Chapter 7 - Integrating Theory & Counseling Skills

Chapter 7

Integrating Theory & Counseling Skills

© 2015. Cengage Learning.All rights reserved.

Integrative as Professional

• Between 33% and 70% describe themselves as eclectic or integrative in orientation– Refuse to affiliate themselves with any single

theory of practice• Eclectic means a practitioner is flexible enough

to use a variety of approaches, selecting the best available and appropriate, depending on what is indicated for a given client and situation


Integrative as Professional

• Eclectic has become associated in the field with a kind of haphazard grabbing of bits and pieces from various theories with no underlying rationale– Tend to prefer the word integrative• Suggests a thought-out, coherent integration of

theoretical ideas and interventions, grounded in a philosophy of human behavior


Transpersonal Psychology

• One of the most challenging new integrative theories in the counseling field

• Merges Eastern spiritual values, humanistic philosophy, cognitive therapy, and behavioral techniques

• Theorists ask us to conceptualize human growth as having the potential to transcend limits of body and self, of ego and personality, and of space and time


Transpersonal Psychology

• Counselors concerned with helping clients look so deeply within themselves that they experience a sense of connection with something greater than themselves– Could be feeling of oneness with nature,

humanity, the universe, or a higher power– Whatever the connection, it transcends one’s own

boundaries of self


The Therapeutic Relationship

• The quality of the therapeutic relationship– Any theory is functionally useless without the

cooperation, trust, and motivation of the client• Can be created and maintained only by a supportive,

respectful relationship

• The perception of shared power– Without approximate equality of responsibility

between counselor and client, the encounter is likely to be devoid of commitment, freedom, and independence


The Therapeutic Relationship

• The counselor’s understanding of theory– Before you can use an idea effectively, you must

understand its subtle complexities• Intellectual and attitudinal commitment– Credibility and enthusiastic application depend on

the counselor’s personal commitment to theory• Flexible integration within institutional

requirements– Counselors do not work in a vacuum


What Are Your Thoughts About Counseling?

• Do you think that real change can only take place when you resolve issues from the past, or can you focus purely on what is bothering you in the present?

• Do you believe that counseling should primarily focus on resolving strong emotions, or rather concentrate instead on thinking processes?


What Are Your Thoughts About Counseling?

• Should counseling ideally work with clients in groups, families, or individual sessions?

• Do you see counseling as essentially a form of individualized instruction, coaching, consultation, provocative dialogue, caring support, or a structure for the practice of new behavior?


Practice, Practice, Practice

• For many students, participation in the practicum or internship helps shatter the illusion that only one theory works

• Taking a class in counseling strategies also helps– Learn generic skills practiced by almost all

counselors, regardless of theoretical orientation • Includes interpretation, reflection, summarization


There is a Method

• Renewed flexibility is the logical result of your first actual experience as a counselor– You soon realize imitating a mentor is hollow

without an integrated understanding of the theory


There is a Method

• May have temporarily abandoned organized theory in attempts to get through practicum– Experimenting with a variety of ideas to alleviate

the personal anxiety that occurs while helping a client

• Adventurous students will try out a few of their own ideas, but such behavior may be risky unless it is successful


Never Forget Theory

• As an employed professional, you have the opportunity to test theories and techniques that were presented in the classroom

• Refinement of your theory is encouraged by colleagues and supervisors who have firm ideas of their own regarding the best ways to help clients


Never Forget Theory

• Fundamental concepts favored in textbooks and classroom are sometimes downplayed by the seasoned professionals– “Forget relying on theory. Around here we do

things our own way.”• Of course, the supervisors are really presenting

theories of their own choice


Pragmatic Approach

• Prior to any therapeutic action, a counselor asks several internal questions– What appears to be happening? – What do I wish to accomplish? – How will this intervention meet the desired goal?


Evidence Based Practice

• When counselors and other mental health professionals refer to evidence-based practice, they are usually referring to the concept of applying treatments that have been well documented in systematic research studies



• Clients have a right to be given treatments that have proven efficacy– May be unethical for counselors to diverge from

this principle • Managed care companies, government

programs (Medicare), and the marketplace require that counselors be held accountable for using the best-possible approach



• The counseling profession is enhanced in the eyes of the public when counselors, regardless of their settings, are consistent in their methods


Evidence Based Practice Research Steps

• Develop a question that can guide you in conducting a search for research evidence– “What are effective treatments in helping…?”

• Conduct a comprehensive search of the evidence– Can include databases, web sites, books, or other

source of relevant research-based information


Evidence Based Practice Research Steps

• Critically evaluate research you come across– Acquire knowledge of research methodologies to

discern the quality of studies you read• Select and implement the intervention that is

supported by the research evidence– Make sure you are competent at using this

treatment, or seek supervision from a counselor who has the requisite knowledge and experience

• Monitor the progress of the client© 2015. Cengage Learning.

All rights reserved.

Disorder and What Therapy to Use

• Attention Deficit– Behavioral Parent Training

• Bi-Polar– Psychoeducation for mania– Family-focused therapy for depression

• Borderline Personality Disorder– Dialectical behavioral therapy



• Depression and Generalized Anxiety– Cognitive therapy– Behavioral therapy

• Obsessive Compulsive Disorder– Cognitive exposure– Response therapy

• Panic Disorder– Cognitive behavioral therapy



• Post Traumatic Stress Disorder (PTSD)– Prolonged exposure– Cognitive processing therapy– Present-centered therapy– Eye-Movement Desensitization Reprocessing

(EMDR)


Insight Oriented Theorists Believe

• Cognitive-behavioral counseling performs well in research studies– Researchers themselves prefer this approach– Known as the “allegiance effect” and it biases

studies • Regardless of treatment used, the counseling

relationship and working alliance are the most powerful agents of client change– Repeatedly demonstrated in research


Insight Oriented Theorists Believe

• Clients, not treatments, are ultimately responsible for client change– Clients grow when they are active self-healers– Clients should have the right to choose between

growth-oriented treatment and a short-term symptom-relief approach

• Empirical research studies only tell us what clients report on a psychological test– May have little to with how clients experience life


Choosing A Theory

• In a sense, you allow a theory to choose you• Reflect upon what you believe in, then see

which best matches your own values and those of your clients– No matter which ideals, preferences, religious

values, interests, goals you cherish the most, your clients will come from a variety of different backgrounds, many of which will be in marked contrast to what you consider most important


Choosing A Theory

• Remember that your job is to help clients work through their issues within the context of their cultures– Not for you to impose your values on others

• Complete the Theoretical Dilemmas Inventory to find more about your preference and beliefs


Stages of the Counseling Process

• Assessment– Counselors use written instruments and clinical

observation skills to formulate ideas about client’s presenting complaints

– Working diagnosis is usually created• Helps practitioner make decisions with client regarding

treatment plan and structure

– Counselors use attending, listening, focusing, and observation skills to help build a relationship and decide how they will proceed



• Exploration– Reflections of feeling and content and questioning

and probing used to help clients clarify issues in the present and from the past

– Efforts are also devoted to building a solid therapeutic relationship

– Clients are helped to tell their story• Describe the circumstances that led them to their

current predicament



– Catharsis in being able to explore more deeply what is going on

– Collect background information related to family-of-origin issues, health and emotional history, and other relevant areas that may be helpful in the case



• Understanding– Can focus on issues from the past, current family

interactions, dysfunctional thinking, behavioral inconsistencies, or functional aspects of continuing to act self-destructively

– Regardless of emphasis, the intent is to help clients understand what they have been doing and why, and explore other options that may be available to them



• Action– Skills include goal setting, role-playing, and

assigned homework, and other strategies that help clients translate what they have been working on in sessions to their lives outside of sessions



• Evaluation– Counselors use skills and their knowledge of

assessment, evaluation, and research methods to help clients determine the extent to which they have reached desired goals

– Adjustments may need to be made to recycle the process back to previous stages as needed


Education

Chapter 7 - Integrating Theory & Counseling Skills