Today, the majority of counselors and therapists operate from an integrative standpoint; that is, they are open to “various ways of integrating diverse theories and techniques” (Corey, 2009b, p.
449). In fact, a survey in Psychotherapy Networker (2007) found that over 95% of respondents proclaimed to practice an integrative approach (cited in Corey, 2009b, p. 449). Corey (2009a; 2009b) explains that no one theory is comprehensive enough to attend to all aspects of the human – thought, feeling, and behavior.Therefore, in order to work with clients on all three of these levels, which Corey (2009b) asserts is necessary for the therapy to be complete, one must use a combination of various approaches that focus on each of these facets of the human psyche (p. 11).
As previously explained, Corey (2010) stresses the importance of an integrative approach. At the beginning of this course, I agreed wholeheartedly with this assertion. However, I have come to believe that the counselor’s theoretical orientation should depend less on the counselor and more on the client.It has been a prevalent theme throughout everything I have read that certain clients and certain issues respond to certain treatments and that theoretical orientation is not as important as the quality of the relationship between the counselor and client (Corey, 2009a; Corey, 2009b). I hope to develop a working knowledge of as many approaches as possible since I believe different people and issues will respond best to different approaches. In my opinion, it is not up to me to decide what is best for the client.
Ideally, I will be able to select the theoretical approach from which I work with a client based on that client’s unique culture, personality, and needs. After coming to this realization, I found that I was leaning toward the practice of technical eclecticism, or, more simply, picking the correct techniques and treatment approaches for each individual client based on the person and the problem (Corey, 2009b). Although Corey (2009b) warns against adopting this approach, it is what makes the most sense to me.To develop my own personal integrative theory of counseling, I will start with a thorough, working knowledge of four approaches: psychodynamic, existential, cognitive-behavioral, and feminist. I will also strive to gain as deep an understanding as possible of all other current theories. I believe everyone is different.
Not only because of how social and cultural factors have impacted development, but also because of how each person’s unique personality has led them to react to those influences.For example, two people that experience the same traumatic childhood event, physical abuse, for example, will likely respond to it in very different ways. One may suffer severe psychological issues throughout life as a result, while the other may go on to thrive and the psychological trauma will be minimal. While reading the diverse theories presented in this course, I could understand where each one was coming from and believe that each theory probably applies to a group of people.For example, some people are very focused on finding the meaning of life and figuring out their purpose while others are more concerned with setting and achieving goals. For an individual like the former example, an existential approach would be appropriate, whereas for the latter, cognitive behavioral therapy would be more suitable.
Lazarus asserts that to effectively serve a diverse clientele with a wide range of problems a counselor must be “flexible and versatile” (Corey, 2009b, p. 456).Lazarus also proposes that different people will respond better to different types of counselors (e. . directive vs. non-directive, warm and accepting vs.
confrontational) (p. 458). He even goes further to suggest that clients need the counselor to play different roles and present different relating styles at different stages of the counseling process (p. 458). This is the approach that seems to make the most sense to me for several reasons.
First, people, including mental health professionals, possess a range of qualities. No one is just warm and accepting or just confrontational. We all possess these qualities to a certain degree.Therefore, to be genuine with our clients it is necessary for us to display these different parts of our personalities at different times. Second, although a client may come to counseling broken and hopeless and require a supportive, accepting, and warm counselor, if this relationship continues the client may never be pushed to make any real change.
After the development of a strong working alliance between the therapist and counselor, it may (or may not) be necessary for the counselor to challenge or confront the client in some way to provoke change. It depends on the person.I agree with Lazarus completely when he says that a skilled mental health professional will know when to be warm or tough, when to confront a client or not, and when directive or non-directive (p. 458-459). Clients, because they each have their own unique identity that has been influenced by more factors than one can count or even identify, will respond differently to different relational styles, techniques, and treatments and this may change throughout the counseling process.
In my opinion, it is the counselor’s job to know which approach or technique should be used to be the most effective with a particular client.Although I ascribe to the idea of technical eclecticism, I feel that this is a skill that does not come easily. It will take a great deal of experience before I am able to practice technical eclecticism effectively. Therefore, I intend to base my practice, in the beginning, on aspects of these four theories: psychodynamic, existential, cognitive behavioral, and feminist. In the following paragraphs I will discuss how each of these approaches will contribute to my unique integrative approach. I would describe my view of human nature as integrative.
I believe that past experiences, social and cultural factors, and intrapsychic processes all influence human development. Like psychodynamic theorists, I believe that childhood experiences can have an enormous impact on an individual’s development (Corey, 2009a; Corey, 2009b). However, I don’t think this absolves people of responsibility for their behavior. Although I acknowledge to tremendous impact early experiences can have on a person, I think there comes a point in development where individuals have to take responsibility for who they are.
This view is more in line with existential way of thinking (Corey, 2009a; Corey, 2009b).In addition, my experience with people has shown me that some people are more profoundly impacted by experiences in their past than others. Next, I believe that cultural factors, especially gender, are enormous forces in the shaping of an individual. This view is consistent with a feminist approach (Corey, 2009a; Corey, 2009b). Again, I believe that some people will be more influenced by some of these factors than others.
I am also aware of the fact that although we are all strongly influenced by societal gender roles, not everyone (probably not most people) will suffer psychological distress as a result.I think having an integrative view of human nature and a profound understanding of the fact that everything influences everyone differently will help me avoid creating a problem where one does not exist. For example, if a client comes in with issues of depression, I will not automatically spend a copious amount of time digging into his or her past. Instead, I will also look at the present situation and social factors to best determine what is causing that individual distress. If the client is not concerned with how gender roles have had an affect on him or her, I will not try to force the client to explore this issue.This is because I understand that experience is subjective.
This phenomenological view is also associated with an existential approach (Corey, 2009a; Corey, 2009b). Something that is traumatic or triggers psychological distress in one person will not in another. Therefore, it is best to explore all areas of the person to discover what they perceive as the cause of the issue. One thing that almost all therapeutic approaches have in common is that they acknowledge the importance of the development of a therapeutic alliance (Corey, 2009b).Hubble, Duncan, and Miller (1999) did a research review of 40 years worth of data and found that the client-counselor relationship is responsible for 30% of the therapeutic outcome, which is double the percentage attributed to theoretical models and techniques (cited in Corey, 2009b, p.
477). These statistics clearly demonstrate how important it is for the client to develop a positive working alliance with the counselor. I agree with Carl Rogers’ assertion that counselors must be genuine and empathic (Corey, 2009a; Corey, 2009b).Although I think self-disclosure may convey genuineness, it is something I will probably refrain from until I am a little more experienced because of the boundary issues that can manifest as a result of its use (Remley & Herlihy, 2010).
Unlike Carl Rogers, however, I do not believe that unconditional positive regard is necessary and do think it may actually hinder change if displayed throughout the duration of the counseling process. Once a strong therapeutic alliance has been developed, I think that challenging and confronting clients can also stimulate a great deal of growth and change.Like the majority of the counseling approaches, I believe a strong therapeutic alliance is the foundation of the counseling process, but is not necessarily sufficient to induce change (although due to the fact that everyone is different, I cannot assert that this is always the case) (Corey, 2009a; Corey, 2009b). In my mind, the goals of therapy will vary from client to client.
Some goals will be more specific, such as reducing depressive symptoms, and some may be more general, such as gaining an increased awareness of self. I intend to let the client define the goals of therapy.My role as a counselor will be to facilitate the client in making change. I am very drawn to the use of experiments in Gestalt theory such as creating a dialogue with conflicting parts of oneself, reexperiencing past unfinished situations in the here and now, the reversal exercise, and the empty chair technique (I do understand that some, if not all of these techniques require special training) (Corey, 2009a; Corey, 2009b; Corey & Haynes, 2005).
I also like the technique of pointing out inconsistencies between what the client is saying and doing (tapping his or her foot while claiming to feel relaxed, for example).This is something I learned at residency. Although I would like to encourage the client to figure things out for him- or herself, in today’s managed care era, it is not likely that clients will have the time to engage in a lengthy counseling process, which often accompanies such non-directive approaches (Remley & Herlihy, 2010). Therefore, I think it is important to be very well-versed in behavioral and cognitive behavioral techniques. Not only do these interventions have the most empirical evidence, they also generally produce the desired result in a shorter period of time than other therapies (Corey, 2009a; Corey, 2009b).
I understand that my approach may be a bit idealistic and even unrealistic, but I believe it is a good starting point. I hope to keep an open mind throughout my development as a counselor-in-training and my career as a professional counselor. I still have a great deal to learn about all of these theories and I am eager to do so. Furthermore, my practicum and internship experiences will help me to figure out what really does work for me. I believe my theoretical orientation is something that will develop throughout my career as a professional counselor and I genuinely look forward to embarking on that journey.