How do counsellors help?

Counselling is a helping relationship. But how exactly do help? In this episode, we'll discuss how different modalities view psychotherapy's mechanism of action.

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Transcript

(00:05):
Welcome to the mental health professional's podcast. I'm your host, Chris. And today we are looking at how do counsellors help? How do psychotherapists help? Because in some ways it might sound obvious that counsellors provide help with people processing their emotions. But how does this happen?

(00:45):
Well, interestingly, we don't really know, and it's not that we don't really know. It's what you mean by that is the different psychotherapies, different modalities, different schools disagree about how counselling help. So we all agree that counselling is a helping relationship and that we do it is efficacious. We help clients, but different modalities disagree about how that helping actually happens. And then today's episode, we're going to discuss the different theories about how the helping relationship does in fact help. So it's, I would say a spectrum and we're going to start. So at one end, we've got something like person-centred counselling, created by Carl Rogers. And Rogers said that the relationship itself was the only thing that mattered. So really the person, the client was going to do all of the changing themselves. And we as a practitioner, we're just there to provide the relationship.

(01:48):
And he talked about the six necessary and sufficient conditions now called the core conditions, which are empathy, unconditional, positive regard, and congruence. And Rogers just said, if we could just provide these conditions in each therapy session and allow them to exist, if we could just be there and be supportive in this unique, special way, fill it, fulfilling these core conditions, then that would be everything a person needed to improve, to solve their problems and to self-actualize. So it's a very hands-off approach that focuses on the relationship and says, the relationship is the magic there. Then if we move a little further on the scale, we could look at something like solutions, focused therapy, and again, solutions focused is very client led. So it's client as expert rather than therapist is expert in solutions-focused. We say the client is the expert in themselves, and we're there just to facilitate that growth.

(02:53):
And we'd certainly use some skills, some solution-focused skills, like getting people to describe that best hopes, their preferred future, and really asking questions. Questions is probably the key technique in solutions focus. So it's almost like a coaching role where again, if you're coaching someone in sport, you would trust them to be the expert in what works for them. And you would just facilitate their learning. And then solution-focused is very similar. We would bring some coaching techniques into that. We bring some great question asking skills and a range of other solution-focused skills, but the client is completely the expert. We go completely with their agenda. And we're really that to again, facilitate that learning about themselves, about what works for them, about what strengths they have to solve their own problems. And we help them to, to build that solution. Then if we move a bit further on the scale now we've got something like cognitive behavioral therapy.

(04:03):
CBT certainly thinks the relationship is important, but here we're starting to bring in some more expert knowledge from the practitioner. So we're introducing things like the cognitive model, the idea that our emotions, our faults and our behaviors, we are linked in a triangle and by changing one, you can change the other. And we're still trying to get the client to do all the work. But if we're looking at the cognitive aspect, we might get them to talk about how the force work. And we'll do maybe a bit of explaining, talking about things like automatic negative force and how we can have some biases and how we might jump to the worst case scenario. Or we might explain the common thinking errors, such as jumping to conclusions and black and white thinking task, revising, and then get the client to identify those. So here, we're almost a consultant we're helping the client work for their problems, but we're bringing a bit of teaching, a bit of expert knowledge alongside the client's knowledge.

(05:07):
And combining that and together, trying to come up with a solution solution might involve something like behavioral experiments, doing some contingency management, but there's expertise coming in from both sides here. Then finally, if we get to the kind of far end, we're looking at something like psychodynamic, which is many practitioners would say that here, the therapist is the expert. So you might go to a dream analysis session. You will describe your dreams. And the therapist will tell you what's going on. It's their job to interpret. Most of the expert knowledge here is coming from the practitioner and the client really just supplies the information. And, but the change benefit the way, the way that the practitioner helps them helps the client is by bringing that expert knowledge into the room. Now, not all psychodynamic practitioners might agree with that definition. I'll have that little caveat, but that in terms of the range, that's more the end that psychodynamic is sitting on.

(06:20):
So how do we help? We've got kind of person centered here that says the client knows everything they need to know, and we just need to provide the relationship. We've got the upper hand where we're bringing more expert knowledge in what is it that's helping the client? Well, let's not fall into the trap of doing our own black and white thinking here might not be that it's either a great relationship, a great therapeutic Alliance between the client and therapist. And it's not only that the therapist knows a lot of things about the cognitive model and potential strategies for improving. It might not be judged that the coaching magic and the techniques and skills being brought into the room, but potentially it is all of these things that we look at person centered. There is clear, at least some expertise coming into the room because the therapist knows how to develop that great therapeutic relationship.

(07:21):
They know how to listen well, and they know how to use minimal encourages. There's a lot of techniques to what some practitioners might label as just sitting and listening to someone, if you don't like person centered, but there's actually a ton of techniques involved there. Similarly, on this end, something like CBT really does think that their relationship, the therapeutic Alliance is important. It's not, it's not important. It's just that there are additional tools as well. So in terms of what is, what is the magic then actually helps the client? It's probably a combination of a really strong therapeutic Alliance, a strong therapeutic relationship. And in some ways the expertise that the therapist brings into the room, but this doesn't mean telling a client what to do. This can mean the techniques in order to listen to a client in order to hear the goals in order to be able to work in a client oriented way, still requires a lot of self-discipline a lot of training and a lot of skills to do that. Hopefully that has provided you with a bit of a guide as to how counselors help. How does the helping relationship work inside a client therapist relationship.