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Counseling Theory
Behavior Therapy or Cognitive Behavior therapy
Required Assignments (RAs) are substantive assignments intended to measure student performance against selected course objectives and/or program outcomes within a course. RAs are completed by all students across all Argosy University campuses and delivery formats without exception.
Each RA contributes to a significant portion of the overall course grade and is assessed by faculty using the grading criteria designed for that assignment. These are individual assignments and students earn individual grades. Required Assignment: Theoretical Orientation Development Plan Paper 300 pts
Description of RA: From what you have learned in this course, select a theoretical perspective that interests you the most. In this assignment, you will conduct a literature search on that theoretical approach and develop a personalized plan for your continued development.
Theoretical Orientation Development Plan Paper Review the literature and construct a paper presenting and supporting your personal counseling theoretical preference (choosing from the major theories studied in this course). You should conduct a computerized literature search on the particular theoretical approach that feels like the best fit. Remember to select a theory that aligns with your worldview and your perspective of the best therapeutic relationship. References should be from empirical/scholarly works that support and further define the position. You should include the following in your paper:
• Summarize the fundamental elements of your theory of choice, including definitions of important terms, personality development, and major historical figures associated with the theory.
• Explain how your personal worldview (e.g. core beliefs about others and the world) connects to the theory of choice. • Explain how the therapeutic relationship aligns with your interpersonal style.
• Discuss how your theory of choice addresses the multicultural nature of our diverse society.
• Present support for the effectiveness of your chosen theoretical approach by examining and analyzing the existing efficacy-based research. Include findings across age groups, gender, and/or multicultural groups.
• Discuss limitations of your chosen therapeutic approach, including any clients or presenting problems for which it may not be appropriate. Support your ideas with findings from existing research on the approach.
• Identify the ethical standards from the American Counseling Association’s Code of Ethics (2014) that apply to the use of an approach determined to be unsuitable for a particular group or presenting problem. Discuss the potential harm that could be caused by applying an unsuitable approach. Spring 1 – 2018
• Provide an example of how you would apply a minimum of two specific theoretical techniques to a fictitious client’s need.
• Provide a plan for how you will continue to develop your knowledge and skills related to that theory.
Your final deliverable will be a Word document, approximately 8-10 pages in length, utilizing a minimum of 7 scholarly references. Your paper should be written in a clear, concise, and organized manner; demonstrate ethical scholarship in accurate representation and attribution of sources; and display accurate spelling, grammar, punctuation, and APA format.
CACREP Standards: 2.F.5.a, 5.C.1.a, 5.C.1.b, 2.F.5.g, 2.F.5.h, 2.F.5.j, 5.C.3.b, 2.F.5.n, 2.F.2.c,
5.C.2.c, 2.F.1.i, 5.C.2.l
Theoretical Summary: Summarize the fundamental elements of your theory of choice, including definitions of important terms, personality development, and major historical figures associated with the theory.
Summary clearly states all critical elements of the theory of choice. All relevant technical terms are defined, theoretical understanding of personality development is described, and the importance of each historical figure is clearly and accurately stated. /40 pts.
Personal Worldview: Explain how your personal worldview connects to the theory of choice.
Correlation between the student’s worldview and the theory of choice is clearly stated. The effect of the worldview towards the use of the theory is appropriate. /20 pts.
Interpersonal Style: Explain how the therapeutic relationship described in your theory of choice aligns with your interpersonal style.
Correlation between important aspects of the therapeutic relationship and the student’s interpersonal style is clearly stated. How the student’s interpersonal style would be appropriate or be a challenge is clearly stated. /20 pts.
Cultural and
Developmental Considerations: Discuss how your theory of choice addresses the multicultural nature of our diverse society and individual developmental needs.
The effect of the theory towards a variety of clients is accurate and clearly stated. /38 pts.
Theoretical Strengths: Present research findings in support of the effectiveness of your chosen theoretical approach.
Findings are presented of at least one peer-reviewed, efficacy study on the chosen theoretical approach. /30 pts.
Theoretical Limitations: Present research findings related to the limitations of your chosen theoretical approach.
Findings are presented of at least one peer-reviewed study examining the limitations of the chosen approach. /30 pts.
Ethical Considerations: Identify at least two ethical standards from the ACA Code of Ethics that address the inappropriate use of an approach or technique. Discuss specific, potential harmful effects of doing so.
At least two relevant ethical standards are identified, defined, and applied to the potential misapplication of a technique or approach. At least two examples of potential harmful effects are identified. /30 pts.
Technique Application: Provide an example of how you would apply a minimum of two
specifically theoretical techniques to a fictitious client’s need.
The description of implementation correctly aligns with each theory. Specific needs of the client are addressed, and the description of how each theory addresses the specific needs is clear and accurate. /54 pts.
Plan for Development: Describe how you will continue to develop your knowledge and skills related to the selected theory.
The plan includes details and specific resources that will be accessed and utilized to increase and enhance knowledge and skills related to the theory of choice. /10 pts.
Academic Writing
Write in a clear, concise, and organized manner; demonstrate ethical scholarship in accurate representation and attribution of sources (i.e. APA); and display accurate spelling, grammar, and punctuation.
Written in a clear, concise, and organized manner; demonstrated ethical scholarship in appropriate and accurate representation and attribution of sources; and displayed accurate spelling, grammar, and punctuation. Use of scholarly sources aligns with specified assignment requirements.
The Place of Techniques and Evaluation in Counseling
Drawing on Techniques from Various Approaches
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. |
DEVELOPING YOUR
THEORETICAL
ORIENTATION IN
COUNSELING AND PSYCHOTHERAPY
Third Edition
DUANE A. HALBUR
Georgia Military College
Life Management Group, Inc.
KIMBERLY VESS HALBUR
Medical College of Georgia at Georgia Regents University
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Library of Congress Cataloging-in-Publication Data
Halbur, Duane.
Developing your theoretical orientation in counseling and psychotherapy/Duane A. Halbur, Kimberly Vess Halbur.—Third edition. pages cm
Includes bibliographical references and index.
ISBN 978-0-13-348893-7
ISBN 0-13-348893-4
1. Psychology—Philosophy. 2. Counseling. 3. Psychotherapy. I. Halbur, Kimberly Vess. II. Title.
BF38.H33 2015
158.3—dc23
2014011528
10 9 8 7 6 5 4 3 2 1
ISBN 10: 0-13-348893-4 ISBN 13: 978-0-13-348893-7
In memory of
Edna May Thompson and
Carol Lynn Halbur,
who gave us much love and many of our theories about life and helped us to pass them along to our children
Dominic Anthony Halbur and
Carolyn Maye Halbur
| About the Authors |
Dr. Duane Halbur’s research interests include the needs of school counselors, philosophical counseling, and the integration of technology in counseling. Along with teaching and writing, he works as a licensed counselor in private practice specializing in children and families in transition. Dr. Kimberly Vess Halbur’s research includes cultural competencies for the helping professions and medical fields.
iv
We first wrote Developing Your Theoretical Orientation in Counseling and Psychotherapy with the objective of assisting other helping professionals through finding their theoretical orientation more easily than we did. We realize that the term helping professionals may seem generic, but we use it in an effort to include helpers who work with diverse populations in a wide array of fields. Specifically, we are speaking to mental health counselors, psychologists, social workers, school counselors, substance abuse counselors, psychotherapists, and peer helpers. This third edition attempts to assist clinicians further in finding their theoretical orientation in a diverse society while enjoying the process of self-exploration. The theories are presented in a way that allows the reader to identify quickly the philosophical and cultural foundations of the theories while accessing the goals and techniques of the theories.
Because the work of helping professionals needs to be grounded in theory, we have featured in this text an innovative model for selecting a theoretical orientation and hands-on activities to assist readers in their quest for a theoretical approach to helping. Learning activities, reflection questions, and case studies are included throughout the text, with several featured prominently in Chapter 5. These activities have been updated to demonstrate traditional and contemporary theories as well as multicultural perspectives so important to the helping fields.
| Preface |
The Intentional Theory Selection (ITS) model is a contemporary model for selecting a theoretical orientation. This model can assist helpers in finding a theory that is congruent with their personal values. We also acknowledge that the selection of a theoretical orientation may be quite cyclical. Just as in life, change in theoretical orientation is constant and inevitable. Thus, a professional helper may revisit the model many times throughout his or her career.
This text may also serve as a reminder or overview of the foremost helping theories and their respective schools of thought. We provide readers with a reminder of the basic philosophies, goals, and techniques of the major theories of counseling. We hope this text offers just enough information to remind professional helpers of what they already know while enticing them to seek out and learn more about a presented theory.
In addition to a summary of selected counseling theories, students and counselors will be exposed to 10 applied ways to aid in the self-discovery process. This self-discovery will begin the readers’ processes of intentionally finding a theoretical orientation that is congruent with their own worldview, beliefs, and values. The Selective Theory Sorter– Revised (STS–R) is a survey that was developed to help students and counselors discover which researched theories they might endorse. This sorter, more important in self- discovery than in assessment, is one of several tools that will be offered to readers while they are in the process of finding their own theoretical orientation.
We hope that readers find the material and the ITS model refreshing and at the same time meaningful. Those in the helping professions know, through research and
v
PREFACE
observation, that theory is important. Many innovators, researchers, and clinicians have dedicated their research and life work to finding techniques and philosophies that can best serve our clientele. We owe so much to these pioneers who have helped us to be effective and ethical in the work we do.
The helping professions are truly important to a developing society. Helping professionals have the opportunity to prevent and remediate when they serve in a field that makes its daily impact by improving the lives of others. As you work on your own professional identity and struggles, remember that this opportunity is both a blessing and a responsibility. In this text, as in many endeavors in your professional life, you will be asked to look inward. As professionals, we ask this of clients; as authors, we ask this of you. Take this opportunity to challenge yourself and grow.
We have presented the ITS model and the STS–R at many professional conferences and have greatly appreciated the feedback and the anticipation for this project to be in print for a third time. We still receive emails and phone calls from faculty members who have adopted the text and their students who have enjoyed using it. The interest we have received professionally has served as a muse and motivation for us to improve and update it in this third edition.
NEW TO THIS EDITION
The third edition of Developing Your Theoretical Orientation in Counseling and Psychotherapy offers the following new elements:
■ An increased focus on diversity, including commentary regarding the application of each theory in a culturally rich profession.
■ A greater review of the implications of empirically validated treatments.
■ A greater review of the implications of common-factor approaches to counseling.
■ An expansion and update of the counseling theories, which are necessary for the successful completion of national and state counselor examinations, including updated techniques.
■ Greater explanation of the application of multicultural counseling and feminism.
■ Increased focus on material that readers will find relevant to Counseling for Accreditation of Counseling and Related Educational Programs™ (CACREP) 2016 Standards.
■ Updated websites related to theories and theoretical training to allow readers quick access to more information.
■ Updated cases to assist readers through the process of choosing their theoretical orientation.
With the addition of several new topics, the references have been updated significantly since the previous editions. Readers with experience with the first and second editions will also note a more consistent voice throughout the text.
We would like to thank the reviewers of our manuscript for their insights and comments: John P. Galassi, University of North Carolina at Chapel Hill; Terence Patterson, University of San Francisco; David Shriberg, Loyola University of Chicago; and Amy M. Williams, University of Northern Colorado.
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CHAPTER ONE
Why Theoretical Orientation is Important 1
A PERSONAL EXPERIENCE 1
THE BIG PUZZLE 2
WHAT IS THEORETICAL ORIENTATION? 3
THE HELPER’S TOOL BELT 3
WHAT CAN A THEORETICAL ORIENTATION DO FOR ME? 4
HOW HAVE OTHERS PICKED A THEORETICAL ORIENTATION? 5
WHAT IF I’M ECLECTIC? 6
EMPIRICALLY VALIDATED THERAPIES: ARE THEY BETTER? 8
GUIDANCE FROM COMMON FACTORS: DO THEY ALL WORK? 9
ONCE I HAVE IT, HOW CAN I USE IT? 10
HOW ARE THEORETICAL ORIENTATION AND ETHICS RELATED? 10
THE MAIN POINTS 11
Contents
REFLECTION QUESTIONS 11
CHAPTER TWO
Incorporating Theory into Practice 13
MAKING THEORY USEFUL: A MODEL 13
THEORY DEVELOPMENT 14
IMPORTANCE OF YOUR LIFE PHILOSOPHY 15
LIFE PHILOSOPHY—IT’S PERSONAL 16
SCHOOLS OF THOUGHT 17
THEORIES 18
GOALS AND TECHNIQUES: INTERVENTIONS AT WORK 19
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CONTENTS
COUNSELORS ARE DIVERSE 20
RESISTANCE TO THEORIES: ECLECTIC, INTEGRATED, OR JUST DON’T KNOW 21
DOES IT REALLY WORK? 23
WHAT TO TAKE HOME 24
REFLECTION QUESTIONS 25
CHAPTER THREE
Top 10 Ways to Find Your Theoretical Orientation 27
FIND YOURSELF 28
ARTICULATE YOUR VALUES 29
SURVEY YOUR PREFERENCES 30
USE YOUR PERSONALITY 30 Taking the MBTI 37
CAPTURE YOURSELF 37
LET OTHERS INSPIRE YOU IN YOUR LEARNING 38
READ ORIGINAL WORKS 38
GET REAL 38
STUDY WITH A MASTER 39
BROADEN YOUR EXPERIENCES 40
TOP 10 WRAP-UP 40
REFLECTION QUESTIONS 41
SUGGESTED READINGS AND WEBPAGES 41
CHAPTER FOUR
Six Schools of Thought and Their Theories of Helping 45
PSYCHODYNAMIC SCHOOL OF THOUGHT 48
Psychoanalytic Theory 48
Analytical Theory 53
Individual Psychology 55
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CONTENTS ix
BEHAVIORAL SCHOOL OF THOUGHT 58
Behavioral Therapy 58
HUMANISTIC SCHOOL OF THOUGHT 61 Person-Centered 62
Existential 64 Gestalt 67
PRAGMATIC SCHOOL OF THOUGHT 70
Cognitive-Behavioral 70
Rational Emotive Behavioral Therapy 72 Reality Therapy 74
CONSTRUCTIVIST SCHOOL OF THOUGHT 76
Multicultural Counseling and Therapy 77
Feminist Therapy 79
Narrative Therapy 81
Solution-Focused Brief Therapy 84
FAMILY APPROACHES SCHOOL OF THOUGHT 86
Bowen Family Systems Therapy 86
Strategic Family Therapy 88
Structural Family Therapy 89
Family Therapies and Diversity 91
SUMMARY 92
REFLECTION QUESTIONS 92
CHAPTER FIVE
Case Examples for Integrating Theory into Practice 93
CLINICIAN CASE STUDIES 93 Case One: Evan 93
Case Two: Jill 95
Case Three: Garrett 97
Case Four: Lillian 99
Comment on the Cases 101
CLIENT CASE STUDIES 102
Case One: Tony 102
Case Two: Nancy 102
Case Three: Brenda 103
CONTENTS SUPERVISION CASE STUDIES 104 Case One: Grace 104 Case Two: Casey 104 Case Three: Dominic 105 Summary of Supervision Case Studies 106 PUTTING IT ALL TOGETHER 106 Importance Revisited 106 How Theory Is Found 106 Benefit of the ITS Model to the Field 107 References 109 Index 115
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A PERSONAL EXPERIENCE
Since our first years of teaching graduate counseling classes, students have often asked, “How did you decide your theoretical orientation?” This question is reasonable and understandable because students in the helping professions are frequently asked about their theoretical orientation. Thus, we began pondering the development of our own theoretical orientations, which centered inevitably around three core issues: personalities, mentors and supervisors, and clients.
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First, we contemplated how personality might play a role in the theories that we liked and the ways we worked with clients. For example, one of us is an outgoing, energetic person who reflects these traits in interactions with others, both personally and professionally, and who sets high standards and believes that, in general, people strive to do what they believe is right. The other tends to focus on philosophical understanding, however, and consequently practices existential questioning in everyday life. These personal tendencies greatly influence our theories. One of us focuses on social and humanistic theories, while the other works with theories that have strong philosophical foundations. Personal qualities, values, actions, and assumptions clearly have an impact on our theoretical orientations and consequently on our work with clients.
Next, we thought about our mentors and supervisors and the various theoretical orientations they espoused. For instance, one mentor was very clearly humanistic and relied on Gestalt interventions. Some faculty members were fairly diverse in their theoretical orientations and championed constructivist, client-centered, cognitivebehavioral, and ecological approaches. One clinical supervisor said that he was a “planned eclectic.” These mentors and supervisors greatly affected our choices of theoretical orientation. Their feedback, guidance, and expectations were always tinted by their theoretical orientations. As a result, we knew that they had affected our choices as well; we were just not sure how.
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Acknowledging that we had been exposed to a wealth of theoretical orientations, we began to think about past and present clients with whom we had worked. We thought about how effective our theoretical orientations were for them. We c oncluded that each client must have also affected us as we selected our theoretical orientations. Despite, or perhaps because of, our examinations of these theoretical orientation issues, we seemed to answer students by saying, “You just figure it out as you go along.
When a theory really ‘fits’ for you, you will know it.”
But we knew this answer was not satisfactory. We remembered all too well our first years as helping professionals. We had often been quizzed about our own theoretical orientations and yet we had not been given any tools other than the required survey course in major theories to guide us. As we recounted our own similar struggles, we were reminded in many ways just how important theoretical orientation is in the helping professions. Thus, we wanted to offer clinicians and our students specific strategies to use in developing their theoretical orientation.
THE BIG PUZZLE
Selecting a theoretical orientation is typically a puzzling experience for students in the helping professions. A common goal of training programs is to teach effective helping skills. Academic programs also strive to help students conduct counseling in a way that is intentional and theory based. Consequently, students are frequently asked during the course of their graduate programs to state their theoretical orientation, typically by writing a paper about it. The assignment usually goes something like this: After reading a brief overview of counseling theories, which one do you believe fits your style of counseling?
Although this assignment is valuable, it may occur too early in the education of professional helpers. Because these students do not yet have enough clinical experience to guide them, they typically respond to the theoretical orientation assignment by picking theories that sound good on paper. Students at this stage usually have little understanding of the theories they choose. Unfortunately, many students continue to support, research, and apply their chosen theory, which ultimately limits their overall understanding of counseling theories. Some students simply choose the instructor’s theoretical orientation in hope of receiving a high grade on the assignment. Others pick the theory that they understand best. It is not that students are attempting to be lazy or manipulate instructors for a higher grade; rather, they are overwhelmed by the multitude of theories and therapeutic interventions to which they are exposed. Even when students find theories that they like on paper, they often feel lost and unable to apply theory to practice. Hence, most students in the helping professions find it extremely difficult to develop and articulate in both words and practice their own theoretical orientation. This dilemma can easily be compared to the experience of holding pieces to a jigsaw puzzle without having the picture on the front of the box that contained the puzzle pieces. In this situation, the corner and the edge pieces are easily identified, but the central pieces are difficult to discern.
On the journey to finding a theoretical orientation, the role of soul searching and clinical practice cannot be emphasized enough. Although this text does not offer
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direct clinical experience, it does provide for self-evaluation and soul searching. This text does offer applied methods to assist students and clinicians as they look for their theory of counseling. Within these pages you will first be offered the Intentional Theory Selection (ITS) model, which can serve as a guide to make finding your theoretical orientation a process. Tools, such as the Selective Theory Sorter–Revised (STS–R), will also be offered to serve as pragmatic assistants. Many resources, theory summaries, reflective questions, and case studies will also be offered to help clinicians and counselors-in-training begin to complete a puzzle that culminates in forming their theoretical orientation.
WHAT IS THEORETICAL ORIENTATION?
Before students in the helping professions can begin the voyage to finding and solidifying a theoretical orientation, they must have a working definition of the term theoretical orientation. This definition enables students, counselors, and the field in general to have a similar idea of what being theoretically orientated means. Poznanski and McLennan (1995) provide an excellent definition: A theoretical orientation is “a conceptual framework used by a counselor to understand client therapeutic needs” (p. 412). More specifically, theoretical orientation provides helpers with a theory-based framework for “(a) generating hypotheses about a client’s experience and behavior, (b) formulating a rationale for specific treatment interventions, and (c) evaluating the ongoing therapeutic process” (Poznanski & McLennan, 1995, p. 412). Thus, theoretical orientation forms the foundation for helping professionals in counseling, social work, and applied psychology. Having a theoretical orientation provides helpers with goals and techniques that set the stage for translating theory into practice (Strupp, 1955).
As students in the helping professions learn skills and theories, they often struggle with ways to integrate the information. Yet theory and practical application need a balance (Drapela, 1990). In counseling classes, for example, students may learn to express empathy and to confront, but they do not yet understand how to practice those skills with the intention that follows from a specific theoretical orientation. By choosing a theoretical orientation to practice and applying it, a counselor is able to use general counseling skills in an applied and intentional way.
THE HELPER’S TOOL BELT
Once counselors learn the basic helping skills, they have the opportunity to use them in an intentional way. In many ways, a theoretical orientation serves as a tool belt. The tool belt is filled with a multitude of tools that serve different functions. Among the tools, counselors will find the basic skills of confrontation, reflection of feeling, openended questions, and empathy. Additionally, counselors who have a theoretical foundation have tools specific to their theory. For example, a Gestalt counselor has the tool of the empty-chair technique, and the behaviorist counselor has the tool of behavioral contracting. Any of these tools can be useful in the construction (helping)
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process. All of the techniques have the potential of achieving the same desired result: helping the client. The difficult part is knowing when to use each tool. Continuing with the tool belt analogy, there is an old adage that says something like this: “If you only have a hammer, everything looks like a nail.”
For example, a student enrolled in a graduate counseling program is seeing a client at his practicum site. The client, a college freshman, is very frustrated with her mother and anxious about going home over the holiday break. The student believes that the client needs to express her feelings toward her mother. Depending on the counselor’s theoretical orientation, the tool selected for the expression of the client’s feelings may vary. If the counselor prefers rational emotive behavioral therapy (REBT), he may explore with the client her beliefs about going home for the holidays. If the counselor works from an existential framework, he might encourage the client to be authentic with her mother regarding her feelings of frustration. If the counselor ascribes to Gestalt theory, however, he may decide to use the empty-chair technique, prompting the client to express her feelings during the session. In this particular case, the counselor decides to use the empty-chair technique. The intervention looks somewhat awkward, and the counselor is clearly uncomfortable with the intervention and the processing of it with his client. After the session, the counselor says to his instructor, “Wasn’t that awful? I can’t believe it didn’t work. I really thought the c lient would like it.” Unfortunately, the counselor picked an intervention that really was not in his typical tool belt because his natural theory was REBT. He used an intervention, a tool that was not congruent with his theory. Although you can use a wrench to pound a nail, it will likely not feel right and may not be as effective.
WHAT CAN A THEORETICAL ORIENTATION DO FOR ME?
A theoretical orientation provides helpers with a framework for therapy that sets the foundation for intentional counseling. For the counselor, being intentional is a prerequisite to ethical and effective helping. Theory is an important factor in structuring therapy and directing interventions (Hansen & Freimuth, 1997). Consequently, intentional counseling requires counselors to rely on their theoretical orientation to guide therapy. Thus, when counselors get lost in the therapeutic process, theory can provide a road map. Theory is also a way for counselors to organize and listen to data and information given to them by clients. A number of theories provide specific steps to treatment planning; these steps may assist counselors in being intentional and consistent in their role as a therapist. Ideally, counselors’ interventions stem from their theoretical orientation; however, human beings do not fit neatly into categories. Hackney (1992) has written eloquently about theory and process, stating that, like human nature, “client problems are typically multidimensional” (p. 2). The following is a clinical example.
Louis, a 23-year-old, Mexican-American male seeks therapy. During the initial interview, he states: “I am a loser. I have a college degree and can’t get a job. I don’t ask people out on dates because I know they’ll see immediately that I’m a loser. When I do
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go out to meet people, women seem to avoid me.” The therapist believes the client has a problem with self-esteem. While self-esteem is an important facet of the client’s experience, it needs to be viewed from a larger perspective. The client’s problem seems to encompass his thinking, feeling, behavior, and interactions with the world around him. A therapist who has a specific theoretical orientation will be able to view the client holistically, knowing that the theory will provide a road map for the therapy.
Espousing a theoretical orientation to helping has numerous benefits for both clinicians and the clients they serve. Specifically, a theoretical orientation provides ways to organize client information. An orientation can also help intentionality and consistency within the work of a professional helper. Although the helper should understand what a theoretical orientation is, why it is important, and what it can do for both the client and the counselor, this information provides little help to a counselor who must pick a theory from which to work. The ways in which others have picked a theory may help students understand where they can go to pick a working theory.
HOW HAVE OTHERS PICKED A THEORETICAL ORIENTATION?
Hackney (1992) noted that most helpers choose their theoretical orientation based on one of three considerations: (1) the theoretical orientation of the helper’s training program, (2) the helper’s life philosophy, and/or (3) the helper’s professional experience as a client. Some helpers also consider the evidence supporting the various therapies or even look at the common characteristics of effective therapies. While helpers commonly use these traditional methods to find their theoretical orientation, each has inherent pitfalls. The shortcomings of each of these methods will be discussed in order to provide a rationale for a new model of choosing a theory that is presented in Chapter 2.
First, initial training programs may or may not expose students to every theoretical orientation. For example, if faculty members at the same institution support the same theoretical orientation, they limit their students’ exposure to the myriad of available theories. Conversely, if students enroll in an academic program where every faculty member has a different theoretical orientation, the students may receive mixed messages about “effective” therapy. Another potential difficulty for students is underexposure to the process of developing a personal orientation because faculties choose not to discuss their own theoretical orientations in hopes of being unbiased in their teaching. Thus, a theoretical orientation to helping cannot be based solely on students’ training programs.
Second, some counselors base their theoretical orientation on their own personality and philosophy of life. This approach can also present difficulties. For example, counselors who are predominantly optimistic and believe the best about people may choose a humanistic approach. Other counselors may believe that people’s thoughts are the core of their problems and choose REBT as a way to help clients develop more rational thinking. Both beliefs ultimately influence how counselors perceive, interact with, and treat their clients, even if those clients have a personality and worldview
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much different from those of the counselors. Although theory provides a framework for working with most clients, counselors must remember that each client is unique. A counselor must remain both open to experience and flexible with clients.
The third way helpers determine their theoretical orientation is through clinical experience, even though helpers may realize that their theoretical orientation does not fit for all clients or clinical situations. For example, counselors who favor a humanistic orientation may have difficulty in career-counseling settings. While these counselors may be skilled at the reflection of feeling, genuineness, and rapport building that lay at the core of the humanistic approach, their clients who are seeking résumé reviews and job information may feel frustrated when they get a “listening ear” but not the results they expected, such as direct advice on finding an internship or tips on interviewing.
In such cases, counselors need to adjust their theory to fit the needs of the client.
The fourth strategy employed by counselors to determine their theoretical orientation is choosing an evidence-based theory. While this is a sound decision-making strategy, it may be difficult for counselors to find an evidence-based theory that fits their personality, values, and/or client needs. Those who choose their theory in this way limit themselves to theories that lend themselves to empirical testing and validation. For example, therapies that focus on helping clients strive toward actualization and personality change may not be easy to validate and thus may be ignored in the process of choosing a theoretical orientation.
Counselors not only must maintain their fundamental beliefs and values regarding the helping relationship but also must adapt their interventions to help the client. In the example of the humanist in the career-counseling situation, he may choose to hold onto the belief that people are basically good and striving for actualization. However, in an attempt to meet the needs of the client, the humanistic career counselor may be open to a change of perception—one that acknowledges that formal career exploration can lead to greater actualization. In another example, while attempting to be grounded in theory, a cognitive-behavioral therapist utilized cognitive techniques that were not appropriate for her client because the client had low intellectual functioning. In attempting to stay completely in harmony with her theory, the therapist was not meeting her client’s needs. Consequently, she had to adapt her style and take a more behavioral approach.
WHAT IF I’M ECLECTIC?
Most examples provided in the text thus far highlight a counselor with one specific theoretical orientation. However, many counselors do not believe that one size fits all and believe that they can best serve their clients by offering a variety of approaches to their clients. Thus, they believe there is better efficacy in applying different theories and techniques to different clients. In general, eclecticism has been found to be a practiced theoretical orientation (Norcross, 1997), with many offering it as their primary identified theory. However, some cautions about eclecticism should be noted. First, eclecticism requires extensive training and competency, which beginning counselors typically lack (Norcross, 2005). To truly be an effective, eclectic counselor, clinicians
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should be able to be intentional in their application of techniques. They should have a great understanding of what techniques to apply when specific symptoms present or specific client characteristics emerge. Often those that purport to be eclectic share that their goals include assessing their clients, identifying clients’ needs, and providing those techniques or therapies that would be most beneficial to the clients. This, however, takes a great deal of skill and knowledge. It is truly a daunting task, during the complex interchange of a therapy session, to assess a client and pull from one’s repertoire the “right” technique or the “right “therapy” that will meet a presenting client’s needs. In addition, many who identify as eclectic have not completely identified and acknowledged the differences between technique and theory. Most who identify as eclectic refer to the eclectic component of their work as the action stage where interventions are offered to clients. Thus a potentially more accurate way to describe their work is by saying that they offer a variety of techniques or interventions.
Most eclectic counselors have an overarching theory that guides their work. Although this may not be true of all eclectic counselors, in practice, most counselors have a theoretical orientation they lean toward or even consider their primary orientation. “Switching” theoretical orientations to meet client needs does indeed seem to make sense. In the field of counseling, however, theoretical orientation offers a framework for how a clinician might view development, pathology, and the counseling relationship itself. Altering one’s view, or application of, such constructs while in the middle of a therapeutic relationship would seem to be almost risky to the productivity of therapy and could even be confusing to clients. If a clinician is to choose eclectic as an approach, however, it would seem that he or she should have a vast understanding of the theories and therapies they hope to utilize with clients. Thus, the authors of this text and many others recommend that beginning counselors may be best served by developing a single theoretical orientation that works best for them and learning to be as effective as possible within that paradigm.
However, eclecticism is indeed endorsed by many counselors, so its merit should not be just thrown out. Sometimes eclecticism is titled strategic eclecticism, highlighting the intentionality and purposefulness of using a wide variety of therapies and techniques. However, the authors offer a reframe. There is a difference between being eclectic and applying a variety of techniques. A counselor who is truly eclectic in terms of theory would change fundamental beliefs about human development, psychopathology, and epistemology from situation to situation and from client to client. However, applying a variety of techniques while maintaining a firm foundation in a fundamental belief is a different process. For example, an existential therapist working with a client with a phobia may use systematic desensitization (an eclectic technique for a t raditional existentialist) while maintaining that removing such a phobia will enable the client to move toward greater actualization and live a more meaningful life (theoretically founded).
Being grounded in a theoretical orientation does not stop you from being flexible to the needs of clients. To truly serve clients, we should be fluid in the process and adaptable in the relationship. We should be willing, and competent, to be able to understand clients from a variety of perspectives. Their symptoms, characteristics, and immediate needs should affect how therapists work with clients. As a therapist
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works with diverse clients and their needs, however, flexibility and eclecticism in fundamental beliefs seems like a potential disservice not only to clients but also to therapists who strive to be congruent, ethical, and effective.
EMPIRICALLY VALIDATED THERAPIES:
ARE THEY BETTER?
Similar to those who choose eclecticism as an answer to the question of theoretical orientation are those who choose how to work with clients based on research. Some clinicians and researchers believe that the best way to decide how to work with clients is by examining the research and seeing what, through scientific inquiry, we know are effective therapies. Research in the fields of counseling, psychology, and the related helping professions has produced a variety of empirically validated therapies (EVTs), with a large number of those being “proven” (see Chamless et al., 1998) to work.
Those who promote using EVTs or empirically supported treatments (ESTs; see Parson, 2009) as the focus of their work worry less about what theory to “choose” and instead ask what technique or theory is “proven” to work with the client issue that is presented. To discover EVTs, specific techniques are typically applied to clients with an isolated or limited symptomology through the use of controlled research methods to see which therapies indeed prove to be most effective for specific clients and specific symptoms. This commonsense approach is becoming vastly popular through the helping professions; however, it does present some difficulties.
Many of these proven approaches specifically look at therapies that attempt to address one specific symptom. Most of the EVTs discovered do not promote client health and welfare or alleviate diagnosed disorders. They look instead at how specific symptoms can be reduced or eliminated. Thus, EVT techniques are predominately behavior-based because there is a propensity to measure symptoms while using these techniques.
Consequently, although the EVT argument is often presented as relevant when discussing clinicians choosing a theoretical orientation, most EVTs are not theories at all. This is partly because, for a therapy to be empirically validated, it must “be studied as a treatment for a disorder or problem, be manualized, and be validated either by two different studies done using a randomized clinical trials design, or by use of a single-subject design (traditionally of relevance primarily to behavioral therapies)” (Bohart, O’Hara, & Leitner, 1998, p. 142). Thus, they may be categorized more accurately as techniques or collections of interventions. In addition, many of these therapies do not, as a theory would, provide conceptualization of clients, perspectives of development, or frameworks for the progression of therapy. They are focused on the relief of specific symptoms and include approaches such as interactive behavioral therapy (IBT) for people with intellectual disabilities (Tomasulo & Razza, 2009), dialectical behavioral therapy (DBT) for people with borderline personality disorder (Hoffman & Steiner-Grossman, 2012) and for eating disorders (Safer, Telch, Chen, & Linhan, 2009), and cognitive behavioral therapy for panic disorder (Craske & Zunker, 2001).
Many of the studies validating these approaches analyze interventions and approaches with clients that have specific symptoms (Yalom, 2002) and not with
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clients with complicated diagnoses. Although there is scientific support for the use of empirically validated therapies, there is limited ability about generalizing findings to a diversity of clients and symptomologies. As Yalom (2002) states, however, “nonvalidated therapies are not invalidated therapies” (p. 223).
GUIDANCE FROM COMMON FACTORS:
DO THEY ALL WORK?
Theories vary greatly in their depth, complexity, and usefulness. In the counseling field, there really could be as many theories, and there likely are, as there are counselors. However, the theoretical approaches that are generally published are those proven to have some generalized effectiveness (Kottler, 1999). Some answer the question of choosing their theoretical orientation by looking at the characteristics from all theories of counseling and examining the commonalities and the effectiveness about all of them. This so-called dodo bird effect states that factors common to all the various counseling theories account for the efficacy of all of the currently practiced psychotherapy theories (Leibert, 2011; Wampold, 2001). This effect states that we can find common, curative characteristics (Grencavage & Norcross, 1990) that occur in counseling and therapeutic relationships to explain why therapy ultimately works.
Wampold sought data for differential efficacies among therapies but discovered the opposite. Wampold ascribed this to the common factors theory of uniform efficacy among all existing psychotherapies. The idea that common factors among the different counselors are what account for their efficacy was first proposed by Rosenzweig (1936). This concept received little attention until nearly 40 years later, when Luborsky, Singer, and Luborsky (1975) found empirical data to suggest that all therapies had nearly equal outcomes, thereby confirming the accuracy of the dodo bird effect. Since that time, numerous studies have been done and articles have been written that support the dodo bird effect (Assay & Lambert, 1999; Duncan, 2002; Wampold et al., 1997).
Assay and Lambert (1999) concluded from their empirical study comparing various therapies that specific factors or techniques accounted for only 15% of the variance in treatment outcome, whereas common factors accounted for the remaining 85%. Specifically, they found that client factors (what the client brings to therapy) accounted for the majority of the variance in outcome (40%), followed by relationship factors (30%) and by placebo, hope, and expectancy (15%). Wampold (2001) offered similar common factors, including alliance, allegiance, adherence, and counselor effects.
Of particular importance are Assay and Lambert’s (1999) expectancy factor and Wampold’s (2001) allegiance factor. Expectancy involves the clients’ belief in the credibility of the theory and thus their expectation that it will be helpful and produce positive change. Allegiance involves a condition similar to that of expectancy, except it is the counselor who must believe that the treatment he or she is offering is efficacious. The concepts of expectancy and allegiance parallel Frank’s (1973) assertion that counseling is most helpful when both the client and the counselor believe in its efficacy. Arthur (2001) expressed a similar sentiment regarding efficacy in his review
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of studies on factors contributing to counselors’ choices of theoretical orientation. These common factors lead to the first consideration for counselors-in-training when choosing a theoretical orientation: They must assess whether they believe in the theory themselves and whether they believe they can convey that conviction to clients sufficiently to gain their acceptance of the theory as well.
Finding what is common and effective in various theories of therapy has proven successful to researchers (eg., Grencavage & Norcross, 1990) and beneficial to clinicians (Halbur & Halbur, 2006) across the various counseling theories. If people accept wholeheartedly the premise of the dodo bird, then what theoretical orientation one chooses is not nearly as important as that a theoretical orientation is chosen. As stated above, research on common factors theory has suggested that, although all major theories have the potential for equally effective outcomes, counselors’ belief in their theory is critical to its actual effectiveness (Arthur, 2001; Assay & Lambert, 1999; Frank, 1973; Wampold, 2001).
ONCE I HAVE IT, HOW CAN I USE IT?
Once a counselor’s theoretical orientation is developed, it must be put into action. Counselors are often ready to jump in with one of the many techniques shown to be effective with clients (e.g., Erford, Eaves, Bryant, & Young, 2010). It is important to know first, however, how to move forward. Theoretical orientation is used as a blueprint to organize a client’s information as well as a tool to guide clinical decisions, diagnosis, intervention selection, and treatment planning. Theoretical orientation can help determine the direction of and activities used during the course of counseling. Certainly, counselors use theory to explain or conceptualize clients’ problems. According to Kottler (1999), theory is “the place to start when you are trying to sort out a complex, confusing situation” (p. 30). Similarly, Strohmer, Shivy, and Chodo (1990) suggest that counselors may also use theoretical orientation to confirm selectively their hypotheses regarding their clients. Not only does theoretical orientation help in case conceptualization, diagnosis, and treatment planning, but it may also allow for a clinician to behave ethically.
