Psychotherapy and Counselling

Psychotherapy and Counselling. Introduction

There are many reasons why individuals seek the services of psychotherapists and counsellors. They provide treatment for mental health disorders like depression or anxiety, and also help in difficult decision-making processes and life crises.

Psychotherapy and counselling, alongside medication, plays a vital role in treating mental healt disorders.

This overview covers key psychotherapy approaches, such as Cognitive Behavioral Therapy (CBT), depth psychology-based therapies and person-centered therapies.

Crossover Between Psychotherapist and Counsellor

A person seeking to find a psychotherapist or counsellor to “talk” to might want clarification on the difference between counselling and psychotherapy.

All licensed counsellors/psychotherapists through their academic training and internship requirements, have been trained in the “talking cure” called interchangeably counselling or psychotherapy.

People wildly accept the words “counsellor” and counselling”, because of their neutral and non-stigmatized meaning. The lines between the terms counselling and psychotherapy couldn’t be clearly defined as both words are used interchangeable describing the “talking-cure”.

The term “counselling” is specific for the Anglo-Saxon therapeutic couture. In German there is only one word “psychotherapy” describing the verbal interaction between the therapist and patient.

A professional counsellor should be personable, have good academic credentials, have experience, and hold an appropriate license. Dubai Health Authority (DHA) assures educational standards among mental health professionals applying for licensure in Dubai. The requirements are the education in psychology and additional training in counselling/psychotherapy.

Talking to psychotherapist or friend?

Humans are “social animals” and as such they need the interaction with other people exchanging views, opinions and getting advice. That’s why it’s essential to have someone to talk to when we’re feeling overwhelmed or struggling with our emotions. Our self-awareness and sense of belonging to a particular group, language and culture couldn’t be formed without mirroring ourselves in the people around us. The family and friends are at the core of the social network indispensable for our normal functioning.

It’s only natural that people facing problems will turn for help to their family and friends. However, there are situations in life which might overwhelm individual’s capacity to cope leading to severe psychiatric problems. In such situations support and advises from the family or friends are not enough. The collapse of individual’s coping mechanisms is the demarcation line where the professional help from a psychotherapist becomes necessary.

Getting professional help from a counsellor fosters personal development and addresses and heals symptoms of mental health disorders, such as depression, anxiety, addiction, OCD etc.

The counselling sessions can take place over the course of months up to years in variating frequency from weekly to monthly.

Psychotherapist and counsellor. The requierments

Psychotherapists called also counsellors are professionals trained in the therapeutic “talking cure” called psychotherapy or counselling. A qualified psychotherapist is a graduate in psychology or a medical doctor additionally trained in the psychotherapy. Such training lasts several years and requires thousands of hours of supervised therapeutic experience. The reason is to teach the therapist understanding the mechanism of the invisible “engines”, the emotional complexes behind the human behaviours. Because of this “hidden agenda” psychiatric conditions are incomprehensible to lay people. Therefore, patients in major crisis need professional help from a qualified psychotherapist.

During the psychotherapeutic training the future therapist must create an awareness of emotional processes taking place between him and the patient. In the psychotherapy the therapist triggers emotional reactions in the patient. Such transfer of feelings from patient to therapist is called transference. Correspondingly, “countertransference” refers to therapist’s feelings and attitudes influenced by the therapist’s own unsolved problems projected into the patient.

Therapeutic relationship in counselling and psychotherapy

An essential component of counselling is the trustworthy relationship between the counsellor and the patient. In a collaborative effort with the patient, the counsellor will know what therapies to put in place to effect positive change. Patients use the non-judgmental, safe setting of the session to freely explore their unique, individual problems.

The counsellor takes the role of a guide to facilitate positive change in the patient. Counselling gives patients an opportunity to discover their own answers and take positive steps to resolve their issues.

Therapeutic neutrality in psychotherapy

Friends and family members often have personal opinions, biases, and emotional connections to the people they care about. While this can be comforting, it can also make it difficult for them to provide objective support and advice. In contrary, the psychotherapist has an external look at the system in which his patient’s lives and acts.

Therapists are also trained to be objective, meaning that they don’t take sides, providing an unbiased perspective, helping individuals to understand their thoughts and emotions and make positive changes in their lives.

Even for the therapists Freud created important role excluding from the therapy family members and close friends of the psychotherapist. The reason has been articulated above: the psychotherapist must be objective in his judgment which excludes too close emotional involvement with his client.

Structured approach in psychotherapy

In contrast to speaking with a friend, psychotherapy provides a structured approach to problem-solving and emotional regulation. Psychotherapist helps clients set specific goals, identify underlying issues, and develop coping strategies to address their challenges. This structured approach can be incredibly helpful for individuals who feel overwhelmed or struggle to manage their emotions effectively.

When is psychotherapy helpful?

Psychotherapy is crucial in treating mental or psychosomatic disorders by alleviating psychological distress. It’s a structured, planned process between patient and therapist for resolving personal and interpersonal conflicts and modifying behavioral issues. Psychotherapy uses psychological methods focusing on experiences and behaviors, emphasizing verbal and nonverbal communication. Most psychotherapeutic methods aim to help patients develop coping strategies, increase self-efficacy, and build self-confidence through communicative and/or practice-based techniques. Therapy often includes individual and group sessions.

In recent years, psychotherapy has significantly evolved, adapting to patients’ specific needs rather than adhering to traditional school-based methods like psychoanalysis. Many forms today are tailored to specific disorders, known as disorder-specific or disorder-oriented approaches.

There are many reasons to consider psychotherapy, from traumatic events to severe mental disorders. Therapy is crucial when you can no longer manage issues alone or maintain daily life, especially if problems persist or worsen. Deciding on therapy should involve a psychiatrist, psychotherapist, and general practitioner.

Seek professional help if:

• while experiancing unexplained emotional changes.
• lack of concentration, thought disruptions, or daily life difficulties.
• sociall withdrawal or feeling increasingly mistrustful of others.
• experiancing persistent mood swings, aggression, or irritability.
• when life challenges feel overwhelming, and coping seems impossible alone.
• in case of prolonged sleep issues.
• when anxiety dominates life, restricting faily activities.
• if excessive drinking can’t be stoped and impacts work or personal life.

For which conditions can psychotherapy be used?

Some people hesitate to seek professional help for mental health issues. For many, visiting a psychiatrist or psychotherapist is burdened by prejudice, fear, or feelings of personal failure. Many tend to blame themselves and believe they should manage their condition alone. However, even occasional but recurring emotional issues should not delay professional guidance. Untreated mental health issues can easily escalate, cause additional health problems, and make recovery harder.

Psychotherapy alone or in combination with medication can be used for treatment of following disorders:

• depression
• generalized anxiety disorder (GAD)
• social and specific phobias
• panic disorder
• PTSD
• ADHD
• Psychosis (in close cooperation with a psychiatris)
• obsessive-compulsive disorder (OCD)
• personality disorders: borderline, narcissistic
• bipolar disorder
• eating disorders: anorexia and bulimia
• addiction
• anger management
• chronic pain
• marital conflicts
• grief and loss

The variety of disorders shows why tailored therapy forms are essential for patients’ needs. Psychotherapy can occur individually (you and the therapist), in couples, family, or group settings. Given the diversity of methods, scientific studies are crucial to confirm psychotherapy’s effectiveness.

Therapeutic relationship in psychotherapy and counselling

An essential component of counselling is the trustworthy relationship between the therapist and the patient. In a collaborative effort with the patient, the therapist will chose the appropriate psychotherapeutic technic.

The therapist offers a confidential and private setting that facilitates a process helping patients gradually identify the rootcauses of their problems, and after becoming conscious of them, to implement the changes.

The therapist takes the role of a guide to facilitate positive change in the patient. Counselling gives patients an opportunity to discover their own answers and take positive steps to resolve their issues.

Classical Psychoanalysis

Classical psychoanalysis, developed by neurologist Sigmund Freud (1856–1939), is the foundation of psychotherapy. Freud believed each person has three inner parts: the “Id” for unconscious drives, the “Ego” for reality connection, and the “Superego” as a conscience shaped by external values, like those of parents. Freud saw sexual drive (libido) as central to mental energy, expressed in age-typical phases from infancy to adulthood. He believed disruptions in early libido development could cause psychological issues.

Freud viewed mental disorder symptoms as substitutes for unresolved childhood problems. Psychoanalysis aims to make these unresolved conflicts conscious. Analysts pay attention to patient resistance to processing unconscious experiences and the defense mechanisms developed to balance desires and reality.

In sessions, patients freely share current thoughts and feelings, a technique Freud termed “free association,” central to psychoanalysis. Freud believed patients would eventually reveal a “pattern” that clarifies their conflict to the therapist. By re-experiencing early feelings, especially towards family, the patient “transfers” childhood wishes and emotions onto the analyst, allowing early situations and experiences to be interpreted.

Since Freud, psychoanalysis has evolved, notably through Ego Psychology, Self-Psychology, and Object Relations Theory. Today, classical psychoanalysis is rarely practiced due to its long duration and limited empirical support for effectiveness.

Psychodynamic / in-depth psychotherapies

Psychodynamic psychotherapies focus on patient’s problematic behaviours, feelings, and thoughts uncovering unconscious meanings and motivations behind them. The first method of psychotherapy that focused on unconscious conflicts and motivations was Freudian psychoanalysis. However, in the past hundred years the therapeutic techniques based on psychoanalysis evolved. Psychotherapy practitioners categorize techniques derived from psychoanalysis as “Psychoanalytical Therapy,” “Psychodynamic Therapy,” or “In-depth Psychotherapy.”  On the other spectrum stands the behavioral psychotherapy.

Today the classical Freudian psychoanalysis has been revised since its initial formulations and largely replaced. The position of patient lying on the sofa has been abandond in favour of the position of equality in which patient and psychotherapist sit close to eachother. Today’s psychodynymic psychotherapysts also revised Freud’s narow explination of the conflict’s exclusivelly sexual nature. They aknwololdged that the conflicts can be caused by unresolved traumatic child events but also by much more “prozaic” problems like lost of social position, conflcts at work or in the relationships, also without pre-existent negative chidlhood experiances.

Psychoanalytical therapy

The term “psychoanalytical psychotherapy” belonging to psychodynamic psychotherapies, has been established by C.G. Jung, who wanted to distinguish his method from Freud’s psychoanalysis. It was Jung who abandoned the sofa and turned the psychotherapy into a dialog between the therapist and the patient. The modification introduced by Jung became a standard used by several variations of psychodynamic psychotherapy.

The other difference of today’s psychoanalytical therapy is lower frequency of the sessions compared to the original psychoanalysis. Freud use dto see his patients 5 to 6 times per week. Today the frequency has been reduced to once per week or even less.

Approaches of psychodynamic / in-depth psychotherapy

The analytical treatment process is the most comprehensive form of psychotherapy. It often requires a few years of treatment. Psychodynamic psychotherapy aims to influence the deeper layers of patient’s personality. On average psychoanalytical psychotherapy lasts longer than cognitive behaviour therapy. The scope of analytical psychotherapy is to raise patients’ awareness of their inner world, which influences their insight of their past and present relationships and helps them understand and resolve their problems. Unlike other therapies, it approaches deep-seated change in personality and in emotional development. The investment of time, money, and emotional energy can produce significant rewards in terms of improved relationships, creativity, professional and social progress.

Dynamics of psychodynamic/in-depth psychotherapy

Psychodynamic or in-depth psychotherapy focus on unconscious inner conflicts often stemming from childhood trauma or negative upbringing experiences. Therapists aim to make these conflicts conscious, with early trauma considered central to understanding and treating the mental health problem.

In traditional psychoanalysis, patients explore the roots of their issues through transfer and interpretation. In depth therapy, focus is on the transfer’s manifestations in the therapeutic relationship, fostering a shared reality between patient and therapist. Here, patients revisit painful memories, gaining cognitive and emotional insight within a stable therapeutic bond.

The Transference Focused Therapy (TFP) applied for treatment of personality disorders, therapists temporarily assume ego functions to help manage emotions and impulses, providing corrective emotional experiences. This therapy centers on present psychological conflicts, addressing underlying motivations and relationship conflicts causing the patient’s distress. The therapist’s approach is active and goal-oriented, requiring quick diagnosis, with therapy sessions conducted in an everyday conversational setting where patients observe the therapist’s gestures and expressions.

Depth psychology-based therapies are proven effective for treatment of depression, various forms of anxiety, OCD, PTSD, and the TFP for treatment of Borderline Personality Disorders, using transference-focused and mentalization-based approaches.

Transference

The term “transference” originates from Freudian psychoanalysis. It refers to the patient’s feelings and attitudes towards the therapist influenced by the patient’s old patterns. Transferences are typically unconscious involving the fundamental dynamics from infancy.

We all “transfer” our feelings in our everyday lives. Both loving and constructive feelings and attitudes can be transferred, as well as aggressive and conflicting old relationship dynamics.

Example: An employee is repeatedly devalued harshly and unfairly by her supervisor. Nevertheless, she admires him and tries to please him through good performance and an attractive appearance. In relationships as well, she repeatedly seeks out strong partners, often experiencing violence, yet she does not leave. In doing so, she transfers feelings that actually belong to her violent father onto her boss or partner. She desires confirmation or affection from them, which she longed for from her father but never received.

Countertransference

In psychodynamic psychotherapy, countertransference refers to therapist’s emotional reactions towards the patient based on therapist’s own feelings, biases, and desires. The observation of this phenomenon traces back to Sigmund Freud. Freud noticed that the transfer of feelings between patient and the therapist works in both directions. Because of countertransference there is a risk that therapist departs from his objective position.

In the therapeutic relationship understanding the process of transference and countertransference is considered fundamental. Analysing the flow of feelings between the patient and the therapist allows to reconstruct patient’s past disease-causing relationship patterns. In the second step they can be addressed, understood and neutralized in the therapeutic setting.

Working with transference and countertransference

The transference from patient to the therapist, if understood, is always a valuable therapeutic tool. In contrary the countertransference must be considered a disruptive factor. Transference and countertransference processes are a kind of “time machine”, as old, usually childhood constellations and the associated feelings are activated during the therapeutic process.

To handle this constructively in therapy, the psychotherapist must be aware of his own “blind spots”, his transference tendencies. That’s why the training in the psychodynamic psychotherapy requires the therapist to be analysed by an experienced supervisor.

The process of transference interpretation explores the connections between patient’s current problems and his childhood dynamics helping to find ways out of the crisis. Thus, working with transference requires specialized training and extensive personal therapy for the therapist.

The research on psychodynamic psychotherapies

There is a growing research and evidence base for psychoanalytic psychotherapy, which is aimed at the general reader, clinician, commissioner, academic, and policy maker.

Cognitive Behavioral Therapy (CBT)

Behavioral therapy is effective for various conflicts, mental illnesses, and disorders. Because it incorporates thought patterns, it’s now often called Cognitive Behavioral Therapy (CBT). It is one of the most frequently used, scientifically validated psychotherapeutic methods today, effective in treating diverse mental health issues. Based on modern learning theory, it holds that behavior can be learned, maintained, and unlearned. “Behavior” includes observable actions as well as thoughts, feelings, and motives.

Psychological disorders are seen as mislearned responses to external and internal stimuli, aiming to unlearn maladaptive behavior or learn necessary responses. Patients are encouraged to develop positive, active behaviors.

CBT is problem-focused. Initially, therapists and patients work together to analyze core problems and underlying behavior patterns, identifying factors that trigger or maintain reactions. Therapy goals are then clearly defined, principles explained, and a structured plan is set. The patient actively participates, completing tasks or “homework” between sessions, with an emphasis on “self-help” methods for better everyday coping. Therapy typically ends upon goal achievement.

Behavioral therapy is used for treatment of anxiety, depression, psychoses (like schizophrenia), eating disorders (like anorexia), addictions (e.g., alcohol problems), obsessive-compulsive disorders, sexual dysfunctions, psychosomatic issues, and various childhood and adolescent disorders.

Cognitive Techniques

help individuals crating an insight and solving their problems. Cognitive therapy can be used for treatment of conditions like depression, anxiety, OCD, and more. Patients often generalize, focus narrowly, or think in extremes. Therapy first involves self-observation, identifying issues, recognizing personal blocks, developing alternatives, and reevaluating thoughts and behaviors—like distancing oneself, reinterpreting situations positively, or viewing problems as challenges.

Exposure Techniques

Exposure techniques reduce fear by confronting avoided thoughts or situations, especially useful for anxiety, PTSD, eating disorders, and OCD. Two main methods are systematic desensitization and flooding. Systematic desensitization uses relaxation to gradually face fears, from mild to intense, aiming for a fear-free experience—especially for specific phobias, like test anxiety.

In flooding, patients face their greatest fear directly, staying in the situation until the fear decreases, learning they can control both the situation and their anxiety.

Operant Techniques

This behavior therapy form promotes new, desired behavior mainly through positive reinforcement (rewards). The idea is that positive consequences encourage repeating desired behaviors. Positive reinforcements can be social (e.g., praise, attention) or material (e.g., tokens), with patients choosing their own motivational incentives. In contrast, negative consequences, like punishment, reduce behaviors in operant methods.

Modeling

Modeling is based on people observing and imitating complex behaviors of role models, integrating them successfully. This includes adopting complex action or behavior patterns. For example, with OCD, the therapist demonstrates “normal” hand-washing or checking a locked door.

Building Skills

Developing specific skills in underdeveloped areas complements other treatments effectively. In role-playing, patients practice behaviors to handle challenging situations better. For social deficits (e.g., social phobia), contact training helps patients express needs and assert themselves. Besides social skill training, problem-solving, and communication training are also key.

Disorder-Specific Methods

Those cognitive behavioral method has been developed adressinf disorder specific problems.

Dialectical Behavior Therapy (DBT)

DBT, a specialized cognitive behavioral therapy, was created for treating borderline personality disorder. DBT focuses on emotional regulation, seeing symptoms (e.g., self-injury) as attempts to reduce emotional distress. Therapy helps patients recognize their distress and develop effective coping strategies for intense emotional states. DBT also addresses self-image and interpersonal behaviors, integrating trauma techniques as needed.

Studies show DBT is effective in treating borderline personality disorder.

Cognitive Behavioral Analysis System of Psychotherapy (CBASP)

CBASP, uniquely designed for chronic depression, combines interpersonal, cognitive, behavioral, and psychodynamic strategies. It targets social learning, helping patients distinguish past dysfunctional relationship patterns from present interactions with the therapist and others, altering negative interaction styles. Explicit transfer hypotheses are developed to clarify “confusions” during therapy, guiding patients in distinguishing the therapist from past key figures. Building behavioral skills is also essential in CBASP.

Studies indicate CBASP is as effective as medication, with combined CBASP and pharmacotherapy being most successful.

Interpersonal Therapy

Originally, IPT is a short-term therapy (around 20 sessions) focused on treating unipolar depressive episodes. For recurrent depression, a maintenance phase of several months is usually added. IPT directly addresses patients’ life contexts related to depression, including complicated grief, role transitions, loneliness/social deficits, and interpersonal conflicts. Treatment uses a medical model with or without medication, aiming to reduce depression symptoms and support emotional and behavioral coping with interpersonal and psychosocial stressors. The therapist actively supports, instills hope, and advocates for the patient.

Though not yet covered by insurance, IPT is recommended in international guidelines and is one of the most evidence-based, well-researched depression treatments. IPT has been recognized by the Scientific Advisory Board for Psychotherapy as a scientifically validated method for mood and eating disorders (e.g., depression, bipolar disorders).

Mentalization-Based Therapy (MBT)

MBT, developed by Anthony Bateman and Peter Fonagy, combines psychodynamic, systemic, client-centered, and dialectical-behavioral approaches. Mentalization refers to interpreting one’s own and others’ behaviors by attributing mental states. This ability, formed in early, secure attachments, enables infants to engage in affective, pre-verbal communication with caregivers, essential for mentalization development. MBT aims to help people understand their and others’ desires, thoughts, and emotions as underlying actions, involving self-reflection, empathy, and relationship exploration. Originally developed as a manualized program for Borderline Personality Disorder, MBT includes individual and group therapy.

Foundations of MBT

Developed in England, MBT aims to improve mentalization abilities in inpatient, partial, or outpatient psychiatric settings. Mentalization, essential in psychotherapy, affects both self and other perception, with deficits linked to severe psychological disorders. This program includes individual and group therapy over at least 18 months.

Methods of MBT

MBT goals include better behavioral control, emotional regulation, nurturing relationships, life goals, and frustration management. Therapists foster curiosity by forming a collaborative alliance, avoiding an “expert” role, and exploring the patient’s inner world together, enhancing the patient’s trust and learning in social settings.

MBT Setting

MBT centers on a safe therapeutic relationship, providing structured interventions focused on the present to stabilize self-esteem, emotions, and relationships, incorporating past events only as they impact the patient’s current experience.

Holistic or Integrative Approach

The integrative or holistic approach is also known as the multimodal or pluralistic approach. Many counsellors and psychotherapists don’t draw upon one particular approach. Instead, they combine techniques from different schools of psychotherapy and plan interventions taking into account the needs of the client.

Systemic Family Therapy

Family therapy aims to help members identify and address relationship issues together. All affected family members participate as needed, with the goal of improving individual well-being through better relationships.

A family therapist doesn’t provide solutions but helps family members develop new ways of interacting. Individual issues or symptoms are viewed as part of a broader dynamic involving multiple people. Interventions focus on understanding problems in their context.

Integrative or Holistic Therapy

During psychotherapy and counselling the psychologist blends elements from various approaches to create a treatment that best serves their clients’ needs.

EMDR (Eye Movement Desensitization and Reprocessing)

Eye Movement Desensitization and Reprocessing therapy is well established psychotherapy method for treatment of PTSD, anxiety, depression, and panic attacks. The therapist guides the patients to be mindfully aware of the symptoms and memories of the trauma and their effects on his mind and body. As treatment progresses, symptoms should decrease and disappear.

Humanistic approach in therapy

The humanistic approach rests on the concept of self-actualisation—every individual has an innate tendency to advance their potential and improve themselves.  Above all, the approach focuses on care and empathy for the client. Therefore, therapy sessions are centred around positivity and shaped around particular preferences and needs of the individual. Humanistic therapies include client-centred therapy, gestalt therapy and existential therapy.

Origins of humanistic therapies

The important theoretical movement of humanistic psychology sprung up in the 1950s and 1960s. Often psychologists, psychotherapists, and counselors refer to this as the “third force” in psychology. It evolved in response to perceived limitations of psychoanalysis (1st force) and behaviorism (2nd force).

The origin of humanistic psychology is attributed to the psychologist Abraham Maslow, who in his groundbreaking work emphasized the idea of self-actualization and developed a developed a five-tier model of human needs called “Hierarchy of Needs,” which are often depicted within a pyramid. He and contemporary psychologists like Carl Rogers, Fritz Perls, and Marc Rollo felt these existing theories did not address the meaning of behavior and the nature of healthy growth.

According to humanistic psychologists, humans are not pushed by unconscious motives (Freudian psychoanalytic view), or passively shaped by their learning experiences (Watson’s behavioristic view). Humanistic psychologists, psychotherapists, and counselors believe human beings determine their own fates through the decisions they make. In other words, people have a powerful inborn tendency to grow, improve, and take control of their own lives. These psychologists believed outside forces influence humans, but their own free will determines their behavior.

Humanistic psychologists, psychotherapists and counselors realize that this branch of psychology is the least scientific. This is because many of the issues with which they are concerned do not lend themselves to scientific scrutiny. These topics revolve around the ideas of free will, values, the essential goodness of people, the motives that inspire the creation of art and philosophy and the uniqueness of every human personality.

There are 3 branches of humanistic psychology in humanistic therapy

1. Client Centered Therapy associated with Abraham Maslow and Carl Rogers.

2. Gestalt Therapy associated with Fritz Perls

3. Existential Therapy most prominently associated with Marc Rollo, Viktor Frankel, and Irving Yalom

Self-Actualization

Maslow proposed that the goals of humanistic psychology in therapy are directed toward helping people achieve freedom, hope, self-fulfillment, and strong identities. Psychologists and psychotherapists guide a person to become more self-actualized through self-directed change, while building self-esteem, along the way. Abraham Maslow posited that fundamental needs (biological and safety) must be satisfied before an individual is able to progress to psychological needs (love and esteem), which in turn must be met before the person can meet self-actualization needs.

Person-Centered Therapy

Developed by Carl Rogers, person-centered therapy emphasizes forming a therapeutic relationship, focusing on empathy, respect, and authenticity. As implied by “person-centered,” the concept of the person is vital in Rogers’ work.

Rogers believed all living beings have a self-preservation and growth tendency, the “actualizing tendency,” driving individuals to realize their potential. Rogers’ ideal is the “fully functioning person,” someone open to all experiences.

Theory

Carl Roger developed a theory of “the self” that explains nicely how positive change comes out of humanistic psychotherapy.

He believed that “the self” had 3 components to it:

1. Perceived Self (how person sees self & and others see them)

2. The Real Self (how a person really is).

3. And the Ideal Self (how person would like to be).

When a person has a conflict between his perceived self and his real self a state of incongruence occurs. It is this incongruence that can cause symptoms, such as anxiety or depression, or feeling stuck and discontent. The focus of therapy is to help the client self-actualize into his ideal self. Dr. Rogers often used the following phrase during his counseling sessions, “So, you find it hard to believe that they would love and accept you if they knew who you really were” (Rogers, 1959).

Therapy goals

Rogers believed all living beings have a self-preservation and growth tendency, the “actualizing tendency,” which drives individuals to realize their potential. Rogers’ ideal is the “fully functioning person,” someone open to all experiences.

Like other scientific therapies, person-centered therapy aims for the “healing of abnormal physical or mental conditions.” However, its inherent goals differ: therapy reorganizes the patient’s self-structure, allowing more experiences to become part of self-identity. Patients become open to immediate experiences, perceive themselves and others more realistically, solve problems better, and gain self-confidence and responsibility.

The closest one can come to describing a specific technique in client centered psychotherapy is to have unconditional positive regard for the client and to use reflection to facilitate insight. Reflection is when the therapist reflects the emotions of the client in order to help clients become aware of the meanings of their statements.

Person-centered therapy is proven effective for treatment of depression, anxiety, adjustment, and somatic disorders.

Gestalt Therapy

Gestalt therapy is a complex psychological humanistic therapy. It is a system that stresses the development of client self-awareness and personal responsibility. The psychologist, psychotherapist, or counselor takes an active role (questioning and challenging the client) to help the client become aware of his or her true feelings.

The focus of Gestalt Therapy is on the whole person. Psychologists, counselors and psychotherapists look at how the mind (e.g. thoughts) and body (e.g. body language, physiological sensations) are integrated and how the person integrates into the environment (e.g. workplace, school, friends). During counseling Gestalt Therapy facilitates clients’ integrating themselves as whole persons and restoring balance in their environment.

In psychotherapy, clients become aware of what they are doing, how they are doing it, and how they change themselves, and at the same time, learn to accept and value themselves. Individuals, according to this approach, define, develop, and learn about themselves in relationship to others, and that they are constantly changing.

Key element of Gestalt therapy

Awareness is a key element in Gestalt Therapy, as it is seen as the essence of a healthy person and the goal of treatment. When people are aware, they can self-regulate in their environments. Self-regulation skill is necessary for reliable emotional well-being. Behaviorally, self-regulation is the ability to act in your long-term best interest, consistent with your deepest values. (Violation of one’s deepest values causes guilt, shame, and anxiety, which undermine well-being.) Emotionally, self-regulation is the ability to calm yourself down when you’re upset and cheer yourself up when you’re down (Stosny, 2011).

According to Gestalt Therapy underlying causes of a lack awareness are:

1. When there is a preoccupation with the past, flaws or strengths, or fantasies etc. that the person no longer sees the whole picture.

2. Low self-esteem

There are three ways people may achieve awareness:

1. Contact with the environment (family, school, friends, work etc.) through seeing, listening, touching, speaking, moving, smelling, and tasting individuals can grow. This happens when they react to the environment and change.

2. Here and now: Gestalt therapy focuses on reaching awareness of the present moment and the present context. Through counseling and psychotherapy, clients learn to discover feelings that may have been suppressed or masked by other feelings. Further in counseling therapy, these previously suppressed emotions are acknowledged, and a person learns how to accept and trust them. Needs and emotions that were previously suppressed or unacknowledged can surface as well. Through this process, a person gains a new sense of self when the overall awareness increases. In the here and now the clients learn to avoid dwelling on the past or anxiously anticipating the future. Past experiences can be explored during counseling sessions, but the counselor or psychotherapist and client will focus on exploring what factors made a particular memory come up in this moment, or how the present moment is impacted by experiences of the past.

3. Responsibility: Here people take responsibility for their own life instead of blaming others.

Humanistic psychology facilitates the clearing of “unfinished business”

Unfinished business refers to people who do not finish things in their lives and as a result of this stop their personal development. Examples of unfinished business are resentment, rage, hatred, pain, anxiety, grief, guilt, and abandonment. People with unfinished business often resent the past and because they can’t focus on the here and now. One of the major goals of Gestalt Therapy is to help people work through their unfinished business and bring about closure.

Existential Therapy

Existential therapy is more a way of thinking than a neatly defined model with specific techniques.

It is a philosophical approach to therapy, which assumes we are free to choose and are responsible for our choices. At its best, existential psychotherapy realistically confronts the ultimate concerns including the difficult facts of life, such as death, loss, responsibility, loneliness, freedom, meaningless and suffering. Psychotherapists and counselors who practice existential psychotherapy, or are influenced by this school of thought, believe that mental health disorders, such as generalized anxiety disorder, depression, panic attacks, and their symptoms, anger, sleeplessness, meaninglessness, are a result of existential angst (fear) and imbalance.

During psychotherapy and counseling, the goal is to understand and relieve the symptoms of mental health disorders. Through this client centered approach, the client can discover his/her actual subjective experience or “being” (Dasein/German). The focus of the treatment is on the here-and-now, but anything that emerges from the past will be processed and dealt with. Coming to terms with reality—the things we struggle with– without denying, avoiding, distorting or downplaying it is key to existential therapy.

Logotherapy

Logotherapy is a meaning centered form of humanistic therapy developed by Viktor Frankl. The word logos is a Greek word and translates to meaning. He was an Austrian psychiatrist and neurologist who developed logotherapy in response to being imprisoned in a concentration camp. During this horrific experience he made observations and gained insights that led to his developing logotherapy.

The Viktor Frankle Institute of Logotherapy (2017) states:
“Viktor Frankl’s Logotherapy is based on the premise that the human person is motivated by a “will to meaning,” an inner pull to find a meaning in life. The following list of tenets represents basic principles of logotherapy:

1. Life has meaning under all circumstances, even the most miserable ones.

2. Our main motivation for living is our will to find meaning in life.

3. We have freedom to find meaning in what we do, and what we experience, or at least in the stand we take when faced with a situation of unchangeable suffering.” (VFIL, 2017)

Victor Frankl said, …”the meaning of life always changes, but it never ceases to be. According to logotherapy, we can discover this meaning in life in three different ways: (1) by creating a work or doing a deed; (2 ) by experiencing something or encountering someone; and (3) by the attitude we take toward unavoidable suffering.” (Frankel, 1984, p. 133)

Psychotherapy aims to achieve sustainable changes in patint’s life

The main objective of the psychotherapy is the sustainable, enduring change. The person gains an insight into his uniqueness, developing awareness of his specific skills and talents facilitating the way to “be yourself”.

While sustainable change is the main benefit, there are many other worthwhile outcomes of the transformational journey, such as: 

• Gaining awareness about person’s assumptions, fears, dreams, talents, cultural stimuli
• Shifting to an empowered perspective and mindset
• Realising that we are part of the society, and that proper growth can’t happen in isolation.

Finding the right psychotherapist/counsellor

If you are looking for mental healthcare, you might feel overwhelmed by the different specialists in this field. You will find psychiatrists and psychologists offering their services. This article offers you a guideline on how to find the right mental health specialist for your needs:

• If you suffer from severe symptoms that curtail your ability to function in daily life, it is advisable to make an appointment with our psychiatrist for a psychiatric consultation to assess if medication is indicated.
• When you are you are mildly or moderately depressed, while still maintaining a good level of professional and social functioning, an appropriate starting point would be to see one of our psychologists for an assessment.
• Should you be uncertain about whom to see, consult with one of our psychologists to assess if you need a psychiatric evaluation.

Not all patients getting psychotherapy/counselling need medication to improve and heal. For some “talk therapy” is enough. However, when a patient takes medication, it is advisable to also get psychotherapy. Above all, research studies have proved that the combination of psychiatric treatment (medicine) and psychotherapy (counselling) yield the best treatment outcomes for mental health.

Psychotherapy and Counselling. Summary

The first method of psychotherapy was the psychoanalysis developed by Sigmund Freud. Today, the classical Freudian psychoanalysis with the patient lying on a sofa and the therapist out of sight, sitting behind the analyst, and making now and then few commentsis rarely practiced.

Freud’s psychoanalysis is the common source for later psychotherapeutic technics, called psychodynakic or in-depth psychotherapies. In those methods the frequency of treatment sessions is lower than in the classical Freudian psychoanalysis.

Contemporary techniques of psychotherapy and counselling

The underlying principle of Psychotherapy is the scrutiny of everything that could serve the change. Depending on the method psychotherapy follows the two main roads. One of them is the behaviourism based on the principal of conditioning. The second is based on the psychodynamic approach looking more “behind the scenes” trying to find the root cause of the problem. Today those scholls are not separated by a sharp boundary. Behaviourism is using some elements of psychodynamic methods, and vice versa. The modern psychotherapeutic procedures include client centred holistic approach towards the person’s life. Ideally the psychotherapy involves building an understanding of the person’s trough self, his hidden “blueprint” for life.

Cognitive-Behavioural Therapy (CBT)

The cognitive-behavioural approach focuses on the interrelationship between thoughts, emotions (feelings) and behaviour. Cognitive-behavioural interventions aim to improve an individual’s distressing psychological condition. Above all, CBT techniques help people develop more functional cognitions and behaviours. The approach is based on the cognitive model of psychopathology (Beck 1964). The model suggests that it is not the situation itself that results in our emotions and behaviours, but the way we appraise, or interpret the situation.

Cognitive behavioral therapy CBT is a scientific evidence-based psychotherapy technique. CBT for mental health disorders, like depression, anxiety, or PTSD), reduces or eliminates distressing mental health symptoms. CBT applied to everyday life challenges, also offers a useful tool for daily coping. A very simple way to explain CBT is to say that if you change how you think about an incident, you will change how you feel about it and behave with emotional maturity.

Psychodynamic psychotherapies

Psychodynamic psychotherapie provide an effective treatment for a range of psychiatric disorders, such as depression, disticnt phorms of anxiety, OCD. The therapy can be also appied in stable phase of bipolar disorder. A modified psychodynamic psychotherapy, called Transference Focused Psychotherapy (TFP) concentrating, as the name suggests, on the trnasference but “in here nad now”, is one of the most effective treatment method for borderline personality disorder.

Distinct phorms of psychodynamic psychotherapies can contribute significantly to patients’ mental and physical health, sense of well-being, and ability to manage their lives more effectively. It can help not only to cure psychiatric disorders, but can also help people seeking a greater sense of understanding of themselves and their unconcious motivations leading to more meaningfull and fullfied life. Jung described his psychoanalytical psychotherapy as a “catalyst” of the individuation proces.

However, the decition if one of the psychodynamic technics is the treatment of choice for a particular problem depends on a variety of factors. It is helpful to have one preliminary consultations with an experienced psychotherapist before deciding whether psychdynamic psychotherapy is appropriate.

Goals of psychotherapy and counselling

Family and friends can provide support and comfort helping an individual to master minor life problems. However, while family and friends can offer a shoulder to cry on, psychotherapist provides professional therapy with structured approach focused on solving deep rooted problems a lay person is not aware of.

The psychotherapy shouldn’t be misunderstood as a “mental short cut” finding the solution for person’s problems in weeks. It takes always time, at least one year to close the “inner gap” between the superficial understanding, the Ego-Consciousness. The symptoms appear by the tension created by the gap between our inner needs and the conscious self, e.g. the superficial understanding of what we are.

The main aim of psychotherapy is to devise the exceptional future the person aims for. Psychotherapy is a procedure with the potential to produce extraordinary results through consistency of the therapeutic proces and less trough the frequency of the sessions. Time used therapeutically is itself a therapeutic agent. The person needs time to reflect on his life and to implement the changes of his “life paradigm”.

Psychotherapy roles

The general conditions required for the psychotherapy are: a certified therapist, standardized setting, an emotionally neutral place and strong observation of the confidentiality rules.

Depending on the therapy technic the counselling sessions can take place over the course of months up to years in variating frequency from weekly to monthly.

Psychotherapist’s expertise

Psychotherapists are experts in mental health and have received extensive training in the field. They are equipped with a range of therapeutic techniques and tools to help individuals work through their issues and make meaningful changes in their lives.

Confidentiality roles

One of the most significant benefits of psychotherapy is that patient’s information remains secret. Therapists are bound by ethical and legal standards that protect the privacy of their clients. It means that every problem discussed in therapy stays between the patient and the psychotherapist. This level of confidentiality can be incredibly reassuring for individuals who are concerned about their privacy or feel uncomfortable sharing personal information with others.

If indicated, the counsellor will refer to a psychiatrist to assess if medication is advised as an additional treatment approach.

FAQ. Psychotherapy and Counselling

There are many reasons people conclude that they need to see a psychotherapist.  Some individuals are seeking personal development because they feel stuck; others suffer from depression, anxiety, OCD and burnout, or are having marital problems. The first difficulty is the question how to choose the right specialists for my mental health condition.

Is every psychologist a psychotherapist?

The answer is no. Psychologist is an academic degree. A person who finished studies in psychology is not by default a psychotherapist. The license in psychotherapy requires a postgraduate training consisting of several hundred hours theory and supervised psychotherapy.

What is counselling?

During counseling sessions peaple talk about their specific current problema and how to address and solve them. The counselor does not advise, but takes the role of a guide to facilitate positive change.  Patients use the nonjudgmental safe setting of a counseling session to freely explore their unique problems.  This gives them an opportunity to discover their own answers to be able to take positive steps to resolve their issues.  Counseling sessions have a present day, solution based focus.  Counseling often is a short term therapy, as compared to psychotherapy. 

What is psychotherapy?

Psychotherapy, or “therapy” in short, often is longer in duration than counselling.   Psychotherapy can take place over the course of 1 or 2 years where clients see their therapist 1 to 4 times per month. 

During psychotherapy psychological problems that are built up over the course of a long time are explored. Patients gain more insight into their feelings and actions. Emotional issues underlying problems and difficulties are identified and healing promoted. 

Many mental health professionals will call themselves counsellors, because this is a widely accepted and non-stigmatized mental health care service.  The lines between counselpsychotherapy,ling and psychotherapy are often crossed. There might be initial counseling work during which deeper, life- long behavioral and emotional patterns are discovered, requiering psychotherapy. Conversely, there might be a patient in therapy who will benefit from solution focused counseling to resolve a current issue. 

Qualifications of a licensed psychotherapist

The first difficulty is the question of how to choose the right specialists for my mental health condition. Is every psychologist a psychotherapist? The answer is no. Psychologist is an academic degree. A person who finished studies in psychology is not by default a psychotherapist. The license in psychotherapy requires postgraduate training consisting of several hundred hours theory and supervised psychotherapy.

There are four important things for you to note when you are looking for a qualified psychotherapist:

1. Look for licensed psychotherapists with a Master’s Degree or PhD in psychology from an accredited university with additional training in psychotherapy.
2. They will have the clinical skills to diagnose and treat mental health disorders (depression, anxiety, OCD, etc.).
3. They have the professional knowledge know when to refer to a psychiatrist for pharmacotherapy (medication to balance brain chemistry)
4. If you have mental health benefits on your insurance plan, the insurance companies request that you see a licenced psychotherapist to reimburse you for the sessions.

Psychotherapist versus Psychiatrist

Some people don’t understand the difference between psychiatrist and psychotherapist.

A psychiatrist is a mental healthcare provider who prescribes medication.  Psychiatrists are medical doctors with additional specialization in psychiatry.  If you think you might need medication to treat a mental health disorder, e.g. depression, anxiety, or OCD, a psychiatrist would be the right choice for a consultation.

Life Coach versus Psychotherapist

The difference between the psychotherapist and life coach is licensure. Life coaching is an unlicensed profession.  However, they have set up their own standards of education and training hours and are self-governing. There are a number of life coaches in Dubai. However, it is in your best interest to have a closer look at the life coach’s education (degrees) and training hours. In general, psychotherapists are psychologists with extra training in the psychotherapy. In contrary life coaches participate only in few weeks of training.

Please be aware that life coaches most likely do not have the education, training and experience to diagnose and treat mental health disorders.

What qualities do I look for in a psychotherapist?

This is a very important question because a positive, therapeutic relationship needs to build between the client and the therapist. Every client has unique needs to feel safe, secure, and understood. Think about whom you would be comfortable opening up to.  Would it be a person of the same or opposite sex?  Would you like to speak in your native language to feel like the most subtle of nuances will be picked up?  Is it important to you to make and understand cultural references?  Is religion a factor?  Does the age and personal status of the person working with you make a difference?

Clearly, these are questions that can guide you in choosing a psychotherapist. Most professionals post a bio from which you can learn most basic details. It will be upon meeting the psychotherapist that you will be able to feel if someone is a good match, and you will be able to ask questions.  Personally, I am an open book, but a professional does have the right to respectfully maintain their privacy.

Therapy is a process through which you heal, gain insights, grow, and find a positive way to go forward in your life. Therefore, in therapy, you should always feel respected, not be judged, and not be told how to manage your life. 

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