CHAPTER 1 Introduction
There is nothing so practical as theory.
—Kurt Lewin, social psychologist
There is no therapy without theory.
—Earl
Ginter, counselor educator
COUNSELING THEORY
What Is Counseling Theory?
Imagine this: You are conducting your first individual counseling session. You have oriented your client to procedures and to ethical and legal considerations in the counseling process. You are ready to turn the focus to your client and her reason for being in counseling. You might facilitate the beginning by saying, “Well, Kim, now that we have dispensed with the paperwork, where would you like to start today?” That sounds easy enough. No problem. We do not need theory to do that, right? Now the client begins to tell her story, and the information begins to accumulate. Having begun, how do you proceed? What is your purpose, what are your goals, and how do you pursue them? How do you conceptualize your client’s psychological dynamics? How do you determine what you can do to help her reach her counseling goals?
In a standard 50-minute session, you have myriad choices. How do you decide whether and when to follow your client, guide her, and/or direct her? How do you decide whether and when to address the counseling relationship, assessment of the client, or strategies for change? With each communication, your client will provide you with additional information; how will you organize and interpret that information? With each client communication, you have a variety of responses from which to choose; how will you choose the one response you make? Your choices are crucial; they will influence the direction of the session and the experience your client has in the session. Under the pressure of limited time, how do you make these multileveled, multilayered decisions? If these choices sound complicated, it is because the process of counseling is a complex inter- and intra-personal journey, one involving several questions for each counselor to answer—questions about how best to help one’s client.
It is these very questions that counseling theory answers. Good application of theory brings some sense of order and meaning to what, otherwise, would be a meaningless jumble of data. Pioneering counselor educator C. H. Patterson (1973) defined theory as concepts, along with corresponding terms, that are related to each other and are internally
consistent with each other, that is, that do not contradict each other. Theory provides a rationale for action.
In essence, a counseling theory is the story of a person. It is the theorist’s story of each human being’s life, including your life—and each of your clients’ lives. Like any good piece of literature, a good counseling theory provides good character development. In the case of counseling theory, this means an explanation of how each person was innately endowed and developed throughout one’s lifetime so far: how one became who one is today. Good theory also provides an explanation for problems people encounter in life and how they address those problems and seek further development through counseling. In your clients’ life stories, you play an important role. Good theory includes a description of a counselor’s role in facilitating a client’s ongoing development in her or his ongoing life story.
What Are the Advantages of Counseling Theory?
Almost certainly, you have had the experience of setting out on a journey to a place you have never been before. You probably appreciated any information you could get regarding what to expect and how best to go about the journey. If you ever have been—or could imagine being—a tour guide, then you know that your need to be prepared probably multiplied exponentially: You now have a contract whereby the members of your tour group pay you in exchange for your provision of a particular kind and high quality of service. How helpful it would be if someone had already done the legwork you need to provide that service and had put their collective wisdom into one resource book for you: a guidebook.
A tour guide using a guidebook can be compared to a counselor using a counseling theory. Counseling theory constitutes an organized, consistent way for you to anticipate, understand, and respond to the variety of clients and issues you will encounter as a counselor. Counseling theory is your guidebook about how to accompany and assist clients in the journey of change. This is the conceptual advantage of a guidebook.
A tour guide using a guidebook is also advantaged in other ways. The guide can feel secure in the structure the guidebook provides yet retain flexibility to respond to unique situations that will inevitably arise. That structure and flexibility can help both guide and traveler feel confident and relaxed, secure in how they will proceed and able to focus on the sights—what they will encounter along their journey together. Thus, a guidebook advantages both guide and traveler in the process of their journey. Similarly, a counseling theory provides both counselor and client with a secure yet flexible process for the activity of counseling.
Another advantage is that, through experience, a guide can evaluate the quality of the guidebook and continue revising it with improvements that reflect current “best practices.” Similarly, counseling theory provides a basis for counselors, both in their own experiences and through larger scale research, to evaluate and improve their service to clients. This is the quality advantage.
And, having done so, if—heaven forbid—a disgruntled traveler should sue the tour guide, a well-organized guidebook that has been evaluated for its effectiveness and improved based on those evaluations would serve as a cornerstone of the tour guide’s defense. Similarly, a key feature of a counselor’s defense in the case of a malpractice suit is the ability to justify one’s treatment based on theory that is supported by the traditional and/or current professional literature. This is the legal advantage.
Why Are There So Many Counseling Theories?
Having grasped the advantages of identifying a theory of counseling to guide one’s practice, your next logical question is likely to be which theory. A trip to the travel section of any bookstore can reveal that, for any travel destination, several different guidebooks exist. Compared with each other, the guidebooks have certain similarities and certain differences. Correspondingly, as the table of contents in this book shows, not just one but numerous counseling theories exist, also with certain similarities and differences. They are similar in their sharing of a few very core assumptions: that each person is born with certain innate tendencies and psychological functions; that each person’s environment contributes to the kind of person one becomes; that, as a result of some interaction of innate tendencies, environment, and perhaps other factors, people develop; that some modes of functioning are preferable to others; that, once developed, people can develop further—can change in the direction of the more preferable mode of functioning; and that an interpersonal process called counseling can facilitate that change. Beyond these basics, each theory includes its own beliefs about how people are innately endowed, how the environment influences people, how people develop, what constitutes preferable modes of functioning, how people change, and how counseling facilitates that change—and the beliefs of each theory in some way contradict the beliefs of every other theory.
Why is there not one single theory of counseling upon which everyone agrees? The answer to this question may be illustrated by the story of the five blind men and the elephant:
Five men from India, all blind from birth, met each day and passed the time by making up elaborate, amusing stories. One day, while visiting together, they heard a rustling. Unbeknownst to them, an elephant had wandered nearby. Sensing that the sound came from a harmless source, they each approached and reached out to the source of the rustling sound. Touching different parts, they immediately fell into disagreement in their attempts to explain what the thing was. The first man, feeling the elephant’s body, interpreted it to be a mud wall and expressed confusion as to how it suddenly could have materialized in that location. The second, touching a tusk, interpreted it to be an ivory spear. The third, feeling the elephant’s moving trunk, interpreted it to be a python hanging from a tree. The fourth, tugging gently on the elephant’s tail, interpreted it to be a rope. The fifth, reaching around the elephant’s leg, interpreted it to be a palm tree. Just then, a small boy passing by asked why they all were examining that elephant. At first, the men were uncharacteristically at a loss for words, but once the boy had passed, the first three men expressed a sense of foolishness and shame at having so boldly asserted their limited interpretations as the complete story or the whole truth. “ ‘Perhaps it’s better to be silent,’ suggested the fourth man. ‘But better still,’ concluded the fifth man, ‘is to learn the truth from one who directly knows it.’ ”
(Das, 1996, p. 59)
Another helpful analogy is the hologram. A hologram is a three-dimensional image created when laser light goes through a two-dimensional holographic negative. A regular photographic negative, if cut into pieces, shows only a part of the picture. By contrast, if a holographic negative is shattered, each piece contains a dim reflection of the whole picture. Each piece is accurate to the extent that it reflects the whole picture; simultaneously, each piece is inaccurate to the extent that it only dimly reflects the full richness of the whole picture.
At least until recently, the human psyche may very well have been to counseling theorists what the elephant was to the blind men and what the hologram is to the holographic fragment. Humanity, the human psyche, and human behavior are so diverse and complex that each person who tried to comprehend it did so to some degree accurately—but also incompletely. What was left, then, was that each person who tried to grasp these phenomena held a piece of the truth. Illustrated most clearly by the blind men and the elephant, the various pieces of truth appeared to contradict each other. To the extent that a particular piece of truth resonated with some people, they became adherents to that perspective, and the perspective was affirmed and reified. Yet each piece of truth, if projected to represent the whole truth, was done so only erroneously.
This analogy is particularly true of most of the theories we describe in this text. Each one represents the perspective of a separate school of thought that developed some time between 1900 and around 1980; their development constituted the first phase of the history of psychotherapy (Anchin & Magnavita, 2008). Culminating in the 1980s, some theorists and researchers pursued an integrative perspective, seeking to identify commonalities and reconcile differences between the separate schools; these pursuits constituted the second phase. Perhaps at least in part because every separate school of thought contradicts every other school in some way, and integrationists found that they could not reconcile those differences by remaining on a parallel perspective with the various schools, some theorists and researchers assumed a metaperspective—rising above the various perspectives themselves to take an overview to see how the various theories might fit together—and began developing unifying theories. In these umbrella systems of thought, the theorists honored the differences between the schools while placing each school—often along with pertinent knowledge from other fields, such as genetics and physics—into a systematic “grand scheme” of psychotherapy. They assumed the role of the small boy who, from something of a distance, could see how the various unique features of the elephant interrelated in a unified whole. In this text, we present two such metatheories: Mahoney’s in Chapter 12, and Wilber’s in Chapter 14.
Most beginning counselors find this plethora of theoretical perspectives rather dizzying. Before we offer some hopefully stabilizing advice, we address another question.
What Are Some Disadvantages of Counseling Theory?
In summary, just as a guidebook is an invaluable resource to a tour guide, a counseling theory is an invaluable resource to a counselor. Nevertheless, just as every guidebook is limited in that it reflects the author’s own unique take on the travel destination, every counseling theory is limited to the degree that it reflects the theorist’s own unique take on human experience and behavior.
To elaborate, most guidebook authors highlight some features of the territory and make little or no mention of other features. Consider the traveler whose purpose is to visit other countries’ museums. On the journey itself, she sees a building in the distance, but because her guidebook does not mention it, she misinterprets an actual museum for some unimportant store, and she misses the exact kind of experience for which she undertook the journey. Or the traveler who is very focused on the features mentioned in the guidebook may not even have noticed the building–museum. In the extreme, when later encountering other tourists who claimed to have visited the museum, the traveler may doubt their veracity and disbelieve that the museum even existed, for surely it would have appeared in the guidebook if it existed and were of any importance.
Similarly, a counseling theory can become a perceptual filter through which a counselor might miss, dismiss, misinterpret, or deny important data about a client. For example, some theories have little to say about the meaning or value of dreams as an instrument of change. Others downplay the influence of biology in personality functioning. Yet others have little to say of spiritual experience or reduce it to a rationalization. A client who had a meaningful dream, who suspects a strong biological influence in one’s lifelong struggles, or who had a profound spiritual experience runs the risk of being poorly served by a counselor bound to any of these respective theories.
This disadvantage is more likely to occur with a theory associated with a separate school of thought. The answer might seem to be to focus on a unifying metatheory, because it’s likely to be more comprehensive. The problem is that such a theory, to a neophyte counselor-in-preparation, can seem overwhelming. Imagine being a brand new tour guide and trying—in one course, or even one entire master’s degree—to know everything about any location in the world!
How Can You Reconcile the Advantages and Disadvantages?
Again, to summarize, counseling theory has its advantages, but it also is quite plural and has disadvantages. Considering all this, how are you, the student of counseling, to approach counseling theory?
• If, in an attempt to be as comprehensive as possible, you seek to master a unifying metatheory in your master’s degree, you probably set yourself up for overwhelm and failure.
• If you try to be at least somewhat more comprehensive by seeking to master more than one separate-school theory, you encounter contradictions and set yourself up for dilemmas and inconsistent functioning.
• If you align with one separate-school theory, you function with blinders.
• If you throw up your hands and try to counsel without a theory (which we consider impossible in any case), you lose the several vital advantages of functioning on the basis of a guiding theory.
A hint at the answer we endorse comes from metatheorists like Mahoney and Wilber. Both have described evolving in their beliefs as they grew in knowledge and experience. To varying degrees, their developmental processes reflect our own. For example, one of us (JMH) identified first as a behaviorist, then as person-centered, then as cognitive, and currently as integral. As a starting place, and as a realistic goal for a master’s degree, we believe the best alternative is for a student counselor to identify one guidebook— one separate-school theoretical basis—and master the complexity and intricacy of that approach as a foundation for practice. Within the master’s course of study, once a firm foundation is established, we endorse a student counselor consulting other guidebooks for enhancements—ideas and techniques—that do not contradict one’s fundamental approach to counseling. The most mindful student counselor will undertake this process with the awareness of the downside (the blinders one’s theory inevitably creates) and will endeavor to minimize that detriment as much as possible. The mindful student will also remain aware that one’s identification of a guiding theory (one’s best current answer to the question of a guiding theory) will evolve as one continues to learn both didactically and clinically–experientially and continues to assess the truth value of one’s identified theory
(Brabeck & Welfel, 1985). In other words, one guidebook, even with its limitations, is better than no guidebook—and mastering it as a basis for practice prepares a student counselor to build on that foundation as one continues to evolve as a practitioner.
To identify what guidebook you will use as your main resource, you must first familiarize yourself with each one. One purpose of this textbook, then, is to present an introduction to each of the guidebooks that most current counseling professionals use. As you become acquainted with each one in turn, you will probably find that you resonate with more than one. This reaction makes sense, considering that the elephant does have tusks, does have a tail, and does have a trunk—that each theory is an accurate reflection, albeit dim, of the whole truth. The fact that each theory is at least partially correct, however, raises another crucial question that we address next.
Which Is the Best Counseling Theory?
The next question might very well be which guidebook (counseling theory) is best to use as your foundation. In fact, quite a bit of controversy exists in the field of counseling in this regard. We will address this issue by responding to several related questions.
Has Research Shown One Theory of Counseling to Be More Effective Than Another?
In a nutshell, we believe the best answer is no. As a result of the most comprehensive investigations, no one counseling approach has emerged as clearly superior to all others (Elliott, 2002; Lambert, 2004; Wampold, 2006). Again, this finding is probably due to the fact that the elephant does have a trunk, a tail, and so on. Research on the effectiveness of psychotherapy is, however, a crucial and somewhat more complex topic, one to which we will turn very shortly in a later section of this chapter. For the purpose of identifying one best theory, however, research gives little direction.
Are Proponents of One Theory Any Wiser Than Those of Another?
This question is somewhat more difficult to answer. As Richards and Bergin (1997) said regarding the three primary worldviews to which humans adhere (see Table 1.1), wise and thoughtful people align with each of these mutually exclusive perspectives. In other words, at the most fundamental level of how they see the world, intelligent, insightful people disagree. What Richards and Bergin said about worldviews can also be said of counseling theories: At the most fundamental level of how counseling theorists see people—people’s nature, how they develop, and how they change—wise and thoughtful theorists disagree. Because the evaluation of what is “more wise” is a subjective one, you are encouraged to keep this question in mind as you sequentially explore each of the theories we describe in this book.
Assuming for the moment that popularity reflects collective wisdom, to which theory do most current practitioners subscribe? Research into this question yields only a somewhat clearer answer (Bechtoldt, Norcross, Wyckoff, Pokrywa, & Campbell, 2001; Glass, Victor, & Arnkoff, 1993; Jensen, Bergen, & Greaves, 1990). Of the counselors who specify one guiding theory, in some studies they indicate psychodynamic (as represented in this text by Chapter 3), whereas in others they identify cognitive-behavioral and existential theories followed by psychodynamic, person-centered, and system approaches. We encourage you not to allow yourself to be swayed too much by these findings. Throughout
Three Major W orldviews Among Humans
TABLE 1.1
Objective Idealistic (Eastern)
Naturalism and Supernaturalism
Subjective Idealistic (Western or Monotheistic)
Supernaturalism
Phenomena exist that transcend nature. Some belief, disbelief in transcendent phenomena.
Atheism and Polytheism
Naturalistic (Scientific)
Metaphysical assumptions about the nature of reality:
Naturalism
Theism
Everything is exclusively a phenomenon of nature.
Atheism
God is not real. God is real. No single transcendent God.
Determinism Free will Free will
Humans have freedom to choose.
Contextualism
Some real phenomena are unique and unrepeatable.
Holism
The whole is greater than the sum of its parts.
Holism
Reality is increasingly lost with smaller parts.
Mechanism
The universe is a manifestation of intentional intelligence.
Materialism
Some belief, some disbelief, universe is spirit. ( Continued )
Humans have freedom to choose though often within biological and environmental limits.
Contextualism
Some real phenomena are unique and unrepeatable.
Holism
The whole is greater than the sum of its parts.
Holism
Reality is increasingly lost with successively smaller parts.
Mechanism
The universe is a manifestation of some intentional intelligence.
Materialism
Every event is determined by a cause.
Universalism
Universal laws exist whereby phenomena are generalizable and repeatable.
Reductionism
Any phenomenon can be understood by reducing it to its parts.
Atomism
The foundation of reality is found in increasingly smaller parts.
Mechanism
The universe is like a machine.
Materialism
The universe is essentially matter. The universe is essentially spirit.
TABLE 1.1 (Continued)
Objective Idealistic (Eastern)
Subjective Idealistic (Western or Monotheistic)
Ethical altruism
Optimal universal “good” and “rights” exist.
Naturalistic (Scientific)
Axiological assumptions about what is valuable, good, and right:
Ethical altruism
Optimal good is foregoing pleasure and bearing pain to benefit others.
Ethical universals and absolutes
Ethical hedonism
Optimal good is a maximum of pleasure and minimum of pain.
Some universal “goods” and “rights” exist.
Ethical universals and absolutes “Good” and “right” are never universal, always relative to a context. At least some universal “goods” and “rights” exist.
Ethical relativism
Noesis
Some knowing transcends the observable.
Theistic idealism
Where theistic, consciousness is a part of God.
Epistemological pluralism
Some source(s) of knowing transcend the senses.
Noesis
Epistemological assumptions about what can be known:
Positivism
Observable facts are our only source of positive knowing. Some source(s) of knowing transcend what is observable.
Theistic realism
Classical realism
The universe is separate from human consciousness, which can know it. God is separate from human consciousness, which cannot know it.
Epistemological pluralism
Some source(s) of knowing transcend the senses.
Empiricism
Our physical senses are the only reliable source of knowledge.
Source: Adapted from Richards, P. S., & Bergin, A. E. (1997). A spiritual strategy for counseling and psychotherapy . Washington, DC: American Psychological Association.
the history of Western psychotherapy over the past century, the answer would have been very different depending on when the question was asked. The most popular theory today may be in relative disfavor tomorrow.
Considering that a counselor does best to identify one primary theory from an informed knowledge of those that are most widely endorsed, but that no one best theory can be identified on the basis of research, relative wisdom, or collective wisdom, how do you, a counselor in training, identify your own guiding theory? It is to this question that we now turn.
How Do You Identify Your Guiding Theory of Counseling?
This discussion may, so far, seem to imply that theory is “out there,” separate from you, a guidebook external to you that you consult as needed. This implication is partly true. It is equally true, however, and perhaps more important to know, that you already have a counseling theory. That is, you already have beliefs about what causes people to be as they are and what they need in order to continue in their development; in the process of living, you already have begun to develop your own fledgling guidebook. And the basic philosophy you have established probably matches one of the existing theories better than any of the others. We believe this match constitutes the best basis upon which to identify a starting place for your counseling theory foundation: to discover to which theory you initially, philosophically have the strongest allegiance and then and use that theory as a starting place for your practice of counseling (Luborsky et al., 1999).
The problem is that you’ve probably developed your guidebook informally and without conscious awareness. If you are to find the best match, you must become aware of your own basic beliefs about how people develop and change, and you must subject those beliefs to scrutiny.
Let us first address the idea that you already have a counseling theory. One way to discover you already have a theory is to realize that, if you had to conduct a counseling session right now, you could do so. You would make choices about how to begin, how to proceed, how to respond moment to moment. You would make at least some of those choices based on your belief that those choices would be more effective than other choices. Although you couldn’t say how effective your choices would be, nevertheless, you likely would have some rationale for at least much of what you do.
Another way to know that you already have a theory of counseling is to answer questions that theories of counseling address, such as those in the box.
As briefly as possible, give your current answer to each of the following questions:
HUMAN NATURE
At the core, are people basically good, evil, or neutral?
How much of personality is inborn, that is, determined or influenced by biological and/or other innate factors? How much of a person’s individuality is the result of innate factors, such as heredity?
What, if any, inborn drives, motives, tendencies, or other psychological or behavioral characteristics do all humans share?
How is the human psyche structured? Does it work as a unified whole or as parts that may or may not work together harmoniously at various times?
ROLE OF THE ENVIRONMENT IN PERSONALITY DEVELOPMENT
How influential is one’s physical and/or social environment in the development of one’s personality?
How does the environment influence personality development? How might environmental influence vary throughout the life span?
MODEL OF FUNCTIONALITY
What constitutes functionality—mental health—in a person? Dysfunctionality— mental unhealth?
How do innate and environmental factors interact such that a person manifests relatively more healthy or unhealthy functioning?
PERSONALITY CHANGE
Once a personality has developed to a lesser or greater degree, how does it change? What conditions are necessary but not sufficient for change to occur? What conditions are both necessary and sufficient? What is the role of thoughts, feelings, and/or actions in the process of change? Is change best facilitated by focusing on one’s past, present, and/or future? What is the relative role of insight and/or action in facilitating change? How responsible is—and can—a person be for changing oneself?
You almost certainly had some ideas in response to these questions. Those ideas constitute your current theory of counseling. Now that it is clear that you have a theory of counseling (whatever its degree of development) a next question might be, how good is your theory? How might you evaluate the quality of your theory? One way to explore this question is to put yourself in the role of a counseling client.
THE SEVEN C’S
Think back to a time when you felt the most vulnerable, the most in need of assistance in coping with some aspect of yourself or your environment. Imagine that, at the time, you went to a counselor. By placing an X on each continuum in this box, rate the qualities you hope you would find in your counselor.
MY IDEAL COUNSELOR WOULD HAVE A THEORY OF COUNSELING THAT IS
Very complete 0–0–0–0–0 Very incomplete
(Indicates how comprehensive your counselor’s beliefs about people are, how well her beliefs prepare her to work effectively with a wide variety of people and issues.)
Very clear, straightforward 0–0–0–0–0 Very complex, obscure (Indicates how easily you and others can understand your counselor’s belief system, how straightforward it is, how free it is of an excess of complicated terms and concepts, how “elegant” it is.)
Very internally consistent 0–0–0–0–0 Very internally inconsistent (Indicates how much your counselor’s belief system contains elements that complement rather than contradict each other.)
Very concrete 0–0–0–0–0 Very abstract (Indicates how easily the concepts in your counselor’s belief system can be perceived in real life, can be measured; especially how easily your progress in counseling—and, thus, the effectiveness of the theory itself—can be assessed.)
Very current 0–0–0–0–0 Very out of date (Indicates how well your counselor’s beliefs match what the best contemporary research has shown to be true of people and to be effective in helping people change.)
Very creative 0–0–0–0–0 Very rigid, fixed (Indicates how well your counselor’s belief system can accommodate new information and the extent to which it provides her with the foundation to develop innovative approaches to unique people and situations.)
Very conscious 0–0–0–0–0 Very unconscious (Indicates how aware your counselor is of her belief system, how purposefully she can access and utilize specific concepts and skills; how well she can devise a course of action based on a rationale and explain her rationale when asked to do so.)
If you are like many counseling theorists (Combs, 1989, p. 159), you value a counselor whose guiding theory of counseling is complete, clear, consistent, concrete, current, creative, and conscious: the seven c’s. (Perhaps our next book will be titled Counseling Theory: Your Guidebook to Sailing the Seven C’s!) In other words, most people prefer a counselor who uses a well-thought-out, up-to-date approach that is sensitive to individual needs and can be understood by clients and counselors alike.
Now return to your own answers to the questions about personality development and change. How confident are you that your ideas fulfill the criteria of the seven c’s?
Personal Theory Development as Process
The process of identifying a guiding theory can, at first, seem a formidable task. It is not a matter of choosing a theory, like you might choose whether to eat strawberry or vanilla ice cream. Rather, it is a process of identification. We use this term in two senses. One is in the sense that you are sure to identify with or resonate with the different theories to various degrees and identify with one more than the others. The other sense is in relation to the concept of your identity: that your guiding theory of counseling is a reflection of your identity, of who you are. Just as identity is a phenomenon that develops over time and experience, so is guiding theory (Brabeck & Welfel, 1985). Identification of a guiding theory is not a single decision but, rather, is an ongoing process involving several steps or stages.
Watts (1993) developed a four-stage model to describe the process of identifying a guiding theory. Beginning with the exploration stage, he encouraged students to conduct
an internal inventory of values and beliefs, as you began to do by answering the questions posed earlier in this chapter. From this foundation of self-awareness, you are in the best position to explore the major theories of counseling. You can learn about prominent theories through classroom study, audio and video recordings, consultation with practitioners, and texts such as this one. The goal of the exploration stage is to begin to compare and contrast your beliefs and values with those represented in the various theories.
Watts, like we, recommended that you enter the second, examination stage by identifying from among all the theories the one that seems closest to your views. Once you have made this tentative commitment, immerse yourself in primary resources (print and visual media produced by the original theorist or those who, themselves, identify the theory as their guiding theory). Recommended resources at the end of each chapter provide you with an opportunity to explore primary sources of each theory. Also examine research on the effectiveness of the theory—both by proponents and nonproponents of the theory—to evaluate its truth value (Brabeck & Welfel, 1985). As the immersion progresses, if you begin to feel that the fit between theory and yourself is awkward, then return to the exploration stage to revisit your personal values and your understanding of existing theories.
If you continue to feel a resonance with the theory, you are ready to proceed with the examination stage by beginning to apply your theory with clients under supervision in a prepracticum or practicum course. When beginning to counsel, as when beginning to develop any skill, it’s natural for you to experience a certain amount of awkwardness. Remember when you were first learning to drive? You may have sincerely believed in the appropriateness of all the skills your instructor was helping you learn, but doing them all simultaneously and well was another thing altogether! You probably felt somewhat overwhelmed, whereas by now you have probably had the experience of driving from point A to point B without even thinking consciously of what you were doing! In driving, as in counseling, it is important to persevere in practicing skills that you believe in but that might feel initially quite foreign until those skills become second nature.
Another factor to consider in this second part of the examination phase is the enormous amount of anxiety that most beginning counselors feel initially. The stress of getting out of the classroom and into the counseling room can be very disequilibrating. Consider the following metaphor for this experience: During your academic preparation you are learning to create a set of filters, of glasses, which guides your view of self, others (clients), and the world. The better you are able to integrate personal values and theory, the better your glasses will fit. You walk into the clinical experience able to see reasonably well, and consequently you feel rather confident, even proud of your glasses and your ability to use them. During your first session as the counselor, and repeatedly after that, you begin to feel pressure to be or to do something you are not; it is as if a giant hand comes down from the sky and knocks the glasses off your head. You have difficulty seeing the client through your glasses. Anxiety sets in and you feel you must desperately grasp for any technique that works. It might be helpful to know that the big hand of anxiety is normal at this stage and that your glasses cannot be completely removed (leaving you blind) because they are a part of you: They are your beliefs. In reality, the filters are only moved off their previous position, knocked sideways, and can be repositioned or altered as you gain more experience. Confidence in your abilities and your theory grow in the remaining stages. However, if you have persevered on the basis of a good understanding of the counseling theory you have identified, yet you continue to feel awkward, you have trouble putting the theory into practice, you are not seeing positive outcomes with many of your clients, and/or your ongoing critical examination of the theory leaves you doubting that it is your current best guide to the practice of
counseling, you probably do not have a good fit. In this case, you probably need to cycle back to the exploration stage.
Assuming you experience an increasing sense of good fit with your guiding theory throughout the examination stage, the third and fourth stages include taking the mesh between theory and personal values to a level of integration and personalization. Integration occurs when you have assimilated the theory such that you think and act according to the theory in a way that is consistent and that feels natural and spontaneous. This aspect of the process is similar to the student of a new language who, after considerable immersion in it, awakens one morning to the realization that the new language is so deeply integrated that the person was actually dreaming in the new language. At this point in the theory identification process, technical eclecticism may become fitting, whereby you evaluate techniques from other theories for compatibility with the philosophy of your personal theory and adopt or adapt those you find compatible. Personalization involves a lifelong commitment to refining, expanding, and clarifying your personal beliefs, values, knowledge, and skills in continuing to develop an internally consistent and ever-richer approach to counseling.
Whereas the first two of Watts’s stages are achievable within the structure of your graduate program, your achievement of the last two stages depends largely on your investment in the process as you proceed professionally after graduation. Many counselors never reach the integration stage because they fail to develop the necessary level of self-understanding. Some therapists choose the path of “I attended a workshop on hypnotism. I think I will try that with my 3:00 client,” using any new technique regardless of rationale and, unethically, without sufficient preparation. Exploring self and theory takes persistence and passion. This exploration is characterized not by blind devotion but by intellectual and personal openness and curiosity. The payoff of the journey is greater self-understanding, clearer client conceptualization, greater effectiveness, and a reduced likelihood of burnout (Boy & Pine, 1983).
To return to our analogies from earlier in the chapter, in this process of coming to understand and work with the elephant that is the human psyche, each counselor is probably neither as ignorant as the blind men nor as omniscient as the small boy. Rather, each is in the process of perceiving the elephant ever more clearly and accurately—and working with it more effectively. Thus, the best any counselor-in-training can do is identify the guiding theory that best approximates her own beliefs about people, then commit to the ongoing process of refining those beliefs in light of personal experience and current, high-quality research. In the final section of this chapter, we will discuss yet more rationale in support of this approach to a difficult but important issue in your development as a professional counselor.
HOW THIS BOOK IS ORGANIZED
To help you approach each theory in the most understandable way and to help you in your comparison of the various theories, we have organized the theory chapters with a particular format. By reading the following outline overview, you will prepare yourself to make the most of the chapters that follow.
I. Background of the theory
Historical context. What was the historical and cultural context in which this theory developed?
Founder’s biographical overview. What were the major experiences of the founder’s life, and how did his life relate to his theory?
Philosophical underpinnings. What philosophical perspectives provided the conceptual foundation of this theory?
II. Personality development. Beginning at an infant’s birth and proceeding chronologically into adulthood, how does a person’s personality develop, according to this theory?
Nature of humans. What factors in personality are inborn at birth and influential across the life span?
The function of the psyche. What inborn motives, such as drives, needs, or tendencies, consistently animate the person across the life span? What operating principles are fundamental to the psyche?
The structure of the psyche. What psychological constructs exist at birth either actually or as potentials? Psychic structure typically is either aggregate, having parts that can operate independent of or in opposition to each other, or holistic, being a unified whole whereby any parts operate in the service of the whole.
Role of the environment. How do factors other than innate factors influence personality development?
Impact of the familial environment. What is the role of one’s early familial environment, and how important is the influence of that environment throughout one’s life?
Extrafamilial factors. What is the role of one’s environment besides one’s early familial environment, and how important is the influence of that environment throughout one’s life?
The healthy–adaptive versus unhealthy–maladaptive personality. What characterizes optimal and less-than-optimal human functioning? How do the influences of human nature, the environment, and any other factors interact to result in optimal and less-than-optimal functioning?
III. The personality change process. Each theory rests on the basic assumption that personality, whether partially, substantially, or fully formed, can develop beyond its current form, that is, can change. How does this theory conceptualize and promote personality change, particularly through the counseling process?
Basic principles of change. In general, how do people change, either in or out of the counseling setting? What is the “prime mover” of change: feelings, thoughts, and/or actions?
Change through counseling. In particular, what characterizes the change process in the counseling setting?
The client’s role. What is the client’s part in the change process?
Motivation to change. Why do clients seek counseling? If a client is mandated to counseling, what influence will that fact have on the change process?
The client’s experience. From the client’s perspective, what provokes a client to seek (or in the case of a mandate not seek) counseling?
The counselor’s conceptualization. From the counselor’s perspective, what dynamics underlying the client’s experience provoke (or don’t provoke) the client to seek counseling?
Capacity for change. How much is the client’s personality determined, and, consequently, how free is the client to change?
Responsibility for change. How passive or active must the client be in the counseling process?
Source of resistance. To what extent does the theory embrace the idea that clients in counseling sometimes resist change? To the extent that it does, how does the theory conceptualize the psychological dynamics at work in resistance?
The counselor’s role. What is the counselor’s role in the client’s change process?
Goals of counseling. What does the counselor conceptualize to be the aim of the counseling process?
Characteristics of an effective counselor. What attitudes and behaviors characterize the counselor who is most likely to facilitate client change?
Stages and techniques
The therapeutic relationship. What constitutes a “good” therapeutic relationship, how important is it, and how is such a relationship established and maintained throughout the counseling process?
Assessment. To what extent is formal and/or informal assessment used, when during the counseling process is it used, and what form(s) does it take?
Change strategies. What specific techniques does the counselor employ to facilitate developmental change?
Addressing client resistance. In each theory that embraces the concept of client resistance, how does the counselor recognize and respond to resistance?
IV. Contributions and limitations of the theory
Interface with recent developments in the mental health field. (These topics are discussed in depth in the next section of this chapter.)
The nature–nurture question
DSM-5 diagnosis
Pharmacotherapy
Managed care and brief therapy
Technical eclecticism
Diversity issues, including client ethnicity, gender, sexual orientation, and spirituality
The effectiveness of psychotherapy
What limitations have proponents and nonproponents noted regarding the applicability and/or effectiveness of this theory?
What distinguishing addition has this theory made to counseling and psychotherapy?
V. Current status. Since its original inception, how has the theory developed to its current status?
VI. Summary
VII. Recommended resources: print, audiovisual, and website
VIII. References
RECENT DEVELOPMENTS IN MENTAL HEALTH PERTINENT TO COUNSELING THEORY
In this final section of this introductory chapter, we will address in more detail one aspect of the outline that appears in the previous section. A crucial ingredient in the evaluation of a counseling theory is the extent to which the theory has incorporated, or could incorporate, information that has been discovered since the theory was created. Most of the
theories we describe in this text were developed prior to 1980. However, over the past three decades, research and practice in the mental health field, along with social change, have yielded new information and perspectives. It is no fault of traditional theorists that they did not consider these developments when they were formulating their theories; they cannot be held responsible for knowledge that did not exist at that time. You, however, a counseling student of the early twenty-first century, are in a position to consider these developments as you study each counseling theory. You are responsible for knowledge that exists at this time. The following discussion addresses several of these developments and their implications for you in your process of identifying your guiding theory of counseling.
The Nature–Nurture Question
To what extent is personality a manifestation of nature (the influence of heredity), or of nurture (the influence of experience in the natural and social environment)? In 1990, the American Counseling Association’s Journal of Counseling and Development published a special feature on the genetic origins of behavior (Baker & Clark, 1990). They cited such researchers as Thomas Bouchard (Skovholt, 1990), director of the Minnesota Center for Twin and Adoption Research, whose research team has studied dozens of identical twins separated by adoption at or shortly after birth and reunited as adults for the first time at the center’s research site in Minneapolis. These research participants have provided a unique opportunity to study concordance rates: the extent to which personality traits are shared in two people who possess identical genes but who were raised in different environments. Findings from these and other studies have yielded several results that contradict or challenge prevailing beliefs up to and including the late twentieth century:
• For most personality traits, genes explain at least 30% and up to 50%, of the variance in the trait (Gatz, 1990, p. 601).
• Environmental factors—all effects except genetic—explain the remaining 50% to 70% of variance (Gatz, 1990, p. 601).
• Of the environmental factors that explain the remaining variance, shared factors, such as growing up in the same family, have little or no influence on personality traits. Rather, nonshared experiences, those unique to the individual, have the greatest effect (Gatz, 1990, p. 601). Therefore, “parenting styles and traditional family variables may be relatively unimportant in understanding problem behavior” (Baker & Clark, 1990, p. 598). Rather, in understanding the environmental contribution to the development of a particular personality trait, counselors might do well to focus on a client’s unique experiences with caregivers or other people or situations (Baker & Clark, 1990, pp. 598–599). Unique experiences include such things as illness, accidents, specific interactions with a specific caregiver, and receiving awards. It should be noted that some critics have questioned the validity of this particular assertion.
• Caregiver behavior may be the result rather than the cause of a child’s genetically predisposed behavior, a kind of “reverse causality” (Rowe, 1990, p. 609).
• “Genes may be expressed at one age and not another” or only under specific circumstances (Baker & Clark, 1990, p. 599).
• “Biology is not necessarily destiny” (Baker & Clark, 1990, p. 599). When a genetic influence is known to exist, environmental accommodations often can maximize or minimize the genetic influence.
• Several phenomena that are the focus of counseling or are addressed in counseling have a known or a strongly suspected genetic influence: schizophrenia, depression, manic depression, and Alzheimer’s disease (Gatz, 1990); chronic anxiety and panic disorder (Carey, 1990); reading disabilities (LaBuda, DeFries, & Pennington, 1990); antisocial behavior (Raine & Dunkin, 1990); extreme introversion (Ellis & Robbins, 1990); and substance addiction (Leshner, 2001).
• The prevailing view in the mental health field is that distressing psychological symptoms are the result of some combination of genetic vulnerability and environmental factors. Even more specifically, in the diathesis-stress model (Elwood, Hahn, Olatunji, & Williams, 2009), two factors, genetic endowment and early learning, create some degree of latent vulnerability to or protection from psychopathology that later manifests when a person encounters particular type(s) and intensity(s) of stressors.
Near the end of each chapter, we will help you apply this information to the theory at hand by offering our answers to the following questions:
What do people of this particular theoretical persuasion believe about the nature–nurture question?
How do those beliefs compare with the recent developments described earlier? If they differ, could the recent developments cited earlier be incorporated into the theory without violating the theory’s basic premises?
DSM-5 Diagnosis
In 1952, the American Psychiatric Association published the first edition of its Diagnostic and Statistical Manual of Mental Disorders. The most recent fifth edition, DSM-5, was published in 2013 (American Psychiatric Association [APA], 2013, pp. 5–6). The purpose of these publications was to identify categories of, establish nationally acceptable nomenclature and descriptions of, and determine incidences for the various mental disorders. The bulk of DSM-5 consists of Section II: Diagnostic Criteria and Codes for 22 categories of mental disorder, such as depressive, anxiety, substance-related and addictive, and personality disorders. The diagnostic criteria for each disorder consists of a list of symptoms that occur within a specific time period. According to the authors of the DSM-5, “the current diagnostic criteria are the best available description of how mental disorders are expressed and can be recognized by trained clinicians” (APA, 2013, p. xii).
The acceptability of diagnosis—and even of the concept of “mental disorder”—varies from one counseling theory to another. In the extremes, some theories eschew the diagnosis of clients, whereas others consider it essential. Even in those orientations in which diagnosis is considered vital, clinicians are often quite mindful of the power of labeling and, consequently, handle a diagnosis with requisite care. Community agency counselors are often required, and private practice counselors seeking third-party payment from managed care providers are almost always required, to render a DSM-5 diagnosis for clients. Among theorists who eschew DSM diagnosis, the question of the DSM’s theoretical orientation is, itself, a factor. Although DSM authors claim its categorizing system is atheoretical, critics have pointed out how the authors’ empirical approach—focusing on patterns of individual behavior as they appear from outside the individual—is based in theory. This approach results in a neglect of factors that are clearly included and considered
important in at least some counseling theories: contextual factors in diagnosis, such as clients’ subjective meanings, cultures, and systems (Douthit & Marquis, 2006). Whereas the Cultural Formulation section of DSM-5 appears to be a step in the right direction regarding acknowledging the significant role that a client’s culture plays in mental disorder or well-being, it appears in a separate section following Section II; thus, clinicians can disregard it. It remains for the DSM to integrate cultural considerations—as well as considerations of legitimate subjective individual meanings and of systemic factors such as race and socioeconomic level (a tendency to overdiagnose racial minorities and members of lower socioeconomic groups)—into a holistic approach to diagnosis that potentially includes all aspects of all theories. Rather than seek to be atheoretical—a goal we consider to be impossible—the DSM authors could render the resource more acceptable to counselors identified with a wide range of counseling theories by making the document more pantheoretical: including in an integrated way the contexts addressed in all theories of counseling.
Near the end of each chapter, we will help you apply this information to the theory at hand by offering our answers to the following questions:
How does each theorist view the act of diagnosing, and even the concept of “mental disorder”?
If you will be dealing with managed care, which almost always requires the mental health practitioner to diagnose each client, how compatible is that requirement with the theory?
How might you reconcile any discrepancy between the theory’s view on diagnosis and the pragmatic necessity of rendering diagnoses?
Pharmacotherapy
Psychiatrists and other physicians can prescribe any of a number of medications that reduce or eliminate distressing psychological symptoms. Some research has indicated that psychoactive medication can be as effective as, or even more effective than, psychotherapy, at least in the short run; other research has indicated the superiority of psychotherapy over psychoactive medication; and yet other research has indicated that medication in conjunction with psychotherapy is often most effective (Holiner Psychiatric Group, 1998). An excellent source on the subject of pharmacotherapy is Preston, O’Neal, and Talaga’s (2013) Handbook of Clinical Psychopharmacology for Therapists.
Evaluating the potential benefits and drawbacks of pharmacotherapy can be complex and value laden. For example, premature ejaculation abates with certain psychoactive medications, but the disorder recurs as soon as the medication is discontinued. Conversely, premature ejaculation is highly responsive to certain quite simple and easy sexual exercises; the symptoms abate for as many as 95% of men within just a few weeks, and the men then have a skill that will serve them for the rest of their lives (LoPiccolo, 1998). In cases such as this, counselors tend to value “skills over pills.” However, some conditions require pills along with or in addition to skills.
Near the end of each chapter, we will help you apply this information to the theory at hand by offering our answers to the following questions:
To what extent does the theory address pharmacotherapy, providing guidelines about if and when pharmacotherapy should be considered or used?
To the extent that the theory does not address this issue, how compatible is the theory with pharmacotherapy?
To what extent could pharmacotherapeutic considerations be added to the practice of this theory without violating the theory’s basic premises?
Managed Care and Brief Therapy
Prior to approximately 1980, when a mental health practitioner worked with a client who received insurance reimbursement for expenses incurred from psychotherapy, the typical arrangement was for the client to choose the psychotherapist, for the psychotherapist to determine the length of therapy and therapeutic approach, and for the client or therapist to file directly to the insurance company for reimbursement. Since about 1980, managed care has changed that process. Managed care refers to health maintenance organizations (HMOs), preferred provider organizations (PPOs), and government-funded programs such as Medicaid and Medicare (Glosoff, Garcia, Herlihy, & Remley, 1999). Organizations such as these restrict those mental health professionals they will reimburse, determine how many sessions for which they will reimburse, require substantial paperwork describing treatment protocol and client progress, and reimburse only for certain favored psychotherapeutic approaches. The favored approaches are those that are brief and that have been supported by empirical evidence, in particular, cognitive-behavioral. We have heard some counselors refer sardonically to managed care as “managed cost” or, even more pointedly, “mangled care.”
Some counselors work in environments heavily dependent on managed care for reimbursement, such as the community agency or the private practice. If you anticipate possibly being such a counselor, near the end of each chapter, we will help you apply the preceding information to the theory at hand by offering our answers to the following questions:
Does this therapeutic approach constitute a form of brief therapy?
If not, have recent practitioners published guidelines for adapting the approach to a brief therapy format?
If not, could the approach be adapted to a brief therapy format?
How amenable is the theory to incorporating the counseling techniques favored by managed care?
Technical Eclecticism
Recent surveys reveal an increasing tendency for mental health professionals to identify their theoretical orientation as “eclectic” (Bechtoldt et al., 2001). Eclecticism means “selecting what seems best from various systems” (Morris, 1976). This practice suggests an atheoretical or polytheoretical approach to counseling. As we discussed earlier in this chapter, we disagree with both of these approaches. Following is a summary of our viewpoint.
First, we believe it is simply impossible for a counselor to be atheoretical. The counselor must make choices about how to respond to a client from moment to moment; those choices are based on some rationale, however conscious or nonconscious; and a rationale
