This assignment is a reflective essay on my own integrative counselling practice style. To start off with I will be identifying and evaluating characteristics of the therapeutic relationship when using an integrative or an eclectic approach. Next, I will be exploring and demonstrating practical integrative counselling skills. I will then be assessing multiple approaches within integrative counselling and their usefulness with various client groups. Finally, I will be reflecting on how knowledge of several counselling models helps an individual understand their self and their counselling practice.
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Since discovering my integrative counselling style, there are factors which I have learned to value such as; the therapeutic relationship, working relationship and picking suitable theories and approaches which cater to the client’s needs. Within integrative counselling the alliance between the therapist and their client is the key point for the therapeutic journey to start (Faris and Ooijen 2012). This factor needs to be appreciated and encouraged, this allows the client to feel safe which allow the journey to move forward (Faris and Ooijen 2012). Also, along the therapeutic journey the therapist can adapt their approach to the needs of the client (Faris and Ooijen 2012). This will allow the client to feel safe enough to express their feelings and further develop their understanding of the issue (Faris and Ooijen 2012).
There are many benefits working within an integrative approach, one of the benefits are a therapist can tailor the approach to suit various client groups (Faris and Ooijen 2012). For example, during skills practice if my client has negative automatic I will challenge them during the session, then if I were to suggest the client to do “homework” and they do not agree I could then use other techniques from other theories which I think are suitable for the client’s situation. It brings consideration to the therapist theoretical perspectives and allows them to integrate suitable models that work within their practice (Faris and Ooijen 2012). Finally, it allows the therapist to incorporate different modalities which provide the therapist choice to develop their practice as they progress within their professional development (Faris and Ooijen 2012).
Despite there being so many benefits there are some criticisms of using an integrative approach. one of the criticisms is the therapist could confuse the client by using a mixture of approaches and models (Faris and Ooijen 2012). Another criticism is that a therapist may integrate various different approaches however they don’t have sufficient knowledge about the ones they are using (Faris and Ooijen 2012). A major issue is integrative therapist becoming ‘Jack of all trades, and a master of none’ (Faris and Ooijen 2012). Finally, the therapist may pick theories and approaches they favour rather than choosing ones they feel will benefit the needs of the client (Faris and Ooijen 2012).
Pluralistic counselling is the “mutual involvement of patient and therapist in a helping relationship” (Tyron and Winogard 2002:109) The therapist will ensure they know what the client wants/needs from the sessions. This also links in with the four segments within counselling. Theoretical integration, assimilative integration, common factors and technical eclecticism (Short & Thomas 2015).
Within my current skills practice I tend to use the technical eclectic approach “the systematic use of techniques within an organising framework, but without necessary reference to the theories that gave rise with them” (Hollanders 1999:484). During the counselling session I pick various techniques which I think are beneficial for the client without having a theoretical explanation. However, when reflecting upon the session I then link the techniques to the theory and the approach. For example, if the client were to talk about their current emotions I would the person-centred approach and ensure core conditions are put into to place, so the client feels safe enough to talk about their feelings and experiences (Rogers 1957). On the other hand, if I was using psychodynamic approach I would be aware of factors such as is the client using any defence mechanisms or is there any transference or counter transference (Freud 1915). Also, if a client had negative thoughts about themselves I would use techniques from the cognitive behavioural approach and challenge the client’s negative thoughts (Beck 1967). The three main theories which I tend to integrate are Rogers’ Person-centred approach (1957), Freuds psychodynamic approach (1915) and Becks cognitive behavioural (1967)
The main idea of this the person-centred therapy is to help a client grow this is done by the therapist helping their client by decreasing the level of incongruence, increasing their self-worth and helping the client move towards becoming a fully functioning individual (Miller 2012). Rogers specified; “it is that the individual has within himself or herself vast resources for self-understanding, for altering his or her self-concept, attitudes and self-directed behaviour—and that these resources can be tapped if only a definable climate of facilitative psychological attitudes can be provided” (Rogers 1986).
Rogers (1959) considered the therapeutic relationship to be vital as it allows the client to discuss their feelings and allows them to be their real self. This allows the client to become a full functioning individual (Rogers 1959). The therapeutic relationship is “the ability of the client and the counsellor to work together purposefully to achieve agreed upon goals” (Greenson 1971).
I connect with rogers’ person-centred approach for example the core conditions (congruence, empathy and unconditional positive regards) (Rogers 1957) this is because during a practice skill session I opened up about my relationship with my father and how badly he treated me during my childhood and the person who was counselling me used empathy and unconditional regard. This was a tough subject for me because I don’t really like talking about my feelings but because the counsellor used the core conditions it allowed me to open up. Even though the counsellor knew me and it wasn’t a genuine counselling setting which caused incongruence. The trainee counsellor made me safe enough to talk about my situation.
However, there are some aspects of this theory which I don’t agree with. For example, with Rogers’ states for an individual to grow the only two factors that need to be in place are the core conditions and the therapeutic relationship needs to be valued (Rogers 1957). I agree with the idea that the core conditions need to be in place and the therapeutic relationship needs to be valued however I don’t agree with the idea that these are the only factors that are needed to help an individual grow towards becoming a fully functioning individual.
Also, Person centred approach tends to focus on the here and now (Rogers 1957). So, if I was just to use the person-centred approach the session would include the emotions the client is currently feeling and wouldn’t allow them to talk about past experiences. For example, if a client had a fear of buttons the person-centred approach would allow the client to have the space to talk about their fear without feeling judged. However, if I were to incorporate the psychodynamic approach the client could talk about past experiences and it allows the client to explore deeper about their fear by the therapist asking questions such as “can you remember a time where you weren’t scared of buttons?”. By the client talking about the past could help them unpick the fear and discover where it steamed from. On the other hand, if the client wanted to overcome their fear of buttons I could use cognitive behavioural theory. I would work with the client to overcome this fear. For example, I could use graded exposure therapy. Graded exposure therapy is a procedure that is slowly done over a period of time with the therapist to expose a client to some form of stress (Better Movement 2014). By the therapist doing this will hopefully make the client less reactive to the initial thing that caused them stress (Better Movement 2014).
Conditions of worth are “the terms on which one receives approval from significant others’ (Feltham and Dryden 1993: 34). I connect with the idea of the conditions of worth because I have experienced conditions throughout my life. For example, because I am the only child my family members and people within my culture expect me to do well and be a certain way because they believe as an only child my parents give me all their attention and spend their money on me, they expect me to get good grades, be a “good child” and not bring shame to my family. Due to this expectation I always would try and get the best grades and I avoid situations which I believe could bring shame to my family. This has had a negative impact on me as I put pressure on myself to be a certain way which have some aspects I dot agree with. By recognising this idea within my client’s I could help the clients overcome these expectations.
I have a similar view about psychodynamic, there are some aspects of Freud theory I don’t agree with. The main idea of the psychodynamic approach is to discover client’s unconscious emotions and drives that the client isn’t aware of (Boeree 2017). The conscious mind is the perceptions, memories, thought, fantasies and emotions (Boeree 2017). These are the factors the individual is aware of (Boeree 2017). The preconscious mind is the “available memory” (Boeree 2017). These are factors which can simply be brought into the conscious mind (Boeree 2017). Then there is the unconscious mind these are thoughts and feelings which the client isn’t aware of, these are factors such as drives and instincts (Boeree 2017).
Freud (1915) also developed the idea of the id, ego and superego (Boeree 2017). The Id is the only one out of the three drives which is existing from birth. The id is unconscious and primitive behaviours (Boeree 2017). Freud stated that the Id is the main factor of personality (Boeree 2017). The ego balances out the demands/desires of the id and the superego (Boeree 2017). It maintains the three levels of consciousness and is established within the 3 years of an individual’s birth (Boeree 2017). Finally, the superego it attempts to defeat the id’s urges and to make the ego idealistic. It works alongside the three levels of consciousness and is developed last (Boeree 2017). ‘Freud’s concept of the id (the biological component), the ego (the psychological component) and the superego (the social component) is simply a sort of map designed to clarify the nature of the personality’ (Seligman 2006:50).
I connect with the idea of the Id, ego and the superego because there have been some situations where I have experienced the conflict of these three personalities. This is how I like to imagine how this process works; the id being a car going at high speed, the ego is the law saying you have to drive at speed 30 on normal roads this is to ensure everyone around you is safe as well as yourself and finally the superego is a dual carriage way or a motor way this satisfies the id by allowing you to drive the car at a high speed for a long period of time.
Another idea Freud (1915) developed was the defence mechanisms. Defence mechanism are there to protect the ego (Boeree 2017). This is done by individual repressing impulses and making them more acceptable (Boeree 2017). The defence mechanisms include; denial, repression, regression, sublimation, intellectualization, displacement, projection, rationalization and reaction formation. I also connect with this idea, since learning the defence mechanisms I have learnt that I use displacement and regression. For example, if I have had a stressful day at university when I come back home I tend to take that frustration on my mum this is me displacing my feelings on to someone else. Sometimes if I don’t get I want to regress and start to moan and whinge like I would as a child this would be a form of regression.
Also, by learning about the defence mechanism will make me more cautious to recognise them within my client. I also feel it would be beneficial to teach this idea to my client to help them recognise them within their daily lives This is called psycho-education, is when the therapist teaches the theory to the client (Belmont Wellness 2018) By doing this the client can apply it within their life. It also allows the client to see the progression they have made (Belmont Wellness 2018).Another example is, if I were to teach my client the Maslow’s hierarchy of needs model within my session, over a period of time the client will be able to see how far they have moved up within the hierarchy if they have progressed (Maslow 1943).
Finally, Freud (1915) looked at was transference and counter transference. Transference are emotions, these can be sexual however a common form of transference is anger (Boeree 2017). For example, if a female client had a mother who was stern and controlling and they had a therapist who reminded them of their mother this may trigger the same response that they would feel towards their mother and project it on to the therapist (Boeree 2017). On the other hand, counter transference is when the therapist responds back emotionally to the client by shifting their emotions they feel for someone else onto their client (Boeree 2017). This is done unconsciously by the therapist (Boeree 2017). I like this idea because it will make me cautious not to counter transfer and notice if the client is transferring. If I ever do notice myself counter transferring I would have to mention this in supervision and try and find a solution.
Another theory I integrate is cognitive behavioural theory, Ellis (1957) and Beck (1967) are two known theorists within the cognitive behavioural approach. Ellis created the ABC model as he believes that a therapist should identified the negative automatic thoughts a client has and to challenge them (Ellis 1957). Beck suggested challenging the client in a subtle way whereas Ellis on the other hand has a harsher approach by challenging the irrational thoughts (Sanders 2002:25). Within the ABC each letter has a meaning, so the A is activating events, the B means for beliefs and the C is consequences (Beck 1967). Beck established a different approach; the main idea of the approach was to substitute negative thoughts with positive ones (Beck 1967). Ellis then established Rational Emotive Behavioural therapy within the ABC model he additional factors he put int were D meaning dispute and E meaning effect (Beck 1967).
I don’t connect with Ellis’ challenging approach as I feel it is too harsh. This is because when being taught his approach it seemed like it was as if the therapist is interrogating the client. I also felt by challenging the client’s negative thoughts in a harsh approach may be harmful for the client rather than beneficial. Rather than normalising the client’s feelings and working through them together I felt as if using this approach may make the client feel bad about how they feel and rather than opening up they may refrain from expressing their feelings. Whereas with Becks model it is more subtle which I think makes the client think about the thoughts rather than feeling guilty about having them thoughts. However, I connect with the idea of replacing the negative automatic thoughts with positive thoughts. By doing this I feel as if it would increase the client’s self-esteem and think better about themselves.
By using integrative counselling approach within my practice will allow me to work with various client groups. If I were to use one approach this would be unfair and can be maleficent towards the client as you are using assuming that one approach would be useful for all the issues the client may talk about. By using an integrative approach will allow me to use suitable theories and approaches as well as being confident enough to cater to what the clients wants and needs.
Overall, I still feel as if I am still discovering what style of practice I use. I have some idea of what it is however I still am unsure. There are some theories and approaches I connect with and other I don’t connect with. As I further develop my knowledge I will get a better understanding of my personal approach. As of now, I feel as if I have an eclectic approach which takes techniques from all of the main theories however, I use them very loosely and currently I have not got a solid foundation that I work from.
References
Beck, A. T. (1967). Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press.
Better Movement (2014) Graded exposure [Online] Available at http://https://www.bettermovement.org/blog/2014/graded-exposure [Accessed 23/10/18]
Boeree, G. (2017) Personality Theories: From Freud to Frankl [Online]. Pennsylvania: CreateSpace. Available at http://social-psychology.de/do/pt_freud [Accessed 23/10/18].
Belmont Wellness (2018) Psychoeducation for the Therapist [Online] Available at http://https://belmontwellness.com/for-mental-health-professionals/psychoeducation-therapist/ [Accessed 23/10/18]
Dryden, c. and Feltham, w. (1983). Dictionary of Counselling. 1st ed. London.
Freud, S. (1915). The unconscious. SE, 14: 159-204.
Faris, A. and Ooijen, E. (2012). Integrative counselling & psychotherapy. London: SAGE.
Greenson, R. (1971). The real relationship between the patient and the psychoanalyst. In M. Kanzer (ed.), The Unconscious Today (pp. 213-232). New York: International Universities Press.
Hollanders, H. (1999) ‘Eclecticism and Integration in Counselling: Implications for Training’. British Journal of Guidance and Counselling, 27(4). 483.
Maslow, A.H. (1943). “A theory of human motivation”. Psychological Review. 50 (4): 370–96
Miller, A. (2012). Instructor’s Manual for Carl Rogers on Person-Centered Therapy. [ebook] Mill Valley, CA: Psychotherapy.net. Available at: http://www.psychotherapy.net/data/uploads/5110340dadcda.pdf [Accessed 21 Oct. 2018].
Rogers, Carl R. (1957). “The necessary and sufficient conditions of therapeutic personality change”. Journal of Consulting Psychology. 21 (2): 95–103
Rogers, C. (1959). A Theory of Therapy, Personality and Interpersonal Relationships as Developed in the Client-centred Framework. In (ed.) S. Koch, Psychology: A Study of a Science. Vol. 3: Formulations of the Person and the Social Context. New York: McGraw Hill.
Rogers, C. (1986). Carl Rogers on the Development of the Person-Centred Approach. Person-Centred Review, 1(3), 257-259.
Sanders, p. (2002) First steps in counselling. 3rd edn. Ross-on-Wye: PCCS Books Ltd.
Seligman, L. (2006). Theories of cou3nselling and psychotherapy: Systems, strategies, and skills. (2nd ed.). Upper Saddle River, New Jersey: Pearson Education, Ltd.
Short, F., Thomas, P. (2015). Core Approaches in Counselling and Psychotherapy. London: Routledge
Tryon, G. S., & Winograd, G. (2002). Goal consensus and collab- oration. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions to patients (pp. 109–125). New York: Oxford
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