Authentic Counselling Training
Diploma in Counselling
[Under construction: 12 September 2005]
Combining Counselling Approaches
Whilst there are many ways that are not therapeutic, some even destructive, for two people to be in relationship, counselling is an umbrella term for ways in which one person (the counsellor/therapist) can be in relationship with another person (the client) that is intended to be therapeutic for the client. Over the past century practitioners such as Freud, Jung, Klein, Assagioli, Rogers, Kelly, Ellis, Berne, Perls and May, to name but a few, have each discovered unique ways for a therapist to be in relationship with a client that tend to be therapeutic for the client. These different ways to be in a therapeutic relationship exhibit obvious distinctions, for instance whilst one way may involve a client using a black-coloured couch, while the therapist, taking notes, is sitting on a chair out of sight of the client, another way has the client and counsellor sitting face to face on easy chairs; in one approach the counsellor may use subceived feelings to empathise deeply with the client, whereas in another the skilled helper may action plan with the client about locating a potential future life-partner. These are examples of the ‘doing’ ways of being in relationship. Just beneath the surface of this practical level lie theoretical ideas about how these different ways of being in relationship are therapeutic. A part of this theory level is made up of responses to questions such as the following:
o What is it to be human? What is it to be less than human?
o What is it to be a person? What is it to be less than a person?
o What is it for a person to be fully functioning? What is it for a person to be less than fully functioning?
o What antecedent / current circumstances may be implicated in a person to being/becoming less than fully functioning?
o What, if anything, can be done to help a person who is less than fully functioning to become fully functioning?
o What features identify as suitable for counselling a person who is less than fully functioning?
o What abilities and qualities are required of the counsellor?
From responses to such questions, a theoretical framework for a therapeutic approach can be construed. For example, the theoretical framework of the person-centred approach consists, amongst other concepts, of: an organismic self, a concept of the self, and differentiation between the two; the role played in personality formation by conditions of worth, and how these conditions were imposed; the actualising tendency and its role in personal growth; seven stages of process, and the effect on a client of a therapeutic relationship. Each counselling model has its own unique theoretical framework.
Considered more carefully, the first two pairs of questions, above (What is it to be human? What is it to be less than human? What is it to be a person? What is it to be less than a person?), are more philosophical than theoretical, for which answers are necessary in order to be able to respond to the third pair of questions. Lying beneath the theoretical level, therefore, are philosophical footings on which rest all the overlying theory and practice. Sometimes this philosophical foundation is explicit, Carl Rogers’ nineteen propositions being an example. Often the philosophical base of a counselling approach is implicit. Regardless, this philosophical foundation derives from several sources, including, obviously, responses to some of the questions pinpointed above. Some models of therapy rest on an overtly Christian base, whereas others are humanistic, and still others more medical. Some counselling models see human beings as animals, and therefore focus on reward, aversion and conditioning; whereas other models see human beings as complex, sophisticated animals, with hidden depths in which strange and difficult material lurks, and with hidden controlling drives to be kept in check; still other models see people as masters of their own destiny, with free will. It is helpful to realise that all models of therapy are created in a time and place. The patriarchal, expert-led, medicalised model of therapy formulated by Sigmund Freud was as much of its time and place as the expressive, creative client-centred approach formulated in the 1960s by Natalie Rogers. (It can only be speculated about what model of therapy might have been devised during the reign of Genghis Khan.) In addition to being people of their time, Freud and Rogers (as examples) each had their own personal beliefs and value systems, their own personal philosophy about people, life, the world, the universe (“Who am I? Why am I here? Why is anyone here? What is the meaning of life?”). For example, much is always made of the fact that Carl Rogers spent many of his formative years living on a farm, assuming that his personal philosophy was influenced by seeing nature burgeoning around him. A further influence on the philosophical base of a counselling approach is its adherence to, or reaction against, a prevailing model. For example, whilst the respective models of Klein, Winnicot and Berne can be viewed as developing but adhering to the work of Freud, the respective models proposed by Assagioli (transpersonal: psychosynthesis), Rogers (humanistic: client-centred) and Skinner (behavioural) can be seen as a reaction against the work of Freud. In summary, there are many influences on the respective philosophies that underlie each counselling model.
Counselling models tend to live in families, clustering around several aspects of their philosophical base that are held common. For instance, both client-centred therapy and gestalt therapy (amongst many others) hold that a person’s reality springs directly from that person’s unique phenomenological experience; both Freudian psychoanalysis and Jungian psychoanalysis hold that people are subject to irrational drives and motivations beyond their awareness.
The formulation and development of a new counselling model involves substantial interaction between the philosophical (environment, place, time, therapist, etc.), theoretical ideas (some novel and others derived from other counselling models or even from other disciplines) and therapeutic practice (what takes place in the counselling room). When Carl Rogers was formulating his client-centred therapy, he allowed practice and theory constantly to interact and to change each other. He worked out some of the underlying philosophy (19 propositions), and allowed this philosophy to impact on the emerging model as a whole.
A counselling model needs to be internally consistent, both horizontally and vertically. This means both that neither aspects of its philosophy, nor aspects of its theory, nor aspects of its practice should be self-contradictory, and also that there should be no contradictions between philosophy, theory and practice. An example of vertical internal consistency is taken from Carl Rogers’ client-centred model, in which it is held that all people have at work inside themselves a tendency towards self-actualisation (philosophical), and that in order for the process of self-actualisation to take place the actualising tendency should be allowed to express itself in whatever way it can (theoretical), and therefore that the counsellor should be non-directive of the client’s disclosure (practice). An example of horizontal internal consistency (at the practice level) is taken from the rational emotive approach devised by Albert Ellis, in which the client, whilst always treated with courtesy, is consistently challenged when they make statements that show evidence of faulty thinking, shown the way in which their thinking is faulty, and offered healthy ways to think and behave. It is not easy to give examples of internal inconsistency within tried and tested therapeutic models, for such a model is unlikely to have survived in use for long. However, it is possible to imagine an example of poor quality counselling practice manifesting horizontal internal inconsistency at the level of practice. For example, it would be internally inconsistent were a psychodynamic counsellor to attribute their own feelings in a counselling relationship variously as counter-transference (feelings arising in the counsellor in reaction to a client’s transferential material) and subceived empathy (feelings arising in the counsellor that, although unexpressed by the client, and possibly even beyond the immediate awareness of the client, all the same belong to the client), for counter-transference and subceived empathy (as well as belonging to different counselling models) are mutually exclusive.
From time to time an experienced therapist decides that s/he likes some, but not all, aspects of one counselling model, and other aspects, but not all, of another counselling model. For example, Gerard Egan decided that he liked the relationship-building practices of the person-centred approach, and some of the challenging practices of cognitive approaches, and the getting-into-action practices of behavioural approaches. Egan carefully stitched together a model consisting of the most useful (in his view) practices of several different approaches, and constructed a stage model of counselling in which the different approaches are utilised at different stages in the counselling relationship. Egan was not overly concerned about theoretical or philosophical consistency, preferring to rely on the efficacy of the skilled helper model to achieve what he intended it achieve. Practitioners of this model are encouraged to select and use skills and techniques specific to the stage of the counselling relationship. Egan termed this type of selection by the counsellor of skills and techniques ‘systematic eclecticism’. Sue Culley devised an approach she called (confusingly in the context of this document) the ‘integrative skills’ approach. Like Egan’s skilled helper model, Culley’s integrative skills model is also a stage model, but is less rigid and prescribed than Egan’s model. Egan distinguished systematic eclecticism from what he termed ‘random eclecticism’, in which the counsellor has a broad smorgasbord of skills and techniques at his/her disposal and makes use of any of them as s/he sees fit. This approach is also sometimes referred to as the toolbox approach, or the bag of magic tricks, and may appeal particularly to the less experienced counsellor. The counselling approach of such a counsellor may be broadly based within, say, the client-centred approach, but when they get a bit stuck they do some empty chair work (a practice borrowed from gestalt) or some stone work (imagery) or challenge some faulty thinking by the client. There is, however, no guarantee that using a hotchpotch of whatever skills and techniques come to hand will result in a therapeutic experience for the client. What unites all eclectic practice, whether systematic or random, is the absence of vertical consistency: there is no underlying uniting theory, and the philosophy on which such approaches are based may be shown to have multiple internal inconsistencies.
From the foregoing it might be assumed, therefore, that the only valid way to counsel is to follow consistently one approach, and not to mix up counselling models. Two features oppose this assumption. First, whilst there are now held to be in excess of two hundred different counselling approaches, and double that number of variations, counselling models rarely remain static. The adherents of an approach are quite likely to develop the model, for instance to be more widely applicable, to incorporate new ideas, or to change their proximity to other models. One type of example is the combining of two or more approaches: a process called integration. Unlike the eclectic process, integration involves attempting to unite two or more models not only in terms of practice, but also at a theoretical and a philosophical level. An example of the collision of two models to create a new model is the formation of cognitive behavioural therapy from a cognitive model and a behaviourist model. Another example is the broad thrust of the approach used by some drug and alcohol counselling services (such as NECA: North East Council on Addictions) which is a combination of Miller’s motivational interviewing model and the cycle of change model proposed by Prochaska and DiClemtente. When two or more counselling approaches are carefully and thoughtfully integrated in this way, not only is the resulting experience is likely to be therapeutic for the client, but its consistent application permits assessment of the strengths of the newly created model, its limits of validity, and how successful it really is.
The second feature opposing the assumption that the only valid way to counsel is to follow consistently one approach is that the only person who fully holds the philosophical position of any particular counselling approach is the person who devised it. The only person who fully held the philosophical position underlying Carl Rogers’ client-centred approach was Carl Rogers. Every subsequent client-centred writer has developed a post-Rogerian client-centred model in ways that are consistent with their own (albeit similar) respective philosophical position. The resulting differences can be seen both in terms of variation in emphasis on specific values and the inclusion of further concepts, and also in their practice. An example of variation in emphasis is that whilst Carl Rogers (as shown in such films as Gloria, Cathy and The Right to be Desperate) placed considerable value on expressing to the client material that is within the client’s immediate awareness, some more recent writers have given emphasis to working at the edge of the client’s awareness; Mearns and Thorne (for example) present an empathy scale suggesting that working at empathic depth is of greater value than attempting to match the client’s depth of understanding. An example of the inclusion of further concepts is the development, by Dave Mearns, of ‘configurations of self’, which may be thought of as a person-centred presentation of sub-personalities. Although Roberto Assagioli was working on his psychosynthetic approach, for which the concept of sub-personalities is of significance, for many of the years during which Carl Rogers was working on his client-centred approach, Rogers never developed such a concept. Dave Mearns, however, not only holds a concept of ‘configurations of self’, but has also integrated the concept into his theoretical understanding, assured himself that it remains consistent with his philosophical understanding, and worked out how to integrate this concept into his practice in ways that are consistent with the ways in which he works with a client. In being true to his own theoretical understanding, Mearns has, in effect, been able to integrate a concept from one successful counselling approach into another successful counselling approach.
The final step in this exploration of integration as a way of combining counselling models is to recognise that all counsellors, not just counselling writers, are able to integrate material from one counselling approach into another counselling approach. In order to develop as a counsellor, it may be that each counsellor needs to examine their own philosophical assumptions, their own theoretical conceptualisation, and their own practice preferences. If a person-centred counsellor holds strongly a concept of ‘unfinished business’, a popular way of describing the key gestalt concept of an incomplete or interrupted gestalt, then somehow or other the counsellor needs to establish how this concept fits consistently into a broader theoretical understanding, what the philosophical implications are of this inclusion, and how this concept can be worked with in the otherwise person-centred counselling room. It would be possible to imagine the counsellor wishing to effect a more wholesale integration of a person-centred approach with a gestalt approach. This is partly because these two approaches share in common many aspects of their philosophy, and partly because there are relatively few philosophical contradictions between the two approaches. In contrast, were a counsellor trained in the person-centred approach to discover through an examination of their personal philosophical foundation that they believe that, in general, a person’s motivation, rather than being self-actualising, is in fact determined and controlled by needs and drives hidden in their unconscious mind; that personal dysfunction arises not from the imposition of conditions of worth but from arrested psycho-sexual development; and that a person’s relationships, rather than being open to a warm and genuine encounter, show, to a greater or lesser extent, evidence of the unconscious application of past significant relationships, then that counsellor, although trained in the person-centred approach, may feel more at home in the psychodynamic approach. In this instance there is little need for wholesale integration, and every need for the counsellor to train in the practice of psychodynamic counselling.
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