Cognitive Behavioral Therapy (CBT) is currently considered the gold standard in counseling with numerous studies supporting its effectiveness for the treatment of common mental health issues such as depression, anxiety and the general management of stress and emotions. So, what exactly is CBT? Though the human mind is incredible and resilient, research shows that our brains have limitations when it comes to accurate perceptions & judgments. Moreover, we think and behave in patterns. This therapy focuses on these facts, recognizing that the interaction between thinking, behaving and feeling can be altered by identifying problematic patterns and substituting them with new and more effective ways of coping. This includes uncovering attitudes and thoughts which are contributing to our suffering or problems, as well as drawing on behavioral adjustments such as exposure and response prevention strategies (i.e., a gradient exposure to stress-inducing situations) and skills-building (i.e., clients may learn new abilities to manage their feelings, relationships and life stressors).

Acceptance and Commitment Therapy (ACT) is an evidence-based counseling method that incorporates psychological concepts from Buddhist philosophy into counseling sessions. Though ACT has not been as extensively researched as Cognitive Behavioral Therapy (CBT) there is existing research which shows positive benefits that are comparable to cognitive-behavioral therapy in terms of effectiveness, and it is suggested as an adjunctive therapy to enhance and supplement CBT.

Through ACT, clients learn to detach their identity from difficult emotional experiences and uncontrollable life outcomes. It incorporates mindfulness principles, with a focus on meditation, and a refocus from fighting against difficult emotional and life experiences to living for one’s personal values. It’s shown effectiveness in the treatment of depression and anxiety, and is one of the primary therapies recommended by the American Psychological Association for the treatment of chronic illness and chronic pain.

Some clients just need to talk in a non-judgmental and neutral atmosphere. Client-centered counseling differs from other therapeutic approaches as the focus is on the client driving the treatment agenda. Other forms of therapy such as Cognitive Behavioral Therapy and Acceptance and Commitment Therapy have elements of this in terms of collaboration; however, they often are more structured and linear, and can include the use of manualized treatment such as specific readings, workbooks, worksheets, etc.

Another unique aspect of client-centered counseling is that it rejects the medical model adapted from physical medicine. This means that the focus of counseling isn’t so much on labeling people as having “disorders,” but focusing on all experiences as human and occurring within the normal range of possibilities.

The primary method of growth through the client-centered approach is ensuring that the counselor is congruent (i.e., the counselor is aware and accepting of his or her own reactions to the client and client interactions), genuine (i.e., expresses those reactions in a constructive way), empathetic (i.e., is able to take on the perspective of the client and feel what he or she is feeling), and holds clients with what is termed, “unconditional positive regard” (i.e., seeing each client as at the core, a growth-oriented human being with positive attributes and potential). It’s thought that if the therapist maintains these within the relationship it can provide a sufficient environment for the client to tap into his or her natural strengths, and self-directed tendency to solve dilemmas, thus advancing the client to the next stage of his or her personal development.

This counseling method is likely best described as an attitude towards counseling, specifically associated with working with the gay, lesbian, and bisexual (GLB) population. Providers who subscribe to this approach to counseling, understand that negative attitudes towards the GLB population exist within the culture and are expressed within families, faith communities, the government, and even within medical and mental health providers themselves. Consequently, the focus of this approach to counseling is in affirming that sexual orientation is a complex issue and should be met with broad compassion, scientific information and general support. It holds that clients have the right to self-determine if and how they define their sexual orientation, and seeks to support every client with how they want to express these aspects of themselves in their lives.

Affirmative counselors provide general validation of lesbian, gay, bisexual and questioning clients’ experiences, hopes, fears, and feelings; accurate and up-to-date scientific information about sexual orientation; and reinforce clients’ right to self-determination without unduly pressuring clients to go in any particular direction related to expressing and managing their sexuality.

Sometimes when we are distressed and experiencing particular challenges it can be easy to forget our strengths, accomplishments, and resources. This form of counseling is centered on compensating for this by re-orienting clients to their own inherent resources to remedy difficulties as quickly as possible. It focuses on directly facing current dilemmas by drawing on successful attitudes, behaviors, and relational and tangible resources that clients have used in the past to meet other problems. 

Feminist and multicultural counseling approaches adopt the mentality that the personal is political. This means that many problems that present themselves within the counseling office are either influenced, or even caused, by societal attitudes and cultural norms and policies which may contribute to clients’ individual suffering.  Counselors who adopt this approach seek to understand the experiences of minorities and those who are traditionally kept from positions of power, and best adapt interventions which honor and respect these realities, while empowering clients to counter oppressive forces within their own psyche, personal lives and relationships, and/or through civic advocacy and engagement.

If you work with a counselor who adopts a feminist and multicultural approach, they may explore with you how societal influences may be negatively affecting your symptoms. For example, men in counseling who present with relationship problems may explore how the concepts of healthy and unhealthy masculinity are contributing to the issues at-hand. Whereas, women may be prompted to identify how internalized and unchallenged sexism may contribute to negative self-image, self-esteem, and difficulties with assertiveness.

Overall, this approach holds that individuals are unique and worthy of respect and consideration in terms of the various identities that they hold, and that symptoms that are presented at the individual level are often indicative of larger cultural problems. Assisting clients in identifying this can help them appropriately externalize self-blame and depressive and anxious feelings; while leading to self-responsibility which leads to actions that assist in correcting the negative aspects of the cultural atmosphere, and generally improving their lives.

Mental health therapy has traditionally been created out of the medical model. The medical model holds that health, whether it be physical or emotional/mental, is the absence of negative symptoms. Consequently, health professionals may focus on what we call “disease,” and “disorders,” assuming that as long as these are not present, people are what we call, “healthy.” Positive psychology takes us further than this, generally stating that there is more to life than avoiding difficulties. This approach redirects our attention and focus beyond decreasing negative symptoms in our lives to increasing the presence of scientifically-supported aspects of living which promote well-being and happiness. Positive psychology is an exciting, albeit new, direction for the mental health field and is already demonstrating promising results as a complimentary approach to the medical model in helping people access fulfillment and happiness.

Existential psychology is an approach to therapy which is focused on exploring the depth of the human experience.  While other therapeutic approaches such as Cognitive Behavioral Therapy focus on addressing and reducing symptoms associated with “disorders”, the aim of existential psychology is to explore deeper underlying causes which are related to the general human condition.  This approach holds that most of, if not all, client problems can be reduced to four underlying dilemmas which are inherent to the human condition.  These dilemmas are: isolation/individuality (i.e., coping with being different than others yet needing connection), freedom (i.e., taking risks and self-responsibility for making choices and managing our individual lives), meaning (i.e., creating purpose in life), and death (i.e., facing inevitable losses and limitations).  Existential Psychology proposes that challenges we face in our lives have one or more of these as an ever-present undercurrent.  Existential therapists assist clients in reducing maladaptive defenses against the reality of these dilemmas and emphasize accepting life’s ambiguities, while taking responsibility for making the most out of the human journey.

Existential psychology is more philosophical rather than technical. It may be of particular interest to those who have faced great tragedies which can significantly disturb our sense of purpose and meaning. Indeed, one of its most famous contributors and proponents, Viktor Frankl, was a Jewish psychiatrist who survived the Holocaust. It may also be of special interest to those who hold an affinity for intellectual curiosity and openness, abstract thinking and/or those who would like to explore the deep questions of life and obtain insight into what it means to be human and fully alive.