If you are considering talking therapy, it is very important you find the best therapist for your needs, but where do you start? This great article by BACP Accred. counsellor Geoff Boutle should give you a great foundation.


Which Counsellor & Which Therapy?  – The Client’s Dilemma

By Geoff Boutle

This article reflects on issues facing clients who are considering undertaking counselling and deciding who to work with.

The decision to go for counselling is difficult enough but that challenge can be compounded by the need to decide which counsellor to contact and what type of therapy to opt for.  

A glance at the web pages of counselling directories can highlight the many different types of counselling. A review of the descriptions of each approach and the possible benefits claimed can also be confusing.  The task for the client is to try to understand enough about these different approaches to ensure that the right form of counselling is selected but that can be a challenging undertaking.

The counsellor may be more important than the type of counselling...

Some differences are quickly evident but others will be more subtle. That can raise concerns for the new client.  Those concerns may however be eased by the comment which is often heard, that the actual counselling approach may matter less than the choice of the right counsellor. Supporters of this view will argue that if the relationship in the room between the client and the counsellor works well, the client is likely to benefit from the work within the therapy room irrespective of the modality.


Differences in approach

There are however some very substantial differences between two of the mainstream counselling approaches that clients may be offered, that of Cognitive Behaviour Therapy (CBT) and Psychodynamic Counselling.  

These therapies which can be seen as sitting at opposite ends of the counselling spectrum, are such that they are likely to evoke very different responses from clients.  One will require a reflective, almost introspective approach whilst the second looks to focus on specific actions often against a background of a limited and defined number of sessions. 


CBT is the more recent of these two modalities.  It can be represented as a coming together of two earlier forms of therapy; Behavioural Psychotherapy and Cognitive Therapy.  Important founding fathers include Albert Ellis and Aaron Beck who saw in these new approaches a pragmatic approach to dealing with emotional challenges.  This contrasted with the earlier more inward looking techniques. This form of therapy now has many enthusiastic advocates including health services practitioners.

NICE (National Institute for Clinical Excellence) identified CBT as the preferred therapy for dealing with certain emotional health issues. The way in which that preference was defined, suggested to some observers a predisposition towards a medical model. That was reflected in a process driven way of working focussing on achieving a remedial cure.  That seemed to suggest some form of psychopathology which evoked criticism from those clients who saw themselves as venturing into the counselling room for developmental reasons rather than because of some latent emotional dysfunction. 

CBT is regarded by some advocates as a useful way of working when there is a specific issue which needs to be resolved.  CBT focuses attention on the present rather than the past and looks in particular at those cognitions and behaviours which adversely impact on the emotional well-being of the client.  CBT will often use modelling and recording techniques working with forms or diaries to support a change in behavioural strategies.  This encourages the client to gradually move to a new way of thinking and behaving.  The approach focuses on developing a rational set of thoughts and behaviours which will then help to bring about change.

Psychodynamic counselling

Psychodynamic counselling which is at the alternative end of the counselling spectrum, has very different origins. The first forays in the nineteenth and early twentieth century came from thinkers and practioners such as Freud, Jung and Klein. The name which is best well known is that of Freud.  The phrase ‘a Freudian slip’ is in everyday usage and some is a tangible recognition of the impact of his work on the public consciousness.  

The approach of these founding fathers can be seen by some to continue to underpin what is now contemporary psychodynamic counselling. There are however very different views held on the benefits of this type of counselling.  Concern is expressed by certain observers that it is not possible to prove the effectiveness of this more reflective therapy and that the lack of validation weakens this approach.  That contention is now being robustly challenged by an increasing amount of evidenced based research. 

Psychodynamic counselling is a form of therapy which recognises the power of the past on the emotions of today. It contends that our current ways of thinking, feeling and acting have been impacted by what has occurred in past relationships.  By bringing these to the fore in the counselling room, we can take away some of that dysfunctional influence and weaken the power of the unconscious to sabotage the present. This approach is intended to bring into the light of day that which can sit just below the level of consciousness, and by doing so remove some of the pain and confusion that has been retained from earlier years.

This may be particularly helpful to those clients who want to gain a greater understanding of why they act as they do.  For those clients it may be important to not just bring about change for the future but to do so from a position of greater understanding of their internal world.  It is argued that this deeper understanding of the self can come as a result of working with this type of therapy. 

An integrated approach

These two models appear very different with regard to both process and outcome. Yet each in turn reflects key elements of those concerns which often bring clients into the counselling room.

Many clients will want to understand that which causes them to behave in what is  clearly an unhelpful and counterproductive way.  It is also true that most clients seek to find alternative ways of thinking and behaving which will help them deal more effectively with the emotional issues of life. These two concerns tend to suggest that if CBT and Psychodynamic Therapy could be successfully brought together, that synthesis of approach could help the client to meet both those two key needs.

That blending is not an easy task.  The two approaches require flexibility as well as very specific technical skills.  To combine such different approaches would be difficult for some traditionalists who as firm advocates of one approach would struggle to work with such a flexible attitude.  

For this method to work it would certainly be important for the therapists to be professionally trained in both techniques and to be able to demonstrate this through accreditation with one of the key main counselling associations such as BACP or BABCP. Nevertheless if the therapist can show a firm theoretical and practical appreciation of each modality and demonstrate ways in her or his practice, of bringing these two modalities together, the outcome could be beneficial for the right client.

This technical development is unlikely by itself to prove sufficient for the client.  For this process to work it would also be important for other key counselling competencies such as empathy and unconditional regard for the client to be present.

If the client is to benefit from this more integrated approach the counselling room must be a place of safety within which the client can work on these twin tracks of both understanding and change. If that can be achieved then this approach could well provide a useful way forward for the right client.

Mental Healthy would like to note that in any therapeutic situation whether privately, through the NHS or charity sector, you have the right to know what approach is being used and what outcomes you and your therapist are aiming for, ask your therapist about this in your initial consultation.

With thanks to Geoff Boutle - Basingstoke Counselling

Geoff is an experienced BACP Accredited counsellor working with clients on a range of personal issues including anxiety, stress, loss of self esteem and depression. His practice is located in leasent offices in an attractive location in Worting House, near Basingstoke in Hampshire UK. He uses a number of different approaches, from cognitive behavioural therapy to existential counselling and brief solution focussed therapy to provide the right support for each individual client. You can email Geoff here: [email protected]

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