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Introduction
TonicTalk Counselling and Psychotherapy is a client funded Therapeutic practice that provides a number of different Therapeutic services of which Counselling and Psychotherapy are the bedrock of the services offered. Counselling and Psychotherapy are generally referred to on this site by the generic name of Therapy; however in this section and others, where necessary, we will refer to them specifically. TonicTalk and its Therapists aim to provide high quality, cost effective Therapy with long term sustainable results to all our clients.

In line with our ethical belief in the Autonomy of the individual and their right to make informed decisions concerning their lives and health care; what follows is a brief description of the nature of Counselling and Psychotherapy and their similarities and differences.

Differences
Often people ask ‘what is the difference between Counselling and Psychotherapy’ and in truth, we are yet to be able to concretely and absolutely define definite lines of demarcation and difference between them. Some say that Counselling is for short term or problem focussed therapy and Psychotherapy focuses on resolving deeper issues and is long term. This is not true, both offer short and long term therapy, both focus on the implicit behind the issue and can work in the here and now or where necessary, work with formative childhood issues and events.

Some classical Psychotherapists will claim that they are the only Therapists who work with the ‘Transference’, (the technical name for the projections of the client onto the Therapist), within the Therapeutic relationship. However, this again is not the case, since all reputable Therapists know that the Therapeutic Relationship is of primary concern and therefore all elements of that relationship must be taken into account and worked with. If Transference exists as an element of the Therapeutic relationship; regardless of the Term or name used to identify it by different Therapeutic schools, all Therapists will naturally work with it as part of their work within the relationship. Since Psychotherapists do not exclusively focus on the Transference and Counsellors do not avoid focus on Transference; we are therefore not happy to say that this is ‘the difference’.

Given appropriately trained and experienced professional Counsellors and Psychotherapists there is nothing that separates the efficacy of Counselling and Psychotherapy, nor is there anything of any true significance to separate Counselling and Psychotherapy as each are huge ‘collections’ of  varying Therapeutic ‘models and practices’. Even though there may be surfaces differences with respect to the language and names used to identify and describe the same psychological processes; there is however a convergence of theory and model whereby different models can be mapped onto each other.

However, we can say for certain that there are definite differences between the different ‘schools’ of thought within both Counselling and Psychotherapy. And that many of the schools are incompatible with each other as that have different fundamental beliefs concerning the drives and functionality of the psyche. Each therapeutic model is predicated on particular set of beliefs and values concerning psychological development and architecture / structure and the significant drives or motivating forces or factors or the disposition towards certain tendencies.

These beliefs and values determine the compatibility between models, allowing them to either work in unison and be compatible; or be at odds and incompatible. It is therefore also helpful for a client and Therapist to know the beliefs and values behind the Therapeutic model that they are utilising in their Therapy sessions so as to ensure that the model works in unison with the client rather than against the client. As the client grows and progresses through their therapy it is desirable for the Therapy to dynamically change with them to include these changes in the understanding of the client. Thus, if a client moves from a polarised view to a more unified and dynamic view the model needs to adapt to cater for this change in perspective and understanding. It is important at all times to ‘track’ the client and work within their ‘Frame or Reference’ rather that enforce an alien perspective upon them. 

Historically
From our experience, though this is not by design, it seems that Psychotherapy has far more respect within the medical community and perhaps to a lesser extent, the general public than Counselling. This notion probably comes from the fact that Psychotherapies predate or are the forerunners of Counselling and therefore is seen as ‘classical’ and also as more academic and requiring more rigorous training. Additionally ‘Counselling’ has in many ways gained a negative reputation because of a number of significant factors:

  1. Quite surprisingly, in the UK the professional titles ‘Counsellor’ and ‘Psychotherapists’ are not, (at the time of writing Jan 2010), protected by legislation and therefore anyone can set themselves up as a Counsellor or Psychotherapist with little or no training and without reference to a professional association or insurance. All they need is a place to practice, some furniture, some advertising and the will to do so.
  2. Equally surprisingly, in the UK the qualification ‘diploma’ is not protected by any standards and therefore any organisation can provide courses and qualify their students with diploma. Since ‘Counselling’ is a popular subject and such courses are expensive, a number of organisations whose primary objective was to make substantial profits from students rather than provide appropriate education provided courses that are less than rigorous creating ‘Therapists’ that are less than able.
  3. Counselling is often chosen as a profession by those that have experienced difficulties in their lives or have significant personal issues and rather than seek help themselves, they believe that because of their experience they can help others or use ‘helping’ or ‘caring for others’ as a way of gaining self worth. Obviously these motivations are inappropriate for Therapists.
  4. ‘Counselling’ is also provided by non professional ‘do gooders’ who see it as ‘part time’ supplementary employment or ‘charitable work’ and do not the training, experience or professionalism to give the work the respect it deserves.
  5. Counsellor is also a title used by those who offer services such as advice giving, guidance, financial advice and many other services. This adds to the confusion as to what a Counsellor actually is.

All these factors have historically served to confuse the nature of Counselling and bring it into disrepute. However, in 2011 the government will legislate to regulate both Counselling and Psychotherapy. In the mean time, do not be put off by these issues, instead read our section ‘About Therapy’ which will give you information to help you choose a therapist who is professional and can provide the help you need.

Similarities
As with all reputable Therapy, Counselling and Psychotherapy are two groups or schools of Therapy that while different in some ways share a huge raft of similarities.

What is Therapy?
Counselling and Psychotherapy are ‘Talking Therapies’ in which a Therapeutic collaboration between client and Therapist, based on proven Psychological theory and method, is practiced within a positive Experiential Therapeutic Relationship with the express purpose of assisting a client’s personal growth; resilience and self-reliance to overcome issues and concerns and to improve their psychological health and well being. Counselling and Psychotherapy can take many forms with the application of numerous theoretical models.

While many Therapists offer ‘training’ as part of Therapy and that training may have some therapeutic value; ‘training’ is not Therapy. Often Therapists offer psychological training to help clients relax, communicate more effectively with their loved ones and themselves, overcome anger and anxiety issues and more besides, however, the distinction needs to me made between these two functions. At TonicTalk, we offer training as separate courses, either one to one or in group; or where appropriate, integrated into a Therapy session. However, we are mindful not to turn the Therapy, which a client has contracted us to provide, into training which is a far less rigorous and less therapeutic form of client work.

Also, a client may ask for their Therapist’s opinion or advice; however, once again, handing down ‘Sage like’ opinions and advice is not Therapy. While we realise that it may seem avoidant or even churlish not to meet a client’s request we also realise that in so doing, that there is no Therapeutic value in the opinions and advice of others including Therapists. Therefore, while perhaps for relational reasons such a request may be met, it is the understanding and examining of that which drives the request and the feelings and thoughts triggered when the need is met or not met which is of Therapeutic significance.

More to come...

Efficacy
Studies have shown that the vast majority of Counselling and Psychotherapeutic models and practices are similarly effective with respect to their desired results and outcomes. This therefore offers an opportunity to both Therapist and client alike to choose amongst the 250 plus different Therapeutic models, techniques and practices something that works well for both Client and Therapist in their joint venture.

However, it is worth noting that the results with respect to outcomes are influenced by client and Therapist perception as to the nature of the individual and the goal of Therapy. Not all therapies perceive people in the same way nor seek the same gaols when in practice. For example, many Therapies including Cognitive and Behavioural style therapies such as CBT which claim similar or better results that other Therapies are predicated on the premise that ‘an individual’s feelings and actions are caused by their thoughts and not external situations’ and therefore seek to work with cognition (thoughts) or behaviour to achieve their goal which is to alter behaviour and thought. This then determines the nature, longevity, and efficacy of their results and claims based on those results.

Though the premise of these Therapies may be ‘true’ on a superficial level, they lack a depth of understanding that other Therapies consider essential. Yes, ‘an individual’s feelings and actions are caused by their thoughts and not external situations’, however where do these thoughts originate and what causes them? These actions, feelings and thoughts are all symptoms or manifestations of deeper causation and therefore working to change them is to work not to resolve an issue but rather resolve an unpleasant symptom. Clients are thus offered ‘easy fixes and solutions’ and while at the same time being denied the possibility of understanding and resolving their true issues Also working to change these thoughts through denying their validity or labelling them as ‘negative’ serves to deny the client their ‘frame of reference’, value and autonomy therefore working against a healthy experiential Therapeutic relationship.

Therefore as a client it is important to examine the nature of the Therapy being offered and whether or not it will provide for a sustainable result for you.

Note: At TonicTalk we do not offer Cognitive or Behavioural Therapies as ‘stand alone’ Therapies and that includes CBT and REBT. We do not believe in their efficacy or compatibility with other Therapies.

Influential Factors
Since studies have shown that there is little to choose between Therapeutic models and practices therefore rather than focus on the differences between Therapies, further studies have shown that there are common factors that affect the efficacy and outcomes of all forms of Therapy. The common factors and their level of influence on outcomes and efficacy are as follows:

  • 40% - Client extra-therapeutic variables
  • 30% - Quality of the Therapeutic Relationship or ‘alliance’
  • 15% - Expectation and Hope
  • 15% - Therapist Techniques and Therapeutic Model and Approach

(Asay and Lambert 1999 ‘The Empirical Case for the common Factors in Therapy….’ Which supported Lambert’s earlier, 1992, observations).

‘Client extra-therapeutic variables (40%)’ takes into account external ‘environmental’ and ‘Personal’ factors for example, Client Personal Factors include: beliefs, values, strengths and weaknesses, attitude, talents, skills, motivation, resilience, resources, resourcefulness, fear and resistance. Client Environmental Factors include: social and familial support or lack thereof; fortunate or unfortunate events; remissions or relapses; influence of others; and other positive, negative or destructive external influences or events. Other Client Personal Factors directly relating to Therapy include: depth and severity of issues and concerns, the client’s ego and psychological strength, and the client’s ability or willingness to relate to others, and identify, communicate and focus upon issues.

‘Quality of the Therapeutic Relationship (30%)’ takes into account the relationship formed between Therapist and Client. As far as the therapist is concerned this the single most significant area in which she can exert influence on Therapeutic efficacy and outcomes and therefore is perilous to Therapy to neglect.
 
‘Expectation and Hope (15%)’ as a factor is concerned primarily with the Client’s perspective and beliefs but also, the Therapist’s perspective can have a huge influence on the client. If a client enters into therapy with no expectation or a low-expectation that it will have a positive result or without hope, the likelihood is that if this view is not ‘turned around’ there will be little to no positive outcome to the Therapy. Attitudes with respect to ‘Expectation and Hope’ tend to be self-fulfilling such that individuals tend to work towards what they believe and away from what they don’t, and this is despite their Therapist’s exuberance and positive aspect.

However, if a therapist is able to maintain and convey healthy and realistic attitudes, expectations and hopes in the light of the client’s difficulties, issues and concerns; while at the same time being fully engaged with the client’s frame of reference and attitude towards their own issues and concerns the likelihood is that the client will be empowered. In this case the Therapist need be careful not to overpower the client or deny their frame of reference but instead work from where the client is to a new position.

‘Therapist Techniques and Therapeutic Model and Approach (15%)’ this factor is concerned with the Therapeutic model, techniques and approach that are being utilised within the client session by the Therapist. A therapist needs to be mindful to adapt to the client’s needs, frame of reference, ability and understanding. If a model is used that can be understood by the client and that capitalises on the client’s natural strengths and abilities and works in harmony with the client then the client will feel empowered and engaged with. However, if instead an ‘ill fitting’ model is chosen that is incomprehensible to the client and imposed upon them regardless of their ability to engage with it or understand it, it will feel as a violation or denial of the client’s being. 

Considering there are over 250 Therapeutic models and approaches to choose from, there is no need for a client to ‘put up with’ an ‘alien’ approach being inflicted upon her. It is incumbent upon the Therapist to adapt to the client and not for the client to adapt to the Therapist.

Therapeutic Relationship
The experiential Therapeutic Relationship is the single most significant factor that a Therapist has influence on. It forms the arena in which all Therapy takes place and the foundation of all client Therapeutic experience and change. As such the Therapist needs to be mindful of the dynamics of the Relationship and anything that may affect it.

More to come.....