Key Theories and Approaches of Counselling
Senior 6 · Psychology (Languages)
Key Theories and Approaches of Counselling
Lesson 4 of 4
25 min
From 1954 to 1959 the American psychiatrist Murray Bowen ran an unusual project at the National Institute of Mental Health in Maryland, in the United States. Instead of treating patients alone, he invited whole families, parents together with their adult son or daughter who had a diagnosis of schizophrenia, to live on a research ward for months at a time. Staff observed them every day.
Bowen noticed that the patient’s difficulties rose and fell with tensions in the whole family: when the parents’ relationship became strained, the patient often became more unwell, and the family’s attention shifted onto him or her. He concluded that a family works as an emotional unit, so a problem shown by one member cannot be understood apart from the others. This idea, that people must be understood as wholes within their relationships and communities, links the two families of approaches in this lesson: holistic approaches and family systems therapy.
Definition
Holistic approach: an approach that treats the person as a whole (body, mind, emotions, relationships, meaning and spirituality, and community) rather than focusing on one problem or one part.
Gestalt therapy: a holistic approach developed by Fritz and Laura Perls that focuses on awareness in the “here and now” and on completing “unfinished business”.
Integrative (eclectic) counselling: combining ideas and techniques from several approaches to suit each client.
Family systems therapy: an approach that sees the family as a system, so that one member’s problem is understood through the family’s relationships and patterns.
Genogram: a diagram of a family over at least three generations, showing relationships and patterns.
| Approach | Key ideas | Typical technique |
|---|---|---|
| Gestalt therapy (Fritz and Laura Perls, 1950s) | The whole person is more than the sum of parts; awareness of feelings, body and behaviour now; “unfinished business” from the past | The empty chair: the client speaks to an imagined person (for example, a parent who has died) in an empty chair, then may answer as that person |
| Existential approaches (for example Viktor Frankl’s logotherapy) | The search for meaning, freedom and responsibility; Frankl, a survivor of Nazi concentration camps, argued that people can endure suffering if they find meaning in it (Man’s Search for Meaning, 1946) | Exploring what gives the client’s life purpose and how they choose to respond to what they cannot change |
| Integrative counselling | No single theory fits every client; most practising counsellors combine approaches | For example, client-centred listening with CBT techniques for anxiety |
| Biopsychosocial-spiritual and community approaches | Health, thoughts, relationships, faith and community all matter | Combining counselling with exercise, sleep, faith support and community groups such as sociotherapy |
Evidence varies: the empty-chair technique has some experimental support, for example Sandra Paivio and Leslie Greenberg (1995) found it reduced distress about unresolved relationships more than an educational group did; existential approaches have less research. Studies of many therapies suggest that shared “common factors”, such as the relationship, hope and a clear rationale, explain much of their benefit, which supports integrative practice.
Since 2005, small groups of neighbours in many Rwandan communities have met once a week for about fifteen weeks in community-based sociotherapy, known in Kinyarwanda as Mvura Nkuvure (“heal me, I heal you”). Each group of about ten to fifteen people is guided by trained facilitators from the community and works through themes such as safety, trust, care and respect. Members talk about problems in their daily lives, including the lasting effects of the 1994 Genocide against the Tutsi, poverty and family conflict, and support each other in finding ways forward. A 2011 study by Willem Scholte and colleagues compared participants with similar people who had not yet joined, and found that participants’ emotional distress fell more over the programme, although it was not a randomised trial.
Family therapists argue that a problem shown by one member, the identified patient, often reflects the patterns of the whole family. Causes are circular, not linear: a mother nags because her son withdraws, and he withdraws because she nags.
Figure 1. An illustrative genogram. The conflict with the father and the very close tie with the mother may form a triangle, a pattern a family therapist would explore with the whole family.
Reviews of research (for example Alan Carr, 2019) find good evidence that family-based approaches help with children’s behaviour problems, adolescents’ substance use and eating disorders. In Rwanda, where extended families are closely involved in members’ lives, a family perspective can be especially relevant, but it requires sensitivity to elders’ authority and to family members’ different experiences of the past.
Community Based Sociotherapy (Rwanda): “What is Sociotherapy”. Listen for how groups are organised and how members help each other, and compare it with individual counselling.
Important
Evaluate holistic and family approaches. Their strength is that they see people in context: a student’s anxiety may be linked to family conflict, loss, lack of meaning or community tensions, which a narrow focus on symptoms would miss. Community and family approaches can also reach many people where professionals are few. Their weaknesses are that broad concepts (“wholeness”, “meaning”) are hard to measure, so research is thinner than for CBT; involving the whole family is difficult if members refuse or if there is abuse, when safety must come first; and powerful techniques such as the empty chair need trained practitioners.
Warning
Don’t blame the family. Family systems therapy looks at patterns, not at who is “at fault”. Its aim is to change interactions, not to find a culprit.
Tip
Exam technique: for “compare two approaches”, use the same headings for each: view of the person, cause of problems, role of the counsellor, main techniques, evidence, and a limitation.
Practice
Further reading
Sources and credits
Written by Ganzaa: the text, the table, Figure 1 (illustrative) and the exercises.
