Modalities in
Practice
In Counselling and Psychotherapy
An Introduction to Counselling and Psychotherapy: From Theory to Practice
Overview of Modalities
• It is said there is in excess of 450 different approaches to
counselling and psychotherapy
• Much debate as to the relative efficacy of different
approaches
• Training closely linked to modality
• The majority of the mainstream approaches can be considered
under one of four primary ‘umbrella’ headings:
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Psychodynamic approaches
Humanistic approaches
Cognitive-behavioural approaches
Integrative or pluralistic approaches.
Psychodynamic Approach
• Psychoanalysis shaped and informed by work of Freud (1856–
1939) and his contemporaries, including Jung 1875–1961),
Adler (1870–1937) and Klein (1882–1960)
• Contemporary psychodynamic practice, while informed by
ideas from psychoanalysis, also informed by theories of
attachment developed initially by Bowlby (1907–1990)
• Therapeutic work strongly incorporates concepts of the
unconscious and how that shapes and informs thoughts,
feelings and behaviours
• Task of therapy includes bringing unconscious processes into
conscious awareness
• Key concepts include transference, countertransference,
object relationships and projective identification.
Humanistic Approaches
• Humanistic approaches developed in the US in the 1940s and
1950s onwards, drawing on concepts of humanistic
psychology
• Many of the concepts of psychoanalysis and behavioural
therapy were rejected by key theorists, including Maslow
(1908–1970), Rogers (1902–1987) and Moustakas (b. 1923)
• Rogers’ assertion was that individuals, given the right
conditions, have the capacity to change and move towards a
position of health and growth
• A number of discrete approaches come under the ‘humanistic’
umbrella, each with specific theoretical concepts, including:
person-centred; gestalt; and transactional analysis.
Cognitive-Behavioural Approach
• Cognitive-behavioural approaches (therapy) (CBT) are an
integration of behavioural and cognitive therapy
• Early proponents of behaviourism included Pavlov (1849–
1936) and B. F. Skinner (1904–1990), while key theorists of
cognitive therapy include Beck (b. 1921) and Ellis (1913–2007)
• CBT assumes that change in behaviour and cognition
(thinking) can lead to change at an emotional level, thus
leading to a reduction in distress and the alleviation of
symptoms
• There are a number of approaches that fall under the CBT
umbrella, including Rational Emotive Behaviour Therapy
(REBT), Cognitive Analytic Therapy (CAT) and CompassionBased Therapy.
Integrative & Pluralistic Approaches
• Integrative therapy draws on a number of principles and ideas
from key therapies and integrate them into a new whole (e.g.,
drawing from psychodynamic and person-centred therapies)
• Integrative approaches are distinct from eclectic approaches,
where the latter draws on techniques and interventions in a
‘as and when’ basis
• Cooper and McLeod (2010, p. 9) state that a pluralistic
approach is based on the, ‘assumption that different clients
are likely to benefit from different therapeutic methods at
different points in time, and that therapists should work
collaboratively with clients to help them identify what they
want from therapy and how they might achieve it.’
Cooper, M. and McLeod, J. (2010) Pluralistic Counselling and Psychotherapy. London: Sage.
Approaches in Practice
• All main approaches outlined here can be found in a variety of
settings, including:
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Health care settings, including primary and secondary care
Social care settings
The third sector
Independent practice
• The last few years has seen a particular emergence of CBT in
health-care settings, partly due to an abundance of
quantitative research evidence (e.g., RCTs), and partly due to
the commissioning of IAPT services for adults and latterly for
children and young people
• Research evidence supports the use of all four umbrella
approaches with a range of different client presentations.