COUNSELLING PSYCHOLOGY merged.pdf

 Psychoanalytic, Adlerian, and 7 Humanistic Theories of Counseling Chapter Overview From this chapter you will learn about: The nature of and importance of relatively early theories of counseling The premises, counselor roles, goals, techniques, and st...

 Psychoanalytic, Adlerian, and 7 Humanistic Theories of Counseling Chapter Overview From this chapter you will learn about: The nature of and importance of relatively early theories of counseling The premises, counselor roles, goals, techniques, and strengths/limitations of psychoanalytic theories The premises, counselor roles, goals, techniques, and strengths/limitations of Adlerian theory The premises, counselor roles, goals, techniques, Andrew Moss/Alamy Stock Photo and strengths/limitations of humanistic theories, specifically person-centered I know how the pressure can build sometimes counseling, existential in your own metallic tea-kettle world, counseling, and Gestalt Sporadically you whistle to me, therapy at other times you explode! Somewhere beneath that noisy facade As you read consider: (in silence or stillness perhaps) How theories guide and Feelings might flow with quickness and strength, direct what counselors do like the Dan or the Shenandoah, in sessions But now they incessantly boil in your mind How theories influence steam-filling dark shadows and choking conversation. each other and overlap Reprinted from “Tea-Kettle Song,” by S. T. Gladding, 1974, School Counselor, 21, while maintaining their p. 209. © Samuel T. Gladding. distinctiveness Which theories appeal to you most and why 146  Chapter 7 Psychoanalytic, Adlerian, and Humanistic Theories of Counseling 147 Counseling, by definition, is a process that involves interpersonal relationships (Patterson, 1985). Frequently it is conducted on an individual level in which an atmosphere of trust is fostered between counselor and client that ensures communication, exploration, planning, change, and growth. In counseling, a client gains the benefit of immediate feedback from the counselor about behaviors, feelings, plans, and progress. The following four variables determine the amount of growth and change that take place in any type of counseling: 1. counselor, 2. client, 3. setting, and 4. theoretical orientation. We have already examined some of the universal qualities of effective counselors and the counseling process. Certain characteristics seem to distinguish these aspects of counseling. For example, effective counselors have a deep understanding of themselves, an ability to nonjudg- mentally know others, an appreciation for the influence of cultures, and a strong educational background. They understand and work with their clients using agreed-on goals and realizing that the personalities of and relationship between counselors and clients have a powerful impact on each other and the counseling process. The setting in which counseling is conducted is also a critical variable. Counselors respond to client needs in different ways in various settings, such as schools, agencies, and mental health centers. The stages of counseling relationships likewise play a role in how counseling is conducted. Deep understanding of themselves Ability to nonjudgmentally know others Appreciate the influences of culture Strong educational and research background in counseling Qualities of Effective Counselors This chapter focuses on three theoretical orientations to counseling: psychoanalytic, Adle- rian, and humanistic. These theories are grouped together because they were among the earliest counseling theories constructed. Psychoanalysis became popular in the 1910s and 1920s, Adle- rian therapy in the 1930s and 1940s, and humanistic theories in the 1940s and early 1950s. Thus, there is a chronology in regard to these theories with some of the theorists actually meet- ing or knowing each other—for example Sigmund Freud, Alfred Adler, Fritz Perls, and Viktor Frankl (Alex Vesley, personal communication, June 4, 2011). While there are variations and distinctions within and among these theories, some of their practices overlap with practitioners, such as Adlerians in Vienna, Austria, using a number of psychoanalytic methods including transference and countertransference. Even within the humanistic-oriented theories—person-centered, existential, and Gestalt—there is some overlap with all the founders of these approaches having had a strong exposure to Freud or having prac- ticed psychoanalysis before they formulated their distinct ways of working. Thus, the theories covered in this chapter are among the oldest and most overlapping—at least in their origin— among any that are used in the profession today. Before examining them, however, we will first focus on the nature of and importance of theory within the counseling process. 148 Part II Counseling Processes and Theories THEORY A theory is a model that counselors use as a guide to hypothesize about the formation of pos- sible solutions to a problem. “Theoretical understanding is an essential part of effective coun- seling practice. Theories help counselors organize clinical data, make complex processes coherent, and provide conceptual guidance for interventions” (Hansen, 2006, p. 291). Counselors decide which theory or theories to use on the basis of their educational back- ground, philosophy, and the needs of clients. Not all approaches are appropriate for all coun- selors or clients. Exceptional practitioners who formulated their ideas on the basis of their experiences and observations have developed most counseling theories. Yet most theorists are somewhat tentative about their positions, realizing that no one theory fits all situations and clients (Tursi & Cochran, 2006). Indeed, one theory may not be adequate for the same client over an extended period. Counselors must choose their theoretical positions carefully and reg- ularly reassess them. Some theoretical models are more comprehensive than others are and “all theories are hopelessly entangled in culture, politics, and language” (Hansen, 2006, p. 293). Effective coun- selors realize this and are aware of which theories are most comprehensive and for what reasons. They know that theories determine what and how they see in counseling and that theories can be cataloged in a number of ways including modernism and postmodernism categories. Hansen, Stevic, and Warner (1986) list five requirements of a good theory. It must be clear and easily understood, comprehensive, explicit and heuristic, specific in relating means to desired out- comes, and useful to its intended practitioners. 1. Clear, easily understood, and communicable. It is coherent and not contradictory. 2. Comprehensive. It encompasses explanations for a wide variety of phenomena. 3. Explicit and heuristic. It generates research because of its design. 4. Specific in relating means to desired outcomes. It contains a way of achieving a desired end product (i.e., it is pragmatic). 5. Useful to its intended practitioners. It provides guidelines for research and practice. Requirements of a Good Theory In addition to these five qualities, a good theory for counselors is one that matches their personal philosophies of helping. Shertzer and Stone (1974) suggest that a counseling theory must fit counselors like a suit of clothes. Some theories, like some suits, need tailoring. Therefore, effective counselors realize the importance of alterations. Counselors who wish to be versatile and effective should learn a wide variety of counseling theories and know how to apply each without violating its internal consistency (Auvenshine & Noffsinger, 1984). PERSONAL REFLECTION When have you received coaching or instruction on how to kick a ball or draw a figure so that you could improve as an athlete or an artist? How do you think that experience relates to a good coun- seling theory?  Chapter 7 Psychoanalytic, Adlerian, and Humanistic Theories of Counseling 149 Importance of Theory Theory is the foundation of good counseling. It challenges counselors to be caring and creative within the confines of a highly personal relationship that is structured for growth and insight (Gladding, 1990b). Theory has an impact on how client communication is conceptualized, how interpersonal relationships develop, how professional ethics are implemented, and how counsel- ors view themselves as professionals. In counseling, theory impacts how: Communication is conceptualized Interpersonal relationships develop Professional ethics are implemented Counselors view themselves as professionals The How of Theory Without theoretical backing, counselors operate haphazardly in a trial-and-error manner and risk being both ineffective and harmful. Brammer, Abrego, and Shostrom (1993) stress the pragmatic value of a solidly formulated theory for counselors. Theory helps explain what happens in a coun- seling relationship and assists the counselor in predicting, evaluating, and improving results. Theory provides a framework for making scientific observations about counseling. Theorizing encourages the coherence of ideas about counseling and the production of new ideas. Hence, coun- seling theory can be practical by helping to make sense out of the counselor’s observations. Boy and Pine (1983) elaborate on the practical value of theory by suggesting that theory is the why behind the how of counselors’ roles, providing a framework within which counsel- ors can operate. Counselors guided by theory can meet the demands of their roles because they have reasons for what they do. Boy and Pine point out six functions of theory that help coun- selors in a practical way: 1. Theory helps counselors find unity and relatedness within the diversity of existence. 2. Theory compels counselors to examine relationships they would otherwise overlook. 3. Theory gives counselors operational guidelines by which to work and helps them evaluate their development as professionals. 4. Theory helps counselors focus on relevant data and tells them what to look for. 5. Theory helps counselors assist clients in the effective modification of their behavior. 6. Theory helps counselors evaluate both old and new approaches to the process of counsel- ing. It is the base from which new counseling approaches are constructed. “The ultimate criterion for all counseling theories is how well they provide explanations of what occurs in counseling” (Kelly, 1988, pp. 212–213). The value of theories as ways of orga- nizing information “hinges on the degree to which they are grounded in the reality of people’s lives” (Young, 1988, p. 336). Theory into Practice As of 2016, it was estimated that there were around 1,000 theories of psychotherapy and coun- seling available worldwide (Sharf, 2016). Most of them did not have many followers or much research to back their effectiveness. However, the sheer number of theories means counselors have a wide variety of approaches from which to choose. Effective counselors are choosy, 150 Part II Counseling Processes and Theories though. They scrutinize theories for proven effectiveness and match them to personal beliefs and realities about the nature of people and change. Instead of generating new theories, Okun (1990) states, the present emphasis in counseling is on connecting existing theories. This emphasis is built on the fundamental assumption that “no one theoretical viewpoint can provide all of the answers for the clients we see today” (p. xvi). Furthermore, counselors seem to be pragmatically flexible in adapting techniques and interven- tions from different theoretical approaches into their work without actually accepting the prem- ises of some theoretical points of view. This practice seems to be of necessity because counselors must consider intrapersonal, interpersonal, and external factors when working with clients, and few theories blend all these dimensions together. The largest percentage of professional counselors today identify themselves as integrated or eclectic in the use of theory and techniques (Lazarus & Beutler, 1993; Sharf, 2016). That is, they use various theories and techniques to match their clients’ needs with “an average of 4.4 theories making up their therapeutic work with clients” (Cheston, 2000, p. 254). As needs change, counselors depart from a theory they are using to use another approach (a phenomenon called style-shift counseling). Changes counselors make are related to the client’s developmen- tal level (Ivey, Ivey, Myers, & Sweeney, 2005). To be effective, counselors must consider how far their clients have progressed in their structural development, as described by Jean Piaget. For example, a client who is not developmentally aware of his or her environment may need a thera- peutic approach that focuses on “emotions, the body, and experience in the here and now,” whereas a client who is at a more advanced level of development may respond best to a “consult- ing-formal operations” approach in which the emphasis is on thinking about actions (Ivey & Goncalves, 1988, p. 410). The point is that counselors and theories must start with where their clients are, helping them develop in a holistic manner. Whereas a strength of eclecticism is its ability to draw on various theories, techniques, and practices to meet client needs, this approach has its drawbacks. For instance, an eclectic approach can be hazardous to the counseling process if the counselor is not thoroughly familiar with all aspects of the theories involved. In such situations, the counselor may become a techni- cian without understanding why certain approaches work best with specific clients at certain times and certain ways (Cheston, 2000). This unexamined approach of undereducated counsel- ors is sometimes sarcastically referred to as “electric”—that is, such counselors try any and all methods that “turn them on.” The problem with an eclectic orientation is that counselors often do more harm than good if they have little or no understanding about what is helping the client. To combat this problem, McBride and Martin (1990) advocate a hierarchy of eclectic practices and discuss the importance of having a sound theoretical base as a guide. The lowest or first level of eclecticism is really syncretism—a sloppy, unsystematic process of putting unre- lated clinical concepts together. It is encouraged when graduate students are urged to formulate their own theories of counseling without first having experienced how tested models work. The second level of eclecticism is traditional. It incorporates “an orderly combination of compatible features from diverse sources [into a] harmonious whole” (English & English, 1956, p. 168). It is more thought out than syncretism, and theories are examined in greater depth. On a third level, eclecticism is described as professional or theoretical or as theoretical integrationism (Lazarus & Beutler, 1993; Simon, 1989). This type of eclecticism requires that counselors master at least two theories before trying to make any combinations. The trouble with this approach is that it assumes a degree of equality between theories (which may not be true) and the existence of criteria “to determine what portions or pieces of each theory to preserve or expunge” (Lazarus & Beutler, 1993, p. 382). It differs from the traditional model in that no mas- tery of theory is expected in the traditional approach.  Chapter 7 Psychoanalytic, Adlerian, and Humanistic Theories of Counseling 151 A fourth level of eclecticism is called technical eclecticism, exemplified in the work of Arnold Lazarus (2008) and his multimodal approach to counseling, which assesses what he describes as the seven elements of a client’s experience. These vectors are summarized in the acronym BASIC ID: Behavior Affect Sensations (e.g., seeing, hearing, smelling, touching, tasting) Imagery Cognitions (e.g., beliefs and values) Interpersonal relationships Drugs (i.e., any concerns about health, including drug use, fitness, or diet) In this approach, procedures from different theories are selected and used in treatment “without necessarily subscribing to the theories that spawned them” (Lazarus & Beutler, 1993, p. 384). The idea is that techniques, not theories, are actually used in treating clients. Therefore, after properly assessing clients, counselors may use behavioral methods (such as assertiveness training) with existential techniques (such as confronting persons about the meaning in their lives) if the situations warrant. This approach is in line with what Cavanagh and Levitov (2002) propose as a healthy eclectic approach to counseling. It requires counselors to have (a) a sound knowledge and understanding of the counseling theories used, (b) a basic integrative philosophy of human behavior that brings disparate parts of differing theories into a meaningful collage, and (c) a flex- ible means of fitting the approach to the client, not vice versa. Counselors who follow this model may operate pragmatically and effectively within an eclectic framework. The critical variables in being a healthy eclectic counselor are a mastery of theory and an acute sensitivity to knowing what approach to use when, where, and how (Harman, 1977). A final type of eclectic approach is the transtheoretical model (TTM) of change (Norcross & Beutler, 2008; Prochaska & DiClemente, 1992). This model is developmentally based and has been empirically derived over time. It is “an alternative to technical eclectic approaches that tend to be inclusive to the point that various components are ‘poorly’ held together” (Petrocelli, 2002, p. 23). The model is direction focused and proposes five stages of change: precontemplation, contemplation, preparation, action, and maintenance. They can be depicted along a linear line. Clients who are not ready to at least contemplate change will not, regardless of the theory used. Maintenance Action Preparation Contemplation Precontemplation The Transtheoretical Model (TTM) of Change 152 Part II Counseling Processes and Theories “Counseling from a TTM perspective allows for a more macroscopic approach (involv- ing a broad and comprehensive theoretical framework) and personal adaptation (involving an increase in critical, logical, accurate, and scientific-like thinking) rather than simple personal adjustment” (Petrocelli, 2002, p. 25). Its main drawbacks are its comprehensiveness and com- plexity and the fact that TTM has been tested only among limited groups (for example, addic- tions populations). Past the pure theory views and eclectic approaches, counseling theories are now entering a postmodernist perspective. As such they are being seen as prepackaged narratives that help clients create new meaning systems, “not by objectively discovering old ones” (Hansen, 2006, p. 295). The essence of such a view is seen in social constructive approaches. For the rest of this chapter and the next, 13 mainline theories that have gained popularity over time will be explained. CASE EXAMPLE Tim’s Theories Tim was a newly minted counselor. As such, he was observant and quick to pick up nuances in various forms of related therapeutic approaches. However, Tim was troubled. He liked most of the theories he read about and had a hard time deciding which ones he would master. He really began to waffle when he found out that most of the theories worked well when implemented by a master therapist—one who had practiced counseling diligently for at least 10 years. Knowing Tim’s plight and the fact that he did not want to use only techniques, what might you advise him to do in deciding on a theoretical approach? Would eclecticism work for some- one as undecided as Tim? Why or why not? PSYCHOANALYTIC THEORIES From a historical point of view alone, psychoanalytic theories are important and in briefer as well as classic forms are still practiced today. They were among the first to gain public recogni- tion and acceptance. Psychoanalysis in its classic form, as developed by Sigmund Freud, is examined in this section. Freud’s conceptualization and implementation of psychoanalysis is the basis from which many other theories developed, either by modifying parts of this approach or reacting against it. Psychoanalysis FOUNDERS/DEVELOPERS. Sigmund Freud, a Viennese psychiatrist (1856–1939), is the person primarily associated with psychoanalysis. His genius created the original ideas. His daughter, Anna Freud, further elaborated the theory, especially as it relates to children and development of defense mechanisms. In more recent times, Heinz Kohut has extended the theory to developmen- tal issues, especially attachment, through his conceptualization of object relations theory. VIEW OF HUMAN NATURE. Freud’s view of human nature is dynamic with the transformation and exchange of energy within the personality (Hall, 1954). People have a conscious mind  Chapter 7 Psychoanalytic, Adlerian, and Humanistic Theories of Counseling 153 (attuned to an awareness of the outside world), a preconscious mind (that contains hidden mem- ories or forgotten experiences that can be remembered), and an unconscious mind (containing the instinctual, repressed, and powerful forces). According to Freud, the personality consists of three parts: 1. Id (comprised of amoral basic instincts, which operates according to the pleasure prin- ciple) 2. Ego (the conscious, decision-making “executive of the mind,” which operates according to the reality principle) 3. Superego (the conscience of the mind that contains the values of parental figures and that operates according to the moral principle) The id and the superego are confined to the unconscious; the ego operates primarily in the conscious but also in the preconscious and unconscious. Psychoanalysis is also built on what Freud referred to as psychosexual developmental stages. Each of the stages focuses on a zone of pleasure that is dominant at a particular time: oral stage, where the mouth is the chief pleasure zone and basic gratification is from suck- ing and biting; anal stage, where delight is in either withholding or eliminating feces; phallic stage, where the chief zone of pleasure is the sex organs, and members of both sexes must work through their sexual desires; latency, where energy is focused on peer activities and personal mastery of cognitive learning and physical skills; and genital stage, where if all has gone well previously, each gender takes more interest in the other and normal heterosexual patterns of interaction appear. Excessive frustration or overindulgence in the first three stages are the main difficulties that can arise going through these stages, in which case the person could become fixated (or arrested) at that level of development and/or overly dependent on the use of immature defense mechanisms (i.e., ways of coping with anxiety on an unconscious level by denying or distorting reality). While there are numerous defense mechanisms, seven of the most prevalent are briefly explained in Table 7.1. ROLE OF THE COUNSELOR. Professionals who practice classical psychoanalysis function as experts. They encourage their clients to talk about whatever comes to mind, especially childhood experiences. To create an atmosphere in which the client feels free to express difficult thoughts, psychoanalysts, after a few face-to-face sessions, often have the client lie down on a couch while the analyst remains out of view (usually seated behind the client’s head). The analyst’s role is to let clients gain insight by reliving and working through the unresolved past experiences that come into focus during sessions. The development of transference is encouraged to help clients deal realistically with unconscious material. Unlike some other approaches, psychoanalysis encourages the counselor to interpret for the client. GOALS. The goals of psychoanalysis vary according to the client, but they focus mainly on personal adjustment, usually inducing a reorganization of internal forces within the person. In most cases, a primary goal is to help the client become more aware of the unconscious aspects of his or her personality and to work through current reactions that may be dysfunctional (Tursi & Cochran, 2006). 154 Part II Counseling Processes and Theories TABLE 7.1 Basic Psychoanalytic Defense Mechanisms Repression The most basic of the defense mechanisms, repression is the unconscious exclusion of distressing or painful thoughts and memories. All other defense mechanisms make some use of repression. Denial In this process, a person refuses to see or accept any problem or troublesome aspect of life. Denial operates at the preconscious or conscious level. Regression When individuals are under stress, they often return to a less mature way of behaving. Projection Instead of stating what one really thinks or feels, he or she attributes an unacceptable thought, feeling, or motive onto another. Rationalization This defense mechanism involves giving an “intellectual reason” to justify a certain action. The reason and the action are connected only in the person’s mind after the behavior has been completed. Reaction Formation When an individual behaves in a manner that is just the opposite of how he or she feels, it is known as a “reaction formation.” This type of behavior is usually quite exaggerated, such as acting especially nice to someone whom one dislikes intensely. Displacement This defense is a redirection of an emotional response onto a “safe target.” The substitute person or object receives the feeling instead of the person directly connected with it. Source: Gladding, S. T. (2008). Group work: A counseling specialty. Upper Saddle River, NJ: Prentice Hall. Pearson Education, Inc. A second major goal, often tied to the first, is to help a client work through a developmen- tal stage not previously resolved. If accomplished, clients become unstuck and are able to live more productively. Working through unresolved developmental stages may require a major reconstruction of the personality. A final goal of psychoanalysis is helping clients cope with the demands of the society in which they live. Unhappy people, according to this theory, are not in tune with themselves or soci- ety. Psychoanalysis stresses environmental adjustment, especially in the areas of work and inti- macy. The focus is on strengthening the ego so that perceptions and plans become more realistic. TECHNIQUES. Psychoanalytic techniques are most often applied within a specific setting, such as a counselor’s office or a hospital’s interview room. Among the most prominent of these tech- niques are free association, dream analysis, analysis of transference, analysis of resistance, and interpretation. Although each technique is examined separately here, in practice they are integrated. Free Association. In free association, the client abandons the normal way of censoring thoughts by consciously repressing them and instead says whatever comes to mind, even if the thoughts seem silly, irrational, suggestive, or painful. In this way, the id is requested to speak and the ego remains silent (Freud, 1936). Unconscious material enters the conscious mind, and there the counselor interprets it. Dream Analysis. Freud believed that dreams were a main avenue to understanding the unconscious, even calling them “the royal road to the unconscious.” He thought dreams were an attempt to fulfill a childhood wish or express unacknowledged sexual desires. In  Chapter 7 Psychoanalytic, Adlerian, and Humanistic Theories of Counseling 155 dream analysis, clients are encouraged to dream and remember dreams. The counselor is especially sensitive to two aspects of dreams: the manifest content (obvious meaning) and the latent content (hidden but true meaning) (Jones, 1979). The analyst helps interpret both aspects to the client. Analysis of Transference. Transference is the client’s response to a counselor as if the counselor were some significant figure in the client’s past, usually a parent figure. The analyst encourages this transference and interprets the positive or negative feelings expressed. The release of feelings is therapeutic, an emotional catharsis. But the real value of these experiences lies in the client’s increased self-knowledge, which comes through the counselor’s analysis of the transference. Those who experience transference and under- stand what is happening are then freed to move on to another developmental stage. Analysis of Resistance. Sometimes clients initially make progress while undergoing psychoanalysis and then slow down or stop. Their resistance to the therapeutic process may take many forms, such as missing appointments, being late for appointments, not pay- ing fees, persisting in transference, blocking thoughts during free association, or refusing to recall dreams or early memories. A counselor’s analysis of resistance can help clients gain insight into it as well as other behaviors. If resistance is not dealt with, the therapeutic process will probably come to a halt. Interpretation. Interpretation should be considered part of the techniques we have already examined and complementary to them. When interpreting, the counselor helps the client understand the meaning of past and present personal events. Interpretation encom- passes explanations and analysis of a client’s thoughts, feelings, and actions. Counselors must carefully time the use of interpretation. If it comes too soon in the relationship, it can drive the client away. However, if it is not employed at all or used infrequently, the client may fail to develop insight. STRENGTHS AND CONTRIBUTIONS. Classical psychoanalysis has several unique emphases: The approach emphasizes the importance of sexuality and the unconscious in human behavior. Before this theory came into being, sexuality (especially childhood sexuality) was denied, and little attention was paid to unconscious forces. The approach lends itself to empirical studies; it is heuristic. Freud’s proposals have gen- erated a tremendous amount of research. The approach provides a theoretical base of support for a number of diagnostic instru- ments. Some psychological tests, such as the Thematic Apperception Test or the Rorschach Ink Blots, are rooted in psychoanalytic theory. Psychoanalysis continues to evolve and most recently has emphasized adaptive processes and social relations. The approach appears to be effective for those who suffer from a wide variety of disor- ders, including hysteria, narcissism, obsessive-compulsive reactions, character disorders, anxiety, phobias, and sexual difficulties (Luborsky, O’Reilly-Landry, & Arlow, 2008). The approach stresses the importance of developmental growth stages. LIMITATIONS. The following limiting factors are a part of psychoanalysis: The classical psychoanalytic approach is time-consuming and expensive. A person who undergoes psychoanalysis is usually seen three to five times a week over a period of years (Bankart, 1997; Nye, 2000). 156 Part II Counseling Processes and Theories The approach does not seem to lend itself to working with older clients or even a large variety of clients. “Patients benefiting most from analysis” are mainly “middle-aged men and women oppressed by a sense of futility and searching for meaning in life” (Bradley & Cox, 2001, p. 35). The approach has been claimed almost exclusively by psychiatry, despite Freud’s wishes (Vandenbos, Cummings, & Deleon, 1992). Counselors and psychologists without medical degrees have had a difficult time getting extensive training in psychoanalysis. The approach is based on many concepts that are not easily communicated or under- stood—the id, ego, and superego, for instance. Psychoanalytical terminology seems overly complicated. The approach is deterministic. For instance, Freud attributed certain limitations in women to be a result of gender—that is, of being female. The approach does not lend itself to the needs of most individuals who seek professional counseling. The psychoanalytic model has become associated with people who have major adjustment difficulties or want or need to explore the unconscious. PERSONAL REFLECTION Sometimes classic psychoanalysis is characterized this way: Too much superego, you’re a cabbage; too much id, you’re a savage. How does such a characterization do justice or injustice to achieving a healthy ego within a person? What does it say about the therapeutic challenge in implementing the psychoanalytic approach in counseling? What does it say about the strength of the ego? ADLERIAN THEORY Adlerian theory focuses on social interests as well as the purposefulness of behavior and the importance of developing a healthy style of life. The therapeutic approach that has grown out of this theory is internationally popular. Adlerian Counseling FOUNDERS/DEVELOPERS. Alfred Adler (1870–1937) was the founder of the Adlerian approach to counseling, also known as Individual Psychology (to emphasize the holistic and indivisible nature of people). He was a contemporary of Sigmund Freud and even a member of his Vienna Psychoanalytic Society. However, Adler differed from Freud about the importance of biological drives as the primary motivating force of life and stressed the importance of subjective feelings and social interests. His theory is more hopeful. Individual psychology waned in popularity after his death but was revitalized by Rudolph Dreikurs, Manford Sonstegard, Oscar Christensen, Raymond Corsini, Donald Dinkmeyer, and Thomas Sweeney, among others. VIEW OF HUMAN NATURE. A central idea for Adler in regard to human nature is that people are primarily motivated by social interest, that is, a feeling of being connected to society as a part of the social whole, an active interest in and empathy with others, as well as a need and willingness to contribute to the general social good (Maniacci, Sackett-Maniacci, & Mosak, 2014; Overholser, 2010). Those with social interest take responsibility for themselves and others and are cooperative and positive in regard to their mental health. “Those who are failures,  Chapter 7 Psychoanalytic, Adlerian, and Humanistic Theories of Counseling 157 i­ ncluding neurotics, psychotics, and criminally oriented individuals are failures because they are lacking in social interest” (Daugherty, Murphy, & Paugh, 2001, p. 466). Adler’s theory holds that conscious aspects of behavior, rather than the unconscious, are central to the development of personality. A major Adlerian tenet is that people strive to become successful (i.e., the best they can be), a process he called striving for perfection or complete- ness (Adler, 1964). There is also a tendency for each person initially to feel inferior to others. If this feeling is not overcome, the person develops an inferiority complex. Such a complex, if not changed, becomes the basis by which one’s personality is defined. In contrast, a person who overcompensates for feelings of inferiority develops a superiority complex, which is what Adler also described as a neurotic fiction that is unproductive. Adler believed that people are as influenced by future (teleological) goals as by past causes. His theory also places considerable emphasis on birth order: those who share ordinal birth positions (e.g., firstborns) may have more in common with one another than siblings from the same family (Dreikurs, 1950). Five ordinal positions are emphasized in Adlerian literature on the family constellation: firstborns, secondborns, middle children, youngest children, and only children (Dreikurs, 1967; Dreikurs & Soltz, 1964; Sweeney, 2009). In addition to birth order, the family environment is important to a person’s development, particularly in the first 5 years of life. Adlerian theory stresses that each person creates a style of life (an individual’s methods of relating to others, viewing the world, and governing behavior) by age 5. This is done by the child primarily through interacting with other family members. A negative family atmosphere might be authoritarian, rejecting, suppressive, materialistic, over- protective, or pitying (Dreikurs & Soltz, 1964), whereas a positive family atmosphere might be democratic, accepting, open, and social. Nevertheless, perception of the family atmosphere, rather than any events themselves, is crucial to the development of a style of life (Adler, 1964). Individuals behave as if the world were a certain way and are guided by their fictions—that is, their subjective evaluations of themselves and their environments. Overall, Adlerians believe there are three main life tasks: society, work, and sexuality. As mentioned previously, Adlerian theory places strong emphasis on developing social interest and contributing to society. The theory holds that work is essential for human survival and that we must learn to be interdependent. Furthermore, a person must define his or her sexuality in regard to self and others, in a spirit of cooperation rather than competition. Adler also mentions two other challenges of life, although he does not fully develop them: spirituality and coping with self (Dreikurs & Mosak, 1966). According to Adlerian theory, it is crucial to emphasize that, when facing any life task, courage (a willingness to take risks without knowing what the consequences may be) is required. ROLE OF THE COUNSELOR. Adlerian counselors function primarily as diagnosticians, teach- ers, and models in the equalitarian relationships they establish with their clients. They try to assess why clients are oriented to a certain way of thinking and behaving. The counselor makes an assessment by gathering information on the family constellation and a client’s earliest memo- ries. The counselor then shares impressions, opinions, and feelings with the client and concen- trates on promoting the therapeutic relationship. The client is encouraged to examine and change a faulty lifestyle by developing social interest (Adler, 1927, 1931). Adlerians are frequently active in sharing hunches or guesses with clients and are often directive when assigning clients homework, such as to act “as if” the client were the person he or she wants to be. Adlerian counselors employ a variety of techniques, some of which are bor- rowed from other approaches. 158 Part II Counseling Processes and Theories GOALS. The goals of Adlerian counseling revolve around helping people develop healthy, holistic lifestyles. This may mean educating or reeducating clients about what such lifestyles are as well as helping them overcome feelings of inferiority. One of the major goals of Adlerian counseling is to help clients overcome a faulty style of life—that is, a life that is self-centered and based on mistaken goals and incorrect assumptions associated with feelings of inferiority. These feelings might stem from being born with a physical or mental defect, being pampered by parents, or being neglected. The feelings must be corrected, and inappropriate forms of behavior must be stopped. To do so, the counselor assumes the role of teacher and interpreter of events. Adlerian counseling deals with the whole person (Kern & Watts, 1993). The client is ultimately in charge of deciding whether to pursue social or self-interests. TECHNIQUES. The establishment of a counseling relationship is crucial if the goals of Adlerian counseling are to be achieved. Certain techniques help enhance this process. Adlerian counselors try to develop a warm, supportive, empathic, friendly, and equalitarian relationship with clients. Counseling is seen as a collaborative effort (Adler, 1956). Counselors actively listen and respond in much the same way that person-centered counselors do (James & Gilliland, 2013). After a relationship has been established, the counselor concentrates on an analysis of the client’s lifestyle, including examination of the family constellation, early memories, dreams, and priorities. As previously noted, the family constellation and the atmosphere in which chil- dren grow greatly influence both self-perception and the perceptions of others. No two children are born into the same environment, but a child’s ordinal position and assessment of the family atmosphere have a major impact on development and behavior. Often, a client is able to gain insight by recalling early memories, especially events before the age of 10. Adler (1931) con- tended that a person remembers childhood events that are consistent with his or her present view of self, others, and the world in general. Adlerian counselors look both for themes and specific details within these early recollections (Slavik, 1991; Statton & Wilborn, 1991; Watkins, 1985). Figures from the past are treated as prototypes rather than specific individuals. Recent and past dreams are also a part of lifestyle analysis. Adlerian theory holds that dreams are a possible rehearsal for future courses of action. Recurrent dreams are especially important. A look at the client’s priorities is helpful in understanding his or her style of life. A client may persist in one predominant lifestyle, such as always trying to please, unless challenged to change. Counselors next try to help clients develop insight, especially by asking open-ended ques- tions and making interpretations. Open-ended questions allow clients to explore patterns in their lives that have gone unnoticed. Interpretation often takes the form of intuitive guesses. The abil- ity to empathize is especially important in this process, for the counselor must be able to feel what it is like to be the client before zeroing in on the reasons for the client’s present behaviors. At other times, interpretations are based on the counselor’s general knowledge of ordinal posi- tion and family constellation. To foster behavioral change, the Adlerian counselor uses specific techniques: Confrontation. The counselor challenges clients to consider their own private logic. When clients examine this logic, they often realize they can change it and their behavior. Asking “the question.” The counselor asks, “What would be different if you were well?” Clients are often asked the question during the initial interview, but it is appropriate at any time.  Chapter 7 Psychoanalytic, Adlerian, and Humanistic Theories of Counseling 159 Encouragement. Encouragement implies faith in a person (Dinkmeyer & Losoncy, 1980; Dreikurs & Soltz, 1964). Counselors encourage their clients to feel good about themselves and others (Adler, 1931). They state their belief that behavior change is possi- ble for clients. Encouragement is the key to making productive lifestyle choices in learning and living. Acting “as if.” Clients are instructed to act “as if” they are the persons they want to be— for instance, the ideal persons they see in their dreams (Gold, 1979). Adler originally got the idea of acting “as if” from Hans Vaihinger (1911), who wrote that people create the worlds they live in by the assumptions they make about the world. Spitting in the client’s soup. A counselor points out certain behaviors to clients and thus ruins the payoff for the behavior. For example, a mother who always acts superior to her daughter by showing her up may continue to do so after the behavior has been pointed out, but the reward for doing so is now gone. Catching oneself. Clients learn to become aware of self-destructive behaviors or thoughts. At first, the counselor may help in the process, but eventually this responsibility is taken over by clients. Task setting. Clients initially set short-range, attainable goals and eventually work up to long-term, realistic objectives. Once clients make behavioral changes and realize some control over their lives, counseling ends. Push button. Clients are encouraged to realize they have choices about what stimuli in their lives they pay attention to. They are taught to create the feelings they want by concen- trating on their thoughts. The technique is like pushing a button because clients can choose to remember negative or positive experiences (Maniacci et al., 2014). STRENGTHS AND CONTRIBUTIONS. The Adlerian approach to counseling has a number of unique contributions and emphases: The approach fosters an equalitarian atmosphere through the positive techniques that counselors promote. Rapport and commitment are enhanced by its processes, and the chances for change are increased. Counselor encouragement and support are valued com- modities. Adlerian counselors approach their clients with an educational orientation and take an optimistic outlook on life. The approach is versatile over the life span. “Adlerian theorists have developed counsel- ing models for working with children, adolescents, parents, entire families, teacher groups, and other segments of society” (Purkey & Schmidt, 1987, p. 115). Play therapy for chil- dren ages 4 to 9 seems to be especially effective. The approach is useful in the treatment of a variety of disorders, including conduct disor- ders, antisocial disorders, anxiety disorders of childhood and adolescence, some affective disorders, and personality disorders (Seligman, 2004). The approach has contributed to other helping theories and to the public’s knowledge and understanding of human interactions. Many of Adler’s ideas have been integrated into other counseling approaches. The approach can be employed selectively in different cultural contexts (Brown, 1997). For instance, the concept of “encouragement” is appropriately emphasized in working with groups that have traditionally emphasized collaboration such as Hispanics and Asian Americans, whereas the concept “sibling rivalry” may be highlighted with traditional European North Americans who stress competition. 160 Part II Counseling Processes and Theories LIMITATIONS. Adlerian theory is limited in the following ways: The approach lacks a firm, supportive research base. Relatively few empirical studies clearly outline Adlerian counseling’s effectiveness. The approach is vague in regard to some of its terms and concepts. The approach may be too optimistic about human nature, especially social cooperation and interest. Some critics consider this view neglectful of other life dimensions, such as the power and place of the unconscious. The approach’s basic principles, such as a democratic family structure, may not fit well in working with clients whose cultural context stresses the idea of a lineal social relation- ship, such as with traditional Arab Americans (Brown, 1997). The approach, which relies heavily on verbal erudition, logic, and insight, may be lim- ited in its applicability to clients who are not intellectually bright (James & Gilliland, 2013). CASE EXAMPLE Ansley Acts “As If” Ansley had always been verbally aggressive. She had a sharp tongue and an exceptional vocabu- lary. She could put other girls in their place quickly. Thus, she was both admired and hated. On the suggestion of a friend, Ansley saw an Adlerian counselor. She liked the social emphasis that she learned, so she decided to change her ways. Ansley thought the quickest way to become the person she wanted to be was to act “as if.” Was Ansley naive to think that acting “as if” would help her become her ideal? From an Adlerian perspective, what else would you suggest she do or try? HUMANISTIC THEORIES The term humanistic, as a descriptor of counseling, focuses on the potential of individuals to actively choose and purposefully decide about matters related to themselves and their environ- ments. Professionals who embrace humanistic counseling approaches help people increase self- understanding through experiencing their feelings. The term is broad and encompasses counseling theories that are focused on people as decision makers and initiators of their own growth and development. Three of these theories are covered here: person-centered, existential, and Gestalt. Person-Centered Counseling FOUNDERS/DEVELOPERS. Carl Rogers (1902–1987) is the person most identified with person- centered counseling. Indeed, it was Rogers who first formulated the theory in the form of nondi- rective psychotherapy in his 1942 book, Counseling and Psychotherapy. The theory later evolved into client-centered and person-centered counseling with multiple applications to groups, fami- lies, and communities as well as individuals. VIEW OF HUMAN NATURE. Implicit in person-centered counseling is a particular view of human nature: People are essentially good (Rogers, 1961). Humans are characteristically  Chapter 7 Psychoanalytic, Adlerian, and Humanistic Theories of Counseling 161 “­ positive, forward-moving, constructive, realistic, and trustworthy” (Rogers, 1957, p. 199). Each person is aware, inner directed, and moving toward self-actualization from infancy on. According to Rogers, self-actualization is the most prevalent and motivating drive of exis- tence and encompasses actions that influence the total person. “The organism has one basic ten- dency and striving, to actualize, maintain, and enhance the experiencing organism” (Rogers, 1951, p. 487). Person-centered theorists believe that each person is capable of finding a personal meaning and purpose in life. Dysfunctionality is really a failure to learn and change (Bohart & Watson, 2011). Rogers views the individual from a phenomenological perspective: What is important is the person’s perception of reality rather than an event itself (Rogers, 1955). This way of seeing the person is similar to Adler’s. The concept of self is another idea that Rogers and Adler share. But for Rogers the concept is so central to his theory that his ideas are often referred to as self theory. The self is an outgrowth of what a person experiences, and an awareness of self helps a person differentiate himself or herself from others (Nye, 2000). For a healthy self to emerge, a person needs positive regard—love, warmth, care, respect, and acceptance. But in childhood, as well as later in life, a person often receives conditional regard from parents and others. Feelings of worth develop if the person behaves in certain ways because conditional acceptance teaches the person to feel valued only when conforming to oth- ers’ wishes. Thus, a person may have to deny or distort a perception when someone on whom the person depends for approval sees a situation differently. An individual who is caught in such a dilemma becomes aware of incongruities between self-perception and experience. If a person does not do as others wish, he or she will not be accepted and valued. Yet if a person conforms, he or she opens up a gap between the ideal self (what the person is striving to become) and the real self (what the person is). The further the ideal self is from the real self, the more alienated and maladjusted a person becomes. ROLE OF THE COUNSELOR. The counselor’s role is a holistic one. He or she sets up and pro- motes a climate in which the client is free and encouraged to explore all aspects of self (Rogers, 1951, 1980). This atmosphere focuses on the counselor–client relationship, which Rogers describes as one with a special “I-Thou” personal quality. The counselor is aware of the client’s verbal and nonverbal language, and the counselor reflects back what he or she is hearing or observing (Braaten, 1986). Neither the client nor the counselor knows what direction the ses- sions will take or what goals will emerge in the process. The client is a person in process who is “entitled to direct his or her own therapy” (Moon, 2007, p. 277). Thus, the counselor trusts the client to develop an agenda on which he or she wishes to work. The counselor’s job is to work as a facilitator rather than a director. In the person-centered approach, the counselor is the process expert and expert learner (of the client). Patience is essential (Miller, 1996). GOALS. The goals of person-centered counseling center around the client as a person, not his or her problem. Rogers (1977) emphasizes that people need to be assisted in learning how to cope with situations. One of the main ways to accomplish this is by helping a client become a fully functioning person who has no need to apply defense mechanisms to everyday experiences. Such an individual becomes increasingly willing to change and grow. He or she is more open to experience, more trusting of self-perception, and engaged in self-exploration and evaluation (Rogers, 1961). Furthermore, a fully functioning person develops a greater acceptance of self and others and becomes a better decision maker in the here and now. Ultimately, a client is helped to identify, use, and integrate his or her own resources and potential (Boy & Pine, 1983; Miller, 1996). 162 Part II Counseling Processes and Theories TECHNIQUES. For person-centered therapists, the quality of the counseling relationship is much more important than techniques (Glauser & Bozarth, 2001). Rogers (1957) believed there are three necessary and sufficient (i.e., core) conditions of counseling: 1. empathy, 2. unconditional positive regard (acceptance, prizing), and 3. congruence (genuineness, openness, authenticity, transparency). Empathy may be subjective, interpersonal, or objective (Clark, 2004; Rogers, 1964). “Subjective empathy enables a counselor to momentarily experience what it is like to be a cli- ent, interpersonal empathy relates to understanding a client’s phenomenological experiencing, and objective empathy uses reputable knowledge sources outside of a client’s frame of refer- ence” (Clark, 2010, p. 348). In therapeutic situations, empathy is primarily the counselor’s ability to feel with clients and convey this understanding back to them. This may be done in multiple ways but, essentially, empathy is an attempt to think with, rather than for or about, the client and to grasp the client’s communications, intentions, and meanings (Brammer et al., 1993; Clark, 2007; Moon, 2007). Rogers (1975) noted, “The research keeps piling up and it points strongly to the conclusion that a high degree of empathy in a relationship is possibly the most potent and certainly one of the most potent factors in bringing about change and learning” (p. 3). Unconditional positive regard, also known as acceptance, is a deep and genuine caring for the client as a person—that is, prizing the person just for being (Rogers, 1961, 1980). Congruence is the condition of being transparent in the therapeutic relationship by giving up roles and facades (Rogers, 1980). It is the “counselor’s readiness for setting aside concerns and personal preoccupations and for being available and open in relationship with the client” (Moon, 2007, p. 278). Since 1980, person-centered counselors have tried a number of other procedures for work- ing with clients, such as limited self-disclosure of feelings, thoughts, and values. Motivational interviewing (MI) has also grown out of the person-centered approach and has been used to help ambivalent clients more clearly assess their thoughts and feelings as they contemplate making changes. “Typically MI is differentiated from Rogers’s style in that MI is directive, attending to and reinforcing selective change talk regarding the presenting behavioral problem” (Mason, 2009, p. 357). At the heart of person-centered counseling, regardless of procedures, is that clients grow by experiencing themselves and others in relationships (Cormier, Nurius, & Osborn, 2017). Therefore, Rogers (1967) and person-centered counselors of today believe that “significant posi- tive personality change” cannot occur except in relationships (p. 73). Methods that help promote the counselor–client relationship include, but are not limited to, active and passive listening, accurate reflection of thoughts and feelings, clarification, summari- zation, confrontation, and general or open-ended leads. Questions are avoided whenever possi- ble (Tursi & Cochran, 2006). STRENGTHS AND CONTRIBUTIONS. Person-centered counseling’s unique aspects include the following: The approach revolutionized the counseling profession by linking counseling with psycho- therapy and demystifying it by making audiotapes of actual sessions and publishing actual transcripts of counseling sessions (Goodyear, 1987; Sommers-Flanagan, 2007).  Chapter 7 Psychoanalytic, Adlerian, and Humanistic Theories of Counseling 163 The person-centered approach to counseling is applicable to a wide range of human prob- lems, including institutional changes, labor–management relationships, leadership devel- opment, career decision making, and international diplomacy. For instance, Cornelius-White (2005) has found the person-centered approach can be effective in pro- moting multicultural counseling. Likewise, Lemoire and Chen (2005) have argued that “the person-centered approach seems to have the potential to create the necessary condi- tions that counteract stigmatization, allowing adolescents who are associated with a stig- matized sexual minority group to cope with their sexual identity in a manner that is more constructive for them” (p. 146). The approach has generated extensive research (Tursi & Cochran, 2006). It initially set the standard for doing research on counseling variables, especially those that Rogers (1957) deemed “necessary and sufficient” to bring about therapeutic change. The approach is effective in a number of settings. Person-centered counseling helps improve psychological adjustment, learning, and frustration tolerance and decrease defen- siveness. It is appropriate in treating mild to moderate anxiety states, adjustment disorders, and conditions not attributable to mental disorders, such as uncomplicated bereavement or interpersonal relations (Seligman, 2004). The person-centered approach may be especially helpful in working with clients who have experienced tragedies since it allows them “to struggle through emotions and actually become less affected in time by fully realizing feelings related to the tragedies” (Tursi & Cochran, 2006, p. 395). The approach focuses on the open and accepting relationship established by counselors and clients and the short-term nature of the helping process. The basics of the approach take a relatively short time to learn. With its emphasis on mas- tering listening skills, person-centered counseling is a foundation for training many para- professional helpers. Furthermore, it is the basis for several new and emerging approaches to treatment, and it is frequently combined with other theoretical orientations to counsel- ing such as cognitive and behavioral (Prochaska & Norcross, 2014; Seligman & Reichenberg, 2014). The approach has a positive view of human nature and it continues to evolve. LIMITATIONS. The limitations of person-centered theory are also noteworthy: The approach may be too simplistic, optimistic, leisurely, and unfocused for clients in cri- sis or who need more structure and direction (Seligman & Reichenberg, 2014; Tursi & Cochran, 2006). The approach depends on bright, insightful, hard-working clients for best results. It has limited applicability and is seldom employed with the severely disabled or young children (Henderson & Thompson, 2016). The approach ignores diagnosis, the unconscious, developmental theories, and innately generated sexual and aggressive drives. Many critics think it is overly optimistic. The approach deals only with surface issues and does not challenge the client to explore deeper areas. Because person-centered counseling is short term, it may not make a perma- nent impact on the person. The approach is more attitudinal than technique-based. It is void of specific techniques to bring about client change (Moon, 2007). 164 Part II Counseling Processes and Theories PERSONAL REFLECTION What do you find most appealing about the person-centered approach? Why? What do you find least appealing? Why? Existential Counseling FOUNDERS/DEVELOPERS. Rollo May (1909–1994) and Viktor Frankl (1905–1997) are two of the most influential professionals in the field of existential counseling. May dealt extensively with anxiety, especially in regard to his life and death struggle with tuberculosis, whereas Frankl, who was interred in Nazi concentration camps during World War II, focused on the meaning of life even under the most horrendous death camp conditions. VIEW OF HUMAN NATURE. “The existential approach disclaims the deterministic view of human nature and emphasizes the freedom that human beings have to choose what to make of their circumstances” (Fernando, 2007, p. 226). As a group, existentialists believe that people form their lives by the choices they make. Even in the worst situations, such as the Nazi death camps, there is an opportunity to make important life-and-death decisions, such as whether to struggle to stay alive (Frankl, 1969). Existentialists focus on this free will of choice and the action that goes with it. They view people as the authors of their lives. They contend that people are responsible for any decision in life they make and that some choices are healthier and more meaningful than others. According to Frankl (1962), the “meaning of life always changes but it never ceases to be” (p. 113). His theory, known as logotherapy, states that meaning goes beyond self-actualiza- tion and exists at three levels: (a) ultimate meanings (e.g., there is an order to the universe); (b) meaning of the moment; and (c) common, day-to-day meaning (Das, 1998). We can discover life’s meaning in three ways: 1. by doing a deed, that is, by achieving or accomplishing something, 2. by experiencing a value, such as a work of nature, culture, or love, and 3. by suffering, that is, by finding a proper attitude toward unalterable fate. Existentialists believe that psychopathology is a failure to make meaningful choices and maximize one’s potential (McIllroy, 1979). Choices may be avoided and potentials not realized because of the anxiety that is involved in action. Anxiety is often associated with paralysis, but May (1977) argues that normal anxiety may be healthy and motivational and can help people change. ROLE OF THE COUNSELOR. There are no uniform roles that existential counselors follow. Every client is considered unique. Therefore, counselors are sensitive to all aspects of their cli- ents’ character, “such as voice, posture, facial expression, even dress and apparently accidental movements of the body” (May, 1939, p. 101). Basically, counselors concentrate on being authentic with their clients and entering into deep and personal relationships with them. “The counselor strives to be with the client in the here-and-now, and to understand and experience the ongoing emotional and mental state of the client. In order to do this, the counselor needs to express his or her own feelings” (Fernando, 2007, p. 231). Therefore, it is not unusual for an existential counselor to share personal experiences with a client to deepen the relationship and help the client realize a shared humanness and struggle. Buhler and Allen (1972) suggest that  Chapter 7 Psychoanalytic, Adlerian, and Humanistic Theories of Counseling 165 existential counselors focus on person-to-person relationships that emphasize mutuality, whole- ness, and growth. Counselors who practice from Frankl’s logotherapy perspective are Socratic in engaging their clients in dialogue (Alex Vesley, June 3, 2011, personal communication). However, all existential counselors serve as a model of how to achieve individual potential and make decisions. They concentrate on helping the client experience subjective feelings, gain clearer self-understanding, and move toward the establishment of a new way of being in the world. The focus is living productively in the present, not recovering a personal past. They also focus on ultimate human concerns such as death, freedom, isolation, and meaninglessness (Yalom & Josselson, 2011). GOALS. The goals of existentialists include helping clients realize the importance of meaning, responsibility, awareness, freedom, and potential. Existentialists hope that during the course of counseling, clients will take more responsibility for their lives. “The aim of therapy is that the patient experience his existence as real” (May, Angel, & Ellenberger, 1958, p. 85). In the pro- cess, the client is freed from being an observer of events and becomes a shaper of meaningful personal activity and an embracer of personal values that lead to a meaningful lifestyle. TECHNIQUES. “Existential theory does not limit the counselor to specific techniques and inter- ventions” (Fernando, 2007, p. 230). The existential approach has fewer techniques available than almost any other model of counseling. Yet this apparent weakness (i.e., a lack of therapeutic tricks and psychological jargon) is paradoxically a strength because it allows existential counsel- ors to borrow ideas as well as use a wide range of personal and professional skills. “Approaching human beings merely in terms of techniques necessarily implies manipulating them,” and manip- ulation is opposed to what existentialists espouse (Frankl, 1967, p. 139). Thus, existentialists are free to use techniques as widely diversified as desensitization and free association or to disasso- ciate themselves from these practices entirely. For instance, Southwick, Gilmartin, Mcdonough, and Morrissey (2006) used logotherapy as part of a group educational treatment in working with chronic combat-related PTSD veterans by having those in the group focus on meaning combined with having them perform community service such as tutoring children and delivering Meals-on- Wheels. The result for the majority of the participants was an increase in selfless acts and more motivation for intentional living. The most effective and powerful technique existential counselors have is the relationship with the client. Ideally, the counselor transcends his or her own needs and focuses on the client. In the process, the counselor is open and self-revealing in an attempt to help the client become more in touch with personal feelings and experiences. The emphasis in the relationship is on authenticity, honesty, and spontaneity (Mendelowitz & Schneider, 2008). Existential counselors also make use of confrontation. Clients are confronted with the idea that everyone is responsible for his or her own life (Blair, 2004). Existential counselors borrow some techniques from other models of counseling such as the employment of awareness exer- cises, imagery, paradox, deflection, and goal-setting activities. STRENGTHS AND CONTRIBUTIONS. The existential approach to counseling has a number of strengths: The approach emphasizes the uniqueness of each individual and the importance of mean- ingfulness in their lives. It is a very humanistic way of working with others (Alex Vesley, June 3, 2011, personal communication). 166 Part II Counseling Processes and Theories The approach recognizes that anxiety is not necessarily a negative condition. Anxiety is a part of human life and can motivate some individuals to make healthy and productive deci- sions (Fernando, 2007). The approach gives counselors access to a tremendous amount of philosophy and literature that is both informative and enlightening about human nature (Mendelowitz & Schneider, 2008). The approach stresses continued human growth and development and offers hope to cli- ents through directed readings and therapeutic encounters with the counselor. The approach is effective in multicultural counseling situations because its global view of human existence allows counselors to focus on the person of the client in an “I-Thou” manner without regard to ethnic or social background (Epp, 1998; Jackson, 1987). The approach helps connect individuals to universal problems faced by humankind, such as the search for peace and the absence of caring (Baldwin, 1989). The approach may be combined with other perspectives and methods (such as those based on learning principles and behaviorism) to treat extremely difficult problems, such as addiction (Fernando, 2007). LIMITATIONS. Professionals who embrace different and more structured approaches have noted several limitations in the existential approach: The approach has not produced a fully developed model of counseling. Professionals who stress developmental stages of counseling are particularly vehement in this criticism. The approach lacks educational and training programs. Each practitioner is unique. Although uniqueness is valued, it prohibits the systematic teaching of theory. The approach is difficult to implement beyond an individual level because of its subjective nature. Existentialism lacks the type of methodology and validation processes prevalent in most other approaches. In short, it lacks the uniformity that beginning counselors can read- ily understand. The approach is closer to existential philosophy than to other theories of counseling. This distinction limits its usefulness in some cases. CASE EXAMPLE Ned’s Nothingness Ned was an existentialist who believed in nothingness. He did not think there was any meaning or logic to life and that those who took such a position were naive. His strong stance at times alienated him from others, but generally Ned was respected for his philosophical reasoning. One day, seeking support for his views, Ned called a local private practice group and made an appointment to see Jim, a counselor who had a reputation for being an existentialist. Ned expected Jim to discuss philosophy with him and to support his nihilism. Instead, Jim told Ned that he found great meaning every day in all that he did. Ned was surprised. How could Ned have been so inaccurate in his assessment of Jim? How could the gulf between Ned and Jim be broached constructively?  Chapter 7 Psychoanalytic, Adlerian, and Humanistic Theories of Counseling 167 Gestalt Therapy Gestalt therapy is associated with Gestalt psychology, a school of thought that stresses percep- tion of completeness and wholeness. The term gestalt means whole figure. Gestalt psychology and therapy arose as a reaction to the reductionist emphasis in other schools of psychology and counseling, such as psychoanalysis and behaviorism. Thus, Gestalt therapy emphasizes how people function in their totality. FOUNDERS/DEVELOPERS. Frederick (Fritz) Perls (1893–1970) is credited with establishing Gestalt therapy and popularizing it both through his flamboyant personality and his writings. Laura Perls (his wife) and Paul Goodman helped Perls develop and refine his original ideas. A number of other theorists, particularly Joen Fagan and Irma Lee Shepherd (1970), developed the model further. VIEW OF HUMAN NATURE. Gestaltists believe that human beings work for wholeness and completeness in life. Each person has a self-actualizing tendency that emerges through personal interaction with the environment and the beginning of self-awareness. Self-actualization is cen- tered in the present; it “is the process of being what one is and not a process of striving to become” (Kempler, 1973, p. 262). The Gestalt view of human nature places trust on the inner wisdom of people, much as person-centered counseling does. Each person seeks to live integra- tively and productively, striving to coordinate the various parts of the person into a healthy, uni- fied whole. From a Gestalt perspective, persons are more than a sum of their parts (Perls, 1969). The Gestalt view is antideterministic: Each person is able to change and become respon- sible (Hatcher & Himelsteint, 1997). Individuals are actors in the events around them, not just reactors to events. Overall, the Gestalt point of view takes a position that is existential, experien- tial, and phenomenological: The now is what really matters. One discovers different aspects of oneself through experience, not talk, and a person’s own assessment and interpretation of his or her life at a given moment in time are what is most important. According to Gestalt therapy, many troubled individuals have an overdependency on intel- lectual experience (Simkin, 1975). Such an emphasis diminishes the importance of emotions and the senses, limiting a person’s ability to respond to various situations. Another common problem is the inability to identify and resolve unfinished business—that is, earlier thoughts, feelings, and reactions that still affect personal functioning and interfere with living life in the present. The most typical unfinished business in life is not forgiving one’s parents for their mistakes. Gestaltists do not attribute either of these difficulties to any unconscious forces within persons. Rather, the focus is on awareness, the ability of the client to be in full mental and sensory contact of experiencing the now (James & Gilliland, 2013). Every person operates on some conscious level, from being very aware to being very unaware. Healthy individuals are those who are most aware. According to Gestaltists, a person may experience difficulty in several ways. First, he or she may lose contact with the environment and the resources in it. Second, the person may become overinvolved with the environment and out of touch with the self. Third, he or she may fail to put aside unfinished business. Fourth, he or she may become fragmented or scattered in many directions. Fifth, the person may experience conflict between the top dog (what one thinks one should do) and the underdog (what one wants to do). Finally, the person may have difficulty handling the dichotomies of life, such as love/hate, masculinity/femininity, and ­pleasure/pain. 168 Part II Counseling Processes and Theories PERSONAL REFLECTION Most people have gone to sleep at night sometime in their lives having not finished a task they started on, for example, homework, cleaning, car maintenance. How do you think counselors’ awareness of such times can increase their empathy for clients? How might it influence them otherwise? ROLE OF THE COUNSELOR. The role of the Gestalt counselor is to create an atmosphere that promotes a client’s exploration of what is needed to grow. The counselor provides such an atmo- sphere by being intensely and personally involved with clients and being honest. Polster and Polster (1973) stress that counselors must be exciting, energetic, and fully human. Involvement occurs in the now, which is a continuing process (Perls, 1969). The now often involves having the counselor help a client focus on blocking energy and using that energy in positive and adap- tive ways (Zinker, 1978). The now also entails the counselor’s helping the client recognize pat- terns in his or her life (Fagan, 1970). GOALS. The goals of Gestalt therapy are well defined. They include an emphasis on the here and now and a recognition of the immediacy of experience (Bankart, 1997). Further goals include a focus on both nonverbal and verbal expression, and a focus on the concept that life includes making choices (Fagan & Shepherd, 1970). The Gestalt approach concentrates on helping a client resolve the past to become integrated. This goal includes the completion of mentally growing up. It emphasizes the coalescence of the emotional, cognitive, and behavioral aspects of the person. A primary focus is the acceptance of polarities within the person (Gelso & Carter, 1985). As a group, Gestalt therapists emphasize action, pushing their clients to experience feel- ings and behaviors. They also stress the meaning of the word now. Perls (1969) developed a formula that expresses the word’s essence: “Now = experience = awareness = reality. The past is no more and the future not yet. Only the now exists” (p. 14). TECHNIQUES. Some of the most innovative counseling techniques ever developed are found in Gestalt therapy (Harman, 1997). These techniques take two forms: exercises and experiments. Exercises are ready-made techniques, such as the enactment of fantasies, role-playing, and psy- chodrama (Coven, 1977). They are employed to evoke a certain response from the client, such as anger or exploration. Experiments, on the other hand, are activities that grow out of the interac- tion between counselor and client. They are not planned, and what is learned is often a surprise to both the client and the counselor. Many of the techniques of Gestalt therapy take the form of unplanned experiments (Mann, 2010; Zinker, 1978). The concentration here, however, is on exercise-oriented counseling techniques. One common exercise is dream work. Perls describes dreams as messages that represent a person’s place at a certain time (Bernard, 1986). Unlike psychoanalysts, Gestalt counselors do not interpret. Rather, clients present dreams and are then directed to experience what it is like to be each part of the dream—a type of dramatized free association. In this way, a client can get more in touch with the multiple aspects of the self. Another effective technique is the empty chair (Figure 7.1). In this procedure, clients talk to the various parts of their personality, such as the part that is dominant and the part that is passive. An empty chair is the focus. A client may simply talk to the chair as a representative of  Chapter 7 Psychoanalytic, Adlerian, and Humanistic Theories of Counseling 169 FIGURE 7.1 The empty chair one part of the self, or the client may switch from chair to chair and have each chair represent a different part. In this dialogue, both rational and irrational parts of the client come into focus; the client not only sees these sides but also becomes able to deal with the dichotomies within the self. This method is not recommended for those who are severely emotionally disturbed (Bernard, 1986). One of the most powerful Gestalt exercises is confrontation. Counselors point out to a cli- ent incongruent behaviors and feelings, such as a client’s smiling when admitting to nervous- ness. Truly nervous people do not smile. Confrontation involves asking clients what and how questions. Why questions are avoided because they lead to intellectualization. Some other powerful Gestalt exercises that are individually oriented are often used in groups (Harman, 1997; Wheeler & Axelsson, 2015). Making the rounds. This exercise is employed when the counselor feels that a particu- lar theme or feeling expressed by a client should be faced by every person in the group. The client may say, for instance, “I can’t stand anyone.” The client is then instructed to say this sentence to each person in the group, adding some remarks about each group member. The rounds exercise is flexible and may include nonverbal and positive feelings, too. By participating in it, clients become more aware of inner feelings. I take responsibility. In this exercise, clients make statements about perceptions and close each statement with the phrase “and I take responsibility for it.” The exercise helps clients integrate and own perceptions and behaviors. Exaggeration. Clients accentuate unwitting movement or gestures. In doing so, the inner meaning of these behaviors becomes more apparent. 170 Part II Counseling Processes and Theories May I feed you a sentence? The counselor, who is aware that implicit attitudes or mes- sages are implied in what the client is saying, asks whether the client will say a certain sentence (provided by the counselor) that makes the client’s thoughts explicit. If the coun- selor is correct about the underlying message, the client will gain insight as the sentence is repeated. STRENGTHS AND CONTRIBUTIONS. Gestalt therapy strengths and contributions include the following: The approach emphasizes helping people incorporate and accept all aspects of life. An individual cannot be understood outside the context of a whole person who is choosing to act on the environment in the present. The approach helps a client focus on resolving areas of unfinished business. When a client is able to make these resolutions, life can be lived productively. The approach places primary emphasis on doing rather than talking. Activity helps indi- viduals experience what the process of change is about and make more rapid progress. The approach is flexible and not limited to a few techniques. Any activity that helps clients become more integrative can be employed in Gestalt therapy. The approach is appropriate for certain affective disorders, anxiety states, somatoform disorders, adjustment disorders, and DSM diagnoses such as occupational problem and interpersonal problem (Seligman, 2004). In short, Gestalt therapy is versatile. LIMITATIONS. Gestalt therapy also has some limitations: The approach lacks a strong theoretical base. Some critics view Gestalt counseling as all experience and technique—that is, as too gimmicky. They maintain that it is antitheoretical. The approach deals strictly with the now and how of experience (Perls, 1969). This two- pronged principle does not allow for passive insight and change, which some clients are more likely to use. The approach eschews diagnosis and testing. The approach is too concerned with individual development and is criticized for its self- centeredness. The focus is entirely on feeling and personal discovery. PERSONAL REFLECTION What is something in your life that is greater than the sum of its parts? How do you know this? Summary and Conclusion This chapter has examined variables associated with transtheoretical model of change and its relationship counseling, especially theory. It has specifically cov- to counseling were also highlighted. ered the nature of and importance of theory in coun- The bulk of the chapter, though, looked at seling and what qualities are associated with a good three orientations to counseling—psychoanalytic, theory. Furthermore, it has examined how theory Adlerian, and humanistic. There are some varia- works and how it can become practical and practiced tions in the practice of psychoanalytic and Adlerian such as in different forms of eclecticism. The counseling, but the core of these approaches  Chapter 7 Psychoanalytic, Adlerian, and Humanistic Theories of Counseling 171 remains basically the same regardless of what the founders/developers of the approach, aspects of the theories are emphasized. In the the theory’s view of human nature, humanistic orientation, however, there are three the role of the counselor, distinct theories: person-centered, existential, and therapeutic goals, Gestalt. Each of these theories, while helping and primary techniques, empowering clients to make choices and be in strengths/contributions, and touch with their feelings, differs significantly from limitations of the approach. the others. Therefore, the humanistic orientation to A summary of these theories can be found in counseling is more diverse than the psychoanalytic Appendix B. and Adlerian. Regardless, with each of the five counseling theories covered, a brief overview was given in a uniform manner on MyCounselingLab® for Introduction to Counseling Try the Topic 5 Assignments: Counseling Theory.  Behavioral, Cognitive, Systemic, Brief, 8 and Crisis Theories of Counseling Chapter Overview From this chapter you will learn about: Behavioral, cognitive– behavioral, systemic, and brief theories of counseling The strengths and limitations of each of the theories covered The distinct and universal nature of crisis counseling As you read consider: The role of the counselor in promoting each theory The major goals and most WavebreakMediaMicro/Fotolia frequently used techniques in each theory The differences and She stands similarities in linear versus leaning on his outstretched arm systems counseling sobbing awkwardly approaches Almost suspended between the air and his shoulder like a leaf being blown in the wind from a branch of a tree at the end of summer. He tries to give her comfort quietly offering up soft words and patting her head sporadically. “It’s okay,” he whispers realizing that as the words leave his mouth he is lying And that their life together has collapsed like the South Tower of the World Trade Center that killed their only son. Reprinted from “Reflections on Counseling After the Crisis,” by S. T. Gladding. In G. R. Walz & C. J. Kirkman (Eds.), (2002). Helping People Cope with Tragedy & Grief (p. 9). Greensboro, NC: CAPS Publication. © Samuel T. Gladding 172  Chapter 8 Behavioral, Cognitive, Systemic, Brief, and Crisis Theories of Counseling 173 This chapter covers a plethora of theories that are currently in vogue in counseling. These theories fall under five main orientations: behavioral counseling, cognitive counseling, systemic counseling, brief counseling, and crisis counseling. Within each orientation are several theoretical ways of working with clients that emphasize different aspects of the orientation. For this chapter, behavioral counseling will be treated as an entity even though those who are more cognitively based and professionals who are more action oriented also appear within this approach. Under cognitive counseling, rational emotive behavioral therapy (REBT), a theory that started out much more cognitive than it is today, will be described along with reality therapy (RT) and Aaron Beck’s cognitive therapy (CT). Sometimes these theories are described as cognitive–behavioral. Following this material is a presentation on systems and brief counseling approaches as well as a description of crisis theory and the unique ways it is used in counseling. In discussing all these theories, a uniform descriptive method will be used, as in the ­previous chapter. Specifically, the sections describing these theories will focus on founders/ developers, the view of human nature, the role of the counselor, goals, techniques, strengths and contributions, and limitations. BEHAVIORAL COUNSELING Behavioral theories of counseling focus on a broad range of client behaviors. Often, a person has difficulties because of a deficit or an excess of behavior. Counselors who take a behavioral approach seek to help clients learn new, appropriate ways of acting, or help them modify or eliminate excessive actions. In such cases, adaptive behaviors replace those that were maladap- tive, and the counselor functions as a learning specialist for the client (Krumboltz, 1966a). Also, “behavioral change opens doors to perceptual change” (Shadley, 2010, p.17). Behavioral counseling approaches are especially popular in institutional settings, such as mental hospitals or sheltered workshops. They are the approaches of choice in working with clients who have specific problems such as eating disorders, substance abuse, and psychosexual dysfunction. Behavioral approaches are also useful in addressing difficulties associated with anxiety, stress, assertiveness, parenting, and social interaction (Cormier, 2015; Seligman & Reichenberg, 2014). Behavioral Therapy FOUNDERS/DEVELOPERS. B. F. (Burrhus Frederick) Skinner (1904–1990) is the person most responsible for the popularization of behavioral treatment methods. Applied behavior analysis is a direct extension of Skinner’s (1953) radical behaviorism (Antony, 2014), which is based on operant conditioning. Other notables in the behavioral therapy camp are historical figures, such as Ivan Pavlov, John B. Watson, and Mary Cover Jones. Contemporary figures, such as Albert Bandura, John Krumboltz, Neil Jacobson, Steven Hayes, and Marsha Linehan, have also greatly added to this way of working with clients. VIEW OF HUMAN NATURE. Behaviorists, as a group, share the following ideas about human nature (Rimm & Cunningham, 1985; Seligman & Reichenberg, 2014): A concentration on behavioral processes—that is, processes closely associated with overt behavior (except for cognitive–behaviorists) A focus on the here and now as opposed to the then and there of behavior An assumption that all behavior is learned, whether it be adaptive or maladaptive 174 Part II Counseling Processes and Theories A belief that learning can be effective in changing maladaptive behavior A focus on setting up well-defined therapy goals with their clients A rejection of the idea