A Pluralistic Approach
A pluralistic approach is a collaborative mix of various models of therapy. The basic idea is to follow the rule that each and every client is unique - and therefore will require different outcomes from the therapy they receive.
Taking this as a starting point, a pluralistic approach creates a different framework for each client, and the therapist is able to implement a range of different and varied models and methods into their practice.
One of the key elements of this approach is that a mutual decision-making process is put into place. From here, the client is able to talk about what they hope to gain from therapy and the therapist is able to devise the most effective way to help them to achieve this.
Here are brief explanations of some of the models of therapy I use:
Person Centred Therapy (PCT)
Elements of PCT influence my approach to clients, putting them at the centre of our work. A leading author on this style of therapy, Carl Rogers, views the client as the best informed about themselves.
PCT explores the client’s beliefs and values; for example, where they believe they have to meet certain conditions to deserve or receive love and acceptance. This process enables us to work together to become more compatible around their relationships and for this to happen there needs to be a psychological connection and communication between therapist and client. This in turn creates an environment conducive to change, enabling increased self-awareness of the client’s own issues and the space for them to heal.
PCT underlines the power of the relationship between therapist and client and in these interactions I accept that our worlds are brought together in the therapy session. Client’s perceptions about themselves are seen as internally constructed throughout their life, and how they respond to life events impacts their relationships and further experiences.
Cognitive Behavioural Therapy (CBT)
CBT is a time-limited, evidence-based approach which at it’s core is the belief that our thoughts, emotions and actions are inter-connected. I use a person-centred approach to establish a therapeutic relationship and where relevant, utilise CBT to help with behavioural change.
Negative patterns of thinking, feelings and behaviours can lead to some individuals feeling helpless, hopeless and unlovable. CBT refers to this as ‘automatic negative thoughts’ which may lead the client to have a distorted view of what feels real. It also explores the client’s reasoning, including cognitive distortions such as catastrophising - expecting that the worst will happen. I will often give homework to my clients, encouraging them to note related emotions and events over the forthcoming week, which will inform our next session.
I also use Socratic Questioning as a way to co-investigate and uncover a client’s interpretations that contribute to their difficulties. This enables the therapist to challenge the client’s thoughts and beliefs about themselves by exploring the evidence for them. The client is then able to gauge a more realistic, evidence-based perspective, utilising behavioural experiments.
The way we think and feel about something, or an event, will influence the way in which we respond. With CBT the desired emotional or behavioural change happens as our beliefs and interpretations change and subsequently the client may then practice different behaviours.
Schema Therapy (ST)
ST brings together additional theories around core beliefs and structures that have become embedded in the client’s thought process. ST recognises that we all have core emotional needs: security, safety and stability - which if not met, due to perhaps a challenging or toxic childhood, can develop into what is described as a ‘distorted view of self’.
ST explores current issues through the lens of early life experiences that track through history to the present. For example, the client may expect that others will repeatedly hurt, abuse, humiliate, manipulate or take advantage of them. Consequently, our work explores their ‘lived experiences’ and offers a longer term process with the use of change techniques.
Narrative Therapy (NT)
NT sees us as the authors of our own story - and our aim is to help the client to re-author that story in a different way, which can change our experience and perception as well as our behaviour. NT recognises the client as being the expert of their own life and engages with their self-stories which are often carried throughout their lives. As we experience events and interactions, we give meaning to them, and they in turn influence how we see ourselves and the world we experience.
I often use externalising language to enable the client to counter false assumptions, such as being out of touch with their feelings and feeling anxious and depressed. These feelings often lead to self-blame and the client’s failure to acknowledge that external factors have impacted in who they are.
By using these techniques I aim to empower the client to begin a process of re-authoring in order to embrace more of the complexity of their lives and to live life more fully.
Relapse Therapy (RT)
Relapse refers to the reoccurrence of addictive behaviour following an attempt to recover and those struggling with addictions often need to attend several rehab programmes before they can achieve a solid foundation for their recovery and long-term abstinence.
Following detoxification, the client will usually feel significantly better, emotionally and physically, having a much improved cognition, and may experience a return to reasonable physical health. However this often creates the illusion that they are recovering, when in fact their struggles are the consequence of deeper emotional pain which has never been dealt with or resolved. The fact that the client is feeling physically better will not resolve their emotional pain.
Relapse will often occur, not by one thought alone, but rather by a mix of ‘seemingly irrelevant decisions’ which is often triggered by physical, emotional and sensual encounters. Relapse is usually seen seen as part of the recovery process and our aim is to enable clients to recognise the early signs - triggered by anything from resentment, a casual meeting or a familiar sight or smell. Typically, the sequence of change begins with pre-contemplation, moving on to contemplation, followed by preparation - which on most occasions will lead to actions and subsequently, relapse.