counseling and Psychotherapy theoriesin context and practice no.3

Nor Style Definitions
future, solutions, and reshaping the narrative or story the client is living. Therapy is effective
when therapist and client have a conversation or dialogue and co-create a reality wherein the
client engages in positive, solution-focused strategies for constructing and maintaining his or her
world.
It takes a long time to fully understand and become proficient at even one wellarticulated
theory. We’re asking you to give them all serious thought and to try out at
least three or four of them, while at the same time staying authentic to your own gifts,
skills, and leanings. Further, we believe you will eventually—perhaps much later—develop
your own ethical amalgamation of theory and technique, based on research, experience,
and your clients’ needs.
OUR BIASES
When soliciting guidance for writing this book, we asked a number of prominent scholars
and respected practitioners to answer the question “What criticisms do you have regarding
current theories of counseling and psychotherapy books?” In response, we received
the following advice from the renowned Italian strategic/constructivist therapist,
Giorgio Nardone:
Very often, while going through some current theory books, I have come across great contradictions.
While declaring that the text would not be following a particular preferred psychological
approach, already from the very first lines, one can easily deduce the authors’
Introduction to Psychotherapy and Counseling Theory and Technique 25
Table 1.1 Continued
Multicultural and Eastern theories of therapy. Multicultural theory focuses on the power of culture
in influencing human behavior, emotions, and values. This theory takes no position on the
iate goodness or badness of humans and generally accepts and tolerates diverse culturally
sanctioned behaviors. Psychopathology varies depending upon cultural experiences and beliefs.
Multiculturalists tailor their approaches to clients’ cultural orientation. Many multicultural approaches
acknowledge and embrace religious and spiritual perspectives. There are no clear explanations
for why clients benefit from therapy and spiritual counseling approaches are distinctly
nonempirical in their orientation.
Integration/eclectic theory. Psychotherapy and counseling integration acknowledges the potential
positive contributions of all theoretical orientations to effective therapy. No single theory is
viewed as more correct or inherently better than any other. Three approaches to weaving together
diverse theoretical perspectives are emphasized. First, a common factors approach to therapy is
used to develop therapy approaches based on what active ingredients work across a wide range
of theoretical approaches. Second, technical eclecticism emphasizes using the best treatment
technique available, given a particular client and a particular problem. Third, theoretical integration
seeks to weave together two or more therapy systems to create a more effective hybrid
system. The nature of humans, psychopathology, and theoretical constructs shifts, depending
upon the approach being employed. Effective therapy is characterized by positive outcomes.
At first glance, which theoretical approaches do you find most appealing? Are
you more inclined toward the scientific security of behaviorism or more attracted
to the relationship emphasis of person-centered therapy? As you explore the various
theories throughout this book, start thinking about which approach you’d
like to date, but as DeLucia-Waack suggests, try to avoid prematurely eloping
with one of the approaches.
Questions for Reflection
point of view, carefully embedded within the presented pages. Even the choice of the text’s
layout and the ample space given to certain approaches and not to others reveal the authors’
un-discussible preference. I believe it would be more correct if the authors would
simply declare their own perspective, while maintaining a respectful position in the exposition
of other theories.
It is impossible to be absolutely “objective” or “neutral” in writing a book. However,
the reader will surely understand and accept this preference and moreover he/she will undoubtedly
appreciate the authors’ honesty. (G. Nardone, personal communication, July,
2002)
At this point, you’ve already met several of our biases, but based on the advice and
inspiration of Dr. Nardone, we thought we should provide you with a more formal and
explicit introduction.
Our Theoretical Roots
At this point, we’ve been eclectic so long it seems like we both must have been born
eclectic. However, after closely reading about Dr. Nardone’s appreciation for honesty,
we decided to look deeper and explore our possible biases. After all, telling you that
we’re eclectic doesn’t tell you much about our deeper preferences, tendencies, and biases.
In a sense, it’s true that we were born and raised eclectic. In graduate school, we both
attended a staunchly generalist program. Our clinical psychology faculty at the University
of Montana in the 1980s included a psychoanalytic/hypnoanalytic professor, a
cognitively oriented professor, a person-centered professor, and two behaviorists. John
went to a strictly psychoanalytic predoctoral internship at a medical center in New
York in 1985, and Rita went to a family systems–oriented child and family clinic in Oregon
in 1988. After licensure, John spent time teaching, working as a health psychologist
in an industrial setting, in private practice, and as director of a nonprofit organization
dedicated to parent education. Rita has consulted with two different Vet Centers,
established a part-time private practice, and taught the past 12 years as a professor of
counselor education. During this time period, we lived in Montana, New York, Washington,
Oregon, Belize, Central America, and Northampton, England.
John’s favorite theoretical figures are Carl Rogers, Alfred Adler, and Irving Yalom.
Rita casts her votes for Carl Rogers, Viktor Frankl, and Jean Baker Miller. John loves
to quote Freud and Rita loves to hate Freud, considering him antithetical to her feminist
beliefs.
Our generalist background makes us slow to jump on contemporary bandwagons.
For example, we’re especially cautious about any purportedly new theory or technique
that claims remarkable recovery rates for psychologically distressed individuals. Hopefully,
this doesn’t mean we’re not open to new ideas. We’re just reluctant to believe that
having clients hum a few tunes while practicing thought field therapy will cure their
longstanding personal problems.
Balance and Uncertainty
We have a strong bias against certainty. Several years ago we attended a workshop conducted
by the great structural family therapist and theorist Salvador Minuchin. The
subtitle of his presentation was “Don’t be too sure.” We agree. No theory holds the
26 Counseling and Psychotherapy Theories in Context and Practice
key to all problems. No theory entirely explains what it means to be human. When we get
too sure about our theory, we close ourselves off to different perspectives of reality;
even worse, being too sure places us in danger of forcing the client to fit the theory,
rather than the other way around.
We also tend to be skeptical about empirical research. You probably started getting
that impression as you read earlier sections in this chapter. The biggest problem with
research is that it’s tremendously difficult to conduct studies that truly reflect what happens
in the real therapy offices of practitioners around the world. As W. Silverman
(1996) stated, “Efficacy studies do not reflect models and they do not represent psychotherapy
as practiced in the field” (p. 210).
On the other hand, we definitely value counseling and psychotherapy research—we
just try not to overvalue it. When a particular form of treatment makes great claims of
effectiveness in the absence of empirical research, we become very suspicious.
Theory versus Technique
Despite the minimal evidence supporting the importance of technique, we’re big fans
of therapy techniques. In our Tough Kids, Cool Counseling book, we wrote about our
belief that, especially for children, techniques, properly implemented, facilitate and
deepen the therapeutic relationship (Sommers-Flanagan & Sommers-Flanagan, 1997).
This is perhaps our biggest bias, and we hope that in admitting it we meet the high standards
of Dr. Nardone. We believe that the primary purpose of using different therapy
techniques is to help build therapy relationships. Overall, after therapy is long over
with, we believe clients are much more likely to remember and benefit from a warm,
supportive, collaborative, and interesting relationship. And we’re not afraid to use a few
techniques, from a place of honesty and integrity, to build a relationship that we hope
clients will remember (see Practitioner Commentary 1.2 for a discussion of the importance
of experiencing your theory).
THE ZEITGEIST, THE ORTGEIST, AND THE POLTERGEIST
The Zeitgeist is defined as “the spirit of the time.” It refers to the fact that more often
than would be predicted by chance, more than one individual makes a significant discovery
at around the same time. This spirit of the time explains why Pierre Janet and
Sigmund Freud, in France and Austria, could both independently discover the existence
of the unconscious at about the same time. In other words, in the late 1890s, the
Zeitgeist was such that the unconscious was ready to be discovered.
The Ortgeist refers to the “spirit of the place.” It also explains Freud and Janet and
Introduction to Psychotherapy and Counseling Theory and Technique 27
Okay, now that we’ve bared our theoretical souls, maybe you should follow suit
and take a look at your personal biases. Even if you don’t want to go that deep,
at least consider our biases and reflect on where you stand on the issues we’ve
raised. What are your theoretical roots? Where do you stand on the issue of balance
and uncertainty? What do you think and how do you feel about using specific
techniques to further the therapy relationship?
Questions for Reflection
the discovery of the unconscious. Perhaps the Ortgeist spirit was operating in Europe
in the late 1890s. Bankart (1997) speaks of the Zeitgeist and Ortgeist in relation to
Freud: “A genuine understanding of Freud’s psychoanalysis, for example, requires (and
at the same time provides) a reasonably deep understanding of middle-class life in turnof-
the-century Europe” (Bankart, p. 8).
Similarly, recently on the National Public Radio show “The Writer’s Almanac,” Garrison
Keillor quoted the plainspoken philosopher Eric Hoffer’s perspective on Freud:
Ah, don’t talk to me about Freud. Freud lived in a tight little circle in Viea, and inside
that tight little circle was another tight little circle, and inside that tight little circle was still
another tight little circle. What applies to that poor man, Freud, does not necessarily apply
to me. (Keillor, 2002)
A Poltergeist is a mischievous spirit or ghost. We include reference to it here because,
in our experience, conducting psychotherapy or counseling sometimes includes mysterious
and mischievous surprises. An example of a poltergeist is given in the famous
Harry Potter book series:
28 Counseling and Psychotherapy Theories in Context and Practice
Experience Your Theory
The following practitioner commentary was contributed by Ellen Hawley
McWhirter. She is an associate professor in the counseling psychology department
at the University of Oregon.
I was fortunate to be provided with very good theoretical training during both
my master’s and doctoral programs. In addition to reading basic theories texts,
for example, we were required to read Rogers, Ellis, Freud, Adler, and other theoreticians’
original works. However, it was not reading about theories that
helped me move from being able to describe theories to being able to describe
what I do in consistent theoretical terms. It was the combination of practicing,
trying out, and receiving supervision on my attempts to live out theory in my sessions.
When I was completing my predoctoral internship, I had a wonderful supervisor
who allowed me to sit in on her sessions, and who conducted supervision
in a way that paralleled the way she did therapy (although supervision never
felt like therapy). That exposure might not have even changed what I did on the
outside; I’m not sure. But it radically changed the way I felt on the inside: It was
like finally finding a shoe that fit just right. What is ironic is that I had never read
Teyber [the author of Interpersonal Process in Psychotherapy] and didn’t know
what to call her way of doing therapy. When I began teaching practicum myself,
I read Teyber’s book and realized that my supervisor had been doing interpersonal
process [see Teyber, 1997]. The more I read, the more it fit. This theory
more than any other is consistent with things I believe about human change processes
and about how to facilitate those processes. Now I require that text for all
students in practicum, regardless of their preferred theory, because it promotes
self-reflection and in-session process that enriches their growth and their sessions.
PRACTITIONER COMMENTARY 1.2
Peeves the Poltergeist was worth two locked doors and a trick staircase if you met him
when you were late for class. He would drop wastepaper baskets on your head, pull rugs
from under your feet, pelt you with bits of chalk, or sneak up behind you, invisible, grab
your nose, and screech, “GOT YOUR CONK!” (Rowling, 1997, p. 132)
As a therapist, you should be prepared for the unexpected. Sometimes your clients
will say and do outrageous things. At other times, you will suddenly feel the urge to say
or do something inappropriate. For whatever reason, sitting privately with another individual
for long periods of time can produce unusual and profound experiences. Just
when you least suspect it, your VCR will malfunction or you’ll abruptly feel like crying
or you’ll feel fidgety and want to leave the room or the clock hanging on the wall in your
office will stop or your client will tell you something absolutely outrageous. Our point
is: Don’t be surprised when you feel surprised.
Overall, we hope as you explore the theories in this book and as you come to know
contemporary perspectives in counseling and psychotherapy, that you’ll keep the Zeitgeist,
Ortgeist, and Poltergeist in mind. What spirits of time, place, and mischief are operating
right now? What will be the next big discovery and next big scandal in the field
of counseling and psychotherapy?
CONCLUDING COMMENTS
In this chapter we’ve taken you on a very quick tour of major issues in counseling and
psychotherapy. From historical context to contemporary research to ethical essentials,
the field of counseling and psychotherapy is filled with amazing and interesting information.
We wish you the best as you begin to explore the main theories of therapy in
greater depth.
STUDENT REVIEW ASSIGNMENTS
At the end of each chapter, rather than providing a traditional summary, we offer you
an opportunity for a more interactive review.
Critical Corner
In this section, we have included some extremely critical statements about counseling
and psychotherapy designed to provoke a response in you. If you like, you can write
your response to the criticisms in the space provided.
1. Most of the psychological theories reviewed in this book were developed by privileged,
White, and European or American males. Given the narrow origins of
these theories, how can the information provided be useful to you as a developing
mental health professional?
Response:
2. Smith, Glass, and Miller (1980), in their extended meta-analysis of therapy outcome
studies, concluded that the average person treated in therapy was better off
Introduction to Psychotherapy and Counseling Theory and Technique 29
than 80% of the untreated sample. Of course, they neglected to comment on the
inverse fact that average untreated person was better off than about 20% of the
treated clients. What does this inverse statement suggest? Are there large numbers
of treated therapy clients who are getting worse? Or are some untreated clients
somehow spontaneously getting better?
Response:
3. In this chapter we’ve suggested that you begin to explore different theories and
that, in the end, perhaps the best theory will be your personal theory. Is this a
valid suggestion? Might you be better off simply adopting a particular theory and
hanging in there with it, despite its limitations? Wouldn’t you be better off just
knowing one theory very well, rather than knowing a little bit about many different
perspectives?
Response:
Reviewing Key Terms
• The biomedical perspective • Extratherapeutic change
• The religious/spiritual perspective • Confidentiality
• The psychosocial perspective • Informed consent
• Trephining • Zeitgeist
• Meta-analysis • Ortgeist
• The Dodo bird effect • Poltergeist
Review Questions
1. What is the difference between a therapeutic experience and a therapy experience?
2. Who was Hans Eysenck and why is he important to the evolution of psychotherapy
and counseling?
3. What are the common factors and their relative importance as described by Lambert
(1992)?
4. Why is sexual contact between therapist and client now referred to as sexual abuse
of clients?
5. What are the limits of confidentiality in therapy?
RECOMMENDED READINGS AND RESOURCES
Please feel free to explore the following resources.
Lead Theory Journals
There are hundreds of journals related to counseling, psychotherapy, mental health, social
work, and psychology. The following list is only partial, but it represents some of
the mainstream journals in the previously mentioned areas.
30 Counseling and Psychotherapy Theories in Context and Practice
• American Journal of Psychotherapy
• American Psychologist
• Journal of Consulting and Clinical
Psychology
• Journal of Counseling and
Development
• Journal of Counseling Psychology
• Journal of Mental Health Counseling
• Journal of School Psychology
• Journal of Social Work Practice
• Professional Psychology
• Psychological Bulletin
• Psychotherapy
• School Psychology Quarterly
• School Psychology Review
• Social Work
• Social Work in Health Care
• Social Work Research
• The Counseling Psychologist
• The School Counselor
Introduction to Psychotherapy and Counseling Theory and Technique 31
Books and Articles: Ethics Codes
American Association for Marriage and Family Therapy. (1991). Code of ethics. Washington,
DC: Author.
American Counseling Association. (1995). Code of ethics and standards of practice. Alexandria,
VA: Author.
American Psychiatric Association. (1993). Principles of medical ethics with aotations especially
applicable to psychiatry.Washington, DC: Author.
American Psychological Association. (2002). Ethical principles of psychologists and code of
conduct. American Psychologist, 57, 1060–1073.
National Association of Social Workers. (1993). Code of ethics. Silver Springs, MD: Author.
Books and Articles: Ethics and Theories Readings
Bankart, C. P. (1997). Talking cures: A history of Western and Eastern psychotherapies. Pacific
Grove, CA: Brooks/Cole.
Corey, G., Corey, M. S., & Callanan, P. (2001). Issues and ethics in the helping professions (6th ed.).
Belmont, CA: Brooks/Cole.
Eysenck, H. J. (1952). The effects of psychotherapy: An evaluation. Journal of Consulting Psychology,
16, 319–324.
Frank, J. D. (1961). Persuasion and healing. Baltimore: Johns Hopkins Press.
Haley, J. (1977). A quiz for young therapists. Psychotherapy, 14(2), 165–168.
Hubble, M. A., Duncan, B. L., & Miller, S. D. (Eds.). (1999). The heart and soul of change. Washington,
DC: American Psychological Association.
Kottler, J. A., & Brown, R. W. (1996). Introduction to therapeutic counseling. Pacific Grove, CA:
Brooks/Cole.
Luborsky, L., Singer, B., & Luborsky, L. (1975). Comparative studies of psychotherapies: Is it
true that “Everybody has won so all shall have prizes”? Archives of General Psychiatry, 32,
995–1008.
Mahoney, M. (1991). Human change processes. New York: Basic Books.
Masson, J. M. (1988). Against therapy: Emotional tyray and the myth of psychological healing.
New York: Atheneum.
Pope, K. S., & Vasquez, M. J. T. (1998). Ethics in psychotherapy and counseling: A practical guide
(2nd ed.). San Francisco, CA: Jossey-Bass/Pfeiffer.
Welfel, E. R. (2001). Ethics in counseling and psychotherapy (2nd ed.). Pacific Grove, CA: Brooks/
Cole.
Videotapes
Corey, G., Corey, M. S., & Walters, T. (1998). Ethics in action: Student version and workbook
[Videotape]. Pacific Grove, CA: Brooks/Cole.
Training Opportunities and Web Sites
The following web sites will coect you with specific professional mental health associations.
These associations are excellent resources for obtaining cutting-edge information
about what’s happening in your field of interest. They also often list upcoming
training opportunities. Most of these web sites include information on ethical codes
and principles associated with each professional group.
American Association of Marriage and Family Counselors (web site: www.aamft.org)
American Counseling Association (web site: www.counseling.org)
American Psychological Association (web site: www.apa.org)
National Association of Social Work (web site: www.naswdc.org)
32 Counseling and Psychotherapy Theories in Context and Practice