Counseling theories converge: Person, client, therapist

Establishing a theoretical orientation as a counselor is vital in working with clients in the mental health profession. This is common knowledge in the field because any well-grounded professional needs a basis by which to operate.

As a professional counselor, one must know how to respond to various complex individual and family issues, behaviors and emotions. If the counselor does not know how to respond to the client, then he or she may appear incompetent to the client. Actually, the counselor may be incompetent regarding that particular issue. Most theories propose that counselors are competent to address most of the major life issues that clients present within the therapeutic relationship, however. Therefore, being knowledgeable and well-trained in a particular theory may increase a counselor’s competence and confidence when working with clients in need.

A new counseling student may wonder, “What is the process for tailoring my own counseling theory?” Personally, I can trace my theoretical orientations back to several factors that include but are not limited to life experiences, personal beliefs and values, perspectives on how people change, my own work in individual therapy and professional experiences working with diverse client populations. These orientations include person-centered therapy, cognitive behavior therapy (CBT), brief psychodynamic therapy and motivational interviewing.

Theoretical orientation was originally formed by my life experiences. Part of my life experience was being raised in a home with parents who worked in a helping profession most of their lives. My father was a pastor for more than 40 years and the founder and headmaster of a private school for 13 years, while my mother served as a secretary in both of those arenas.

Some of my earlier memories involve observing my father modeling interpersonal skills among the parishioners he served. Some of those people were especially difficult. He would tell me, “Keith, you just have to love them and accept them where they are. Eventually, that love and acceptance will get through to them. It’s all about the relationship.”

Similarly, Carl Rogers, founder of person-centered therapy, attested that the necessary conditions for therapy are contained solely within the therapeutic relationship itself. At least six specific conditions emerge out of this relationships, including unconditional positive regard, genuineness and empathy, as referenced in the popular theories text Systems of Psychotherapy: A Transtheoretical Analysis by James Prochaska and John Norcross. I would say there is an excellent chance that if my father were alive today, he would identify with Rogers as it relates to how people change.

Throughout my life, I was able to test this “theory” as I connected with other people and made observations about how people change. I observed that, in fact, people do change within the context of how people relate to them. I originally learned my own version of “person-centered therapy” through the modeling of relationships from my father, but I learned later in life that the relationship is not the only necessary ingredient for helping within the counseling profession, even though it remains a foundational one.

Another theoretical orientation I identify with is cognitive therapy, also commonly referred to as cognitive behavior therapy. CBT posits that one’s emotions and behaviors are often caused or derived by one’s thoughts. In other words, if a person is depressed or anxious, then that person has certain cognitive errors or distortions that cause that person to be depressed or anxious. For example, a person experiencing severe anxiety and panic attacks might have common thoughts such as “I’m going to die” or “I can’t handle this!” By confronting the cognitive error and replacing it with a more realistic thought (“This is uncomfortable, but it will pass on its own” or “This is tough, but I can handle it”), the person will reduce or even eliminate the anxiety completely.

I identify with this therapy largely because of my own psychotherapeutic work. I can attest to CBT’s efficacy in my own life. For example, I learned that my inner thoughts of “should” statements (“I shouldn’t be this” or “I should have done this”) exacerbate my personal anxiety. I realized that by increasing my own thought awareness, I could identify my cognitive distortions that were unrealistic or even completely false. Once I learned to be more aware of my thoughts, it helped me to reduce my anxiety significantly.

I have also experienced the importance of my changing beliefs through the years and how this has affected my emotional and behavioral life. From a spiritual perspective, my thoughts and beliefs about God, myself and others have also shifted the way I feel about those important aspects of my life. For example, I previously held the view that God expected a performance of good deeds in order to receive His love and acceptance. When I confronted that “spiritual cognitive error,” however, I was able to free myself from significant anxiety that had a spiritual basis.

In my therapeutic work with diverse client populations, I have also found it helpful to confront their thought and belief patterns and examine how these affect their other emotional problems. For instance, I worked with a client who had moderate to severe anxiety that often resulted in panic attacks and vomiting. The client stated, “I can’t figure out why I’m having anxiety. Things in life are going well.” In other words, he did not think he had any external or life circumstances that warranted anxiety and was therefore perplexed. I assigned the client to keep a thought journal in which he would regularly record his thoughts, especially during times of higher anxiety. After journaling for two weeks, he said he realized he had the following thoughts during times of anxiety: “I can’t handle this” and “If this happens, then I won’t be a good husband, and that would be unbearable.” The client was astonished that these thoughts were manifested during anxiety, and his awareness increased. We explored some cognitive restructuring around those thoughts, and he was able to form more realistic thoughts and beliefs given the situation. Four weeks later, he reported that he had not experienced any significant anxiety or panic attacks since our session. This was the first time he had been free of anxiety in over a year. Thanks to personal and professional experiences such as these, today I strongly identify with CBT.

When reading my theories textbook about psychodynamic therapies, I must admit I was a little surprised. After almost 11 years of working in mental health, I thought I had solidified my theoretical orientation. Then I read about the following themes that, according to Prochaska and Norcross, characterize brief psychodynamic therapy:

• Emphasis on past experiences
• Focus on client’s emotional expression
• Exploration of client’s desires, fantasies and dreams
• Emphasis on the therapeutic relationship
• Exploration of client’s attempt to avoid issues
• Focus on the interpersonal experiences of clients
• Identification of client patterns in relationships

I continued to be surprised as I read about the specifics of the therapeutic working alliance. This alliance is based on collaboration with the client about therapy goals, consensus on treatment tasks and a connection within the professional relationship. This alliance seems to merge well with my leanings toward person-centered therapy and Rogers’ themes. I also connected with the principle of consensus in treatment tasks because I have always viewed informed consent to be a living and ongoing process with the client. For instance, when I am working through an evidence-based treatment for PTSD with a trauma client, ongoing informed consent (specific phases of treatment) is a necessary collaboration in order for the client to feel a continued sense of safety and trust. Another theme from brief psychodynamic therapy is that therapists seem to be more empathic, similar to the tradition of person-centered therapy.

A final theoretical orientation I relate with is motivational interviewing (MI). MI is considered to be in the same category as other person-centered therapies. It is based on skills related to empathy and warmth, while focusing on working with clients who often are resistant to treatment. It was originally developed for resistant clients who were receiving substance abuse treatment. Four active elements of MI are expressing empathy, developing discrepancy, rolling with resistance and supporting self-efficacy.

Expressing empathy entails the therapist applying reflective listening skills to express a genuine concern for the client and a basic understanding of the client’s message. Developing discrepancy relates to identifying the difference between the client’s current behavior and deeply held values. Rolling with resistance involves the therapist avoiding any argument with the client because the client’s resistance is simply his or her way of voicing ambivalence. Supporting self-efficacy involves the therapist portraying that the client is capable of change. It is the client who is responsible for finding his or her own solution to the issue. Four important skills of therapists who operate from an MI orientation are open questions, affirmation, summaries and reflective listening. From my clinical perspective gained while working with the military population, I have discovered that MI helps veterans in establishing their own goals for treatment. I also believe that MI is helpful as a supervision model, and I am excited about utilizing it in my doctoral studies while supervising graduate counseling students.

Given my orientation to various counseling theories, I ask myself whether I am an integrative therapist who works across theoretical systems in a purposeful way, or whether I just pick and choose as I prefer without any rationale behind my choices. I would like to believe that I am more of an integrative therapist who chooses commonalities among systems in a purposeful manner concerning the theories I select. However, I must explore this on a deeper level to obtain an accurate answer.

When I reflect about this process, I discover common themes between the therapies of person-centered, motivational interviewing and brief psychodynamic regarding the important of the relationship, working alliance and assisting clients in developing their own goals. However, my leaning toward CBT is incongruent with the other therapies in some of these important aspects. Instead of the relationship being the “end all, be all,” CBT is oriented toward thoughts and how they affect behaviors and emotions.

I believe some of my incongruence is in conjunction with my own work in CBT and how it has helped me. I have experienced firsthand the effectiveness of CBT. Therefore, I have integrated it into my way of helping others. I have been helped, so I choose to help others in the same way I have benefited. Consequently, my integrative orientation is partly based on common themes between therapies and partly based on my personal experience within my own therapeutic work. This is how I resolve this discrepancy of sorts regarding my orientation.

What is the process of developing one’s own theory as a counselor? A counseling theory is not something that is solidified by simply reading a theories textbook and choosing from a plethora of options. Developing a theoretical orientation is initiated and enhanced by personal reflection, readings, working in the mental health field and life experience. Furthermore, it can be integrated by participating in one’s own individual therapy. It is derived from within, particularly from the beliefs and significant relationships of the counselor. It changes over time and is dependent upon personal growth or working with diverse populations. Counselors should not be surprised if they identify with a particular theory when they revisit those theories years later. I am a person, a client and a therapist, and I attest to this process.

 

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Keith J. Myers is a licensed professional counselor and doctoral student of counselor education and supervision at Mercer University. He is also an intensively trained eye movement desensitization and reprocessing therapist and serves on the American Counseling Association’s Ethics Committee. Contact him at keithm355@gmail.com.