Psychodynamic Approaches versus Experiential and Relationship Oriented Therapies

While learning about counseling, counselors have to develop their own counseling style. This requires the counselors to not only know about the theories, but they must also know how to apply them in their patient’s life. The theories can be grouped into “five categories” according to Gerald Corey in the text Theories and Practice of Counseling and Psychotherapy; “1) Psychodynamic approaches, 2) Experiential and relationship oriented therapies, 3) The action therapies, 4) General approach, and 5) Post modern approaches” (2009, p. 8-10). This paper will compare and contrast the first two approaches (theories).

Psychodynamic approaches include the Psychoanalytic therapy and the Adlerian therapy; both of these approaches can be considered “Analytical approaches” with the exception that the Adlerian therapy does not focus on the unconscious aspects of the individual (p. 8). According to Corey it could be argued that, “Perhaps Freud’s greatest contributions are his concepts of the unconscious and of the levels of consciousness, which are keys to understanding behavior and the problems of personality” (p. 62). The two approaches differ in the importance that the unconscious mind plays, but Alder stresses that “people are in control of their fate, not victims of it” and Freud believes the unconscious controls the conscious behaviors (p. 98). There are some other differences with these approaches, but the author felt it was important for these two approaches to be grouped into the same category.

The Experiential and relationship oriented therapies include the Existential therapy, the Person-centered therapy, and the Gestalt therapy. These approaches stress “what it means to be fully human” and the importance of the client-therapist relationship (p. 8). The relationship that is built between the therapies will encourage the client and the therapist to work together through life’s problems. For example, the therapist is a spring board for the client and he/she can bounce ideas off of the therapist. The therapist will use the information provided to help them understand the client’s frame of mind and references, so that they can help the client to become aware of themselves. These theories encourage the therapists to help the client look at their life, and to become self determined to make change; this takes action on the clients part. 

The therapist’s function and role in the therapeutic relationship between the first set of theories and the second differ greatly. “Classical Psychoanalysis assume an anonymous stance;” whereas more modern/current psychoanalysis portrays the therapist as helping the client to interact “in the here and now” of their life (p. 70-71).  The therapeutic relationship and the treatment process of this approach require a great deal of time, effort, and expense because it focuses the clients attention on personal “insight” and reflection of maladaptive behaviors and anxiety (p. 72-4). The Adlerian Therapy has goals as well. They provide the client with an environment that is conducive to meeting the goals and developing socially useful goals (p. 100-104). Corey explains that the Adlerian therapist “assists clients in better understanding, challenging, and changing their life story” (p. 105).  

Founder Carl Roger, of the Person-centered therapy, believed that, “the therapist must be willing to be real in the relationship with clients: by being congruent, accepting, and empathic, the therapist is a catalyst for change” (Corey, p. 171). The text points out that the therapist does not take on the normal role of a therapist, because they do not ask normal “Intake” questions or probe into the client’s life. The therapist is there for the client at that given moment, and their role is to be “without roles.” Viktor Frankl, Rollo May, and Irvin Yalom were the key figures in the Existential therapy and their view was that people “are capable of self-awareness, which is the distinct capacity that allows us to reflect and to decide” (p. 138) In fact, it is the ability to be aware of our wants, needs, and desires that make us unique from other animals (mammals). However, along with the capacity to be self-aware comes questions and concerns; such as, “Who am I? What can I know? What ought I to do? What can I hope for Where am I going” (Corey, p. 139).

Freud drew attention to the “Ego-Defense Mechanisms:” which are the “motivations” for the behaviors that patients display when they are “overwhelmed” and unable to cope with anxiety (p. 63); in turn, the person-centered approach allows the therapist to work on themes that the client portrays (their words and deeds). Roger’s believed that people, clients, have their own empowerment and that they can change without intervention. They can do this with the help of the therapist; the client will more than likely show “themes” and these “themes” can be discussed in sessions.  

When “devising a treatment program” therapists need to ask: “What works for whom under which particular circumstance? Why are some procedures helpful and others unhelpful?” (p.458). For example, Gestalt therapy “leads to intense emotional expression; if these feelings are not explored and if cognitive work is not done, clients are likely to be left unfinished and will not have a sense of integration of their learning” (p. 474).  

Treatment plans are unique to the client; even though a therapist might use the same techniques or similar ones, the approach needs to fit the client’s needs. Therapists need to know when to be assertive and when to be less assertive. The way the therapists speak and acts should be adaptable: adaptable in that they don’t push a client’s buttons because they can. They develop a working therapeutic relationship.

The theories discussed do not have a so called “integrated perspective” when dealing with clients, so for some counselors there is a challenge in developing an “integrated plan” (p. 454). Therefore therapist will want to make sure that they are not trying to integrate approaches; in such a way, that they are confusing their clients or not being realistic about the progress clients are (are not) making. This writer feels that some form of therapy, insight, and knowledge it better than none. However, “A summary of the research data shows that the various treatment approaches achieve roughly equivalent results” (p. 476). Researchers have found that their our “four factors accounting for change in therapy: client factors (40%), alliance factors (the therapeutic relationship: 30%), expectancy factors (hope and allegiance: 15%), and theoretical models and techniques (15%)  (p. 476). The evidence is clear that therapy works although some would argue about what techniques work better.

All of the theories have applications; meaning that they have been proven to work (show that change can take place). I believe that the theories are not a one size fits all approach. The therapist has to decide where the patient is, what/if there is a diagnosis, and if the patient is prepared to accept what they are being told. Then, the therapist can go from the spot where the patient is and the therapist can determine what approach they would use. If an approach does not work then the therapist should reevaluate what is going on. For me, I appreciated the fact that the therapist answered any questions I had with tangible materials (handouts), and that she listened to me when I said I didn’t like something, so we focused on the things that I was willing to try (notice I don’t say that I liked). Talking through what I was thinking and feeling allowed me to hear myself and to process the information. Being in therapy allowed me the chance to speak my mind without repercussions; I felt safe. The psychologist that worked with me on my PTSD was very different from my therapist. The first day she laid out a plan for the rapid eye movement treatment, and she explained to clear the entire day because I would be exhausted afterwards. I saw her for twelve weeks, and my body doesn’t respond the way it used to. The point is that as a therapist we need to know when to refer someone. Once my treatment was completed, I wasn’t left alone I stayed in therapy for a little while longer just to make sure things were okay and I was good.