Counseling Psychology

Osemeka Anthony


ID UAD7638HBY14286





























Counseling Psychology

(Course Work)



























PhD in Psychology

Atlantic International University

School of Social and Human Studies













Table of Contents

Table Content-------------------------------------------------------------------------------------2

Introduction----------------------------------------------------------------------------------------3

Background history------------------------------------------------------------------------------4-8

Description of Counseling Psychology-----------------------------------------------------8-10

Types of counseling---------------------------------------------------------------------------10-14

Principles of Counseling----------------------------------------------------------------------14-32

The Mirror role of counseling----------------------------------------------------------------32-37

Regular vs. Christian marriage counseling-The difference--------------------------------37-46

Counseling psychology vs. clinical psychology-----------------------------------------46-54

Counseling methods survey- Theories/Theorists and Terminology---------------54-60

Counseling and Psychotherapy-------------------------------------------------------------60-64

Comparing therapeutic effectiveness------------------------------------------------------64-95

Traditional/Alternative approaches to mental health care-----------------------------95-102







































































1.0. Introduction



1.1. Counseling psychology is a psychological specialty that encompasses research and applied work in several broad domains: counseling process and outcome; supervision and training; career development and counseling; diversity and multiculturalism; and prevention and health. Some unifying themes among counseling psychologists include a focus on assets and strengths, person-environment interactions, educational and career development, brief interactions, and a focus on intact personalities. In the United States of America, the premier scholarly journals of the profession are the Journal of Counseling Psychology and The Counseling Psychologist In Europe, the scholarly journals of the profession include the European Journal of Counseling Psychology (under the auspices of the European Association of Counseling Psychology) and the Counseling Psychology Review (under the auspices of the British Psychological Society. Counseling Psychology Quarterly is an international interdisciplinary publication of Rout ledge (part of the Taylor & Francis Group)

1.2.Two differences in particular may distinguish the field of counseling from the field of counseling psychology: first, counseling is almost entirely an applied field: that is, the occupation of counselors is generally counseling and psychotherapy. In contrast, counseling psychology is both a research and applied field; applied work might include teaching, consultation, and clinical work, which in turn could include supervision, assessment, and forensic evaluation, in addition to counseling or psychotherapy. A second distinction is the breadth of topics encompassed by counseling psychology. In addition to studying and teaching counseling, counseling psychologists also engage in research in areas such as career development, culture, ethnicity, gender, identity development, personality, sexual orientation, race, and research methodology.



















2.0. Background History



2.1. Psychology is the study of human behavior. It covers everything that a person thinks or feels. Since it is all-encompassing, you will find psychologists in every field of study under the sun. The history of psychology originated in the antiquities. Yet, it only became a recognized field on its own in the mid-1800 and for this reason, it is known as a fairly new discipline of study. The origins of psychology germinated in the fields of medicine and philosophy. We can thank the ancient Greeks for this. From the field of science, Hippocrates, known as the father of medicine, was one of the greatest influences on modern-day psychology. Similarly, Socrates, Plato, and Aristotle, the great ancient Greeks philosophers, were among the greatest influences on modern-day psychology from the philosophical perspective. As a result of the tremendous influence of both these fields on psychology, there once was an ongoing debate as to whether psychology is a science or an art. Basically, it is believed that psychology is a mixture of both science and philosophy. I believe that one discipline without the other would not do justice to the field of psychology at all.

2.2.Psychology is not a hard science like chemistry or physics. It is known as a soft science because it does not postulate scientific laws governing nature. Human nature is so complex; people don’t always react in the same way, thus making it extremely difficult to establish "laws". For a science to be called a pure science or "hard" science, you must have laws that you can prove over and over again. For example, gravity is a law of nature. If you let go of a pencil in midair it will always fall–according to a law of physics.

Conversely, to use depression as an example from the realm of psychology, many people may have symptoms of depression but these people will not experience it in quite the same way. It is for this reason that the hard-nosed scientists laugh at psychology. In defense of my field, psychology does use the scientific method.

Psychologists test their theories using scientific methods of research. They will create experiments and measure the results. For example, if a psychologist deems that a person has depression, it is not because he/she felt like it, pulled it of his/her bag as a possible diagnosis or thought it sounded good. The diagnosis is based on scientific study and years of reseach in the field. However, since humans are different from the elements, you cannot treat them as such. Just as I said before, a pencil will always fall if dropped in midair. However, a person has a thinking process that affects every decision that he or she makes in life, and these mental processes will affect the outcome of depression and affect their mood. Because of the additional influences of human thinking in reaction to various physical symptoms such as depression, the truisms found in philosophy must factor into the psychological evaluation as well.

The field of psychology became a recognized discipline in Europe in the mid-1800s. The first psychologists were German. They scientifically studied the physical reactions of the body when experiencing pain and formulated theories about reaching pain thresholds, etc. They did this by scientific means. They chose to study physical changes in the body by measuring sweat, heart rhythms, etc. They attempted to establish scientific data to explain and back up the body’s reaction to pain. They also studied how people learn with regards to their thinking processes, again by using the scientific method and measuring the subjects’ responses in memory tests. Later, people like Dr. Sigmund Freud, who was a medical doctor, proposed theories about human nature with regard to how humans think and feel, which he combined that with the scientific (medical) knowledge of the day. As a result, the division in psychology became apparent way back then. You had the scientists (the learning people), who were strictly concerned with physical aspects; and the clinicians, such as Freud, who studied the philosophical aspect and combined it with scientific study. Today in universities you can choose to go into scientific psychology, which is pure research work, or clinical psychology where you will have patients and treat their various concerns. The psychology students who elected research (scientific) and their professors were nicknamed the “rat people by students who preferred the clinical aspect of psychology. These "rat people" are the people who experiment with rats and are responsible for helping to find cures for cancer, AIDS, etc. They work in conjunction with the medical field; chemistry, biology, etc., to finds cures for human ailments, including drug addiction and alcoholism. You name it and there will be research about it. These psychologists and students of psychology almost never see people. They don’t have clients, they conduct experiments in the laboratory and they work with animals, studying their behavior to various stimuli. In using animals as test subjects they create models that can be applied to human nature. They not only help find cures for human diseases that way, they formulate theories about how humans learn by reacting to their environment and they aid in the research of veterinary sciences.

Incidentally, the research done by the "rat people" brings in big government research grants for American and Canadian universities; they are the big moneymakers. American and Canadian universities are world leaders in the area of scientific psychology research. Our governments pour millions of dollars into this type of research. Other psychologists in the scientific stream research the behaviour of people rather than animals. For example, they may study the effects of the element of surprise introduced into a group setting, or test babies (developmental psychology) to see if they are responding to different stimuli the way they should at each stage of development. These psychologists, who are scientists, are not necessarily oriented toward individual clients. Their focus is to study groups and formulate theories about what is normal behavior for that group.

2.3. The division between science and philosophy that launched the great debate on whether or not psychology is a science or an art. The debate stemmed from the fact that psychology borrows from the sciences as well as from the great philosophical minds of all time. The people who deal with clients and listen to their emotional and cognitive needs i.e. the Clinical psychology has its roots in philosophy rather than medicine. Clinical psychologists are primarily interested in the client. They take the theories that the research psychologists formulate and apply them on an individual level (Applied Psychology). If a psychologist diagnoses someone with depression, he/she just did not pull the diagnosis out of a hat. The counselor or psychologist uses scientific research as a basis for the diagnosis, but then takes the theories one step further. The counselor uses his/her knowledge of research to help the client ameliorate his/her situation.

Using the depression example, the clinician would know from the research that clinically depressed people (the most severe depression cases) don’t really want to do anything; they are totally unmotivated, apathetic, and lethargic. Therefore, getting them to start doing things helps alleviate the depression can be challenging. Knowing this, a clinician will sit down with the client and talk about different things that the client would like to do as part of therapy. For one client it might be swimming, for another it might be using the Internet, etc.

2.4. Finally, there are two main divisions of psychology: scientific and clinical. Under each division, there are hundreds of fields of studies. The clinical psychologist deals with severe mental disorders such as schizophrenia, major depression, Dissociative Identity Disorder basically the same clientele as for psychiatrists.

Now, by introducing the subject of psychiatrists, it immediately brings to mind the question, what is the difference between the psychologists and psychiatrists. Simply stated, a psychiatrist is a medical doctor who has taken special training in the workings of the mind and he or she understands that human mental disorders originate from a biological malfunction. Furthermore, he/she is also authorized to prescribe drugs to correct or ameliorate these disorders. On the other hand, the clinical psychologist is not a medical doctor. He/she has studied the workings of the mind but only has a psychology degree, not a medical degree. Without a medical degree, the psychologist is not authorized to prescribe drugs.

2.5.The counselor or counseling psychologist’s focus is not on abnormal human behavior as in the heavy-duty mental disorders, but their focus is concerned with normal behavior. Therefore, counselors and counseling psychologists work with people who have everyday issues or concerns. The first counselors were guidance counselors in schools and universities who dealt with issues that students face. The discipline has now extended to clinical psychology. You will find counselors in schools, clinics, community centers, hospitals, businesses-just about anywhere. Counselors deal with a wide variety of issues, such as problems in school, marital and family relationships, grief counseling, career counseling, depression, self-esteem issues; the list goes on and on. However, for psychologists and counselors alike, therapy is basically applying the scientific theories of psychology to everyday life and coming up with a plan to help your client, such as the example previously given for depression.

To date, there are over 350 different therapies out there. Of course, no one individual therapist was ever trained in all of them. But they are out there good, bad or otherwise. Some of these therapies work better than others, making it difficult for a person seeking help to really know who to go to. When you have cancer you go to a cancer specialist, but when you need to see a psychologist or counselor it is not easy to find the right one.

Consequently, it is required by law that when seeking a psychologist or counselor, the professional must tell you his/her particular brand of psychology and what he/she plans to accomplish with you through the use of it. At that point, a prospective client can decide if this is the type of therapy that he/she feels will help; or the client can begin therapy and choose afterwards based on results.

2.6. Counseling psychology, like many modern psychology specialities, started as a result of World War II. During the war, the U.S. military had a strong need for vocational placement and training. In the 1940s and 1950s the Veterens Administration created a specialty called counseling psychology, and Division 17 (now known as the Society for Counseling Psychology) of the American Psychological Association was formed. This fostered interest in counselor training, and the creation of the first few counseling psychology Ph.D programs. The first counseling psychology Ph.D programs were at the University of Minnesota; Ohio State University; University of Maryland, College Park; University of Missouri-Columbia; Teachers College, Columbia University; and University of Texas at Austin.



3.0. Archival description of counseling Psychology

Counseling psychology is a general practice and health service provider specialty in professional psychology. It focuses on personal and interpersonal functioning across the life span and on emotional, social, vocational, educational, health-related, developmental and organizational concerns. Counseling psychology centers on typical or normal developmental issues as well as atypical or disordered development as it applies to human experience from individual, family, group, systems, and organizational perspectives. Counseling psychologists help people with physical, emotional, and mental disorders improve well-being, alleviate distress and maladjustment, and resolve crises. In addition, practitioners in this professional specialty provide assessment, diagnosis, and treatment of psychopathology.

3.1.Advanced Scientific and Theoretical Knowledge Germane to the Specialty

Building upon a core knowledge base of general psychology (i.e., the biological, cognitive/affective, social, and individual bases of behavior, history and systems of psychology) common to the other applied specialties within professional psychology, the competent and skillful practice of Counseling Psychology requires knowledge of career development and vocational behavior, individual differences (including racial, cultural, gender, lifestyle, and economic diversity), psychological measurement and principles of psychological/diagnostic and environmental assessment, social and organizational psychology, human life span development, consultation and supervision, psychopathology, learning (cognitive, behavioral), personality, methods of research and evaluation, and individual and group interventions (counseling/psychotherapy).

Professional preparation for the specialty of Counseling Psychology occurs at the doctoral and postdoctoral level.

3.2. Parameters to Define Professional Practice in Counseling Psychology

Within the context of life span development, counseling psychologists focus on healthy aspects and strengths of the client (individual, couple, family, group, system, or organization), environmental/situational influences (including the context of cultural, gender, and lifestyle issues) and the role of career and vocation on individual development and functioning.

3.2.0. Populations:

3.2.1. Client populations served by counseling psychologists can be organized along three dimensions: individuals, groups (including couples and families) and organizations. Counseling psychologists work with individual clients of all ages such as children who have behavior problems; late adolescents with educational and career concerns or substance abuse problems; adults facing marital or family difficulties, career shifts, or overcoming disabilities; older adults facing retirement. They work with groups in a variety of settings toward achieving solutions to many of these same problems, as well as toward enhancement of personal and interpersonal functioning. Counseling psychologists also consult with organizations and work groups to help provide a work environment conducive to human functioning and to enhance the ability of organizations to increase productivity and effectiveness.

3.2.2. Problems:

The problems addressed by the specialty of Counseling Psychology are varied and multifaceted and are addressed from developmental (lifespan), environmental, and cultural perspectives. They include, but are not limited to:

• educational and vocational career/work adjustment concerns,

• vocational choice, and school-work-retirement transitions,

• relationship difficulties-including marital and family difficulties,

• learning and skill deficits,

• stress management and coping,

• organizational problems,

• adaptation to physical disabilities, disease, or injury

• personal/social adjustment,

• personality dysfunction, and

• Mental disorders.



3.2.3. Procedures:

The procedures and techniques used within Counseling Psychology include, but are not limited to:

• individual, family, group and systemic counseling;

• behavioral and psychotherapeutic interventions;

• crisis intervention, disaster and trauma management;

• psychodiagnostic assessment techniques;

• psychoeducational/preventive programming;

• organizational consulting;

• program evaluation and treatment outcome;

• training; clinical supervision;

• test construction and validation; and

• Methodologies for quantitative and qualitative inquiry.

Intervention procedures and techniques have as their focus change in client cognitions, feelings and behavior and may be preventive, skill-enhancing or remedial. The intervention procedures may range from short term or time-specified to longer term approaches.



4.0. Types of Counseling

4.1. Counseling should be looked upon in terms of the amount of direction that the counselor gives the counselee. This direction ranges from full direction (directive counseling) to no direction

(nondirective counseling).

4.2. Directive Counseling

Directive counseling is the process of listening to a counselee’s problem, deciding with the counselee what should be done, and then encouraging and motivating the person to do it. This type of counseling accomplishes the function of advice; but it may also reassure; give emotional release; and, to a minor extent, clarify thinking. Most everyone likes to give advice, counselors included, and it is easy to do. But is it effective? Does the counselor really understand the counselee’s problem? Does the counselor have the technical knowledge of human behavior and the judgment to make the “right” decision? If the decision is right, will the client or counselee follow it? The answer to these questions is often no, and that is why advice- giving is sometimes an unwise act in counseling. Although advice-giving is of questionable value, some of the other functions achieved by directive counseling are worthwhile. If the counselor is a good listener, then the client should experience some emotional release. As the result of the emotional release, plus ideas that the counselor imparts, the counselee may also clarify thinking. Both advice and reassurance may be worthwhile if they give the counselee more courage to take a workable course of action that the counselee supports.

4.3.Nondirective Counseling

Nondirective, or client-centered, counseling is the process of skillfully listening to a counselee, encouraging the person to explain bothersome problems, and helping him or her to understand those problems and determine courses of action. This type of counseling focuses on the client, rather than on the counselor as a judge and advisor; hence, it is “client-centered.” This type of counseling is used by professional counselors, but nonprofessionals may use its techniques to work more effectively with service client. The unique advantage of nondirective counseling is its ability to cause the client’s reorientation. It stresses changing the person, instead of dealing only with the immediate problem in the usual manner of directive counseling. The counselor attempts to ask discerning questions, restate ideas, clarify feelings, and attempts to understand why these feelings exist. Professional counselors treat each counselee as a social and organizational equal. They primarily listen and try to help their client discover and follow improved courses of action. They especially “listen between the lines” to learn the full meaning of their client’s feelings. They look for assumptions underlying the counselee’s statements and for the events the counselee may, at first, have avoided talking about. A person’s feelings can be likened to an iceberg. The counselor will usually only see the revealed feelings and emotions. Underlying these surface indications is the true problem that the counselee is almost always initially reluctant to reveal.











4.4.Person Centred counseling

Person Centred counseling also known as client centred or non directive therapy was developed in the 1930's by American Carl Rogers. It is an approach that places a lot of emphasis and responsibility on the client with the counselor taking a more passive role than in some of the other counseling methods such as Psychodynamic therapy. The goals of person centred counseling include increased self esteem and openness to experience, better understanding of oneself and to decrease feelings of guilt, defensiveness and insecurity also to experience more positive relationships with others and to gain ability to express feelings/emotions more easily. Carl Rogers believed that certain attitudes of the counselor are core to the success of the person centred approach. Congruence, by which is meant the counselors ability to be genuine and willingness to relate to clients without hiding behind a professional mask. Unconditional positive regard, meaning that the counselor accepts the client for who they are without judging or disapproving of any character or personality traits. The counselor should convey this attitude by listening without interrupting or giving advice. This attitude should relax the client and create an atmosphere where they feel more comfortable to share their feelings Empathy Where the therapist appreciates the client’s circumstances from their viewpoint, being understanding and sensitive to the client’s feelings. In some other forms of therapy such as BALNK empathy is considered a first step to enable counseling to proceed. But in Person centered approach it is a major part of the counseling by itself.

4.5.Psychodynamic counseling

The Principles of the psychodynamic approach originate from the ideas of the Psychoanalytic school which was founded by Sigmund Freud. It places a lot of emphasis on past experiences from childhood effecting current behavior in the unconscious mind.

In Psychodynamic therapy the patient (more commonly not the client as in other types of counseling) speaks and the therapist then makes interpretations and tries to find hidden meanings in the Patients words. This is in contrast to the person centred approach of being non-interpretive.











4.6.Cognitive Behavioral Therapy

The Earliest form of Cognitive Behavioral Therapy (CBT) was pioneered by Albert Ellis in The 1950's who called his approach Rational Emotive Behavioral Therapy (REBT). Aaron T. Beck developed another CBT like approach called Cognitive Therapy in the 1960's in recent years these two methods have combined into CBT.

CBT is a form of counseling that picks up on faulty thought patterns that may cause counter-productive behavior and emotions. The counseling focuses on changing the client’s thoughts in order to change their emotional state. Instead of reacting to the reality of a situation a person reacts instead to their own distorted viewpoint of the situation. For example a person might think they are good for nothing simply because they might have failed one exam. The counselor tries to make the client aware of this distorted way of thinking and change them.

CBT also tries to make the client replace negative behaviors with healthier more positive ones. Unlike the Psychodynamic approach it does not focus on uncovering unconscious motivations that may be behind the negative behavior. CBT Therapists don't try to find out why clients act as they do they just try to teach them to change their behavior

4.7.0.Essential skills used for counseling:

4.7.1.Reflection

Reflection is the process of acting like a verbal mirror reflecting the clients words back at them and repeating or rephrasing parts of what they say. This can help convey to the client that you are listening carefully and trying to understand what they say; this can have a calming effect on the counseling session and will help put the client at ease.

4.7.2.The following is an example of reflection.

Client: I have been having a really tough time at work at the moment I feel as if I am over my head and overwhelmed by my workload.

Counselor: It sounds as if work is really hard going for you at the moment and you are overwhelmed by the situation."

4.7.3.Non -Verbal Communication

Non -Verbal Communication is an essential part of communicating with the client. Research shows that up to 80% of all communication is non verbal. Positive non-verbal communication can convey warmth acceptance and attentiveness.



4.7.4.Positive non verbal communication can include the following.

Making eye contact

maintaining an interested facial expression

nodding

facing the other person

maintaining an open position (i.e.. not crossing legs and arms)

maintaining an attentive posture

keeping a close proximity

4.7.5. Negative Non verbal communication should be avoided and includes:

checking your watch

fidgeting

sighing

foot tapping

Staring out the window



4.7.6. Open ended questioning

Open ended questioning can help the client explore their situation further, this type of questioning can be useful for moving the session forward, and shows to the client that the counselor is interested and involved. The counselor must be careful not to ask questions to satisfy their curiosity and must also be client focused for example the counselor shouldn't ask "How does your Mother feel?"

4.7.8. The following is an example of use of open ended questioning..

"Tell me how have you been getting on with your brother lately?"

Which would be much more effective than simply asking?

"Is your brother being aloof lately"?







5.0.Principles of Counseling

Sympathetic listener, their tensions begin to subside. They become more relaxed and tend to become more coherent and rational. The release of tensions does not necessarily mean that the solution to the problem has been found, but it does help remove mental blocks in the way of a solution.

5.1.Clarified Thinking

Clarified thinking tends to be a normal result of emotional release. The fact is that not all clarified thinking takes place while the counselor and counselee are talking. All or part of it may take place later as a result of developments during the counseling relationship. The net result of clarified thinking is that a person is encouraged to accept responsibility for problems and to be more realistic in solving them.

5.2.Reorientation

Reorientation is more than mere emotional release or clear thinking about a problem. It involves a change in the client’s emotional self through a change in basic goals and aspirations. Very often it requires a revision of the client’s level of aspiration to bring it more in line with actual attainment. It causes people to recognize and accept their own limitations. The counselor’s job is to recognize those in need of reorientation before their need becomes severe, so that they can be referred to professional help. Reorientation is the kind of function needed to help alcoholics return to normalcy or to treat those with mental disorders.

5.2.0.Six Principles for Good Counseling



5.2.1.Good counseling is characterized by the following six principles:



5.2.2.Treat each client well. All clients deserve respect, whatever their age, marital status, ethnic group, sex, or sexual and reproductive health behavior. (Always Greet.)

5.2.3.Interact. Each client is a different person. Ask questions, listen, and respond to each client's own needs, concerns, and situation. (Ask question)

5.2.4.Give the right amount of information. Enough for the client to make informed choices but not so much that the client is overloaded. (Tell.)

5.2.5.Tailor and personalize information. Give clients the specific information that they need and want, and help clients see what the information means to them. (Tell.)

Unless a valid medical reason prevents it, provide the family planning method that the client wants. (Help.)

5.2.6.Help clients remember instructions. (Explain.)



6.0.Greeting



6.1.Make a Good Connection and Keep It



In good counseling, counselor and their clients often go through a series of connected and overlapping steps. These steps can be remembered by the letters in the word “GATHER, and letter. G stands for “Greet.”

The counselor’s friendly, respectful greeting makes the client feel welcome. It makes a good connection between counselor and client right from the start. A good connection builds trust, and clients rely on counselors that they trust.

This good connection should be kept up. Throughout every visit, all clients deserve understanding, respect, and honesty from everyone they meet.



6.2.How to make clients feel welcome

• Make sure each client is greeted in a friendly, respectful way as soon as she or he comes in. The staff member who first greets clients should understand how important this job is.

• Try to have places for clients to sit while they wait.

• Make the waiting area cheerful and interesting. For example, you can find or make posters that give useful health information.

• Have brochures and pamphlets for clients to look at.

• Tell newcomers what to expect during their visit. This can be done in person, with pamphlets or signs, and perhaps even with a videotape. Invite clients to speak up and ask questions whenever they want.

• If a client will be examined or undergo a procedure, explain what will happen clearly and with reassurance.

• Point out the staff member who can help if a waiting client needs something or has a question.

• Be sure every client has privacy from being seen or heard by others during counseling and during any physical examination or procedure.

• Tell clients that information about them and what they say will not be repeated to others (confidentiality).

• Reassure and comfort clients if needed.

6.3.Key words for greeting



Experienced health care providers know "key words." These words and phrases help put clients at ease. They help clients recognize and express their needs. They help clients make good decisions for themselves. Key words save time, too: They go quickly to the heart of the matter.

Here are some providers' "key words" for greeting clients. Of course, the right words may be different in different cultures.

"Welcome to [name of health care facility or organization]. My name is [give name]. I am please that you have come."

"How can we help you today?" (Respond to the client's answer by explaining what will happen next. For example, you might say, "Have you visited us before? Please tell me your name so that we can give your records to the nurse." OR: "Please have a seat here. We will be able to help you in about [state how many minutes].")



6.4.0.Asking

6.4.1.Why and How to Ask Questions

In GATHER, A stands for “Ask.” The provider questions effectively and listens actively to the client’s answers.

6.4.2.Why ask questions?

To learn why the client has come.

To help the client express needs and wants.

To help the client express feelings and attitudes, and so to learn how the client feels.

To help the client think clearly about choices.

To show the client that you care.



6.4.3.How can you “question effectively”?

• Use a tone of voice that shows interest, concern, and friendliness.

• Use words that clients understand.

• Ask only one question at a time. Wait with interest for the answer.

• Ask questions that encourage clients to express their needs.

• Use words such as “then?” “and?” “oh?” These words encourage clients to keep talking.

• When you must ask a delicate question, explain why— for example, asking about number of sexual partners to find out about STD risk.

• Avoid starting questions with “why.” Sometimes “why” sounds as if you were finding fault.

• Ask the same question in other ways if the client has not understood.

6.4.4.Key words for ASKING



"What do you hope that we can do for you today?"

Some clients are shy about telling their needs, purposes, or hopes. Still, if you do not find out what they really want, they may leave disappointed. They may not follow instructions. They may not come back. They even may complain about the care you gave them. So it often helps to ask the client politely but directly what the client hopes for on this visit.



6.4.5.Open questions work better! The questions below are open questions. They invite clients to give full, honest answers. They help clients think about their choices. The answer to an open question often suggests the next question.

"Could you please tell me your reasons for coming?"

"What have you heard about this method?"

"What questions do you have about family planning?"

"How do you feel about that?"



The questions below are closed questions. They require a specific answer, often just "yes" or "no." They cut off discussion. Some of these are also leading questions. They push the client to answer in the way that the questioner wants.

"Are you here for family planning?"

"Have you heard of this method?"

"Don't you prefer this method?"

"Don't you think young women should avoid sex before they are married?"

6.4.6.Responding to Client's Feelings

Family planning and other reproductive health concerns can be a very private matter for clients. When they talk about these subjects, they may feel embarrassed, confused, worried, or afraid. These feelings affect their decisions. Some feelings may make choices difficult. Some feelings may lead to choices that clients regret later.



6.4.7.How can you help clients deal with their feelings?



First, ask about feelings and help clients talk about them. Give your full attention. Listen actively and question effectively. Watch clients’ body movements and expressions. These can help you learn what clients feel.

Once you recognize clients’ feelings, let them know in clear and simple words that you understand. This is called “reflecting feelings.” You cannot change clients’ feelings. Only they can do that. But when you reflect feelings, you are showing that you understand. You also are saying that it is all right to feel that way.

As clients talk about their feelings, they understand themselves better. Then they may find it easier to make wise and healthy choices.

Look at these two examples:











6.4.8.Reflecting Feelings

Example 1







Example 2




























6.4.9.Discussing Sex?



Even for experienced health care counselor, discussing sex can be difficult. Using sexual terms or slang can be embarrassing. As a result, counselors may not volunteer important information, answer clients’ questions fully, or ask important questions about sexual behavior. Counselors may even try to influence a client’s choice of methods to avoid explaining use of condoms or vaginal methods, for example.

But reproductive health and sex cannot be separated. To make healthy decisions, clients often need to discuss sexual behavior. Therefore counselors need to be comfortable with hearing and using sexual terms and also with using pictures or models of the body. Here are suggested exercises that can make discussing sex easier:

Make a list of terms and slang related to sex. Discuss how you feel about hearing and using these words. Compare the words for men with those for women. Do these words avoid negative meanings? Which words would you rather use? Do your clients understand these words?

When alone, look at your face in a mirror and say the words that make you uncomfortable. With practice, you will be more at ease and confident.

Practice using pictures or a model to show clearly how to put a condom on a penis.

Clients, too, often find it hard to talk about sex. Here are some tips for helping them:

6.4.10.Give clients sensitive information in other forms. Then they can take it into account even if they do not want to discuss it openly. For example, posters, pamphlets, videos, radio, and TV can explain the risks of having more than one sex partner, the signs of STDs, or the need for condoms.

6.4.11.Starting discussion about sex is often the most difficult step. How can you gently let clients know that you are willing to discuss sex but will not force them to do so? You might ask, “Did you see the wall chart about STDs in the waiting area? Did it raise any questions?” or “Some women say they worry that their husbands have other sex partners, but they don’t know how to talk with their husbands about it. How do you think you would handle that situation?” From here, you can lead gradually to more personal discussion if the client is willing.





6.4.12.How to “Listen Actively”

• Accept your clients as they are. Treat each as an individual.

• Listen to what your clients say and also how they say it. Notice tone of voice, choice of words, facial expressions, and gestures.

• Put yourself in your client’s place as you listen.

• Keep silent sometimes. Give your clients time to think, ask questions, and talk. Move at the client’s speed.

• Listen to your client carefully instead of thinking what you are going to say next.

• Every now and then repeat what you have heard. Then both you and your client know whether you have understood.

• Sit comfortably. Avoid distracting movements. Look directly at your clients when they speak, not at your papers or out of the window.

7.0.Countering False Rumors



Asking clients what they have heard about family planning methods or STDs often turns up rumors.

7.1.What are rumors?

Unreliable information passed around the community, mostly by word of mouth. Rumors become widely known and are believed to be true, but often they are inaccurate or false. The original source is usually forgotten.

7.2.Where do rumors about reproductive health start?

• Unintended mistakes when a person passes on what he or she has heard.

• Traditional beliefs about the body and health.

• Exaggerations to make a story more entertaining.

• Unclear explanation from health care counselors— or no explanation at all.

• People trying to explain something that has no obvious explanation, such as an unexpected side effect.

• Errors or exaggerations in news reports or mass-media entertainment.

• Someone trying to hurt the reputation of family planning, other reproductive health care, or health care counselors.

7.3.Tips for dealing with false rumors that clients have heard:

• Clearly ask all new family planning clients what they have heard and what concerns they have about methods. These questions may bring out rumors.

• Explain politely why the rumor is not true. Also explain what is true in ways that the client understands.

• Find out what the client needs to know to have confidence in the family planning method, other reproductive health care, or the provider. Find out who the client will believe.

• Be aware of traditional beliefs about health. This awareness can help you understand rumors. It also can help you explain health matters in ways that clients can easily understand.

• Encourage clients to check with a health care counselors if they are not sure about what they hear.

7.4.Tips for dealing with false rumors in the community:

• Find a credible, respected person who can tell people the truth and counter the rumor. Community leaders and satisfied users can be especially good.

• Try to figure out why the rumor started. Perhaps a real event needs to be explained.

• If rumors are circulating or perhaps even appear in the news, your director can contact reporters and editors and help them learn the true story. Your director could offer to be interviewed or to make a broadcast. Also, your director could offer to help reporters check out any future rumors.

• Encourage people to check first with health care providers before they repeat rumors.









8.0.Telling

8.1.Tailored & Personalized.In GATHER, T stands for “Tell.” The counselor responds to the client’s situation, needs, and concerns. The counselor tells the client information that helps the client reach a decision and make an informed choice. To make wise choices, clients need useful, understandable information. This information should describe the client’s various options and explain possible results. To help with understanding, you can make information both tailored and personalized.

8.2.Tailored information is information that helps the client make a specific decision. In the “Ask” step of GATHER, you can learn what decisions the client is facing. Then, in the “Tell” step, you can give specific information that helps the client make those decisions. You can skip information that makes no difference to the client. Information that makes no difference can overload and confuse the client.

8.3.Personalized information is information put in terms of the client’s own situation. Personalizing information helps the client understand what the information means to her or him personally. (See example below.)

8.4.Example—Information for a man deciding how to protect himself against HIV/AIDS:

Good: "Having certain other STDs can raise the changes of getting HIV/AIDS."

Better (tailored): "For a person with more than one sex partner, the best protection against getting STDs during sex is using a condom every time."

Best (tailored & personalized): "You mentioned that you have two girlfriends now. The best way to protect yourself and your girlfriends is using a condom every time you have sex with either of them."

8.5.Tailoring Information for Method Choice

Family planning clients should have access to full information about all available methods. At the same time, describing every method in equal detail can be confusing to a client trying to choose a method. Here is an easy way to find out what the client needs to know:

8.5.0.Ask what method the client wants. Most clients already have a method in mind. In general, clients should get the method they want. They will use it longer and more effectively. Make sure the client (1) understands the method, (2) has no medical reason to avoid it (see chart, Help Clients Choose a Family Planning Method), and (3) knows other methods are available when she or he wants to switch.

8.5.1.What if the client cannot use that method? Ask what the client likes about that method, and then describe similar methods. For example, a woman wants an IUD because it is long-acting, very effective, and reversible. But she cannot use an IUD for medical reasons. You can tell her about Norplant implants because implants also are long-acting, very effective, and reversible.

8.5.2.What if the client has no method in mind? Ask what is most important to the client about a method. (For example—very effective? convenient? discreet? reversible? no chance of side effects?) The answers help suggest methods that could meet the client’s needs.

8.5.3.Key words for Telling

"Do you have a method in mind?"

Most new family planning clients already have a method in mind. The "Tell" step in good counseling about method choice starts with that method.

"And what is it about this method that you like?"

This question helps check whether the client really understands the method. Any mistaken ideas can be gently corrected. Also, the provider can mention other available methods with the same advantages in case the client does not know these other methods.

Clients should have the method that they want so long as they understand the method and there is no medical reason to avoid it.



Counseling is important, but counselors also can tell people about methods in many other ways—for example, radio, television, newspapers, community and clinic presentations, pamphlets, and wall charts. Clients who know more about methods before counseling can make better decisions during counseling.





9.0.Counseling Starts in the Community

Informing the community and counseling clients go hand-in-hand. The better that people can be informed before counseling, the better that counseling can help clients make informed choices that meet their needs.

9.1.Why give community talks & hold group discussions?

• To inform many people at once. This saves time.

• To tell the community about services.

• To start people thinking about their choices even before they meet with a health care provider.

• To save time during counseling for addressing each client’s needs and helping the client learn instructions.

• To answer questions that people are too shy to ask.

• To start a continuing discussion in the community.

• To create a common understanding among people. This helps avoid rumors.

• To make people aware of risky reproductive health behavior and to encourage safer behavior.

• To help people share their experiences and support each other’s healthy decisions.

9.2. When & where?

• When community groups meet.

• At workplaces and schools.

• At specially planned public gatherings.

• At other public events such as sports matches, fairs, exhibitions.

• While clients wait in clinics.







9.3.Tips for talks & discussions

• Find out in advance who the audience will be, what they know, and what they want to know.

• Prepare. Know your goals, main points, and a few discussion questions. Plan your time.

• To begin, introduce yourself and the topic.

• Help people feel at ease. In a small group, you could start a short game or ask people to introduce themselves.

• Start discussion with clear, simple information.

• Use words that everyone understands.

• Use audiovisual materials, including sample contraceptives if appropriate.

• Help keep discussion going. Keep eye contact. Encourage people to comment and ask questions. Ask “what” and “how” questions in a respectful way.

• Invite people to talk about their own experiences.

• If discussion strays from the topic, gently lead it back with an appropriate question.

• Summarize important points during the discussion and again at the end.

• At the end, suggest one important action that every person there can take—for example, each person can tell one other person in the community something important that they have learned.

10.0Help

10.1.Key Help from a Few Questions

In GATHER, H stands for “Help.” The client and counselor discuss the choices, their different results for the client, and how the client would feel about these results. In this way the counselor helps the client reach a decision. Often the choice is what family planning method to use. Other choices could be how to protect oneself from STDs or, for a young person, whether to begin having sex.









10.2.Tips on Counseling Young Adults

Often young adults face more and different reproductive health issues than older clients. Thus counseling young adults requires being even more open, more flexible, more knowledgeable, and more understanding. Counseling young adults can be challenging, but it can be very rewarding to help young people make wise and healthy decisions.

• Be open. Let young people know that no question is wrong, and even embarrassing topics can be discussed.

• Be flexible. Talk about whatever issues the young person wants to discuss.

• Give simple, direct answers in plain words. Learn to discuss puberty and sex comfortably (see Can You Talk About Sex?).

• Be trustworthy. Honesty is crucial to young clients. You—and the information you give—need to be believable. If you do not know an answer, say so. Then find out.

• Stress confidentiality. Make clear that you will not tell anyone else about the client’s visit, the discussion, or the client’s decisions.

• Be approachable. Don’t get upset or excited. Keep cool.

• Show respect, as you do for other clients. Do not talk down to young clients.

• Be understanding. Recall how you felt when you were young. Avoid judgments.

• Be patient. Young people may take time to get to the point or to reach a decision. Sometimes several meetings are needed.

10.3.Tips on Counseling Young Adults

Often young adults face more and different reproductive health issues than older clients. Thus counseling young adults requires being even more open, more flexible, more knowledgeable, and more understanding. Counseling young adults can be challenging, but it can be very rewarding to help young people make wise and healthy decisions.

• Be open. Let young people know that no question is wrong, and even embarrassing topics can be discussed.

• Be flexible. Talk about whatever issues the young person wants to discuss.

• Give simple, direct answers in plain words. Learn to discuss puberty and sex comfortably (see Can You Talk About Sex?).

• Be trustworthy. Honesty is crucial to young clients. You—and the information you give—need to be believable. If you do not know an answer, say so. Then find out.

• Stress confidentiality. Make clear that you will not tell anyone else about the client’s visit, the discussion, or the client’s decisions.

• Be approachable. Don’t get upset or excited. Keep cool.

• Show respect, as you do for other clients. Do not talk down to young clients.

• Be understanding. Recall how you felt when you were young. Avoid judgments.

• Be patient. Young people may take time to get to the point or to reach a decision. Sometimes several meetings are needed.

Young adults are special clients. Keep this in mind:

• Young adults often need skills as much as facts. They need to learn how to deal with other people—including older people. For good reproductive health, important skills are knowing how to say no, how to negotiate, and how to make decisions.

• Young people often want to know how social relationships and sexual relationships fit together. Often, this is more important to them than facts about reproductive health.

• Young people often focus on the present. They find it hard to make long-range plans or to prepare for the distant future.

• Young people often find it hard to understand the idea of risk or risky behavior.

• Sexually active young adults often face more STD risk than older clients.

• A young person’s sexual behavior may be forced or pressured—possibly by an older person.

• A young person may have sex only once in a while.

• A young person may plan not to have sex again but still do so.

• Young adults of the same age may have very different levels of knowledge and different sexual attitudes, behavior, and experiences.





11.0.Explaining



11.1.Explaining So Clients Remember

In GATHER, E stands for “Explain.” The counselor explains to the client how to carry out the client’s decision. When explaining, the counselor tries to tailor and personalize instructions to suit the individual client’s way of life (see Telling Clients Information).

11.2Key words for Explaining

"Do you think you can do this? What might stop you?"If the client sees problems, you and the client can discuss ways to overcome them.

11.3.Twelve (11) Tips To Help Clients Remember

The way you give information—especially instructions—can help clients remember them:

Keep it short. Choose the few most important points that the client must remember.

Keep it simple. Use short sentences and common words that clients understand.

Keep it separate. Keep important instructions separate from information that does not need to be remembered.

Point out what to remember. For example, “These 3 points are important to remember:” Then list the 3 points. Most important to remember is what to do and when.

Put first things first. Give the most important information first. It will be remembered best.

Organize. Put information in categories. For example: “There are 4 medical reasons to come back to the clinic.”

Repeat. The last thing you say can remind the client of the most important instruction.

Show as well as speak. Sample contraceptives, flip charts, wall charts, and other pictures reinforce the spoken word. (See below.)

Make links. Help clients find a routine event that reminds them to act—for example, “When you first eat something each day, think about taking your pill at that time.” OR “Please come back for your next injection in the week after the summer festival.”

Check understanding. Ask clients to repeat important instructions. This helps them remember. Also, you can gently correct any errors.

Send it home. Give the client simple print materials to take home. Review this material with the client first.



12.0.Returning



12.1.The Returning Client Deserves Attention, Too

In GATHER, R stands for “Return.” All clients should be invited to return to their counselor whenever they wish, for any reason. At the same time, clients should not be made to come back when not necessary. For example, counselors should give clients plenty of supplies and not schedule unneeded follow-ups

12.2.Care for Continuing Clients

All returning clients deserve attention, whatever their reason for returning. Returning clients deserve just as much attention as new clients.

Counseling a returning client should be flexible. It should be tailored to meet each client’s reasons for returning. The returning client should not be made to go through full method-choice counseling again.

12.3.Here are 2 general rules for counseling returning clients:

Find out what the client wants.

To find out what the client wants, you can ask:

”How can we help you today? What would you like to discuss?”

“What has been your experience with your family planning method (or other care)? Satisfied? Any problems?”

”Any new health problems since your last visit?” (For the most part, a health condition that rules out a family planning method in the first place also means the client should switch methods if that condition develops during use.)

12.4.Respond to what the client wants.

If the client has problems, help resolve them. This can include offering a new method or referring the client elsewhere.

If the client has questions, answer them.

If the client needs more supplies, provide them generously.

If appropriate, check whether the client is using the method correctly, and offer advice if not.



13.0. The mirror role of counseling



There are many myths about what Counseling is. Most of them are rooted in some outdated ideas about psychology and psychotherapy. Unfortunately, images of old men in beards, clients on couches and patients in asylums still define what counseling is for many individuals who might benefit from what counseling offers today. Often, people dismiss counseling as:

• Something for “mad or crazy people”?

• Professional help for people with really major problems?

• An activity for people who are way too preoccupied with themselves!

• A crutch for people who are just too weak to handle life.

• Where you go and get analyzed by somebody and then hope something changes for the better!

Usually, if counseling is described in these ways, the descriptions are coming from people who have never been to counseling before.

Counseling is many things, but for better understanding of what it is, there is need to start by clarifying what counseling is NOT!









13.1.Clarifying what counseling is NOT?

13.2.Counseling is NOT a place that people go to find out if they’re "crazy" ...but rather to get support because sometimes the world can seem pretty “crazy.”

13.3.Counseling is NOT something that attends only to challenges regarded as “major problems” and dismissing things some may regard as “less important problems” but rather attends to the issues that students bring in whenever they feel the distress is getting in the way of living life with satisfaction. Counseling simply helps show those who come to counseling that they possess the strength and abilities to manage their challenges.

13.4. Counseling is NOT an activity for self-absorbed people. In fact, most students who seek counseling are struggling because they are very sensitive to the feelings and experiences of others and want to preserve their relationships by working on the difficulties that threaten them.

13.5.Counseling is NOT an activity where one expert analyzes the client. Rather, it is an activity where counselor and client work as a team to make positive changes in the client's approach to life.

13.6.Counseling is NOT a crutch for weak people. Rather, it is a vehicle for strong people who decide to face their challenges directly rather than continue in the more frightened and “escape”-oriented ways that others use to deal with difficulties.

14.0.A Mirror

14.1.Counseling is a unique relationship in which the Counselor’s job is to hold up a mirror for the client to see himself or herself in. We all have experiences in which we can’t see things about ourselves without a mirror. Whether our hair is fully combed, whether we have something stuck in our teeth, or whether we have a wound in a hard to see place, we often need mirrors to see these things well enough to do something about them. And, sometimes, we need someone to hold the mirror so we can see the things at are at more hidden angles.

In addition to knowing what angles to hold the mirror from, the counselor understands that sometimes it takes a while for folks to see what they need.... especially if there are more subtle things needing our recognition. Finally, because most people tend to be hard on themselves (if not downright mean to themselves) the counselor knows to hold the mirror in such a way that the client can see himself or herself from a caring, supportive, and sympathetic perspective.





15.0.Reflections



Often counselors seem to only be repeating what clients are saying to them or paraphrasing clients rather than giving answers.

I hear you saying....

It seems that you are....

I can feel that you are experiencing...

How does that make you feel?

What emotions do you have about this?

Actually, when counselors are doing this, there is a strategy behind it. Remember, counseling is not about experts fixing problematic people. Mirrors don’t comb our hair; they just motivate us to pick up the comb by showing the areas that need our attention. When counselors ask such questions or make such statements, they are not necessarily seeking answers from clients. Rather, they are simply giving the clients an opportunity to focus on the things that seem out of view for them.... often this involves pointing the mirror to some neglected painful emotions.

15.1.Counseling is about reflecting back to the client that he or she is being heard and providing them an opportunity to hear themselves. Often, hearing one's own thoughts and feelings in another person's words adds a clarity and support that's difficult to grasp when the emotional turmoil simply swims around in our heads without any form. When students can see the most complete reflection of themselves, pain and all, they are more capable of learning about the details of themselves. With this enhanced perspective, those in counseling can make the adjustments needed to make their lives more satisfying.

15.2.The Counseling Relationship-Mirrors With Expertise



Sometimes, because Counselors have a lot of experience witnessing human beings in various forms of life challenges, they can ask questions or share observations that are more revealing than what friends or family members might say. With these new revelations, clients make decisions and--with the support of the counselor, clients take action toward positive growth in their lives.

Thus, the relationship between the Counselor (this supportive mirror) and the Client is helpful in and of itself. The Counseling Relationship is one that exists between a person with caring expertise and a person with discouraging isolation around difficult life experiences. It is a relationship that emerges through a sharing of personal history and exploring powerful emotions.



Confusions Traumas Rejections

Hurt Hopes Anger

Fears Abandonment



Because the counselor is a real person who typically cares genuinely about the client, a relationship develops between the person of the counselor and the person of the client. Genuine connection, defined by closeness between two persons out of the trust-based sharing, emerges between them.

However, because the counselor typically self-discloses very little in the counseling relationship in order to maintain a focus on meeting the client’s needs, and because the counselor’s job is to “hold up the mirror,” you, the client are actually forming a new relationship with yourself--- in more emotional detail and with a more accepting perspective.

Thus, the client in pain and confusion begins to form a close relationship with the client as a growing individual, increasingly equipped to take care of him or her Self. This point is important to emphasize because it explains Counseling as a venture aimed at helping clients become autonomous rather than fostering dependence on professionals.



15.3.Mirrors Come in Different Shapes



There are different formats of counseling and different approaches counselors may take, but most are in one of three forms: Individual Counseling, Couples Counseling, and Group Counseling.

Students are often hesitant to engage in anything other than individual counseling. While often this is the most appropriate intervention, the other formats have unique advantages that should be considered.

Often, students are resistant to couples counseling, opting to talk “about their relationship” with a counselor in individual counseling. Couples counseling adds the partner’s perspective to the

counseling to the benefits of individual counseling.

Group Counseling, a prospect that is intimidating to many students, has several advantages. For one thing, Group Counseling provides at least as many mirrors as there are group members, compared to the single mirror available in individual counseling. When a person’s difficulties have a significant interpersonal component in other words, if the client’s struggle is something that impacts relationships with others.

Group Counseling is often most helpful because it provides a safe place to get feedback on how they are experienced by others. For individuals having difficulty establishing or maintaining relationships…





Shyness,

New Friends or New Romantic Interests Don’t Call,

Confusing Conflicts,

Feeling Left Out from Social Groups---

the group offers an arena where the client eventually begins acting and reacting in similar ways to their relating style outside the group. The group, facilitated toward a supportive and caring approach, can shed light in how you may come across as well as helping correct some incorrect assumptions that may lead to some of the relationship difficulties to begin with. Counseling-Is an Honest and Supportive Mirror. It’s a Relationship that Builds Confidence.

Counseling is when a counselor agrees to see a client in a confidential place to examine and explore any problems they be having within their life such as dissatisfaction with life or a loss of sense of direction or purpose. The client must always be willing and accepting of the process of counseling as no one can be forced to go and be effectively counseled. The counselor will listen carefully and patiently which will enable him/her to more easily identify any problems or difficulties from the client’s point of view and can help them to see things more clearly and from a different point of view. Whilst in the counseling sessions the client can explore all aspects of their life and feelings in a way that might not be possible with loved ones. When kept bottled up emotions such as anger, anxiety grief and embarrassment can become very powerful and intense, counseling gives the client a chance to explore and understand these often very frightening and powerful emotions. Acceptance, respect and being non-judgmental of the client are essential for the counselor. After time mutual trust between the client and counselor should develop. Counseling is not giving advice or teaching someone how to do something correctly the way a mentor such as a teacher or tutor does. Nor is it persuading a client to take a particular course of action as maybe an advice worker like a youth worker would do. Counseling differs from social work as in the latter sometimes there would be a degree of intervention and possibly non willingness on the client’s part.



16.0.The differences between regular marriage counseling and Christian marriage counseling



16.1.The Bible

There is a big difference between regular marriage counseling and Christian marriage counseling. That difference has to do with the Bible.

16.2.Christian marriage counselors use the Bible as their standard for counseling. Prayer and the use of the Bible help the counselor give the couple the guidance they need to solve their problems in a Biblical way. Regular counseling uses behavior modification, role playing and talking as their main tools to helping couples going to counseling. In Christian counseling, the counselor looks at the way the couple's families were. Example, in the family tree how many divorces, how many stayed married but had bad marriages, infidelity, are all examples of what is looked at and the reason for it is the Biblical principle of "the sins of the father are passed down from generation to generation" and that is true. So a lot of times, what couples go in for are things that are passed down by mother or father in their lives, and spiritual matters as that need spiritual guidance to overcome the sins of the past, and to stop the "generational curse" and to start a new family tree without the sins being passed down to your children or grandchildren.

In regular counseling a family tree may be looked at but from a different perspective, that being how your parents probably messed up and so now you have the problems you wanted to avoid in your life and how best to get over it all. The techniques used are non biblical and more in how to change your life and meet the needs of your spouse along the way. Both have you talking about the spouse and to each other, but how that is done is the difference. But I think the biggest difference is in Christian counseling you are to forgive, and in regular counseling, it may be brought up but it is not as big a deal as it is in Christian counseling, because as Christ forgave us so we are to forgive one another. And forgiveness is a process, one that starts with a willingness and decision to forgive. In regular counseling, that may come somewhere down the road, but it is not usually one that is taken from the beginning. For in regular counseling, it can be gripe session after gripe session, and that is not getting to where you need to be, that begins with forgiveness and learning how to move on from there and that point. Either form of counseling is good, but if you are a Christian, and you want to learn how to forgive, how to be a good spouse according to what God says, then Christian counseling is for you. If you are not at that stage where you can forgive your spouse, then regualar counseling is a good start. With both forms of counseling, it will only work if BOTH of you are commited to your marriage and really want it to work, if not, you are wasting your time, the counselor's time and your money for it will not work. It takes two to make a marriage work, so it takes two to be fully present and participating in whatever the therapist assigns or has you discussing. Saying things to appease the therapist does not work either, for eventually your lies will be found out, so just be honest in dealing with counseling and be honest to the process of therapy. It can be a great benefit for couples with problems who are willing to really do the work and it will be rewarding. If you are not willing, you will not succeed, and therefore the likelihood of your marriage is at stake.

16.3.Marriage is work

The fact of the matter is that marriage is work, everyday. Marriage is a challenge regardless of any one person's belief system. It requires unconditional love and commitment. Today's statistics show that half of all Christian marriages end in divorce. Equal to that of secular divorce, in today's world. This is not only a sad state of affairs for the church, but for society at large.

Christian marriages are founded upon biblical standards. The bible and it's teacher teaches that marriage is a covenant. A promise made between a man and a woman, in the presence of God, that is meant for a life time. The marriage is seen and respected as an unconditional contract. A contract, a covenant that ends only in the event of death. Teaching that “till death do us part", is a very literal and serious commitment.

From the beginning God has made marriage apart of the plan for His creation. The enemy has systematically attempted to destroy this tradition. All one needs to do is check the world wide statistics of divorce to realize that he has all but succeeded at this destruction. Christian marriages are in as much trouble as their secular counterparts, as already mentioned. Counseling has become a necessity in today's marriages, unfortunately speaking.

Foundational technique is the distinguishing factor between Secular and Christian marriage counseling. Counseling is defined as the professional guidance of the individual by utilizing psychological methods especially in collecting case history data. Using various techniques of the personal interview, and testing interests and aptitudes, according to the Webster's online dictionary. Marriage counseling is all that, in respect to the marriage contract. In a world that virtually encourages divorce; the need for marital counseling cannot be denied.

Secular and Christian marriage counseling have the same goals. The desire to assist a couple in overcoming their problems is the basis. The intent of both is to create healthy individuals in a healthy and meaningful relationship. It is the tools used that distinguish the two. Both counsel methods utilize professional guidelines. Secular counseling focuses on psychology. At times psychiatry, is needed as well, should the need for medical attention for one or both of the counselees, arise. The guidelines are used to advise, resolve and set goals for the couple within the marriage boundaries. Christian counseling utilizes these tools, to a degree, as well.

This is where the two separate.

While secular counselors utilize the tools mentioned above, it is the Christian counselor that has the immovable tools that help to repair a marriage. Secular counseling techniques utilize the latest psychological findings or norms, both of which change consistently over time.

Christian counselors utilize biblical standards that have not changed with time, at all. Joined with the "norms" of secular counseling, it becomes a foundation for restoration. Christian counselors, quite simply believe that they have an absolute standard that does not change, that the secular counselors do not.

The bible, and its numerous guidelines for the marriage, remains the basis for restoring the marriage that is in trouble. Through biblical training, the troubled couple, will learn to use the tools instrumental to keep a marriage within the will of God.

The couple will learn to understand themselves, each other and God. Christian counseling also gives clarity to what it is God wants and expects from the marriage. It is scripture that helps the couple to set priorities and boundaries within the marriage covenant. The following scripture is only one example of a set of these priorities:

1 Peter 3:1-9



Wives, likewise, be submissive to your own husbands, that even if some do not obey the word, they, without a word, may be won by the conduct of their wives, when they observe your chaste conduct accompanied by fear. Do not let your adornment be merely outwardarranging the hair, wearing gold, or putting on fine apparel rather let it be the hidden person of the heart, with the incorruptible beauty of a gentle and quiet spirit, which is very precious in the sight of God. For in this manner, in former times, the holy women who trusted in God also adorned themselves, being submissive to their own husbands, as Sarah obeyed Abraham, calling him lord, whose daughters you are if you do good and are not afraid with any terror.

16.4.A Word to Husbands

Husbands, likewise, dwell with them with understanding, giving honor to the wife, as to the weaker vessel, and as being heirs together of the grace of life, that your prayers may not be hindered.

16.5.Called to Blessing

Finally, all of you be of one mind, having compassion for one another; love as brothers, be tenderhearted, be courteous; not returning evil for evil or reviling for reviling, but on the contrary blessing, knowing that you were called to this, that you may inherit a blessing.

Within these scriptures the Christian understands what it is God is speaking to the husband and the wife. It is clear how we are to behave and treat one another according to God's will. The properly counseled couple will understand that to treat any of these guidelines in an egotistical manner renders them outside of God's will, hindering the marriage and their partner.

Within these scripture is also a promise from God. If the couple honors their covenant, the promise they made, to God and one another, God is faithful to fulfill His promise. In these scriptures it is the promise of knowing the calling and blessing of their marriage. Utilizing just the aforementioned scripture verses will begin to assist a married couple to reconciliation. If utilized prior to a problem, they will work to prevent any problem beforehand.

It bears pointing out that a non-Christian will take offense with this particular set of scripture. The submission here has not a thing to do with weakness. Rather it has everything to do with the woman being strong enough in the Lord to set an example that her husband will desire for his life. A solid walk with the Lord of his life and marriage.

16.6.The counseling, both secularly and Christian, seek to repair three areas:



* General problems and issues being experienced in the areas of:

*communication

*loss of intimacy

Refocusing on priorities in the marriage.



* Personal problems developed and occurring within the marriage.

Providing marital and relationship building techniques.



* Loss of a sense of [God's] principals in the marriage.

Reassuring the couple that God cares and is a part of the relationship.

At the end of the counseling sessions it will be the Christian counselor that will encourage the couple to remain married. Having instilled, within the marriage, God's Word and prayer. Enabling the couple to quiet the issues that would rise to harm the relationship further.

It is the properly trained Christian couple that recognizes the enemy of their relationship, as put forth in 1 Peter 5:8:

Be sober, be vigilant; because your adversary the devil walks about like a roaring lion, seeking whom he may devour

And it is this couple that will be able to utilize the proper tools to remain a sober and vigilant guard of the relationship.

Most marriages begin with the biblical vows, in a church. Even unbelievers innately seek marriage in line with God's will. Civil marriage ceremonies, conducted by state officials, continue to use the biblical wording within the ceremony. It is odd how some people do not realize this fact. Before God and state we make vows for life, until death.

17.0.The benefits of Christian marriage counseling

17.1.Christian marriage counseling offers faith based Christians a way to confront marital problems while keeping core values close. However, it is also true that professional Christian therapists and psychologists, employ some of the same tested and tried principles that mainstream professionals use. The result is a competent counselor with biblical views. Just as mainstream professionals operate at various levels of knowledge and competency, the same may be said for Christian counselors and therapists. The ability to connect with the hurt and disillusionment of clients is a competence quality that's required to guide people to possible wellness in a marriage. People trust people that provide a gut level comfort. Ministers were once the primary source of marriage counseling and in olden days they had no professional mental health training at all. Many handled their responsibilities with compassion and offered advice that helped marriages heal. Some, however, were blinded by their own doctrines and ideas on how a marriage should work, and people were hurt by their advice. Today, a growing number of Christian churches employ specially trained counseling ministers to provide better solutions for their congregations and community. Ministers who counsel marriage partners should have the necessary training to guide a relationship through turbulent times, and they generally do an excellent job of this. These ministers are educated at various levels and handle a variety of marital issues.

Christian marriage therapists help their patients cope and find solutions to problems through interaction with the offending spouse and they promote responsibility and accountability in the marriage. There are times, however, when it's beneficial to seek a mental health professional who has extensive experience in domestic and behavioral problems. Personality disorder, substance abuse, domestic family abuse, or other severe behavioral problems require a Christian mental health professional if the marriage is to have a chance to survive. Fortunately, the mental health industry has grown and produced Christian psychologists over the past twenty years and some are trained in theology and psychology. Some behavioral problems are medically based. Christians are not immune to impulse behavioral issues such as ADHD or bipolar disorder. These are the facts of the world in which we live. There is help. Christian psychologists can counsel wisely but will consult with a psychiatrist or a physician for medical prescriptions. Christians typically don't want to talk about abusive situations in the home, but bringing them into the light gives the abused the power to move out of a hurtful or dangerous situation. Christian therapists and psychologists often recommend a trial separation while the marital issues are being worked on, and sometimes, this means permanent separation. Permanent separation and divorce happens in the Christian community but the Christian counselor is committed to doing everything possible to help you find workable solutions. That is a priority; but they also know that people have a choice and sometimes one spouse chooses to leave the marriage. They also help people to move forward in that situation. Unresolved issues, medical problems, money problems, unfaithful spouses, are issues that lead to marriage breakdown. Some issues are suitable for ministers and therapists to oversee but it's good to know that there are Christian professionals trained to help with any issue we may have to face.

17.2.Marriage counseling is a therapy established to help both spouses understand their troubling issues and hopefully, restore their marriage. Many Christian couples prefer Christian marriage counseling over regular because although both have the same goals to save and restore the marriage, they have different outlooks and values. Regular counseling concentrates on the rights and welfare of the individuals in the marriage and their responsibility to each other and to their home. And this is good. But Christian Marriage Counseling goes beyond the legalities and focuses on two predominant concerns: the relationship between the spouses and God, and the promise they made to Him. The counselors are trained to see the big picture that surrounds the troubled marriage, and can offer suggestions for help from other counselling groups such as financial counseling. But their main focus is to help both spouses keep their relationship with God open. We may not be of this world but we certainly are in it, and we face the same issues that can attack and challenge any marriage. The greatest benefit of Christian counseling is that we are made aware of our issues from a Godly perspective and not with a humanistic viewpoint. The counselor will talk to both partners and listen to the issues at hand, and will take them apart one at a time and help the couple to find Godly solutions to each one. There may be infidelity involved or perhaps the couple is simply drifting apart from years of being in the world and fighting their battles alone. They will be drawn to the word of their mouth and the promise they made on their wedding day. Their vows were made to each other, but together they made a promise to God to love and care for each other until death. We often forget that this promise was made to God and we feel that when things don't work out we can use that excuse He gave Moses and get a divorce. But it's not quite that easy. Breaking a promise made to God is not a good thing. Our word is as crucial to God as His Word or the Bible is. It has more value than any earthly thing and it is not to be treated carelessly. The counselor will show the couple the importance of the vows they made, and will give every effort to help them realize and accept the need to keep their word before God. This leads to their relationship with God and the love He has for them. If they've drifted away from God, then the counselor will help them to get back. They'll realize that God never stopped loving them and that He will help them to get their relationship with each other back to where it should be. The couple will be shown the need to love and forgive each other for whatever has happened between them. They will be made aware that divorce is not an option for a child of God, but rather for those that won't love and respect Him or the spouse He gave to them. Christian counseling benefits the believer by reinstating the values and virtues of God in them, and by directing them back to where the marriage began at the altar.









17.3.The benefit of Christian marriage counseling is that you bring Christ into the center of your counseling sessions and into your marriage.

Christian marriage counselors use the Bible as the first tool in helping a couple seeking counseling. That is a wonderful advantage for Christians who are seeking counseling. The Bible along with prayer helps brings couples closer together spiritually and physically as well. The emphasis on Christian marriage counseling is that marriage is above else to be treasured, and the counseling will be geared to help you bring your marriage back on track with the use of Biblical principles. The Bible is full of references to marriages, what makes a good marriage, and what makes a bad marriage, it our a Christian's rule book, so it makes sense that if you want to work out a Christian marriage problem, a Christian marriage counselor is the way to go. Besides the Bible and prayer, using tools as getting the couple to find alone time to talk to each other is also important to improve a marriage. A date night, a weekend away, a couple's retreat can all bring new perspective to a marriage. A lot of marital problems are due to lack of communication, lack of finances, and lack of sex. A good Christian marriage counselor is an expert on the Biblical aspects of these things and will help you find through the Bible what God has to say about communication, finances and sex and yes, they are all found in the Bible! In Ecclesiates, King Solomon, laments that there "is nothing new under sun" and there is not, what problems were seen in his day and age, we still have today, and that is why knowing the Principle of the Bible, how to apply them to your life are very important and a Christian counselor can help you do that. Another benefit of a Christian counselor is that Christians are told to look to those who are wise for help, and a Christian counselor is wise on the matter of marriage. They are they to guide you through the process of understanding the problem and how to solve it God's way. Another benefit is that Christians are to confess their sins one to another, and a Christian marriage counselor is one to listen and help you find a way to get your life and marriage back on track, teach you to forgive yourself and your spouse and how to fight in a way that is not damaging to the marriage but allows you to express yourself and be heard. How not to be confrontational when fighting, there is a correct way, using "I" statements and a wrong way that puts blame on the spouse. By stating how you feel or how you see a situation allows the other person to hear you out without being defensive. It is important to learn for we don't take the time to really listen to people these and what they have to say.

18.0.Counseling Psychology vs. Clinical Psychology

One might ask the simple question, “What is the difference between clinical psychology and counseling psychology?” The answer, however, is not at all simple because psychology can be applied in many different ways. Some persons who study psychology end up practicing as counselors, some practice as psychotherapists, and some practice as psychologists. To make it even more complicated, some psychologists use techniques of psychotherapy and some use techniques of counseling. So let’s disentangle some of these elements.

18.1.0.General Psychology



18.1.1.Social Work

We humans are social creatures, and most of our behavior takes place in a social context. Accordingly, the science of Sociology studies our social or collective behavior. But each of us, as an individual, is motivated not just by social rituals but also by mind and free will. Therefore, if you want to focus on community social functioning as it is affected by medical care and mental health functioning, you would study the field of Social Work.



18.1.2.Biological Psychology



Now, if you want to understand how the mind works biologically that is, if you want to understand the mechanics, so to speak, of the nervous system you would study the field of medicine called Neurology or the branch of psychology called Biological Psychology.



18.1.3.Experimental Psychology



You could also study the physiology of sensation and perception, and that could take you into the associated field of General Psychology. Those who take this path usually end up in academic psychology (also called Experimental Psychology), teaching or conducting research. This research can be applied to everyday life in an almost infinite variety of ways. On example would be the application of human factors research to the design of machines to make them more “user friendly.” And then, of course, all this knowledge can be applied clinically.



18.1.4.The difference between a clinical psychologist and a counseling psychologist?



Many people are puzzled by the fact that some professional psychologists identify themselves as "counseling" psychologists, while others describe themselves as "clinical" psychologists. Counseling and clinical psychologists often perform similar work as researchers and/or practitioners and may work side by side in any number of settings, including academic institutions, hospitals, community mental health centers, independent practice, and college counseling centers, where they may have overlapping roles and functions. To add to the confusion, the term "clinical" psychology is sometimes used in a generic sense by legislators to refer to psychologists authorized to provide direct services in health care settings, regardless of their training.

18.1.5.The differences between counseling and clinical psychologists are rooted in the history of each specialty, which has influenced the focus and emphasis of the training they receive. Both counseling and clinical psychologists are trained to provide counseling and psychotherapy. In order to understand the traditions and orientation of each specialty, it may be helpful to consider the etymology of each of the descriptive terms. Clinical derives from the Greek, "kline," which means bed, (and is also found in the root of the word "recline"). Clinical practice has traditionally referred to care provided at the bedside of an ill patient. Counsel is from the Latin, "consulere," which means to consult, advice, or deliberate. These differences, broadly speaking, reflect the earliest focus of each field. Clinical psychologists have traditionally studied disturbances in mental health, while counseling psychologists' earliest role was to provide vocational guidance and advice. Today, though, the differences between psychologists from each specialty are more nuanced, and there are perhaps more similarities than differences among individual psychologists from each field.

18.1.6.The specialties of counseling and clinical psychology evolved concurrently, and at times, their paths of development intertwined. At the end of the 19th century and the beginning of the 20th, psychologists began to seek ways to apply the findings of psychological science to the problems people experience in the world, in areas such as learning disabilities or mental illness. These first psychological clinics offered assessment and treatment services. Later, "clinical psychologists" began to provide psychotherapy, which previously had been the exclusive domain of psychiatrists. At the same time, as society became increasingly industrialized, the vocational guidance movement began to offer assistance to those seeking careers in which they would be most successful (and to provide employers with the most productive employees). Over time, this field relied increasingly on scientific psychology, as psychologists researched the personality traits, interests, and aptitudes that affected job performance and satisfaction, and developed instruments to measure candidates' qualities and evaluate the work environment. In 1945, the American Psychological Association established a Division of Personnel and Guidance Psychologists.

18.1.7.The roles of both groups of psychologists changed significantly in the aftermath of World War II. Returning veterans frequently suffered from poor mental health, and required assistance to enable them to reintegrate successfully into society. In order to meet this unprecedented demand for mental health services, the Veterans Administration hospital system employed large numbers of both clinical and vocational psychologists, and established training programs for them. Large numbers of clinical psychologists began to treat veterans' psychiatric problems, while the VA also contracted with colleges and universities to provide vocational and educational advisement services. Because work is an integral part of the fabric of life, vocational psychologists often found that the personal readjustment counseling they offered took into account other factors in clients' experiences.

In 1951, the Division of Personnel and Guidance Psychologists changed its name to the Division of Counseling Psychology. In this way, the specialty formalized the expansion of its focus from solely career issues, to an emphasis on overall well being throughout the life span. Counseling psychologists have frequently stressed the field's historical focus on a normal client population; that is, the research conducted and published in the professional literature is oriented toward people without serious or persistent mental illnesses. The Georgia conference (1987) reaffirmed counseling psychology's reliance on a developmental perspective to focus on the strengths and adaptive strategies of an individual across the life span.

Thus, the approach a counseling psychologist takes may reflect this perspective. However, both counseling and clinical psychologists are licensed in all 50 states as 'licensed psychologists', and as such are all able to practice independently as health care providers. Counseling psychologists are employed in a wide range of settings including college and university counseling centers, university research and teaching positions, independent practice, health care settings, hospitals, organizational consulting groups, and many others. If you are seeking psychotherapy with a psychologist, or are looking to employ one, it is NOT ONLY worthwhile BUT ESSENTIAL to ask the individual psychologist, whether counseling or clinical, to describe his or her training, orientation and current style of practice.

18.1.8.What do counseling psychologists do?

Counseling Psychologists do so many things it is hard to give a synopsis. Generally speaking, a counseling psychologist can consult with a variety of agencies (e.g. schools, government, private organizations), teach at the college level (undergrad and graduate levels), do research, therapy (e.g. group, individual, family), hold academic administrative positions (e.g. dean of a college), etc. Counseling psychologists study and work in a variety of settings. Some areas that counseling psychologists work in and study are:

• substance abuse

• vocational psychology

• child development

• adolescent development

• adult development/aging

• health psychology (e.g. including long term care, AIDS, cancer, etc)

• mental illness (e.g. anxiety disorders)

• forensic psychology

• sport psychology

• neuropsychology

• aggression/anger control

• anxiety disorders

• interpersonal relationships

• assessment

• rehabilitation

• community psychology

• counseling process/outcome

• group processes

• crisis intervention

• developmental disabilities

• eating disorders

• supervision

• multiculturalism

Counseling psychologists can work in a variety of settings as well. Many of them include: college counseling centers, private practice, hospitals, private organizations, and government.

18.1.9.Clinical and Counseling Psychology are two of the largest and most popular fields in psychology. Clinical and counseling psychologists deal with the causes, prevention, diagnosis, and treatment of individuals with psychological problems. These problems vary considerably as to their degree of severity. Although very similar, clinical and counseling psychologists differ with respect to the disorders of the patients they treat. Typically, clinical psychologists treat more severe disorders, such as phobias, bipolar disorder, and schizophrenia. On the other hand, counseling psychologists work with patients suffering from everyday stresses, including career planning, academic performance, and marriage and family difficulties. Clinical and counseling psychologists can be found working in individual practices, schools, colleges and universities, hospitals, and other mental health facilities. The particular method of therapy utilized by each clinical and counseling psychologist is often influenced by the theoretical orientation they adhere to. There are a total of over 200 theoretical orientations, each providing a different explanation behind the causes of psychological disorders and their appropriate treatments. Some orientations are more popular than others; however, most psychologists integrate two or more into their therapy. Furthermore, some theoretical orientations are better at explaining and treating certain disorders more than others. Regardless of their orientation preference, clinical and counseling psychologists are trained to assist a variety of individuals and their emotional difficulties. 19.0.Important Terms and Definitions

19.1.Assessment- Clinical assessment assists clinicians in choosing the best treatment methods for their clients via techniques such as interviews and testing.

DSM-IV- The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) contains common diagnostic classifications of psychological disorders.

Cognitive-Behavioral- Therapy Cognitive-behavioral therapists stress that our thoughts affect our emotions, our ability to relate to others, and our self-confidence. They believe that irrational and self-defeating thinking bring about psychological problems.

19.2.Feminist Therapy- This therapy grew out of the need for women to cope with the demands of the family, discrimination, and working outside the home. It encourages clients to develop their own strengths and to focus on personal empowerment.

19.3.Psychosocial Rehabilitation- Psychosocial rehabilitation may be used for people with severe mood disorders and schizophrenia. It helps them to cope with their disorder while living in a community setting.

19.4.Interesting Subfields Within Clinical and Counseling Psychology

Within clinical and counseling psychology there are a variety of subfields. Often, psychologists choose a subfield they find particularly interesting and specialize in it. A subfield could be a particular theoretical orientation which guides the psychologist's therapeutic methods or it could be a particular disorder the psychologist is skilled at treating.

19.5.Research -Psychologists are continuously doing research in order to test the effectiveness of therapies, drug treatments, and many other psychological questions.

19.6.Counseling -Counseling involves working with a variety of individuals and their everyday problems in individual, family, or group settings.

19.7.Psychotherapy- Psychotherapy is used for individuals with severe psychopathologies, such as schizophrenia and severe depression. Treatment strategies often include medication, and sometimes hospitalization.

19.8.Psychiatry- Psychiatry is the field of medicine that specializes in prescribing medications for psychological disorders. This requires a medical degree and specialized training in the effects of certain medications.

19.9.Child and Adolescent Psychology -Children and adolescents sometimes experience difficulties unique to their age group. Psychologists in this area give special attention to these issues and concerns.

20.0.Practicing Clinical and Counseling Psychology



A typical day as a clinical or counseling psychologist is difficult to describe because the work is so varied. For example, a psychologist in private practice may have some extra responsibilities than one working in a hospital or clinic setting. Regardless, each clinical and counseling psychologist encounters many of the same things throughout a typical day. The beginning of the day starts with the psychologist getting the files ready of the clients being seen that day. Typically a psychologist will see no more than five clients per day. Psychologists see a variety of clients ranging from children to adults and couples to families. Each client brings along their own personal problems and individual needs. All this must be taken into account when deciding which therapy is best for each specific client. Children and adolescents are the most difficult population to work with, typically because it may be difficult to gain the parents' cooperation with therapy. Disorders such as depression and anxiety are on the average relatively easy to treat. More difficult to treat are obsessive-compulsive disorder and bipolar disorder, depending on the severity of each. Schizophrenia is by far the hardest disorder to treat. If caught in its early stages, it can be maintained; however, people suffering from schizophrenia will never lead a normal life. At the end of the day, which sometimes lasts up to 12 hours, psychologists must complete the appropriate paperwork for the clients seen that day. This can be a very tedious task because insurance companies require detailed paperwork on clients.



20.1.Pros and Cons of a Career in Clinical and Counseling Psychology

There are both positive and negative aspects to working in Clinical or Counseling Psychology. It is imperative to carefully think about each of these aspects before considering a career in this field. Here are some key points to consider:

Some Potential Attractions of Careers in Clinical and Counseling Psychology



Personal -Fulfillment Working with and helping clients can bring a great deal of personal satisfaction.

Making a -Difference Unique feelings come when you see a client make changes in their lives because you have helped them.

Being Your -Own Boss In private practice, clinical and counseling psychologists are often their own bosses and set their own hours.

Changing -Environment Each client provides different and interesting information about themselves; therefore, the psychologist is rarely bored from doing routine work.

Learning -Experience Clients' diagnoses and therapeutic plans tend to be at least somewhat unique, providing ongoing learning opportunities.





Some Potential Drawbacks of Careers in Clinical and Counseling Psychology



Long Hours - Clinical and counseling psychologists often put in up to 12 hours a day between working with clients and the accompanying paperwork.

High Risk of Burnout -Therapy can be very intense and emotionally exhausting, especially if clients do not respond to treatment or who threaten to commit suicide.

Paperwork -There is an enormous amount of paperwork associated with each client. Health insurance companies alone require a lot of paperwork about clients.

Unchanging Clients -Some disorders are easier to treat than others. It can become very aggravating and frustrating to continuously work with a client who does not make life changes.

Intensive- Therapy is very draining because a therapist's full attention must be given to each client. There is little room for daydreaming or allowing your thoughts to wander.



20.2.Education and Training for Careers in Clinical and Counseling Psychology



NEEDED SKILLS, ABILITIES, and KNOWLEDGE: It is important to be able to lead, inspire, and work effectively with people. Job opportunities are highly limited with a bachelor's degree in psychology. In order to work independently in a private practice, licensure is needed. Most states require a psychologist to complete a doctoral degree before becoming licensed; however, some states permit a license with just a master's degree. Without a license, a psychologist is required to work under the supervision of a doctoral-level psychologist. Licensing laws vary from state to state, however, all states require that applicants pass an examination prior to becoming licensed. In addition, some states require that their clinical and counseling psychologists continue their education for license renewal.



21.0.Counseling Methods Survey- Theories/Theorists & Terminology



21.1.Theories and Theorists

(The following people are not all pure types)

21.2.Psychoanalytic

21.3.Freud, Sigmund: This man is the founder of psychoanalysis, and believed religion to be "the universal obessional neurosis of humanity." He considered sexual impulses to be a primary source of motivation for man, and that mental activity is essentially unconscious; i.e., that the unconscious is a hidden reservoir of the mind which is filled with drives and impulses which govern a person's thinking and behavior. .

21.4. Adler, Alfred: The first well-known dissenter from Freud's school of thought. Adler became the father of what he called "individual psychology." He shifted the motivational emphasis from biological instincts to social relationships. He believed man's primary motivation to be a "will to power." This is based upon his conception of the universal need of children to be dependent upon adults. Such dependency produces feelings of inadequacy and inferiority which each must strive to overcome. (Adler is also considered a humanist.)

21.5. Jung, Carl: Here is another dissenter from Freud's school who de-emphasized the role of sex in personality development. Jung also disagreed on the importance of dealing with an individual's past. He submitted that attention must be given to man's religious, aesthetic, and other such needs. Thus, in Jung we see the seeds of modern day existentialism being planted. He is also noted for his work with the concepts of introversion/extroversion and archetypes.

21.6. Horney, Karen: She is the first person to talk about a self-concept, and thus we can see in her approach the roots of the third force theorists. Problems are considered to stem from a "basic anxiety consists of diminishing discrepancies between one's ideal-self and self-concept.

21.7. Sullivan, Harry S. The term "interpersonal anxiety" was coined by this man to express his belief that man's greatest need is for satisfactory relationships with others. But these basic relationship needs are not considered to be linked to physiological needs. Sullivan was the first to formally construct a motivational hierarchy of physiological needs.

21.8.Erikson, Erik: He designed what are called the eight stages of ego development. Each stage is said to be dependent upon the former. Counseling centers around identifying one's present stage of development and working toward the next.

21.9.Fromm, Erich: His work was grounded in Freudian psychoanalytic theory, but evolved into humanistic psychology. In his books Escape From Freedom and The Art of Loving , Fromm sets forth his idea that man fears being independent, and therefore, seeks structure for security. Fromm is a total humanist, expander of secular existentialism, and initially developed the self-love concepts adapted by today's church.

21.10.Berne, Eric: This man is the father of "transactional analysis." Therapy consists of analyzing and categorizing communication "bits" as expressing certain roles. The goal is the understanding of why communication fails and making appropriate adjustments. The roles (parent, adult, and child) are comparable to the psychoanalytic personality structures (super-ego, ego, and id, respectively).

21.11.Harris, Thomas: He is a popular transactional analyst who wrote the book I'm OK, You're OK

21.2.0.Behavioristic

21.2.1.Watson, J. B. As an originator of behaviorism, Watson stressed a reductionistic approach to the study of human behavior. Reacting to the use of unseen constructs to explain behavior, he opted for operationally defined constructs.

21.2.2. Skinner, B. F. This man is most responsible for popularizing behavioristic philosophy. He authored Walden II , a book describing a utopian society based upon this approach to controlling human behavior. He firmly asserts that man can be wholly understood and controlled through the basic principles of learning (once they are discovered). Motivation is seen as a purely hedonistic matter.

21.2.3.Wolpe, Joseph: A method called "systematic desensitization" has been developed by Wolpe to deal with fear. In this approach, responses prohibitive of fear are elicited and then the previously fear producing stimulus is gradually introduced into the situation. Thus, given the same stimulus, the new response is supposedly substituted for the fear response.

21.2.4.Glasser, William: The father of "reality therapy" has been well accepted by the teaching profession and in the field of corrections. His is a hedonistic approach to directing individuals in seeking the best possible life given the powers and circumstances that exist.

21.2.5. Dobson, James: The author of Dare to Discipline presents an approach to child-rearing which is based primarily upon developing a system of immediate rewards and punishments. The admonition aspect of Ephesians 6:4 is absent and the nature of his system is extra-Biblical. He is primarily known, however, as a self-love practitioner.

21.3.0.Humanistic ("Self" Theorists)

21.3.1. Rogers, Carl: As the father of "client-centered therapy," Rogers has said that the counselor is to be "nondirective" in the sessions--his job is to reflect the counselee's responses back to him and, thus, set up a catalytic atmosphere of acceptance. Such an environment is supposed to allow the client to get in touch with the innate resources within himself for successfully dealing with life and developing self-esteem.

21.3.2. Maslow, Abraham: The term "self-actualization" has been popularized by this man. The underlying assumption is that man is basically good and has within himself all he needs to develop his full potential to be a worthwhile individual; i.e., to self-actualize. Maslow is also noted for developing a hierarchy of motivational needs, including both physiological and psychological ones. The physiological were more primary in his thinking.

21.3.3. Frankly, Viktor: He is the father of "logotherapy," an existential approach to counseling. Maladjustment is seen as an attempt to establish some meaningfulness to one's existence. We are motivated primarily by a desire for identity. Clients are urged to formally establish a personal set of spiritual and ethical values gleaned from their past experiences.

21.3.4. May, Rollo: Another existentialist, May speaks of discovering what is known as a state of "satori." This is based upon the premise that one thing is as good as another and striving is useless, i.e., be content with what you are and what you have. He sees no need for value judgments.

21.3.5. Hiltner, Seward: This man has advocated applying non-directive techniques to pastoral counseling. He says that the pastor can best help by being an understanding and non-judgmental friend to the counselee, helping the latter "get in touch with himself."

21.3.6. Mowrer, O. Hobart: The father of "integrity therapy," Mowrer believes that the solution to man's problems lies in the group milieu. The group provides all that is necessary to handle guilt (confession and restitution on the human level only), and then to develop a sense of self-worth.

21.3.7. Perls, Fritz: This man is a the founder of "Gestalt" therapy. He believes conventional morals cut man off from freely experiencing life with his physical senses. He is rather directive in his approach to encouraging clients to get in touch with their "feelings" in the "now" and act according to them.

21.3.8.Ellis, Albert: He has developed a counseling approach called "Rational Emotive Therapy" (RET). The counselor is to be very directive in attacking certain unproductive evaluations and behaviors of the client -- the counselor tells the client what to do and how to think.



21.4.0.Terms

21.4.1.Psychoanalytic

21.4.2. Libido: the instinctual drives of id which are the source of motivation and "psychic energy."

21.4.3. Oedipus Complex: repressed attitudes of hostility of a child toward the parent of the same sex, and love (sexual desire) for the parent of the opposite sex, which may then lead to certain neurotic symptoms.

21.4.4. Cathexes the investment of psychic energy in some person or thing which can serve as an object for fulfilling one of the various instinctual drives.

21.4.5. Catharsis: the actual discharge of psychic energy associated with a previously suppressed cathexes, usually done as part of the "talk therapy."

21.4.6. Ventilation: the discharge of pent-up emotional energy by striking out in some way -- in counseling, by verbally getting things off one's chest.

21.4.7.Transference: the shifting of emotional energy from one person or object to the therapist in the counseling session -- taking an unpleasant past experience and reliving it in the presence of a warm, accepting therapist; thus, the superego is reduced in strength.

21.4.8.Transactional Analysis: a modern day approach growing out of Freud's basic personality structures. (See Eric Berne)

21.5.0.Behaviorist

21.5.1. Operant Conditioning: a form of learning in which the correct response (or approximations to it) is selectively reinforced and supposedly becomes more likely to occur.

21.5.2. Desensitization: a process by which reactions to traumatic experiences are reduced in intensity by repeatedly exposing the individual to them in mild form, either in reality or in fantasy.

21.5.3. Operationalism: a movement to insist that all definitions in the study of human behavior be linked to observational data; the behavior is to be explained in terms of the operations evoking it.

21.5.4. Parsimony (principle of): the most basic (simple) of two hypotheses should always be accepted: i.e., explanations of human behavior are to be void of abstract concepts such as "superego," "will" and "self."

21.5.5. Hedonism: idea that man is motivated primarily by a pleasure/pain principle.

21.6.0.Humanistic

21.6.1. Support: the attempt to maintain a person at his present manner of functioning through listening and showing the client "acceptance."

21.6.2. Self-actualization: the realization of one's full potential as a human being brought about be putting faith in one's self and doing whatever comes "natural."

21.6.3.Client Centered Therapy: begun by Carl Rogers, which calls for the counselor to act as a reflector helping the client get in touch with himself, his potentials for self-actualization, and solving all his own problems.

21.6.4. Directive Therapy: that in which the counselor instructs the client on what to do and how to change in accordance with the counselors own value system and adjustment to life.

21.6.5. Existentialism: a view of man which emphasizes man's responsibility for himself and to himself for becoming a meaningful person as he himself defines this.

21.7.0.Additional Terminology/Abnormal Behavior

21.7.1.Neurosis: an abnormal reaction pattern marked by acute anxiety, which lowers one's efficiency, but which does not portray a break with reality. (Some examples are amnesias, multiple personality, phobias, neurasthenia, and hysterical paralysis.)

21.7.2.Psychosis: abnormal reaction patterns which portray a lack of contact with reality and are usually characterized by delusions and hallucinations.

21.7.3.Schizophrenia: person displays a retreat from reality into an imaginary world -- thoughts appear irrational and often unconnected.

a. Simple: withdrawal from social contacts and a display of emotional indifference.

b. Hebephrenic: regression to a silly, childish level of behavior where responsibility for coping may be avoided.

c. Catatonic: characterized by behavioral states of motionlessness and/or great excitement.

d. Paranoid: marked by persecutory delusions and/or visions of grandeur.

e. Undifferentiated: others

21.7.4.Paranoid: marked by delusions of persecution and/or grandeur but without appearing to be out of contact with reality.

21.7.5.Affective Psychotic Reactions: a severe disorder of mood accompanied by thought disturbances.

a. Depression: emotional state of dejection, feelings of worthlessness and guilt, and usually apprehension.

b. Manic-Depression: characterized by prolonged periods of excitement and over-activity (manic) or by periods of depression and under activity (depressive), or by alternations or mixture of the two.



22.0.Psychotherapy Industry



The operation of the multi-billion-dollar psychotherapy industry depends on the existence of a multitude of therapists. When the average person asks, "Who can help me solve my problems?" the automatic answer is, "You need to find a good therapist." From all walks of life, students enroll in a vast and highly variable sea of training curricula designed to supply the ever-enlarging demand for therapists and counselors. Most of these students do not realize that there is no standardized, agreed-upon, or proven curriculum for their chosen profession. By the time they do realize it, it often is of little concern to them or their customers. The lack of scientific support for insight-oriented psychotherapy has little impact on the throngs of individuals who pursue the revered mantle of "therapist." Nor does it seem to dissuade the troubled millions who seek their help. While the therapist is the central figure in psychotherapy, the Bible's teaching on the "care of souls" describes no such central figure. It speaks only of exhorting and encouraging one another, of discipling the new believer, and of discipline within the church. In so speaking, Scripture presents a complete, authoritative, and sufficient theology of soul care. It is a theology both distinctive from and clearly opposed to that which has evolved in the practice of psychotherapy. Scripture speaks of what we might call counseling, but it speaks against those who pretend to read minds and communicate with spirits, even for the supposedly noble purpose of helping another in distress. It urges those of us who follow Christ to know and use God's Word, to care for fellow believers, and to confront sin in those for whom we show that care. The church is to rebuke, train, encourage, and generally disciple those who are troubled or are going astray. To do this is one of the ways we "love one another" (I John 4:7). To fail to do this, or to substitute human wisdom for God's revealed wisdom, is to fail to love.

This stands in contrast to most "Christian therapists," who have taken on not only the fundamental doctrines of the secular insight-oriented psychotherapy industry, but also its practices and trappings. Among these counselors who characterize themselves as "Christian," all too often we find: (1) the claim to possess the secret knowledge of an elite corps, along with the use of a vocabulary so elusive and complex that an aura of sheer magic surrounds it, (2) credentials framed on the wall, and (3) fifty-minute therapy sessions, after which they charge fees for what should be considered discipling. These counselors move within the church, more as people possessing secret knowledge than as loving church leaders fighting the good fight.

Quite apart from these professional counselors, Christians have the following four sources available for counsel: the Holy Spirit, the Word of God, other Christians, and the organized church.



23.0.Counseling & Psychotherapy



23.1.History: The Modern day psychological therapies trace their history back to the work of Sigmund Freud in Vienna in the 1880s. Trained as a neurologist, Freud entered private practice in 1886 and by 1896 had developed a method of working with hysterical patients which he called 'psychoanalysis'. Others such as Alfred Adler, Snador Ferenczi, Karl Abraham and Otto Rank were also analyzed by Freud and had brief apprentice-type training from him before becoming psychoanalysts in their own right. In the early 1900s, Ernest Jones and A.A. Brill, from the UK and US respectively, visited Freud in Vienna and returned to their own countries to promote Freud's methods; Freud himself began a lecture tour of North America in 1909. Gradually many such as Ferenczi, Adler, Rank, Stekel and Reich began to develop their own theories and approaches, which sometimes differed markedly from Freud's. Jung in particular, a close collaborator of Freud's from 1907-1913 who was in some sense 'groomed' as Freud's intellectual successor, eventually split from Freud and pursued the development of his own school of analytical psychology, drawing heavily on both Freud's and Adler's ideas. All these immediate descendants of Freud's approach are characterized by a focus on the dynamics of the relationships between different parts of the psyche and the external world; thus the term 'psychodynamics'. A separate strand of psychological therapies developed later under the influence of psychology and learning theory and leading thinkers such as B.F. Skinner. Rejecting the notion of 'hidden' aspects of the psyche which cannot be examined empirically (such as Freud's rendition of the 'unconscious'), practitioners in the behavioral tradition began to focus on what could actually be observed in the outside world.

Finally, under the influence of Adler and Rank, a 'third way' was pioneered by the US psychologist Carl Rogers. Originally called 'client-centred' and later 'person-centred', Rogers's approach focuses on the experience of the person, neither adopting elaborate and empirically untestable theoretical constructs of the type common in psychodynamic traditions, nor neglecting the internal world of the client in the way of early behaviourists. Other approaches also developed under what came to be called the 'humanistic' branch of psychotherapy, including Gestalt therapy and the psychodrama of J.L. Moreno. The figure below illustrates some of the historical links between these three main strands which developed from Freud's original contributions.













23.2.The Medical vs. Non-Medical Split



Freud strongly supported the idea of lay analysts without medical training, and he analysed several lay people who later went on to become leading psychoanalysts, including Oskar Pfister, Otto Rank and his own daughter Anna Freud. He published two staunch defenses of lay analysis in 1926 and 1927, arguing that medicine and the practice of analysis were two different things. When Ernest Jones brought psychoanalysis to the UK in 1913, he followed Freud's preferences in this area, and the tradition of lay involvement continues to this day in the UK, where most psychoanalysts, psychotherapists and counselors have a lay background.

In the US, however, Freud's analyzed A.A. Brill insisted that analysts should be medically qualified even though there were already many lay analysts practicing in the US who, like Brill, had trained with Freud in Vienna. Brill prevailed, however: in 1926 the state of New York made lay analysis illegal, and shortly thereafter the American Medical Association warned its members not to cooperate with lay analysts. To this day, almost all US psychoanalysts are medically qualified, and counselors typically study psychology as undergraduates before becoming counselors



23.3.Counseling vs. Psychotherapy Dichotomy



It was largely in response to the US prejudice against lay therapists that Carl Rogers adopted the word 'counseling', originally used by social activist Frank Parsons in 1908. As a psychologist, Rogers was not originally permitted by the psychiatry profession to call himself a 'psychotherapist'. Ironically, Rogers himself became renowned as one of the most influential empirical scientists in the fields of psychology and psychiatry, introducing rigorous scientific methods to psychology and psychotherapy that psychoanalysts themselves had long resisted (and, in the view of many, still largely resist today). He became a joint Professor in the Departments of Psychology and Psychiatry at the University of Wisconsin as well as Head of the Psychotherapy Research Section of the Wisconsin Psychiatric Institute.

In the field as it now stands, the argument as to whether counseling differs significantly from psychotherapy is largely academic. Those from psychodynamic traditions sometimes equate 'psychoanalysis' and 'psychotherapy' -- suggesting that only psychoanalysts are really psychotherapists -- but this view is not common anywhere else. Others use 'psychotherapy' to refer to longer-term work (even though some psychotherapists offer brief therapy) and 'counseling' to refer to shorter term work (even though some counselors may work with clients for years). The two terms are commonly used interchangeably in the US, with the obvious exception of 'guidance counseling', which is often provided in educational settings and focuses on career and social issues.



23.4.Counseling and Psychotherapy Today



Modern counseling and psychotherapy have benefited tremendously from the empirical tradition which was given such impetus by Carl Rogers, even though the research agendas of psychology and counseling have diverged greatly over the last half century. Additional work in cognitive psychology, learning theory and behavior has informed many therapeutic approaches. The richness of the bodies of both empirical and theoretical work which are now available, coupled with the raw complexity of human beings, has led to a profusion of different approaches to the field. By some accounts, the different strands of counseling and psychotherapy now number in the hundreds. Mainstream approaches, however, are much fewer in number, and over time it is likely that many of the less well-grounded schools of thought will fade away, while more new ones will emerge to take their place. While the main approaches continue to develop, and others appear and then fade away, clients are left to choose for themselves what might be best for them.



24.0.Comparing Therapeutic Effectiveness



Contrary to recent high-profile (but under-researched) commentary in UK tabloids and radio, there is a huge body of empirical evidence supporting the effectiveness of counseling and psychotherapy for addressing many different kinds of psychological distress. The topic on 24.1.Comparing Effectiveness summarizes some of the main conclusions emerging from this research evidence.



24.1.0.Evaluating Therapeutic Effectiveness in Counseling And Psychotherapy



24.1.1.Overall Effectiveness vs. Individual Effectiveness

Research evidence about the effectiveness of counseling and psychotherapy overall is relatively unambiguous: counseling does work. For a wide range of types of psychological distress, both subjective client reports and more objective measurements indicate that counseling and psychotherapy are effective, both in the short term and over longer time periods. For certain kinds of psychological distress, such as depression, some evidence also suggests that the benefits of counseling can interact positively with medications such as anti-depressants: in other words, counseling and medication together sometimes offer better results than either counseling or medication on their own.

What is more ambiguous, however, is the research evidence on the effectiveness of specific types of counseling or psychotherapy. Overall, no one therapeutic approach stands out as offering better results than any other. (However, evidence from efficacy studies is gradually accumulating to indicate that some kinds of distress are particularly well addressed by certain approaches; clients with panic disorders, for instance, often respond particularly well to cognitive behavioral therapy.) At first glance, it might seem that this failure to discriminate between therapeutic approaches in terms of overall effectiveness could be attributed simply to the fact that different people will respond in their own ways to different types of counseling: if clients choose the 'right' or 'wrong' types of therapy only by accident, this might result in particular types offering good results in some areas and bad results in others, with the overall result that no one type of counseling would stand out. But because studies are typically designed to detect and isolate these types of regularities, we know that random choice about therapy type does not, by itself, provide a sufficient explanation of the evidence.

While no one type of therapy stands out in terms of overall effectiveness, however, individual counselors clearly do. Within given approaches, research shows very significant variation between individual counselors. Indeed, the evidence suggests that the abilities of individual therapists may be a more significant factor in determining outcome than therapeutic orientation! So there may not be a clear answer to the question of whether there are better or worse therapeutic orientations, but there certainly are better and worse therapists. Pinning down exactly why this is so -- exactly what kinds of factors account for the variation in individual results -- is much more difficult. The research evidence cannot yet help the client to understand exactly why one therapist might be better or worse for them than any other. Worse, there is no evidence that any of the various counselor accreditation schemes serve to pick out better therapists, and neither years of counselor experience nor duration of their training have any strong bearing on therapeutic outcome. (Indeed, some research has even suggested that counselors in training and newly-qualified counselors are more effective than their more experienced peers!)

24.1.2.What Effectiveness Research Might Mean for Clients

If the aggregate effect of all main types of counseling and psychotherapy is positive, and if the individual therapeutic approaches do not distinguish themselves clearly in terms of overall effectiveness, does this mean that therapeutic orientation is irrelevant from an individual client's point of view? Definitely not!

While the quality of the relationship which a client can establish with a particular counselor probably heads the list of factors to consider when entering counseling, the match between an individual client's preferences and a particular style of counseling remains extremely important. This match (or mismatch) can strongly influence how the client feels about the process and the relationship and consequently bears on how easy it is for that client to make progress. Virtually all relevant empirical studies agree that clients benefit more when they are committed to working within the therapeutic approach offered in their particular counseling environment and some studies suggest that client variables such as this account for about 40% of therapeutic change, more than any other factors. A client who doubts whether a cognitive model adequately represents their experience probably will find less benefit from cognitive or cognitive behavioral therapy, while a client who would like their counselor to give them a great deal of advice and instruction may not get very much from person-centred counseling. By analogy, while it is probably possible to walk 5 miles in shoes that are either much too big or painfully small or have too much traction or not enough, the right choice of footwear can make it much easier to do so in comfort, enjoying the scenery along the way, and having some energy left at the end. Likewise, many different kinds of shoes will do for such a walk, but some will be a help while others may actually be a hindrance. Some time spent considering the different types of counseling and psychotherapy available before embarking on a therapeutic journey will be time well spent.

As for the question of individual counselor effectiveness, perhaps the most important lesson to be drawn from the research is that clients should make up their own minds based upon their own experience with a counselor, rather than relying entirely on evidence such as paper qualifications, years of experience, or recognition via professional accreditation schemes. (The section About Counseling and Psychotherapy includes some suggestions both on finding counselors and on selecting one.) Remember that the quality of the relationship which the client can establish with the counselor probably heads the list of factors influencing therapeutic outcome, so at the end of the day, the client's judgment of this relationship probably carries the most weight.

24.1.3.What Effectiveness Research Might Mean for Counselors

One of the more pernicious conclusions occasionally drawn from the absence of evidence favoring any one type of counseling or psychotherapy over any other is that individual counselors needn't concern themselves very much with orientation. This line of thought seems to go along with a kind of 'therapeutic relativism' which suggests that everything has its value, and no way of working with a given client is really better than any other. Similarly, one sometimes hears the view expressed that critically evaluating the theoretical differences between approaches is unimportant, and one can just be entirely pragmatic: do what works. Perhaps the most defeatist approach is that there is just no point learning about various therapeutic approaches, given that none has ever demonstrated a clear overall advantage over others.

There are good reasons for rejecting each of these responses. First among them is that there is no justification for inferring from the evidence that a specific individual client (as opposed to the aggregate set of all clients) will be helped just as much by one approach as by any other. We don't yet have the evidence to answer unambiguously the question of what works for which types of clients, but that doesn't relieve the counselor of the responsibility to consider what will work for his or her specific clients. Moreover, the absence of evidence about overall differences in effectiveness does not imply that there are no differences in how to be effective. (Indeed, there patently are differences in counselor effectiveness, but research has yet to separate out the most relevant variables at work.) The same is true of why a given approach or counselor is effective. In fact, some theorists and researchers have gone to considerable effort to account for the success of a given approach in terms of what it might accomplish in light of the theoretical model espoused by another. There may be considerable benefits for the client (not least among them, speed and cost) if the counselor is effective because he or she is getting it 'right' by design, rather than by accident.

(As one example of accounting for the success of one approach in terms of another, the cognitive therapist -- and former psychoanalyst -- Aaron Beck provides convincing arguments in terms of cognitive therapy for why the therapeutic interventions of a psychoanalyst might have a successful outcome; the cognitive explanation is entirely consistent with the falsity of psychoanalytic theory. In other words, the psychoanalyst might be acting on an entirely mistaken view of the client's psychology, yet these misguided interventions might inadvertently hit right on target in terms of eventual outcome.)

The response that counselors should just be pragmatic, doing what works, is actually very credible. But even here, it is difficult to see how a counselor could just do what works without some grasp of the theoretical underpinnings of whatever overall approach or technique he or she might be inclined to employ with a given client. It is preferable for the client if any suggestions from the counselor that a particular approach might be helpful are made on the basis of some informed view of why it might work: a counselor’s suggestion of a particular way of working should not be made by default, it should be both deliberate and informed. In other words, it may be true that one should 'do what works', but doing that requires some effort to understand and evaluate underlying theory.

One last curious conclusion about the evidence is worth addressing. Namely, some proponents of person-centered theory suggest that it is unsurprising that different therapeutic orientations do not differ in terms of aggregate effectiveness. They suggest that only individual therapists who manifest the 'core conditions' of person-centered theory will be effective, and that anyone from any orientation could do a good job of offering the core conditions. The evidence does not support this conclusion: these conditions have been researched along with many others, and there is no evidence to suggest that success can be picked out just by looking at the core conditions. (It is entirely possible that the view is true, but for now it remains an item of faith, not a conclusion correctly derived from reliable empirical evidence.) Moreover, if it were true, it would imply an interesting conclusion which person-centre proponents would presumably find unpalatable: namely, those counselors who successfully manifest the core conditions are no more likely to be found in the ranks of the person-centered tradition than within any other therapeutic tradition. In other words, it would imply than person-centre counselors are no more likely to be person-centre than any other type of counselor.

Finally, all this might strike some practitioners as being entirely tangential to their own take on counseling and psychotherapy. For some, scientific research is irrelevant anyway, and even if the particular benefits of a given approach became empirically evident, they would still prefer to maintain the purity of their own particular therapeutic orientation and their own ways of dealing with individual clients. (One psychologist wrote that "one can no more argue someone out of a counseling model by advancing empirical evidence than one could argue them out of a religious belief".) One way of getting at whether there is any tension in this view -- and there needn't necessarily be any at all -- is by way of a question which is worth asking for any counselor: what would it take to convince you that you are approaching a given client in the wrong way? The client telling you so? A scientific study? The client telling you so twenty times? Twenty scientific studies? Alternatively: what would it take to convince you that a given client would benefit more from something other than what you are doing?

25.0.Comparing existential vs. person-centered approaches.

25.1.Existential vs. person-centered Counseling approaches

At times I do ponder Why does the universe exist? What if it didn't? What would be left over if it stopped existing? Wouldn't something still exist? What color would it be? Even now, the questions elicit the same peculiar twisting sensation from my stomach. And now, as then, I find the basic mystery of why anything exists the most unfathomable of all.

25.2.Underlying Theory of Existential Counseling and Psychotherapy

Largely dispensing with psychological constructs and theories about personality, the existential approach characterizes human beings as creatures of continual change and transformation, living essentially finite lives in a context of personal strengths and weaknesses as well as opportunities and limitations created by their environment. With attention given to this entire context of the client's life, the existential approach is all about exploring meaning and value and learning to live authentically that is, in accordance with one's own ideals, priorities and values. Authentic living means being true to oneself and honest about one's own possibilities and limitations, continually creating one's own identity even in the face of deep uncertainty about everything in the future except for the eventual arrival of our own death. Authentic living means living deliberately, rather than by default. Psychological health, from an existential perspective, is characterized by an ability to navigate the complexities of one's own life, the world, and one's relationships with the world. Disturbance, on the other hand, is taken as the outcome of avoiding life's truths and of working under the shadow of other people's expectations and values. Self deception about these factors provides a powerful psychological defense mechanism. Existential counseling maintains that disturbance is an inevitable experience for virtually everyone; the question is not so much how to avoid it as it is how to face it with openness and a willingness to engage with life rather than a tendency to retreat, withdraw or refrain from responsibility.

25.3.Therapeutic Approach of Existential Counseling

The role of the existential therapist is really to facilitate the client's own encounter with themselves, to work alongside them in the job of exploring and understanding better the client's values, assumptions and ideals. The therapist is concerned to engage seriously with what matters most to the client, to avoid imposing their own judgments, and to help the client to elucidate and elaborate on their own perspective, with an ultimate view to the client's being able to live life well and in their own way. Great emphasis is placed on the therapist's responsibility to be aware of and to question their own biases and prejudices. The therapist must be self aware and able to set aside as much as possible their pre-conceptions and to encounter the client's world with an open mind. The therapist brings a sort of deliberate naiveté to the therapeutic relationship, with a goal of understanding the client's meaning rather than their own and recognizing the client's assumptions and underlying life themes with a clarity which the client may not yet be able to muster. The therapist will be sensitive to and help the client explore their weaknesses, limitations and responsibilities as well as their strengths, opportunities and freedoms. Above all, they will value the meaning which the client creates in their own emotions, thoughts, beliefs, and personal history. In the course of exploring the client's world, the therapist may appeal to a 4-part framework encompassing the client's existence in the physical dimension of the natural world, the body, health and illness; the social dimension of public relationships; the psychological or personal dimension, where we experience our relationship with ourselves as well as intimacy with others; and the spiritual dimension of ideals, philosophy and ultimate meaning. Crucially, however, this framework of four dimensions is not imposed on the client by the therapist; it simply informs the therapist's understanding of the client's world so that, for instance, if a client never mentioned intimate relationships, the therapist would become aware of a deficiency in their understanding of the client's personal dimension.





The existential approach seeks clarity and meaning in all these dimensions and thus, in a sense, it begins with a significantly broader view of human existence than those approaches which focus on specific psychological mechanisms or which focus on the self as a meaningful entity, separable from its relations and interactions with the surrounding world.

25.4.Criticisms of Existential Counseling

Although sometimes criticized for 'intellectualizing' the client's life situation, this characterization is on target only to the extent that reflection, self examination, and self awareness are 'intellectual' activities. As one leading author puts it, "The approach is not about intellectualizing, but about verbalizing the basic impressions, ideas, intuitions and feelings a person has about life". Nonetheless, as discussed below, this quality of existential counseling means that it is perhaps more narrow than some other approaches in terms of the client set whose concerns it can most successfully address. (Of course this criticism cuts both ways, and many other approaches may be less able to help clients who specifically approach life with something like the spirit favored by existential counseling.)

25.5.Best Fit With Clients

Generally speaking, clients who view their problems as challenges of living, rather than symptoms of psychopathology, and clients who are genuinely attracted to increasing self awareness and self examination, will be well served by existential counseling. The approach will appeal to clients who are interested in the search for meaning and in deeply personal philosophical investigations. The approach is well suited to those who are attempting to clarify their own personal ideology and/or those who are facing significant personal adversity or change; some existential practitioners suggest the approach is particularly appropriate for those who feel at the very edge of existence, including those with terminal illnesses or who are contemplating suicide, or perhaps those who are just beginning a new phase of life in some way. Clients who are less inclined to examine and explore their personal assumptions and ideals, or who would like to achieve immediate relief of specific psychological symptoms -- as well as those who would like advice or diagnosis from their counselor will probably find less value in existential counseling. Unfortunately, a clear empirical picture of factors influencing efficacy in existential counseling has not yet emerged in the research literature.

25.6.Underlying Theory of Person-Centred Counseling

The person-centred approach views the client as their own best authority on their own experience, and it views the client as being fully capable of fulfilling their own potential for growth. It recognizes, however, that achieving potential requires favorable conditions and that under adverse conditions, individuals may well not grow and develop in the ways that they otherwise could. In particular, when individuals are denied acceptance and positive regard from others or when that positive regard is made conditional upon the individual behaving in particular ways they may begin to lose touch with what their own experience means for them, and their innate tendency to grow in a direction consistent with that meaning may be stifled.

One reason this may occur is that individuals often cope with the conditional acceptance offered to them by others by gradually coming to incorporate these conditions into their own views about themselves. They may form a self-concept which includes views of themselves like, "I am the sort of person who must never be late", or "I am the sort of person who always respects others", or "I am the sort of person who always keeps the house clean". Because of a fundamental need for positive regard from others, it is easier to 'be' this sort of person -- and to receive positive regard from others as a result -- than it is to 'be' anything else and risk losing that positive regard. Over time, their intrinsic sense of their own identity and their own evaluations of experience and attributions of value may be replaced by creations partly or even entirely due to the pressures felt from other people. That is, the individual displaces personal judgments and meanings with those of others.

Psychological disturbance occurs when the individual's 'self-concept' begins to clash with immediate personal experience i.e., when the evidence of the individual's own senses or the individual's own judgments clashes with what the self-concept says 'ought' to be the case. Unfortunately, disturbance is apt to continue as long as the individual depends on the conditionally positive judgments of others for their sense of self-worth and as long as the individual relies on a self-concept designed in part to earn those positive judgments. Experiences which challenge the self-concept are apt to be distorted or even denied altogether in order to preserve it.

25.7.Therapeutic Approach of Person-Centred Counseling

The person-centred approach maintains that three core conditions provide a climate conducive to growth and therapeutic change. They contrast starkly with those conditions believed to be responsible for psychological disturbance. The core conditions are:

• Unconditional positive regard

• Empathic understanding

• Congruence

The first unconditional positive regard -- means that the counselor accepts the client unconditionally and non-judgmentally. The client is free to explore all thoughts and feelings, positive or negative, without danger of rejection or condemnation. Crucially, the client is free to explore and to express without having to do anything in particular or meet any particular standards of behavior to 'earn' positive regard from the counselor. The second empathic understanding -- means that the counselor accurately understands the client's thoughts, feelings, and meanings from the client's own perspective. When the counselor perceives what the world is like from the client's point of view, it demonstrates not only that that view has value, but also that the client is being accepted. The third congruence -- means that the counselor is authentic and genuine. The counselor does not present an aloof professional facade, but is present and transparent to the client. There is no air of authority or hidden knowledge, and the client does not have to speculate about what the counselor is 'really like'.

Together, these three core conditions are believed to enable the client to develop and grow in their own way -- to strengthen and expand their own identity and to become the person that they 'really' are independently of the pressures of others to act or think in particular ways.

As a result, person-centred theory takes these core conditions as both necessary and sufficient for therapeutic movement to occur i.e., that if these core conditions are provided, and then the client will experience therapeutic change. (Indeed, the achievement of identifying and articulating these core conditions and launching a significant programmed of scientific research to test hypotheses about them was one of the greatest contributions of Carl Rogers, the American psychologist who first began formulating the person-centred approach in the 1930s and 1940s.) Notably, person-centred theory suggests that there is nothing essentially unique about the counseling relationship and that in fact healthy relationships with significant others may well manifest the core conditions and thus be therapeutic, although normally in a transitory sort of way, rather than consistently and continually.

Finally, as noted at the outset, the person-centred approach takes clients as their own best authorities. The focus of person-centred therapy is always on the client's own feelings and thoughts, not on those of the therapist and certainly not on diagnosis or categorization. The person-centred therapist makes every attempt to foster an environment in which clients can encounter themselves and become more intimate with their own thoughts, feelings and meanings.

25.8.Criticisms of Person-Centred Counseling

A frequent criticism of the person-centred approach is that delivering the core conditions is what all good therapists do anyway, before they move on to applying their expertise and doing the real work of 'making clients better'. On the face of it, this criticism reflects a misunderstanding of the real challenges of consistently manifesting unconditional positive regard, empathic understanding and congruence. This is especially true of congruence: to the extent that some therapeutic techniques deployed in some other traditions depend on the counselor’s willingness to 'hold back', mentally formulate hypotheses about the client, or conceal their own personal reactions behind a consistent professional face, there is a real challenge in applying these techniques with the openness and honesty which defines congruence. It may also demonstrate something of a reluctance to take seriously the empirical research on counseling effectiveness and the conclusion that the quality of the client-counselor relationship is a leading predictor of therapeutic effectiveness although this is somewhat more controversial, since one might argue that providing the core conditions is not the only way to achieve a quality relationship. (See the page on Comparing Effectiveness.)

At a deeper level, however, there is a more sophisticated point lurking, which many expositions of person-centred theory seem to avoid addressing head-on. Namely, given that the self is the single most important resource the person-centred counselor brings to the therapeutic relationship, it makes sense to ask: what (if anything) is it important that this self has, apart from the three core conditions? I.e., manifesting of the core conditions does not by itself tell us what experiences or philosophies the counselor is bringing to the relationship. It tells us that the client will have transparent access to that self -- because the counselor is congruent -- but it doesn't tell us anything else about that self. Whether or not that self should be developed in any particular way, or whether that self should acquire any particular background knowledge, seems to me a question which is more often side-stepped than answered within the person-centred tradition.

(Another way to understand this point is this: given two counselors, each of whom manifests the core conditions to some specified degree, what else, if anything, matters? Would it be better for a given client to have the one who is an expert at astrophysics or the one who is an economist? Would it be better for a given client to have the one who struggled through a decade of ethnic cleansing in a war-torn country or the one who went to private school in an affluent suburb and subsequently worked as a stockbroker? Aside from academic expertise and personal history, what about personal philosophy, parenthood, and other factors?)

25.9.Best Fit With Clients

Clients who have a strong urge in the direction of exploring themselves and their feelings and who value personal responsibility may be particularly attracted to the person-centred approach. Those who would like a counselor to offer them extensive advice, to diagnose their problems, or to analyze their psyches will probably find the person-centred approach less helpful. Clients who would like to address specific psychological habits or patterns of thinking may find some variation in the helpfulness of the person-centred approach, as the individual therapeutic styles of person-centred counselors vary widely, and some will feel more able than others to engage directly with these types of concerns.















25.10.Therapeutic Approach



The role of the existential therapist is really to facilitate the client's own encounter with himself, to work alongside him in the job of exploring and understanding better his values, assumptions and ideals. The therapist is concerned to engage seriously with what matters most to the client, to avoid imposing her own judgments, and to help the client to elucidate and elaborate on his own perspective, with an ultimate view to the client's being able to live life well and in his own way.

Existential counseling places great emphasis on the therapist's responsibility to be aware of -- and to question -- her own biases and prejudices. The therapist must be able to set aside as much as possible her pre-conceptions and to encounter the client's world with an open mind. The therapist brings a sort of deliberate naiveté to the therapeutic relationship, with a goal of understanding the client's meaning rather than her own and recognizing the client's assumptions and underlying life themes with a clarity which the client may not yet be able to muster. The therapist will be sensitive to and help the client explore his weaknesses, limitations and responsibilities as well as his strengths, opportunities and freedoms. Above all, she will value the meaning which the client creates in his own emotions, thoughts, beliefs, and personal history. In the course of exploring the client's world, the therapist may appeal to a 4-part framework encompassing the client's existence in: the physical dimension of the natural world, the body, health and illness; the social dimension of public relationships; the psychological or personal dimension, where we experience our relationship with ourselves as well as intimacy with others; and the spiritual dimension of ideals, philosophy and ultimate meaning. Crucially, however, this framework of four dimensions is not imposed on the client by the therapist; it simply informs the therapist's understanding of the client's world so that, for instance, if a client never mentioned intimate relationships, the therapist would become aware of a deficiency in her understanding of the client's personal dimension. The existential approach seeks clarity and meaning in all these dimensions and thus, in a sense, it begins with a significantly broader view of human existence than approaches which focus on specific psychological mechanisms or which focus on the self as a meaningful entity, separable from its relations and interactions with the surrounding world.

25.11.Theoretical Commitments and Underlying Assumptions

Authors differ in their views on the underlying assumptions of person-centred theory, but the central features of Carl Rogers's own beliefs are well expressed in his major theoretical treatise (Rogers 1959), one of his main formulations of the core conditions (Rogers 1957), and the summary of the person-centred approach published very late in his life (Rogers 1986). In terms of existential counseling, several authors are available, but the most accessible resources to my knowledge are van Deurzen (2002a) and van Deurzen (2002b); van Deurzen-Smith (1997) offers some entry into the more philosophical underpinnings of the approach, including the work of several existential philosophers. It is more than an interesting historical footnote that the philosopher probably most frequently mentioned by Rogers and always in very approving terms also contributes significantly to the thought underlying existential counseling: Soren Kierkegaard. And authors like Rollo May and Paul Tillich strongly influenced the development of both US existential thought and the person-centred approach; as van Deurzen observes, there are "obvious existential elements" in the person-centred approach (van Deurzen 2000, pp. 331). My intent, however, is not to develop historical connections between the two traditions; nor is it to paint a complete theoretical picture of either. Rather, I will pick out some specific underlying assumptions and explore them in more detail.

25.12.Personality Theory and Disturbance

Rogers's major theoretical treatise sets out an over-arching view of personality development and of the creation and maintenance of psychological disturbance which informs essentially all of person-centred practice. Existential counseling, by contrast, eschews over-arching theories of personality, and it is significant that so, too, does virtually all of modern psychology. Psychologist Charles Legg, after observing that half a century ago, Carl Rogers was at the forefront of empirical research in psychology, notes that "Rogers' approach reflects the intellectual roots of psychology in 'modernism', the belief that it is possible to have all-encompassing theories of the physical and social world that would permit 'technological' fixes to a wide range of social problems" (Legg 1998, p. 3). He goes on:Counseling’s initial concern with comprehensive theories fitted with the intellectual ethos of its day but, since then, mainstream psychology has become more modest while counseling has retained its commitment to theories, thus staying rooted in the psychology of the 1940s and 1950s. By the middle of the twentieth century, academic psychologists had begun to lose faith in universal models as they collapsed under the weight of contradictory evidence and conceptual analysis. (Legg 1998, p. 3) In this respect, psychology has moved on, while counseling has not. The empirical foundations of person-centred personality theory are virtually never discussed in the modern literature: even research on the core conditions as predictors of therapeutic outcome virtually never addresses the underlying personality theory itself. In my view, were Rogers at the peak of his career today, he would appeal to current empirical research in psychology to overhaul radically the received wisdom of the person-centred mainstream. It is ironic that some followers of one of the last century's greatest empiricists have, in this respect, become just that followers and have shied away from thawing out the icy innards of frozen theory. This does not mean that the person-centred approach is just wrong about personality theory. But it does mean, in my view that person-centred personality theory should be taken only as a useful background heuristic and not by any means as the bedrock of the person-centred approach. Certainly the existential approach escapes the criticisms above levelled at person-centred theory, but it does so only at the cost of avoiding the engagement in the first place: there is no personality theory to question! What does it have to offer instead, and what does it have to say about disturbance? The most important point for present purposes is that whereas the 'self-concept" occupies a central theoretical niche for the person-centred approach, the existential approach focuses on the relationships a person has both with himself and with the world around him. While the person-centred approach focuses on the development of the self under more or less hospitable conditions (correlating, roughly, with the relative availability of positive regard), the existential approach focuses on the individual's relationships. When the individual does not manage to navigate those relationships effectively or when the truths embodied in those relationships is avoided disturbance occurs. Effective navigation means being open to whatever life brings, both good and bad. This recognition and determination to integrate diametrically opposed poles runs throughout existential thought and in this context leads van Deurzen to comment:

It is only in facing both positive and negative poles of existence that we generate the necessary power to move ahead. Thus well-being is not the naive enjoyment of a state of total balance given to one by Mother Nature and perfect parents. It can only be negotiated gradually by coming to terms with life, the world and oneself. (van Deurzen 2002b, 184)

Here van Deurzen's allusion to "life, the world and oneself" also serves as a reminder that for the existential approach, disturbance may not be just about impaired openness to current experience; it may be about existence, meaning and temporality. The existential counselor readily acknowledges that someone might be relatively free of the kinds of distortions, denials, conditions of worth and other hallmarks of disturbance which populate person-centred theory and yet still experience existential angst. One might enjoy relatively healthy psychological functioning with respect to present experience and yet fail to apprehend one's own life's meaning. In the person-centred framework, the (usually unstated) assumption seems to be that once a person has overcome their psychological challenges, such difficulties automatically disappear.

25.13.Locus of Evaluation, Authenticity and the Fully-Functioning Person

The existential analogue of the person-centred notion of being fully-functioning is authenticity, and both approaches place significant emphasis on the internalization of the individual's locus of evaluation in achieving authenticity (although existential thought does not use the actual term 'locus of evaluation'). As van Deurzen (2002a, p. xi) suggests, "the fundamental objective of the approach is to enable people to rediscover their own values, beliefs and their life's purpose". She reinforces this emphasis on the client's own direction-setting:

It is crucial for the therapist to remember that nobody can determine what another person's commitment ought to be. Two people in similar circumstances might feel moved in opposite directions. Suggesting positive action to a client will be likely to forestall her own exploration of her present situation and it will thus set her back rather than move her on. (van Deurzen 2002a, 185)

This emphasis on keeping the client at the centre of the counselling task and on promoting the development of what the person-centred approach calls the client's own internal locus of evaluation permeates existential thinking. The locus of evaluation is just as directly connected with authenticity for the existential approach as it is for the person centred-approach: "This is what authentic living is all about: becoming increasingly capable of following the direction that one's conscience indicates as the right direction and thus becoming the author of one's own destiny" (van Deurzen 2002a, p. 43). While the two approaches' views of authentic living are also broadly in keeping with one another, the most notable difference centres on time. Although Rogers refers to the client's "increasing use of all his organic equipment to sense, as accurately as possible, the existential situation within and without" (Rogers 1961, p. 191), there is little explicitly temporal about his view of full functioning. Emphasizing the importance of experience in the moment, the temporal context characteristic of the existential approach a context of continual change and transformation and ultimate death -- makes no appearance in Rogers's explication of full functioning. To be sure, Rogers is very clear that the fully-functioning person is in a state of change, but that state is deliberately stripped of temporal context: "he lives more completely in this moment, but learns that this is the soundest living for all time" (Rogers 1961, p. 192).

This focus on the 'moment-within-change' is akin to taking the first derivative of a function, like noting the instantaneous velocity of a moving object. It reflects the state-dominated view of cognitive functioning and of computation shared by Rogers's contemporaries in the cognitive sciences, a view partly displaced from cognitive science in subsequent decades by the reintegration of dynamical systems theory. (See Mulhauser 1998, pp. 109-117 for a treatment of this topic specifically with regard to the notion of 'mental states'.) In my view, this now largely outmoded absence of temporal context marks a significant weakness of the person-centred approach.

25.14.The Actualizing Tendency

The question of the fundamental nature of human beings carries deep significance, whatever theoretical approach one considers. Van Deurzen's description captures one facet of the distinction between the two approaches very nicely:

Humanistic approaches perceive human beings as basically positive creatures who develop constructively, given the right conditions. The existential position is that people may evolve in any direction, good or bad, and that only reflection on what constitutes good and bad makes it possible to exercise one's choice in the matter. (van Deurzen 2002a, pp. 50-51)

Superficially appealing analogies about potatoes or even about biological systems in general have unfortunately served to stifle rather than to stimulate serious engagement with Rogers's view of the actualizing tendency, captured but understated in van Deurzen's first sentence above. The problem with potato analogies is that potatoes don't have minds. It is one thing to extrapolate from the tendency of potatoes to fulfil their biological and physiological potential to the tendency of mammals and even human beings to fulfil their biological and physiological potential. But it is an altogether different matter to extrapolate from the biological and physiological tendencies of potatoes to the psychological tendencies of human beings. Psychological disturbance is entirely consistent with the fulfilment of physiological potential; in other words, it is entirely conceivable that a human being could fulfil physiological potential even while undergoing deleterious psychological change. Indeed, to the extent that biological analogies derive their ultimate authority from evolutionary theory, it is even worse than this: not only is there scant evidence to suggest that selective pressures for ontogenetic psychological fulfilment exist at all, but there are good prima facie reasons for believing selective pressures will have favoured the deployment of a range of psychological defence mechanisms which promote immediate functioning even while compromising longer term psychological health! Rogers himself acknowledges (Rogers 1959) that mechanisms such as denial and distortion may serve a specific (beneficial) purpose. Evolution cares only whether an organism is expediently-served now, not whether expedient functioning now is going to lead to negative psychological consequences later.

But perhaps most interesting of all is a very simple observation which this discussion prompts. Namely, one may read Rogers's view as implying that if one is making bad, self-defeating choices, then this is a sign of disturbance (or, at the least, a sign that the actualizing tendency is not being expressed). Again, the existential approach does not support this implication, allowing that one may be functioning relatively well from the standpoint of psychological health yet still be making bad choices. One obvious alternative interpretation of Rogers is simply that the actualizing tendency does not necessarily carry a positive psychological bias, only a bias toward the full expression of biological potential. Neither horn of this apparent dilemma seems immediately palatable to the person-centred theorist: either Rogers views inexpert living as tantamount to psychopathology, or the actualizing tendency does not carry anything like the positive psychological bias his followers so often attribute to it.

It is a pity to me that the subtle shades of meaning surrounding Rogers's notion of the actualizing tendency receive comparatively little attention within the person-centred literature. Either this bit of "theory" is central to one's actual practice of counselling, or it is not. If it is central, then it deserves careful attention and exploration. If it is not central, then I wonder what is?

25.15.Therapeutic Practice

The relationship between these two approaches to counseling becomes more complex when seen the through the eyes of practical application.

26.0.The Role of Expertise and Skills

Van Deurzen apparently has no qualms about positioning the existential counsellor as an expert: "From the outset the therapeutic relationship will be strictly defined as a professional one, where the practitioner is the expert, consulted and employed by the client" (van Deurzen 2002a, p. 34). Elsewhere, she indicates that "existential therapists are required to be wise and capable of profound and wide-ranging understanding of what it means to be human" (van Deurzen 2002b, p. 198). The notion that the therapist should lay claim to wisdom is unpalatable to me (and I think I can hear Carl Rogers turning in his grave).

It appears to me that this view of the therapist does not follow naturally from other parts of the theoretical apparatus of existential counseling, but is instead bolted on as an additional requirement. I.e., nothing in the rest of the existential approach appears to demand the therapist be wise, only that the therapist must be capable of facilitating the client's own exploration of what matters to him. We can reasonably infer that the therapist requires certain skills of philosophical reflection and must have the psychological capacity to follow the client's explorations throughout the whole realm of human experience, from emotion to intellect. But the having of such skills does not seem to me to imply that the therapist is actually wise (any more than being relatively free of psychological disturbance implies that one grasps the meaning of life).

Person-centred approaches, of course, are typically taken to abhor expertise of all kinds. In my view, there is significant internal inconsistency in this attitude, and if this were another article, I would love to address that topic, but instead I would like to focus on what person-centred theory doesn't say about the role of expertise. My concern centres on what person-centred theory doesn't say about the actual therapeutic quality of what the therapist delivers to the client in the form of congruent responses. Much attention is paid to congruence, as one of Rogers's core conditions, but very little is paid to what is actually said when being congruent. That is, attention centres on the form of the response is it congruent? and not on the content of that response. The received wisdom seems to be that if the therapist just does a good job of being congruent, and if the therapist is herself accepting and empathic and relatively free of psychological disturbance (or at least self-aware about her areas of psychological disturbance), then it won't really matter so much what she actually says.

The problem for the person-centred approach is that in many areas, it is possible empirically to categorize responses as being generally more facilitative or generally less facilitative (e.g., in the case of sexual abuse, see Draucker 2000). Yet both types of responses might well come from congruent, sensitive, empathic, relatively well-adjusted therapists! One can imagine two different therapists, each of whom does a good job of delivering the core conditions, yet who differ in their responses to a given client in a way which makes a therapeutic difference. One obvious potential differentiator between the two then becomes the knowledge which each possesses about the likelihood that a given response will be facilitative. It is difficult to conceive of how a more knowledgeable counsellor could be less helpful to a client, ceteris paribus. Indeed, it is difficult to conceive of how a more knowledgeable counsellor could fail to be more helpful, ceteris paribus. If that is true, then it suggest that the person-centred rejection of expertise rests upon an unjustified assumption that increasing knowledge somehow implies impairment of a therapist's ability to deliver the core conditions -- that the ignorant therapist is somehow apt to be more empathic, congruent, or accepting (i.e., that the ceteris paribus rider is necessarily false).

So it seems that while at least one author has unnecessarily laden the existential approach with a requirement that its therapists be wise, the person-centred approach has faltered in taking its rejection of expertise to an extreme that may actually be counter-productive to clients.

In my own experience with clients interested in exploring questions of meaning, I have found that my philosophical background has enabled me to keep up, to understand more quickly, and thus to be more present and available to the client than I believe I would have been without that background. It was simply familiarity with some of the ways of thinking, intuiting, and finding meaning in emotion which clients employed which I believe helped me to make more facilitative responses than I otherwise might have. There has been no question of applying philosophical 'expertise' -- and certainly not 'wisdom'! Rather, fluency in the patterns of thought and meaning explored by clients has simply made me a better person-centred counselor for those clients.

26.1.The Client's Frame of Reference

Questions of how closely one should adopt the client's frame of reference attract subtle discussion within the existential approach. This subtlety may be of some use to person-centred practitioners, some of whom uncritically adopt the notion that it is necessary to take up the client's frame of reference without apparently considering whether there could be anything more to the story (much like adopting congruence without complementary consideration of the therapeutic quality of congruent responses).As van Deurzen describes:

The therapist's aim is to be able to consider the client's issues and dilemmas from a fundamentally open stance. She never assumes that she knows or understands the client's point of view completely. She will need to elicit clarification of many concepts that the client seems to take for granted and on which she appears to expect agreement with the therapist. When the client realizes that the practitioner does not automatically assume understanding, agreement or disagreement, she becomes free to investigate her own assumptions more carefully. (van Deurzen 2002a, p. 98)

In other words, the therapist does not operate uncritically from within the client's frame of reference, automatically adopting, even temporarily, all of the client's own assumptions. Obviously the existential counselor still makes every attempt to understand exactly what the client means; but the counselor does not automatically operate from within that position herself. Crucially, while Rogers himself has written eloquently about adopting the client's frame of reference, this notion is not implicit in the core conditions: I can see no reason whatsoever why it should be necessary to adopt the client's frame of reference oneself in order to demonstrate to the client acceptance, congruence, and most relevantly, empathy. It may make it easier to do so, for those who have difficulty holding within their minds and bodies two frames of reference simultaneously, but it should by no means be taken as a person-centred requirement! In my own practice, I fairly frequently experience exchanges like the following, where I find myself responding to a client's seemingly rhetorical question in a fashion which proves facilitative:

Client A: Of course he would say that, wouldn't he, because it was my fault, wasn't it?

Counselor: I don't know. Was it your fault?

Client A: Well, yeah! I mean, I don't know. Well, I guess maybe not...

Or alternatively:

Client B: Needless to say, it feels weird not to be looking after him, because that's what's expected, isn't it --for a wife to look after her ill husband?

Counselor: Is it?

Client B: Well, yes, that's what people assume. It's just that they don't understand the situation. It isn't normal. I think that's what bothers me: they just don't understand. Sometimes I don't even want people to know about it, because I know they won't understand, and they’ll judge me.

This sort of exchange ordinarily takes place only within the context of a long string of client expressions with which I directly express empathy, so clients are well aware that I am capable of actively grasping their own point of view and that I am not merely challenging them gratuitously. In this context, my questions can be understood in the spirit they are intended: genuine open-mindedness. Naturally, I do not wish to imply that any person-centred therapist might not make exactly the same kinds of replies, and I can think of many reasons for asking the questions apart from open-mindedness, such as a desire for clarification. Nonetheless, these brief exchanges illustrate the potential value, within a context of overall understanding, of refraining from adopting client assumptions unquestioned. And they differ noticeably from the sort of direct empathic response one might make, for example empathizing with client A's feeling of being at fault or with client B's feeling of weirdness.

Van Deurzen provides another example illustrating the existential approach's broad perspective, contrasted with wholly in-the-moment empathy and its reinforcing side effects:

Take, for instance, a client who starts out complaining about the constraints imposed by her family life. She may be ready to file for divorce because her feelings of extreme dissatisfaction tell her that she cannot bear this any longer. One could implicitly encourage her to go ahead with divorce proceedings simply by consistent (and probably quite genuine) empathy. Detaching oneself from the situation rather than evaluating it from the client's position clearly reveals how one-sided and erroneous such an approach would be. (van Deurzen 2002a, pp. 51-52)

Of course, from a person-centred perspective, one could reply that a congruent counselor might remind the client of the repercussions of her contemplated course of action; i.e., a good person-centred therapist wouldn't just offer empathy. The difference is that existential counseling makes this type of feedback an explicit consideration, rather than merely hoping the counselor will have some good sense!

26.2.Self-Awareness

Both existential and person-centred approaches emphasize the therapist's self-awareness about assumptions and judgments. In the existential context, for instance:

The existential approach assumes the importance of the client's capacity for making well-informed choices about her own life and her attitudes towards it. This places great emphasis on the need for the practitioner to be acutely aware of her professional and personal assumptions. (van Deurzen 2002a, p. 2)

What fascinates me, however, is that existential practice is entirely symmetric in emphasizing self-awareness for the client as well, whereas person-centred practice is asymmetric: trainee counselors are inculcated with messages to self-question and to value self-awareness, but the importance of acquiring self-awareness is not explicitly promoted to the client. In a sense, existential counseling is a little like person-centred counseling training. This curious asymmetry may yield different underlying messages delivered to clients. The existential message is something along the lines of, "the two of us, you and me, we are involved in the very same undertaking, coming to grips with the vagaries of life and meaning and death, although today we shall focus entirely on your undertaking and not mine". The person-centred message is something along the lines of, "the two of us, you and me, we are involved in very different undertakings, and what matters is just that I will be here with you to understand and accept you and to reflect congruently on your undertaking and not mine".

There seems to me a further difference in terms of the nature of self-awareness itself. In particular, my experience of person-centred counseling training suggests that the primary region onto which the light of self-awareness is directed is present emotion. The other two areas of feeling (divided by psychologists into emotion, mood, and desire) receive significantly less explicit attention, while broader questions about life, professional values and ideals, critical evaluations of particular aspects of counseling theory, and so forth receive less still. (When such topics are addressed, I sometimes get the impression they are judged as 'all in the head' and are somehow less important than present emotions.) My own personal experience of person-centred training is that 'self-awareness' is narrow 'part-of-self-awareness', and it clashes significantly with my own view of what it means to be self-aware. A frequent refrain of person-centred training is to embrace the 'whole person', but my own experience suggests the person-centred approach sometimes comes up short of its own aspirations. There are many potential explanations for this, but one might be that it represents an (erroneous, in my view) inference about overall self-awareness from Rogers's descriptions of therapeutic movement as coinciding with clients" discussing emotions in the present --i.e., that if clients in therapy move toward discussing emotions in the present, then that is what we should do in counseling training in an effort to become self-aware.

The existential concept of self-exploration, much more akin to my own view of self-awareness, has been nicely captured:

It involves deep thinking about one's way of being so as to reach to an inwardness, which will become the core of one's actions and outward relations. This thinking is not the thinking of cerebral analysis, but the thinking of reflective attention to what is already there; it bears great similarity with meditation. Bringing to light in oneself what is already there is a matter of paying attention and respect to oneself and it is not dependent on having a high IQ. (van Deurzen 2002a, pp. 168-169)



26.3.In summary

It is in identifying areas of weakness highlighted in each approach by the other, as well as areas strengthened in each by a careful consideration of the insights of the other, that I find personal value in terms of developing my own therapeutic practice. The primary question for me at this stage centres on the extent to which, having located these areas, one can enhance therapeutic practice without diluting one's theoretical commitments into some kind of mushy middle ground. In some instances, the answer is straightforward: there seems no harm at all, for example, in jettisoning 'part-of-self-awareness' in favor of an existential concept of self-awareness. Likewise for the client's frame of reference: I believe therapeutic effectiveness is enhanced by taking an open stance rather than the client's stance, and I can see no reason why this should necessarily conflict with person-centred theory or any therapist's ability to deliver the core conditions (although clearly it could, if approached incompetently).

In other areas, such as the actualizing tendency and the role of over-arching theories of personality, matters are less clear. Here the question is less whether therapeutic practice can be enhanced by paying attention to the ideas of a different tradition; it is more a matter of evaluating underlying theory and clarifying a position which consistently integrates that theory with personal philosophy. In my view, person-centred theory development has long suffered from neglect, in part due to a tendency to infer (erroneously) that empirical support for relationships factors as predictors of therapeutic outcome translates directly into empirical support for underlying person-centred theory. And while existentialism itself provides a huge body of philosophical literature, existential counseling hardly fares any better than the person-centred approach in terms of offering a robust theory of counseling. I am left feeling that both are wanting and that a great deal more work will need to be done by individual practitioners evaluating their own engagement with either.

27.0.An Introduction to Cognitive Therapy & Cognitive Behavioral Approaches

Cognitive therapy (or cognitive behavioral therapy) helps the client to uncover and alter distortions of thought or perceptions which may be causing or prolonging psychological distress.

27.1.Underlying Theory of Cognitive Therapy

The central insight of cognitive therapy as originally formulated over three decades ago is that thoughts mediate between stimuli, such as external events, and emotions. As in the figure below, a stimulus elicits a thought which might be an evaluative judgment of some kind -- which in turn gives rise to an emotion. In other words, it is not the stimulus itself which somehow elicits an emotional response directly, but our evaluation of or thought about that stimulus. (Some practitioners use Ellis's ABC model, described in the section on rational emotive behavior therapy, to describe the role of thoughts or attitudes mediating between events and our emotional responses.) Two ancillary assumptions underpin the approach of the cognitive therapist: 1) the client is capable of becoming aware of his or her own thoughts and of changing them, and 2) sometimes the thoughts elicited by stimuli distort or otherwise fail to reflect reality accurately.







A common 'everyday example' of alternative thoughts or beliefs about the same experience and their resulting emotions might be the case of an individual being turned down for a job. She might believe that she was passed over for the job because she was fundamentally incompetent. In that case, she might well become depressed, and she might be less likely to apply for similar jobs in the future. If, on the other hand, she believed that she was passed over because the field of candidates was exceptionally strong, she might feel disappointed but not depressed, and the experience probably wouldn't dissuade her from applying for other similar jobs.

Cognitive therapy suggests that psychological distress is caused by distorted thoughts about stimuli giving rise to distressed emotions. The theory is particularly well developed (and empirically supported) in the case of depression, where clients frequently experience unduly negative thoughts which arise automatically even in response to stimuli which might otherwise be experienced as positive. For instance, a depressed client hearing "please stop talking in class" might think "everything I do is wrong; there is no point in even trying". The same client might hear "you've received top marks on your essay" and think "that was a fluke; I won't ever get a mark like that again", or he might hear "you've really improved over the last term" and think "I was really abysmal at the start of term". Any of these thoughts could lead to feelings of hopelessness or reduced self esteem, maintaining or worsening the individual's depression.

Usually cognitive therapeutic work is informed by an awareness of the role of the client's behavior as well (thus the term 'cognitive behavioral therapy', or CBT). The task of cognitive therapy or CBT is partly to understand how the three components of emotions, behaviors and thoughts interrelate, and how they may be influenced by external stimuli -- including events which may have occurred early in the client's life.







27.2.Therapeutic Approach of Cognitive or Cognitive Behavioral Therapy



Cognitive therapy aims to help the client to become aware of thought distortions which are causing psychological distress, and of behavioral patterns which are reinforcing it, and to correct them. The objective is not to correct every distortion in a client's entire outlook -- and after all, virtually everyone distorts reality in many ways just those which may be at the root of distress. The therapist will make every effort to understand experiences from the client's point of view, and the client and therapist will work collaboratively with an empirical spirit, like scientists, exploring the client's thoughts, assumptions and inferences. The therapist helps the client learn to test these by checking them against reality and against other assumptions.

Often this process will continue outside the therapeutic session. For instance, a client whose fear of dying in a car crash is causing them great anxiety when it comes time to drive to work might record on a slip of paper their estimate of the odds of dying in a car crash at various points in the morning when they first get up, when they are nearly ready to leave the house, when they are almost to the car, and when they are actually driving. (For someone experiencing such anxiety, these odds might go something like: 1,000 to 1 against when first getting up; 20 to 1 against when nearly ready to leave the house; 2 to 1 against when almost to the car; 5 to 1 in favor of dying in a car crash when actually driving.) This can help the client to see that their estimated odds of actually dying in a car crash are changing just as they move about the house and complete the morning routine. This can be the first step toward making those estimates more realistic and reducing the anxiety which accompanies the thought that one is very likely to die in a crash while driving

Because of the interrelationship between thoughts, feelings and behaviors, therapeutic interventions frequently involve the client's behavior. For instance, a client with a strong fear that squirrels will jump onto their head if they walk under trees may go to great lengths to avoid walking under trees. This behavior will prevent the client from acquiring information that contradicts their thought that "if I walk under a tree, a squirrel will jump onto my head" or perhaps their mental image of a squirrel jumping onto their head the moment they step under a tree. The therapist may help the client to overcome this avoidance of walking under trees as part of the process of correcting the distorted thought that walking under trees will lead to squirrels jumping on the client's head.

Throughout this process of learning, exploring and testing, the client acquires coping strategies as well as improved skills of awareness, introspection and evaluation. This enables them to manage the process on their own in the future, reducing their reliance on the therapist and reducing the likelihood of experiencing a relapse.

27.3.Criticisms of Cognitive Therapy and CBT

On first hearing of the basic cognitive therapeutic approach, many people will observe that simply being told that a view doesn't accurately reflect reality doesn't actually make them feel any better. They might say, "I know squirrels aren't likely to jump on my head, but I can't help worrying about it anyway". But to suggest that a cognitive therapist merely tells the client something is wrong is to caricature the approach (and, in fact, few cognitive therapists would actually tell a client some view doesn't reflect reality anyway; they would help the client to explore whether it reflects reality). This would be like criticizing the person-centred approach on the grounds that a therapist merely telling a client they are free to discuss anything they like, without judgment from the therapist, doesn't make it feel any easier to talk about difficult problems.

A more salient criticism for some clients may be that the therapist initially may fulfil something

g of an authority role, in the sense that they provide problem solving experience or expertise in cognitive psychology. Some people may also feel that the therapist can be 'leading' in their questioning and somewhat directive in terms of their recommendations.





27.4.Best Fit With Clients

Clients who are comfortable with introspection, who readily adopt the scientific method for exploring their own psychology, and who place credence in the basic theoretical approach of cognitive therapy, may find this approach a good match. Clients who are less comfortable with any of these, or whose distress is of a more general interpersonal nature -- such that it cannot easily be framed in terms of an interplay between thoughts, emotions and behaviors within a given environment -- may be less well served by cognitive therapy. Cognitive and cognitive-behavioral therapies have often proved especially helpful to clients suffering from depression, anxiety, panic and obsessive-compulsive disorder.

28.0.An Introduction to Rational Emotive Behavior Therapy

Rational emotive behavior therapy focuses on uncovering irrational beliefs which may lead to unhealthy negative emotions and replacing them with more productive rational alternatives.

28.1.Underlying Theory of Rational Emotive Behavior Therapy

Rational emotive behavior therapy ('REBT') views human beings as 'responsibly hedonistic' in the sense that they strive to remain alive and to achieve some degree of happiness. However, it also holds that humans are prone to adopting irrational beliefs and behaviors which stand in the way of their achieving their goals and purposes. Often, these irrational attitudes or philosophies take the form of extreme or dogmatic 'musts', should', or 'ought to’s’ they contrast with rational and flexible desires, wishes, preferences and wants. The presence of extreme philosophies can make all the difference between healthy negative emotions (such as sadness or regret or concern) and unhealthy negative emotions (such as depression or guilt or anxiety). For example, one person's philosophy after experiencing a loss might take the form: "It is unfortunate that this loss has occurred, although there is no actual reason why it should not have occurred. It is sad that it has happened, but it is not awful, and I can continue to function." Another's might take the form: "This absolutely should not have happened, and it is horrific that it did. These circumstances are now intolerable, and I cannot continue to function." The first person's response is apt to lead to sadness, while the second person may be well on their way to depression. Most importantly of all, REBT maintains that individuals have it within their power to change their beliefs and philosophies profoundly, and thereby to change radically their state of psychological health.

REBT employs the 'ABC framework' depicted in the figure below -- to clarify the relationship between activating events (A); our beliefs about them (B); and the cognitive, emotional or behavioral consequences of our beliefs (C). The ABC model is also used in some renditions of cognitive therapy or cognitive behavioral therapy, where it is also applied to clarify the role of mental activities or predispositions in mediating between experiences and emotional responses.







The figure below shows how the framework distinguishes between the effects of rational beliefs about negative events, which give rise to healthy negative emotions, and the effects of irrational beliefs about negative events, which lead to unhealthy negative emotions.





In addition to the ABC framework, REBT also employs three primary insights:

While external events are of undoubted influence, psychological disturbance is largely a matter of personal choice in the sense that individuals consciously or unconsciously select both rational beliefs and irrational beliefs at (B) when negative events occur at (A)

Past history and present life conditions strongly affect the person, but they do not, in and of themselves, disturb the person; rather, it is the individual's responses which disturb them, and it is again a matter of individual choice whether to maintain the philosophies at (B) which cause disturbance.

Modifying the philosophies at (B) requires persistence and hard work, but it can be done.

28.2.Therapeutic Approach of Rational Emotive Behavior Therapy

The main purpose of REBT is to help clients to replace absolutist philosophies, full of 'musts' and 'should', with more flexible ones; part of this includes learning to accept that all human beings (including themselves) are fallible and learning to increase their tolerance for frustration while aiming to achieve their goals. Although emphasizing the same 'core conditions' as person-centred counseling namely, empathy, unconditional positive regard, and counselor genuineness in the counseling relationship, REBT views these conditions as neither necessary nor sufficient for therapeutic change to occur.

The basic process of change which REBT attempts to foster begins with the client acknowledging the existence of a problem and identifying any 'meta-disturbances' about that problem (i.e., problems about the problem, such as feeling guilty about being depressed). The client then identifies the underlying irrational belief which caused the original problem and comes to understand both why it is irrational and why a rational alternative would be preferable. The client challenges their irrational belief and employs a variety of cognitive, behavioural, emotive and imagery techniques to strengthen their conviction in a rational alternative. (For example, rational emotive imagery, or REI, helps clients practice changing unhealthy negative emotions into healthy ones at (C) while imagining the negative event at (A), as a way of changing their underlying philosophy at (B); this is designed to help clients move from an intellectual insight about which of their beliefs are rational and which irrational to a stronger 'gut' instinct about the same.) They identify impediments to progress and overcome them, and they work continuously to consolidate their gains and to prevent relapse.

To further this process, REBT advocates 'selective eclecticism', which means that REBT counsellors are encouraged to make use of techniques from other approaches, while still working specifically within the theoretical framework of REBT. In other words, REBT maintains theoretical coherence while pragmatically employing techniques that work.

Throughout, the counsellor may take a very directive role, actively disputing the client's irrational beliefs, agreeing homework assignments which help the client to overcome their irrational beliefs, and in general 'pushing' the client to challenge themselves and to accept the discomfort which may accompany the change process.

28.3.Criticisms of Rational Emotive Behavior Therapy

As one leading proponent of REBT has indicated, REBT is easy to practise poorly, and it is from this that one immediate criticism suggests itself from the perspective of someone who takes a philosophical approach to life anyway: inelegant REBT could be profoundly irritating! The kind of conceptual disputing favoured by REBT could easily meander off track into minutiae relatively far removed from the client's central concern, and the mental gymnastics required to keep client and therapist on the same track could easily eat up time better spent on more productive activities. The counsellor's and client's estimations of relative importance could diverge rather profoundly, particularly if the client's outlook really does embody significant irrationalities. Having said all that, each of the preceding sentences includes the qualifier 'could', and with a great deal of skill, each pitfall undoubtedly could be avoided.

Perhaps more importantly, it would appear that the need to match therapeutic approach with client preference is even more pressing with REBT than with many others. In other words, it seems very important to adopt the REBT approach only with clients who truly are suitable, as it otherwise risks being strongly counter-productive. On this point, however, it is crucial to realize that some clients specifically do appreciate exactly this kind of approach, and counselors who are unable or unwilling to provide the disputation required are probably not right for those clients.

28.4.Best Fit With Clients

REBT is much less empirically supported than some other approaches: the requisite studies simply have not been completed yet, and the relevant data points for determining the best match with clients are therefore thin on the ground. However, one may envision clients responding particularly well who are both willing and able to conceptualise their problems within the ABC framework, and who are committed to active participation in the process of identifying and changing irrational beliefs (including performing homework assignments in support of the latter). Clients will also need to be able to work collaboratively with a counsellor who will challenge and dispute with them directly, and a scientific and at least somewhat logical outlook would seem a pre-requisite. REBT would be less suitable for clients who do not meet one or more of the above. And as hinted above in the section on Criticims, one might also speculate that clients who are already highly skilled in philosophical engagement could find the approach less useful. (Perhaps REBT-style self help could be of more benefit for such clients?

29.0.Traditional /Alternative approaches to mental health care

29.1.Reasons why traditional therapies are used to treat mental illnesses?

Mental health professionals use a variety of approaches to give people tools to deal with ingrained, troublesome patterns of behavior and to help them manage symptoms of mental illness. The best therapists will work with you to design a treatment plan that will be most effective for you. This sometimes involves a single method, or it may involve elements of several different methods, often referred to as an "eclectic approach" to therapy.

29.1.0.Behavioral Therapy:

As the name implies, this approach focuses on behavior-changing unwanted behaviors through rewards, reinforcements, and desensitization. Desensitization, or Exposure Therapy, is a process of confronting something that arouses anxiety, discomfort, or fear and overcoming the unwanted responses. Behavioral therapy often involves the cooperation of others, especially family and close friends, to reinforce a desired behavior.

29.1.1.Biomedical Treatment:

Medication alone, or in combination with psychotherapy, has proven to be an effective treatment for a number of emotional, behavioral, and mental disorders. The kind of medication a psychiatrist prescribes varies with the disorder and the individual being treated.

29.1.2.Cognitive Therapy:

This method aims to identify and correct distorted thinking patterns that can lead to feelings and behaviors that may be troublesome, self-defeating, or even self-destructive. The goal is to replace such thinking with a more balanced view that, in turn, leads to more fulfilling and productive behavior.

30.0.Cognitive/Behavioral Therapy:

A combination of cognitive and behavioral therapies, this approach helps people change negative thought patterns, beliefs, and behaviors so they can manage symptoms and enjoy more productive, less stressful lives.

30.1.Couples Counseling and Family Therapy:

These two similar approaches to therapy involve discussions and problem-solving sessions facilitated by a therapist-sometimes with the couple or entire family group, sometimes with individuals. Such therapy can help couples and family members improve their understanding of, and the way they respond to, one another. This type of therapy can resolve patterns of behavior that might lead to more severe mental illness. Family therapy can help educate the individuals about the nature of mental disorders and teach them skills to cope better with the effects of having a family member with a mental illness-such as how to deal with feelings of anger or guilt.

30.2.Electroconvulsive Therapy:

Also known as ECT, this highly controversial technique uses low voltage electrical stimulation of the brain to treat some forms of major depression, acute mania, and some forms of schizophrenia. This potentially life-saving technique is considered only when other therapies have failed, when a person is seriously medically ill and/or unable to take medication, or when a person is very likely to commit suicide. Substantial improvements in the equipment, dosing guidelines, and anesthesia have significantly reduced the possibility of side effects.

30.3.Group Therapy:

This form of therapy involves groups of usually 4 to 12 people who have similar problems and who meet regularly with a therapist. The therapist uses the emotional interactions of the group's members to help them get relief from distress and possibly modify their behavior.

30.4.Interpersonal Psychotherapy:

Interpersonal Psychotherapy:

Through one-on-one conversations, this approach focuses on the patient's current life and relationships within the family, social, and work environments. The goal is to identify and resolve problems with insight, as well as build on strengths.

30.5.Light Therapy:

Seasonal affective disorder (SAD) is a form of depression that appears related to fluctuations in the exposure to natural light. It usually strikes during autumn and often continues through the winter when natural light is reduced. Researchers have found that people who have SAD can be helped with the symptoms of their illness if they spend blocks of time bathed in light from a special full-spectrum light source, called a "light box."



30.6.Play Therapy:

Geared toward young children, this technique uses a variety of activities-such as painting, puppets, and dioramas-to establish communication with the therapist and resolve problems. Play allows the child to express emotions and problems that would be too difficult to discuss with another person.

30.7.Psychoanalysis:

This approach focuses on past conflicts as the underpinnings to current emotional and behavioral problems. In this long-term and intensive therapy, an individual meets with a psychoanalyst three to five times a week, using "free association" to explore unconscious motivations and earlier, unproductive patterns of resolving issues.

30.8.Psychodynamic Psychotherapy:

Based on the principles of psychoanalysis, this therapy is less intense, tends to occur once or twice a week, and spans a shorter time. It is based on the premise that human behavior is determined by one's past experiences, genetic factors, and current situation. This approach recognizes the significant influence that emotions and unconscious motivation can have on human behavior.



31.0.Alternative approaches



31.1.Alternative approaches to mental health care?

An alternative approach to mental health care is one that emphasizes the interrelationship between mind, body, and spirit. Although some alternative approaches have a long history, many remain controversial. The National Center for Complementary and Alternative Medicine at the National Institutes of Health was created in 1992 to help evaluate alternative methods of treatment and to integrate those that are effective into mainstream health care practice. It is crucial, however, to consult with your health care providers about the approaches you are using to achieve mental wellness.

31.2.Self-help

Many people with mental illnesses find that self-help groups are an invaluable resource for recovery and for empowerment. Self-help generally refers to groups or meetings that:

Involve people who have similar needs

Are facilitated by a consumer, survivor, or other layperson;

Assist people to deal with a "life-disrupting" event, such as a death, abuse, serious accident, addiction, or diagnosis of a physical, emotional, or mental disability, for oneself or a relative;

Are operated on an informal, free-of-charge, and nonprofit basis;

Provide support and education; and

Are voluntary, anonymous, and confidential.

31.3.Diet and Nutrition

Adjusting both diet and nutrition may help some people with mental illnesses manage their symptoms and promote recovery. For example, research suggests that eliminating milk and wheat products can reduce the severity of symptoms for some people who have schizophrenia and some children with autism. Similarly, some holistic/natural physicians use herbal treatments, B-complex vitamins, riboflavin, magnesium, and thiamine to treat anxiety, autism, depression, drug-induced psychoses, and hyperactivity.

31.4.Pastoral Counseling

Some people prefer to seek help for mental health problems from their pastor, rabbi, or priest, rather than from therapists who are not affiliated with a religious community. Counselors working within traditional faith communities increasingly are recognizing the need to incorporate psychotherapy and/or medication, along with prayer and spirituality, to effectively help some people with mental disorders.

31.5.Animal Assisted Therapies

Working with an animal (or animals) under the guidance of a health care professional may benefit some people with mental illness by facilitating positive changes, such as increased empathy and enhanced socialization skills. Animals can be used as part of group therapy programs to encourage communication and increase the ability to focus. Developing self-esteem and reducing loneliness and anxiety are just some potential benefits of individual-animal therapy (Delta Society, 2002).

32.0.Expressive Therapies



32.1.Art Therapy:

Drawing, painting, and sculpting help many people to reconcile inner conflicts, release deeply repressed emotions, and foster self-awareness, as well as personal growth. Some mental health providers use art therapy as both a diagnostic tool and as a way to help treat disorders such as depression, abuse-related trauma, and schizophrenia. You may be able to find a therapist in your area who has received special training and certification in art therapy.

32.2.Dance/Movement Therapy

Some people find that their spirits soar when they let their feet fly. Others-particularly those who prefer more structure or who feel they have "two left feet"-gain the same sense of release and inner peace from the Eastern martial arts, such as Aikido and Tai Chi. Those who are recovering from physical, sexual, or emotional abuse may find these techniques especially helpful for gaining a sense of ease with their own bodies. The underlying premise to dance/movement therapy is that it can help a person integrate the emotional, physical, and cognitive facets of "self."

32.3.Music/Sound Therapy

It is no coincidence that many people turn on soothing music to relax or snazzy tunes to help feel upbeat. Research suggests that music stimulates the body's natural "feel good" chemicals (opiates and endorphins). This stimulation results in improved blood flow, blood pressure, pulse rate, breathing, and posture changes. Music or sound therapy has been used to treat disorders such as stress, grief, depression, schizophrenia, and autism in children, and to diagnose mental health needs.

32.4.Culturally Based Healing Arts

Traditional Oriental medicine (such as acupuncture, shiatsu, and reiki), Indian systems of health care (such as Ayurveda and yoga), and Native American healing practices (such as the Sweat Lodge and Talking Circles) all incorporate the beliefs that:

Wellness is a state of balance between the spiritual, physical, and mental/emotional "selves."

An imbalance of forces within the body is the cause of illness.

Herbal/natural remedies, combined with sound nutrition, exercise, and meditation/prayer, will correct this imbalance.

32.5.Acupuncture

The Chinese practice of inserting needles into the body at specific points manipulates the body's flow of energy to balance the endocrine system. This manipulation regulates functions such as heart rate, body temperature, and respiration, as well as sleep patterns and emotional changes. Acupuncture has been used in clinics to assist people with substance abuse disorders through detoxification; to relieve stress and anxiety; to treat attention deficit and hyperactivity disorder in children; to reduce symptoms of depression; and to help people with physical ailments.

32.6.Ayurveda

Ayurvedic medicine is described as "knowledge of how to live." It incorporates an individualized regimen--such as diet, meditation, herbal preparations, or other techniques--to treat a variety of conditions, including depression, to facilitate lifestyle changes, and to teach people how to release stress and tension through yoga or transcendental meditation.

32.7.Yoga/meditation

Practitioners of this ancient Indian system of health care use breathing exercises, posture, stretches, and meditation to balance the body's energy centers. Yoga is used in combination with other treatment for depression, anxiety, and stress-related disorders.

32.8.Native American traditional practices

Ceremonial dances, chants, and cleansing rituals are part of Indian Health Service programs to heal depression, stress, trauma (including those related to physical and sexual abuse), and substance abuse.

32.9.Cuentos

Based on folktales, this form of therapy originated in Puerto Rico. The stories used contain healing themes and models of behavior such as self-transformation and endurance through adversity. Cuentos is used primarily to help Hispanic children recover from depression and other mental health problems related to leaving one's homeland and living in a foreign culture.

33.0.Relaxation and Stress Reduction Techniques

33.1.Biofeedback

Learning to control muscle tension and "involuntary" body functioning, such as heart rate and skin temperature, can be a path to mastering one's fears. It is used in combination with, or as an alternative to, medication to treat disorders such as anxiety, panic, and phobias. For example, a person can learn to "retrain" his or her breathing habits in stressful situations to induce relaxation and decrease hyperventilation. Some preliminary research indicates it may offer an additional tool for treating schizophrenia and depression.

33.2.Guided Imagery or Visualization

This process involves going into a state of deep relaxation and creating a mental image of recovery and wellness. Physicians, nurses, and mental health providers occasionally use this approach to treat alcohol and drug addictions, depression, panic disorders, phobias, and stress.

33.3.Massage therapy

The underlying principle of this approach is that rubbing, kneading, brushing, and tapping a person's muscles can help release tension and pent emotions. It has been used to treat trauma-related depression and stress. A highly unregulated industry, certification for massage therapy varies widely from State to State. Some States have strict guidelines, while others have none.

33.4.Technology-Based Applications

The boom in electronic tools at home and in the office makes access to mental health information just a telephone call or a "mouse click" away. Technology is also making treatment more widely available in once-isolated areas.

33.5.Telemedicine

Plugging into video and computer technology is a relatively new innovation in health care. It allows both consumers and providers in remote or rural areas to gain access to mental health or specialty expertise. Telemedicine can enable consulting providers to speak to and observe patients directly. It also can be used in education and training programs for generalist clinicians.

33.6.Telephone counseling

Active listening skills are a hallmark of telephone counselors. These also provide information and referral to interested callers. For many people telephone counseling often is a first step to receiving in-depth mental health care. Research shows that such counseling from specially trained mental health providers reaches many people who otherwise might not get the help they need. Before calling, be sure to check the telephone number for service fees; a 900 area code means you will be billed for the call, an 800 or 888 area code means the call is toll-free.

33.7.Electronic communications

Technologies such as the Internet, bulletin boards, and electronic mail lists provide access directly to consumers and the public on a wide range of information. On-line consumer groups can exchange information, experiences, and views on mental health, treatment systems, alternative medicine, and other related topics.



33.8.Radio psychiatry

Another relative newcomer to therapy, radio psychiatry was first introduced in the United States in 1976. Radio psychiatrists and psychologists provide advice, information, and referrals in response to a variety of mental health questions from callers. The American Psychiatric Association and the American Psychological Association have issued ethical guidelines for the role of psychiatrists and psychologists on radio shows.



Conclusion

Scripture speaks of what we might call counseling, but it speaks against those who pretend to read minds and communicate with spirits, even for the supposedly noble purpose of helping another in distress. It urges those of us who follow Christ to know and use God's Word, to care for fellow believers, and to confront sin in those for whom we show that care. The church is to rebuke, train, encourage, and generally disciple those who are troubled or are going astray. To do this is one of the ways we "love one another" (I John 4:7). To fail to do this, or to substitute human wisdom for God's revealed wisdom, is to fail to love.

This stands in contrast to most "Christian therapists," who have taken on not only the fundamental doctrines of the secular insight-oriented psychotherapy industry, but also its practices and trappings. Among these counselors who characterize themselves as "Christian," all too often we find: (1) the claim to possess the secret knowledge of an elite corps, along with the use of a vocabulary so elusive and complex that an aura of sheer magic surrounds it, (2) credentials framed on the wall, and (3) fifty-minute therapy sessions, after which they charge fees for what should be considered discipling. These counselors move within the church, more as people possessing secret knowledge than as loving church leaders fighting the good fight.

Quite apart from these professional counselors, Christians have the following four sources available for counsel: the Holy Spirit, the Word of God, other Christians, and the organized church.









References

Aaron T. Beck, Brian F. Shaw,(1987).Cognitive Therapy of Depression.

Bechtoldt, H., & Norcross, J. C. (2000). Theoretical orientations and employment settings of clinical and counseling psychologists.

Brems, C., & Johnson, M. E. (1997). Comparison of recent graduates of clinical versus counseling psychology programs.

Betz, N. (2008). Advances in Vocational Theories. Handbook of Counseling Psychology (4th ed). NY: Wiley

Constantine, M. (2007). Racial microaggressions against African American clients in cross-racial counseling relationships. Journal of Counseling Psychology, 54(1), 1-16

Constantine, M., & Sue, D. (2007). Perceptions of racial microaggressions among black supervisees in cross-racial dyads. Journal of Counseling Psychology, 54(2), 142-153.

Coppersmith, E. (1980). The family floor plan: A tool of training, assessment, and intervention in family therapy. Journal of Marital & Family Therapy, 6, 141-145.

Duhl, F. S., Kantor, D., & Duhl, B. S. (1973). Learning Space and action in family therapy: A primer of sculpting.Techniques of family psychotherapy: A primer. New York:

Dillon, F., Worthington, R.& Schwartz, S. (2008). Gender and sexual identity-based predictors of lesbian, gay, and bisexual affirmative counseling self-efficacy. Professional Psychology: Research and Practice, 39(3), 353-360.

David L. Rennie,(1998).Person-Centered Counseling: An Experiential Approach

Ellenberger, H.F. (1970). The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry. New York.

Edmund J. Bourne (2005).The Anxiety and Phobia Workbook.

Frisch, M., Cornell, J. Villanueva, M., & Retzlaff, P. (1992). Clinical validation of the Quality of Life Inventory. Psychological Assessment, 4(1), 92-101.

Fitzgerald, L. F., & Osipow, S. H. (1986). An occupational analysis of counseling psychology: How special is the specialty?

Gaddy, C. D., Charlot-Swilley, D., Nelson, P. D., & Reich, J. N. (1995). Selected outcomes of accredited programs. Professional Psychology: Research and Practice, 26, 507-513.

Gelso, C.J., & Fretz, B. (2001). Counseling Psychology, (2nd ed.): Brooks Cole.

Gelso, C. J. & Samstag, L. W. (2008). A tripartite model of the therapeutic relationship.

Greenson, R. (1967). (1967), The Technique and Practice of psychoanalysis. New York: International Universities Press.

Gelso, C.J. and Hayes, J.A. (1998). The Psychotherapy Relationship: Theory, Research and Practice. (p. 22-46)

Gordon Edlin, Kelli McCormack Brown (1999).Essentials for Health and Wellness.

Helms, J. E. (1995). An update on Helms' White and people of color racial identity models

Heppner, P., Leong, F.T.L., Chiao, H. (2008). A Growing Internationalization of Counseling Psychology. Handbook of Counseling Psychology.

Hill, C., & Lent, R. (2006). A narrative and meta-analytic review of helping skills training:

Israel, T., & Cohen, J. (2008). Therapists' helpful and unhelpful situations with LGBT clients: An exploratory study. Professional Psychology: Research and Practice, 39(3), 361-368.

Irvin D. Yalom (2003).The Gift of Therapy.

Jung, C.G. (1963/1989). Memories, Dreams, Reflections. Revised edition.

John Sommers-Flanagan, Rita Sommers-Flanagan(2004). Counseling and Psychotherapy Theories in Context and Practice: Skills, Strategies, and Techniques.

Koder, D., Helmes, E., & Pachana, N. (2008). Clinical psychologists meeting the needs of older adults in Australia

Lambert, M.J., and Burlingame, G.M. (2004). The Outcome Questionnaire. Use of Psychological Testing for Treatment Planning and Outcomes Assessment (3rd ed) (pp. 191 -234).Mayne, T. J.,

Ladany, N. & Inman, A. (2008). Handbook of Counseling Psychology,

Legg, C. (1998) Psychology and the Reflective Counselor. London: BPS Blackwell (The British Psychological Society).

Martin E. Seligman(2006). Learned Optimism: How to Change Your Mind and Your Life.

McColdrick, M., & Gerson, R. (1985). Genograms in family assessment. New York: Norton. Minuchin, S., & Fishman, H. (1981). Techniques of family therapy. Cambridge, MA: Harvard University Press.

M. J. Ryan (2007). Attitudes Of Gratitude.

Margaret Ross(2003).Counseling Is Like: the Use of Analogies in Counseling.

Mick Cooper (2003).Existential Therapies.

Norcross, J. C., & Sayette, M. A. (2000). Insider's guide to graduate programs in clinical and counseling psychology. New York: Guilford.

Norcross, J. C., Hanych, J. M., & Terranova, R. D. (1996). Graduate study in psychology

Norcross, J. C., Karg, R., & Prochaska, J. O. (1997). Clinical psychologists in the 1990's. II. The Clinical Psychologist, 50, 4-11.

Norcross, J. C., & Turkson, M. A. (1998). Selecting a doctoral program in professional psychology:

Nutt, R.L., and Brooks, G.R. (2008). Psychology of Gender. Handbook of Counseling Psychology (4th ed) (pp. 267-283).

Norcros, J., and Mayne, T. (2008). Insider's Guide to Graduate Programs in Clinical and Counseling Psychology. Guilford Press.

Perls, F. S., Hefferline, R. F., & Goodman, P. (1951). Gestalt therapy. New York: Julian Press.

Romano, V., Fitzpatrick, M., &and Janzen, J. (2008). The secure-base hypothesis: Global attachment, attachment to counselor, and session exploration in psychotherapy. Journal of Counseling Psychology, 55(4), 495-504.

Robert Manthei (1997). Counseling: The Skills of Finding Solutions to Problems.

Richard Nelson-Jones(2004). Introduction to Counseling Skills: Texts and Activities.

Rachel Naomi Remen (1997). Kitchen Table Wisdom.

Susan Culley,Tim Bond (2003).Integrative Counseling Skills in Action (Counseling in Action series).

Stephen B Fawcett, Leslie Borck-Jameson(1982).Learning Counseling and Problem-Solving Skills/With Instructors Manual.

Spengler, P. M., Cohen, G.R., Rush, J.D. (2009). The Meta-Analysis of Clinical Judgment Project: Effects of Experience in Judgment Accuracy. The Counseling Psychologist 2009 37: 350-399

Steve De Shazer (1985).Keys to Solution in Brief Therapy.

Shaffer, P. A., Vogel, D. L., & Wei, M. (2006). The mediating roles of anticipated risks. An attachment perspective. Journal of Counseling Psychology, 53, 422-452

Swift, J.K., & Callahan, J.L. (2008). A delay discounting measure of great expectations and the effectiveness of psychotherapy client decision making. Professional Psychology: Sherman, R., & Fredman, N. (1986). Handbook of structural techniques in marriage and family therapy. New York: Brunner/Mazel.

Stuart, R. (1989). Helping couples change. New York: Guildford Press.

Thorne, B. (1992) Carl Rogers. London: Sage.

Vogel, D. L., Wade, N. G., & Hackler, A. H. (2007). Perceived public stigma and the willingness to seek counseling: The mediating roles of self-stigma and attitudes towards counseling. Journal of Counseling Psychology, 54, 40-50.

Watkins, C. E., & Himmell, C. D. (1986). Counseling psychology and clinical psychology: Some preliminary comparative data. American Psychologist, 41, 581-582.

Williams, E. N., Hayes, J. A., & Fauth, J. (2008). Therapist self-awareness: Interdisciplinary connections and future directions. Handbook of Counseling Psychology (4th eddy) (pp. 267-283).

Westefeld, J.S. (2009). Supervision of Psychotherapy: Models, Issues, and Recommendations. Whiston, S.C. and Rahardja, D. (2008). Vocational Counseling Process and Outcome. Handbook of Counseling Psychology.

Whyte, L.L. (1962). The Unconscious Before Freud. London: Tavistock.

Wayne Perry (2008).Basic Counseling Techniques: A Beginning Therapist's Tool Kit.

Windy Dryden(2006). Brief Counseling: A Practical Integrative Approach.











































.