Different approaches in counselling and psychotherapy

What is the difference between counselling and psychotherapy?
There is currently no generally accepted distinction between counselling and psychotherapy. There are well founded traditions which use the terms interchangeably and others which distinguish between them. If there are differences, then they relate more to the individual psychotherapist's or counsellor's training and interests rather than to any intrinsic difference in the two activities. In general psychotherapy is concerned with the treatment of more severe psychological disorders and therefore may take place over a longer period of time. Counselling on the other hand is generally concerned with more 'everyday' problems that are often possible to address within a short, fixed-term contract with a client. In terms of the services which I offer I tend to use the terms interchangeably.

What is Integrative Psychotherapy?
My own training is in Integrative Psychotherapy and I completed the 4 year Master's Degree programme at the Sherwood Psychotherapy Institute in Nottingham. Training institutions vary a little in their course content but there are two key pillars of the Sherwood training which I have integrated into my own practise, namely a relational and developmental approach.


What are the benefits of counselling and psychotherapy?
Counselling is the provision by qualified practitioners of a formal and professional relationship within which individuals can profitably explore difficult, and often painful, emotions and experiences. These may include feelings of anxiety, depression, trauma, or perhaps the loss of meaning of ones life. It is a process which seeks to help the person gain an increased capacity for choice, through which the individual becomes more autonomous and self determined.

By listening attentively and patiently the counsellor can begin to perceive the difficulties from the client's point of view and can help them to see things more clearly, possibly from a different perspective. Counselling is a way of enabling choice or change or of reducing confusion. It does not involve giving advice or directing a client to take a particular course of action. Counsellors do not judge or exploit their clients in any way.

In the counselling sessions the client can explore various aspects of their life and feelings, talking about them freely and openly in a way that is rarely possible with friends or family. Bottled up feelings such as anger, anxiety, grief and embarrassment can become very intense and counselling offers an opportunity to explore them, with the possibility of making them easier to understand. The counsellor will encourage the expression of feelings and as a result of their training will be able to accept and reflect the client's problems without becoming burdened by them.

Acceptance and respect for the client are essentials for a counsellor and, as the relationship develops, so too does trust between the counsellor and client, enabling the client to look at many aspects of their life, their relationships and themselves which they may not have considered or been able to face before. The counsellor may help the client to examine in detail the behaviour or situations which are proving troublesome and to find an area where it would be possible to initiate some change as a start. The counsellor may help the client to look at the options open to them and help them to decide the best for them.

Cognitive Behavioural Therapy (CBT)
Cognitive Behaviour Therapy (CBT) is one of the major orientations of psychotherapy and is based upon concepts and principles which are derived from cognitive and behavioural psychological models of human behaviour. It is recommended by the National Institute of Clinical Excellence (NICE) for the treatment of conditions such depression, anxiety, phobias and Post Traumatic Stress Disorder (PTSD).

Clients and therapists collaborate to identify and understand problems in terms of the relationship between thoughts, feelings and behaviour. This then leads to identification of personalised, usually time-limited therapy goals and strategies which are continually monitored and evaluated.

The treatments are inherently empowering in nature, the outcome being to focus on specific psychological and practical skills aimed at enabling the client to tackle their problems by harnessing their own resources. The acquisition and utilisation of such skills is seen as the main goal, and the active component in promoting change with an emphasis on putting what has been learned into practice between sessions - “homework”.

Eye Movement Desensitisation and Reprocessing (EMDR)
EMDR stands for Eye Movement Desensitisation & Reprocessing. It is a psychotherapeutic procedure that was originated and developed by Dr Francine Shapiro in the United States in 1987.

EMDR was originally designed to treat traumatic or "dysfunctional" memories and experiences and their psychological consequences, and the procedure has mainly been used in the treatment of Post Traumatic Stress Disorder (PTSD). However EMDR has been increasingly used over the years to treat e.g., test and performance anxiety, anxiety and panic disorders, pain, sexual dysfunction, and a wide range of experientially based disorders.

EMDR is an evidence based therapeutic procedure. That is, although the procedure originally developed out of self-observation, the evolution and development of the procedure has been dictated by clinical and research findings. Most of the components in EMDR are recognisable from other well-known therapies although they are arranged in a unique order. However, one unusual element in EMDR is bilateral stimulation usually in the form of eye movements, but also sometimes in the form of bilateral auditory or tactile stimulation. There is a great deal of evidence that bilateral stimulation speeds up the reprocessing of disturbing emotional or traumatic material and at the same time helps the client in making contact with disturbing material in a safer way than without the bilateral stimulation. A number of replicated research trials have demonstrated that eye movements reduce the vividness of emotional and traumatic imagery. It is believed that the eye movements induced in EMDR mirror the natural eye movement process that occurs in the REM (Rapid Eye Movement) phase of sleep during which information is processed naturally.

In EMDR, the therapist will always firstly carry out a careful psychological assessment of whether EMDR would be suitable for the problem (s) presented, and will elicit a memory representing the problem. The client will be asked for a picture that represents the memory, a negative belief that they have about themselves in relation to the memory, and to notice associated physical sensations. Thereafter, a number of sets of eye movements or other bilateral stimulation are commenced, and after each set of eye movements the therapist will ask the client what they noticed. Typically, the images, emotions, and sensations experienced change through this process. At some point these changes become more positive and adaptive as the client reprocesses old dysfunctional information and connects with presently held adaptive and functional information. The aim is always to enable the client to recollect the original traumatic material without disturbance and to have new and more adaptive beliefs about themselves in relation to the experience.

EMDR is currently recommended by the National Institute of Clinical Excellence for the treatment of PTSD.