Non Cognitive Psychotherapy Introduction

We live in a world where evidence-based treatments in medicine and psychotherapy are de rigueur. These treatments are required by governmental authorities interacting with health professionals. However, we know that in counselling at least that all therapies work and that they all work about as well as each other (e.g. Wampold et al., 1997)!

So despite the fact that much is made of the need to use 'evidence-based therapies', the evidence shows that the specific technical differences among therapies may not curative by themselves. This finding points to the importance of common factors present in all therapies being therapeutically significant.

Now I don't think this finding means that it doesn't matter what therapists do. And one thing is certain: counsellors will not help clients if they don't have some belief that the methods they are using have some efficacy. Nor will counsellors be able to convince clients that what they are doing is meaningful and helpful.

I am presently re-reading Non Cognitive Psychotherapy: Advancing Mood Management* by L. Russell Hoover (2001) mainly because the title intrigues me; it is uncommon to find a psychotherapy these days that advertises itself as 'non-cognitive'.

This author attacks standard cognitive therapy (CT) which assumes as its guiding, first principle that thoughts create moods and emotions. (I should say that at this juncture that I have little sympathy with CT and have expressed my views elsewhere on this blog.)

CT says (to put it simply) that when an adverse situation occurs it activates certain thoughts/beliefs [COGNITIONS] and these cause emotions of sadness, anger or fear which form angry, sad, fearful or depressive moods. Hence, CT tries to get clients to modify or change their cognitions so that the pain of the reaction is lessened.

In the video below, you will see the famous Albert Ellis in action with a famous client known as 'Gloria'. Ellis was one of the pioneers of cognitive therapy. He originally called his therapy rational therapy (RT) (but finally titled it rational-emotive-behavior therapy or REBT). This video should give you an idea of Ellis' form of cognitive therapy though Aaron Beck's form of CT is different in manner from RT or REBT.

* Unfortunately, I find Russell Hoover's writing style to be verbose and overladen with adjectives that add nothing to clarity and make reading his book extremely difficult. It's a great pity because as I will try to show he has something important to share about counselling.

Trust: A Crucial Ingredient in Counselling Relationships

What is trust? 

Trust is 'reliance on the integrity, strength, ability, surety, etc., of a person or thing; confidence' according to the dictionary.

  

Trust is a critical element in all human relationships. Trust is important in marriage as it is in family relationships in general because without reliance on the integrity of a marriage partner or a parent or child, relationships quickly become compromised.

Trust is also a crucial ingredient in counselling relationships because without reliance on the integrity and ability of the psychologist-counsellor little real sharing by clients of their problematic living issues will occur.

It can be said that trust (or trustworthiness) superintends two other vital aspects to the counselling relationship. These two aspects are counsellor competence and counsellor likeability. A large body of research derived from social psychology has found that client-perceived counsellor trustworthiness, competence and likeability are highly correlated with counselling effectiveness. This type of theory is an interpersonal view of counselling. (See here.)

Clients who don't trust others

In some clients, the issue of trust itself becomes the focus of counselling. Perhaps the client has been abused physically, emotionally or sexually. Such abuse often results in a chronic problem with trust. Such clients find that their primary relationships are plagued by mistrust.

Counselling can help by firstly identifying where the mistrust may have become rooted in the person's life.

And then the counselling process itself can become the vehicle for opening up issues of trust and resolving those same issues because every moment of the counselling is dependent on some trust. Counselling becomes an exercise in learning to drop out of date attitudes to trusting others and learning to develop healthy attitudes to others.

Knowing What's Important in Therapeutic Counselling

Unless clients are 'psychologically minded' (that's the jargon) they don't always know what is important to say to the counsellor-psychologist.

Such clients can attend sessions for a significant time and not divulge important incidents in their early lives in particular. (Some do this knowingly but that is another issue; usually an issue of trust.)

I have had this experience as a psychologist as it has challenged me to think about why I might have contributed to my not getting important knowledge about early incidents significant enough to affect the present lives of the clients.

In some cases it has occurred because the client came to me with one problem and then over a longer period the problem became another problem. In other cases, it has happened because the clients saw me for one problem and then a year or so later came back for further counselling.

Counselling in the Light of the Christian Gospel (3)

(*Acknowledgement below.)

A way of understanding the bond between counsellee and counsellor which I believe is fruitful is by using the notion of the caregiver-child attachment style.

According to attachment therapy, a therapy deriving from the work of John Bowlby, that style established in the family influences other important relationships as the child grows up.

More especially these styles or patterns of relating affect our adult relationships for weal or woe.

Attachment relationship styles have been classed as 'secure', 'anxious–preoccupied', 'dismissive–avoidant', and 'fearful–avoidant'. These attachment styles develop between between care-givers and children for a number of reasons. Temperament of child and caregiver will be at least one factor but others include past history of mother and physical health of mother and child.

What I find interesting is that these styles will emerge in relationships with God and also in relationships with counsellors. (Of course, they show up in romantic relationships so knowledge about these styles can be invaluable in suggesting possible ways to go in counselling married and unmarried couples.)

Importantly, we need to keep mind that God, the Lover of our souls continuously seeks our companionship through His Son the Lord Jesus, inviting us to believe 'into' Him. That's right! Not just to believe 'in' Him but to believe into Him which expresses more eloquently the full commitment that is asked of all Christ-followers.

No theory of relationship of relationship can adequately portray the full essence of relationship. (Theories are limited to generalisations about samples and don't have the ability to describe any specific relationship.) However, relationships are a vital factor in all counselling and various ways of describing and studying them deepens our knowledge of what counselling involves.

(*With kind acknowledgement for the graphic above to http://4.bp.blogspot.com/ )

Counselling in the Light of the Christian Gospel (2)

• A Rogerian Model for Counselling Others

According to Carl Rogers (1902-1987), the father of the 20th century counselling movement, counsellors should ensure that they provide the basic quality conditions of empathy, respect (towards counsellees) and 'congruence' (genuineness) in counselling sessions to ensure counselling effectiveness.

Rogers believed these three conditions to be both necessary and sufficient for effective counselling. If any one of these conditions is not provided then counselling will suffer but provided they are offered by the counsellor then they will be effective without the addition of any techniques.

Rogers' method grew out of his assumption that any person's true self is usually in conflict with the ideal self he is forced to be in public. The 'incongruence' or disparity between these two is reflected in tension between the true and the ideal self.

Rogers therefore understood people to be first and foremost individuals, autonomous individuals who Rousseau-like were forced to compromise their true selves in order to live at peace in family, school and society at large. However, this compromise led to neuroses because such a compromise entails tension at the core of the person.

At the religious level, Rogers' views cannot be accepted by orthodox Christians because people are not autonomous in Rogers' sense that each person has his own law within himself. That is blatant humanism and Rogers was well aware that it was.

One important criticism of the Rogerian therapeutic offered conditions model at the practical level is that it did not take into account how those counsellor offered conditions were received by the counsellee.

• A Pan-theoretical View of the Therapeutic Relationship: The Alliance in Therapy

Other models did arise to challenge Rogers' formulation. But the finding that comparisons among actual counselling informed by different theoretical models did not show any significant differences among the competing theory-practice models led researchers/theorists to look for a model that is not dependent on one theoretical framework.

From the fact about the non-significant differences among different theory orientations emerged the idea that common factors were operative under different terminology in all types of counselling.

Although the 'alliance' idea originally emerged from psycho-dynamic theory it was lifted out of that background in the 1970s and connected with the 'common factors' movement. (Note: the 'alliance' concept is also known by other names such as 'working alliance', 'therapeutic alliance' and 'helping alliance'.)

This 'freeing' of the alliance concept from a particular body of counselling theory has led to ways of trying to understand what this atheoreticising process means.

Adam Horvath, a major contributor to alliance studies, has developed the image of the 'psychological commons' as a lexical space for ideas to hang out for which we do not have strict definitions but rather descriptions. (To be continued.)