Counseling Theories and Techniques

Helping Relationship

  • Considerable research indicates the counseling relationship impacts counseling success.
  • Counseling theories provide the philosophy and strategies for building and maintaining relationships.
  • Four key elements:
    • Human relations core: Empathy, respect, genuineness (Carl Rogers).
    • Social influence core: Competence, power, intimacy. Expertness, attractiveness, trustworthiness (Stanley Strong).
    • Skills core: Microskills - attending, inquiry, reflection (Allen Ivey).
    • Theory core: Understanding self, interpersonal relationships, client problems, and effective interventions.

Psychoanalytic (Sigmund Freud)

  • Personality structure:
    • Id: Unconscious motivation, pleasure principle.
    • Ego: Controlled by the reality principle.
    • Superego: Internalized ethics.
  • Therapy techniques:
    • Free association.
    • Interpretation of dreams and client material.
    • Transference (client projections onto therapist).
    • Countertransference (therapist projections onto client).

Neo-Freudians

  • Moved away from Freud's emphasis on the id, focusing more on the ego and sociodynamic forces.
  • Karen Horney:
    • Security is the major motivation; anxiety arises when it's not achieved.
    • Irrational attempts to mend relationships can become neurotic needs.
  • Erich Fromm:
    • Individuals must connect with others for self-fulfillment (social character).
    • Society offers chances for mutual love and respect.
  • Harry Stack Sullivan:
    • Social systems (interpersonal) approach for understanding behavior.
    • Behavior understood via social interactions, not linear mechanisms.
  • Other neo-Freudians: Otto Rank, Wilheim Reich, Theodore Reik.
  • Carl Jung and Alfred Adler are discussed later.

Object Relations Theory

  • Based on psychoanalytic concepts.
  • Object relations: Interpersonal relationships represented intrapsychically.
  • Freud: Object = significant person/thing, target of feelings/drives.
  • Object relations shape current interactions in reality and fantasy.
  • Four developmental stages (first 3 years):
    1. Fusion with mother: normal infantile autism (first 3-4 weeks).
    2. Symbiosis: with mother (3rd-8th month).
    3. Separation/Individuation: (starts 4th/5th month).
    4. Constancy of self and object: (by 36th month).
  • Successful progression provides a secure base for development, fostering trust.
  • Disruptions can lead to attachment, borderline, and narcissistic disorders.
  • Margaret Mahler: Psychological Birth of the Human Infant.
  • Heinz Kohut and Otto Kernberg are also key figures.

Person-Centered (Client-Centered, Rogerian)

  • Rogers opposed the directive psychoanalytic approach.
  • Focused on the person's phenomenological world, reflecting their communication.
  • Process of becoming, self-actualization, and client-counselor relationship were critical.
  • Shifted focus from past to present, emphasizing feelings.
  • Counselor qualities:
    • Unconditional positive regard.
    • Genuineness (congruence).
    • Empathic understanding.
  • These are core facilitative conditions.
  • Rogers' books: Counseling and Psychotherapy (1942), Client Centered Therapy (1951), On Becoming A Person (1961).

Gestalt (Frederick 'Fritz' Perls)

  • Based on existential principles, present-focused, holistic systems viewpoint.
  • Individuals experience needs; the most prominent need is the 'figure,' others are 'ground.'
  • Meeting the need completes the 'gestalt,' and a new need emerges.
  • Therapy aims to help individuals become whole, completing 'gestalts.'
  • Key concepts:
    • Personal responsibility
    • Unfinished business
    • Awareness of the ‘now’
  • Experiential therapy, encouraging client responsibility.
  • Counselor uses confrontation, encourages experiencing and finishing business.
  • Techniques: Role-playing, two-chair, dream work.
  • Client, not counselor, does the interpreting.
  • Perls' books: Gestalt Therapy Verbatim and In And Out of the Garbage Can.

Individual Psychology (Alfred Adler and Rudolph Dreikurs)

  • Belief in individual uniqueness influenced by social factors.
  • Each person feels inferiority and strives for superiority.
  • Lifestyle: unified life plan giving meaning to experiences (habits, family, career).
  • Counseling goals:
    • Help client understand lifestyle.
    • Identify social and community interests.
    • Explain clients to themselves and overcome inferiority.
  • Techniques: Insight-oriented such as life histories, homework, paradoxical intentions.

Transactional Analysis (Eric Berne)

  • Personality has three ego states: Parent, Adult, Child.
  • Life script develops in childhood, influencing behavior.
  • Transactions can be 'games' to avoid intimacy.
    • Complementary transactions (Adult to Adult) = good communication.
    • Crossed transactions (Adult to Child & Child to Parent) = communication barriers.
  • Goal: Teach the language and ideas of TA to recognize ego states and analyze transactions.
  • Techniques: Teaching, diagnosing, interpreting, contracts, confrontation.
  • Berne wrote: Games People Play.
  • Thomas Harris wrote: I'm OK-You’re OK.

Existential (Rollo May, Victor Frankl, Irvin Yalom)

  • Other Existentialists: Soren Kierkegaard, Paul Tillich, Martin Heidegger, Jean Paul Sartre.
  • Phenomenology is the basis.
    • Study of direct experiences taken at face value.
  • Freedom of choice and responsibility for one's fate.
  • Search for meaning and struggle with loneliness.
  • Anxiety and guilt are central:
    • Anxiety = threat of non-being.
    • Guilt = failure to fulfill potential.
  • Goal: Understanding one's being and awareness of freedom and responsibility.
  • Authentic relationship is important.
  • Client-centered techniques are appropriate.
  • Logotherapy (Victor Frankl): individuals find meaning in their life journey.
    • Motivation to find meaning.
    • Freedom to choose actions, thoughts, and reactions.
    • Personal responsibility with freedom of choice.

Cognitive and Behavioral Counseling

  • Proponents: Joseph Wolpe, Donald Meichenbaum, Aaron Beck, Albert Bandura.
  • Albert Ellis (REBT) and Arnold Lazarus (Multimodal Therapy) are often included.
  • Based on stimulus-response and stimulus-organism-response paradigms.
  • Behavior is learned and can be unlearned/relearned.
  • Goals: Identify antecedents and reinforcements of behavior.
  • Counselor helps create learning conditions and might directly intervene.
  • Goals are behaviorally stated.
  • Techniques: Operant/classical conditioning, social modeling, problem-solving, direct training, reinforcement, decision making.
  • Most counselors establish a strong relationship with the client.

Dialectical Behavior Therapy (DBT)

  • Developed by Marsha Linehan for borderline personality disorder.
  • Used for a variety of disorders (traumatic brain injury, eating, mood).
  • Used with adolescents and adults; includes a group component.
  • Family members may be involved with adolescents.
  • Principles: cognitive-behavioral techniques, emotional/cognitive regulation via trigger identification.
  • Dialectical principle: recognizing two sides to situations (accepting change/resistance).
  • Long-term intervention due to skill acquisition.
  • Four modules:
    1. Mindfulness: present moment, nonjudgmental.
    2. Distress tolerance: accepting self and situation.
    3. Interpersonal effectiveness: asking for needs, saying no, coping with conflict.
    4. Emotion regulation: identifying emotions, reducing vulnerability, increasing positive emotions.
  • Tools: Diary cards, chain analysis, milieu dynamics.
  • Counselor must have training in required skills.

Rational Emotive Behavior Therapy (REBT)

  • Albert Ellis: Our interpretation of events, not events themselves, influences us.
  • Individuals have the potential for rational thinking.
  • Irrational beliefs learned in childhood are continuously re-indoctrinated, leading to inappropriate behavior.
  • Concepts: Belief system, self-talk, 'crooked thinking'.
  • A-B-C-D-E system:
    • A = external event.
    • B = belief (self-verbalization).
    • C = consequent affect (rational/irrational).
    • D = disputing irrational belief.
    • E = effect (cognitive change).
  • Emotive techniques: role-playing and imagery.
  • Self-talk is the source of emotional disturbance.

Multimodal Therapy

  • Arnold Lazarus' comprehensive, holistic, and eclectic approach with behavioral ties.
  • Addresses seven interactive modalities (BASIC ID):
    • B = Behaviors (acts, habits, reactions).
    • A = Affective responses (emotions, moods).
    • S = Sensations (five senses).
    • I = Images (self-perception, memories, dreams).
    • C = Cognitions (insights, philosophies, ideas).
    • I = Interpersonal relationships (interactions).
    • D = Drugs (biology, including nutrition).
  • Assessment of all modalities is necessary.
  • Techniques: anxiety-management, modeling, imagery, relaxation, assertiveness, biofeedback, hypnosis, bibliotherapy, thought stopping.

Reality Therapy (William Glasser)

  • Based on Choice Theory; Glasser continues to refer to it as Reality Therapy.
  • Individuals control their fate and lives.
  • Perceptions control behavior; behavior fills needs.
  • Five genetically-based needs:
    1. Survival
    2. Love and belonging
    3. Power or achievement
    4. Freedom or independence
    5. Fun
  • Choice theory: We act to control the world to satisfy needs.
  • Taking responsibility is key.
  • Characteristics:
    • Emphasize choice and responsibility
    • Reject transference
    • Present-focused
    • Avoid focusing on symptoms
    • Challenge traditional views of mental illness
  • Wubbolding's WDEP system:
    • W- exploring client wants.
    • D- discussing actions and feelings.
    • E- self-evaluation.
    • P- planning for change

Feminist Therapy

  • Origins in the women's movement (1960s); no single developer.
  • Basic perspectives:
    • Gender is central.
    • Awareness of sociocultural influences.
    • Empower women and address societal changes.
  • Principles:
    • The personal is political.
    • Commitment to social change.
    • Value women's voices/knowledge.
    • Egalitarian counseling relationship.
    • Focus on strengths and redefine distress.
    • Recognize all types of oppression.
  • Therapists work toward societal change.
  • Techniques:
    • Gender-role analysis.
    • Empowering techniques.
    • Self-nurturance activities.
    • Power analysis.
    • Bibliotherapy.
    • Assertiveness training.
    • Reframing/re-labeling.
    • Groups.
    • Social Action.

Solution-Focused Brief Therapy (SFBT)

  • Doesn't address history or past experience of a problem.
  • Understanding the problem isn't necessary for solutions.
  • Positive orientation; clients construct solutions.
  • Focuses on what's working and exceptions to the problems.
  • Techniques:
    • Exceptions question: When did the problem NOT exist?
    • Miracle question: How would you know if a miracle happened?
    • Scaling questions: Identify changes on a scale; duplicate positive changes.
  • Important for managed care and employee assistance programs due to session number limitations.
  • Focus on resolving the immediate problem and developing coping skills.
  • Intermittent counseling: Seeing a counselor on/off as needed.
  • May not adequately address all problems; ethical considerations regarding competence and abandonment.

Narrative Therapy

  • Strength-based therapy; philosophical basis is social constructionism.
  • Believes independent objective reality exists through subjective experiences; client’s perception is valid.
  • Reality is based on language/words.
  • Clients' lives are stories in progress, told from different perspectives.
  • Stories use words to give meaning and determine feelings/attitudes.
  • Stories are subjective and constructed by the individual within a context (family, culture, etc.).
  • Therapist encourages other perspectives and interpretations.
  • Story might be 'deconstructed,' and new meanings substituted.
  • Focus is on rewriting the story by strengths and exceptions
  • Techniques:
    • Questions and clarifications.
    • Externalization and deconstruction (person is not the problem, the problem is the problem).
    • Re-authoring.
    • Documenting the evidence through writing of letters.

Integrative Counseling

  • Goes beyond eclecticism (using techniques from various theories).
  • Implies creating a model by synthesizing existing theories/practices.
  • Developing a personal theory based on values, worldview, education, and experience.
  • Counselor incorporates processes/techniques from other perspectives.
  • Results in an individualistic, congruent, and flexible theory.

Comparison of Theories of Psychotherapy

  • Summary of Corey (2012) on Basic Philosophies and Key Concepts from major counseling theories.

Psychoanalytic

*   Basic Philosophy: Human beings are determined by psychic energy and early experiences. Unconscious motives and conflicts are central to present behavior. Early development is critical.
*   Key Concepts: Normal development is based on the resolution/integration of psychosexual stages. Faulty personality results. Anxiety results from basic conflicts repression. Unconscious processes are centrally in current behavior.

Adlerian

*   Basic Philosophy: Motivated by social interest, goals, inferiority/superiority, life tasks. Emphasis on living cooperatively, interpreting events, influencing, and their capacity to create them. Style of life is created early.
*   Key Concepts: Unity of personality, viewing people subjectively, importance of life goals. Motivated by social interest, finding goals to give life meaning. Striving for significance/superiority, developing style, and understanding the family constellation. Providing encouragement and assisting clients in changing their cognitive perspective/behavior. \

Existential

*   Basic Philosophy: Central focus of human condition, self-awareness, freedom, fate, responsibility, anxiety, search for meaning, being alone/with others, striving for authenticity, dealing with living/dying.
*   Key Concepts: Experiential approach, core human conditions. Interest is in present and becoming. Has a focus on the future, and stresses self-awareness before action.

Person-centered

*   Basic Philosophy: Positive, inclination toward becoming fully functioning. Experiencing feelings denied to awareness. Increased awareness, spontaneity, trust in self.
*   Key Concepts: Potential to become aware of problems/resolve them. Faith is laced in the client's capacity for self-direction. Mental health is a congruent of ideal/real self. Maladjustment is the result of wanting to be something and what one actually is. The focus is on the present moments and on experiencing/expressing feelings.

Gestalt

*   Basic Philosophy: strives for wholeness and integration of thinking, feeling, and behaving. Key concepts include contact with self/others, contact boundaries, and awareness. Nondeterministic. Grounded and here and now and emphasizes awareness, personal choice, and responsibility
*   Key Concepts: Emphasis on experiencing the “what” and the “how” to accept self. Key concepts include holism, figure-formation process, awareness, unfinished business and avoidance, contact, and energy.

Behavior

*   Basic Philosophy: Product of learning. Product/producer of the environment. Based on classical and operant principles.
*   Key Concepts: Overt behavior, precision, specific plans, and evaluation. Attention is given to present behavior, which is based on principles of learning theory. Normal is learned, abnormal is the result of faulty learning

Cognitive behavior

*   Basic Philosophy: Incorporate faulty thinking, leading to disturbances. Cognitions are the major determinants of how we feel and act. Therapy is oriented toward cognition and behavior. Psychoeducational model, which emphasizes therapy as a learning process.
*   Key Concepts: problems may be rooted from childhood but the present thinking reinforces. Belief system is the primary cause of disorders. Internal dialogue plays a central role in one's behavior. Clients focus on examining assumptions and replacing them with effective beliefs.

Reality

*   Basic Philosophy: Based on choice theory, needing quality relationships to be happy. Problems are the result of our resisting the control by others or of our attempt to control others. Best achieve satisfying interpersonal relationships.
*   Key Concepts: Focus on what clients are doing and evaluating. 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

*   Basic Philosophy: Criticize traditional theories based on gender-biased concepts (androcentric, gendercentric, ethnocentrist, heterosexist, and intrapsychic). Constructs are gender-fair, flexible, interactionist, and life-span oriented. gender and power are at the heart of feminist therapy. systems approach that recognizes the cultural, social, and political factors
*   Key Concepts: Personal is political, therapists have to commit to social change, women's voices and ways of knowing women's experiences are honored, counseling relationship is egalitarian, therapy focuses on strengths and definition of psychological distress, and all types of oppression are recognized

Postmodern

*   Basic Philosophy: There are multiple realities. People create meaning in their lives through conversations with others. avoid pathologizing clients, take a dim view of diagnosis, Underlying causes do not matter. Focus on discovering client strengths resources. Solution oriented.
*   Key Concepts: therapy tends to be brief. The person that is not the problem, and problems tend to come and go. emphasis is on externalizing problems and looking for exceptions. Therapy consists of a collaborative dialogue

Family systems

*   Basic Philosophy: unit. behavior grows out in order is growing out of relationship with the family Key system. one pan of the system. will result in. other pans as well functioning with others.
*   Key Concepts: Focus is on communication patterns within family, both verbal and nonverbal. key concepts include differentiation, triangles, power coalitions, family of origin patterns.

Neurobiology and Psychotherapy

  • Brain growth depends on genetics and environmental interaction; experiences promote re-mapping of brain regions
  • Psychotherapy restructures neural networks
  • Triune model of the brain: principal locations and functions of the brain.
    1. Surviving brain is the stem and responds to danger. Controls automatic functions (flight-fight).
    2. Feeling brain (limbic system) is the emotion center, mediating feelings/thoughts, and storing memory.
    3. Cortex (Thinking brain) comprises thinking and executive functions, meaning-making and self-awareness.
  • Neuroplasticity, refers to formation of new neurons/reorganization due to new situations/experiences
  • Counseling approaches, skills, and interventions result in new neurons/connections and neurotransmitter production
  • CBT (Cognitive Behavior Therapy) promotes cognitive restructuring useful in trauma (PTSD) ; promotes new connections and memory reduction
  • Biofeedback (or neurofeedback) can