Counseling Theory- Psychoanalytic Theory 2

Table of Contents

Counseling Theory

The psychoanalytic approach emphasizes the importance of early childhood development and events. Do you find that current problems are mostly rooted in early childhood events or influences? To what extent do you believe people can resolve their adult problems that stem from childhood without exploring past events? When you apply this basic psychoanalytic concept specifically to yourself, what connections between your own past and present are you aware?

The Place of Techniques and Evaluation in Counseling

Drawing on Techniques from Various Approaches

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Techniques of Therapy

Applications of the Approaches

Contributions to Multicultural Counseling

Limitations in Multicultural Counseling

Contributions of the Approaches

Overview of Contemporary Counseling Models

Ego-Defense Mechanisms

Comparison of Freud’s Psychosexual Stages and Erikson’s Psychosocial Stages

The Basic Philosophies

Key Concepts

Goals of Therapy

The Therapeutic Relationship

Limitations of the Approaches

The Place of Techniques and Evaluation in Counseling

Drawing on Techniques from Various Approaches

Techniques of Therapy

Psychoanalytic therapy	The key techniques are interpretation, dream analysis, free association, analysis of resistance, analysis of transference, and countertransference. Techniques are designed to help clients gain access to their unconscious conflicts, which leads to insight and eventual assimilation of new material by the ego.
Adlerian therapy	Adlerians pay more attention to the subjective experiences of clients than to using techniques. Some techniques include gathering life-history data (family constellation, early recollections, personal priorities), sharing interpretations with clients, offering encouragement, and assisting clients in searching for new possibilities.
Existential therapy	Few techniques flow from this approach because it stresses understanding first and technique second. The therapist can borrow techniques from other approaches and incorporate them in an existential framework. Diagnosis, testing, and external measurements are not deemed important. Issues addressed are freedom and responsibility, isolation and relationships, meaning and meaninglessness, living and dying.
Person-centered therapy	This approach uses few techniques but stresses the attitudes of the therapist and a “way of being.” Therapists strive for active listening, reflection of feelings, clarification, “being there” for the client, and focusing on the moment-to-moment experiencing of the client. This model does not include diagnostic testing, interpretation, taking a case history, or questioning or probing for information.
Gestalt therapy	A wide range of experiments are designed to intensify experiencing and to integrate conflicting feelings. Experiments are co-created by therapist and client through an I/Thou dialogue. Therapists have latitude to creatively invent their own experiments. Formal diagnosis and testing are not a required part of therapy.
Behavior therapy	The main techniques are reinforcement, shaping, modeling, systematic desensitization, relaxation methods, flooding, eye movement and desensitization reprocessing, cognitive restructuring, social skills training, self-management programs, mindfulness and acceptance methods, behavioral rehearsal, and coaching. Diagnosis or assessment is done at the outset to determine a treatment plan. Questions concentrate on “what,” “how,” and “when” (but not “why”). Contracts and homework assignments are also typically used.
Cognitive behavior therapy	Therapists use a variety of cognitive, emotive, and behavioral techniques; diverse methods are tailored to suit individual clients. This is an active, directive, time-limited, present-centered, psychoeducational, structured therapy. Some techniques include engaging in Socratic dialogue, collaborative empiricism, debating irrational beliefs, carrying out homework assignments, gathering data on assumptions one has made, keeping a record of activities, forming alternative interpretations, learning new coping skills, changing one’s language and thinking patterns, role playing, imagery, confronting faulty beliefs, self-instructional training, and stress inoculation training.
Choice theory/ Reality therapy	This is an active, directive, and didactic therapy. Skillful questioning is a central technique used for the duration of the therapy process. Various techniques may be used to get clients to evaluate what they are presently doing to see if they are willing to change. If clients decide that their present behavior is not effective, they develop a specific plan for change and make a commitment to follow through.
Feminist therapy	Although techniques from traditional approaches are used, feminist practitioners tend to employ consciousness-raising techniques aimed at helping clients recognize the impact of gender-role socialization on their lives. Other techniques frequently used include gender-role analysis and intervention, power analysis and intervention, demystifying therapy, bibliotherapy, journal writing, therapist self-disclosure, assertiveness training, reframing and relabeling, cognitive restructuring, identifying and challenging untested beliefs, role playing, psychodramatic methods, group work, and social action.
Postmodern approaches	In solution-focused therapy the main technique involves change-talk, with emphasis on times in a client’s life when the problem was not a problem. Other techniques include creative use of questioning, the miracle question, and scaling questions, which assist clients in developing alternative stories. In narrative therapy, specific techniques include listening to a client’s problem-saturated story without getting stuck, externalizing and naming the problem, externalizing conversations, and discovering clues to competence. Narrative therapists often write letters to clients and assist them in finding an audience that will support their changes and new stories.
Family systems therapy	A variety of techniques may be used, depending on the particular theoretical orientation of the therapist. Some techniques include genograms, teaching, asking questions, joining the family, tracking sequences, family mapping, reframing, restructuring, enactments, and setting boundaries. Techniques may be experiential, cognitive, or behavioral in nature. Most are designed to bring about change in a short time.

Techniques of Therapy

Applications of the Approaches

Psychoanalytic therapy	Candidates for analytic therapy include professionals who want to become therapists, people who have had intensive therapy and want to go further, and those who are in psychological pain. Analytic therapy is not recommended for self-centered and impulsive individuals or for people with psychotic disorders. Techniques can be applied to individual and group therapy.
Adlerian therapy	Because the approach is based on a growth model, it is applicable to such varied spheres of life as child guidance, parent–child counseling, marital and family therapy, individual counseling with all age groups, correctional and rehabilitation counseling, group counseling, substance abuse programs, and brief counseling. It is ideally suited to preventive care and alleviating a broad range of conditions that interfere with growth.
Existential therapy	This approach is especially suited to people facing a developmental crisis or a transition in life and for those with existential concerns (making choices, dealing with freedom and responsibility, coping with guilt and anxiety, making sense of life, and finding values) or those seeking personal enhancement. The approach can be applied to both individual and group counseling, and to couples and family therapy, crisis intervention, and community mental health work.
Person-centered therapy	Has wide applicability to individual and group counseling. It is especially well suited for the initial phases of crisis intervention work. Its principles have been applied to couples and family therapy, community programs, administration and management, and human relations training. It is a useful approach for teaching, parent–child relations, and for working with groups of people from diverse cultural backgrounds.
Gestalt therapy	Addresses a wide range of problems and populations: crisis intervention, treatment of a range of psychosomatic disorders, couples and family therapy, awareness training of mental health professionals, behavior problems in children, and teaching and learning. It is well suited to both individual and group counseling. The methods are powerful catalysts for opening up feelings and getting clients into contact with their present-centered experience.
Behavior therapy	A pragmatic approach based on empirical validation of results. Enjoys wide applicability to individual, group, couples, and family counseling. Some problems to which the approach is well suited are phobic disorders, depression, trauma, sexual disorders, children’s behavioral disorders, stuttering, and prevention of cardiovascular disease. Beyond clinical practice, its principles are applied in fields such as pediatrics, stress management, behavioral medicine, education, and geriatrics.
Cognitive behavior therapy	Has been widely applied to treatment of depression, anxiety, relationship problems, stress management, skill training, substance abuse, assertion training, eating disorders, panic attacks, performance anxiety, and social phobias. CBT is especially useful for assisting people in modifying their cognitions. Many self-help approaches utilize its principles. CBT can be applied to a wide range of client populations with a variety of specific problems.
Choice theory/ Reality therapy	Geared to teaching people ways of using choice theory in everyday living to increase effective behaviors. It has been applied to individual counseling with a wide range of clients, group counseling, working with youthful law offenders, and couples and family therapy. In some instances it is well suited to brief therapy and crisis intervention.
Feminist therapy	Principles and techniques can be applied to a range of therapeutic modalities such as individual therapy, relationship counseling, family therapy, group counseling, and community intervention. The approach can be applied to both women and men with the goal of bringing about empowerment.
Postmodern approaches	Solution-focused therapy is well suited for people with adjustment disorders and for problems of anxiety and depression. Narrative therapy is now being used for a broad range of human difficulties including eating disorders, family distress, depression, and relationship concerns. These approaches can be applied to working with children, adolescents, adults, couples, families, and the community in a wide variety of settings. Both solution-focused and narrative approaches lend themselves to group counseling and to school counseling.
Family systems therapy	Useful for dealing with marital distress, problems of communicating among family members, power struggles, crisis situations in the family, helping individuals attain their potential, and enhancing the overall functioning of the family.

Applications of the Approaches

Contributions to Multicultural Counseling

Psychoanalytic therapy	Its focus on family dynamics is appropriate for working with many cultural groups. The therapist’s formality appeals to clients who expect professional distance. Notion of ego defense is helpful in understanding inner dynamics and dealing with environmental stresses.
Adlerian therapy	Its focus on social interest, helping others, collectivism, pursuing meaning in life, importance of family, goal orientation, and belonging is congruent with the values of many cultures. Focus on person-in-the-environment allows for cultural factors to be explored.
Existential therapy	Focus is on understanding client’s phenomenological world, including cultural background. This approach leads to empowerment in an oppressive society. Existential therapy can help clients examine their options for change within the context of their cultural realities. The existential approach is particularly suited to counseling diverse clients because of the philosophical foundation that emphasizes the human condition.
Person-centered therapy	Focus is on breaking cultural barriers and facilitating open dialogue among diverse cultural populations. Main strengths are respect for clients’ values, active listening, welcoming of differences, nonjudgmental attitude, understanding, willingness to allow clients to determine what will be explored in sessions, and prizing cultural pluralism.
Gestalt therapy	Its focus on expressing oneself nonverbally is congruent with those cultures that look beyond words for messages. Provides many experiments in working with clients who have cultural injunctions against freely expressing feelings. Can help to overcome language barrier with bilingual clients.Focus on bodily expressions is a subtle way to help clients recognize their conflicts.
Behavior therapy	Focus on behavior, rather than on feelings, is compatible with many cultures. Strengths include a collaborative relationship between counselor and client in working toward mutually agreed-upon goals, continual assessment to determine if the techniques are suited to clients’ unique situations, assisting clients in learning practical skills, an educational focus, and stress on self-management strategies.
Cognitive behavior therapy	Focus is on a collaborative approach that offers clients opportunities to express their areas of concern. The psychoeducational dimensions are often useful in exploring cultural conflicts and teaching new behavior. The emphasis on thinking (as opposed to identifying and expressing feelings) is likely to be acceptable to many clients. The focus on teaching and learning tends to avoid the stigma of mental illness. Clients are likely to value the active and directive stance of the therapist.
Choice theory/ Reality therapy	Focus is on clients making their own evaluation of behavior (including how they respond to their culture). Through personal assessment clients can determine the degree to which their needs and wants are being satisfied. They can find a balance between retaining their own ethnic identity and integrating some of the values and practices of the dominant society.
Feminist therapy	Focus is on both individual change and social transformation. A key contribution is that both the women’s movement and the multicultural movement have called attention to the negative impact of discrimination and oppression for both women and men. Emphasizes the influence of expected cultural roles and explores client’s satisfaction with and knowledge of these roles.
Postmodern approaches	Focus is on the social and cultural context of behavior. Stories that are being authored in the therapy office need to be anchored in the social world in which the client lives. Therapists do not make assumptions about people and honor each client’s unique story and cultural background. Therapists take an active role in challenging social and cultural injustices that lead to oppression of certain groups. Therapy becomes a process of liberation from oppressive cultural values and enables clients to become active agents of their destinies.
Family systems therapy	Focus is on the family or community system. Many ethnic and cultural groups place value on the role of the extended family. Many family therapies deal with extended family members and with support systems. Networking is a part of the process, which is congruent with the values of many clients. There is a greater chance for individual change if other family members are supportive. This approach offers ways of working toward the health of the family unit and the welfare of each member.

Contributions to Multicultural Counseling

Limitations in Multicultural Counseling

Psychoanalytic therapy	Its focus on insight, intrapsychic dynamics, and long-term treatment is often not valued by clients who prefer to learn coping skills for dealing with pressing daily concerns. Internal focus is often in conflict with cultural values that stress an interpersonal and environmental focus.
Adlerian therapy	This approach’s detailed interview about one’s family background can conflict with cultures that have injunctions against disclosing family matters. Some clients may view the counselor as an authority who will provide answers to problems, which conflicts with the egalitarian, person-to person spirit as a way to reduce social distance.
Existential therapy	Values of individuality, freedom, autonomy, and self-realization often conflict with cultural values of collectivism, respect for tradition, deference to authority, and interdependence. Some may be deterred by the absence of specific techniques. Others will expect more focus on surviving in their world.
Person-centered therapy	Some of the core values of this approach may not be congruent with the client’s culture. Lack of counselor direction and structure are unacceptable for clients who are seeking help and immediate answers from a knowledgeable professional.
Gestalt therapy	Clients who have been culturally conditioned to be emotionally reserved may not embrace Gestalt experiments. Some may not see how “being aware of present experiencing” will lead to solving their problems.
Behavior therapy	Family members may not value clients’ newly acquired assertive style, so clients must be taught how to cope with resistance by others. Counselors need to help clients assess the possible consequences of making behavioral changes.
Cognitive behavior therapy	Before too quickly attempting to change the beliefs and actions of clients, it is essential for the therapist to understand and respect their world. Some clients may have serious reservations about questioning their basic cultural values and beliefs. Clients could become dependent on the therapist choosing appropriate ways to solve problems.
Choice theory/ Reality therapy	This approach stresses taking charge of one’s own life, yet some clients are more interested in changing their external environment. Counselors need to appreciate the role of discrimination and racism and help clients deal with social and political realities.
Feminist therapy	This model has been criticized for its bias toward the values of White, middle-class, heterosexual women, which are not applicable to many other groups of women nor to men. Therapists need to assess with their clients the price of making significant personal change, which may result in isolation from extended family as clients assume new roles and make life changes.
Postmodern approaches	Some clients come to therapy wanting to talk about their problems and may be put off by the insistence on talking about exceptions to their problems. Clients may view the therapist as an expert and be reluctant to view themselves as experts. Certain clients may doubt the helpfulness of a therapist who assumes a “not-knowing” position.
Family systems therapy	Family therapy rests on value assumptions that are not congruent with the values of clients from some cultures. Western concepts such as individuation, self-actualization, self-determination, independence, and self-expression may be foreign to some clients. In some cultures, admitting problems within the family is shameful. The value of “keeping problems within the family” may make it difficult to explore conflicts openly.

Contributions of the Approaches

Psychoanalytic therapy	More than any other system, this approach has generated controversy as well as exploration and has stimulated further thinking and development of therapy. It has provided a detailed and comprehensive description of personality structure and functioning. It has brought into prominence factors such as the unconscious as a determinant of behavior and the role of trauma during the first six years of life. It has developed several techniques for tapping the unconscious and shed light on the dynamics of transference and countertransference, resistance, anxiety, and the mechanisms of ego defense.
Adlerian therapy	A key contribution is the influence that Adlerian concepts have had on other systems and the integration of these concepts into various contemporary therapies. This is one of the first approaches to therapy that was humanistic, unified, holistic, and goal-oriented and that put an emphasis on social and psychological factors.
Existential therapy	Its major contribution is recognition of the need for a subjective approach based on a complete view of the human condition. It calls attention to the need for a philosophical statement on what it means to be a person. Stress on the I/Thou relationship lessens the chances of dehumanizing therapy. It provides a perspective for understanding anxiety, guilt, freedom, death, isolation, and commitment.
Person-centered therapy	Clients take an active stance and assume responsibility for the direction of therapy. This unique approach has been subjected to empirical testing, and as a result both theory and methods have been modified. It is an open system. People without advanced training can benefit by translating the therapeutic conditions to both their personal and professional lives. Basic concepts are straightforward and easy to grasp and apply. It is a foundation for building a trusting relationship, applicable to all therapies.
Gestalt therapy	The emphasis on direct experiencing and doing rather than on merely talking about feelings provides a perspective on growth and enhancement, not merely a treatment of disorders. It uses clients’ behavior as the basis for making them aware of their inner creative potential. The approach to dreams is a unique, creative tool to help clients discover basic conflicts. Therapy is viewed as an existential encounter; it is process-oriented, not technique-oriented. It recognizes nonverbal behavior as a key to understanding.
Behavior therapy	Emphasis is on assessment and evaluation techniques, thus providing a basis for accountable practice. Specific problems are identified, and clients are kept informed about progress toward their goals. The approach has demonstrated effectiveness in many areas of human functioning. The roles of the therapist as reinforcer, model, teacher, and consultant are explicit. The approach has undergone extensive expansion, and research literature abounds. No longer is it a mechanistic approach, for it now makes room for cognitive factors and encourages self-directed programs for behavioral change.
Cognitive behavior therapy	Major contributions include emphasis on a comprehensive therapeutic practice; numerous cognitive, emotive, and behavioral techniques; an openness to incorporating techniques from other approaches; and a methodology for challenging and changing faulty or negative thinking. Most forms can be integrated into other mainstream therapies. REBT makes full use of action oriented homework, various psychoeducational methods, and keeping records of progress. CT is a structured therapy that has a good track record for treating depression and anxiety in a short time. Strengths-based CBT is a form of positive psychology that addresses the resources within the client for change.
Choice theory/ Reality therapy	This is a positive approach with an action orientation that relies on simple and clear concepts that are easily grasped in many helping professions. It can be used by teachers, nurses, ministers, educators, social workers, and counselors. Due to the direct methods, it appeals to many clients who are often seen as resistant to therapy. It is a short-term approach that can be applied to a diverse population, and it has been a significant force in challenging the medical model of therapy.
Feminist therapy	The feminist perspective is responsible for encouraging increasing numbers of women to question gender stereotypes and to reject limited views of what a woman is expected to be. It is paving the way for gender-sensitive practice and bringing attention to the gendered uses of power in relationships. The unified feminist voice brought attention to the extent and implications of child abuse, incest, rape, sexual harassment, and domestic violence. Feminist principles and interventions can be incorporated in other therapy approaches.
Postmodern approaches	The brevity of these approaches fit well with the limitations imposed by a managed care structure. The emphasis on client strengths and competence appeals to clients who want to create solutions and revise their life stories in a positive direction. Clients are not blamed for their problems but are helped to understand how they might relate in more satisfying ways to such problems. A strength of these approaches is the question format that invites clients to view themselves in new and more effective ways.
Family systems therapy	From a systemic perspective, neither the individual nor the family is blamed for a particular dysfunction. The family is empowered through the process of identifying and exploring interactional patterns. Working with an entire unit provides a new perspective on understanding and working through both individual problems and relationship concerns. By exploring one’s family of origin, there are increased opportunities to resolve other conflicts in systems outside of the family

Contributions of the Approaches

Limitations of the Approaches

Psychoanalytic therapy	Requires lengthy training for therapists and much time and expense for clients. The model stresses biological and instinctual factors to the neglect of social, cultural, and interpersonal ones. Its methods are less applicable for solving specific daily life problems of clients and may not be appropriate for some ethnic and cultural groups. Many clients lack the degree of ego strength needed for regressive and reconstructive therapy. It may be inappropriate for certain counseling settings.
Adlerian therapy	Weak in terms of precision, testability, and empirical validity. Few attempts have been made to validate the basic concepts by scientific methods. Tends to oversimplify some complex human problems and is based heavily on common sense.
Existential therapy	Many basic concepts are fuzzy and ill-defined, making its general framework abstract at times. Lacks a systematic statement of principles and practices of therapy. Has limited applicability to lower functioning and nonverbal clients and to clients in extreme crisis who need direction.
Person-centered therapy	Possible danger from the therapist who remains passive and inactive, limiting responses to reflection. Many clients feel a need for greater direction, more structure, and more techniques. Clients in crisis may need more directive measures. Applied to individual counseling, some cultural groups will expect more counselor activity.
Gestalt therapy	Techniques lead to intense emotional expression; if these feelings are not explored and if cognitive work is not done, clients are likely to be left unfinished and will not have a sense of integration of their learning. Clients who have difficulty using imagination may not profit from certain experiments.
Behavior therapy	Major criticisms are that it may change behavior but not feelings; that it ignores the relational factors in therapy; that it does not provide insight; that it ignores historical causes of present behavior; that it involves control by the therapist; and that it is limited in its capacity to address certain aspects of the human condition.
Cognitive behavior therapy	Tends to play down emotions, does not focus on exploring the unconscious or underlying conflicts, de-emphasizes the value of insight, and sometimes does not give enough weight to the client’s past. CBT might be too structured for some clients.

Choice theory/ Reality therapy	Discounts the therapeutic value of exploration of the client’s past, dreams, the unconscious, early childhood experiences, and transference. The approach is limited to less complex problems. It is a problem-solving therapy that tends to discourage exploration of deeper emotional issues.
Feminist therapy	A possible limitation is the potential for therapists to impose a new set of values on clients—such as striving for equality, power in relationships, defining oneself, freedom to pursue a career outside the home, and the right to an education. Therapists need to keep in mind that clients are their own best experts, which means it is up to them to decide which values to live by.
Postmodern approaches	There is little empirical validation of the effectiveness of therapy outcomes. Some critics contend that these approaches endorse cheerleading and an overly positive perspective. Some are critical of the stance taken by most postmodern therapists regarding assessment and diagnosis, and also react negatively to the “not-knowing” stance of the therapist. Because some of the solution-focused and narrative therapy techniques are relatively easy to learn, practitioners may use these interventions in a mechanical way or implement these techniques without a sound rationale.
Family systems therapy	Limitations include problems in being able to involve all the members of a family in the therapy. Some family members may be resistant to changing the structure of the system. Therapists’ self knowledge and willingness to work on their own family-of-origin issues is crucial, for the potential for countertransference is high. It is essential that the therapist be well trained, receive quality supervision, and be competent in assessing and treating individuals in a family context.

Limitations of the Approaches

Overview of Contemporary Counseling Models

Psychodynamic Approaches

Psychoanalytic therapy Founder: Sigmund Freud. A theory of personality development, a philosophy of human nature, and a method of psychotherapy that focuses on unconscious factors that motivate behavior. Attention is given to the events of the first six years of life as determinants of the later development of personality.

Adlerian therapy Founder: Alfred Adler. Key Figure: Following Adler, Rudolf Dreikurs is credited with popularizing this approach in the United States. This is a growth model that stresses assuming responsibility, creating one’s own destiny, and finding meaning and goals to create a purposeful life. Key concepts are used in most other current therapies.

Experiential and Relationship-Oriented Therapies

Existential therapy Key figures: Viktor Frankl, Rollo May, and Irvin Yalom. Reacting against the tendency to view therapy as a system of well-defined techniques, this model stresses building therapy on the basic conditions of human existence, such as choice, the freedom and responsibility to shape one’s life, and self-determination. It focuses on the quality of the person-to-person therapeutic relationship.

Person-centered therapy Founder: Carl Rogers; Key figure: Natalie Rogers. This approach was developed during the 1940s as a nondirective reaction against psychoanalysis. Based on a subjective view of human experiencing, it places faith in and gives responsibility to the client in dealing with problems and concerns.

Gestalt therapy Founders: Fritz and Laura Perls; Key figures: Miriam and Erving Polster. An experiential therapy stressing awareness and integration; it grew as a reaction against analytic therapy. It integrates the functioning of body and mind and places emphasis on the therapeutic relationship.

Cognitive Behavioral Approaches

Behavior therapy Key figures: B. F. Skinner, and Albert Bandura. This approach applies the principles of learning to the resolution of specific behavioral problems. Results are subject to continual experimentation. The methods of this approach are always in the process of refinement. The mindfulness and acceptance-based approaches are rapidly gaining popularity.

Cognitive behavior therapy Founders: Albert Ellis and A. T. Beck. Albert Ellis founded rational emotive behavior therapy, a highly didactic, cognitive, action-oriented model of therapy, and A. T. Beck founded cognitive therapy, which gives a primary role to thinking as it influences behavior. Judith Beck continues to develop CBT; Christine Padesky has developed strengths-based CBT; and Donald Meichenbaum, who helped develop cognitive behavior therapy, has made significant contributions to resilience as a factor in coping with trauma.

Choice theory/Reality Founder: William Glasser. Key figure: Robert Wubbolding. This short-term approach is based therapy on choice theory and focuses on the client assuming responsibility in the present. Through the therapeutic process, the client is able to learn more effective ways of meeting her or his needs.

Systems and Postmodern Approaches

Feminist therapy This approach grew out of the efforts of many women, a few of whom are Jean Baker Miller, Carolyn Zerbe Enns, Oliva Espin, and Laura Brown. A central concept is the concern for the psychological oppression of women. Focusing on the constraints imposed by the sociopolitical status to which women have been relegated, this approach explores women’s identity development, self-concept, goals and aspirations, and emotional well-being.

Postmodern approaches A number of key figures are associated with the development of these various approaches to therapy. Steve de Shazer and Insoo Kim Berg are the cofounders of solution-focused brief therapy. Michael White and David Epston are the major figures associated with narrative therapy. Social constructionism, solution-focused brief therapy, and narrative therapy all assume that there is no single truth; rather, it is believed that reality is socially constructed through human interaction. These approaches maintain that the client is an expert in his or her own life.

Family systems therapy A number of significant figures have been pioneers of the family systems approach, two of whom include Murray Bowen and Virginia Satir. This systemic approach is based on the assumption that the key to changing the individual is understanding and working with the family.

Overview of Contemporary Counseling Models

Ego-Defense Mechanisms

	Defense	Uses for Behavior
Repression	Threatening or painful thoughts and feelings are excluded from awareness.	One of the most important Freudian processes, it is the basis of many other ego defenses and of neurotic disorders. Freud explained repression as an involuntary removal of something from consciousness. It is assumed that most of the painful events of the first five or six years of life are buried, yet these events do influence later behavior.
Denial	“Closing one’s eyes” to the existence of a threatening aspect of reality.	Denial of reality is perhaps the simplest of all self defense mechanisms. It is a way of distorting what the individual thinks, feels, or perceives in a traumatic situation. This mechanism is similar to repression, yet it generally operates at preconscious and conscious levels.
Reaction formation	Actively expressing the opposite impulse when confronted with a threatening impulse.	By developing conscious attitudes and behaviors that are diametrically opposed to disturbing desires, people do not have to face the anxiety that would result if they were to recognize these dimensions of themselves. Individuals may conceal hate with a facade of love, be extremely nice when they harbor negative reactions, or mask cruelty with excessive kindness.
Projection	Attributing to others one’s own unacceptable desires and impulses.	This is a mechanism of self-deception. Lustful, aggressive, or other impulses are seen as being possessed by “those people out there, but not by me.”
Displacement	Directing energy toward another object or person when the original object or person is inaccessible.	Displacement is a way of coping with anxiety that involves discharging impulses by shifting from a threatening object to a “safer target.” For example, the meek man who feels intimidated by his boss comes home and unloads inappropriate hostility onto his children.
Rationalization	Manufacturing “good” reasons to explain away a bruised ego.	Rationalization helps justify specific behaviors, and it aids in softening the blow connected with disappointments. When people do not get positions, they have applied for in their work, they think of logical reasons they did not succeed, and they sometimes attempt to convince themselves that they really did not want the position anyway.
Sublimation	Diverting sexual or aggressive energy into other channels.	Energy is usually diverted into socially acceptable and sometimes even admirable channels. For example, aggressive impulses can be channeled into athletic activities, so that the person finds a way of expressing aggressive feelings and, as an added bonus, is often praised.
Regression	Going back to an earlier phase of development when there were fewer demands.	In the face of severe stress or extreme challenge, individuals may attempt to cope with their anxiety by clinging to immature and inappropriate behaviors. For example, children who are frightened in school may indulge in infantile behavior such as weeping, excessive dependence, thumb-sucking, hiding, or clinging to the teacher.
Introjection	Taking in and “swallowing” the values and standards of others.	Positive forms of introjection include incorporation of parental values or the attributes and values of the therapist (assuming that these are not merely uncritically accepted). One negative example is that in concentration camps some of the prisoners dealt with overwhelming anxiety by accepting the values of the enemy through identification with the aggressor.
Identification	Identifying with successful causes, organizations, or people in the hope that you will be perceived as worthwhile.	Identification can enhance self-worth and protect one from a sense of being a failure. This is part of the developmental process by which children learn gender-role behaviors, but it can also be a defensive reaction when used by people who feel basically inferior.
Compensation	Masking perceived weaknesses or developing certain positive traits to make up for limitations.	This mechanism can have direct adjustive value, and it can also be an attempt by the person to say “Don’t see the ways in which I am inferior, but see me in my accomplishments.”

Ego-Defense Mechanisms

Comparison of Freud’s Psychosexual Stages and Erikson’s Psychosocial Stages

Period of Life	Freud	Erikson
First year of life	Oral stageSucking at mother’s breasts satisfies need for food and pleasure. Infant needs to get basic nurturing, or later feelings of greediness and acquisitiveness may develop. Oral fixations result from deprivation of oral gratification in infancy. Later personality problems can include mistrust of others, rejecting others; love, and fear of or inability to form intimate relationships.	Infancy: Trust versus mistrustIf significant others provide for basic physical and emotional needs, infant develops a sense of trust. If basic needs are not met, an attitude of mistrust toward the world, especially toward interpersonal relationships, is the result.
Ages 1-3	Anal stageAnal zone becomes of major significance in formation of personality. Main developmental tasks include learning independence, accepting personal power, and learning to express negative feelings such as rage and aggression. Parental discipline patterns and attitudes have significant consequences for child’s later personality development.	Early childhood: Autonomy versus shame and doubtA time for developing autonomy. Basic struggle is between a sense of self-reliance and a sense of self-doubt. Child needs to explore and experiment, to make mistakes, and to test limits. If parents promote dependency, child’s autonomy is inhibited and capacity to deal with world successfully is hampered.
Ages 3-6	Phallic stageBasic conflict centers on unconscious incestuous desires that child develops for parent of opposite sex and that, because of their threatening nature, are repressed. Male phallic stage, known as Oedipus complex, involves mother as love object for boy. Female phallic stage, known as Electra complex, involves girl’s striving for father’s love and approval. How parents respond, verbally and nonverbally, to child’s emerging sexuality has an impact on sexual attitudes and feelings that child develops.	Preschool age: Initiative versus guiltBasic task is to achieve a sense of competence and initiative. If children are given freedom to select personally meaningful activities, they tend to develop a positive view of self and follow through with their projects. If they are not allowed to make their own decisions, they tend to develop guilt over taking initiative. They then refrain from taking an active stance and allow others to choose for them.
Ages 6-12	Latency stageAfter the torment of sexual impulses of preceding years, this period is relatively quiescent. Sexual interests are replaced by interests in school, playmates, sports, and a range of new activities. This is a time of socialization as child turns outward and forms relationships with others.	School age: Industry versus inferiorityChild needs to expand understanding of world, continue to develop appropriate gender-role identity, and learn the basic skills required for school success. Basic task is to achieve a sense of industry, which refers to setting and attaining personal goals. Failure to do so results in a sense of inadequacy.
Ages 12-18	Genital stageOld themes of phallic stage are revived. This stage begins with puberty and lasts until senility sets in. Even though there are societal restrictions and taboos, adolescents can deal with sexual energy by investing it in various socially acceptable activities such as forming friendships, engaging in art or in sports, and preparing for a career.	Adolescence: Identity versus role confusion A time of transition between childhood and adulthood.A time for testing limits, for breaking dependent ties, and for establishing a new identity. Major conflicts center on clarification of self-identity, life goals, and life’s meaning. Failure to achieve a sense of identity results in role confusion.

Period of Life	Freud	Erikson
Ages 18-35	Genital stage continuesCore characteristic of mature adult is the freedom “to love and to work.” This move toward adulthood involves freedom from parental influence and capacity to care for others.	Young adulthood: Intimacy versus isolation. Developmental task at this time is to form intimate relationships. Failure to achieve intimacy can lead to alienation and isolation.
Ages 35-60	Genital stage continues	Middle age: Generativity versus stagnation. There is a need to go beyond self and family and be involved in helping the next generation. This is a time of adjusting to the discrepancy between one’s dream and one’s actual accomplishments. Failure to achieve a sense of productivity often leads to psychological stagnation.
Ages 60+	Genital stage continues	Later life: Integrity versus despairIf one looks back on life with few regrets and feels personally worthwhile, ego integrity results. Failure to achieve ego integrity can lead to feelings of despair, hopelessness, guilt, resentment, and self-rejection.

Comparison of Freud’s Psychosexual Stages and Erikson’s Psychosocial Stages

The Basic Philosophies

Psychoanalytic therapy	Human beings are basically determined by psychic energy and by early experiences. Unconscious motives and conflicts are central in present behavior. Early development is of critical importance because later personality problems have their roots in repressed childhood conflicts.
Adlerian therapy	Humans are motivated by social interest, by striving toward goals, by inferiority and superiority, and by dealing with the tasks of life. Emphasis is on the individual’s positive capacities to live in society cooperatively. People have the capacity to interpret, influence, and create events. Each person at an early age creates a unique style of life, which tends to remain relatively constant throughout life.
Existential therapy	The central focus is on the nature of the human condition, which includes a capacity for self awareness, freedom of choice to decide one’s fate, responsibility, anxiety, the search for meaning, being alone and being in relation with others, striving for authenticity, and facing living and dying.
Person-centered therapy	Positive view of people; we have an inclination toward becoming fully functioning. In the context of the therapeutic relationship, the client experiences feelings that were previously denied to awareness.The client moves toward increased awareness, spontaneity, trust in self, and inner-directedness.
Gestalt therapy	The person strives for wholeness and integration of thinking, feeling, and behaving. Some key concepts include contact with self and others, contact boundaries, and awareness. The view is nondeterministic in that the person is viewed as having the capacity to recognize how earlier influences are related to present difficulties. As an experiential approach, it is grounded in the here and now and emphasizes awareness, personal choice, and responsibility.
Behavior therapy	Behavior is the product of learning. We are both the product and the producer of the environment. Traditional behavior therapy is based on classical and operant principles. Contemporary behavior therapy has branched out in many directions, including mindfulness and acceptance approaches.
Cognitive behavior therapy	Individuals tend to incorporate faulty thinking, which leads to emotional and behavioral disturbances. Cognitions are the major determinants of how we feel and act. Therapy is primarily oriented toward cognition and behavior, and it stresses the role of thinking, deciding, questioning, doing, and redeciding. This is a psychoeducational model, which emphasizes therapy as a learning process, including acquiring and practicing new skills, learning new ways of thinking, and acquiring more effective ways of coping with problems.
Choice theory/ Reality therapy	Based on choice theory, this approach assumes that we need quality relationships to be happy. Psychological problems are the result of our resisting control by others or of our attempt to control others. Choice theory is an explanation of human nature and how to best achieve satisfying interpersonal relationships.
Feminist therapy	Feminists criticize many traditional theories to the degree that they are based on gender-biased concepts, such as being androcentric, gender centric, ethnocentric, heterosexist, and intrapsychic. The constructs of feminist therapy include being gender fair, flexible, interactionist, and life-span-oriented. Gender and power are at the heart of feminist therapy. This is a systems approach that recognizes the cultural, social, and political factors that contribute to an individual’s problems.
Postmodern approaches	Based on the premise that there are multiple realities and multiple truths, postmodern therapies reject the idea that reality is external and can be grasped. People create meaning in their lives through conversations with others. The postmodern approaches avoid pathologizing clients, take a dim view of diagnosis, avoid searching for underlying causes of problems, and place a high value on discovering clients’ strengths and resources. Rather than talking about problems, the focus of therapy is on creating solutions in the present and the future.
Family systems therapy	The family is viewed from an interactive and systemic perspective. Clients are connected to a living system; a change in one part of the system will result in a change in other parts. The family provides the context for understanding how individuals function in relationship to others and how they behave. Treatment deals with the family unit. An individual’s dysfunctional behavior grows out of the interactional unit of the family and out of larger systems as well.

The Basic Philosophies

Key Concepts

Psychoanalytic therapy	Normal personality development is based on successful resolution and integration of psychosexual stages of development. Faulty personality development is the result of inadequate resolution of some specific stage. Anxiety is a result of repression of basic conflicts. Unconscious processes are centrally related to current behavior.
Adlerian therapy	Key concepts include the unity of personality, the need to view people from their subjective perspective, and the importance of life goals that give direction to behavior. People are motivated by social interest and by finding goals to give life meaning. Other key concepts are striving for significance and superiority, developing a unique lifestyle, and understanding the family constellation. Therapy is a matter of providing encouragement and assisting clients in changing their cognitive perspective and behavior.
Existential therapy	Essentially an experiential approach to counseling rather than a firm theoretical model, it stresses core human conditions. Interest is on the present and on what one is becoming. The approach has a future orientation and stresses self-awareness before action.
Person-centered therapy	The client has the potential to become aware of problems and the means to resolve them. Faith is placed in the client’s capacity for self-direction. Mental health is a congruence of ideal self and real self. Maladjustment is the result of a discrepancy between what one wants to be and what one is. In therapy attention is given to the present moment and on experiencing and expressing feelings.
Gestalt therapy	Emphasis is on the “what” and “how” of experiencing in the here and now to help clients accept all aspects of themselves. Key concepts include holism, figure-formation process, awareness, unfinished business and avoidance, contact, and energy.
Behavior therapy	Focus is on overt behavior, precision in specifying goals of treatment, development of specific treatment plans, and objective evaluation of therapy outcomes. Present behavior is given attention. Therapy is based on the principles of learning theory. Normal behavior is learned through reinforcement and imitation. Abnormal behavior is the result of faulty learning.
Cognitive behavior therapy	Although psychological problems may be rooted in childhood, they are reinforced by present ways of thinking. A person’s belief system and thinking is the primary cause of disorders. Internal dialogue plays a central role in one’s behavior. Clients focus on examining faulty assumptions and misconceptions and on replacing these with effective beliefs.
Choice theory/ Reality therapy	The basic focus is on what clients are doing and how to get them to evaluate whether their present actions are working for them. People are mainly motivated to satisfy their needs, especially the need for significant relationships. The approach rejects the medical model, the notion of transference, the unconscious, and dwelling on one’s past.
Feminist therapy	Core principles of feminist therapy are that the personal is political, therapists have a commitment to social change, women’s voices and ways of knowing are valued and women’s experiences are honored, the counseling relationship is egalitarian, therapy focuses on strengths and a reformulated definition of psychological distress, and all types of oppression are recognized.
Postmodern approaches	Therapy tends to be brief and addresses the present and the future. The person is not the problem; the problem is the problem. The emphasis is on externalizing the problem and looking for exceptions to the problem. Therapy consists of a collaborative dialogue in which the therapist and the client co-create solutions. By identifying instances when the problem did not exist, clients can create new meanings for themselves and fashion a new life story.
Family systems therapy	Focus is on communication patterns within a family, both verbal and nonverbal. Problems in relationships are likely to be passed on from generation to generation. Key concepts vary depending on specific orientation but include differentiation, triangles, power coalitions, family-of-origin dynamics, functional versus dysfunctional interaction patterns, and dealing with here-and-now interactions. The present is more important than exploring past experiences.

Key Concepts

Goals of Therapy

Psychoanalytic therapy	To make the unconscious conscious. To reconstruct the basic personality. To assist clients in reliving earlier experiences and working through repressed conflicts. To achieve intellectual and emotional awareness.
Adlerian therapy	To challenge clients’ basic premises and life goals. To offer encouragement so individuals can develop socially useful goals and increase social interest. To develop the client’s sense of belonging.
Existential therapy	To help people see that they are free and to become aware of their possibilities. To challenge them to recognize that they are responsible for events that they formerly thought were happening to them. To identify factors that block freedom.
Person-centered therapy	To provide a safe climate conducive to clients’ self-exploration. To help clients recognize blocks to growth and experience aspects of self that were formerly denied or distorted. To enable them to move toward openness, greater trust in self, willingness to be a process, and increased spontaneity and aliveness. To find meaning in life and to experience life fully. To become more self-directed.
Gestalt therapy	To assist clients in gaining awareness of moment-to-moment experiencing and to expand the capacity to make choices. To foster integration of the self.
Behavior therapy	To eliminate maladaptive behaviors and learn more effective behaviors. To identify factors that influence behavior and find out what can be done about problematic behavior. To encourage clients to take an active and collaborative role in clearly setting treatment goals and evaluating how well these goals are being met.
Cognitive behavior therapy	To teach clients to confront faulty beliefs with contradictory evidence that they gather and evaluate. To help clients seek out their faulty beliefs and minimize them. To become aware of automatic thoughts and to change them. To assist clients in identifying their inner strengths, and to explore the kind of life they would like to have.
Choice theory/ Reality therapy	To help people become more effective in meeting all of their psychological needs. To enable clients to get reconnected with the people they have chosen to put into their quality worlds and teach clients choice theory.
Feminist therapy	To bring about transformation both in the individual client and in society. To assist clients in recognizing, claiming, and using their personal power to free themselves from the limitations of gender-role socialization. To confront all forms of institutional policies that discriminate or oppress on any basis.
Postmodern approaches	To change the way clients, view problems and what they can do about these concerns. To collaboratively establish specific, clear, concrete, realistic, and observable goals leading to increased positive change. To help clients create a self-identity grounded on competence and resourcefulness so they can resolve present and future concerns. To assist clients in viewing their lives in positive ways, rather than being problem saturated.
Family systems therapy	To help family members gain awareness of patterns of relationships that are not working well and to create new ways of interacting. To identify how a client’s problematic behavior may serve a function or purpose for the family. To understand how dysfunctional patterns can be handed down across generations. To recognize how family rules can affect each family member. To understand how past family of origin experiences continue to have an impact on individuals.

The Therapeutic Relationship

Psychoanalytic therapy	The classical analyst remains anonymous, and clients develop projections toward him or her. The focus is on reducing the resistances that develop in working with transference and on establishing more rational control. Clients undergo long-term analysis, engage in free association to uncover conflicts, and gain insight by talking. The analyst makes interpretations to teach clients the meaning of current behavior as it relates to the past. In contemporary relational psychoanalytic therapy, the relationship is central, and emphasis is given to here-and-now dimensions of this relationship.
Adlerian therapy	The emphasis is on joint responsibility, on mutually determining goals, on mutual trust and respect, and on equality. The focus is on identifying, exploring, and disclosing mistaken goals and faulty assumptions within the person’s lifestyle.
Existential therapy	The therapist’s main tasks are to accurately grasp clients’ being in the world and to establish a personal and authentic encounter with them. The immediacy of the client–therapist relationship and the authenticity of the here-and-now encounter are stressed. Both client and therapist can be changed by the encounter.
Person-centered therapy	The relationship is of primary importance. The qualities of the therapist, including genuineness, warmth, accurate empathy, respect, and being nonjudgmental—and communication of these attitudes to clients—are stressed. Clients use this genuine relationship with the therapist to help them transfer what they learn to other relationships.
Gestalt therapy	Central importance is given to the I/Thou relationship and the quality of the therapist’s presence. The therapist’s attitudes and behavior count more than the techniques used. The therapist does not interpret for clients but assists them in developing the means to make their own interpretations. Clients identify and work on unfinished business from the past that interferes with current functioning.
Behavior therapy	The therapist is active and directive and functions as a teacher or mentor in helping clients learn more effective behavior. Clients must be active in the process and experiment with new behaviors. Although a quality client–therapist relationship is not viewed as sufficient to bring about change, it is considered essential for implementing behavioral procedures.
Cognitive behavior therapy	In REBT the therapist functions as a teacher and the client as a student. The therapist is highly directive and teaches clients an A-B-C model of changing their cognitions. In CT the focus is on a collaborative relationship. Using a Socratic dialogue, the therapist assists clients in identifying dysfunctional beliefs and discovering alternative rules for living. The therapist promotes corrective experiences that lead to learning new skills. Clients gain insight into their problems and then must actively practice changing self-defeating thinking and acting. In strengths-based CBT, active incorporation of client strengths encourages full engagement in therapy and often provides avenues for change that otherwise would be missed.
Choice theory/ Reality therapy	A fundamental task is for the therapist to create a good relationship with the client. Therapists are then able to engage clients in an evaluation of all of their relationships with respect to what they want and how effective they are in getting this. Therapists find out what clients want, ask what they are choosing to do, invite them to evaluate present behavior, help them make plans for change, and get them to make a commitment. The therapist is a client’s advocate, as long as the client is willing to attempt to behave responsibly.
Feminist therapy	The therapeutic relationship is based on empowerment and egalitarianism. Therapists actively break down the hierarchy of power and reduce artificial barriers by engaging in appropriate self disclosure and teaching clients about the therapy process. Therapists strive to create a collaborative relationship in which clients can become their own expert.

Postmodern approaches

Therapy is a collaborative partnership. Clients are viewed as the experts on their own life. Therapists use questioning dialogue to help clients free themselves from their problem-saturated stories and create new life-affirming stories. Solution-focused therapists assume an active role in guiding the client away from problem-talk and toward solution-talk. Clients are encouraged to explore their strengths and to create solutions that will lead to a richer future. Narrative therapists assist clients in externalizing problems and guide them in examining self-limiting stories and creating new and more liberating stories.

Family systems therapy

The family therapist functions as a teacher, coach, model, and consultant. The family learns ways to detect and solve problems that are keeping members stuck, and it learns about patterns that have been transmitted from generation to generation. Some approaches focus on the role of therapist as expert; others concentrate on intensifying what is going on in the here and now of the family session. All family therapists are concerned with the process of family interaction and teaching patterns of communication.

The Therapeutic Relationship

Limitations of the Approaches

Psychoanalytic therapy	Requires lengthy training for therapists and much time and expense for clients. The model stresses biological and instinctual factors to the neglect of social, cultural, and interpersonal ones. Its methods are less applicable for solving specific daily life problems of clients and may not be appropriate for some ethnic and cultural groups. Many clients lack the degree of ego strength needed for regressive and reconstructive therapy. It may be inappropriate for certain counseling settings.
Adlerian therapy	Weak in terms of precision, testability, and empirical validity. Few attempts have been made to validate the basic concepts by scientific methods. Tends to oversimplify some complex human problems and is based heavily on common sense.
Existential therapy	Many basic concepts are fuzzy and ill-defined, making its general framework abstract at times. Lacks a systematic statement of principles and practices of therapy. Has limited applicability to lower functioning and nonverbal clients and to clients in extreme crisis who need direction.
Person-centered therapy	Possible danger from the therapist who remains passive and inactive, limiting responses to reflection. Many clients feel a need for greater direction, more structure, and more techniques. Clients in crisis may need more directive measures. Applied to individual counseling, some cultural groups will expect more counselor activity.
Gestalt therapy	Techniques lead to intense emotional expression; if these feelings are not explored and if cognitive work is not done, clients are likely to be left unfinished and will not have a sense of integration of their learning. Clients who have difficulty using imagination may not profit from certain experiments.
Behavior therapy	Major criticisms are that it may change behavior but not feelings; that it ignores the relational factors in therapy; that it does not provide insight; that it ignores historical causes of present behavior; that it involves control by the therapist; and that it is limited in its capacity to address certain aspects of the human condition.
Cognitive behavior therapy	Tends to play down emotions, does not focus on exploring the unconscious or underlying conflicts, de-emphasizes the value of insight, and sometimes does not give enough weight to the client’s past. CBT might be too structured for some clients.

Choice theory/ Reality therapy	Discounts the therapeutic value of exploration of the client’s past, dreams, the unconscious, early childhood experiences, and transference. The approach is limited to less complex problems. It is a problem-solving therapy that tends to discourage exploration of deeper emotional issues.
Feminist therapy	A possible limitation is the potential for therapists to impose a new set of values on clients—such as striving for equality, power in relationships, defining oneself, freedom to pursue a career outside the home, and the right to an education. Therapists need to keep in mind that clients are their own best experts, which means it is up to them to decide which values to live by.
Postmodern approaches	There is little empirical validation of the effectiveness of therapy outcomes. Some critics contend that these approaches endorse cheerleading and an overly positive perspective. Some are critical of the stance taken by most postmodern therapists regarding assessment and diagnosis, and also react negatively to the “not-knowing” stance of the therapist. Because some of the solution-focused and narrative therapy techniques are relatively easy to learn, practitioners may use these interventions in a mechanical way or implement these techniques without a sound rationale.
Family systems therapy	Limitations include problems in being able to involve all the members of a family in the therapy. Some family members may be resistant to changing the structure of the system. Therapists’ self knowledge and willingness to work on their own family-of-origin issues is crucial, for the potential for countertransference is high. It is essential that the therapist be well trained, receive quality supervision, and be competent in assessing and treating individuals in a family context.

Limitations of the Approaches

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Theories at-a-Glance

The tables in this book compare theories over a range of topics, thereby providing you with the ability to easily compare, contrast, and grasp the practical aspects of each theory. These tables also serve as invaluable resources that can be used to review the key concepts, philosophies, limitations, contributions to multicultural counseling, applications, techniques, and goals of all theories in this text.

The following chart provides a convenient guide to the tables in this text.

Pages

6–7	Table 1.1	Overview of Contemporary Counseling Models
62–63	Table 4.1	Ego-Defense Mechanisms
65–66	Table 4.2	Comparison of Freud’s Psychosexual Stages and Erikson’s Psychosocial Stages
432	Table 15.1	The Basic Philosophies
433–434	Table 15.2	Key Concepts
438	Table 15.3	Goals of Therapy
441–442	Table 15.4	The Therapeutic Relationship
443–444	Table 15.5	Techniques of Therapy
444–445	Table 15.6	Applications of the Approaches
446	Table 15.7	Contributions to Multicultural Counseling
447	Table 15.8	Limitations in Multicultural Counseling
448–449	Table 15.9	Contributions of the Approaches
449–450	Table 15.10	Limitations of the Approaches

Overview of Focus Questions for the Theories

For the chapters dealing with the different theories, you will have a basic understanding of this book if you can answer the following questions as they apply to each of the eleven theories:

Who are the key figures (founder or founders) associated with the approach?

What are some of the basic assumptions underlying this approach?

What are a few of the key concepts that are essential to this theory?

What do you consider to be the most important goals of this therapy?

What is the role the therapeutic relationship plays in terms of therapy outcomes?

What are a few of the techniques from this therapy model that you would want to incorporate into your counseling practice?

What are some of the ways that this theory is applied to client populations, settings, and treatment of problems?

What do you see as the major strength of this theory from a diversity perspective?

What do you see as the major shortcoming of this theory from a diversity perspective?

What do you consider to be the most significant contribution of this approach?

What do you consider to be the most significant limitation of this approach?


	Theory and PracTice of counseling and PsychoTheraPyTenth Edition

Gerald Corey

California State University, Fullerton

Diplomate in Counseling Psychology,

American Board of Professional Psychology

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To the founders and key figures of the theories presented in this book—with appreciation for their contributions to contemporary counseling practice.

abouT The auThor

gerald corey is Professor Emeritus of Human Services and Counseling at California State University at Fullerton. He received his doctorate in counseling from the University of Southern California. He is a Diplomate in Counseling Psychology, American Board of Professional Psychology; a licensed psychologist; and a National Certified Counselor. He is a Fellow of the American Psychological Association (Division 17, Counseling Psychology; and Division 49, Group Psychotherapy); a Fellow of the American Counseling Association; and a Fellow of the Association for Specialists in Group Work. He also holds memberships in the American Group Psychotherapy Association; the American Mental Health Counselors Association; the Association for Spiritual, Ethical, and Religious Values in Counseling; the Association for Counselor Education and Supervision; and the Western Association of Counselor Education and Supervision. Both Jerry and Marianne Corey received the Lifetime Achievement Award from the American Mental Health Counselors Association in 2011, and both of them received the Eminent Career Award from ASGW in 2001. Jerry was given the Outstanding Professor of the Year Award from California State University at Fullerton in 1991. He regularly teaches both undergraduate and graduate courses in group counseling and ethics in counseling. He is the author or coauthor of 15 textbooks in counseling currently in print, along with more than 60 journal articles and book chapters. Several of his books have been translated into other languages. Theory and Practice of Counseling and Psychotherapy has been translated into Arabic, Indonesian, Portuguese, Turkish, Korean, and Chinese. Theory and

Practice of Group Counseling has been translated into Korean, Chinese, Spanish, and Russian. Issues and Ethics in the Helping Professions has been translated into Korean, Japanese, and Chinese.

In the past 40 years Jerry and Marianne Corey have conducted group counseling training workshops for mental health professionals at many universities in the United States as well as in Canada, Mexico, China, Hong Kong, Korea, Germany, Belgium, Scotland, England, and Ireland. In his leisure time, Jerry likes to travel, hike and bicycle in the mountains, and drive his 1931 Model A Ford. Marianne and Jerry have been married since 1964. They have two adult daughters, Heidi and Cindy, two granddaughters (Kyla and Keegan), and one grandson (Corey).

Recent publications by Jerry Corey, all with Cengage Learning, include:

Theory and Practice of Group Counseling, Ninth Edition (and Student Manual) (2016)

Becoming a Helper, Seventh Edition (2016, with Marianne Schneider Corey)

Issues and Ethics in the Helping Professions, Ninth Edition (2015, with Marianne Schneider Corey, Cindy Corey, and Patrick Callanan)

Group Techniques, Fourth Edition (2015, with Marianne Schneider Corey, Patrick Callanan, and J. Michael Russell)

Groups: Process and Practice, Ninth Edition (2014, with Marianne Schneider Corey and Cindy Corey)



I Never Knew I Had a Choice

, Tenth Edition (2014, with Marianne Schneider

Corey)



Case Approach to Counseling and Psychotherapy

, Eighth Edition (2013)



The Art of Integrative Counseling

, Third Edition (2013)

Jerry Corey is coauthor (with Barbara Herlihy) of

Boundary Issues in Counseling:

Multiple Roles and Responsibilities

, Third Edition (2015) and

ACA Ethical Standards Case-

book

, Seventh Edition (2015); he is coauthor (with Robert Haynes, Patrice Moulton,

and Michelle Muratori) of

Clinical Supervision in the Helping Professions: A Practical

Guide

, Second Edition (2010); he is the author of

Creating Your Professional Path: Les-

sons From My Journey

(2010). All four of these books are published by the American

Counseling Association.

He has also made several educational DVD programs on various aspects of

counseling practice: (1)

Ethics in Action

DVD and Workbook

(2015, with Marianne

Schneider Corey and Robert Haynes); (2)

Groups in Action: Evolution and Challenges

DVD and Workbook

(2014, with Marianne Schneider Corey and Robert Haynes);

(3)

DVD for Theory and Practice of Counseling and Psychotherapy: The Case of Stan and

Lecturettes

(2013); (4)

DVD for Integrative Counseling: The Case of Ruth and Lecturettes

(2013,

with Robert Haynes); and (5)

DVD for Theory and Practice of Group Counseling

(2012).

All of these programs are available through Cengage Learning.

Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Preface xi

PART 1

BASIC ISSUES IN

COUNSELING PRACTICE

1 Introduction and Overview 1 introduction 2

Where I Stand 3

Suggestions for Using the Book 5 Overview of the Theory Chapters 6

Introduction to the Case of Stan 9 Introduction to the Case of Gwen 13

2 The Counselor: Person and

Professional 17 introduction 18

The Counselor as a Therapeutic Person 18 Personal Therapy for the Counselor 20

The Counselor’s Values and the Therapeutic Process 22

Becoming an Effective Multicultural Counselor 25

Issues Faced by Beginning Therapists 28

Summary 35

3 Ethical Issues in Counseling

Practice 37 introduction 38

Putting Clients’ Needs Before Your Own 38

Ethical Decision Making 39 The Right of Informed Consent 41 Dimensions of Confidentiality 42

Ethical Issues From a Multicultural Perspective 43

Ethical Issues in the Assessment Process 45

Ethical Aspects of Evidence-Based Practice 48

Managing Multiple Relationships in Counseling

Practice 49

Becoming an Ethical Counselor 52

Summary 53

Where to Go From Here 53

Contents

Recommended Supplementary Readings for Part 1 54

PART 2

THEORIES AND TECHNIQUES OF COUNSELING

4 Psychoanalytic Therapy 57

introduction 58

Key Concepts 59

The Therapeutic Process 66

Application: Therapeutic Techniques and

Procedures 72

Jung’s Perspective on the Development of

Personality 77

Contemporary Trends: Object-Relations Theory, Self Psychology, and Relational Psychoanalysis 79

Psychoanalytic Therapy From a Multicultural

Perspective 84

Psychoanalytic Therapy applied to the case of stan 85

Psychoanalytic Therapy applied to the case of gwen 87

Summary and Evaluation 89

Self-Reflection and Discussion Questions 92

Where to Go From Here 92 Recommended Supplementary Readings 93

5 Adlerian Therapy 95

introduction 98

Key Concepts 98

The Therapeutic Process 104

Application: Therapeutic Techniques and

Procedures 108

Adlerian Therapy From a Multicultural Perspective 119

adlerian Therapy applied to the case of stan 121 adlerian Therapy applied to the case of gwen 122

vii

viii Contents

Summary and Evaluation 124

Self-Reflection and Discussion Questions 126

Where to Go From Here 127 Recommended Supplementary Readings 128

6 Existential Therapy 129

introduction 132

Key Concepts 137

The Therapeutic Process 146

Application: Therapeutic Techniques and Procedures 149

Existential Therapy From a Multicultural Perspective 153 existential Therapy applied to the case of stan 155

existential Therapy applied to the case of gwen 156 Summary and Evaluation 157

Self-Reflection and Discussion Questions 160

Where to Go From Here 160 Recommended Supplementary Readings 162

7 Person-Centered Therapy 163

introduction 165

Key Concepts 170

The Therapeutic Process 171

Application: Therapeutic Techniques and

Procedures 176

Person-Centered Expressive Arts

Therapy 180

Motivational Interviewing 182

Person-Centered Therapy From a Multicultural Perspective 184

Person-centered Therapy applied to the case of stan 186

Person-centered Therapy applied to the case of gwen 187 Summary and Evaluation 190

Self-Reflection and Discussion Questions 193

Where to Go From Here 193 Recommended Supplementary Readings 195

8 Gestalt Therapy 197

introduction 199

Key Concepts 200

The Therapeutic Process 206

Application: Therapeutic Techniques and

Procedures 211

Gestalt Therapy From a Multicultural Perspective 220

gestalt Therapy applied to the case of stan 221 gestalt Therapy applied to the case of gwen 223 Summary and Evaluation 224

Self-Reflection and Discussion Questions 227

Where to Go From Here 227 Recommended Supplementary Readings 229

9 Behavior Therapy 231

introduction 233

Key Concepts 236

The Therapeutic Process 238

Application: Therapeutic Techniques and

Procedures 240

Behavior Therapy From a Multicultural Perspective 258

behavior Therapy applied to the case of stan 259 behavior Therapy applied to the case of gwen 260 Summary and Evaluation 262

Self-Reflection and Discussion Questions 265

Where to Go From Here 266 Recommended Supplementary Readings 267

10 Cognitive Behavior Therapy 269

introduction 270

Albert Ellis’s Rational Emotive Behavior

Therapy 270

Key Concepts 272

The Therapeutic Process 273

Application: Therapeutic Techniques and

Procedures 275

Aaron Beck’s Cognitive Therapy 281

Christine Padesky and Kathleen Mooney’s

Strengths-Based Cognitive Behavioral Therapy 289

Donald Meichenbaum’s Cognitive Behavior Modification 293

Cognitive Behavior Therapy From a Multicultural Perspective 298

cognitive behavior Therapy applied to the case of stan 300

cognitive behavior Therapy applied to the case of gwen 302 Summary and Evaluation 303

Self-Reflection and Discussion Questions 307

Where to Go From Here 308 Recommended Supplementary Readings 310

11 Choice Theory/Reality

Therapy 311

introduction 313

Key Concepts 314

The Therapeutic Process 318

Application: Therapeutic Techniques and

Procedures 320

Choice Theory/Reality Therapy From a Multicultural Perspective 327

reality Therapy applied to the case of stan 329 reality Therapy applied to the case of gwen 331 Summary and Evaluation 332

Self-Reflection and Discussion Questions 334

Where to Go From Here 334 Recommended Supplementary Readings 336

12 Feminist Therapy 337

introduction 339

Key Concepts 341

The Therapeutic Process 345

Application: Therapeutic Techniques and

Procedures 348

Feminist Therapy From a Multicultural and Social Justice Perspective 354 feminist Therapy applied to the case of stan 355 feminist Therapy applied to the case of gwen 357 Summary and Evaluation 360

Self-Reflection and Discussion Questions 364

Where to Go From Here 364 Recommended Supplementary Readings 366

13 Postmodern Approaches 367

Some Contemporary Founders of Postmodern

Therapies 368

Introduction to Social Constructionism 368 Solution-Focused Brief Therapy 371

Narrative Therapy 382

Postmodern Approaches From a Multicultural

Perspective 390

Postmodern approaches applied to the case of stan 392

Contents ix

Postmodern approaches applied to the case of gwen 394

Summary and Evaluation 396

Self-Reflection and Discussion Questions 398

Where to Go From Here 399 Recommended Supplementary Readings 400

14 Family Systems Therapy 403

introduction 404

Development of Family Systems Therapy 406

A Multilayered Process of Family Therapy 409

Family Systems Therapy From a Multicultural Perspective 415

family Therapy applied to the case of stan 417 family Therapy applied to the case of gwen 420 Summary and Evaluation 422

Self-Reflection and Discussion Questions 424

Where to Go From Here 424

More emphasis on the client-as-expert in the therapy relationship in

postmodern approaches

More clinical examples to illustrate the use of SFBT techniques

New material on the defining characteristics of brief therapy

Increased emphasis on the collaborative nature of narrative therapy and

SFBT Revision of narrative therapy section chapter 14 family systems Therapy

Streamlined to focus mainly on an integrative approach to family therapy

More on recent developments in family systems therapy

More attention given to feminism, multiculturalism, and postmodern constructionism as applied to family therapy

Chapter 15 (“An Integrative Perspective”) pulls together themes from all 11 theoretical orientations. This chapter represents a major revision of the discussion of the psychotherapy integration movement; updates of the various integrative approaches; revision of the section on integration of spirituality in counseling; added material on research demonstrating the therapeutic alliance; expanded discussion on the central role of the client in determining therapy outcomes; new section on feedback-informed treatment; and updated coverage of the conclusions from the research literature on the effectiveness of psychotherapy. New to this chapter are two cases (Stan and Gwen) that illustrate integrative approaches. Chapter 15 develops the notion that an integrative approach to counseling practice is in keeping with meeting the needs of diverse client populations in many different settings. Numerous tables and other integrating material help students compare and contrast the 11 approaches.

This text can be used in a flexible way. Some instructors will follow the sequencing of chapters in the book. Others will prefer to begin with the theory chapters (Part 2) and then deal later with the student’s personal characteristics and ethical issues. The topics can be covered in whatever order makes the most sense. Readers are offered some suggestions for using this book in Chapter 1.

In this edition I have made every effort to incorporate those aspects that have worked best in the courses on counseling theory and practice that I teach. To help readers apply theory to practice, I have also revised the Student Manual, which is designed for experiential work. The Student Manual for Theory and Practice of Counseling and Psychotherapy still contains open-ended questions, many new cases for exploration and discussion, structured exercises, self-inventories, and a variety of activities that can be done both in class and out of class. The tenth edition features a structured overview, as well as a glossary, for each of the theories, and chapter quizzes for assessing the level of student mastery of basic concepts. New to this tenth edition of the Student Manual are experiential exercises for the Case of Gwen and questions raised by experts in each of the theory chapters. Each expert addresses the same six questions as applied to each of the given theories.

MindTap™ is a new online resource available to accompany this textbook. It contains the video program for Theory and Practice of Counseling and Psychotherapy: The Case of Stan and Lecturettes, a glossary of key terms, interviews with experts (questions and answers by experts in the various theories), and case examples for each of the theories illustrating ways of applying these concepts and techniques to a counseling case. A concise version of working with Stan from an integrative perspective now appears in Chapter 15. Chapter 16, “Case Illustration: An Integrative Approach in Working With Stan,” has been deleted from this edition but is available on MindTap™. A chapter covering Transactional Analysis is also available on MindTap™.

Case Approach to Counseling and Psychotherapy (Eighth Edition) features experts working with the case of Ruth from the various therapeutic approaches. The casebook, which is now available online, can supplement this book or stand alone.

Accompanying this tenth edition of the text and Student Manual are lecturettes on how I draw from key concepts and techniques from the various theories presented in the book. This DVD program has been developed for student purchase and use as a self-study program, and it completes an ideal learning package. The Art of Integrative Counseling (Third Edition), which expands on the material in Chapter 15 of the textbook, also complements this book.

Some professors have found the textbook and the Student Manual or MindTap™ to be ideal companions and realistic resources for a single course. Others like to use the textbook and the casebook as companions. With this revision it is now possible to have a unique learning package of several books, along with the DVD for Integrative Counseling: The Case of Ruth and Lecturettes. The Case Approach to Counseling and Psychotherapy and the Art of Integrative Counseling can also be used in a various classes, a few of which include case-management practicum, fieldwork courses, or counseling techniques courses.

Also available is a revised and updated Instructor’s Resource Manual, which includes suggestions for teaching the course, class activities to stimulate interest, PowerPoint presentations for all chapters, and a variety of test questions and a final examination. This instructor’s manual is now geared for the following learning package:

Theory and Practice of Counseling and Psychotherapy, Student Manual for Theory and Practice of Counseling and Psychotherapy, Case Approach to Counseling and Psychotherapy, The Art of Integrative Counseling, and two video programs: DVD for Integrative Counseling: The Case of Ruth and Lecturettes, and DVD for Theory and Practice of Counseling and Psychotherapy: The Case of Stan and Lecturettes.

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