Which Therapy To Choose and Why (& Podcast)
By far the most popular is Retail Therapy.
It’s available 24/7, it can be done alone, together or in groups. And comes with a lovely surprise in the letterbox once a month.
Alternatively, you could try one of the talking therapies:CBT, NLP & Hypnotherapy are called Solution Focused.Psychotherapy is known as Person-Centred.
This paper asks “Which therapy and why?”
CBT (Cognitive Behavioural Therapy), NLP (Neuro-Linguistic Programming) & Hypnotherapy
They focus on the problem, to eliminate or reduce unwanted patterns of behaviour.
“When I get out of bed, I kick the cat, and I don’t want to because I love my cat”
1. Get out of the other side of the bed, or
2. Don’t get out of bed, or
3. Get rid of the cat, or
4. Upon waking, tap on the bed post 4 times, to remind you not to kick the cat, or
The CBT therapist seeks to pinpoint a trigger (getting out of bed) and unwanted behaviour (kicking the cat) and provides a solution to interrupt the pattern (tapping the bed post). The therapy will focus on reducing the frequency of the problem. An NLP Practitioner will do pretty much the same as CBT, although will use more specific reframing and anchoring to hard code the new behaviour into the mind.
If you are determined enough to break a known habit (e.g. smoking) then Hypnotherapy will strengthen your self-talk and therefore likelihood of success. The first session often includes a hypnosis susceptibility test, so you will quickly know whether it will work for you.
CBT is the only therapy available on the NHS and favoured by workplace Employee Programmes (EAP). It’s usually capped at 6 sessions and provides a solution to a specified problem at a known price.
NLP & Hypnotherapy are considered as fringe science, largely because they were born outside the academic and clinical mainstream. NLP is more of a coaching technique than a therapeutic model whilst many doubt the authenticity of Hypnosis. When you see people hypnotised on TV eating an onion believing it to be an apple, this is not trickery. Those people are in a hypnotic state.
The two mainstream models are Psycho-analytic and Psycho-dynamic.
Psychoanalytic provides the client the opportunity to explore their own thoughts, with little or no prompting or intervention by the therapist. Picture the client laid on a couch and the therapist with clipboard in hand nodding sagely. It’s an entirely client led, person-centred and analytic approach to therapy. It can be the purest, rarest, most indulgent form of therapy and self-discovery.
Psychodynamic has its roots in Psychoanalytic and, like CBT, is very successful for “solving specific problems” however, it also treats a much more a diverse range of psychological difficulties. It’s the most widespread talking therapy and its dynamic nature means it can be adapted to the needs of each client.
The Psychodynamic therapist interprets the unwanted behaviour as a surface level expression of a deeper mental or emotional difficulty, the source of which is in the clients past. In many cases the client cannot pinpoint a specific problem, it’s a feeling of depression, sadness, feeling burdened, needing someone to talk to, or may have been triggered by a significant life event (relationship, bereavement, job etc).
In the cat scenario the Psychotherapist will examine the problem and seek to establish a wider and deeper perspective:
“When I get out of bed, I kick the cat, and I don’t want to because I love my cat”
“How do you feel when you wake up?”, Client: “Well I don’t know, but I check my phone for
emails and I know there will be something I’ve not done, or done wrongly; My boss is so demanding, I can never seem to get things right, even though I try so, so hard”. “And my partner will be on at me, probably about my alarm ringtone being too loud or musical”.
“Then the cat starts with its incessant meowing”, “Bl**dy cat”
Clearly the cat needs to go. That’ll solve it. Or maybe the partner needs to go. Or maybe give up the job, or perhaps it’s the alarm clock. Maybe it’s something else, something deeper? Maybe it’s me!
The therapist will help the client to explore their past to identify key events, beliefs, limiting decisions and patterns of learned behaviour to highlight associations between past and current thoughts, feelings and behaviours. That’s why Psychotherapists have tissues; because exploring our memories can stir up powerful aged feelings, and unreleased emotion. The very thought of talking about past experiences and emotions often stimulates “we don’t talk about that”, which itself is a learned (protective) behaviour.
In the cat example there is a suggestion this person has a strong emotional response when dealing with criticism, often feeling overwhelmed or not good enough (a common phenomenon unwittingly harvested in childhood). Maybe the client’s historic relationships with a critical parent is influencing their adult behaviour? Person-centred therapy gently explores the client’s past, and the cat can sleep peacefully.
A third, little known modality known as ‘Psychology with a soul’ is Psychosynthesis. It introduces a Mind, Body, Spirit synthesis into the therapy room and can include exploration of the Primal Wound (UNDDA), which practitioners believe to be at the heart of emotional neglect. This modality along with ‘Inner Child Therapy’ offer the therapist even more powerful ways to pinpoint acute emotional trauma.
Further Examples of CBT and Psychodynamic Psychotherapy
Examples of CBT
A client couldn’t drive long distances without stopping at almost every motorway toilet as he feared not beingabletogettotheloo. Matterswerebroughttoaheadwhenhethenstartedtoavoidlongdistance travel altogether, as a result of his “toilet anxiety”.
CBT provided a solution. To carefully plot his journey by checking which motorway services he can stop at along the way and picking the lowest number of interruptions on his journey. And, to start carrying a change of clothes. Just in case.
So, as a result of CBT he can drive longer distances but not without his change of clothing and his precise loo stops, which he pulled over at, irrespective of whether he needed the loo or not.
Another CBT I witnessed was a lady who used to check her house door locks up to 30 times every time she left the house, and the same before she went to her bed. She recalled how it had increased from 5 to 10 to 15 and was now at 30. She could see that if she didn’t stop it would reach 50, or 100!
After her 6 CBT sessions she reduced this to only 5 door checks on each door before leaving the house. So, CBT helped, but the problem hadn’t been resolved, and there was every likelihood it would rise back to 30 checks and above.
How Psychodynamic Psychotherapy helped further
Where CBT doesn’t seek to understand or deal with the underlaying cause or source of the problem, Psychodynamic Psychotherapy does. The therapist seeks to understand the pattern, history and source of the unwanted behaviour by exploring the feelings which sit behind the trigger and behaviour.
It transpires that the man with the driving problem once had a significant toilet miss-hap as a very young child and was publicly humiliated about it by his older brother. He remembered it vividly.
Whilst out on a family trip his brother mischievously prevented him from using the loo when he needed to and as a result had a very distressing “number 2’ event. To make matters worse he felt particularly ashamed and experienced the indignity of spending his day out with his visibly dirty trousers on.
Nothing more than childhood mischief you might think. However, this little boy was terrified of making a mess in his pants when away from home, and on that day, he decided in that moment never to get caught out again, and never have to face the fear of the associated humiliation [Psychosynthesis Primal Wound].
Fast forward to adulthood and this toilet fear became part of a powerful adult behaviour.
The therapy not only pinpointed the source of fear, but also helped him recognise that excessive toilet planning could not heal that humiliating moment from his childhood. As he came to accept this his difficulty with travel dissipated. The last time I spoke to him his toilet anxiety wasn’t a controlling factor in his choice of travel; and he had a much healthier relationship with his older brother too.
In the second example it transpired the door locking lady had experienced a break in at her home as a child, but that wasn’t particularly the source of her fear. It became apparent that she had lost (or rather misplaced) a set of keys to her house and had decided not to change her locks because she was of the belief that she “shouldn’t ever waste money, ever”, a lifelong rule which she followed since childhood. But the behaviour of failing to pay for new locks and keys left her feeling unsafe in her own home.
She feared wasting money more than her own safety and the incessant door locking was a process which she had adopted to help her feel safer. A change of locks and keys changed her feelings of safety at home immeasurably.
So, what is the difference?
The CBT Practitioner will likely ask “so, what’s the problem”.
The NLP Practitioner will start with “so, tell me how you do your problem”.
The Hypnotherapist stares and says “look into my eyes, not around the eyes, into the eyes ......and sleep”
The Psychoanalytic Psychotherapist gets out the clipboard and says “now lay down and begin”
The Psychodynamic Psychotherapist likely starts by asking “so, how are you feeling today”
Finally, a Psychologist or Psychiatrist is not a therapist or counsellor. It is someone who can dispense medicine or offer other forms of clinical intervention, not talking therapy.
This is how the National Health Service differentiates the CBT and Psychotherapy:
“Psychotherapy is a more in-depth form of therapy than CBT, and it can be used to address a wider range of issues. A psychotherapist can help you explore your thoughts, feelings and beliefs, they will help you consider how your personality and life experiences influence your current thoughts, feelings, relationships and behaviour. This understanding should enable you to deal with difficult situations more effectively.”
from the desk of
PGCEE, MNCS (Accred), FETC (Ad.Dip)