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Although I’d like to have people in my life, I just don’t seem to know how to go about making friends or getting close to people. I’d like to turn my life around, but I have no sense of direction. I want to make a difference. I am afraid of failure. I know when I feel alone, scared, and overwhelmed, I drink heavily to feel better. I am afraid of women. Sometimes at night I feel a terrible anxiety and feel as if I’m dying. I often feel guilty that I’ve wasted my life, that I’ve failed, and that I’ve let people down. At times like this, I get depressed. I like it that I have determination and that I really want to change. I’ve never really felt loved or wanted by my parents. I’d like to get rid of my self-destructive tendencies and learn to trust people more. I put myself down a lot, but I’d like to feel better about myself.

Traits of a counsellor   

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Effective therapists have an identity. They know who they are, what they are capable of becoming, what they want out of life, and what is essential. Effective therapists respect and appreciate themselves. They can give and receive help and love out of their own sense of self-worth and strength. They feel adequate with others and allow others to feel powerful with them. Effective therapists are open to change. They exhibit a willingness and courage to leave the security of the known if they are not satisfied with the way they are. They make decisions about how they would like to change, and they work toward becoming the person they want to become. Effective therapists make choices that are life oriented. They are aware of early decisions they made about themselves, others, and the world. They are not the victims of these early decisions, and they are willing to revise them if necessary. They are committed to living fully rather than settling for mere existence. Effective therapists are authentic, sincere, and honest. They do not hide behind rigid roles or facades. Who they are in their personal life and in their professional work is congruent. Effective therapists have a sense of humor. They are able to put the events of life in perspective. They have not forgotten how to laugh, especially at their own foibles and contradictions. Effective therapists make mistakes and are willing to admit them. They do not dismiss their errors lightly, yet they do not choose to dwell on misery. Effective therapists generally live in the present. They are not riveted to the past, nor are they fixated on the future. They are able to experience and be present with others in the “now.” Effective therapists appreciate the influence of culture. They are aware of the ways in which their own culture affects them, and they respect the diversity of values espoused by other cultures. They are sensitive to the unique differences arising out of social class, race, sexual orientation, and gender. Effective therapists have a sincere interest in the welfare of others. This concern is based on respect, care, trust, and a real valuing of others. Effective therapists possess effective interpersonal skills. They are capable of entering the world of others without getting lost in this world, and they strive to create collaborative relationships with others. They readily entertain another person’s perspective and can work together toward consensual goals. Effective therapists become deeply involved in their work and derive meaning from it. They can accept the rewards flowing from their work, yet they are not slaves to their work. Effective therapists are passionate. They have the courage to pursue their dreams and passions, and they radiate a sense of energy. Effective therapists are able to maintain healthy boundaries. Although they strive to be fully present for their clients, they don’t carry the problems of their clients around with them during leisure hours. They know how to say no, which enables them to maintain balance in their lives.

Personal therapy (1) As part of the therapist’s training, personal therapy offers a model of therapeutic practice in which the trainee experiences the work of a more experienced therapist and learns experientially what is helpful or not helpful; (2) A beneficial experience in personal therapy can further enhance a therapist’s interpersonal skills that are essential to skillfully practicing therapy; and (3) Successful personal therapy can contribute to a therapist’s ability to deal with the ongoing stresses associated with clinical work. Here are some other circumstances in which information must legally be reported by counselors:    

When the therapist believes a client under the age of 16 is the victim of incest, rape, child abuse, or some other crime When the therapist determines that the client needs hospitalization When information is made an issue in a court action When clients request that their records be released to them or to a third party

Effective therapists incorporate a wide range of procedures in their therapeutic style. Much depends on the purpose of therapy, the setting, the personality, and style of the therapist, the qualities of the particular client, and the problems selected for intervention. Regardless of the therapeutic model you may be working with, you must decide what relationship style to adopt; what techniques, procedures, or intervention methods to use; when to use them; and with which clients. Take time to review Table 15.5 on therapeutic techniques and Table 15.6 on applications for each approach. Pay careful attention to the focus of each type of therapy and how that focus might be useful in your practice.

Techniques of Therapy The key techniques are interpretation, dream analysis, free association, analysis of resistance, analysis of transference, and countertransference. Techniques are designed to help clients gain access to their unconscious conflicts, which leads to insight and eventual assimilation of new material by the ego. Adlerian therapy Adlerians pay more attention to the subjective experiences of clients than to using techniques. Some techniques include gathering life-history data (family constellation, early recollections, personal priorities), sharing interpretations with clients, offering encouragement, and assisting clients in searching for new possibilities. Few techniques flow from this approach because it stresses understanding first and Existential technique second. The therapist can borrow techniques from other approaches and therapy incorporate them in an existential framework. Diagnosis, testing, and external measurements are not deemed important. Issues addressed are freedom and responsibility, isolation and relationships, meaning and meaninglessness, living and dying. Person-centered This approach uses few techniques but stresses the attitudes of the therapist and a “way of being.” Therapists strive for active listening, reflection of feelings, clarification, therapy “being there” for the client, and focusing on the moment-to-moment experiencing of the client. This model does not include diagnostic testing, interpretation, taking a case history, or questioning or probing for information. Gestalt therapy A wide range of experiments are designed to intensify experiencing and to integrate conflicting feelings. Experiments are co-created by therapist and client through an I/Thou dialogue. Therapists have latitude to creatively invent their own experiments. Formal diagnosis and testing are not a required part of therapy. Behavior therapy The main techniques are reinforcement, shaping, modeling, systematic desensitization, relaxation methods, flooding, eye movement and desensitization reprocessing, cognitive restructuring, social skills training, self-management programs, mindfulness and acceptance methods, behavioral rehearsal, and coaching. Diagnosis or assessment is done at the outset to determine a treatment plan. Questions concentrate on “what,” “how,” and “when” (but not “why”). Contracts and homework assignments are also typically used. Therapists use a variety of cognitive, emotive, and behavioral techniques; diverse Cognitive behavior therapy methods are tailored to suit individual clients. This is an active, directive, time-limited, present-centered, psychoeducational, structured therapy. Some techniques include engaging in Socratic dialogue, collaborative empiricism, debating irrational beliefs, carrying out homework assignments, gathering data on assumptions one has made, keeping a record of activities, forming alternative interpretations, learning new coping skills, changing one’s language and thinking patterns, role playing, imagery, confronting faulty beliefs, self-instructional training, and stress inoculation training. This is an active, directive, and didactic therapy. Skillful questioning is a central Choice technique used for the duration of the therapy process. Various techniques may be used theory/Reality to get clients to evaluate what they are presently doing to see if they are willing to therapy change. If clients decide that their present behavior is not effective, they develop a specific plan for change and make a commitment to follow through. Psychoanalytic therapy

Feminist therapy Although techniques from traditional approaches are used, feminist practitioners tend to employ consciousness-raising techniques aimed at helping clients recognize the impact of gender-role socialization on their lives. Other techniques frequently used include gender-role analysis and intervention, power analysis and intervention, demystifying therapy, bibliotherapy, journal writing, therapist self-disclosure, assertiveness training, reframing and relabeling, cognitive restructuring, identifying and challenging untested beliefs, role playing, psychodramatic methods, group work, and social action. In solution-focused therapy the main technique involves change-talk, with emphasis on Postmodern times in a client’s life when the problem was not a problem. Other techniques include approaches creative use of questioning, the miracle question, and scaling questions, which assist clients in developing alternative stories. In narrative therapy, specific techniques include listening to a client’s problem-saturated story without getting stuck, externalizing and naming the problem, externalizing conversations, and discovering clues to competence. Narrative therapists often write letters to clients and assist them in finding an audience that will support their changes and new stories. Family systems A variety of techniques may be used, depending on the particular theoretical orientation of the therapist. Some techniques include genograms, teaching, asking questions, joining therapy the family, tracking sequences, family mapping, reframing, restructuring, enactments, and setting boundaries. Techniques may be experiential, cognitive, or behavioral in nature. Most are designed to bring about change in a short time.

Applications of the Approaches Psychoanalytic therapy

Candidates for analytic therapy include professionals who want to become therapists, people who have had intensive therapy and want to go further, and those who are in psychological pain. Analytic therapy is not recommended for selfcentered and impulsive individuals or for people with psychotic disorders. Techniques can be applied to individual and group therapy.

Adlerian therapy Because the approach is based on a growth model, it is applicable to such varied spheres of life as child guidance, parent–child counseling, marital and family therapy, individual counseling with all age groups, correctional and rehabilitation counseling, group counseling, substance abuse programs, and brief counseling. It is ideally suited to preventive care and alleviating a broad range of conditions that interfere with growth. Existential therapy

This approach is especially suited to people facing a developmental crisis or a transition in life and for those with existential concerns (making choices, dealing with freedom and responsibility, coping with guilt and anxiety, making sense of life, and finding values) or those seeking personal enhancement. The approach can be applied to both individual and group counseling, and to couples and family therapy, crisis intervention, and community mental health work.

Person-centered therapy

Has wide applicability to individual and group counseling. It is especially well suited for the initial phases of crisis intervention work. Its principles have been applied to couples and family therapy, community programs, administration and management, and human relations training. It is a useful approach for teaching, parent–child relations, and for working with groups of people from diverse cultural backgrounds.

Gestalt therapy

Addresses a wide range of problems and populations: crisis intervention, treatment of a range of psychosomatic disorders, couples and family therapy, awareness training of mental health professionals, behavior problems in children, and teaching and learning. It is well suited to both individual and group counseling. The methods

are powerful catalysts for opening up feelings and getting clients into contact with their present-centered experience. Behavior therapy A pragmatic approach based on empirical validation of results. Enjoys wide applicability to individual, group, couples, and family counseling. Some problems to which the approach is well suited are phobic disorders, depression, trauma, sexual disorders, children’s behavioral disorders, stuttering, and prevention of cardiovascular disease. Beyond clinical practice, its principles are applied in fields such as pediatrics, stress management, behavioral medicine, education, and geriatrics. Has been widely applied to treatment of depression, anxiety, relationship problems, Cognitive behavior therapy stress management, skill training, substance abuse, assertion training, eating disorders, panic attacks, performance anxiety, and social phobias. CBT is especially useful for assisting people in modifying their cognitions. Many self-help approaches utilize its principles. CBT can be applied to a wide range of client populations with a variety of specific problems. Choice theory/Reality therapy

Geared to teaching people ways of using choice theory in everyday living to increase effective behaviors. It has been applied to individual counseling with a wide range of clients, group counseling, working with youthful law offenders, and couples and family therapy. In some instances it is well suited to brief therapy and crisis intervention.

Feminist therapy Principles and techniques can be applied to a range of therapeutic modalities such as individual therapy, relationship counseling, family therapy, group counseling, and community intervention. The approach can be applied to both women and men with the goal of bringing about empowerment. Postmodern approaches

Solution-focused therapy is well suited for people with adjustment disorders and for problems of anxiety and depression. Narrative therapy is now being used for a broad range of human difficulties including eating disorders, family distress, depression, and relationship concerns. These approaches can be applied to working with children, adolescents, adults, couples, families, and the community in a wide variety of settings. Both solution-focused and narrative approaches lend themselves to group counseling and to school counseling.

Family systems therapy

Useful for dealing with marital distress, problems of communicating among family members, power struggles, crisis situations in the family, helping individuals attain their potential, and enhancing the overall functioning of the family.

Goals of Therapy Psychoanalytic therapy

To make the unconscious conscious. To reconstruct the basic personality. To assist clients in reliving earlier experiences and working through repressed conflicts. To achieve intellectual and emotional awareness.

Adlerian therapy

To challenge clients’ basic premises and life goals. To offer encouragement so individuals can develop socially useful goals and increase social interest. To develop the client’s sense of belonging.

Existential therapy

To help people see that they are free and to become aware of their possibilities. To challenge them to recognize that they are responsible for events that they formerly thought were happening to them. To identify factors that block freedom.

Person-centered therapy

To provide a safe climate conducive to clients’ self-exploration. To help clients recognize blocks to growth and experience aspects of self that were formerly denied or distorted. To enable them to move toward openness, greater trust in self, willingness to be a process, and increased spontaneity and aliveness. To find meaning in life and to experience life fully. To become more self-directed.

Gestalt therapy

To assist clients in gaining awareness of moment-to-moment experiencing and to expand the capacity to make choices. To foster integration of the self.

Behavior therapy

To eliminate maladaptive behaviors and learn more effective behaviors. To identify factors that influence behavior and find out what can be done about problematic behavior. To encourage clients to take an active and collaborative role in clearly setting treatment goals and evaluating how well these goals are being met.

Cognitive behavior therapy

To teach clients to confront faulty beliefs with contradictory evidence that they gather and evaluate. To help clients seek out their faulty beliefs and minimize them. To become aware of automatic thoughts and to change them. To assist clients in identifying their inner strengths, and to explore the kind of life they would like to have.

Choice theory/Reality To help people become more effective in meeting all of their psychological needs. To enable clients to get reconnected with the people they have chosen to put into therapy their quality worlds and teach clients choice theory. Feminist therapy

To bring about transformation both in the individual client and in society. To assist clients in recognizing, claiming, and using their personal power to free themselves from the limitations of gender-role socialization. To confront all forms of institutional policies that discriminate or oppress on any basis.

Postmodern approaches

To change the way clients view problems and what they can do about these concerns. To collaboratively establish specific, clear, concrete, realistic, and observable goals leading to increased positive change. To help clients create a selfidentity grounded on competence and resourcefulness so they can resolve present and future concerns. To assist clients in viewing their lives in positive ways, rather than being problem saturated.

Family systems therapy

To help family members gain awareness of patterns of relationships that are not working well and to create new ways of interacting. To identify how a client’s problematic behavior may serve a function or purpose for the family. To understand how dysfunctional patterns can be handed down across generations. To recognize how family rules can affect each family member. To understand how past family of

origin experiences continue to have an impact on individuals.

Table 15.4

The Therapeutic Relationship Psychoanalytic therapy

The classical analyst remains anonymous, and clients develop projections toward him or her. The focus is on reducing the resistances that develop in working with transference and on establishing more rational control. Clients undergo long-term analysis, engage in free association to uncover conflicts, and gain insight by talking. The analyst makes interpretations to teach clients the meaning of current behavior as it relates to the past. In contemporary relational psychoanalytic therapy, the relati...