Tag Archives: Counseling

On Becoming a Counselor: What’s a Rogerian, Anyway? by Lauren Leslie

carl-rogers

IMHO, more people should read Carl Rogers. But I understand, sometimes there just isn’t enough time in the day to fit in your Yoga class, mindfulness meditation practice, cardio workout, meal prep, work and family-life, and other responsibilities. So here’s an option: Below you’ll find a review of a classic Carl Rogers work: On Becoming a Person. It was written by Lauren Leslie to fulfill an assignment I give in our Counseling Theories class. It’s a fun read and gives you an abbreviated glimpse of the amazing Carl Rogers from the perspective of a first-year graduate student in clinical mental health counseling.

On Becoming a Counselor: What’s a Rogerian, Anyway?

Lauren Leslie
University of Montana

            Carl Rogers’ On Becoming a Person is a collection of essays and edited speeches written between 1951 and 1961, while client-centered humanistic therapy was being simultaneously embraced and challenged by the establishment. Rogers states he intends to write to professional psychologists, members of the counseling profession, and informed laymen, different populations who nonetheless have at least one thing in common:

. . .while the group to which this book speaks meaningfully will…have many wide-ranging interests, a common thread may well be their concern about the person and his  becoming, in a modern world which appears intent upon ignoring or diminishing him. (Rogers, 2012, “To the Reader” para. 8)

Throughout the text, Rogers offers a picture of himself as a person and a therapist. He provides insights into the growth of his theoretical framework as well as therapy transcripts to flesh out central elements of client-centered practice. Ultimately, the text crystallizes the effectiveness of empathy, congruence, and unconditional positive regard within a therapeutic relationship, and it is difficult to argue against Rogers’ persuasive and clear writing. Critics insist Rogers’ model is incomplete or insufficient, but the core tenets remain central to the practice of contemporary psychotherapy.

On Becoming a Person collects texts of varying genres into a sort of holistic catalog of Rogerian thought. Due to this variety of genre, Rogers’ tone and subject matter shifts; he addresses his own personality and life, includes transcripts of counseling sessions, and tries to systematize examples of his practice into stages of client development to analyze effectiveness of treatment. Rogers philosophizes on the human condition and therapeutic practice, Kierkegaard and Buber, and scientific research and personal change. It is a sweeping book which attempts meaningful understanding and data-driven conclusions. At one point, Rogers claims “There is no general agreement as to what constitutes ‘success’ [in psychotherapy]…. The concept of ‘cure’ is entirely inappropriate, since … we are dealing with learned behavior, not with a disease” (Rogers, 2012, p. 227). He consistently moves in opposition to the kind of concrete, experimental thinking favored in certain parts of the psychological community and comes off far more as a philosopher studying existential questions than as a data-driven scientist.

In considering himself, Rogers (2012) states, a client “discovers how much of his life is guided by what he thinks he should be, not by what he is. Often he discovers that he exists only in response to the demands of others…” (p. 109). In the same passage, he muses on the insight of Kierkegaard on this point: “He points out that…the deepest form of despair is to choose ‘to be another than himself.’ On the other hand, ‘…to be that self which one truly is, is indeed the opposite of despair,’” (p. 109). If this isn’t existential philosophy, the reader must ask, what is? In his own practice, Rogers (2012) characterizes a fundamental shift from “How can I treat, or cure, or change this person?” (p. 32) to his later, fuller question “How can I provide a relationship which this person may use for his own personal growth?” (p. 32). From his training in psychology, Rogers claims to have followed his own instincts into client-centered therapy. His writing overtly embraces that exploration.

Despite his philosophical bent, in large sections of his writing, Rogers draws on established scientific structures or language. He writes a whole chapter which tries to formulate a “general law of interpersonal relationships,” then launches into a lengthy and example-laden consideration of the firmness of knowledge and conclusions within the behavioral sciences at the time. His cognitive resting place seems to be that the behavioral sciences are in their infancy, and while practitioners may rely on a lot of interesting information now being discovered, exploration, philosophy, and instinct still hold places of honor within the field. More than fifty years after the book’s first publication, the situation seems to have changed very little, though there is more data in certain areas. Though Rogers seems to have viewed psychotherapy as a scientific practice, his person-centered view showed him countless variables with which to contend. Perhaps in an environment without controls, philosophy and instinct present better-formed or more immediate solutions than experimentation can.

Rogers seems to boil complex situations down to essentials wherever he can: relationship is his central theme, and empathy, congruence, and unconditional positive regard are the three relationship components. This pursuit of simplicity may be attentiveness to the broad audience of On Becoming a Person or may be indicative of Rogers’ own worldview. Whatever its source, it leaves Rogers open to criticism from those who see things as unsimplifiable. In a similar way, the individual variation and client focus implicit in Rogers’ therapy leave him open to criticism from those who see him acting only as a clarifying mirror for clients, not as a truly congruent party to change-spurring relationships. In one example of a common critique, Ralph H. Quinn (1993) contends that “[a] fully person-centered therapist…would feel compelled to stay with the client’s lead…[and] trust that the client knows best” (p. 20) rather than confronting the client in a moment of genuine human response.

Genuineness in psychotherapy…does not mean simply the willingness to confront a client…. More than anything it means that the therapist must strive to be fully present with the client, to bring all of himself or herself to the therapeutic relationship. As therapists, we must be willing to risk as much as we ask our clients to risk, to be as transparent and courageous as they must be, if the therapy is to produce real life change. (Quinn, 1993, p. 20-21)

This section includes the assertion that bold congruence and full presence are not already parts of person-centered therapy, and Rogers was remiss in not addressing them. Quinn (1993) later implies a fully person-centered approach can easily be seen as practicing “Pollyannish optimism and therapeutic passivity” (p. 21). Such criticism is valid enough, and points out elements of Rogers’ work that may be over-simplified. However, the complexity with which Rogers addresses each essay, idea, and client interaction suggests he did not see humanity or psychotherapy as simple, and did not approach them passively. Rogers may not have dwelled enough in his writing on the practice of congruence; perhaps it was an element that seemed also to contain infinite variables and defy simple definition. I tend to think this criticism stems from a misinterpretation of Rogers’ intentions and practices. In the final analysis, even critic Quinn (1993) only suggests practicing more (riskier?) congruence on the part of the therapist, not abandoning Rogers’ principles.

In terms of my own use of this book, its variety in tone and subject matter makes it a uniquely useful text. Each section and each essay can be read independently, and dipping into Rogers’ world is a clarifying and centering experience that could bring me back to the core of therapeutic practice in times of questioning and uncertainty. Reading this book now gave me a window into the complexities inherent in a model that can be seen as very simple (by Rogers’ design, admittedly). Considering this approach in my own attempts to define or grasp client “distress” has been helpful in placing myself in the wide world of this human-helping profession, and has helped me frame my own conception of what I am doing here and what a client might want or need from me in this role. This reading has been one new way of incorporating personal change into myself: deliberately approaching the self I am discovering myself to be.

 

References

Quinn, R.H. (1993). Confronting Carl Rogers: A developmental-interactional approach to

person-centered therapy. Journal of Humanistic Psychology, 33(1), 6-23. doi:

10.1177/0022167893331002

Rogers, C. (2012). On Becoming a Person. [Kindle Voyage version]. Retrieved from

Amazon.com

The 6th Edition of Clinical Interviewing is Now Available

Way back in 1990, a university book salesman came by my faculty office at the University of Portland. He was trying to sell me some textbooks. When I balked at what he was offering, he asked, “Do you have any textbook ideas of your own?” I said something like, “Sure” or “As a matter of fact, I do.” He handed me his card and a paper copy of Allyn & Bacon’s proposal guidelines.

Not having ever written a book, I never thought they’d accept my proposal.

They did. But after three years, A & B dropped our text.

Lucky for us.

Two  years later, Rita and I decided to try to resurrect our Clinical Interviewing text. We polished up a proposal, sent it out to three excellent publishers, and immediately got contract offers from W. W. Norton, Guilford, and John Wiley & Sons.

We went with Wiley.

Here we are 18 years later in the 6th edition. It’s been fun and a ton of work. Over the past five years we’ve started recording video clips and interviewing demonstrations to go along with the text. For the 6th edition, we got some pretty fantastic reviews from some pretty fancy (and fantastic) people. Here they are:

“I’m a huge admirer of the authors’ excellent work.  This book reflects their considerable clinical experience and provides great content, engaging writing, and enduring wisdom.”
John C. Norcross, Ph.D., ABPP, Distinguished Professor of Psychology, University of Scranton

“The most recent edition of Clinical Interviewing is simply outstanding.  It not only provides a complete skeletal outline of the interview process in sequential fashion, but fleshes out numerous suggestions, examples, and guidelines in conducting successful and therapeutic interviews.  Well-grounded in the theory, research and practice of clinical relationships, John and Rita Sommers-Flanagan bring to life for readers the real clinical challenges confronting beginning mental health trainees and professionals.  Not only do the authors provide a clear and conceptual description of the interview process from beginning to end, but they identify important areas of required mastery (suicide assessment, mental status exams, diagnosis and treatment electronic interviewing, and work with special populations).  Especially impressive is the authors’ ability to integrate cultural competence and cultural humility in the interview process.  Few texts on interview skills cover so thoroughly the need to attend to cultural dimensions of work with diverse clients.  This is an awesome book written in an engaging and interesting manner.  I plan to use this text in my own course on advanced professional issues.  Kudos to the authors for producing such a valuable text.”
—Derald Wing Sue, Ph.D., Professor of Psychology and Education, Teachers College, Columbia University

“This 6th edition of Clinical Interviewing is everything we’ve come to expect from the Sommers-Flanagan team, and more!  Readers will find all the essential information needed to conduct a clinical interview, presented in a clear, straightforward, and engaging style.  The infusion of multicultural sensitivity and humility prepares the budding clinician not only for contemporary practice, but well into the future.  Notable strengths of the book are its careful attention to ethical practice and counselor self-care. The case studies obviously are grounded in the authors’ extensive experience and bring to life the complexities of clinical interviewing.  This is a ‘must-have’ resource that belongs on the bookshelf of every mental health counselor trainee and practitioner.”
Barbara Herlihy, PhD. NCC, LPC-S, University Research Professor, Counselor Education Program, University of New Orleans

You can check out the text on Amazon https://www.amazon.com/Clinical-Interviewing-John-Sommers-Flanagan/dp/1119215587/ref=dp_ob_title_bk  or Wiley http://www.wiley.com/WileyCDA/WileyTitle/productCd-1119215587.html  or other major (and minor) booksellers.

 

 

The Practically Perfect Parenting Podcast — Episode 2

Hello Parents, Fans of Parents, and Fans of Healthy Child Development:

I need a tiny bit of your time and help.

As you know, the Practically Perfect Parenting Podcast was launched on October 31. Yesterday, Episode 2 became live. The title: Practically Perfect Positive Discipline. Today, I’m flexing my marketing muscles (which, as it turns out, are disappointingly more like Gilligan’s than the Incredible Hulk)

Podcasts are a competitive media genre. One way we can try to improve our status from way out here in little Missoula, Montana is for people to listen, like, and rate.

Here’s how you can help:

If you use iTunes, here’s the link. https://itunes.apple.com/us/podcast/practically-perfect-parenting/id1170841304?mt=2#episodeGuid=2d80f23353e2c7f9d21af865f190d2c4

Please check it out and if you like it, like it, and then give it the rating you think it deserves. We’re trying to get enough ratings to climb up the iTunes rating list.

If you don’t use iTunes, you can get to our podcasts via this link: http://practicallyperfectparenting.libsyn.com/2016

And, either way, we’d love it if you’d like our Facebook page. To do that, go here: https://www.facebook.com/Practically-Perfect-Parenting-Podcast-210732536013377/?notif_t=page_fan&notif_id=1479160427608384

In addition to your social media ratings, we’re ALWAYS interested in your supportive or constructive feedback. We also take questions and suggestions for new show topics. You can provide any or all of that here on my blog or directly to me via email at john.sf@mso.umt.edu

Thanks!

Dr. John and Dr. Sara, The Practically Perfect Podcasters

pppp2

A New Journal Article on Suicide Assessment Interviewing

Article · Oct 2016 · Professional Psychology Research and Practice
index

Check Out These Blogs about Counseling Theories

John and Jon on M

Over the past five years I’ve written over 50 blog posts linked to teaching and learning the theory and practice of counseling and psychotherapy. While procrastinating on another project, I decided to organize these blog posts by topic. If you follow the links below, they’ll take you to blog posts relevant to specific theories. Included in some of these are a few links to short (and free) theories-based video examples. If you teach a theories course, you could select some of these links to assign students outside readings or you could peruse them yourself to stimulate a few lecture ideas.

Please note that if you use our Counseling and Psychotherapy Theories in Context and Practice textbook, there’s a bit of redundancy with the textbook’s content. However, if you don’t use the text, the material will be new to you and your students.

Chapter 1 – Opening and Overview

A Plan for Maximizing Positive Counseling and Psychotherapy Outcomes: https://johnsommersflanagan.com/2014/09/07/a-plan-for-maximizing-positive-counseling-and-psychotherapy-outcomes/

Teaching Counseling and Psychotherapy Theories: Reflections on Week 1: https://johnsommersflanagan.com/2012/08/29/teaching-counseling-and-psychotherapy-theories-reflections-on-week-1/

Reformulating Clinical Depression: The Social-Psycho-Bio Model: https://johnsommersflanagan.com/2013/09/03/reformulating-clinical-depression-the-social-psycho-bio-model/

What’s the Difference between Counseling and Psychotherapy? https://johnsommersflanagan.com/2016/07/14/theories-highlights-i-whats-the-difference-between-counseling-and-psychotherapy/

Neuroscience New Year’s Resolutions: https://johnsommersflanagan.com/2016/01/15/neuroscience-new-years-resolutions-for-2016/

Evidence-Based Relationships in Counseling and Psychotherapy: https://johnsommersflanagan.com/2015/09/29/evidence-based-relationships-three-new-case-examples/

Chapter 2 – Psychoanalytic Approaches

Attachment-Informed Psychotherapy: https://johnsommersflanagan.com/2015/08/12/attachment-informed-psychotherapy/

The Story of Freud’s Seduction Hypothesis: https://johnsommersflanagan.com/2016/07/15/theories-highlights-ii-the-story-of-freuds-seduction-hypothesis/

The Working Alliance in Counseling and Psychotherapy: https://johnsommersflanagan.com/2016/04/06/five-recommendations-for-developing-a-positive-working-alliance/

Chapter 3 – Adlerian Approaches: Individual Psychology

The Three-Step Emotional Change Trick: https://johnsommersflanagan.com/2012/09/23/the-three-step-emotional-change-trick/

A Parenting Homework Assignment on Natural and Logical Consequences: https://johnsommersflanagan.com/2011/11/30/a-parenting-homework-assignment-on-natural-and-logical-consequences/

More Than Praise — Other Ways Parents Can Be Positive With Their Children: https://johnsommersflanagan.com/2012/08/16/more-than-praise-other-ways-parents-can-be-positive-with-their-children/

Chapter 4 – Existential Approaches

Reflections on Listening to Irvin Yalom at the ACA Conference: https://johnsommersflanagan.com/2012/03/25/reflections-on-listening-to-irvin-yalom-at-the-aca-conference/

A Short Existential Case Example from Counseling and Psychotherapy Theories . . .: https://johnsommersflanagan.com/2015/08/25/a-short-existential-case-example-from-counseling-and-psychotherapy-theories/

Fun with Existential Theory: https://johnsommersflanagan.com/2016/08/01/fun-with-existential-theory/

Chapter 5 – Person-Centered Approaches

Reflections on Magic: https://johnsommersflanagan.com/2011/11/28/reflections-on-magic/

Listening as Meditation on Psychotherapy.net: https://johnsommersflanagan.com/2014/02/25/listening-as-meditation-on-psychotherapy-net/

An Interview with Natalie Rogers (Daughter of Carl Rogers) about Person-Centered Therapy: https://johnsommersflanagan.com/2015/08/04/an-interview-with-natalie-rogers-daughter-of-carl-rogers-about-person-centered-therapy/

Why Therapists Should Never Say, “I know how you feel”: https://johnsommersflanagan.com/2013/05/30/why-therapists-should-never-say-i-know-how-you-feel/

Carl Rogers and Brain-Science do an Empathy Smackdown in Chapter 3: https://johnsommersflanagan.com/2015/07/09/carl-rogers-and-brain-science-do-an-empathy-smackdown-in-chapter-3/

An Invitation for Collaboration: https://johnsommersflanagan.com/2016/03/27/using-an-invitation-for-collaboration-in-counseling-and-psychotherapy/

Chapter 6 – Gestalt Approaches

Go Go Gestalt: The Theories Video Shoot, Part I: https://johnsommersflanagan.com/2012/04/24/go-go-gestalt-the-theories-video-shoot-part-i-2/

Chapter 7 – Behavioral Approaches

A Black Friday Tribute to Mary Cover Jones and her Evidence-Based Cookies: https://johnsommersflanagan.com/2011/11/25/a-black-friday-tribute-to-mary-cover-jones-and-her-evidence-based-cookies/

Behavioral Activation Therapy: Let’s Just Skip the Cognitions: https://johnsommersflanagan.com/2014/06/30/behavioral-activation-therapy-lets-just-skip-the-cognitions/

Imaginal or In Vivo Exposure and Desensitization: https://johnsommersflanagan.com/2012/05/19/imaginal-or-in-vivo-exposure-and-desensitization-2/

A New Look at Time-Out for Kids and Parents: https://johnsommersflanagan.com/2012/08/04/a-new-look-at-time-out-for-kids-and-parents/

Information on Using Time-Out — Part II: https://johnsommersflanagan.com/2012/08/05/information-on-using-time-out-part-ii/

Talking with Parents about Positive Reinforcement: https://johnsommersflanagan.com/2014/09/06/talking-with-parents-about-positive-reinforcement/

Backward Behavior Modification: https://johnsommersflanagan.com/2012/12/02/backward-behavior-modification/

Behaviorism for Everyone: https://johnsommersflanagan.com/2015/10/06/dont-let-your-philosophical-beliefs-make-you-less-professionally-competent/

Chapter 8 – Cognitive-Behavioral Approaches

Positive Thinking is Not (Necessarily) Rational Thinking: https://johnsommersflanagan.com/2011/12/06/positive-thinking-is-not-necessarily-rational-thinking/

How to Use the Six Column CBT Technique: https://johnsommersflanagan.com/2014/02/18/how-to-use-the-six-column-cbt-technique/

A Quick Look at the Collaborative Cognitive Therapy Process: https://johnsommersflanagan.com/2012/09/30/a-quick-look-at-the-collaborative-cognitive-therapy-process/

Tomorrow’s Election and Confirmation Bias: https://johnsommersflanagan.com/2012/11/05/tomorrows-election-and-confirmation-bias/

Confirmation Bias on My Way to Spearfish, South Dakota: https://johnsommersflanagan.com/2014/04/30/confirmation-bias-on-my-way-to-spearfish-south-dakota/

Chapter 9 – Choice Theory and Reality Therapy

The Seven Magic Words for Parents: https://johnsommersflanagan.com/2012/12/23/the-seven-magic-words-for-parents/

Give Information and then Back-Off: A Choice Theory Parenting Assignment: https://johnsommersflanagan.com/2012/07/09/give-information-and-then-back-off-a-choice-theory-parenting-assignment/

How Parents Can Use Problem-Solving Power: https://johnsommersflanagan.com/2012/10/23/how-parents-can-use-problem-solving-power/

Chapter 10 – Feminist Approaches

Opening Thoughts on Feminism: https://johnsommersflanagan.com/2012/04/03/opening-thoughts-on-feminism-3/

The Girl Code by Ashley Marallo: https://johnsommersflanagan.com/2012/12/03/the-girl-code-by-ashley-marallo/

A Guest Essay on the Girl Code and Feminism: https://johnsommersflanagan.com/2014/12/07/a-guest-essay-on-the-girl-code-and-feminism/

Feminist Culture in Music: https://johnsommersflanagan.com/2013/11/18/feminist-culture-in-music/

Chapter 11 – Constructive (Solution-Based and Narrative) Approaches

Is Solution-Focused Therapy as Powerfully Effective as Solution-Focused Therapists Would Have Us Believe?: https://johnsommersflanagan.com/2012/07/01/is-solution-focused-therapy-as-powerfully-effective-as-solution-focused-therapists-would-have-us-believe-2/

Secrets of the Miracle Question: https://johnsommersflanagan.com/2015/03/04/secrets-of-the-miracle-question/

The Love Reframe: https://johnsommersflanagan.com/2013/04/07/the-love-reframe/

Constructivism vs. Social Constructionism: What’s the Difference? https://johnsommersflanagan.com/2015/12/05/constructivism-vs-social-constructionism-whats-the-difference/

Chapter 12 – Family Systems Approaches

None posted on this topic. Obviously, I need help here.

Chapter 13 – Multicultural Approaches

Four Good Ideas about Multicultural Counseling and Psychotherapy—In Honor of Martin Luther King, Jr.: https://johnsommersflanagan.com/2012/01/16/four-good-ideas-about-multicultural-counseling-and-psychotherapy-in-honor-of-martin-luther-king-jr/

Good Ideas about Multicultural Counseling and Psychotherapy – Part II: https://johnsommersflanagan.com/2012/01/22/good-ideas-about-multicultural-counseling-and-psychotherapy-part-ii/

Cultural Adaptations in the DSM-5: Insert Foot in Mouth Here: https://johnsommersflanagan.com/2014/07/08/cultural-adaptations-in-the-dsm-5-insert-foot-in-mouth-here/

Psychic Communications . . . and Cultural Differences in Mental Status: https://johnsommersflanagan.com/2013/01/02/psychic-communications-and-cultural-differences-in-mental-status/

A White Male Psychologist Reflects on White Privilege: https://johnsommersflanagan.com/2012/09/14/a-white-male-psychologist-reflects-on-white-privilege/

Tips for Counseling Culturally Diverse Youth: https://johnsommersflanagan.com/2015/11/19/counseling-culturally-diverse-youth-research-based-and-common-sense-tips/

Chapter 14 – Integrative Approaches

Making Memories in L.A.: An Interview with Matt Englar-Carlson: https://johnsommersflanagan.com/2016/05/20/making-memories-in-l-a/

My Response to a Petition from a Theories Class at Xavier University: https://johnsommersflanagan.com/2016/04/29/why-xavier-university-students-in-cincinnati-sent-me-a-petition/

With Wubbolding

Fun with Existential Theory

I think existentialists have gotten a bad rap over the years. They don’t deserve their depressive reputation. If you’re not sure about this claim, invite a bunch of existentialists over for a party. They know how to have a good time. Just think of Jean Paul Sartre and Simone de Beauvoir. I’m sure they did some table-dancing (among other things) in their time.

Why are they so much fun? Well, in addition to their tendency to go on and on about death and meaninglessness, existentialists were some of the original embracers of carpe diem. They believe in seizing the day (or moment)–regardless of whether they’re playing Pokemon Go or working with you in counseling or psychotherapy.

Below I’ve included a short excerpt from the upcoming 3rd edition of Counseling and Psychotherapy Theories in Context and Practice. One of the reasons I’m posting this is because one of the reviewers of the 2nd edition noted that we were trying too hard to to be “cute” . . . so I thought I’d see if any of you blog-readers think that’s the case. This particular excerpt is as cute as we get in this chapter. What do you think?? Overboard? Just right? Or should we try to be more like Stephen Colbert. You be the judge in this moment in time.

Theoretical Principles

As noted previously, there’s no single theorist or theory of existential psychotherapy. Consequently, although we focus on key existential philosophical and phenomenological principles, other existential writers and theorists may emphasize principles slightly different from the following.

The I-Am Experience

The I-am experience is the experience of being, of existing (R. May et al., 1958). The experience of being is often referred to as ontological experience (ontos means “to be” and logical means “the science of”). Literally, then, a major focus of existential therapy consists of exploring immediate human experience. You might think of it as suddenly waking up and being completely tuned into what it’s like to exist and be here and now in this particular moment in time.

Existentialists like to use hyphens to capture the interconnectedness of phenomenological experience. For example, in contrast to May’s I-am experience, Boss (1963) and Binswanger (1933) used Dasein (which is translated to being-in-the-world) to describe the sense-of-existence. Also, the phrase, “Dasein choosing,” which is translated to the-person-who-is-responsible-for-his-existence choosing is used. We should note that this practice is in no way related to our own hyphenated last names, although it has inspired John to consider adding a hyphenated middle name so he can refer to himself in the third person as, “John-who-is-responsible-for-his-existence-Sommers-Flanagan,” which he thinks sort of rolls right off the tongue.

It follows, as-if-anything-really-follows-from-the-preceding, that existential therapy is almost always in the service of self-awareness or self-discovery. However, unlike psychoanalysts, existentialists seek to expand client self-awareness rather than interpreting client unconscious processes. This is because existentialists believe the entirety of an individual’s human experience is accessible to consciousness. It’s not so much a matter of uncovering an elusive unconscious as it is a matter of elucidating the conscious and deepening the relational.

Four Existential Ways of Being

There are four primary existential ways of being-in-the-world. They include:

  1. Umwelt: Being-with-nature or the physical world.
  2. Mitwelt: Being-with-others or the social world.
  3. Eigenwelt: Being-with-oneself or the world of the self.
  4. Uberwelt: Being-with-the-spiritual or over world.

The first three of these existential ways of being were described by Boss (1963), Binswanger (1963), and May et al. (1958). The fourth way of being was added by van Deurzen (1988).

These four dimensions of existence are ubiquitous and simultaneous. Some people focus more on one dimension than others or shift from one to another depending on particular intentions or situations. For example, while on a mountain hike up the Stillwater gorge in Montana, it’s difficult not to become profoundly into being-with-nature as water powerfully cascades around you, making all conversation (being-with-others) impossible. However, depending on other factors, this experience can take people inward toward eigenwelt, toward an uberwelt spiritual experience, or stimulate a deep mitwelt (albeit a nonverbal one). In most cases the direction that your being moves in a given situation is likely a combination of several factors, including, but not limited to: anxiety, previous experiences, intention, as well as your spiritual predisposition.

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Theories Highlights II: The Story of Freud’s Seduction Hypothesis

Let’s put it this way: When it comes to the history of counseling and psychotherapy, there’s plenty of conflict and drama. In the following excerpt from Chapter 2 of Counseling and Psychotherapy Theories in Context and Practice, you’ll get to read about Freud and his formulation and then recanting of the seduction hypothesis. Is it all true and factual? Probably not. Is it fascinating? As Freud would have likely said, “Hell yes!”

Historical Context

As suggested toward the end of Chapter 1, psychological theories are partly a product of the prevailing Zeitgeist and Ortgeist. Bankart (1997) stated:

To fathom Freud’s near-obsession with the sexual foundations of emotional distress is also to come to a fuller awareness of the sexual repression and hypocrisy in the lives of the Austrian middle class at the turn of the…[nineteenth] century and the effect of this repression on the mental health of adolescents and young adults during the time when Freud derived his theories. (p. 8)

A good illustration of psychoanalytic historical context and of Freud’s dominant persuasive powers is the dramatic story of Freud’s development and subsequent recanting of the seduction hypothesis. This story captures his psychoanalytic thinking along with the social dynamics of his time. Interestingly, there’s conflict over the truth of this story—which further illustrates the divisive nature of Freud and his legacy. As you read through the drama of the seduction hypothesis, keep in mind that certain points have been contested…but the unfolding of a spectacular drama around sexuality, sexual fantasy, and sexual abuse in a sexually repressed society is likely accurate.

The Seduction Hypothesis

In 1885, Freud went to France to study under the famous neurologist Jean Charcot. According to Jeffrey Masson, former projects director of the Freud Archives, it’s likely that Freud visited the Paris Morgue, observing autopsies of young children who had been brutally physically and sexually abused (Masson, 1984). Masson speculated that Freud’s exposure to the grisly reality of child abuse combined with stories of abuse he heard from his patients, led him to believe that hysteria was caused by child sexual abuse.

Later, Freud presented a paper titled “The Aetiology of Hysteria” at the Society for Psychiatry and Neurology in Vienna (Freud, 1896). In this paper, he outlined a controversial hypothesis:

I therefore put forward the thesis that at the bottom of every case of hysteria there are one or more occurrences of premature sexual experience, occurrences which belong to the earliest years of childhood, but which can be reproduced through the work of psychoanalysis in spite of the intervening decades. (Freud, 1896, cited in Masson, 1984, p. 263)

Note that Freud stated, “. . . at the bottom of every case of hysteria.” He was emphasizing a clear causal connection between childhood sexual abuse and hysteria. This presentation was based on 18 cases (12 women and 6 men), all of which included childhood sexual abuse. At least three key points are important in this presentation:

  1. Freud’s idea about the connection between childhood sexual abuse and subsequent psychopathology may represent an early formulation of the contemporary diagnosis of Posttraumatic Stress Disorder and/or Dissociative Identity Disorder.
  2. Critics contend that in Freud’s paper, “the ‘facts’ of specific case histories are never provided” (Wilcocks, 1994).
  3. Freud may have been constructing sexual memories both through a direct pressure technique and by distorting what he heard to fit with his pre-existing ideas (Esterson, 2001).

Despite a lack of supporting detail in his presentation and the possibility that he was building evidence to support his theory, Freud goes on to suggest that hysterical symptoms don’t arise immediately, but instead develop later:

Our view then is that infantile sexual experiences…create the hysterical symptoms, but…they do not do so immediately, but . . . only exercise a pathogenic action later, when they have been aroused after puberty in the form of unconscious memories. (Freud, 1896, cited in Masson, 1984, p. 272)

It appears that Freud continued to believe his clients’ sexual abuse stories (or perhaps he believed his own constructed version of his client’s sexual abuse stories) until the late 1800s or early 1900s.

Recanting the Seduction Hypothesis

Imagine yourself alone with a great and horrible insight. In Masson’s version of the seduction hypothesis story, this was Freud’s situation. Masson (1984) describes the reception Freud received after presenting his hypothesis (and this part of the seduction hypothesis story is not disputed):

The paper…met with total silence. Afterwards, he was urged never to publish it, lest his reputation be damaged beyond repair. The silence around him deepened, as did the loneliness. But he defied his colleagues and published “The Aietology of Hysteria.” (pp. xviii–xix)

Five days after presenting his paper, Freud wrote about the experience to his friend and otolaryngologist (ear, nose and throat physician) Wilhelm Fliess. Freud’s anger is obvious:

[My] lecture on the aetiology of hysteria at the Psychiatric Society met with an icy reception from the asses, and from Kraft-Ebing [the distinguished professor and head of the Department of Psychiatry at the University of Vienna] the strange comment: “It sounds like a scientific fairy tale.” And this after one has demonstrated to them a solution to a more than thousand-year-old problem, a “source of the Nile!” They can all go to hell. (Schur, 1972, p. 104)

Although it’s clear that Freud’s lecture received “an icy reception” it’s less clear why the audience was unimpressed. According to Masson, the reception is icy because Freud is bringing up sex and sexual abuse and that psychiatry (and most professionals and citizens at the time) were uncomfortable with facts linked to high sexual abuse rates. Alternatively, others have suggested that Freud’s style, perhaps a combination of arrogance along with an absence of scientific rigor or detail, moved the audience to rebuke him. For example, Wilcocks (1994) wrote:

The inferential support offered—without detail, of course—is that in eighteen cases out of eighteen, Freud has “discovered” the same etiological factors. But since neither we nor his audience are/were privy to the circumstances of any of his cases, this claim—whatever it’s other inferential mistakes—is simply useless. (p. 129)

It may never be clear whether Freud’s motives in presenting the seduction hypothesis were noble or manipulative. However, regardless of motive, the ensuing years following his “Aetiology of Hysteria” lecture were difficult. Reportedly, his private practice was in decline and his professional life in shambles. It was at this time that Freud began what has been described as “his lonely and painful self-analysis” (Prochaska & Norcross, 2003, p. 29). His 2-year self-analysis included uncovering memories of yearning for his mother and equally powerful feelings of resentment toward his father (Bankart, 1997).

Eventually, Freud discarded his seduction hypothesis in favor of the Oedipus complex (where the child holds unconscious wishes to have sexual relations with the parent of the opposite sex). Some suggest this was because he began noticing seductive patterns in so many parent-child interactions that it was unrealistic to assume that child sexual abuse occurred at such a ubiquitous rate. Others believe Freud was ahead of his time in discovering child sexual abuse, but buckled under the social and psychological pressure, abandoning the truths his patients shared with him. Still others contend that while Freud was constructing his theoretical principles, he was projecting and mixing his own fantasies into his clients’ stories. The following statement illustrates the highly personalized nature of some of Freud’s theorizing:

I found in myself a constant love for my mother, and jealousy of my father. I now consider this to be a universal event in childhood. (R. A. Paul, 1991)

Eventually, in 1925, long after he recanted the seduction hypothesis, he reflected on his struggle:

I believed these stories, and consequently supposed that I had discovered the roots of the subsequent neurosis in these experiences of sexual seduction in childhood.… If the reader feels inclined to shake his head at my credulity, I cannot altogether blame him.… I was at last obliged to recognize that these scenes of seduction had never taken place, and that they were only fantasies which my patients had made up. (Freud, 1925, cited in Masson, 1984, p. 11)

In the creation and recanting of the seduction hypothesis, it’s difficult to sort out fact from fantasy. Perhaps this is as it should be, as it illustrates at least one formidable lesson about psychology. That is, when diving headlong into the deep psychological processes of humans, it’s possible to elicit confused and confusing storylines and to knowingly or unknowingly (unconsciously) mix (or project) our own personal issues into the plot. In the end, it may be that we create Kraft-Ebing’s “Scientific fairy tale” or, alternatively, something with lasting and meaningful significance. More likely, we create a combination of the two. (See Table 2.1 for three possible conclusions about Freud and the seduction hypothesis.)

Table 2.1: Freud’s Seduction Hypothesis: Three Conclusions

The official Freudian storyline goes something like this: Sigmund Freud was an astute observer who had to discard his earlier views about child seduction and sexual abuse to discover the more basic truth of the power of internal fantasy and of spontaneous childhood sexuality.

Although he initially believed his clients’ sexual abuse reports, he later discovered that it was not actual abuse, but imagined sexualized relationships (fantasies) between children and caretakers—aka: the Oedipus complex—that caused psychopathology.

Masson’s (1984) version, subsequently labeled “a new fable based on old myths” (Esterson, 1998), suggests that Freud was ahead of his time in recognizing child sexual abuse. These abuses were real and it was correct of Freud to identify them and to develop his seduction hypothesis. However—and unfortunately—Freud abandoned his sexually abused clients by recanting the seduction theory. He abandoned them because of pressure from medical and scientific colleagues and because society was not ready to face the reality of rampant child sexual abuse. Freudian critics suggest that Freud was an exceptionally bright, persuasive, and powerful speaker and writer, but he was practicing bad science. He was more interested in building his theory than psychological reality. Consequently, he twisted his clients’ stories, mixing them with his own issues and fantasies, and created an elaborate theory initially around sexual abuse and later around sexual fantasy. His theories, although fascinating and capturing much about the projective potential in human thinking, are more about Freud than they are about his clients.

Theories Highlights I: What’s the difference between counseling and psychotherapy?

My younger daughter has graduated, our video shoots for the Clinical Interviewing text are “in the can,” my time with the grandkids has passed, and the family reunion is over. Now, as the summer sun blazes, I’ve retreated to my standing desk and dived head-first into revising the 3rd edition of our Counseling and Psychotherapy Theories textbook. Later today, I’ll refresh myself with a different sort of dive into the beautiful and frigid Stillwater River.

As I work on revising this textbook I’ll be posting a series of “Theories Highlights.” They will be short excerpts from the forthcoming 3rd edition. Here’s the first one. As always, I’d love feedback if you feel like sharing.

From Chapter 1:

Definitions of Counseling and Psychotherapy

Over the years, many students have asked: “Should I get a PhD in psychology, a master’s degree in counseling, or a master’s in social work?”

This question usually brings forth a lengthy response, during which we not only explain the differences between these various degrees, but also discuss additional career information pertaining to the PsyD degree, psychiatry, school counseling, school psychology, and the psychiatric nurse practitioner credential. This sometimes leads to the confusing topic of the differences between counseling and psychotherapy. If time permits during these discussions, we also share our thoughts about less-confusing topics, like the meaning of life.

Sorting out differences between mental health disciplines is difficult. Jay Haley (1977) was once asked: “In relation to being a successful therapist, what are the differences between psychiatrists, social workers, and psychologists?” He responded: “Except for ideology, salary, status, and power the differences are irrelevant” (p. 165). Haley articulated the reality that many different professional tracks can lead you toward becoming a successful therapist, despite a few ideological, salary, status, and power differences.

In this section we explore three confusing and sometimes conflict-ridden questions: What is psychotherapy? What is counseling? And what are the differences between the two?

What Is Psychotherapy?

Anna O., an early psychoanalytic patient of Josef Breuer (a mentor of Sigmund Freud), referred to the treatment she received as “the talking cure.” This is an elegant, albeit vague description of psychotherapy. Technically, it tells us very little, but at the intuitive level, it explains psychotherapy very well. Anna was saying something most people readily admit: Talking, expressing, verbalizing, or sharing one’s pain and life story is potentially healing. This definition isn’t satisfactory as a research definition, but it provides an elegant historic and foundational frame.

As we write today, heated arguments about how to practice psychotherapy continue (Baker & McFall, 2014; Laska, Gurman, & Wampold, 2014). This debate won’t soon end and is directly relevant to how psychotherapy is defined (Wampold & Imel, 2015). We explore dimensions of this debate in the pages to come. For now, keep in mind that although historically Anna O. viewed and experienced talking as her cure (an expressive process), many contemporary researchers and writers emphasize that the opposite is more important—that a future Anna O. would benefit even more from listening to and learning from her therapist (a receptive process). Based on this perspective, some factions in the great psychotherapy debate believe therapists are more effective when they actively and expertly teach their clients cognitive and behavioral principles and skills (aka psychoeducation).

We have four favorite (and different) psychotherapy definitions we’d like to share:

  • A conversation with a therapeutic purpose (Korchin, 1976).
  • The purchase of friendship (Schofield, 1964).
  • [A] situation in which two people interact and try to come to an understanding of one another, with the specific goal of accomplishing something beneficial for the complaining person (Bruch, 1981).
  • When one person with an emotional disorder gets help from another person who has a little less of an emotional disorder (J. Watkins, personal communication, October 13, 1983).

What Is Counseling?

In some settings, an evaluative or judgmental distinction is made between counseling and psychotherapy. Alfred Adler, whom we’ll get to know more intimately in Chapter 3, might say that counseling has an inferiority complex with respect to its older sibling, psychotherapy (Adler, 1958). Or, perhaps it could be that psychotherapy has a superiority complex toward its younger rival, counseling. Either way, at some point you may notice or experience people passing judgment on the relative merits of psychotherapy and counseling.

Counselors have struggled to define their craft in ways similar to psychotherapists. Consider, Kottler and Brown’s (2008) perspective:

Counseling is indeed an ambiguous enterprise. It is done by persons who can’t agree on what to call themselves, what credentials are necessary to practice, or even what the best way is to practice—whether to deal with feelings, thoughts, or behaviors; whether to be primarily supportive or confrontational; whether to focus on the past or the present. Further, the consumers of counseling services can’t exactly articulate what their concerns are, what counseling can and can’t do for them, or what they want when it’s over. (pp. 16–17)

As with the term psychotherapy, a good definition of counseling is hard to find. Here’s a sampling:

  • Counseling is the artful application of scientifically derived psychological knowledge and techniques for the purpose of changing human behavior (Burke, 1989, p. 12).
  • Counseling consists of whatever ethical activities a counselor undertakes in an effort to help the client engage in those types of behavior that will lead to a resolution of the client’s problems (Krumboltz, 1965, p. 3).
  • [Counseling is] an activity…for working with relatively normal-functioning individuals who are experiencing developmental or adjustment problems (Kottler & Brown, 1996, p. 7).

We now turn to the question of the differences between counseling and psychotherapy.

What Are the Differences Between Psychotherapy and Counseling?

Years ago, Patterson (1973) answered this question directly: “There are no essential differences between counseling and psychotherapy” (p. xiv). On this issue, we agree with Patterson and Corsini and Wedding (2000), who wrote:

Counseling and psychotherapy are the same qualitatively; they differ only quantitatively; there is nothing that a psychotherapist does that a counselor does not do. (p. 2)

This statement implies that counselors and psychotherapists engage in the same behaviors—listening, questioning, interpreting, explaining, and advising, but may do so in different proportions.

For the most part, the professional literature implies that psychotherapists are less directive, go a little deeper, work a little longer, and charge a higher fee. In contrast, counselors are slightly more directive, work more on developmentally normal—but troubling—issues, work more overtly on practical client problems, work more briefly, and charge a bit less. In the case of individual counselors and psychotherapists, each of these tendencies may be reversed. For example, some counselors work longer with clients and charge more, whereas some psychotherapists work more briefly with clients and charge less. Additionally, although it used to be that counselors worked with clients who displayed less severe problems and psychotherapists worked with patients who display more severe problems, now, perhaps because obtaining services from master’s-level counselors or social workers is less expensive, counselors often work with lower income clients whose financial stress interacts with and complicates their personal and family problems.

A Working Definition of Counseling and Psychotherapy

At the very least, there are strong similarities between counseling and psychotherapy. Because the similarities vastly outweigh the differences we use the words counseling and psychotherapy interchangeably. And sometimes we use the word therapy as an alternative.

For the purposes of this text and to keep things simple, we offer a 12-part general definition of counseling and psychotherapy (in case you weren’t sure, this reference to keeping things “simple” is an example of sarcasm). Counseling or psychotherapy is:

(a) a process that involves (b) a trained professional who abides by (c) accepted ethical guidelines and has (d) competencies for working with (e) diverse individuals who are in distress or have life problems that led them to (f) seek help (possibly at the insistence of others) or they may be (g) seeking personal growth, but either way, these parties (h) establish an explicit agreement (informed consent) to (i) work together (more or less collaboratively) toward (j) mutually acceptable goals (k) using theoretically-based or evidence-based procedures that, in the broadest sense, have been shown to (l) facilitate human learning or human development or reduce disturbing symptoms.

We should note that, although this definition is long and multifaceted, it’s still probably insufficient. For example, it wouldn’t fit for any self-administered forms of therapy, such as self-analysis or self-hypnosis—although we’re quite certain that if you read through this definition several times, you’re likely to experience a self-induced hypnotic trance-state.

 

 

 

Making Memories in L.A.

I’ve never been the sort of person who can memorize a script or speech. My preference is to have an outline handy so I can speak to a coherent set of points and go free form from there. Memorizing or reading speeches always struck me as too lacking in spontaneity. This is probably pure rationalization. More likely, I either don’t have the self-discipline or cognitive ability to memorize speeches. But I’d just as soon forget that explanation.

Tomorrow I’ll be participating in an Alexander Street Press video recording session in L.A. It would be nice to have memorized at least some of my 2+ hours of content. I comfort myself with the unrealistic hope that—when the moment strikes—I’ll be locked in, spontaneous, and articulate, in a profound sort of way.

Last month I was in my first-ever theatrical performance. I had a bit role (or two) in Death by Dessert, put on by the Old Stone Players in Absarokee, MT. The crowds were immense (upwards of 90). Fortunately, my lines were short, and I memorized them all. The longest of my 14 lines (some of which included, “Okay” and “Yes sir.”) was: “What a shocking development. A set of twins. A boy and a girl.” I nailed those 13 words in four straight performances. Tomorrow, all I need to do is fill up about 130 minutes.

So I made up a pretend script for my L.A. recording. Most of which I’m fairly sure I’ll forget in the heat of the moment. I’ve also made up some personal notes, but because, when on camera, I’m too proud to want to let myself look down at my notes, they’ll probably go unused. This means I’ll achieve my goal of being spontaneous and being spontaneous usually works well if I’m not too anxious. The bad news is that because this will be video-recorded I will of course be anxious and Mr. Anxiety will exert his ugly head and super-funny sense of humor. The way it works for me is that Mr. Anxiety grabs a big eraser, causing all my profound thoughts to suddenly disappear, leaving me with the sort of blank mind that I wish for when trying to meditate. Then, I’m forced to fill in the blank, which makes me sound more like Sarah Palin than the silver-tongued sophisticate that I imagine myself to be.

The reassuring part of all this is that Dr. Matt Englar-Carlson (one of the nicest guys on the planet), son of Dr. Jon Carlson (one of the other nicest guys on the planet) will be interviewing me and facilitating the process. That’s good, because when I start sounding like Sarah Palin, it’s best to be around very nice and forgiving people.

Anyway, this brings me to my script, which I’m studying right now in one way or another. I’ve included a portion below. It seemed prudent to post this now, because by tomorrow at this time, the screen will be blank.

Matt E-C: Can you talk about your approach to counseling?

John S-F: I consider myself dogmatically eclectic. I believe, rather strongly, that we counselor-types need to shift our approach depending on the client, problem, goals, setting, and other factors. I think counselors should modify their theory to fit the client; clients shouldn’t be expected to adapt to their counselor’s theory.

That said, I think most of what we do requires a relational connection or working alliance. It’s important to establish credibility and trust. With this in mind I follow concrete steps linked to what Norcross has called “Evidence-Based Relationships.” There are several relational factors that appear to contribute substantially to positive counseling outcomes. A few examples include: (a) the working alliance (which includes the Adlerian concept of goal alignment); (b) Rogers’s core conditions; and (c) progress monitoring. Overall, I hope to establish a positive and collaborative working relationship and then use specific techniques, activities, and homework assignments that fit with clients and their problems/goals.

Matt E-C: If the counseling is effective what do you want to see happen?

John S-F: Early in the process of working with teenagers I use what I call an authentic purpose statement. This is a clear statement of MY PURPOSE in the room. It varies depending on the client, the referral situation, the setting, and other factors, but one example is: “My goal is to help you accomplish your goals, as long as they’re legal and healthy.” Occasionally I’ll add, “. . . and sometimes we might disagree on what’s legal and healthy and need to talk about it.”

Mostly I want clients to achieve their counseling goals. But I’d be lying if I didn’t admit that I have my own thoughts and values about good counseling goals. For example, I value social interest, healthy egalitarian and respectful relationships, self-management, healthy habits, and psychological/emotional awareness. I think these are usually good goals for most clients. You may notice I didn’t include happiness or anxiety management in my list of good counseling goals. Although I value symptom reduction and often work directly on that, overall I think a life well-lived is a better way to alleviate depression and anxiety than providing treatments that are too circumscribed.

Matt E-C: Can you tell the viewers a little about your background and how you learned the skills of professional counseling?

John S-F: I have an early pivotal memory. I was a Junior at Oregon State University. Having just transferred from a Community College where I pretty much ONLY focused on athletics, I had only recently declared myself to be a psychology major. I remember the first time I “tried” to do counseling in a pre-practicum undergraduate psychology class. My professor was a man named Thomas Murphy. He was Native American. At that point I was fairly lost in terms of my potential professional career. He set us up to do “counseling” with each other in front of the class. My counseling partner had a bicycle accident on her way to class. She showed up; she wasn’t physically injured, but was very distressed and angry. All I did was use my best listening skills. The feedback I got from Dr. Murphy and the class was fabulously positive (you might say encouraging). I think that was the day I became a counselor.

Later, I got my Ph.D. in clinical psychology from the University of Montana. At the time, the program was purposefully eclectic. We had cognitive, psychoanalytic/hypnoanalytic, person-centered, existential, and behavioral professors. While in that program, I volunteered to help with a dissertation and got training in Constance Fischer’s collaborative assessment approach, which was profound and enlightening.

I also did a year-long psychoanalytic internship in Syracuse, NY.

Looking back, none of my training experiences were perfect (and I wasn’t either), but in every situation I was able to learn and grow and develop myself as a person and professional.

Matt E-C: When you train counselors what are some of the most important areas that you want to make sure they learn or develop?

John S-F: If students aren’t able to listen non-directively, then I think they should find a different profession. When I hear myself say that, it sounds too bIunt and narrow minded, but I mean it. I don’t expect students to be constantly person-centered, but if they can’t ever become person-centered and do so intentionally, that’s a big problem and they’ll need to address it in their professional development. It scares them when they hear this, but I want them to understand my expectations.

Students should be open to supervision; that’s another expectation. When they’re not, it drastically limits their professional development. It’s not so much that I want them to be open to me, but they should be open to the possibility that there’s a better way to do counseling than what they’re doing; and they should keep trying to improve themselves.

I also want students to learn theory AND techniques and to understand how the two are related. One of my old supervisors used to talk about how it was unacceptable to “fly by the seat of your pants.” I still don’t really get the metaphor, but when I’m supervising, I want to be able to pause the recording and get a solid answer when I ask, “What are you doing and where are you going?” I tell students that we may not agree on what’s best at any specific point, but I want them to be able to articulate their rationale.

Students should respect scientific research and not be woo-woo. On the other hand, I want them to be open to intuition and to the fact that much of the variation that contributes to positive counseling outcomes is simply unknown. Minuchin used to say, “Don’t be too sure” and I like that attitude very much. When students act too sure, I usually try to teach them a constructive lesson about letting go of some of their certainty.

OKAY. THAT’S IT FOR NOW. THANKS FOR READING. I HOPE MR. ANXIETY TAKES A DAY OFF TOMORROW.

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Five Recommendations for Developing a Positive Working Alliance

The working alliance is one of the most robust predictors of positive counseling and psychotherapy outcomes. This excerpt, from the forthcoming 6th edition of Clinical Interviewing, describes five recommendations. You can always email me directly if you have questions about these resources I post. Have an excellent Wednesday evening.

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Therapists who want to develop a positive working alliance (and that should include everyone) will employ alliance-building strategies beginning with first contact. Using Bordin’s (1979) model, alliance-building strategies focus on (a) collaborative goal setting; (b) engaging clients in mutual therapy-related tasks; and (c) development of a positive emotional bond. Progress monitoring is also recommended. The following list includes alliance-building concepts and illustrations:

  1. Initial interviews and early sessions are especially important to alliance-building. Many clients will be naïve about psychotherapy. This makes role inductions essential. Here’s a cognitive-behavioral therapy (CBT) example:

For the rest of today’s session, we are going to be doing a structured clinical interview. This interview assesses a range of different psychological difficulties. It is a way to make sure that we “cover all of our bases.” We want to see if social anxiety is the best explanation for your problems and also whether you are having any other difficulties that we should be aware of. (Ledley, Marx, & Heimberg, 2010, p. 36)

  1. Asking clients direct questions about what they want from counseling and then integrating that information into your treatment plan helps build the alliance. In CBT this includes making a problem list (J. Beck, 2011).

Clinician:     What brings you to counseling and how can I be of help?

Client:         I’ve just been super down lately. You know. Tough to get up in the morning and face the world. Just feeling pretty crappy.

Clinician:     Then we definitely want to put that on our list of goals. Can I write that down? [Client nods assent] How about for now we say, “Find ways to help you start feeling more up?”

Client:         Sounds good to me.

  1. Engaging in collaborative goal-setting to achieve goal consensus is central to alliance-building. In CBT this involves transforming the “problem list” into a set of mutual treatment goals.

Clinician:     So far I’ve got three goals written down: (1) Find ways to help you start feeling more up, (2) Help you deal with the stress of having your sister living with you and your family, and (3) Improving your attitude about exercising. Does that sound about right?

Client:         Totally. It would be amazing to tackle those successfully.

Problem lists and goals are a good start, but clients engage with clinicians better when they know the treatment plan (TP) for moving from problems to goals. The TP includes specific tasks that will happen in therapy and may begin in the first clinical interview. Here’s an example of a “Devil’s Advocacy” technique where the clinician takes on the client’s negative thoughts and then has the client respond (Newman, 2013). You’ll notice that collaboratively engaging in mutual tasks offers spontaneous opportunities for deeper connection and clinician-client bonding:

Clinician:     You said you want a romantic relationship, but then you start thinking it’s too painful and pointless. Let’s try a technique where I take on your negative thinking and you respond with a reasonable counter argument. Would you try this with me?

Client:         Sure. I can try.

Clinician:     Excellent. Here we go: “It’s pointless to pursue a romantic relationship because they always come to a painful end.”

Client:         That’s possible, but it’s also possible to have some good times along the way toward the painful end.

Clinician:     [Smiles, breaks from role, and says] . . . That’s the best come-back ever.

  1. Soliciting feedback from clients from the first session on to monitor the quality and direction of the working alliance contributes to the alliance. Although you can use an instrument for this, you can also ask directly:

We’ve been talking for 20 minutes and so I want to check in with you on how you’re feeling about our time together so far. How are you doing with this process?

  1. Making sure you’re able to respond to client anger without becoming defensive or counterattacking is essential to positive working relationships. We usually apply radical acceptance (Linehan, 1993). Here’s an excerpt from an initial session with an 18-year-old male where the clinician accepted the client’s aggressive message and transformed it into a relational issue:

Clinician:     I want to welcome you to therapy with me and I hope we can work together in ways you find helpful.

Client:         You talk just like a shrink. I punched my last therapist in the nose (client glares at therapist and awaits a response) (J. Sommers-Flanagan & Bequette, 2013, p. 15).

Clinician:     Thanks for telling me that. I’d never want to have the kind of relationship with you where you felt like hitting me. And so if I ever say anything that offensive, I hope you’ll just tell me, and I’ll stop.