By Dennis Sale
IN the previous column, nutrition (e.g., diet) was explored and the importance of making thoughtful choices from the vast information sources was emphasised. In this column, the focus is on health-related approaches that seek to improve wellbeing through creating changes in people’s perception, beliefs, and behaviour. There are many approaches in this industry sector, ranging from those that go into deep understanding of sub/unconscious processes (e.g., psychoanalysis) to those that focus specifically on changing cognition and behaviour (e.g., cognitive behavioural therapy).
The more familiar approaches in today’s context are psychotherapy and counselling. Both are approaches to mental-health treatment, but they differ in their approach, focus and duration. Psychotherapy and counselling are often used interchangeably as both have the goal of improving mental health, wellbeing, and overall quality of life. Also, both employ interpersonal techniques such as active listening, empathy, and sensory acuity as key elements of therapeutic practice. The latter technique is the ability to use attention and observation skills to ascertain a client’s verbal and non-verbal cues to gain a deeper understanding of their emotional states and experiences.
The main differences are in the depth in which underlying causes of emotional or behavioural issues are explored in the therapeutic process. Counselling is essentially a shorter-term form of therapy that focuses on specific problems or immediate concerns to help individuals to address problems related to such life areas as relationships, career, or life transitions with the goal of providing practical advice and support. Psychotherapy is a broader term and encompasses various forms of therapy that aim to help individuals address emotional, behavioural, or psychological challenges. It can be a longer-term process, involving multiple sessions over an extended period, to identify the deeper processes and experiences (e.g., causation) underpinning specific mental-health issues.
Within the broad field of psychotherapy, there is variation in approach and practices, which is based on differing assumptions about human nature and psychological development. For example, my initiation in this field was in client-centred therapy, pioneered by Carl Rogers, one of the founding fathers of what is referred to as humanistic psychology. I was trained in this approach in the 1970s by Carl himself. Rogers offered an optimistic perspective on the human condition and its development, which was in stark contrast to both the other main personality theories of that time; the chaotic and dark model of personality by Sigmund Freud (psychoanalytic theory) and the mechanistic model of human behaviour of B.F. Skinner (behaviourism). Client-centred therapy has the following main assumptions:
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Human nature is essentially good or at least neutral: Rogers believed that people have the capacity for self-actualisation – that is, given the right parenting and social conditions, individuals can develop positive self-regard, grow, flourish, and experience realisation of their inherent talents and dispositions.
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The therapeutic relationship is key: The relationship between the therapist and the client in the therapeutic process is central to promoting psychological growth and the journey to self-actualisation. The therapist must create a warm, accepting, and empathetic environment, and this involves high competence in interpersonal communication skills.
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The client is the expert on their own experience: The client is the best source of information about their own feelings, thoughts and experiences. The therapist’s primary role is to provide a supportive and non-directive environment that allows the client to explore, analyse and evaluate their own feelings and thoughts in relation to making life decisions.
A modern development in the humanistic tradition is that of positive psychology. While both approaches are concerned with wellbeing, positive psychology places a more explicit focus on the study of happiness, life satisfaction, and other indicators of wellbeing. Positive psychology therapists employ a variety of techniques to help clients foster positive emotions, strengths, and virtues, including:
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Mindfulness and meditation: Helping clients to pay attention to their thoughts and feelings without judgment through guided meditation exercises to focus on the present moment.
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Strengths-based interventions: Helping clients to identify their unique strengths and talents, cultivating positive emotion such as joy, and facilitating the setting of goals that are meaningful to them as individuals.
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Positive affirmations: Encouraging clients to create and repeat positive affirmations about themselves, as well as recall and reflect on positive memories in their lives.
Another mainstream approach in psychotherapy is what is referred to as cognitive-behavioural therapy (CBT). This approach places an emphasis on identifying and understanding the thinking patterns and behaviours of clients that are mitigating their health and wellbeing. From this basis, the goal is to facilitate clients’ reframing of aspects of their belief systems, thinking, and behaviours which are the likely main underpinning causes of their mental distress. I have used this extensively in helping young people to reframe their negative beliefs in the context of their life situations in more positive ways and to adopt a growth mindset (e.g., success is possible with effort), especially in the way they approach their learning. Essentially, beliefs are no more than perceptions that have been around for a long time – but they shape people’s perception of reality and interactions with others and things in their world. Hence, the effective employment of therapeutic techniques that dismantle limiting beliefs at the level of mind and build personal effectiveness at the behavioural level is a game-changing outcome in therapy.
For myself, I was most influenced by the Austrian neurologist, psychiatrist, and Holocaust survivor, Viktor Frankl. He developed logotherapy, an approach based on his three-year experience in the concentration camps. Frankl saw human suffering as an existential feature of the human condition, and it’s how we deal with the inevitable challenges and trauma that life throws at us that matters. Trauma can have devastating long-term effects, but individual differences play a significant part in how they impact future outcomes. For example, some people have extremely traumatic experiences but cope and become well-adjusted proactive adults, while others seem to lack such coping capability. In most basic terms logotherapy, while accepting the impact of previous experience, focuses more on the ‘here and now’ existential reality and what can be done productively in future. The primary aim is to help clients find meaning and purpose in their lives – even in the face of extreme suffering. It is grounded in a humanistic world-view that empathises the inherent value and potential of individuals, as well as the core belief that individuals ultimately have a choice in their behaviour and are responsible for their actions.
Effective psychotherapeutic approaches offer benefit for enhancing wellbeing. For example, CBT is widely considered to be effective for a range of mental-health conditions, including depression, anxiety disorders, and substance abuse. Studies (e.g., Lim & Tierney, 2023) have demonstrated CBT’s effectiveness in improving symptoms, reducing relapse rates, and enhancing quality of life. Similarly, for positive psychology, studies (e.g., Hofmann et al, 2013) have demonstrated that the therapy can improve self-esteem, self-awareness, and overall wellbeing. For logotherapy, while there has been less research here than for other approaches, the existing studies (e.g., Julom & de Guzmán, 2013) support the view that it can be effective in promoting a sense of purpose and meaning for clients, which is an essential condition for longer term wellbeing.
In summary, psychotherapy can offer much in helping people to address life’s diverse existential challenges and develop the capability to attain better mental health and wellbeing. While the modern world has created conditions that have made many people’s lives more overtly comfortable, this may not constitute realities that enhance – and may even mitigate – the essential psychological functioning underpinning mental health and wellbeing. In the next column I explore two popular health technology “tools”: cryotherapy (ice bath) and hyperbaric oxygen therapy (oxygen chamber).
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Dennis Sale worked in the Singapore education system for 25 years as advisor, researcher and examiner. He coached over 15,000 teaching professionals and provided 100+ consultancies in the Asian region. Dennis is author of the books Creative Teachers: Self-directed Learners (Springer 2020) and Creative Teaching: An Evidence-Based Approach (Springer, 2015). To contact Dennis, visit dennissale.com.
