60,99 €
Mehr erfahren.
- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Useful as a supplemental text in advanced theories and practicum courses, this fourth edition discusses the key concepts and techniques from many contemporary theories and how to develop an integrative approach to the counseling process to better meet individual client needs. Dr. Corey introduces the techniques that he draws from in his own integrative approach to counseling using a wide variety of case examples with diverse clients. Topics covered include assessing presenting issues; developing a productive working alliance; establishing therapeutic goals; understanding and addressing diversity; working with resistant clients; using evidence-based practice in cognitive, emotive, and behavioral work with clients; dealing with transference and countertransference; and incorporating trends in integrative therapies. To encourage active learning, reflective exercises throughout the text provide readers with opportunities to put themselves in the role of therapist and client.
"No one knows more about theory-based counseling than Gerald Corey, who has spent the past 50+ years helping us to gain real insight into multiple models. In this book, Corey takes readers from forming a working alliance with clientsthrough the processes for setting and achieving goals. His skill at and understanding of the termination processes is worth the entire book. Not only will The Art of Integrative Counseling be the core text for counseling process and skills courses, it will provide the foundation for effective, truly integrated counseling throughout one’s career."
—James Robert Bitter, EdD, East Tennessee State University
"Gerald Corey's fourth edition of The Art of Integrative Counseling provides important concepts to consider when developing an integrative approach to working with clients. For beginning counselors, it demonstrates how one can be integrative whether one is behaviorally, cognitively, or affectively oriented. For more advanced counselors, it reminds them of the wealth of information that all theories offer and how techniques or theories can be synthesized into a more effective approach. Whether you are a new counselor trying to figure out how to integrate the many theories you learned about, or a seasoned professional seeking new ways of working with clients, this book has something for you."
—Edward Neukrug, EdD, Old Dominion University
*Requests for digital versions from ACA can be found on www.wiley.com.
*To purchase print copies, please visit the ACA website
*Reproduction requests for material from books published by ACA should be directed to [email protected]
Das E-Book können Sie in Legimi-Apps oder einer beliebigen App lesen, die das folgende Format unterstützen:
Seitenzahl: 581
Veröffentlichungsjahr: 2018
Ähnliche
Contents
Cover
Title Page
Copyright
Preface
About the Fourth Edition of
The Art of Integrative Counseling
What’s New in the Fourth Edition of
The Art of Integrative Counseling
?
About the Author
Acknowledgments
Chapter 1: The Beginning Stages of Counseling
An Integrative Theoretical Approach: An Overview
Becoming the Client: Put Yourself in the Shoes of the Client
Initial Sessions and the Case of Gwen
Initial Sessions and the Case of Chet
Concluding Comments
Chapter 2: The Therapeutic Relationship
Developing a Working Alliance
Self-Disclosure in the Therapeutic Relationship
Your Role as a Counselor in Creating a Working Relationship
Becoming the Client: Sharing in a Collaborative Partnership
Developing a Therapeutic Alliance With Sidney
Developing a Therapeutic Alliance With Rita
Concluding Comments
Chapter 3: Establishing Therapeutic Goals
Overview of Goals From Various Theoretical Perspectives
Becoming the Client: Establishing Counseling Goals
Clarifying Counseling Goals With Joleen
Clarifying Counseling Goals With Aaron
Concluding Comments
Chapter 4: Understanding and Addressing Diversity
My Introduction to Multicultural and Diversity Perspectives
Perspectives on Multicultural Concerns
Diversity as Central in the Counseling Process
Counseling LGBTQI People
Recognizing the Spiritual Domain
Becoming the Client: Understanding How to Work With Diversity
Theories Applied to Understanding Diversity Perspectives
Understanding Win-May From a Diversity Perspective
Understanding Gabriel From a Diversity Perspective
Concluding Comments
Chapter 5: Understanding and Working With Resistance
Understanding the Dynamics of Resistance
Respecting and Reframing Resistance
Becoming the Client: Experiencing Resistance in Yourself
Understanding Kelsey’s Resistance
Understanding Rico’s Resistance
Guidelines for Dealing With Resistance in Clients
Concluding Comments
Chapter 6: Cognitive Focus in Counseling
Benefits and Limitations of a Cognitive Focus
Becoming the Client: Experiencing Cognitive Behavior Techniques
Working With Marissa From a Cognitive Behavior Perspective
Working With Erv From a Cognitive Behavior Perspective
Concluding Comments
Chapter 7: Emotive Focus in Counseling
Experiential Approaches and the Role of Emotion in Therapy
Becoming the Client: Experiencing Emotion-Focused Therapy
Working With Elaine in Identifying and Exploring Feelings
Working With Andrew in Identifying and Exploring Feelings
Concluding Comments
Chapter 8: Behavioral Focus in Counseling
Benefits and Limitations of a Behavioral Focus
Multimodal Therapy: Assessment and Therapy Goals
The Third Wave of Behavior Therapy
Becoming the Client: Experiencing Behavior-Oriented Therapy
Developing a Behavioral Contract
Working With Shante Using a Behavioral Focus
Working With Marlin Using a Behavioral Focus
Concluding Comments
Chapter 9: An Integrative Perspective
Searching for Common Factors Across Therapy Schools
The Foundation of My Integrative Approach
Drawing on the Action-Oriented Therapies
Drawing on Feminist and Family Systems Approaches
Becoming the Client: Becoming the Person You Want to Be
Working With Petra From an Integrative Perspective
Couples Counseling in an Integrative Way: Lani and Rob
Study a Primary Theory—But Be Open to Integration
Benefits and Limitations of Integration
Concluding Comments
Chapter 10: Working With Transference and Countertransference
Contrasting Views of Transference
The Connection Between Transference and Countertransference
Working With Transference Therapeutically
Addressing Countertransference Issues
Becoming the Client: The Value of Personal Therapy
Working With Transference and Countertransference With Matt
Working With Transference and Countertransference With Bonnie
Concluding Comments
Chapter 11: Understanding How the Past Influences the Present and the Future
Understanding How the Past, Present, and Future Are Intertwined
Becoming the Client: Examining Your Past, Present, and Future
Working With Tricia’s Past, Present, and Future
Working With Jasper’s Past, Present, and Future
Concluding Comments
Chapter 12: Evaluation and Termination
Guidelines for Effective Termination Strategies
Becoming the Client: Taking Credit for Your Changes
Evaluation and Termination With Chelsea
Evaluation and Termination With Charles
Your Thoughts on Ending the Therapeutic Relationship
Some Final Thoughts on Psychotherapy Integration
Concluding Comments
References
Index
Technical Support
End User License Agreement
Guide
Cover
Table of Contents
Begin Reading
Chapter 1
Pages
i
ii
iii
vii
viii
ix
xi
xii
xiii
xv
xvi
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
229
230
231
232
233
234
235
236
237
238
239
Fourth Edition
The Art of Integrative Counseling
Gerald Corey
6101 Stevenson Avenue, Suite 600 | Alexandria, VA 22304www.counseling.org
Copyright © 2019 by the American Counseling Association. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the written permission of the publisher.
American Counseling Association6101 Stevenson Avenue, Suite 600Alexandria, VA 22304
Associate Publisher | Carolyn C. Baker
Digital and Print Development Editor | Nancy Driver
Senior Production Manager | Bonny E. Gaston
Copy Editor | Kay Mikel
Cover and text design by Bonny E. Gaston
Library of Congress Cataloging-in-Publication DataNames: Corey, Gerald, author.Title: The art of integrative counseling / Gerald Corey.Description: Fourth edition. | Alexandria, VA : American Counseling Association, [2019] | Includes bibliographical references and index.Identifiers: LCCN 2018031001 | ISBN 9781556203855 (pbk. : alk. paper)Subjects: LCSH: Counseling. | Psychotherapy.Classification: LCC BF636.6 C6697 2019 | DDC 158.3—dc23 LC record available at https://lccn.loc.gov/2018031001
To the many students I have had the privilege to know and to teach.
Preface
In my books dealing with the theory and practice of counseling, I devote specific chapters to presenting an integrative approach to counseling practice and a case example of the application of my integrative perspective. The Art of Integrative Counseling is basically an extension of these chapters and is aimed at helping readers conceptualize the various dimensions of an integrative perspective.
About the Fourth Edition of The Art of Integrative Counseling
The Art of Integrative Counseling has special relevance for graduate students and new professionals, especially for those who are interested in applying counseling theories to practice . . . and for those interested in understanding how they can develop their own integrative approach to the practice of counseling. This book can be used as a supplementary text to a standard theories of counseling book, and it also can be used for courses in advanced counseling practice, counseling techniques, therapeutic procedures, practicum, and internship. This new edition deals with basic concepts and techniques from many contemporary theories, including psychoanalytic therapy, Adlerian therapy, existential therapy, person-centered therapy, Gestalt therapy, psychodrama, reality therapy, behavior therapy, cognitive behavior therapy, solution-focused brief therapy, motivational interviewing, narrative therapy, feminist therapy, and family systems therapy.
One of the trends in the counseling field is the move toward integration of various theoretical systems and approaches to counseling. Most practitioners believe that an integrative approach is a more useful guide to practice than relying on a single theory. Many standard textbooks are based on an exploration of concepts and techniques from contemporary counseling and psychotherapy theories. However, only a few books are devoted to integrating the best from all of these theoretical models. In this book I strive to do several things: (1) describe the concepts and techniques that I most draw from in my own integrative approach to counseling practice; (2) demonstrate how concepts and techniques can be borrowed from a variety of theoretical models and applied to the counseling process from the initial to termination stages; (3) invite you to imagine that you are a client in counseling with me as I describe my approach to integrative counseling; and (4) suggest ways for you (as a counseling professional) to think about designing your own integrative approach that will serve as a foundation for what you do in your counseling practice. To encourage active learning, I ask you to put yourself in the role of a therapist at times, and to assume the role of a client at other times, as you reflect these topics.
I cannot tell you how to develop a personal integrative style that will work best for you. However, I have provided some guidelines to assist you in the task of considering which key concepts and techniques you might incorporate in your personal therapeutic style. There is no “one right way” to formulate an integrative perspective. From reading and studying this book, I hope you will acquire a framework that can assist you in systematically constructing an integrative counseling approach that works best for the professional you are and for the clients you will serve.
What’s New in the Fourth Edition of The Art of Integrative Counseling?
The Fourth Edition of The Art of Integrative Counseling has been revised to bring the discussions up to date and to refine existing ideas while retaining the informal, personal style of writing that characterized previous editions. I present key findings from recent research on topics such as the central role of the therapeutic relationship (Chapter 2), the role of client feedback on therapy outcomes (Chapter 3), how addressing diversity is central in an integrative approach to therapy (Chapter 4), evidence-based practice as it applies to working with clients in cognitive, emotive, and behavioral ways (Chapters 6, 7, 8), trends in integrative therapies (Chapter 9), and the future of psychotherapy integration and the role of evidence-based practice (Chapter 12).
Other material new to the Fourth Edition includes an expanded treatment of diversity issues, especially the role of spirituality in counseling practice, coverage on the various forms of diversity, and more emphasis on tailoring psychotherapy to individuals from diverse cultural backgrounds (Chapter 4); a broadened discussion of the dynamics of resistance, along with the importance of respecting and reframing resistance, and more on the stages of change (Chapter 5); new material and expansion of the cognitive behavior approaches, and how cognitive behavior therapy can provide a foundation for an integrative approach to counseling practice (Chapter 6); new sections on incorporating mindfulness and acceptance-based concepts into an integrative perspective (Chapter 8); an emphasis on flexibility and tailoring treatment to individuals and using motivational interviewing in an integrative approach (Chapter 9); more discussion of understanding the dynamics of transference and countertransference (Chapter 10); understanding the role of the past, present, and future as it pertains to counseling individuals (Chapter 11); more emphasis on solution-focused brief therapy and narrative therapy (Chapters 4, 9, 11); and an expanded discussion on termination including the use of therapist’s letters, and relapse prevention strategies to help clients deal with setbacks that occur after the end of therapy sessions (Chapter 12). All of the chapters have been carefully examined to determine how the topics fit with contemporary integrative approaches, and I have given particular attention to trends in the psychotherapy integration movement.
About the Author
Gerald Corey, EdD, is professor emeritus of Human Services and Counseling at California State University at Fullerton. He received his doctorate in counseling from the University of Southern California. He is a Diplomate in Counseling Psychology, American Board of Professional Psychology; a licensed psychologist; and a National Certified Counselor. He is a Fellow of the American Psychological Association (Division 17, Counseling Psychology, and also Division 49, Group Psychotherapy); a Fellow of the American Counseling Association; and a Fellow of the Association for Specialists in Group Work. He also holds memberships in the American Psychological Association; the American Counseling Association; the Association for Specialists in Group Work; the American Group Psychotherapy Association; the American Mental Health Counselors Association; the Association for Spiritual, Ethical, and Religious Values in Counseling; the Association for Counselor Education and Supervision; and the Western Association of Counselor Education and Supervision. Both Jerry and Marianne Corey received the Lifetime Achievement Award from the American Mental Health Counselors Association in 2011, and both of them received the Eminent Career Award from ASGW in 2001. Jerry was given the Outstanding Professor of the Year Award from California State University at Fullerton in 1991. He regularly teaches both undergraduate and graduate courses in group counseling and ethics in counseling at California State University, Fullerton. He is the author or coauthor of 16 textbooks in counseling currently in print, along with more than 60 journal articles and book chapters. Several of his books have been translated into other languages. Theory and Practice of Counseling and Psychotherapy has been translated into Arabic, Indonesian, Portuguese, Turkish, Korean, and Chinese. Theory and Practice of Group Counseling has been translated into Korean, Chinese, Spanish, and Russian.
During the past 40 years Jerry and Marianne Corey have conducted group counseling training workshops for mental health professionals at many universities in the United States as well as in Canada, Mexico, China, Hong Kong, Korea, Germany, Belgium, Scotland, England, and Ireland. In his leisure time, Jerry likes to travel, hike and bicycle in the mountains and the desert, and drive his grandchildren and friends in his 1931 Model A Ford. Marianne and Jerry have been married since 1964. They have two adult daughters (Heidi and Cindy), two granddaughters (Kyla and Keegan), and one grandson (Corey).
Gerald Corey has six books that are published by the American Counseling Association. In addition to the Fourth Edition of The Art of Integrative Counseling (2019), Jerry is coauthor (with Michelle Muratori, Jude Austin, and Julius Austin) of Counselor Self-Care (2018); he is coauthor (with Barbara Herlihy) of Boundary Issues in Counseling: Multiple Roles and Responsibilities, Third Edition (2015) and ACA Ethical Standards Casebook, Seventh Edition (2015); he is coauthor (with Robert Haynes, Patrice Moulton, and Michelle Muratori) of Clinical Supervision in the Helping Professions: A Practical Guide, Second Edition (2010); and he is the author of Creating Your Professional Path: Lessons From My Journey (2010).
Other publications by Gerald Corey, all with Cengage Learning, include:
Issues and Ethics in the Helping Professions
, Tenth Edition (2019, with Marianne Schneider Corey and Cindy Corey). This work has been translated into Japanese, Chinese, and Korean.
Groups: Process and Practice
, Tenth Edition (2018, with Marianne Schneider Corey and Cindy Corey)
I Never Knew I Had a Choice
, Eleventh Edition (2018, with Marianne Schneider Corey and Michelle Muratori)
Theory and Practice of Counseling and Psychotherapy
, Tenth Edition (and
Student Manual
) (2017)
Theory and Practice of Group Counseling
, Ninth Edition (and
Student Manual
) (2016)
Becoming a Helper
, Seventh Edition (2016, with Marianne Schneider Corey)
Group Techniques
, Fourth Edition (2015, with Marianne Schneider Corey, Patrick Callanan, and J. Michael Russell)
Case Approach to Counseling and Psychotherapy
, Eighth Edition (2013)
He has also made several educational DVD programs on various aspects of counseling practice: (1) Group video to accompany Theory and Practice of Group Counseling (2019); (2) Ethics in Action: DVD and Workbook (2015, with Marianne Schneider Corey and Robert Haynes); (3) Groups in Action: Evolution and Challenges DVD and Workbook (2014, with Marianne Schneider Corey and Robert Haynes); (4) DVD for Theory and Practice of Counseling and Psychotherapy: The Case of Stan and Lecturettes (2013); (5) DVD for Integrative Counseling: The Case of Ruth and Lecturettes (2013, with Robert Haynes); and (6) DVD lecturettes to accompany Theory and Practice of Group Counseling (2012). All of these video programs are available through Cengage Learning.
Acknowledgments
I am indebted to those who reviewed this book and provided me with constructive input for the Fourth Edition. I especially want to recognize Jim Bitter of East Tennessee State University, who added material to most of the chapters and critiqued all of the cases. Jim and I had frequent and productive discussions on what material to add and what to revise to bring the book in line with current developments. Robert Haynes, a clinical psychologist and a former director of training and supervising interns at a state mental hospital, reviewed all the new material in this edition as well as the cases. He has reviewed all of the past editions, and his insights have provided continuity in the evolution of this book. Marianne Schneider Corey read and critiqued the entire manuscript as well as editing the cases. Kellie Kirksey, of the Cleveland Clinic Center for Integrative and Lifestyle Medicine, created the case of Gwen and provided ideas for working with Gwen from an integrative perspective. Michelle Muratori, of Johns Hopkins University, worked with me on updating the cases of Rita, Kelsey, Elaine, Shante, Bonnie, Tricia, and Chelsea. Jamie Bludworth, of Arizona State University, and I have presented learning institutes at ACA conferences for the past 9 years on counseling theory in practice. We have had frequent discussions on ways to integrate various approaches, and he contributed to the development of the cases of Joleen, Aaron, Andrew, and Charles. I appreciate the consultation with Debbie Joffe Ellis, a key figure in rational emotive behavior therapy, on the cognitive behavioral presentation and the case of Marissa. Jude Austin, of the University of Mary Hardin-Baylor, developed the case of Sidney. Julius Austin, of the University of Louisiana at Monroe, developed the case of Win-May. I have enjoyed my many discussions on applying theory to practice with both Jude and Julius Austin. Amy Manfrini, of California State University at Fullerton, contributed to the cases of Lani and Rob and Rico. Randy Alle-Corliss and I have been coteaching for years, and we worked collaboratively in designing and revising the cases of Chet and Jasper. My former students Nicholas Lazzareschi and Jeff Markow reviewed the manuscript and provided suggestions that were incorporated in the final manuscript. Special recognition goes to Amanda Connell, a valued colleague with whom I coteach a group class at California State University at Fullerton, who critiqued the entire manuscript and assisted in revising many of the cases. All who reviewed the manuscript gave particular attention to the cases and made suggestions that I used as I developed these cases. Presenting these cases was truly a collaborative endeavor.
Special appreciation goes to Carolyn Baker, the associate publisher at the American Counseling Association. Carolyn contributed her expertise by reviewing the entire manuscript, providing insightful comments on content issues and suggestions for consistency in style, and offering support throughout the revision process. A special note of thanks goes to the manuscript editor, Kay Mikel, who made sure the presentation was clear, practical, personal, and effective. A book such as this is truly a team effort, and both Carolyn and Kay are key people on this team.
—Gerald Corey
Chapter 1The Beginning Stages of Counseling
Although you may be just starting your practicum or internship in the helping professions, already you may have been asked to answer these questions: “What is your approach to counseling?” “How does your theoretical orientation influence the manner in which you practice?” You will revisit these questions throughout your career in job interviews and self-evaluations.
This book will assist you in conceptualizing what you do as a counseling practitioner and help you clarify your theoretical orientation. I want to stimulate your thinking about the importance of developing an integrative approach to counseling practice that pays attention to what your clients are thinking, feeling, and doing. Combining these three dimensions is the basis for a powerful and comprehensive approach to counseling practice. If any of these dimensions is excluded, the therapeutic approach is incomplete.
It is important to examine the contemporary theories of counseling to determine which concepts and techniques you can incorporate in your approach to practice. Creating your own integrative stance is truly a challenge. You cannot simply pick bits and pieces from theories in a random and fragmented manner. Each theory represents a different vantage point from which to look at human behavior. Study all the major theories, resist too quickly embracing any single point of view, and look for a basis for an integrative perspective that will guide your practice.
A theory is a good road map for understanding the therapy process, but no one theory is best for all clients under all sets of circumstances (Norcross, Goldfried, & Arigo, 2016). Research has clearly established that psychotherapy works and is remarkably effective, but no particular theory or technique has proved to be superior to all others (Wampold, 2010). Each theory has something unique to offer you. There is a growing recognition that counseling and therapy can be most effective when contributions from various approaches are integrated (Goldfried, Glass, & Arnkoff, 2011). Goldfried and colleagues believe that evidence-based practice will increasingly become the organizing force for integration. Empirical pragmatism, rather than theory, will be the integrative theme of the 21st century. In addition, evidence increasingly supports the idea that the therapeutic alliance (the therapeutic relationship) and the therapist as a person are critical factors in determining therapy outcomes (Elkins, 2016; Hubble, Duncan, Miller, & Wampold, 2010; Keenan & Rubin, 2016); these topics are addressed in detail in Chapter 2.
The aim of this book is to assist you in acquiring your own unique perspective on counseling, which will aid you in eventually developing your integrative approach to counseling practice. To develop this kind of integration, you need to be well grounded in a number of theories, be open to the idea that some aspects of these theories can be unified in different ways, be familiar with the research literature in the field of psychotherapy, and be willing to continually test your hypotheses to determine how well they are working. In developing and conceptualizing your integrative counseling approach, consider your own personality, and think about what concepts and techniques work best with a range of clients. Choosing techniques that are suitable for particular problems and for different clients requires knowledge, skill, art, and clinical experience. It is also an art to know when and how to use a particular therapeutic intervention.
To be an effective counselor it is essential that you be willing to take an honest look at your own life. Are you willing to do for yourself what you ask clients to do? It will be difficult to inspire clients to seek help when they need it if you are not open to change in your own life. Your own self-exploration likely will be one of the most important factors in learning how to use many of the techniques in this book. You can learn many ways to creatively intervene with your clients by experiencing what it is like to be a client. (See Chapter 10 for more on the value of personal therapy for counselors in training.) As much as possible, I will ask you to put yourself in the shoes of the client. The “Becoming a Client” sections in this book are useful sources of self-exploration and offer strategies for intervening with your own clients.
An Integrative Theoretical Approach: An Overview
This book represents my own integrative approach to counseling. I define an integrative approach to counseling as being rooted in a theory or theories, with techniques systematically borrowed from other approaches and tailored to a client’s unique needs. I am not suggesting that you adopt my conceptualization of theory applied to practice. You will develop your own integrative style based on your personality and the kinds of clients you expect to counsel. By describing my personal orientation to counseling, I hope to provide a framework to assist you in designing a theoretical orientation that makes sense to you.
The early history of counseling was full of theoretical wars as practitioners argued over the “best” way to bring about personality change. Many practitioners and scholars were resistant to psychotherapy integration, often to the point of being blind to alternative theories and ignoring effective methods from other theoretical schools. However, since the 1980s most therapists have seriously considered integrating the best from the various schools. Therapists now acknowledge the limitations inherent in specific theories and the potential value of other theoretical systems. Most practitioners use some form of integration today, and research supports the efficacy of an integrative approach (Norcross et al., 2016). For example, two popular therapeutic approaches are cognitive behavior therapy and motivational interviewing. Naar and Safren (2017) devote an entire book to ways of combining these strategies for maximum effectiveness.
As a student, you can begin the process of developing a style tailored to your own personality by familiarizing yourself with the major approaches to therapeutic practice. Then choose one theory to study in some depth and branch out from there in your search for an integrative style. I recommend that you study in depth the one theory that comes closest to your worldview and values, and use this theory as a foundation for developing your personal orientation. Being grounded in a theory provides an anchor for making sense of what you are doing as a counselor. Without a theoretical foundation you are liable to flounder, and neither you nor your client is likely to experience productive results.
Attempting to practice without having an explicit theoretical rationale is like trying to build a house without a set of blueprints. The foundation of a house needs to be sturdy and strong to support the structure. If you operate in a theoretical vacuum and are unable to draw on theory to support your interventions, your attempts to help people change will have uncertain outcomes. Theory provides a foundation for understanding human nature, developmental processes, learning processes, function and dysfunction, and purposes and motivations. This model is not a rigid set of structures; rather, it provides a general framework that enables you to make sense of the many facets of the counseling process and gives direction to what you do and say.
You need to believe in the basic philosophy of the theory you embrace and that the treatment you are delivering will be effective. Therapists providing a treatment that they find interesting and fits for them are likely to be more effective than therapists who deliver a treatment not to their liking (Wampold, 2010). The treatment needs to be consistent with your beliefs, values, and personality. Ask yourself: “Which treatment delivered by me will be most effective?” (p. 49).
I draw on concepts and techniques from most of the contemporary counseling models. I then adapt them to a style that fits me personally, taking into account the universal thinking, feeling, and behaving dimensions of human experience. I typically ask clients to think about the decisions they have made about themselves. Some of these decisions may have been necessary for their psychological survival as children but may now be ineffective. I encourage clients to pay attention to their “self-talk” and to ask themselves these questions:
How do your problems reflect the assumptions you make about yourself, about others, and about life?
How do you create your problems by the thoughts and beliefs to which you cling?
How can you begin to free yourself by critically evaluating the statements you repeat to yourself?
These interventions help clients think about events in their lives, how they have interpreted those events, and what they need to do cognitively to change their belief systems.
Once clients begin thinking about their problems, they often feel stuck due to unexpressed and unresolved emotional concerns. I encourage clients to experience the range of their feelings and to talk about how certain events have affected them. The healing process is facilitated by using techniques that engage clients’ feelings and allow them to feel listened to and understood. In addition to encouraging clients to pay attention to their beliefs and decisions, I ask clients questions about their feelings and behavior:
Do you ever feel so overwhelmed by your feelings that you think there is little or nothing you can do about it?
Do your feelings tell you anything about how you see life or suggest how you protect yourself from perceived danger?
How do your feelings fuel your actions?
What habit or routine do you do every day without thinking, and how does that work for you?
What behaviors or actions do you avoid?
Do you initiate some actions and then immediately regret them?
Thinking and feeling are vital components in the helping process, but eventually clients must express themselves in the behaving or acting dimension. Clients can spend countless hours gaining insights and venting pent-up feelings, but eventually they need to get involved in a program of change. Their feelings and thoughts can then be tested and adapted to real-life situations. If the helping process includes a focus on what people are doing, there is a greater chance that clients also will be able to change their thinking and feeling. Using an integrative counseling style, interaction among these three dimensions occurs throughout the counseling process.
It is crucial to help clients consolidate what they are learning by encouraging them to apply new behaviors to situations they encounter every day. Some strategies I use are contracts, between-sessions assignments, action programs, self-monitoring techniques, support systems, and self-directed programs of change. (These strategies are discussed in some detail in Chapters 8, 9, and 12.) These approaches all stress the role of commitment on the part of clients to practice new behaviors, to follow through with a realistic plan for change, and to develop practical methods of carrying out this plan in everyday life.
Clearly defining and articulating a set of values and a philosophy of life are essential to moving through life with balance and conviction. Ultimately, the most meaningful counseling perspective for you to use is one that is an extension of your values and personality. As your philosophy of life evolves, so will your philosophy of counseling. Developing a personalized approach that guides your practice is an ongoing process, and your personal approach to counseling will undergo continuous revision. Reflecting on your own values, life experiences, and philosophy of life is a good starting point.
Becoming the Client: Put Yourself in the Shoes of the Client
The Initial Counseling Session
The main tasks of the initial session include developing a therapeutic alliance, gaining a picture of the client’s problems and concerns, determining the focus of treatment, building motivation, and providing information about the therapeutic process so the client can make informed decisions (Naar & Safren, 2017). The initial interview focuses on key areas, including identifying information, the presenting problem, relevant recent history, current functioning, and expectations of therapy (Maniacci & Sackett-Maniacci, 2019).
One of my goals in writing this book is to include you experientially in the process of deciding which aspects of current theories you might incorporate into your own philosophy of counseling. I ask you to “become the client” now and reflect on integration from that perspective. Imagine that you are the client and we are about to have our first session. As a therapist, I realize that the first few minutes are critical in setting the tone. I begin by explaining the confidential nature of our work together, including the limitations of confidentiality. By explaining a few of the foundational aspects and guidelines of therapy, I hope to provide a sense of safety that will encourage you to talk freely. To promote trust and rapport, I ask what you expect from this session today.
What I most want to do is to listen to your story. Meeting and valuing you as a person is essential to positive change. To create a working therapeutic relationship, I try to make a good connection with you by being present—being fully open to and affected by you. My aim is to establish a positive relationship by listening, responding with clarity and empathy, demonstrating respect for your capacity to understand yourself, and exhibiting faith, hope, and caring. Here are some questions I am likely to ask you during the first session. Reflect on your responses to each of these questions:
What brings you here? What has been going on in your life recently that prompted you to seek professional help at this time?
What expectations do you have of therapy? Of me? What are your hopes, fears, and reservations? What goals do you have for yourself through therapy?
Could you give me a picture of some significant turning points in your life? Who have been the important people in your life? What significant decisions have you made? What are some of the struggles you’ve dealt with, and what are some of the issues that are current for you?
To the extent possible, I avoid preconceived notions about what our dialog will consist of or how the therapy process will unfold. My hope is that you will share your present thoughts and feelings as they arise in this session. You may not be sure what you want from counseling, and you may have ambivalent feelings about being with me. You may be uncertain about how being in counseling will change your relationships at home. This lack of certainty is a good place to begin. I want to give you a chance to express your expectations, hopes, concerns, reservations, and doubts about making a commitment to the counseling process. This is one way I get to know you and connect with you.
I am not consciously thinking about applying a specific set of techniques. I adapt my interventions to fit your needs as a client. I take into account an array of factors about you, including your readiness to confront an issue, your stage in the change process, your cultural background, your value system, and your trust in me. I want to help you identify and experience whatever you are feeling, understand how your assumptions are influencing how you feel and behave, and encourage you to experiment with new behaviors.
Informed Consent
For the informed consent process and the initial sessions, I draw heavily on an Adlerian approach, largely because Adlerians strive to create a democratic spirit that permeates the entire counseling process. Educating you (the client) about the counseling process, addressing your questions, and clarifying your expectations are routes to ethical and effective counseling practice. The challenge is to create a balance between giving you too much or too little information. In the first session, I give you a well-written informed consent document that provides much of this information without overwhelming you. The main agenda is to provide you with the opportunity to talk about what you hope to gain from being in counseling. For you to feel safe enough to meaningfully express yourself, you need to have at least some minimal information about the nature of the therapeutic relationship. What would you want to know about how counseling works as you begin as my client? What do you consider essential to know before you make a commitment to this professional relationship? Here are some topics we might explore as part of the therapeutic contract during our early sessions:
Why is confidentiality essential to our work together, and what are the limits of confidentiality?
How does the therapeutic process work?
What is my primary role as a therapist?
What is expected of you as a client, both during the sessions and outside of sessions?
How can you and I become collaborators?
What is the approximate length of the counseling process? How long will it take for you to begin to feel better and act more effectively?
How will we know when it is time to end our work? Who has the right and the responsibility to terminate?
What are your rights and responsibilities as the client?
What are some of the benefits and risks of therapy that you can expect?
During this first session, let’s assume that you say this to me: “One of the troubles I have is trusting myself. I always think about what others expect of me. I’ve tried to please others for so long that I don’t know who I am most of the time.” This is a good opportunity for me to briefly educate you about a key task of therapy: challenging you to begin to examine the ways in which you think, feel, and act.
I want to establish a collaborative working relationship with you. (In Chapter 2, I discuss in detail how I strive to create an effective therapeutic alliance.) I spend time explaining my view of the therapy process and how it works. By demystifying the therapeutic process, I am conveying the message that you are largely in charge of the direction your therapy will take. I operate on the assumption that you are the expert on your own life. I encourage you to look within to find your own answers; I won’t try to provide easy solutions or answers. I will provide guidance and support as you strive to develop your own answers. As an outcome of our work together, I hope to help you increase your awareness of your choices and investigate ways that you limit or restrict yourself.
By this time, we have talked about the nature of counseling, the purpose and limitations of confidentiality, the procedures that we may employ, and the benefits and risks of the process. What questions and reactions do you have? In later sessions we will discuss specific therapy procedures I believe may be appropriate as we uncover your particular problems. You will help choose the techniques used in dealing with your problems.
Informing you about the counseling process is an important professional responsibility and an ethical requirement of all the major mental health professions. To what extent has this discussion helped you feel informed and a partner in the therapeutic venture?
Initial Assessment
Next, I begin the process of conducting an assessment of your circumstances and sharing my impressions with you. Early in this phase, I assess for risk factors such as suicidality, as well as determine whether we should begin with an approach of stabilization or exploration. An initial therapeutic path of stabilization may be needed if you are in crisis, have substance misuse issues, or suffer from emotional dysregulation. Understanding your current coping strategies, strengths, relationships, and meaning in life is also beneficial. Assessment consists of evaluating the relevant factors in your life to identify themes for further exploration in therapy. Adlerians are skilled in asking questions and leading clients to find answers (Maniacci & Sackett-Maniacci, 2019). I am likely to employ an Adlerian technique as part of your assessment by asking you some version of “The Question”: “How would your life be different if you did not have this problem?” “What would you do differently if you did not have this symptom or problem?” “How would your life be different if you didn’t have these issues, concerns, or problems?” If you answer that “nothing would be different, except the symptoms would be gone,” I suspect the symptoms may be physiological or organic even though they manifest themselves as psychological complaints. However, if you say that “if it weren’t for this depression, I would get out more and see my friends,” I suspect your problem serves the purpose of helping you to avoid something you perceive as necessary but from which you would like to retreat. Such a statement may reveal your concern about the possibility of being a good friend or being welcomed by your friends. Raising such questions can be a good catalyst to stimulate your reflection on what it might be like for you if you were able to change some problematic area in your life.
I am also interested in learning something about your family of origin during the initial assessment. Understanding and assessing your family of origin will reveal patterns of interpersonal behavior and communication you learned in your family that are likely to be repeated in other interactions outside your family. As a way of learning about the influence of your family on the person you are, I may ask you to identify what you learned from interacting with your parents, from observing your parents’ interactions with each other, and from observing how your parents interacted with each sibling. This is not simply a question-and-answer interview; rather, it is an assessment that enlists you as a partner in the therapeutic process (Naar & Safren, 2017).
Assessment is an ongoing process. It will not be completed during the intake interview, nor will fixed judgments be made. Assessment can be linked directly to the therapeutic process, forming a basis for developing methods of evaluating how well my interventions are working to achieve your goals. At this time, I encourage you to tell your story. As you do, I listen not only to the content but also to the manner in which you present the story of your life. I am interested in learning about strengths and resources you have to draw on in addressing your life concerns. This kind of assessment goes beyond simply understanding your problems. Together we can build on the positive patterns your life story reveals.
Therapeutic Time Limitations
In the 1970s, the field of psychotherapy began to shift from long-term psychotherapy to more problem-focused, short-term therapies such as cognitive behavior therapy. If you are my client in a setting in which brief therapy is the standard, it is especially important for me to be clear about the number of sessions the agency allows or for which your insurance will pay. If an agency policy specifies that you can be seen for only six sessions, you have a right to know this from the outset. If we are working from a short-term therapy approach, I will always keep in mind the short duration of our work together. The goal is to help you learn, as quickly and efficiently as possible, the coping skills you need to live in self-directed ways.
Practicing brief therapy requires that we set clear and realistic treatment goals, that our sessions are structured with a clear focus, and that I assume an active role in making interventions. At times, even one session can be enough to get you back on track. For example, you may be uncertain about pursuing a doctoral program, and a single session could assist you in clarifying ambivalence and making a plan. Hoyt (2009) describes single-session therapy as the most common length of treatment. Practitioners with varying theoretical orientations suggest the utility of single-session therapy in certain cases. Short-term therapies are increasing in popularity (Norcross, Pfund, & Prochaska, 2013); indeed, short-term therapies have become the treatment imperative (Norcross & Beutler, 2019). Time-limited brief therapy refers to a variety of time-sensitive, goal-directed, efficiency-oriented methods; these methods can be incorporated in any theoretical approach (Hoyt, 2015).
The limitation of time can assist us in establishing realistic goals. Toward the end of each session, I will ask you the degree to which you see yourself reaching the goals you have established, and I will also ask you to take a few moments to fill out a rating scale for the session. (This written rating scale is described by Duncan, Miller, and Sparks [2004] in The Heroic Client.) As a part of feedback-informed therapy, I will ask you to rate four areas:
Relationship:
To what degree did you feel heard, understood, and respected?
Goals and topics:
To what degree did we work on and talk about what you wanted to work on and talk about?
Approach or method:
To what degree is my therapy approach a good fit for you?
Overall:
To what degree was the session right for you today?
By reviewing the course of treatment, you are in a position to identify what is and is not working for you in the counseling process. I will include you by asking for your feedback on the progress of treatment and your experience in the therapeutic process. If I listen to feedback from you, together we can modify what we are doing in our therapy sessions, making the therapeutic process a collaborative endeavor. More information on using feedback from clients to improve therapeutic outcomes can be found in Feedback-Informed Treatment in Clinical Practice: Reaching for Excellence (Prescott, Maeschalck, & Miller, 2017).
Even though the emphasis these days is on brief therapy, my approach is more in line with brief intermittent therapy. I want to focus on and address the major concerns in your life today, but I expect we will have brief, ongoing checkups over time, somewhat like a yearly medical checkup, if you like that idea. My overriding goal is to increase the chances that you will not continue to need a therapist. If I do my work well, eventually I hope to put myself out of business. I am open to exploring termination issues with you at any point during the counseling process. As my client, would you want to know about these matters from the start? To what extent do you think discussing termination early on could be helpful to you?
Each chapter features two cases that demonstrate my integrative approach to counseling with a variety of clients. The cases are meant to highlight the application of key principles and themes in the chapter. I have made an effort to keep these cases relatively brief, emphasizing the interventions I made with each client. As you read and reflect on each case, think of how you might work with each client.
Initial Sessions and the Case of Gwen
Gwen is a 56-year-old, married, African American woman presenting with difficulty sleeping, stress, isolation associated with her job, and a history of anxiety and depression.1 Gwen is the oldest of five children, and after her parents’ divorce, she took on the responsibility of caring for her younger siblings. As the eldest child, Gwen learned very early that she was responsible not only for herself but also for all those in need around her. She often sacrificed her own desires in an effort to please others. She knows how to stand up for herself, but too often she takes on the role of helper and loses her sense of personal meaning and identity.
Gwen has been married to Ron for 31 years and states that they have problems at times, but basically they have a good relationship. They have three adult children. Gwen has a master’s degree in accounting and is employed at a large firm as a CPA. She reports being the only woman of color at her job. Because she is the only one speaking up for issues of diversity, gender, and racial equality at her workplace, she often feels isolated and tired. She does not have enough time to spend with friends or to do the things she once enjoyed because of her long work hours. Gwen is also the primary caretaker of her mother, who resides with her and is in the advanced stages of dementia.
Intake Session
This is Gwen’s first time in formal counseling, and she is seeking counseling because she is having difficulty staying focused at work and is generally feeling sad and overwhelmed. Gwen also reports experiencing a great deal of anxiety. Gwen begins by saying she is tired of the stressors she has been holding inside. She states that she has held everything together for everyone far too long. During this initial session, I address the relevant aspects of informed consent and begin an ongoing process of educating Gwen on how the therapeutic process works.
Gwen says she feels a heaviness in her heart, which is associated with all that is expected of her at work and with her family, what she has not accomplished, and where she is heading. A number of life concerns bring Gwen into counseling. A few of her concerns relate to her work. She experiences mounting tension on the job, and when she asserts her opinions, she is labeled as emotional and angry. The more tension she experiences at work, the less she engages at home. An additional concern is that her mother is losing her memory.
Gwen has lived for a long time believing therapy was for weak people and certainly not for an African American woman of strong faith. Gwen has not been in therapy before, and I need to establish a climate of trust and respect so she feels it is safe to express her feelings and experiences. As we develop our working alliance, I help Gwen understand that she has already begun the change process by doing something different and coming in for therapy.
The first step of our journey is to build a working alliance based on mutual respect. I follow the lead provided by Gwen of what is troubling her and attempt to work within the framework of what she says she wants. At each step along the way, I show empathy and compassion for her challenges as she works to rebuild self-trust and reconnect to her own sense of personal power and value.
Questions to Facilitate the Initial Session
It is to be expected that Gwen has some anxiety about initiating therapy. I want to provide her with the opportunity to talk about what it is like for her to come to the office today. That in itself provides the direction for much of our session. I structure the initial session so that she can talk about her expectations and about her fears, hopes, and ambivalent feelings. At this early stage of working with Gwen, I do not have a clear idea of where our journey will take us, for much depends on how far Gwen wants to go and what she is willing to explore. I begin by giving her a chance to say what she was thinking and feeling as she came to her initial therapy session. I then ask some of these questions, giving her time to respond to each one:
What prompted you to call for an appointment now, given that you have been feeling this way for some time? What has occurred, changed, happened? Was there any event that precipitated your calling?
What do you want me to know about you?
What are your experiences of sexism and racism, and how do they play into what you are experiencing right now?
In what areas is your life going well?
What do you wish was different?
In what areas are you presently experiencing conflict or struggle?
What were you experiencing as you were getting ready to come to this session?
These questions open the discussion of what Gwen is experiencing as she makes her first contact with me. They are central to the assessment process, which begins during the initial session. A guiding question in the back of my mind during this assessment is, “What does this client most need to understand about herself to grow and to deal more effectively with her present relationships?”
Establishing a Therapeutic Relationship With Gwen
From the beginning, I want Gwen to understand as much as possible about our mutual responsibilities as partners in this therapeutic endeavor. Informing Gwen about how the therapeutic process works, obtaining her informed consent, acknowledging that I am both a different gender and a different race than she (and that I will need her help in knowing how these affect her life), and establishing a therapeutic alliance are key matters to attend to early in our sessions. Because the therapeutic relationship is central to the outcome of therapy, this is something I begin to establish at our first meeting. This relationship is critical at the initial stages of therapy, but it must be maintained during all stages if therapy is to be effective.
In establishing the therapeutic relationship, I am influenced by the assumption that therapy is a joint venture, not something that I do to a passive client. I tend to ask myself questions such as these: “To what degree am I able to listen to and hear Gwen in a nonjudgmental way?” “Am I able to empathize and care for her?” “Do I have the capacity to enter her subjective world without losing my own identity?” I begin by being as honest as I can with Gwen, especially about my limitations. I invite Gwen to raise any questions that will help build our working alliance.
Theories During the Early Stage of Counseling
At the beginning of the counseling relationship, my concern is to establish a foundation that will provide safety for clients to be able to undertake the risks necessary in making fundamental life changes. I incorporate many constructs from the person-centered approach in my therapeutic style. For example, I believe Gwen will tell me a great deal about what she wants from life if I can really listen with deep understanding. Although I see my overall style as being active and directive, I first and foremost want to see the world from Gwen’s vantage point. She will provide me with leads if only I care enough to carefully listen and observe. From the person-centered approach, I value the emphasis on striving to experience Gwen’s world from her subjective perspective and trusting in her basic wisdom. This approach places emphasis on the quality of our relationship, which I believe is the curative factor that brings about healing and change. I want to approach meeting Gwen with as much presence, openness, and interest as I am able to bring to the initial counseling session. What I most want to do is assist her in creating her own agenda rather than being too quick to present my agenda to her. I believe Gwen is the expert on her own life. Consistent with the spirit of person-centered therapy, I believe that Gwen, with good support, has the capacity to identify what she wants in her life and that she will be able to chart her own course.
I assume that Gwen cannot be understood without considering the various systems that affect her: family, social groups, community, church, and other cultural forces. For the counseling process to be effective, it is critical to understand how Gwen influences and is influenced by her social world. (As multicultural, feminist, and family therapists have emphasized, the human condition needs to be understood within the context of a system, which includes the social and cultural framework.) Ignoring either the internal or the external perspective in understanding Gwen’s life experience will restrict my effectiveness with her.
Use of Techniques
I introduce ideas and techniques, and I let Gwen know that she is free to say what is helpful to her and what does not work for her in our sessions. In deciding on techniques to introduce, I take into account an array of factors about Gwen. Some of the areas I consider include her readiness to confront an issue, her stage in the change process, her cultural background, her value system, and her trust in me.
I typically begin and end each session by asking Gwen about the session. I depend on regular feedback to make the process truly collaborative and to ensure that Gwen’s therapeutic goals are primary. My role as a therapist is to be as fully present as possible so I can effectively integrate therapeutic approaches that will assist Gwen on her journey of transformation as she moves toward a state of optimal functioning and balance.
Reflection Questions
Reflect on what you would most hope to accomplish with Gwen during the initial session. Consider these questions:
What would you focus on with Gwen during the assessment process?
What specific aspects of the informed consent process would you most want to address at the first session?
How competent would you feel in working with Gwen given any of the differences between you? What differences would you see as being most important to address?
Initial Sessions and the Case of Chet
Chet, age 42, decided to seek counseling after a crisis in his marriage, which led to his wife (Amelia) filing for a divorce. Married for 15 years, he was utterly shocked when his wife said that she felt a strong need to become more independent and that their marriage was no longer fulfilling. Although there were periods of conflict in their relationship, Chet never imagined the situation was so desperate that Amelia would decide to pursue a divorce.
Amelia is in her own personal therapy and also participates in a women’s group. Chet wanted Amelia to join him in marital therapy, but she refused. He is concerned that her dissatisfaction with their relationship has been stirred up by what she hears in her women’s group. Chet comes from a culture that honors family stability, and divorce is frowned upon. He is angry with Amelia for going against traditional family roles and values, and he has a hard time understanding why she is not willing to work on keeping their marriage intact. Chet feels helpless about the situation, and often feels panic and extreme sadness.
I am especially interested in what Chet most hopes to get from our work together. At the initial session, Chet asks how counseling can help him get out of his depression, anxiety, and hopelessness. One of his expectations is that he will reveal his problems and that I will then give him advice. He admits to feeling anxious about approaching his first counseling session, but he adds that he is scared about being lonely and lost when it comes to creating new relationships. In response to my question about what he expects to get from counseling, he replies, “I want to know how to cope with the breakup of my 15-year marriage. I really need to know how I can deal with my depression, anger, and anxiety over the divorce.”
The Therapeutic Contract
I begin to establish a therapeutic alliance with Chet by formulating a working contract that will give some direction to his sessions. I discuss with him what I see as my primary responsibilities and functions, as well as Chet’s responsibilities in the process. I want him to know at the outset that I expect him to be an active party in this relationship, and I tell him that I function in an active and directive way. (This is characteristic of most of the cognitive behavior and action-oriented therapies.)
Early in the counseling process, it is essential that I get some sense of what Chet wants from counseling and from life. Although his responses are vague at first, I work with Chet to be as specific and concrete as possible regarding how he views his life situation and what he expects from the therapy process. (This process is especially important in Adlerian therapy, behavior therapy, cognitive behavior therapy, reality therapy, and feminist therapy. Goals are discussed further in Chapter 3.)
