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Sunday, 4 August 2013

An evaluation of counseling theories and the integrative approach to counseling

An integrative approach to counseling combines the various approaches of the schools of though employed in counseling in order to enhance the success of the counseling processes. This approach creates a creative synthesis of the specific elements of various theoretical orientations thereby creating integrating concepts that can fit the unique personality and style of the counselors (Watts and Carlson, 1999). According to Watts and Carlson (1999), the integrative approach has gained prominence since the 1980s with most therapists agreeing with its role in improving the effectiveness of the counseling of their clients. This has been due to the acknowledgement of the fact that no single theoretical approach can comprehensively cover the complexities of human behavior taking consideration of the wide range of personalities and problems. The integrative approach to counseling can be achieved in a number of ways: theoretical integration, technical eclecticism, and common factors (Preston, 1998). Technical eclecticism is a combination of techniques drawn from different schools and does not require the practitioner to subscribe to the schools that designed the different techniques (Lazarus and Beutler, 1993). Theoretical integration goes beyond the blending of techniques. It focuses on producing creation of a framework that combines the best theoretical approaches in order to produce an outcome that is more effective than either of the theories when used alone (Lazarus and Beutler, 1995). The common factors approach analyses a variety of theoretical alignments with the aim of putting together the commonly found elements (Preston, 1998). It is important for the practitioner to embrace the theories that are most compatible with their personality in order to remain effective when conducting therapy.

When considering the schools of counseling to include when developing an integrative model, it is important that the counselor selects the theoretical frameworks that are most compatible with their personality. This goes a long way in ensuring that the practitioner is effective in their practice. The preferred approaches in this section are the Existential and the Person-Centered theories.

The existential approach proposes that inner conflicts within people are due to their confrontation with the realities around them (Mary and Yalom, 2000). These realities may include death, freedom and the responsibility that comes with it, isolation and meaninglessness. These four realities form the core framework within which the therapists develop solutions during their counseling endeavors. This theory recognizes the desire for humans to feel connected with each other (Deurzen and Arnold-Baker, 2005). It reckons that people would often want to have meaning in each other’s lives but must guard against depending on others for validation of their existence and importance. This implies that the validation of a person should emanate from within them and not from people around them. Regarding the question of psychological dysfunction, this theory does not recognize the existence of mental illness (Deurzen and Kenward, 2005). It emphasizes that all states of being are merely an expression of the choices that people make on how to live their lives. It however recognizes the inability of people to come to terms with the realities around them and advocates for helping such individuals to counter these realities better by exposing the alternative choices at their disposal (Milton and Judd, 1999). Existential approach recognizes the ability of humans to face squarely the realities of life by making various choices and taking responsibility for such choices. It reckons that it is not crucial that one overcomes the feelings of meaninglessness. Instead, people should develop new meanings for their lives and use them to attain self actualization.

Having considered the essentials of the theory, focus is turned on the manner in which therapy is conducted under this theoretical framework. Existential approach lays no emphasis on the client’s past: it instead concentrates on the present and the future and explores the choices that are at the disposal of the client that would suit them best (Schneider and Krug, 2010). The practitioner may draw attention to the manner in which the client dealt with situations in the past but will ultimately emphasize on the present choices to be made and the responsibility that goes with it. The clients are made to accept that their state has more to do with their choices and not as a result of a special status, fate or destiny (Schneider and Krug, 2010). This invigorates their desire to take control of their lives by embracing their freedom and the responsibility that goes with it. These mainly dwell on the levels of experience and existence which persons across cultural divides come face to face with from time to time. This theory outlines the four dimensions of human existence as the physical, the psychological, the social and the spiritual (Milton, 1993). The physical dimension relates to the natural world and the environment. This relates to the attitudes that people may have on their own physical bodies, other people’s bodies, the climate, weather, buildings, health and mortality among others. The typical source of conflict in this dimension places the need to dominate against the need to accept realities that cannot be changed. The realization of the inevitability of some negative or feared outcomes despite the steps taken to insure self against them is often the source of great tension that may often be the subject of therapeutic experience (Milton, 1993).

The social dimension relates to the interaction between people and each other, the public and the cultural context in which they live. The attitudes may include love, hate, cooperation, and competition which in turn lead to contradictions such of isolation versus belonging and rejection versus acceptance. The failure of one to gain acceptance or lack the feeling of belonging in the society may need the need of a counselor in order to help the clients make informed choices. The psychological dimension relates to how individuals create a personal world through the interaction with their inner selves (Schneider and Krug, 2010). People will always have an image of themselves in relation to their strengths, weaknesses and potential. In the event that these beliefs are challenged to disprove the beliefs held by the individual, it often results in a state of great confusion which may persist for longer than the average acceptable periods. The spiritual dimension involves the creation of an ideal world by persons who try to finding meaning by fitting in pieces of a puzzle by themselves (Milton, 1993). This may be done by embracing a religion or embracing a certain belief seen to be sufficiently explanatory to the person.

The person-centered theory is associated with a great psychologist Carl Rogers and was developed in 1940s and 1950s (Cooper, Watson and Hoedampf, 2010). It’s one of the most popular theories applied in psychotherapy. In this approach, the counselor creates a comfortable environmental and remains non-judgmental. The therapist also demonstrates genuineness, empathy and remains visibly positive about their clients while using a non-directive approach (Poyrazli, 2003). This approach enables the clients to find their own solutions to their problems. The rationale for this emphasis is based on the presumption that people are the ones who are best placed to tell what is good for them. The main contribution of the therapist is being a facilitator in the process of own-solution finding by the clients (Cooper, Watson and Hoedampf, 2010). This approach has been criticized for its lack of structure and its provision of a conditional relationship (Prochaska and Norcross, 2007). However, analysts view it as one of the most effective approaches when applied in isolation. The following conditions must exist for this approach to remain effective: therapist-client psychological contact where each of the two parties perceive the other positively; client vulnerability where the client is motivated to stay in the relationship due to their vulnerability to anxiety; therapist congruence or genuineness; therapist positive regard for the client; the therapist’s empathetic understanding and client perception where the client perceives the therapist as understanding and genuinely concerned about their welfare (Cooper, Watson and Hoedampf, 2010). According to Poyrazli (2003), this approach is favorable in its applicability across many scenarios and on persons coming from diverse cultural backgrounds without necessitating material adjustments to the approach taken.

The least appealing schools of counseling considered relate to the psychoanalytical approach to counseling. Psychoanalysis is mainly associated with Sigmond Freud although the psychoanalysis ideas have been contributed to by a myriad of other neurologists (Edelson, 1984). Psychoanalysis focuses on human psychological functioning and behavior as well as that of the society. It comprises three key components namely: investigation methods of the human mind and the way people think; sets of theories that attempt to explore human behavior; and methods of treating mental or psychological illness (Edelson, 1984). The main theories associated with this approach to counseling include the topographical theory, the structural theory and the ego psychology (Mitchell and Black, 1995). The topographical theory separates the thinking processes into three components namely the conscious, the pre-conscious, and the unconscious (Mitchell and Black, 1995). The structural theory on the other hand concentrates on the human psyche and subdivides it into id, ego, and super-ego (Mitchell and Black, 1995). The id is naturally present in all humans and is present at birth. The ego develops through experiences and is usually a reflection of reality. The super-ego is composed of the self observation and self criticism of the individuals and mainly reflects what they think of themselves vis a vis the environment.

 The ego psychology has generated input from many neurologists with many theories being advanced to further explore the theoretical framework. These theories include the modern conflict theory, the object relations theory, the self psychology theory, the Lacanian psychoanalysis theory, the interpersonal psychoanalysis theory, the culturalist psychoanalysis theory, the relational psychoanalysis, the interpersonal-relational psychoanalysis, the intersubjective psychoanalysis and the modern psychoanalysis among others (Stolorow, Atwood and Orange, 2002). The treatment techniques mainly concentrate on the interpretation of the client’s conflicts which are mostly unconscious that interfere with the mental day to day functioning. The conflicts may cause symptoms such as anxiety, phobias, compulsions, and depression. Psychoanalytical approach to counseling comes with a number of challenges and limitations. To start with, it presumes that the therapist should know what primarily ails the clients and takes a directive approach where the therapist directs the clients to take various actions as he seems best (Mitchell and Black, 1995). Moreover, the various theories in this school tend to conflict each other thereby leaving doubts on what the school explicitly advocates for. The technicality of the approach may also be highly restrictive as it does not provide the therapists with the freedom to apply techniques based on their own assessment of the client needs (Edelson, 1984). It has been in many cases equated to the traditional Christianity that remained rigid and opposed new and innovative practices of the religion.

The integrative approach will therefore factor in the existential and the person-centered theories. The combined approach of focusing on the interaction between the individual and the realities around them as well as the focus on the individual where the therapist plays the role of a facilitator is complimentary and bound to achieve superior results on counseling clients (Goldfried and Castonguay, 1992). Integrative approach to counseling offers a number of advantages to the counselor. Human beings are integrative beings and their actions cannot be comprehensively understood in the light of single theories (Lazarus, 1995). To be able to counsel such persons effectively, the counselor must apply a combination of affective and cognitive behavioral techniques. The advantages offered by using the existential approach to counseling is that it focuses on the results and does not restrict on the techniques to be employed while counseling. The end result is that the counselor would only need to focus on serving the clients and apply techniques which in their opinion serve the purpose of the therapy best. The integrative approach to counseling also helps the therapist to explore a number of theories (Lazarus, 1995). This broadens their spectrum and understanding on the ways to deal with the increasingly complex psychological conditions.

The process of integration must be approached with great caution. This is due to the fact that, unlike the parent theories that were developed after careful thought by the founders, the integration often takes place against a background of mostly inexperienced practitioners who barely understand the theories in question (Milton and Judd, 1999). The resultant techniques adopted may therefore end up being pretty confusing and with little lack of focus, lead to ineffectiveness or in worse circumstances further harm the clients for whose improvement is being sought. To mitigate the risk of such eventualities, therapists wishing to pursue an integrative approach to counseling are advised to base their integration on one theory which they find to be most preferable to them. In this case, the most preferable theory was the existential theory which concentrates on exploring the choices available to clients in order to cope with the realities around them. The fact that this theory focuses mainly on the objective of the counseling makes it highly compatible with a myriad of other theories and techniques while remaining objective about the effectiveness of the techniques adopted (Schneider and Krug, 2010). The other limitation associated with pursuing an integrative approach based on the existential theory is the lack of structural frameworks to guide the practitioner when integrating with other theories. The only guiding principle is the focus on results which is highly subjective. This may be counter-productive where the counselor chooses to exploit conflicting techniques in the process of counseling clients.

The integrative approach to counseling has been very popular with therapists in the recent years. This is due to the acknowledgement of the fact that human beings are in themselves highly integrated and may therefore be served effectively though the application of a single theory in therapy. The integrative approach has been found to be more effective than the application of any theory in isolation in most cases. The process of integration must however be taken with utmost caution to prevent the ill effects that often result in the combination of conflicting techniques that may end up being counter-productive. This hazard can be mitigated by the therapists using their most favorite theories as the philosophical base for forming the integrative approach. This serves to ensure that whatever techniques are adopted are checked for consistency with the provisions of the primary theory. The theory selected to serve as the base in this paper is the existential approach which states that inner conflicts within people are due to their confrontation with the realities around them. These realities may include death, freedom and the responsibility that comes with it, isolation and meaninglessness. These four realities form the core framework within which the therapists develop solutions during their counseling endeavors. The existential approach does not explicitly provide for the techniques to be used in offering therapy. Instead, it focuses on the results and leaves the specific of application to the counselor. This makes it the ideal theory to provide the philosophical base for integration.

For more theory and case studies on:

Cooper, M., Watson, J. C., and Hoeldampf, D. (2010). Person-centered and experiential therapies work: A review of the research on counseling, psychotherapy and related practices. Ross-on-Wye, UK: PCCS Books
Deurzen, E. V., and Arnold-Baker, C., eds. (2005). Existential Perspectives on Human Issues: a Handbook for Practice, London: Palgrave, Macmillan
Deurzen, E. V., and Kenward, R. (2005). Dictionary of Existential Psychotherapy and Counseling, London: Sage Publications
Edelson, M.  (1984). Hypothesis and Evidence in Psychoanalysis. Chicago: Chicago University Press
Goldfried, M. R., and Castonguay, L. G. (1992). The future of psychotherapy integration. Psychotherapy, 29 (l), 4–10
Lazarus, A. A. (1995). Different types of eclecticism and integration: Let’s be aware of the dangers. Journal of Psychotherapy Integration, 5(1), 27–39
Lazarus, A. A., & Beutler, L. E. (1993). On technical eclecticism. Journal of Counseling and Development, 71(4), 381–385
May, R., and Yalom, I. (2000). Existential psychotherapy. In R. J. Corsini & D. Wedding (Eds.), Current psychotherapies, 6, 273–302
Milton , M., and Judd, D. (1999). The Dilemma that is Assessment. Journal of the Society for Existential Analysis, 102-114
Milton, M. (1993). Existential Thought and Client Centred Therapy. Counseling Psychology Quarterly, V6 (3). 239-248
Mitchell, S.A., and Black, M.J. (1995). Freud and beyond: a history of modern psychoanalytic thought. New York: Basic Books
Poyrazli, S. (2003). Validity of Rogerian Therapy in Turkish Culture: A Cross-Cultural Perspective. Journal of Humanistic Counseling, Education & Development, 42(1), 107-115
Preston, J. (1998). Integrative brief therapy: Cognitive, psychodynamic, humanistic and neurobehavioral approaches. San Luis Obispo, CA: Impact
Prochaska, J. O., and Norcross, J. C. (2007). Systems of Psychotherapy: A Trans-theoretical Analysis, 6th Ed. Belmont, CA: Thompson Brooks/Cole
Schneider, K.J., and Krug, O.T. (2010). Existential-Humanistic Therapy. Washington, DC: American Psychological Association Press.
Stolorow, R., Atwood, G., and Orange, D. (2002). Worlds of Experience: Interweaving Philosophical and Clinical Dimensions in Psychoanalysis. New York: Basic Books
Watts, R. E., and Carlson, J. (Eds.). (1999). Interventions and strategies in counseling and psychotherapy. Philadelphia, PA: Accelerated Development/Taylor & Francis Group

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