broken, crazy or wrong but rather on something that happened in your life that shouldn’t and your brain had an understandable reaction to this event (usually, trauma of some sort whether that be abuse or being bullied at school).
There was recently an article in a Danish newspaper, where someone with an eating disorder said she was tired of the focus being on what was wrong with her and measuring her mental health based on the number on a scale. She wanted the mental health professionals to ask what happened for her to develop an eating disorder and what’s wrong with our society that creates these problems for people.
This is a way of working and thinking that I feel very passionately about. The so-called ‘medical model’ has caused so much stigma and problems and prolonged people’s pain by insisting on a medical explanation for mental health problems, such as the chemical imbalance myth (I won’t go into that here, but if you Google that term, you’ll get a lot of articles about it). I’m not here to say that there isn’t or can’t be a genetic or biological reason for someone’s struggles (though the evidence of this is lacking and problematic at best) and I’m certainly not here to suggest that medicine can’t help (despite the issues around research in this area), but what I am interested in, is in having helpful conversations were we, especially us practitioners but also society as a whole, reduce or remove stigma instead of adding to it without outdated ways of thinking and talking to each other. Even if there was solid proof of a biological basis for a mental health problem, is it helpful to focus on that instead of focusing on how to get better, how to improve, how it makes the person feel, and make them feel understood, accepted and loved regardless?
Back to actual, structured methods…
The likelihood of there being a method out there that suits your unique self is high but you have to know that you can and are allowed to search for this to be able to find it. If you’re highly spiritual and it’s important to you that your belief system is respected and taken into account when talking to a therapist, then you should go and seek someone who understands and respects these beliefs. And if you are a person of science and evidence-based methods, then you should find someone who offers this kind of approach.
There is no therapist in the world who can accommodate every single person out there and who knows all the methods that exist, able to apply just the right one for your unique self. You’ll have to do some of that work yourself.
If you’re dealing with complex trauma and you’re in a place where it’s impacting your sleep and eating, your quality of life, and your relationship with yourself and with others, you really should go and see someone who specialises in trauma. Not a ‘trauma-informed’ therapist, nor necessarily a psychologist, but someone who’s trained in trauma-specific methods like EMDR, or if you’re wanting to quit smoking and believe in the power of suggestion, you should perhaps try a hypnotherapist (and no, they don’t take control of your mind or anything sinister like that. You’re fully conscious and in control, all the time, unless, perhaps, if you go and see Darren Brown).
If you prefer something more practical CBT might be your thing. However, if you’re dealing with issues from your past (which can be trauma related without you being traumatised – most of us will have experienced trauma in our lives. Some people talk about trauma with a small t such as bullying, divorce, or physical health problems and then there is trauma with a big T such as abuse, neglect, war, violence, etc) or if you’re dealing with systemic issues such as discrimination or racism, CBT can be problematic as it puts the full responsibility on the individual and ignores society’s role. Likewise, if you know you tend to intellectualise things and not feel your emotions, CBT might help you sustain an unhelpful way of living rather than help you get in touch with your emotions so that you can work through them.
If you like to be listened to, feel validated and have a mirror held up, try someone who’s person-centred, or if you’d like something that’s quite perspective, maybe solution-focused therapy is your jam.
If you’re a creative person and you like to journal or draw or otherwise think outside the box, find a creative practitioner.
If you hope to get a diagnosis and medicine, we’re not talking method as much as the right practitioner and you should talk to your doctor and get referred to a (clinical) psychologist or psychiatrist. And if you’re wanting to improve in your career, become a better team leader or manager or get your team to excel at work, maybe a coach is more your thing.
Here are the methods I offer and apply (interchangeably, rather than strictly one method per session).
At the core of my practice lies the person-centred approach.
Carl Rogers is quite a famous fella among us counsellors, and he invented the 'person-centred' way of working with clients, to challenge other therapeutic methods like Freud's psychoanalytical style.
The name kind of gives it away - the client is at the centre of attention.
It's based on listening a lot, reflecting back feelings to the client and offering unconditional positive regard, empathy and congruence.
Mighty fancy words, right?
Unconditional Positive Regard is the basic acceptance and support of a person regardless of what the person says or does, especially in the context of client-centred therapy.
Empathy is the ability to understand and share another person's feelings and shouldn't be misunderstood as 'sympathy' which refers more to feeling pity for someone. Pity is saying "I feel so sorry for you", whereas empathy is more like saying "I can understand why you reacted like that. I'd find that situation very difficult to handle too."
I'm both a big fan and big critic of the CBT approach. As you can read above, I think CBT is a very handy and practical way to address some basic issues, like obsessive or compulsive thoughts but I also think it's hugely lacking in addressing past and systemic issues. It's becoming more widely known that CBT isn't a great method for neurodivergent people.
Cognition is the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses. So what is going on in your head - your thoughts and feelings.
Behaviour obviously refers to your behaviour, as in your reaction to things but also your bodily/physical reaction.
CBT is often done by walking through a specific situation (see below) and try to come up with alternative explanations to find more healthy thoughts, feelings and behavoiurs to a situation. CBT is supported by giving clients worksheets to fill out at home, such as a thought diary, to monitor where thoughts and emotions might become unhelpful to behaviours.
It's a lot easier to explain in a handy diagram:
The therapy part is when we think, feel and behave/react in a way that's problematic or unhealthy.
So, for example, a person with depression, let's call them Joey, sees a friend on the street and waves. The friend doesn't wave back. Joey now thinks the friend doesn't like them and was ignoring them (thought). This can lead to further thoughts of worthlessness and being disliked by everybody (this is called 'black-and-white thinking'). Joey's heart starts racing and they feel flustered with burning cheeks and stinging eyes because they feel like crying (bodily reaction). This makes the emotion fly, and Joey feels hurt, sad, and rejected. By the time Joey gets home, they’re in a bad mood and shout at their partner, and may even go and hurt themselves, by self-harm by cutting, banging a head against a wall or drinking or taking drugs, to release some of the negative feelings (behaviour).
CBT offers a way to analyse this pattern and offer alternative ways to react. Maybe the friend didn't see Joey, in which case there was no need to react so strongly. Even if the friend did ignore Joey, does that make Joey worthless? Is it correct for Joey to think that they’re disliked by all? What about their partner? (Here, the counsellor would be working with Joey's thoughts and presumptions - their cognition - to try and alter this black-and-white thinking).
Could Joey do a few breathing exercises to calm down their bodily reactions before the emotions become too strong to control?
When Joey comes home next time, after having had CBT, they might not feel quite so emotionally upset because they’ve been able to reason a bit more with themselves and they don’t shout at their partner but gets a hug instead and they don't feel like self-harming today (behaviour) because they controlled their thinking (cognition) and feelings and this helped to control their behaviour as well.
Have you heard of Danish Søren Kirkegaard? He was a philosopher and the father of Existentialism. He, famously said: "Life can only be understood backwards, but must be lived forward." How many of us have said, "if only I'd known this when I was younger?"
Existentialism is a philosophical theory and approach, which emphasises the existence of the individual person as a free and responsible agent determining their own development through acts of the will (fancy, right? I stole that from Google's dictionary).
Existentialism, as a philosophy, often focuses on the meaning of life and what our purpose on this Earth is, as it deals with the questions around our existence. Why are we here? What am I to do now? What happens when I die (and so, often, existentialism also focuses on the fear of death or our discomfort with mortality).
Existentialism is a massive framework and many different philosophers, as well as practitioners, believe different things about this framework and, therefore, apply different methods.
I tend to focus on these four aspects 1) The importance of responsibility and feeling like we’re responsible individuals with responsibility over something 2) Coming to an awareness or having an understanding of our version of what purpose and meaning is 3) Isolation versus connection 4) Being ok with our mortality.
You may also be familiar with the term 'existential crisis' which is something we cal all go through at various different times of our lives. Here's what The School of Life has to say about that...
Michael White and David Epston came up with the framework ‘narrative therapy’ and David Drake created the framework ‘narrative coaching’, whereas I specialise in something I call ‘narrative practices’ borrowing from narrative therapy, coaching as well as psychology (neuroscience and evolutionary psychology), sociology, anthropology, creative means and much more.
It’s about growing one’s awareness of the stories we tell ourselves and whether they’re helpful or hindering. It’s learning to write and re-write better narratives for ourselves and allowing the space, patience and compassion for seeing other people’s narratives, unique and separate as they are from our own stories and perspectives.
In our first proper session (the one after the taster session) I will ask for your consent to tell me your life story as it helps me to see the 'narrative' you live in.
Have you ever found that a sibling doesn't remember your childhood the same as you? That's because they have a different narrative, much like when you're arguing with your partner - it's because you don't see eye to eye because you each have a different narrative, a different story of what’s happened.
Using narrative therapy is a way of working with 'your story' in life and during events, to become clear on your perspective, and add a different perspective to the mix, for example, or to change the story a little bit to open up your eyes to possibilities instead of limitations.
Narrative therapy can also help externalise a problem, which can be very liberating and rewarding. Instead of thinking of ‘you’ as the problem, it’s about thinking about the problem as the problem. It’s not ‘you’ that’s anxious but rather that Anxiety has a hold of you and for us to examine what it’s doing to you, what it’s whispering, what it’s making you believe against your better judgement.
And we might ‘thicken’ the story by adding forgotten or ignored layers to your story. For a long time, I told a story of being bullied as a child and how it gave me a ‘bad childhood’ and I was so blinded by this ‘thin’ story that I forgot all the good things that happened in my childhood as well. Once I’d ‘thickened’ the story it changed my whole relationship with my past and it helped me create a better narrative for my future as well.
Transactional Analysis (TA)
T.A. can be a very powerful tool to bring into therapy and allows you to evaluate how you communicate with others and why, as well as how you feel about yourself in any given situation. These two videos do a great job of explaining it.
But there is lots more to TA than the PAC (Parent-Adult-Child) model shown in the two videos. Like, the beliefs, or scripts, we live by, like, ‘be perfect’, ‘be invisible’, ‘be strong’, ‘hurry up’, ‘don’t grow up’, ‘don’t exist’, ‘don’t feel’, ‘don’t think’, ‘don’t speak’, ‘don’t be important’, ‘don’t waste your life/time’ and so on.
TA looks at ‘racket feelings’, so our ‘go-to’ feelings when things go wrong, may that be anger, sadness, frustration, blame or a number of other repeat feelings we picked up somewhere in childhood and are now, unconsciously, playing out over and over.
TA also uses a framework called the ‘drama triangle’ which I’ve written an e-book about which you can get here.
In my article here I write about how psychology is a big and important factor.
What that means is that I use science, data, research and evidence-based methods to inform my practice, including offering the people I work with educational tools and resources (what's called 'psycho-educational means'. I suspect, whoever came up with this word wanted to feel really clever, as it's certainly not a helpful layman's term).
The ways that psychology informs my work is, by staying up-to-date with the current scientific beliefs around how we, as humans, work and how the world around us influences us. I also use neuroscience and evolutionary science to enhance people's experience of understanding themselves and their problems. You can read more about that here in my article You're Saner Than You Think.
I hope this helped you get a bit clearer on ways to work in therapy and the ways that I work.
If you were to add some thought to the Manual of You what might you think would work well for you? What might you like and why?
If you have any questions, feel free to get in touch, or if you're wanting to book a heavily discounted taster session, click below...
Thank you for reading. I hope you enjoyed this article. If you did, or didn't, or want to add something or have a question, feel free to comment below (but try and be kind about it - I'm a terribly sensitive soul).
Don't forget that this is just my opinion. You don't have to agree. These pieces of writing are just here to make you think and take from it what you like and find helpful and ignore the rest. At the end of the day, it's your life and, therefore, what you consume, what you believe, and what you think and feel is your choice.
Also, this article has been brought to you by a perfectly imperfect, flawsome dyslexic. I hope any potential spelling or grammar mistakes didn't take away from your enjoyment.
Meandering thoughts about life and the meaning of everything, from a know-it-not-all!