COMPARISONS OF THEORETICAL COUNSELING MODELS PART 4

THE INFLUENCE OF THEORETICAL MODELS ON COUNSELING

The varying ideas and beliefs of counseling modalities greatly influence the manner and approach in which therapists help clients. Therapists need to use the theoretical approach most suited to each individual client’s issues to be most effective.

Cognitive Model

The cognitive model is one of the more popular theoretical models used by therapists. Cognitive therapy is brief, focused, time limited, and only deals with the presenting problem.

The major focus of cognitive therapy is on thinking patterns and their modifications. It also focuses on taking new ideas and acting them out. By examining the dysfunctional thinking and self-defeating thought patterns that keep clients from improving, therapists help clients create more satisfying relationships and functional lives.

Behavioral Model

The behavioral model helps clients through demonstrating accurate listening, concern, caring, acceptance, and understanding of the client as a unique person. For therapists to maximize their helping potential, they must first develop positive relationships with their clients, thereby ensuring greater understanding of clients’ issues and which intervention strategies to develop.

By involving clients in goal setting, therapists also provide them with enough motivation to succeed in acquiring adaptive and functional behaviors. Modern day therapists involve clients in the analysis, planning, process, and evaluation of their behavior management program.

Psychodynamic Model

Psychodynamics attempts to help clients by discovering how their past influences the present. Therapists using this approach often use free association as a tool as an aid to understanding past influences. Orthodox psychoanalysis gives special attention to sexual development during the Oedipal period. However, Jungians search for cultural archetypes in history that determine how we live our lives today, and family therapy explores how intergenerational family issues affect our present condition.

Existential Model

The existential model focuses on the meaning of human existence. Existentialism purports that people are responsible for their own lives. Using the existentialist approach, therapists help clients learn to drop their masks and become more open and self-trusting.

To help accomplish the aim of existential therapy, therapists demonstrate unconditional positive regard and empathetic understanding of clients’ internal frame of reference. Clients can become more mature and self-integrated through therapists’ reflecting clients’ feelings.

Family Systems Model

Family therapy has been compared by therapists as simultaneously running a circus with different acts. In the family systems model, therapists follow sequential stages in their attempt to help clients.

The first stage involves the first contact therapists have with their clients. During the first contact with family members, therapists connect with each person in a way that is intimate and meaningful. The second stage requires the therapist to become part of the family through trust and confidence-building with all family members. In this stage therapists use warmth, authority, and interpersonal skills to create connections with each family member.

Conclusion

While each theoretical approach and modality has its advantages and disadvantages, it is imperative that therapists choose the approach most suited to clients’ issues. For example, while there are some similarities, there are important differences between behavioral theory and existential theory. 

Behavioral approaches work best with clients who are more rigid in their thought patterns, are more comfortable with structure, and are very goal-oriented. Existential approaches work best with clients who are above average in intelligence, are comfortable with the more gray areas of life, and who are have good communication skills.

Behaviorism and existentialism are alike in that both theories encourage establishing a more humanistically-oriented, warm, genuine, and generally positive relationship with clients, influenced by respect and unconditional regard for clients. Rapport with clients is an essential requirement for building a solid therapeutic foundation in both approaches. However, while behaviorism strives to be structured, concrete, immediate, and focus on goal-setting, existentialism is very flexible in focusing on abstract, philosophical constructs that influence meaning in clients’ lives.

A behavioral approach is therapist-directed, whereas existentialism lets clients decide the flow of their sessions. Behaviorism’s focus on goals contrasts with existentialism’s focus on clients’ beliefs about life and relationships and letting clients’ discover themselves through dialog and introspection. Finally, behaviorism focuses on the extrinsic or outside world and behavior, while existentialism concerns itself mainly with the intrinsic or internal world of clients, their thoughts, feelings, and attitudes.

While both approaches have the goal of alleviating clients’ suffering, their methods are very different. Yet, each is a valid approach, depending on the type of client, their issues, time allowed for therapy. Therefore, all theoretical approaches can be useful if applied appropriately. It is therapists’ responsibility to be knowledgeable about the commonly used modalities so that they know how, when and with whom to apply a particular therapeutic approach, thereby maximizing their therapeutic potential.

SEE POSTS:  COMPARISONS OF THEORETICAL COUNSELING MODELS  PARTS 1, 2 AND 3

COMPARISONS OF THEORETICAL COUNSELING MODELS PART 1

CURRENT STRATEGIES USED BASED ON THEORETICAL ORIENTATION

Ideally, the strategy counselors use to treat clients are based on specific theoretical orientations they chose that are most appropriate for the presenting problems of clients. Five theoretical orientations commonly used are cognitive, behavioral, psychodynamic, existential, and family systems. Each of these theories purports different strategies as the best method for treating clients.

Cognitive Strategies

Cognitive therapy is used to treat common presenting issues such as substance abuse, anxiety, and depression. One of the cognitive strategies currently used is A-B-C-D analysis that is closely associated with rational-emotive therapy. In A-B-C-D strategy, A represents the activating event, B represents the clients’ belief system, C presents the consequence produced by the interaction between A and B, and D represents the disputation of such irrational beliefs and thoughts. The goals of the A-B-C-D modality, as in many of the strategies used in cognitive therapy, are designed to help “the client modify existing thought patterns, or remind the client to avoid undesirable thought, or even help the client assess events more constructively”. The main goal, therefore, is to change thoughts so that a positive change in feelings and behaviors of clients can follow, thereby alleviating clients’ distress.

Behavioral Strategies

Behavioral therapy is another commonly used approach in helping clients resolve issues. The general goal of behavioral therapy is to “help clients develop adaptive and supportive behaviors to a variety of settings”. Phobias are usually treated with behavioral therapy.

One of the most important strategies of behavioral therapy is goal-setting which allows clients to translate their concerns into specific therapeutic tasks. Goal setting also encourages the client to take small, successive steps toward resolving their issues. Therapeutic goals must be concrete, observable, and measurable and developed by both client and counselor to be specific and realistic.

In most cases, client-involvement in designing their goals is paramount, thus increasing the likelihood of their motivation and commitment in goal completion. For example, behavioral contracts are commonly used to help clients feel more committed to completing a task because contracts require clients to decide which behaviors they want and are able to attain.

Psychodynamic Strategies

Psychodynamic therapy places emphasis on clients’ unconscious processes. Therapists using a psychodynamic approach attempt “to deal with underlying characterological changes”. Therapists usually play an authoritative role and encourage clients’ transference to identify and resolve clients’ issues. In contrast, however, the free association psychodynamic modality often used requires therapists to become more like teachers/consultants rather than parental figures. Free association allows clients to freely report whatever enters their mind without bias or criticism from therapists thereby aiding unhampered reporting of clients’ unconscious mind.

Existential Strategies

Existential therapy allows clients to explore the meaning of life and their human existence. The existential approach is useful in helping clients examine issues of personal meaning in their lives and realize their ability for empowerment. Techniques of existentialism are extremely flexible.

Four steps essential in using an existentialist approach are: (1) being in the moment, (2) integrating the felt experience into primary relationships, (3) making connections to the past, and (4) integrating what was learned.

By including these steps, both therapists and clients are better facilitated in exploring the world of clients, thereby identifying presenting issues and possible solutions.

Family Systems

A systemic view “sees the family as the primary unit and holds that all the members of the family are important contributors to clients’ psychological functioning and development”. The family systems approach allows clients to separate the person from the problem, reduces guilt, and helps clients in joining with other family members to defeat the problem. Therapists using a family systems approach often use narrative therapy to help teach clients to externalize rather than internalize their problems.

 (I wrote this post for students and practitioners of psychology/therapy; however, I believe it contains much interesting information for the layperson, especially those interested in psychology and/or philosophy.)

SEE POSTS:  PARTS 2, 3 AND 4  COMPARISONS OF THEORETICAL COUNSELING MODELS

INDIVIDUAL THERAPY, THEORETICAL ORIENTATION AND GROUPS

I wrote this post for students and practitioners of psychology/therapy; however, I believe it contains much interesting information for the layperson, especially those interested in psychology and/or philosophy.

INTRODUCTION

The choice of theoretical approach practitioners use in their efforts to conduct the most effective groups raises many questions. How can individual needs be best served? How deep do therapists need to delve into the psyche of clients? What are clients’ level of cognitive functioning? How well can both therapists and clients conceive of and discuss life’s issues and meanings? How important is the need for immediate relief of psychiatric symptoms? What are clients’ and therapists’ strengths and weaknesses? How flexible and integrative are therapists? What length of time are both clients and therapists willing to devote to treatment? What are the resources for treatment? What are the money, social support, education, and development factors? What are clients’ and therapists’ biases?

One of the most important questions, however, is: What are the sources of clients’ problems? Deciding on a group theoretical approach is one of the first steps in the discovery process because focusing on methods of getting at the root causes of clients’ issues can better serve their mental health needs.

THEORETICAL METHODS

To find underlying sources of clients’ dysfunctions clinicians need to look at methods of eliciting information on sources of dysfunction. In focusing on what appears to be the obvious—that clients are people, not pigeons (that is, just laboratory subjects)—it appears imperative clinicians approach clients with those attributes that historically appeal to humans.

Warmth, kindness, caring, and respect all increase the likelihood of engendering positive and productive responses from clients. A humanistic approach needs to be the starting, middle, and ending points in assessment. Combining this general approach with other theoretical approaches can help mental health practitioners elicit more accurate information.

Humanism maintains that clients know the answers to their problems within themselves. However, it is up to therapists to open the door to this cache of knowledge. By encouraging client cooperation and participation, a humanistic approach helps open the door to client-understanding and problem treatment, and helps close it by bringing closure, thereby completing the phases of effective treatment. The humanistic approach is especially valuable because it seems to be effective in building positive relationships with most people, regardless of their differences. Whatever theory is employed in making assessments, it would seem that the method of approaching and implementing those theories depends heavily on incorporating a humanistic approach when conducting groups.

The next layer of discovery appears to lie in examining client behaviors. Behavioral learning theory focuses on what is observable in clients. Behavior is the crust of clients’ psyches. Clinicians can see behavior and measure it—it helps them gain a foothold in understanding clients’ dysfunction. Based on the concept of rewards and punishment, behavioral theory promotes the belief that what can be learned, can be unlearned. But by addressing outward manifestations of dysfunction, can we adequately address the underlying issues? Behavioral theory gives therapists a concrete starting point for effective assessment of individuals’ suitable for groups. However, because outward manifestations are the most superficial aspect of clients’ issues, therapists need to dig deeper to find out what causes these behaviors.

In agreement with social learning theory, mental health practitioners can assess societal and relationally conditioned behaviors that contribute to clients’ dysfunction. By combining both behavioral and social learning theories, practitioners can further enhance their ability to understand clients’ issues and, thereby, their suitability for a particular group. Exploring added dimensions of clients’ worldviews, belief systems, and how they interact resulting in decisions a greater understanding of behavior emerges.

But what is the next step? Do clinicians focus on understanding and changing client behaviors based on their social context or clients’ personal habits or can comprehensive positive change be facilitated by revising clients’ external behaviors alone? Which comes first—the chicken or the egg? In order to understand clients’ outer manifestations, it seems more effective for therapists to focus on clients’ inner world. Part of clients’ inner world consists of the way clients’ think. Therefore, to promote more effective individual suitability for groups, clients’ cognitive functions need to be examined.

Approaching assessment from a cognitive view focuses on thoughts that set up behavior, which in turn helps determine social learning. Cognitive assessment also helps clinicians understand clients’ thoughts that lead to the distressing emotions that usually bring them to therapy in the first place. Therefore, tailoring questions to elicit clients’ thoughts and beliefs leads to more readily available conscious information that facilitates group determination.

According to cognitive theory, therapists can then focus on fostering change in clients’ faulty thinking to facilitate behavioral change. Although many studies seem to indicate that changing thought processes can lead to changes in behaviors, it begs the question: From where do clients’ dysfunctional thinking stem? Are not behaviors external symptoms of deeper issues? Examining sources of cognitive deficits and, therefore, resultant dysfunctional behaviors, takes therapists another step deeper into clients’ psyche.

Once therapists are able to elicit disclosure from clients, they can then apply clients’ thoughts and beliefs to understanding reasons for their behaviors, and help them arrive at a possible diagnosis. Ascertaining a basic understanding of individual client’s issues then promotes better decision-making as to whether or not a particular group will be appropriate for the client.

http://www.mind-mapping.co.uk/make-mind-map.htm

Exploring clients’ philosophies provides a roadmap for challenging faulty thinking. Psychologist and philosopher William James described philosophy as “an unusually stubborn effort to think clearly. (Fulford, et al., 2001, p. 130)” However, clients’ philosophies are often not products of clear thinking. If helping clients think clearly improves clients’ functioning, then the next step in assessment requires understanding their muddy thinking.

An effective understanding of clients’ cognitions requires putting those cognitions into concepts. To help clients answer questions such as, “What does it all mean?”, and “Why did I do that?” practitioners must also be clear about their personal beliefs, philosophies and thinking. Critical thinking is key to paving the way to client-understanding.

An existential approach to individual client assessment can help clinicians sort out how clients’ philosophies affect and motivate them and learn more about their cognitive capabilities. If a penchant for philosophizing and an above average intellect is determined, it may be helpful for that client to participate in a group with an existential framework.

Existentialism is useful for tying environmental, behavioral, cognitive, and affective aspects of clients’ issues together into a cohesive and coherent picture. Without assessing the totality of who clients are, including their philosophies, therapists’ subsequent efforts at effective diagnosis and treatment are significantly hampered.

References by request.