Five Counseling Theories and Approaches

• • Psychotherapy theories provide a framework for therapists and counselors to interpret a client’s behavior, thoughts, and feelings and help them navigate a client’s journey from diagnosis to post-treatment.
  • Theoretical approaches are an understandably integral part of the therapeutic process.

Psychoanalysis/Psychodynamic Theory

• • • Psychoanalysis or psychodynamic theory, also known as the “historical perspective,” has its roots with Sigmund Freud, who believed there were unconscious forces that drive behavior.
    • The techniques he developed, such as free association, dream analysis, and transference are still used by psychoanalysts today.
    • Psychotherapists and counselors who use this approach direct much of their focus and energy on analyzing past relationships and, in particular, traumatic childhood experiences in relation to an individual’s current life.
    • Psychodynamic theory can be more time intensive in comparison to some short-term theories because it involves changing deeply ingrained behaviors and requires significant work on understanding one’s self.

Behavioral Theory

• • • Behavioral theory is based on the belief that behavior is learned.
    • Classic conditioning and operant conditioning are types of behavioral therapy.
    • Behavioral therapists work on changing unwanted and destructive behaviors through behavior modification techniques such as positive or negative reinforcement.

Cognitive Theory

• • • This counseling theory focuses on how people’s thinking can change feelings and behaviors.
    • Therapy based on cognitive theory is brief in nature and oriented toward problem solving.
    • Cognitive therapists focus more on their client’s present situation and distorted thinking than on their past.
    • Cognitive and behavioral therapy are often combined as one form of theory practiced by counselors and therapists (CBT).

Humanistic Approach

• • • Humanistic therapists care most about the present and helping their clients achieve their highest potential.
    • Humanistic theories include client-centered, gestalt, and existential therapies.
    • Client-centered therapy focuses on the belief that clients control their own destinies, and therapists need to show genuine care and interest.
    • Gestalt therapists focus on what’s going on in the moment.
    • Existential therapists help clients find meaning in their lives by focusing on free will, self-determination, and responsibility.

Holistic/Integrative Therapy

• • • Holistic and integrative therapy involves integrating various elements of different theories to the practice.
    • May include nontraditional therapies such as hypnotherapy or guided imagery.
    • The key is to use the techniques and psychotherapy tools best suited for a particular client and problem.

DIFFERENT MODEL/APPROACHES TO COUNSELING

• • This page provides an overview of three of the main approaches used by the professional counsellors: Psychodynamic, humanistic and behavioural – there are many more approaches but these three are the most commonly practiced.
  • While some professional counsellors use only one approach, others are more flexible and might use techniques from more than one method.

Psychodynamic Approach to Counselling

• • • Evolved from the work of Sigmund Freud (1856-1939).
    • Based on Freud’s idea that true knowledge of people and their problems is possible through an understanding of particular areas of the human mind: The Conscious, The Subconscious, The Unconscious.
    • Freud’s main interest and aim was to bring things from the unconscious into the conscious – psychoanalysis.
    • Freud maintained that the personality consists of three related elements: Id, Ego and Superego.
    • The main goal of psychodynamic counselling is to help people to balance the three elements of their personality.

Humanistic Approach to Counselling

• • • Childhood events and difficulties are not given the same importance as in the psychodynamic approach.
    • Assumes that everyone has an innate capacity to grow emotionally and psychologically towards self-actualization and personal fulfillment.
    • Encourages the client to learn to understand how negative responses to life events can lead to psychological discomfort.
    • Aims for acceptance of both the negative and positive aspects of oneself.
    • Humanistic counsellors aim to help clients to explore their own thoughts and feelings and to work out their own solutions to their problems.
    • Client-Centered Counselling: Developed by Carl Rogers, focuses on how clients feel at the present moment. Central theme is the belief that we all have inherent resources to deal with life. The client is the best expert on their own thoughts, feelings, experiences and problems. The counsellor does not suggest any course of action, make recommendations, ask probing questions or try to interpret anything the client says. A trained client-centered counsellor aims to show empathy, warmth and genuineness.
    • Empathy: Understanding the client’s issues from their own frame of reference.
    • Warmth: Showing the client that they are valued, non-judgmental acceptance.
    • Genuineness (congruence): Counsellor’s ability to be open and honest.

Behavioural Approach to Counselling

• • • Focuses on the assumption that the environment determines an individual’s behaviour.
    • Behaviour is ‘learned’ and, therefore, it can be unlearned.
    • Focuses on the behaviour of the individual and aims to help him/her to modify unwanted behaviours.
    • A counsellor would identify the unwanted behaviour with a client and together they would work to change or adapt the behaviour.
    • Problems which respond well include phobias, anxiety attacks and eating disorders.
    • Uses a range of behaviour modification techniques.
    • The aim would be that the unwanted behaviour stops altogether or is changed in such a way that it is no longer a problem.
    • Clients might be taught skills to help them manage their lives more effectively, e.g., relaxation techniques and positive reinforcement.
    • Another method involves learning desirable behaviour by watching and copying others.
    • Concerned with the outcome rather than the process of change.
    • Uses the skills of listening, reflection and clarification to assess factors relating to the undesirable behaviour.

THE COUNSELLING PROCESS

THE SIX STAGES OF THE COUNSELLING PROCESS

Stage one: Relationship building: The quality of the counseling relationship has the MOST SIGNIFICANT IMPACT on successful client outcomes. Involves counselor-offered conditions (empathy, unconditional positive regard, congruence, respect, immediacy, confrontation, concreteness, self-disclosure) and counselor- and Client-offered conditions.

• • • • Empathy: Considered the most important core condition. Involves listening, understanding, and communicating that understanding to the client. Multistage process: counselor’s emotional reaction, understanding client’s perspective, communicating empathy, client feeling cared for. Primary empathy (attending, listening, communicating accurate perceptions) and Advanced empathy (including self-disclosure, directives, or interpretations).
      • Unconditional positive regard: Communicating to clients that they have value and worth.
      • Congruence: Behaving consistently with thoughts and feelings (being genuine).
      • Respect: Focusing on the positive attributes of the client.
      • Immediacy: Communicating in the here-and-now of the session.
      • Confrontation: Pointing out discrepancies in client’s words and actions.
      • Concreteness: Helping clients discuss themselves in specific terms.
      • Self-disclosure: Making the self known to others.
      • Social influence model: Emphasizes counselor-offered conditions.
      • Working alliance: Agreement on goals, agreement on tasks, emotional bond.

Stage two: Assessment and Diagnosis: Assessment helps develop an in-depth understanding of a client and mental disorders. Diagnosis is “identification of the disease-causing pathogens responsible for a physical illness” (medical term). Involves standardized measures (psychological tests with norms) and non-standardized measures (clinical interview, life history). Four reasons for diagnosis: facilitating communication, indicating treatment strategies, communicating etiology, aiding scientific investigation. Diagnosis: DSM-IV TR based (Axis 1-5). Calibration: ability to read nonverbal feedback. Calibration cues include blotches, breathing, eye focus, skin color, voice, nostrils, muscle patterns, lips, chin/eye, hands.

Stage three: Formulation of Counseling Goals: Goals serve motivational, educational, and evaluative functions. Process goals (conditions for counseling to work, counselor’s responsibility) and outcome goals (what client hopes to accomplish). Five types of outcome goals: facilitating behavior change, enhancing coping skills, promoting decision making, improving relationships, facilitating client’s potential.

Stage four: Intervention and Problem Solving: Once goals are set, determine intervention strategy (group counseling, family counseling, couple counseling, mostly individual counseling). One way to conceptualize intervention is practicing problem solving: problem detection, definition, alternative solutions, decision making, execution, verification.

Stage five: Termination and follow-up: Ultimate goal is for counselors to be unnecessary. Components of termination associated with positive outcomes: discussion of end, review of course, closure of relationship, discussion of future plans. Follow-up session can be set up.

Stage six: Research and Evaluation: Important aspect contributing to the science of counseling.

SPECIFIC COMMON CONDITIONS THAT REQUIRE COUNSELING

• • CRISIS INTERVENTION
    • A crisis: a situation that seems dangerous and completely out of a person’s control. Indicators: crying, anger. Common causes: intense threat, complete surprise, loss of control/hope, no solution. How to identify from speech (panic, suicidal threats, statements like “This cannot be happening to me”). Possible solutions for crying, anger, no response, anxiety, threats of suicide.
    • GUIDELINES FOR CRISIS COUNSELING: W-E-A-T-H-E-R approach (Watch, Elicit, Ask, Treat, Help, Empower, Relate).

• • DEALING WITH SOME OF THE MOST COMMON EMOTIONS
    • 1. Denial: Help face reality through storytelling or enacting.
    • 2. Anger: (See table above for management).
    • 3. Guilt: Help them know they are human and events may be uncontrollable.
    • 4. Loneliness: Encourage sharing with friends, joining support groups, making friends.
    • In Summary: Involving self in activities, relaxing, focusing on future with hope helps.

• • PRE-POST-TEST COUNSELING IN HIV
    • Important for providing critical information. Pre-test counseling discusses confidentiality, test procedure, risk behavior assessment, risk reduction strategies, implications of positive test, coping strategies, consenting to test.
    • Testing procedure involves identifying HIV antibodies or the virus. Post-test counseling given after result: if negative, discuss window period, risk reduction, follow-up testing; if positive, discuss emotional responses, coping strategies, psycho-social support, disclosure, follow-up, safe sex, positive living information, nutritional supplements, follow-up tests for CD4, physical exam, importance of PAP smears for women. Post-Exposure Prophylaxis (PEP) can be provided within 72 hours of exposure.
    • HIV Pre-Test and Post Test Counseling for Pregnant Women recommendations outlined by CDC (universal testing, opt-out screening, repeat testing for high-risk or in high-prevalence areas).

• • RAPE AND SEXUAL ABUSE COUNSELLING
    • Definitions: Sexual harassment, sexual abuse/molestation/sexual assault, rape, defilement, chastity. Every person’s reaction is different. Suggestions for enabling disclosure: Listen (at their pace, avoid pushing details). Recognize Harm Done (accept the impact, show empathy). Convey Belief (accept what happened, don’t dispute). Recognise Strength and Courage (appreciate their disclosure and coping).

• • COUNSELING AND BEREAVEMENT
    • Definition: Bereavement is the period of grief and mourning after a death. Grief is a mental, physical, social or emotional reaction. Bereavement is adjusting to loss, no standard time limit or right/wrong way to feel. Bereavement counselling may provide support. Acknowledging loss is needed to move forward. Bereavement counselling helps find a place for loss and acceptance. Bereavement is about accepting, adjusting, and keeping memory alive.
    • Stages of bereavement: Accepting the loss, experiencing the pain, adjusting to life without them, moving on. Accepting that loss happened is essential. Experiencing the pain involves various emotions (sorrow, longing, guilt, numbness, anger, hopelessness, loneliness, despair). Adjusting to life without them involves the realization that life goes on. Moving on means channeling emotions into new things.
    • The importance of mourning: Involves rituals, allows us to say goodbye, affirms what happened.
    • Coping with grief: Can be like waves. Reactions like wanting to stay in bed, neglecting self, not eating, feeling unable to carry on, not working, taking feelings out on others are normal unless prolonged. Need professional support if drinking/drug use increases, suicidal thoughts, reckless/violent behavior.
    • Suicide grief: Complex, involves numbness, disorganization (loneliness, depression, trouble functioning, replaying events), reorganization (loss becomes part of life, return to routine).
    • How to tell if grief has become depression: Grief comes in waves, triggered by things; depression is pervasive. Signs of depression include guilt unrelated to loss, worthlessness, sluggishness, confusion, incoherent speech, difficulty with tasks, hallucinations.
    • Bereavement counseling: Offers understanding of mourning, explores obstacles to moving on, helps resolve conflict, adjust to new self, address depression/suicidal thoughts. Aims to get to a point of normal functioning. Remembering the lost person through anniversaries or memorials can help.