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“The relationship is the therapy” (Kahn). Discuss in relation to humanistic, psychodynamic and cognitive/behavioural approaches.

Many people seek therapy every day for a wide variety of different reasons. Some of these are suffering from clinically diagnosed disorders such as schizophrenia, depression or anxiety. Others may simply be experiencing more minor difficulties in their life that are causing them to feel unhappy and are therefore seeking some kind of independent guidance. For individuals seeking help this can be a daunting process - there are so many types of therapists available from counsellors to life coaches to psychologists to psychiatrists. Each of these appears to be offering something slightly different to the client. In addition, each individual seeking to become a client will bring his or her own personality to the client - therapist relationship. Similarly each therapist brings his or her own approach and personality to this relationship. There are many broad approaches to therapy within psychology and psychotherapy. The following piece focuses on three popular approaches to therapy popularised and used mainly by psychologists. It will discuss aspects of the client-therapist relationship within each of these three approaches. The approaches considered are Humanistic/phenomenological, Psychodynamic / psychoanalytical and Cognitive / Behavioural therapy. In the following paragraphs each type of therapy will be described, where appropriate the key names in the field will be introduced and the aims of the approach will be examined. Throughout this piece aspects of the relationship between the therapist and the client and the impact this has on the process of therapy will be discussed. Lastly a summary of the approaches will be provided and thoughts on the client therapist relationship will be introduced. The final section will also consider how this relationship can be managed to ensure success for the client.

The first approach to be described will be the humanistic approach - this is also referred to in some of the literature in the area as the phenomenological approach. This approach focuses on the self and the way in which a person views themselves. One of the most recognised names in humanistic therapy is Carl Rogers, a psychologist who was working in the 1950's. Rogers believed that each of us have a self-concept which is made up of two different components. He believed that this self-concept consisted of a real self - who is how we truly believe ourselves to be and an ideal self - the way a person would like to be (Eysenck, 1995). These two concepts of the self can be assessed using something-called Q sort methodology. When completing a Q-sort individuals are required to sort through cards that have a variety of statements on and rank these cards in an order according to which are most like them and which are least like them. The statements relating to the self-concept would include things such as "I am a happy person", "I enjoy being with other people", "I am a friendly person", "I am a positive person" and so on. The individual is then asked to carry out the same process with the cards for which statements are most like their ideal self. The therapist will then use a method of analysis to calculate the difference between the person's view of their actual self and their ideal self. This measurement is referred to as the amount of incongruence between the two selves. In the humanistic/phenomenological viewpoint it is this incongruence that is believed to contribute to mental illness. Therefore the less incongruence that exists between the two selves the less likely a person is to encounter mental health problems. Carl Rogers developed the Person-Centred approach (also known as client-centred) to therapy in the 1950's. This approach aims to reduce the amount of incongruence between the individuals' perceptions of their actual and ideal self. Rogers identified three conditions which he described as "necessary and sufficient" to his approach to therapy (Wickman & Campbell, 2003). These conditions are

In summary it can be seen that the humanistic approach to therapy encourages a warm and empathy based relationship between the therapist and client. This relationship is then expected to encourage the client to feel accepted, as the therapist is non-judgemental and accepting of them regardless of their behaviour. The ultimate aim of this approach to therapy is to reduce the amount of incongruence between the client's actual self and their ideal self by showing them that it is OK to be yourself and that you can find acceptance being like that. In contrast the therapist using a psychoanalytical / psychodynamic approach to therapy remains neutral towards the client. By taking this approach it is expected that the client is able to freely express their feelings and emotions without experiencing any kind of retaliation from the therapist. Similarly to the humanistic approach it provides for the client a "safe" environment where they will not be judged. The ultimate aim of therapy from this approach is to access the clients repressed emotions, memories and thoughts and for the client to be able to accept and admit to these to enable them to continue with their development and growth. The process of the therapy encourages the client to ascertain the truth about themselves and to "delight in their individuality" (Roth, 1996). The CBT approach is less focused on the actual relationship between the client and the therapist and instead concentrates more on the process of therapy and making changes to the client's thoughts and behaviour. The ultimate aim of this approach is for the client to become independent and able to overcome the thoughts/beliefs that are limiting them and to change their behaviour from avoidance to actually facing situations. Relaxation is used to help the client to do this. Similarly the behaviourist approach to therapy again uses techniques that produce a change in the client's behaviour. This can be done through learning a stimulus response association or by using rewards and/or punishment to produce new associations.

From the brief descriptions above the three approaches to therapy appear very distinct. Many practising psychologists will actually specialise in just one of these approaches, which emphasises the distinction. Kahn (1996), made a suggestion that it might actually be the relationship between the client and the therapist that is the most important factor determining the therapies success, and therefore, the relationship is the in fact the therapy. He also talks about bringing the different approaches together and how it might be that combining aspects of them could bring about a successful outcome. As stated at the beginning of this piece each client is and individual and is therefore unique. As such different approaches to therapy are needed and will suit different clients. Some clients have the unfortunate experience of trying a number of different types of therapy before they find one that is suitable for them. It is the job of the experienced practitioner to make a judgement as to the best approach to take with each new client they encounter.

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