The aim of this essay is to compare and contrast two counselling theories of my choice. I have chosen to compare Psychodynamic Counselling and Cognitive Behavioural Therapy.
The philosophy behind the Psychodynamic Counselling approach is that we all have an unconscious mind as well as a conscious one. It states that the unconscious mind can hold on to painful memories and feelings, which interfere with the conscious mind through the creation of cognitive defences. The theory also states that our personalities are split roughly into three portions: The Id (the primal aspect that wants pleasure and it wants it now), the Superego (the part that wants to keep us safe and take no risks), and the Ego: (which seeks to balance the wild Id and the sensible Superego). Psychodynamic Counselling seeks to bring unconscious problems into the conscious mind so they can be resolved, and the defences that are impacting on the client’s life can be dismantled; as well strengthening the client’s Ego so it can better mediate the other two aspects of personality.
The philosophy behind Cognitive Behavioural Therapy is that how we think, how we feel emotions, how we interpret our bodily sensations, how we act, and the situations we find ourselves in all interact together; or more specifically, that our thoughts determine our feelings and our behaviour. Negative or unrealistic thoughts can cause distress in our bodies, and skew how we interpret situations, which can then have further negative impact on how we act in those situations. It revolves around the idea that the problem is not the problem – the problem is our attitude towards the problem.
As you can see, while they both essentially help someone deal with their problems by talking about how they think, they use wildly different techniques, have distinct vernacular and they look at different aspects of a client’s mind in order to heal it.
Psychodynamic Counselling deals with memories and how they can affect us in the present.
Cognitive Behavioural Therapy deals with the present and how memories don’t have to define us.
In some ways they are the two opposite sides of the same coin. They do differ in terms of suggested contract length though. Psychodynamic Counselling tends to be long-term or even open-ended, as it delves heavily into early memories and formative childhood relationships; whereas Cognitive Behavioural Therapy is definitely a more short-term option that looks to teach quick and easy, actionable methods.
Psychodynamic Counselling sees the self as a collection of impulses and drives that sometimes work with each other, sometimes against; sometimes consciously, sometimes not. As I mentioned above, the theory works on the idea that our personality is comprised of three aspects – two of which are diametrically opposed, and the other seeks to mediate them both. It also states that a large portion of our behaviours derive from our early childhood development.
Sigmund Freud, the founder of psychoanalysis, upon which Psychodynamic Counselling is heavily based, posited that it were possible for a person to get “stuck” at a certain developmental stage, and that a lot of present-day problematic behaviours can be attributed to the stage that they got stuck at. I can see how this makes sense, as after all, the human body does start off as a hungry digestive tract with no idea of its own consciousness, and not having its needs met at a particular developmental point could result in a fixation on things related to that stage. I can relate to this personally, as, for example, if I am craving an ice lolly on a hot day and I don’t get one, I’ll fixate on it until I do get one.
Cognitive Behavioural Therapy sees the self as a malleable entity, built from the events of the past, but not necessarily bound by them. Although the therapist and the client work together in a collaborative relationship, it, as a therapy, focuses very much on the client as an individual, and how they must be the ones to put in the work and change their cognitive habits. It’s interesting that both theories see change in the self as possible. Both see the past as unchangeable, Cognitive Behavioural Therapy even to the point where it is almost ignored, but it is about reframing the events of the past, and coming to realise that those events do not have to define who a person truly is or how they act. Also, I did notice that a negative internal monologue and the Superego concept from Psychodynamic Counselling could be roughly comparative. In Cognitive Behavioural Therapy a negative internal monologue seeks to protect the client by not allowing him the confidence to get out of his comfort zone; it chides the client and puts them down at given any opportunity, which does not encourage positive growth as a person. An overly critical or protective Superego does the same thing; it seeks to hold the client in a safe place by overpowering the Id and the Ego, but no positive personal growth is possible in this safe place.
In Psychodynamic Counselling, personal history is the basis of the entire theory. As well as developing from a series of psycho-sexual stages, traumatic memories can be repressed into the unconscious mind, which create cognitive defences. These defences aid in the clients survival when they are younger, but can be detrimental if they are carried into adulthood. A Psychodynamic Counsellor will help a client identify these defences and their origin, in order to dismantle them. Two of the more common ego defences are Repression and Projection, and I’d like to look at them from the perspective of Psychodynamic Counselling, and then see how Cognitive Behavioural Therapy interprets them.
In Psychodynamic Counselling, Repression deals with painful, frightening or threatening emotions, memories, drives or impulses that are pushed deep into the unconscious, usually when a parental or authority figure disapproves of them early on in life; this then becomes part of the Superego. The client will then unconsciously desire to perform these actions, but at the same time not want to, and feel very conflicted about them. Repressed emotions also exist as a concept within Cognitive Behavioural Therapy – but the focus is to use mindfulness techniques and thought experiments to expel them from the body, rather than dismantling them by exploring their origins or through free-association.
Projection is an attempt to banish or disown unwanted, negative or disliked thoughts or behaviours by attributing them to someone else. Because projective identification, as it is known, is particularly challenging to deal with in Psychodynamic Counselling, it would be treated delicately through the use of transference. Transference is the idea that a client can project their feelings about someone onto the counsellor unconsciously, and this can, at times, be considered inappropriate. Going on to explore this inappropriateness is a powerful way to resolve the Ego defence. By contrast, Cognitive Behavioural Therapy could challenge the client’s projection by asking them to question whether what they think about the person they are projecting onto is accurate, or maybe even talk with the target of their projective identification to see if they really do hold certain attitudes or beliefs. While I don’t think Cognitive Behavioural Therapy is necessarily dismissive of a person’s personal history, it does not hold it to the same degree of importance as Psychodynamic Counselling does. It is all about perspective, and how a client interprets their past. A client and counsellor won’t go back and work out exactly when the seeds of a particular behaviour were planted, but it will trim back the plant that has grown from them to make it more manageable.
Both theories hold importance in patterns of relating to others. A pattern is defined as something that repeats, so it is apt that Psychodynamic Counselling is mostly concerned with patterns created in childhood relationships, and how those patterns can be repeated and cause issues in the present; whereas Cognitive Behavioural Therapy looks to see if the present day patterns of relating are healthy and based in reality, rather than being based on assumptions or pre-conceived notions. When looking at patterns of relating in terms of Psychodynamic Counselling, it is almost impossible not to mention how the personality of a person is formed through interaction with its parents early on in life. Where these interactions fell on the scale of being good enough to downright bad determines the temperament of the person, and what patterns they carry forward into adult life.
In contrast to this, Cognitive Behavioural Therapy looks at relationships as exercises in being open and honest. The crux of the theory is that the problem is not the problem, the problem is the attitude towards the problem – and this also rings true about how the client should approach their relationships with others. Cognitive Behavioural Therapy is very clear in that other people cannot be changed, but the clients can change themselves, and how they see others, and how they interact with them. There are specific exercises in Cognitive Behavioural Therapy that seek to challenge skewed beliefs when it comes to relationships, with the aim for the clients to better develop more open, supportive and resilient relations with others.
The theories differ in their pattern of relating between the client and the counsellor. In Psychodynamic Counselling the counsellor is a blank slate that can be projected upon, and the resulting transference is used as an interpretational and exploratory tool. In Cognitive Behavioural Therapy the counsellor is more of a teacher, and the client is a student. Both patterns of relating are collaborative, in different ways.
In terms of strengths and weaknesses, Psychodynamic Counselling is obviously very much suited to treating historical problems like Childhood Sexual Abuse, Post-Traumatic Stress Disorder, and less suited to common or garden day-to-day issues; whereas Cognitive Behavioural Therapy is definitely useful for presenting problems like phobias and anxiety, but not quite so useful for delving into repressed memories or how a client felt about their father. Clients can sometimes have problems conceptualising the more abstract constructs in Psychodynamic Counselling, such as the distinction between the conscious and unconscious mind, whereas the simple and practical applications of Cognitive Behavioural Therapy tend to be rooted in reality, and are much easier to grasp. As Psychodynamic Counselling tends to be a more long-term commitment, it is usually more expensive than Cognitive Behavioural Therapy.
To conclude, I have to decide which theory I prefer, and explain why. I’m not sure I can do that. It would be like trying to decide method of cooking bacon is the best – I don’t really mind which way it has been cooked as long as I get a bacon sandwich in the end. They are different tools for different jobs, but it would be perfectly acceptable for a counsellor that is trained in both theories to use Cognitive Behavioural Therapy techniques early on in a therapeutic relationship to help ease the here-and-now symptoms, and then move to more in-depth Psychodynamic Counselling work over time. Alternatively, if a client seeing a Cognitive Behavioural Therapy counsellor in private practise wanted to explore their childhood, then referring them to a counsellor that works with Psychodynamic Counselling would probably lead to a much more productive outcome. Getting the most out of therapy is not about the client finding the perfect modality to be healed by, but by the client finding the theory that works for them, and creating a safe and collaborative therapeutic relationship with a counsellor that they gel with. There is no right or wrong way, as long as client and counsellor are kept safe.
There are some extreme issues that are not suited to one or the other modality, and while they both have their own strengths and weaknesses, I feel the vast majority of presenting problems could be dealt with via either theory. A client that came in and presented a phobia of spiders could go backwards through their own history and pinpoint the exact moment the phobia took hold; or they could progressively work through their fear of spiders in the present through thought exercises and gradual exposure to spiders in a safe environment – Different procedures, same result.
Psychodynamic Counselling goes back in time and gives you the reason why you perform a particular problematic behaviour, which, when brought into the present day conscious mind and examined, allows you the freedom to stop performing the behaviour. Cognitive Behavioural Therapy remains in the present and provides you with the tools you need to stop performing a particular problematic behaviour, and then, when you are not performing that particular behaviour anymore, the reason behind it becomes moot. But to be quite honest, after all this backwards and forwards, I think I prefer Person Centred Counselling.
