To therapy, or not to therapy. That is the question. 

This article has been written by registered psychologist, Belinda Flannery, from UNE Counselling and Psychological Services (UNE CAPS).

Or rather… should that be…what therapy??

Many terms, acronyms, and phrases are bandied around when it comes to the sphere of therapy in the mental health space. “In therapy”, “in counselling”, “in session”, “in treatment”, “my therapist”, “my psychiatrist”, “my counsellor”, “my psychotherapist”, “my psychologist”, long term therapy, short term therapy, psychotherapy, talk therapy, positive psychology therapy, strength-based therapy, client-centered therapy, behaviour therapy, solution-focused therapy, narrative therapy, existential therapy, art therapy, play therapy, CBT, ACT, DBT, ECT, MBCT, AAT (just to name a few of the approximate 835 psychotherapy related abbreviations)!

Phew… it’s exhausting and therapy hasn’t even begun!

Based on the above it’s pretty obvious that the world pertaining to therapy is complex and a bit of a minefield. And it’s also pretty clear for the purposes of this article we can’t cover all there is to cover when it comes to the type, nature, goals, and outcomes of therapy.

So, I thought it may be helpful to narrow things down somewhat. Therefore, the goal will be to simplify and introduce a few core features. We will first define therapy and look at why people may seek therapy. We will then explore three types of therapy; Cognitive Behaviour Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Strengths-Based Therapy.  And we will then conclude by identifying some key features that constitute effective therapeutic outcomes when it comes to the client/therapist relationship.

So let’s get started!

WHY PEOPLE SEEK THERAPY

Change. It’s as simple as one word.

However, the complexity lies within the nature of the change that is being sought.

But hold on a sec…let’s first go back a step and offer a definition of “therapy”.

The word therapy has Greek origins meaning to serve, to treat, and to cure, with particular reference to the medical setting. Therapy is, therefore, typically associated with the treatment of a problem following a diagnosis. Such origins lend heavily to a medical model that focuses on deficits experienced by the patient/client and the treatment of such deficits (that is, to eradicate them) by the clinician. However, I feel that this can somewhat colour people’s perceptions of therapy within mental health. While there is certainly a time and place for diagnostic work and treatment planning, therapy is not exclusively “just that”. When it comes to mental health, therapy can also promote wellness, enrich or enhance daily life, support life decisions, and be a vehicle for self-discovery and personal growth. Regardless of meeting diagnostic criteria, therapy can support the worried well or even the not so worried (come to think of it!). This brings us to the term psychotherapy, otherwise known as “talk therapy”.

In short, psychotherapy or talk therapy encompasses a broad range of therapies that involve regular (short or long term) confidential personal interactions (i.e., talking…hence the term talk therapy) between client and therapist (who may be a psychologist, counsellor, social worker, psychiatrist or psychotherapist). Now, this doesn’t mean that one simply comes into a therapy session to “have a chat”. Talk therapy is directed by the therapist in specific ways (according to the type of therapy or therapies being used in session) to enable change…and that change (yep, you guessed it) is defined by the client.

Early sessions in the therapeutic process may be spent exploring and supporting the client to identify why they are seeking therapy. It may be the desire to alleviate the pain and discomfort associated with the death of a loved one, the breakdown in a romantic relationship, or the dissolution of a friendship. It may be to seek professional guidance and support regarding mental health concerns, for example, stress, anxiety, and depression. It may be a want to better understand oneself, address undesirable behaviours (for example substance abuse or aggressive tendencies) or navigate a turning point where a decision needs to be made.

The reasons why people seek therapy are varied and complex and as such the therapeutic process often reflects this. By exploring the client’s feelings, thoughts, and behaviours, the therapeutic process becomes a vehicle from which change can occur. Now, this process can and does differ depending on the type of therapy employed, to which we will now turn (well three of them anyway!).

COGNITIVE BEHAVIOUR THERAPY (CBT)

CBT is one of the more commonly used psychotherapies due to a large body of scientific evidence that supports its effectiveness.  CBT is used to treat a broad range of psychological and emotional barriers to wellbeing, including anxiety and the anxiety disorders (such as post-traumatic stress disorder (PTSD), phobic behaviours (such as social phobia), obsessive-compulsive disorder (OCD)), depression, addictive behaviours, low self-esteem, and relationship concerns. CBT has its roots in behaviour therapy (just think stimulus-response as in the movie ‘A Clockwork Orange’ (a must-see cult classic if you haven’t seen it)) however, the defining feature of CBT is the inclusion of the cognitive (thinking) component of human behaviour. We are more than mere Pavlovian dogs salivating at the ring of a bell, or pigeons manipulating a bar in a Skinner box to be reinforced with food or water…our thoughts direct our emotions and in turn our behaviours…and CBT likes to get to the root of these when a client presents with a desire for change. By changing thought processes/patterns (in line with this theoretical model) one may achieve change in their emotional and behavioural responses, in turn positively influencing wellbeing and quality of life.  For example, CBT can treat a client presenting with depressive symptoms by offering tools to challenge and replace negative and defeatist thoughts with more positive, realistic, and adaptive thought processes…leading to change.

ACCEPTANCE AND COMMITMENT THERAPY

(ACT…said as in the word ‘act’, not A.C.T)  

If CBT was the second wave in psychotherapy to behaviourism’s first wave, then ACT is regarded as the third wave. For those of you unfamiliar with but who may have heard of ACT in more popular psychological references, you may jump to visions of the Buddha sitting under the Bodhi tree, burning cedar incense sticks, and tie-dyed yoga outfits. Indeed, research has shown that ACT shares similarity with some common tenets in Buddhism and acknowledges that the integration of psychological, spiritual, and cultural perspectives can advance the effectiveness of psychotherapy. However, ACT does differ from Buddhism on a number of key elements and is regarded as a psychological intervention that has wide clinical applications and a growing body of empirical support. Derived from Relational Frame Theory (something we really don’t need to get into here, but basically ACT has theoretical underpinnings to do with the development of human thought), ACT’s core message is derived from its name: accept what is outside of your personal control and commit to action that improves and enriches your life in a meaningful way. The therapeutic process of ACT provides the client with tools to maximise their human potential to lead a full, meaningful, and rich personal life and it achieves this in two ways. First, the client learns how to effectively deal with (versus replace as seen in CBT) challenging and painful thoughts and emotions so they have less impact and influence on their behaviour and wellbeing (for e.g., through mindfulness (connecting with the present) practice). Second, the client learns how to identify and clarify what is truly important (i.e., their values) and to use this knowledge as a motivating and inspirational guide to creating meaningful change.

STRENGTH-BASED THERAPY (POSITIVE PSYCHOLOGY)

Think back earlier to when we were talking about therapy being associated with the medical model, the assessment and treatment of problems and/or deficits…well, strengths-based therapy does the exact opposite. Strength-based therapy stems from positive psychology; a scientific field of psychological inquiry interested in human flourishing and optimal functioning (i.e., what makes us tick and thrive!). And what is core to how we tick and thrive? Well, I’m glad you asked! The cultivation of what is best within us…our strengths! Hence, strength-based therapy enables the client to identify and play to their strengths in order to lead meaningful and fulfilling lives. Research has shown that when people know their strengths and use them, they feel better about themselves, hence happier and more likely to achieve their goals. Sounds simple…right? Well, there is a hitch. Some (most?) of us are oblivious to what we do well. We think that thing we just did is a bit ho-hum…a bit ordinary, when in fact it may reflect an individual strength. Therefore, a core component of strength-based therapy is the instrumental role the therapist has in helping the client view themselves through a different lens, to clearly see and label their strengths and in turn use them to create positive change.

EFFECTIVE THERAPY

Effective therapy…well, it’s like a pair of comfy shoes… and by that, I mean the fit’s got to be right.

And that fit depends not only on the therapeutic approach matching the client’s individual situation, traits and needs but also the fit between the client and therapist (the therapeutic relationship). This is important, as therapy, whilst it can be short term typically requires a few sessions at least, so it’s got to feel right…right? Who keeps walking around in shoes if they continually rub (especially after giving them a second chance hoping they stretched on the first wear)? We grin and bear the discomfort until we get home, we take them off, swear to never wear them again (they end up collecting dust at the back of the cupboard, no matter how expensive they were), whilst we reach for a better fit, shoes that are comfier, shoes that don’t leave blisters, shoes that feel good. Yep, therapy is just like that.

So how do we avoid the rub, avoid the blisters? Now don’t get me wrong, at times therapy can create discomfort (and that’s important to know). However, unlike ill-fitting shoes that continue to rub on already blistered skin (“ouch”), good therapy acknowledges this and offers support and cushioning to ease the discomfort and gradually heal the pain.

The next important point to make is that (typically) therapy is not a one size fits all approach. Effective therapy can often involve a blended approach, whereby the therapist has a toolbox of strategies derived from a range of therapeutic approaches in which they have been trained. This allows the therapist to tailor therapy to better meet the individual needs of each client, thereby avoiding a cookie-cutter approach to psychotherapy. The client is not a replication of the last client nor the next, so an effective therapist bends and shifts to accommodate such differences.

Lastly (and I may have left the best bit to now), all the above becomes redundant without the key ingredient that is therapeutic rapport. How can effective therapy be achieved if the client feels that the therapist just isn’t getting it? And in turn, how can effective therapy be achieved if the client does not feel comfortable and safe to engage in an honest and transparent way? It is a relationship. After all, effective therapy is a two-way street, a collaboration. So, I want to leave you with the following…understanding, warmth, acceptance, openness, trust, responsiveness, validation, compassion, empathy, flexibility, optimism, respect (and a splash of good humour!)…the key ingredients to therapeutic rapport and in turn (yep you guessed it)…change!

We certainly haven’t covered everything here – but we hope we have made a start!

UNE students can access free counselling through UNE Student Counselling and Psychological Services (CAPS). They are fully qualified and registered psychologists, offering on-campus appointments and phone/video chat sessions for online students. The service is confidential and free for UNE students.

You can contact them Monday- Friday, 9am-4 pm, on (02) 6773 2897.

For more urgent assistance, UNE offers After Hours Support on weekdays from 4.00pm to 9.00am AEST, weekends and public holidays. Phone 1300 661 927 or text 0488 884 169. Alternatively, you can contact Lifeline on 13 11 14.

If you have concerns about how stress and mental health are impacting your studies, contact Advocacy & Welfare on (02) 6773 3116 or at advocacy@une.edu.au.

You’re never alone at UNE!