72 International Journal for in Africa (3:1)

Psychotherapy And Counselling

Francis Akwash Department of Nasarawa State University, Keffi

Abstract Counseling and psychotherapy must be adapted to meet the developmental needs of children. It is generally held to be one part of an effective strategy for some purposes and not for others. In addition to therapy for the child, or even instead of it, children may benefit if their parents speak to a therapist, take parenting classes, attend grief counseling, or take other actions to resolve stressful situations that affect the child. Parent management training is a highly effective form of psychotherapy that teaches parents skills to reduce their child's behavior problems.. Psychotherapy can be said to have been practiced through the ages. Historically, psychotherapy has sometimes meant "interpretative" (i.e. Freudian) methods, namely psychoanalysis, in contrast with other methods to treat psychiatric disorders such as behavior modification. Psychotherapy may be delivered in person, one on one or in groups, over the phone via telephone counseling, or via the internet. Psychotherapists may be mental health professionals, professionals from other backgrounds trained in a specific therapy, or in some cases non-professionals. Psychiatrists are first trained as physicians. One major aim of couselling is that it helps people identify problems and crises and encourages them to take positive steps to resolve these issues, as psychotherapy helps people with psychological problems that have built up over the course of a long period of time. Counselling and psychotherapy employ various techniques and strategies to resolve issues or behavioural problems. Therapy may address specific forms of diagnosable mental illness, or everyday problems in managing or maintaining interpersonal relationships or meeting personal goals. A course of therapy may happen before, during or after pharmacotherapy (e.g. taking psychiatric medication).

Key words: Psychotherapy and Counselling

What is Counselling? Counselling is a term that can be Counselling is a term that can be used to used to describe any sort of talking describe any sort of talking therapy. What therapy. What is talk therapy? Sharing what is talk therapy? Sharing what is troubling is troubling you in a safe, supportive you in a safe, supportive environment to a environment to a person who is trained to person who is trained to listen and respond listen and respond in a way that helps you to in a way that helps you to understand understand yourself and others better. yourself and others better. Talking therapies Talking therapies help you find more help you find more effective ways to live a effective ways to live a satisfying life. All satisfying life. forms of talk therapy are a sort of counselling. But the term is most often

Akwash, F. (2018). Psychotherapy and Counselling, 73 International Journal for Psychotherapy in Africa 3(1):72-88 used to describe the talk therapies which of the reasons why people choose to study focus on your behaviour patterns. These counselling and psychotherapy courses at are the choices and actions you are presently ICHAS. taking that are causing your life to be as it is. Counselling might reference your past. Transferable Skills But in general counselling’s focus is on Courses in Counselling and Psychotherapy helping you with what you are teach participants many useful skills such as experiencing right now. Counselling active listening, empathy and self-awareness is often what is called ‘time-limited’ or that can be of benefit to people in any ‘short-term’. In other words, you decide career, not just those who want to be with your therapist during the first meeting professional Counsellors. These skills will how many sessions you will work together, benefit anyone who is employed in a sector which can be anywhere from 12 to 24 weeks where they have to deal with members of or more. Because it’s shorter term, the public, or demonstrate good counselling can be quite structured, with communication skills. an agenda laid out in advance. The issues that counselling most Personal Development often deals with are the things a client is Many people simply have an interest in currently feeling stressed by, whether that counselling and want to learn more about it. is the challenges they are facing on a daily Perhaps they want to develop skills that will basis at home or work or its a traumatic benefit them in everyday life, or simply circumstance such as a breakup, divorce, or because they’ve always been interested in bereavement. Counselling can also help with the area. things like confidence issues and addictions. Counselling can be done not just as an A Specialised Career individual but also as a couple, family, or Many people undertake counselling courses group. to develop the specialised skills needed to The forms of talk therapy that are become professional counsellors. Others usually referred to as ‘counselling’ in the undertake higher-level counselling courses UK include: to enhance or develop skills for the  Cognitive behavioural therapy (CBT) workplace.  Person-centred therapy (also called humanistic therapy) Psychotherapy  Couples counselling Psychotherapy is the use of psychological  Integrative counselling (a blend of methods, particularly when based on regular various approaches) personal interaction, to help a person change and overcome problems in desired ways. Why Study Counselling? Psychotherapy aims to improve an There are several reasons why someone individual's well-being and mental health, to might choose to complete a counselling resolve or mitigate troublesome behaviors, programme. As well as offering a range of beliefs, compulsions, , or , full and part-time courses aimed at those and to improve relationships and social seeking to pursue a career in counselling, we skills. Certain are also provide courses that allow people to considered evidence-based for treating some explore counselling as an interest or for their diagnosed mental disorders. There are over a own personal development. Below are some thousand different psychotherapy

74 International Journal for Psychotherapy in Africa (3:1) techniques, some being minor variations, counseling may refer to guidance for while others are based on very different everyday problems in specific areas, conceptions of psychology, ethics (how to typically for shorter durations with a less live) or techniques. Most involve one-to-one medical focus. Somatotherapy refers to the sessions, between client and therapist, but use of physical changes as injuries and some are conducted with groups,[1] including illnesses'Bold text''''Bold text''''Bold families. Psychotherapists may be mental text''''''', and sociotherapy to the use of a health professionals such as psychiatrists, person's social environment to effect psychologists, clinical social workers, or therapeutic change. Psychotherapy may marriage and family therapists. address spirituality as part of mental life, Psychotherapists may also come from a and some forms are derived from spiritual variety of other backgrounds, and depending philosophies, but practices based on treating on the jurisdiction may be legally regulated, the spiritual as a separate dimension would voluntarily regulated or unregulated. not necessarily be considered psychotherapy. Definitions Historically, psychotherapy has The term psychotherapy is derived from sometimes meant "interpretative" (i.e. Ancient Greek psyche (ψυχή meaning Freudian) methods, namely psychoanalysis, "breath; spirit; soul") and therapeia in contrast with other methods to treat (θεραπεία "healing; medical treatment"). psychiatric disorders such as behavior The Oxford English Dictionary defines it modification. now as "The treatment of disorders of the Psychotherapy is often dubbed mind or personality by psychological "talking therapy", particularly for a general methods..." audience, though not all forms of The American Psychological psychotherapy rely on verbal Association adopted a resolution on the communication. Children or adults who do effectiveness of psychotherapy in 2012 not engage in verbal communication (or not based on a definition developed by John C. in the usual way) are not excluded from Norcross: "Psychotherapy is the informed psychotherapy; indeed some types are and intentional application of clinical designed for such cases. methods and interpersonal stances derived Psychotherapy can also be done in a from established psychological principles couple, as a family, or as a group. for the purpose of assisting people to modify The forms of talk therapy that are their behaviors, cognitions, emotions, and/or usually referred to as ‘psychotherapy’ in the other personal characteristics in directions UK include: that the participants deem desirable".  Psychodynamic psychotherapy Influential editions of a work by psychiatrist  Existential psychotherapy Jerome Frank defined psychotherapy as a  Psychoanalytic psychotherapy healing relationship using socially  Jungian psychoanalysis authorized methods in a series of contacts  Dialectical primarily involving words, acts and  Acceptance and commitment therapy rituals—regarded as forms of persuasion and  Integrative psychotherapy (a blend of rhetoric. approaches) Some definitions of counseling overlap with psychotherapy (particularly Shorter forms of psychotherapy include: non-directive client-centered approaches), or

Akwash, F. (2018). Psychotherapy and Counselling, 75 International Journal for Psychotherapy in Africa 3(1):72-88

 Cognitive analytical therapy (an Overview of Psychotherapy offshoot of cognitive and There are hundreds of psychotherapy psychoanalytic theory) approaches or schools of . By 1980  Dynamic interpersonal therapy (an there were more than 250; by 1996 more offshoot of psychodynamic and than 450; and at the start of the 21st century psychoanalytic theory) there were over a thousand different named psychotherapies—some being minor Delivery variations while others are based on very Psychotherapy may be delivered in person, different conceptions of psychology, ethics one on one or in groups, over the phone via (how to live) or technique. In practice telephone counseling, or via the internet. therapy is often not of one pure type but draws from a number of perspectives and Regulation schools—known as an integrative or eclectic Psychotherapists may be mental health approach. The importance of the therapeutic professionals, professionals from other relationship, also known as therapeutic backgrounds trained in a specific therapy, or alliance, between client and therapist is in some cases non-professionals. often regarded as crucial to psychotherapy. Psychiatrists are first trained as physicians. Common factors theory addresses this and As such, they may prescribe prescription other core aspects thought to be responsible medication. Specialist psychiatric training for effective psychotherapy. begins after medical school in psychiatric (1856–1939), a Viennese neurologist who residencies. Clinical psychologists have studied with Charcot in 1885, relinquished specialist doctoral degrees in psychology spellbinding with the expectation of with clinical and research components. complimentary affiliation and the Clinical social workers, mental health and elucidation of dreams, as a method for intellectual disability nurses may have achieving "purification" and comprehension specialized training and practical experience manifestations. The other ingredients of his in psychotherapy. Many of the wide variety 'models', which changed throughout the of training programs and institutional years, included the part of the oblivious, settings are multi-professional. In most juvenile sexuality, restraint (created from countries professionals doing specialized Pierre Janet) and other 'safeguard psychotherapeutic work also require a components' (later recorded methodically by program of continuing education after the his little girl Anna Freud), distinguishing basic degree. proof with the lost "protest" in grieving, and As sensitive and deeply personal the vacillation of emotions. He likewise topics are often discussed during portrayed the perils and the restorative psychotherapy, therapists are expected, and capability of "transference"; the emotions usually legally bound, to respect client or coordinated towards the specialist by a patient confidentiality. The critical patient reinstituting experiences from prior importance of client confidentiality—and persuasive connections. A considerable lot the limited circumstances in which it may of his thoughts were too broad to be in any need to be broken for the protection of way amiable to trial testing and conceivable clients or others—is enshrined in the invalidation, and he was reprimanded for regulatory psychotherapeutic organizations' this by Jaspers. Different examiners who codes of ethical practice. gave bits of knowledge into the advancement of mental indications included

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Melanie Klein ('the neurotic schizoid psychotherapy, including couples therapy position') and Donald Winnicott, who and family therapy. worked in London (1935), predominantly Therapies are sometimes classified with kids. Since the 1960s, however, the according to their duration; a small number utilization of analysis for the treatment of of sessions over a few weeks or months may extreme emotional sickness has been be classed as brief therapy (or short-term logically dissolved. Different types of therapy), others where regular sessions take psychotherapy have been created, chiefly for place for years may be classed as long-term. non-maniacal conditions, with firmer Some practitioners distinguish establishments regarding evidence of between more "uncovering" (or "depth") adequacy and practicability. These approaches and more "supportive" incorporate subjective treatments (after psychotherapy. Uncovering psychotherapy Beck), behavioral treatments (after Skinner emphasizes facilitating the client's insight and Wolpe) and additional time-constrained into the roots of their difficulties. The best- and centered structures, for example, known example is classical psychoanalysis. interpersonal psychotherapy. In youth issue Supportive psychotherapy by contrast and in schizophrenia, the systems of family stresses strengthening the client's coping treatment hold esteem. A portion of the mechanisms and often providing thoughts emerging from therapy are encouragement and advice, as well as presently pervasive and some are a piece of reality-testing and limit-setting where the armamentarium of ordinary clinical necessary. Depending on the client's issues practice. They are not just medications, they and situation, a more supportive or more additionally help to understand uncovering approach may be optimal. conduct. Most forms of psychotherapy use Psychotherapies are categorized in spoken conversation. Some also use various several different ways. A distinction can be other forms of communication such as the made between those based on a medical written word, artwork, drama, narrative model and those based on a humanistic story or music. Psychotherapy with children model. In the medical model the client is and their parents often involves play, seen as unwell and the therapist employs dramatization (i.e. role-play), and drawing, their skill to help the client back to health. with a co-constructed narrative from these The extensive use of the DSM-IV, the non-verbal and displaced modes of diagnostic and statistical manual of mental interacting. disorders in the United States, is an example There are also different formats for of a medically exclusive model. The delivering some therapies, as well as the humanistic or non-medical model in contrast usual face to face: for example via telephone strives to depathologise the human or via online interaction. There have also condition. The therapist attempts to create a been developments in computer-assisted relational environment conducive to therapy, such as virtual reality therapy for experiential learning and help build the behavioral exposure, multimedia programs client's confidence in their own natural to each cognitive techniques, and handheld process resulting in a deeper understanding devices for improved monitoring or putting of themselves. The therapist may see ideas into practice. themselves as a facilitator/helper. Another distinction is between individual one-to-one therapy sessions, and group

Akwash, F. (2018). Psychotherapy and Counselling, 77 International Journal for Psychotherapy in Africa 3(1):72-88

History scientific controversies around the use of [41] History of psychotherapy and Timeline of hypnosis in medicine. Also in 1892, at the psychotherapy second congress of experimental Psychotherapy can be said to have been psychology, van Eeden attempted to take the practiced through the ages, as medics, credit for the term psychotherapy and to philosophers, spiritual practitioners and distance the term from hypnosis. people in general used psychological Behaviorism developed in the 1920s, and methods to heal others. behavior modification as a therapy became In the Western tradition, by the 19th popularized in the 1950s and 1960s. Notable century, a moral treatment movement (then contributors were Joseph Wolpe in South meaning morale or mental) developed based Africa, M.B. Shipiro and Hans Eysenck in on non-invasive non-restraint therapeutic Britain, and John B. Watson and B.F. methods. Another influential movement Skinner in the United States. Behavioral was started by Franz Mesmer (1734–1815) therapy approaches relied on principles of and his student Armand-Marie-Jacques de operant conditioning, classical conditioning Chastenet, Marquis of Puységur (1751– and social learning theory to bring about 1825). Called Mesmerism or animal therapeutic change in observable symptoms. magnetism, it would have a strong influence The approach became commonly used for on the rise of dynamic psychology and phobias, as well as other disorders. psychiatry as well as theories about Some therapeutic approaches hypnosis. In 1853 Walter Cooper Dendy developed out of the European school of introduced the term "psycho-therapeia" existential philosophy. Concerned mainly regarding how physicians might influence with the individual's ability to develop and the mental states of sufferers and thus their preserve a sense of meaning and purpose bodily ailments, for example by creating throughout life, major contributors to the opposing emotions to promote mental field (e.g., Irvin Yalom, Rollo May) and balance. Daniel Hack Tuke cited the term Europe (Viktor Frankl, Ludwig Binswanger, and wrote about "psycho-therapeutics" in Medard Boss, R.D.Laing, Emmy van 1872, in which he also proposed making a Deurzen) attempted to create therapies science of animal magnetism. Hippolyte sensitive to common "life crises" springing Bernheim and colleagues in the "Nancy from the essential bleakness of human self- School" developed the concept of awareness, previously accessible only "psychotherapy" in the sense of using the through the complex writings of existential mind to heal the body through hypnotism, philosophers (e.g., Søren Kierkegaard, Jean- yet further. Charles Lloyd Tuckey's 1889 Paul Sartre, Gabriel Marcel, Martin work, Psycho-therapeutics, or Treatment by Heidegger, Friedrich Nietzsche). The Hypnotism and Suggestion popularized the uniqueness of the patient-therapist work of the Nancy School in English. Also relationship thus also forms a vehicle for in 1889 a clinic used the word in its title for therapeutic inquiry. A related body of the first time, when Frederik van Eeden and thought in psychotherapy started in the Albert Willem in Amsterdam renamed theirs 1950s with Carl Rogers. Based also on the "Clinique de Psycho-thérapeutique works of Abraham Maslow and his Suggestive" after visiting Nancy. During hierarchy of human needs, Rogers brought this time, travelling stage hypnosis became person-centered psychotherapy into popular, and such activities added to the mainstream focus. The primary requirement was that the client be in receipt of three core

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"conditions" from his counselor or therapist: developed, including acceptance and unconditional positive regard, sometimes commitment therapy and dialectical described as "prizing" the client's humanity; behavior therapy, which expanded the congruence [authenticity/ genuineness/ concepts to other disorders and/or added transparency]; and empathic understanding. novel components and mindfulness This type of interaction was thought to exercises. Counseling methods developed, enable clients to fully experience and including solution-focused therapy and express themselves, and thus develop systemic coaching. according to their innate potential. Others Postmodern psychotherapies such as developed the approach, like Fritz and Laura narrative therapy and coherence therapy did Perls in the creation of , as not impose definitions of mental health and well as Marshall Rosenberg, founder of illness, but rather saw the goal of therapy as Nonviolent Communication, and Eric Berne, something constructed by the client and founder of transactional analysis. Later these therapist in a social context. Systemic fields of psychotherapy would become what therapy also developed, which focuses on is known as humanistic psychotherapy family and group dynamics—and today. Self-help groups and books became transpersonal psychology, which focuses on widespread. the spiritual facet of human experience. During the 1950s, Albert Ellis Other orientations developed in the last originated rational emotive behavior therapy three decades include feminist therapy, brief (REBT). Independently a few years later, therapy, somatic psychology, expressive psychiatrist Aaron T. Beck developed a therapy, applied and the form of psychotherapy known as cognitive human givens approach. A survey of over therapy. Both of these included relatively 2,500 US therapists in 2006 revealed the short, structured and present-focused most utilized models of therapy and the ten techniques aimed at identifying and most influential therapists of the previous changing a person's beliefs, appraisals and quarter-century. reaction-patterns, by contrast with the more long-lasting insight-based approach of Europe psychodynamic or humanistic therapies. As of 2015 there is still much variation Beck's approach used primarily the socratic between European countries. A few have no method, and links have been drawn between regulation of the practice or no protection of ancient stoic philosophy and these cognitive the title. Some have a system of voluntary [45] therapies. registration with independent professional Cognitive and behavioral therapy organisations, while others attempt to approaches were increasingly combined and restrict it to mental health professionals with grouped under the umbrella term cognitive years of additional state-certified training. behavioral therapy (CBT) in the 1970s. Which titles are "protected" also varies. The Many approaches within CBT are oriented European Association for Psychotherapy set towards active/directive yet collaborative up after the 1990 Strasbourg Declaration on empiricism (a form of reality-testing), Psychotherapy attempts to set independent assessing and modifying core beliefs and pan-European standards. dysfunctional schemas. These approaches In Germany, the practice of gained widespread acceptance as a primary psychotherapy for adults is restricted to treatment for numerous disorders. A "third qualified psychologists and physicians wave" of cognitive and behavioral therapies

Akwash, F. (2018). Psychotherapy and Counselling, 79 International Journal for Psychotherapy in Africa 3(1):72-88

(including psychiatrists) who have Authority for Health and Social Care (PSA) completed five years of specialist practical launched an Accredited Voluntary Registers training and certification in psychotherapy. scheme. Social workers may complete the specialist training for child and teenage clients. United States Similarly in Italy, the practice of In some states, counselors or therapists must psychotherapy is restricted to graduates in be licensed to use certain words and titles on psychology or medicine who have self-identification or advertising: in some completed four years of recognised other states, the restrictions on practice are specialist training. Sweden has a similar more closely associated with the charging of restriction on the title "psychotherapist", fees. Licensing and regulation are performed which may only be used by professionals by the various states. Presentation of who have gone through a post-graduate practice as licensed, but without such a training in psychotherapy and then applied license, is generally illegal. Without a for a licence, issued by the National Board license, for example a practitioner cannot of Health and Welfare. bill insurance companies. Information about French legislation restricts the use of state licensure is provided by the American the title "psychotherapist" to professionals Psychological Association. on the National Register of In addition to state laws, the American Psychotherapists, which requires a training Psychological Association enacts "Ethical in clinical psychopathology and a period of Principles" for its members. The American internship which is only open to physicians Board of Professional Psychology examines or titulars of a master's degree in psychology and certifies "psychologists who or psychoanalysis. demonstrate competence in approved Austria and Switzerland (2011) have specialty areas in professional psychology". laws that recognize multidifunctional- disciplinary approaches. Humanistic In the United Kingdom, psychotherapy is voluntarily regulated. These psychotherapies, also known as National registers for psychotherapists and "experiential", are based on humanistic counsellors are maintained by three main psychology and emerged in reaction to both umbrella bodies: The United Kingdom behaviorism and psychoanalysis, being Council for Psychotherapy (UKCP), The dubbed the "third force". They are primarily British Association for Counselling and concerned with the human development and Psychotherapy (BACP) and The British needs of the individual, with an emphasis on Psychoanalytic Council. There are many subjective meaning, a rejection of smaller professional bodies and associations determinism, and a concern for positive such as the Association of Child growth rather than pathology. Some posit an Psychotherapists (ACP) and the British inherent human capacity to maximize Psychotherapy Foundation (formerly the potential, "the self-actualizing tendency"; British Association of Psychotherapists). the task of therapy is to create a relational The government and Health and Care environment where this tendency might Professions Council considered mandatory flourish. Humanistic psychology can in turn legal registration but decided that it was best be rooted in existentialism—the belief that left to professional bodies to regulate human beings can only find meaning by themselves, so the Professional Standards creating it. This is the goal of existential

80 International Journal for Psychotherapy in Africa (3:1) therapy. Existential therapy is in turn Techniques for analytic group therapy have philosophically associated with also developed. phenomenology. Gestalt therapy, originally called Cognitive-behavioral "concentration therapy", is an Behavior therapies use behavioral existential/experiential form that facilitates techniques, including applied behavior awareness in the various contexts of life, by analysis (also known as behavior moving from talking about relatively remote modification), to change maladaptive situations to action and direct current patterns of behavior to improve emotional experience. Derived from various responses, cognitions, and interactions with influences, including an overhaul of others. Functional analytic psychotherapy is psychoanalysis, it stands on top of one form of this approach. By nature, essentially four load-bearing theoretical behavioral therapies are empirical (data- walls: phenomenological method, dialogical driven), contextual (focused on the relationship, field-theoretical strategies, and environment and context), functional experimental freedom. (interested in the effect or consequence a A briefer form of humanistic therapy behavior ultimately has), probabilistic is the human givens approach, introduced in (viewing behavior as statistically 1998/9. It is a solution-focused intervention predictable), monistic (rejecting mind-body based on identifying emotional needs—such dualism and treating the person as a unit), as for security, autonomy and social and relational (analyzing bidirectional connection—and using various educational interactions). and psychological methods to help people Cognitive therapy focuses directly on meet those needs more fully or changing the thoughts, in order to improve appropriately. the emotions and behaviors. Cognitive behavioral therapy attempts to combine the Insight-oriented above two approaches, focused on the Insight-oriented psychotherapies focus on construction and re-construction of people's revealing or interpreting unconscious cognitions, emotions and behaviors. processes. Most commonly referring to Generally in CBT, the therapist, through a psychodynamic therapy, of which wide array of modalities, helps clients psychoanalysis is the oldest and most assess, recognize and deal with problematic intensive form, these applications of depth and dysfunctional ways of thinking, emoting psychology encourage the verbalization of and behaving. all the patient's thoughts, including free A "third wave" reflected an influence associations, fantasies, and dreams, from of Eastern philosophy in clinical which the analyst formulates the nature of psychology, incorporating principles such as the past and present unconscious conflicts meditation into interventions such as which are causing the patient's symptoms mindfulness-based cognitive therapy, and character problems. acceptance and commitment therapy and There are four main schools of dialectical behavior therapy. psychoanalysis, which all influenced Interpersonal psychotherapy (IPT) is a psychodynamic theory:[67] Freudian, Ego relatively brief form of psychotherapy psychology, Object relations theory and (deriving from both CBT and Glen Gabbard. and Self psychology. psychodynamic approaches) that has been increasingly studied and endorsed by

Akwash, F. (2018). Psychotherapy and Counselling, 81 International Journal for Psychotherapy in Africa 3(1):72-88 guidelines for some conditions. It focuses on which provided the impetus for the the links between mood and social development since the war of both social circumstances, helping to build social skills therapy, that is, the therapeutic community and social support. It aims to foster movement, and the use of small groups for adaptation to current interpersonal roles and the treatment of neurotic and personality situations. disorders. Today group therapy is used in Other types include reality clinical settings and in private practice therapy/choice theory, cognitive processing settings. therapy, EMDR, and multimodal therapy. Expressive Systemic Expressive therapy Systemic therapy seeks to address people Expressive therapy is any form of therapy not just individually, as is often the focus of that utilizes artistic expression as its core other forms of therapy, but in relationship, means of treating clients. Expressive dealing with the interactions of groups, their therapists use the different disciplines of the patterns and dynamics (includes family creative arts as therapeutic interventions. therapy and marriage counseling). This includes the modalities dance therapy, is a type of drama therapy, art therapy, music therapy, systemic psychology. writing therapy, among others. Expressive The term group therapy was first used therapists believe that often the most around 1920 by Jacob L. Moreno, whose effective way of treating a client is through main contribution was the development of the expression of imagination in a creative psychodrama, in which groups were used as work and integrating and processing what both cast and audience for the exploration of issues are raised in the act. individual problems by reenactment under the direction of the leader. The more Postmodernist analytic and exploratory use of groups in Also known as post-structuralist or both hospital and out-patient settings was constructivist. Narrative therapy gives pioneered by a few European attention to each person's "dominant story" psychoanalysts who emigrated to the USA, by means of therapeutic conversations, such as Paul Schilder, who treated severely which also may involve exploring unhelpful neurotic and mildly psychotic out-patients in ideas and how they came to prominence. small groups at Bellevue Hospital, New Possible social and cultural influences may York. The power of groups was most be explored if the client deems it helpful. influentially demonstrated in Britain during Coherence therapy posits multiple levels of the Second World War, when several mental constructs that create symptoms as a psychoanalysts and psychiatrists proved the way to strive for self-protection or self- value of group methods for officer selection realization. Feminist therapy does not accept in the War Office Selection Boards. A that there is one single or correct way of chance to run an Army psychiatric unit on looking at reality and therefore is considered group lines was then given to several of a postmodernist approach. these pioneers, notably Wilfred Bion and Rickman, followed by S. H. Foulkes, Main, Other and Bridger. The Northfield Hospital in Transpersonal psychology addresses the Birmingham gave its name to what came to client in the context of a spiritual be called the two "Northfield Experiments", understanding of consciousness. Positive

82 International Journal for Psychotherapy in Africa (3:1) psychotherapy (PPT) (since 1968) is a Parent management training is a highly method in the field of humanistic and effective form of psychotherapy that teaches psychodynamic psychotherapy and is based parents skills to reduce their child's behavior on a positive image of humans, with a problems. health-promoting, resource-oriented and Many counseling preparation conflict-centered approach. programs include courses in human Hypnotherapy is undertaken while a development. Since children often do not subject is in a state of hypnosis. have the ability to articulate thoughts and Hypnotherapy is often applied in order to feelings, counselors will use a variety of modify a subject's behavior, emotional media such as crayons, paint, clay, puppets, content, and attitudes, as well as a wide bibliocounseling (books), toys, board games, range of conditions including: dysfunctional et cetera. The use of play therapy is often habits, anxiety, stress-related illness, pain rooted in psychodynamic theory, but other management, and personal development. approaches such as Solution Focused Brief Some non-Western indigenous Counseling may also employ the use of play therapies have been developed. In African in counseling. In many cases the counselor countries this includes harmony restoration may prefer to work with the care taker of the therapy, meseron therapy and systemic child, especially if the child is younger than therapies based on the Ubuntu philosophy. age four. Yet, by doing so, the counselor Integrative psychotherapy is an risks the perpetuation of maladaptive attempt to combine ideas and strategies from interactive patterns and the adverse effects more than one theoretical approach. These on development that have already been approaches include mixing core beliefs and affected on the child's end of the combining proven techniques. Forms of relationship. Therefore, contemporary integrative psychotherapy include thinking on working with this young age multimodal therapy, the transtheoretical group has leaned towards working with model, cyclical psychodynamics, systematic parent and child simultaneously within the treatment selection, cognitive analytic interaction, as well as individually as therapy, Internal Family Systems Model, needed. multitheoretical psychotherapy and conceptual interaction. In practice, most Effects experienced psychotherapists develop their How to assess own integrative approach over time. There is considerable controversy about whether, or when, psychotherapy efficacy is Child best evaluated by randomized controlled Child psychotherapy trials or more individualized idiographic Counseling and psychotherapy must be methods. adapted to meet the developmental needs of One issue with trials is what to use as children. It is generally held to be one part a placebo treatment group or non-treatment of an effective strategy for some purposes control group. Often this is patients on a and not for others. In addition to therapy for waiting list, or people receiving some kind the child, or even instead of it, children may of regular non-specific contact or support. benefit if their parents speak to a therapist, One issue is the best way to match the use of take parenting classes, attend grief inert tablets or sham treatments in placebo- counseling, or take other actions to resolve controlled studies in pharmaceutical trials. stressful situations that affect the child. Several interpretations and differing

Akwash, F. (2018). Psychotherapy and Counselling, 83 International Journal for Psychotherapy in Africa 3(1):72-88 assumptions and language remain. Another place. Anxious and depressed patients in issue is the attempt to standardize and two short-term therapies (solution-focused manualize therapies and link them to and brief psychodynamic) improved faster, specific symptoms of diagnostic categories, but after five years long-term psychotherapy making them more amenable to research. and psychoanalysis gave greater benefits. Some report that this may reduce efficacy or Several patient and therapist factors appear gloss over individual needs. Finagy and to predict suitability for different Roth's opinion is that the benefits of the psychotherapies. evidence-based approach outweighs the difficulties. Mechanisms of change Many psychotherapists believe that Different therapeutic approaches may be the nuances of psychotherapy cannot be associated with particular theories about captured by questionnaire-style observation, what needs to change in a person for a and prefer to rely on their own clinical successful therapeutic outcome. experiences and conceptual arguments to In general, processes of emotional arousal support the type of treatment they practice. and memory have long been held to play an Psychodynamic therapists in particular have important role. One theory combining these opposed evidence-based approaches as not aspects proposes that permanent change appropriate to their methods or assumptions, occurs to the extent that the though some have increasingly accepted the neuropsychological mechanism of memory challenge. reconsolidation is triggered and is able to incorporate new emotional experiences. Outcomes Large-scale international reviews of Adherence scientific studies have concluded that Adherence to a course of psychotherapy— psychotherapy is effective for numerous continuing to attend sessions or complete conditions. tasks—is a major issue. One line of research consistently finds The dropout level—early that supposedly different forms of termination—ranges from around 30% to psychotherapy show similar effectiveness— 60%, depending partly on how it is defined. historically dubbed the Dodo bird verdict The range is lower for research settings for because all win. Further analyses seek to various reasons, such as the selection of identify the factors that the psychotherapies clients and how they are inducted. Early have in common that seem to account for termination is associated on average with this, known as common factors theory; for various demographic and clinical example the quality of the therapeutic characteristics of clients, therapists and relationship, interpretation of problem, and treatment interactions. The high level of the confrontation of painful emotions. dropout has raised some criticism about the However, specific therapies have been relevance and efficacy of psychotherapy. tested for use with specific disorders, and Most psychologists use between- regulatory organizations in both the UK and session tasks in their general therapy work, US make recommendations for different and cognitive behavioral therapies in conditions. particular use and see them as an "active The Helsinki Psychotherapy Study ingredient". It is not clear how often clients was one of several large long-term clinical do not complete them, but it is thought to be trials of psychotherapies that have taken a pervasive phenomenon.

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From the other side, the adherence of On the other hand, some argue therapists to therapy protocols and psychotherapy is under-utilized and under- techniques—known as "treatment researched by contemporary psychiatry integrity"—has also been studied, with despite offering more promise than stagnant complex mixed results. medication development. In 2015 the US National Institute of Mental Health is Adverse effects allocating only 5.4% of its budget to new Research on adverse effects of clinical trials of psychotherapies psychotherapy has been limited for various (medication trials are largely funded by reasons, yet they may be expected to occur pharmaceutical companies), despite plentiful in 5% to 20% of patients. Problems include evidence they can work and that patients are deterioration of symptoms or developing more likely to prefer them. new symptoms, strains in other Some suggest that successful relationships, and dependency on the therapeutic relationships, based on true therapist. Some techniques or therapists may acceptance of the client as a human being carry more risks than others, and some client without contingency, require a theological characteristics may make them more assumption, an ontological acceptance of vulnerable. Side-effects from properly God. conducted therapy should be distinguished Further critiques have emerged from from harms caused by malpractice. feminist, constructionist and discursive sources. Key to these is the issue of power. General critiques In this regard there is a concern that clients Some are skeptical of the healing power of are persuaded—both inside and outside the psychotherapeutic relationships. Some consulting room—to understand themselves dismiss psychotherapy altogether in the and their difficulties in ways that are sense of a scientific discipline requiring consistent with therapeutic ideas. This professional practitioners, instead favoring means that alternative ideas (e.g., feminist, biomedical treatments. Others have pointed economic, spiritual) are sometimes out ways in which the values and techniques implicitly undermined. Critics suggest that of therapists can be harmful as well as we idealize the situation when we think of helpful to clients (or indirectly to other therapy only as a helping relationship— people in a client's life). arguing instead that it is fundamentally a Many resources available to a person political practice, in that some cultural ideas experiencing emotional distress—the and practices are supported while others are friendly support of friends, peers, family undermined or disqualified, and that while it members, clergy contacts, personal reading, is seldom intended, the therapist-client healthy exercise, research, and independent relationship always participates in society's coping—all present considerable value. power relations and political dynamics. A Critics note that humans have been dealing noted academic who espoused this criticism with crises, navigating severe social was Michel Foucault. problems and finding solutions to life Counselling and Psychotherapy are problems long before the advent of often considered to be interchangeable psychotherapy. Of course, it may well be therapies that overlap in a number of ways. something in the patient that does not Counselling, in specific situations, is offered develop these "natural" supports that as part of the psychotherapy process; requires therapy.

Akwash, F. (2018). Psychotherapy and Counselling, 85 International Journal for Psychotherapy in Africa 3(1):72-88 whereas a counsellor may work with clients  It will help you understand your in a psychotherapeutic manner. feelings, thoughts and actions more The key difference between the two courses clearly. of therapeutic communication treatment lies  Psychotherapy is a longer-term in the recommended time required to see process of treatment that identifies benefits. Counselling usually refers to a emotional issues and the background brief treatment that centres around to problems and difficulties. behaviour patterns. Psychotherapy focuses on working with clients for a longer-term Counselling & Psychotherapy Definition and draws from insight into emotional Psychotherapy and Counselling are problems and difficulties. professional activities that utilise an interpersonal relationship to enable people Who’s Who? to develop self-understanding and to make A psychotherapist is a trained individual changes in their lives. Professional who is able to offer a form of counselling to counsellors and psychotherapists work clients. Someone with the same within a clearly contracted, principled qualifications however, may decide to be relationship that enables individuals to called a counsellor instead. Generally a obtain assistance in exploring and resolving practitioner offering short-term treatment is issues of an interpersonal, intrapsychic, or known as a counsellor. An individual with personal nature. Professional Counselling two or more years of training will opt to be and Psychotherapy are explicitly contracted known as a psychotherapist. and require in-depth training to utilise a To the public the title counsellor appears range of therapeutic interventions, and less intrusive and more easily acceptable should be differentiated from the use of than the name psychotherapist suggests. A counselling skills by other professionals. psychotherapist may therefore call Professional Psychotherapy/Counselling: him/herself a counsellor, in order to attract  Utilise counselling, potential clients. psychotherapeutic, and psychological theories, and a set of advanced Counselling: interpersonal skills which emphasise  Helps people identify problems and facilitating clients’ change processes crises and encourages them to take in the therapeutic context. This work positive steps to resolve these issues. with client processes is based on an  It is the best course of therapeutic ethos of respect for clients, their treatment for anyone who already has values, their beliefs, their uniqueness an understanding of wellbeing, and and their right to self-determination. who is also able to resolve problems.  Require in-depth training processes to  Counselling is a short-term process develop understanding and knowledge that encourages the change of about human behaviour, therapeutic behaviour. capacities, and ethical and professional boundaries. Psychotherapy:  Take account of the cultural and  Helps people with psychological socio-political context in which the problems that have built up over the client lives and how these factors course of a long period of time. affect the presenting problem. This includes awareness and assessment of

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social and cultural influences such as Counselling vs psychotherapy age, development, (dis)ability,  Both explore feelings, beliefs, and religion, cultural identity, Indigenous thoughts. identity, sexual orientation,  Both focus on creating a safe, socioeconomic status, nationality and supportive environment. gender. Professional Psychotherapists  Both help you understand yourself and Counsellors value such better. differences and avoid discrimination  Both help you understand others on the basis of these aspects of better. identity.  Both help you make better choices  May involve intervening with current and move forward in life. problems, immediate crises, or long-  Both involve working with a therapist term difficulties. The work may be with at least three years of training. short-term or long-term, depending on the nature of the difficulties, and may BUT involve working with individuals,  counselling is more likely to be action couples, families or groups. and behaviour focused  Counselling and Psychotherapy occur  counselling is more likely to be short- in a variety of contexts in the public term and private sectors.  counselling is more likely to focus on  Regard ongoing clinical supervision, your present issues over past issues professional development, self-  psychotherapy tends to go on longer awareness, self-development, self- than a round of counselling sessions monitoring and self-examination as  psychotherapy is more likely to be in- central to effective and ethical depth than counselling practice. Such practices lead to  psychotherapy is more likely to enhanced capacity to utilise the self of explore the past as well as the present the practitioner effectively in the  psychotherapy is more likely to therapeutic relationship. explore childhood root issues instead of just behavioural patterns Although Counselling and  psychotherapy means your therapist Psychotherapy overlap considerably, there has at least four years of training are also recognised differences. While the  psychotherapy can deal with deep work of Counsellors and Psychotherapists mental health problems and disorders with clients may be of considerable depth, that have developed over a long the focus of Counselling is more likely to be period of time on specific problems, changes in life adjustments and fostering clients’ wellbeing. The above proposed similarities and Psychotherapy is more concerned with the differences aside, it’s still a murky world restructuring of the personality or self and when it comes to comparing the development of insight. At advanced psychotherapy with counselling. A levels of training, Counselling has a greater counsellor might work very deeply in a way overlap with Psychotherapy than at that seems psychotherapeutic. A foundation levels. psychotherapist might offer counselling as part of a bigger treatment plan.

Akwash, F. (2018). Psychotherapy and Counselling, 87 International Journal for Psychotherapy in Africa 3(1):72-88

The only definite, watertight answer for therapy before and have troubles resolving what is the exact difference between a problems, a more open-ended therapy that psychotherapist and a counsellor is it helps you understand yourself deeply and depends on what training program and build self confidence might be life changing. theoretical approach your therapist has chosen for themselves. Was their training Who are we? program called counselling, or The Foundation for Psychotherapy and psychotherapy? Counselling (FPC) is the home for So do I need a counsellor, or a Counsellors, Psychodynamic psychotherapist? Psychotherapists, Psychoanalytic Although psychotherapy training is Psychotherapists and Group-Analytic a year or two longer than counselling therapists all of whom completed their therapy in the UK, more years of training training at WPF Therapy, one of the largest do not necessarily a better therapist and most respected training institutions in make. Plus, most counsellors and the UK. psychotherapists take additional training on Psychodynamic, Psychoanalytic and top of their original certification. They are Group-Analytic therapy are all known as also required in the UK to invest in a certain 'talking therapies'. It is believed that about a amount of hours of Continued Professional quarter of the UK population will struggle Development (CPD) each year. with a mental health issue in the course of a The therapist that is right for you year, whether suffering from depression, will be the one that suits your personality, anxiety, or struggling with more acute needs, and issues. psychiatric conditions. We find that many So perhaps the question is less, do I people are often not aware of what they are need a counsellor or psychotherapist, and struggling with, aside from feeling stuck, more, what sort of therapy and therapist lonely, or desperate in a way that is having a works for me? profound effect on their lives. Do I want a short term therapy that Whether qualified as individual or mostly focuses on my thoughts and actions group practitioners, our therapists have a (CBT), short term therapy that looks mostly diverse range of experience and many have at my relationships (Dynamic interpersonal developed specialist areas of concern since therapy or Cognitive analytical therapy), qualifying. Most of our therapists have years therapy where I decide the agenda (Person- of experience, having built upon the centred), or therapy that leads me to deeply foundation of our training. Many of our explore all that I am (Existential therapists can offer reduced-fees under psychotherapy)? Do I want a male or female certain circumstances. therapist, someone who is very gentle or a We are confident that we can help you bit firm, someone with a sense of humour or find a therapist appropriately suited, to someone quiet and reserved? support you with you individual needs and What sort of therapy you need is concerns. All our members abide by the also affected by whether you’ve already code of ethics and professional standards done other forms of therapy. If you have defined by the three major accrediting done years of psychotherapy in the past and organisations – the British Psychoanalytic have a strong understanding of yourself, you Council (BPC), British Association for might just need a round of action-focussed Counselling & Psychotherapy (BACP) and counselling. Whereas if you have never tried

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United Kingdom of Counselling & Griffin, Joe; Tyrrell, Ivan (1998). Psychotherapy (UKCP). Psychotherapy, Counselling and the Human Givens (Organising Idea). Counselling Courses and Psychotherapy ISBN 1899398953. Courses at ICHAS, Dublin, Limerick, and History of Counselling & Psychotherapy Nationwide Greg Mulhauser, ICHAS is at the forefront of the education CounsellingResource Library, 2014 and training of Counsellors and Psychotherapy in a Traditional Society: Psychotherapists in Ireland, providing an Context, Concept and Practice Vijoy extensive range of Counselling K Varma, Nitin Gupta. Jaypee and Psychotherapy Courses. All our courses Brothers Publishers. 2008. Page 230 in Counselling and Psychotherapy are QQI Rogers, C. R. (1951) "Client-Centered accredited and awarded to include; Therapy: Its Current Practice, introductory Certificate Courses in Implications, and Theory", Boston: Counselling skills and Psychotherapy Houghton Mifflin. studies; Undergraduate Courses in Roth A., and Fonagy P. (2005) What Works Counselling and Psychotherapy and related for Whom: A critical review of studies; Post Graduate and Masters Courses psychotherapy research. Second in Counselling and Psychotherapy. All our Edition. The Guildford Press Counselling Courses and Psychotherapy Silverman, Doris K. (2005). "What Works Courses are offered in both Dublin and in Psychotherapy and How Do We Limerick, and also nationally through our Know?: What Evidence-Based Blended Learning Environment. Practice Has to Offer". Psychoanalytic Psychology. 22 (2): 306–12. References Theory and Practice of Nursing: An APA Recognition of Psychotherapy Integrated Approach to Caring Effectiveness Approved August 2012 Practice Lynn Basford, Oliver Slevin, Eysenck, Hans (2004) [1999]. Gregory, Nelson Thornes, 2003. Page 533 Richard L., ed. Oxford Companion to Wheeler, G. (1991) "Gestalt reconsidered", the Mind. New York: Gardner Press. Oxford Companions (2nd ed.). Oxford University Press. pp. 92– 3ISBN 0198602243.