The Therapy Turf Wars

“My therapeutic approach is better than yours!” All too often therapists with one particular approach criticize one – or all – of the others, and I’m sick of it. CBT is frequently involved in these turf wars, partly because it’s the favourite of the NHS. Some CBT therapists imply that their approach is vastly superior to all others, ignoring the evidence that supports the effectiveness of other schools of therapy. Humanistic therapists frequently respond in kind, suggesting that CBT is shallow, simplistic and unable to tackle deep rooted issues.

Ruby Wax is an especially irritating ‘turf war’ critic. Ruby is a passionate advocate of Mindfulness Based Cognitive Therapy, an approach I have a lot of respect for. Sadly Ruby feels it necessary to dismiss several of the most important ‘rival’ schools of therapy with funny parodies. Carl Rogers developed the Person Centred Approach (PCA) that unpins most Counselling in the UK today. According to Ruby the PCA is about repeating “whatever you said back to you like a parrot but with love” (Wax, 2013). She goes on to dismiss Gestalt, Existential and Psychoanalytic approaches. Ruby; it may be funny, but it’s not clever!

Triggering my ire today is a book about the Human Givens Approach, which claims that the PCA, Psychodynamic school and CBT are all “piecemeal approaches” and that none of them “are sufficient on its own” (Griffin and Tyrrell, 2007). Their solution is, of course, the Human Givens Approach! The research evidence suggests that PCA, Psychodynamic and CBT can all be effective in certain circumstances. CBT is backed by a robust research base and a Person Centred Approach is one of only four therapeutic modalities approved for the treatment of depression under the NHS.

All this frustrates and saddens me. The Human Givens Approach has a great deal to offer and I’ve integrated it into my own therapeutic practice. But I’m galled that those who developed it feel the need to dismiss other approaches as inadequate. It sometimes feels like I’m back in the school playground hearing one kid saying “My Dad’s bigger than your Dad!” Viewing all this though a psychodynamic lens, I wonder if some therapists have unresolved childhood issues?

The parable of the blind men and an elephant
We need a wide perspective

Given that the human mind is the most complex system in the known universe, is it really plausible that one school of therapy will have the definitive and complete answer to every individual’s unique mental health problems? Maybe one day, but most certainly not yet. Meanwhile I’m adopting a pluralistic approach, learning as much as I can about as many different paths to healing as possible. I try to take a wide perspective, asking myself the question; for this particular client, at this specific moment, which therapeutic lens is going to be the most helpful? This is usually called having an ‘integrative’ approach, but I think I’m best described as a pragmatic therapist: My only interest is what works?

Focusing and the Cognitive Iceberg

Focusing is a simple technique that helps you to become aware of what’s called a ‘felt sense’ – a feeling in the body that has a meaning. Focusing has myriad applications including personal growth, creativity and psychotherapy. I’m nearly halfway thorough my two-year Focusing Oriented Therapist training and it’s deepening my work in all kinds of ways.

For example, it’s opening new insights into how the cognitive iceberg might be applied to psychotherapy. First, let me outline how the cognitive iceberg can be used to illustrate the Focusing process. Gendlin, who first identified the felt sense, writes that it “comes between the usual conscious person and the deep, universal reaches of human nature, where we are no longer ourselves ” (Gendlin, 1984). On my cognitive iceberg the felt sense is represented by the dotted area just below awareness. Focusing is the process that enables the felt sense to emerge into awareness, as illustrated by the vertical arrows.

Focusing and the cognitive iceberg diagram
Focusing and the cognitive iceberg diagram

Now, what happens when a client and therapist are working together? The therapist is paying careful attention to whole situation; the client/therapist relationship, their own processes and what is going on for the client. A Focusing Oriented Therapist will be ‘listening’ with their whole body and be in touch with their felt sense.

Therapist and client Focusing diagram
Therapist and client Focusing

The arrows on this diagram schematically illustrate something of the process – note that I haven’t included the verbal exchanges which will also be going on. There is an exchange of ‘information’ between the therapist and client below awareness at the level I call the ‘deep body’. Both the client and therapist are also Focusing, becoming aware of material arising from felt senses.

There are many therapeutic processes going on here. The client will often be working through something difficult and the presence of the therapist can facilitate that: It’s as if the feeling is shared between them and the therapist’s embodied engagement processes some of the pain. Sometimes the therapist’s felt sense will alert them to something going on for the client and their embodied empathy can help the client. It’s also possible for the therapist to have a felt sense of something that comes from outside the client’s awareness and, with care, they can help it emerge.

I’ve covered a lot in this short post and I hope it’s reasonably clear. Please do ask me for clarification if not. I’ll add that this is all very speculative, but I hope that’s what makes this blog interesting!