Introduction to the Counseling Profession

Chapter 8

Individual Counseling:Brief Approaches

Chapter Topics

Introduction“With most insurance providers and state funding there are stipulations as to how many sessions will be provided to each individual. Therefore, if 12 sessions is what the state will provide, then it is up to the client to fully fund anything beyond that commitment.”

Because of this stipulation and others to be mentioned throughout this chapter, counseling professionals must be responsive in creating individualized treatment plans that fit within these time constraints.

Pioneers of Brief Counseling: Milton Erickson, Richard Bandler, and Jay Haley

Brief Approaches“It would be more accurate to assume that brief counseling is not so much about the number of sessions, but the establishment of a clear focus for the treatment.”

Background

Counselors using brief approaches are limited to a prescribed number of sessions prior to the onset of treatment with six generally being the minimum.

While the number of sessions may vary as a result of insurance stipulations, program structure, client schedule, and so on, the counselor is ethically responsible for providing an enriching therapeutic experience that promotes the welfare of the client.

Brief Approaches

Principles of Brief Approaches

One major area of differentiation for brief approaches over others is the lack of interest in the client’s history or the subconscious.

By focusing on the present, clients may experience less anxiety over past and future events they cannot change or control.

Clients may allocate resources to the pressing problem at hand.

By taking personal ownership of remediation it becomes that much more meaningful to the client.

Solution-Focused CounselingPioneers: Steve de Shazer and Insoo Kim Berg

Premise

Solution-focused counseling is “future-focused, goal-directed, and focuses on solutions, rather than on the problems that brought clients to seek therapy.”

The client holds the tools necessary for self-improvement.

Solution-Focused CounselingTechniques

With solutions in mind, the counselor uses talk therapy to facilitate the creation and achievement of goals by the client.

Counselors use compliments that offer validation and positive reinforcement.

Counselors and clients look for previous solutions to the same or similar problems that were successful.

Counselors help clients look for exceptions to the problem.

Counselors ask the “miracle question” and scaling questions to find solutions and measure progress.

Brief Cognitive-Behavioral Counseling

Premise

Behaviorists stress the significance of the specificity of goals to help alleviate the negative antecedents and consequences resulting from a progression of maladaptive behavior.

Cognitive therapy focuses on maladaptive thoughts that evolve around illogical representations of the self or irrational beliefs about the environment and those living in it. Psychological dysfunction, or pathology, is a result of faulty logic in one's cognitions.

By using behavioral techniques to manipulate cognitions and vice versa, the client stands a much better chance of recovery than merely treating just one component or the other.

“Behavior theory focuses on maladaptive behaviors, cognitive theory focuses on maladaptive thoughts."

Brief Cognitive-Behavioral Counseling

Pioneers: Too numerous to name

Techniques

Extinction and cue exposure procedures.

Positive and negative reinforcement and punishment.

Identifying and removing triggers.

Identifying and changing maladaptive thinking.

Rational-Emotive Behavior Therapy (REBT)

Pioneer: Albert Ellis

Premise

By adjusting one's irrational thoughts into more rational ones, positive adjustments at both the emotional and behavioral level will result.

“Rational emotive behavioral therapy (REBT) views human nature as including innate tendencies toward growth, actualization, and rationality as well as opposing tendencies toward irrationality and dysfunction."

REBT

Rational-Emotive Behavior Therapy (REBT)

Techniques

People experience undesirable activating events (A), about which they have distorted (irrational) or undistorted (rational) beliefs or cognitions (B). These beliefs then lead to dysfunctional or functional emotional, behavioral, and cognitive consequences (C).

Ellis' proposed A-B-C-D-E therapeutic approach utilizes a strong therapeutic alliance to help the client dispute (D) these irrational beliefs in order to elicit a new, socially appropriate effect (E)

Brief Theory in its Humanistic Form

Pioneers: Abraham Maslow, Carl Rogers, and Fritz Perls

Basic Components

Empathic Understanding Respect Exploration of Problems Exploration of Goals and Expectations Clarification of the Helping Role Assessment and Enhancement of Motivation Negotiation of a Contract Demonstration of Authenticity

“The humanistic school of thought is phenomenological in the respect that it focuses on the here-and-now while believing that individuals possess the basic inclination to become fully functioning.”

Brief Theory in its Humanistic Form

Person-Centered Counseling (Carl Rogers)

Premise

Client is the center of this approach. Views individuals in a positive light. Clients are the experts on their own lives. Helps clients in their quest for self-actualization.

Primary Principles

Unconditional positive regard. Warm, positive, accepting attitude. Accurate empathy. Help clients become more congruent and self-accepting. Positive relationship between counselor and client.

Brief Theory in its Humanistic Form

Gestalt Therapy (Fritz & Laura Perls)

Premise

The analysis of parts can never provide an understanding of the whole.

The client is an individual and product of the environment

Techniques

Teaches “the phenomenological method of developing awareness.

Focuses on the consequences of the interaction between the client and his or her environment.

Brief Theory in its Humanistic Form

Gestalt Therapy (Fritz & Laura Perls)

Techniques

Counseling is done through dialogue and conversation between the counselor and client to delve into the inconsistencies between the client’s interpretations and direct perceptions.

Focuses on the present, and asks more about the “how” than the “why” behind a particular phenomenon.

Uses experiments (e.g., empty chair).

Existential Brief Counseling

Premise

Central to existential therapy is Frankl's concept of the existential vacuum. "If meaning is what we desire, then meaninglessness is a hole, an emptiness, in our lives.

Takes a phenomenological approach that focuses on the here and now.

Concerned with how individuals relate to their objective world, to other human beings, and to their own sense of self.

An individual's reality is unique to that of anyone else's as it is something that no other human being in existence could ever fully experience.

Existential Brief Counseling

Six Underlying Assumptions

1. All persons have the capacity for self-awareness.2. As free beings, everyone must accept the responsibility the comes with

freedom.3.Each person has a unique identity that can only be known through relationships with others.4.Each person must continually recreate himself. The meaning of life and of existence is never fixed, rather it constantly changes.5.Anxiety is part of the human condition.6.Death is a basic human condition that gives significance to life.

Existential Brief Counseling

Techniques

Intent is to help the client reestablish meaning while taking ownership of one's actions.

Counselors help clients confront their fears.

Counselors help clients identify specific concerns rooted in the individual's existence.

When the concern is pinpointed, it serves as a frame of reference for meaning, understanding, and progress.

Counselors help clients to develop remedies to work through the client's current roadblocks.

Brief Approaches to Psychoanalysis

Premise

At the core of psychoanalysis is Freud's drive theory– The belief that individuals possess innate drives that express themselves through various unconscious processes.

Freud believed that people struggle to balance complete animalistic and innate pleasure-seeking impulses with the challenges of social constraints.

Theory of personality (i.e., the id, ego, and superego) and the five psychosexual stages (i.e., oral, anal, phallic, latency, and genital stages).

Brief Approaches to Psychoanalysis

Premise

Unconscious processes--although not visibly apparent on the surface--are significant in that they greatly affect one's behaviors and means of socialization.

The goal of therapy is often to change an aspect of one's identity or personality or to integrate key developmental learning missed while the client was stuck at an earlier stage of emotional development.

Brief Approaches to Psychoanalysis

Techniques

Focuses on the unconscious.

Concerned with past incidents and how their relate to the client’s current functioning.

The impetus for change being the resolution of a past, unresolved conflict.

Counselors help clients regain (or in some case acquire for the first time) a positive self-image.

Exposure: Exposing the client to an issue, it may finally be confronted in a productive, meaningful way.