Theory and Practice of Counseling and Psychotherapy

California State University, Fullerton

Diplomate in Counseling Psychology

American Board of Professional Psychology

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Theory and Practice

of Counseling

and Psychotherapy

GERALD COREY

ninth edition

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

About the Author

GERALD COREY is a Professor Emeritus of Human Serv-

ices at California State University at Fullerton and a licensed

psychologist. He received his doctorate in counseling from

the University of Southern California. He is a Diplomate

in Counseling Psychology, American Board of Professional

Psychology; a National Certiﬁed Counselor; a Fellow of the

American Psychological Association (Counseling Psychol-

ogy); a Fellow of the American Counseling Association; and

a Fellow of the Association for Specialists in Group Work.

He also holds memberships in the American Group Psycho-

therapy Association; the American Mental Health Counselors Association; the As-

sociation for Spiritual, Ethical, and Religious Values in Counseling; the Associa-

tion for Counselor Education and Supervision; and the Western Association for

Coun selor Education and Supervision.

Along with Marianne Schneider Corey, Jerry received the Lifetime Achieve-

ment Award from the American Mental Health Counselors Association in 2011

and the Eminent Career Award from the Association for Specialists in Group

Work in 2001. Jerry was the recipient of the Outstanding Professor of the Year

Award from California State University at Fullerton in 1991. He teaches both

undergraduate and graduate courses in group counseling, as well as courses

in experiential groups, the theory and practice of counseling, theories of coun-

seling, and professional ethics. He is the author or coauthor of 16 textbooks

in counseling currently in print, 5 student videos/DVDs with workbooks, and

more than 60 articles in professional publications. Theory and Practice of Coun-

seling and Psychotherapy has been translated into the Arabic, Indonesian, Por-

tuguese, Korean, Chinese, and Turkish languages. Theory and Practice of Group

Counseling has been translated into Chinese, Korean, Russian, and Spanish.

Issues and Ethics in the Helping Professions has been translated into Korean, Japa-

nese, and Chinese.

Jerry and Marianne Corey often presents workshop in group counseling. In

the past 35 years the Coreys have conducted group counseling training workshops

for mental health professionals at many universities in the United States as well as

in Korea, Ireland, Germany, Belgium, Scotland, Mexico, China, Hong Kong, and

Canada. The Coreys also frequently give presentations and workshops at state and

national professional conferences. In his leisure time, Jerry likes to travel, hike and

bicycle in the mountains, and drive his 1931 Model A Ford.

Associated Press

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Recent publications by Jerry Corey, all with Brooks/Cole, Cengage Learning,

include:

t Case Approach to Counseling and Psychotherapy, Eighth Edition (2013)

t The Art of Integrative Counseling, Third Edition (2013)

t Theory and Practice of Group Counseling (and Student Manual, Eighth Edition,

2012)

t Becoming a Helper, Sixth Edition (2011, with Marianne Schneider Corey)

t Issues in Ethics in the Helping Professions, Eighth Edition (2011, with Marianne

Schneider Corey and Patrick Callanan)

t Groups: Process and Practice, Eighth Edition (2010, with Marianne Schneider

Corey and Cindy Corey)

t I Never Knew I Had a Choice, Ninth Edition (2010, with Marianne Schneider

Corey)

t Group Techniques, Third Edition (2004, with Marianne Schneider Corey,

Patrick Callanan, and J. Michael Russell)

Jerry is coauthor (with Barbara Herlihy) of Boundary Issues in Counseling: Multiple

Roles and Responsibilities, Second Edition (2006) and ACA Ethical Standards Case-

book, Sixth Edition (2006); he is coauthor (with Robert Haynes, Patrice Moulton,

and Michelle Muratori) of Clinical Supervision in the Helping Professions: A Practi-

cal Guide, Second Edition (2010); he is the author of Creating Your Professional

Path: Lessons From My Journey (2010). All four of these books are published by the

American Counseling Association.

He also has made several educational DVD and video programs on various as-

pects of counseling practice: DVD for Theory and Practice of Counseling and Psycho-

therapy: The Case of Stan and Lecturettes (2013); DVD for Integrative Counseling: The

Case of Ruth and Lecturettes (2013, with Robert Haynes); DVD—Theory and Practice

of Group Counseling (2012); Groups in Action: Evolution and Challenges—DVD and

Workbook (2006, with Marianne Schneider Corey and Robert Haynes); and Ethics

in Action: CD-ROM (2003, with Marianne Schneider Corey and Robert Haynes).

All of these programs are available through Brooks/Cole, Cengage Learning.

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

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This is an electronic version of the print textbook. Due to electronic rights restrictions,

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content does not materially affect the overall learning experience. The publisher reserves the right

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Theory and Practice of Counseling

and Psychotherapy, Ninth Edition

Gerald Corey

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Printed in the United States of America

1 2 3 4 5 6 7 15 14 13 12 11

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To Terry Hendrix and in memory of Claire Verduin,

our ﬁrst editors at Brooks/Cole; they had faith

in the potential of this book and encouraged us to

write early in our careers.

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PREFACE XII

PART 1

Basic Issues in Counseling Practice3

1 Introduction and Overview4

Introduction 5

Where I Stand 6

Suggestions for Using the Book 8

Overview of the Theory Chapters 9

Introduction to the Case of Stan 13

2 The Counselor: Person and Professional17

Introduction 18

The Counselor as a Therapeutic Person 18

Personal Therapy for the Counselor 20

The Counselor’s Values and the Therapeutic Process 22

Becoming an Effective Multicultural Counselor 24

Issues Faced by Beginning Therapists 28

Summary 34

3 Ethical Issues in Counseling Practice36

Introduction 37

Putting Clients’ Needs Before Your Own 37

Ethical Decision Making 38

The Right of Informed Consent 40

Dimensions of Confidentiality 41

Ethical Issues in a Multicultural Perspective 42

Ethical Issues in the Assessment Process 44

Ethical Aspects of Evidence-Based Practice 46

Contents

vii

CONTENTS

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Managing Multiple Relationships in Counseling Practice 48

Becoming an Ethical Counselor 51

Summary 52

Where to Go From Here 52

Recommended Supplementary Readings for Part 1 53

References and Suggested Readings for Part 1 55

PART 2

Theories and Techniques of Counseling 61

4 Psychoanalytic Therapy 62

Introduction 63

Key Concepts 64

The Therapeutic Process 72

Application: Therapeutic Techniques and Procedures 78

Jung’s Perspective on the Development of Personality 83

Contemporary Trends: Object-Relations Theory,

Self Psychology, and Relational Psychoanalysis 85

Psychoanalytic Therapy From a Multicultural Perspective 91

Psychoanalytic Therapy Applied to the Case of Stan 92

Summary and Evaluation 94

Where to Go From Here 97

Recommended Supplementary Readings

for Part 1

53

References and Suggested Readings

for Part 1 55

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4

introduction

where i stand

suggestions for using the book

overview of the theory chapters

introduction to the case of stan

• Intake Interview and Stan’s Autobiography

• Overview of Some Key Themes in Stan’s Life

chapter 1

Introduction and Overview

4

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introduction

Counseling students can begin to acquire a counseling style tailored to their own

personality by familiarizing themselves with the major approaches to therapeutic

practice. This book surveys 11 approaches to counseling and psychotherapy, pre-

senting the key concepts of each approach and discussing features such as the

therapeutic process (including goals), the client–therapist relationship, and spe-

ciﬁ c procedures used in the practice of counseling. This information will help you

develop a balanced view of the major ideas of each of the theories and acquaint

you with the practical techniques commonly employed by counselors who adhere

to each approach. I encourage you to keep an open mind and to seriously consider

both the unique contributions and the particular limitations of each therapeutic

system presented in Part 2.

You do not gain the knowledge and experience needed to synthesize various

approaches by merely completing an introductory course in counseling theory.

This process will take many years of study, training, and practical counseling ex-

perience. Nevertheless, I recommend a personal integration as a framework for

the professional education of counselors. The danger in presenting one model to

which all students are expected to subscribe is that it can limit their effectiveness

in working with a diverse range of future clients.

An undisciplined mixture of approaches, however, can be an excuse for

failing to develop a sound rationale for systematically adhering to certain con-

cepts and to the techniques that are extensions of them. It is easy to pick and

choose fragments from the various therapies because they support our biases

and preconceptions. By studying the models presented in this book, you will

have a better sense of how to integrate concepts and techniques from differ-

ent approaches when deﬁ ning your own personal synthesis and framework for

counseling.

Each therapeutic approach has useful dimensions. It is not a matter of a theory

being “right” or “wrong,” as every theory offers a unique contribution to under-

standing human behavior and has unique implications for counseling practice.

Accepting the validity of one model does not necessarily imply rejecting other

models. There is a clear place for theoretical pluralism, especially in a society that

is becoming increasingly diverse.

Although I suggest that you remain open to incorporating diverse approaches

into your own personal synthesis—or integrative approach to counseling—let

me caution that you can become overwhelmed and confused if you attempt to

learn everything at once, especially if this is your introductory course in coun-

seling theories. A case can be made for initially getting an overview of the major

theoretical orientations, and then learning a particular approach by becoming

steeped in that approach for some time, rather than superﬁ cially grasping many

theoretical approaches. An integrative perspective is not developed in a random

fashion; rather, it is an ongoing process that is well thought out. Successfully

integrating concepts and techniques from diverse models requires years of reﬂ ec-

tive practice and a great deal of reading about the various theories. In Chapter 15

5

INTRODUCTION AND OVERVIEW

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6

CHAPTER ONE

I discuss in more depth some ways to begin designing your integrative approach

to counseling practice.

See the video program for Chapter 1, DVD for Theory and Practice of

Counseling and Psychotherapy: The Case of Stan and Lecturettes. I suggest

that you view the brief lecturette for each chapter in this book prior to

reading the chapter.

where i stand

My philosophical orientation is strongly inﬂ uenced by the existential approach.

Because this approach does not prescribe a set of techniques and procedures, I

draw techniques from the other models of therapy that are presented in this book.

I particularly like to use role-playing techniques. When people reenact scenes from

their lives, they tend to become more psychologically engaged than when they

merely report anecdotes about themselves. I also incorporate many techniques

derived from cognitive behavior therapy.

The psychoanalytic emphasis on early psychosexual and psychosocial develop-

ment is useful. Our past plays a crucial role in shaping our current personality and

behavior. I challenge the deterministic notion that humans are the product of their

early conditioning and, thus, are victims of their past. But I believe that an explora-

tion of the past is often useful, particularly to the degree that the past continues to

inﬂ uence present-day emotional or behavioral difﬁ culties.

I value the cognitive behavioral focus on how our thinking affects the way we

feel and behave. These therapies also emphasize current behavior. Thinking and

feeling are important dimensions, but it can be a mistake to overemphasize them

and not explore how clients are behaving. What people are doing often gives us a

good clue to what they really want. I also like the emphasis on speciﬁ c goals and

on encouraging clients to formulate concrete aims for their own therapy sessions

and in life. Contracts between clients and therapists can be very useful. I frequently

suggest either speciﬁ c homework assignments or ask my clients to devise their own

assignments, or together we develop goals and tasks that guide the therapy process.

More approaches have been developing methods that involve collaboration be-

tween therapist and client, making the therapeutic venture a shared responsibility.

This collaborative relationship, coupled with teaching clients ways to use what they

learn in therapy in their everyday lives, empowers clients to take an active stance

in their world. It is imperative that clients be active, not only in their counseling

sessions but in daily life as well. Homework can be a vehicle for assisting clients in

putting into action what they are learning in therapy.

A related assumption of mine is that we can exercise increasing freedom to cre-

ate our future. The acceptance of personal responsibility does not imply that we can

be anything that we want. Social, environmental, cultural, and biological realities

oftentimes limit our freedom of choice. Being able to choose must be considered

in the sociopolitical contexts that exert pressure or create constraints; oppression

is a reality that can restrict our ability to choose our future. We are also inﬂ uenced

by our social environment, and much of our behavior is a product of learning and

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7

INTRODUCTION AND OVERVIEW

conditioning. That being said, I believe an increased awareness of these contextual

forces enables us to address these realities. It is crucial to learn how to cope with

the external and internal forces that limit our decisions and behavior.

Feminist therapy has contributed an awareness of how environmental and

social conditions contribute to the problems of women and men and how gender-

role socialization leads to a lack of gender equality. Family therapy teaches us that

it is not possible to understand the individual apart from the context of the system.

Both family therapy and feminist therapy are based on the premise that to un-

derstand the individual it is essential to take into consideration the interpersonal

dimensions and the sociocultural context rather than focusing primarily on the

intrapsychic domain. Thus a comprehensive approach to counseling goes beyond

focusing on our internal dynamics and addresses those environmental and sys-

temic realities that inﬂ uence us.

My philosophy of counseling does not include the assumption that therapy is

exclusively for the “sick” and is aimed at “curing” psychological “ailments.” Such

a focus on the medical model restricts therapeutic practice because it stresses

deﬁ cits rather than strengths. Instead, I agree with the postmodern approaches

(see Chapter 13), which are grounded on the assumption that people have both

internal and external resources to draw upon when constructing solutions to their

problems. Therapists will view these individuals quite differently if they acknowl-

edge that their clients possess competencies rather than pathologies. I view each

individual as having resources and competencies that can be discovered and built

upon in therapy.

Psychotherapy is a process of engagement between two people, both of whom

are bound to change through the therapeutic venture. At its best, this is a collabora-

tive process that involves both the therapist and the client in co-constructing

solutions to concerns. Most of the theories described in this book emphasize the

collaborative nature of the practice of psychotherapy.

Therapists are not in business to change clients, to give them quick advice, or

to solve their problems for them. Instead, counselors facilitate healing through

a process of genuine dialogue with their clients. The kind of person a therapist

is remains the most critical factor affecting the client and promoting change. If

practitioners possess wide knowledge, both theoretical and practical, yet lack

human qualities of compassion, caring, good faith, honesty, presence, realness,

and sensitivity, they are more like technicians. In my judgment those who func-

tion exclusively as technicians do not make a signiﬁ cant difference in the lives of

their clients. It is essential that counselors explore their own values, attitudes, and

beliefs in depth and work to increase their own awareness. Throughout the book,

I encourage you to ﬁ nd ways to personally relate to each of the therapies. Applying

this material to yourself personally takes you beyond a mere academic understand-

ing of theories.

With respect to mastering the techniques of counseling and applying them

appropriately and effectively, it is my belief that you are your own very best tech-

nique. Your reactions to your clients, including sharing how you are affected in

the relationship with them, are useful in moving the therapeutic process along.

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8

CHAPTER ONE

It is impossible to separate the techniques you use from your personality and the

relationship you have with your clients.

Administering techniques to clients without regard for the relationship var-

iables is ineffective. Techniques cannot substitute for the hard work it takes to

develop a constructive client–therapist relationship. Although you can learn atti-

tudes and skills and acquire certain knowledge about personality dynamics and

the therapeutic process, much of effective therapy is the product of artistry. Coun-

seling entails far more than becoming a skilled technician. It implies that you are

able to establish and maintain a good working relationship with your clients, that

you can draw on your own experiences and reactions, and that you can identify

techniques suited to the needs of your clients.

As a counselor, you need to remain open to your own personal development

and to address your personal problems. The most powerful ways for you to teach

your clients is by the behavior you model and by the ways you connect with

them. I suggest you experience a wide variety of techniques yourself as a client.

Reading about a technique in a book is one thing; actually experiencing it from

the vantage point of a client is quite another. If you have practiced mindfulness

exercises, for example, you will have a much better sense for guiding clients in

the practice of becoming increasingly mindful in daily life. If you have carried

out real-life homework assignments as part of your own self-change program,

you can increase your empathy for clients and their potential problems. Your

own anxiety over self-disclosing and addressing personal concerns can be a most

useful anchoring point as you work with the anxieties of your clients. The cour-

age you display in your therapy will help you appreciate how essential courage is

for your clients.

Your personal characteristics are of primary importance in becoming a coun-

selor, but it is not sufﬁ cient to be merely a good person with good intentions. To

be effective, you also must have supervised experiences in counseling and sound

knowledge of counseling theory and techniques. Further, it is essential to be well

grounded in the various theories of personality and to learn how they are related to

theories of counseling. Your conception of the person and the individual characteris-

tics of your client affect the interventions you will make. Differences between you

and your client may require modiﬁ cation of certain aspects of the theories. Some

practitioners make the mistake of relying on one type of intervention (supportive,

confrontational, information giving) for most clients with whom they work. In

reality, different clients may respond better to one type of intervention than to

another. Even during the course of an individual’s therapy, different interventions

may be needed at different times. Practitioners should acquire a broad base of

counseling techniques that are suitable for individual clients rather than forcing

clients to ﬁ t one approach to counseling.

suggestions for using the book

Here are some speciﬁ c recommendations on how to get the fullest value from this

book. The personal tone of the book invites you to relate what you are reading to your

own experiences. As you read Chapter 2, “The Counselor: Person and Professional,”

28549_ch01_rev01.indd 8 20/09/11 2:50 PM

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9

INTRODUCTION AND OVERVIEW

begin the process of reﬂ ecting on your needs, motivations, values, and life expe-

riences. Consider how you are likely to bring the person you are becoming into

your professional work. You will assimilate much more knowledge about the vari-

ous therapies if you make a conscious attempt to apply their key concepts and

techniques to your own personal life. Chapter 2 helps you think about how to use

yourself as your single most important therapeutic instrument, and it addresses a

number of signiﬁ cant ethical issues in counseling practice.

Before you study each therapy in depth in Part 2, I suggest that you at least

brieﬂ y read Chapter 15, which provides a comprehensive review of the key concepts

from all 11 theories presented in this textbook. I try to show how an integration of

these perspectives can form the basis for creating your own personal synthesis to

counseling. In developing an integrative perspective, it is essential to think holisti-

cally. To understand human functioning, it is imperative to account for the physi-

cal, emotional, mental, social, cultural, political, and spiritual dimensions. If any

of these facets of human experience is neglected, a theory is limited in explaining

how we think, feel, and act.

To provide you with a consistent framework for comparing and contrasting

the various therapies, the 11 theory chapters share a common format. This format

includes a few notes on the personal history of the founder or another key ﬁ gure;

a brief historical sketch showing how and why each theory developed at the time

it did; a discussion of the approach’s key concepts; an overview of the therapeutic

process, including the therapist’s role and client’s work; therapeutic techniques

and procedures; applications of the theory from a multicultural perspective;

application of the theory to the case of Stan; a summary and evaluation; sugges-

tions of how to continue your learning about each approach; and suggestions for

Recommended Supplementary Readings

Psychoanalytic Theory: An Introduction&MMJPUUQSPWJEFTUIPSPVHIDPWFSBHF

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Object Relations and Self Psychology: An Introduction4U$MBJSXJUI8JHSFO

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98

CHAPTER FOUR

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References and Suggested Readings

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*Ainslie, R. (2007). Psychoanalytic psycho-

therapy. In A. B. Rochlen (Ed.), Applying coun-

seling theories: An online case-based approach

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Prentice-Hall.

Atkinson, D. R., Thompson, C. E., & Grant,

S. K. (1993). A three-dimensional model for

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Clarkin, J., Yeomans, F., & Kernberg, O.

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American Psychiatric Press.

Corey, G. (2012). Theory and practice of group

counseling (8th ed.). Belmont, CA: Brooks/

Cole, Cengage Learning.

*Corey, G. (2013). Case approach to counseling

and psychotherapy (8th ed.). Belmont, CA:

Brooks/Cole, Cengage Learning.

*Curtis, R. C., & Hirsch, I. (2011). Relational

psychoanalytic psychotherapy. In S. B. Messer

& A. S. Gurman, (Eds.), Essential psychothera-

pies: Theory and practice (3rd ed., pp. 72–104).

New York: Guilford Press.

*Elliot, A. (1994). Psychoanalytic theory: An

introduction. Oxford UK & Cambridge USA:

Blackwell.

Enns, C. Z. (1993). Twenty years of feminist

counseling and therapy: From naming biases

to implementing multifaceted practice. The

Counseling Psychologist, 21(1), 3–87.

*Erikson, E. H. (1963). Childhood and society

(2nd ed.). New York: Norton.

Freud, S. (1949). An outline of psychoanalysis.

New York: Norton.

*Freud, S. (1955). The interpretation of dreams.

London: Hogarth Press.

*Gabbard, G. (2005). Psychodynamic psychiatry

in clinical practice (4th ed.). Washington, DC:

American Psychiatric Press.

*Gelso, C. J., & Hayes, J. A. (2002). The man-

agement of countertransference.

In J. C. Norcross (Ed.), Psychotherapy relation-

ships that work (pp. 267–283). New York:

Oxford University Press.

*Harris, A. S. (1996). Living with paradox: An

introduction to Jungian psychology. Belmont,

CA: Brooks/Cole, Cengage Learning.

Hayes, J. A., (2004). Therapist know thyself:

Recent research on countertransference. Psy-

chotherapy Bulletin, 39(4), 6– 12.

Hayes, J. A., Gelso, C. J., & Hummel, A. M.

(2011). Management of countertransference.

In J.C. Norcross (Ed.), Psychotherapy r

elation-

ships that work: Evidence-based responsiveness

(2nd ed., pp. 239–258). New York: Oxford

University Press.

*Hedges, L. E. (1983). Listening perspectives in

psychotherapy. New York: Aronson.

*Jung, C. G. (1961). Memories, dreams, reflec-

tions. New York: Vintage.

Kernberg, O. F. (1975). Borderline conditions

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Kernberg, O. F. (1997). Convergences and

divergences in contemporary psychoanalytic

technique and psychoanalytic psychotherapy.

In J. K. Zeig (Ed.), The evolution of psychothera-

py: The third conference (pp. 3–22). New York:

Brunner/Mazel.

Kernberg, O. F., Yeomans, F. E., Clarkin, J. F.,

& Levy, K. N. (2008). Transference focused

psychotherapy: Overview and update. Interna-

tional Journal of Psychoanalysis, 89, 601–620.

Klein, M. (1975). The psychoanalysis of children.

New York: Dell.

Kohut, H. (1971). The analysis of self.

New York: International Universities Press.

Kohut, H. (1977). Restoration of the self.

New York: International Universities Press.

Kohut, H. (1984). How does psychoanalysis

cure? Chicago: University of Chicago Press.

99

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

*Levenson, H. (2007). Time-limited dynamic

psychotherapy. In A. B. Rochlen (Ed.), Apply-

ing counseling theories: An online case-based

approach (pp. 75–90). Upper Saddle River, NJ:

Pearson Prentice-Hall.

Levenson, H. (2010). Brief dynamic therapy.

Washington, DC: American Psychological

Association.

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treatment of borderline personality disorder.

New York: Guilford Press.

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New York: Guilford Press.

*Luborsky, E. B., O’Reilly-Landry, M., & Arlow,

J. A. (2011). Psychoanalysis. In R. J. Corsini &

D. Wedding (Eds.), Current psychotherapies

(9th ed., pp. 15–66). Belmont, CA: Brooks/

Cole, Cengage Learning.

Mahler, M. S. (1968). On human symbiosis or

the vicissitudes of individuation. New York: Inter-

national Universities Press.

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borderline adult: A developmental approach.

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psychotherapies: Theory and practice (3rd ed.).

New York: Guilford Press.

Messer, S. B., & Warren, C. S. (2001). Brief

psychodynamic therapy. In R. J. Corsini (Ed.),

Handbook of innovative therapies (2nd ed.,

pp. 67–85). New York: Wiley.

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psychoanalysis: An integration. Cambridge, MA:

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*Mitchell, S. A. (2000). Relationality: From

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Mitchell, S. A., & Black, M. J. (1995). Freud

and beyond: A history of modern psychoanalytic

thought. New York: Basic Books.

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Systems of psychotherapy: A transtheoretical

analysis (7th ed.). Belmont, CA: Brooks/Cole,

Cengage Learning.

Reik, T. (1948). Listening with the third ear.

New York: Pyramid.

*Rutan, J. S., Stone, W. N., & Shay, J. J. (2007).

Psychodynamic group psychotherapy (4th ed.).

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personality (9th ed.). Belmont, CA: Wadsworth,

Cengage Learning.

Smith, L. (2005). Psychotherapy, classism,

and the poor. American Psychologist, 60(7),

687–696.

*St. Clair, M. (

with Wigren, J.). (2004). Object

relations and self psychology: An introduction

(4th ed.). Belmont, CA: Brooks/Cole, Cengage

Learning.

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of the infant: A view from psychoanalysis and

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Strupp, H. H. (1992). The future of psychody-

namic psychotherapy. Psychotherapy, 29(l),

21–27.

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Wolitzsky, D. L. (2011b). Psychoanalytic

theories in psychotherapy. In J. C. Norcross,

G. R. Vandenbos, & D. K. Freedheim (Eds.),

History of psychotherapy (2nd ed., pp. 65–100).

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100

CHAPTER FOUR

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101

introduction

key concepts

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

102

CHAPTER FIVE

ALFRED ADLER (1870–

1937) grew up in a Vienna

family of six boys and two

girls. His younger brother

died at a very young age

in the bed next to Alfred.

Adler’s early childhood was

not a happy time. He was

sickly and very much aware

of death. At age 4 he almost died of pneumonia.

He heard the doctor tell his father that “Alfred is

lost.” Adler associated this time with his decision

to become a physician. Because he was ill so much

during the first few years of his life, Adler was

pampered by his mother. He developed a trusting

relationship with his father, but did not feel very

close to his mother. He was extremely jealous of

his older brother, Sigmund, which led to a strained

relationship between the two during childhood and

adolescence. When we consider Adler’s strained

relationship with Sigmund Freud, one cannot help

but suspect that patterns from his early family

constellation were repeated in this relationship

with Freud.

Adler’s early childhood experiences had an

impact on the formation of his theory. Adler is an

example of a person who shaped his own life as

opposed to having it determined by fate. Adler

was a poor student. His teacher advised his father

to prepare Adler to be a shoemaker, but not much

else. With determined effort Adler eventually rose

to the top of his class. He went on to study medi-

cine at the University of Vienna, entering private

practice as an ophthalmologist, and then shifting to

general medicine. He eventually specialized in neu-

rology and psychiatry, and he had a keen interest in

incurable childhood diseases.

Adler had a passionate concern for the com-

mon person and was outspoken about child-rearing

practices, school reforms, and prejudices that

resulted in conflict. He spoke and wrote in simple,

nontechnical language so that the general popula-

tion could understand and apply the principles

of his approach in a practical way, which helped

people meet the challenges of daily life. Adler’s

(1927/1959) Understanding Human Nature was

the first major psychology book to sell hundreds

of thousands of copies in the United States. After

serving in World War I as a medical officer, Adler

created 32 child guidance clinics in the Vienna

public schools and began training teachers, social

workers, physicians, and other professionals. He

pioneered the practice of teaching profession-

als through live demonstrations with parents and

children before large audiences, now called “open-

forum” family counseling. The clinics he founded

grew in number and in popularity, and he was inde-

fatigable in lecturing and demonstrating his work.

Although Adler had an overcrowded work

schedule most of his professional life, he still

took some time to sing, enjoy music, and be with

friends. In the mid-1920s he began lecturing in the

United States, and he later made frequent visits

and tours. He ignored the warning of his friends

to slow down, and on May 28, 1937, while taking

a walk before a scheduled lecture in Aberdeen,

Scotland, Adler collapsed and died of heart failure.

If you have an interest in learning more about

Adler’s life, see Edward Hoffman’s (1996) excellent

biography, The Drive for Self.

Alfred Adler

introduction

Along with Freud and Jung, Alfred Adler was a major contributor to the initial

development of the psychodynamic approach to therapy. After 8 to 10 years of col-

laboration, Freud and Adler parted company, with Freud taking the position that

Adler was a heretic who had deserted him. Adler resigned as president of the Vien-

na Psychoanalytic Society in 1911 and founded the Society for Individual Psychology

in 1912. Freud then asserted that it was not possible to support Adlerian concepts

and still remain in good standing as a psychoanalyst.

Hulton Archive/Getty Images

28549_ch05_rev01.indd 102 20/09/11 3:19 PM

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103

ADLERIAN THERAPY

Later, a number of other psychoanalysts deviated from Freud’s orthodox

position (see Chapter 4). These Freudian revisionists—including Karen Horney,

Erich Fromm, and Harry Stack Sullivan—agreed that relational, social, and cul-

tural factors were of great signiﬁ cance in shaping personality. Even though these

three therapists are typically called neo-Freudians, it would be more appropri-

ate, as Heinz Ansbacher (1979) has suggested, to refer to them as neo-Adlerians

because they moved away from Freud’s biological and deterministic point of view

and toward Adler’s social-psychological and teleological (or goal-oriented) view of

human nature.

Adler stresses the unity of personality, contending that people can only be

understood as integrated and complete beings. This view also espouses the pur-

poseful nature of behavior, emphasizing that where we have come from is not as

important as where we are striving to go. Adler saw humans as both the creators

and the creations of their own lives; that is, people develop a unique style of liv-

ing that is both a movement toward and an expression of their selected goals. In

this sense, we create ourselves rather than merely being shaped by our childhood

experiences.

After Adler’s death in 1937, Rudolf Dreikurs was the most signiﬁ cant ﬁ gure

in bringing Adlerian psychology to the United States, especially as its principles

applied to education, individual and group therapy, and family counseling.

Dreikurs is credited with giving impetus to the idea of child guidance centers and

to training professionals to work with a wide range of clients.

See the DVD program for Chapter 5, DVD for Theory and Practice of Coun-

seling and Psychotherapy: The Case of Stan and Lecturettes. I suggest that you

view the brief lecture for each chapter prior to reading the chapter.

key concepts

View of Human Nature

Adler abandoned Freud’s basic theories because he believed Freud was exces-

sively narrow in his emphasis on biological and instinctual determination. Adler

believed that the individual begins to form an approach to life somewhere in the

ﬁ rst 6 years of living. He focused on the person’s past as perceived in the present

and how an individual’s interpretation of early events continued to inﬂ uence that

person’s present behavior. According to Adler, humans are motivated primarily

by social relatedness rather than by sexual urges; behavior is purposeful and goal-

directed; and consciousness, more than unconsciousness, is the focus of therapy.

Adler stressed choice and responsibility, meaning in life, and the striving for suc-

cess, completion, and perfection. Adler and Freud created very different theories,

even though both men grew up in the same city in the same era and were educated

as physicians at the same university. Their individual and distinct childhood

experiences, their personal struggles, and the populations with whom they worked

were key factors in the development of their particular views of human nature

(Schultz & Schultz, 2009).

28549_ch05_rev01.indd 103 20/09/11 3:19 PM

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104

CHAPTER FIVE

Adler’s theory starts with a consideration of inferiority feelings, which he saw

as a normal condition of all people and as a source of all human striving. Rather

than being considered a sign of weakness or abnormality, inferiority feelings can

be the wellspring of creativity. They motivate us to strive for mastery, success

(superiority), and completion. We are driven to overcome our sense of inferiority

and to strive for increasingly higher levels of development (Ansbacher & Ansbacher,

1956/1964). Indeed, at around 6 years of age our ﬁ ctional vision of ourselves as

perfect or complete begins to form into a life goal. The life goal uniﬁ es the person-

ality and becomes the source of human motivation; every striving and every effort

to overcome inferiority is now in line with this goal.

From the Adlerian perspective, human behavior is not determined solely by

heredity and environment. Instead, we have the capacity to interpret, inﬂ uence,

and create events. Adler asserted that genetics and heredity are not as important

as what we choose to do with the abilities and limitations we possess. Although

Adlerians reject a deterministic stance, they do not go to the other extreme and

maintain that individuals can become whatever they want to be. Adlerians recog-

nize that biological and environmental conditions limit our capacity to choose and

to create.

Adlerians put the focus on reeducating individuals and reshaping society.

Adler was the forerunner of a subjective approach to psychology that focuses on

internal determinants of behavior such as values, beliefs, attitudes, goals, interests,

and the individual perception of reality. He was a pioneer of an approach that is

holistic, social, goal oriented, systemic, and humanistic. Adler also was the ﬁ rst

systemic therapist: he maintained that it is essential to understand people within

the systems in which they live.

Subjective Perception of Reality

Adlerians attempt to view the world from the client’s subjective frame of reference,

an orientation described as phenomenological. Paying attention to the individual

way in which people perceive their world, referred to as “subjective reality,” includes

the individual’s perceptions, thoughts, feelings, values, beliefs, convictions, and

conclusions. Behavior is understood from the vantage point of this subjective per-

spective. From the Adlerian perspective, objective reality is less important than how

we interpret reality and the meanings we attach to what we experience.

As you will see in subsequent chapters, many contemporary theories have

incorporated this notion of the client’s subjective worldview as a basic factor ex-

plaining behavior, including existential therapy, person-centered therapy, Gestalt

therapy, the cognitive behavioral therapies, reality therapy, feminist therapy, and

the postmodern approaches.

Unity and Patterns of Human Personality

Adler chose the name Individual Psychology (from the Latin individuum, meaning

indivisible) for his theoretical approach because he wanted to avoid reductionism.

Adler emphasized the unity and indivisibility of the person and stressed under-

standing the whole person in the context of his or her life—how all dimensions

of a person are interconnected components, and how all of these components

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ADLERIAN THERAPY

are uniﬁ ed by the individual’s movement toward a life goal. This holistic concept

implies that we cannot be understood in parts; rather, all aspects of ourselves must

be understood in relationship (Carlson & Englar-Carlson, 2008). The focus is on

understanding whole persons within their socially embedded contexts of family,

culture, school, and work. We are social, creative, decision-making beings who act

with purpose and cannot be fully known outside the contexts that have meaning in

our lives (Sherman & Dinkmeyer, 1987).

The human personality becomes uniﬁ ed through development of a life goal.

An individual’s thoughts, feelings, beliefs, convictions, attitudes, character, and

actions are expressions of his or her uniqueness, and all reﬂ ect a plan of life that

allows for movement toward a self-selected life goal. An implication of this holistic

view of personality is that the client is an integral part of a social system. There is

more emphasis on interpersonal relationships than on the individual’s internal

psychodynamics.

behavior as purposeful and goal oriented Individual Psychol-

ogy assumes that all human behavior has a purpose. The concept of the purposeful

nature of behavior is perhaps the cornerstone of Adler’s theory. Adler replaced

deterministic explanations with teleological (purposive, goal-oriented) ones. A basic

assumption of Individual Psychology is that we can only think, feel, and act in rela-

tion to our goal; we can be fully understood only in light of knowing the purposes

and goals toward which we are striving. Although Adlerians are interested in the

future, they do not minimize the importance of past inﬂ uences. They assume that

most decisions are based on the person’s experiences, on the present situation, and

on the direction in which the person is moving—with the latter being the most

important. They look for continuity by paying attention to themes running through

a person’s life.

Adler was inﬂ uenced by the philosopher Hans Vaihinger (1965), who noted

that people often live by ﬁ ctions (or views of how the world should be). Many Adle-

rians use the term ﬁ ctional ﬁ nalism to refer to an imagined life goal that guides a

person’s behavior. It should be noted, however, that Adler ceased using this term

and replaced it with “guiding self-ideal” and “goal of perfection” to account for our

striving toward superiority or perfection (Watts & Holden, 1994). Very early in life,

we begin to envision what we might be like if we were successful, complete, whole,

or perfect. Applied to human motivation, a guiding self-ideal might be expressed

in this way: “Only when I am perfect can I be secure” or “Only when I am impor-

tant can I be accepted.” The guiding self-ideal represents an individual’s image of

a goal of perfection, for which he or she strives in any given situation. Because of

our subjective ﬁ nal goal, we have the creative power to choose what we will accept

as truth, how we will behave, and how we will interpret events.

striving for significance and superiority Adler stressed that

the recognition of inferiority feelings and the consequent striving for perfection

or mastery are innate (Ansbacher & Ansbacher, 1979)—they are two sides of the

same coin. To understand human behavior, it is essential to grasp the ideas of

basic inferiority and compensation. From our earliest years, we recognize that

we are helpless in many ways, which is characterized by feelings of inferiority.

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CHAPTER FIVE

This inferiority is not a negative factor in life. According to Adler, the moment we

experience inferiority we are pulled by the striving for superiority. He maintained

that the goal of success pulls people forward toward mastery and enables them to

overcome obstacles. The goal of superiority contributes to the development of hu-

man community. However, it is important to note that “superiority,” as used by

Adler, does not necessarily mean superiority over others. Rather, it means moving

from a perceived lower (or minus) position to a perceived better (or plus) position.

People cope with feelings of helplessness by striving for competence, mastery,

and perfection. They can seek to change a weakness into a strength, for example,

or strive to excel in one area to compensate for defects in other areas. The unique

ways in which people develop a style of striving for competence is what constitutes

individuality or lifestyle. The manner in which Adler reacted to his childhood and

adolescent experiences is a living example of this aspect of his theory.

lifestyle The movement from a felt minus to a desired plus results in the devel-

opment of a life goal, which in turn uniﬁ es the personality and the individual’s core

beliefs and assumptions. These core beliefs and assumptions guide each person’s

movement through life and organize his or her reality, giving meaning to life events.

Adler called this life movement the individual’s “lifestyle.” Synonyms for this term

include “plan of life,” “style of life,” “strategy for living,” and “road map of life.” Life-

style includes the connecting themes and rules of interaction that give meaning to

our actions. Lifestyle is often described as our perceptions regarding self, others, and

the world. It includes an individual’s characteristic way of thinking, acting, feeling,

living, and striving toward long-term goals (Mosak & Maniacci, 2011).

Adler saw us as actors, creators, and artists. Understanding one’s lifestyle is

somewhat like understanding the style of a composer: “We can begin wherever

we choose: every expression will lead us in the same direction—toward the one

motive, the one melody, around which the personality is built” (Adler, as cited in

Ansbacher & Ansbacher, 1956/1964, p. 332).

People are viewed as adopting a proactive, rather than a reactive, approach

to their social environment. Although events in the environment inﬂ uence the

development of personality, such events are not the causes of what people become;

rather, it is our interpretation of these events that shape personality. Faulty in-

terpretations may lead to mistaken notions in our private logic, which will sig-

niﬁ cantly inﬂ uence present behavior. Once we become aware of the patterns and

continuity of our lives, we are in a position to modify those faulty assumptions and

make basic changes. We can reframe childhood experiences and consciously create

a new style of living.

Social Interest and Community Feeling

Social interest and community feeling (Gemeinschaftsgefühl) are probably Adler’s

most signiﬁ cant and distinctive concepts (Ansbacher, 1992). These terms refer to

individuals’ awareness of being part of the human community and to individuals’

attitudes in dealing with the social world.

Social interest is the action line of one’s community feeling, and it involves

being as concerned about others as one is about onself. This concept involves the

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ADLERIAN THERAPY

capacity to cooperate and contribute (Milliren & Clemmer, 2006). Social interest

requires that we have enough contact with the present to make a move toward a

meaningful future, that we are willing to give and to take, and that we develop our

capacity for contributing to the welfare of others and striving for the betterment of

humanity. The socialization process associated with social interest begins in child-

hood and involves helping children to ﬁ nd a place in society and acquire a sense of

belonging, as well as the ability to make a contribution (Keﬁ r, 1981). While Adler

considered social interest to be innate, he also believed that it must be learned,

developed, and used.

Adler equated social interest with a sense of identiﬁ cation and empathy

with others: “to see with the eyes of another, to hear with the ears of another, to feel

with the heart of another” (as cited in Ansbacher & Ansbacher, 1979, p. 42). Social

interest is the central indicator of mental health. Those with social interest tend to

direct the striving toward the healthy and socially useful side of life. From the Adle-

rian perspective, as social interest develops, feelings of inferiority and alienation

diminish. People express social interest through shared activity and mutual respect.

Individual Psychology rests on a central belief that our happiness and success

are largely related to this social connectedness. Because we are embedded in a

society, and indeed in the whole of humanity, we cannot be understood in isola-

tion from that social context. We are primarily motivated by a desire to belong.

Community feeling embodies the feeling of being connected to all of humanity—

past, present, and future—and to being involved in making the world a better place.

Those who lack this community feeling become discouraged and end up on the

useless side of life. We seek a place in the family and in society to fulﬁ ll basic needs

for security, acceptance, and worthiness. Many of the problems we experience are

related to the fear of not being accepted by the groups we value. If our sense of

belonging is not fulﬁ lled, anxiety is the result. Only when we feel united with oth-

ers are we able to act with courage in facing and dealing with our problems (Adler,

1938/1964).

Adler taught that we must successfully master three universal life tasks: build-

ing friendships (social task), establishing intimacy (love–marriage task), and con-

tributing to society (occupational task). All people need to address these tasks,

regardless of age, gender, time in history, culture, or nationality. Each of these

tasks requires the development of psychological capacities for friendship and be-

longing, for contribution and self-worth, and for cooperation (Bitter, 2006). These

basic life tasks are so fundamental to human living that impairment in any one of

them is often an indicator of a psychological disorder (American Psychiatric As-

sociation, 2000). More often than not, when people seek therapy, it is because they

are struggling unsuccessfully to meet one or more of these life tasks. The aim of

therapy is to assist clients in modifying their lifestyle so they can more effectively

navigate each of these tasks (Carlson & Englar-Carlson, 2008).

Birth Order and Sibling Relationships

The Adlerian approach is unique in giving special attention to the relationships

between siblings and the psychological birth position in one’s family. Adler

identiﬁ ed ﬁ ve psychological positions, or vantage points, from which children

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108

CHAPTER FIVE

tend to view life: oldest, second of only two, middle, youngest, and only. Birth

order is not a deterministic concept but does increase an individual’s probability

of having a certain set of experiences. Actual birth order is less important than

the individual’s interpretation of his or her place in the family. Because Adle-

rians view most human problems as social in nature, they emphasize relation-

ships within the family as our earliest and, perhaps, our most inﬂ uential social

system.

Adler (1931/1958) observed that many people wonder why children in the

same family often differ so widely, and he pointed out that it is a fallacy to assume

that children of the same family are formed in the same environment. Although

siblings share aspects in common in the family constellation, the psychological

situation of each child is different from that of the others due to birth order. The

following description of the inﬂ uence of birth order is based on Ansbacher and

Ansbacher (1964), Dreikurs (1953), and Adler (1931/1958).

1. The oldest child generally receives a good deal of attention, and during the time

she is the only child, she is typically somewhat spoiled as the center of attention.

She tends to be dependable and hard working and strives to keep ahead. When a

new brother or sister arrives on the scene, however, she ﬁ nds herself ousted from

her favored position. She is no longer unique or special. She may readily believe

that the newcomer (or intruder) will rob her of the love to which she is accustomed.

Most often, she reasserts her position by becoming a model child, bossing younger

children, and exhibiting a high achievement drive.

2. The second child of only two is in a different position. From the time she is born,

she shares the attention with another child. The typical second child behaves as

if she were in a race and is generally under full steam at all times. It is as though

this second child were in training to surpass the older brother or sister. This com-

petitive struggle between the ﬁ rst two children inﬂ uences the later course of their

lives. The younger child develops a knack for ﬁ nding out the elder child’s weak

spots and proceeds to win praise from both parents and teachers by achieving

successes where the older sibling has failed. If one is talented in a given area, the

other strives for recognition by developing other abilities. The second-born is often

opposite to the ﬁ rstborn.

3. The middle child often feels squeezed out. This child may become convinced

of the unfairness of life and feel cheated. This person may assume a “poor me”

attitude and can become a problem child. However, especially in families charac-

terized by conﬂ ict, the middle child may become the switchboard and the peace-

maker, the person who holds things together. If there are four children in a family,

the second child will often feel like a middle child and the third will be more easy-

going, more social, and may align with the ﬁ rstborn.

4. The youngest child is always the baby of the family and tends to be the most

pampered one. Because of being pampered or spoiled, he may develop helpless-

ness into an art form and become expert at putting others in his service. Youngest

children tend to go their own way, often developing in ways no others in the family

have attempted and may outshine everyone.

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ADLERIAN THERAPY

5. The only child has a problem of her own. Although she shares some of the char-

acteristics of the oldest child (for example, a high achievement drive), she may not

learn to share or cooperate with other children. She will learn to deal with adults

well, as they make up her original familial world. Often, the only child is pampered

by her parents and may become dependently tied to one or both of them. She may

want to have center stage all of the time, and if her position is challenged, she will

feel it is unfair.

Birth order and the interpretation of one’s position in the family have a great

deal to do with how adults interact in the world. Individuals acquire a certain style

of relating to others in childhood and form a deﬁ nite picture of themselves that

they carry into their adult interactions. In Adlerian therapy, working with family

dynamics, especially relationships among siblings, assumes a key role. Although

it is important to avoid stereotyping individuals, it does help to see how certain

personality trends that began in childhood as a result of sibling rivalry inﬂ uence

individuals throughout life.

the therapeutic process

Therapeutic Goals

Adlerian counseling rests on a collaborative arrangement between the client and

the counselor. In general, the therapeutic process includes forming a relationship

based on mutual respect; a holistic psychological investigation or lifestyle assess-

ment; and disclosing mistaken goals and faulty assumptions within the person’s style

of living. This is followed by a reeducation or reorientation of the client toward

the useful side of life. The main aim of therapy is to develop the client’s sense

of belonging and to assist in the adoption of behaviors and processes character-

ized by community feeling and social interest. This is accomplished by increasing

the client’s self-awareness and challenging and modifying his or her fundamental

premises, life goals, and basic concepts (Dreikurs, 1967, 1997). Milliren, Evans,

and Newbauer (2007), identify this goal of Adlerian therapy: “to assist clients to

understand their unique lifestyles . . . and to act in such a way as to meet the tasks

of life with courage and social interest” (p. 145).

Adlerians do not view clients as being “sick” and in need of being “cured.”

They favor the growth model of personality rather than the medical model. As

Mosak and Maniacci (2011) put it: “The Adlerian is interested not in curing sick

individuals or a sick society but in reeducating individuals and in reshaping soci-

ety” (p. 78). Rather than being stuck in some kind of pathology, Adlerians contend

that clients are often discouraged. The counseling process focuses on providing

information, teaching, guiding, and offering encouragement to discouraged cli-

ents. Encouragement is the most powerful method available for changing a per-

son’s beliefs, for it helps clients build self-conﬁ dence and stimulates courage.

Courage is the willingness to act even when fearful in ways that are consistent with

social interest. Fear and courage go hand in hand; without fear, there would be no

need for courage. The loss of courage, or discouragement, results in mistaken and

dysfunctional behavior. Discouraged people do not act in line with social interest.

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CHAPTER FIVE

Adlerian counselors provide clients with an opportunity to view things from

a different perspective, yet it is up to the clients to decide whether to accept an

alternative perspective. Adlerians work collaboratively with clients to help them

reach their self-deﬁ ned goals. Adlerians educate clients in new ways of looking at

themselves, others, and life. Through the process of providing clients with a new

“cognitive map,” a fundamental understanding of the purpose of their behavior,

counselors assist them in changing their perceptions. Mosak and Maniacci (2011)

lists these goals for the educational process of therapy:

• Fostering social interest

• Helping clients overcome feelings of discouragement and inferiority

• Modifying clients’ views and goals—that is, changing their lifestyle

• Changing faulty motivation

• Encouraging the individual to recognize equality among people

• Helping people to become contributing members of society

Therapist’s Function and Role

Adlerian counselors realize that clients can become discouraged and function

ineffectively because of mistaken beliefs, faulty values, and useless or self-absorbed

goals. These therapists operate on the assumption that clients will feel and behave

better once they discover and correct their basic mistakes. Therapists tend to look

for major mistakes in thinking and valuing such as mistrust, selﬁ shness, unrealis-

tic ambitions, and lack of conﬁ dence.

Adlerians assume a nonpathological perspective and thus do not label clients

with pathological diagnoses. One way of looking at the role of Adlerian therapists

is that they assist clients in better understanding, challenging, and changing their

life story. “When individuals develop a life story that they ﬁ nd limiting and prob-

lem saturated, the goal is to free them from that story in favor of a preferred and

equally viable alternative story” (Disque & Bitter, 1998, p. 434).

A major function of the therapist is to make a comprehensive assessment of

the client’s functioning. Therapists often gather information about the individual’s

style of living by means of a questionnaire on the client’s family constellation,

which includes parents, siblings, and others living in the home, life tasks, and

early recollections. When summarized and interpreted, this questionnaire gives a

picture of the individual’s early social world. From this information on the family

constellation, the therapist is able to get a perspective on the client’s major areas

of success and failure and on the critical inﬂ uences that have had a bearing on the

role the client has assumed in the world.

The counselor also uses early recollections as an assessment procedure. Early

recollections (ERs) are deﬁ ned as “stories of events that a person says occurred

[one time] before he or she was 10 years of age” (Mosak & Di Pietro, 2006, p. 1).

ERs are speciﬁ c incidents that clients recall, along with the feelings and thoughts

that accompanied these childhood incidents. These recollections are quite useful

in getting a better understanding of the client (Clark, 2002). After these early rec-

ollections are summarized and interpreted, the therapist identiﬁ es some of the

major successes and mistakes in the client’s life. The aim is to provide a point of

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ADLERIAN THERAPY

departure for the therapeutic venture. ERs are particularly useful as a functional

assessment device because they indicate what clients do and how they think in

both adaptive and maladaptive ways (Mosak & Di Pietro, 2006). The process of

gathering early memories is part of what is called a lifestyle assessment, which

involves learning to understand the goals and motivations of the client. When this

process is completed, the therapist and the client have targets for therapy.

Mosak and Maniacci (2011) consider dreams to be a useful part of the assess-

ment process. Freud assumed that dreams were wish fulﬁ llment, or, in some

instances, an attempt at solving an old problem; Adler, on the other hand, viewed

dreams as a rehearsal for possible future actions. Just as early recollections reﬂ ect

a client’s long-range goals, dreams suggest possible answers to a client’s present

problems. In interpreting dreams, the therapist considers their purposive func-

tion. Mosak and Maniacci (2011) assert that “dreams serve as weather vanes for

treatment, bringing problems to the surface and pointing to the patient’s move-

ment” (p. 88).

Client’s Experience in Therapy

How do clients maintain their lifestyle, and why do they resist changing it? A per-

son’s style of living serves the individual by staying stable and constant. In other

words, it is predictable. It is, however, also resistant to change throughout most of

one’s life. Generally, people fail to change because they do not recognize the errors

in their thinking or the purposes of their behaviors, do not know what to do differ-

ently, and are fearful of leaving old patterns for new and unpredictable outcomes.

Thus, even though their ways of thinking and behaving are not successful, they

tend to cling to familiar patterns (Sweeney, 2009). Clients in Adlerian counseling

focus their work on desired outcomes and a resilient lifestyle that can provide a

new blueprint for their actions.

In therapy, clients explore what Adlerians call private logic, the concepts about

self, others, and life that constitute the philosophy on which an individual’s life-

style is based. Private logic involves our convictions and beliefs that get in the way

of social interest and that do not facilitate useful, constructive belonging (Carlson,

Watts, & Maniacci, 2006). Clients’ problems arise because the conclusions based

on their private logic often do not conform to the requirements of social living. The

heart of therapy is helping clients to discover the purposes of behaviors or symp-

toms and the basic mistakes associated with their personal coping. Learning how

to correct faulty assumptions and conclusions is central to therapy.

To provide a concrete example, think of a chronically depressed middle-aged

man who begins therapy. After a lifestyle assessment is completed, these basic

mistakes are identiﬁ ed:

• He has convinced himself that nobody could really care about him.

• He rejects people before they have a chance to reject him.

• He is harshly critical of himself, expecting perfection.

• He has expectations that things will rarely work out well.

• He burdens himself with guilt because he is convinced he is letting everyone

down.

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CHAPTER FIVE

Even though this man may have developed these mistaken ideas about himself and

life when he was young, he is still clinging to them as rules for living. His expecta-

tions, most of which are pessimistic, tend to be fulﬁ lled because on some level he

is seeking to validate his beliefs. Indeed, his depression will eventually serve the

purpose of helping him avoid contact with others, a life task at which he expects

to fail. In therapy, this man will learn how to challenge the structure of his private

logic. In his case the syllogism goes as follows:

• “I am basically unlovable.”

• “The world is ﬁ

lled with people who are likely to be rejecting.”

• “Therefore, I must keep to myself so I won’t be hurt.”

This person holds onto several basic mistakes, and his private logic offers a psy-

chological focus for treatment. A central theme or convictions in this client’s life

might be: “I must control everything in my life.” “I must be perfect in everything

I do.”

It is easy to see how depression might follow from this thinking, but Adlerians

also know that the depression serves as an excuse for this man’s retreat from life.

It is important for the therapist to listen for the underlying purposes of this cli-

ent’s behavior. Adlerians see feelings as being aligned with thinking and as the

fuel for behaving. First we think, then we feel, and then we act. Because emotions

and cognitions serve a purpose, a good deal of therapy time is spent in discover-

ing and understanding this purpose and in reorienting the client toward effective

ways of being. Because the client is not perceived by the therapist to be mentally

ill or emotionally disturbed, but as mainly discouraged, the therapist will offer the

client encouragement so that change is possible. Through the therapeutic proc-

ess, the client will discover that he or she has resources and options to draw on in

dealing with signiﬁ cant life issues and life tasks.

Relationship Between Therapist and Client

Adlerians consider a good client–therapist relationship to be one between equals

that is based on cooperation, mutual trust, respect, conﬁ dence, collaboration, and

alignment of goals. They place special value on the counselor’s modeling of com-

munication and acting in good faith. From the beginning of therapy, the relation-

ship is a collaborative one, characterized by two persons working equally toward

speciﬁ c, agreed-upon goals. Adlerian therapists strive to establish and maintain

an egalitarian therapeutic alliance and a person-to-person relationship with their

clients. Developing a strong therapeutic relationship is essential to successful out-

comes (Carlson et al., 2006). Dinkmeyer and Sperry (2000) maintain that at the

outset of counseling clients should begin to formulate a plan, or contract, detailing

what they want, how they plan to get where they are heading, what is preventing

them from successfully attaining their goals, how they can change nonproductive

behavior into constructive behavior, and how they can make full use of their assets

in achieving their purposes. This therapeutic contract sets forth the goals of the

counseling process and speciﬁ es the responsibilities of both therapist and client.

Developing a contract is not a requirement of Adlerian therapy, but a contract can

bring a tight focus to therapy.

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application: therapeutic

techniques and procedures

Adlerian counseling is structured around four central objectives that correspond to

the four phases of the therapeutic process (Dreikurs, 1967). These phases are not

linear and do not progress in rigid steps; rather, they can best be understood as a

weaving that leads to a tapestry. These phases are as follows:

1. Establish the proper therapeutic relationship.

2. Explore the psychological dynamics operating in the client (an assessment).

3. Encourage the development of self-understanding (insight into purpose).

4. Help the client make new choices (reorientation and reeducation).

Dreikurs (1997) incorporated these phases into what he called minor psycho-

therapy in the context and service of holistic medicine. His approach to therapy

has been elaborated in what is now called Adlerian brief therapy, or ABT (Bitter,

Christensen, Hawes, & Nicoll, 1998). This way of working is discussed in the fol-

lowing sections.

Phase 1: Establish the Relationship

The Adlerian practitioner works in a collaborative way with clients, and this rela-

tionship is based on a sense of interest that grows into caring, involvement, and

friendship. Therapeutic progress is possible only when there is an alignment of

clearly deﬁ ned goals between therapist and client. The counseling process, to be

effective, must deal with the personal issues the client recognizes as signiﬁ cant

and is willing to explore and change. The therapeutic efﬁ cacy in the later phases of

Adlerian therapy is predicated upon the development and continuation of a solid

therapeutic relationship during this ﬁ rst phase of therapy (Watts, 2000; Watts &

Pietrzak, 2000).

Adlerian therapists focus on making person-to-person contact with clients

rather than starting with “the problem.” Clients’ concerns surface rather quickly

in therapy, but the initial focus should be on the person, not the problem. One way

to create effective contact is for counselors to help clients become aware of their

assets and strengths rather than dealing continually with their deﬁ cits and lia-

bilities. During the initial phase, a positive relationship is created by listening;

responding; demonstrating respect for clients’ capacity to understand purpose and

seek change; and exhibiting faith, hope, and caring. When clients enter therapy,

they typically have a diminished sense of self-worth and self-respect. They lack faith

in their ability to cope with the tasks of life. Therapists provide support, which is

an antidote to despair and discouragement. For some people, therapy may be one

of the few times in which they have truly experienced a caring human relationship.

Adlerians pay more attention to the subjective experiences of the client than

they do to using techniques. They ﬁ t their techniques to the needs of each client.

During the initial phase of counseling, the main techniques are attending and

listening with empathy, following the subjective experience of the client as closely

as possible, identifying and clarifying goals, and suggesting initial hunches about

purpose in client’s symptoms, actions, and interactions. Adlerian counselors are

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CHAPTER FIVE

generally active, especially during the initial sessions. They provide structure and

assist clients to deﬁ ne personal goals, they conduct psychological assessments,

and they offer interpretations (Carlson et al., 2006). Adlerians attempt to grasp

both the verbal and nonverbal messages of the client; they want to access the core

patterns in the client’s life. If the client feels deeply understood and accepted, the

client is likely to focus on what he or she wants from therapy and thus establish

goals. At this stage the counselor’s function is to provide a wide-angle perspective

that will eventually help the client view his or her world differently.

Phase 2: Explore the Individual’s Psychological Dynamics

The aim of the second phase of Adlerian counseling is to get a deeper understand-

ing of an individual’s lifestyle. During this assessment phase, the focus is on the

individual’s social and cultural context. Rather than attempting to ﬁ t clients into a

preconceived model, Adlerian practitioners allow salient cultural identity concepts

to emerge in the therapy process, and these issues are then addressed (Carlson &

Englar-Carlson, 2008). This assessment phase proceeds from two interview forms:

the subjective interview and the objective interview (Dreikurs, 1997). In the subjective

interview, the counselor helps the client to tell his or her life story as completely as

possible. This process is facilitated by a generous use of empathic listening and

responding. Active listening, however, is not enough. The subjective interview

must follow from a sense of wonder, fascination, and interest. What the client

says will spark an interest in the counselor and lead, naturally, to the next most

signiﬁ cant question or inquiry about the client and his or her life story. Indeed,

the best subjective interviews treat clients as experts in their own lives, allowing

clients to feel completely heard. Throughout the subjective interview, the Adlerian

counselor is listening for clues to the purposive aspects of the client’s coping and

approaches to life. “The subjective interview should extract patterns in the person’s

life, develop hypotheses about what works for the person, and determine what

accounts for the various concerns in the client’s life” (Bitter et al., 1998, p. 98).

Toward the end of this part of the interview, Adlerian brief therapists ask, “Is there

anything else you think I should know to understand you and your concerns?”

An initial assessment of the purpose that symptoms, actions, or difﬁ culties

serve in a person’s life can be gained from what Dreikurs (1997) calls “The Ques-

tion.” Adlerians often end a subjective interview with this question: “How would

your life be different, and what would you be doing differently, if you did not have

this symptom or problem?” Adlerians use this question to help with differential

diagnosis. More often, the symptoms or problems experienced by the client help

the client avoid something that is perceived as necessary but from which the per-

son wishes to retreat, usually a life task: “If it weren’t for my depression, I would

get out more and see my friends.” Such a statement betrays the client’s concern

about the possibility of being a good friend or being welcomed by his or her friends.

“I need to get married, but how can I with these panic attacks?” indicates the per-

son’s worry about being a partner in a marriage. Depression can serve as the cli-

ent’s solution when faced with problems in relationships. If a client reports that

nothing would be different, especially with physical symptoms, Adlerians suspect

that the problem may be organic and require medical intervention.

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ADLERIAN THERAPY

The objective interview seeks to discover information about (a) how problems

in the client’s life began; (b) any precipitating events; (c) a medical history, includ-

ing current and past medications; (d) a social history; (e) the reasons the client

chose therapy at this time; (f) the person’s coping with life tasks; and (g) a lifestyle

assessment. Mozdzierz and his colleagues (1986) describe the counselor as a “life-

style investigator” during this phase of therapy. Based on interview approaches

developed by Adler and Dreikurs, the lifestyle assessment starts with an investiga-

tion of the person’s family constellation and early childhood history (Powers &

Grifﬁ th, 1987; Shulman & Mosak, 1988). Counselors also interpret the person’s

early memories, seeking to understand the meaning that she or he has attached

to life experiences. They operate on the assumption that it is the interpretations

people develop about themselves, others, the world, and life that govern what they

do. Lifestyle assessment seeks to develop a holistic narrative of the person’s life, to

make sense of the way the person copes with life tasks, and to uncover the private

interpretations and logic involved in that coping. For example, if Jenny has lived

most of her life in a critical environment, and now she believes she must be perfect

to avoid even the appearance of failure, the assessment process will highlight the

restricted living that ﬂ ows from this perspective.

the family constellation Adler considered the family of origin as having

a central impact on an individual’s personality. Adler suggested that it was through

the family constellation that each person forms his or her unique view of self, others,

and life. Factors such as cultural and familial values, gender-role expectations, and

the nature of interpersonal relationships are all inﬂ uenced by a child’s observation

of the interactional patterns within the family. Adlerian assessment relies heavily on

an exploration of the client’s family constellation, including the client’s evaluation

of conditions that prevailed in the family when the person was a young child (family

atmosphere), birth order, parental relationship and family values, and extended fam-

ily and culture. Some of these questions are almost always explored:

• Who was the favorite child?

• What was your father’s relationship with the children? Your mother’s?

• Which child was most like your father? Your mother? In what respects?

• Who among the siblings was most different from you? In what ways?

• Who among the siblings was most like you? In what ways?

• What were you like as a child?

• How did your parents get along? In what did they both agree? How did they

handle disagreements? How did they discipline the children?

An investigation of family constellation is far more comprehensive than these few

questions, but these questions give an idea of the type of information the counselor

is seeking. The questions are always tailored to the individual client with the goal

of eliciting the client’s perceptions of self and others, of development, and of the

experiences that have affected that development.

early recollections As you will recall, another assessment procedure used

by Adlerians is to ask the client to provide his or her earliest memories, including the

age of the person at the time of the remembered events and the feelings or reactions

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CHAPTER FIVE

associated with the recollections. Early recollections are one-time occurrences, usu-

ally before the age of 9, pictured by the client in clear detail. Adler reasoned that out

of the millions of early memories we might have we select those special memories

that project the essential convictions and even the basic mistakes of our lives. Early

recollections are a series of small mysteries that can be woven together into a tapes-

try that leads to an understanding of how we view ourselves, how we see the world,

what our life goals are, what motivates us, what we value and believe in, and what we

anticipate for our future (Clark, 2002; Mosak & Di Pietro, 2006).

Early memories cast light on the “story of our life” because they represent met-

aphors for our current views. From the thousands of experiences we have before

the age of 9, we tend to remember only 6 to 12 memories. By understanding why

we retain these memories and what they tell us about how we see ourselves, others,

and life in the present, it is possible to get a clear sense of our mistaken notions,

present attitudes, social interests, and possible future behavior. Early recollections

are speciﬁ c instances that clients tell therapists, and they are very useful in under-

standing those who are sharing a story (Mosak & Di Pietro, 2006). Exploring early

recollections involves discovering how mistaken notions based on faulty goals and

values continue to create problems in a client’s life.

To tap such recollections, the counselor might proceed as follows: “I would like

to hear about your early memories. Think back to when you were very young, as

early as you can remember (before the age of 10), and tell me something that hap-

pened one time.” After receiving each memory, the counselor might also ask: “What

part stands out to you? What was the most vivid part of your early memory? If

you played the whole memory like a movie and stopped it at one frame, what would

be happening? Putting yourself in that moment, what are you feeling? What’s your

reaction?” Three memories are usually considered a minimum to assess a pattern,

and some counselors ask for as many as a dozen memories.

Adlerian therapists use early recollections as a projective technique (Clark, 2002;

Hood & Johnson, 2007) and to (a) assess the client’s convictions about self, others,

life, and ethics; (b) assess the client’s stance in relation to the counseling session

and the counseling relationship; (c) verify the client’s coping patterns; and (d) assess

individual strengths, assets, and interfering ideas (Bitter et al., 1998, p. 99).

In interpreting these early recollections, Adlerians may consider questions

such as these:

• What part does the client take in the memory? Is the client an observer or a

participant?

• Who else is in the memory? What position do others take in relation to the client?

• What are the dominant themes and overall patterns of the memories?

• What feelings are expressed in the memories?

• Why does the client choose to remember this event? What is the client trying to

convey?

integration and summary Once material has been gathered from both

subjective and objective interviews with the client, integrated summaries of the

data are developed. Different summaries are prepared for different clients, but

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ADLERIAN THERAPY

common ones are a narrative summary of the person’s subjective experience and

life story; a summary of family constellation and developmental data; a summa-

ry of early recollections, personal strengths or assets, and interfering ideas; and

a summary of coping strategies. The summaries are presented to the client and

discussed in the session, with the client and the counselor together reﬁ ning

speciﬁ c points. This information provides the client with the chance to discuss

speciﬁ c topics and to raise questions.

Mosak and Maniacci (2011) believe lifestyle can be conceived of as a personal

mythology. People behave as if the myths were true because, for them, they are

true. Mosak and Maniacci list ﬁ ve basic mistakes in what is essentially an integra-

tion of Adlerian psychology and cognitive behavioral theory: overgeneralizations,

false or impossible goals of security, misperceptions of life and life’s demands,

minimization or denial of one’s basic worth, and faulty values.

In addition to the concept of basic mistakes, Adlerian theory is useful in as-

sisting clients to identify and examine some of their common fears. These fears

include being imperfect, being vulnerable, being disapproved of, and suffering

from past regrets (Carlson & Englar-Carlson, 2008).

The Student Manual that accompanies this textbook includes a concrete

example of the lifestyle assessment as it is applied to the case of Stan. In Case

Approach to Counseling and Psychotherapy (Corey, 2013, chap. 3), Drs. Jim Bitter

and Bill Nicoll present a lifestyle assessment of another hypothetical client, Ruth.

Phase 3: Encourage Self-Understanding and Insight

During this third phase, Adlerian therapists interpret the ﬁ ndings of the assess-

ment as an avenue for promoting self-understanding and insight. Mosak and

Maniacci (2011) deﬁ ne insight as “understanding translated into constructive action”

(p. 89). When Adlerians speak of insight, they are referring to an understanding of

the motivations that operate in a client’s life. Self-understanding is only possible

when hidden purposes and goals of behavior are made conscious. Adlerians con-

sider insight as a special form of awareness that facilitates a meaningful understand-

ing within the therapeutic relationship and acts as a foundation for change. Insight

is a means to an end, and not an end in itself. People can make rapid and signiﬁ cant

changes without much insight.

Disclosure and well-timed interpretations are techniques that facilitate the proc-

ess of gaining insight. Interpretation deals with clients’ underlying motives for

behaving the way they do in the here and now. Adlerian disclosures and interpreta-

tions are concerned with creating awareness of one’s direction in life, one’s goals

and purposes, one’s private logic and how it works, and one’s current behavior.

Adlerian interpretations are suggestions presented tentatively in the form of

open-ended questions that can be explored in the sessions. They are hunches or

guesses, and they often begin with phrases such as “I could be wrong, but I am

wondering if . . . ,” “Could it be that . . . ,” or “Is it possible that . . .” Because inter-

pretations are presented in this manner, clients are not led to defend themselves,

and they feel free to discuss and even argue with the counselor’s hunches and

impressions. Through this process, both counselor and client eventually come to

understand the client’s motivations, the ways in which these motivations are now

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CHAPTER FIVE

contributing to the maintenance of the problem, and what the client can do to

correct the situation. During this phase of therapy, the counselor helps the client

understand the limitations of the style of life the client has chosen.

Phase 4: Reorientation and Reeducation

The ﬁ nal stage of the therapeutic process is the action-oriented phase known as

reorientation and reeducation: putting insights into practice. This phase focuses

on helping clients discover a new and more functional perspective. Clients are

both encouraged and challenged to develop the courage to take risks and make

changes in their life. During this phase, clients can choose to adopt a new style of

life based on the insights they gained in the earlier phases of therapy.

Adlerians are interested in more than changes in behavior. Reorientation

involves shifting rules of interaction, process, and motivation. These shifts are

facilitated through changes in awareness, which often occur during the therapy ses-

sion and which are transformed into action outside of the therapy ofﬁ ce (Bitter &

Nicoll, 2004). In addition, especially at this phase of therapy, Adlerians focus on

reeducation (see the section on therapeutic goals).

In some cases, signiﬁ cant changes are needed if clients are to overcome discour-

agement and ﬁ nd a place for themselves in this life. More often, however, clients

merely need to be reoriented toward the useful side of life. The useful side involves a

sense of belonging and being valued, having an interest in others and their welfare,

courage, the acceptance of imperfection, conﬁ dence, a sense of humor, a willing-

ness to contribute, and an outgoing friendliness. The useless side of life is charac-

terized by self-absorption, withdrawal from life tasks, self-protection, or acts against

one’s fellow human beings. People acting on the useless side of life become less

functional and are more susceptible to psychopathology. Adlerian therapy stands

in opposition to self-depreciation, isolation, and retreat, and it seeks to help clients

gain courage and to connect to strengths within themselves, to others, and to life.

Throughout this phase, no intervention is more important than encouragement.

the encouragement process Encouragement is the most distinctive

Adlerian procedure, and it is central to all phases of counseling and therapy. It

is especially important as people consider change in their lives. Encouragement

literally means “to build courage.” Courage develops when people become aware

of their strengths, when they feel they belong and are not alone, and when they

have a sense of hope and can see new possibilities for themselves and their daily

living. Encouragement entails showing faith in people, expecting them to assume

responsibility for their lives, and valuing them for who they are (Carlson et al.,

2006). Carlson and Englar-Carlson (2008) note that encouragement involves

acknowledging that life can be difﬁ cult, yet it is critical to instill a sense of faith in

clients that they can make changes in life. Milliren, Evans, and Newbauer (2007)

consider encouragement key in promoting and activating social interest. They add

that encouragement is the universal therapeutic intervention for Adlerian coun-

selors, that it is a fundamental attitude rather than a technique. Because clients

often do not recognize or accept their positive qualities, strengths, or internal

resources, one of the counselor’s main tasks is to help them do so.

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ADLERIAN THERAPY

Adlerians believe discouragement is the basic condition that prevents people

from functioning, and they see encouragement as the antidote. As a part of the

encouragement process, Adlerians use a variety of relational, cognitive, behavioral,

emotional, and experiential techniques to help clients identify and challenge self-

defeating cognitions, generate perceptional alternatives, and make use of assets,

strengths, and resources (Ansbacher & Ansbacher, 1964; Dinkmeyer & Sperry,

2000; Watts & Pietrzak, 2000; Watts & Shulman, 2003).

Encouragement takes many forms, depending on the phase of the coun-

seling process. In the relationship phase, encouragement results from the mutual

respect the counselor seeks to engender. In the assessment phase, which is partially

designed to illuminate personal strengths, clients are encouraged to recognize that

they are in charge of their own lives and can make different choices based on new

understandings. During reorientation, encouragement comes when new possibili-

ties are generated and when clients are acknowledged and afﬁ rmed for taking posi-

tive steps to change their lives for the better.

change and the search for new possibilities During the reo-

rientation phase of counseling, clients make decisions and modify their goals. They

are encouraged to act as if they were the people they want to be, which can serve

to challenge self-limiting assumptions. Clients are asked to catch themselves in the

process of repeating old patterns that have led to ineffective behavior. Commitment

is an essential part of reorientation. If clients hope to change, they must be willing

to set tasks for themselves in everyday life and do something speciﬁ c about their

problems. In this way, clients translate their new insights into concrete actions. Bit-

ter and Nicoll (2004) emphasize that real change happens between sessions, and

not in therapy itself. They state that arriving at a strategy for change is an important

ﬁ rst step, and stress that it takes courage and encouragement for clients to apply

what they have learned in therapy to daily living.

This action-oriented phase is a time for solving problems and making deci-

sions. The counselor and the client consider possible alternatives and their con-

sequences, evaluate how these alternatives will meet the client’s goals, and decide

on a speciﬁ c course of action. The best alternatives and new possibilities are those

generated by the client, and the counselor must offer the client a great deal of sup-

port and encouragement during this stage of the process.

making a difference Adlerian counselors seek to make a difference in the

lives of their clients. That difference may be manifested by a change in behavior or

attitude or perception. Adlerians use many different techniques to promote change,

some of which have become common interventions in other therapeutic models.

Techniques that go by the names of immediacy, advice, humor, silence, paradoxi-

cal intention, acting as if, spitting in the client’s soup, catching oneself, the push-

button technique, externalization, reauthoring, avoiding the traps, confrontation, use

of stories and fables, early recollection analysis, lifestyle assessment, encouraging,

task setting and commitment, giving homework, and terminating and summariz-

ing have all been used (Carlson & Slavik, 1997; Carlson et al., 2006; Dinkmeyer &

Sperry, 2000; Disque & Bitter, 1998; Mosak & Maniacci, 2011; Mozdzierz, Peluso, &

Lisiecki, 2009). Adlerian practitioners can creatively employ a wide range of other

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techniques, as long as these methods are philosophically consistent with the basic

theoretical premises of Adlerian psychology (Milliren et al., 2007). Adlerians are prag-

matic when it comes to using techniques that are appropriate for a given client. In

general, however, Adlerian practitioners focus on motivation modiﬁ cation more than

behavior change and encourage clients to make holistic changes on the useful side of

living. All counseling is a cooperative effort, and making a difference depends on the

counselor’s ability to win the client’s cooperation.

Areas of Application

Adler anticipated the future direction of the helping professions by calling upon

therapists to become social activists and by addressing the prevention and reme-

diation of social conditions that were contrary to social interest and resulted in

human problems. Adler’s pioneering efforts on prevention services in mental health

led him to increasingly advocate for the role of Individual Psychology in schools and

families. Because Individual Psychology is based on a growth model, not a medical

model, it is applicable to such varied spheres of life as child guidance; parent–child

counseling; couples counseling; family counseling and therapy; group counseling

and therapy; individual counseling with children, adolescents, and adults; cultural

conﬂ icts; correctional and rehabilitation counseling; and mental health institutions.

Adler’s basic ideas have been incorporated into the practices of school psychology,

school counseling, the community mental health movement, and parent education.

Adlerian principles have been widely applied to substance abuse programs, social

problems to combat poverty and crime, problems of the aged, school systems, reli-

gion, and business.

application to education Adler (1930/1978) advocated training both

teachers and parents in effective practices that foster the child’s social interests and

result in a sense of competence and self-worth. Adler had a keen interest in apply-

ing his ideas to education, especially in ﬁ nding ways to remedy faulty lifestyles of

schoolchildren. He initiated a process to work with students in groups and to edu-

cate parents and teachers. By providing teachers with ways to prevent and correct

basic mistakes of children, he sought to promote social interest and mental health.

Adler was ahead of his time in advocating for schools to take an active role in de-

veloping social skills and character education as well as teaching the basics. Many

of the major teacher education models are based on principles of Adlerian psychol-

ogy (see Albert, 1996). Besides Adler, the main proponent of Individual Psychol-

ogy as a foundation for the teaching–learning process was Dreikurs (1968, 1971).

application to parent education Parent education seeks to im-

prove the relationship between parent and child by promoting greater understand-

ing and acceptance. Parents are taught how to recognize the mistaken goals of chil-

dren and to use logical and natural consequences to guide children toward more

productive behavior. Adlerian parent education also stresses listening to children,

helping children accept the consequences of their behavior, applying emotion

coaching, holding family meetings, and using encouragement. Two of the leading

parent education programs in the United States—STEP (Dinkmeyer & McKay,

1997) and Active Parenting (Popkin, 1993)—are based on Adlerian principles.

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application to couples counseling Adlerian therapy with couples

is designed to assess a couple’s beliefs and behaviors while educating them in

more effective ways of meeting their relational goals. Clair Hawes has developed

an approach to couples counseling within the Adlerian brief therapy model. In addi-

tion to addressing the compatibility of lifestyles, Hawes looks at the early recollections

of the marriage and each partner’s relationship to a broad set of life tasks, including

occupation, social relationships, intimate relationships, spirituality, self-care, and

self-worth (Bitter et al., 1998; Hawes, 1993; Hawes & Blanchard, 1993). Carlson,

Watts, and Maniacci (2006) describe how Adlerians achieve the goals of brief

couples therapy: they foster social interest, assist couples in decreasing feelings

of inferiority and overcoming discouragement, help couples modify their views

and goals, help couples to feel a sense of quality in their relationships, and pro-

vide skill-building opportunities. Therapists aim to create solutions for problems,

increase choices of couples, and help clients discover and use their individual and

collective resources.

The full range of techniques applicable to other forms of counseling can be used

when working with couples. In couples counseling, couples are taught speciﬁ c

techniques that enhance communication and cooperation. Some of these tech-

niques are listening, paraphrasing, giving feedback, having marriage conferences,

listing expectations, doing homework, and enacting problem solving. Adlerians

use psychoeducational methods and skills training in counseling couples. For use-

ful books on this topic, see Carlson and Dinkmeyer (2003) and Sperry, Carlson,

and Peluso (2006).

Adlerians will sometimes see clients as a couple, sometimes individually, and

then alternately as a couple and as individuals. Rather than looking for who is at fault

in the relationship, the therapist considers the lifestyles of the partners and the inter-

action of the two lifestyles. Emphasis is given to helping them decide if they want to

maintain their relationship, and, if so, what changes they are willing to make.

application to family counseling With its emphasis on the fam-

ily constellation, holism, and the freedom of the therapist to improvise, Adler’s

approach contributed to the foundation of the family therapy perspective. Adleri-

ans working with families focus on the family atmosphere, the family constellation,

and the interactive goals of each member (Bitter, 2009). The family atmosphere is

the climate characterizing the relationship between the parents and their attitudes

toward life, gender roles, decision making, competition, cooperation, dealing with

conﬂ ict, responsibility, and so forth. This atmosphere, including the role models

the parents provide, inﬂ uences the children as they grow up. The therapeutic proc-

ess seeks to increase awareness of the interaction of the individuals within the

family system. Those who practice Adlerian family therapy strive to understand

the goals, beliefs, and behaviors of each family member and the family as an entity

in its own right. Adler’s and Dreikurs’s inﬂ uence on family therapy is covered in

more depth in Chapter 14.

application to group counseling Adler and his coworkers used

a group approach in their child guidance centers in Vienna as early as 1921

(Dreikurs, 1969). Dreikurs extended and popularized Adler’s work with groups

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122

CHAPTER FIVE

and used group psychotherapy in his private practice for more than 40 years.

Although Dreikurs introduced group therapy into his psychiatric practice as a way

to save time, he quickly discovered some unique characteristics of groups that

made them an effective way of helping people change. Inferiority feelings can be

challenged and counteracted effectively in groups, and the mistaken concepts and

values that are at the root of social and emotional problems can be deeply inﬂ u-

enced because the group is a value-forming agent (Sonstegard & Bitter, 2004).

The rationale for Adlerian group counseling is based on the premise that our

problems are mainly of a social nature. The group provides the social context in

which members can develop a sense of belonging, social connectedness, and com-

munity. Sonstegard and Bitter (2004) write that group participants come to see

that many of their problems are interpersonal in nature, that their behavior has

social meaning, and that their goals can best be understood in the framework

of social purposes.

The use of early recollections is a unique feature of Adlerian group counseling.

As mentioned earlier, from a series of early memories, individuals can get a clear

sense of their mistaken notions, current attitudes, social interests, and possible fu-

ture behavior. Through the mutual sharing of these early recollections, members

develop a sense of connection with one another, and group cohesion is increased.

The group becomes an agent of change because of the improved interpersonal

relationships among members and the emergence of hope.

We particularly value the way Adlerian group counselors implement action

strategies at each of the group sessions and especially during the reorientation

stage when new decisions are made and goals are modiﬁ ed. To challenge self-

limiting assumptions, members are encouraged to act as if they were the persons

they want to be. They are asked to “catch themselves” in the process of repeating

old patterns that have led to ineffective or self-defeating behavior. The mem-

bers come to appreciate that if they hope to change, they need to set tasks for

themselves, apply group lessons to daily life, and take steps in ﬁ nding solutions

to their problems. This ﬁ nal stage is characterized by group leaders and mem-

bers working together to challenge erroneous beliefs about self, life, and others.

During this stage, members are considering alternative beliefs, behaviors, and

attitudes.

Adlerian group counseling can be considered a brief approach to treatment.

The core characteristics associated with brief group therapy include rapid estab-

lishment of a strong therapeutic alliance, clear problem focus and goal alignment,

rapid assessment, emphasis on active and directive therapeutic interventions, a

focus on strengths and abilities of clients, an optimistic view of change, a focus

on both the present and the future, and an emphasis on tailoring treatment to

the unique needs of clients in the most time-efﬁ cient manner possible (Carlson

et al., 2006).

Adlerian brief group therapy is addressed by Sonstegard, Bitter, Pelonis-

Peneros, and Nicoll (2001). For more on the Adlerian approach to group coun-

seling, refer to Theory and Practice of Group Counseling (Corey, 2012, chap. 7) and

Sonstegard and Bitter (2004).

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123

ADLERIAN THERAPY

adlerian therapy from

a multicultural perspective

Strengths From a Diversity Perspective

Adlerian theory addressed social equality issues and social embeddedness of

humans long before multiculturalism assumed central importance in the profes-

sion (Watts & Pietrzak, 2000). Adler introduced notions with implications toward

multiculturalism that have as much or more relevance today as they did during

Adler’s time (Pedersen, as cited in Nystul, 1999b). Some of these ideas include

(1) the importance of the cultural context, (2) the emphasis on health as opposed

to pathology, (3) a holistic perspective on life, (4) the value of understanding indi-

viduals in terms of their core goals and purposes, (5) the ability to exercise freedom

within the context of societal constraints, and (6) the focus on prevention and the

development of a proactive approach in dealing with problems. Adler’s holistic per-

spective is an articulate expression of what Pedersen calls a “culture-centered” or

multicultural approach to counseling. Carlson and Englar-Carlson (2008) maintain

that Adlerian theory is well suited to counseling diverse populations and doing so-

cial justice work. They assert: “Perhaps Adler’s greatest contribution is that he de-

veloped a theory that recognizes and stresses the effects of social class, racism, sex,

and gender on the behavior of individuals. His ideas, therefore, are well received by

those living in today’s global society” (p. 134).

Although the Adlerian approach is called Individual Psychology, its focus is on

the person in a social context. Thus clients are encouraged to deﬁ ne themselves

within their social environments. Adlerians allow broad concepts of age, ethnicity,

lifestyle, sexual/affectional orientations, and gender differences to emerge in ther-

apy. The therapeutic process is grounded within a client’s culture and worldview

rather than attempting to ﬁ t clients into preconceived models.

In their analysis of the various theoretical approaches to counseling, Arciniega

and Newlon (2003) state that Adlerian theory holds a great deal of promise for

addressing diversity issues. They note a number of characteristics of Adlerian the-

ory that are congruent with the values of many racial, cultural, and ethnic groups,

including the emphasis on understanding the individual in a familial and socio-

cultural context; the role of social interest and contributing to others; and the focus

on belonging and the collective spirit. Cultures that stress the welfare of the social

group and emphasize the role of the family will ﬁ nd the basic assumptions of Adle-

rian psychology to be consistent with their values.

Adlerian therapists tend to focus on cooperation and socially oriented values

as opposed to competitive and individualistic values (Carlson & Carlson, 2000).

Native American clients, for example, tend to value cooperation over competition.

One such client told a story about a group of boys who were in a race. When one

boy got ahead of the others, he would slow down and allow the others to catch up,

and they all made it to the ﬁ nish line at the same time. Although the coach tried

to explain that the point of the race was for an individual to ﬁ nish ﬁ rst, these boys

were socialized to work together cooperatively as a group. Adlerian therapy is easily

adaptable to cultural values that emphasize community.

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124

CHAPTER FIVE

Not only is Adlerian theory congruent with the values of people from diverse

cultural groups, but the approach offers ﬂ exibility in applying a range of cognitive

and action-oriented techniques to helping clients explore their practical problems

in a cultural context. Adlerian practitioners are not wedded to any particular set

of procedures. Instead, they are conscious of the value of ﬁ tting their techniques

to each client’s situation. Although they utilize a diverse range of methods, most

of them do conduct a lifestyle assessment. This assessment is heavily focused on

the structure and dynamics within the client’s family. Because of their cultural

background, many clients have been conditioned to respect their family heritage

and to appreciate the impact of their family on their own personal development. It

is essential that counselors be sensitive to the conﬂ icting feelings and struggles of

their clients. If counselors demonstrate an understanding of these cultural values,

it is likely that these clients will be receptive to an exploration of their lifestyle.

Such an exploration will involve a detailed discussion of their own place within

their family.

It should be noted that Adlerians investigate culture in much the same way

that they approach birth order and family atmosphere. Culture is a vantage point

from which life is experienced and interpreted; it is also a background of values,

history, convictions, beliefs, customs, and expectations that must be addressed by

the individual. Culture provides a way of grasping the subjective and experien-

tial perspective of an individual. Although culture inﬂ uences each person, it is

expressed within each individual differently, according to the perception, evalua-

tion, and interpretation of culture that the person holds. Contemporary Adlerians

appreciate the role of spirituality and religion in the lives of clients because these

factors are manifestations of social interest and responsibility to others (Carlson &

Englar-Carlson, 2008).

Adler was one of the ﬁ rst psychologists at the turn of the century to advocate

equality for women. He recognized that men and women were different in many

ways, but he felt that the two genders were deserving of equal value and respect.

This respect and appreciation for difference extends to culture as well as gender.

Adlerians ﬁ nd in different cultures opportunities for viewing the self, others, and

the world in multidimensional ways.

Shortcomings From a Diversity Perspective

As is true of most Western models, the Adlerian approach tends to focus on the

self as the locus of change and responsibility. Because other cultures have differ-

ent conceptions, this primary emphasis on changing the autonomous self may be

problematic for many clients. Assumptions about the Western nuclear family are

built into the Adlerian concepts of birth order and family constellation. For people

brought up in extended family contexts, some of these ideas may be less relevant

or at least may need to be reconﬁ gured.

Adlerian theory has some potential drawbacks for clients from those cultures

who are not interested in exploring past childhood experiences, early memories,

family experiences, and dreams. This approach also has limited effectiveness with

clients who do not understand the purpose of exploring the details of a lifestyle

analysis when dealing with life’s current problems (Arciniega & Newlon, 2003).

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In addition, the culture of some clients may contribute to their viewing the coun-

selor as the “expert” and expecting that the counselor will provide them with solu-

tions to their problems. For these clients, the role of the Adlerian therapist may

pose problems because Adlerian therapists are not experts in solving other people’s

problems. Instead, they view it as their function to collaboratively teach people

alternative methods of coping with life concerns.

Many clients who have pressing problems are likely to be hesitant to discuss

areas of their lives that they may not see as connected to the struggles that bring

them into therapy. Individuals may believe that it is inappropriate to reveal family

information. On this point Carlson and Carlson (2000) suggest that a therapist’s

sensitivity and understanding of a client’s culturally constructed beliefs about dis-

closing family information are critical. If the therapist is able to demonstrate an

understanding of a client’s cultural values, it is likely that this person will be more

open to the assessment and treatment process.

The basic aims of an Adlerian thera-

pist working with Stan are fourfold

and correspond to the four stages

of counseling: (1) establishing and maintain-

ing a good working relationship with Stan,

(2) exploring Stan’s dynamics, (3) encouraging

Stan to develop insight and understanding, and

(4) helping Stan see new alternatives and make

new choices.

To develop mutual trust and respect, I pay

close attention to Stan’s subjective experience

and attempt to get a sense of how he has

reacted to the turning points in his life. During

the initial session, Stan reacts to me as the

expert who has the answers. He is convinced

that when he makes decisions he generally ends

up regretting the results. Stan approaches me

out of desperation. Because I view counseling

as a relationship between equals, I initially focus

on his feeling of being unequal to most other

people. A good place to begin is exploring his

feelings of inferiority, which he says he feels in

most situations. The goals of counseling are

developed mutually, and I avoid deciding for

Stan what his goals should be. I also resist

giving Stan the simple formula he is

requesting.

I prepare a lifestyle assessment based on a

questionnaire that taps information about Stan’s

early years, especially his experiences in his

family. (See the Student Manual for Theory and

Practice of Counseling and Psychotherapy for a

complete description of this lifestyle assessment

form as it is applied to Stan.) This assessment

includes a determination of whether he poses

a danger to himself because Stan did mention

suicidal ideation. During the assessment phase,

which might take a few sessions, I explore with

Stan his social relationships, his relationships

with members of his family, his work responsi-

bilities, his role as a man, and his feelings about

himself. I place considerable emphasis on Stan’s

goals in life and his priorities. I do not pay a great

deal of attention to his past, except to show him

the consistency between his past and present as

he moves toward the future.

As an Adlerian counselor, I place value on

exploring early recollections as a source of

understanding his goals, motivations, and

values. I ask Stan to report his earliest

memories. He replies as follows:

I was about 6. I went to school, and I was

scared of the other kids and the teacher. When I

came home, I cried and told my mother I didn’t

want to go back to school. She yelled at me and

called me a baby. After that I felt horrible and

even more scared.

Adlerian Therapy Applied to the Case of Stan

125

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Another of Stan’s early recollections was at

age 8:

My family was visiting my grandparents. I was

playing outside, and some neighborhood kid

hit me for no reason. We started fighting, and

my mother came out and scolded me for being

such a rough kid. She wouldn’t believe me when

I told her he started the fight. I felt angry and

hurt that she didn’t believe me.

Based on these early recollections, I suggest

that Stan sees life as frightening and unpredict-

ably hostile and that he feels he cannot count on

women; they are likely to be harsh, unbelieving,

and uncaring.

Having gathered the data based on the lifestyle

assessment about his family constellation and his

early recollections, I assist Stan in the process of

summarizing and interpreting this information. I

give particular attention to identifying basic mis-

takes, which are faulty conclusions about life and

self-defeating perceptions. Here are some of the

mistaken conclusions Stan has reached:

• “I must not get close to people, because they

will surely hurt me.”

• “Because m

y own parents didn’t want me and

didn’t love me, I’ll never be desired or loved by

anybody.”

• “If only I could become perfect, maybe people

would acknowledge and accept me.

”

• “Being a man means not showing emotions.”

The information I summarize and interpret

leads to insight and increased self

-understanding

on Stan’s part. He gains increased awareness of

his need to control his world so that he can keep

painful feelings in check. He sees more clearly

some of the ways he tries to gain control over

his pain: through the use of alcohol, avoiding

interpersonal situations that are threatening, and

being unwilling to count on others for psycholog-

ical support. Through continued emphasis on his

beliefs, goals, and intentions, Stan comes to see

how his private logic is inaccurate. In his case, a

syllogism for his style of life can be explained in

this way: (1) “I am unloved, insignificant, and do

not count”; (2) “The world is a threatening place

to be, and life is unfair”; (3) “Therefore, I must

find ways to protect myself and be safe.” During

this phase of the process, I make interpretations

centering on his lifestyle, his current direction,

his goals and purposes, and how his private logic

works. Of course, Stan is expected to carry out

homework assignments that assist him in trans-

lating his insights into new behavior. In this way

he is an active participant in his therapy.

In the reorientation phase of therapy, Stan

and I work together to consider alternative atti-

tudes, beliefs, and actions. By now Stan sees that

he does not have to be locked into past patterns,

feels encouraged, and realizes that he has the

power to change his life. He accepts that he will

not change merely by gaining insights and knows

that he will have to make use of these insights by

carrying out an action-oriented plan. Stan begins

to feel that he can create a new life for himself

and not remain the victim of circumstances.

Follow-Up: You Continue as

Stan’s Adlerian Therapist

Use these questions to help you think about how

you would counsel Stan using an Adlerian approach:

• What are some ways you would attempt to

establish a relationship with Stan based on trust

and mutual respect? Can you imagine an

y diffi-

culties in developing this relationship with him?

• What aspects of Stan’s lifestyle particularly

interest you? In counseling him, how w

ould

these be explored?

• The Adlerian therapist identified four of Stan’s

mistaken conclusions. Can you identify with

any of these basic mistakes? If so, do you think

this would help or hinder your therapeutic

effectiveness with him?

• How might you assist Stan in discovering his

social interest and going beyond a preoc

cupa-

tion with his own problems?

• What strengths and resources in Stan might

you draw on to support his determination and

commitment to chang

e?

See the DVD for Theory and Practice

of Counseling and Psychotherapy: The

Case of Stan and Lecturettes (Session 3 on

Adlerian therapy) for a demonstration of my

approach to counseling Stan by focusing on his

early recollections.

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CHAPTER FIVE

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127

ADLERIAN THERAPY

summary and evaluation

Summary

Adler was far ahead of his time, and most contemporary therapies have incorpo-

rated at least some of his ideas. Individual Psychology assumes that people are

motivated by social factors; are responsible for their own thoughts, feelings, and

actions; are the creators of their own lives, as opposed to being helpless victims;

and are impelled by purposes and goals, looking more toward the future than back

to the past.

The basic goal of the Adlerian approach is to help clients identify and change

their mistaken beliefs about, self, others, and life and thus to participate more

fully in a social world. Clients are not viewed as psychologically sick but as dis-

couraged. The therapeutic process helps individuals become aware of their pat-

terns and make some basic changes in their style of living, which lead to changes

in the way they feel and behave. The role of the family in the development of the

individual is emphasized. Therapy is a cooperative venture that challenges clients

to translate their insights into action in the real world. Contemporary Adlerian

theory is an integrative approach, combining cognitive, constructivist, existential,

psychodynamic, and systems perspectives. Some of these common characteristics

include an emphasis on establishing a respectful client–therapist relationship,

an emphasis on clients’ strengths and resources, and an optimistic and future

orientation.

The Adlerian approach gives practitioners a great deal of freedom in work-

ing with clients. Major Adlerian contributions have been made in the following

areas: elementary education, consultation groups with teachers, parent education

groups, couples and family therapy, and group counseling.

Contributions of the Adlerian Approach

A strength of the Adlerian approach is its ﬂ exibility and its integrative nature.

Adlerian therapists can be both theoretically integrative and technically eclectic

(Watts & Shulman, 2003). This therapeutic approach allows for the use of a variety

of relational, cognitive, behavioral, emotive, and experiential techniques. Adlerian

therapists are resourceful and ﬂ exible in drawing on many methods, which can be

applied to a diverse range of clients in a variety of settings and formats. Therapists

are mainly concerned with doing what is in the best interests of clients rather than

squeezing clients into one theoretical framework (Watts, 1999, 2000; Watts &

Pietrzak, 2000; Watts & Shulman, 2003).

Another contribution of the Adlerian approach is that it is suited to brief, time-

limited therapy. Adler was a proponent of time-limited therapy, and the techniques

used by many contemporary brief therapeutic approaches are very similar to

interventions created by or commonly used by Adlerian practitioners (Carlson et

al., 2006). Adlerian therapy and contemporary brief therapy have in common a

number of characteristics, including quickly establishing a strong therapeutic alli-

ance, a clear problem focus and goal alignment, rapid assessment and application

to treatment, an emphasis on active and directive intervention, a psychoeducational

focus, a present and future orientation, a focus on clients’ strengths and abilities

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128

CHAPTER FIVE

and an optimistic expectation of change, and a time sensitivity that tailors treatment

to the unique needs of the client (Carlson et al., 2006). According to Mosak and

Di Pietro (2006), early recollections are a signiﬁ cant assessment intervention in

brief therapy. They claim that early recollections are often useful in minimizing

the number of therapy sessions. This procedure takes little time to administer and

interpret and provides a direction for therapists to pursue.

Bitter and Nicoll (2000) identify ﬁ ve characteristics that form the basis for an

integrative framework in brief therapy: time limitation, focus, counselor directive-

ness, symptoms as solutions, and the assignment of behavioral tasks. Bringing a

time-limitation process to therapy conveys to clients the expectation that change

will occur in a short period of time. When the number of sessions is speciﬁ ed,

both client and therapist are motivated to stay focused on desired outcomes and

to work as efﬁ ciently as possible. Because there is no assurance that a future ses-

sion will occur, brief therapists tend to ask themselves this question: “If I had only

one session to be useful in this person’s life, what would I want to accomplish?”

(p. 38).

The Adlerian concepts I (Jerry Corey) draw on most in my professional work are

(1) the importance of looking to one’s life goals, including assessing how these goals

inﬂ uence an individual; (2) the focus on the individual’s interpretation of early expe-

riences in the family, with special emphasis on their current impact; (3) the clinical

use of early recollections in both assessment and treatment; (4) the use of dreams as

rehearsals for future action; (5) the need to understand and confront basic mistakes;

(6) the cognitive emphasis, which holds that emotions and behaviors are largely

inﬂ uenced by one’s beliefs and thinking processes; (7) the idea of working out an

action plan designed to help clients make changes; (8) the collaborative relation-

ship, whereby the client and therapist work toward mutually agreed-upon goals;

and (9) the emphasis given to encouragement during the entire counseling proc-

ess. Several Adlerian concepts have implications for personal development. One

of these notions that has helped me to understand the direction of my life is the

assumption that feelings of inferiority are linked to a striving for superiority

(Corey, 2010).

It is difﬁ cult to overestimate the contributions of Adler to contemporary thera-

peutic practice. Many of his ideas were revolutionary and far ahead of his time. His

inﬂ uence went beyond counseling individuals, extending into the community men-

tal health movement (Ansbacher, 1974). Abraham Maslow, Viktor Frankl, Rollo

May, Paul Watzlawick, Karen Horney, Erich Fromm, Aaron T. Beck, and Albert Ellis

have all acknowledged their debt to Adler. Both Frankl and May see him as a fore-

runner of the existential movement because of his position that human beings

are free to choose and are entirely responsible for what they make of themselves.

This view also makes him a forerunner of the subjective approach to psychology,

which focuses on the internal determinants of behavior: values, beliefs, attitudes,

goals, interests, personal meanings, subjective perceptions of reality, and strivings

toward self-realization. Bitter (2008) and his colleagues (Bitter, Robertson, Healey, &

Cole, 2009) have drawn attention to the link between Adlerian thinking and femi-

nist therapy approaches.

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129

ADLERIAN THERAPY

One of Adler’s most important contributions was his inﬂ uence on other therapy

systems. Many of his basic ideas have found their way into most of the other psy-

chological schools, a few of which include existential therapy, cognitive behavior

therapy, rational emotive behavior therapy, reality therapy, solution-focused ther-

apy, and family therapy. In many respects, Adler seems to have paved the way for

current developments in both the cognitive and constructivist therapies (Watts,

2003). Adlerians’ basic premise is that if clients can change their thinking then

they can change their feelings and behavior. A study of contemporary counseling

theories reveals that many of Adler’s notions have reappeared in these modern

approaches with different nomenclature, and often without giving Adler the credit

that is due to him (Watts, 1999; Watts & Pietrzak, 2000; Watts & Shulman, 2003).

It is clear that there are signiﬁ cant linkages between Adlerian theory and most of

the present-day theories, especially those that view the person as purposive, self-

determining, and striving for growth. Carlson and Englar-Carlson (2008) assert

that Adlerians face the challenge of continuing to develop their approach so that it

meets the needs of contemporary global society: “Whereas Adlerian ideas are alive

in other theoretical approaches, there is a question about whether Adlerian theory

as a stand-alone approach is viable in the long term” (p. 133). These authors believe

that for the Adlerian model to survive and thrive it will be necessary to ﬁ nd ways

to strive for signiﬁ cance.

Limitations and Criticisms of the

Adlerian Approach

Adler had to choose between devoting his time to formalizing his theory and teach-

ing others the basic concepts of Individual Psychology. He placed practicing and

teaching before organizing and presenting a well-deﬁ ned and systematic theory.

As a result, his written presentations are often difﬁ cult to follow, and many of

them are transcripts of lectures he gave. Initially, many people considered his ide-

as somewhat loose and too simplistic.

Research supporting the effectiveness of Adlerian theory is limited but has

improved over the last 25 years (Watts & Shulman, 2003). However, a large part of

the theory still requires empirical testing and comparative analysis. This is especial-

ly true in the conceptual areas that Adlerians accept as axiomatic: for example, the

development of lifestyle; the unity of the personality and an acceptance of a sin-

gular view of self; the rejection of the prominence of heredity in determining

behavior, especially pathological behavior; and the usefulness of the multiple inter-

ventions used by various Adlerians.

where to go from here

Refer to the DVD for Integrative Counseling: The Case of Ruth and Lecturettes, Ses-

sion 6 (“Cognitive Focus in Counseling”), which illustrates Ruth’s striving to live

up to expectations and measure up to perfectionist standards. In this particular

therapy session with Ruth, you will see how I draw upon cognitive concepts and

apply them in practice.

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130

CHAPTER FIVE

Free Podcasts for ACA Members

You can download ACA Podcasts (prerecorded interviews) by going to www.

counseling.org and then clicking on the Resource button, and then the Podcast

Series. For Chapter 5, look for Podcast 11, Adlerian Therapy, by Dr. Jon Carlson.

Other Resources

Videos from Psychotherapy.net demonstrate Adlerian therapy with adults, fami-

lies, and children, and are available to students and professionals at their website,

www.Psychotherapy.net. New articles, interviews, blogs, therapy cartoons, and vid-

eos are published monthly. For this chapter, see the following:

Carlson, J. (1997). Adlerian Therapy (Psychotherapy with the Experts Series)

Carlson, J. (2001). Adlerian Parent Consultation (Child Therapy with the Experts

Series)

Kottman, T. (2001). Adlerian Play Therapy (Child Therapy with the Experts Series)

If your thinking is allied with the Adlerian approach, you might consider seeking

training in Individual Psychology or becoming a member of the North American

Society of Adlerian Psychology (NASAP). To obtain information on NASAP and a

list of Adlerian organizations and institutes, contact:

North American Society of Adlerian Psychology (NASAP)

614 Old West Chocolate Avenue

Hershey, PA 17033

Telephone: (717) 579-8795

Fax: (717) 533-8616

E-mail: [email protected]

Website: www.alfredadler.org

The society publishes a newsletter and a quarterly journal and maintains a list of

institutes, training programs, and workshops in Adlerian psychology. The Jour-

nal of Individual Psychology presents current scholarly and professional research.

Columns on counseling, education, and parent and family education are regular

features. Information about subscriptions is available by contacting the society.

If you are interested in pursuing training, postgraduate study, continuing edu-

cation, or a degree, contact NASAP for a list of Adlerian organizations and institutes.

A few training institutes are listed here:

Adler School of Professional Psychology

65 East Wacker Place, Suite 2100

Chicago, IL 60601-7298

Telephone: (312) 201-5900

Fax: (312) 201-5917

E-mail: admissions@adler.edu

Website: www.adler.edu

Adler Graduate School

1550 East 78th Street

Richfield, MN 55423

Telephone: 612-861-7554

Fax: 612-861-7559

E-mail:info@alfredadler.edu

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Adler School of Professional Psychology, Vancouver Campus

595 Burrard Street, Suite 753

P.O. Box 49104

Vancouver, BC, Canada V7X 1G4

Telephone: (604) 482-5510

Fax: (604) 874-4634

Adlerian Training Institute, Inc.

Dr. Bill Nicoll, Coordinator

P.O. Box 881581

Port St. Lucie, FL 34988

Telephone/Fax: (772) 807-4141

Cell Phone: (954) 650-0637

E-mail: adleriantraining@aol.com

Website: www.adleriantraining.com

The Alfred Adler Institute of Northwestern Washington

2565 Mayflower Lane

Bellingham, WA 98226

Telephone: (360) 647-5670

E-mail: [email protected]

Website: http://ourworld.compuserv.com/homepages/hstein/

Alfred Adler Institute of San Francisco

266 Bemis Street

San Francisco, CA 94131

Telephone: (415) 584-3833

E-mail: DPienkow@msn.com

The International Committee of Adlerian

Summer Schools and Institutes

Michael Balla, ICASSI Administrator

257 Billings Avenue

Ottawa, Ontario, Canada K1H 5L1

Fax: (613) 733-0289

E-mail: mjballa@sympatico.ca

Website: www.icassi.net

Recommended Supplementary Readings

Adlerian Therapy: Theory and Practice (Carlson, Watts, & Maniacci, 2006) clearly

presents a comprehensive overview of Adlerian therapy in contemporary practice.

There are chapters on the therapeutic relationship, brief individual therapy, brief

couples therapy, group therapy, play therapy, and consultation. This book lists

Adlerian intervention videos that are available.

Adlerian Counseling and Psychotherapy: A Practitioner’s Approach (Sweeney, 2009)

is one of the most comprehensive books written on the wide range of Adlerian

applications to therapy and wellness.

131

ADLERIAN THERAPY

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Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Adlerian Psychotherapy: An Advanced Approach to Individual Psychology (Oberst &

Stewart, 2003) is an up-to-date and in-depth presentation of Adlerian psychother-

apeutic process, including chapters on family therapy and the relevance of this

model to postmodern approaches.

Early Recollections: Interpretative Method and Application (Mosak & Di Pietro,

2006) is an extensive review of the use of early recollections as a way to under-

stand an individual’s dynamics and behavioral style. This book addresses the

theory, research, and clinical applications of early recollections.

Understanding Life-Style: The Psycho-Clarity Process (Powers & Grifﬁ th, 1987) is a

useful source of information for doing a lifestyle assessment. Separate chapters

deal with interview techniques, lifestyle assessment, early recollections, the fam-

ily constellation, and methods of summarizing and interpreting information.

References and Suggested Readings

132

CHAPTER FIVE

*Books and articles marked with an asterisk are suggested for further study.

Adler, A. (1958). What life should mean to you.

New York: Capricorn. (Original work published

1931)

Adler, A. (1959). Understanding human nature.

New York: Premier Books. (Original work

published 1927)

Adler, A. (1964). Social interest. A challenge to

mankind. New York: Capricorn. (Original work

published 1938)

Adler, A. (1978). The education of children.

Chicago: Regnery Publishing. (Original work

published 1930)

Albert, L. (1996). Cooperative discipline. Circle

Pines, MN: American Guidance Service.

American Psychiatric Association. (2000).

Diagnostic and statistical manual of mental

disorders, text revision (4th ed.). Washington,

DC: Author.

Ansbacher, H. L. (1974). Goal-oriented individ-

ual psychology: Alfred Adler’s theory. In

A. Burton (Ed.), Operational theories of

personality (pp. 99–142). New York: Brunner/

Mazel.

*Ansbacher, H. L. (1979). The increasing

recognition of Adler. In. H. L. Ansbacher & R. R.

Ansbacher (Eds.), Superiority and social interest.

Alfred Adler, A collection of his later writings

(3rd rev. ed., pp. 3–20). New York: Norton.

*Ansbacher, H. L. (1992). Alfred Adler’s

concepts of community feeling and social

interest and the relevance of community

feeling for old age. Individual Psychology,

48(4), 402–412.

*Ansbacher, H. L., & Ansbacher, R. R. (Eds.).

(1964). The individual psychology of Alfred Adler.

New York: Harper & Row/Torchbooks.

(Original work published 1956)

*Ansbacher, H. L., & Ansbacher, R. R. (Eds.).

(1979). Superiority and social interest. Alfred

Adler: A collection of his later writings

(3rd rev. ed.). New York: Norton.

Arciniega, G. M., & Newlon, B. J. (2003).

Counseling and psychotherapy: Multicultural

considerations. In D. Capuzzi & D. F. Gross

(Eds.), Counseling and psychotherapy: Theories

and interventions (3rd ed., pp. 417–441).

Upper Saddle River, NJ: Merrill/

Prentice-Hall.

Bitter, J. R. (2006, May 25). Am I an Adlerian?

Ansbacher Lecture, 54th annual convention

of the North American Society of Adlerian

Psychology (NASAP), Chicago, IL.

Bitter, J. R. (2008). Reconsidering narcissism:

An Adlerian-feminist response to the articles

in the special section of the Journal of Individu-

al Psychology, volume 63, number 2. Journal of

Individual Psychology, 64(3), 270–279.

28549_ch05_rev01.indd 132 20/09/11 3:19 PM

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

133

ADLERIAN THERAPY

Bitter, J. R. (2009). Theory and practice of

family therapy and counseling. Belmont, CA:

Brooks/Cole, Cengage Learning.

*Bitter, J. R., Christensen, O. C., Hawes, C., &

Nicoll, W. G. (1998). Adlerian brief therapy

with individuals, couples, and families.

Directions in Clinical and Counseling Psychology,

8(8), 95–111.

*Bitter, J. R., & Nicoll, W. G. (2000). Adlerian

brief therapy with individuals: Process and

practice. Journal of Individual Psychology, 56(1),

31–44.

*Bitter, J. R., & Nicoll, W. G. (2004). Relational

strategies: Two approaches to Adlerian brief

therapy. Journal of Individual Psychology, 60(1),

42–66.

Bitter, J. R., Robertson, P. E., Healey, A., &

Cole, L. (2009). Reclaiming a pro-feminist

orientation in Adlerian therapy. Journal of

Individual Psychology, 65(1), 13–33.

*Carlson, J. M., & Carlson, J. D. (2000). The

application of Adlerian psychotherapy with

Asian-American clients. Journal of Individual

Psychology, 56(2), 214–225.

Carlson, J., & Dinkmeyer, D. (2003). Time

for a better marriage. Atascadero, CA: Impact

Publishers.

*Carlson, J. D., & Englar-Carlson, M. (2008).

Adlerian therapy. In J. Frew & M. D. Spiegler

(Eds.), Contemporary psychotherapies for a

diverse world (pp. 93–140). Boston: Lahaska Press.

*Carlson, J., & Slavik, S. (Eds.). (1997). Tech-

niques in Adlerian psychology. Philadelphia, PA:

Taylor & Francis.

*Carlson, J., Watts, R. E., & Maniacci, M.

(2006). Adlerian therapy: Theory and practice.

Washington DC: American Psychological

Association.

Clark, A. (2002). Early recollections: Theory

and practice in counseling and psychotherapy.

New York: Brunner Routledge.

*Corey, G. (2010). Creating your professional

path: Lessons from my journey. Alexandria, VA:

American Counseling Association.

*Corey, G. (2012). Theory and practice of group

counseling (8th ed.). Belmont, CA: Brooks/

Cole, Cengage Learning.

*Corey, G. (2013). Case approach to counseling

and psychotherapy (8th ed.). Belmont, CA:

Brooks/Cole, Cengage Learning.

Dinkmeyer, D. C., & Mc Kay, G. D. (1997).

Systematic training for effective parenting [STEP].

Circle Pines, MN: American Guidance Service.

Dinkmeyer, D., Jr., & Sperry, L. (2000).

Counseling and psychotherapy: An integrated

Individual Psychology approach (3r

d ed.). Upper

Saddle River, NJ: Merrill/Prentice-Hall.

*Disque, J

. G., & Bitter, J. R. (1998). Integrat-

ing narrative therapy with Adlerian lifestyle

assessment: A case study. Journal of Individual

Psychology, 54(4), 431–450.

Dreikurs, R. (1953). Fundamentals of Adlerian

psychology. Chicago: Alfred Adler Institute.

Dreikurs, R. (1967). Psychodynamics, psy-

chotherapy, and counseling. Collected papers.

Chicago: Alfred Adler Institute.

Dreikurs, R. (1968). Psychology in the class-

room (2nd ed.). New York: Harper & Row.

Dreikurs, R. (1969). Group psychotherapy from

the point of view of Adlerian psychology. In

H. M. Ruitenbeck (Ed.), Group therapy today: Styles,

methods, and techniques (pp. 37–48). New York:

Aldine-Atherton. (Original work published 1957)

Dreikurs, R. (1971). Social equality: The chal-

lenge of today. Chicago: Regnery.

Dreikurs, R. (1997). Holistic medicine.

Individual Psychology, 53(2), 127–205.

Hawes, E. C. (1993). Marriage counseling

and enrichment. In O. C. Christensen (Ed.),

Adlerian family counseling (Rev. ed., pp.

125–163). Minneapolis, MN: Educational

Media Corporation.

Hawes, C., & Blanchard, L. M. (1993). Life

tasks as an assessment technique in marital

counseling. Individual Psychology, 49, 306–317.

Hoffman, E. (1996). The drive for self: Alfred

Adler and the founding of Individual Psychology.

Reading, MA: Addison-Wesley.

Hood, A. B., & Johnson, R. W. (2007).

Assessment in counseling: A guide to the use of

psychological assessment procedures (4th ed.).

Alexandria, VA: American Counseling

Association.

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

134

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Kefir, N. (1981). Impasse/priority therapy. In

R. J. Corsini (Ed.), Handbook of innovative psy-

chotherapies (pp. 401–415). New York: Wiley.

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duction to Adlerian psychology: Basic princi-

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(Eds.), Readings in the theory and practice of

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(2007). Adlerian theory. In D. Capuzzi & D.

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*Mosak, H. H., & Di Pietro, R. (2006). Early rec-

ollections: Interpretative method and application.

New York: Routledge.

*Mosak, H. H., & Maniacci, M. P. (2011).

Adlerian psychotherapy. In R. J. Corsini & D.

Wedding (Eds.), Current psychotherapies

(9th ed., pp. 67–112). Belmont, CA: Brooks/

Cole, Cengage Learning.

Mosak, H. H., & Shulman, B. H. (1988).

Lifestyle inventory. Muncie, IN: Accelerated

Development.

Mozdzierz, G. J., Lisiecki, J., Bitter, J. R., &

Williams, A. L. (1986). Role-functions for

Adlerian therapists. Individual Psychology,

42(2), 154–177.

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(2009). Principles of counseling and psycho-

therapy: Learning the essential domains and

non-linear thinking of master practitioners.

New York: Routledge.

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55(1), 15–25.

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Atlanta, GA: Active Parenting.

*Powers, R. L., & Griffith, J. (1987). Under-

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Studies.

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individual psychology client workbook with sup-

plements. Chicago: Americas Institute of

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1986)

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personality (9th ed.). Belmont, CA: Wadsworth,

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Pelonis, P.). (2004). Adlerian group counseling

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Sonstegard, M. A., Bitter, J. R., Pelonis-

Peneros, P. P., & Nicoll, W. G. (2001). Adlerian

group psychotherapy: A brief therapy

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*Sperry, L., Carlson, J., & Peluso, P. (2006).

Couples therapy. Denver, CO: Love.

Sweeney, T. J. (2009). Adlerian counseling

and psychotherapy: A practitioner’s approach

(5th ed.). New York: Routledge (Taylor &

Francis).

Vaihinger, H. (1965). The philosophy of “as if.”

London: Routledge & Kegan Paul.

Watts, R. E. (1999). The vision of Adler: An

introduction. In R. E. Watts & J. Carlson (Eds.),

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Watts, R. E. (2000). Entering the new millen-

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135

ADLERIAN THERAPY

*Watts, R. E., & Holden, J. M. (1994). Why

continue to use “fictional finalism”? Individual

Psychology, 50, 161–163.

Watts, R. E., Peluso, P. R., & Lewis, T. F.

(2005). Expanding the acting as if technique:

An Adlerian/constructive integration. Journal

of Individual Psychology, 61(4), 380–387.

Watts, R. E., & Pietrzak, D. (2000). Adlerian

“encouragement” and the therapeutic process

of solution-focused brief therapy. Journal

of Counseling and Development, 78(4),

442–447.

Watts, R. E., & Shulman, B. H. (2003). Inte-

grating Adlerian and constructive therapies:

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Adlerian, cognitive, and constructivist therapies:

An integrative dialogue (pp. 9–37). New York:

Springer.

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

136

introduction

• Historical Background in Philosophy

and Existentialism

• Key Figures in Contemporary Existential

Psychotherapy

key concepts

• View of Human Nature

• Proposition 1: The Capacity for Self-Awareness

• Proposition 2: Freedom and Responsibility

• Proposition 3: Striving for Identity and

Relationship to Others

• Proposition 4: The Search for Meaning

• Proposition 5: Anxiety as a Condition

of Living

• Proposition 6: Awareness of Death and

Nonbeing

the therapeutic process

• Therapeutic Goals

• Therapist’s Function and Role

• Client’s Experience in Therapy

• Relationship Between Therapist and Client

application: therapeutic

techniques and procedures

• Phases of Existential Counseling

• Clients Appropriate for Existential Counseling

• Application to Brief Therapy

• Application to Group Counseling

existential therapy from a

multicultural perspective

• Strengths From a Diversity Perspective

• Shortcoming From a Diversity Perspective

existential therapy applied to

the case of stan

summary and evaluation

• Summary

• Contributions of the Existential Approach

• Limitations and Criticisms of the Existential

Approach

where to go from here

• Recommended Supplementary Readings

• References and Suggested Readings

chapter 6

Existential Therapy

•

Refer

y Read

ed Readings

136

tic pro

eutic Goals

rapist’s Function and Role

ent’s Experience in Therapy

lationship Between Therapist and Cl

a C

Living

•

Proposition 6: Awareness o

Non

b

eing

the thera

•

Thera

•

Th

•

C

•

Re

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137

EXISTENTIAL THERAPY

Viktor Frankl / Rollo May / Irvin Yalom

VIKTOR FRANKL (1905–

1997) was born and educat-

ed in Vienna. He founded the

Youth Advisement Centers

there in 1928 and directed

them until 1938. From 1942

to 1945 Frankl was a pris-

oner in the Nazi concentra-

tion camps at Auschwitz

and Dachau, where his parents, brother, wife, and

children died. He vividly remembered his horrible

experiences in these camps, yet he was able to

use them in a constructive way and did not allow

them to dampen his love and enthusiasm for life.

He traveled all around the world, giving lectures

in Europe, Latin America, Southeast Asia, and the

United States.

Frankl received his MD in 1930 and his PhD

in philosophy in 1949, both from the University of

Vienna. He became an associate professor at the

University of Vienna and later was a distinguished

speaker at the United States International University

in San Diego. He was a visiting professor at Har-

vard, Stanford, and Southern Methodist universi-

ties. Frankl’s works have been translated into more

than 20 languages, and his ideas continue to have

a major impact on the development of existential

therapy. His compelling book Man’s Search for Mean-

ing (1963) has been a best-seller around the world.

Although Frankl had begun to develop an exis-

tential approach to clinical practice before his grim

years in the Nazi death camps, his experiences

there confirmed his views. Frankl (1963) observed

and personally experienced the truths expressed

by existential philosophers and writers who hold

that we have choices in every situation. Even in

terrible circumstances, he believed, we could

preserve a vestige of spiritual freedom and inde-

pendence of mind. He learned experientially that

everything could be taken from a person except

one thing: “the last of human freedoms—to choose

one’s attitude in any given set of circumstances, to

choose one’s own way” (p. 104). ). Frankl believed

that the essence of being human lies in searching

for meaning and purpose. He believed that love

is the highest goal to which humans can aspire and

that our salvation is through love. We can discover

this meaning through our actions and deeds, by

experiencing a value (such as love or achievements

through work), and by suffering.

Frankl knew and read Freud and attended

some of the meetings of Freud’s psychoanalytic

group. Frankl acknowledged his indebtedness

to Freud, although he disagreed with the rigidity

of Freud’s psychoanalytic system. Frankl often

remarked that Freud was a depth psychologist and

that he is a height psychologist who built

on Freud’s foundations. Reacting against most of

Freud’s deterministic notions, Frankl developed

his own theory and practice of psychotherapy,

which emphasized the concepts of freedom,

responsibility, meaning, and the search for values.

He established his international reputation as the

founder of what has been called “The Third School

of Viennese Psychoanalysis,” the other two being

Sigmund Freud’s psychoanalysis and Alfred Adler’s

Individual Psychology.

I have selected Frankl as one of the key figures

of the existential approach because of the dramatic

way in which his theories were tested by the trag-

edies of his life. His life was an illustration of his

theory, for he lived what his theory espouses.

IMAGNO/Viktor Frankl Archiv

ROLLO MAY (1909–1994)

first lived in Ohio and then

moved to Michigan as a

young child along with his

five brothers and a sister.

He remembered his home

life as being unhappy, a

situation that contributed

to his interest in psychol-

ogy and counseling. In his personal life May

struggled with his own existential concerns and the

failure of two marriages.

Despite his unhappy life experiences, he gradu-

ated from Oberlin College in 1930 and then went

to Greece as a teacher. During his summers in

Greece he traveled to Vienna to study with Alfred

Adler. After receiving a degree in theology from

Union Theological Seminary, May decided that the

Hulton Archive/Getty Images

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138

CHAPTER SIX

best way to reach out and help people was through

psychology instead of theology. He completed his

doctorate in clinical psychology at Columbia Uni-

versity and started a private practice in New York;

he also became a supervisory training analyst for

the William Alanson Institute.

While May was pursuing his doctoral program,

he came down with tuberculosis, which resulted in

a 2-year stay in a sanitarium. During his recovery

period, May spent much time learning firsthand

about the nature of anxiety. He also spent time

reading, and he studied the works of Søren Kierke-

gaard, which was the catalyst for his recognizing

the existential dimensions of anxiety. This study

resulted in his book The Meaning of Anxiety (1950).

His popular book Love and Will (1969) reflects his

own personal struggles with love and intimate rela-

tionships and mirrors Western society’s question-

ing of its values pertaining to sex and marriage.

The greatest personal influence on Rollo May

was the existential theologian Paul Tillich (author

of The Courage to Be, 1952), who became his men-

tor and a personal friend. The two spent much

time together discussing philosophical, religious,

and psychological topics. Most of May’s

writings reflect a concern with the nature of

human experience, such as recognizing and deal-

ing with power, accepting freedom and respon-

sibility, and discovering one’s identity. He draws

from his rich knowledge based on the classics and

his existential perspective.

Rollo May was one of the main proponents

of humanistic approaches to psychotherapy, and

he was the principal American spokesperson of

European existential thinking as it is applied to

psychotherapy. He believed psychotherapy should

be aimed at helping people discover the mean-

ing of their lives and should be concerned with

the problems of being rather than with problem

solving. Questions of being include learning to

deal with issues such as sex and intimacy, growing

old, facing death, and taking action in the world.

According to May, the real challenge is for people

to be able to live in a world where they are alone

and where they will eventually have to face death.

He contends that our individualism should be

balanced by what Adler refers to as social inter-

est. It is the task of therapists to help individuals

find ways to contribute to the betterment of the

society in which they live.

IRVIN YALOM (b. 1931- )

was born of parents who

immigrated from Russia

shortly after World War I.

During his early childhood,

Yalom lived in the inner city

of Washington, D.C., in a

poor neighborhood. Life on

the streets was perilous,

and Yalom took refuge indoors reading novels and

other works. Twice a week he made the hazardous

bicycle trek to the library to stock up on reading

supplies. He found an alternative and satisfying

world in reading fiction, which was a source of

inspiration and wisdom to him. Early in his life he

decided that writing a novel was the very finest

thing a person could do, and subsequently he has

written several teaching novels.

Irvin Yalom is professor emeritus of psychia-

try at the Stanford University School of Medicine.

A psychiatrist and author, Yalom has been a

major figure in the field of group psychotherapy

since publication in 1970 of his influential book

The Theory and Practice of Group Psychotherapy

(1970/2005), which has been translated into 12

languages and is currently in its fifth edition. His

pioneering work, Existential Psychotherapy, written

in 1980, is a classic and authoritative textbook on

existential therapy. Drawing on his clinical experi-

ence and on empirical research, philosophy, and

literature, Yalom developed an existential approach

to psychotherapy that addresses four “givens of

existence” or ultimate human concerns: freedom

and responsibility, existential isolation, meaning-

lessness, and death. These existential themes deal

with the client’s existence, or being-in-the-world.

Yalom urges all therapists, regardless of theoretical

orientation, to develop a sensibility to existential

issues because generally these issues emerge in all

courses of therapy.

Psychotherapy has been endlessly intriguing

for Yalom, who has approached all of his patients

with a sense of wonderment at the stories they

reveal. He believes that a different therapy must be

Photo courtesy of Joseph Siroker.

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EXISTENTIAL THERAPY

designed for each client because each has a unique

story. He advocates using the here and now of

the therapeutic relationship to explore the client’s

interpersonal world, and he believes the therapist

must be transparent, especially regarding his or

her experience of the client. His basic philosophy

is existential and interpersonal, which he applies to

both individual and group therapy.

Irvin Yalom has authored many stories and

novels related to psychotherapy, including Love’s

Executioner (1987), When Nietzsche Wept (1992),

Lying on the Couch (1997), Momma and the Meaning

of Life (2000), and The Schopenhauer Cure (2005a).

His 2008 nonfiction book, Staring at the Sun:

Overcoming the Terror of Death, is a treatise on the

role of death anxiety in psychotherapy, illustrating

how death and the meaning of life are foundational

themes associated with in-depth therapeutic

work. Yalom’s works, translated into more than 20

languages, have been widely read by therapists and

laypeople alike.

Yalom’s wife, Marilyn, has a PhD in compara-

tive literature and has had a successful career as

a university professor and writer. His four children

have chosen a variety of careers—medicine, pho-

tography, creative writing, theater directing, and

clinical psychology. He has five grandchildren and

is still counting.

introduction

Existential therapy is more a way of thinking, or an attitude about psychotherapy,

than a particular style of practicing psychotherapy. It is neither an independent

nor separate school of therapy, nor is it a clearly deﬁ ned model with speciﬁ c tech-

niques. Existential therapy can best be described as a philosophical approach that

inﬂ uences a counselor’s therapeutic practice. Yalom and Josselson (2011) capture

the essence of this approach:

Existential psychotherapy is an attitude toward human suffering [that] has no manual. It

asks deep questions about the nature of the human being and the nature of anxiety, despair,

grief, loneliness, isolation, and anomie. It also deals centrally with the questions of mean-

ing, creativity, and love. (p. 310)

Existential therapy focuses onexploring themes such as mortality, meaning, free-

dom, responsibility, anxiety, and aloneness as these relate to a person’s current

struggle. The goal of existential therapy is to assist clients in their exploration of

the existential “givens of life,” how these are sometimes ignored or denied, and

how addressing them can ultimately lead to a deeper, more reﬂ ective and mean-

ingful existence. Clients are invited to reﬂ ect on life, to recognize their range of

alternatives, and to decide among them.

The existential approach rejects the deterministic view of human nature es-

poused by traditional psychoanalysis and radical behaviorism. Psychoanalysis sees

the individual as primarily determined by unconscious forces, irrational drives,

and past events; behaviorists see the individual as primarily determined by socio-

cultural conditioning. Although deterministic forces affect us and we sometimes

cannot control external events thrust upon us, existential therapists believe we

retain the freedom to choose how we respond to such events. Existential therapy

is grounded on the assumption that we are free and therefore responsible for our

choices and actions. We are the authors of our lives, and we design the pathways

we follow. This chapter addresses some of the existential concepts and themes that

have signiﬁ cant implications for the existentially oriented practitioner.

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CHAPTER SIX

A basic existential premise is that we are not victims of circumstance because,

to a large extent, we are what we choose to be. Once clients begin the process of

recognizing the ways in which they have passively accepted circumstances and

surrendered control, they can start down a path of consciously shaping their own

lives. The ﬁ rst step in the therapeutic journey is for clients to accept responsibility.

As Yalom (2003) puts it, “Once individuals recognize their role in creating their

own life predicament, they also realize that they, and only they, have the power to

change that situation” (p. 141). One of the aims of existential therapy is to challenge

people to stop deceiving themselves regarding their lack of responsibility for what

is happening to them and their excessive demands on life (van Deurzen, 2002b).

Emmy van Deurzen (2002a), a key contributor to British existential psychol-

ogy, writes that existential counseling is not designed to “cure” people of illness in

the tradition of the medical model. She does not view clients as being sick, but as

“sick of life or clumsy at living” (p. 18) and unable to live a productive life.

See the DVD program for Chapter 6, DVD for Theory and Practice of Counseling

and Psychotherapy: The Case of Stan and Lecturettes. I suggest that you view

the brief lecture for each chapter prior to reading the chapter.

Historical Background in Philosophy and Existentialism

The existential therapy movement was not founded by any particular person or

group; many streams of thought contributed to it. Drawing from a major orienta-

tion in philosophy, existential therapy arose spontaneously in different parts of Eu-

rope and among different schools of psychology and psychiatry in the 1940s and

1950s. Many Europeans found that their lives had been devastated by World War

II, and they struggled with existential issues including feelings of isolation, aliena-

tion, and meaninglessness. Early writers focused on the individual’s experience

of being alone in the world and facing the anxiety of this situation. The European

existential perspective focused on human limitations and the tragic dimensions of

life (Sharp & Bugental, 2001).

The thinking of existential psychologists and psychiatrists was inﬂ uenced by a

number of philosophers and writers during the 19th century. To understand the

philosophical underpinnings of modern existential psychotherapy, one must have

some awareness of such ﬁ gures as Søren Kierkegaard, Friedrich Nietzsche, Martin

Heidegger, Jean-Paul Sartre, and Martin Buber. These major ﬁ gures of existential-

ism and existential phenomenology and their cultural, philosophical, and religious

writings provided the basis for the formation of existential therapy. Ludwig Bin-

swanger and Medard Boss are also included in this section because both were early

existential psychoanalysts who contributed key ideas to existential psychotherapy.

søren kierkegaard (1813–1855) A Danish philosopher and Chris-

tian theologian, Kierkegaard was particularly concerned with angst—a Danish and

German word whose meaning lies between the English words dread and anxiety—

and he addressed the role of anxiety and uncertainty in life. Existential anxiety

is associated with making basic decisions about how we want to live, and it is

not pathological. Kierkegaard believed that anxiety is the school in which we are

educated to be a self. Without the experience of angst, we may go through life as

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EXISTENTIAL THERAPY

sleepwalkers. But many of us, especially in adolescence, are awakened into real life

by a terrible uneasiness. Life is one contingency after another, with no guarantees

beyond the certainty of death. This is by no means a comfortable state, but it is

necessary to our becoming human. Kierkegaard believed that “the sickness unto

death” arises when we are not true to ourselves. What is needed is the willingness

to risk a leap of faith in making choices. Becoming human is a project, and our task

is not so much to discover who we are as to create ourselves.

friedrich nietzsche (1844–1900) The German philosopher Nietzsche

is the iconoclastic counterpart to Kierkegaard, expressing a revolutionary approach to

the self, to ethics, and to society. Like Kierkegaard, he emphasized the importance

of subjectivity. Nietzsche set out to prove that the ancient deﬁ nition of humans

as rational was entirely misleading. We are far more creatures of will than we are

impersonal intellects. But where Kierkegaard emphasized the “subjective truth” of

an intense concern with God, Nietzsche located values within the individual’s “will to

power.” We give up an honest acknowledgment of this source of value when society

invites us to rationalize powerlessness by advocating other worldly concerns. If, like

sheep, we acquiesce in “herd morality,” we will be nothing but mediocrities. But if

we release ourselves by giving free rein to our will to power, we will tap our poten-

tiality for creativity and originality. Kierkegaard and Nietzsche, with their pioneer-

ing analyses of anxiety, depression, subjectivity, and the authentic self, together are

generally considered to be the originators of the existential perspective (Sharp &

Bugental, 2001).

martin heidegger (1889–1976) Heidegger’s phenomenological exis-

tentialism reminds us that we exist “in the world” and should not try to think of

ourselves as beings apart from the world into which we are thrown. The way we

ﬁ ll our everyday life with superﬁ cial conversation and routine shows that we often

assume we are going to live forever and can afford to waste day after day. Our

moods and feelings (including anxiety about death) are a way of understanding

whether we are living authentically or whether we are inauthentically constructing

our lives around the expectations of others. When we translate this wisdom from

vague feeling to explicit awareness, we may develop a more positive resolve about

how we want to be. Phenomenological existentialism, as presented by Heidegger,

provides a view of human history that does not focus on past events but motivates

individuals to look forward to “authentic experiences” that are yet to come.

martin buber (1878–1965) Leaving Germany to live in the new state of

Israel, Buber took a less individualistic stand than most of the other existentialists.

He said that we humans live in a kind of betweenness; that is, there is never just an

I, but always an other. The I, the person who is the agent, changes depending on

whether the other is an it or a Thou. But sometimes we make the serious mistake

of reducing another person to the status of a mere object, in which case the rela-

tionship becomes I/it. Although Buber recognizes that of necessity we must have

many I/it interactions (in everyday life), we are seriously limited if we live only in

the world of the I/it. Buber stresses the importance of presence, which has three

functions: (1) it enables true I/Thou relationships; (2) it allows for meaning to exist

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CHAPTER SIX

in a situation; and (3) it enables an individual to be responsible in the here and now

(Gould, 1993). In a famous dialogue with Carl Rogers, Buber argued that the thera-

pist and client could never be on the same footing because the latter comes to the

former for help. When the relationship is fully mutual, we have become “dialogic,”

a fully human condition.

ludwig binswanger (1881–1966) An existential analyst, Binswanger

proposed a holistic model of self that addresses the relationship between the per-

son and his or her environment. He used a phenomenological approach to explore

signiﬁ cant features of the self, including choice, freedom, and caring. He based his

existential approach largely on the ideas of Heidegger and accepted Heidegger’s

notion that we are “thrown into the world.” However, this “thrown-ness” does not

release us from the responsibility of our choices and for planning for the future

(Gould, 1993). Existential analysis (dasein analyse) emphasizes the subjective and

spiritual dimensions of human existence. Binswanger (1975) contended that crises

in therapy were typically major choice points for the client. Although he originally

looked to psychoanalytic theory to shed light on psychosis, he moved toward an exis-

tential view of his patients. This perspective enabled him to understand the worldview

and immediate experience of his patients, as well as the meaning of their behavior, as

opposed to superimposing his view as a therapist on their experience and behavior.

medard boss (1903–1991) Both Binswanger and Boss were early existen-

tial psychoanalysts and signiﬁ cant ﬁ gures in the development of existential psycho-

therapy. They made reference to dasein or being-in-the-world, which pertains to our

ability to reﬂ ect on life events and attribute meaning to these events. They believed

that the therapist must enter the client’s subjective world without presuppositions

that would get in the way of this experiential understanding. Both Binswanger

and Boss were signiﬁ cantly inﬂ uenced by Heidegger’s seminal work, Being and

Time (1962), which provided a broad basis for understanding the individual (May,

1958). Boss was deeply inﬂ uenced by Freudian psychoanalysis, but even more so

by Heidegger. Boss’s major professional interest was applying Heidegger’s phil-

osophical notions to therapeutic practice, and he was especially concerned with

integrating Freud’s methods with Heidegger’s concepts, as described in his book

Daseinanalysis and Psychoanalysis (1963).

jean-paul sartre (1905–1980) A philosopher and novelist, Sartre was

convinced, in part by his years in the French Resistance in World War II, that

humans are even more free than earlier existentialists had believed. The existence

of a space—nothingness—between the whole of our past and the now frees us to

choose what we will. Our values are what we choose. The failure to acknowledge

our freedom and choices results in emotional problems. This freedom is hard to

face, so we tend to invent an excuse by saying, “I can’t change now because of

my past conditioning.” Sartre called excuses “bad faith.” No matter what we have

been, we can make choices now and become something quite different. We are

condemned to be free. To choose is to become committed; this is the responsibility

that is the other side of freedom. Sartre’s view was that at every moment, by our

actions, we are choosing who we are being. Our existence is never ﬁ xed or ﬁ nished.

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EXISTENTIAL THERAPY

Every one of our actions represents a fresh choice. When we attempt to pin down

who we are, we engage in self-deception (Russell, 2007).

Key Figures in Contemporary Existential Psychotherapy

Viktor Frankl, Rollo May, Irvin Yalom, and James Bugental all developed their

existential approaches to psychotherapy from strong backgrounds in both existen-

tial and humanistic psychology. Some of their contributions to psychotherapy are

illustrated in the brief sketches that follow.

viktor frankl (1905–1997) Viktor Frankl was a central ﬁ gure in de-

veloping existential therapy in Europe and also in bringing it to the United States.

As a youth, Frankl was deeply inﬂ uenced by Freud, but he became a student of

Adler. Later, he was inﬂ uenced by the writings of existential philosophers, and he

began developing his own existential philosophy and psychotherapy. He was fond

of quoting Nietzsche: “He who has a why to live for can bear with almost any how”

(as cited in Frankl, 1963, pp. 121, 164). Frankl contended that those words could

be the motto for all psychotherapeutic practice. Another quotation from Nietzsche

seems to capture the essence of his own experience and his writings: “That which

does not kill me, makes me stronger” (as cited in Frankl, 1963, p. 130).

Frankl developed logotherapy, which means “therapy through meaning.”

Frankl’s philosophical model sheds light on what it means to be fully alive. The

central themes running through his works are life has meaning, under all circum-

stances; the central motivation for living is the will to meaning; we have the freedom

to ﬁ nd meaning in all that we think; and we must integrate body, mind, and spirit to be

fully alive. Frankl said that Freud viewed humans as motivated by the “will to pleas-

ure” and that Adler focused on the “will to power.” For Frankl, the most powerful

motivation for humans is the “will to meaning.” Frankl’s writings reﬂ ect the theme

that the modern person has the means to live, but often has no meaning to live for.

The therapeutic process is aimed at challenging individuals to ﬁ nd meaning and

purpose through, among other things, suffering, work, and love (Frankl, 1965).

(For more background information on Viktor Frankl, see his biography at the

beginning of this chapter).

rollo may (1909–1994) Along with Frankl, psychologist Rollo May was

deeply inﬂ uenced by the existential philosophers, by the concepts of Freudian psy-

chology, and by many aspects of Alfred Adler’s Individual Psychology. May was

one of the key ﬁ gures responsible for bringing existentialism from Europe to the

United States and for translating key concepts into psychotherapeutic practice. His

writings have had a signiﬁ cant impact on existentially oriented practitioners. Of

primary importance in introducing existential therapy to the United States was

the book Existence: A New Dimension in Psychiatry and Psychology (May, Angel, &

Ellenberger, 1958). According to May, it takes courage to “be,” and our choices

determine the kind of person we become. There is a constant struggle within us.

Although we want to grow toward maturity and independence, we realize that

expansion is often a painful process. Hence, the struggle is between the security of

dependence and the joys and pains of growth. (For more background information

on Rollo May, see his biography at the beginning of this chapter).

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CHAPTER SIX

irvin yalom (1931- ) Irvin Yalom is a signiﬁ cant contemporary existential

therapist in the United States. He acknowledges the contributions of both Euro-

pean and American psychologists and psychiatrists who have inﬂ uenced the devel-

opment of existential thinking and practice (Yalom, 1980). Yalom has developed

his approach to individual and group psychotherapy based on the notion that

existentialism deals with basic “givens of existence”: isolation and relationship with

others; death and living fully; and meaninglessness and meaning. Yalom believes

the vast majority of experienced therapists, regardless of their theoretical orienta-

tion, employ many of the core existential themes. He also contends that how we

address these existential themes has a good deal to do with the design and quality

of our lives. Yalom recognizes Frankl as an eminently pragmatic thinker who has

had an impact on his writing and practice. He also acknowledges the inﬂ uence on

his writings of several novelists and philosophers. More speciﬁ cally, he draws on

the following themes from those philosophers discussed earlier:

• From Kierkegaard: creative anxiety, despair, fear and dread, guilt, and nothingness

• From Nietzsche: death, suicide, and will

• From Heidegger: authentic being, caring, death, guilt, individual responsibility,

and isolation

• From Sartre: meaninglessness, responsibility, and choice

• From Buber: interpersonal relationships, I/Thou perspective in therapy, and

self-transcendence

(For more background information on Irvin Yalom, see his biography at the

beginning of this chapter.)

james bugental (1915–2008) James Bugental coined the term “existen-

tial-humanistic” psychotherapy, and he was a leading spokesman for this approach.

His philosophical and therapeutic approach included a curiosity and focus that

moved him away from the traditional therapeutic milieu of labeling and diagnos-

ing clients. His work emphasized the cultivation of both client and therapist pres-

ence. He developed techniques to assist the client in deepening inner exploration,

or searching. The therapist’s primary task involved helping clients to make new dis-

coveries about themselves in the living moment, as opposed to merely talking about

themselves.

Central to Bugental’s approach is his view of resistance, which from an existential-

humanistic perspective is not resistance to therapy per se but rather to being fully

present both during the therapy hour and in life. Resistance is seen as part of

the self-and-world construct —how a person understands his or her being and rela-

tionship to the world at large. Forms of resistance include intellectualizing, being

argumentative, always seeking to please, and any other life-limiting pattern. As re-

sistance emerges in the therapy sessions, the therapist repeatedly notes, or “tags,”

the resistance so the client increases his or her awareness and ultimately has an

increased range of choices.

Bugental’s theory and practice emphasized the distinction between therapeutic

process and content. He became known for being a masterful teacher and psycho-

therapist, primarily because he lived his work. He was an existentialist at heart,

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EXISTENTIAL THERAPY

which made him a great model and mentor, not only for clients but also for stu-

dents and professionals. In his workshops, he developed many exercises to help

therapists reﬁ ne and practice their skills. He frequently brought his techniques

to life with live demonstrations, which emphasized therapeutic work taking place

in the moment, impromptu here-and-now dialogue, and exploring in the context

of self as client or therapist. Bugental’s (1987) classic text, The Art of the Psycho-

therapist, is widely recognized for deconstructing the therapy process and moving

beyond theory and generalizations to show what actually occurs moment-to-

moment in the therapeutic encounter. Psychotherapy Isn’t What You Think (Bugental,

1999) is the last book he wrote before he died in 2008, at the age of 93.

other contributors to existential therapy A more recent in-

ﬂ uential ﬁ gure in contemporary existential psychology is Kirk Schneider, who with

colleagues Orah Krug, David Elkins, and Ken Bradford are helping to extend exis-

tential principles to a new generation of practitioners. Schneider and his colleagues

developed an existential-integrative therapy (see Schneider, 2008, 2011; Schneider &

Krug, 2010) mainly because of the need to address today’s ethnically and diagnosti-

cally diverse clinical populations. The existential-integrative approach emphasizes

such areas as personal and interpersonal presence, the working through of resist-

ance, the rediscovery of meaning and awe, and contemplative practices. These

themes are increasingly being incorporated into the therapeutic mainstream.

Signiﬁ cant developments in the existential approach are also occurring in

Britain, largely due to the efforts of Emmy van Deurzen, who is developing aca-

demic and training programs at the New School of Psychotherapy and Counselling

(see Other Resources at the end of the chapter for details). In the past decades the

existential approach has spread rapidly in Britain and is now an alternative to tra-

ditional methods (van Deurzen, 2002b). For a description of the historical context

and development of existential therapy in Britain, see van Deurzen (2002b) and

Cooper (2003); for an excellent overview of the theory and practice of existential

therapy, see van Deurzen (2002a) and Schneider and Krug (2010).

key concepts

View of Human Nature

The crucial signiﬁ cance of the existential movement is that it reacts against the

tendency to identify therapy with a set of techniques. Instead, it bases therapeu-

tic practice on an understanding of what it means to be human. The existential

movement stands for respect for the person, for exploring new aspects of human

behavior, and for divergent methods of understanding people. It uses numerous

approaches to therapy based on its assumptions about human nature.

The existential tradition seeks a balance between recognizing the limits and

tragic dimensions of human existence on one hand and the possibilities and

opportunities of human life on the other hand. It grew out of a desire to help people

engage the dilemmas of contemporary life, such as isolation, alienation, and mean-

inglessness. The current focus of the existential approach is on the individual’s

experience of being in the world alone and facing the anxiety of this isolation.

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CHAPTER SIX

“No relationship can eliminate existential isolation, but aloneness can be shared in

such a way that love compensates for its pain” (Yalom & Josselson, 2011, p. 326).

The existential view of human nature is captured, in part, by the notion that the

signiﬁ cance of our existence is never ﬁ xed once and for all; rather, we continually

recreate ourselves through our projects. Humans are in a constant state of transi-

tion, emerging, evolving, and becoming in response to the tensions, contradictions,

and conﬂ icts in our lives. Being a person implies that we are discovering and mak-

ing sense of our existence. We continually question ourselves, others, and the world.

Although the speciﬁ c questions we raise vary in accordance with our developmental

stage in life, the fundamental themes do not vary. We pose the same questions

philosophers have pondered throughout Western history: “Who am I?” “What can I

know?” “What ought I to do?” “What can I hope for?” “Where am I going?”

The basic dimensions of the human condition, according to the existential

approach, include (1) the capacity for self-awareness; (2) freedom and responsi-

bility; (3) creating one’s identity and establishing meaningful relationships with

others; (4) the search for meaning, purpose, values, and goals; (5) anxiety as a con-

dition of living; and (6) awareness of death and nonbeing. I develop these proposi-

tions in the following sections by summarizing themes that emerge in the writings

of existential philosophers and psychotherapists, and I also discuss the implica-

tions for counseling practice of each of these propositions.

Proposition 1: The Capacity for Self-Awareness

Freedom, choice, and responsibility constitute the foundation of self-awareness. The

greater our awareness, the greater our possibilities for freedom (see Proposition 2).

Schneider (2008) explains that the core existential position is that we are both free (will-

ful, creative, and expressive) and limited (by environmental and social constraints). We

increase our capacity to live fully as we expand our awareness in the following areas:

• We are ﬁ

nite and do not have unlimited time to do what we want in life.

• We have the potential to take action or not to act; inaction is a decision.

• We choose our actions, and therefore we can partially create our own destiny.

• Meaning is the product of discovering how we are “thrown” or situated in the

world and then, through commitment, living creatively.

• As we increase our awareness of the choices available to us, we also increase our

sense of responsibility for the consequences of these choices.

• We are subject to loneliness, meaninglessness, emptiness, guilt, and isolation.

• We are basically alone, yet we have an opportunity to relate to other beings.

We can choose either to expand or to restrict our consciousness. Because self-

awareness is at the root of most other human capacities, the decision to expand it is

fundamental to human growth. Here are some areas of emerging awareness that

individuals may experience in the counseling process:

• They see how they are trading the security of dependence for the anxieties that

accompany choosing for themselves.

• They begin to see that their identity is anchored in someone else’s deﬁ nition

of

them; that is, they are seeking approval and conﬁ rmation of their being in others

instead of looking to themselves for afﬁ rmation.

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EXISTENTIAL THERAPY

• They learn that in many ways they are keeping themselves prisoner by some of

their past decisions, and they realize that they can make new decisions.

• They learn that although they cannot change certain events in their lives they

can change the way they view and react to these events.

• They learn that they are not condemned to a future similar to the past, for they

can learn from their past and thereby reshape their future.

• They realize that they are so preoccupied with suffering, death, and dying that

they are not appreciating living.

• They are able to accept their limitations yet still feel worthwhile, for they under-

stand that they do not need to be perfect to feel worthy.

• They come to realize that they are failing to live in the present moment because

of preoccupation with the past, planning for the future, or trying to do too many

things at once.

Increasing self-awareness—which includes awareness of alternatives, motivations,

factors inﬂ

uencing the person, and personal goals—is an aim of all counseling.

Clients need to learn that a price must be paid for increased awareness. As we

become more aware, it is more difﬁ cult to “go home again.” Ignorance of our

condition may have brought contentment along with a feeling of partial deadness,

but as we open the doors in our world, we can expect more turmoil as well as the

potential for more fulﬁ llment.

Proposition 2: Freedom and Responsibility

A characteristic existential theme is that people are free to choose among alterna-

tives and therefore play a large role in shaping their own destiny. Schneider and

Krug (2010) write that existential therapy embraces three values: (1) the freedom to

become within the context of natural and self-imposed limitations; (2) the capacity

to reﬂ ect on the meaning of our choices; and (3) the capacity to act on the choices we

make. A central existential concept is that although we long for freedom, we often try

to escape from our freedom by deﬁ ning ourselves as a ﬁ xed or static entity (Russell,

2007). We have no choice about being thrust into the world, yet the manner in

which we live and what we become are the result of our choices. Because of the real-

ity of this freedom, our task is to accept responsibility for directing our lives. How-

ever, it is possible to avoid this reality by making excuses. In speaking about “bad

faith,” the existential philosopher Jean-Paul Sartre (1971) refers to the inauthenticity

of not accepting personal responsibility. Here are two statements that reveal bad

faith: “Since that’s the way I’m made, I couldn’t help what I did” or “Naturally I’m

this way, because I grew up in a dysfunctional family.” An inauthentic mode of

existence consists of lacking awareness of personal responsibility for our lives and

passively assuming that our existence is largely controlled by external forces. Sartre

claims we are constantly confronted with the choice of what kind of person we are

becoming, and to exist is never to be ﬁ nished with this kind of choosing.

Freedom implies that we are responsible for our lives, for our actions, and

for our failures to take action. From Sartre’s perspective people are condemned

to freedom. He calls for a commitment to choosing for ourselves. Existential guilt

is being aware of having evaded a commitment, or having chosen not to choose.

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This guilt is a condition that grows out of a sense of incompleteness, or a realiza-

tion that we are not what we might have become. Guilt may be a sign that we have

failed to rise to the challenge of our anxiety and that we have tried to evade it by

not doing what we know is possible for us to do (van Deurzen, 2002a). This condi-

tion is not viewed as neurotic, nor is it seen as a symptom that needs to be cured.

Instead, the existential therapist explores it to see what clients can learn about the

ways in which they are living their life. This guilt also results from allowing others

to deﬁ ne us or to make our choices for us. Sartre said, “We are our choices.”

Authenticity implies that we are living by being true to our own evaluation of what

is a valuable existence for ourselves; it is the courage to be who we are.

For existentialists, then, being free and being human are identical. Freedom

and responsibility go hand in hand. We are the authors of our lives in the sense

that we create our destiny, our life situation, and our problems (Russell, 1978).

Assuming responsibility is a basic condition for change. Clients who refuse to

accept responsibility by persistently blaming others for their problems are not

likely to proﬁ t from therapy.

Frankl (1978) also links freedom with responsibility. He suggested that the

Statue of Liberty on the East Coast should be balanced with a Statue of Respon-

sibility on the West Coast. His basic premise is that freedom is bound by certain

limitations. We are not free from conditions, but we are free to take a stand against

these restrictions. Ultimately, these conditions are subject to our decisions, which

means we are responsible.

The therapist assists clients in discovering how they are avoiding freedom

and encourages them to learn to risk using it. Not to do so is to cripple clients

and make them dependent on the therapist. Therapists have the task of teaching

clients that they can explicitly accept that they have choices, even though they may

have devoted most of their life to evading them. Those who are in therapy often

have mixed feelings when it comes to choice. As Russell (2007) puts it: “We resent

it when we don’t have choices, but we get anxious when we do! Existentialism is all

about broadening the vision of our choices” (p. 111).

People often seek psychotherapy because they feel that they have lost control

of how they are living. They may look to the counselor to direct them, give them

advice, or produce magical cures. They may also need to be heard and understood.

Two central tasks of the therapist are inviting clients to recognize how they have

allowed others to decide for them and encouraging them to take steps toward

choosing for themselves. In inviting clients to explore other ways of being that are

more fulﬁ lling than their present restricted existence, some existential counselors

ask, “Although you have lived in a certain pattern, now that you recognize the price

of some of your ways, are you willing to consider creating new patterns?” Others

may have a vested interest in keeping the client in an old pattern, so the initiative

for changing it will have to come from the client.

Cultural factors need to be taken into account in assisting clients in the process

of examining their choices. A person who is struggling with feeling limited by her

family situation can be invited to look at her part in this process and values that

are a part of her culture. For example, Meta, a Norwegian American, is working to

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EXISTENTIAL THERAPY

attain a professional identity as a social worker, but her family thinks she is being

selﬁ sh and neglecting her primary duties. The family is likely to exert pressure on

her to give up her personal interests in favor of what they feel is best for the wel-

fare of the entire family. Meta may feel trapped in the situation and see no way out

unless she rejects what her family wants. In cases such as this, it is useful to

explore the client’s underlying values and to help her determine whether her values

are working for her and for her family. Clients such as Meta have the challenge of

weighing values and balancing behaviors between two cultures. Ultimately, Meta

must decide in what ways she might change her situation, and she needs to assess

values based on her culture. The existential therapist will invite Meta to begin to

explore what she can do and to realize that she can be authentic in spite of pres-

sures on her by her situation. According to Vontress (2008), we can be authentic

in any society, whether we are a part of an individualistic or collectivistic society.

It is essential to respect the purpose that people have in mind when they initiate

therapy. If we pay careful attention to what our clients tell us about what they want,

we can operate within an existential framework. We can encourage individuals to

weigh the alternatives and to explore the consequences of what they are doing with

their lives. Although oppressive forces may be severely limiting the quality of their

lives, we can help people see that they are not solely the victims of circumstances

beyond their control. Even though we sometimes cannot control things that hap-

pen to us, we have complete control over how we choose to perceive and handle

them. Although our freedom to act is limited by external reality, our freedom to

be relates to our internal reality. At the same time that people are learning how to

change their external environment, they can be challenged to look within them-

selves to recognize their own contributions to their problems. Through the therapy

experience, clients may be able to discover new courses of action that will lead to a

change in their situation.

Proposition 3: Striving for Identity

and Relationship to Others

People are concerned about preserving their uniqueness and centeredness, yet at

the same time they have an interest in going outside of themselves to relate to other

beings and to nature. Each of us would like to discover a self or, to put it more authen-

tically, to create our personal identity. This is not an automatic process, and creating

an identity takes courage. As relational beings, we also strive for connectedness with

others. Many existential writers discuss loneliness, uprootedness, and alienation,

which can be seen as the failure to develop ties with others and with nature.

The trouble with so many of us is that we have sought directions, answers,

values, and beliefs from the important people in our world. Rather than trusting

ourselves to search within and ﬁ nd our own answers to the conﬂ icts in our life, we

sell out by becoming what others expect of us. Our being becomes rooted in their

expectations, and we become strangers to ourselves.

the courage to be Paul Tillich (1886–1965), a leading Protestant theolo-

gian of the 20th century, believes awareness of our ﬁ nite nature gives us an appre-

ciation of ultimate concerns. It takes courage to discover the true “ground of our

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CHAPTER SIX

being” and to use its power to transcend those aspects of nonbeing that would de-

stroy us (Tillich, 1952). Courage entails the will to move forward in spite of anxiety-

producing situations, such as facing our death (May, 1975). We struggle to discover,

to create, and to maintain the core deep within our being. One of the greatest fears

of clients is that they will discover that there is no core, no self, no substance, and

that they are merely reﬂ ections of everyone’s expectations of them. A client may

say, “My fear is that I’ll discover I’m nobody, that there really is nothing to me.

I’ll ﬁ nd out that I’m an empty shell, hollow inside, and nothing will exist if I shed

my masks.” If clients demonstrate the courage to confront these fears, they might

well leave therapy with an increased tolerance for the uncertainty of life. By assist-

ing clients in facing the fear that their lives or selves are empty and meaningless,

therapists can help clients to create a self that has meaning and substance that they

have chosen.

Existential therapists may begin by asking their clients to allow themselves to

intensify the feeling that they are nothing more than the sum of others’ expecta-

tions and that they are merely the introjects of parents and parent substitutes.

How do they feel now? Are they condemned to stay this way forever? Is there a way

out? Can they create a self if they ﬁ nd that they are without one? Where can they

begin? Once clients have demonstrated the courage to recognize this fear, to put it

into words and share it, it does not seem so overwhelming. I ﬁ nd that it is best to

begin work by inviting clients to accept the ways in which they have lived outside

themselves and to explore ways in which they are out of contact with themselves.

the experience of aloneness The existentialists postulate that part

of the human condition is the experience of aloneness. But they add that we can

derive strength from the experience of looking to ourselves and sensing our sepa-

ration. The sense of isolation comes when we recognize that we cannot depend on

anyone else for our own conﬁ rmation; that is, we alone must give a sense of mean-

ing to life, and we alone must decide how we will live. If we are unable to tolerate

ourselves when we are alone, how can we expect anyone else to be enriched by our

company? Before we can have any solid relationship with another, we must have a

relationship with ourselves. We are challenged to learn to listen to ourselves. We

have to be able to stand alone before we can truly stand beside another.

There is a paradox in the proposition that humans are existentially both alone

and related, but this very paradox describes the human condition. To think that

we can cure the condition, or that it should be cured, is erroneous. Ultimately we

are alone, yet our aloneness is set in the context of our inevitable relatedness to

other people.

the experience of relatedness We humans depend on relationships

with others. We want to be signiﬁ cant in another’s world, and we want to feel that

another’s presence is important in our world. When we are able to stand alone and

tap into our own strength, our relationships with others are based on our fulﬁ ll-

ment, not our deprivation. If we feel personally deprived, however, we can expect

little but a clinging and symbiotic relationship with someone else.

Perhaps one of the functions of therapy is to help clients distinguish between a

neurotically dependent attachment to another and a life-afﬁ rming relationship in

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EXISTENTIAL THERAPY

which both persons are enhanced. The therapist can challenge clients to examine

what they get from their relationships, how they avoid intimate contact, how they

prevent themselves from having equal relationships, and how they might create

therapeutic, healthy, and mature human relationships. Existential therapists speak

of intersubjectivity, which is the fact of our interrelatedness with others and the

need for us to struggle with this in a creative way.

struggling with our identity Because of our fear of dealing with

our aloneness, Farha (1994) points out that some of us get caught up in ritualis-

tic behavior patterns that cement us to an image or identity we acquired in early

childhood. He writes that some of us become trapped in a doing mode to avoid the

experience of being.

Part of the therapeutic journey consists of the therapist challenging clients

to begin to examine the ways in which they have lost touch with their identity,

especially by letting others design their life for them. The therapy process itself

is often frightening for clients when they realize that they have surrendered their

freedom to others and that in the therapy relationship they will have to assume

their freedom again. By refusing to give easy solutions or answers, existential

therapists confront clients with the reality that they alone must ﬁ nd their own

answers.

Proposition 4: The Search for Meaning

A distinctly human characteristic is the struggle for a sense of signiﬁ cance and

purpose in life. In my experience the underlying conﬂ icts that bring people into

counseling and therapy are centered in these existential questions: “Why am I

here?” “What do I want from life?” “What gives my life purpose?” “Where is the

source of meaning for me in life?”

Existential therapy can provide the conceptual framework for helping clients

challenge the meaning in their lives. Questions that the therapist might ask are,

“Do you like the direction of your life?” “Are you pleased with what you now are

and what you are becoming?” “If you are confused about who you are and what you

want for yourself, what are you doing to get some clarity?”

the problem of discarding old values One of the problems in

therapy is that clients may discard traditional (and imposed) values without creat-

ing other, suitable ones to replace them. What does the therapist do when clients

no longer cling to values that they never really challenged or internalized and now

experience a vacuum? Clients may report that they feel like a boat without a rudder.

They seek new guidelines and values that are appropriate for the newly discovered

facets of themselves, and yet for a time they are without them. One of the tasks of

the therapeutic process is to help clients create a value system based on a way of

living that is consistent with their way of being.

The therapist’s job is to trust in the capacity of clients to eventually create an

internally derived value system that provides the foundation for a meaningful life.

They will no doubt ﬂ ounder for a time and experience anxiety as a result of the

absence of clear-cut values. The therapist’s trust is important in helping clients

trust their own capacity to create a new source of values.

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CHAPTER SIX

meaninglessness When the world they live in seems meaningless, clients

may wonder whether it is worth it to continue struggling or even living. Faced with

the prospect of our mortality, we might ask, “Is there any point to what I do now,

since I will eventually die? Will what I do be forgotten when I am gone? Given the

fact of mortality, why should I busy myself with anything?” A man in one of my

groups captured precisely the idea of personal signiﬁ cance when he said, “I feel

like another page in a book that has been turned quickly, and nobody bothered to

read the page.” For Frankl (1978) such a feeling of meaninglessness is the major

existential neurosis of modern life.

Meaninglessness in life can lead to emptiness and hollowness, or a condition

that Frankl calls the existential vacuum. This condition is often experienced when

people do not busy themselves with routine or with work. Because there is no

preordained design for living, people are faced with the task of creating their own

meaning. At times people who feel trapped by the emptiness of life withdraw from

the struggle of creating a life with purpose. Experiencing meaninglessness and

establishing values that are part of a meaningful life are issues that become the

heart of counseling.

creating new meaning Logotherapy is designed to help clients ﬁ nd

meaning in life. The therapist’s function is not to tell clients what their particular

meaning in life should be but to point out that they can create meaning even in suf-

fering (Frankl, 1978). This view holds that human suffering (the tragic and negative

aspects of life) can be turned into human achievement by the stand an individual

takes when faced with it. Frankl also contends that people who confront pain, guilt,

despair, and death can effectively deal with their despair and thus triumph.

Yet meaning is not something that we can directly search for and obtain. Para-

doxically, the more rationally we seek it, the more likely we are to miss it. Frankl

(1978) and Yalom and Josselson (2011) are in basic agreement that, like pleasure,

meaning must be pursued obliquely. Finding satisfaction and meaning in life is

a by-product of engagement, which is a commitment to creating, loving, working,

and building. Meaning is created out of an individual’s engagement with what is

valued, and this commitment provides the purpose that makes life worthwhile

(van Deurzen, 2002a). I like the way Vontress (2008) captures the idea that mean-

ing in life is an ongoing process we struggle with throughout our lives: “What

provides meaning one day may not provide meaning the next, and what has been

meaningful to a person throughout life may be meaningless when a person is on

his or her deathbed” (p. 158).

Proposition 5: Anxiety as a Condition of Living

Anxiety arises from one’s personal strivings to survive and to maintain and as-

sert one’s being, and the feelings anxiety generates are an inevitable aspect of the

human condition. Existential anxiety is the unavoidable result of being confronted

with the “givens of existence”—death, freedom, choice, isolation, and meaningless-

ness (Vontress, 2008; Yalom, 1980; Yalom & Josselson, 2011). Existential anxiety

arises as we recognize the realities of our mortality, our confrontation with pain and

suffering, our need to struggle for survival, and our basic fallibility. We experience

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EXISTENTIAL THERAPY

this anxiety as we become increasingly aware of our freedom and the consequenc-

es of accepting or rejecting that freedom. In fact, when we make a decision that

involves reconstruction of our life, the accompanying anxiety can be a signal that we

are ready for personal change and can be a stimulus for growth. If we learn to listen

to the subtle messages of anxiety, we can dare to take the steps necessary to change

the direction of our lives.

Existential therapists differentiate between normal and neurotic anxiety, and

they see anxiety as a potential source of growth. Normal anxiety is an appropriate

response to an event being faced. Further, this kind of anxiety does not have to

be repressed, and it can be used as a motivation to change. Because we could not

survive without some anxiety, it is not a therapeutic goal to eliminate normal anxi-

ety. Existential philosophers have argued that at the root of our normal (or ontic)

anxiety, which is an appropriate anxiety that relates to concrete things in the world,

is a more fundamental existential (or ontological) anxiety, which is based on our

awareness of our own temporality and is present even when we do not have to face

particularly difﬁ cult situations. Neurotic anxiety, in contrast, is anxiety about con-

crete things that is out of proportion to the situation. Neurotic anxiety is typically

out of awareness, and it tends to immobilize the person. Being psychologically

healthy entails living with as little neurotic anxiety as possible, while accepting and

struggling with the unavoidable existential anxiety that is a part of living.

Many people who seek counseling want solutions that will enable them to elimi-

nate anxiety. Attempts to avoid anxiety by creating the illusion that there is security

in life may help us cope with the unknown, yet we really know on some level that

we are deceiving ourselves when we think we have found ﬁ xed security. Facing

existential anxiety involves viewing life as an adventure rather than hiding behind

imagined securities that seem to offer protection. Opening up to new life means

opening up to anxiety. We pay a steep price when we short-circuit anxiety.

People who have the courage to face themselves are, nonetheless, frightened. I

am convinced that those who are willing to live with their anxiety for a time proﬁ t

from personal therapy. Those who ﬂ ee too quickly into comfortable patterns might

experience temporary relief but in the long run seem to experience the frustration

of being stuck in old ways.

The existential therapist can help clients recognize that learning how to tolerate

ambiguity and uncertainty and how to live without props can be a necessary phase in

the journey from dependence to autonomy. The therapist and client can explore the

possibility that although breaking away from crippling patterns and building new

ways of living will be fraught with anxiety for a while, anxiety will diminish as the cli-

ent experiences more satisfaction with newer ways of being. When a client becomes

more self-conﬁ dent, the anxiety that results from an expectation of catastrophe is

likely to decrease.

Proposition 6: Awareness of Death and Nonbeing

The existentialist does not view death negatively but holds that awareness of death

as a basic human condition gives signiﬁ cance to living. A distinguishing human

characteristic is the ability to grasp the reality of the future and the inevitability of

death. It is necessary to think about death if we are to think signiﬁ cantly about life.

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CHAPTER SIX

Death should not be considered a threat; death provides the motivation for us to

take advantage of appreciating the present moment. Instead of being frozen by the

fear of death, death can be viewed as a positive force that enables us to live as fully

as possible. Although the notion of death is a wake-up call, it is also something

that we strive to avoid (Russell, 2007). If we defend ourselves against the reality

of our eventual death, life becomes insipid and meaningless. But if we realize that

we are mortal, we know that we do not have an eternity to complete our projects

and that the present is crucial. Our awareness of death is the source of zest for life

and creativity. Death and life are interdependent, and though physical death de-

stroys us, the idea of death saves us (Yalom, 1980, 2003).

Yalom (2008) recommends that therapists talk directly to clients about the

reality of death. He believes the fear of death percolates beneath the surface and

haunts us throughout life. Death is a visitor in the therapeutic process, and Yalom

believes that ignoring its presence sends the message that death is too overwhelm-

ing to explore. Confronting this fear can be the factor that helps us transform an

inauthentic mode of living into a more authentic one. Accepting the reality of our

personal death can result in a massive shift in the way we live in the world (Yalom &

Josselson, 2011). We can turn our fear of death into a positive force when we accept

the reality of our mortality. In Staring at the Sun: Overcoming the Terror of Death,

Yalom (2008) develops the idea that confronting death enables us to live in a more

compassionate way.

One focus in existential therapy is on exploring the degree to which clients

are doing the things they value. Without being morbidly preoccupied by the ever-

present threat of nonbeing, clients can develop a healthy awareness of death as a

way to evaluate how well they are living and what changes they want to make in

their lives. Those who fear death also fear life. When we emotionally accept the

reality of our eventual death, we realize more clearly that our actions do count, that

we do have choices, and that we must accept the ultimate responsibility for how

well we are living (Corey & Corey, 2010).

the therapeutic process

Therapeutic Goals

Existential therapy is best considered as an invitation to clients to recognize the

ways in which they are not living fully authentic lives and to make choices that

will lead to their becoming what they are capable of being. An aim of therapy is to

assist clients in moving toward authenticity and learning to recognize when they

are deceiving themselves (van Deurzen, 2002a). The existential orientation holds

that there is no escape from freedom as we will always be held responsible. We can

relinquish our freedom, however, which is the ultimate inauthenticity. Existential

therapy aims at helping clients face anxiety and engage in action that is based on

the authentic purpose of creating a worthy existence.

May (1981) contends that people come to therapy with the self-serving illu-

sion that they are inwardly enslaved and that someone else (the therapist) can free

them. Existential therapists are mainly concerned about helping people to reclaim

and reown their lives. The task of existential therapy is to teach clients to listen to

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EXISTENTIAL THERAPY

what they already know about themselves, even though they may not be attend-

ing to what they know. Schneider and Krug (2010) identify four essential aims of

existential-humanistic therapy: (1) to help clients become more present to both

themselves and others; (2) to assist clients in identifying ways they block them-

selves from fuller presence; (3) to challenge clients to assume responsibility for de-

signing their present lives; and (4) to encourage clients to choose more expanded

ways of being in their daily lives.

Increased awareness is the central goal of existential therapy, which allows

clients to discover that alternative possibilities exist where none were recognized

before. Clients come to realize that they are able to make changes in their way of

being in the world.

Therapist’s Function and Role

Existential therapists are primarily concerned with understanding the subjective

world of clients to help them come to new understandings and options. Existen-

tial therapists are especially concerned about clients avoiding responsibility; they

consistently invite clients to accept personal responsibility. When clients complain

about the predicaments they are in and blame others, the therapist is likely to ask

them how they contributed to their situation.

Therapists with an existential orientation usually deal with people who have

what could be called a restricted existence. These clients have a limited aware-

ness of themselves and are often vague about the nature of their problems. They

may see few, if any, options for dealing with life situations, and they tend to feel

trapped, helpless, and stuck. For Bugental (1997), a therapist’s function is to assist

clients in seeing the ways in which they constrict their awareness and the cost of

such constrictions. The therapist may hold up a mirror, so to speak, so that clients

can gradually engage in self-confrontation. In this way clients can see how they be-

came the way they are and how they might enlarge the way they live. Once clients

are aware of factors in their past and of stiﬂ ing modes of their present existence,

they can begin to accept responsibility for changing their future.

Existential practitioners may make use of techniques that originate from

diverse theoretical orientations, yet no set of techniques is considered essen-

tial. The therapeutic journey is creative and uncertain and different for each cli-

ent. Russell (2007) captures this notion well when he writes: “There is no one

right way to do therapy, and certainly no rigid doctrine for existentially rooted

techniques. What is crucial is that you create your own authentic way of being

attuned to your clients” (p. 123). Existential therapists encourage experimenta-

tion not only within the therapy ofﬁ ce but also outside of the therapy setting,

based on the belief that life outside therapy is what counts. Practitioners often

ask clients to reﬂ ect on or write about problematic events they encounter in daily

life (Schneider, 2011).

Client’s Experience in Therapy

Clients in existential therapy are clearly encouraged to assume responsibility for

how they are currently choosing to be in their world. Effective therapy does not stop

with this awareness itself, for the therapist encourages clients to take action on the

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CHAPTER SIX

basis of the insights they develop through the therapeutic process. Experimentation

with new ways of behaving in the outside world is necessary if clients are to change.

Further, clients must be active in the therapeutic process, for during the sessions

they must decide what fears, guilt feelings, and anxieties they will explore.

Merely deciding to enter psychotherapy is itself a frightening prospect for most

people. The experience of opening the doors to oneself can be frightening, excit-

ing, joyful, depressing, or a combination of all of these. As clients wedge open the

closed doors, they also begin to loosen the deterministic shackles that have kept

them psychologically bound. Gradually, they become aware of what they have been

and who they are now, and they are better able to decide what kind of future they

want. Through the process of their therapy, individuals can explore alternatives for

making their visions real.

When clients plead helplessness and attempt to convince themselves that they

are powerless, May (1981) reminds them that their journey toward freedom began

by putting one foot in front of the other to get to his ofﬁ ce. As narrow as their range

of freedom may be, individuals can begin building and augmenting that range by

taking small steps. The therapeutic journey that opens up new horizons is poeti-

cally described by van Deurzen (2010):

Embarking on our existential journey requires us to be prepared to be touched and shaken by

what we ﬁ nd on the way and to not be afraid to discover our own limitations and weaknesses,

uncertainties and doubts. It is only with such an attitude of openness and wonder that we can

encounter the impenetrable everyday mysteries, which take us beyond our own preoccupa-

tions and sorrows and which by confronting us with death, make us rediscover life. (p. 5)

Another aspect of the experience of being a client in existential therapy is confront-

ing ultimate concerns rather than coping with immediate problems. Rather than

being solution-oriented, existential therapy is aimed toward removing roadblocks

to meaningful living and helping clients assume responsibility for their actions

(Yalom & Josselson, 2011). Existential therapists assist people in facing life with

courage, hope, and a willingness to ﬁ nd meaning in life.

Relationship Between Therapist and Client

Existential therapists give central prominence to their relationship with the client.

The relationship is important in itself because the quality of this person-to-person

encounter in the therapeutic situation is the stimulus for positive change. Atten-

tion is given to the client’s immediate, ongoing experience, especially what is go-

ing on in the interaction between the therapist and the client. Therapy is viewed

as a social microcosm in the sense that the interpersonal and existential problems

of the client will become apparent in the here and now of the therapy relationship

(Yalom & Josselson, 2011).

Therapists with an existential orientation believe their basic attitudes toward the

client and their own personal characteristics of honesty, integrity, and courage are

what they have to offer. Therapy is a journey taken by therapist and client that delves

deeply into the world as perceived and experienced by the client. But this type of quest

demands that therapists also be in contact with their own phenomenological world.

Existential therapy is a voyage into self-discovery and a journey of life-discovery

for both client and therapist (van Deurzen, 2010; Yalom & Josselson, 2011).

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EXISTENTIAL THERAPY

Buber’s (1970) conception of the I/Thou relationship has signiﬁ cant implica-

tions here. His understanding of the self is based on two fundamental relation-

ships: the “I/it” and the “I/Thou.” The I/it is the relation to time and space, which

is a necessary starting place for the self. The I/Thou is the relationship essential

for connecting the self to the spirit and, in so doing, to achieve true dialogue. This

form of relationship is the paradigm of the fully human self, the achievement of

which is the goal of Buber’s existential philosophy. Relating in an I/Thou fashion

means that there is direct, mutual, and present interaction. Rather than prizing

therapeutic objectivity and professional distance, existential therapists strive to cre-

ate caring and intimate relationships with clients.

The core of the therapeutic relationship is respect, which implies faith in

clients’ potential to cope authentically with their troubles and in their ability to

discover alternative ways of being. Existential therapists share their reactions to

clients with genuine concern and empathy as one way of deepening the therapeu-

tic relationship. Therapists invite clients to grow by modeling authentic behavior.

If therapists keep themselves hidden during the therapeutic session or if they en-

gage in inauthentic behavior, clients will also remain guarded and persist in their

inauthentic ways.

Bugental (1987) emphasizes the crucial role the presence of the therapist plays

in the therapeutic relationship. In his view many therapists and therapeutic sys-

tems overlook its fundamental importance. He contends that therapists are too

often so concerned with the content of what is being said that they are not aware of

the distance between themselves and their clients:

The therapeutic alliance is the powerful joining of forces which energizes and supports the

long, difﬁ cult, and frequently painful work of life-changing psychotherapy. The conception

of the therapist here is not of a disinterested observer-technician but of a fully alive human

companion for the client. (p. 49)

Schneider (2011) believes that the therapist’s presence is both a condition and a goal

of therapeutic change. Presence serves the dual functions of reconnecting people

to their pain and to attuning them to the opportunities to transform their pain.

application: therapeutic

techniques and procedures

The existential approach is unlike most other therapies in that it is not technique-

oriented. Although existentially oriented therapists may incorporate many tech-

niques from other models, these interventions are made within the context of striv-

ing to understand the subjective world of the client. The interventions existential

practitioners employ are based on philosophical views about the nature of human

existence. These practitioners prefer description, understanding, and exploration

of the client’s subjective reality, as opposed to diagnosis, treatment, and prognosis

(van Deurzen, 2002b). As Vontress (2008) puts it: “Existential therapists prefer

to be thought of as philosophical companions, not as people who repair psyches”

(p. 161). Yalom and Josselson (2011) assert that existential therapists are “fel-

low travelers” (p. 332), willing to make themselves known through appropriate

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CHAPTER SIX

self-disclosure. As mentioned earlier, existential therapists are free to draw from

techniques that ﬂ ow from many other orientations. However, they do not employ an

array of unintegrated techniques; they have a set of assumptions and attitudes that

guide their interventions with clients. See Case Approach to Counseling and Psycho-

therapy (Corey, 2013, chap. 4) for an illustration of how Dr. J. Michael Russell works

in an existential way with some key themes in the case of Ruth.

Van Deurzen (2010) identiﬁ es as a primary ground rule of existential work the

openness to the individual creativity of the therapist and the client. She maintains

that existential therapists need to adapt their interventions to their own person-

ality and style, as well as being sensitive to what each client requires. The main

guideline is that the existential practitioner’s interventions are responsive to the

uniqueness of each client.

Van Deurzen (2002a, 2002b) believes that the starting point for existential

work is for practitioners to clarify their views on life and living. She stresses the

importance of therapists reaching sufﬁ cient depth and openness in their own lives

to venture into clients’ murky waters without getting lost. The nature of existential

work is assisting people in the process of living with greater expertise and ease.

Van Deurzen (2010) identiﬁ es how therapists make a difference with clients: “We

help them to get better at reﬂ ecting on their situation, deal with their dilemma,

face their predicament and think for themselves” (p. 236). Van Deurzen reminds

us that existential therapy is a collaborative adventure in which both client and

therapist will be transformed if they allow themselves to be touched by life. When

the deepest self of the therapist meets the deepest part of the client, the counseling

process is at its best. Therapy is a creative, evolving process of discovery that can be

conceptualized in three general phases.

Phases of Existential Counseling

During the initial phase of counseling, therapists assist clients in identifying

and clarifying their assumptions about the world. Clients are invited to deﬁ ne and

question the ways in which they perceive and make sense of their existence. They

examine their values, beliefs, and assumptions to determine their validity. This is

a difﬁ cult task for many clients because they may initially present their problems

as resulting almost entirely from external causes. They may focus on what other

people “make them feel” or on how others are largely responsible for their actions

or inaction. The counselor teaches them how to reﬂ ect on their own existence and

to examine their role in creating their problems in living.

During the middle phase of existential counseling, clients are assisted in more

fully examining the source and authority of their present value system. This proc-

ess of self-exploration typically leads to new insights and some restructuring of

values and attitudes. Individuals get a better idea of what kind of life they consider

worthy to live and develop a clearer sense of their internal valuing process.

The ﬁ nal phase of existential counseling focuses on helping people take what

they are learning about themselves and put it into action. Transformation is not

limited to what takes place during the therapy hour. The therapeutic hour is a

small contribution to a person’s renewed engagement with life, or a rehearsal

for life (van Deurzen, 2002b). The aim of therapy is to enable clients to discover

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EXISTENTIAL THERAPY

ways of implementing their examined and internalized values in a concrete way

between sessions and after therapy has terminated. Clients typically discover their

strengths and ﬁ nd ways to put them to the service of living a purposeful existence.

Clients Appropriate for Existential Counseling

Existential practice has been applied in a variety of settings and with a diverse pop-

ulation of clients, including those with substance abuse issues, ethnic and racial

minorities, gay and lesbian clients, and psychiatric inpatients (Schneider, 2011). A

strength of the perspective is its focus on available choices and pathways toward

personal growth. For people who are coping with developmental crises, experienc-

ing grief and loss, confronting death, or facing a major life decision, existential

therapy is especially appropriate. Some examples of these critical turning points

that mark passages from one stage of life into another are the struggle for identity

in adolescence, coping with possible disappointments in middle age, adjusting to

children leaving home, coping with failures in marriage and work, and dealing

with increased physical limitations as one ages. These developmental challenges

involve both dangers and opportunities. Uncertainty, anxiety, and struggling with

decisions are all part of this process.

Van Deurzen (2002b) suggests that this form of therapy is most appropriate

for clients who are committed to dealing with their problems about living, for peo-

ple who feel alienated from the current expectations of society, or for those who

are searching for meaning in their lives. It tends to work well with people who

are at a crossroads and who question the state of affairs in the world and are will-

ing to challenge the status quo. It can be useful for people who are on the edge of

existence, such as those who are dying or contemplating suicide, who are working

through a developmental or situational crisis, who feel that they no longer belong

in their surroundings, or who are starting a new phase of life.

Application to Brief Therapy

The existential approach can focus clients on signiﬁ cant areas such as assuming

personal responsibility, making a commitment to deciding and acting, and ex-

panding their awareness of their current situation. It is possible for a time-limited

approach to serve as a catalyst for clients to become actively and fully involved in

each of their therapy sessions. Strasser and Strasser (1997), who are connected to

the British school of existential analysis, maintain that there are clear beneﬁ ts to

time-limited therapy, which mirrors the time-limited reality of human existence.

Sharp and Bugental (2001) maintain that short-term applications of the existential

approach require more structuring and clearly deﬁ ned and less ambitious goals.

At the termination of short-term therapy, it is important for individuals to evaluate

what they have accomplished and what issues may need to be addressed later. It is

essential that both therapist and client determine that short-term work is appropri-

ate, and that beneﬁ cial outcomes are likely.

Application to Group Counseling

An existential group can be described as people making a commitment to a lifelong

journey of self-exploration with these goals: (1) enabling members to become honest

with themselves, (2) widening their perspectives on themselves and the world

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CHAPTER SIX

around them, and (3) clarifying what gives meaning to their present and future life

(van Deurzen, 2002b). An open attitude toward life is essential, as is the willingness

to explore unknown territory. Recurring universal themes evolve in many groups

and challenge members to seriously explore existential concerns such as choice,

freedom and anxiety, awareness of death, meaning in life, and living fully.

Yalom (1980) contends that the group provides the optimal conditions for

therapeutic work on responsibility. The members are responsible for the way they

behave in the group, and this provides a mirror for how they are likely to act in

the world. A group represents a microcosm of the world in which participants live

and function. Over time the interpersonal and existential problems of the partici-

pants become evident in the here-and-now interactions within the group (Yalom &

Josselson, 2011). Through feedback, members learn to view themselves through

others’ eyes, and they learn the ways in which their behavior affects others. Build-

ing on what members learn about their interpersonal functioning in the group,

they can take increased responsibility for making changes in everyday life. The

group experience provides the opportunity to participants to relate to others in

meaningful ways, to learn to be themselves in the company of other people, and to

establish rewarding, nourishing relationships.

In existential group counseling, members come to terms with the paradoxes of

existence: that life can be undone by death, that success is precarious, that we are

determined to be free, that we are responsible for a world we did not choose, that

we must make choices in the face of doubt and uncertainty. Members experience

anxiety when they recognize the realities of the human condition, including pain

and suffering, the need to struggle for survival, and their basic fallibility. Clients

learn that there are no ultimate answers for ultimate concerns. Through the sup-

port that is within a group, participants are able to tap the strength needed to create

an internally derived value system that is consistent with their way of being.

A group provides a powerful context to look at oneself, and to consider what

choices might be more authentically one’s own. Members can openly share their

fears related to living in unfulﬁ lling ways and come to recognize how they have

compromised their integrity. Members can gradually discover ways in which they

have lost their direction and can begin to be more true to themselves. Members

learn that it is not in others that they ﬁ nd the answers to questions about signiﬁ -

cance and purpose in life. Existential group leaders help members live in authentic

ways and refrain from prescribing simple solutions. For a more detailed discus-

sion of the existential approach to group counseling, see Corey (2012, chap. 9).

existential therapy from a

multicultural perspective

Strengths From a Diversity Perspective

Because the existential approach does not dictate a particular way of viewing or relat-

ing to reality, and because of its broad perspective, this approach is highly relevant in

working in a multicultural context (van Deurzen, 2002a). Vontress and colleagues

(1999) write about the existential foundation of cross-cultural counseling: “Existential

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161

EXISTENTIAL THERAPY

counseling is probably the most useful approach to helping clients of all cultures ﬁ nd

meaning and harmony in their lives, because it focuses on the sober issues each of us

must inevitably face: love, anxiety, suffering, and death” (p. 32). These are the human

experiences that transcend the boundaries that separate cultures.

Existential therapy is useful in working with culturally diverse clients because

of its focus on universality, or the common ground that we all share. This approach

emphasizes presence, the I/Thou relationship, and courage. As such, it can be

effectively applied with diverse client populations with a range of speciﬁ c problems

and in a wide array of settings (Schneider, 2008, 2011; Schneider & Krug, 2010).

Schneider’s (2008) “existential-integrative” model of practice coordinates a variety

of therapeutic modes within an overarching existential or experiential framework.

Vontress (1996) points out that all people are multicultural in the sense that they

are all products of many cultures. He encourages counselors-in-training to focus

on the universal commonalities of clients ﬁ rst and secondarily on areas of differ-

ences. In working with cultural diversity, it is essential to recognize simultaneously

the commonalities and differences of human beings: “Cross-cultural counseling,

in short, does not intend to teach speciﬁ c interventions for each culture, but to

infuse the counselor with a cultural sensitivity and tolerant philosophical outlook

that will beﬁ t all cultures” (p. 164).

The focus on subjective experience, or phenomenology, is a strength from a

multicultural perspective.

Another strength of the existential approach is that it

enables clients to examine the degree to which their behavior is being inﬂ uenced

by social and cultural conditioning. Clients can be challenged to look at the price

they are paying for the decisions they have made. Although it is true that some

clients may not feel a sense of freedom, their freedom can be increased if they

recognize the social limits they are facing. Their freedom can be hindered by insti-

tutions and limited by their family. In fact, it may be difﬁ

cult to separate individual

freedom from the context of their family structure.

There is wide-ranging international interest in the existential approach. Several

Scandinavian societies, an East European society (encompassing Estonia, Latvia,

Lithuania, Russia, Ukraine, and Belarus), and Mexican and South American socie-

ties are thriving. In addition, an Internet course, SEPTIMUS, is taught in Ireland,

Iceland, Sweden, Poland, Czech Republic, Romania, Italy, Portugal, France, Belgium,

the United Kingdom, Israel, and Australia. Most recently, the First International East-

West Existential Psychology conference was held in Nanjing, China, with representa-

tives from the United States, Korea, and Japan. These international developments, as

well as the creation of the International Collaborative of Existential Counselors and

Psychotherapists, which has members from all over the world, reveal that existential

therapy has wide appeal to diverse populations in many parts of the world.

Shortcomings From a Diversity Perspective

For those who hold a systemic perspective, the existentialists can be criticized on the

grounds that they are excessively individualistic and that they ignore the social factors

that cause human problems. However, with the advent of the “existential-integrative”

model of practice (Schneider, 2008), this situation is beginning to change. According

to Schneider (2011), existential practitioners are not only concerned with facilitating

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CHAPTER SIX

individual change but with promoting an in-depth inquiry that has implications for

social change: “One cannot simply heal individuals to the neglect of the social con-

text within which they are thrust. To be a responsible practitioner, one must develop

a vision of responsible social change alongside and in coordination with one’s vision

of individual transformation” (p. 281).

Some individuals who seek counseling may operate on the assumption that

they have very little choice because environmental circumstances severely restrict

their ability to inﬂ uence the direction of their lives. Even if they change internal-

ly, they see little hope that the external realities of racism, discrimination, and

oppression will change. They are likely to experience a deep sense of frustration and

feelings of powerlessness when it comes to making changes outside of themselves.

As you will see in Chapter 12, feminist therapists maintain that therapeutic practice

will be effective only to the extent that therapists intervene with some form of social

action to change those factors that are creating clients’ problems. In working with

people of color who come from the barrio or ghetto, for example, it is important to

engage their survival issues. If a counselor too quickly puts across the message to

these clients that they have a choice in making their lives better, they may feel pa-

tronized and misunderstood. These real-life concerns can provide a good focus for

counseling, assuming the therapist is willing to deal with them.

A potential problem within existential theory is that it is highly focused on the

philosophical assumption of self-determination, which may not take into account

the complex factors that many people who have been oppressed must deal with. In

many cultures it is not possible to talk about the self and self-determination apart

from the context of the social network and environmental conditions. However,

a case can be made for the existential approach being instrumental in enabling

clients to make conscious choices when it comes to the values they live by. Existen-

tial therapists do not push autonomy apart from a client’s culture. They do assist

clients in critically evaluating the source of their values and making a choice rather

than uncritically accepting the values of their culture and family.

Many clients expect a structured and problem-oriented approach to counseling

that is not found in the conventional existential approach. Although clients may

feel better if they have an opportunity to talk and to be understood, they are likely to

expect the counselor to do something to bring about a change in their life situation.

A major task for the counselor who practices from an existential perspective is to

provide enough concrete direction for these clients without taking the responsibility

away from them.

As an existentially oriented therapist, I

counsel Stan with the assumption that

he has the capacity to increase his

self-awareness and decide for himself the future

direction of his life. I want him to realize more

than anything else that he does not have to be

the victim of his past conditioning but can be the

architect in redesigning his future. He can free

himself of his deterministic shackles and

accept the responsibility that comes with

directing his own life. This approach emphasizes

the importance of my understanding of Stan’s

Existential Therapy Applied to the Case of Stan

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world, primarily by establishing an authentic

relationship as a means to a fuller degree of

self-understanding.

Stan is demonstrating what Sartre would call

“bad faith” by not accepting personal respon-

sibility. I confront Stan with the ways in which

he is attempting to escape from his freedom

through alcohol and drugs. Eventually, I chal-

lenge Stan’s passivity. I reaffirm that he is now

entirely responsible for his life, for his actions,

and for his failure to take action. I do this in a

supportive yet firm manner.

I do not see Stan’s anxiety as something

negative, but as a vital part of living with uncer-

tainty and freedom. Because there are no guar-

antees and because the individual is ultimately

alone, Stan can expect to experience some degree

of healthy anxiety, aloneness, guilt, and even

despair. These conditions are not neurotic in

themselves, but the way in which Stan orients

himself and copes with these conditions is critical.

Stan sometimes talks about his suicidal feel-

ings. Certainly, I investigate further to determine

if he poses an immediate threat to himself. In

addition to this assessment to determine lethality,

I view his thoughts of “being better off dead” as

symbolic. Could it be that Stan feels he is dying

as a person? Is Stan using his human potential?

Is he choosing a way of merely existing instead

of affirming life? Is Stan mainly trying to elicit

sympathy from his family? I invite Stan to explore

the meaning and purpose in his life. Is there any

reason for him to want to continue living? What

are some of the projects that enrich his life? What

can he do to find a sense of purpose that will

make him feel more significant and alive?

Stan needs to accept the reality that he may

at times feel alone. Choosing for oneself and

living from one’s own center accentuates the

experience of aloneness. He is not, however,

condemned to a life of isolation, alienation from

others, and loneliness. I hope to help Stan dis-

cover his own centeredness and live by the values

he chooses and creates for himself. By doing so,

Stan can become a more substantial person and

come to appreciate himself more. When he does,

the chances are lessened that he will have a need

to secure approval from others, particularly his

parents and parental substitutes. Instead of form-

ing a dependent relationship, Stan could choose

to relate to others out of his strength. Only then

would there be the possibility of overcoming his

feelings of separateness and isolation.

Follow-Up: You Continue as

Stan’s Existential Therapist

Use these questions to help you think about

how you would counsel Stan using an existential

approach:

• If Stan resisted your attempts to help him see

that he is responsible for the direction of his

life, how might y

ou intervene?

• Stan experiences a great deal of anxiety. From

an existential perspective, how do you vie

w his

anxiety? How might you work with his anxiety

in helpful ways?

• If Stan talks with you about suicide as a re-

sponse to despair and a life without meaning,

how would you respond?

See the DVD for Theory and Practice of

Counseling and Psychotherapy: The Case

of Stan and Lecturettes (Session 4 on existential

therapy) for a demonstration of my approach

to counseling Stan from this perspective. This

session focuses on the themes of death and the

meaning of life.

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EXISTENTIAL THERAPY

summary and evaluation

Summary

As humans, according to the existentialist view, we are capable of self-awareness,

which is the distinctive capacity that allows us to reﬂ ect and to decide. With this

awareness we become free beings who are responsible for choosing the way we live,

and we inﬂ uence our own destiny. This awareness of freedom and responsibility

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164

CHAPTER SIX

gives rise to existential anxiety, which is another basic human characteristic. Wheth-

er we like it or not, we are free, even though we may seek to avoid reﬂ ecting on this

freedom. The knowledge that we must choose, even though the outcome is not cer-

tain, leads to anxiety. This anxiety is heightened when we reﬂ ect on the reality that

we are mortal. Facing the inevitable prospect of eventual death gives the present

moment signiﬁ cance, for we become aware that we do not have forever to accom-

plish our projects. Our task is to create a life that has meaning and purpose. As

humans we are unique in that we strive toward fashioning purposes and values that

give meaning to living. Whatever meaning our life has is developed through free-

dom and a commitment to make choices in the face of uncertainty.

Existential therapy places central prominence on the person-to-person relation-

ship. It assumes that client growth occurs through this genuine encounter. It is not

the techniques a therapist uses that make a therapeutic difference; rather, it is the

quality of the client–therapist relationship that heals. It is essential that therapists

reach sufﬁ cient depth and openness in their own lives to allow them to venture

into their clients’ subjective world without losing their own sense of identity. Pres-

ence is both a condition for therapy to occur and a goal of therapy. Existential thera-

pists are fellow travelers, and as such they strive to be authentic and self-disclosing

in their therapy work. Because this approach focuses on the goals of therapy, ba-

sic conditions of being human, and therapy as a shared journey, practitioners are

not bound by speciﬁ c techniques. Although existential therapists may apply tech-

niques from other orientations, their interventions are guided by a philosophical

framework about what it means to be human.

Contributions of the Existential Approach

The existential approach has helped bring the person back into central focus. It

concentrates on the central facts of human existence: self-consciousness and our

consequent freedom. To the existentialist goes the credit for providing a new view

of death as a positive force, not a morbid prospect to fear, for death gives life mean-

ing. Existentialists have contributed a new dimension to the understanding of anx-

iety, guilt, frustration, loneliness, and alienation.

I particularly appreciate the way van Deurzen (2002a) views the existential

practitioner as a mentor and fellow traveler who encourages people to reﬂ ect upon

the problems they encounter in living. What clients need is “some assistance in

surveying the terrain and in deciding on the right route so that they can again ﬁ nd

their way” (p. 18). According to van Deurzen, the existential approach encourages

people to live life by their own standards and values: “The aim of existential work is

to assist people in developing their talents in their own personal way, helping them

in being true to what they value” (p. 21).

One of the major contributions of the existential approach is its emphasis on

the human quality of the therapeutic relationship. This aspect lessens the chances

of dehumanizing psychotherapy by making it a mechanical process. Existential

counselors reject the notions of therapeutic objectivity and professional distance,

viewing them as being unhelpful.

I very much value the existential emphasis on freedom and responsibility

and the person’s capacity to redesign his or her life by choosing with awareness.

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165

EXISTENTIAL THERAPY

This perspective provides a sound philosophical base on which to build a personal

and unique therapeutic style because it addresses itself to the core struggles of the

contemporary person.

contributions to the integration of psychotherapies

From my perspective, the key concepts of the existential approach can be inte-

grated into most therapeutic schools. Regardless of a therapist’s orientation, the

foundation for practice can be based on existential themes. Existential psychother-

apy continues to have an enduring impact on a variety of psychological practices.

“Indeed, existential psychotherapy is in the ironic position of being one of the most

widely inﬂ uential yet least ofﬁ cially embraced orientations on the professional

scene” (Schneider, 2008, p. 1). Bruce Wampold (2008), a leading researcher in the

psychotherapy ﬁ eld, agrees “that an understanding of the principles of existential

therapy is needed by all therapists, as it adds a perspective that might . . . form the

basis for all effective treatments” (p. 6).

A key contribution is the possibility of a creative integration of the concep-

tual propositions of existential therapy with many other therapeutic orientations

(Bugental & Bracke, 1992; Schneider, 2008, 2011; Schneider & Krug, 2010). One

example of such a creative integration is provided by Dattilio (2002), who inte-

grates cognitive behavioral techniques with the themes of an existential approach.

As a cognitive behavior therapist and author, Dattilio maintains that he directs

much of his efforts to “helping clients make a deep existential shift—to a new

understanding of the world” (p. 75). He uses techniques such as restructuring

of belief systems, relaxation methods, and a variety of cognitive and behavioral

strategies, but he does so within an existential framework that can begin the proc-

ess of real-life transformation. Many of his clients suffer from panic attacks or

depression. Dattilio often explores with these people existential themes of mean-

ing, guilt, hopelessness, anxiety—and at the same time he provides them with cog-

nitive behavioral tools to cope with the problems of daily living. In short, he grounds

symptomatic treatment in an existential approach.

Some people have argued that the new trend toward positive psychology is

similar to the existential approach, but this rests on a superﬁ cial comparison of

these two approaches. Existential therapists favor intensity and passionate experi-

ence, including that of happiness, but they equally value the darker side of human

nature and would encourage clients to learn to value both sides of their experience

(van Deurzen, 2009).

Limitations and Criticisms of the Existential Approach

A major criticism often aimed at this approach is that it lacks a systematic state-

ment of the principles and practices of psychotherapy. Some practitioners have

trouble with what they perceive as its mystical language and concepts. Some thera-

pists who claim adherence to an existential orientation describe their therapeutic

style in vague and global terms such as self-actualization, dialogic encounter, au-

thenticity, and being in the world. This particular use of language causes confusion

at times and makes it difﬁ cult to conduct research on the process or outcomes of

existential therapy.

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166

CHAPTER SIX

Both beginning and advanced practitioners who are not of a philosophical turn

of mind tend to ﬁ nd many of the existential concepts lofty and elusive. As we have

seen, this approach places primary emphasis on a subjective understanding of the

world of clients. It is assumed that techniques follow understanding. The fact that

few techniques are generated by this approach makes it essential for practitioners

to develop their own innovative procedures or to borrow from other schools of

therapy. For counselors who believe they need a speciﬁ c set of techniques to coun-

sel effectively, this approach has limitations (Vontress, 2008).

Practitioners who prefer a counseling practice based on research contend that

the concepts should be empirically sound, that deﬁ nitions should be operational,

that the hypotheses should be testable, and that therapeutic practice should be

based on the results of research into both the process and outcomes of counseling.

Certainly, the notions of manualized therapy and evidence-based practice are not

part of the existential perspective because every psychotherapy experience is unique

(Walsh & McElwain, 2002). According to Cooper (2003), existential practitioners

generally reject the idea that the therapeutic process can be measured and evalu-

ated in quantitative and empirical ways. Although existential practices are gener-

ally upheld by recent research on therapeutic effectiveness (see Elkins, 2009), few

studies directly evaluate and examine the existential approach. To a large extent,

existential therapy makes use of techniques from other theories, which makes it

difﬁ cult to apply research to this approach to study its effectiveness (Sharf, 2012).

According to van Deurzen (2002b), the main limitation of this approach is

that of the level of maturity, life experience, and intensive training required of

practitioners. Existential therapists need to be wise and capable of profound and

wide-ranging understanding of what it means to be human. Authenticity is a

cardinal characteristic of a competent existential practitioner, which is certainly

more involved than mastering a body of knowledge and acquiring technical skills.

Russell (2007) puts this notion nicely: “Authenticity means being able to sign your

own name on your work and your life. It means you will want to take responsibility

for creating your own way of being a therapist” (p.123).

where to go from here

Refer to the DVD for Integrative Counseling: The Case of Ruth and Lecturettes, Ses-

sion 11 (“Understanding How the Past Inﬂ uences the Present and the Future”),

for a demonstration of ways I utilize existential notions in counseling Ruth. We

engage in a role play where Ruth becomes the voice of her church and I take on

a new role as Ruth—one in which I have been willing to challenge certain beliefs

from church. This segment illustrates how I assist Ruth in ﬁ nding new values.

In Session 12 (“Working Toward Decisions and Behavioral Changes”) I challenge

Ruth to make new decisions, which is also an existential concept.

Free Podcasts for ACA Members

You can download ACA Podcasts (prerecorded interviews) at www.counseling.org;

click on the Resource button and then the Podcast Series. For Chapter 6, Existen-

tial Therapy, look for Podcast 14 by Dr. Gerald Corey.

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167

EXISTENTIAL THERAPY

Other Resources

The American Psychological Association offers a DVD by K. J. Schneider (2009)

titled Existential-Humanistic Therapy in their Systems of Psychotherapy Video Series.

Psychotherapy.net is a comprehensive resource for students and profession-

als that offers videos and interviews on existential therapy featuring Irvin Yalom,

James Bugental, and Rollo May. New video and editorial content is made available

monthly. DVDs relevant to this chapter are available at www.psychotherapy.net

and include the following:

Bugental, J.F.T. (1995). Existential-Humanistic Psychotherapy in Action

Bugental, J. (1997). Existential-Humanistic Psychotherapy (Psychotherapy

with the Experts Series)

Bugental, J. (2008). James Bugental: Live Case Consultation

May, R. (2007). Rollo May on Existential Psychotherapy

Yalom, I. (2002) The Gift of Therapy: A Conversation with Irvin Yalom, M.D.

Yalom, I. (2006). Irvin Yalom: Live Case Consultation

Yalom, I. (2011) Confronting Death and Other Existential Issues in

Psychotherapy

If you are interesting in further information on Irvin Yalom, check out his website

at www.yalom.com.

The Existential-Humanistic Institute, Dr. Kirk Schneider, Orah Krug, and Nader

Shabahangi

Website:www.ehinstitute.org

The Existential-Humanistic Institute’s (EHI) primary focus is training; offering

courses, and in conjunction with Saybrook University, a new certiﬁ cate program

in existential-humanistic therapy and theory. A secondary focus is community

building. EHI was formed as a nonproﬁ t organization under the auspices of the

Paciﬁ c Institute in 1997 and provides a home for those mental health profession-

als, scholars, and students who seek in-depth training in existential-humanistic

theory and practice. EHI’s year-long certiﬁ cate program offers graduate and post-

graduate students an opportunity to gain a basic foundation in the theory and

practice of existential-humanistic therapy. EHI offers courses on the principles of

existential-humanistic practice and case seminars in existential-humanistic theory

and practice. Most of EHI’s instructors have studied extensively with such masters

as James Bugental, Irvin Yalom, and Rollo May, and are, like Kirk Schneider and

Orah Krug, acknowledged leaders of the existential-humanistic movement today.

Society for Existential Analysis

Website: www.existentialanalysis.co.uk/

Additional Information: www.dilemmas.org

The Society for Existential Analysis is a professional organization devoted to

exploring issues pertaining to an existential/phenomenological approach to coun-

seling and therapy. Membership is open to anyone interested in this approach

and includes students, trainees, psychotherapists, philosophers, psychiatrists,

counselors, and psychologists. Members receive a regular newsletter and an

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168

CHAPTER SIX

annual copy of the Journal of the Society for Existential Analysis. The society provides

a list of existentially oriented psychotherapists for referral purposes. The School of

Psychotherapy and Counselling at Regent’s College in London offers an advanced

diploma in existential psychotherapy as well as short courses in the ﬁ eld.

International Society for Existential Psychotherapy and Counselling

Website: www.existentialpsychotherapy.net

The International Society for Existential Psychotherapy and Counselling was cre-

ated in London in July 2006 and was renamed International Collaborative of Exis-

tential Counselors and Psychotherapists soon after (www.icecap.org.uk). It brings

together the existing national societies as well as providing a forum for the devel-

opment and accreditation of the approach.

Psychotherapy Training on the Net: SEPTIMUS

Website: www.septimus.info

Additional Information: www.psychotherapytraining.net

SEPTIMUS is an Internet-based course taught in Ireland, Iceland, Sweden, Po-

land, Czech Republic, Romania, Italy, Portugal, Austria, Belgium, France, Israel,

Australia, and the United Kingdom.

New School of Psychotherapy and Counselling

Royal Waterloo House

51-55 Waterloo Road

London, England SE1 8TX

Telephone: +44 (0) 20 7928 43 44

E-mail: [email protected]

Website: www.nspc.org.uk

The New School of Psychotherapy and Counselling (NSPC) is set up especially for

training existential therapists. It offers an MA and doctoral program in Existen-

tial Psychotherapy and Counseling together with Middlesex University, as well as

an MSC and professional doctorate in Existential Counseling Psychology and Psy-

chotherapy also jointly with Middlesex University. NSPC offers intensive courses

for distance learners (worldwide student body), including e-learning.

Recommended Supplementary Readings

Everyday Mysteries: A Handbook of Existential Psychotherapy (van Deurzen, 2010) pro-

vides a framework for practicing counseling from an existential perspective. The au-

thor puts into clear perspective topics such as anxiety, authentic living, clarifying one’s

worldview, determining values, discovering meaning, and coming to terms with life.

Existential Therapies (Cooper, 2003) provides a useful and clear introduction to

the existential therapies. There are separate chapters on logotherapy, the British

school of existential analysis, the U.S. existential-humanistic approach, dimen-

sions of existential therapeutic practice, and brief existential therapies.

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Existential Psychotherapy (Yalom, 1980) is a superb treatment of the ultimate

human concerns of death, freedom, isolation, and meaninglessness as these

issues relate to therapy. This book has depth and clarity, and it is rich with clini-

cal examples that illustrate existential themes.

Existential-Humanistic Therapy (Schneider & Krug, 2010) is a clear presentation

of the theory and practice of existential-humanistic therapy. This approach incor-

porates techniques from other contemporary therapeutic approaches.

Existential-Integrative Psychotherapy: Guideposts to the Core of Practice (Schneider,

2008) is an edited book that offers recent and future trends in existential-

integrative therapy and case illustrations of this model.

I Never Knew I Had a Choice (Corey & Corey, 2010) is a self-help book written

from an existential perspective. Topics include our struggle to achieve autonomy;

the meaning of loneliness, death, and loss; and how we choose our values and

philosophy of life.

References and Suggested Readings

169

EXISTENTIAL THERAPY

*Books and articles marked with an asterisk are suggested for further study.

Binswanger, L. (1975). Being-in-the-world:

Selected papers of Ludwig Binswanger. London:

Souvenir Press.

Boss, M. (1963). Daseinanalysis and psychoa-

nalysis. New York: Basic Books.

Buber, M. (1970). I and thou (W. Kaufmann,

Trans.). New York: Scribner’s.

Bugental, J.F.T. (1986). Existential-humanistic

psychotherapy. In I. L. Kutash & A. Wolf (Eds.),

Psychotherapist’s casebook (pp. 222–236). San

Francisco: Jossey-Bass.

*Bugental, J.F.T. (1987). The art of the psycho-

therapist. New York: Norton.

Bugental, J.F.T. (1997). There is a fundamental

division in how psychotherapy is conceived. In

J. K. Zeig (Ed.), The evolution of psychotherapy:

The third conference (pp. 185–196). New York:

Brunner/Mazel.

*Bugental, J.F.T. (1999). Psychotherapy isn’t

what you think: Bringing the psychotherapeutic

engagement into the living moment. Phoenix,

AZ: Zeig, Tucker.

Bugental, J.F.T. (2008). Preliminary sketches

for a short-term existential-humanistic

therapy. In K. J. Schneider (Ed.), Existential-

integrative psychotherapy: Guideposts to the

core of practice (pp. 165–168). New York:

Routledge.

Bugental, J.F.T., & Bracke, P. E. (1992). The fu-

ture of existential-humanistic psychotherapy.

Psychotherapy, 29(l), 28–33.

*Cooper, M. (2003). Existential therapies.

London: Sage.

Corey, G. (2012). Theory and practice of group

counseling (8th ed.). Belmont, CA: Brooks/

Cole, Cengage Learning.

*Corey, G. (2013). Case approach to counseling

and psychotherapy (8th ed.). Belmont, CA:

Brooks/Cole, Cengage Learning.

*Corey, G., & Corey, M. (2010). I never knew I

had a choice (9th ed.). Belmont, CA: Brooks/

Cole, Cengage Learning.

Dattilio, F. M. (2002, January-February).

Cognitive-behaviorism comes of age: Ground-

ing symptomatic treatment in an existential

approach. The Psychotherapy Networker, 26(1),

75–78.

*Deurzen, E., van. (2002a). Existential counsel-

ling and psychotherapy in practice (2nd ed.).

London: Sage.

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170

CHAPTER SIX

*Deurzen, E., van. (2002b). Existential therapy.

In W. Dryden (Ed.), Handbook of individual

therapy (4th ed., pp. 179–208). London: Sage.

Deurzen, E., van. (2009). Psychotherapy and

the quest for happiness. London: Sage.

*Deurzen, E., van. (2010). Everyday mysteries: A

handbook of existential psychotherapy (2nd ed).

London: Routledge.

*Elkins, D. N. (2009). Humanistic psychology:

A clinical manifesto. Colorado Springs, CO:

University of the Rockies Press.

Farha, B. (1994). Ontological awareness: An

existential/cosmological epistemology. The

Person-Centered Periodical, 1(1), 15–29.

*Frankl, V. (1963). Man’s search for meaning.

Boston: Beacon.

*Frankl, V. (1965). The doctor and the soul.

New York: Bantam Books.

*Frankl, V. (1978). The unheard cry for

meaning. New York: Simon & Schuster

(Touchstone).

Gould, W. B. (1993). Viktor E. Frankl: Life with

meaning. Pacific Grove, CA: Brooks/Cole.

Heidegger, M. (1962). Being and time.

New York: Harper & Row.

May, R. (1950). The meaning of anxiety.

New York: Ronald Press.

*May, R. (1953). Man’s search for himself.

New York: Dell.

May, R. (1958). The origins and significance

of the existential movement in psychology. In

R. May, E. Angel, & H. R. Ellenberger (Eds.),

Existence: A new dimension in psychiatry and

psychology. New York: Basic Books.

*May, R. (Ed.). (1961). Existential psychology.

New York: Random House.

May, R. (1969). Love and will. New York: Norton.

May, R. (1975). The courage to create.

New York: Norton.

May, R. (1981). Freedom and destiny. New York:

Norton.

*May, R. (1983). The discovery of being:

Writings in existential psychology. New York:

Norton.

May, R., Angel, E., & Ellenberger, H. F. (Eds.).

(1958). Existence: A new dimension in psychiatry

and psychology. New York: Basic Books.

Russell, J. M. (1978). Sartre, therapy, and

expanding the concept of responsibility.

American Journal of Psychoanalysis, 38, 25

9–269.

*Russell, J. M.

(2007). Existential psychother-

apy. In A. B. Rochlen (Ed.), Applying coun-

seling theories: An online case-based approach

(pp. 107–125). Upper Saddle River, NJ: Pear-

son Prentice-Hall.

Sartre, J. P. (1971). Being and nothingness.

New York: Bantam Books.

*Schneider, K. J. (Ed.). (2008). Existential-

integrative psychotherapy: Guideposts to the core

of practice. New York: Routledge.

*Schneider, K. J. (2011). Existential-humanistic

psychotherapies. In S. B. Messer & A. S.

Gurman, (Eds.), Essential psychotherapies:

Theory and practice (3rd ed., pp. 261–294).

New York: Guilford Press.

*Schneider, K. J., & Krug, O. T. (2010). Exis-

tential-humanistic therapy. Washington, DC:

American Psychological Association.

*Schneider, K. J., & May, R. (Eds.). (1995). The

psychology of existence: An integrative, clinical

perspective. New York: McGraw-Hill.

Sharf, R. S. (2012). Theories of psychotherapy

and counseling: Concepts and cases (5th ed.).

Belmont, CA: Brooks/Cole, Cengage

Learning.

*Sharp, J. G., & Bugental, J.F.T. (2001). Existen-

tial-humanistic psychotherapy. In R. J. Corsini

(Ed.), Handbook of innovative therapies (2nd ed.,

pp. 206–217). New York: Wiley.

*Strasser, F., & Strasser, A. (1997). Existential

time-limited therapy: The wheel of existence.

Chichester: Wiley.

Tillich, P. (1952). The courage to be. New

Haven, CT: Yale University Press.

*Vontress, C. E. (1996). A personal retrospec-

tive on cross-cultural counseling. Journal

of Multicultural Counseling and Development,

24(3), 156–166.

*Vontress, C. E. (2008). Existential therapy. In

J. Frew & M. D. Spiegler (Eds.), Contemporary

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171

EXISTENTIAL THERAPY

psychotherapies for a diverse world

(pp. 141–176). Boston: Lahaska Press.

*Vontress, C. E., Johnson, J. A., & Epp, L. R.

(1999). Cross-cultural counseling: A casebook.

Alexandria, VA: American Counseling

Association.

*Walsh, R. A., & McElwain, B. (2002). Existen-

tial psychotherapies. In D. J. Cain & J. Seeman

(Eds.), Humanistic psychotherapies: Handbook

of research and practice (pp. 253–278).

Washington, DC: American Psychological

Association.

*Watson, J. C., Goldman, R. N., & Greenberg,

L. S. (2011). Humanistic and experiential

theories in psychotherapy. In J. C. Norcross, G.

R. Vandenbos, & D. K. Freedheim (Eds.), History

of psychotherapy (2nd ed., pp. 141–172).

Washington, DC: American Psychological

Association.

Wampold, B. (2008, February 6). Existential-

integrative psychotherapy comes of age

[Review of Existential-integrative psycho-

therapy: Guideposts to the core of

practice]. PsycCritiques, 53, Release 6,

Article 1, p. 6.

*Yalom, I. D. (1980). Existential psychotherapy.

New York: Basic Books.

*Yalom, I. D. (1987). Love’s executioner: And

other tales of psychotherapy. New York: Harper

Perennial.

Yalom, I. D. (1992). When Nietzche wept.

New York: Basic Books.

*Yalom, I. D. (1997). Lying on the couch: A novel.

New York: Harper Perennial.

*Yalom, I. D. (2000). Momma and the meaning

of life: Tales of psychotherapy. New York: Harper

Perennial.

*Yalom, I. D. (2003). The gift of therapy: An open

letter to a new generation of therapists and their

patients. New York: HarperCollins (Perennial).

Yalom, I. D. (2005a). The Schopenhauer cure: A

novel. New York: HarperCollins.

*Yalom, I. D. (with Leszcz, M). (2005b). The

theory and practice of group psychotherapy (5th

ed.). New York: Basic Books. (Original work

published 1970)

*Yalom, I. D. (2008). Staring at the sun: Overcom-

ing the terror of death. San Francisco: Jossey-Bass.

*Yalom, I. D., & Josselson, R. (2011). Existential

psychotherapy. In R. Corsini & D. Wedding (Eds.),

Current psychotherapies (9th ed., pp. 310–341).

Belmont, CA: Brooks/Cole, Cengage Learning.

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172

introduction

• Four Periods of Development of the Approach

• Existentialism and Humanism

• Abraham Maslow’s Contributions to

Humanistic Psychology

key concepts

• View of Human Nature

the therapeutic process

• Therapeutic Goals

• Therapist’s Function and Role

• Client’s Experience in Therapy

• Relationship Between Therapist and Client

application: therapeutic

techniques and procedures

• Early Emphasis on Reﬂ ection of Feelings

• Evolution of Person-Centered Methods

• The Role of Assessment

• Application of the Philosophy of the

Person-Centered Approach

• Application to Crisis Intervention

• Application to Group Counseling

person-centered expressive

arts therapy

• Principles of Expressive Arts Therapy

• Creativity and Offering Stimulating Experiences

• Contributions of Natalie Rogers

motivational interviewing

• The MI Spirit

• The Basic Principles of Motivational

Interviewing

• The Stages of Change

person-centered therapy from

a multicultural perspective

• Strengths From a Diversity Perspective

• Shortcomings From a Diversity

Perspective

person-centered therapy applied

to the case of stan

summary and evaluation

• Summary

• Contributions of the Person-Centered

Approach

• Limitations and Criticisms of the Person-

Centered Approach

where to go from here

• Recommended Supplementary Readings

• References and Suggested Readings

chapter 7

Person-Centered Therapy

es

•

Recom

•

Referenc

mentary Read

and Suggested Readings

cation to Gro

ntered ex

y

essive Arts Th

ring Stimulati

atalie Rogers

n-c

erap

es of Exp

y and Of

butions of

172

ati

Contr

f Assessment

cation of the Philosophy of th

son-Centered Approach

plication to Crisis Intervention

plication to Group Counseling

essive

perso

arts t

•

Princ

•

Cre

•

C

ication: therape

techniques and proc

•

Early Emphasis on Reﬂ ecti

•

Evolution of Pe

•

The Rol

•

App

Pe

•

A

App

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173

PERSON-CENTERED THERAPY

Carl Rogers

CARL ROGERS (1902–1987),

a major spokesperson for

humanistic psychology, led a

life that reflected the ideas he

developed for half a century.

He showed a questioning

stance, a deep openness to

change, and the courage to

forge into unknown territory

both as a person and as a professional. In writ-

ing about his early years, Rogers (1961) recalled

his family atmosphere as characterized by close

and warm relationships but also by strict religious

standards. Play was discouraged, and the virtues

of the Protestant ethic were extolled. His boyhood

was somewhat lonely, and he pursued scholarly

interests instead of social ones. Rogers was an

introverted person, and he spent a lot of time

reading and engaging in imaginative activity and

reflection. During his college years his interests and

academic major changed from agriculture to history,

then to religion, and finally to clinical psychology.

Rogers held academic positions in various

fields, including education, social work, coun-

seling, psychotherapy, group therapy, peace, and

interpersonal relations, and he earned recognition

around the world for originating and developing

the humanistic movement in psychotherapy. His

foundational ideas, especially the central role of the

client–therapist relationship as a means to growth

and change, have been incorporated by many other

theoretical approaches. Rogers was a pioneer

whose groundbreaking discoveries continue to

have far-reaching effects on the field of psycho-

therapy (Cain, 2010).

It is difficult to overestimate the significance

of Rogers’s contributions to clinical and counseling

psychology. He was a courageous pioneer who

“was about 50 years ahead of his time and has

been waiting for us to catch up” (Elkins, 2009,

p. 20). Often called the “father of psychotherapy

research,” Rogers was the first to study the coun-

seling process in depth by analyzing the transcripts

of actual therapy sessions; he was the first clinician

to conduct major studies on psychotherapy using

quantitative methods; he was the first to formulate

a comprehensive theory of personality and psy-

chotherapy grounded in empirical research; and he

contributed to developing a theory of psychother-

apy that de-emphasized pathology and focused on

the strengths and resources of individuals. He was

not afraid to take a strong position and challenged

the status quo throughout his professional career.

During the last 15 years of his life, Rogers ap-

plied the person-centered approach to world peace

by training policymakers, leaders, and groups in

conflict. Perhaps his greatest passion was directed

toward the reduction of interracial tensions and

the effort to achieve world peace, for which he was

nominated for the Nobel Peace Prize.

For a detailed video presentation of the life and

works of Carl Rogers, see Carl Rogers: A Daughter’s

Tribute (CD ROM, 2002), which is described at the

end of this chapter. See also Carl Rogers: The Quiet

Revolutionary (Rogers & Russell, 2002) and The Life

and Work of Carl Rogers (Kirschenbaum, 2009).

introduction

Of all the pioneers who have founded a therapeutic approach, for me Carl Rogers

stands out as one of the most inﬂ uential ﬁ gures in revolutionizing the direction of

counseling theory and practice. Rogers has become known as a “quiet revolution-

ary” who both contributed to theory development and whose inﬂ uence continues to

shape counseling practice today (see Cain, 2010; Kirschenbaum, 2009; Rogers &

Russell, 2002).

The person-centered approach shares many concepts and values with the

existential perspective presented in Chapter 6. Rogers’s basic assumptions are

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CHAPTER SEVEN

that people are essentially trustworthy, that they have a vast potential for under-

standing themselves and resolving their own problems without direct interven-

tion on the therapist’s part, and that they are capable of self-directed growth if

they are involved in a speciﬁ c kind of therapeutic relationship. From the begin-

ning, Rogers emphasized the attitudes and personal characteristics of the thera-

pist and the quality of the client–therapist relationship as the prime determi-

nants of the outcome of the therapeutic process. He consistently relegated to

a secondary position matters such as the therapist’s knowledge of theory and

techniques. This belief in the client’s capacity for self-healing is in contrast with

many theories that view the therapist’s techniques as the most powerful agents

that lead to change (Bohart & Tallman, 2010). Clearly, Rogers revolutionized the

ﬁ eld of psychotherapy by proposing a theory that centered on the client as the

primary agent for constructive self-change (Bohart & Tallman, 2010; Bozarth,

Zimring, & Tausch, 2002).

Contemporary person-centered therapy is the result of an evolutionary process

that continues to remain open to change and reﬁ nement (see Cain, 2010; Cain &

Seeman, 2002). Rogers did not present the person-centered theory as a ﬁ xed and

completed approach to therapy. He hoped that others would view his theory as

a set of tentative principles relating to how the therapy process develops, not as

dogma. Rogers expected his model to evolve and was open and receptive to change.

See the video program for Chapter 7, DVD for Theory and Practice of Counseling

and Psychotherapy: The Case of Stan and Lecturettes. I suggest that you view

the brief lecture for each chapter prior to reading the chapter.

Four Periods of Development of the Approach

In tracing the major turning points in Rogers’s approach, Zimring and Raskin

(1992) and Bozarth, Zimring, and Tausch (2002) have identiﬁ ed four periods of

development. In the ﬁ rst period, during the 1940s, Rogers developed what was

known as nondirective counseling, which provided a powerful and revolutionary

alternative to the directive and interpretive approaches to therapy then being prac-

ticed. While he was a professor at Ohio State University, Rogers (1942) published

Counseling and Psychotherapy: Newer Concepts in Practice, which described the phi-

losophy and practice of nondirective counseling. Rogers’s theory emphasized the

counselor’s creation of a permissive and nondirective climate. His theory took

power away from the therapist and honored the inherent power of the client. When

he challenged the basic assumption that “the counselor knows best,” he realized

this radical idea would affect the power dynamics and politics of the counseling

profession, and indeed it caused a great furor (Elkins, 2009).

Rogers also challenged the validity of commonly accepted therapeutic proce-

dures such as advice, suggestion, direction, persuasion, teaching, diagnosis, and

interpretation. Based on his conviction that diagnostic concepts and procedures

were inadequate, prejudicial, and often misused, Rogers omitted them from his

approach. Nondirective counselors avoided sharing a great deal about themselves

with clients and instead focused mainly on reﬂ ecting and clarifying the clients’

verbal and nonverbal communications.

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In the second period, during the 1950s, Rogers (1951) wrote Client-Centered

Therapy and renamed his approach client-centered therapy, to reﬂ ect its emphasis

on the client rather than on nondirective methods. In addition, he started the Coun-

seling Center at the University of Chicago. This period was characterized by a shift

from clariﬁ cation of feelings to a focus on the phenomenological world of the client.

Rogers assumed that the best vantage point for understanding how people behave

was from their own internal frame of reference. He focused more explicitly on the

actualizing tendency as the basic motivational force that leads to client change.

The third period, which began in the late 1950s and extended into the 1970s,

addressed the necessary and sufﬁ cient conditions of therapy. Rogers (1957) set

forth a hypothesis that resulted in three decades of research. A signiﬁ cant pub-

lication was On Becoming a Person (Rogers, 1961), which addressed the nature of

“becoming the self that one truly is,” an idea he borrowed from Kierkegaard. Rogers

published this work during the time that he held joint appointments in the depart-

ments of psychology and psychiatry at the University of Wisconsin. In this book he

described the process of “becoming one’s experience,” which is characterized by

an openness to experience, a trust in one’s experience, an internal locus of evalua-

tion, and the willingness to be in process. During the 1950s and 1960s, Rogers and

his associates continued to test the underlying hypotheses of the client-centered

approach by conducting extensive research on both the process and the outcomes

of psychotherapy. He was interested in how people best progress in psychotherapy,

and he studied the qualities of the client–therapist relationship as a catalyst lead-

ing to personality change. On the basis of this research the approach was further

reﬁ ned and expanded (Rogers, 1961). For example, client-centered philosophy was

applied to education and was called student-centered teaching (Rogers & Freiberg,

1994). The approach was also applied to encounter groups (Rogers, 1970).

The fourth phase, during the 1980s and the 1990s, was marked by considerable

expansion to education, couples and families, industry, groups, conﬂ ict resolution,

politics, and the search for world peace. Because of Rogers’s ever-widening scope

of inﬂ uence, including his interest in how people obtain, possess, share, or surren-

der power and control over others and themselves, his theory became known as the

person-centered approach. This shift in terms reﬂ ected the broadening application

of the approach. Although the person-centered approach has been applied mainly

to individual and group counseling, important areas of further application include

education, family life, leadership and administration, organizational development,

health care, cross-cultural and interracial activity, and international relations. It

was during the 1980s that Rogers directed his efforts toward applying the person-

centered approach to politics, especially to efforts related to the achievement of

world peace.

In a comprehensive review of the research on person-centered therapy over a

period of 60 years, Bozarth, Zimring, and Tausch (2002) concluded the following:

• In the earliest years of the approach, the client rather than the therapist deter-

mined the direction and goals of therapy and the therapist’s role was to help

the client clarify feelings. This style of nondirective therapy was associated with

increased understanding, greater self-exploration, and improved self-concepts.

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CHAPTER SEVEN

• Later a shift from clariﬁ cation of feelings to a focus on the client’s lived experi-

ences took place. Many of Rogers’s hypotheses were conﬁ rmed, and there was

strong evidence for the value of the therapeutic relationship and the client’s

resources as the crux of successful therapy.

• As person-centered therapy developed further, research centered on the core

conditions assumed to be both necessary and sufﬁ

cient for successful therapy.

The attitude of the therapist—an empathic understanding of the client’s world

and the ability to communicate a nonjudgmental stance to the client—along

with the therapist’s genuineness were found to be basic to a successful therapy

outcome.

• The main source of successful psychotherapy is the client. The therapist’s atten-

tion to the client’s frame of reference fosters the client’s utilization of inner and

outer resources.

Existentialism and Humanism

In the 1960s and 1970s there was a growing interest among counselors in a “third

force” in therapy as an alternative to the psychoanalytic and behavioral approaches.

Under this heading fall existential therapy (Chapter 6), person-centered therapy

(Chapter 7), Gestalt therapy (Chapter 8), and certain other experiential and rela-

tionship-oriented approaches.

Partly because of this historical connection and partly because representatives

of existentialist thinking and humanistic thinking have not always clearly sorted

out their views, the connections between the terms existentialism and humanism

have tended to be confusing for students and theorists alike. The two viewpoints

have much in common, yet there also are signiﬁ cant philosophical differences

between them. They share a respect for the client’s subjective experience, the

uniqueness and individuality of each client, and a trust in the capacity of the cli-

ent to make positive and constructive conscious choices. They have in common

an emphasis on concepts such as freedom, choice, values, personal responsibility,

autonomy, purpose, and meaning. Both approaches place little value on the role

of techniques in the therapeutic process and emphasize instead the importance of

genuine encounter. They differ in that existentialists take the position that we are

faced with the anxiety of choosing to create an identity in a world that lacks intrinsic

meaning. Existentialists tend to acknowledge the stark realities of human experi-

ence, and their writings often focus on death, anxiety, depression, and isolation.

The humanists, in contrast, take the somewhat less anxiety-evoking position and

more optimistic view that each of us has a natural potential that we can actualize

and through which we can ﬁ nd meaning. Many contemporary existential therapists

refer to themselves as existential-humanistic practitioners, indicating that their roots

are in existential philosophy but that they have incorporated many aspects of North

American humanistic psychotherapies (Cain, 2002a; Schneider & Krug, 2010).

As will become evident in this chapter, the existential and person-centered

approaches have parallel concepts with regard to the client–therapist relationship at

the core of therapy. The phenomenological emphasis that is basic to the existentialist

approach is also fundamental to person-centered theory. Both approaches focus on

the client’s perceptions and call for the therapist to be fully present with the client

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PERSON-CENTERED THERAPY

so that it is possible to understand the client’s subjective world, and they both em-

phasize the client’s capacity for self-awareness and self-healing. The therapist aims

to provide the client with a safe, responsive, and caring relationship to facilitate self-

exploration, growth, and healing (Watson, Goldman, & Greenberg, 2011).

Abraham Maslow’s Contributions

to Humanistic Psychology

Abraham Maslow (1970) was a pioneer in the development of humanistic psychol-

ogy and was inﬂ uential in furthering the understanding of self-actualizing indi-

viduals. Many of Carl Rogers’s ideas, especially on the positive aspects of being

human and the fully functioning person, are built on Maslow’s basic philosophy.

Maslow criticized Freudian psychology for what he saw as its preoccupation with

the sick and negative side of human nature. Maslow believed too much research

was being conducted on anxiety, hostility, and neuroses and too little into joy, crea-

tivity, and self-fulﬁ llment. Self-actualization was the central theme of the work

of Abraham Maslow (1968, 1970, 1971). The positive psychology movement that

recently has come into prominence shares many concepts on the healthy side of

human existence with the humanistic approach.

Maslow studied what he called “self-actualizing people” and found that they

differed in important ways from so-called normal individuals. The core character-

istics of self-actualizing people are self-awareness, freedom, basic honesty and car-

ing, and trust and autonomy. Other characteristics of self-actualizing individuals

include a capacity to welcome uncertainty in their lives, acceptance of themselves

and others, spontaneity and creativity, a need for privacy and solitude, autonomy,

a capacity for deep and intense interpersonal relationships, a genuine caring for

others, an inner-directedness (as opposed to the tendency to live by others’ expec-

tations), the absence of artiﬁ cial dichotomies within themselves (such as work/

play, love/hate, and weak/strong), and a sense of humor (Maslow, 1970). All of

these personal characteristics have been identiﬁ ed by Rogers as being central to

the person-centered philosophy.

Maslow postulated a hierarchy of needs as a source of motivation, with the most

basic needs being physiological needs. If we are hungry and thirsty, our attention

is riveted on meeting these basic needs. Next are the safety needs, which include

a sense of security and stability. Once our physical and safety needs are fulﬁ lled,

we become concerned with meeting our needs for belonging and love, followed by

working on our need for esteem, both from self and others. We are able to strive

toward self-actualization only after these four basic needs are met. The key factor

determining which need is dominant at a given time is the degree to which those

below it are satisﬁ ed. We cannot strive toward self-actualization, for example, if our

self-esteem is low.

the vision of humanistic philosophy The underlying vision of

humanistic philosophy is captured by the metaphor of how an acorn, if provided

with the appropriate conditions, will “automatically” grow in positive ways, pushed

naturally toward its actualization as an oak. In contrast, for many existentialists

there is nothing that we “are,” no internal “nature” we can count on. We are faced

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178

CHAPTER SEVEN

at every moment with a choice about what to make of this condition. Maslow’s em-

phasis on the healthy side of being human and the emphasis on joy, creativity, and

self-fulﬁ llment are part of the person-centered philosophy. The humanistic phi-

losophy on which the person-centered approach rests is expressed in attitudes and

behaviors that create a growth-producing climate. According to Rogers (1986b),

when this philosophy is lived, it helps people develop their capacities and stimu-

lates constructive change in others. Individuals are empowered, and they are able

to use this power for personal and social transformation.

key concepts

View of Human Nature

A common theme originating in Rogers’s early writing and continuing to permeate

all of his works is a basic sense of trust in the client’s ability to move forward in a

constructive manner if conditions fostering growth are present. His professional

experience taught him that if one is able to get to the core of an individual, one ﬁ nds

a trustworthy, positive center (Rogers, 1987a). In keeping with the philosophy of

humanistic psychology, Rogers ﬁ rmly maintained that people are trustworthy, re-

sourceful, capable of self-understanding and self-direction, able to make construc-

tive changes, and able to live effective and productive lives. When therapists are able

to experience and communicate their realness, support, caring, and nonjudgmental

understanding, signiﬁ cant changes in the client are most likely to occur.

Rogers maintained that three therapist attributes create a growth-promoting

climate in which individuals can move forward and become what they are capable

of becoming: (1) congruence (genuineness, or realness), (2) unconditional positive

regard (acceptance and caring), and (3) accurate empathic understanding (an ability to

deeply grasp the subjective world of another person). According to Rogers, if thera-

pists communicate these attitudes, those being helped will become less defensive

and more open to themselves and their world, and they will behave in prosocial

and constructive ways.

Brodley (1999) writes about the actualizing tendency, a directional process of

striving toward realization, fulﬁ llment, autonomy, and self-determination. This nat-

ural inclination of humans is based on Maslow’s (1970) studies of self-actualizing

people. This growth force within us provides an internal source of healing, but it

does not imply a movement away from relationships, interdependence, connec-

tion, or socialization. This humanistic view of human nature has signiﬁ cant im-

plications for the practice of therapy. Because of the belief that the individual has

an inherent capacity to move away from maladjustment and toward psychological

health and growth, the therapist places the primary responsibility on the client.

The person-centered approach rejects the role of the therapist as the authority who

knows best and of the passive client who merely follows the beliefs of the therapist.

Therapy is rooted in the client’s capacity for awareness and self-directed change in

attitudes and behavior.

In the person-centered approach the emphasis is on how clients act in their

world with others, how they can move forward in constructive directions, and how

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PERSON-CENTERED THERAPY

they can successfully deal with obstacles (both from within themselves and outside

of themselves) that are blocking their growth. By promoting self-awareness and

self-reﬂ ection, clients learn to exercise choice. Humanistic therapists emphasize

a discovery-oriented approach in which clients are the experts on their own inner

experience (Watson, Goldman, & Greenberg, 2011), and they encourage clients to

make changes that will lead to living fully and authentically, with the realization

that this kind of existence demands a continuing struggle. Maslow taught us that

becoming self-actualizing individuals is an ongoing process rather than a ﬁ nal

destination.

the therapeutic process

Therapeutic Goals

The person-centered approach aims toward the client achieving a greater degree

of independence and integration. Its focus is on the person, not on the person’s

presenting problem. Rogers did not believe the goal of therapy was merely to solve

problems. Rather, the goal is to assist clients in their growth process so clients can

better cope with problems as they identify them.

Rogers (1961) wrote that people who enter psychotherapy often ask: “How can

I discover my real self? How can I become what I deeply wish to become? How can

I get behind my facades and become myself?” The underlying aim of therapy is to

provide a climate conducive to helping the individual strive toward self-actualiza-

tion. Before clients are able to work toward that goal, they must ﬁ rst get behind the

masks they wear, which they develop through the process of socialization. Clients

come to recognize that they have lost contact with themselves by using facades. In

a climate of safety in the therapeutic session, they also come to realize that there

are more authentic ways of being.

When the facades are put aside during the therapeutic process, what kind of

person emerges from behind the pretenses? Rogers (1961) described people who

are becoming increasingly actualized as having (1) an openness to experience,

(2) a trust in themselves, (3) an internal source of evaluation, and (4) a willingness

to continue growing. Encouraging these characteristics is the basic goal of person-

centered therapy.

These four characteristics provide a general framework for understanding the

direction of therapeutic movement. The therapist does not choose speciﬁ c goals

for the client. The cornerstone of person-centered theory is the view that clients

in a relationship with a facilitating therapist have the capacity to deﬁ ne and clarify

their own goals. Person-centered therapists are in agreement on the matter of not

setting goals for what clients need to change, yet they differ on the matter of how to

best help clients achieve their own goals and to ﬁ nd their own answers (Bohart &

Watson, 2011).

Therapist’s Function and Role

The role of person-centered therapists is rooted in their ways of being and atti-

tudes, not in techniques designed to get the client to “do something.” Research on

person-centered therapy seems to indicate that the attitude of therapists, rather than

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CHAPTER SEVEN

their knowledge, theories, or techniques, facilitate personality change in the client

(Rogers, 1961). Basically, therapists use themselves as an instrument of change.

When they encounter the client on a person-to-person level, their “role” is to be

without roles. They do not get lost in a professional role. It is the therapist’s attitude

and belief in the inner resources of the client that creates the therapeutic climate for

growth (Bozarth et al., 2002).

Thorne (2002a) reinforces the importance of therapists encountering clients

in a person-to-person way, as opposed to being overly reliant on a professional con-

tract. He cautions about retreating into a stance of pseudo-professionalism charac-

terized by presenting a detailed contract to clients, rigid observation of boundaries,

and the commitment to empirically validated methods. He suggests that this over-

emphasis on professionalism is aimed at protecting therapists from overinvolve-

ment with clients, which often results in underinvolvement with them.

Person-centered theory holds that the therapist’s function is to be present and

accessible to clients and to focus on their immediate experience. First and fore-

most, the therapist must be willing to be real in the relationship with clients. By

being congruent, accepting, and empathic, the therapist is a catalyst for change. In-

stead of viewing clients in preconceived diagnostic categories, the therapist meets

them on a moment-to-moment experiential basis and enters their world. Through

the therapist’s attitude of genuine caring, respect, acceptance, support, and un-

derstanding, clients are able to loosen their defenses and rigid perceptions and

move to a higher level of personal functioning. When these therapist attitudes are

present, clients then have the necessary freedom to explore areas of their life that

were either denied to awareness or distorted.

Client’s Experience in Therapy

Therapeutic change depends on clients’ perceptions both of their own experience

in therapy and of the counselor’s basic attitudes. If the counselor creates a cli-

mate conducive to self-exploration, clients have the opportunity to explore the full

range of their experience, which includes their feelings, beliefs, behavior, and

worldview. What follows is a general sketch of clients’ experiences in therapy.

Clients come to the counselor in a state of incongruence; that is, a discrepancy

exists between their self-perception and their experience in reality. For example,

Leon, a college student, may see himself as a future physician, yet his below-aver-

age grades could exclude him from medical school. The discrepancy between how

Leon sees himself (self-concept) or how he would like to view himself (ideal self-

concept) and the reality of his poor academic performance may result in anxiety

and personal vulnerability, which can provide the necessary motivation to enter

therapy. Leon must perceive that a problem exists or, at least, that he is uncomfort-

able enough with his present psychological adjustment to want to explore possibili-

ties for change.

One reason clients seek therapy is a feeling of basic helplessness, powerless-

ness, and an inability to make decisions or effectively direct their own lives. They

may hope to ﬁ nd “the way” through the guidance of the therapist. Within the per-

son-centered framework, however, clients soon learn that they can be responsible

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for themselves in the relationship and that they can learn to be more free by using

the relationship to gain greater self-understanding.

As counseling progresses, clients are able to explore a wider range of beliefs and

feelings. They can express their fears, anxiety, guilt, shame, hatred, anger, and other

emotions that they had deemed too negative to accept and incorporate into their

self-structure. With therapy, people distort less and move to a greater acceptance and

integration of conﬂ icting and confusing feelings. They increasingly discover aspects

within themselves that had been kept hidden. As clients feel understood and accepted,

they become less defensive and become more open to their experience. Because they

feel safer and are less vulnerable, they become more realistic, perceive others with

greater accuracy, and become better able to understand and accept others. Individuals

in therapy come to appreciate themselves more as they are, and their behavior shows

more ﬂ exibility and creativity. They become less concerned about meeting others’

expectations, and thus begin to behave in ways that are truer to themselves. These

individuals direct their own lives instead of looking outside of themselves for

answers. They move in the direction of being more in contact with what they are

experiencing at the present moment, less bound by the past, less determined, freer to

make decisions, and increasingly trusting in themselves to manage their own lives.

In short, their experience in therapy is like throwing off the self-imposed shackles

that had kept them in a psychological prison. With increased freedom they tend to

become more mature psychologically and move toward increased self-actualization.

Person-centered therapy is grounded on the assumption that it is clients who

heal themselves, who create their own self-growth, and who are active self-healers

(Bohart & Tallman, 1999, 2010; Bohart & Watson, 2011). The therapy relationship

provides a supportive structure within which clients’ self-healing capacities are

activated. What clients value most is being understood and accepted, which results

in creating a safe place to explore feelings, thoughts, behaviors, and experiences;

clients also value support for trying out new behaviors (Bohart & Tallman, 2010).

Relationship Between Therapist and Client

Rogers (1957) based his hypothesis of the “necessary and sufﬁ cient conditions for

therapeutic personality change” on the quality of the relationship: “If I can provide

a certain type of relationship, the other person will discover within himself or her-

self the capacity to use that relationship for growth and change, and personal devel-

opment will occur” (Rogers, 1961, p. 33). Rogers (1967) hypothesized further that

“signiﬁ cant positive personality change does not occur except in a relationship”

(p. 73). Rogers’s hypothesis was formulated on the basis of many years of his pro-

fessional experience, and it remains basically unchanged to this day. This hypoth-

esis (cited in Cain 2002a, p. 20) is stated thusly:

1. Two persons are in psychological contact.

2. The ﬁ rst, whom we shall term the client, is in a state of incongruence, being

vulnerable or anxious.

3. The second person, whom we term the therapist, is congruent (real or genuine)

in the relationship.

4. The therapist experiences unconditional positive regard for the client.

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CHAPTER SEVEN

5. The therapist experiences an empathic understanding of the client’s internal

frame of reference and endeavors to communicate this experience to the client.

6. The communication to the client of the therapist’s empathic understanding and

unconditional positive regard is to a minimal degree achieved.

Rogers hypothesized that no other conditions were necessary. If the therapeutic

core conditions exist over some period of time, constructive personality change

will occur. The core conditions do not vary according to client type. Further, they

are both necessary and sufﬁ cient for therapeutic change to occur.

From Rogers’s perspective the client–therapist relationship is characterized by

equality. Therapists do not keep their knowledge a secret or attempt to mystify the

therapeutic process. The process of change in the client depends to a large degree

on the quality of this equal relationship. As clients experience the therapist listen-

ing in an accepting way to them, they gradually learn how to listen acceptingly to

themselves. As they ﬁ nd the therapist caring for and valuing them (even the as-

pects that have been hidden and regarded as negative), clients begin to see worth

and value in themselves. As they experience the realness of the therapist, clients

drop many of their pretenses and are real with both themselves and the therapist.

This humanistic approach is perhaps best characterized as a way of being and as

a shared journey in which therapist and client reveal their humanness and partici-

pate in a growth experience. The therapist can be a relational guide on this journey

because he or she is usually more experienced and more psychologically experienced

in this role than the client. Thorne (2002b) delivered this message: “Therapists can-

not conﬁ dently invite their clients to travel further than they have journeyed them-

selves, but for person-centred therapists the quality, depth and continuity of their

own experiencing becomes the very cornerstone of the competence they bring to

their professional activity” (p. 144). Therapists are invested in broadening their own

life experiences and are willing to do what it takes to deepen their self-knowledge.

Rogers admitted that his theory was striking provocative and radical. His for-

mulation has generated considerable controversy, for he maintained that many

conditions other therapists commonly regard as necessary for effective psychother-

apy were nonessential. The core therapist conditions of congruence, unconditional

positive regard, and accurate empathic understanding subsequently have been em-

braced by many therapeutic schools as essential in facilitating therapeutic change.

These core qualities of therapists, along with the therapist’s presence, work holis-

tically to create a safe environment for learning (Cain, 2010). Regardless of theo-

retical orientation, most therapists strive to listen fully and empathically to clients,

especially during the initial stages of therapy. We now turn to a detailed discussion

of how these core conditions are an integral part of the therapeutic relationship.

congruence, or genuineness implies that therapists are real; that is,

they are genuine, integrated, and authentic during the therapy hour. They are with-

out a false front, their inner experience and outer expression of that experience

match, and they can openly express feelings, thoughts, reactions, and attitudes that

are present in the relationship with the client. This communication is done with

careful reﬂ ection and considered judgment on the therapist’s part (Kolden, Klein,

Wang, & Austin, 2011).

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PERSON-CENTERED THERAPY

Through authenticity the therapist serves as a model of a human being strug-

gling toward greater realness. Being congruent might necessitate expressing a

range of feelings including anger, frustration, liking, concern, and annoyance.

This does not mean that therapists should impulsively share all their reactions, for

self-disclosure must be appropriate, well timed, and have a constructive therapeu-

tic intent. Counselors can try too hard to be genuine; sharing because one thinks

it will be good for the client, without being genuinely moved to express something

regarded as personal, can be incongruent. Person-centered therapy stresses that

counseling will be inhibited if the counselor feels one way about the client but acts

in a different way. For example, if the practitioner dislikes or disapproves of the

client but feigns acceptance, therapy will be impaired. Cain (2010) stresses that

therapists need to be attuned to the emerging needs of the client and to respond in

ways that are in the best interests of the individual. If therapists keep this in mind,

they are likely to make sound clinical decisions most of the time.

Rogers’s concept of congruence does not imply that only a fully self-actualized

therapist can be effective in counseling. Because therapists are human, they can-

not be expected to be fully authentic. Congruence exists on a continuum from

highly congruent to very incongruent. This is true of all three characteristics.

unconditional positive regard and acceptance The second

attitude therapists need to communicate is deep and genuine caring for the client

as a person, or a condition of unconditional positive regard, which can best be

achieved through empathic identiﬁ cation with the client (Farber & Doolin, 2011).

The caring is nonpossessive and is not contaminated by evaluation or judgment of

the client’s feelings, thoughts, and behavior as good or bad. Therapists value and

warmly accept clients without placing stipulations on their acceptance. It is not

an attitude of “I’ll accept you when . . .”; rather, it is one of “I’ll accept you as you

are.” Therapists communicate through their behavior that they value their clients

as they are and that clients are free to have feelings and experiences. Acceptance

is the recognition of clients’ rights to have their own beliefs and feelings; it is not

the approval of all behavior. All overt behavior need not be approved of or accepted.

According to Rogers’s (1977) research, the greater the degree of caring, priz-

ing, accepting, and valuing of the client in a nonpossessive way, the greater the

chance that therapy will be successful. He also makes it clear that it is not possible

for therapists to genuinely feel acceptance and unconditional caring at all times.

However, if therapists have little respect for their clients, or an active dislike or

disgust, it is not likely that the therapeutic work will be fruitful. If therapists’ caring

stems from their own need to be liked and appreciated, constructive change in the

client is inhibited. This notion of positive regard has implications for all therapists,

regardless of their theoretical orientation (Farber & Doolin, 2011).

accurate empathic understanding One of the main tasks of the ther-

apist is to understand clients’ experience and feelings sensitively and accurately as they

are revealed in the moment-to-moment interaction during the therapy session. The

therapist strives to sense clients’ subjective experience, particularly in the here and

now. The aim is to encourage clients to get closer to themselves, to feel more deeply

and intensely, and to recognize and resolve the incongruity that exists within them.

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CHAPTER SEVEN

Empathy is a deep and subjective understanding of the client with the client.

Empathy is not sympathy, or feeling sorry for a client. Therapists are able to share the

client’s subjective world by drawing from their own experiences that may be similar

to the client’s feelings. Yet therapists must not lose their own separateness. Rogers

asserts that when therapists can grasp the client’s private world as the client sees

and feels it—without losing the separateness of their own identity—constructive

change is likely to occur. Empathy, particularly emotionally focused empathy,

helps clients (1) pay attention to and value their experiencing, (2) process their

experience both cognitively and bodily, (3) view prior experiences in new ways, and

(4) increase their conﬁ dence in making choices and in pursuing a course of action

(Cain, 2010).

Clark (2010) describes an integral model of empathy in the counseling process

that is based on three ways of knowing: (1) subjective empathy enables practition-

ers to experience what it is like to be the client; (2) interpersonal empathy pertains

to understanding a client’s internal frame of reference and conveying a sense of

the private meanings to the person; and (3) objective empathy relies on knowledge

sources outside of a client’s frame of reference. By using a multiple-perspective

model of empathy, counselors have a broader way to understand clients.

Accurate empathy is the cornerstone of the person-centered approach, and it

is a necessary ingredient of any effective therapy (Cain, 2010). Accurate empathic

understanding implies that the therapist will sense clients’ feelings as if they were

his or her own without becoming lost in those feelings. It is a way for therapists

to hear the meanings expressed by their clients that often lie at the edge of their

awareness. A primary means of determining whether an individual experienc-

es a therapist’s empathy is to secure feedback from the client (Norcross, 2010).

According to Watson (2002), full empathy entails understanding the meaning and

feeling of a client’s experiencing. Therapists need to understand clients on both

emotional and cognitive levels. Empathy is an active ingredient of change that fa-

cilitates clients’ cognitive processes and emotional self-regulation. Watson (2002)

states that 60 years of research has consistently demonstrated that empathy is the

most powerful determinant of client progress in therapy.

Clients’ perceptions of feeling understood by their therapists relate favorably to

outcome. Empathic therapists strive to discover the meaning of the client’s experi-

ence, understand the overall goals of the client, and tailor their responses to the

particular client. Effective empathy is grounded in authentic caring for the client

(Elliott, Bohart, Watson, & Greenberg, 2011).

application: therapeutic

techniques and procedures

Early Emphasis on Reflection of Feelings

Rogers’s original emphasis was on grasping the world of the client and reﬂ ecting

this understanding. As his view of psychotherapy developed, however, his focus

shifted away from a nondirective stance and emphasized the therapist’s relation-

ship with the client. Many followers of Rogers simply imitated his reﬂ ective style,

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PERSON-CENTERED THERAPY

and client-centered therapy has often been identiﬁ ed primarily with the technique

of reﬂ ection despite Rogers’s contention that the therapist’s relational attitudes

and fundamental ways of being with the client constitute the heart of the change

process. Rogers and other contributors to the development of the person-centered

approach have been critical of the stereotypic view that this approach is basically a

simple restatement of what the client just said.

Evolution of Person-Centered Methods

Contemporary person-centered therapy is the result of an evolutionary process of

more than 70 years, and it continues to remain open to change and reﬁ nement.

One of Rogers’s main contributions to the counseling ﬁ eld is the notion that the

quality of the therapeutic relationship, as opposed to administering techniques,

is the primary agent of growth in the client. The therapist’s ability to establish a

strong connection with clients is the critical factor determining successful coun-

seling outcomes.

No techniques are basic to the practice of person-centered therapy; “being with”

clients and entering imaginatively into their world of perceptions and feelings is

sufﬁ cient for facilitating a process of change. Person-centered therapists are not

prohibited from suggesting techniques, but how these suggestions are presented is

crucial. Techniques may be suggested when doing so fosters the process of client

and therapist being together in an empathic way. Techniques are not attempts at

“doing anything” to a client (Bohart & Watson, 2011).

The person-centered philosophy is based on the assumption that clients have

the resourcefulness for positive movement without the counselor assuming an

active, directive, or problem-solving role. Traditional person-centered therapists

would not tend to suggest a technique (Bohart & Watson, 2011). What is essential

for clients’ progress is the therapist’s presence, being completely attentive to and

immersed in the client as well as in the client’s expressed concerns (Cain, 2010).

This way of being is far more powerful than any technique a therapist might use

to bring about change. Qualities and skills such as listening, accepting, respect-

ing, understanding, and responding must be honest expressions by the therapist.

As discussed in Chapter 2, counselors need to evolve as persons, not just acquire

a repertoire of therapeutic strategies. Therapists mainly stay within the client’s

frame of reference and strive to understand and reﬂ ect the client’s communication

and experience.

Rogers expected person-centered therapy to continue to evolve and supported

others in breaking new ground. One of the main ways in which person-centered

therapy has evolved is the diversity, innovation, and individualization in practice.

There is no longer one way of practicing person-centered therapy (Cain, 2010), and

there has been increased latitude for therapists to share their reactions, to confront

clients in a caring way, and to participate more actively and fully in the therapeutic

process (Bozarth et al., 2002). Immediacy, or addressing what is going on between

the client and therapist, is highly valued in this approach. This development en-

courages the use of a wider variety of methods and allows for considerable diversity

in personal style among person-centered therapists. The shift toward genuineness

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CHAPTER SEVEN

enables person-centered therapists both to practice in more ﬂ exible and integra-

tive ways that suit their personalities and to have greater ﬂ exibility in tailoring the

counseling relationship to suit different clients (Bohart & Watson, 2011).

Cain (2008, 2010) believes it is essential for therapists to adapt their therapeu-

tic style to accommodate the unique needs of each client. Person-centered thera-

pists have the freedom to use a variety of responses and methods to assist their

clients; a guiding question therapists need to ask is, “Does it ﬁ t?” Cain contends

that, ideally, therapists will continually monitor whether what they are doing ﬁ ts,

especially whether their therapeutic style is compatible with their clients’ way of

viewing and understanding their problems. For an illustration of how Dr. David

Cain works with the case of Ruth in a person-centered style, see Case Approach to

Counseling and Psychotherapy (Corey, 2013, chap. 5).

Today, those who practice a person-centered approach work in diverse ways

that reﬂ ect both advances in theory and practice and a plethora of personal styles.

This is appropriate and fortunate, for none of us can emulate the style of Carl

Rogers and still be true to ourselves. If we strive to model our style after Rogers,

and if that style does not ﬁ t for us, we are not being ourselves and we are not being

fully congruent.

The Role of Assessment

Assessment is frequently viewed as a prerequisite to the treatment process. Many

mental health agencies use a variety of assessment procedures, including diagnos-

tic screening, identiﬁ cation of clients’ strengths and liabilities, and various tests.

Person-centered therapists generally do not ﬁ nd traditional assessment and diag-

nosis to be useful because these procedures encourage an external and expert per-

spective on the client (Bohart & Watson, 2011). What matters is not how the coun-

selor assesses the client but the client’s self-assessment. From a person-centered

perspective, the best source of knowledge about the client is the individual client.

In the early development of nondirective therapy, Rogers (1942) recommend-

ed caution in using psychometric measures or in taking a complete case history

at the outset of counseling. If a counseling relationship began with a battery of

psychological tests and a detailed case history, he believed clients could get the

impression that the counselor would be providing the solutions to their problems.

Assessment seems to be gaining in importance in short-term treatments in most

counseling agencies, and it is imperative that clients be involved in a collaborative

process in making decisions that are central to their therapy. Today it may not be a

question of whether to incorporate assessment into therapeutic practice but of how

to involve clients as fully as possible in their assessment and treatment process.

Application of the Philosophy of the

Person-Centered Approach

The person-centered approach has been applied to working with individuals, groups,

and families. Bozrath, Zimring, and Tausch (2002) cite studies done through the

1990s that revealed the effectiveness of person-centered therapy with a wide range

of client problems including anxiety disorders, alcoholism, psychosomatic problems,

agoraphobia, interpersonal difﬁ culties, depression, cancer, and personality disorders.

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PERSON-CENTERED THERAPY

Person-centered therapy has been shown to be as viable as the more goal-oriented

therapies. Furthermore, outcome research conducted in the 1990s revealed that

effective therapy is based on the client–therapist relationship in combination

with the inner and external resources of the client (Duncan, Miller, Wampold, &

Hubble, 2010).

The person-centered approach has been applied extensively in training both

professionals and paraprofessionals who work with people in a variety of settings.

This approach emphasizes staying with clients as opposed to getting ahead of

them with interpretations. People without advanced psychological education are

able to beneﬁ t by translating the therapeutic conditions of genuineness, empathic

understanding, and unconditional positive regard into both their personal and pro-

fessional lives. Learning to listen with acceptance to oneself is a valuable life skill

that enables individuals to be their own therapists. The basic concepts are straight-

forward and easy to comprehend, and they encourage locating power in the person

rather than fostering an authoritarian structure in which control and power are

denied to the person. These core skills also provide an essential foundation for

virtually all of the other therapy systems covered in this book. If counselors are

lacking in these relationship and communication skills, they will not be effective

in carrying out a treatment program for their clients.

The person-centered approach demands a great deal of the therapist. An ef-

fective person-centered therapist must be grounded, centered, genuine, respect-

ful, caring, present, a focused and astute listener, patient, and accepting in a way

that involves maturity. Without a person-centered way of being, mere application

of skills is likely to be hollow. Natalie Rogers (2011) points out that the person-

centered approach is a way of being that is easy to understand intellectually but

is very difﬁ cult to put into practice. She continues to ﬁ nd the core conditions of

genuineness, positive regard, and empathy most important in developing trust,

safety, and growth in a group.

Application to Crisis Intervention

The person-centered approach is especially applicable in crisis intervention such as

an unwanted pregnancy, an illness, a disastrous event, or the loss of a loved one. Peo-

ple in the helping professions (nursing, medicine, education, the ministry) are often

ﬁ rst on the scene in a variety of crises, and they can do much if the basic attitudes

described in this chapter are present. When people are in crisis, one of the ﬁ rst steps

is to give them an opportunity to fully express themselves. Sensitive listening, hear-

ing, and understanding are essential at this point. Being heard and understood helps

ground people in crises, helps to calm them in the midst of turmoil, and enables

them to think more clearly and make better decisions. Although a person’s crisis is

not likely to be resolved by one or two contacts with a helper, such contacts can pave

the way for being open to receiving help later. If the person in crisis does not feel

understood and accepted, he or she may lose hope of “returning to normal” and may

not seek help in the future. Genuine support, caring, and nonpossessive warmth can

go a long way in building bridges that can motivate people to do something to work

through and resolve a crisis. Communicating a deep sense of understanding should

always precede other more problem-solving interventions.

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CHAPTER SEVEN

In crisis situations person-centered therapists may need to provide more struc-

ture and direction than would be the case for clients who are not experiencing a

crisis. Suggestions, guidance, and even direction may be called for if clients are

not able to function effectively. For example, in certain cases it may be necessary

to take action to hospitalize a suicidal client to protect this person from self-harm.

Application to Group Counseling

The person-centered approach emphasizes the unique role of the group counselor

as a facilitator rather than a leader. The primary function of the facilitator is to cre-

ate a safe and healing climate—a place where the group members can interact in

honest and meaningful ways. In this climate members become more appreciative

and trusting of themselves as they are and are able to move toward self-direction

and empowerment. Ultimately, group members make their own choices and bring

about change for themselves. Yet with the presence of the facilitator and the sup-

port of other members, participants realize that they do not have to experience

the struggles of change alone and that groups as collective entities have their own

source of transformation. The facilitator’s way of being can create a productive

climate within a group:

Facilitators cannot make participants trust the group process. Facilitators earn trust by

being respectful, caring, and even loving. Being an effective group facilitator has much to

do with one’s “way of being.” No method or technique can evoke trust unless the facilitator

herself has a capacity to be fully present, considerate, caring, authentic, and responsive.

This includes the ability to challenge people constructively (N. Rogers, 2011, p. 57)

Rogers (1970) clearly believed that groups tend to move forward if the facilitator

exhibits a deep sense of trust in the members and refrains from using techniques

or exercises to get a group moving. The core conditions of person-centered therapy

apply to the process of a group. The role of the facilitator is to empathically under-

stand what an individual is communicating within the group. Instead of leading

the members toward speciﬁ c goals, the group facilitator assists members in de-

veloping attitudes and behaviors of genuineness, acceptance, and empathy, which

enables the members to interact with each other in therapeutic ways to ﬁ nd their

own sense of direction as a group.

From Rogers’s perspective, facilitators should avoid making interpretive com-

ments or group process observations because such comments are apt to make

the group self-conscious and slow the process down. Group process observations

should come from members, a view that is consistent with Rogers’s philosophy of

placing the responsibility for the direction of the group on the members. Accord-

ing to Raskin, Rogers, and Witty (2008), groups are fully capable of articulating

and pursuing their own goals. They assert, “when the therapeutic conditions are

present in a group and when the group is trusted to ﬁ nd its own way of being,

group members tend to develop processes that are right for them and to resolve

conﬂ icts within time constraints in the situation” (p. 143).

Regardless of a group leader’s theoretical orientation, the core conditions that

have been described here are highly applicable to any leader’s style of group facili-

tation. Only when the leader is able to create a person-centered climate will move-

ment take place within a group. All of the theories discussed in this book depend

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189

PERSON-CENTERED THERAPY

on the quality of the therapeutic relationship as a foundation. As you will see, the

cognitive behavioral approaches to group work place emphasis on creating a work-

ing alliance and collaborative relationships. In this way, most effective approaches

to group work share key elements of a person-centered philosophy. For a more

detailed treatment of person-centered group counseling, see Corey (2012, chap.

10). Also see Natalie Rogers’s (2011), The Creative Connection for Groups: Person-

Centered Expressive Arts for Healing and Social Change.

person-centered expressive

arts therapy*

Natalie Rogers (1993, 2011) expanded on her father, Carl Rogers’s (1961), theory

of creativity using the expressive arts to enhance personal growth for individuals

and groups. Rogers’s approach, known as expressive arts therapy, extends the per-

son-centered approach to spontaneous creative expression, which symbolizes deep

and sometimes inaccessible feelings and emotional states. Counselors trained in

person-centered expressive arts offer their clients the opportunity to create move-

ment, visual art, journal writing, sound, and music to express their feelings and

gain insight from these activities.

Principles of Expressive Arts Therapy

Expressive arts therapy uses various artistic forms—movement, drawing, painting,

sculpting, music, writing, and improvisation—toward the end of growth, healing,

and self-discovery. This is a multimodal approach integrating mind, body, emo-

tions, and inner spiritual resources. Methods of expressive arts therapy are based on

humanistic principles but giving fuller form to Carl Rogers’s notions of creativity.

These principles include the following (N. Rogers, 1993):

• All people have an innate ability to be creative.

• The creative process is transformative and healing. The healing aspects involve

activities such as meditation, movement, art, music, and journal writing.

• Personal growth and higher states of consciousness are achieved through self-

awareness, self-understanding, and insight.

• Self-awareness, understanding, and insight are achieved by delving into our

feelings of grief, anger, pain, fear, joy, and ecstasy.

• Our feelings and emotions are an energy source that can be channeled into the

expressive arts to be released and transformed.

• The expressive arts lead us into the unconscious, thereby enabling us to express

previously unknown facets of ourselves and bring to light new information and

awareness.

• One art form stimulates and nurtures the other, bringing us to an inner core or

essence that is our life energy.

*Much of the material in this section is based on key ideas that are more fully developed in two of Natalie

Rogers’s books, The Creative Connection: Expressive Arts as Healing (Rogers, 1993) and The Creative Connec-

tion for Groups: Person-Centered Expressive Arts for Healing and Social Change (Rogers, 2011). This section was

written in close collaboration with Natalie Rogers.

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• A connection exists between our life force—our inner core, or soul—and the

essence of all beings.

• As we journey inward to discover our essence or wholeness, we discover our

relatedness to the outer world, and the inner and outer become one.

The various art modes interrelate in what Natalie Rogers calls the “creative connec-

tion.” When we move, it affects how we write or paint. When we write or paint, it

affects how we feel and think.

Natalie Rogers’s approach is based on a person-centered theory of individual

and group process. The same conditions that Carl Rogers and his colleagues found

basic to fostering a facilitative client–counselor relationship also help support crea-

tivity. Personal growth takes place in a safe, supportive environment created by

counselors or facilitators who are genuine, warm, empathic, open, honest, congru-

ent, and caring—qualities that are best learned by ﬁ

rst being experienced. Taking

time to reﬂ ect on and evaluate these experiences allows for personal integration at

many levels—intellectual, emotional, physical, and spiritual.

Creativity and Offering Stimulating Experiences

According to Natalie Rogers, this deep faith in the individual’s innate drive to

become fully oneself is basic to the work in person-centered expressive arts. Indi-

viduals have a tremendous capacity for self-healing through creativity if given the

proper environment. When one feels appreciated, trusted, and given support to

use individuality to develop a plan, create a project, write a paper, or to be authen-

tic, the challenge is exciting, stimulating, and gives a sense of personal expansion.

N. Rogers believes the tendency to actualize and become one’s full potential, in-

cluding innate creativity, is undervalued, discounted, and frequently squashed in

our society. Traditional educational institutions tend to promote conformity rather

than original thinking and the creative process.

Person-centered expressive arts therapy utilizes the arts for spontaneous cre-

ative expression that symbolizes deep and sometimes inaccessible feelings and

emotional states. The conditions that foster creativity require acceptance of the

individual, a nonjudgmental setting, empathy, psychological freedom, and availa-

bility of stimulating and challenging experiences. With this type of environment in

place, the facilitative internal conditions of the client are encouraged and inspired:

a nondefensive openness to experience and an internal locus of evaluation that

receives but is not overly concerned with the reactions of others. N. Rogers (1993)

believes that we cheat ourselves out of a fulﬁ lling and joyous source of creativity if

we cling to the idea that an artist is the only one who can enter the realm of creativ-

ity. Art is not only for the few who develop a talent or master a medium. We all can

use various art forms to facilitate self-expression and personal growth.

Contributions of Natalie Rogers

As is clear from this brief section, Natalie Rogers has built upon a person-centered

philosophy and incorporated expressive and creative arts as a basis for personal

growth. Cain (2010) believes “Natalie Rogers’s expressive arts therapy represents

a major innovation in practice and helped open the way for other person-centered

therapists to expand the variety and range of practice” (p. 60). Sommers-Flanagan

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(2007) notes that person-centered expressive arts therapy may be a solution for

clients who are stuck in linear and rigid ways of being. He concludes: “Using her

own love of creativity and art in combination with her father’s renowned thera-

peutic approach, Natalie Rogers developed a form of therapy that extends person-

centered counseling into a new and exciting domain” (p. 124). Rogers continues

her active professional life, conducting workshops in the United States, Europe,

Japan, Hong Kong, Latin America, and Russia. At the end of this chapter are some

resources for those interested in training in the person-centered approach to ex-

pressive arts therapy.

motivational interviewing

Motivational Interviewing (MI) is a humanistic, client-centered, psychosocial, di-

rective counseling approach that was developed by William R. Miller and Stephen

Rollnick in the early 1980s. The clinical and research applications of motivational

interviewing have received increased attention in recent years, and MI has been

shown to be effective as a relatively brief intervention (Levensky, Kersh, Cavasos, &

Brooks, 2008). MI has been deﬁ ned as “a directive, client centered counseling

style for eliciting behavior change by helping clients to explore and resolve am-

bivalence” (Rollnick & Miller, 1995, p. 326). Motivational interviewing is based on

humanistic principles, has some basic similarities with person-centered therapy,

and expands the traditional person-centered approach.

Motivational interviewing was initially designed as a brief intervention for

problem drinking, but more recently this approach has been applied to a wide

range of clinical problems including substance abuse, compulsive gambling, eat-

ing disorders, anxiety disorders, depression, suicidality, chronic disease manage-

ment, and health behavior change practices (Arkowitz & Miller, 2008; Arkowitz &

Westra, 2009). MI stresses client self-responsibility and promotes an invitational

style for working cooperatively with clients to generate alternative solutions to

behavioral problems. MI therapists avoid arguing with clients, avoid assuming a

confrontational stance, reframe resistance as a healthy response, express empathy,

and listen reﬂ ectively. MI therapists do not view clients as opponents to be de-

feated but as allies who play a major role in their present and future success. Both

MI and person-centered practitioners believe in the client’s abilities, strengths,

resources, and competencies. The underlying assumption is that clients want to be

healthy and desire positive change.

The MI Spirit

MI is rooted in the philosophy of person-centered therapy, but with a “twist.”

Unlike the nondirective and unstructured person-centered approach, MI is delib-

erately directive and is aimed at reducing client ambivalence about change and

increasing intrinsic motivation (Arkowitz & Miller, 2008). It is essential that thera-

pists function within the spirit of MI, rather than simply applying the strategies of

the approach (Levensky et al., 2008). The attitudes and skills in MI are based on a

person-centered philosophy and include using open-ended questions, employing

reﬂ ective listening, afﬁ rming and supporting the client, responding to resistance

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CHAPTER SEVEN

in a nonconfrontational manner, guiding a discussion of ambivalence, summariz-

ing and linking at the end of sessions, and eliciting and reinforcing change talk.

MI works by activating clients’ own motivation for change and adherence to treat-

ment. Practitioners assist clients in becoming their own advocates for change and

the primary agents of change in their lives.

In both person-centered therapy and MI, the counselor provides the condi-

tions for growth and change by communicating attitudes of accurate empathy

and unconditional positive regard. In MI, the therapeutic relationship is as impor-

tant in achieving successful outcomes as the speciﬁ c theoretical model or school

of psychotherapy from which the therapist operates (Miller & Rollnick, 2002).

Both MI and person-centered therapy are based on the premise that individuals

have within themselves the capacity to generate intrinsic motivation to change.

Responsibility for change rests with clients, not with the counselor, and therapist

and client share a sense of hope and optimism that change is possible. Once cli-

ents believe that they have the capacity to change and heal, new possibilities open

up for them.

The Basic Principles of Motivational Interviewing

Miller and Rollnick (2002) formulated ﬁ ve basic principles of MI, which are sum-

marized below:

1. Therapists practicing motivational interviewing strive to experience the world

from the client’s perspective without judgment or criticism. MI emphasizes reﬂ ec-

tive listening, which is a way for practitioners to better understand the subjective

world of clients. Expressing empathy is foundational in creating a safe climate for

clients to explore their ambivalence for change. When clients are slow to change,

it may be assumed that they have compelling reasons to remain as they are as well

as having reasons to change.

2. MI is designed to evoke and explore both discrepancies and ambivalence. Coun-

selors using MI reﬂ ect discrepancies between the behaviors and values of clients to

increase the motivation to change. Counselors pay particular attention to clients’

arguments for changing compared to their arguments for not changing. Thera-

pists elicit and reinforce change talk by employing speciﬁ c strategies to strengthen

discussion about change. MI therapists assume a directive stance by steering the

conversation in the direction of considering change without persuading clients to

change. Clinicians encourage clients to determine whether change will occur, and

if so, what kinds of changes will occur and when.

3. Reluctance to change is viewed as a normal and expected part of the therapeutic

process. Although individuals may see advantages to making life changes, they

also may have many concerns and fears about changing. People who seek therapy

are often ambivalent about change, and their motivation may ebb and ﬂ ow dur-

ing the course of therapy. A central goal of MI is to increase internal motivation

to change based on the personal goals and values of clients (Arkowitz & Miller,

2008). MI therapists assume a respectful view of resistance and work therapeuti-

cally with any reluctance or caution on the part of clients.

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PERSON-CENTERED THERAPY

4. Practitioners operating from an MI orientation support clients’ self-efﬁ cacy,

mainly by encouraging them to use their own resources to take necessary actions

that can lead to success in changing. MI clinicians strive to enhance client agency

about change and emphasize the right and inherent ability of clients to formulate

their own personal goals and to make their own decisions. MI focuses on present

and future conditions and empowers clients to ﬁ nd ways to achieve their goals.

5. When clients show signs of readiness to change through decreased resistance

to change and increased talk about change, a critical phase of MI begins. In this

stage, clients may express a desire and ability to change, show an interest in ques-

tions about change, experiment with making changes between sessions, and envi-

sion a future picture of how their life will be different once the desired changes

have been made. At this time therapists shift their focus toward strengthening

clients’ commitments to change and helping them implement a change plan.

The Stages of Change

The stages of change model assumes that people progress through a series of ﬁ ve

identiﬁ able stages in the counseling process. In the precontemplation stage, there is

no intention of changing a behavior pattern in the near future. In the contemplation

stage, people are aware of a problem and are considering overcoming it, but they

have not yet made a commitment to take action to bring about the change. In the

preparation stage, individuals intend to take action immediately and report some

small behavioral changes. In the action stage, individuals are taking steps to modify

their behavior to solve their problems. During the maintenance stage, people work

to consolidate their gains and prevent relapse.

People do not pass neatly through these ﬁ ve stages in linear fashion, and a cli-

ent’s readiness can ﬂ uctuate throughout the change process. If change is initially

unsuccessful, individuals may return to an earlier stage (Prochaska & Norcross,

2010). MI therapists strive to match speciﬁ c interventions with whatever stage of

change clients are experiencing. If there is a mismatch between process and stage,

movement through the stage will be impeded and is likely to be manifested in

reluctant behavior. When clients demonstrate any form of reluctance or resistance,

this could be due to a therapist’s misjudgment of a client’s readiness to change.

Certain behaviors on a therapist’s part may lead to a client feeling invalidated or

misunderstood, which is likely to result in what appears to be a client’s resistive

behavior (Levensky et al., 2008).

Working within the framework of the stages of change model has implica-

tions for the therapist’s role at the different stages. Norcross, Krebs, and Prochaska

(2011) describe the relational stances and roles taken by therapists during the

course of therapy. With clients in the precontemplation stage, the role assumed

is that of a nurturing parent. With clients in contemplation, therapists function as

a Socratic teacher who encourages them to achieve their own insights. For clients

who are in the preparation stage, therapists take the stance of an experienced coach.

With clients who are progressing into action and maintenance, therapists function

in the role of a consultant. As termination approaches, therapists are consulted less

often as a way to foster client autonomy.

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CHAPTER SEVEN

Motivational interviewing is but one example of how therapeutic strategies

have been developed based on the foundational principles and philosophy of the

person-centered approach. Indeed, most of the therapeutic models illustrate how

the core therapeutic conditions are necessary aspects leading to client change.

Where many therapeutic approaches, including motivational interviewing, diverge

from traditional person-centered therapy is the assumption that the therapeu-

tic factors are both necessary and sufﬁ cient in bringing about change. Many other

models employ speciﬁ c intervention strategies to address speciﬁ c concerns clients

bring to therapy.

person-centered therapy from

a multicultural perspective

Strengths From a Diversity Perspective

One of the strengths of the person-centered approach is its impact on the ﬁ eld of

human relations with diverse cultural groups. Person-centered philosophy and prac-

tice can now be studied in several European countries, South America, and Japan.

Here are some examples of ways in which this approach has been incorporated in

various countries and cultures:

• In several European countries person-centered concepts have had a signiﬁ cant

impact on the practice of counseling as well as on education, cross-cultural com-

munication, and reduction of racial and political tensions. In the 1980s Rogers

(1987b) elaborated on a theory of reducing tension among antagonistic groups

that he began developing in 1948.

• In the 1970s Rogers and his associates began conducting workshops promoting

cross-cultural communication. Well into the 1980s he led large workshops in

many parts of the world. International encounter groups have provided partici-

pants with multicultural experiences.

• Japan, Australia, South America, Mexico, and the United Kingdom have all

been receptive to person-centered concepts and have adapted these practices to

ﬁ

t their cultures.

• Shortly before his death, Rogers conducted intensive workshops with profes-

sionals in the former Soviet Union.

Cain (1987c) sums up the reach of the person-centered approach to cultural diver-

sity: “Our international family consists of millions of persons worldwide whose

lives have been affected by Carl Rogers’s writings and personal efforts as well as

his many colleagues who have brought his and their own innovative thinking and

programs to many corners of the earth” (p. 149).

There is no doubt that Carl Rogers has had a global impact. His work has reached

more than 30 countries, and his writings have been translated into 12 languages.

In addition to this global impact, the emphasis on the core conditions makes the

person-centered approach useful in understanding diverse worldviews. The under-

lying philosophy of person-centered therapy is grounded on the importance of hear-

ing the deeper messages of a client. Empathy, being present, and respecting the

values of clients are essential attitudes and skills in counseling culturally diverse

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PERSON-CENTERED THERAPY

clients. Cain (2008, 2010) contends that although person-centered therapists are

aware of diversity factors, they do not make initial assumptions about individuals.

They realize that each client’s journey is unique and take steps to tailor their meth-

ods to ﬁ t each individual.

Several writers consider person-centered therapy as being ideally suited to cli-

ents in a diverse world. Cain (2008, 2010) views this approach as being a potent

way of working with individuals representing a wide range of cultural backgrounds

because the core therapeutic conditions are qualities that are universal. Bohart and

Watson (2011) claim that the person-centered philosophy is particularly appropri-

ate for working with diverse client populations because the counselor does not

assume the role of expert who is going to impose a “right way of being” on the cli-

ent. Instead, the therapist is a “fellow explorer” who attempts to understand the cli-

ent’s phenomenological world in an interested, accepting, and open way and checks

with the client to conﬁ rm that the therapist’s perceptions are accurate. Motivational

interviewing, which is based on the philosophy of person-centered therapy, is a cul-

turally sensitive approach that can be effective across population domains, includ-

ing gender, age, ethnicity, and sexual orientation (Levensky et al., 2008).

Shortcomings From a Diversity Perspective

Although the person-centered approach has made signiﬁ cant contributions to

counseling people from diverse social, political, and cultural backgrounds, there

are some shortcomings to practicing exclusively within this framework. Many cli-

ents who come to community mental health clinics or who are involved in outpa-

tient treatment want more structure than this approach provides. Some clients

seek professional help to deal with a crisis, to alleviate emotional problems, or to

learn coping skills in dealing with everyday problems. Because of certain cultural

messages, when these clients do seek professional help, it may be as a last resort.

They often expect a directive counselor and can be put off by a professional who

does not provide sufﬁ cient structure.

A second shortcoming of the person-centered approach is that it is difﬁ cult to

translate the core therapeutic conditions into actual practice in certain cultures.

Communication of these core conditions must be consistent with the client’s cul-

tural framework. Consider, for example, the expression of therapist congruence

and empathy. Clients accustomed to indirect communication may not be comfort-

able with direct expressions of empathy or self-disclosure on the therapist’s part.

For some clients the most appropriate way to express empathy is for the therapist

to demonstrate it indirectly through respecting their need for distance or through

suggesting task-focused interventions (Bohart & Greenberg, 1997).

A third shortcoming in applying the person-centered approach with clients

from diverse cultures pertains to the fact that this approach extols the value of

an internal locus of evaluation. The humanistic foundation of person-centered

therapy emphasizes dimensions such as self-awareness, freedom, autonomy, self-

acceptance, inner-directedness, and self-actualization. In collectivist cultures, cli-

ents are likely to be highly inﬂ uenced by societal expectations and not simply mo-

tivated by their own personal preferences. The focus on development of individual

autonomy and personal growth may be viewed as being selﬁ sh in a culture that

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196

CHAPTER SEVEN

stresses the common good. Cain (2010) contends that “persons from collectivistic

cultures are oriented less toward self-actualization and more toward intimacy, con-

nection, and harmony with others and toward what is best for the community and

the common good” (p. 143).

Consider Lupe, a Latina client who values the interests of her family over her

self-interests. From a person-centered perspective she could be viewed as being in

danger of “losing her own identity” by being primarily concerned with her role in

taking care of others in the family. Rather than pushing her to make her personal

wants a priority, the counselor will explore Lupe’s cultural values and her level of

commitment to these values in working with her. It would be inappropriate for the

counselor to impose a vision of the kind of woman she should be. (This topic is

discussed more extensively in Chapter 12.)

Although there may be particular shortcomings in practicing exclusively with-

in a person-centered perspective, it should not be concluded that this approach is

unsuitable for working with clients from diverse cultures. There is great diversity

among any group of people, and therefore, there is room for a variety of thera-

peutic styles. According to Cain (2010), rigid insistence on a nondirective style of

counseling for all clients, regardless of their cultural background or personal pref-

erence, may be perceived as an imposition that does not ﬁ t the client’s interper-

sonal and therapeutic needs. Counseling a culturally different client may require

more activity and structuring than is usually the case in a person-centered frame-

work, but the potential positive impact of a counselor who responds empathically

to a culturally different client cannot be overestimated.

Stan’s autobiography indicates that

he has a sense of what he wants

for his life. As a person-centered

therapist, I rely on his self-report of the way he

views himself rather than on a formal assess-

ment and diagnosis. My concern is with under-

standing him from his internal frame of refer-

ence. Stan has stated goals that are meaningful

for him. He is motivated to change and seems

to have sufficient anxiety to work toward these

desired changes. I have faith in Stan’s ability

to find his own way, and I trust that he has the

necessary resources for reaching his therapy

goals. I encourage Stan to speak freely about

the discrepancy between the person he sees

himself as being and the person he would like

to become; about his feelings of being a failure,

being inadequate; about his fears and uncer-

tainties; and about his hopelessness at

times. I attempt to create an atmosphere of

freedom and security that will encourage Stan

to explore the threatening aspects of his

self-concept.

Stan has a low evaluation of his self-worth.

Although he finds it difficult to believe that

others really like him, he wants to feel loved.

He says, “I hope I can learn to love at least a

few people, most of all, women.” He wants to

feel equal to others and not have to apologize

for his existence, yet most of the time he feels

inferior. By creating a supportive, trusting, and

encouraging atmosphere, I can help Stan learn

to be more accepting of himself, with both his

strengths and limitations. He has the opportu-

nity to openly express his fears of women, of

not being able to work with people, and of feel-

ing inadequate and stupid. He can explore how

he feels judged by his parents and by

Person-Centered Therapy Applied to the Case of Stan

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summary and evaluation

Summary

Person-centered therapy is based on a philosophy of human nature that postulates

an innate striving for self-actualization. Further, Rogers’s view of human nature

is phenomenological; that is, we structure ourselves according to our perceptions

of reality. We are motivated to actualize ourselves in the reality that we perceive.

Rogers’s theory rests on the assumption that clients can understand the fac-

tors in their lives that are causing them to be unhappy. They also have the capacity

for self-direction and constructive personal change. Change will occur if a con-

gruent therapist makes psychological contact with a client in a state of anxiety or

incongruence. It is essential for the therapist to establish a relationship the cli-

ent perceives as genuine, accepting, and understanding. Therapeutic counseling

is based on an I/Thou, or person-to-person, relationship in the safety and accept-

ance of which clients drop their defenses and come to accept and integrate aspects

that they have denied or distorted. The person-centered approach emphasizes this

authorities. He has an opportunity to express

his guilt—that is, his feelings that he has not

lived up to his parents’ expectations and that

he has let them and himself down. He can

also relate his feelings of hurt over not having

ever felt loved and wanted. He can express the

loneliness and isolation that he so often feels,

as well as the need to numb these feelings with

alcohol or drugs.

Stan is no longer totally alone, for he is taking

the risk of letting me into his private world of

feelings. Stan gradually gets a sharper focus on

his experiencing and is able to clarify his own

feelings and attitudes. He sees that he has the

capacity to make his own decisions. In short, our

therapeutic relationship frees him from his self-

defeating ways. Because of the caring and faith

he experiences from me in our relationship, Stan

is able to increase his own faith and confidence

in himself.

My empathy assists Stan in hearing him-

self and accessing himself at a deeper level.

Stan gradually becomes more sensitive to his

own internal messages and less dependent on

confirmation from others around him. As a result

of the therapeutic venture, Stan discovers that

there is someone in his life whom he can depend

on—himself.

Follow-Up: You Continue as Stan’s Person-

Centered Therapist

Use these questions to help you think about how

you would counsel Stan using a person-centered

approach:

• How would you respond to Stan’s deep feelings

of self-doubt? Could you enter his frame of r

ef-

erence and respond in an empathic manner that

lets Stan know you hear his pain and struggle

without needing to give advice or suggestions?

• How would you describe Stan’s deeper strug-

gles? What sense do you have of his world?

•

To what extent do you think that the relation-

ship you would develop with Stan would help

him mo

ve forward in a positive direction?

What, if anything, might get in your way—

either with him or in yourself—in establishing

a therapeutic relationship?

See DVD for Theory and Practice of

Counseling and Psychotherapy: The Case

of Stan and Lecturettes (Session 5 on person-

centered therapy) for a demonstration of my

approach to counseling Stan from this perspec-

tive. This session focuses on exploring the

immediacy of our relationship and assisting

Stan in finding his own way.

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CHAPTER SEVEN

personal relationship between client and therapist; the therapist’s attitudes are

more critical than are knowledge, theory, or techniques employed. In the context

of this relationship, clients unleash their growth potential and become more of the

person they are capable of becoming.

This approach places primary responsibility for the direction of therapy on the

client. In the therapeutic context, individuals have the opportunity to decide for

themselves and come to terms with their own personal power. The underlying

assumption is that no one knows the client better than the client; in short, the cli-

ent is viewed as an expert on his or her own life (Cain, 2010). The general goals

of therapy are becoming more open to experience, achieving self-trust, developing

an internal source of evaluation, and being willing to continue growing. Speciﬁ c

goals are not suggested for clients; rather, clients choose their own values and

goals. Current applications of the theory emphasize more active participation by

the therapist than was the case earlier. Counselors are now encouraged to be fully

involved as persons in the therapeutic relationship. More latitude is allowed for

therapists to express their reactions and feelings as they are appropriate to what is

occurring in therapy. Person-centered practitioners are willing to be transparent

about persistent feelings that exist in their relationships with clients (Watson et al.,

2011). It is the therapist’s job to adapt and accommodate in a manner that works

best for each client, which means being ﬂ exible in the application of methods in

the counseling process (Cain, 2010).

Contributions of the Person-Centered Approach

When Rogers founded nondirective counseling more than 70 years ago, there

were very few other therapeutic models. The longevity of this approach is certainly

a factor to consider in assessing its inﬂ uence. Cain (2008) states: “An extensive

body of research has been generated and provides support for the effectiveness

of person-centered therapy with a wide range of clients and problems of all age

groups” (p. 214).

Rogers had, and his theory continues to have, a major impact on the ﬁ eld of

counseling and psychotherapy. When he introduced his revolutionary ideas in the

1940s, he provided a powerful and radical alternative to psychoanalysis and to the

directive approaches then practiced. Rogers was a pioneer in shifting the therapeu-

tic focus from an emphasis on technique and reliance on therapist authority to that

of the power of the therapeutic relationship.

Kirschenbaum (2009) contends that the scope and inﬂ uence of Rogers’s work

has continued well beyond his death; the person-centered approach is alive, well,

and expanding. Today there is not one version of person-centered therapy, but a

number of continuously evolving person-centered psychotherapies (Cain, 2010).

Although few psychotherapists claim to have an exclusive person-centered theo-

retical orientation, the philosophy and principles of this approach permeate the

practice of most therapists. Other schools of therapy are increasingly recogniz-

ing the centrality of the therapeutic relationship as a route to therapeutic change

(Kirschenbaum, 2009).

Person-centered therapy is strongly represented in Europe, and there is con-

tinuing interest in this approach in both South America and the Far East. The

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PERSON-CENTERED THERAPY

person-centered approach has established a ﬁ rm foothold in British universities.

According to Natalie Rogers (2011), some of the most in-depth training of person-

centered counselors is in the United Kingdom. In addition, British scholars includ-

ing Fairhurst (1999), Keys (2003), Lago and Smith (2003), Mearns and Cooper

(2005), Mearns and Thorne (2000, 2007), Merry (1999), Natiello (2001), Thorne

(2002a, 2002b), and Watson (2003) continue to expand and reﬁ ne this approach.

As we have seen, Natalie Rogers has made a signiﬁ cant contribution to the

application of the person-centered approach by incorporating the expressive arts as

a medium to facilitate healing and social change, primarily in a group setting. She

has been instrumental in the evolution of the person-centered approach by using

nonverbal methods to enable individuals to heal and to develop. Many individu-

als who have difﬁ culty expressing themselves verbally can ﬁ nd new possibilities

for self-expression through nonverbal channels and through the expressive arts

(N. Rogers, 2011).

emphasis on research One of Rogers’s contributions to the ﬁ eld of psy-

chotherapy was his willingness to state his concepts as testable hypotheses and to

submit them to research. He literally opened the ﬁ eld to research. He was truly a

pioneer in his insistence on subjecting the transcripts of therapy sessions to criti-

cal examination and applying research technology to counselor–client dialogues

(Combs, 1988). Rogers’s basic hypothesis gave rise to a great deal of research and

debate in the ﬁ eld of psychotherapy, perhaps more than any other school of ther-

apy (Cain, 2002a). According to Cain (2010), an enormous body of research, con-

ducted over a period of 70 years, supports the effectiveness of the person-centered

approach. This research is ongoing in many parts of the world and continues to

expand and reﬁ ne our understanding of what constitutes effective psychotherapy.

Cain (2010) concludes, “person centered therapy is as vital and effective as it has

ever been and continues to develop in ways that will make it increasingly so in the

years to come” (p. 169).

Even his critics give Rogers credit for having conducted and inspired others to

conduct extensive studies of counseling process and outcome. Rogers presented a

challenge to psychology to design new models of scientiﬁ c investigation capable of

dealing with the inner, subjective experiences of the person. His theories of ther-

apy and personality change have had a tremendous heuristic effect, and though

much controversy surrounds this approach, his work has challenged practitioners

and theoreticians to examine their own therapeutic styles and beliefs.

the importance of empathy Among the major contributions of person-

centered therapy are the implications of empathy for the practice of counseling.

More than any other approach, person-centered therapy has demonstrated that

therapist empathy plays a vital role in facilitating constructive change in the client.

Watson’s (2002) comprehensive review of the research literature on therapeutic

empathy has consistently demonstrated that therapist empathy is the most potent

predictor of client progress in therapy. Indeed, empathy is an essential component

of successful therapy in every therapeutic modality.

Person-centered research has been conducted predominantly on the hypoth-

esized necessary and sufﬁ cient conditions of therapeutic personality change (Cain,

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CHAPTER SEVEN

1986, 1987b). Most of the other counseling approaches covered in this book have

incorporated the importance of the therapist’s attitude and behavior in creating a

therapeutic relationship that is conducive to the use of their techniques. For in-

stance, the cognitive behavioral approaches have developed a wide range of strate-

gies designed to help clients deal with speciﬁ c problems, and they recognize that

a trusting and accepting client–therapist relationship is necessary for successful

application of these procedures. In contrast to the person-centered approach, how-

ever, cognitive behavioral practitioners contend that the working relationship is

not sufﬁ cient to produce change. They contend that active procedures, in combina-

tion with a collaborative relationship, are needed to bring about change.

innovations in person-centered therapy One of the strengths

of the person-centered approach is “the development of innovative and sophisti-

cated methods to work with an increasingly difﬁ cult, diverse, and complex range

of individuals, couples, families, and groups” (Cain, 2002b, p. xxii). A number of

people have made signiﬁ cant advancements that are compatible with the essential

values and concepts of person-centered therapy. Table 7.1 describes some of the

innovators who have played a role in the evolution of person-centered therapy.

Rogers consistently opposed the institutionalization of a client-centered

“school.” Likewise, he reacted negatively to the idea of founding institutes, grant-

ing certiﬁ cates, and setting standards for membership. He feared this institution-

alization would lead to an increasingly narrow, rigid, and dogmatic perspective. If

Rogers (1987a) were to give students-in-training advice it would be: “There is one

best school of therapy. It is the school of therapy you develop for yourself based on

a continuing critical examination of the effects of your way of being in the relation-

ship” (p. 185).

emotion-focused therapy One of the developments associated with

the person-centered approach is the emergence of emotion-focused therapy (EFT).

Leslie Greenberg (2011) is a prominent ﬁ gure in the development of this integra-

tive approach. Emotion-focused therapy is rooted in a person-centered philosophy,

but it is integrative in that it synthesizes aspects of Gestalt therapy and existential

therapy. EFT is a therapeutic practice informed by an understanding of the role of

emotion in psychotherapeutic change. A number of strategies in EFT are aimed

at the goal of strengthening the self, regulating affect, and creating new mean-

ing. Many traditional therapies emphasize conscious understanding and cognitive

and behavioral change, yet they often neglect the foundational role of emotional

change. EFT emphasizes the importance of awareness, acceptance, and under-

standing of emotion and the visceral experience of emotion. In EFT, clients are

assisted to identify, experience, accept, explore, transform, and manage their emo-

tions. A premise of EFT is that we can change only when we accept ourselves as

we are. This approach has a good deal to offer with respect to teaching us about the

role of emotion in personal change and how emotional change can be a primary

pathway to cognitive and behavioral change.

Other therapeutic approaches are increasingly focusing on emotions. For

example, both psychoanalytic and cognitive behavioral approaches are giving more

attention to the role of emotions and are rapidly assimilating many aspects of EFT.

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201

PERSON-CENTERED THERAPY

TABLE 7.1 Therapists Who Contributed to the Evolution

of Person-Centered Theory

INNOVATOR CONTRIBUTION

Natalie Rogers (1993, 1995, 2011) Expanded the theory by developing person-centered

expressive arts therapy in groups.

Virginia Axline (1964, 1969) Made signiﬁ cant contributions to client-centered

therapy with children and play therapy.

Eugene Gendlin (1996) Developed experiential techniques, such as focusing, as

a way to enhance client experiencing.

Laura Rice (Rice & Greenberg,

1984)

Taught therapists to be more evocative in re-creating

crucial experiences that continue to trouble the client.

Peggy Natiello (2001) Works on collaborative power and gender issues.

Art Combs (1988, 1989, 1999) Developed perceptual psychology.

Leslie Greenberg (2011); Greenberg

and colleagues (Greenberg,

Korman, & Paivio, 2002;

Greenberg, Rice, & Elliott, 1993)

Contributed to the development of emotion-focused

therapy. Focused on the importance of facilitating

emotional change in therapy and advanced person-

centered theory and methods. Demonstrated that the

emotional route can be a key to changing cognitions

and behavior.

David Rennie (1998) Provided a glimpse at the inner workings of the

therapeutic process.

Art Bohart (Bohart & Greenberg,

1997; Bohart & Tallman, 1999;

2010; Bohart & Watson, 2011)

Contributed to a deeper understanding of empathy in

therapeutic practice and the active role of the client.

Jeanne Watson (2002) Demonstrated that when empathy is operating on the

cognitive, affective, and interpersonal levels it is one of

the therapist’s most powerful tools.

Dave Mearns and Brian Thorne

(2000, 2007)

Contributed to understanding new frontiers in the

theory and practice of the person-centered approach

and have been signiﬁ cant ﬁ gures in teaching and

supervising in the United Kingdom.

C. H. Patterson (1995) Showed that client-centered therapy is a universal

system of psychotherapy.

Barry Duncan, Scott Miller, Bruce

Wampold, & Mark Hubble (2010)

Demonstrated that the client-centered relationship

and the core conditions are essential to all therapeutic

approaches.

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202

CHAPTER SEVEN

A strength of EFT is that it is an evidence-based approach, an idea that is increas-

ingly being emphasized in graduate programs (Greenberg, 2011).

Limitations and Criticisms of the Person-Centered Approach

Although I applaud person-centered therapists for their willingness to subject their

hypotheses and procedures to empirical scrutiny, some researchers have been crit-

ical of the methodological errors contained in some of these studies. Accusations

of scientiﬁ c shortcomings involve using control subjects who are not candidates

for therapy, failing to use an untreated control group, failing to account for placebo

effects, relying on self-reports as a major way to assess the outcomes of therapy,

and using inappropriate statistical procedures.

There is a similar limitation shared by both the person-centered and existential

(experiential) approaches. Neither of these therapeutic modalities emphasizes the

role of techniques aimed at bringing about change in clients’ behavior. Proponents

of psychotherapy manuals, or manualized treatment methods for speciﬁ c disor-

ders, ﬁ nd serious limitations in the experiential approaches due to their lack of

attention to proven techniques and strategies. Those who call for accountability as

deﬁ ned by evidence-based practices within the ﬁ eld of mental health also are quite

critical of the experiential approaches.

I do not believe manualized treatment methods can be considered the gold

standard in psychotherapy, however. There is good research demonstrating that

techniques account for only 15% of client outcome (see Duncan et al., 2010), whereas

contextual factors have powerful effects on what happens in therapy (Elkins, 2009).

Research points to relational and client factors as the main predictors of effective

therapy. Furthermore, the evaluation of evidence-based practices should be broad-

ened to include best available research, the expertise of the clinician, and client char-

acteristics, culture, and preferences (see Norcross, Hogan, & Koocher, 2008).

A potential limitation of the person-centered approach is that some students-in-

training and practitioners with this orientation may have a tendency to be very support-

ive of clients without being challenging. Out of their misunderstanding of the basic

concepts of the approach, some have limited the range of their responses and coun-

seling styles mainly to reﬂ ections and empathic listening. Although there is value in

really hearing a client and in reﬂ ecting and communicating understanding, counseling

entails more than this. I believe that the therapeutic core conditions are necessary for

therapy to succeed, yet I do not see them as being sufﬁ cient conditions for change for

all clients at all times. From my perspective, these basic attitudes are the foundation on

which counselors must then build the skills of therapeutic intervention. Motivational

interviewing rests on the therapeutic core conditions, for example, but MI employs a

range of strategies that enable clients to develop action plans leading to change.

A related challenge for counselors using this approach is to truly support

clients in ﬁ nding their own way. Counselors sometimes experience difﬁ culty in

allowing clients to decide their own speciﬁ c goals in therapy. It is easy to give lip

service to the concept of clients’ ﬁ nding their own way, but it takes considerable

respect for clients and faith on the therapist’s part to encourage clients to listen to

themselves and follow their own directions, particularly when they make choices

that are not what the therapist hoped for.

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203

PERSON-CENTERED THERAPY

More than any other quality, the therapist’s genuineness determines the power

of the therapeutic relationship. If therapists submerge their unique identity and style

in a passive and nondirective manner, they are not likely to affect clients in powerful

ways. Therapist authenticity and congruence are so vital to this approach that those

who practice within this framework must feel natural in doing so and must ﬁ nd a

way to express their own reactions to clients. If not, a real possibility is that person-

centered therapy will be reduced to a bland, safe, and ineffectual approach.

where to go from here

In the DVD for Integrative Counseling: The Case of Ruth and Lecturettes, you will see

a concrete illustration of how I view the therapeutic relationship as the foundation

for our work together. Refer especially to Session 1 (“Beginning of Counseling”),

Session 2 (“The Therapeutic Relationship”), and Session 3 (“Establishing Thera-

peutic Goals”) for a demonstration of how I apply principles from the person-

centered approach to my work with Ruth.

Free Podcasts for ACA Members

You can download ACA Podcasts (prerecorded interviews) by going to www.coun-

seling.org; click on the Resource button and then select the Podcast Series. For

Chapter 7, Carl Rogers and the Person-Centered Approach, look for Podcast 7 by

by Dr. Howard Kirschenbaum.

Other Resources

The American Psychological Association offers the following DVDs in their Psy-

chotherapy Video Series:

Greenberg, L. S. (2010). Emotion-Focused Therapy Over Time

Cain, D. J. (2010). Person-Centered Therapy Over Time

Psychotherapy.net is a comprehensive resource for students and professionals that

offers videos and interviews featuring Natalie Rogers, Rollo May, and more. New

articles, interviews, blogs, therapy cartoons, and videos are published monthly.

DVDs relevant to this chapter are available at www.psychotherapy.net and include

the following:

Rogers, N. (1997). Person-Centered Expressive Arts Therapy

May, R. (2007). Rollo May on Existential Psychotherapy

Association for the Development of the Person-Centered Approach, Inc. (ADPCA)

P. O. Box 3876

Chicago, IL 60690-3876

E-mail: [email protected]

Website: www.adpca.org

Journal Editor: jonmrose@aol.com

The Association for the Development of the Person-Centered Approach (ADPCA)

is an interdisciplinary and international organization that consists of a network of

individuals who support the development and application of the person-centered

approach. Membership includes a subscription to the Person-Centered Journal, the

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204

CHAPTER SEVEN

association’s newsletter, a membership directory, and information about the an-

nual meeting. ADPCA also provides information about continuing education and

supervision and training in the person-centered approach. For information about

the Person-Centered Journal, contact the editor (Jon Rose).

Association for Humanistic Psychology

1516 Oak Street #320A

Alameda, CA 94501-2947

Telephone: (510) 769-6495

Fax: (510) 769-6433

E-mail: [email protected]om

Website: www.ahpweb.org

Journal website: http://jhp.sagepub.com

The Association for Humanistic Psychology (AHP) is devoted to promoting per-

sonal integrity, creative learning, and active responsibility in embracing the chal-

lenges of being human in these times. Information about the Journal of Human-

istic Psychology is available from the Association for Humanistic Psychology or at

publisher’s website.

Society for Humanistic Psychology

Website: http://www.societyforhumanisticpsychology.com/

Division 32 of APA, Society for Humanistic Psychology, represents a constellation

of “humanistic psychologies” that includes the earlier Rogerian, transpersonal,

and existential orientations as well as the more recently developing perspectives.

Division 32 seeks to contribute to psychotherapy, education, theory, research, epis-

temological diversity, cultural diversity, organization, management, social respon-

sibility, and change. The division has been at the forefront in the development of

qualitative research methodologies. The Society for Humanistic Psychology offers

journal access to The Humanistic Psychologist. Information about membership,

conferences, and journals is available from the website of Division 32.

Carl Rogers: A Daughter’s Tribute

Website: www.nrogers.com

The Carl Rogers CD-ROM is a visually beautiful and lasting archive of the life

and works of the founder of humanistic psychology. It includes excerpts from his

16 books, over 120 photographs spanning his lifetime, and award-winning video

footage of two encounter groups and Carl’s early counseling sessions. It is an es-

sential resource for students, teachers, libraries, and universities. It is a profound

tribute to one of the most important thinkers, inﬂ uential psychologists, and peace

activists of the 20th century. Developed for Natalie Rogers, PhD, by Mindgarden

Media, Inc.

Center for Studies of the Person

1150 Silverado, Suite #112

La Jolla, CA 92037

Telephone: (858) 459-3861

E-mail: centerfortheperson@yahoo.com

Website: www.centerfortheperson.org

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205

The Center for Studies of the Person (CSP) offers workshops, training seminars, ex-

periential small groups, residential workshops, and sharing of learning in community

meetings. The Distance Learning Project and the Carl Rogers Institute for Psychother-

apy Training and Supervision provide experiential and didactic training and supervi-

sion for professionals interested in developing their own person-centered orientation.

Saybrook Graduate School

E-mail: admissions@saybrook.edu

Website: www.nrogers.com

For training in expressive art therapy, you could join Natalie Rogers, PhD, and Shel-

lee Davis, MA, faculty of the certiﬁ cate program at Saybrook Graduate School in

their course, “Expressive Arts for Healing and Social Change: A Person-Centered

Approach.” A 16-unit certiﬁ cate program includes 6 separate weeks spread over 2

years at a retreat center north of San Francisco. Rogers and Davis offer expressive

arts within a person-centered counseling framework. They use counseling demon-

strations, practice counseling sessions, readings, discussions, papers, and a creative

project to teach experiential and theoretical methods.

Recommended Supplementary Readings

On Becoming a Person (Rogers, 1961) is one of the best primary sources for fur-

ther reading on person-centered therapy. This is a collection of Rogers’s articles

on the process of psychotherapy, its outcomes, the therapeutic relationship, edu-

cation, family life, communication, and the nature of the healthy person.

A Way of Being (Rogers, 1980) contains a series of writings on Rogers’s personal

experiences and perspectives, as well as chapters on the foundations and applica-

tions of the person-centered approach.

The Creative Connection: Expressive Arts as Healing (N. Rogers, 1993) is a practical,

spirited book lavishly illustrated with color and action photos and ﬁ lled with fresh

ideas to stimulate creativity, self-expression, healing, and transformation. Natalie

Rogers combines the philosophy of her father with the expressive arts to enhance

communication between client and therapist.

The Life and Work of Carl Rogers (Kirschenbaum, 2009) is a deﬁ nitive biography

of Carl Rogers that follows his life from his early childhood through his death.

This book illustrates the legacy of Carl Rogers and shows his enormous inﬂ uence

on the ﬁ eld of counseling and psychotherapy.

Person-Centered Psychotherapies (Cain, 2010) contains a clear discussion of person-

centered theory, the therapeutic process, evaluation of the approach, and future

developments.

Humanistic Psychology: A Clinical Manifesto (Elkins, 2009) offers an insightful

critique of the medical model of psychotherapy and the myth of empirically

PERSON-CENTERED THERAPY

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supported treatments. The author calls for a relationship-based approach to psy-

chotherapy that can provide both individual and social transformation.

References and Suggested Readings

206

CHAPTER SEVEN

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PERSON-CENTERED THERAPY

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210

introduction

key concepts

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chapter 8

Gestalt Therapy

210

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211

GESTALT THERAPY

Fritz Perls / LAURA PERLS

FREDERICK S. (“FRITZ”) PERLS, MD, PhD

(1893–1970), was the main originator and devel-

oper of Gestalt therapy. Born in Berlin, Germany,

into a lower-middle-class Jewish family, he later

identified himself as a source of much trouble for

his parents. Although he failed the seventh grade

twice and was expelled from school because of

difficulties with the authorities, his brilliance was

never quashed, and he returned—not only to

complete high school but to earn his medical

degree (MD) with a specialization in psychiatry.

In 1916 he joined the German Army and served

as a medic in World War I. His experiences with

soldiers who were gassed on the front lines led to

his interest in mental functioning, which led him to

Gestalt psychology.

After the war Perls worked with Kurt Goldstein

at the Goldstein Institute for Brain-Damaged

Soldiers in Frankfurt. It was through this associa-

tion that he came to see the importance of viewing

humans as a whole rather than as a sum of dis-

cretely functioning parts. It was also through this

association that he met his wife, Laura, who was

earning her PhD with Goldstein. Later he moved to

Vienna and began his psychoanalytic training.

Perls was in analysis with Wilhelm Reich, a

psychoanalyst who pioneered methods of self-

understanding and personality change by working

with the body.

Perls and several of his colleagues established

the New York Institute for Gestalt Therapy in 1952.

Eventually Fritz left New York and settled in Big

Sur, California, where he conducted workshops and

seminars at the Esalen Institute, carving out his

reputation as an innovator in psychotherapy. Here

he had a great impact on people, partly through his

professional writings, but mainly through personal

contact in his workshops.

Personally, Perls was both vital and perplexing.

People typically either responded to him in awe

or found him harshly confrontational and saw him

as meeting his own needs through showmanship.

Having a predilection for the theater since child-

hood, he loved being on stage and putting on a

show. He was viewed variously as insightful, witty,

bright, provocative, manipulative, hostile, demand-

ing, and inspirational. Unfortunately, some of the

people who attended his workshops went on to

mimic the less attractive side of Perls’s personality.

Even though Perls was not happy with this, he did

little to discourage it.

For a firsthand account of the life of Fritz Perls,

I recommend his autobiography, In and Out of the

Garbage Pail (1969b). For a well-researched chap-

ter on the history of Gestalt therapy, see Bowman

(2005).

LAURA POSNER PERLS, PhD (1905–1990),

was born in Pforzheim, Germany, the daughter

of well-to-do parents. She began playing the

piano at the age of 5 and played with profes-

sional skill by the time she was 18. From the

age of 8 she was involved in modern dance, and

both music and modern dance remained vital

parts of her adult life and were incorporated

into her therapy with some clients. By the time

Laura began her practice as a psychoanalyst she

had prepared for a career as a concert pianist,

had attended law school, achieved a doctoral

degree in Gestalt psychology, and made an

intensive study of existential philosophy with

Paul Tillich and Martin Buber. Clearly, Laura

already had a rich background when she met

Fritz in 1926 and they began their collaboration,

which resulted in the theoretical foundations

of Gestalt therapy. Laura and Fritz were married

in 1930 and had two children while living and

practicing in South Africa. Laura continued to

be the mainstay for the New York Institute

for Gestalt Therapy after Fritz abandoned his

family to become internationally famous as the

traveling minstrel for Gestalt therapy. Laura

also made significant contributions to the

development and maintenance of the Gestalt

therapy movement in the United States and

throughout the world (although in very different

ways) from the late 1940s until her death

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212

CHAPTER EIGHT

introduction

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in 1990. Laura’s own words make it clear that

Fritz was a generator, not a developer or organ-

izer. At the 25th anniversary of the New York

Institute for Gestalt Therapy, Laura Perls (1990)

stated, “Without the constant support from

his friends, and from me, without the constant

encouragement and collaboration, Fritz would

never have written a line, nor founded

anything” (p. 18).

Laura paid a great deal of attention to

contact and support, which differed from Fritz’s

attention to intrapsychic phenomena and his

focus on awareness. Her emphasis on contact

underscored the role of the interpersonal and

of being responsive at a time when the popular

notion of Gestalt therapy was that it fostered

responsibility only to oneself. She corrected

some of the excesses committed in the name

of Gestalt therapy and adhered to the basic

principles of Gestalt therapy theory as

written in Gestalt Therapy: Excitement and

Growth in the Human Personality (Perls, Heffer-

line, & Goodman, 1951). She taught that every

Gestalt therapist needs to develop his or her

own therapeutic style. From her perspective,

whatever is integrated in our personality

becomes support for what we use technically

(Humphrey, 1986).

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213

GESTALT THERAPY

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CZNPNFOU FYQFSJFODJOH Emotion-focused therapy &'5 EFWFMPQFE CZ -FTMJF

(SFFOCFSHJTSFMBUFEUP (FTUBMU UIFSBQZ &'5 FOUBJMTUIFQSBDUJDFPGUIFS

BQZCFJOH JOGPSNFE CZ VOEFSTUBOEJOH UIFSPMFPGFNPUJPOJOQTZDIPUIFSBQFVUJD

DIBOHF&NPUJPOGPDVTFEUIFSBQZCMFOETUIFSFMBUJPOBMBTQFDUTPGUIFQFSTPODFO

UFSFEBQQSPBDIXJUIUIFBDUJWFQIFOPNFOPMPHJDBMBXBSFOFTTFYQFSJNFOUTPG(F

TUBMUUIFSBQZ&'5JTBOJOUFHSBUJWFNPEFMESBXJOHGSPNUIFSFMBUJPOTIJQPSJFOUFE

BQQSPBDIFT PG FYJTUFOUJBM UIFSBQZ QFSTPODFOUFSFE UIFSBQZ BOE (FTUBMU UIFSBQZ

&'5NFUIPEPMPHZJTTJNJMBSUP(FTUBMUUIFSBQZ CVU FNQIBTJ[FT FNQJSJDBMMZ TVQ

QPSUFE USFBUNFOUT *OEFQUI QSFTFOUBUJPOT PG FNPUJPOGPDVTFE UIFSBQZ DBO CF

GPVOE JO Learning Emotion-Focused Therapy: The Process-Experiential Approach to

Change&MMJPUU8BUTPO(PMENBO(SFFOCFSHBOEEmotion-Focused Ther-

apy(SFFOCFSH

See the video program for Chapter 8, DVD for Theory and Practice of Counseling

and Psychotherapy: The Case of Stan and Lecturettes. I suggest that you view

the brief lecture for each chapter prior to reading the chapter.

key concepts

View of Human Nature

'SJU[1FSMTBQSBDUJDFE(FTUBMUUIFSBQZQBUFSOBMJTUJDBMMZ$MJFOUTIBWFUPHSPX

VQTUBOEPOUIFJSPXOUXPGFFUBOEiEFBMXJUIUIFJSMJGFQSPCMFNTUIFNTFMWFTw

Q1FSMTTTUZMFPGEPJOHUIFSBQZJOWPMWFEUXPQFSTPOBMBHFOEBTNPWJOHUIF

DMJFOUGSPNFOWJSPONFOUBMTVQQPSUUPTFMGTVQQPSUBOESFJOUFHSBUJOHUIFEJTPXOFE

QBSUTPGPOFTQFSTPOBMJUZ)JTDPODFQUJPOPGIVNBOOBUVSFBOEUIFTFUXPBHFO

EBTTFUUIFTUBHFGPSBWBSJFUZPGUFDIOJRVFTBOEGPSIJTDPOGSPOUBUJPOBMTUZMFPG

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

214

CHAPTER EIGHT

DPOEVDUJOH UIFSBQZ )F XBT B NBTUFS BU JOUFOUJPOBMMZ GSVTUSBUJOH DMJFOUT UP FO

IBODFUIFJSBXBSFOFTT

5IF(FTUBMUWJFXPGIVNBOOBUVSFJTSPPUFEJOFYJTUFOUJBMQIJMPTPQIZQIFOPN

FOPMPHZBOEmFMEUIFPSZ(FOVJOFLOPXMFEHFJTUIFQSPEVDUPGXIBUJTJNNFEJ

BUFMZFWJEFOUJOUIFFYQFSJFODFPGUIFQFSDFJWFS5IFSBQZ BJNTBUBXBSFOFTTBOE

DPOUBDU XJUI UIF FOWJSPONFOU XIJDI DPOTJTUT PG CPUI UIF FYUFSOBM BOE JOUFSOBM

XPSMET5IFRVBMJUZPGDPOUBDUXJUIBTQFDUTPGUIFFYUFSOBMXPSMEGPSFYBNQMFPUIFS

QFPQMFBOEUIFJOUFSOBMXPSMEGPSFYBNQMFQBSUTPGUIFTFMGUIBUBSFEJTPXOFEBSF

NPOJUPSFE5IFQSPDFTTPGiSFPXOJOHwQBSUTPGPOFTFMGUIBUIBWFCFFOEJTPXOFE

BOEUIFVOJmDBUJPOQSPDFTTQSPDFFETUFQCZTUFQVOUJMDMJFOUTDBODBSSZPO XJUI

UIFJSPXOQFSTPOBMHSPXUI#ZCFDPNJOHBXBSFDMJFOUTCFDPNFBCMFUPNBLFJO

GPSNFEDIPJDFTBOEUIVTUPMJWFBNPSFNFBOJOHGVMFYJTUFODF

"CBTJDBTTVNQUJPOPG(FTUBMUUIFSBQZJTUIBUJOEJWJEVBMTIBWFUIFDBQBDJUZUP

TFMGSFHVMBUFXIFOUIFZBSFBXBSFPGXIBUJTIBQQFOJOHJOBOEBSPVOEUIFN5IFS

BQZQSPWJEFTUIFTFUUJOHBOEPQQPSUVOJUZGPSUIBUBXBSFOFTTUPCFTVQQPSUFEBOE

SFTUPSFE5IFUIFSBQJTUJTBUUFOUJWFUPUIFDMJFOUTQSFTFOUFYQFSJFODFBOEUSVTUTJO

UIFQSPDFTT UIFSFCZBTTJTUJOHUIFDMJFOU JO NPWJOHUPXBSEJODSFBTFEBXBSFOFTT

DPOUBDUBOEJOUFHSBUJPO#SPXO

5IF(FTUBMUUIFPSZPGDIBOHFQPTJUTUIBUUIFNPSFXFXPSLBUCFDPNJOHXIPPS

XIBUXFBSFOPUUIFNPSFXFSFNBJOUIFTBNF'SJU[THPPEGSJFOEBOEQTZDIJBUSJTU

DPMMFBHVF"SOJF#FJTTFSTVHHFTUFEUIBUBVUIFOUJDDIBOHFPDDVSTNPSFGSPN

CFJOHXIPXFBSFUIBOGSPNUSZJOHUPCFXIPXFBSFOPU#FJTTFSDBMMFEUIJTTJNQMF

UFOFUUIFparadoxical theory of change. *UJTJNQPSUBOUGPSDMJFOUTUPiCFwBTGVMMZ

BTQPTTJCMF JOUIFJSDVSSFOUDPOEJUJPO SBUIFS UIBOTUSJWJOHUPCFDPNF XIBUUIFZ

iTIPVMECFw(FTUBMUUIFSBQJTUTGPDVTPODSFBUJOHUIFDPOEJUJPOTUIBUQSPNPUFDMJFOU

HSPXUISBUIFSUIBOSFMZJOHPOUIFSBQJTUEJSFDUFEDIBOHF:POUFG

Some Principles of Gestalt Therapy Theory

4FWFSBM CBTJD QSJODJQMFT VOEFSMZJOH UIF UIFPSZ PG (FTUBMU UIFSBQZ BSF CSJFnZ EF

TDSJCFEJOUIJTTFDUJPOIPMJTNmFMEUIFPSZUIFmHVSFGPSNBUJPOQSPDFTTBOEPS

HBOJTNJDTFMGSFHVMBUJPO0UIFSLFZDPODFQUTPG(FTUBMUUIFSBQZBSFEFWFMPQFEJO

NPSFEFUBJMJOUIFTFDUJPOTUIBUGPMMPX

holismGestaltJTB(FSNBOXPSENFBOJOHBXIPMFPSDPNQMFUJPOPSBGPSNUIBU

DBOOPUCFTFQBSBUFEJOUPQBSUTXJUIPVUMPTJOHJUTFTTFODF"MMPGOBUVSFJTTFFOBTB

VOJmFEBOEDPIFSFOUXIPMFBOEUIFXIPMFJTEJGGFSFOUGSPNUIFTVNPGJUTQBSUT

#FDBVTF(FTUBMUUIFSBQJTUTBSFJOUFSFTUFEJOUIFXIPMFQFSTPOUIFZQMBDFOPTVQFSJ

PSWBMVFPOBQBSUJDVMBSBTQFDUPGUIFJOEJWJEVBM(FTUBMUQSBDUJDFBUUFOETUPBDMJFOUT

UIPVHIUTGFFMJOHTCFIBWJPSTCPEZNFNPSJFTBOEESFBNT&NQIBTJTNBZCFPO

BﬁgureUIPTFBTQFDUTPGUIFJOEJWJEVBMTFYQFSJFODFUIBUBSFNPTUTBMJFOUBUBOZ

NPNFOUPSUIFgroundUIPTFBTQFDUTPGUIFDMJFOUTQSFTFOUBUJPOUIBUBSFPGUFO

PVUPGIJTPSIFSBXBSFOFTT$VFTUPUIJTCBDLHSPVOEDBOCFGPVOEPOUIFTVSGBDF

UISPVHIQIZTJDBMHFTUVSFTUPOFPGWPJDFEFNFBOPSBOEPUIFSOPOWFSCBMDPOUFOU

5IJTJTPGUFOSFGFSSFEUPCZ(FTUBMUUIFSBQJTUTBTiBUUFOEJOHUPUIFPCWJPVTwXIJMF

QBZJOHBUUFOUJPOUPIPXUIFQBSUTmUUPHFUIFSIPXUIFJOEJWJEVBMNBLFTDPOUBDU

XJUIUIFFOWJSPONFOUBOEJOUFHSBUJPO

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

215

GESTALT THERAPY

field theory(FTUBMUUIFSBQZJTCBTFEPOﬁeld theory,XIJDITJNQMZQVUBT

TFSUTUIBUUIFPSHBOJTNNVTUCFTFFOJOJUTFOWJSPONFOUPSJOJUTDPOUFYUBTQBSUPG

UIFDPOTUBOUMZDIBOHJOHmFME(FTUBMUUIFSBQZSFTUTPOUIFQSJODJQMFUIBUFWFSZUIJOHJT

SFMBUJPOBMJOnVYJOUFSSFMBUFEBOEJOQSPDFTT(FTUBMUUIFSBQJTUTQBZBUUFOUJPOUPBOE

FYQMPSFXIBUJTPDDVSSJOHBUUIFCPVOEBSZCFUXFFOUIFQFSTPOBOEUIFFOWJSPONFOU

the figure-formation process %FSJWFEGSPNUIFTUVEZPGWJTVBMQFS

DFQUJPOCZBHSPVQPG(FTUBMUQTZDIPMPHJTUTUIFmHVSFGPSNBUJPOQSPDFTTEFTDSJCFT

IPXUIFJOEJWJEVBMPSHBOJ[FTFYQFSJFODFGSPNNPNFOUUPNPNFOU*O(FTUBMUUIFSB

QZUIFmFMEEJGGFSFOUJBUFTJOUPBGPSFHSPVOEmHVSFBOEBCBDLHSPVOEHSPVOE5IF

ﬁgure-formation processUSBDLTIPXTPNFBTQFDUPGUIFFOWJSPONFOUBMmFMEFNFSH

FTGSPNUIFCBDLHSPVOEBOECFDPNFTUIFGPDBMQPJOUPGUIFJOEJWJEVBMTBUUFOUJPO

BOEJOUFSFTU5IFEPNJOBOUOFFETPGBOJOEJWJEVBMBUBHJWFONPNFOUJOnVFODF

UIJTQSPDFTT'SFX

organismic self-regulation 5IF mHVSFGPSNBUJPO QSPDFTT JT JOUFS

UXJOFEXJUIUIFQSJODJQMFPGorganismic self-regulation,BQSPDFTTCZXIJDIFRVJ

MJCSJVN JT iEJTUVSCFEw CZ UIF FNFSHFODF PG B OFFE B TFOTBUJPO PS BO JOUFSFTU

0SHBOJTNTXJMMEPUIFJSCFTUUPSFHVMBUFUIFNTFMWFTHJWFOUIFJSPXODBQBCJMJUJFT

BOEUIFSFTPVSDFTPG UIFJS FOWJSPONFOU -BUOFS*OEJWJEVBMTDBO UBLF BD

UJPOTBOENBLFDPOUBDUTUIBUXJMMSFTUPSFFRVJMJCSJVNPSDPOUSJCVUFUPHSPXUIBOE

DIBOHF8IBUFNFSHFTJOUIFSBQFVUJDXPSLJTBTTPDJBUFEXJUIXIBUJTPGJOUFSFTU

PSXIBUUIFDMJFOUOFFETUPQVSTVFBTFOTFPGFRVJMJCSJVNPSDIBOHF(FTUBMUUIFSB

QJTUTEJSFDUUIFDMJFOUTBXBSFOFTTUPUIFmHVSFTUIBUFNFSHFGSPNUIFCBDLHSPVOE

EVSJOHBUIFSBQZTFTTJPOBOEVTFUIFmHVSFGPSNBUJPOQSPDFTTBTBHVJEFGPSUIF

GPDVTPGUIFSBQFVUJDXPSL

The Now

0OFPGUIFNBJODPOUSJCVUJPOTPGUIF(FTUBMUBQQSPBDIJTJUTFNQIBTJTPOMFBSOJOH

UPBQQSFDJBUFBOEGVMMZFYQFSJFODFUIFQSFTFOUNPNFOU'PDVTJOHPOUIFQBTUBOE

UIFGVUVSFDBOCF BXBZUP BWPJEDPNJOHUP UFSNTXJUIUIF QSFTFOU1PMTUFSBOE

1PMTUFSEFWFMPQFEUIFUIFTJTUIBUiQPXFSJTJOUIFQSFTFOUw*UJTBDPNNPO

UFOEFODZGPSDMJFOUTUPJOWFTUUIFJSFOFSHJFTJOCFNPBOJOHUIFJSQBTUNJTUBLFTBOE

SVNJOBUJOHBCPVUIPXMJGFDPVMEBOETIPVMEIBWFCFFOEJGGFSFOUPSFOHBHJOHJO

FOEMFTTSFTPMVUJPOTBOEQMBOTGPSUIFGVUVSF"TDMJFOUTEJSFDUUIFJSFOFSHZUPXBSE

XIBUXBTPSXIBUNJHIUIBWFCFFOPSMJWFJOGBOUBTZBCPVUUIFGVUVSFUIFQPXFSPG

UIFQSFTFOUEJNJOJTIFT

Phenomenological inquiryJOWPMWFTQBZJOHBUUFOUJPOUPXIBUJTPDDVSSJOHOPX

5PIFMQUIFDMJFOUNBLFDPOUBDUXJUIUIFQSFTFOUNPNFOU(FTUBMUUIFSBQJTUTBTL

iXIBUwBOEiIPXwRVFTUJPOTCVUSBSFMZBTLiXIZwRVFTUJPOT5PQSPNPUFiOPXw

BXBSFOFTT UIF UIFSBQJTU FODPVSBHFT B EJBMPHVF JO UIF QSFTFOU UFOTF CZ BTLJOH

RVFTUJPOTMJLFUIFTFi8IBUJTIBQQFOJOHOPX wi8IBUJTHPJOHPOOPX wi8IBU

BSFZPVFYQFSJFODJOHBTZPVTJUUIFSFBOEBUUFNQUUPUBML wi8IBUJTZPVSBXBSFOFTT

BUUIJTNPNFOU wi)PXBSFZPVFYQFSJFODJOHZPVSGFBS wi)PXBSFZPVBUUFNQUJOH

UPXJUIESBXBUUIJTNPNFOU w1IFOPNFOPMPHJDBMJORVJSZBMTPJOWPMWFTTVTQFOEJOH

BOZQSFDPODFJWFEJEFBTBTTVNQUJPOTPSJOUFSQSFUBUJPOTDPODFSOJOHUIFNFBOJOH

PGBDMJFOUTFYQFSJFODF

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

216

CHAPTER EIGHT

.PTUQFPQMFDBOTUBZJOUIFQSFTFOUGPSPOMZBTIPSUUJNFBOEBSFJODMJOFEUP

mOEXBZTPGJOUFSSVQUJOHUIFnPXPGUIFQSFTFOU*OTUFBEPGFYQFSJFODJOHUIFJSGFFM

JOHTJOUIFIFSFBOEOPXDMJFOUTPGUFOtalk aboutUIFJSGFFMJOHTBMNPTUBTJGUIFJS

GFFMJOHTXFSFEFUBDIFEGSPNUIFJSQSFTFOUFYQFSJFODJOH0OFPGUIFBJNTPG(FTUBMU

UIFSBQZJTUPIFMQDMJFOUTCFDPNFBXBSFPGUIFJSQSFTFOUFYQFSJFODF'PSFYBNQMF

JG+PTFQIJOFCFHJOTUPUBMLBCPVUTBEOFTTQBJOPSDPOGVTJPOUIF(FTUBMUUIFSBQJTU

JOWJUFTIFSUPFYQFSJFODFIFSTBEOFTTQBJOPSDPOGVTJPOnow."TTIFBUUFOETUP

UIFQSFTFOUFYQFSJFODFUIFUIFSBQJTUHBVHFTIPXNVDIBOYJFUZPSEJTDPNGPSUJT

QSFTFOUBOEDIPPTFTGVSUIFSJOUFSWFOUJPOTBDDPSEJOHMZ5IFUIFSBQJTUNJHIUDIPPTF

OPUUPDPNNFOUBT+PTFQIJOFNPWFTBXBZGSPNUIFQSFTFOUNPNFOUPOMZUPFY

UFOEBOPUIFSJOWJUBUJPOTFWFSBMNJOVUFTMBUFS*GBGFFMJOHFNFSHFTUIFUIFSBQJTU

NJHIUTVHHFTUBOFYQFSJNFOUUIBUXPVMEIFMQ+PTFQIJOFUPJODSFBTFIFSBXBSFOFTT

PGUIFGFFMJOHTVDIBTFYQMPSJOHXIFSFBOEIPXTIFFYQFSJFODFTJU-JLFXJTFJGB

UIPVHIUPSJEFBFNFSHFTJOUSPEVDJOHBOFYQFSJNFOUDBOIFMQIFSEFMWFJOUPUIF

UIPVHIUFYQMPSFJUNPSFGVMMZBOEDPOTJEFSJUTFGGFDUTBOEQPTTJCMFSBNJmDBUJPOT

(FTUBMUUIFSBQJTUTSFDPHOJ[FUIBUUIFQBTUXJMMNBLFSFHVMBSBQQFBSBODFTJOUIF

QSFTFOUNPNFOUVTVBMMZCFDBVTFPGTPNFMBDLPGDPNQMFUJPOPGUIBUQBTUFYQFSJ

FODF8IFOUIFQBTUTFFNTUPIBWFBTJHOJmDBOUCFBSJOHPODMJFOUTQSFTFOUBUUJ

UVEFTPSCFIBWJPSJUJTEFBMUXJUICZCSJOHJOHJUJOUPUIFQSFTFOUBTNVDIBTQPT

TJCMF8IFODMJFOUTTQFBLBCPVUUIFJSQBTUUIFUIFSBQJTUNBZBTLUIFNUPSFFOBDUJU

BTUIPVHIUIFZXFSFMJWJOHJUOPX5IFUIFSBQJTUEJSFDUTDMJFOUTUPiCSJOHUIFGBOUBTZ

IFSFwPSiUFMMNFUIFESFBNBTUIPVHIZPVXFSFIBWJOHJUOPXwTUSJWJOHUPIFMQ

UIFNSFMJWFXIBUUIFZFYQFSJFODFEFBSMJFS'PSFYBNQMFSBUIFSUIBOUBMLJOHBCPVU

BQBTUDIJMEIPPEUSBVNBXJUIIFSGBUIFSBDMJFOUCFDPNFTUIFIVSUDIJMEBOEUBMLT

EJSFDUMZUPIFSGBUIFSJOGBOUBTZPSCZJNBHJOJOHIJNCFJOHQSFTFOUJOUIFSPPNJO

BOFNQUZDIBJS

Unfinished Business

8IFOmHVSFTFNFSHFGSPNUIFCBDLHSPVOECVUBSFOPUDPNQMFUFEBOESFTPMWFE

JOEJWJEVBMTBSFMFGUXJUIunﬁnished business,XIJDIDBOCFNBOJGFTUFEJOVOFY

QSFTTFEGFFMJOHTTVDIBTSFTFOUNFOUSBHFIBUSFEQBJOBOYJFUZHSJFGHVJMUBOE

BCBOEPONFOU 6OBDLOPXMFEHFE GFFMJOHT DSFBUF VOOFDFTTBSZ FNPUJPOBM EFCSJT

UIBUDMVUUFSTQSFTFOUDFOUFSFEBXBSFOFTT#FDBVTFUIFGFFMJOHTBSFOPUGVMMZFYQF

SJFODFEJOBXBSFOFTTUIFZMJOHFSJOUIFCBDLHSPVOEBOEBSFDBSSJFEJOUPQSFTFOU

MJGFJOXBZTUIBUJOUFSGFSFXJUIFGGFDUJWFDPOUBDUXJUI POFTFMGBOEPUIFSTi5IFTF

JODPNQMFUFEJSFDUJPOTdo seekDPNQMFUJPOBOEXIFOUIFZHFUQPXFSGVMFOPVHIUIF

JOEJWJEVBMJTCFTFUXJUIQSFPDDVQBUJPODPNQVMTJWFCFIBWJPSXBSJOFTTPQQSFTTJWF

FOFSHZBOENVDITFMGEFGFBUJOHCFIBWJPSw1PMTUFS1PMTUFSQ6OmO

JTIFECVTJOFTTQFSTJTUTVOUJMUIFJOEJWJEVBMGBDFTBOEEFBMTXJUIUIFVOFYQSFTTFE

GFFMJOHT5IFFGGFDUTPGVOmOJTIFECVTJOFTTPGUFOTIPXVQJOTPNFCMPDLBHFXJUI

JOUIFCPEZ(FTUBMUUIFSBQJTUTFNQIBTJ[FQBZJOHBUUFOUJPOUPUIFCPEJMZFYQFSJFODF

POUIF BTTVNQUJPO UIBU JG GFFMJOHT BSF VOFYQSFTTFE UIFZ UFOE UP SFTVMUJO TPNF

QIZTJDBMTFOTBUJPOTPSQSPCMFNT

5IFimpasse, PSTUVDLQPJOUJTUIFUJNFXIFOFYUFSOBMTVQQPSUJTOPUBWBJMBCMF

PSUIFDVTUPNBSZXBZPGCFJOHEPFTOPUXPSL5IFUIFSBQJTUTUBTLJT UP BDDPN

QBOZ DMJFOUT JO FYQFSJFODJOH UIF JNQBTTF XJUIPVU SFTDVJOH PS GSVTUSBUJOH UIFN

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

217

GESTALT THERAPY

5IFDPVOTFMPSBTTJTUTDMJFOUTCZQSPWJEJOHTJUVBUJPOTUIBUFODPVSBHFUIFNUPGVMMZ

FYQFSJFODFUIFJSDPOEJUJPOPGCFJOHTUVDL#ZDPNQMFUFMZFYQFSJFODJOHUIFJNQBTTF

UIFZ BSF BCMF UP HFU JOUP DPOUBDU XJUI UIFJS GSVTUSBUJPOT BOE BDDFQU XIBUFWFS JT

SBUIFSUIBO XJTIJOH UIFZ XFSF EJGGFSFOU (FTUBMU UIFSBQZ JT CBTFE PO UIFOPUJPO

UIBUJOEJWJEVBMTIBWFBTUSJWJOHUPXBSEBDUVBMJ[BUJPOBOEHSPXUIBOEUIBUJGUIFZ

BDDFQUBMMBTQFDUTPGUIFNTFMWFTXJUIPVUKVEHJOHUIFTFEJNFOTJPOTUIFZDBOCFHJO

UPUIJOLGFFMBOEBDUEJGGFSFOUMZ

Contact and Resistances to Contact

*O(FTUBMUUIFSBQZDPOUBDUJTOFDFTTBSZJGDIBOHFBOEHSPXUIBSFUPPDDVSCon-

tactJTNBEFCZTFFJOHIFBSJOHTNFMMJOHUPVDIJOHBOENPWJOH&GGFDUJWFDPOUBDU

NFBOTJOUFSBDUJOHXJUIOBUVSFBOEXJUIPUIFSQFPQMFXJUIPVUMPTJOHPOFTTFOTF

PG JOEJWJEVBMJUZ 1SFSFRVJTJUFT GPS HPPE DPOUBDU BSF DMFBS BXBSFOFTT GVMM FOFSHZ

BOEUIFBCJMJUZUPFYQSFTTPOFTFMG;JOLFS.JSJBN1PMTUFSDMBJNFE

UIBUDPOUBDUJTUIFMJGFCMPPEPGHSPXUI*UJTUIFDPOUJOVBMMZSFOFXFEDSFBUJWFBEKVTU

NFOUPGJOEJWJEVBMTUPUIFJSFOWJSPONFOU*UFOUBJMT[FTUJNBHJOBUJPOBOEDSFBUJW

JUZ5IFSFBSFPOMZNPNFOUTPGUIJTUZQFPGDPOUBDUTPJUJTNPTUBDDVSBUFUPUIJOL

PGMFWFMTPGDPOUBDUSBUIFSUIBOBmOBMTUBUFUPBDIJFWF"GUFSBDPOUBDUFYQFSJFODF

UIFSFJTUZQJDBMMZBXJUIESBXBMUPJOUFHSBUFXIBUIBTCFFOMFBSOFE(FTUBMUUIFSB

QJTUTUBMLBCPVUUIFUXPGVODUJPOTPGCPVOEBSJFTUPDPOOFDUBOEUPTFQBSBUF#PUI

DPOUBDUBOEXJUIESBXBMBSFOFDFTTBSZBOEJNQPSUBOUUPIFBMUIZGVODUJPOJOH

(FTUBMUUIFSBQJTUTBMTPGPDVTPOJOUFSSVQUJPOTEJTUVSCBODFTBOESFTJTUBODFTUP

DPOUBDUXIJDIXFSFEFWFMPQFEBTDPQJOHQSPDFTTFTCVUPGUFOFOEVQQSFWFOUJOHVT

GSPNFYQFSJFODJOHUIFQSFTFOUJOBGVMMBOESFBMXBZ3FTJTUBODFTBSFUZQJDBMMZBEPQU

FEPVUPGPVSBXBSFOFTTBOEXIFOUIFZGVODUJPOJOBDISPOJDXBZDBODPOUSJCVUF

UPEZTGVODUJPOBMCFIBWJPS#FDBVTFSFTJTUBODFTBSFEFWFMPQFEBTBNFBOTPGDPQJOH

XJUIMJGFTJUVBUJPOTUIFZQPTTFTTQPTJUJWFRVBMJUJFTBTXFMMBTQSPCMFNBUJDPOFTBOE

NBOZDPOUFNQPSBSZ(FTUBMUUIFSBQJTUTSFGFSUPUIFNBTiDPOUBDUCPVOEBSZQIFOPN

FOBw1PMTUFSBOE1PMTUFSEFTDSJCFmWFEJGGFSFOULJOETPGDPOUBDUCPVOEBSZ

EJTUVSCBODFTJOUSPKFDUJPOQSPKFDUJPOSFUSPnFDUJPOEFnFDUJPOBOEDPOnVFODF

IntrojectionJTUIFUFOEFODZUPVODSJUJDBMMZBDDFQUPUIFSTCFMJFGTBOETUBOEBSET

XJUIPVUBTTJNJMBUJOHUIFNUPNBLFUIFNDPOHSVFOUXJUIXIPXFBSF5IFTFJO

USPKFDUTSFNBJOBMJFOUPVTCFDBVTFXFIBWFOPUBOBMZ[FEBOESFTUSVDUVSFEUIFN

8IFOXFJOUSPKFDUXFQBTTJWFMZJODPSQPSBUFXIBUUIFFOWJSPONFOUQSPWJEFTSBUIFS

UIBODMFBSMZJEFOUJGZJOHXIBUXFXBOUPSOFFE*GXFSFNBJOJOUIJTTUBHFPVSFO

FSHZJTCPVOEVQJOUBLJOHUIJOHTBTXFmOEUIFNBOECFMJFWJOHUIBUBVUIPSJUJFT

LOPXXIBUJTCFTUGPSVTSBUIFSUIBOXPSLJOHGPSUIJOHTPVSTFMWFT

ProjectionJTUIFSFWFSTF PG JOUSPKFDUJPO *OQSPKFDUJPOXFEJTPXO DFSUBJO BT

QFDUTPGPVSTFMWFTCZBTTJHOJOHUIFNUPUIFFOWJSPONFOU5IPTFBUUSJCVUFTPGPVS

QFSTPOBMJUZUIBUBSFJODPOTJTUFOUXJUIPVSTFMGJNBHFBSFEJTPXOFEBOEQVUPOUP

BTTJHOFEUPBOETFFOJOPUIFSQFPQMFUIVTCMBNJOHPUIFSTGPSMPUTPGPVSQSPC

MFNT#ZTFFJOHJOPUIFSTUIFWFSZRVBMJUJFTUIBUXFSFGVTFUPBDLOPXMFEHFJOPVS

TFMWFTXFBWPJEUBLJOHSFTQPOTJCJMJUZGPSPVSPXOGFFMJOHTBOEUIFQFSTPOXIPXF

BSFBOEUIJTLFFQTVTQPXFSMFTTUPJOJUJBUFDIBOHF1FPQMFXIPVTFQSPKFDUJPOBT

BQBUUFSOUFOEUPGFFMUIBUUIFZBSFWJDUJNTPGDJSDVNTUBODFTBOEUIFZCFMJFWFUIBU

QFPQMFIBWFIJEEFONFBOJOHTCFIJOEXIBUUIFZTBZ

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

218

CHAPTER EIGHT

Retroﬂection DPOTJTUTPGUVSOJOHCBDLPOUPPVSTFMWFTXIBUXFXPVMEMJLFUPEP

UPTPNFPOFFMTFPSEPJOHUPPVSTFMWFTXIBUXFXPVMEMJLFTPNFPOFFMTFUPEPUPPS

GPSVT5IJTQSPDFTTJTQSJODJQBMMZBOJOUFSSVQUJPOPGUIFBDUJPOQIBTFJOUIFDZDMF

PGFYQFSJFODFBOEUZQJDBMMZJOWPMWFTBGBJSBNPVOUPGBOYJFUZ1FPQMFXIPSFMZPO

SFUSPnFDUJPOUFOEUPJOIJCJUUIFNTFMWFTGSPNUBLJOHBDUJPOPVUPGGFBSPGFNCBS

SBTTNFOU HVJMU BOE SFTFOUNFOU 1FPQMF XIP TFMGNVUJMBUF PS XIP JOKVSF UIFN

TFMWFTGPSFYBNQMFBSFPGUFOEJSFDUJOHBHHSFTTJPOJOXBSEPVUPGGFBSPGEJSFDUJOH

JUUPXBSEPUIFST%FQSFTTJPOBOEQTZDIPTPNBUJDDPNQMBJOUTBSFPGUFODSFBUFECZ

SFUSPnFDUJOH5ZQJDBMMZUIFTFNBMBEBQUJWFTUZMFTPGGVODUJPOJOHBSFBEPQUFEPVUTJEF

PGPVSBXBSFOFTTQBSUPGUIFQSPDFTTPG(FTUBMUUIFSBQZJTUPIFMQVTEJTDPWFSBTFMG

SFHVMBUPSZTZTUFNTPUIBUXFDBOEFBMSFBMJTUJDBMMZXJUIUIFXPSME

DeﬂectionJTUIFQSPDFTTPGEJTUSBDUJPOPSWFFSJOHPGGTPUIBUJUJTEJGmDVMUUP

NBJOUBJOBTVTUBJOFETFOTFPGDPOUBDU8FBUUFNQUUPEJGGVTFPSEFGVTFDPOUBDU

UISPVHIUIFPWFSVTFPGIVNPSBCTUSBDUHFOFSBMJ[BUJPOTBOERVFTUJPOTSBUIFS

UIBOTUBUFNFOUT'SFX8IFOXFEFnFDUXFTQFBLUISPVHIBOEGPSPUI

FSTCFBUJOHBSPVOEUIFCVTISBUIFSUIBOCFJOHEJSFDUBOEFOHBHJOHUIFFOWJSPO

NFOUJOBOJODPOTJTUFOUBOEJODPOTFRVFOUJBMCBTJTXIJDISFTVMUTJOFNPUJPOBM

EFQMFUJPO

ConﬂuenceJOWPMWFTCMVSSJOHUIFEJGGFSFOUJBUJPOCFUXFFOUIFTFMGBOEUIFFO

WJSPONFOU"TXFTUSJWFUPCMFOEJOBOEHFUBMPOHXJUIFWFSZPOFUIFSFJTOPDMFBS

EFNBSDBUJPO CFUXFFO JOUFSOBM FYQFSJFODF BOE PVUFS SFBMJUZ $POnVFODF JO SFMB

UJPOTIJQTJOWPMWFTUIFBCTFODFPGDPOnJDUTTMPXOFTTUPBOHFSBOEBCFMJFGUIBUBMM

QBSUJFTFYQFSJFODFUIFTBNFGFFMJOHTBOEUIPVHIUTXFEP5IJTTUZMFPGDPOUBDUJT

DIBSBDUFSJTUJDPGDMJFOUTXIPIBWFBIJHIOFFEUPCFBDDFQUFEBOEMJLFEUIVTmOEJOH

FONFTINFOUDPNGPSUBCMF 5IJTDPOEJUJPONBLFTHFOVJOFDPOUBDU FYUSFNFMZ EJG

mDVMU"UIFSBQJTUNJHIUBTTJTUDMJFOUTXIPVTFUIJTDIBOOFMPGSFTJTUBODFCZBTLJOH

RVFTUJPOTTVDIBTi8IBUBSFZPVEPJOHOPX wi8IBUBSFZPVFYQFSJFODJOHBUUIJT

NPNFOU wi8IBUEPZPVXBOUSJHIUOPX w

5FSNT TVDI BT interruptions in contactPSboundary disturbance SFGFS UP UIF

DIBSBDUFSJTUJDTUZMFTQFPQMFFNQMPZJOUIFJSBUUFNQUTUPDPOUSPMUIFJSFOWJSPONFOU

UISPVHIPOFPGUIFTFDIBOOFMTPGSFTJTUBODF5IFQSFNJTFJO(FTUBMUUIFSBQZJTUIBU

DPOUBDUJTCPUIOPSNBMBOEIFBMUIZBOEDMJFOUTBSFFODPVSBHFEUPCFDPNFJODSFBT

JOHMZBXBSFPGUIFJSEPNJOBOUTUZMFPGCMPDLJOHDPOUBDUBOEUIFJSVTFPGSFTJTUBODF

5PEBZT(FTUBMUUIFSBQJTUTSFBEJMZBUUFOEUPIPXDMJFOUTJOUFSSVQUDPOUBDUBQQSPBDI

JOHUIFJOUFSSVQUJWFTUZMFTXJUISFTQFDUBOEUBLJOHFBDITUZMFTFSJPVTMZLOPXJOH

UIBUJUIBTTFSWFEBOJNQPSUBOUGVODUJPOJOUIFQBTU*UJTJNQPSUBOUUPFYQMPSFXIBU

UIFSFTJTUBODFEPFTGPSDMJFOUTXIBUJUQSPUFDUTUIFNGSPNBOEXIBUJULFFQTUIFN

GSPNFYQFSJFODJOH

Energy and Blocks to Energy

*O (FTUBMU UIFSBQZ TQFDJBM BUUFOUJPO JT HJWFO UP XIFSF FOFSHZ JT MPDBUFE IPX JU

JTVTFEBOEIPXJUDBOCFCMPDLFE#MPDLFEFOFSHZJTBOPUIFSGPSNPGEFGFOTJWF

CFIBWJPS*UDBOCFNBOJGFTUFECZUFOTJPOJOTPNFQBSUPGUIFCPEZCZQPTUVSFCZ

LFFQJOHPOFTCPEZUJHIUBOEDMPTFECZOPUCSFBUIJOHEFFQMZCZMPPLJOHBXBZGSPN

QFPQMFXIFO TQFBLJOH UP BWPJE DPOUBDUCZ DIPLJOH PGG TFOTBUJPOT CZ OVNCJOH

GFFMJOHTBOECZTQFBLJOHXJUIBSFTUSJDUFEWPJDFUPNFOUJPOPOMZBGFX

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

219

GESTALT THERAPY

4PNF PG UIF UIFSBQFVUJD FOEFBWPS JOWPMWFT mOEJOH UIF GPDVT PG JOUFSSVQUFE

FOFSHZBOECSJOHJOHUIFTFTFOTBUJPOTUPUIFDMJFOUTBXBSFOFTT$MJFOUTNBZOPU

CFBXBSF PG UIFJSFOFSHZPSXIFSFJUJT MPDBUFE BOE UIFZNBZFYQFSJFODFJUJOB

OFHBUJWFXBZ0OFPGUIFUBTLTPGUIFUIFSBQJTUJTUPIFMQDMJFOUTJEFOUJGZUIFXBZT

JOXIJDIUIFZBSFCMPDLJOHFOFSHZBOEUSBOTGPSNUIJTCMPDLFEFOFSHZJOUPNPSF

BEBQUJWFCFIBWJPST$MJFOUTDBOCFFODPVSBHFEUPSFDPHOJ[FIPXUIFJSSFTJTUBODF

JTCFJOHFYQSFTTFEJOUIFJSCPEZ3BUIFSUIBOUSZJOHUPSJEUIFNTFMWFTPGDFSUBJO

CPEJMZTZNQUPNTDMJFOUTDBOCFFODPVSBHFEUPEFMWFGVMMZJOUPUFOTJPOTUBUFT'PS

FYBNQMFCZBMMPXJOHUIFNTFMWFTUPFYBHHFSBUFUIFJSUJHIUNPVUIBOETIBLJOHMFHT

UIFZDBOEJTDPWFSGPSUIFNTFMWFTIPXUIFZBSFEJWFSUJOHFOFSHZBOELFFQJOHUIFN

TFMWFTGSPNBGVMMFYQSFTTJPOPGBMJWFOFTT

the therapeutic process

Therapeutic Goals

(FTUBMUUIFSBQZEPFTOPUBTDSJCFUPBiHPBMPSJFOUFEwNFUIPEPMPHZQFSTF)PXFWFS

BT.FMOJDL BOE /FWJT  BQUMZ TBZ i#FDBVTF PG UIF DPNQMFYJUZ PGUIFSBQFV

UJDXPSLBXFMMHSPVOEFENFUIPEPMPHZJTFTTFOUJBM    5IF TJY NFUIPEPMPHJDBM

DPNQPOFOUTXFDPOTJEFSWJUBMPSJOUFHSBMUP(FTUBMUUIFSBQZBSFBUIFDPOUJOV

VNPGFYQFSJFODFCUIFIFSFBOEOPXDUIFQBSBEPYJDBMUIFPSZPGDIBOHFE

UIFFYQFSJNFOU FUIFBVUIFOUJDFODPVOUFSBOE G QSPDFTTPSJFOUFEEJBHOPTJTw

QQo%FTQJUFOPUCFJOHGPDVTFEPOQSFEFUFSNJOFEHPBMTGPSUIFJSDMJFOUT

(FTUBMU UIFSBQJTUT DMFBSMZ BUUFOE UP B CBTJD HPBMOBNFMZ BTTJTUJOH UIF DMJFOU UP

BUUBJOHSFBUFS BXBSFOFTTBOEXJUIJUHSFBUFS DIPJDF "XBSFOFTTJODMVEFTLOPX

JOHUIFFOWJSPONFOULOPXJOHPOFTFMGBDDFQUJOHPOFTFMGBOECFJOHBCMFUPNBLF

DPOUBDU*ODSFBTFEBOEFOSJDIFEBXBSFOFTTCZJUTFMGJTTFFOBTDVSBUJWF8JUIPVU

BXBSFOFTTDMJFOUTEPOPUQPTTFTTUIFUPPMTGPSQFSTPOBMJUZDIBOHF8JUIBXBSFOFTT

UIFZIBWFUIFDBQBDJUZUPGBDFBOEBDDFQUEFOJFEQBSUTBTXFMMBTUPGVMMZFYQFSJFODF

UIFJSTVCKFDUJWJUZ5IFZDBOFYQFSJFODFUIFJSVOJUZBOEXIPMFOFTT8IFODMJFOUT

TUBZXJUIUIFJSBXBSFOFTTJNQPSUBOUVOmOJTIFECVTJOFTTXJMMFNFSHFBOEDBOCF

EFBMUXJUIJOUIFSBQZ5IF(FTUBMUBQQSPBDIIFMQTDMJFOUTOPUFUIFJSPXOBXBSFOFTT

QSPDFTTTPUIBUUIFZDBOCFSFTQPOTJCMFBOEDBOTFMFDUJWFMZBOEEJTDSJNJOBUJOHMZ

NBLFDIPJDFT"XBSFOFTTFNFSHFTXJUIJOUIFDPOUFYUPGBHFOVJOFNFFUJOHCF

UXFFODMJFOUBOEUIFSBQJTU

5IFFYJTUFOUJBMWJFXTFF $IBQUFS  JTUIBUXFBSF DPOUJOVBMMZ FOHBHFE JO B

QSPDFTTPGSFNBLJOHBOEEJTDPWFSJOHPVSTFMWFT8FEPOPUIBWFBTUBUJDJEFOUJUZ

CVUEJTDPWFSOFXGBDFUTPGPVSCFJOHBTXFGBDFOFXDIBMMFOHFT(FTUBMUUIFSBQZ

JTCBTJDBMMZBOFYJTUFOUJBMFODPVOUFSPVUPGXIJDIDMJFOUTUFOEUPNPWFJODFSUBJO

EJSFDUJPOT5ISPVHIBDSFBUJWFJOWPMWFNFOUJO(FTUBMUQSPDFTT;JOLFSFY

QFDUTDMJFOUTXJMMEPUIFGPMMPXJOH

t .PWFUPXBSEJODSFBTFEBXBSFOFTTPGUIFNTFMWFT

t (SBEVBMMZBTTVNFPXOFSTIJQPGUIFJSFYQFSJFODFBTPQQPTFEUPNBLJOHPUIFST

SFTQPOTJCMFGPSXIBUUIFZBSFUIJOLJOHGFFMJOHBOEEPJOH

t %FWFMPQTLJMMTBOE

BDRVJSFWBMVFTUIBUXJMMBMMPXUIFNUPTBUJTGZUIFJSOFFETXJUI

PVUWJPMBUJOHUIFSJHIUTPGPUIFST

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

220

CHAPTER EIGHT

t #FDPNFNPSFBXBSFPGBMMPGUIFJSTFOTFT

t -FBSOUPBDDFQUSFTQPOTJCJMJUZGPSXIBUUIFZEPJODMVEJOHBDDFQUJOHUIFDPOTF

RVFODFTPGUIFJSBDUJPOT

t #FBCMFUPBTLGPSBOEHFUIFMQGSPNPUIFSTBOECFBCMFUPHJWFUPPUIFST

Therapist’s Function and Role

"DDPSEJOHUP1FSMT)FGGFSMJOFBOE(PPENBOUIFUIFSBQJTUTKPCJTUPJOWJUF

DMJFOUTJOUPBOBDUJWFQBSUOFSTIJQXIFSFUIFZDBOMFBSOBCPVUUIFNTFMWFTCZBEPQU

JOHBOFYQFSJNFOUBMBUUJUVEFUPXBSEMJGFJOXIJDIUIFZUSZPVUOFXCFIBWJPSTBOE

OPUJDFXIBUIBQQFOT(FTUBMUUIFSBQJTUTVTFBDUJWFNFUIPETBOEQFSTPOBMFOHBHF

NFOUXJUIDMJFOUTUPJODSFBTFUIFJSBXBSFOFTTGSFFEPNBOETFMGEJSFDUJPOSBUIFS

UIBOEJSFDUJOHUIFNUPXBSEQSFTFUHPBMT:POUFG+BDPC

$POUFNQPSBSZ(FTUBMU QSBDUJUJPOFST WJFXDMJFOUT BT UIF FYQFSUT PO UIFJS PXO

FYQFSJFODFBOEFODPVSBHFUIFNUPBUUFOEUPUIFJSTFOTPSZBXBSFOFTTJOUIFQSFTFOU

NPNFOU(FTUBMUUIFSBQJTUTWBMVFTFMGEJTDPWFSZBOEBTTVNFUIBUDMJFOUTDBOEJT

DPWFSGPSUIFNTFMWFTUIFXBZTJOXIJDIUIFZCMPDLPSJOUFSSVQUUIFJSBXBSFOFTTBOE

FYQFSJFODF 8BUTPO (PMENBO  (SFFOCFSH  :POUFG  TUSFTTFT UIBU

BMUIPVHIUIFUIFSBQJTUGVODUJPOTBTBHVJEFBOEBDBUBMZTUQSFTFOUTFYQFSJNFOUTBOE

TIBSFTPCTFSWBUJPOTUIFCBTJDXPSLPGUIFSBQZJTEPOFCZUIFDMJFOU:POUFGNBJO

UBJOTUIBUUIFUIFSBQJTUTUBTLJTUPDSFBUFBDMJNBUFJOXIJDIDMJFOUTBSFMJLFMZUPUSZ

PVUOFXXBZTPGCFJOH BOECFIBWJOH(FTUBMUUIFSBQJTUT EPOPUGPSDFDIBOHF PO

DMJFOUTUISPVHIDPOGSPOUBUJPO*OTUFBEUIFZXPSLXJUIJOBDPOUFYUPG*5IPVEJB

MPHVFJOBIFSFBOEOPXGSBNFXPSL

"OJNQPSUBOUGVODUJPOPG(FTUBMUUIFSBQJTUTJTQBZJOHBUUFOUJPOUPDMJFOUTCPEZ

MBOHVBHF5IFTFOPOWFSCBMDVFTQSPWJEFSJDIJOGPSNBUJPOBTUIFZPGUFOSFQSFTFOU

GFFMJOHTPGXIJDIUIFDMJFOUJTVOBXBSF5IFUIFSBQJTUOFFETUPCFBMFSUGPSHBQTJO

BUUFOUJPOBOE BXBSFOFTT BOEGPS JODPOHSVJUJFT CFUXFFO WFSCBMJ[BUJPOT BOE XIBU

DMJFOUT BSF EPJOH XJUI UIFJS CPEJFT 5IFSBQJTUT NJHIU EJSFDU DMJFOUT UP TQFBL GPS

BOECFDPNFUIFJSHFTUVSFTPSCPEZQBSUTCZBTLJOHi8IBUEPZPVSFZFTTBZ wi*G

ZPVSIBOETDPVMETQFBLBUUIJTNPNFOUXIBUXPVMEUIFZTBZ wi$BOZPVDBSSZPO

BDPOWFSTBUJPOCFUXFFOZPVSSJHIUBOEMFGUIBOET w$MJFOUTNBZWFSCBMMZFYQSFTT

BOHFSBOEBUUIFTBNFUJNFTNJMF0SUIFZNBZTBZUIFZBSFJOQBJOBOEBUUIFTBNF

UJNFMBVHI5IFSBQJTUTDBOBTLDMJFOUTUPCFDPNFBXBSFPGIPXUIFZBSFVTJOHUIFJS

MBVHIUFSUPNBTLGFFMJOHTPGBOHFSPSQBJO

*OBEEJUJPOUPDBMMJOHBUUFOUJPOUPDMJFOUTOPOWFSCBMMBOHVBHFUIF(FTUBMUDPVO

TFMPSQMBDFTFNQIBTJTPOUIFSFMBUJPOTIJQCFUXFFOMBOHVBHFQBUUFSOTBOEQFSTPO

BMJUZ$MJFOUTTQFFDIQBUUFSOTBSFPGUFOBOFYQSFTTJPOPGUIFJSGFFMJOHTUIPVHIUT

BOEBUUJUVEFT5IF(FTUBMUBQQSPBDIGPDVTFTPOPWFSUTQFBLJOHIBCJUTBTBXBZUP

JODSFBTF DMJFOUT BXBSFOFTT PG UIFNTFMWFT FTQFDJBMMZ CZ BTLJOH UIFN UP OPUJDF

XIFUIFSUIFJSXPSETBSFDPOHSVFOUXJUIXIBUUIFZBSFFYQFSJFODJOHPSJOTUFBEBSF

EJTUBODJOHUIFNGSPNUIFJSFNPUJPOT

-BOHVBHF DBO CPUI EFTDSJCF BOE DPODFBM #Z GPDVTJOH PO MBOHVBHF DMJFOUT

BSFBCMFUPJODSFBTFUIFJSBXBSFOFTTPGXIBUUIFZBSFFYQFSJFODJOHJOUIFQSFTFOU

NPNFOUBOEPGIPXUIFZBSFBWPJEJOHDPNJOHJOUPDPOUBDUXJUIUIJTIFSFBOEOPX

FYQFSJFODF)FSFBSFTPNFFYBNQMFTPGUIFBTQFDUTPGMBOHVBHFUIBU(FTUBMUUIFSB

QJTUTNJHIUGPDVTPO

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

221

GESTALT THERAPY

tiIt” talk.8IFODMJFOUTTBZiJUwJOTUFBEPGi*wUIFZBSFVTJOHEFQFSTPOBMJ[JOH

MBOHVBHF5IFDPVOTFMPSNBZBTLUIFNUPTVCTUJUVUFQFSTPOBMQSPOPVOTGPSJNQFS

TPOBMPOFTTPUIBUUIFZXJMMBTTVNFBOJODSFBTFETFOTFPGSFTQPOTJCJMJUZ'PSFYBN

QMFJGBDMJFOUTBZTi*UJTEJGmDVMUUPNBLFGSJFOETwIFDPVMECFBTLFEUPSFTUBUFUIJT

CZNBLJOHBOi*wTUBUFNFOUi*IBWFUSPVCMFNBLJOHGSJFOETw

t “You” talk.(MPCBMBOEJNQFSTPOBMMBOHVBHFUFOET

UPLFFQUIFQFSTPOIJEEFO

5IFUIFSBQJTUPGUFOQPJOUTPVUHFOFSBMJ[FEVTFTPGiZPVwBOEBTLTUIFDMJFOUUPTVC

TUJUVUFi*wXIFOUIJTJTXIBUJTNFBOU

t Questions.2VFTUJPOTIBWFBUFOEFODZUP

LFFQUIF RVFTUJPOFS IJEEFO TBGF

BOEVOLOPXO(FTUBMUDPVOTFMPSTPGUFOBTLDMJFOUTUPDIBOHFUIFJSRVFTUJPOTJOUP

TUBUFNFOUT*ONBLJOHQFSTPOBMTUBUFNFOUTDMJFOUTCFHJOUPBTTVNFSFTQPOTJCJMJUZ

GPSXIBUUIFZTBZ5IFZNBZCFDPNFBXBSFPGIPXUIFZBSFLFFQJOHUIFNTFMWFT

NZTUFSJPVTUISPVHIBCBSSBHFPGRVFTUJPOTBOEIPXUIJTTFSWFTUPQSFWFOUUIFN

GSPNNBLJOHEFDMBSBUJPOTUIBUFYQSFTTUIFNTFMWFT

t Language that denies power.4PNFDMJFOUTIBWFBUFOEFODZ

UPEFOZUIFJSQFS

TPOBMQPXFSCZBEEJOHRVBMJmFSTPSEJTDMBJNFSTUPUIFJSTUBUFNFOUT5IFUIFSBQJTU

NBZBMTPQPJOUPVUUPDMJFOUTIPXDFSUBJORVBMJmFSTTVCUSBDUGSPNUIFJSFGGFDUJWF

OFTT&YQFSJNFOUJOHXJUI PNJUUJOH RVBMJmFST TVDIBTiNBZCFw iQFSIBQTw iTPSU

PGwi*HVFTTwiQPTTJCMZwBOEi*TVQQPTFwDBOIFMQDMJFOUTDIBOHFBNCJWBMFOUNFT

TBHFTJOUPDMFBSBOEEJSFDUTUBUFNFOUT-JLFXJTFXIFODMJFOUTTBZi*DBOUwUIFZ

BSFSFBMMZJNQMZJOHi*XPOUw"TLJOHDMJFOUTUPTVCTUJUVUFiXPOUwGPSiDBOUwPGUFO

BTTJTUTUIFNJOPXOJOHBOEBDDFQUJOHUIFJSQPXFSCZUBLJOHSFTQPOTJCJMJUZGPSUIFJS

EFDJTJPOT5IFDPVOTFMPSNVTUCFDBSFGVMJOJOUFSWFOJOHTPUIBUDMJFOUTEPOPUGFFM

UIBUFWFSZUIJOHUIFZTBZJTTVCKFDUUPTDSVUJOZ3BUIFSUIBOGPTUFSJOHBNPSCJELJOE

PGJOUSPTQFDUJPOUIFDPVOTFMPSIPQFTUPGPTUFSBXBSFOFTTPGXIBUJTSFBMMZCFJOH

FYQSFTTFEUISPVHIXPSET

t Listening to clients’ metaphors.*OIJTXPSLTIPQT&SW1PMTUFS

FNQIBTJ[FT

UIFJNQPSUBODFPGBUIFSBQJTUMFBSOJOHIPXUPMJTUFOUPUIFNFUBQIPSTPGDMJFOUT#Z

UVOJOHJOUPNFUBQIPSTUIFUIFSBQJTUHFUTSJDIDMVFTUPDMJFOUTJOUFSOBMTUSVHHMFT

&YBNQMFTPG NFUBQIPSTUIBUDBOCF BNQMJmFE JODMVEFDMJFOUTUBUFNFOUTTVDI BT

i*UTIBSEGPSNFUPTQJMMNZHVUTJOIFSFwi"UUJNFT*GFFMUIBU*EPOUIBWFBMFH

UPTUBOEPOwi*GFFMMJLF*IBWFBIPMFJONZTPVMwi*OFFEUPCFQSFQBSFEJODBTF

TPNFPOFCMBTUTNFwi*GFMUSJQQFEUPTISFETBGUFSZPVDPOGSPOUFENFMBTUXFFLw

i"GUFSUIJTTFTTJPO*GFFMBTUIPVHI*WFCFFOQVUUISPVHIBNFBUHSJOEFSw#FOFBUI

UIFNFUBQIPSNBZMJFBTVQQSFTTFEJOUFSOBMEJBMPHVFUIBUSFQSFTFOUTDSJUJDBMVOmO

JTIFECVTJOFTTPSSFBDUJPOTUPBQSFTFOUJOUFSBDUJPO'PSFYBNQMFUPUIFDMJFOUXIP

TBZTTIFGFFMTUIBUTIFIBTCFFOQVUUISPVHIBNFBUHSJOEFSUIFUIFSBQJTUDPVME

BTLi8IBUJTZPVSFYQFSJFODFPGCFJOHHSPVOENFBU wPSi8IPJTEPJOHUIFHSJOE

JOH w*UJTFTTFOUJBMUPFODPVSBHFUIJTDMJFOUUPTBZNPSFBCPVUXIBUTIFJTFYQFSJ

FODJOH5IFBSUPGUIFSBQZDPOTJTUTPGBTTJTUJOHDMJFOUTJOUSBOTMBUJOHUIFNFBOJOH

PGUIFJSNFUBQIPSTTPUIBUUIFZDBOCFEFBMUXJUIJOUIFSBQZ

t Listening for language that uncovers a story.1PMTUFSBMTPUFBDIFTUIF

WBMVF

PGXIBUIFDBMMTinFTIJOHPVUBnBTIw)FSFQPSUTUIBUDMJFOUTPGUFOVTFMBOHVBHF

UIBUJTFMVTJWFZFUHJWFTTJHOJmDBOUDMVFTUPBTUPSZUIBUJMMVTUSBUFTUIFJSMJGFTUSVH

HMFT&GGFDUJWFUIFSBQJTUTMFBSOUPQJDLPVUBTNBMMQBSUPGXIBUTPNFPOFTBZTBOE

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

222

CHAPTER EIGHT

UIFOUPGPDVTPOBOEEFWFMPQUIJTFMFNFOU$MJFOUTBSFMJLFMZUPTMJEFPWFSQSFHOBOU

QISBTFTCVUUIFBMFSUUIFSBQJTUDBOBTLRVFTUJPOTUIBUXJMMIFMQUIFNnFTIPVUUIFJS

TUPSZMJOF*UJTFTTFOUJBMGPSUIFSBQJTUTUPQBZBUUFOUJPOUPXIBUJTGBTDJOBUJOHBCPVU

UIFQFSTPOXIPJTTJUUJOHCFGPSFUIFNBOEHFUUIBUQFSTPOUPUFMMBTUPSZ

*OBXPSLTIPQ*PCTFSWFE&SW1PMTUFSTNBHOJmDFOUTUZMFJODIBMMFOHJOHBQFSTPO

+PFXIPIBEWPMVOUFFSFEGPSBEFNPOTUSBUJPOPGBOJOEJWJEVBMTFTTJPO"MUIPVHI

+PFIBEBGBTDJOBUJOHTUPSZUPSFWFBMBCPVUBQBSUJDVMBSGBDFUPGIJTMJGFIFXBTQSF

TFOUJOHIJNTFMGJOBMJGFMFTTNBOOFSBOEUIFFOFSHZ XBTHPJOHnBU&WFOUVBMMZ

1PMTUFSBTLFEIJNi"SFZPVLFFQJOHNZJOUFSFTUSJHIUOPX %PFTJUNBUUFSUPZPV

XIFUIFS*BNFOHBHFEXJUIZPV w+PFMPPLFETIPDLFECVUIFTPPOHPUUIFQPJOU

)FBDDFQUFE1PMTUFSTDIBMMFOHFUPNBLFTVSFUIBUIFOPUPOMZLFQUUIFUIFSBQJTU

JOUFSFTUFECVUBMTPQSFTFOUFEIJNTFMGJOBXBZUPLFFQUIPTFJOUIFBVEJFODFJOUFS

FTUFE*UXBTDMFBSUIBU1PMTUFSXBTEJSFDUJOH+PFTBUUFOUJPOUPBQSPDFTTPGIPXIF

XBTFYQSFTTJOHIJTGFFMJOHTBOEMJGFFYQFSJFODFTSBUIFSUIBOCFJOHDPODFSOFEXJUI

XIBUIFXBTUBMLJOHBCPVU

1PMTUFSCFMJFWFTTUPSZUFMMJOHJTOPUBMXBZTBGPSNPGSFTJTUBODF*OTUFBEJUDBO

CFUIFIFBSUPGUIFUIFSBQFVUJDQSPDFTT)FNBJOUBJOTUIBUQFPQMFBSFTUPSZUFMMJOH

CFJOHT5IFUIFSBQJTUTUBTLJTUPBTTJTUDMJFOUTJOUFMMJOHUIFJSTUPSZJOBMJWFMZXBZ

1PMTUFSCCFMJFWFTNBOZQFPQMFDPNFUPUIFSBQZUPDIBOHFUIFUJUMFTPGUIFJS

TUPSJFTSBUIFSUIBOUPUSBOTGPSNUIFJSMJGFTUPSJFT

Client’s Experience in Therapy

5IFHFOFSBMPSJFOUBUJPOPG(FTUBMUUIFSBQZJTUPXBSEEJBMPHVF8IFSFBT'SJU[1FSMT

XPVMEIBWFTBJEUIBUDMJFOUTNVTUCFDPOGSPOUFEBCPVUIPXUIFZBWPJEBDDFQUJOH

SFTQPOTJCJMJUZUIFEJBMPHJDBUUJUVEFDBSSJFEJOUP(FTUBMUUIFSBQZPSJHJOBMMZCZ-BVSB

1FSMTDSFBUFTUIFHSPVOEGPSBNFFUJOHQMBDFCFUXFFODMJFOUBOEUIFSBQJTU0UIFS

JTTVFTUIBUDBOCFDPNFUIFGPDBMQPJOUPGUIFSBQZJODMVEFUIFDMJFOUoUIFSBQJTUSFMB

UJPOTIJQBOEUIFTJNJMBSJUJFTJOUIFXBZTDMJFOUTSFMBUFUPUIFUIFSBQJTUBOEUPPUIFST

JOUIFJSFOWJSPONFOU

(FTUBMUUIFSBQJTUTEPOPUNBLFJOUFSQSFUBUJPOTUIBUFYQMBJOUIFEZOBNJDTPGBO

JOEJWJEVBMTCFIBWJPSPSUFMMBDMJFOUXIZIFPSTIFJTBDUJOHJOBDFSUBJOXBZCFDBVTF

UIFZBSFOPUUIFFYQFSUTPOUIFDMJFOUTFYQFSJFODF$MJFOUTJO(FTUBMUUIFSBQZBSF

BDUJWFQBSUJDJQBOUTXIPNBLFUIFJSPXOJOUFSQSFUBUJPOTBOENFBOJOHT*UJTUIFZ

XIPJODSFBTFBXBSFOFTTBOEEFDJEFXIBUUIFZXJMMPSXJMMOPUEPXJUIUIFJSQFSTPOBM

NFBOJOH

.JSJBN1PMTUFSEFTDSJCFEBUISFFTUBHFJOUFHSBUJPOTFRVFODFUIBUDIBS

BDUFSJ[FTDMJFOUHSPXUIJOUIFSBQZ5IFmSTUQBSUPGUIJTTFRVFODFDPOTJTUTPGdis-

covery.$MJFOUTBSFMJLFMZUPSFBDIBOFXSFBMJ[BUJPOBCPVUUIFNTFMWFTPSUPBDRVJSF

BOPWFMWJFXPGBOPMETJUVBUJPOPSUIFZNBZUBLFBOFXMPPLBUTPNFTJHOJmDBOU

QFSTPOJOUIFJSMJWFT4VDIEJTDPWFSJFTPGUFODPNFBTBTVSQSJTFUPUIFN

5IF TFDPOE TUBHF PG UIF JOUFHSBUJPO TFRVFODF JT accommodation, XIJDI JO

WPMWFTDMJFOUTSFDPHOJ[JOHUIBUUIFZIBWFBDIPJDF$MJFOUTCFHJOCZUSZJOHPVUOFX

CFIBWJPSTJOUIFTVQQPSUJWFFOWJSPONFOUPGUIFUIFSBQZPGmDFBOEUIFOUIFZFY

QBOEUIFJSBXBSFOFTTPGUIFXPSME.BLJOHOFXDIPJDFTJTPGUFOEPOFBXLXBSE

MZ CVU XJUI UIFSBQFVUJD TVQQPSU DMJFOUT DBO HBJO TLJMM JO DPQJOH XJUI EJGmDVMU

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

223

GESTALT THERAPY

TJUVBUJPOT$MJFOUTBSFMJLFMZUPQBSUJDJQBUFJOPVUPGPGmDFFYQFSJNFOUTXIJDIDBO

CFEJTDVTTFEJOUIFOFYUUIFSBQZTFTTJPO

5IFUIJSETUBHFPGUIFJOUFHSBUJPOTFRVFODFJTassimilation,XIJDIJOWPMWFTDMJ

FOUTMFBSOJOHIPXUPJOnVFODFUIFJSFOWJSPONFOU"UUIJTQIBTFDMJFOUTGFFMDBQB

CMFPGEFBMJOHXJUIUIFTVSQSJTFTUIFZFODPVOUFSJOFWFSZEBZMJWJOH5IFZBSFOPX

CFHJOOJOHUPEPNPSFUIBOQBTTJWFMZBDDFQUUIFFOWJSPONFOU#FIBWJPSBUUIJTTUBHF

NBZJODMVEF UBLJOHBTUBOEPO B DSJUJDBMJTTVF&WFOUVBMMZDMJFOUT EFWFMPQDPOm

EFODFJOUIFJSBCJMJUZUPJNQSPWFBOEJNQSPWJTF*NQSPWJTBUJPOJTUIFDPOmEFODF

UIBUDPNFTGSPNLOPXMFEHFBOETLJMMT$MJFOUTBSFBCMFUPNBLFDIPJDFTUIBUXJMM

SFTVMUJOHFUUJOHXIBUUIFZXBOU5IFUIFSBQJTUQPJOUTPVUUIBUTPNFUIJOHIBTCFFO

BDDPNQMJTIFEBOEBDLOPXMFEHFTUIFDIBOHFTUIBUIBWFUBLFOQMBDFXJUIJOUIFDMJ

FOU"UUIJTQIBTFDMJFOUTIBWFMFBSOFEXIBUUIFZDBOEPUPNBYJNJ[FUIFJSDIBODFT

PGHFUUJOHXIBUJTOFFEFEGSPNUIFJSFOWJSPONFOU

Relationship Between Therapist and Client

"TBOFYJTUFOUJBMCSBOEPGUIFSBQZ(FTUBMUQSBDUJDFJOWPMWFTBQFSTPOUPQFSTPOSF

MBUJPOTIJQCFUXFFOUIFSBQJTUBOEDMJFOU5IFSBQJTUTBSFSFTQPOTJCMFGPSUIFRVBMJUZ

PGUIFJSQSFTFODFGPSLOPXJOHUIFNTFMWFTBOEUIFDMJFOUBOEGPSSFNBJOJOHPQFO

UPUIFDMJFOU5IFZBSFBMTPSFTQPOTJCMFGPSFTUBCMJTIJOHBOENBJOUBJOJOHBUIFSB

QFVUJDBUNPTQIFSFUIBUXJMMGPTUFSBTQJSJUPGXPSLPOUIFDMJFOUTQBSU*UJTJNQPS

UBOUUIBUUIFSBQJTUTBMMPXUIFNTFMWFTUPCFBGGFDUFECZUIFJSDMJFOUTBOEUIBUUIFZ

BDUJWFMZTIBSF UIFJS PXO QSFTFOU QFSDFQUJPOTBOE FYQFSJFODFT BT UIFZ FODPVOUFS

DMJFOUTJOUIFIFSFBOEOPX

(FTUBMUUIFSBQJTUTOPUPOMZBMMPXUIFJSDMJFOUTUPCFXIPUIFZBSFCVUBMTPSF

NBJOUIFNTFMWFTBOEEPOPUHFUMPTUJOBSPMF5IFSBQJTUTBSFFYQFDUFEUPFODPVOUFS

DMJFOUTXJUIIPOFTUBOEJNNFEJBUFSFBDUJPOTBOEUIFSBQJTUTTIBSFUIFJSQFSTPOBM

FYQFSJFODFBOETUPSJFTJOSFMFWBOUBOEBQQSPQSJBUFXBZT'VSUIFSUIFZHJWFGFFE

CBDLUIBUBMMPXTDMJFOUTUPEFWFMPQBOBXBSFOFTTPGXIBUUIFZBSFBDUVBMMZEPJOH

#SPXOTVHHFTUTUIBUUIFSBQJTUTTIBSFUIFJSSFBDUJPOTXJUIDMJFOUTZFUTIF

BMTPTUSFTTFTUIFJNQPSUBODFPGEFNPOTUSBUJOHBOBUUJUVEFPGSFTQFDUBDDFQUBODF

QSFTFOUDFOUFSFEOFTTBOEQSFTFODF

"OVNCFSPGXSJUFSTIBWFHJWFODFOUSBMJNQPSUBODFUPUIF*5IPVSFMBUJPOTIJQ

BOE UIF RVBMJUZ PG UIF UIFSBQJTUT QSFTFODF BT PQQPTFE UP UFDIOJDBM TLJMMT 5IFZ

XBSOPGUIFEBOHFSTPGCFDPNJOHUFDIOJRVFCPVOEBOEMPTJOHTJHIUPGUIFJSPXO

CFJOH BT UIFZ FOHBHF UIF DMJFOU 5IF UIFSBQJTUT BUUJUVEFT BOE CFIBWJPS BOE UIF

SFMBUJPOTIJQUIBUJTFTUBCMJTIFEBSFXIBUSFBMMZDPVOU#SPXO'SFX-FF

.FMOJDL/FWJT1BSMFUU&1PMTUFSBC.1PMTUFS

:POUFG+BDPCT5IFTFXSJUFSTQPJOUPVUUIBUDVSSFOU(FTUBMUUIFSBQZ

IBTNPWFECFZPOEFBSMJFSUIFSBQFVUJDQSBDUJDFT

.BOZDPOUFNQPSBSZ (FTUBMUUIFSBQJTUT QMBDF JODSFBTJOH FNQIBTJT PO GBDUPST

TVDIBTQSFTFODFBVUIFOUJDEJBMPHVFHFOUMFOFTTNPSFEJSFDUTFMGFYQSFTTJPOCZ

UIFUIFSBQJTUEFDSFBTFEVTFPGTUFSFPUZQJDFYFSDJTFTBOEHSFBUFSUSVTUJOUIFDMJFOUT

FYQFSJFODJOH-BVSB1FSMTTUSFTTFEUIFOPUJPOUIBUUIFQFSTPOPGUIFUIFSB

QJTUJTNPSFJNQPSUBOUUIBOVTJOHUFDIOJRVFT4IFTBZTi5IFSFBSFBTNBOZTUZMFT

BTUIFSF BSF UIFSBQJTUT BOE DMJFOUT XIP EJTDPWFS UIFNTFMWFT BOE FBDI PUIFSBOE

UPHFUIFSJOWFOU UIFJS SFMBUJPOTIJQwQ  +BDPCT  BTTFSUT UIBU B DVSSFOU

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

224

CHAPTER EIGHT

USFOE JO (FTUBMU QSBDUJDF JT UPXBSE HSFBUFS FNQIBTJT PO UIF DMJFOUoUIFSBQJTU SF

MBUJPOTIJQ SBUIFS UIBO PO UFDIOJRVFT EJWPSDFE GSPN UIF DPOUFYU PG UIJT FODPVO

UFS4IFCFMJFWFTUIFSBQJTUTXIPPQFSBUFGSPNUIJTPSJFOUBUJPOBSFBCMFUPFTUBCMJTI

B QSFTFOUDFOUFSFE OPOKVEHNFOUBM EJBMPHVF UIBU BMMPXT DMJFOUT UP EFFQFO UIFJS

BXBSFOFTTBOEUPNBLFDPOUBDUXJUIBOPUIFSQFSTPO

1PMTUFS BOE 1PMTUFS  FNQIBTJ[FE UIF JNQPSUBODF PG UIFSBQJTUT LOPX

JOHUIFNTFMWFTBOECFJOHUIFSBQFVUJDJOTUSVNFOUT-JLFBSUJTUTXIPOFFEUPCFJO

UPVDIXJUIXIBUUIFZBSFQBJOUJOHUIFSBQJTUTBSFBSUJTUJDQBSUJDJQBOUTJOUIFDSFB

UJPOPGOFXMJGF5IF1PMTUFSTJNQMPSFUIFSBQJTUTUPVTFUIFJSPXOFYQFSJFODFTBT

FTTFOUJBM JOHSFEJFOUT JO UIF UIFSBQZ QSPDFTT "DDPSEJOH UP UIFN UIFSBQJTUT BSF

NPSFUIBONFSFSFTQPOEFSTPSDBUBMZTUT*GUIFZBSFUPNBLFFGGFDUJWFDPOUBDUXJUI

DMJFOUTUIFSBQJTUTNVTUCFJOUVOFXJUICPUIUIFJSDMJFOUTBOEUIFNTFMWFT5IFSBQZ

JTBUXPXBZFOHBHFNFOUUIBUDIBOHFTCPUIUIFDMJFOUBOEUIFUIFSBQJTU*GUIFSB

QJTUTBSFOPUTFOTJUJWFMZUVOFEUPUIFJSPXORVBMJUJFTPGUFOEFSOFTTUPVHIOFTTBOE

DPNQBTTJPOBOEUPUIFJSSFBDUJPOTUPUIFDMJFOUUIFZCFDPNFUFDIOJDJBOT&YQFSJ

NFOUTTIPVMECFBJNFEBUBXBSFOFTTOPUBUTJNQMFTPMVUJPOTUPBDMJFOUTQSPCMFN

application: therapeutic

techniques and procedures

The Experiment in Gestalt Therapy

"MUIPVHIUIF(FTUBMUBQQSPBDIJTDPODFSOFEXJUIUIFPCWJPVTJUTTJNQMJDJUZTIPVME

OPUCFUBLFOUPNFBOUIBUUIFUIFSBQJTUTKPCJTFBTZ%FWFMPQJOHBWBSJFUZPGJOUFS

WFOUJPOTJTTJNQMFCVUFNQMPZJOHUIFTFNFUIPETJOBNFDIBOJDBMGBTIJPOBMMPXT

DMJFOUTUPDPOUJOVFJOBVUIFOUJDMJWJOH*GDMJFOUTBSFUPCFDPNFBVUIFOUJDUIFZOFFE

DPOUBDUXJUIBOBVUIFOUJDUIFSBQJTU:POUFGBOE+BDPCTQPJOUPVUUIBUUFDI

OJRVFTJO(FTUBMUUIFSBQZBSFDPOTJEFSFEFYQFSJNFOUTBOEDMJFOUTIFBSUIFNFT

TBHFi5SZUIJTPVUBOETFFXIBUJUJTMJLFGPSZPVw(FTUBMUUIFSBQZNFUIPEPMPHZ

JTUBJMPSFEUPUIFOFFETPGDMJFOUTBOEFYQFSJNFOUTBSFUZQJDBMMZQSFTFOUFEJOBO

JOWJUBUJPOBMNBOOFS%S+PO'SFXB(FTUBMU UIFSBQJTU EFNPOTUSBUFT (FTUBMU JO

UFSWFOUJPOTBQQMJFEUPUIFDBTFPG3VUIJOCase Approach to Counseling and Psycho-

therapy$PSFZDIBQ

#FGPSF EJTDVTTJOH UIF WBSJFUZ PG (FTUBMU NFUIPET ZPV DPVME JODMVEF JO ZPVS

SFQFSUPJSFPGDPVOTFMJOHQSPDFEVSFTJUJTIFMQGVMUPEJGGFSFOUJBUFCFUXFFOFYFSDJTFT

PS UFDIOJRVFT BOE FYQFSJNFOUT Exercises BSF SFBEZNBEF UFDIOJRVFT UIBU BSF

TPNFUJNFTVTFEUPNBLFTPNFUIJOHIBQQFOJOBUIFSBQZTFTTJPOPSUPBDIJFWFB

HPBM5IFZDBOCFDBUBMZTUTGPSJOEJWJEVBMXPSLPSGPSQSPNPUJOHJOUFSBDUJPOBNPOH

NFNCFSTPGBUIFSBQZHSPVQ Experiments,JODPOUSBTU HSPXPVUPGUIFJOUFSBD

UJPOCFUXFFODMJFOUBOEUIFSBQJTUBOEUIFZFNFSHFXJUIJOUIJTEJBMPHJDQSPDFTT

5IFZDBOCFDPOTJEFSFEUIFWFSZDPSOFSTUPOFPGFYQFSJFOUJBMMFBSOJOH'SFX

EFmOFTUIFFYQFSJNFOU iBTBNFUIPEUIBUTIJGUTUIFGPDVTPGDPVOTFMJOHGSPNUBML

JOHBCPVUBUPQJDUPBOBDUJWJUZUIBUXJMMIFJHIUFOUIFDMJFOUTBXBSFOFTTBOEVOEFS

TUBOEJOH UISPVHI FYQFSJFODFw Q  "DDPSEJOH UP .FMOJDL BOE /FWJT 

FYQFSJNFOUTIBWFCFFODPOGVTFEXJUIUFDIOJRVFTi"UFDIOJRVFJTBQFSGPSNFEFY

QFSJNFOUXJUITQFDJmDMFBSOJOHHPBMT"OFYQFSJNFOUPOUIFPUIFSIBOEnPXT

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

225

GESTALT THERAPY

EJSFDUMZGSPNQTZDIPUIFSBQZUIFPSZBOEJTDSBGUFEUPmUUIFJOEJWJEVBMBTIFPSTIF

FYJTUTJOUIFIFSFBOEOPXwQ5IFQVSQPTFPGBOFYQFSJNFOUJTUPBTTJTUBO

JOEJWJEVBMJOBDUJWFTFMGFYQMPSBUJPO.FMOJDLBOE/FWJTTVHHFTUVTJOHUIF(FTUBMU

DPOUJOVVNPGFYQFSJFODFBTBHVJEFGPSDVTUPNEFTJHOJOHFYQFSJNFOUT

5IFFYQFSJNFOUJTGVOEBNFOUBMUP(FTUBMUUIFSBQZ;JOLFSTFFTUIFSB

QZTFTTJPOTBTBTFSJFTPGFYQFSJNFOUTXIJDIBSFUIFBWFOVFTGPSDMJFOUTUPMFBSO

FYQFSJFOUJBMMZ8IBUJTMFBSOFEGSPNBOFYQFSJNFOUJTBTVSQSJTFUPCPUIUIFDMJFOU

BOEUIFUIFSBQJTU(FTUBMUFYQFSJNFOUTBSFBDSFBUJWFBEWFOUVSFBOEBXBZJOXIJDI

DMJFOUTDBOFYQSFTT UIFNTFMWFT CFIBWJPSBMMZ&YQFSJNFOUTBSF TQPOUBOFPVT POF

PGBLJOEBOESFMFWBOUUPBQBSUJDVMBSNPNFOUBOEBQBSUJDVMBSEFWFMPQNFOUPGB

mHVSFGPSNBUJPOQSPDFTT5IFZBSFOPUEFTJHOFEUPBDIJFWFBQBSUJDVMBSHPBMCVU

PDDVSJOUIFDPOUFYUPGBNPNFOUUPNPNFOUDPOUBDUJOHQSPDFTTCFUXFFOUIFSBQJTU

BOE DMJFOU 1PMTUFS  JOEJDBUFT UIBU FYQFSJNFOUT BSF EFTJHOFE CZ UIF UIFSB

QJTUBOEFWPMWFGSPNUIF UIFNFBMSFBEZEFWFMPQJOH UISPVHIUIFSBQFVUJDFOHBHF

NFOUTVDIBTUIFDMJFOUTSFQPSUPGOFFETESFBNTGBOUBTJFTBOECPEZBXBSFOFTT

(FTUBMUUIFSBQJTUTJOWJUFDMJFOUTUPFOHBHFJOFYQFSJNFOUTUIBUMFBEUPGSFTIFNP

UJPOBMFYQFSJFODJOHBOEOFXJOTJHIUT4USVNQGFM(PMENBO&YQFSJNFOUB

UJPOJTBOBUUJUVEFJOIFSFOUJOBMM(FTUBMUUIFSBQZJUJTBDPMMBCPSBUJWFQSPDFTTXJUI

GVMMQBSUJDJQBUJPOPGUIFDMJFOU$MJFOUTUFTUBOFYQFSJNFOUUPEFUFSNJOFXIBUEPFT

BOEEPFTOPUmUGPSUIFNUISPVHIUIFJSPXOBXBSFOFTT:POUFG

.JSJBN1PMTUFSTBZTUIBUBOFYQFSJNFOUJTBXBZUPCSJOHPVUTPNFLJOE

PGJOUFSOBMDPOnJDUCZNBLJOHUIJTTUSVHHMFBOBDUVBMQSPDFTT*UJTBJNFEBUGBDJMJUBU

JOHBDMJFOUTBCJMJUZUPXPSLUISPVHIUIFTUVDLQPJOUTPGIJTPSIFSMJGF&YQFSJNFOUT

FODPVSBHFTQPOUBOFJUZBOEJOWFOUJWFOFTTCZCSJOHJOHUIFQPTTJCJMJUJFTGPSBDUJPO

EJSFDUMZJOUPUIFUIFSBQZTFTTJPO#ZESBNBUJ[JOHPSQMBZJOHPVUQSPCMFNTJUVBUJPOT

PSSFMBUJPOTIJQTJOUIFSFMBUJWFTBGFUZPGUIFUIFSBQZDPOUFYUDMJFOUTJODSFBTFUIFJS

SBOHFPGnFYJCJMJUZPGCFIBWJPS"DDPSEJOHUP.1PMTUFS(FTUBMUFYQFSJNFOUTDBO

UBLFNBOZGPSNTJNBHJOJOHBUISFBUFOJOHGVUVSFFODPVOUFSTFUUJOHVQBEJBMPHVF

CFUXFFOBDMJFOUBOETPNFTJHOJmDBOUQFSTPOJOIJTPSIFSMJGFESBNBUJ[JOHUIF

NFNPSZ PG B QBJOGVM FWFOU SFMJWJOH B QBSUJDVMBSMZ QSPGPVOE FBSMZ FYQFSJFODF JO

UIFQSFTFOUBTTVNJOHUIFJEFOUJUZPGPOFTNPUIFSPSGBUIFSUISPVHISPMFQMBZJOH

GPDVTJOHPOHFTUVSFTQPTUVSFBOEPUIFSOPOWFSCBMTJHOTPGJOOFSFYQSFTTJPOPS

DBSSZJOHPOBEJBMPHVFCFUXFFOUXPDPOnJDUJOHBTQFDUTXJUIJOUIFQFSTPO5ISPVHI

UIFTFFYQFSJNFOUTDMJFOUTNBZBDUVBMMZFYQFSJFODFUIFGFFMJOHTBTTPDJBUFEXJUIUIFJS

DPOnJDUT&YQFSJNFOUTCSJOHTUSVHHMFTUPMJGFCZJOWJUJOHDMJFOUTUPFOBDUUIFNJO

UIFQSFTFOU*UJTDSVDJBMUIBUFYQFSJNFOUTCFUBJMPSFEUPFBDIJOEJWJEVBMBOEVTFEJO

BUJNFMZBOEBQQSPQSJBUFNBOOFSUIFZBMTPOFFEUPCFDBSSJFEPVUJOBDPOUFYUUIBU

PGGFSTBCBMBODFCFUXFFOTVQQPSUBOESJTL4FOTJUJWJUZBOEDBSFGVMBUUFOUJPOPOUIF

UIFSBQJTUTQBSUBSFFTTFOUJBMTPUIBUDMJFOUTBSFiOFJUIFSCMBTUFEJOUPFYQFSJFODFTUIBU

BSFUPPUISFBUFOJOHOPSBMMPXFEUPTUBZJOTBGFCVUJOGFSUJMFUFSSJUPSZw1PMTUFS

1PMTUFSQ

Preparing Clients for Gestalt Experiments

*GTUVEFOUTJOUSBJOJOHMJNJUUIFJSVOEFSTUBOEJOHPG(FTUBMUUIFSBQZUPTJNQMZSFBE

JOHBCPVUUIFBQQSPBDI(FTUBMUNFUIPETBSFMJLFMZUPTFFNBCTUSBDUBOEUIFOPUJPO

PGFYQFSJNFOUTNBZTFFNTUSBOHF"TLJOHDMJFOUTUPiCFDPNFwBOPCKFDUJOPOF

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

226

CHAPTER EIGHT

PG UIFJS ESFBNT GPS JOTUBODF NBZ TFFN TJMMZ BOE QPJOUMFTT *U JT JNQPSUBOU GPS

DPVOTFMPSTUPpersonallyFYQFSJFODFUIFQPXFSPG(FTUBMUFYQFSJNFOUTBOEUPGFFM

DPNGPSUBCMFTVHHFTUJOHUIFNUPDMJFOUT*OUIJTSFHBSEJUDBOCFNPTUVTFGVMGPS

USBJOFFTUPQFSTPOBMMZFYQFSJFODF(FTUBMUNFUIPETBTBDMJFOU

*UJTBMTPFTTFOUJBM UIBUDPVOTFMPSTFTUBCMJTI BSFMBUJPOTIJQXJUI UIFJSDMJFOUT

TPUIBUUIFDMJFOUTXJMMGFFMUSVTUJOHFOPVHIUPQBSUJDJQBUFJOUIFMFBSOJOHUIBUDBO

SFTVMUGSPN(FTUBMUFYQFSJNFOUT$MJFOUTXJMMHFUNPSFGSPN(FTUBMUFYQFSJNFOUTJG

UIFZBSFPSJFOUFEBOEQSFQBSFEGPSUIFN5ISPVHIBUSVTUJOHSFMBUJPOTIJQXJUIUIF

UIFSBQJTUDMJFOUTBSFMJLFMZUPSFDPHOJ[FUIFJSSFTJTUBODFBOEBMMPXUIFNTFMWFTUP

QBSUJDJQBUFJOUIFTFFYQFSJNFOUT

*G DMJFOUT BSF UP DPPQFSBUF DPVOTFMPST NVTU BWPJE EJSFDUJOH UIFN JO B DPN

NBOEJOHGBTIJPOUPDBSSZPVUBOFYQFSJNFOU5ZQJDBMMZ*BTLDMJFOUTJGUIFZBSFXJMM

JOHUPUSZPVUBOFYQFSJNFOUUPTFFXIBUUIFZNJHIUMFBSOGSPNJU*BMTPUFMMDMJFOUT

UIBUUIFZDBOTUPQXIFOUIFZDIPPTFUPTPUIFQPXFSJTXJUIUIFN$MJFOUTBUUJNFT

TBZUIBUUIFZGFFMTJMMZPSTFMGDPOTDJPVTPSUIBUUIFUBTLGFFMTBSUJmDJBMPSVOSFBM"U

TVDIUJNFT*BNMJLFMZUPSFTQPOECZBTLJOHi"SFZPVXJMMJOHUPHJWFJUBUSZBOE

TFFXIBUIBQQFOT w

*DBOOPUPWFSFNQIBTJ[FUIFQPXFSPGUIFUIFSBQFVUJDSFMBUJPOTIJQBOEUIFOF

DFTTJUZGPSUSVTUBTUIFGPVOEBUJPOGPSJNQMFNFOUJOHBOZFYQFSJNFOU*G*NFFUXJUI

IFTJUBUJPO*UFOEUPCFJOUFSFTUFEJOFYQMPSJOHUIFDMJFOUTSFMVDUBODF*UJTIFMQGVM

UP LOPX UIF SFBTPO UIF DMJFOU JT TUPQQJOH )FTJUBUJPO JO CFDPNJOH FNPUJPOBMMZ

JOWPMWFEPGUFOJTBGVODUJPOPGUIFDMJFOUTDVMUVSBMCBDLHSPVOE4PNFDMJFOUTIBWF

CFFODPOEJUJPOFEUPXPSLIBSEUPNBJOUBJOFNPUJPOBMDPOUSPM5IFZNBZIBWFSFT

FSWBUJPOTBCPVUFYQSFTTJOHJOUFOTFGFFMJOHTPQFOMZFWFOJGUIFZBSFJOBOFNPUJPOBM

TUBUF5IJTDBOXFMMCFEVFUPUIFJSTPDJBMJ[BUJPOBOEUPDVMUVSBMOPSNTUIFZBCJEF

CZ*OTPNFDVMUVSFTJUJTDPOTJEFSFESVEFUPFYQSFTTFNPUJPOTPQFOMZBOEUIFSF

BSFDFSUBJODVMUVSBMJOKVODUJPOTBHBJOTUTIPXJOHPOFTWVMOFSBCJMJUZPSQTZDIPMPHJ

DBMQBJO(FTUBMUFYQFSJNFOUTXPSLCFTUXIFOUIFUIFSBQJTUJTSFTQFDUGVMPGUIFDMJ

FOUTDVMUVSBMCBDLHSPVOEBOEJTJOHPPEDPOUBDUXJUIUIFQFSTPO5IFSBQJTUTOFFE

UPVOEFSTUBOEUIBUGPSDMJFOUTXJUIBMPOHIJTUPSZPGDPOUBJOJOHUIFJSGFFMJOHTUIFZ

XJMMNPTUMJLFMZCFSFMVDUBOUUPQBSUJDJQBUFJOFYQFSJNFOUTUIBUBSFMJLFMZUPCSJOH

UIFJSFNPUJPOTUPUIFTVSGBDF0GDPVSTFNBOZNFOIBWFCFFOTPDJBMJ[FEOPUUPFY

QSFTTJOUFOTFGFFMJOHT5IFJSSFMVDUBODFUPBMMPXUIFNTFMWFTUPCFFNPUJPOBMTIPVME

CFEFBMUXJUIJOBSFTQFDUGVMNBOOFS

0UIFSDMJFOUTNBZSFTJTUCFDPNJOHFNPUJPOBMMZJOWPMWFECFDBVTFPGUIFJSGFBS

MBDLPGUSVTUDPODFSOPWFSMPTJOHDPOUSPMPSTPNFPUIFSDPODFSO5IFwayJOXIJDI

DMJFOUTSFTJTUEPJOHBOFYQFSJNFOUSFWFBMTBHSFBUEFBMBCPVUUIFJSQFSTPOBMJUZBOE

UIFJSXBZPGCFJOHJOUIFXPSME5IFSFGPSF(FTUBMUUIFSBQJTUTFYQFDUBOESFTQFDUUIF

FNFSHFODFPGSFMVDUBODFPOBDMJFOUTQBSU5IFUIFSBQJTUTBJNJTOPUUPFMJNJOBUF

DMJFOUTEFGFOTFTCVUUPNFFUDMJFOUTXIFSFWFSUIFZBSF

5IFFTTFODFPGDVSSFOU (FTUBMUUIFSBQZJOWPMWFTIPOPSJOHBOESFTQFDUJOHSF

MVDUBODFPSSFTJTUBODFBOETVQQPSUJOHDMJFOUTUPCFDPNFNPSFBXBSFPGUIFJSFY

QFSJFODF *G UIF UIFSBQJTU NFFUT XJUI IFTJUBUJPO JU JT B HPPE JEFB UP FYQMPSF JUT

NFBOJOHGPSUIFDMJFOU$POUFNQPSBSZ(FTUBMUUIFSBQZQMBDFTNVDIMFTTFNQIBTJT

POSFTJTUBODFUIBOUIFFBSMZWFSTJPOPG(FTUBMUUIFSBQZ"MUIPVHIJUJTQPTTJCMFUP

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

227

GESTALT THERAPY

MPPL BU iSFTJTUBODF UP BXBSFOFTTw BOE iSFTJTUBODF UP DPOUBDUw UIF JEFB PG SFTJTU

BODFJTWJFXFEBTVOOFDFTTBSZCZTPNF(FTUBMUUIFSBQJTUT'SFXBSHVFTUIBU

UIFOPUJPOPGSFTJTUBODFJTDPNQMFUFMZGPSFJHOUPUIFUIFPSZBOEQSBDUJDFPG(FTUBMU

UIFSBQZBOETVHHFTUTUIBUSFTJTUBODFJTBUFSNGSFRVFOUMZVTFEGPSDMJFOUTXIPBSF

OPUEPJOHXIBUUIFUIFSBQJTUXBOUTUIFNUPEP1PMTUFSBOE1PMTUFSTVHHFTU

UIBUJUJTCFTUGPSUIFSBQJTUTUPPCTFSWFXIBUJTBDUVBMMZBOEQSFTFOUMZIBQQFOJOH

SBUIFS UIBO USZJOH UP NBLF TPNFUIJOH IBQQFO 5IJT HFUT BXBZ GSPN UIF OPUJPO

UIBUDMJFOUT BSF SFTJTUJOH BOEUIVT CFIBWJOH XSPOHMZ"DDPSEJOH UP UIF 1PMTUFST

DIBOHFPDDVSTUISPVHIDPOUBDUBOEBXBSFOFTTPOFEPFTOPUIBWFUPUSZUPDIBOHF

.BVSFSXSJUFTBCPVUiBQQSFDJBUJOHSFTJTUBODFwBTBDSFBUJWFBEKVTUNFOUUP

BTJUVBUJPOSBUIFSUIBOTPNFUIJOHUPPWFSDPNF.BVSFSDMBJNTUIBUXFOFFEUPSF

TQFDUSFTJTUBODFUBLFJUTFSJPVTMZBOEWJFXJUBTiUIFFOFSHZwBOEOPUiUIFFOFNZw

*UJTXFMMUPSFNFNCFSUIBU(FTUBMUFYQFSJNFOUTBSFEFTJHOFEUPFYQBOEDMJFOUT

BXBSFOFTTBOEUPIFMQUIFNUSZPVUOFXNPEFTPGCFIBWJPS8JUIJOUIFTBGFUZPGUIF

UIFSBQFVUJDTJUVBUJPODMJFOUTBSFHJWFOPQQPSUVOJUJFTBOEFODPVSBHFEUPiUSZPOwB

OFX CFIBWJPS 5IJT IFJHIUFOT UIF BXBSFOFTT PG B QBSUJDVMBS BTQFDU PG GVODUJPO

JOHXIJDIMFBETUPJODSFBTFETFMGVOEFSTUBOEJOH#SFTIHPME:POUFG

&YQFSJNFOUTBSFPOMZNFBOTUPUIFFOEPGIFMQJOHQFPQMFCFDPNFNPSFBXBSFBOE

NBLJOHDIBOHFTUIFZNPTUEFTJSF

The Role of Confrontation

4UVEFOUTBSFTPNFUJNFTQVUPGGCZUIFJSQFSDFQUJPOUIBUB(FTUBMUDPVOTFMPSTTUZMF

JTEJSFDUBOEDPOGSPOUBUJPOBM*UFMMNZTUVEFOUTUIBUJUJTBNJTUBLFUPFRVBUFUIF

QSBDUJDFPGBOZUIFPSZXJUIJUTGPVOEFS"TIBTCFFONFOUJPOFEUIFDPOUFNQPSBSZ

QSBDUJDFPG(FTUBMUUIFSBQZIBTQSPHSFTTFECFZPOEUIFTUZMFFYIJCJUFECZ'SJU[1FSMT

:POUFGSFGFSTUPUIF1FSMTJBOTUZMFBTBiCPPNCPPNCPPNUIFSBQZwDIBSBD

UFSJ[FECZUIFBUSJDTBCSBTJWFDPOGSPOUBUJPOBOEJOUFOTFDBUIBSTJT)FJNQMJFTUIBU

UIFDIBSJTNBUJDTUZMFPG1FSMTQSPCBCMZNFUNPSFPGIJTPXOOBSDJTTJTUJDOFFETUIBO

UIFOFFETPGIJTDMJFOUT:POUFGJTDSJUJDBMPGUIFBOUJJOUFMMFDUVBMJOEJ

WJEVBMJTUJDESBNBUJDBOEDPOGSPOUBUJPOBMnBWPSUIBUDIBSBDUFSJ[FE(FTUBMUUIFSBQZ

JOUIFiBOZUIJOHHPFTFOWJSPONFOUwPGUIFTBOET"DDPSEJOHUP:POUFG

UIFOFXFSWFSTJPOPGSFMBUJPOBM(FTUBMUUIFSBQZIBTFWPMWFEUPJODMVEFNPSF

TVQQPSUBOEJODSFBTFELJOEOFTTBOEDPNQBTTJPOJOUIFSBQZ5IJTBQQSPBDIiDPN

CJOFTTVTUBJOFEFNQBUIJDJORVJSZXJUIDSJTQDMFBSBOESFMFWBOUBXBSFOFTTGPDVT

JOHwQ1FSMTQSBDUJDFEBIJHIMZDPOGSPOUBUJPOBMBQQSPBDIBTBXBZUPEFBMXJUI

BWPJEBODF )PXFWFS UIJT DPOGSPOUBUJPOBM NPEFM JT OPU SFQSFTFOUBUJWF PG (FTUBMU

UIFSBQZBTJUJTDVSSFOUMZCFJOHQSBDUJDFE#PXNBO'SFX:POUFG

+BDPCT

$POGSPOUBUJPOJT VTFE BUUJNFTJOUIFQSBDUJDFPG (FTUBMU UIFSBQZ ZFUJUEPFT

OPUIBWFUPCFWJFXFEBTBIBSTIBUUBDLConfrontationDBOCFEPOFJOTVDIBXBZ

UIBUDMJFOUTDPPQFSBUFFTQFDJBMMZXIFOUIFZBSFinvitedUPFYBNJOFUIFJSCFIBWJPST

BUUJUVEFTBOEUIPVHIUT5IFSBQJTUTDBOFODPVSBHFDMJFOUTUPMPPLBUDFSUBJOJODPO

HSVJUJFTFTQFDJBMMZHBQTCFUXFFOUIFJSWFSCBMBOEOPOWFSCBMFYQSFTTJPO'VSUIFS

DPOGSPOUBUJPOEPFTOPUIBWFUPCFBJNFEBUXFBLOFTTFTPSOFHBUJWFUSBJUTDMJFOUT

DBOCFDIBMMFOHFEUPSFDPHOJ[FIPXUIFZBSFCMPDLJOHUIFJSTUSFOHUIT

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

228

CHAPTER EIGHT

$PVOTFMPST XIP DBSF FOPVHI UP NBLF EFNBOET PO UIFJS DMJFOUT BSF UFMMJOH

UIFNJOFGGFDUUIBUUIFZ DPVMECFJO GVMMFSDPOUBDUXJUIUIFNTFMWFTBOEPUIFST

6MUJNBUFMZIPXFWFSDMJFOUTNVTUEFDJEFGPSUIFNTFMWFTJGUIFZXBOUUPBDDFQUUIJT

JOWJUBUJPOUPMFBSONPSFBCPVUUIFNTFMWFT5IJTDBWFBUOFFETUPCFLFQUJONJOE

XJUIBMMPGUIFFYQFSJNFOUTUIBUBSFUPCFEFTDSJCFE

Gestalt Therapy Interventions

&YQFSJNFOUTDBOCFVTFGVMUPPMTUPIFMQUIFDMJFOUHBJOGVMMFSBXBSFOFTTFYQFSJ

FODFJOUFSOBMDPOnJDUTSFTPMWFJODPOTJTUFODJFTBOEEJDIPUPNJFTBOEXPSLUISPVHI

BOJNQBTTFUIBUJTQSFWFOUJOHDPNQMFUJPOPGVOmOJTIFECVTJOFTT&YFSDJTFTDBO

CFVTFEUPFMJDJUFNPUJPOQSPEVDFBDUJPOPSBDIJFWFBTQFDJmDHPBM8IFOVTFE

BU UIFJS CFTU UIF JOUFSWFOUJPOT EFTDSJCFE IFSF mU UIF UIFSBQFVUJD TJUVBUJPO BOE

IJHIMJHIUXIBUFWFSUIFDMJFOUJTFYQFSJFODJOH5IFGPMMPXJOHNBUFSJBMJTCBTFEPO

-FWJUTLZBOE1FSMTXJUINZPXOTVHHFTUJPOTBEEFEGPSJNQMFNFOUJOHUIFTF

NFUIPET

the internal dialogue exercise 0OFHPBM PG (FTUBMU UIFSBQZ JT UP

CSJOHBCPVUJOUFHSBUFEGVODUJPOJOHBOEBDDFQUBODFPGBTQFDUTPGPOFTQFSTPOBMJUZ

UIBUIBWFCFFOEJTPXOFEBOEEFOJFE(FTUBMUUIFSBQJTUTQBZDMPTFBUUFOUJPOUPTQMJUT

JOQFSTPOBMJUZGVODUJPO"NBJOEJWJTJPOJTCFUXFFOUIFiUPQEPHwBOEUIFiVOEFS

EPHwBOEUIFSBQZPGUFOGPDVTFTPOUIFXBSCFUXFFOUIFUXP

5IFUPQEPHJTSJHIUFPVTBVUIPSJUBSJBONPSBMJTUJDEFNBOEJOHCPTTZBOENB

OJQVMBUJWF5IJTJTUIFiDSJUJDBMQBSFOUwUIBUCBEHFSTXJUIiTIPVMETwBOEiPVHIUTw

BOENBOJQVMBUFTXJUIUISFBUTPGDBUBTUSPQIF5IFVOEFSEPHNBOJQVMBUFTCZQMBZ

JOHUIFSPMFPGWJDUJNCZCFJOHEFGFOTJWFBQPMPHFUJDIFMQMFTTBOEXFBLBOECZ

GFJHOJOHQPXFSMFTTOFTT5IJTJTUIF QBTTJWFTJEFUIFPOF XJUIPVUSFTQPOTJCJMJUZ

BOEUIFPOFUIBUmOETFYDVTFT

5IFUPQEPHBOEUIFVOEFSEPHBSFFOHBHFEJOBDPOTUBOUTUSVHHMFGPSDPOUSPM

5IFTUSVHHMFIFMQTUPFYQMBJOXIZPOFTSFTPMVUJPOTBOEQSPNJTFTPGUFOHPVOGVM

mMMFEBOEXIZPOFTQSPDSBTUJOBUJPOQFSTJTUT5IFUZSBOOJDBMUPQEPHEFNBOETUIBU

POFCFUIVTBOETPXIFSFBTUIFVOEFSEPHEFmBOUMZQMBZTUIFSPMFPGEJTPCFEJFOU

DIJME"TBSFTVMUPGUIJTTUSVHHMFGPSDPOUSPMUIFJOEJWJEVBMCFDPNFTGSBHNFOUFE

JOUPDPOUSPMMFSBOEDPOUSPMMFE5IFDJWJMXBSCFUXFFOUIFUXPTJEFTDPOUJOVFTXJUI

CPUITJEFTmHIUJOHGPSUIFJSFYJTUFODF

5IFDPOnJDUCFUXFFOUIFUXPPQQPTJOHQPMFTJOUIFQFSTPOBMJUZJTSPPUFEJOUIF

NFDIBOJTNPGJOUSPKFDUJPOXIJDIJOWPMWFTJODPSQPSBUJOHBTQFDUTPGPUIFSTVTVBMMZ

QBSFOUTJOUPPOFTQFSTPOBMJUZ*UJTFTTFOUJBMUIBUDMJFOUTCFDPNFBXBSFPGUIFJS

JOUSPKFDUTFTQFDJBMMZUIFUPYJDJOUSPKFDUTUIBUQPJTPOUIFQFSTPOBOEQSFWFOUQFS

TPOBMJUZJOUFHSBUJPO

5IFempty-chair techniqueJTPOFXBZPGHFUUJOHUIFDMJFOUUPFYUFSOBMJ[FUIF

JOUSPKFDUBUFDIOJRVF1FSMTVTFEBHSFBUEFBM6TJOHUXPDIBJSTUIFUIFSBQJTUBTLT

UIFDMJFOUUPTJUJOPOFDIBJSBOECFGVMMZUIFUPQEPHBOEUIFOTIJGUUPUIFPUIFSDIBJS

BOECFDPNFUIFVOEFSEPH5IFEJBMPHVFDBODPOUJOVFCFUXFFOCPUITJEFTPGUIF

DMJFOU&TTFOUJBMMZUIJTJTBSPMFQMBZJOHUFDIOJRVFJOXIJDIBMMUIFQBSUTBSFQMBZFE

CZUIFDMJFOU*OUIJTXBZUIFJOUSPKFDUTDBOTVSGBDFBOEUIFDMJFOUDBOFYQFSJFODF

UIFDPOnJDUNPSFGVMMZ5IFDPOnJDUDBOCFSFTPMWFECZUIFDMJFOUTBDDFQUBODFBOE

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

229

GESTALT THERAPY

JOUFHSBUJPOPGCPUITJEFT5IJTFYFSDJTFIFMQTDMJFOUTHFUJOUPVDIXJUIBGFFMJOHPS

BTJEFPGUIFNTFMWFTUIBUUIFZNBZCFEFOZJOHSBUIFSUIBONFSFMZUBMLJOHBCPVU

BDPOnJDUFEGFFMJOHUIFZJOUFOTJGZUIFGFFMJOHBOEFYQFSJFODFJUGVMMZ'VSUIFSCZ

IFMQJOHDMJFOUTSFBMJ[FUIBUUIFGFFMJOHJTBWFSZSFBMQBSUPGUIFNTFMWFTUIFJOUFS

WFOUJPOEJTDPVSBHFTDMJFOUTGSPNEJTBTTPDJBUJOHUIFGFFMJOH

5IFHPBMPGUIJTFYFSDJTFJTUPQSPNPUFBIJHIFSMFWFMPGJOUFHSBUJPOCFUXFFO

UIFQPMBSJUJFTBOEDPOnJDUTUIBUFYJTUJOFWFSZPOF5IFBJNJTOPUUPSJEPOFTFMGPG

DFSUBJOUSBJUTCVUUPMFBSOUPBDDFQUBOEMJWFXJUIUIFQPMBSJUJFT

making the rounds .BLJOHUIFSPVOETJTB(FTUBMUFYFSDJTFUIBUJOWPMWFT

BTLJOHBQFSTPOJOBHSPVQUPHPVQUPPUIFSTJOUIFHSPVQBOEFJUIFSTQFBLUPPS

EPTPNFUIJOH XJUI FBDI QFSTPO 5IFQVSQPTFJTUPDPOGSPOUUPSJTLUP EJTDMPTF

UIFTFMGUPFYQFSJNFOUXJUIOFXCFIBWJPSBOEUPHSPXBOEDIBOHF*IBWFFYQFSJ

NFOUFEXJUIiNBLJOHUIFSPVOETwXIFO*TFOTFEUIBUBQBSUJDJQBOUOFFEFEUPGBDF

FBDIQFSTPOJOUIFHSPVQXJUITPNFUIFNF'PSFYBNQMFBHSPVQNFNCFSNJHIU

TBZi*WFCFFOTJUUJOHIFSFGPSBMPOHUJNFXBOUJOHUPQBSUJDJQBUFCVUIPMEJOHCBDL

CFDBVTF*NBGSBJEPGUSVTUJOHQFPQMFJOIFSF"OECFTJEFT*EPOUUIJOL*NXPSUI

UIFUJNFPGUIFHSPVQBOZXBZw*NJHIUDPVOUFSXJUIi"SFZPVXJMMJOHUPEPTPNF

UIJOHSJHIUOPXUPHFUZPVSTFMGNPSFJOWFTUFEBOEUPCFHJOUPXPSLPOHBJOJOHUSVTU

BOE TFMGDPOmEFODF w *G UIF QFSTPO BOTXFST BGmSNBUJWFMZ NZ TVHHFTUJPO DPVME

XFMMCFi(PBSPVOEUPFBDIQFSTPOBOEmOJTIUIJTTFOUFODFA*EPOUUSVTUZPVCF

DBVTFw"OZOVNCFSPGFYFSDJTFTDPVMECFJOWFOUFEUPIFMQJOEJWJEVBMTJOWPMWF

UIFNTFMWFTBOEDIPPTFUPXPSLPOUIFUIJOHTUIBULFFQUIFNGSP[FOJOGFBS

4PNFPUIFSSFMBUFEJMMVTUSBUJPOTBOEFYBNQMFTUIBU*mOEBQQSPQSJBUFGPSUIF

NBLJOHUIFSPVOETJOUFSWFOUJPOBSFSFnFDUFEJODMJFOUTDPNNFOUTTVDIBTUIFTF

i*XPVMEMJLFUPSFBDIPVUUPQFPQMFNPSFPGUFOwi/PCPEZJOIFSFTFFNTUPDBSF

WFSZNVDIwi*EMJLFUPNBLFDPOUBDUXJUIZPVCVU*NBGSBJEPGCFJOHSFKFDUFE<PS

BDDFQUFE>wi*UTIBSEGPSNFUPBDDFQUDPNQMJNFOUT*BMXBZTEJTDPVOUHPPEUIJOHT

QFPQMFTBZUPNFw

the reversal exercise$FSUBJOTZNQUPNTBOECFIBWJPSTPGUFOSFQSFTFOU

SFWFSTBMTPGVOEFSMZJOHPSMBUFOUJNQVMTFT5IVTUIFUIFSBQJTUDPVMEBTLBQFSTPO

XIPDMBJNTUPTVGGFSGSPNTFWFSFJOIJCJUJPOTBOEFYDFTTJWFUJNJEJUZUPQMBZUIFSPMF

PGBOFYIJCJUJPOJTU*SFNFNCFSBDMJFOUJOPOFPGPVSUIFSBQZHSPVQTXIPIBEEJG

mDVMUZCFJOHBOZUIJOHCVUTVHBSZTXFFU*BTLFEIFSUPSFWFSTFIFSUZQJDBMTUZMFBOE

CFBTOFHBUJWFBTTIFDPVMECF5IFSFWFSTBMXPSLFEXFMMTPPOTIFXBTQMBZJOHIFS

QBSUXJUISFBMHVTUPBOEMBUFSTIFXBTBCMFUPSFDPHOJ[FBOEBDDFQUIFSiOFHBUJWF

TJEFwBTXFMMBTIFSiQPTJUJWFTJEFw

5IFUIFPSZ VOEFSMZJOH UIFSFWFSTBM UFDIOJRVF JT UIBU DMJFOUT UBLF UIF QMVOHF

JOUPUIFWFSZUIJOHUIBUJTGSBVHIUXJUIBOYJFUZBOENBLFDPOUBDUXJUIUIPTFQBSUTPG

UIFNTFMWFTUIBUIBWFCFFOTVCNFSHFEBOEEFOJFE5IJTUFDIOJRVFDBOIFMQDMJFOUT

CFHJOUPBDDFQUDFSUBJOQFSTPOBMBUUSJCVUFTUIBUUIFZIBWFUSJFEUPEFOZ

the rehearsal exercise 0GUFOUJNFT XF HFU TUVDL SFIFBSTJOH TJMFOUMZ UP

PVSTFMWFT TP UIBU XF XJMM HBJO BDDFQUBODF 8IFO JU DPNFT UP UIF QFSGPSNBODF XF

FYQFSJFODFTUBHFGSJHIUPSBOYJFUZCFDBVTFXFGFBSUIBUXFXJMMOPUQMBZPVSSPMFXFMM

*OUFSOBMSFIFBSTBM DPOTVNFT NVDIFOFSHZBOEGSFRVFOUMZJOIJCJUTPVS TQPOUBOFJUZ

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

230

CHAPTER EIGHT

BOEXJMMJOHOFTTUPFYQFSJNFOUXJUIOFXCFIBWJPS8IFODMJFOUTTIBSFUIFJSSFIFBSTBMT

PVUMPVEXJUIBUIFSBQJTUUIFZCFDPNFNPSFBXBSFPGUIFNBOZQSFQBSBUPSZNFBOT

UIFZVTFJOCPMTUFSJOHUIFJSTPDJBMSPMFT5IFZBMTPCFDPNFJODSFBTJOHMZBXBSFPGIPX

UIFZUSZUPNFFUUIFFYQFDUBUJPOTPGPUIFSTPGUIFEFHSFFUPXIJDIUIFZXBOUUPCFBQ

QSPWFEBDDFQUFEBOEMJLFEBOEPGUIFFYUFOUUPXIJDIUIFZHPUPBUUBJOBDDFQUBODF

the exaggeration exercise0OFBJNPG(FTUBMUUIFSBQZJTGPSDMJFOUTUP

CFDPNFNPSFBXBSFPGUIFTVCUMFTJHOBMTBOEDVFTUIFZBSFTFOEJOHUISPVHICPEZ

MBOHVBHF.PWFNFOUTQPTUVSFTBOEHFTUVSFTNBZDPNNVOJDBUFTJHOJmDBOUNFBO

JOHTZFUUIFDVFTNBZCFJODPNQMFUF*OUIJTFYFSDJTFUIFQFSTPOJTBTLFEUPFYBH

HFSBUFUIFNPWFNFOUPSHFTUVSFSFQFBUFEMZXIJDIVTVBMMZJOUFOTJmFTUIFGFFMJOH

BUUBDIFEUPUIFCFIBWJPSBOENBLFTUIFJOOFSNFBOJOHDMFBSFS4PNFFYBNQMFTPG

CFIBWJPSTUIBUMFOEUIFNTFMWFTUPUIFFYBHHFSBUJPOUFDIOJRVFBSFUSFNCMJOHTIBL

JOHIBOETMFHTTMPVDIFEQPTUVSFBOECFOUTIPVMEFSTDMFODIFEmTUTUJHIUGSPXO

JOHGBDJBMHSJNBDJOHDSPTTFEBSNTBOETPGPSUI*GBDMJFOUSFQPSUTUIBUIJTPSIFS

MFHTBSFTIBLJOHUIFUIFSBQJTUNBZBTLUIFDMJFOUUPTUBOEVQBOEFYBHHFSBUFUIF

TIBLJOH5IFOUIFUIFSBQJTUNBZBTLUIFDMJFOUUPQVUXPSETUPUIFTIBLJOHMJNCT

staying with the feeling .PTU DMJFOUT EFTJSF UP FTDBQF GSPN GFBSGVM

TUJNVMJBOEUPBWPJEVOQMFBTBOUGFFMJOHT"ULFZNPNFOUTXIFODMJFOUTSFGFSUPB

GFFMJOHPSBNPPEUIBUJTVOQMFBTBOUBOEGSPNXIJDIUIFZIBWFBHSFBUEFTJSFUP

nFFUIFUIFSBQJTUNBZVSHFDMJFOUTUPTUBZXJUIUIFJSGFFMJOHBOEFODPVSBHFUIFNUP

HPEFFQFSJOUPUIFGFFMJOHPSCFIBWJPSUIFZXJTIUPBWPJE'BDJOHBOEFYQFSJFODJOH

GFFMJOHTOPUPOMZUBLFTDPVSBHFCVUBMTPJTBNBSLPGBXJMMJOHOFTTUPFOEVSFUIF

QBJOOFDFTTBSZGPSVOCMPDLJOHBOENBLJOHXBZGPSOFXFSMFWFMTPGHSPXUI

the gestalt approach to dream work*OQTZDIPBOBMZTJTESFBNT

BSFJOUFSQSFUFEJOUFMMFDUVBMJOTJHIUJTTUSFTTFEBOEGSFFBTTPDJBUJPOJTVTFEUPFY

QMPSFUIFVODPOTDJPVTNFBOJOHTPGESFBNT5IF(FTUBMUBQQSPBDIEPFTOPUJOUFS

QSFUBOEBOBMZ[FESFBNT*OTUFBEUIFJOUFOUJTUPCSJOHESFBNTCBDLUPMJGFBOE

SFMJWFUIFNBTUIPVHIUIFZXFSFIBQQFOJOHOPX5IFESFBNJTBDUFEPVUJOUIF

QSFTFOUBOEUIFESFBNFSCFDPNFTBQBSUPGIJTPSIFSESFBN5IFTVHHFTUFEGPS

NBUGPSXPSLJOHXJUIESFBNTJODMVEFTNBLJOHBMJTUPGBMMUIFEFUBJMTPGUIFESFBN

SFNFNCFSJOHFBDIQFSTPOFWFOUBOENPPEJOJUBOEUIFOCFDPNJOHFBDIPGUIFTF

QBSUTCZUSBOTGPSNJOHPOFTFMGBDUJOHBTGVMMZBTQPTTJCMFBOEJOWFOUJOHEJBMPHVF

&BDIQBSUPGUIF ESFBNJTBTTVNFE UPCFB QSPKFDUJPOPGUIF TFMGBOEUIF DMJFOU

DSFBUFTTDSJQUTGPSFODPVOUFSTCFUXFFOUIFWBSJPVTDIBSBDUFSTPSQBSUT"MMPGUIF

EJGGFSFOUQBSUT PG B ESFBN BSF FYQSFTTJPOT PG UIF DMJFOUT PXO DPOUSBEJDUPSZBOE

JODPOTJTUFOUTJEFTBOECZFOHBHJOHJOBEJBMPHVFCFUXFFOUIFTFPQQPTJOHTJEFT

UIFDMJFOUHSBEVBMMZCFDPNFTNPSFBXBSFPGUIFSBOHFPGIJTPSIFSPXOGFFMJOHT

1FSMTTDPODFQUPGQSPKFDUJPOJTDFOUSBMJOIJTUIFPSZPGESFBNGPSNBUJPOFWFSZ

QFSTPOBOEFWFSZPCKFDUJOUIFESFBNSFQSFTFOUTBQSPKFDUFEBTQFDUPGUIFESFBNFS

1FSMTBTVHHFTUFEUIBUiXFTUBSUXJUIUIFJNQPTTJCMFBTTVNQUJPOUIBUXIBU

FWFSXFCFMJFWFXFTFFJOBOPUIFSQFSTPOPSJOUIFXPSMEJTOPUIJOHCVUBQSPKFDUJPOw

Q3FDPHOJ[JOHUIFTFOTFTBOEVOEFSTUBOEJOHQSPKFDUJPOTHPIBOEJOIBOE

$MJFOUTEPOPUUIJOLBCPVUPSBOBMZ[FUIFESFBNCVUVTFJUBTBTDSJQUBOEFYQFSJ

NFOUXJUIUIFEJBMPHVFBNPOHUIFWBSJPVTQBSUTPGUIFESFBN#FDBVTFDMJFOUTDBO

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

231

GESTALT THERAPY

BDUPVUBmHIUCFUXFFOPQQPTJOHTJEFTFWFOUVBMMZUIFZDBOBQQSFDJBUFBOEBDDFQU

UIFJSJOOFSEJGGFSFODFTBOEJOUFHSBUFUIFPQQPTJOHGPSDFT'SFVEDBMMFEUIFESFBN

UIFSPZBMSPBEUPUIFVODPOTDJPVTCVUUP1FSMTESFBNTBSFUIFiSPZBMSPBEUPJOUFHSB

UJPOwQ

"DDPSEJOHUP1FSMTUIFESFBNJTUIFNPTUTQPOUBOFPVTFYQSFTTJPOPGUIFFYJTU

FODFPGUIFIVNBOCFJOH*USFQSFTFOUTBOVOmOJTIFETJUVBUJPOCVUFWFSZESFBN

BMTPDPOUBJOTBOFYJTUFOUJBMNFTTBHFSFHBSEJOHPOFTFMGBOEPOFTDVSSFOUTUSVHHMF

&WFSZUIJOHDBOCFGPVOEJOESFBNTJGBMMUIFQBSUTBSFVOEFSTUPPEBOEBTTJNJMBUFE

ESFBNTTFSWFBTBOFYDFMMFOUXBZUPEJTDPWFSQFSTPOBMJUZWPJETCZSFWFBMJOHNJTTJOH

QBSUTBOEDMJFOUTNFUIPETPGBWPJEBODF1FSMTBTTFSUTUIBUJGESFBNTBSFQSPQFSMZ

XPSLFEXJUIUIFFYJTUFOUJBMNFTTBHFCFDPNFTDMFBSFS*GQFPQMFEPOPUSFNFNCFS

ESFBNTUIFZNBZCFSFGVTJOHUPGBDFXIBUJTXSPOHXJUIUIFJSMJGF"UUIFWFSZMFBTU

UIF(FTUBMUDPVOTFMPSBTLT DMJFOUTUPUBML UPUIFJSNJTTJOH ESFBNT'PSFYBNQMF

BTEJSFDUFECZIFSUIFSBQJTUBDMJFOUSFQPSUFEUIFGPMMPXJOHESFBNJOUIFQSFTFOU

UFOTFBTUIPVHITIFXFSFTUJMMESFBNJOH

*IBWFUISFFNPOLFZTJOBDBHF0OFCJHNPOLFZBOEUXPMJUUMFPOFT*GFFMWFSZBUUBDIFEUP

UIFTFNPOLFZTBMUIPVHIUIFZBSFDSFBUJOHBMPUPGDIBPTJOBDBHFUIBUJTEJWJEFEJOUPUISFF

TFQBSBUFTQBDFT5IFZBSFmHIUJOHXJUIPOFBOPUIFSUIFCJHNPOLFZJTmHIUJOHXJUIUIF

MJUUMFNPOLFZ5IFZBSFHFUUJOHPVUPGUIFDBHFBOEUIFZBSFDMJOHJOHPOUPNF*GFFMMJLF

QVTIJOHUIFNBXBZGSPNNF*GFFMUPUBMMZPWFSXIFMNFECZUIFDIBPTUIBUUIFZBSFDSFBUJOH

BSPVOENF*UVSOUPNZNPUIFSBOEUFMMIFSUIBU*OFFEIFMQUIBU*DBOOPMPOHFSIBOEMF

UIFTFNPOLFZTCFDBVTFUIFZBSFESJWJOHNFDSB[Z*GFFMWFSZTBEBOEWFSZUJSFEBOE*GFFM

EJTDPVSBHFE*BNXBMLJOHBXBZGSPNUIFDBHFUIJOLJOHUIBU*SFBMMZMPWFUIFTFNPOLFZT

ZFU*IBWFUPHFUSJEPGUIFN*BNUFMMJOHNZTFMGUIBU*BNMJLFFWFSZCPEZFMTF*HFUQFUT

BOEUIFOXIFOUIJOHTHFUSPVHI*XBOUUPHFUSJEPGUIFN*BNUSZJOHWFSZIBSEUPmOEB

TPMVUJPOUPLFFQJOHUIFTFNPOLFZTBOEOPUBMMPXJOHUIFNUPIBWFTVDIBUFSSJCMFFGGFDUPO

NF#FGPSF*XBLFVQGSPNNZESFBN*BNNBLJOHUIFEFDJTJPOUPQVUFBDINPOLFZJOB

TFQBSBUFDBHFBOENBZCFUIBUJTUIFXBZUPLFFQUIFN

5IF UIFSBQJTU UIFO BTLFE IJT DMJFOU #SFOEB UP iCFDPNFw EJGGFSFOU QBSUT PG IFS

ESFBN5IVTTIFCFDBNFUIFDBHFBOETIFCFDBNFBOEIBEBEJBMPHVFXJUIFBDI

NPOLFZBOEUIFOTIFCFDBNFIFSNPUIFSBOETPGPSUI0OFPGUIFNPTUQPXFS

GVMBTQFDUTPGUIJTUFDIOJRVFXBT#SFOEBTSFQPSUJOHIFSESFBNBTUIPVHIJUXFSF

TUJMMIBQQFOJOH4IFRVJDLMZQFSDFJWFEUIBUIFSESFBNFYQSFTTFEBTUSVHHMFTIFXBT

IBWJOHXJUIIFSIVTCBOEBOEIFSUXPDIJMESFO'SPNIFSEJBMPHVFXPSL#SFOEB

EJTDPWFSFEUIBUTIFCPUIBQQSFDJBUFEBOESFTFOUFEIFSGBNJMZ4IFMFBSOFEUIBUTIF

OFFEFEUPMFUUIFNLOPXBCPVUIFSGFFMJOHTBOEUIBUUPHFUIFSUIFZNJHIUXPSLPO

JNQSPWJOHBOJOUFOTFMZEJGmDVMUMJGFTUZMF4IFEJEOPUOFFEBOJOUFSQSFUBUJPOGSPN

IFSUIFSBQJTUUPVOEFSTUBOEUIFDMFBSNFTTBHFPGIFSESFBN

Application to Group Counseling

"TBUIFSBQFVUJDPSJFOUBUJPOCBTFEPOmFMEUIFPSZ(FTUBMUUIFSBQZJTXFMMTVJUFE

GPSBHSPVQDPOUFYU(FTUBMUUIFSBQZFODPVSBHFTEJSFDUFYQFSJFODFBOEBDUJPOTBT

PQQPTFEUPNFSFMZtalking aboutDPOnJDUTQSPCMFNTBOEGFFMJOHT*GNFNCFSTIBWF

BOYJFUJFTQFSUBJOJOHUPTPNFGVUVSFFWFOUUIFZDBOFOBDUUIFTFGVUVSFDPODFSOTJO

UIFQSFTFOU5IJTIFSFBOEOPXGPDVTFOMJWFOTUIFHSPVQBOEBTTJTUTNFNCFSTJO

WJWJEMZFYQMPSJOHUIFJSDPODFSOT.PWJOHGSPNtalking aboutUPBDUJPOJTPGUFOEPOF

CZUIFVTFPG FYQFSJNFOUT JO BHSPVQ(FTUBMUUIFSBQZ FNQMPZT B SJDI WBSJFUZPG

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

232

CHAPTER EIGHT

JOUFSWFOUJPOTEFTJHOFEUPJOUFOTJGZXIBUHSPVQNFNCFSTBSFFYQFSJFODJOHJOUIF

QSFTFOUNPNFOUGPSUIFQVSQPTFPGMFBEJOHUPJODSFBTFEBXBSFOFTT

8IFOPOFNFNCFSJTUIFGPDVTPGXPSLPUIFSNFNCFSTDBOCFVTFEUPFO

IBODFBOJOEJWJEVBMTXPSL5ISPVHIUIFTLJMMPGMJOLJOHUIFHSPVQMFBEFSDBO

CSJOHBOVNCFSPGNFNCFSTJOUPUIFFYQMPSBUJPOPGBQSPCMFN*QSFGFSBOJO

UFSBDUJWFTUZMFPG(FTUBMUHSPVQXPSLBOEmOEUIBUCSJOHJOHJOBOJOUFSQFSTPOBM

EJNFOTJPONBYJNJ[FTUIFUIFSBQFVUJDQPUFODZXJUIJOUIFHSPVQ*EPOPUMJLFUP

JOUSPEVDFBUFDIOJRVFUPQSPNPUFTPNFUIJOHIBQQFOJOHXJUIJOBHSPVQSBUIFS*

UFOEUPJOWJUFNFNCFSTUPUSZPVUEJGGFSFOUCFIBWJPSBMTUZMFTBTBXBZUPIFJHIUFO

XIBUBHJWFONFNCFSNJHIUCFFYQFSJFODJOHBUUIFNPNFOU"HSPVQGPSNBUQSP

WJEFTBDPOUFYUGPSBHSFBUEFBMPGDSFBUJWJUZJOVTJOHJOUFSWFOUJPOTBOEEFTJHOJOH

FYQFSJNFOUT5IFTFFYQFSJNFOUTOFFEUPCFUBJMPSFEUPFBDIHSPVQNFNCFSBOE

VTFEJOBUJNFMZNBOOFSUIFZBMTPOFFEUPCFDBSSJFEPVUJOBDPOUFYUUIBUPGGFST

BCBMBODFCFUXFFOTVQQPSUBOESJTL&YQFSJNFOUTBUUIFJSCFTUFWPMWFGSPNXIBU

JTHPJOHPOXJUIJOJOEJWJEVBMNFNCFSTBOEXIBUJTIBQQFOJOHJOUIFHSPVQBU

UIFNPNFOU

"MUIPVHI(FTUBMUHSPVQMFBEFSTFODPVSBHFNFNCFSTUPIFJHIUFOUIFJSBXBSF

OFTT BOE BUUFOE UP UIFJS JOUFSQFSTPOBM TUZMF PG SFMBUJOH MFBEFST UFOE UP UBLF BO

BDUJWFSPMFJODSFBUJOHFYQFSJNFOUTUPIFMQNFNCFSTUBQUIFJSSFTPVSDFT(FTUBMU

MFBEFSTBSFBDUJWFMZFOHBHFEXJUIUIFNFNCFSTBOEMFBEFSTGSFRVFOUMZFOHBHFJO

TFMGEJTDMPTVSFBTBXBZUPFOIBODFSFMBUJPOTIJQTBOEDSFBUFBTFOTFPGNVUVBMJUZ

XJUIJOUIFHSPVQ(FTUBMUMFBEFSTGPDVTPOBXBSFOFTTDPOUBDUBOEFYQFSJNFOUB

UJPO:POUFG+BDPCT

*GNFNCFSTFYQFSJFODFUIFHSPVQBTCFJOHBTBGFQMBDFUIFZXJMMCFJODMJOFEUP

NPWFJOUPUIFVOLOPXOBOEDIBMMFOHFUIFNTFMWFT5PJODSFBTFUIFDIBODFTUIBU

NFNCFSTXJMMCFOFmUGSPN(FTUBMUNFUIPETHSPVQMFBEFSTOFFEUPDPNNVOJDBUF

UIF HFOFSBM QVSQPTF PG UIFTF JOUFSWFOUJPOT BOE DSFBUF BO FYQFSJNFOUBM DMJNBUF

-FBEFSTBSFOPUUSZJOHUPQVTIBOBHFOEBSBUIFSNFNCFSTBSFGSFFUPUSZTPNF

UIJOHOFXBOEEFUFSNJOFGPSUIFNTFMWFTUIFPVUDPNFTPGBOFYQFSJNFOU

*OUSBJOJOHXPSLTIPQTJOHSPVQDPVOTFMJOHUIBU.BSJBOOF4DIOFJEFS$PSFZ

BOE*DPOEVDUFEJO,PSFBUIF(FTUBMUBQQSPBDIXBTXFMMBDDFQUFE(SPVQNFN

CFSTXFSFWFSZPQFOBOEXJMMJOHUPTIBSFUIFNTFMWFTFNPUJPOBMMZPODFBDMJNBUFPG

TBGFUZXBTDSFBUFE"EPQUJOHUIFTUBODFPGQIFOPNFOPMPHJDBMJORVJSZXFTUSJWFUP

BWPJENBLJOHBTTVNQUJPOTBCPVUUIFNFNCFSTPGBHSPVQBOEXFBSFDBSFGVMOPU

UPJNQPTFPVSXPSMEWJFXTPSWBMVFTPOUIFN*OTUFBEXFBQQSPBDIDMJFOUTXJUI

SFTQFDUJOUFSFTUDPNQBTTJPOBOEQSFTFODF8FXPSLDPMMBCPSBUJWFMZXJUIPVSDMJ

FOUTUPEJTDPWFSIPXUPCFTUIFMQUIFNSFTPMWFUIFEJGmDVMUJFTUIFZFYQFSJFODFJO

UFSOBMMZJOUFSQFSTPOBMMZBOEJOUIFDPOUFYUPGUIFJSTPDJBMFOWJSPONFOU"MUIPVHI

JUJTVOSFBMJTUJDUPUIJOLZPVOFFEUPLOPXFWFSZUIJOHBCPVUEJGGFSFOUDVMUVSFTJU

JTFTTFOUJBMUPCSJOHBOBUUJUVEFPGSFTQFDUBOEBQQSFDJBUJPOGPSEJGGFSFODFTUPZPVS

XPSLJOEJWFSTFDVMUVSBMFOWJSPONFOUTBSPVOEUIFXPSME8JUIUIFTFBUUJUVEFTXF

GPVOEUIBUXFXFSFBCMFUPVTFNBOZ(FTUBMUJOUFSWFOUJPOTXJUI,PSFBOQFPQMFJOB

HSPVQUSBJOJOHDPOUFYU*OTPNFXBZTUIJTJTOPUTVSQSJTJOHCFDBVTFJO,PSFBUIFSF

JTBOFNQIBTJTPODPMMFDUJWJTUJDWBMVFTBOEHSPVQXPSLmUTXFMMJOUPUIF,PSFBO

DVMUVSF

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

233

GESTALT THERAPY

'PSBNPSFEFUBJMFEBDDPVOUPG(FTUBMUUIFSBQZJOHSPVQTTFF'FEFSBOE'SFX

'FEFSBOE$PSFZDIBQ

gestalt therapy from a

multicultural perspective

Strengths From a Diversity Perspective

5IFSFBSF PQQPSUVOJUJFT UPDSFBUJWFMZ VTF (FTUBMU NFUIPET XJUI DVMUVSBMMZ EJWFSTF

QPQVMBUJPOTJGJOUFSWFOUJPOTBSFUJNFEBQQSPQSJBUFMZBOEVTFEnFYJCMZ'SFX

IBTNBEFUIFDBTFUIBUiDPOUFNQPSBSZ(FTUBMUUIFSBQZIBTFWPMWFEBTBDVMUVSBMMZ

TFOTJUJWFBOEEJWFSTJUZGSJFOEMZPSJFOUBUJPOwQ)FOPUFTUIBU(FTUBMUUIFSBQZ

DBO CF B VTFGVM BOE FGGFDUJWF BQQSPBDI XJUI DMJFOUT GSPN EJWFSTF CBDLHSPVOET

CFDBVTFJUUBLFTUIFDMJFOUTDPOUFYUJOUPBDDPVOU0OFPGUIFBEWBOUBHFTPGESBXJOH

PO(FTUBMUFYQFSJNFOUTJTUIBUUIFZDBOCFUBJMPSFEUPmUUIFVOJRVFXBZJOXIJDI

BOJOEJWJEVBMQFSDFJWFTBOEJOUFSQSFUTIJTPSIFSDVMUVSF"MUIPVHINPTUUIFSBQJTUT

IBWFQSFDPODFQUJPOT(FTUBMUUIFSBQJTUTTUSJWFUPBQQSPBDIFBDIDMJFOUJOBOPQFO

XBZ5IFZEPUIJTCZDIFDLJOHPVUUIFJSCJBTFTBOEWJFXTJOEJBMPHVFXJUIUIFDMJFOU

5IJTJTQBSUJDVMBSMZJNQPSUBOUJOXPSLJOHXJUIJOEJWJEVBMTGSPNPUIFSDVMUVSFT

'FSOCBDIFS BOE 1MVNNFS  TUSFTT UIF JNQPSUBODF PG BTTJTUJOH (FTUBMU

UIFSBQZ USBJOFFT JO EFWFMPQJOH UIFJS PXO BXBSFOFTT i5P EFWFMPQ BXBSFOFTT PG

POFTDVMUVSBMJEFOUJUZPOFNVTUBUUFOEUPJUTJOnVFODFOPUPOMZJOUSBJOJOHCVUBMTP

BTQBSUPGPOHPJOHEFWFMPQNFOUPGB(FTUBMUQSBDUJUJPOFSwQ'FSOCBDIFSBOE

1MVNNFSDPOUFOEUIBUiUPVOEFSUBLFXPSLBDSPTTDVMUVSFTGSPNB(FTUBMUQFSTQFD

UJWFJUJTFTTFOUJBMUIBUXFFYQMPSFPVSPXODVMUVSBMTFMWFTUPNBLFDPOUBDUBOE

FODPVSBHFDPOUBDUJOBOEXJUIPUIFSTXFOFFEUPLOPXBCPVUPVSTFMWFTwQ

(FTUBMUUIFSBQZJTQBSUJDVMBSMZFGGFDUJWFJOIFMQJOHQFPQMFJOUFHSBUFUIFQPMBSJ

UJFTXJUIJOUIFNTFMWFT.BOZCJDVMUVSBMDMJFOUTFYQFSJFODFBOPOHPJOHTUSVHHMFUP

SFDPODJMFXIBUBQQFBSTUPCFEJWFSTFBTQFDUTPGUIFUXPDVMUVSFTJOXIJDIUIFZMJWF

*OPOFPGNZXFFLMPOHHSPVQTBEZOBNJDQJFDFPGXPSLXBTEPOFCZBXPNBO

XJUI &VSPQFBO SPPUT )FS TUSVHHMF DPOTJTUFE PG JOUFHSBUJOH IFS "NFSJDBO TJEF

XJUIIFSFYQFSJFODFTJO(FSNBOZBTBDIJME*TVHHFTUFEUIBUTIFiCSJOHIFSGBNJMZ

JOUPUIJTHSPVQwCZUBMLJOHUPTFMFDUFENFNCFSTJOUIFHSPVQBTUIPVHIUIFZXFSF

NFNCFSTPGIFSGBNJMZ*JOWJUFEIFSUPJNBHJOFUIBUTIFXBTZFBSTPMEBOEUIBU

TIFDPVMEOPXTBZUPIFSQBSFOUTBOETJCMJOHTUIJOHTUIBUTIFIBEOFWFSFYQSFTTFE

4IF XBT BTLFE UP TQFBL JO (FSNBO TJODF UIJT XBT IFS QSJNBSZ MBOHVBHF BT B

DIJME5IFDPNCJOFEGBDUPSTPGIFSUSVTUJOUIFHSPVQIFSXJMMJOHOFTTUPSFDSFBUF

BOFBSMZTDFOFCZSFMJWJOHJUJOUIFQSFTFOUNPNFOUBOEIFSTZNCPMJDXPSLXJUI

GBOUBTZIFMQFEIFSBDIJFWFBTJHOJmDBOUCSFBLUISPVHI4IFXBTBCMFUPQVUBOFX

FOEJOHUPBOPMEBOEVOmOJTIFETJUVBUJPOUISPVHIIFSQBSUJDJQBUJPOJOUIJT(FTUBMU

FYQFSJNFOU

5IFSF BSF NBOZ PQQPSUVOJUJFT UP BQQMZ (FTUBMU FYQFSJNFOUT JO DSFBUJWF XBZT

XJUIEJWFSTFDMJFOUQPQVMBUJPOT*ODVMUVSFTXIFSFJOEJSFDUTQFFDIJTUIFOPSNOPO

WFSCBMCFIBWJPSTNBZFNQIBTJ[FUIFVOTQPLFODPOUFOUPGWFSCBMDPNNVOJDBUJPO

5IFTFDMJFOUTNBZFYQSFTTUIFNTFMWFTOPOWFSCBMMZNPSFFYQSFTTJWFMZUIBOUIFZEP

XJUIXPSET(FTUBMUUIFSBQJTUTUZQJDBMMZBTLDMJFOUTUPGPDVTPOUIFJSHFTUVSFTGBDJBM

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

234

CHAPTER EIGHT

FYQSFTTJPOTBOEXIBUUIFZBSFFYQFSJFODJOHXJUIJOUIFJSPXOCPEJFT5IFZBUUFNQU

UP GVMMZ VOEFSTUBOE UIF CBDLHSPVOE PG UIFJS DMJFOUT DVMUVSF 5IFZ BSF DPODFSOFE

BCPVUXIJDIBTQFDUTPGUIJTCBDLHSPVOECFDPNFDFOUSBMPSmHVSBMGPSUIFJSDMJFOUT

BOEXIBUNFBOJOHDMJFOUTQMBDFPOUIFTFmHVSFT

Shortcomings From a Diversity Perspective

5PBHSFBUFSFYUFOUUIBOJTUSVFPGNPTUPUIFSBQQSPBDIFTUIFSFBSFTPNFQPUFO

UJBMQSPCMFNTJOUPPRVJDLMZVUJMJ[JOHTPNF(FTUBMUFYQFSJNFOUTXJUITPNFDMJFOUT

(FTUBMUNFUIPETDBOMFBEUPBIJHIMFWFMPGJOUFOTFGFFMJOHT5IJTGPDVTPOBGGFDU

IBTTPNFDMFBSMJNJUBUJPOTXJUIUIPTFDMJFOUTXIPIBWFCFFODVMUVSBMMZDPOEJUJPOFE

UPCFFNPUJPOBMMZSFTFSWFEBOEUPBWPJEPQFOMZFYQSFTTJOHGFFMJOHT"TNFOUJPOFE

FBSMJFSTPNFJOEJWJEVBMTCFMJFWFFYQSFTTJOHGFFMJOHTPQFOMZJTBTJHOPGXFBLOFTT

BOEBEJTQMBZPGPOFTWVMOFSBCJMJUZ$PVOTFMPSTXIPPQFSBUFPOUIFBTTVNQUJPO

UIBUDBUIBSTJTJTOFDFTTBSZGPSBOZDIBOHFUPPDDVSBSFMJLFMZUPmOEDFSUBJODMJFOUT

CFDPNJOH JODSFBTJOHMZ SFMVDUBOU UP QBSUJDJQBUF JO FYQFSJNFOUT BOE TVDI DMJFOUT

NBZQSFNBUVSFMZUFSNJOBUFDPVOTFMJOH0UIFSJOEJWJEVBMTIBWFTUSPOHDVMUVSBMJO

KVODUJPOTQSPIJCJUJOHUIFNGSPNEJSFDUMZFYQSFTTJOHUIFJSFNPUJPOTUPUIFJSQBS

FOUT TVDI BT i/FWFS TIPX ZPVS QBSFOUT UIBU ZPV BSF BOHSZ BU UIFNw PS i4USJWF

GPS QFBDF BOE IBSNPOZ BOE BWPJE DPOnJDUTw * SFDBMM B DMJFOU GSPN *OEJB XIP

XBTBTLFECZIJTDPVOTFMPSUPiCSJOHZPVSGBUIFSJOUPUIFSPPNw5IFDMJFOUXBT

WFSZSFMVDUBOUUPFWFOTZNCPMJDBMMZUFMMIJTGBUIFSPGIJTEJTBQQPJOUNFOUXJUIUIFJS

SFMBUJPOTIJQ*OIJTDVMUVSFUIFBDDFQUFEXBZUPEFBMXJUIIJTGBUIFSXBTUPVTFIJT

VODMFBTBHPCFUXFFOBOEJUXBTDPOTJEFSFEIJHIMZJOBQQSPQSJBUFUPFYQSFTTBOZ

OFHBUJWFGFFMJOHTUPXBSEIJTGBUIFS5IFDMJFOUMBUFSTBJEUIBUIFXPVMEIBWFGFMUWFSZ

HVJMUZJGIFIBETZNCPMJDBMMZUPMEIJTGBUIFSXIBUIFTPNFUJNFTUIPVHIUBOEGFMU

(FTUBMUUIFSBQJTUTXIPIBWFUSVMZJOUFHSBUFEUIFJSBQQSPBDIBSFTFOTJUJWFFOPVHI

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BDFSUBJOFGGFDU

Gestalt-oriented therapy focuses on the

unfinished business Stan has with his

parents, siblings, and ex-wife. It appears

that this unfinished business consists mainly of

feelings of resentment, and Stan turns this resent-

ment on himself. His present life situation is

spotlighted, but he may also need to reexperience

past feelings that could be interfering with his

present attempts to develop intimacy with others.

Although the focus is on Stan’s present

behavior, I guide him toward becoming aware

of how he is carrying old baggage around and

how it interferes with his life today. My task is to

assist him in re-creating the context in which he

made creative adjustments during his childhood

years that no longer serving him well. One of

his cardinal introjections was, “I’m stupid, and it

would be better if I did not exist.”

Gestalt Therapy Applied to the Case of Stan

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235

GESTALT THERAPY

Stan has been influenced by cultural mes-

sages that he has accepted. I am interested in

exploring his cultural background, including

his values and the values characteristic of his

culture. With this focus, I assist Stan in identify-

ing some of the following cultural introjections:

“Don’t talk about your family with strangers,

and don’t hang your dirty linen in public.” “Don’t

confront your parents because they deserve re-

spect.” “Don’t be too concerned about yourself.”

“Don’t show your vulnerabilities; hide your feel-

ings and weaknesses.” I invite Stan to examine

those introjections to assess their utility in his

present circumstances. Although he can decide

to retain those aspects of his culture that he

prizes, he is in a position to modify or reject

other cultural expectations. Of course, this will

be done when these issues emerge in the fore-

ground of his work.

I ask Stan to attend to what he becomes

aware of as the session begins: “What are you

experiencing as we are getting started today?”

As I encourage Stan to tune in to his present

experience and selectively make observations, a

number of figures will emerge. The goal is to

focus on a figure of interest, one that seems to

hold the most energy or relevance for Stan. When

a figure is identified, my task is to deepen Stan’s

awareness of this thought, feeling, body sensa-

tion, or insight through related experiments.

In typical Gestalt fashion, Stan deals with

his present struggles within the context of our

relationship and through experimentation. One

possible experiment would involve Stan becom-

ing some of those individuals who told him how

to think, feel, and behave as a child. He can then

become the child that he was and respond to

them from the place where he feels the most

confusion or pain. He experiences in new ways

the feelings that accompany his beliefs about

himself, and he comes to a deeper appreciation

of how his feelings and thoughts influence what

he is doing today.

Stan has learned to hide his emotions rather

than to reveal them. Understanding this about

him, we explore his objections and concerns about

“getting into feelings.” The figure of interest now

is his hesitation to experience or express emotion.

Although I have no agenda to get Stan to experi-

ence his feelings at this point, it is important for

him to increase his awareness of his reluctance

and to explore the meaning it holds for him.

If Stan decides that he wants to experience

his emotions rather than deny them, I ask: “What

are you aware of now having said what you did?”

Stan says that he can’t get his ex-wife out of his

mind. He tells me about the pain he feels over

that relationship and how he is frightened of get-

ting involved again lest he be hurt again. I con-

tinue to ask him to focus inward and get a sense

of what stands out for him at this very moment.

Stan replies: “I’m hurt and angry over all the pain

that I’ve allowed her to inflict on me.” I ask him to

imagine himself in earlier scenes with his ex-wife,

as though the painful situation were occurring

in the here and now. He symbolically relives and

reexperiences the situation by talking “directly”

to his wife. By expressing his resentments and

hurts directly, Stan can begin to complete some

unfinished business that is interfering with his

current functioning. By participating in this

experiment, Stan is attaining more awareness of

what he is now doing and how he keeps himself

locked into his past.

Follow-Up: You Continue as Stan’s

Gestalt Therapist

Use these questions to help you think about how

to work with Stan using the Gestalt approach:

t How might you begin a session with Stan?

Would you suggest a direction he should pur-

sue

? Would you wait for him to initiate work?

Would you ask him to continue from where he

left off in the previous session? Would you at-

tend to whatever theme or issue becomes fig-

ural to him?

t What unfinished business can you identify in

Stan’s case? Does any of his experience of be-

ing stuck r

emind you of yourself? How might

you work with Stan if he did bring up your own

unfinished business?

t What kind of an experiment might you pro-

pose to assist Stan in learning more about his

hesitation and reluctance to access and e

x-

press his feelings?

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

236

summary and evaluation

Summary

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Contributions of Gestalt Therapy

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t Stan participated in an experiment to deal

with pain, resentment, and hurt over situa-

tions with his ex-wife. How might you have

worked with the material Stan brought up?

What kind of experiment might you design?

How would you decide what kind of experi-

ment to create?

t How might you work with Stan’s cultural mes-

sages? Would you be able to respect his cul-

tur

al values and still encourage him to make

an assessment of some of the ways in which

his culture is affecting him today?

See DVD for Theory and Practice of

Counseling and Psychotherapy: The Case

of Stan and Lecturettes (Session 6 on Gestalt

therapy) for a demonstration of my approach

to counseling Stan from this perspective. This

session consists of Stan exploring one of his

dreams in Gestalt fashion.

CHAPTER EIGHT

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

237

GESTALT THERAPY

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Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

238

CHAPTER EIGHT

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239

GESTALT THERAPY

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where to go from here

*O UIF DVD for Integrative Counseling: The Case of Ruth and Lecturettes, 4FTTJPO 

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Gestalt Institute of Cleveland. Inc.

1588 Hazel Drive

Cleveland, OH 44106-1791

Telephone: (216) 421-0468

Fax: (216) 421-1729

E-mail: registrar@gestaltcleveland.org

Website: www.gestaltcleveland.org

Pacific Gestalt Institute

1626 Westwood Blvd., Suite 104

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

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240

CHAPTER EIGHT

Los Angeles, CA 90024

Telephone: (310) 446-9720

Fax: (310) 475-4704

E-mail: info@gestalttherapy.org

Website: www.gestalttherapy.org

Gestalt Center for Psychotherapy and Training

220 Fifth Avenue, Suite 802

New York, NY 10001

Telephone: (212) 387-9429

E-mail: info@gestaltnyc.org

Website: www.gestaltnyc.org

Gestalt International Study Center

1035 Cemetery Road

South Wellfleet, Cape Cod, MA 02667

Telephone: (508) 349-7900

E-mail: [email protected]g

Website: www.GISC.org

Gestalt Therapy Training Center Northwest

757 SE 34th Avenue

Portland, OR 97214

Telephone: (503) 230-0900

E-mail: [email protected]

Website: www.gttcnw.org

Gestalt Associates Training, Los Angeles

1460 Seventh Street, Suite 300

Santa Monica, CA 90401

Telephone/Fax: (310) 395-6844

E-mail: ritaresnick@gatla.org

Website: www.gatla.org

5IFNPTUQSPNJOFOUQSPGFTTJPOBMBTTPDJBUJPOTGPS(FTUBMUUIFSBQZUIBUIPMEJOUFS

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Association for the Advancement of Gestalt Therapy (AAGT)

Website: www.AAGT.org

European Association for Gestalt Therapy (EAGT)

Website: www.EAGT.org

Gestalt Review

Website: www.gestaltreview.com

British Gestalt Journal

Website: www.britishgestaltjournal.com

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

241

Recommended Supplementary Readings

Gestalt Therapy Verbatim (Perls, 1969a) provides a firsthand account of the way Fritz Perls

worked. It contains many verbatim transcripts of workshop demonstrations.

Gestalt Therapy: History, Theory, and Practice (Woldt & Toman, 2005) introduces the historical

underpinnings and key concepts of Gestalt therapy and features applications of those concepts

to therapeutic practice. This is a significant recent publication in the field of Gestalt therapy that

contains pedagogical learning activities and experiments, review questions, and photographs of

all contributors.

Gestalt Therapy Integrated: Contours of Theory and Practice (Polster & Polster, 1973) is a classic in

the field and an excellent source for those who want a more advanced and theoretical treatment

of this model.

References and Suggested Readings

*Barber, P. (2006). Becoming a practitioner

researcher: A Gestalt approach to holistic inquiry.

London: Middlesex University Press.

Beisser, A. R. (1970). The paradoxical theory

of change. In J. Fagan & I. L. Shepherd (Eds.),

Gestalt therapy now (pp. 77–80). New York:

Harper & Row (Colophon).

*Bowman, C. (2005). The history and develop-

ment of Gestalt therapy. In A. Woldt & S. To-

man (Eds.), Gestalt therapy: History, theory, and

practice (pp. 3–20). Thousand Oaks, CA: Sage.

Breshgold, E. (1989). Resistance in Gestalt

therapy: An historical theoretical perspective.

The Gestalt Journal, 12(2), 73–102.

*Brown, J. R. (2007). Gestalt therapy. In A. B.

Rochlen (Ed.), Applying counseling theories: An

online case-based approach (pp. 127–141).

Upper Saddle River, NJ: Pearson Prentice-Hall.

*Brownell, P. (2008). Handbook for theory,

research and practice in Gestalt therapy.

Newcastle, UK: Cambridge Scholar Publishing.

*Cain, D. J. (2002). Defining characteristics,

history, and evolution of humanistic psycho-

therapies. In D. J. Cain & J. Seeman (Eds.),

Humanistic psychotherapies: Handbook of

research and practice (pp. 3–54). Washington,

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243

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244

introduction

• Historical Background

• Four Areas of Development

key concepts

• View of Human Nature

• Basic Characteristics and Assumptions

the therapeutic process

• Therapeutic Goals

• Therapist’s Function and Role

• Client’s Experience in Therapy

• Relationship Between Therapist and Client

application: therapeutic

techniques and procedures

• Applied Behavioral Analysis: Operant

Conditioning Techniques

• Progressive Muscle Relaxation

• Systematic Desensitization

• In Vivo Exposure and Flooding

• Eye Movement Desensitization and

Reprocessing

• Social Skills Training

• Self-Management Programs and Self-Directed

Behavior

• Multimodal Therapy: Clinical Behavior

Therapy

• Mindfulness and Acceptance-Based Cognitive

Behavior Therapy

• Application to Group Counseling

behavior therapy from a

multicultural perspective

• Strengths From a Diversity Perspective

• Shortcomings From a Diversity Perspective

behavior therapy applied to the

case of stan

summary and evaluation

• Summary

• Contributions of Behavior Therapy

• Limitations and Criticisms of Behavior

Therapy

where to go from here

• Recommended Supplementary Readings

• References and Suggested Readings

chapter 9

Behavior Therapy

•

Recomm

•

References

ntary Readin

Recommended Supplementary Readings

Contemporary Behavior Therapy (Spiegler & Guevremont, 2010) is a comprehen-

sive and up-to-date treatment of basic principles and applications of the behavior

therapies, as well as a ﬁ ne discussion of ethical issues. Speciﬁ c chapters deal with

procedures that can be usefully applied to a range of client populations: behavio-

ral assessment, modeling therapy, systematic desensitization, exposure therapies,

cognitive restructuring, and cognitive coping skills.

Interviewing and Change Strategies for Helpers (Cormier, Nurius, & Osborn, 2013)

is a comprehensive and clearly written textbook dealing with training experiences

and skill development. Its excellent documentation offers practitioners a wealth

of material on a variety of topics, such as assessment procedures, selection of

goals, development of appropriate treatment programs, and methods of evaluat-

ing outcomes.

Cognitive Behavior Therapy: Applying Empirically Supported Techniques in Your

Practice (O’Donohue & Fisher, 2008) is a useful collection of edited short chap-

ters describing empirically supported techniques for working with a wide range

of presenting problems.

Behavior Therapy (Antony & Roemer, 2011a) offers a useful and updated overview

of behavior therapy.

Behavior Modiﬁ cation: Principles and Procedures (Miltenberger, 2012) is an excel-

lent resource for learning more about basic principles such as reinforcement,

extinction, punishment, and procedures to establish new behavior.

Acceptance and Mindfulness in Cognitive Behavior Therapy: Understanding and

Applying the New Therapies (Herbert & Forman, 2011) is one of the best resources

for discussion of new developments in the behavior therapy tradition and the

future trends of these therapies.

References and Suggested Readings

*Alberti, R. E., & Emmons, M. L. (2008). Your

perfect right: A guide to assertive behavior

(9th ed.). Atascadero, CA: Impact.

*Antony, M. M., & Roemer, L. (2011a).

Behavior therapy. Washington, DC: American

Psychological Association.

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*Books and articles marked with an asterisk are suggested for further study.

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CHAPTER NINE

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287

introduction

albert ellis’s rational emotive

behavior therapy

key concepts

• View of Human Nature

• View of Emotional Disturbance

• A-B-C Framework

the therapeutic process

• Therapeutic Goals

• Therapist’s Function and Role

• Client’s Experience in Therapy

• Relationship Between Therapist and Client

application: therapeutic

techniques and procedures

• The Practice of Rational Emotive Behavior

Therapy

• Applications of REBT to Various Settings

• Application of REBT as a Brief Therapy

• Application to Group Counseling

aaron beck’s cognitive therapy

• Introduction

• Basic Principles of Cognitive Therapy

• The Client–Therapist Relationship

• Applications of Cognitive Therapy

donald meichenbaum’s cognitive

behavior modification

• Introduction

• How Behavior Changes

• Stress Inoculation Training

• The Constructivist Approach to Cognitive

Behavior Therapy

cognitive behavior therapy from

a multicultural perspective

• Strengths From a Diversity Perspective

• Shortcomings From a Diversity Perspective

cognitive behavior therapy

applied to the case of stan

summary and evaluation

• Summary

• Contributions of the Cognitive Behavioral

Approaches

• Limitations and Criticisms of the Cognitive

Behavioral Approaches

where to go from here

• Recommended Supplementary Readings

• References and Suggested Readings

chapter 10

Cognitive Behavior Therapy

apy

y

•

rom he

commended Supplemen

References and Suggested

aaron b

ntroduction

c Principles o

lient–Therapi

tions of Cogn

•

Bas

•

The

•

Appli

Therapy

•

Applications of REBT

•

Application of REBT as a

•

Application to Group Coun

k’s cognitiv

ognitive Thera

elationsh

hip Bet

application:

techniques a

•

The P

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288

CHAPTER TEN

Albert Ellis / Aaron T. Beck / Judith S. Beck /

Donald Meichenbaum

ALBERT ELLIS (1913–2007)

was born in Pittsburgh but

escaped to the wilds of New

York at the age of 4 and lived

there (except for a year in

New Jersey) for the rest of

his life. He was hospitalized

nine times as a child, mainly

with nephritis, and developed renal glycosuria at

the age of 19 and diabetes at the age of 40. Despite

his many physical challenges, he lived an unusu-

ally robust, active, and energetic life until his death

at age 93. As he put it, “I am busy spreading the

gospel according to St. Albert.”

Realizing that he could counsel people skillfully

and that he greatly enjoyed doing so, Ellis decided

to become a psychologist. Believing psychoanalysis

to be the deepest form of psychotherapy, Ellis was

analyzed and supervised by a training analyst. He

then practiced psychoanalytically oriented psycho-

therapy, but eventually he became disillusioned

with the slow progress of his clients. He observed

that they improved more quickly once they

changed their ways of thinking about themselves

and their problems. Early in 1955 he developed

an approach to psychotherapy he called rational

therapy and later rational emotive therapy, and

which is now known as rational emotive behavior

therapy (REBT). Ellis has rightly been referred to as

the grandfather of cognitive behavior therapy.

To some extent Ellis developed his approach as

a method of dealing with his own problems during

his youth. At one point in his life, for example, he

had exaggerated fears of speaking in public. Dur-

ing his adolescence he was extremely shy around

young women. At age 19 he forced himself to talk

to 100 different women in the Bronx Botanical

Gardens over a period of one month. Although

he never managed to get a date from these brief

encounters, he does report that he desensitized

himself to his fear of rejection by women. By apply-

ing rational and behavioral methods, he managed

to conquer some of his strongest emotional blocks

(Ellis, 1994, 1997).

People who heard Ellis lecture often com-

mented on his abrasive, humorous, and flamboy-

ant style. In his workshops it seemed that he took

delight in giving vent to his eccentric side, such as

peppering his speech with four-letter words. He

greatly enjoyed his work and teaching REBT, which

was his passion and primary commitment in life.

It seems that his work was his life, and he gave

workshops wherever he went in his travels. Ellis

proclaimed, “I wouldn’t go to the Taj Mahal unless

they asked me to do a workshop there!”

Ellis married Australian psychologist Debbie

Joffe in November 2004, whom he has called “the

greatest love of my life” (Ellis, 2008). They shared

the same life goals and ideals, and they worked as a

team presenting workshops. If you are interested in

learning more about the life and work of Albert Ellis, I

recommend two of his books: Rational Emotive Behav-

ior Therapy: It Works for Me—It Can Work for You (Ellis,

2004a) and All Out! An Autobiography (Ellis, 2010).

Photo Courtesy of Albert Ellis Institute

AARON TEMKIN BECK

(b. 1921) was born in Provi-

dence, Rhode Island. His

childhood, although happy,

was interrupted by a life-

threatening illness when

he was 8 years old. As a

consequence, he experi-

enced blood injury fears, fear of suffocation, and

anxiety about his health. Beck used his personal

problems as a basis for understanding others and

for developing his cognitive theory.

A graduate of Brown University and Yale

School of Medicine, Beck initially was trained as a

neurologist, but he switched to psychiatry during

his residency. Beck attempted to validate Freud’s

theory of depression, but his research resulted

in his parting company with Freud’s motivational

model and the explanation of depression as self-

directed anger. As a result of this decision, Beck

endured isolation and rejection from many in the

psychiatric community for many years. Through

his research, Beck developed a cognitive theory

of depression, which represents one of the most

Courtesy of Beck Institute for Cognitive

Behavior Therapy, Bala Cynwyd, PA.

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289

COGNITIVE BEHAVIOR THERAPY

JUDITH S. BECK (b. 1954)

was born in Philadelphia,

the second of four children.

Both her parents were quite

notable in their fields: her

father, as “the father of

cognitive therapy,” and her

mother, as the first female

judge on the appellate court

of the Commonwealth of Pennsylvania. From an

early age, Beck wanted to be an educator, and she

began her professional career teaching children

with learning disabilities. Her ability to break down

complex subjects into easily understandable ideas,

so critical in the education of children with learning

differences, is characteristic of all her work.

Beck later returned to graduate school, studied

education and psychology, and completed a

postdoctoral fellowship at the Center for Cognitive

Behavior Therapy at the University of Pennsylvania.

In 1994 she and her father opened the nonprofit

Beck Institute for Cognitive Therapy in suburban

Philadelphia, and she is currently president of

the institute. A premier training organization, the

institute is devoted to national and international

training in cognitive therapy through workshop

and supervision programs for students and faculty,

deployed and returning military families, health

and mental health professionals at all levels, and

organizations.

Beck travels extensively in the United States

and abroad, teaching and disseminating cognitive

behavior therapy and assisting a wide variety of

organizations in developing or strengthening their

CT programs. She writes a number of CT-oriented

blogs and edits “Cognitive Therapy Today,” an

e-newsletter. She is coauthor of the widely adopted

self-report scales, the Personality Belief Question-

naire and the Beck Youth Inventories II, which

screens children aged 7–18 for symptoms of

depression, anxiety, disruptive behavior, self-

concept, and anger.

Beck is Clinical Associate Professor at the

University of Pennsylvania and was instrumental

in founding the Academy of Cognitive Therapy,

the “home” organization for cognitive therapists

worldwide. She has written nearly a hundred

articles and chapters on a variety of CT topics

and authored several books on cognitive therapy,

including Cognitive Behavior Therapy: Basics and

Beyond (2011a), Cognitive Therapy for Challenging

Problems: What to Do When the Basics Don’t Work

Courtesy of Beck Institute for Cognitive

Behavior Therapy, Bala Cynwyd, PA.

comprehensive conceptualizations. He found the

cognitions of depressed individuals to be charac-

terized by errors in interpretation that he called

“cognitive distortions.” For Beck, negative thoughts

reflect underlying dysfunctional beliefs and

assumptions. When these beliefs are triggered by

situational events, a depressive pattern is put in

motion. Beck believes clients can assume an

active role in modifying their dysfunctional thinking

and thereby gain relief from a range of psychiatric

conditions. His continuous research in the areas

of psychopathology and the utility of cognitive

therapy has earned him a place of prominence in

the scientific community in the United States. Beck

is the pioneering figure in cognitive therapy, one of

the most influential and empirically validated

approaches to psychotherapy.

Beck joined the Department of Psychiatry of

the University of Pennsylvania in 1954, where he

currently holds the position of University Professor

(Emeritus) of Psychiatry. Beck’s pioneering research

established the efficacy of cognitive therapy for

depression. He has successfully applied cognitive

therapy to depression, generalized anxiety and

panic disorders, suicide, alcoholism and drug abuse,

eating disorders, marital and relationship problems,

psychotic disorders, and personality disorders. He

has developed assessment scales for depression,

suicide risk, anxiety, self-concept, and personality.

He is the founder of the Beck Institute, which is

a research and training center directed by one of his

four children, Dr. Judith Beck. He has eight grand-

children and two great-grandchildren and has been

married for more than 60 years. To his credit, Aaron

Beck has focused on developing the cognitive ther-

apy skills of thousands of clinicians throughout the

world. In turn, many of them have established their

own cognitive therapy centers. Beck has a vision

for the cognitive therapy community that is global,

inclusive, collaborative, empowering, and benevo-

lent. He continues to remain active in writing and

research; he has published 21 books and more than

450 articles and book chapters. For more on the life

of Aaron T. Beck, see Aaron T. Beck (Weishaar, 1993).

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290

CHAPTER TEN

introduction

As you saw in Chapter 9, traditional behavior therapy has broadened and largely

moved in the direction of cognitive behavior therapy. Several of the more promi-

nent cognitive behavioral approaches are featured in this chapter, including Al-

bert Ellis’s rational emotive behavior therapy (REBT), Aaron T. Beck’s and Judith

Beck’s cognitive therapy (CT), and Donald Meichenbaum’s cognitive behavior

therapy (CBT). The cognitive behavior therapies, which combine both cognitive

and behavioral principles and methods in a short-term treatment approach, have

generated more empirical research than any other psychotherapy model (Dattilio,

2000a). These approaches all fall under the general umbrella of cognitive behavior

therapies, which is the reason they are grouped together in this chapter.

All of the cognitive behavioral approaches share the same basic characteristics

and assumptions as traditional behavior therapy described in Chapter 9. Although

the approaches are quite diverse, they do share these attributes: (1) a collabora-

tive relationship between client and therapist, (2) the premise that psychological

distress is largely a function of disturbances in cognitive processes, (3) a focus

on changing cognitions to produce desired changes in affect and behavior, (4)

(2005), and the Cognitive Therapy Worksheet

Packet (2011b), as well as trade books with a

cognitive behavioral program for diet and mainte-

nance. Judith Beck has been married for 34 years

and has three adult children, one of whom is a

social worker specializing in CT.

DONALD MEICHEN-

BAUM

(b. 1940) was born

in New York City

(the Bronx) and learned

early to be “street smart”

and to be on the lookout

for high-risk situations. He

attended City College of

New York and received his

PhD in clinical psychology from the University of

Illinois. At the University of Waterloo in Ontario,

Canada,he conducted research on the develop-

ment of cognitive behavior therapy (CBT). He is the

recipient of a Lifetime Achievement Award from

the Clinical Division of the American Psychological

Association for his work on suicide prevention. In

1995 Meichenbaum retired from the University of

Waterloo to become the research director of the

MelissaInstitute for ViolencePrevention, which is

designed to “give science away” in order to reduce

violence and to treat victims of violence.

Meichenbaum attributes the origin of CBT

to his mother, who had a knack for telling stories

about her daily activities that were peppered with

her thoughts, feelings, and a running commentary.

This childhood experience contributed to Meichen-

baum’s psychotherapeutic approach of construc-

tivist narrative therapy, in which clients to tell their

stories and describe what they did to “survive and

cope.” Meichenbaum’s recent work with returning

service members using iPod technology to bolster

resilience is modeled on this approach. When

therapy is successful, Meichenbaum ensures

that clients take credit for the changes they have

achieved. As he observes, “I am at my therapeutic

best when the clientsI see are one step ahead of

me offering the observations or suggestions that

I would otherwise offer” (Donald Meichenbaum,

personal communication, October 21, 2010).

Meichenbaum has published extensively,

including Cognitive Behavior Modification: An Integra-

tive Approach (1977), Stress Inoculation Training (1985),

and Treatment of Individuals with Anger-Control

Problems and Aggressive Behaviors (2002). He has

lectured and consulted internationally and frequently

presents workshops at professional conferences.

Courtesy of Donald Meichenbaum, University of

Waterloo, Department of Psychology

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291

COGNITIVE BEHAVIOR THERAPY

a present-centered, time-limited focus, (5) an active and directive stance by the

therapist, and (6) an educational treatment focusing on speciﬁ c and structured

target problems (Beck & Weishaar, 2011). In addition, both cognitive therapy and

the cognitive behavioral therapies are based on a structured psychoeducation-

al model, emphasize the role of homework, place responsibility on the client to

assume an active role both during and outside therapy sessions, emphasize develop-

ing a strong therapeutic alliance, and draw from a variety of cognitive and behav-

ioral strategies to bring about change. Therapists help clients to examine the manner

in which they understand themselves and their world and to experiment with new

ways of behaving (Dienes, Torres-Harding, Reinecke, Freeman, & Sauer, 2011).

To a large degree, both cognitive therapy and cognitive behavior therapy are

based on the assumption that a reorganization of one’s self-statements will result

in a corresponding reorganization of one’s behavior. Behavioral techniques such

as operant conditioning, modeling, and behavioral rehearsal can be applied to the

more subjective processes of thinking and internal dialogue. Cognitive therapy

and the cognitive behavioral approaches include a variety of behavioral strategies

(discussed in Chapter 9) as a part of their integrative repertoire.

See the video program for Chapter 10, DVD for Theory and Practice of Coun-

seling and Psychotherapy: The Case of Stan and Lecturettes. I suggest that you

view the brief lecture for each chapter prior to reading the chapter.

albert ellis’s rational emotive

behavior therapy

Rational emotive behavior therapy (REBT) was the ﬁ rst of the cognitive behavior

therapies, and today it continues to be a major cognitive behavioral approach.

REBT has a great deal in common with the therapies that are oriented toward

cognition and behavior as it also stresses thinking, judging, deciding, analyzing,

and doing. The basic assumption of REBT is that people contribute to their own

psychological problems, as well as to speciﬁ c symptoms, by the rigid and extreme

beliefs they hold about events and situations. REBT is based on the assumption

that cognitions, emotions, and behaviors interact signiﬁ cantly and have a recip-

rocal cause-and-effect relationship. REBT has consistently emphasized all three

of these modalities and their interactions, thus qualifying it as an integrative

approach (Ellis, 2001a, 2001b, 2002, 2011; Ellis & Dryden, 2007; Wolfe, 2007).

Although REBT is generally conceded to be the parent of today’s cognitive be-

havioral approaches, it was preceded by earlier schools of thought. Ellis gave credit

to Alfred Adler as an inﬂ uential precursor of REBT, and Karen Horney’s (1950)

ideas on the “tyranny of the shoulds” are apparent in the conceptual framework of

REBT. Ellis also acknowledged his debt to the ancient Greeks, especially the Stoic

philosopher Epictetus, who said around 2,000 years ago: “People are disturbed

not by events, but by the views which they take of them” (as cited in Ellis, 2001a,

p. 16). Ellis’s reformulation of Epictetus’s dictum can be stated as, “People disturb

themselves by the rigid and extreme beliefs they hold about events.”

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292

CHAPTER TEN

REBT’s basic hypothesis is that our emotions stem mainly from our beliefs,

which inﬂ uence the evaluations and interpretations we make of the reactions we

have to life situations. Through the therapeutic process, clients learn skills that

give them the tools to identify and dispute irrational beliefs that have been ac-

quired and self-constructed and are now maintained by self-indoctrination. They

learn how to replace such ineffective ways of thinking with effective and rational

cognitions, and as a result they change their emotional reactions to situations. The

therapeutic process allows clients to apply REBT principles of change not only to

a particular presenting problem but also to many other problems in life or future

problems they might encounter.

Several therapeutic implications ﬂ ow from these assumptions: The focus is on

working with thinking and acting rather than primarily with expressing feelings.

Therapy is seen as an educational process. The therapist functions in many ways like

a teacher, especially in collaborating with a client on homework assignments and

in teaching strategies for straight thinking; and the client is a learner who practices

these new skills in everyday life.

REBT differs from many other therapeutic approaches in that it does not place

much value on free association, working with dreams, focusing on the client’s past

history, expressing and exploring feelings, or dealing with transference phenomena.

Ellis (2011) maintains that transference is not encouraged, and when it does occur,

the therapist is likely to confront it. Ellis believes the transference relationship is

based on the irrational belief that the client must be liked and loved by the therapist,

or parent ﬁ gure. Although transference and countertransference may spontaneously

occur in therapy, Ellis claims “they are quickly analyzed, the philosophies behind

them are revealed, and they tend to evaporate in the process” (p. 221). Furthermore,

when a client’s deep feelings emerge, “the client is not given too much chance to

revel in these feelings or abreact strongly about them” (p. 221). Ellis believes that

such cathartic work may result in clients feeling better, but it will rarely aid them in

getting better.

key concepts

View of Human Nature

Rational emotive behavior therapy is based on the assumption that human beings

are born with a potential for both rational, or “straight,” thinking and irrational, or

“crooked,” thinking. People have predispositions for self-preservation, happiness,

thinking and verbalizing, loving, communion with others, and growth and self-

actualization. They also have propensities for self-destruction, avoidance of thought,

procrastination, endless repetition of mistakes, superstition, intolerance, perfection-

ism and self-blame, and avoidance of actualizing growth potentials. REBT encour-

ages people accept themselves even though they will make mistakes.

View of Emotional Disturbance

REBT is based on the premise that we learn irrational beliefs from signiﬁ cant oth-

ers during childhood and then re-create these irrational beliefs throughout our

lifetime. We actively reinforce our self-defeating beliefs through the processes of

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293

COGNITIVE BEHAVIOR THERAPY

autosuggestion and self-repetition, and we then behave in ways that are consistent

with these beliefs. Hence, it is largely our own repetition of early-indoctrinated

irrational beliefs, rather than a parent’s repetition, that keeps dysfunctional atti-

tudes alive and operative within us.

Ellis contends that people do not need to be accepted and loved, even though

this may be highly desirable. The therapist teaches clients how to feel sad, but not

depressed, even when they are unaccepted and unloved by signiﬁ cant others. A

major goal of the REBT therapist is to encourage clients to be less emotionally re-

active, for example, by feeling sadness and disappointment about life’s adversities

rather than by feeling anxiety, depression, and shame.

Ellis insists that blame is at the core of most emotional disturbances. If we want

to become psychologically healthy, we had better stop blaming ourselves and others

and learn to fully and unconditionally accept ourselves despite our imperfections.

Ellis (Ellis & Blau, 1998; Ellis & Harper, 1997) hypothesizes that we have strong ten-

dencies to transform our desires and preferences into dogmatic “shoulds,” “musts,”

“oughts,” demands, and commands. When we are disturbed, it is a good idea to look

to our hidden dogmatic “musts” and absolutist “shoulds.” Such demands underpin

disruptive feelings and dysfunctional behaviors (Ellis, 2001a, 2004a).

Here are three basics musts (or irrational beliefs) that we internalize that inevita-

bly lead to self-defeat (Ellis & Dryden, 2007):

• “I must do well and win the approval of others for my performances or else I am

no good.”

• “Other people must treat me considerately, fairly, kindly, and in exactly the way

I want them to treat me. If they don’t, they are no good and they deserve to be

condemned and punished.”

• “I must get what I want, when I want it; and I must not get what I don’t want. If I

don’t get what I want, it’s terrible, I can’t stand it, and life is no good for depriv-

ing me of what I must have.”

We have a strong tendency to make and keep ourselves emotionally disturbed by inter-

nalizing and perpetuating self-defeating beliefs such as these, which is why it is a real

challenge to achieve and maintain good psychological health (Ellis, 2001a, 2001b).

A-B-C Framework

The A-B-C framework is central to REBT theory and practice. This model provides

a useful tool for understanding the client’s feelings, thoughts, events, and behavior

(Wolfe, 2007). A is the existence of a fact, or an activating event, or an inference

about an event, of an individual. C is the emotional and behavioral consequence or

reaction of the individual; the reaction can be either healthy or unhealthy. A (the

activating event) does not cause C (the emotional consequence). Instead, B, which

is the person’s belief about A, largely creates C, the emotional reaction.

The interaction of the various components can be diagrammed like this:

A (activating event)  B (belief) ® C (emotional and behavioral consequence)



D (disputing intervention) ® E (effect) ® F (new feeling)

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294

CHAPTER TEN

If a person experiences depression after a divorce, for example, it may not be

the divorce itself that causes the depressive reaction nor his inference that he has

failed, but the person’s beliefs about his divorce or about his failure. Ellis maintains

that the beliefs about the rejection and failure (at point B) are what mainly cause

the depression (at point C)—not the actual event of the divorce or the person’s in-

ference of failure (at point A). Believing that human beings are largely responsible

for creating their own emotional reactions and disturbances and showing people

how they can change their irrational beliefs that directly “cause” their disturbed

emotional consequences is at the heart of REBT (Ellis & Dryden, 2007; Ellis &

Harper, 1997).

How is an emotional disturbance fostered? It is fed by the self-defeating sen-

tences clients continually repeat to themselves, such as “I am totally to blame for

the divorce,” “I am a miserable failure, and everything I did was wrong,” “I am a

worthless person.” Ellis repeatedly makes the point that “you mainly feel the way

you think.” Disturbed emotional reactions such as depression and anxiety are initi-

ated and perpetuated by clients’ self-defeating belief systems, which are based on

irrational ideas clients have incorporated and invented.

After A, B, and C comes D (disputing). Essentially, D is the application of meth-

ods to help clients challenge their irrational beliefs. There are three components

of this disputing process: detecting, debating, and discriminating. First, clients

learn how to detect their irrational beliefs, particularly their absolutist “shoulds”

and “musts,” their “awfulizing,” and their “self-downing.” Then clients debate their

dysfunctional beliefs by learning how to logically and empirically question them

and to vigorously argue themselves out of and act against believing them. Finally,

clients learn to discriminate irrational (self-defeating) beliefs from rational (self-

helping) beliefs (Ellis, 1994, 1996). Cognitive restructuring is a central technique

of cognitive therapy that teaches people how to improve themselves by replacing

irrational beliefs with rational beliefs (Ellis, 2008). Restructuring involves helping

clients learn to monitor their self-talk, identify maladaptive self-talk, and substitute

adaptive self-talk for their negative self-talk (Spiegler, 2008).

Ellis (1996, 2001b) maintains that we have the capacity to signiﬁ cantly change our

cognitions, emotions, and behaviors. We can best accomplish this goal by avoiding

preoccupying ourselves with A and by acknowledging the futility of dwelling end-

lessly on emotional consequences at C. Rather, we can choose to examine, challenge,

modify, and uproot B—the irrational beliefs we hold about the activating events at A.

Although REBT uses many other cognitive, emotive, and behavioral methods

to help clients minimize their irrational beliefs, it stresses the process of disput-

ing (D) such beliefs both during therapy sessions and in everyday life. Eventually

clients arrive at E, an effective philosophy, which has a practical side. A new and

effective belief system consists of replacing unhealthy thoughts with healthy ones.

If we are successful in doing this, we also create F, a new set of feelings. Instead of

feeling seriously anxious and depressed, we feel healthily sorry and disappointed

in accord with a situation.

In sum, philosophical restructuring to change our dysfunctional personality involves

these steps: (1) fully acknowledging that we are largely responsible for creating our

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COGNITIVE BEHAVIOR THERAPY

own emotional problems; (2) accepting the notion that we have the ability to change

these disturbances signiﬁ cantly; (3) recognizing that our emotional problems largely

stem from irrational beliefs; (4) clearly perceiving these beliefs; (5) seeing the value of

disputing such self-defeating beliefs; (6) accepting the fact that if we expect to change

we had better work hard in emotive and behavioral ways to counteract our beliefs and

the dysfunctional feelings and actions that follow; (7) understanding what the rational

alternative to these irrational beliefs are; and (8) practicing REBT methods of uprooting

or changing disturbed consequences and practicing their healthy alternatives for the

rest of our life (Ellis, 1999, 2001b, 2002).

the therapeutic process

Therapeutic Goals

According to Ellis (2001b; Ellis & Harper, 1997), we have a strong tendency not only

to rate our acts and behaviors as “good” or “bad,” “worthy” or “unworthy,” but also to

rate ourselves as a total person on the basis of our performances. These ratings consti-

tute one of the main sources of our emotional disturbances. Therefore, most rational

emotive behavior therapists have the general goal of teaching clients how to separate

the evaluation of their behaviors from the evaluation of themselves—their essence and

their totality—and how to accept themselves in spite of their imperfections.

The many roads taken in rational emotive behavior therapy lead toward the

destination of clients minimizing their emotional disturbances and self-defeating

behaviors by acquiring a more realistic and workable philosophy of life. The proc-

ess of REBT involves a collaborative effort on the part of both the therapist and the

client in choosing realistic and self-enhancing therapeutic goals. The therapist’s

task is to help clients differentiate between realistic and unrealistic goals and also

self-defeating and self-enhancing goals (Dryden, 2007). A basic goal is to teach cli-

ents how to change their dysfunctional emotions and behaviors into healthy ones.

Ellis (2001b) states that two of the main goals of REBT are to assist clients in

the process of achieving unconditional self-acceptance (USA) and unconditional other

acceptance (UOA), and to see how these are interrelated. As clients become more

able to accept themselves, they are more likely to unconditionally accept others.

Therapist’s Function and Role

The therapist has speciﬁ c tasks, and the ﬁ rst step is to show clients how they have

incorporated many irrational absolute “shoulds,” “oughts,” and “musts.” The ther-

apist disputes clients’ irrational beliefs and encourages clients to engage in activi-

ties that will counter their self-defeating beliefs and to replace their rigid “musts”

with preferences.

A second step in the therapeutic process is to demonstrate how clients are

keeping their emotional disturbances active by continuing to think illogically and

unrealistically. In other words, because clients keep reindoctrinating themselves,

they are largely responsible for their own psychological problems.

To get beyond mere recognition of irrational thoughts, the therapist takes a third

step—helping clients modify their thinking and minimize their irrational ideas.

Although it is unlikely that we can entirely eliminate the tendency to think irrationally,

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CHAPTER TEN

we can reduce the frequency of such thinking. The therapist encourages clients to

identify the irrational beliefs they originally unquestioningly accepted and demon-

strates how they are continuing to indoctrinate themselves with these beliefs.

The fourth step in the therapeutic process is to challenge clients to develop a

rational philosophy of life so that in the future they can avoid becoming the victim

of other irrational beliefs. Tackling only speciﬁ c problems or symptoms can give

no assurance that new illogical fears will not emerge. It is desirable, then, for the

therapist to dispute the core of the irrational thinking and to teach clients how to

substitute rational beliefs and behaviors for irrational ones.

The therapist takes the mystery out of the therapeutic process, teaching clients

about the cognitive hypothesis of disturbance and showing how rigid and extreme

irrational beliefs lead to disturbed negative consequences. Insight alone does not

typically lead to psychotherapeutic change, but it helps clients to see how they are

continuing to sabotage themselves and what they can do to change.

Client’s Experience in Therapy

Once clients begin to accept that their beliefs underpin their emotions and behav-

iors, they are able to participate effectively in the cognitive restructuring process

(Ellis, Gordon, Neenan, & Palmer, 1997; Ellis & MacLaren, 2005). Because psy-

chotherapy is viewed as a reeducative process, clients learn how to apply logical

thought, participate in experiential exercises, and carry out behavioral homework

as a way to bring about change. Clients can realize that life does not always work

out the way that they would like it to. Even though life is not always pleasant, cli-

ents learn that life can be bearable and that even suffering can be honorable.

The therapeutic process largely focuses on clients’ experiences in the present.

Like the person-centered and existential approaches to therapy, REBT mainly em-

phasizes here-and-now experiences and clients’ present ability to change the pat-

terns of thinking and emoting that they constructed earlier. The therapist does

not devote much time to exploring clients’ early history and making connections

between their past and present behavior unless doing so will aid the therapeutic

process. Nor does the therapist usually explore clients’ early relationships with

their parents or siblings. Instead, the therapeutic process stresses to clients that

they are presently disturbed because they still believe in and act upon their self-

defeating view of themselves, other people, and the world.

Clients are expected to actively work outside the therapy sessions. By working

hard and carrying out behavioral homework assignments, clients can learn to mini-

mize faulty thinking, which leads to disturbances in feeling and behaving. Home-

work is carefully designed and agreed upon and is aimed at getting clients to carry

out positive actions that induce emotional and attitudinal change. These assign-

ments are checked in later sessions, and clients learn effective ways to dispute self-

defeating thinking. Toward the end of therapy, clients review their progress, make

plans, and identify strategies for dealing with continuing or potential problems.

Relationship Between Therapist and Client

Because REBT is essentially a cognitive and directive behavioral process, a warm re-

lationship between therapist and client is not required. As with the person-centered

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COGNITIVE BEHAVIOR THERAPY

therapy of Rogers, REBT practitioners strive to unconditionally accept all clients

and to teach them to unconditionally accept others and themselves. However,

Ellis believes that too much warmth and understanding can be counterproductive

and foster a sense of dependence for approval from the therapist. REBT prac-

titioners accept their clients as imperfect beings who can be helped through a

variety of techniques such as teaching, bibliotherapy, and behavior modiﬁ cation

(Ellis, 2011).

Rational emotive behavior therapists are often open and direct in disclosing

their own beliefs and values. Some are willing to share their own imperfections as

a way of disputing clients’ unrealistic notions that therapists are “completely put

together” persons. On this point, Wolfe (2007) claims “it is important to establish

as much as possible an egalitarian relationship, as opposed to presenting yourself

as a nondisclosing authority ﬁ gure” (p. 186).

application: therapeutic

techniques and procedures

The Practice of Rational Emotive Behavior Therapy

Rational emotive behavior therapists are multimodal and integrative. REBT gener-

ally starts with clients’ disturbed feelings and intensely explores these feelings in

connection with thoughts and behaviors. REBT practitioners tend to use a number of

different modalities (cognitive, imagery, emotive, behavioral, and interpersonal) to

dispel these self-defeating cognitions and to teach people how to acquire a rational

approach to living. Therapists are encouraged to be ﬂ exible and creative in their

use of methods, making sure to tailor the techniques to the unique needs of each

client (Dryden, 2007).

For a concrete illustration of how Dr. Ellis works with the client Ruth, drawing

from cognitive, emotive, and behavioral techniques, see Case Approach to Coun-

seling and Psychotherapy (Corey, 2013a, chap. 8). What follows is a brief summary

of the major cognitive, emotive, and behavioral techniques Ellis describes (Ellis,

2004a; Ellis & Crawford, 2000; Ellis & Dryden, 2007; Ellis & MacLaren, 2005).

cognitive methods REBT practitioners usually incorporate a persuasive

cognitive methodology in the therapeutic process. They demonstrate to clients in a

quick and direct manner what it is that they are continuing to tell themselves. Then

they teach clients how to deal with these self-statements so that they no longer

believe them, encouraging them to acquire a philosophy based on reality. REBT

relies heavily on thinking, disputing, debating, challenging, interpreting, explain-

ing, and teaching. The most efﬁ cient way to bring about lasting emotional and

behavioral change is for clients to change their way of thinking (Dryden, 2007).

Here are some cognitive techniques available to the therapist.

• Disputing irrational beliefs. The most common cognitive method of REBT con-

sists of the therapist actively disputing clients’ irrational beliefs and teaching them

how to do this challenging on their own. Clients go over a particular “must,” absolute

“should,” or “ought” until they no longer hold that irrational belief, or at least until it

is diminished in strength. Here are some examples of questions or statements clients

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CHAPTER TEN

learn to tell themselves: “Why must people treat me fairly?” “How do I become a total

ﬂ op if I don’t succeed at important tasks I try?” “If I don’t get the job I want, it may be

disappointing, but I can certainly stand it.” “If life doesn’t always go the way I would

like it to, it isn’t awful, just inconvenient.”

• Doing cognitive homework. REBT clients are expected to make lists of their

problems, look for their absolutist beliefs, and dispute these beliefs. They often

ﬁ ll out the REBT Self-Help Form, which is reproduced in Corey’s (2013b) Stu-

dent Manual for Theory and Practice of Counseling and Psychotherapy. They can

bring this form to their therapy sessions and critically evaluate the disputation

of some of their beliefs. Homework assignments are a way of tracking down the

“shoulds” and “musts” that are part of their internalized self-messages. Part of

this homework consists of applying the A-B-C model to many of the problems

clients encounter in daily life. Work in the therapy session can be designed in

such a way that out-of-ofﬁ ce tasks are feasible and the client has the skills to

complete these tasks.

In carrying out homework, clients are encouraged to put themselves in risk-

taking situations that will allow them to challenge their self-limiting beliefs. For

example, a client with a talent for acting who is afraid to act in front of an audience

because of fear of failure may be asked to take a small part in a stage play. The client

is helped to replace irrational beliefs—“If I look foolish, this proves I am a fool.”

“If I am not liked, that would be awful.” “I will fail and therefore be a failure.”—

with more positive messages such as these: “Even if I do behave foolishly at times,

this does not make me a foolish person.” “I can act.” “I will do the best I can.” “It’s

nice to be liked, but not everybody has to like me, and if they don’t, that isn’t the

end of the world.” “If I fail, I am human, not a failure.”

The theory behind this and similar assignments is that clients often create

a negative, self-fulﬁ lling prophecy and actually fail because they told themselves

in advance that they would. Clients are encouraged to carry out speciﬁ c assign-

ments during the sessions and, especially, in everyday situations between sessions.

Clients are expected to take the time to record and think about how their beliefs

contribute to their personal problems. In addition, they need to work hard at up-

rooting these self-defeating cognitions. In this way clients gradually learn to deal

with anxiety and to challenge basic irrational thinking. Making changes is hard

work, and doing work outside the sessions is of real value in revising clients’ think-

ing, feeling, and behaving.

• Bibliotherapy. REBT, and other CBT approaches, can be delivered to some

degree in a bibliotherapeutic format. It is probably best to utilize bibliotherapy as

an adjunctive form of treatment. There are advantages of bibliotherapy, such as

cost-effectiveness, widespread availability, and the potential of reaching a broad

spectrum of populations. Bibliotherapeutic approaches have empirical support for

the treatment of depression, for a variety of anxiety disorders, and for a range of

clinical problems (Jacobs, 2008). Because therapy is seen as an educational proc-

ess, clients are encouraged to read REBT self-help books such as Rational Emotive

Behavior Therapy: It Works for Me—It Can Work for You (Ellis, 2004a) and other

books by Ellis (1999, 2000, 2001a, 2001b).

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COGNITIVE BEHAVIOR THERAPY

• Changing one’s language. REBT rests on the premise that imprecise language

is one of the causes of distorted thinking processes. Clients learn that “musts,”

“oughts,” and absolute “shoulds” can be replaced by preferences. Instead of saying “It

would be absolutely awful if . . .”, they learn to say “It would be inconvenient if . . .”.

Clients who use language patterns that reﬂ

ect helplessness and self-condemnation

can learn to employ new self-statements, which help them think and behave differ-

ently. As a consequence, they also begin to feel differently.

• Psychoeducational methods. REBT programs introduce clients to various edu-

cational materials. Therapists educate clients about the nature of their problems

and how treatment is likely to proceed. They ask clients how particular concepts

apply to them. Clients are more likely to cooperate with a treatment program if

they understand how the therapy process works and if they understand why par-

ticular techniques are being used (Ledley, Marx, & Heimberg, 2010).

emotive techniques REBT practitioners use a variety of emotive proce-

dures, including unconditional acceptance, rational emotive role playing, modeling,

rational emotive imagery, and shame-attacking exercises. Clients are taught the val-

ue of unconditional self-acceptance. Even though their behavior may be difﬁ cult to

accept, they can decide to see themselves as fallible human beings. Clients are taught

how destructive it is to engage in “putting oneself down” for perceived deﬁ ciencies.

Although REBT employs a variety of emotive techniques, which tend to be

vivid and evocative in nature, the main purpose is to dispute clients’ irrational

beliefs (Dryden, 2007). These strategies are used both during the therapy sessions

and as homework assignments in daily life. Their purpose is not simply to provide

a cathartic experience but to help clients change some of their thoughts, emotions,

and behaviors (Ellis, 2001b, 2011; Ellis & Dryden, 2007). Let’s look at some of

these evocative and emotive therapeutic techniques in more detail.

• Rational emotive imagery. This technique is a form of intense mental practice

designed to establish new emotional patterns (see Ellis, 2001a, 2001b). Using the

technique of rational emotive imagery (REI), clients are asked to vividly imagine

one of the worst things that might happen to them. They imagine themselves in

speciﬁ

c situations where they experience disturbing feelings. Then they are shown

how to train themselves to develop healthy emotions in place of disruptive ones.

As clients change their feelings about adversities, they stand a better chance of

changing their behavior in the situation. Such a technique can be usefully applied

to interpersonal and other situations that are problematic for the individual. Ellis

(2001a, 2011) maintains that if we keep practicing rational emotive imagery several

times a week for a few weeks, we can reach the point that we no longer feel upset

over negative events.

• Using humor. REBT contends that emotional disturbances often result from

taking oneself too seriously, thus, this approach employs a good deal of humor.

One appealing aspect of REBT is that it fosters the development of a better sense

of humor and helps put life into perspective (Wolfe, 2007). Humor has both cogni-

tive and emotional beneﬁ

ts in bringing about change. Humor shows the absurdity

of certain ideas that clients steadfastly maintain, and it can be of value in helping

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300

CHAPTER TEN

clients take themselves much less seriously. It teaches clients to laugh—not at

themselves, but at their self-defeating ways of thinking.

• Role playing. Role playing has emotive, cognitive, and behavioral compo-

nents, and the therapist often interrupts to show clients what they are telling them-

selves to create their disturbances and what they can do to change their unhealthy

feelings to healthy ones. Clients can rehearse certain behaviors to bring out what

they feel in a situation. The focus is on working through the underlying irrational

beliefs that are related to unpleasant feelings. For example, Dawson may put off

applying to a graduate school because of his fears of not being accepted. Just the

thought of not being accepted to the school of his choice brings out intense feel-

ings of “being stupid.” Dawson role-plays an interview with the dean of graduate

students, notes his anxiety and the speciﬁ

c beliefs leading to it, and challenges his

conviction that he absolutely must be accepted and that not gaining such accept-

ance means that he is a stupid and incompetent person.

• Shame-attacking exercises. The rationale underlying shame-attacking exercis-

es is that emotional disturbance related to the self is often characterized by feel-

ings of shame, guilt, anxiety, and depression. Ellis (1999, 2000, 2001a, 2001b)

developed exercises to help people reduce shame and anxiety over behaving in

certain ways. Ellis asserts that we can stubbornly refuse to feel ashamed by telling

ourselves that it is not catastrophic if someone thinks we are foolish. The exercises

are aimed at increasing self-acceptance and mature responsibility, as well as help-

ing clients see that much of what they think of as being shameful has to do with the

way they deﬁ

ne reality for themselves. Clients may accept a homework assignment

to take the risk of doing something that they are ordinarily afraid to do because of

what others might think. For example, clients may wear “loud” clothes designed

to attract attention, sing loudly, ask a silly question at a lecture, or ask for a left-

handed monkey wrench in a grocery store. By carrying out such assignments, cli-

ents are likely to ﬁ nd out that other people are not really that interested in their

behavior. They work on themselves so that they do not feel ashamed or humiliated,

even when they acknowledge that some of their acts will lead to judgments by oth-

ers. They continue practicing these exercises until they realize that their feelings

of shame are self-created and until they are able to behave in less inhibited ways.

Clients eventually learn that they often have no reason for continuing to let others’

reactions or possible disapproval stop them from doing the things they would like

to do. Note that these exercises do not involve illegal activities or acts that will be

harmful to oneself or to others or that will unduly alarm other people.

behavioral techniques REBT practitioners use most of the standard behav-

ior therapy procedures, especially operant conditioning, self-management princi-

ples, systematic desensitization, relaxation techniques, and modeling. Behavioral

homework assignments to be carried out in real-life situations are particularly im-

portant. These assignments are done systematically and are recorded and analyzed

on a form. Homework gives clients opportunities to practice new skills outside

of the therapy session, which may be even more valuable for clients than work

done during the therapy hour (Ledley et al., 2010). Doing homework may involve

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301

COGNITIVE BEHAVIOR THERAPY

desensitization and live exposure in daily life situations. Clients can be encouraged

to desensitize themselves gradually but also, at times, to perform the very things

they dread doing implosively. For example, a person with a fear of elevators may

decrease this fear by going up and down in an elevator 20 or 30 times in a day.

Clients actually do new and difﬁ cult things, and in this way they put their insights

to use in the form of concrete action. By acting differently, they also tend to incor-

porate functional beliefs.

Applications of REBT to Various Settings

With its clear structure (A-B-C framework), REBT is applicable to a wide range of

settings and populations, including elementary and secondary schools. REBT can

be applied to couples counseling and family therapy. In working with couples, the

partners are taught the principles of REBT so that they can work out their differ-

ences or at least become less disturbed about them. In family therapy, individual

family members are encouraged to consider letting go of the demand that others

in the family behave in ways they would like them to. Instead, REBT teaches family

members that they are primarily responsible for their own actions and for chang-

ing their own reactions to the family situation.

Application of REBT as a Brief Therapy

REBT is well suited as a brief form of therapy, whether it is applied to individuals,

groups, couples, or families. Ellis originally developed REBT to try to make psycho-

therapy shorter and more efﬁ cient than most other systems of therapy, and it is often

used as a brief therapy. Ellis has always maintained that the best therapy is efﬁ cient,

quickly teaching clients how to tackle practical problems of living. Clients learn how to

apply REBT techniques to their present as well as future problems. A distinguishing

characteristic of REBT that makes it a brief form of therapy is that it is a self-help ap-

proach (Vernon, 2007). The A-B-C approach to changing basic disturbance-creating

attitudes can be learned in 1 to 10 sessions and then practiced at home.

Application to Group Counseling

Cognitive behavior therapy (CBT) groups are among the most popular in clinics

and community agency settings. Two of the most common CBT group approaches

are based on the principles and techniques of REBT and cognitive therapy (CT).

REBT practitioners employ an active role in getting members to commit them-

selves to practicing in everyday situations what they are learning in the group sessions.

They view what goes on during the group as being valuable, yet they know that the con-

sistent work between group sessions and after a group ends is even more crucial. The

group context provides members with tools they can use to become self-reliant and

to accept themselves unconditionally as they encounter new problems in daily living.

REBT is also suitable for group therapy because the members are taught to ap-

ply its principles to one another in the group setting. Ellis recommends that most

clients experience group therapy as well as individual therapy at some point. This

form of group therapy focuses on speciﬁ c techniques for changing a client’s self-

defeating thoughts in various concrete situations. In addition to modifying beliefs,

this approach helps group members see how their beliefs inﬂ uence what they feel

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302

CHAPTER TEN

and what they do. This model aims to minimize symptoms by bringing about a

profound change in philosophy. Ellis (2011) contends that REBT is particularly

applicable to group therapy and is frequently the treatment of choice. Group

work affords many opportunities to agree on homework assignments, to practice

assertiveness skills, to take risks by practicing different behaviors, to challenge

self-defeating thinking, to learn from the experiences of others, and to interact

therapeutically and socially with each other in after-group sessions. All of the

cognitive, emotive, and behavioral techniques described earlier are applicable

to group counseling as are the techniques covered in Chapter 9 on behavior

therapy. Behavioral homework and skills training are just two useful methods

for a group format.

A major strength of REBT and cognitive behavioral groups is the emphasis

placed on education and prevention. Because CBT and REBT are based on broad

principles of learning, these approaches can be used to meet the requirements

of a wide variety of groups with a range of different purposes. The speciﬁ city of

CBT allows for links among assessment, treatment, and evaluation strategies. CBT

groups have targeted problems ranging from anxiety and depression to parent ed-

ucation and relationship enhancement. Cognitive behavioral group therapy has

been demonstrated to have beneﬁ cial applications for some of the following specif-

ic problems: depression, anxiety, panic and phobia, obesity, eating disorders, dual

diagnoses, dissociative disorders, and adult attention deﬁ cit disorders (see White &

Freeman, 2000). Based on his survey of outcome studies of cognitive behavioral

group therapy, Petrocelli (2002) concludes that this approach to groups is effec-

tive for treating a wide range of emotional and behavioral problems. For a more

detailed discussion of REBT applied to group counseling, see Corey (2012, chap. 14).

aaron beck’s cognitive therapy

Introduction

Aaron T. Beck developed an approach known as cognitive therapy (CT) as a re-

sult of his research on depression (Beck 1963, 1967). Beck developed cognitive

therapy about the same time that Ellis was developing REBT, yet they appear to

have created their approaches independently. Beck’s observations of depressed

clients revealed that they had a negative bias in their interpretation of certain life

events, which contributed to their cognitive distortions (Beck, 1967). Cognitive

therapy has a number of similarities to both rational emotive behavior therapy and

behavior therapy. All of these therapies are active, directive, time-limited, present-

centered, problem-oriented, collaborative, structured, and empirical. They make

use of homework and require explicit identiﬁ cation of problems and the situations

in which they occur (Beck & Weishaar, 2011).

Cognitive therapy (CT) perceives psychological problems as stemming from com-

monplace processes such as faulty thinking, making incorrect inferences on the basis

of inadequate or incorrect information, and failing to distinguish between fantasy

and reality. Like REBT, CT is an insight-focused therapy with a strong psychoedu-

cational component that emphasizes recognizing and changing unrealistic nega-

tive thoughts and maladaptive beliefs. Cognitive therapy is highly collaborative and

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303

COGNITIVE BEHAVIOR THERAPY

involves designing speciﬁ c learning experiences to help clients monitor their auto-

matic thoughts; examine the validity of their automatic thoughts; understand the

relationship among cognition, feelings, and behavior; develop more accurate and

realistic cognitions; and change underlying beliefs and assumptions (Dobson &

Dozois, 2010; Dozois & Beck, 2011). Cognitive therapy is based on the theoretical

rationale that the way people feel and behave is inﬂ uenced by how they perceive

and structure their experience. The theoretical assumptions of cognitive therapy

are (1) that people’s internal communication is accessible to introspection, (2) that

clients’ beliefs have highly personal meanings, and (3) that these meanings can

be discovered by the client rather than being taught or interpreted by the therapist

(Weishaar, 1993).

Basic Principles of Cognitive Therapy

Beck, formerly a practicing psychoanalytic therapist for many years, grew inter-

ested in his clients’ automatic thoughts (personalized notions that are triggered by

particular stimuli that lead to emotional responses). As a part of a psychoanalytic

research study, he was examining the dream content of depressed clients for anger

that they were turning back on themselves. He began to notice that rather than

retroﬂ ected anger, as Freud theorized with depression, clients exhibited a negative

bias in their interpretation or thinking. Beck asked clients to observe their nega-

tive automatic thoughts that persisted even though they were contrary to objective

evidence, and from this beginning he developed one of the most comprehensive

theories of psychopathology in the world.

Individuals tend to maintain their core beliefs about themselves, their world,

and their future. A primary focus of cognitive therapy is to assist clients in ex-

amining and restructuring their core beliefs (or core schema) (Dozois & Beck,

2011). By encouraging clients to gather and weigh the evidence in support of their

beliefs, therapists help clients bring about enduring changes in their mood and

their behavior.

Beck contends that people with emotional difﬁ culties tend to commit char-

acteristic “logical errors” that distort objective reality. Let’s examine some of the

systematic errors in reasoning that lead to faulty assumptions and misconceptions,

which are termed cognitive distortions (J. Beck, 2011; Beck & Weishaar, 2011).

• Arbitrary inferences refer to making conclusions without supporting and rel-

evant evidence. This includes “catastrophizing,” or thinking of the absolute worst

scenario and outcomes for most situations. You might begin your ﬁ

rst job as a

counselor with the conviction that you will not be liked or valued by either your

colleagues or your clients. You are convinced that you fooled your professors

and somehow just managed to get your degree, but now people will certainly see

through you!

• Selective abstraction consists of forming conclusions based on an isolated

detail of an event. In this process other information is ignored, and the signiﬁ -

cance of the total context is missed. The assumption is that the events that matter

are those dealing with failure and deprivation. As a counselor, you might measure

your worth by your errors and weaknesses, not by your successes.

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• Overgeneralization is a process of holding extreme beliefs on the basis of a

single incident and applying them inappropriately to dissimilar events or settings.

If you have difﬁ

culty working with one adolescent, for example, you might con-

clude that you will not be effective counseling any adolescents. You might also

conclude that you will not be effective working with any clients!

• Magniﬁ

cation and minimization consist of perceiving a case or situation in a

greater or lesser light than it truly deserves. You might make this cognitive error

by assuming that even minor mistakes in counseling a client could easily create a

crisis for the individual and might result in psychological damage.

• Personalization is a tendency for individuals to relate external events to them-

selves, even when there is no basis for making this connection. If a client does not

return for a second counseling session, you might be absolutely convinced that

this absence is due to your terrible performance during the initial session. You

might tell yourself, “This situation proves that I really let that client down, and now

she may never seek help again.”

• Labeling and mislabeling involve portraying one’s identity on the basis of

imperfections and mistakes made in the past and allowing them to deﬁ ne

one’s

true identity. Thus, if you are not able to live up to all of a client’s expectations,

you might say to yourself, “I’m totally worthless and should turn my professional

license in right away.”

• Dichotomous thinking involves categorizing experiences in either-or ex-

tremes. With such polarized thinking, events are labeled in black or white terms.

You might give yourself no latitude for being an imperfect person and imperfect

counselor. You might view yourself as either being the perfectly competent coun-

selor (which means you always succeed with all clients) or as a total ﬂ

op if you are

not fully competent (which means there is no room for any mistakes).

The cognitive therapist operates on the assumption that an important way to

produce lasting change in dysfunctional emotions and behaviors is to modify inac-

curate and dysfunctional thinking. The cognitive therapist teaches clients how to

identify these distorted and dysfunctional cognitions through a process of evalua-

tion. Through a collaborative effort, clients learn the inﬂ uence that cognition has

on their feelings and behaviors and even on environmental events. In cognitive

therapy, clients learn to engage in more realistic thinking, especially if they con-

sistently notice times when they tend to get caught up in catastrophic thinking.

After they have gained insight into how their unrealistic negative thoughts are

affecting them, clients are taught to test these automatic thoughts against reality

by examining and weighing the evidence for and against them. They can begin to

monitor the frequency with which these beliefs intrude in situations in everyday life.

The frequently asked question is, “What is the evidence for _____?” This process of

critically examining their automatic thoughts and core beliefs involves empirically

testing them by actively engaging in a Socratic dialogue with the therapist, carry-

ing out homework assignments, doing behavioral experiments, gathering data on

assumptions they make, and forming alternative interpretations (Dattilio, 2000a;

Freeman & Dattilio, 1994; Tompkins, 2004, 2006). From the start of treatment,

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COGNITIVE BEHAVIOR THERAPY

clients learn to employ speciﬁ c problem-solving and coping skills. Through a proc-

ess of guided discovery, clients acquire insight about the connection between their

thinking and the ways they act and feel.

Cognitive therapy is focused on present problems, regardless of a client’s di-

agnosis. The past may be brought into therapy when the therapist considers it es-

sential to understand how and when certain core dysfunctional beliefs originated

and how these ideas have a current impact on the client’s speciﬁ c schema (Dattilio,

2002a). The goals of this brief therapy include providing symptom relief, assist-

ing clients in resolving their most pressing problems, and teaching clients relapse

prevention strategies.

some differences between ct and rebt In both CT and REBT,

reality testing is highly organized. Clients come to realize on an experiential level

that they have misconstrued situations. Yet there are some important differences

between these two approaches, especially with respect to therapeutic methods

and style.

REBT is often highly directive, persuasive, and confrontational; it also focus-

es on the teaching role of the therapist. The therapist models rational thinking

and helps clients to identify and dispute irrational beliefs. In contrast, CT uses a

Socratic dialogue by posing open-ended questions to clients with the aim of getting

clients to reﬂ ect on personal issues and arrive at their own conclusions. CT places

more emphasis on helping clients identify their misconceptions for themselves

than does REBT. Through this reﬂ ective questioning process, the cognitive thera-

pist attempts to collaborate with clients in testing the validity of their cognitions

(a process termed collaborative empiricism). Therapeutic change is the result of

clients confronting faulty beliefs with contradictory evidence that they have gath-

ered and evaluated.

There are also differences in how Ellis and Beck view faulty thinking. Through

a process of rational disputation, Ellis works to persuade clients that certain of their

beliefs are irrational and nonfunctional. Beck views his clients’ beliefs as being

more inaccurate than irrational and asks his clients to conduct behavioral experi-

ments to test the accuracy of their beliefs (Hollon & DiGiuseppe, 2011). Cognitive

therapists view dysfunctional beliefs as being problematic when they are irrational,

or when they are too absolute, broad, and extreme (Beck & Weishaar, 2011). For

Beck, people live by rules (premises or formulas); they get into trouble when they

label, interpret, and evaluate by a set of rules that are unrealistic or when they use

the rules inappropriately or excessively. If clients make the determination that they

are living by rules that are likely to lead to misery, the therapist may suggest alter-

native rules for them to consider, without indoctrinating them. Although cognitive

therapy often begins by recognizing the client’s frame of reference, the therapist

continues to ask for evidence for a belief system.

The Client–Therapist Relationship

One of the main ways the practice of cognitive therapy differs from the practice of

rational emotive behavior therapy is its emphasis on the therapeutic relationship.

As you will recall, Ellis views the therapist largely as a teacher and does not think

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that a warm personal relationship with clients is essential. In contrast, Beck (1987)

emphasizes that the quality of the therapeutic relationship is basic to the applica-

tion of cognitive therapy. Through his writings, it is clear that Beck believes that

effective therapists must combine empathy and sensitivity, along with techni-

cal competence. The core therapeutic conditions described by Rogers in his

person-centered approach are viewed by cognitive therapists as being necessary,

but not sufﬁ cient, to produce optimum therapeutic effect. A therapeutic alliance

is a necessary ﬁ rst step in cognitive therapy, especially in counseling difﬁ cult-

to-reach clients. Without a working alliance, applying techniques will not be

effective (Dienes et al., 2011). Therapists must also have a cognitive conceptu-

alization of cases, be creative and active, be able to engage clients through a

process of Socratic questioning, and be knowledgeable and skilled in the use

of cognitive and behavioral strategies aimed at guiding clients in signiﬁ cant

self-discoveries that will lead to change (Beck & Weishaar, 2011). Macy (2007)

states that effective cognitive therapists strive to create “warm, empathic rela-

tionships with clients while at the same time effectively using cognitive therapy

techniques that will enable clients to create change in their thinking, feeling,

and behaving” (p. 171).

Cognitive therapists are continuously active and deliberately interactive with

clients, helping clients frame their conclusions in the form of testable hypotheses.

Therapists engage clients’ active participation and collaboration throughout all

phases of therapy, including deciding how often to meet, how long therapy should

last, what problems to explore, and setting an agenda for each therapy session

(J. Beck & Butler, 2005).

Aaron and Judith Beck conceptualize a partnership to devise personally mean-

ingful evaluations of the client’s negative assumptions (J. Beck, 2005, 2011a). The

therapist functions as a catalyst and a guide who helps clients understand how

their beliefs and attitudes inﬂ uence the way they feel and act. Clients are expected

to identify the distortions in their thinking, summarize important points in the

session, and collaboratively devise homework assignments that they agree to carry

out. Cognitive therapists emphasize the client’s role in self-discovery. The assump-

tion is that lasting changes in the client’s thinking and behavior will be most likely

to occur with the client’s initiative, understanding, awareness, and effort (J. Beck,

2005, 2011a; J. Beck & Butler, 2005; Beck & Weishaar, 2011).

In cognitive therapy, the aim is to identify speciﬁ c, measurable goals and to

move directly into the areas that are causing the most difﬁ culty for clients (Dienes

et al. 2011). Cognitive therapists aim to teach clients how to be their own thera-

pist. Typically, a therapist will educate clients about the nature and course of their

problem, about the process of cognitive therapy, and how thoughts inﬂ uence their

emotions and behaviors. The educative process includes providing clients with in-

formation about their presenting problems and about relapse prevention. One way

of educating clients is through bibliotherapy, in which clients complete readings

dealing with the philosophy of cognitive therapy. These readings are assigned as

an adjunct to therapy and are designed to enhance the therapeutic process by pro-

viding an educational focus (Dattilio & Freeman, 2007; Jacobs, 2008). Cognitive

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COGNITIVE BEHAVIOR THERAPY

therapy self-help books also provide an educational focus, such as The Beck Diet

Solution: Train Your Brain to Think Like a Thin Person (J. Beck, 2007a) and The

Complete Beck Diet for Life (J. Beck, 2008).

Homework is often used as a part of cognitive therapy because practicing cog-

nitive behavioral skills outside of the ofﬁ ce facilitates more rapid gains (Dienes

et al., 2011). Homework is tailored to the client’s speciﬁ c problem and arises out of

the collaborative therapeutic relationship. Tompkins (2004, 2006) outlines the key

steps to successful homework assignments and the steps involved in collaboratively

designing homework. The purpose of homework is not merely to teach clients new

skills but also to enable them to test their beliefs and experiment with different

behaviors in daily-life situations. Homework is generally presented to clients as an

experiment, which increases the openness of clients to get involved in an assign-

ment. Emphasis is placed on self-help assignments that serve as a continuation

of issues addressed in a therapy session (Dattilio, 2002b). Cognitive therapists

realize that clients are more likely to complete homework if it is tailored to their

needs, if they participate in designing the homework, if they begin the homework

in the therapy session, and if they talk about potential problems in implementing

the homework (J. Beck, 2005). Tompkins (2006) points out that there are clear

advantages to the therapist and the client working in a collaborative manner in

negotiating mutually agreeable homework tasks. One indicator of a good therapeu-

tic alliance is whether homework is done and done well.

Applications of Cognitive Therapy

Cognitive therapy initially gained recognition as an approach to treating depres-

sion, but extensive research has also been devoted to the study and treatment of

many other psychiatric disorders. One of the reasons for the popularity of cognitive

therapy is due to “strong empirical support for its theoretical framework and to

the large number of outcome studies with clinical populations” (Beck & Weishaar,

2011, p. 305). According to J. Beck (personal communication, January 1, 2011),

hundreds of research studies have conﬁ rmed the theoretical underpinnings of CT,

and hundreds of outcome trials have established its efﬁ cacy for a wide range of

psychiatric disorders, psychological problems, and medical conditions with psy-

chological components.

Cognitive therapy has been successfully used to treat phobias, psychosomatic

disorders, eating disorders, anger, panic disorders, and generalized anxiety disor-

ders (Chambless & Peterman, 2006; Dattilio & Kendall, 2007; Riskind, 2006);

posttraumatic stress disorder, suicidal behavior, borderline personality disorders,

narcissistic personality disorders, and schizophrenic disorders (Dattilio & Freeman,

2007); personality disorders (Pretzer & Beck, 2006); substance abuse (Newman,

2006); chronic pain (Beck, 1987); medical illness (Dattilio & Castaldo, 2001); crisis

intervention (Dattilio & Freeman, 2007); couples and families therapy (Dattilio,

1993, 1998, 2001, 2005, 2010; Dattilio & Padesky, 1990; Epstein, 2006); child

abusers, divorce counseling, skills training, and stress management (Dattilio, 1998;

Granvold, 1994; Reinecke, Dattilio, & Freeman, 2002). Clearly, cognitive therapy

programs have been designed for all ages and for a variety of client populations.

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For an excellent resource on the clinical applications of cognitive therapy to a wide

range of disorders and populations, see Contemporary Cognitive Therapy (Leahy,

2006a).

applying cognitive techniques Beck and Weishaar (2011) describe

both cognitive and behavioral techniques that are part of the overall strategies used

by cognitive therapists. Cognitive techniques focus on identifying and examining

a client’s beliefs, exploring the origins of these beliefs, and modifying them if the

client cannot support these beliefs. Examples of behavioral techniques typically

used by cognitive therapists include activity scheduling, behavioral experiments,

skills training, role playing, behavioral rehearsal, and exposure therapy. Regard-

less of the nature of the speciﬁ c problem, the cognitive therapist is mainly in-

terested in applying procedures that will assist individuals in making alternative

interpretations of events in their daily living. Think about how you might apply the

principles of CT to yourself in this classroom situation and change your feelings

surrounding the situation:

Your professor does not call on you during a particular class session. You feel depressed.

Cognitively, you are telling yourself: “My professor thinks I’m stupid and that I really don’t

have much of value to offer the class. Furthermore, she’s right, because everyone else is

brighter and more articulate than I am. It’s been this way most of my life!”

Some possible alternative interpretations are that the professor wants to include oth-

ers in the discussion, that she is short on time and wants to move ahead, that she

already knows your views, or that she believes you are self-conscious about being

singled out or called on.

The therapist would have you become aware of the distortions in your thinking

patterns by examining your automatic thoughts. The therapist would ask you to

look at your inferences, which may be faulty, and may investigate whether these

inferences can be traced back to earlier experiences in your life. Then the therapist

would help you see how you sometimes come to a conclusion (your decision that

you are stupid, with little of value to offer) when evidence for such a conclusion is

either lacking or based on distorted information from the past.

As a client in cognitive therapy, you would also learn about the process of mag-

niﬁ cation or minimization of thinking, which involves either exaggerating the

meaning of an event (you believe the professor thinks you are stupid because she

did not acknowledge you on this one occasion) or minimizing it (you belittle your

value as a student in the class). The therapist would assist you in learning how you

disregard important aspects of a situation, engage in overly simpliﬁ ed and rigid

thinking, and generalize from a single incident of failure. Can you think of other

situations where you could apply CT procedures?

treatment of depression Based on his research, Beck (1963) chal-

lenged the notion that depression results from anger turned inward. Instead, he

focuses on the content of the depressive’s negative thinking and biased interpreta-

tion of events. Beck (1987) writes about the cognitive triad as a pattern that triggers

depression. In the ﬁ rst component of the triad, clients hold a negative view of them-

selves. They blame their setbacks on personal inadequacies without considering

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309

COGNITIVE BEHAVIOR THERAPY

circumstantial explanations. They are convinced that they lack the qualities essen-

tial to bring them happiness. The second component of the triad consists of the

tendency to interpret their personal world in a negative manner. Depressed people

focus on certain facts that conform to their negative conclusions, a process referred

to as selective abstraction by Beck. The third component of the triad pertains to

depressed clients’ gloomy vision and projections about the future. They expect

their present difﬁ culties to continue, and they anticipate only failure in the future.

Depression-prone people often set rigid, perfectionist goals for themselves

that are impossible to attain. Their negative expectations are so strong that even

if they experience success in speciﬁ c tasks they anticipate failure the next time.

They screen out successful experiences that are not consistent with their nega-

tive self-concept. The thought content of depressed individuals often centers on

a sense of irreversible loss that results in emotional states of sadness, disappoint-

ment, and apathy.

The cognitive therapy approach to treating depressed clients focuses on spe-

ciﬁ c problem areas and the reasons clients give for their symptoms. To assess the

depth of depression, Beck (1967) designed a standardized device known as the

Beck Depression Inventory (BDI). Some of the behavioral symptoms of depres-

sion are inactivity, withdrawal, and avoidance. The therapist is likely to probe with

Socratic questioning such as this: “What would be lost by trying a speciﬁ c activity?

Will you feel worse if you are passive? How do you know that it is pointless to try?”

Therapy procedures include setting up an activity schedule with graded tasks to

be completed. Clients are asked to complete easy tasks ﬁ rst, so that they will meet

with some success and become slightly more optimistic. The point is to enlist the

client’s cooperation with the therapist on the assumption that doing something is

more likely to lead to feeling better than doing nothing.

A central characteristic of most depressive people is self-criticism. Underneath

the person’s negative self-attitudes are themes of weakness, inadequacy, and lack

of responsibility. A number of therapeutic strategies can be used. Clients can be

asked to identify and provide reasons for their excessively self-critical thinking. The

therapist may ask the client, “If your friend were to make a mistake the way you

do, would you be as critical of her as you are of yourself?” The therapist may also

discuss with the client how the “tyranny of shoulds” can lead to increased distress.

Depressed clients typically experience painful emotions. They may say that they

cannot stand the pain or that nothing can make them feel better. One procedure

that may be helpful is to ask them to speak more conversationally about events in

the past week in which their mood lifted even just a little.

Another speciﬁ c characteristic of depressed people is an exaggeration of exter-

nal demands, problems, and pressures. They may express thoughts of being over-

whelmed and that there is so much to accomplish that they can never do it. A cognitive

therapist might ask clients to list things that need to be done, set priorities, check off

tasks that have been accomplished, and break down an external problem into man-

ageable units. When problems are discussed, clients often become aware of how they

are magnifying the importance of these difﬁ culties. Through rational exploration,

clients are able to regain a perspective on deﬁ ning and accomplishing tasks.

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The therapist typically has to take the lead in helping clients make a list of their

responsibilities, set priorities, and develop a realistic plan of action. Because carry-

ing out such a plan is often inhibited by negative automatic thoughts, it is well for

therapists to use cognitive rehearsal techniques in both identifying and changing

negative thoughts. If clients can learn to combat their self-doubts in the therapy

session, they may be able to apply their newly acquired cognitive and behavioral

skills in real-life situations.

application to family therapy The cognitive behavioral approach

focuses on family interaction patterns, and family relationships, cognitions, emo-

tions, and behavior are viewed as exerting a mutual inﬂ uence on one another. A

cognitive inference can evoke emotion and behavior, and emotion and behavior

can likewise inﬂ uence cognition in a reciprocal process that sometimes serves to

maintain the dysfunction of the family unit.

Cognitive therapy, as set forth by Beck (1976), places a heavy emphasis on sche-

ma, or what have elsewhere been deﬁ ned as core beliefs. A key aspect of the therapeu-

tic process involves restructuring distorted beliefs (or schema), which has a pivotal

impact on changing dysfunctional behaviors. Some cognitive behavior therapists place

a strong emphasis on examining cognitions among individual family members as well

as on what may be termed the “family schemata” (Dattilio, 1993, 1998, 2001, 2010).

These are jointly held beliefs about the family that have formed as a result of years of

integrated interaction among members of the family unit. It is the experiences and

perceptions from the family of origin that shape the schema about both the immedi-

ate family and families in general. These schemata have a major impact on how the

individual thinks, feels, and behaves in the family system (Dattilio, 2001, 2005, 2010).

For a concrete illustration of how Dr. Dattilio applies cognitive principles and

works with family schemata, see his cognitive behavioral approach with Ruth in

Case Approach to Counseling and Psychotherapy (Corey, 2013a, chap. 8). For a discus-

sion of myths and misconceptions of cognitive behavior family therapy, see Dattilio

(2001); for a concise presentation on the cognitive behavioral model of family ther-

apy, see Dattilio (2010). Also, for an expanded treatment of applications of cognitive

behavioral approaches to working with couples and families, see Dattilio (1998).

donald meichenbaum’s cognitive

behavior modification

Introduction

Another major alternative to rational emotive behavior therapy is Donald Meichen-

baum’s cognitive behavior modiﬁ cation (CBM), which focuses on changing the cli-

ent’s self-verbalizations. Meichenbaum’s cognitive behavioral approach combines

some of the best elements of behavior therapy and cognitive therapy. According to

Meichenbaum (1977), self-statements affect a person’s behavior in much the same

way as statements made by another person. A basic premise of CBM is that clients,

as a prerequisite to behavior change, must notice how they think, feel, and behave

and the impact they have on others. For change to occur, clients need to interrupt

the scripted nature of their behavior so that they can evaluate their behavior in vari-

ous situations (Meichenbaum, 1993, 2007).

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COGNITIVE BEHAVIOR THERAPY

This approach shares with REBT and Beck’s cognitive therapy the assumption that

distressing emotions are typically the result of maladaptive thoughts. REBT is more

direct and confrontational in uncovering and disputing irrational thoughts, whereas

Meichenbaum’s self-instructional training focuses more on helping clients become

aware of their self-talk and the stories they tell about themselves. Both REBT and CT

focus on changing thinking processes, but Meichenbaum suggests that it may be easi-

er and more effective to behave our way into a new way of thinking rather than to think

our way into a new way of behaving. Furthermore, our emotions and thinking are two

sides of the same coin: the way we feel can affect our way of thinking, just as how we

think can inﬂ uence how we feel. The therapeutic process consists of teaching clients to

make self-statements and training clients to modify the instructions they give to them-

selves so that they can cope more effectively with the problems they encounter. Cogni-

tive restructuring plays a central role in Meichenbaum’s (1977, 1993) self-instructional

training. He describes cognitive structure as the organizing aspect of thinking, which

seems to monitor and direct the choice of thoughts through an “executive processor”

that “holds the blueprints of thinking” that determine when to continue, interrupt,

or change thinking. Together, therapist and client practice the self-instructions and

the desirable behaviors in role-play situations that simulate problem situations in the

client’s daily life. The emphasis is on acquiring practical coping skills for problematic

situations such as impulsive and aggressive behavior, anxiety in social situations, fear

of taking tests, eating problems, and fear of public speaking.

How Behavior Changes

Meichenbaum (1977) proposes that “behavior change occurs through a sequence

of mediating processes involving the interaction of inner speech, cognitive struc-

tures, and behaviors and their resultant outcomes” (p. 218). He describes a three-

phase process of change in which those three aspects are interwoven. According to

him, focusing on only one aspect will probably prove insufﬁ cient.

Phase 1: Self-observation. The beginning step in the change process consists of clients

learning how to observe their own behavior. When clients begin therapy, their in-

ternal dialogue is characterized by negative self-statements and imagery. A critical

factor is their willingness and ability to listen to themselves. This process involves an

increased sensitivity to their thoughts, feelings, actions, physiological reactions, and

ways of reacting to others. If depressed clients hope to make constructive changes, for

example, they must ﬁ rst realize that they are not “victims” of negative thoughts and

feelings. Rather, they are actually contributing to their depression through the things

they tell themselves. Although self-observation is necessary if change is to occur, it is

not sufﬁ cient for change. As therapy progresses, clients acquire new cognitive struc-

tures that enable them to view their problems in a new light. This reconceptualization

process comes about through a collaborative effort between client and therapist.

Phase 2: Starting a new internal dialogue. As a result of the early client–therapist

contacts, clients learn to notice their maladaptive behaviors, and they begin to see

opportunities for adaptive behavioral alternatives. If clients hope to change what

they are telling themselves, they must initiate a new behavioral chain, one that

is incompatible with their maladaptive behaviors. Clients learn that psychological

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distress is a function of the interdependence of cognitions, emotions, behaviors,

and resultant consequences. In therapy, clients learn to change their internal dia-

logue, which serves as a guide to new behavior.

Phase 3: Learning new skills. The third phase of the modiﬁ cation process consists of

helping clients interrupt the downward spiral of thinking, feeling, and behaving

and teaching them more adaptive ways of coping using the resources they bring to

therapy. Clients learn more effective coping skills, which are practiced in real-life

situations. For example, clients who can’t cope with failure may avoid appealing

activities for fear of not succeeding at them. Cognitive restructuring can help them

change their negative view, thus making them more willing to engage in desired

activities. At the same time, clients continue to focus on telling themselves new

sentences and observing and assessing the outcomes. As they behave differently

in situations, they typically get different reactions from others. The stability of what

they learn is greatly inﬂ uenced by what they say to themselves about their newly

acquired behavior and its consequences.

Stress Inoculation Training

A particular application of a coping skills program is teaching clients stress man-

agement techniques by way of a strategy known as stress inoculation training

(SIT). Using cognitive techniques, Meichenbaum (1985, 2007, 2008) has devel-

oped stress inoculation procedures that are a psychological and behavioral ana-

log to immunization on a biological level. Individuals are given opportunities to

deal with relatively mild stress stimuli in successful ways, so that they gradually

develop a tolerance for stronger stimuli. This training is based on the assumption

that we can affect our ability to cope with stress by modifying our beliefs and self-

statements about our performance in stressful situations. Meichenbaum’s stress

inoculation training is concerned with more than merely teaching people speciﬁ c

coping skills. His program is designed to prepare clients for intervention and

motivate them to change, and it deals with issues such as resistance and relapse.

Stress inoculation training consists of a combination of information giving,

Socratic discovery-oriented inquiry, cognitive restructuring, problem solving, relaxa-

tion training, behavioral rehearsals, self-monitoring, self-instruction, self-reinforce-

ment, and modifying environmental situations (Meichenbaum, 2008). SIT involves

collaborative goal setting that nurtures hope, direct-action skills, and acceptance-based

coping skills. These coping skills are designed to be applied to both present problems

and future difﬁ culties. Clients are assisted in generalizing what they learn in the

training to daily living, and relapse prevention strategies are taught. Meichenbaum

(2008) describes stress inoculation training as a complex, multifaceted cognitive be-

havioral intervention that is both a preventive and a treatment approach.

Clients can acquire more effective strategies in dealing with stressful situations

by learning how to modify their cognitive “set,” or core beliefs. The following pro-

cedures are designed to teach these coping skills:

• Expose clients to anxiety-provoking situations by means of role playing and

imagery

• Require clients to evaluate their anxiety level

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313

COGNITIVE BEHAVIOR THERAPY

• Teach clients to become aware of the anxiety-provoking cognitions they experi-

ence in stressful situations

• Help clients examine these thoughts by reevaluating their self-statements

• Have clients note the level of anxiety following this reevaluation

the phases of stress inoculation training Meichenbaum

(2007, 2008) has designed a three-stage model for stress inoculation training:

(1) the conceptual-educational phase, (2) the skills acquisition and consolidation

phase, and (3) the application and follow-through phase.

During the conceptual-educational phase, the primary focus is on creating a

working relationship and therapeutic alliance with clients. This is mainly done by

helping them gain a better understanding of the nature of stress and reconceptual-

izing it in social-interactive terms. The therapist enlists the client’s collaboration

during this early phase and together they rethink the nature of the problem or

the individual’s stress concerns. Initially, clients are provided with a conceptual

framework in simple terms designed to educate them about ways of responding to

a variety of stressful situations. They learn about the role cognitions and emotions

play in creating and maintaining stress through didactic presentations, by curious

questioning, and by a process of guided self-discovery.

Clients often begin treatment feeling that they are the victims of external cir-

cumstances, thoughts, feelings, and behaviors over which they have no control.

As a way to understand the subjective world of clients, the therapist generally

elicits stories that clients tell themselves. Training includes teaching clients to

become aware of their own role in creating their stress and their life stories. They

acquire this awareness by systematically observing the statements they make

internally as well as by monitoring the maladaptive behaviors that ﬂ ow from this

inner dialogue. Such self-monitoring continues throughout all the phases. As is

true in cognitive therapy, clients typically keep an open-ended diary in which they

systematically monitor and record their speciﬁ c thoughts, feelings, and behav-

iors. In teaching these coping skills, therapists strive to be ﬂ exible in their use of

techniques and to be sensitive to the individual, cultural, and situational circum-

stances of their clients.

During the skills acquisition and consolidation phase, the focus is on giving cli-

ents a variety of behavioral and cognitive coping skills to apply to stressful situa-

tions. This phase involves direct actions, such as gathering information about their

fears, learning speciﬁ cally what situations bring about stress, arranging for ways to

lessen the stress by doing something different, and learning methods of physical and

psychological relaxation. The training involves cognitive coping; clients are taught

that adaptive and maladaptive behaviors are linked to their inner dialogue. Through

this training, clients acquire and rehearse a new set of self-statements. Meichenbaum

(1986) provides some examples of coping statements that are rehearsed in this

phase of SIT:

• “How can I prepare for a stressor?” (“What do I have to do? Can I develop a plan

to deal with the stress?”)

• “How can I confront and deal with what is stressing me?” (“What are some ways

I can handle a stressor? How can I meet this challenge?”)

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CHAPTER TEN

• “How can I cope with feeling overwhelmed?” (“What can I do right now? How

can I keep my fears in check?”)

• “How can I make reinforcing self-statements?” (“How can I give myself credit?”)

Clients also are exposed to various behavioral interventions, such as relaxation

training, social skills training, time-management instruction, and self-instructional

training. They are helped to make lifestyle changes by reevaluating priorities,

developing support systems, and taking direct action to alter stressful situations.

Through teaching, demonstration, and guided practice, clients learn the skills of

progressive relaxation and practice them regularly to decrease arousal due to stress.

During the application and follow-through phase, the focus is on carefully arranging

for transfer and maintenance of change from the therapeutic situation to everyday

life. Clients practice their new self-statements and apply their new skills to everyday

life. To consolidate the lessons learned in the training sessions, clients participate in a

variety of activities, including imagery and behavior rehearsal, role playing, modeling,

and graded in vivo exposure. Once clients have become proﬁ

cient in cognitive and

behavioral coping skills, they practice behavioral assignments, which become increas-

ingly demanding. They are asked to write down the homework assignments they are

willing to complete. The outcomes of these assignments are carefully checked at sub-

sequent meetings, and if clients do not follow through with them, the therapist and

the client collaboratively consider the reasons for the failure.

Relapse prevention, which consists of procedures for dealing with the inevitable

setbacks clients are likely to experience as they apply what they are learning to daily

life, is taught at this stage (Marlatt & Donovan, 2005).

Part of relapse prevention

involves teaching clients to view any lapses that occur as “learning opportunities”

rather than “catastrophic failures.” Clients explore a variety of possible high-risk

stressful situations that they may reexperience. Then they rehearse and practice in

a collaborative fashion with the therapist, and with other clients in a group, ways

of applying skills they have learned in the training to maintain the gains they have

made. Follow-up and booster sessions typically take place at 3-, 6-, and 12-month

periods as an incentive for clients to continue practicing and reﬁ

ning their coping

skills. SIT can be considered part of an ongoing stress management program that

extends the beneﬁ ts of training into the future.

Stress inoculation training has potentially useful applications for a wide vari-

ety of problems and clients and for both remediation and prevention. The clinical

application of SIT has been individually tailored to speciﬁ c target populations

and includes anger control, anxiety management, assertion training, improving

creative thinking, treating depression, and dealing with health problems. Stress

inoculation training has been employed with medical patients and with psychiat-

ric patients. SIT has been successfully used with children, adolescents, and adults

who have anger problems, anxiety disorders, phobias, social incompetence,

addictions, alcoholism, sexual dysfunctions, social withdrawal, or posttraumatic

stress disorder (PTSD), including use with veterans who experience combat-

related PTSD (Meichenbaum, 1993, 1994a, 1994b, 2007, 2008). Meichenbaum

(2007) contends that the ﬂ exibility of the SIT format has contributed to its robust

effectiveness.

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315

COGNITIVE BEHAVIOR THERAPY

The Constructivist Approach

to Cognitive Behavior Therapy

Meichenbaum (1997) has developed his approach by incorporating the construc-

tivist narrative perspective (CNP), which focuses on the stories people tell about

themselves and others regarding signiﬁ cant events in their lives. Therapists elicit

stories from their clients that are explored in the therapy process. This approach

begins with the assumption that there are multiple realities. One of the therapeutic

tasks is to help clients appreciate how they construct their realities and how they

author their own stories (see Chapter 13). Meichenbaum describes the constructiv-

ist approach to cognitive behavior therapy as less structured and more discovery-

oriented than standard cognitive therapy. The constructivist approach gives more

emphasis to past development, tends to target deeper core beliefs, and explores

the behavioral impact and emotional toll a client pays for clinging to certain root

metaphors.

Meichenbaum (personal communication, October 21, 2010) claims that we are

all “story tellers” andthat we should beware of the stories that we tell ourselves and

others. For example, victimized clients might seethemselves as “prisoners of the

past” or as “stubborn victims.” These phrases are not idle metaphors; they are the

organizing schemas that color the ways individuals view themselves, their world,

and their future. Therapists help clients appreciate how they construct reality (story

tell) and examine the implications and conclusions clientsdraw from their stories.

Telling the “rest of the story”—what they did to survive and cope—bolsters clients’

strengths and helps them develop resilient-engendering behaviors. In this way,

clients can move frombeing”stubborn victims” to becoming “tenacious survivors”

and perhaps “impressive thrivers.”Meichenabum works in a collaborative fashion

with clients to develop the coping skills necessary to achieve these treatment goals.

He uses aSocratic discovery-oriented approach and the art of questioning to assist

clients in reaching their goals.

Meichenbaum (1997) uses these questions to evaluate the outcomes of therapy:

• Are clients now able to tell a new story about themselves and the world?

• Do clients now use more positive metaphors to describe themselves?

• Are clients able to predict high-risk situations and employ coping skills in deal-

ing with emerging problems?

• Are clients able to take credit for the changes they have been able to bring about?

In successful therapy clients develop their own voices, take pride in what they

have accomplished, and take ownership of the changes they are bringing about. In

short, clients become their own therapists and take the therapists’ voice with them.

cognitive behavior therapy

from a multicultural perspective

Strengths From a Diversity Perspective

There are several strengths of cognitive behavioral approaches in working with

individuals from diverse cultural, ethnic, and racial backgrounds. If therapists un-

derstand the core values of their culturally diverse clients, they can help clients

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316

CHAPTER TEN

explore these values and gain a full awareness of their conﬂ icting feelings. Then

the client and the therapist can work together to modify selected beliefs and prac-

tices. Cognitive behavior therapy tends to be culturally sensitive because it uses the

individual’s belief system, or worldview, as part of the method of self-exploration.

Because counselors with a cognitive behavioral orientation function as teachers,

clients are actively involved in learning skills to deal with the problems of living. In

speaking with colleagues who work with culturally diverse populations, I have learned

that their clients tend to appreciate the emphasis on cognition and action, as well as

the stress on relationship issues. The collaborative approach of CBT offers clients

the structure they may want, yet the therapist still makes every effort to enlist clients’

active cooperation and participation. According to Spiegler (2008), because of its basic

nature and the way CBT is practiced, it is inherently suited to treating diverse clients.

Some of the factors that Spiegler identiﬁ es that makes CBT diversity effective include

individualized treatment, focusing on the external environment, active nature, empha-

sis on learning, reliance on empirical evidence, concern with present behavior, and

brevity. A strength of CBT is integrating assessment throughout therapy, which com-

municates respect for clients’ viewpoints regarding their progress.

According to Hays (2009), there is an “almost perfect ﬁ t” between cognitive

behavior therapy and multicultural therapy because these perspectives share com-

mon assumptions that make integration possible. Some aspects that contribute to

an integrative framework follow:

• Interventions are tailored to the unique needs and strengths of the individual.

• Clients are empowered by learning speciﬁ

c skills they can apply in daily life

(CBT) and by the emphasis on cultural inﬂ uences that contribute to clients’

uniqueness (multicultural therapy).

• Inner resources and strengths of clients are activated to bring about change.

• Clients make changes that minimize stressors, increase personal strengths and

supports, and establish skills for dealing more effectively with their physical and

social (cultural) environments.

Shortcomings From a Diversity Perspective

Exploring values and core beliefs plays an important role in all of the cognitive

behavioral approaches, and it is crucial for therapists to have some understand-

ing of the cultural background of clients and to be sensitive to their struggles.

Therapists would do well to use caution in confronting clients about their be-

liefs and behaviors until they clearly understand their cultural context. On this

matter, Wolfe (2007) suggests that the therapist’s job is to help clients examine

and challenge long-standing cultural assumptions only if they result in dysfunc-

tional emotions or behaviors. She writes that the therapist assists clients in criti-

cally thinking about “potential conﬂ icts with the values of the dominant culture

so they can work toward achieving their own personal goals within their own

sociocultural context” (p. 188).

A potential limitation of REBT is its negative view of dependency. Many cul-

tures view interdependence as necessary to good mental health. According to Ellis

(1994), REBT is aimed at inducing people to examine and change some of their

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317

COGNITIVE BEHAVIOR THERAPY

most basic values. Clients with certain long-cherished cultural values pertaining

to interdependence are not likely to respond favorably to such forceful methods

of persuasion toward independence. “REBT practitioners often employ a rapid-

ﬁ re active-directive-persuasive philosophical methodology. In most instances, they

quickly pin clients down to a few basic dysfunctional beliefs” (Ellis, 2011, p. 214).

This style may intimidate or alienate clients who value being reﬂ ective. Modiﬁ ca-

tions in a therapist’s style need to be made depending on the client’s culture.

Hays (2009) suggests that therapists avoid challenging the core cultural beliefs

of clients, unless the client is clearly open to this. By emphasizing collaboration over

confrontation, the therapist can avoid seeming to be disrespectful. Hays recom-

mends drawing on the client’s culturally related strengths in developing helpful

ways of thinking to replace unhelpful cognitions. For example, consider an Asian

American client, Sung, from a culture that stresses values such as doing one’s best,

cooperation, interdependence, and working hard. It is likely that Sung may feel that

she is bringing shame to her family if she is going through a divorce, and she may

feel guilt if she perceives that she is not living up to the expectations and standards

set for her by her family and her community. The rules for Sung are likely to be

different than are the rules for a male member of her culture. The counselor could

assist Sung in understanding and exploring how both her gender and her culture

are factors to consider in her situation. If Sung is confronted too quickly on living

by the expectations or rules of others, the results are likely to be counterproductive.

Sung might even leave counseling feeling that she has been misunderstood.

Cormier, Nurius, and Osborn (2013) suggest that therapists refrain from jargon

and use of disrespectful language when describing clients’ cognitions, avoiding terms

such as rational and irrational, or maladaptive and dysfunctional. This is especially im-

portant when interacting with individuals who feel marginalized by the mainstream

culture. They recommend adapting the language presented in cognitive restructur-

ing to the client’s primary language, age, and educational level. These guidelines can

certainly be applied to REBT practitioners who might do well to reﬂ ect on the words

they use and their tone, especially when zeroing in on a client’s core beliefs.

The emphasis of CBT on assertiveness, independence, verbal ability, rationality,

cognition, and behavioral change may limit its use in cultures that value subtle com-

munication over assertiveness, interdependence over personal independence, listen-

ing and observing over talking, and acceptance over behavior change (Hayes, 2009).

In CBT the focus is on the present, which can result in the therapist failing to recog-

nize the role of the past in a client’s development. Cognitive behavioral assessments

involve the investigation of a client’s personal history. If the therapist is unaware of

a client’s cultural beliefs, which are rooted in the past, the therapist may have dif-

ﬁ culty interpreting the client’s personal experiences accurately. Another limitation

of CBT from a multicultural perspective involves its individualistic orientation. An

inexperienced therapist may overemphasize cognitive restructuring to the neglect of

environmental interventions. Hays points out that these potential limitations do not

preclude the integration of CBT and multicultural counseling. Instead, being aware

of these limitations “presents opportunities for rethinking, reﬁ ning, adapting and

increasing the relevance and effectiveness of psychotherapy” (p. 356).

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From a cognitive behavioral perspec-

tive, I want Stan to critically evaluate

and modify his self-defeating beliefs,

which will likely result in Stan acquiring more

effective behavior. As his therapist, I am both

goal oriented and problem focused. From the

initial session, I ask Stan to identify his prob-

lems and formulate specific goals and help him

reconceptualize his problems in a way that will

increase his chances of finding solutions.

I follow a clear structure for every session.

The basic procedural sequence includes

(1) preparing him by providing a cognitive ration-

ale for treatment and demystifying treatment;

(2) encouraging him to monitor the thoughts

that accompany his distress; (3) implementing

behavioral and cognitive techniques;

(4) assisting him in identifying and examining

some basic beliefs and ideas; (5) teaching him

ways to examine his beliefs and assumptions

by testing them in reality; and (6) teaching him

basic coping skills that will enable him to avoid

relapsing into old patterns.

As a part of the structure of the therapy

sessions, I ask Stan for a brief review of the

week, elicit feedback from the previous session,

review homework assignments, collaboratively

create an agenda for the session, discuss topics

on the agenda, and set new homework for the

week. I encourage Stan to perform personal

experiments and practice coping skills in daily life.

Stan tells me that he would like to work on

his fear of women and would hope to feel far

less intimidated by them. He reports that he

feels threatened by most women, but especially

by women he perceives as powerful. In work-

ing with Stan’s fears, I proceed with four steps:

educating him about his self-talk; having him

monitor and evaluate his faulty beliefs; using

cognitive and behavioral interventions; and

collaboratively designing homework with Stan

that will give him opportunities to practice new

behaviors in daily life.

First, I educate him about the importance of

examining his automatic thoughts, his self-talk,

and the many “shoulds,” “oughts,” and “musts”

he has accepted without questioning. Work-

ing with Stan as a collaborative partner in his

therapy, I guide him in discovering some basic

cognitions that influence what he tells himself

and how he feels and acts. This is some of his

self-talk:

• “I always have to be strong, tough, and perfect.”

• “I’m not a man if I show any signs of weakness.”

• “If everyone didn’t love me and approve of me,

things would be catastrophic.”

• “If a w

oman rejected me, I really would be re-

duced to a ‘nothing.’”

• “If I fail, I am then a f

ailure as a person.”

• “I’m apologetic for my existence because

I don’t feel equal to others.”

Second, I assist Stan in monitoring and ev

alu-

ating the ways in which he keeps telling himself

these self-defeating sentences. I assist him in

clarifying specific problems and learning how to

critically evaluate some of his faulty thinking:

You’re not your father. I wonder why you con-

tinue telling yourself that you’re just like him? Do

you think you need to continue accepting without

question your parents’ value judgments about your

worth? Where is the evidence that they were right

in their assessment of you? You say you’re such a

failure and that you feel inferior. Do your present

activities support this? If you were not so hard on

yourself, how might your life be different?

Third, once Stan more fully understands the

nature of his cognitive distortions and his self-

defeating beliefs, I draw on a variety of cognitive

and behavioral techniques to help Stan make

the changes he most desires. Through various

cognitive techniques, he learns to identify, evalu-

ate, and respond to his dysfunctional beliefs.

I rely heavily on cognitive techniques such as

Socratic questioning, guided discovery, and cogni-

tive restructuring to assist Stan in examining the

evidence that seems to support or contradict his

core beliefs. I work with Stan so he will view his

basic beliefs and automatic thinking as hypoth-

eses to be tested. In a way, he will become a

personal scientist by checking out the validity of

many of the conclusions and basic assumptions

Cognitive Behavior Therapy Applied to the Case of Stan

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CHAPTER TEN

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that contribute to his personal difficulties. By the

use of guided discovery, Stan learns to evaluate

the validity and functionality of his beliefs and

conclusions. Stan can also profit from cognitive

restructuring, which would entail his observ-

ing his own behavior in various situations. For

example, during the week he can take a particu-

lar situation that is problematic for him, paying

particular attention to his automatic thoughts

and internal dialogue. What is he telling himself

as he approaches a difficult situation? How is he

setting himself up for failure with his self-talk?

As he learns to attend to his maladaptive behav-

iors, he begins to see that what he tells himself

has as much impact as others’ statements about

him. He also sees the connections between his

thinking and his behavioral problems. With this

awareness he is in an ideal place to begin to

learn a new, more functional internal dialogue.

Fourth, I work collaboratively with him in

creating specific homework assignments to

help him deal with his fears. It is expected

that Stan will learn new coping skills, which he

can practice first in the sessions and then in

daily life situations. It is not enough for him to

merely say new things to himself; Stan needs to

apply his new cognitive and behavioral coping

skills in various daily situations. At one point,

for instance, I ask Stan to explore his fears of

powerful women and his reasons for continuing

to tell himself: “They expect me to be strong and

perfect. If I’m not careful, they’ll dominate me.”

His homework includes approaching a woman

for a date. If he succeeds in getting the date, he

can think about his catastrophic expectations of

what might happen. What would be so terrible if

she did not like him or if she refused the

date? Stan tells himself over and over that he

must be approved of by women and that if any

woman rebuffs him the consequences are more

than he can bear. With practice, he learns to

label distortions and is able to automatically

identify his dysfunctional thoughts and moni-

tor his cognitive patterns. Through a variety of

cognitive and behavioral strategies, he is able

to acquire new information, change his basic

beliefs, and implement new and more effective

behavior.

Follow-Up: You Continue as Stan’s

Cognitive Behavior Therapist

Use these questions to help you think about

how to counsel Stan using a cognitive behavior

approach:

• My therapeutic style is characterized as an in-

tegrative form of cognitive beha

vioral therapy.

I borrow concepts and techniques from the

approaches of Ellis, Beck, and Meichenbaum.

In your work with Stan, what specific concepts

would you borrow from these approaches?

What cognitive behavioral techniques would

you use? What possible advantages do you

see, if any, in applying an integrative cognitive

behavioral approach in your work with Stan?

• What are some things you would most want to

teach Stan about how cognitive behavior ther-

ap

y works? How would you explain to him the

therapeutic alliance and the collaborative thera-

peutic relationship?

• What are some of Stan’s most prominent

faulty beliefs that get in the way of his living

fully

? What cognitive and behavioral tech-

niques might you use in helping him examine

his core beliefs?

• Stan lives by many “shoulds” and “oughts.”

His automatic thoughts seem to impede him

from getting what he wants. What techniques

would you use to enc

ourage guided discovery

on his part?

• What are some homework assignments that

would be useful for Stan to carry out? How

would y

ou collaboratively design homework

with Stan? How would you encourage him to

develop action plans to test the validity of his

thinking and his conclusions?

See the DVD for Theory and Practice of

Counseling and Psychotherapy: The Case

of Stan and Lecturettes (Session 8 on cogni-

tive behavior therapy) for a demonstration

of my approach to counseling Stan from this

perspective. This session focuses on exploring

some of Stan’s faulty beliefs through the use

of role-reversal and cognitive restructuring

techniques.

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COGNITIVE BEHAVIOR THERAPY

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320

CHAPTER TEN

summary and evaluation

Summary

REBT has evolved into a comprehensive and integrative approach that emphasizes

thinking, judging, deciding, and doing. This approach is based on the premise of

the interconnectedness of thinking, feeling, and behaving. Therapy begins with cli-

ents’ problematic behaviors and emotions and disputes the thoughts that directly

create them. To block the self-defeating beliefs that are reinforced by a process

of self-indoctrination, REBT therapists employ active and directive techniques

such as teaching, suggestion, persuasion, and homework assignments, and

they challenge clients to substitute a rational belief system for an irrational one.

Therapists demonstrate how and why dysfunctional beliefs lead to negative emo-

tional and behavioral results. They teach clients how to dispute self-defeating

beliefs and behaviors that might occur in the future. REBT stresses action—doing

something about the insights one gains in therapy. Change comes about mainly

by a commitment to consistently practice new behaviors that replace old and

ineffective ones.

Rational emotive behavior therapists are typically eclectic in selecting thera-

peutic strategies. They have the latitude to develop their own personal style and to

exercise creativity; they are not bound by ﬁ xed techniques for particular problems.

Cognitive therapists also practice from an integrative stance, using many methods

to assist clients in modifying their self-talk. The working alliance is given special

importance in cognitive therapy as a way of forming a collaborative partnership.

Although the client–therapist relationship is viewed as necessary, it is not sufﬁ -

cient for successful outcomes. In cognitive therapy, it is presumed that clients are

helped by the skillful use of a range of cognitive and behavioral interventions and

by their willingness to perform homework assignments between sessions.

All of the cognitive behavioral approaches stress the importance of cognitive proc-

esses as determinants of behavior. It is assumed that how people feel and what they

actually do is largely inﬂ uenced by their subjective assessment and interpretation of

situations. Because this appraisal of life situations is inﬂ uenced by beliefs, attitudes, as-

sumptions, and internal dialogue, such cognitions become the major focus of therapy.

Contributions of the Cognitive Behavioral Approaches

Most of the therapies discussed in this book can be considered “cognitive,” in a

general sense, because they have the aim of changing clients’ subjective views

of themselves and the world. The cognitive behavioral approaches focus on un-

dermining faulty assumptions and beliefs and teaching clients the coping skills

needed to deal with their problems. Both Ellis’s REBT and Beck’s CT represent

the most systematic applications of cognitive behavior therapy. Both REBT and CT

are based on a wide range of cognitive behavioral techniques and follow a deﬁ ned

plan of action; they are relatively brief and structured treatments in keeping with

the spirit of cost effectiveness and evidence-based practice (Hollon & DiGiuseppe,

2011). The psychoeducational aspect of CBT is a clear strength that can be applied

to many clinical problems and used effectively in many settings with diverse client

populations.

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321

COGNITIVE BEHAVIOR THERAPY

ellis’s rebt I ﬁ nd aspects of REBT very valuable in my work because I be-

lieve we are responsible for maintaining self-destructive ideas and attitudes that

inﬂ uence our daily transactions. I see value in asking clients questions such as

“What are your assumptions and basic beliefs?” and “Have you examined the

core ideas you live by to determine if they are your own values or merely in-

trojects?” REBT has built on the Adlerian notion that events themselves do not

have the power to determine us; rather, it is our interpretation of these events

that is crucial. The A-B-C framework simply and clearly illustrates how human

disturbances occur and the ways in which problematic behavior can be changed.

Rather than focusing on events themselves, therapy stresses how clients inter-

pret and react to what happens to them and the necessity of actively disputing a

range of faulty beliefs.

One of the strengths of REBT is the focus on teaching clients ways to carry on

their own therapy without the direct intervention of a therapist. I particularly like

the emphasis that REBT puts on supplementary and psychoeducational approaches

such as listening to tapes, reading self-help books, keeping a record of what they

are doing and thinking, carrying out homework assignments, and attending work-

shops. In this way clients can further the process of change in themselves without

becoming excessively dependent on a therapist.

beck’s cognitive therapy Beck’s key concepts share similarities with

REBT, but differ in underlying philosophy, the process by which therapy proceeds,

and the formulation and treatment for different disorders. Beck made pioneering

efforts in the treatment of anxiety, phobias, and depression. Today, empirically

validated treatments for both anxiety and depression have revolutionized thera-

peutic practice; research has demonstrated the efﬁ cacy of cognitive therapy for a

variety of problems (Leahy, 2002; Scher, Segal, & Ingram, 2006). Beck developed

speciﬁ c cognitive procedures to help depressive clients evaluate their assumptions

and beliefs and to create a new cognitive perspective that can lead to optimism

and changed behavior. The effects of cognitive therapy on depression and hope-

lessness have been demonstrated through research to be maintained for at least

one year after treatment. Cognitive therapy has been applied to a wide range of

clinical populations that Beck did not originally believe were appropriate for this

model, including treatment for posttraumatic stress disorder, schizophrenia, delu-

sional disorders, bipolar disorder, and various personality disorders (Leahy, 2002,

2006a). The credibility of the cognitive model grows out of the fact that many of

its propositions have been empirically tested.

Beck demonstrated that a structured therapy that is present centered and

problem oriented can be very effective in treating depression and anxiety in a

relatively short time. One of Beck’s major theoretical contributions has been

bringing private experience back into the realm of legitimate scientiﬁ c inquiry

(Weishaar, 1993). A strength of cognitive therapy is its focus on developing a

detailed case conceptualization as a way to understand how clients view their

world.

A key strength of all the cognitive behavioral therapies is that they are integra-

tive forms of psychotherapy, and this is particularly true of cognitive therapy. Beck

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322

CHAPTER TEN

considers cognitive therapy to be the integrative psychotherapy because it draws

from so many different modalities of psychotherapy (Alford & Beck, 1997).

meichenbaum’s cognitive behavior modification Meichen-

baum’s work in self-instruction and stress inoculation training has been applied

successfully to a variety of client populations and speciﬁ c problems. Of special note

is his contribution to understanding how stress is largely self-induced through

inner dialogue. Meichenbaum’s integration of the constructivist perspective is a

key strength in that he is able to combine elements of the postmodern interest in

stories clients tell with assisting clients in changing their cognitions, feelings, and

behaviors by drawing on a cognitive behavioral conceptual framework.

A contribution of all of the cognitive behavioral approaches is the emphasis on

putting newly acquired insights into action. Homework assignments are well suited

to enabling clients to practice new behaviors and assisting them in the process of

learning more effective coping skills. Adlerian therapy, reality therapy, behavior

therapy, and solution-focused brief therapy all share with the cognitive behavioral

approaches this action orientation. It is important that homework be a natural out-

growth of what is taking place in the therapy session. Clients are more likely to carry

out their homework if the assignments are collaboratively created. Meichenbaum’s

stress inoculation training places special emphasis on practicing new skills both in

the training itself and in daily life, and homework is a key part of the training proc-

ess. Clients learn how to generalize coping skills to various problem situations and

acquire relapse prevention strategies to ensure that their gains are consolidated.

A major contribution made by Ellis, the Becks, and Meichenbaum is the de-

mystiﬁ cation of the therapy process. The cognitive behavioral approaches are

based on an educational model that stresses a working alliance between therapist

and client. The models encourage self-help, provide for continuous feedback from

the client on how well treatment strategies are working, and provide a structure

and direction to the therapy process that allows for evaluation of outcomes. Clients

are active, informed, and responsible for the direction of therapy because they are

partners in the enterprise.

Limitations and Criticisms of the Cognitive

Behavioral Approaches

The cognitive behavioral approaches focus only limited attention on the role of

emotions in treatment. Although Dattilio (2001) admits that CBT places central

emphasis on cognition and behavior, he maintains that emotion is not ignored in

the therapy process; rather, he believes that emotion is a by-product of cognition

and behavior and is addressed in a different fashion. Some potential limitations of

the various CBT approaches follow.

ellis’s rebt I value paying attention to a client’s past without getting lost in

this past and without assuming a fatalistic stance about earlier traumatic experi-

ences. I question the REBT assumption that exploring the past is ineffective in

helping clients change faulty thinking and behavior. From my perspective, explor-

ing past childhood experiences can have a great deal of therapeutic power if the

discussion is connected to our present functioning.

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323

COGNITIVE BEHAVIOR THERAPY

Another potential limitation involves the misuse of the therapist’s power

by imposing ideas of what constitutes rational thinking. Due to the active and

directive nature of this approach, it is particularly important for practitioners

to know themselves well and to avoid imposing their own philosophy of life on

their clients. Because the therapist has a large amount of power by virtue of

persuasion, psychological harm is more possible in REBT than in less directive

approaches.

As Ellis practiced it, REBT is a forceful and confrontational therapy. Some

clients will have trouble with a confrontational style, especially if a strong ther-

apeutic alliance has not been established. It is well to underscore that REBT

can be effective when practiced in a style different from Ellis’s. Indeed, a thera-

pist can be soft-spoken and gentle and still use REBT concepts and methods

effectively. Janet Wolfe, who has supervised hundreds of practitioners in her

30 years at the Albert Ellis Institute, makes the point that therapists do not

need to emulate Ellis’s style to effectively incorporate REBT into their own rep-

ertoire of interventions. Wolfe (2007) encourages practitioners to embrace this

useful therapy approach, but to develop a style that is consistent with their own

personality.

For practitioners who value a spiritual dimension of psychotherapy, Ellis’s views

on religion and spirituality are likely to raise some problems. Historically, Ellis has

declared himself as an atheist and has long been critical of dogmatic religions that

instill guilt in people. Ellis (2004b) has written about the core philosophies that

can either improve our mental health or can lead to disturbances. Although his

tone softened over the years, he was still critical of any philosophies that promoted

rigid beliefs. Personally, I think that a spiritual and a religious orientation can be

incorporated into the practice of REBT if this is meaningful to the client and if

this is done in a thoughtful manner by the therapist. Throughout his life, Ellis was

driven by his passion to teach people about REBT, and he always chuckled when

he said in his workshops that his mission was to spread the gospel according to

St. Albert. Indeed, I would say that his “religion” is embodied in the principles and

practices of REBT. For more on this topic, see The Road to Tolerance (Ellis, 2004b).

beck’s cognitive therapy Cognitive therapy has been criticized for fo-

cusing too much on the power of positive thinking; being too superﬁ cial and sim-

plistic; denying the importance of the client’s past; being too technique oriented;

failing to use the therapeutic relationship; working only on eliminating symptoms,

but failing to explore the underlying causes of difﬁ culties; ignoring the role of un-

conscious factors; and neglecting the role of feelings (Freeman & Dattilio, 1992;

Weishaar, 1993).

Freeman and Dattilio (1992, 1994; Dattilio, 2001) do a good job of debunking

the myths and misconceptions about cognitive therapy. Weishaar (1993) concisely

addresses a number of criticisms leveled at the approach. Although the cognitive

therapist is straightforward and looks for simple rather than complex solutions,

this does not imply that the practice of cognitive therapy is simple. Cognitive thera-

pists do not explore the unconscious or underlying conﬂ icts but work with cli-

ents in the present to bring about changes in their core beliefs. However, they do

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324

CHAPTER TEN

recognize that clients’ current problems are often a product of earlier life experi-

ences, and thus, they may explore with clients, especially those with Axis II disor-

ders, the ways their past is presently inﬂ uencing them.

meichenbaum’s cognitive behavior modification Some

practitioners who apply stress inoculation training focus more on techniques to

change a client’s reaction to stress or pay too much attention to the client’s inter-

nal dialogue. Meichenbaum is a high-energy person and is very charismatic in his

workshop presentations. I suspect that much of the success of his approach has to

do with his level of caring and his creativity in implementing CBT interventions.

Practitioners without his wit, energy, personal ﬂ air, and direct therapeutic style

may not get the same results even though they follow his treatment protocol. This

emphasizes the importance of each therapist developing his or her own unique

therapeutic style. Meichenbaum (1986) cautions cognitive behavioral practitioners

against the tendency to become overly preoccupied with techniques. If progress

is to be made, he suggests that cognitive behavior therapy must develop a test-

able theory of behavior change. He reports that some attempts have been made to

formulate a cognitive social learning theory that will explain behavior change and

specify the best methods of intervention.

A potential limitation of any of the cognitive behavioral approaches is the

therapist’s level of personal development, training, knowledge, skill, and percep-

tiveness. Although this is true of all therapeutic approaches, it is especially true

for CBT practitioners because they tend to be active, highly structured, and offer

clients psychoeducational information and teach life skills. According to Judith

Beck (personal communication, May 27, 2011), a limitation in learning cognitive

therapy is that therapists need to learn the speciﬁ c cognitive formulation for each

disorder they treat and learn how to address the key cognitions and behavioral

strategies for each disorder. Macy (2007) stresses that the effective use of cogni-

tive behavior therapy interventions requires extensive study, training, and practice:

“Effective implementation of these interventions requires that the practitioner be

fully grounded in the therapy’s theory and premises, and be able to use a range of

associated techniques and interventions” (p. 159).

where to go from here

In the DVD for Integrative Counseling: The Case of Ruth and Lecturettes, I work with Ruth

from a cognitive behavioral perspective in a number of therapy sessions. In Sessions

6, 7, and 8, I demonstrate my way of working with Ruth from a cognitive, emotive, and

behavioral focus. See also Session 9 (“Integrative Perspective”), which illustrates the

interactive nature of working with Ruth on thinking, feeling, and doing levels.

Other Resources

DVDs relevant to this chapter offered by the American Psychological Association

from their Systems of Psychotherapy Video Series include the following:

Beck, J. (2005). Cognitive Therapy

Meichenbaum, D. (2007). Cognitive Behavioral Therapy With Donald

Meichenbaum

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325

COGNITIVE BEHAVIOR THERAPY

Vernon, A. (2010). Rational Emotive Behavior Therapy Over Time

Dobson, K. S. (2010). Cognitive Therapy Over Time

Persons, J. (2006). Cognitive-Behavior Therapy

Dobson, K. S. (2008). Cognitive-Behavioral Therapy for Perfectionism Over Time

Dobson, K. S. (2011). Cognitive-Behavioral Therapy Strategies

Psychotherapy.net is a comprehensive resource for students and professionals that

offers videos and interviews on cognitive behavior therapy. New video and editorial

content is made available monthly. DVDs relevant to this chapter are available at

www.psychotherapy.net and include the following:

Beck, J. (2010). Cognitive Therapy for Weight Loss: A Coaching Session

Ellis, A. (1996). Rational-Emotive Therapy for Addictions

Ellis, A. (1996). Coping With the Suicide of a Loved One: An REBT

Approach

Freeman, A. (1994). Depression: A Cognitive Therapy Approach

Krumboltz, J. (1997). Cognitive-Behavioral Therapy With John Krumboltz

(Psychotherapy With the Experts Series)

Lazarus, A. (1997). Multimodal Therapy (Psychotherapy With the Experts

Series)

Liese, B. (2000). Cognitive Therapy for Addictions (Brief Therapy for

Addictions Series)

Masek, B. (2002). Cognitive-Behavioral Child Therapy (Child Therapy

With the Experts Series)

Meichenbaum, D. (1996). Mixed Anxiety and Depression: A Cognitive-

Behavioral Approach

Meichenbaum, D. (2000). Cognitive-Behavioral Therapy With Donald

Meichenbaum (Psychotherapy With the Experts Series)

The Journal of Rational-Emotive and Cognitive-Behavior Therapy is published by

Kluwer Academic/Human Sciences Press. This quarterly journal is an excellent

way to keep informed of a wide variety of cognitive behavioral specialists.

For information about the work of Albert Ellis, and current training oppor-

tunities, contact:

Debbie Joffe

Telephone: (917) 887-2006

Website: www.rebtnetwork.org/

The International Journal of Cognitive Therapy, edited by John Riskind, also pro-

vides information on theory, practice, and research in cognitive behavior therapy.

Information about the journal is available from the International Association of

Cognitive Psychotherapy or by contacting John Riskind directly.

Dr. John Riskind

George Mason University

Department of Psychology, MSN 3F5

Fairfax, VA 22030-4444

Telephone: (703) 993-4094

Private Practice Telephone: (703) 280-8060

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326

CHAPTER TEN

Fax: (703) 993-1359

E-mail: [email protected]

Website: www.the-iacp.com

The Center for Cognitive Therapy, Newport Beach, California, maintains a website

for mental health professionals. They list cognitive therapy books, audio and video

training tapes, current advanced training workshops, and other cognitive therapy

resources and information.

Center for Cognitive Therapy

E-mail: mooney@padesky.com

Website: http://www.padesky.com

For more information about CBT workshops, supervision, a CBT blog, and news-

letter, contact the Beck Institute.

Beck Institute for Cognitive Behavior Therapy

One Belmont Avenue, Suite 700

Bala Cynwyd, PA 19004-1610

Telephone: (610) 664-3020

Fax: (610) 709-5336

E-mail: [email protected]g

Website: www.beckinstitute.org

The “home” organization for cognitive therapists worldwide is the Academy of Cogni-

tive Therapy, which Judith S. Beck was instrumental in founding.

Academy of Cognitive Therapy

Website: www.academyofct.org

The American Institute for Cognitive Therapy is an internationally recognized group

of clinical psychologists and psychotherapists who provide the highest quality cogni-

tive behavioral treatment for depression, anxiety, phobias, eating disorders, person-

ality disorders, child and adolescent problems, and family and marital problems.

American Institute for Cognitive Therapy

Robert L. Leahy, PhD

136 E 57th St., Suite 1101

New York, NY 10022

Telephone: (212) 308-2440

Fax: (212) 308-3099

E-mail: [email protected]om

Website: www.cognitivetherapynyc.com

Donald Meichenbaum is research director of the Melissa Institute for Violence

Prevention, a nonproﬁ t organization designed to “give science away” in order to

reduce violence and to treat victims of violence. The institute is dedicated to the

study and prevention of violence through education, community service, research

support, and consultation.

Melissa Institute for Violence Prevention

Website: www.melissainstitute.org

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Recommended Supplementary Readings

Rational Emotive Behavior Therapy: It Works for Me—It Can Work for You

(Ellis, 2004a) is a personal book that describes the many challenges Ellis has faced

in his life and how he has coped with these realities by applying REBT principles.

The Road to Tolerance: The Philosophy of Rational Emotive Behavior Therapy

(Ellis, 2004b) is a companion book to the book listed above. In this book Ellis

demonstrates that tolerance is a deliberate, rational choice that we can make, both

for the good of ourselves and for others.

Cognitive Behavior Therapy: Basics and Beyond (J. Beck, 2011a) is a main text in

cognitive therapy that presents a comprehensive overview of the approach. An

earlier edition of this book was translated into 20 languages.

Cognitive Therapy for Challenging Problems (J. Beck, 2005) is a comprehensive

account of cognitive therapy procedures applied to clients who present a multi-

plicity of difﬁ cult behaviors. It covers the nuts and bolts of cognitive therapy with

various populations and cites important research on cognitive therapy since its

inception. There are chapters dealing with topics such as the therapeutic alliance,

setting goals, structuring sessions, homework, identifying cognitions, modifying

thoughts and images, modifying assumptions, and modifying core beliefs.

Cognitive Behavior Therapy: Applying Empirically Supported Techniques in Your Prac-

tice (O’Donohue & Fisher, 2008) is a useful collection of short chapters on applying

empirically supported techniques in working with a wide range of presenting prob-

lems. Most of these chapters can be applied to both individual and group therapy.

Mind Over Mood: Change How You Feel by Changing the Way You Think

(Greenberger & Padesky, 1995) provides step-by-step worksheets to identify

moods, solve problems, and test thoughts related to depression, anxiety, anger,

guilt, and shame. This is a popular self-help workbook and a valuable tool for

therapists and clients learning cognitive therapy skills.

Clinician’s Guide to Mind Over Mood (Padesky & Greenberger, 1995) shows

therapists how to integrate Mind Over Mood in therapy and use cognitive therapy

treatment protocols for speciﬁ c diagnoses. This succinct overview of cognitive

therapy has troubleshooting guides, reviews cultural issues, and offers guidelines

for individual, couples, and group therapy.

References and Suggested Readings

327

COGNITIVE BEHAVIOR THERAPY

*Books and articles marked with an asterisk are suggested for further study.

*Alford, B. A., & Beck, A. T. (1997). The inte-

grative power of cognitive therapy. New York:

Guilford Press.

Arnkoff, D. B., & Glass, C. R. (1992). Cognitive

therapy and psychotherapy integration. In

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ton, DC: American Psychological Association.

Beck, A. T. (1963). Thinking and depression:

Idiosyncratic content and cognitive

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

distortions. Archives of General Psychiatry,

9, 324–333.

Beck, A. T. (1967). Depression: Clinical,

experimental, and theoretical aspects. New York:

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Causes and treatment. Philadelphia: University

of Pennsylvania Press, 1972)

*Beck, A. T. (1976). Cognitive therapy and

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Universities Press.

Beck, A. T. (1987). Cognitive therapy. In J. K.

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Mazel.

*Beck, A. T., Rush, A., Shaw, B., & Emery, G.

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tive therapy. In R. J. Corsini & D. Wedding

(Eds.), Current psychotherapies (9th ed.,

pp. 276–309). Belmont, CA: Brooks/Cole,

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Beck, A., Wright, E. D., Newman, C. E., &

Liese, B. (1993). Cognitive therapy of substance

abuse. New York: Guilford Press.

*Beck, J. S. (2005). Cognitive therapy for chal-

lenging problems: What to do when the basics

don’t work. New York: Guilford Press.

Beck, J. S. (2007a). The Beck diet solution: Train

your brain to think like a thin person. New York:

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Beck, J. S. (2007b). Beck diet solution weight

loss workbook. New York: Oxmoor House.

Beck, J. S. (2008). The complete Beck diet for

life. New York: Oxmoor House.

*Beck, J. S. (2011a). Cognitive behavior therapy:

Basics and beyond (2nd ed.). New York:

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*Beck, J. S. (2011b). Cognitive therapy worksheet

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*Burns, D.

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counseling (8th ed.). Belmont, CA: Brooks/

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*Corey, G. (2013a). Case approach to counseling

and psychotherapy (8th ed.). Belmont, CA:

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*Cormier, S., Nurius, P. S., & Osborn, C. J.

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for helpers: Fundamental skills and cognitive

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*Crane, R. (2008). Mindfulness-based cogni-

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*Craske, M. G. (2010). Cognitive-behavioral

therapy. Washington, DC: American Psycho-

logical Association.

*Dattilio, F. M. (1993). Cognitive techniques

with couples and families. The Family Journal,

1(1), 51–65.

*Dattilio, F. M. (Ed.). (1998). Case studies in

couple and family therapy: Systemic and cogni-

tive perspectives. New York: Guilford Press.

Dattilio, F. M. (2000a). Cognitive-behavioral

strategies. In J. Carlson & L. Sperry (Eds.), Brief

therapy with individuals and couples (pp. 33–70).

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Dattilio, F. M. (2000b). Families in crisis. In

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Dattilio, F. M. (2001). Cognitive-behavior

family therapy: Contemporary myths and

misconceptions. Contemporary Family Therapy,

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Dattilio, F. M. (2002a, January–February).

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Dattilio, F. M. (2002b). Homework assign-

ments in couple and family therapy. Journal of

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Dattilio, F. M. (2005). Restructuring family

schemas: A cognitive-behavioral perspective.

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apy with couples and families: A comprehensive

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ferentiating symptoms of anxiety from relapse

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333

introduction

key concepts

• View of Human Nature

• Choice Theory Explanation of Behavior

• Characteristics of Reality Therapy

the therapeutic process

• Therapeutic Goals

• Therapist’s Function and Role

• Client’s Experience in Therapy

• Relationship Between Therapist

and Client

application: therapeutic

techniques and procedures

• The Practice of Reality Therapy

• The Counseling Environment

• Procedures That Lead to Change

• The “WDEP” System

• Application to Group Counseling

reality therapy from a

multicultural perspective

• Strengths From a Diversity Perspective

• Shortcomings From a Diversity Perspective

reality therapy applied to the

case of stan

summary and evaluation

• Summary

• Contributions of Reality Therapy

• Limitations and Criticisms of Reality Therapy

where to go from here

• Recommended Supplementary Readings

• References and Suggested Readings

chapter 11

Reality Therapy

techniques a

•

The Practice of

•

The Counseling

•

Pro

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334

CHAPTER ELEVEN

William Glasser / Robert E. Wubbolding

WILLIAM GLASSER

(b. 1925), currently retired, was

educated at Case Western

Reserve University in Cleve-

land, Ohio. Initially a chemical

engineer, he turned to psychol-

ogy (MA, Clinical Psychology,

1948) and then to psychiatry,

attending medical school

(MD, 1953) with the intention of becoming a psychia-

trist. By 1957 he had completed his psychiatric training

at the Veterans Administration and UCLA in Los

Angeles and in 1961 was board certified in psychiatry.

Glasser was married to Naomi for 47 years, and

she was very involved with the William Glasser Insti-

tute until her death in 1992. In 1995 Glasser married

Carleen, who is an instructor at the institute. Glasser

played tennis often until recently, and now, at age 86,

he enjoys watching basketball on television.

Very early Glasser rejected the Freudian model,

partly due to his observation of psychoanalytically

trained therapists who did not seem to be imple-

menting Freudian principles. Rather, they tended to

hold people responsible for their behavior. Early in

his career, Glasser was a psychiatrist at the Ventura

School, a prison and school for girls operated by the

California Youth Authority. He became convinced

that his psychoanalytic training was of limited utility

in counseling these young people. From these obser-

vations, Glasser thought it best to talk to the sane

part of clients, not their disturbed side. Glasser was

also influenced by G. L. Harrington, a psychiatrist and

mentor. Harrington believed in getting his patients

involved in projects in the real world, and by the end

of his residency Glasser began to put together ideas

that would later be known as reality therapy.

In 1962 Glasser began to present public lectures

on “reality psychiatry,” but few psychiatrists were in

the audience. Most of those attending were educators,

social workers, counselors, and correctional workers,

so Glasser changed the name of his system to “reality

therapy,” which became the title of his groundbreaking

book published in 1965. Educators found the principles

of reality therapy helpful, and he was asked to apply

it to the classroom and the school as an organiza-

tion. As a result of this experience, he wrote Schools

Without Failure in 1968, which had a major impact on

the administration of schools, the training of teachers,

and the way learning is conducted in schools. Glasser

took the position that schools needed to be structured

in ways to help students achieve a success identity as

opposed to a failure identity. He advocated for a

curriculum geared to the lives of learners. Glasser

made significant contributions through in-service

workshops for teachers and administrators. Since the

late 1960s, reality therapy has been further applied

to education and to virtually all other human relation-

ships, especially intimate relationships.

Glasser became convinced that it was of

paramount importance that clients accept personal

responsibility for their behavior. By the early 1980s,

Glasser was looking for a theory that could explain

all his work. Glasser learned about control theory

from William Powers, and he believed this theory

had great potential. He spent the next 10 years ex-

panding, revising, and clarifying what he was initially

taught. By 1996 Glasser had become convinced that

these revisions had so changed the theory that it

was misleading to continue to call it control theory,

and he changed the name to choice theory to reflect

all that he had developed. The essence of reality

therapy, now taught all over the world, is that we

are all responsible for what we choose to do. We

are internally motivated by current needs and

wants, and we control our present behavioral

choices.

ROBERT E. WUBBOLD-

ING, EdD

(b. 1936), born

and raised in Cincinnati,

Ohio, is the youngest of six

children. He received his

doctorate in counseling from

the University of Cincinnati,

is a member of several

professional organizations, and has licenses as a

counselor and as a psychologist. He taught high

school history, worked as a high school and ele-

mentary school counselor, and served as a consult-

ant to drug and alcohol abuse programs of the U.S.

Army and Air Force. In addition, Bob Wubbolding

began a career in the Catholic priesthood but later

“left the clergy freely and honorably.” He is married

Courtesy of The William Glasser Institute,

Chatsworth, CA

Courtesy of Robert E. Wubbolding

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335

REALITY THERAPY

introduction

Reality therapists believe the underlying problem of most clients is the same: they

are either involved in a present unsatisfying relationship or lack what could even

be called a relationship. Many of the problems of clients are caused by their inabil-

ity to connect, to get close to others, or to have a satisfying or successful relation-

ship with at least one signiﬁ cant person in their lives. The therapist guides clients

toward a satisfying relationship and teaches them more effective ways of behaving.

The more clients are able to connect with people, the greater chance they have to

experience happiness.

Few clients understand that their problem, which is unhappiness, results from

the way they are choosing to behave. What they do know is that they feel a great

deal of pain or that they are unhappy because they have been sent for counseling

by someone with authority who is not satisﬁ ed with their behavior—typically a

court ofﬁ cial, a school administrator, an employer, a spouse, or a parent. Reality

therapists recognize that clients choose their behaviors as a way to deal with the

frustrations caused by unsatisfying relationships.

Glasser (2003) contends that clients should not be labeled with a diagnosis

except when it is necessary for insurance purposes. From Glasser’s perspective,

diagnoses are descriptions of the behaviors people choose in their attempt to deal

with the pain and frustration that is endemic to their unsatisfying present relation-

ships. Labeling these ineffective behaviors as mental illness is inaccurate. Glasser

to Sandra Trifilio, a former French teacher, who

shares his passion for his work and is administrator

of the Center for Reality Therapy, as well as editor

of his writings.

He is now the director of the Center for Reality

Therapy in Cincinnati and professor emeritus of

Xavier University, where he taught counselor edu-

cation for 32 years. He loved teaching and viewed

his students as being highly motivated, eager to

learn, and experienced. One of his most meaningful

experiences was teaching graduate students in the

counseling department at Xavier University.

After completing his doctorate, Wubbolding

attended training sessions representing a wide

range of counseling approaches, yet he found

reality therapy to be best suited to his interests.

He attended many intensive training workshops

conducted by William Glasser in Los Angeles, and

in 1988 Glasser appointed him director of training

for the William Glasser Institute.

Wubbolding served as visiting professor at the

University of Southern California in their overseas

programs in Japan, Korea, and Germany, thus

fulfilling his lifelong desire to travel and to live in

other countries. He has become an internationally

known teacher, author, and practitioner of real-

ity therapy and has introduced choice theory and

reality therapy in Europe, Asia, and the Middle

East. Among his specialties is adapting choice

theory and reality therapy to various cultures and

ethnic groups. He received the Gratitude Award

(2009) for Initiating Reality Therapy in the United

Kingdom and the Certificate of Reality Therapy

Psychotherapist by the European Association for

Psychotherapy (2009).

Wubbolding has extended the theory and

practice of reality therapy with his conceptualiza-

tion of the WDEP system, which is described later

in the chapter. He has written 11 books and more

than 145 articles, essays, and chapters in textbooks

as well as preparing 12 videos/DVDs, some of

which are referenced in this chapter. His religious

commitment and his life of service to others are

apparent in his work, and he continues his voca-

tion of teacher, counselor, psychologist, and active

member of his church.

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336

CHAPTER ELEVEN

believes mental illnesses are conditions such as Alzheimer’s disease, epilepsy, head

trauma, and brain infections—conditions associated with tangible brain damage.

Because these people are suffering from a brain abnormality, he contends they

should be treated primarily by neurologists.

Reality therapy is based on choice theory as it is explained in several of Glasser’s

(1998, 2001, 2003) books. (In this chapter, the discussion of Glasser’s ideas pertains

to these three books, unless otherwise speciﬁ ed.) Choice theory is the theoretical

basis for reality therapy; it explains why and how we function. Reality therapy pro-

vides a delivery system for helping individuals take more effective control of their

lives. If choice theory is the highway, reality therapy is the vehicle delivering the

product (Wubbolding, 2011a). Therapy consists mainly of helping and sometimes

teaching clients to make more effective choices as they deal with the people they

need in their lives. Glasser maintains that it is essential for the therapist to estab-

lish a satisfying relationship with clients as a prerequisite for effective therapy.

Once this relationship is developed, the skill of the therapist as a teacher assumes

a central role.

Reality therapy has been used in a variety of settings. The approach is appli-

cable to counseling, social work, education, crisis intervention, corrections and

rehabilitation, institutional management, and community development. Reality

therapy is popular in schools, general hospitals, state mental hospitals, halfway

houses, and alcohol and drug abuse centers. Many of the military clinics that treat

substance abusers use reality therapy as their preferred therapeutic approach.

See the video program for Chapter 11, DVD for Theory and Practice of Counseling

and Psychotherapy: The Case of Stan and Lecturettes. I suggest that you view the

brief lecture for each chapter prior to reading the chapter.

key concepts

View of Human Nature

Choice theory posits that we are not born blank slates waiting to be externally mo-

tivated by forces in the world around us. Rather, we are born with ﬁ ve genetically

encoded needs that drive us all our lives: survival, or self-preservation; love and

belonging; power, or inner control; freedom, or independence; and fun, or enjoyment.

Each of us has all ﬁ ve needs, but they vary in strength. For example, we all have a

need for love and belonging, but some of us need more love than others. Choice

theory is based on the premise that because we are by nature social creatures

we need to both receive and give love. Glasser (2001, 2005) believes the need to

love and to belong is the primary need because we need people to satisfy the other

needs. It is also the most difﬁ cult need to satisfy because we must have a coopera-

tive person to help us meet it.

Our brain functions as a control system. It continually monitors our feelings

to determine how well we are doing in our lifelong effort to satisfy these needs.

Whenever we feel bad, one or more of these ﬁ ve needs is unsatisﬁ ed. Although

we may not be aware of our needs, we know that we want to feel better. Driven by

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337

REALITY THERAPY

pain, we try to ﬁ gure out how to feel better. Reality therapists teach clients choice

theory, sometimes subtly and indirectly, so clients can identify unmet needs and

try to satisfy them.

Choice theory teaches that we do not satisfy our needs directly. What we do,

beginning shortly after birth and continuing all our lives, is to keep close track of

anything we do that feels very good. We store information inside our minds and

build a ﬁ le of wants, called our quality world, which is at the core of our life. It is

our personal Shangri-la—the world we would like to live in if we could. It is com-

pletely based on our wants and needs, but unlike the needs, which are general,

it is very speciﬁ c. The quality world consists of speciﬁ c images of people, activi-

ties, events, beliefs, possessions, and situations that fulﬁ ll our needs (Wubbolding,

2000, 2011a). Our quality world is like a picture album. We develop an inner

picture album of speciﬁ c wants as well as precise ways to satisfy these wants. We

are attempting to behave in a way that gives us the most effective control over our

lives. Some pictures may be blurred, and the therapist’s role is to help the client

clarify them. Pictures exist in priority for most people, yet clients may have dif-

ﬁ culty identifying their priorities. Part of the process of reality therapy is assisting

clients in prioritizing their wants and uncovering what is most important to them

(Wubbolding, 2011a).

People are the most important component of our quality world, and these are

the people we most want to connect with. It contains the people we are closest to

and most enjoy being with. Those who enter therapy generally have no one in their

quality world or, more often, someone in their quality world that they are unable

to relate to in a satisfying way. For therapy to have a chance of success, a therapist

must be the kind of person that clients would consider putting in their quality

world. Getting into the clients’ quality world is the art of therapy. It is from this

relationship with the therapist that clients begin to learn how to get close to the

people they need.

Choice Theory Explanation of Behavior

Choice theory explains that all we ever do from birth to death is behave and, with

rare exceptions, everything we do is chosen. Every total behavior is our best at-

tempt to get what we want to satisfy our needs. Total behavior teaches that all

behavior is made up of four inseparable but distinct components—acting, thinking,

feeling, and physiology—that necessarily accompany all of our actions, thoughts,

and feelings. Choice theory emphasizes thinking and acting, which makes this a

general form of cognitive behavior therapy. The primary emphasis is on what the

client is doing on and how the doing component inﬂ uences the other aspects of to-

tal behavior. Behavior is purposeful because it is designed to close the gap between

what we want and what we perceive we are getting. Speciﬁ c behaviors are always

generated from this discrepancy. Our behaviors come from the inside, and thus

we choose our destiny.

Glasser says that to speak of being depressed, having a headache, being angry,

or being anxious implies passivity and lack of personal responsibility, and it is in-

accurate. It is more accurate to think of these as parts of total behaviors and to use

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CHAPTER ELEVEN

the verb forms depressing, headaching, angering, and anxietying to describe them. It

is more accurate to think of people depressing or angering themselves rather than

being depressed or being angry. When people choose misery by developing a range

of “paining” behaviors, it is because these are the best behaviors they are able to

devise at the time, and these behaviors often get them what they want.

When a reality therapist starts teaching choice theory, the client will often pro-

test and say, “I’m suffering; don’t tell me I’m choosing to suffer like this.” As

painful as depressing is, the therapist explains that people do not choose pain and

suffering directly; rather, it is an unchosen part of their total behavior. The behavior

of the person is the best effort, ineffective as it is, to satisfy needs.

Robert Wubbolding (personal communication, September 7, 2010) has added a

new idea to choice theory. He believes that behavior is a language, and that we send

messages by what we are doing. The purpose of behavior is to inﬂ uence the world

to get what we want. Therapists ask clients what messages they are sending to the

world by way of their actions: “What message do you want others to get?” “What

message are others getting whether or not you intended to send them?” By consid-

ering the messages that clients send to others, counselors can help clients indirectly

gain a greater appreciation of messages they unintentionally send to others.

Characteristics of Reality Therapy

Contemporary reality therapy focuses quickly on the unsatisfying relationship or

the lack of a relationship, which is often the cause of clients’ problems. Glasser has

given increasing attention to the role of meaningful relationships in fostering emo-

tional health. Clients may complain of a problem such as not being able to keep

a job, not doing well in school, or not having a meaningful relationship. When

clients complain about how other people are causing them pain, the therapist does

not get involved with ﬁ nding fault. Reality therapists ask clients to consider how

effective their choices are, especially as these choices affect their relationships with

signiﬁ cant people in their lives. Choice theory teaches that talking about what cli-

ents cannot control is of minimal value; the emphasis is on what clients can control

in their relationships. The basic axiom of choice theory, which is crucial for clients

to understand, is this: “The only person you can control is yourself.” Two books

devoted to how choice theory can help people deal with their relationship problems

and enhance their relationships are Getting Together and Staying Together (Glasser &

Glasser, 2000) and Eight Lessons for a Happier Marriage (Glasser & Glasser, 2007).

Reality therapists do not listen very long to complaining, blaming, and criti-

cizing, for these are the most ineffective behaviors in our behavioral repertoire.

Because reality therapists give little attention to these self-defeating total behaviors,

Glasser maintains that they tend to disappear from therapy. What do reality thera-

pists focus on? Here are some underlying characteristics of reality therapy.

emphasize choice and responsibility If we choose all we do, we

must be responsible for what we choose. This does not mean we should be blamed

or punished, unless we break the law, but it does mean the therapist should never

lose sight of the fact that clients are responsible for what they do. Choice theory

changes the focus of responsibility to choice and choosing.

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Reality therapists deal with people “as if” they have choices. Therapists focus

on those areas where clients have choice, for doing so gets them closer to the peo-

ple they need. For example, being involved in meaningful activities, such as work,

is a good way to gain the respect of other people, and work can help clients fulﬁ ll

their need for power. It is very difﬁ cult for adults to feel good about themselves

if they don’t engage in some form of meaningful activity. As clients begin to feel

good about themselves, it is less necessary for them to continue to choose ineffec-

tive and self-destructive behaviors.

reject transference Reality therapists strive to be themselves in their

professional work. By being themselves, therapists can use the relationship to

teach clients how to relate to others in their lives. Glasser contends that transfer-

ence is a way that both therapist and client avoid being who they are and owning

what they are doing right now. It is unrealistic for therapists to go along with the

idea that they are anyone but themselves. Assume the client claims, “I see you as

my father or mother and this is why I’m behaving the way I am.” In such a situ-

ation a reality therapist is likely to say clearly and ﬁ rmly, “I am not your mother,

father, or anyone but myself.”

keep the therapy in the present Some clients come to counseling

convinced that they must revisit the past if they are to be helped. Many thera-

peutic models teach that to function well in the present people must understand

and revisit their past. Glasser (2001) disagrees with this assumption and contends

that whatever mistakes were made in the past are not pertinent now. An axiom of

choice theory is that the past may have contributed to a current problem but that

the past is never the problem. To function effectively, people need to live and plan

in the present and take steps to create a better future. We can only satisfy our needs

in the present.

The reality therapist does not totally reject the past. If the client wants to talk

about past successes or good relationships in the past, the therapist will listen

because these may be repeated in the present. Reality therapists will devote only

enough time to past failures to assure clients that they are not rejecting them. As

soon as possible, therapists tell clients, “What has happened is over; it can’t be

changed. The more time we spend looking back, the more we avoid looking for-

ward.” Although the past has propelled us to the present, reality therapists contend

that it does not have to determine our future. We are free to make choices, even

though our external world limits our choices (Wubbolding, 2011b).

avoid focusing on symptoms In traditional therapy a great deal of

time is spent focusing on symptoms by asking clients how they feel and why they

are obsessing. Focusing on the past “protects” clients from facing the reality of un-

satisfying present relationships, and focusing on symptoms does the same thing.

Glasser (2003) contends that people who have symptoms believe that if they could

only be symptom-free they would ﬁ nd happiness. Whether people are depress-

ing or paining, they tend to think that what they are experiencing is happening

to them. They are reluctant to accept the reality that their suffering is due to the

total behavior they are choosing. Their symptoms can be viewed as the body’s way

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CHAPTER ELEVEN

of warning them that the behavior they are choosing is not satisfying their basic

needs. The reality therapist spends as little time as he or she can on the symptoms

because they will last only as long as they are needed to deal with an unsatisfying

relationship or the frustration of basic needs.

According to Glasser, if clients believe that the therapist wants to hear about

their symptoms or spend time talking about the past, they are more than willing

to comply. Engaging in long journeys into the past or exploring symptoms results

in lengthy therapy. Glasser (2005) maintains that almost all symptoms are caused

by a present unhappy relationship. By focusing on present problems, especially

interpersonal concerns, therapy can generally be shortened considerably.

challenge traditional views of mental illness Choice the-

ory rejects the traditional notion that people with problematic physical and psycho-

logical symptoms are mentally ill. Glasser (2003) has warned people to be cautious

of psychiatry, which can be hazardous to both one’s physical and mental health.

He criticizes the traditional psychiatric establishment for relying heavily on the

DSM-IV-TR (American Psychiatric Association, 2000) for both diagnosis and

treatment. Glasser (2003) challenges the traditionally accepted views of mental ill-

ness and treatment by the use of medication, especially the widespread use of psy-

chiatric drugs that often result in negative side effects both physically and psycho-

logically. Wubbolding (personal communication, September 7, 2010) emphasizes

that reality therapy is a mental health system rather than a remediating system. He

incorporates the Ericksonian principle that “people don’t have problems, they have

solutions that have not worked.” By reframing diagnostic categories and negative

behaviors, the counselor helps the client to perceive his or her behaviors in a very

different light, which facilitates the search for more effective solutions and choices.

the therapeutic process

Therapeutic Goals

A primary goal of contemporary reality therapy is to help clients get connected

or reconnected with the people they have chosen to put in their quality world.

In addition to fulﬁ lling this need for love and belonging, a basic goal of reality

therapy is to help clients learn better ways of fulﬁ lling all of their needs, includ-

ing achievement, power or inner control, freedom or independence, and fun. The

basic human needs serve to focus treatment planning and setting both short- and

long-term goals. Reality therapists assist clients in making more effective and

responsible choices related to their wants and needs.

In many instances, clients come voluntarily for therapy, and these clients are the

easiest to help. However, another goal entails working with an increasing number

of involuntary clients who may actively resist the therapist and the therapy process.

These individuals often engage in violent behavior, addictions, and other kinds of

antisocial behaviors. It is essential for counselors to do whatever they can to get con-

nected with involuntary clients. If the counselor is unable to make a connection, there

is no possibility of providing signiﬁ cant help. If the counselor can make a connection,

the goal of teaching the client how to fulﬁ ll his or her needs can slowly begin.

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REALITY THERAPY

Therapist’s Function and Role

Therapy is often considered as a mentoring process in which the therapist is the

teacher and the client is the student. Reality therapists teach clients how to engage

in self-evaluation, which is done by raising the question, “Is what you are choosing

to do getting you what you want and need?” Here are some other questions that

therapists tend to ask clients:

• How would you most like to change your life?

• What do you want in your life that you are not getting?

• What would you have in your life if you were to change?

• What do you have to do now to make the changes happen?

The role of the reality therapist is not to make the evaluation for clients but to

challenge clients to examine what they are doing. Reality therapists assist clients

in evaluating their own behavioral direction, speciﬁ

c actions, wants, perceptions,

level of commitment, possibilities for new directions, and action plans. Clients

then decide what to change and formulate a plan to facilitate the desired changes.

The outcome is better relationships, increased happiness, and a sense of inner

control of their lives (Wubbolding, 2011b).

It is the job of therapists to convey the idea that no matter how bad things are

there is hope. If therapists are able to instill this sense of hope, clients feel that

they are no longer alone and that change is possible. The therapist functions as an

advocate, or someone who is on the client’s side. Together they can creatively

address a range of concerns and options.

Client’s Experience in Therapy

Clients are not expected to backtrack into the past or get sidetracked into talking

about symptoms. Neither will much time be spent talking about feelings separate

from the acting and thinking that are part of the total behaviors over which clients

have direct control. The emphasis in on actions. When clients change what they

are doing, they often change how they are feeling and thinking.

Therapists will gently, but ﬁ rmly confront clients. Reality therapists often ask

clients questions such as these: “Is what you are choosing to do bringing you closer

to the people you want to be closer to right now?” “Is what you are doing get-

ting you closer to a new person if you are presently disconnected from everyone?”

These questions are part of the self-evaluation process, which is the cornerstone

of reality therapy.

Clients can expect to experience some urgency in therapy. Time is important,

as each session may be the last. Clients should be able to say to themselves, “I can

begin to use what we talked about today in my life. I am able to bring my present

experiences to therapy as my problems are in the present, and my therapist will not

let me escape from that fact.”

Relationship Between Therapist and Client

Reality therapy emphasizes an understanding and supportive relationship, or

therapeutic alliance, which is the foundation for effective outcomes (Wubbolding &

Brickell, 2005; Wubbolding, Robey, & Brickell, 2010). The therapist’s skill in

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CHAPTER ELEVEN

establishing a trusting relationship is critical. It is also important that the client

perceives the therapist as being skilled and knowledgeable. Although the therapeu-

tic relationship is paramount, it is not an end in itself, and it is not automatically

curative or healing (Wubbolding, 2011a).

For involvement between the therapist and the client to occur, the counselor

must have certain personal qualities, including warmth, sincerity, congruence, un-

derstanding, acceptance, concern, respect for the client, openness, and the willing-

ness to be challenged by others. (For other personal characteristics, see Chapter 2.)

Wubbolding (2010, 2011a, 2011b) identiﬁ es speciﬁ c ways for counselors to create

a climate that leads to involvement with clients. Some of these ways entail using

attending behavior, listening to clients, suspending judgment, doing the unexpected,

using humor appropriately, being oneself as a counselor, engaging in facilitative

self-disclosure, listening for metaphors in the client’s mode of self-expression,

listening for themes, summarizing and focusing, allowing consequences, allowing

silence, and being an ethical practitioner. The basis for therapeutic interventions

to work effectively rests on a fair, ﬁ rm, friendly, and trusting environment. Once

involvement has been established, the counselor assists clients in gaining a deeper

understanding of the consequences of their current behavior.

application: therapeutic

techniques and procedures

The Practice of Reality Therapy

The practice of reality therapy can best be conceptualized as the cycle of counseling,

which consists of two major components: (1) creating the counseling environment

and (2) implementing speciﬁ c procedures that lead to changes in behavior. The art

of counseling is to weave these components together in ways that lead clients to

evaluate their lives and decide to move in more effective directions.

How do these components blend in the counseling process? The cycle of

counseling begins with creating a working relationship with clients, which was

described in the previous section. The process proceeds through an exploration

of clients’ wants, needs, and perceptions. Clients explore their total behavior and

make their own evaluation of how effective they are in getting what they want. If

clients decide to try new behavior, they make plans that will lead to change, and

they commit themselves to those plans. The cycle of counseling includes following

up on how well clients are doing and offering further consultation as needed.

It is important to keep in mind that although the concepts may seem simple as

they are presented here, being able to translate them into actual therapeutic prac-

tice takes considerable skill and creativity. Although the principles will be the same

when used by any counselor who is certiﬁ ed in reality therapy, the manner in which

these principles are applied does vary depending on the counselor’s style and per-

sonal characteristics. These principles are applied in a progressive manner, but they

should not be thought of as discrete and rigid categories. The art of practicing real-

ity therapy involves far more than following procedures in a step-by-step, cookbook

fashion. Although these procedures are described in jargon-free language, they can

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be challenging to implement (Wubbolding, 2007, 2011b). Counseling is not a sim-

plistic method that is applied in the same way with every client. With choice theory

in the background of practice, the counselor tailors the counseling to what the client

presents. Although the counselor is prepared to work in a way that is meaningful

to the client, the move toward satisfying relationships remains in the foreground.

Robert Wubbolding is a reality therapist who has extended the practice of real-

ity therapy (WDEP system) for both implementing and teaching reality therapy

(Wubbolding, 2009). Over the years he has played a major role in the development

of reality therapy. I especially value Wubbolding’s contributions to teaching reality

therapy and to conceptualizing therapeutic procedures. His ideas render choice

theory practical and useable by counselors, and his system provides a basis for con-

ceptualizing and applying the theory. Although reality therapists operate within

the spirit of choice theory, they practice in their own unique ways and develop their

own individual therapeutic style. This section is based on an integrated summary

and adaptation of material from various sources (Glasser, 1992, 1998, 2001; Wub-

bolding, 1988, 1991, 2000, 2007, 2008, 2011a, 2011b; Wubbolding et al., 1998,

2004). The Student Manual that accompanies this textbook contains Wubbolding’s

(2010) chart, which highlights issues and tasks to be accomplished throughout the

cycle of counseling.

The Counseling Environment

The practice of reality therapy rests on the assumption that a supportive and chal-

lenging environment allows clients to begin making life changes. The therapeutic

relationship is the foundation for effective practice; if this is lacking, there is little

hope that the system can be successfully implemented. Counselors who hope to

create a therapeutic alliance strive to avoid behaviors such as arguing, attacking,

accusing, demeaning, bossing, criticizing, ﬁ nding fault, coercing, encouraging ex-

cuses, holding grudges, instilling fear, and giving up easily (Wubbolding, 2010,

2011a, 2011b). In a short period of time, clients generally begin to appreciate the

caring, accepting, noncoercive choice theory environment. It is from this mildly

confrontive yet always noncriticizing, nonblaming, noncomplaining, caring envi-

ronment that clients learn to create the satisfying environment that leads to success-

ful relationships. In this coercion-free atmosphere, clients feel free to be creative

and to begin to try new behaviors.

Procedures That Lead to Change

Reality therapists operate on the assumption that we are motivated to change (1)

when we are convinced that our present behavior is not meeting our needs and

(2) when we believe we can choose other behaviors that will get us closer to what

we want. Reality therapists begin by asking clients what they want from therapy.

Therapists take the mystery and uncertainty out of the therapeutic process. They

also inquire about the choices clients are making in their relationships. In most in-

stances, there is a major unsatisﬁ ed relationship, and clients usually do not believe

they have any choice in what is going on in this relationship. In the beginning the

client may deny this is the case. For example, the client might say, “I’m depressed.

My depression is the problem. Why are you talking about my relationships?” The

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CHAPTER ELEVEN

client often does not want to talk about the real problem, which is the unsatisfying

relationship or lack thereof.

In the ﬁ rst session a skilled therapist looks for and deﬁ nes the wants of the cli-

ent. The therapist also looks for a key unsatisfying present relationship—usually

with a spouse, a child, a parent, or an employer. The therapist might ask, “Whose

behavior can you control?” This question may need to be asked several times during

the next few sessions to deal with the client’s resistance to looking at his or her own

behavior. The emphasis is on encouraging clients to focus on what they can control.

When clients begin to realize that they can control only their own behavior,

therapy is under way. The rest of therapy focuses on how clients can make better

choices. There are more choices available than clients realize, and the therapist

explores these possible choices. Clients may be stuck in misery, blaming, and the

past, but they can choose to change—even if the other person in the relationship

does not change. Wubbolding (2011a) makes the point that clients can learn that

they are not at the mercy of others, are not victims, are capable of gaining a sense

of inner control, and have a range of choices open to them. In short, clients in real-

ity therapy often acquire a sense of hope for a better future.

Reality therapists explore the tenets of choice theory with clients, helping cli-

ents identify basic needs, discovering clients’ quality world, and ﬁ nally, helping

clients understand that they are choosing the total behaviors that are their symp-

toms. In every instance when clients make a change, it is their choice. With the

therapist’s help, clients learn to make better choices than they did when they were

on their own. Through choice theory, clients can acquire and maintain successful

relationships.

The “WDEP” System

Wubbolding (2000) uses the acronym WDEP to describe key procedures in the

practice of reality therapy. The WDEP system of reality therapy can be described as

“effective, practical, usable, theory-based, cross-cultural, and founded on universal

human principles” (Wubbolding, 2007, p. 204). The WDEP system can be used

to help clients explore their wants, possible things they can do, opportunities for

self-evaluation, and design plans for improvement (Wubbolding, 2007, 2011a, 2011b).

Grounded in choice theory, the WDEP system assists people in satisfying their ba-

sic needs. Each of the letters refers to a cluster of strategies: W 5 wants, needs, and

perceptions; D 5 direction and doing; E 5 self-evaluation; and P 5 planning. These

strategies are designed to promote change. Let’s look at each one in more detail.

wants (exploring wants, needs, and perceptions) Reality

therapists assist clients in discovering their wants and hopes. All wants are related

to the ﬁ ve basic needs. The key question asked is, “What do you want?” Through

the therapist’s skillful questioning, clients are assisted in deﬁ ning what they want

from the counseling process and from the world around them. It is useful for cli-

ents to deﬁ ne what they expect and want from the counselor and from themselves.

Part of counseling consists of exploring the “picture album,” or quality world, of

clients and how their behavior is aimed at moving their perception of the external

world closer to their inner world of wants.

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Clients are given the opportunity to explore every facet of their lives, including

what they want from their family, friends, and work. Furthermore, this exploration

of wants, needs, and perceptions should continue throughout the counseling proc-

ess as clients’ pictures change.

Here are some useful questions to help clients pinpoint what they want:

• If you were the person that you wish you were, what kind of person would you be?

• What would your family be like if your wants and their wants matched?

• What would you be doing if you were living as you want to?

• Do you really want to change your life?

• What is it you want that you don’t seem to be getting from life?

• What do you think stops you from making the changes you would like?

Wubbolding and Brickell (2009) now include questions focusing on perceptions:

“How do you look at the situation?” “Where do you see your control?” (p. 51). Peo-

ple have a great deal more control than they often perceive, and these questions

help clients move from a sense of external control to a sense of internal control.

This line of questioning sets the stage for applying other procedures in reality

therapy. It is an art for counselors to know what questions to ask, how to ask them,

and when to ask them. Relevant questions help clients gain insights and arrive at

plans and solutions. Although well-timed, open-ended questions can help clients

identify their counseling goals, excessive questioning can result in resistance and

defensiveness. Part of this phase of counseling involves eliciting a commitment to

counseling. Personal growth will occur to the degree that clients are committed to

making changes in their actions (Wubbolding, 2011b).

direction and doing The focus on the present is characterized by the

key question asked by the reality therapist: “What are you doing?” Even though

problems may be rooted in the past, clients need to learn how to deal with them in

the present by learning better ways of getting what they want. Problems must be

solved either in the present or through a plan for the future. The therapist’s chal-

lenge is to help clients make more need-satisfying choices.

Early in counseling it is essential to discuss with clients the overall direction of

their lives, including where they are going and where their behavior is taking them.

This exploration is preliminary to the subsequent evaluation of whether it is a desir-

able direction. The therapist holds a mirror before the client and asks, “What do you

see for yourself now and in the future?” It often takes some time for this reﬂ ection

to become clearer to clients so they can verbally express their perceptions.

Reality therapy focuses on gaining awareness of and changing current total be-

havior. To accomplish this, reality therapists focus on questions like these: “What

are you doing now?” “What did you actually do yesterday?” “What did you want to

do differently this past week?” “What stopped you from doing what you said you

wanted to do?” “What will you do tomorrow?”

Listening to clients talk about feelings can be productive, but only if it is linked

to what they are doing. When an emergency light on the car dashboard lights up,

the driver is alerted that something is wrong and that immediate action is neces-

sary to remedy a problem. In a similar way, when clients talk about problematic

feelings, most reality therapists afﬁ rm and acknowledge these feelings. Rather than

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CHAPTER ELEVEN

focusing mainly on these feelings, however, reality therapists encourage clients to

take action by changing what they are doing and thinking. It is easier to change

what we are doing and thinking than to change our feelings. From a choice theory

perspective, discussions centering on feelings, without strongly relating them to

what people are doing and thinking, are counterproductive.

self-evaluation Self-evaluation is the cornerstone of reality therapy pro-

cedures. The core of reality therapy, as we have seen, is to ask clients to make

the following self-evaluation: “Does your present behavior have a reasonable

chance of getting you what you want now, and will it take you in the direction

you want to go?” Speciﬁ cally, evaluation involves the client examining behav-

ioral direction, speciﬁ c actions, wants, perceptions, new directions, and plans

(Wubbolding, 2011b). According to Wubbolding (2007), clients often present

a problem with a signiﬁ cant relationship, which is at the root of much of their

dissatisfaction. The counselor can help clients evaluate their behavior by ask-

ing this question: “Is your current behavior bringing you closer to people im-

portant to you or is it driving you further apart?” Through skillful questioning,

the counselor helps clients determine if what they are doing is helping them.

Artful questioning assists clients in evaluating their present behavior and the

direction this is taking them. Wubbolding (2000, 2011a) suggests questions

like these:

• Is what you are doing helping or hurting you?

• Is what you are doing now what you want to be doing?

• Is your behavior working for you?

• Is there a healthy congruence between what you are doing and what you believe?

• Is what you are doing against the rules?

• Is what you want realistic or attainable?

• Does it help you to look at it that way?

• Is it really true that you have no control over your situation?

• How committed are you to the therapeutic process and to changing your life?

• After carefully examining what you want, does it appear to be in your best inter-

ests and in the best interest of others?

Asking clients to evaluate each component of their total behavior is a major task

in reality therapy. It is the counselor’s task to assist clients in evaluating the qual-

ity of their actions and to help them make responsible choices and devise effective

plans. Individuals will not change until they ﬁ

rst decide that a change would be

more advantageous. Without an honest self-assessment, it is unlikely that clients

will change. Reality therapists are relentless in their efforts to help clients con-

duct explicit self-evaluations of each behavioral component. When therapists ask a

depressing client if this behavior is helping in the long run, they introduce the idea

of choice to the client. The process of evaluation of the doing, thinking, feeling,

and physiological components of total behavior is within the scope of the client’s

responsibility.

Reality therapists may be directive with certain clients at the beginning of

treatment. This is done to help clients recognize that some behaviors are not

effective. In working with clients who are in crisis, for example, it is sometimes

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347

REALITY THERAPY

necessary to suggest straightforwardly what will work and what will not. Other

clients, such as alcoholics and children of alcoholics, need direction early in

the course of treatment, for they often do not have the thinking behaviors in

their control system to be able to make consistent evaluations of when their

lives are seriously out of effective control. These clients are likely to have blurred

pictures and, at times, to be unaware of what they want or whether their wants

are realistic. As they grow and continue to interact with the counselor, they

learn to make evaluations with less and less help from the counselor (Wubbold-

ing, 2011a; Wubbolding & Brickell, 2005).

planning and action Much of the signiﬁ cant work of the counseling proc-

ess involves helping clients identify speciﬁ c ways to fulﬁ ll their wants and needs.

Once clients determine what they want to change, they are generally ready to

explore other possible behaviors and formulate an action plan. The key question

is, “What is your plan?” The process of creating and carrying out plans enables

people to begin to gain effective control over their lives. If the plan does not work,

for whatever reason, the counselor and client work together to devise a different

plan. The plan gives the client a starting point, a toehold on life, but plans can be

modiﬁ ed as needed. Throughout this planning phase, the counselor continually

urges the client to be willing to accept the consequences for his or her own choices

and actions. Not only are plans discussed in light of how they can help the client

personally, but plans are also designed in terms of how they are likely to affect oth-

ers in the client’s life.

Wubbolding (2000, 2007, 2008, 2011a, 2011b) discusses the central role of plan-

ning and commitment. The culmination of the cycle of counseling rests with a plan

of action. Although planning is important, it is effective only if the client has made a

self-evaluation and determined that he or she wants to change a behavior. Wubbolding

uses the acronym SAMIC to capture the essence of a good plan: simple, attainable,

measurable, immediate, involved, controlled by the planner, committed to, and con-

sistently done. Wubbolding contends that clients gain more effective control over

their lives with plans that have the following characteristics:

• The plan is within the limits of the motivation and capacities of the client.

Skillful counselors help clients identify plans that involve greater need-fulﬁ lling

payoffs. Clients may be asked, “What plans could you make now that would

result in a more satisfying life?”

• Good plans are simple and easy to understand. They are realistically doable, pos-

itive rather than negative, dependent on the planner, speciﬁ

c, immediate, and

repetitive. Although they need to be speciﬁ c, concrete, and measurable, plans

should be ﬂ exible and open to revision as clients gain a deeper understanding

of the speciﬁ c behaviors they want to change.

• The plan involves a positive course of action, and it is stated in terms of what the

client is willing to do. Even small plans can help clients take signiﬁ cant

steps

toward their desired changes.

•

Counselors encourage clients to develop plans that they can carry out independ-

ently of what others do. Plans that are contingent on others lead clients to sense

that they are not steering their own ship but are at the mercy of the ocean.

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CHAPTER ELEVEN

• Effective plans are repetitive and, ideally, are performed daily.

• Plans are carried out as soon as possible. Counselors can ask the question,

“What are you willing to do today to begin to change your life?”

• Plans involve process-centered activities. For example, clients may plan to do

any of the following: apply for a job, write a letter to a friend, take a yoga class,

substitute nutritious food for junk food, devote 2 hours a week to volunteer

work, or take a vacation that they have been wanting.

• Before clients carry out their plan, it is a good idea for them to evaluate it with

their therapist to determine whether it is realistic and attainable and whether

it relates to what they need and want. After the plan has been carried out

in real life, it is useful to evaluate it again and make any revisions that may be

necessary.

• To help clients commit themselves to their plan, it is useful for them to ﬁ rm

it

up in writing.

Resolutions and plans are empty unless there is a commitment to carry them out.

It is up to clients to determine how to take their plans outside the restricted world

of therapy and into the everyday world. Effective therapy can be the catalyst that

leads to self-directed, responsible living.

Asking clients to determine what they want for themselves, to make a self-

evaluation, and to follow through with action plans includes assisting them in

determining how intensely they are willing to work to attain the changes they

desire. Commitment is not an all-or-nothing matter; it exists in degrees. Wub-

bolding (2007, 2011a, 2011b) maintains that it is important for a therapist to

express concern about clients’ level of commitment, or how much they are will-

ing to work to bring about change. This communicates in an implicit way to

clients that they have within them the power to take charge of their lives. It is

essential that those clients who are reluctant to make a commitment be helped

to express and explore their fears of failing. Clients are helped by a therapist

who does not easily give up believing in their ability to make better choices, even

if they are not always successful in completing their plans. In his workshops,

Wubbolding often mentions this axiom of reality therapy: “To fail to plan is

to plan to fail.”

Application to Group Counseling

With the emphases on connection and interpersonal relationships, reality therapy

is well suited for various kinds of group counseling. Groups provide members

with many opportunities for exploring ways to meet their needs through the

relationships formed within the group. In particular, the WDEP system can be

applied to helping group members satisfy their basic needs. If members talk

about their past experiences or make excuses for their current behavior, the group

leader redirects them to what they are presently doing. From the very beginning

of a group, the members can be asked to take an honest look at what they are

doing and to clarify whether their behavior is getting them what they say they

want. Once group members get a clearer picture of what they have in their lives

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349

REALITY THERAPY

now and what they want to be different, they can use the group as a place to

explore an alternative course of behavior.

This model lends itself to expecting the members to carry out homework

assignments between the group meetings. However, it is the members, with the

help of the leader, who evaluate their own behavior and decide whether they want

to change. Members also take the lead in deciding what kinds of homework tasks

they will set for themselves as a way to achieve their goals. Group leaders often

meet with resistance if they make poorly timed suggestions and plans for how the

members should best live their lives. To their credit, reality therapists keep asking

the members to evaluate for themselves whether what they are doing is getting

them what they want. If the members concede that what they are doing is not

working for them, their resistance is much more likely to melt, and they tend to be

more open to trying different behaviors.

Once the members make some changes, reality therapy provides the struc-

ture for them to formulate speciﬁ c plans for action and to evaluate their level

of success. Feedback from the members and the leader can help individuals

design realistic and attainable plans. Considerable time is devoted during the

group sessions for developing and implementing plans. If people don’t carry out

a plan, it is important to discuss with them what stopped them. Perhaps they

set their goals unrealistically high, or perhaps there is a discrepancy between

what they say they want to change and the steps they are willing to take to bring

about change.

I also like reality therapy’s insistence that change will not come by insight alone;

rather, members have to begin doing something different once they determine

that their behavior is not working for them. I am skeptical about the value of ca-

tharsis as a therapeutic vehicle unless the release of pent-up emotions is eventually

put into some kind of cognitive framework and is followed up with an action plan.

In the groups that I facilitate, group members are challenged to look at the futil-

ity of waiting for others to change. I ask members to assume that the signiﬁ cant

people in their life may never change, which means that they will have to take a

more active stance in shaping their own destiny. I appreciate the emphasis of real-

ity therapy on teaching clients that the only life they can control is their own and

the focus placed on helping group members change their own patterns of acting

and thinking.

For a more detailed discussion of reality therapy in groups, see Corey (2012,

chap. 15).

reality therapy from a

multicultural perspective

Strengths From a Diversity Perspective

The core principles of choice theory and reality therapy have much to offer in the

area of multicultural counseling. In cross-cultural therapy it is essential that coun-

selors respect the differences in worldview between themselves and their clients.

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350

CHAPTER ELEVEN

Counselors demonstrate their respect for the cultural values of their clients by

helping them explore how satisfying their current behavior is both to themselves

and to others. Once clients make this assessment, they can formulate realistic

plans that are consistent with their cultural values. It is a further sign of respect

that the counselor refrains from deciding what behavior should be changed.

Through skillful questioning on the counselor’s part, clients from diverse ethnic

backgrounds can be helped to determine the degree to which they have become

acculturated into the dominant society. Is it possible for them to ﬁ nd a balance,

retaining their ethnic identity and values while integrating some of the values and

practices of the dominant group? Again, the counselor does not determine this

balance for clients, but works with them to arrive at their own answers. With this

focus on thinking and acting rather than on exploring feelings, many clients are

less likely to display resistance to counseling.

Glasser (1998) contends that reality therapy and choice theory can be applied both

individually and in groups to anyone with any psychological problem in any cultural

context. We are all members of the same species and have the same genetic struc-

ture; therefore, relationships are the problem in all cultures. Wubbolding (2007,

2011a, 2011b) asserts that the principles underlying choice theory are universal,

which makes choice theory applicable to all people. All of us have internal needs,

we all make choices, and we all seek to inﬂ uence the world around us. Putting the

principles of choice theory into action demands creativity, sensitivity to cultures

and individuals, and ﬂ exibility in implementing the procedures of reality therapy.

Reality therapy principles and procedures need to be applied differently in various

cultures and must be adapted to the psychological and developmental levels pre-

sented by individuals (Wubbolding, 2011b).

Based on the assumption that reality therapy must be modiﬁ ed to ﬁ t the cultural

context of people other than North Americans, Wubbolding (2000, 2011a) and Wub-

bolding and colleagues (1998, 2004) have expanded the practice of reality therapy

to multicultural situations. Wubbolding’s experience in conducting reality therapy

workshops in Japan, Taiwan, Hong Kong, Singapore, Korea, India, Kuwait, Australia,

Slovenia, Croatia, and countries in western Europe has taught him the difﬁ culty of

generalizing about other cultures. Growing out of these multicultural experiences,

Wubbolding (2000) has adapted the cycle of counseling in working with Japanese

clients. He points to some basic language differences between Japanese and Western

cultures. North Americans are inclined to say what they mean and to be assertive. In

Japanese culture, assertive language is not appropriate between a child and a parent

or between an employee and a supervisor. Ways of communicating are more indirect.

To ask some Japanese clients what they want may seem harsh and intrusive to them.

Because of these style differences, adaptations such as those listed below are needed to

make the practice of reality therapy relevant to Japanese clients:

• The reality therapist’s tendency to ask direct questions may need to be softened,

with questions being raised more elaborately and indirectly. It may be a mistake

to ask individualistic questions built around whether speciﬁ

c behaviors meet

the client’s need. Confrontation should be done only after carefully considering

the context.

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351

REALITY THERAPY

• There is no exact Japanese translation for the word “plan,” nor is there an exact

word for “accountability,” yet both of these are key dimensions in the practice of

reality therapy and are central to Japanese culture.

• In asking clients to make plans and commit to them, Western counselors do not

settle for a response of “I’ll try.” Instead, they tend to push for an explicit pledge

to follow through. In Japanese culture, however, the counselor is likely to accept

“I’ll try” as a ﬁ rm

commitment.

These are but a few illustrations of ways in which reality therapy might be adapted

to non-Western clients. Although this approach assumes that all people have the

same basic needs (survival, love and belonging, power, freedom, and fun), the

way these needs are expressed depends largely on the cultural context. In working

with culturally diverse clients, the therapist must allow latitude for a wide range

of acceptable behaviors to satisfy these needs. As with other theories and the tech-

niques that ﬂ ow from them, ﬂ exibility is a foremost requirement.

A key strength of reality therapy is that it provides clients with tools to make

the changes they desire. This is especially true during the planning phase, which

is central to the process of reality therapy. The focus is on positive steps that can be

taken, not on what cannot be done. Clients identify those problems that are caus-

ing them difﬁ culty, and these problems become the targets for change. This type of

speciﬁ city and the direction that is provided by an effective plan are certainly assets

in working with diverse client groups.

Reality therapy needs to be used artfully and to be applied in different ways

with a variety of clients. Many of its principles and concepts can be incorporated

in a dynamic and personal way in the style of counselors, and there is a basis for

integrating these concepts with most of the other therapeutic approaches covered

in this book.

Shortcomings From a Diversity Perspective

One of the shortcomings of reality therapy in working with clients from cer-

tain ethics groups is that it may not take fully into account some very real

environmental forces that operate against them in their everyday lives. Reality

therapy gives only limited attention to helping people address environmental

and social problems. Discrimination, racism, sexism, homophobia, heterosex-

ism, ageism, negative attitudes toward disabilities, and other social injustices

are unfortunate realities, and these forces do limit many individuals in getting

what they want from life. It is important that therapists acknowledge that peo-

ple do not choose to be the victims of various forms of discrimination and op-

pression. If therapists do not accept these environmental restrictions or are not

interested in bringing about social justice as well as individual change, clients

are likely to feel misunderstood. There is a danger that some reality therapists

may overstress the ability of these clients to take charge of their lives and not

pay enough attention to systemic and environmental factors that can limit the

potential for choice.

Some reality therapists may make the mistake of too quickly or too forcefully

stressing the ability of their clients to take charge of their lives. On this point,

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352

Wubbolding (2008) maintains that because of oppression and discrimination,

some people have fewer choices available to them, yet they do have choices. Wub-

bolding sees reality therapy as helping clients to focus on those choices they do

have. Although focusing on choices clients do have is useful, I believe clients

may need to talk about the ways their choices are restricted by environmental cir-

cumstances. Therapists would do well to consider how both they and their clients

could take even small steps toward bringing about societal changes, as do femi-

nist therapists (see Chapter 12).

Another shortcoming associated with reality therapy is that some clients are

very reluctant to directly verbally express what they need. Their cultural values

and norms may not reinforce them in assertively asking for what they want. In

fact, they may be socialized to think more of what is good for the social group than

of their individual wants. In working with people with these values, counselors

must “soften” reality therapy somewhat. If reality therapy is to be used effectively

with clients from other cultures, the procedures must be adapted to the life experi-

ences and values of members from various cultures (Wubbolding, 2000, 2011a;

Wubbolding et al., 2004).

As a reality therapist, I am guided by

the key concepts of choice theory to

identify Stan’s behavioral dynamics,

to provide a direction for him to work toward,

and to teach him about better alternatives for

achieving what he wants. Stan has not been

effective in getting what he needs—a satisfying

relationship.

Stan has fallen into a victim role, blam-

ing others, and looking backward instead of

forward. Initially, he wants to tell me about the

negative aspects of his life, which he does by

dwelling on his major symptoms: depression,

anxiety, inability to sleep, and other psycho-

somatic symptoms. I listen carefully to his

concerns, but I hope he will come to realize that

he has many options for acting differently. I

operate on the premise that therapy will offer

the opportunity to explore with Stan what he

can build on—successes, productive times,

goals, and hopes for the future.

After creating a relationship with Stan, I

am able to show him that he does not have to

be a victim of his past unless he chooses to be,

and I assure him that he has rehashed his past

miseries enough. As counseling progresses,

Stan learns that even though most of his prob-

lems did indeed begin in childhood, there is

little he can now do to undo his childhood. He

eventually recognizes that all of his symptoms

and avoidances keep him from getting what he

most wants. He eventually realizes that he has

a great deal of control over what he can do for

himself now.

I have Stan describe how his life would be

different if he were symptom free. I am inter-

ested in knowing what he would be doing if he

were meeting his needs for belonging, achieve-

ment, power, freedom, and fun. I explain to him

that he has an ideal picture of what he wants

his life to be, yet he does not possess effec-

tive behaviors for meeting his needs. I talk to

him about all of his basic psychological needs

and how this type of therapy will teach him to

satisfy them in effective ways. I also explain that

his total behavior is made up of acting, thinking,

feeling, and physiology. Even though he says

he hates feeling anxious most of the time, Stan

learns that much of what he is doing and think-

ing is directly leading to his unwanted feelings

and physiological reactions. When he complains

of feeling depressed much of the time, anxious

Reality Therapy Applied to the Case of Stan

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at night, and overcome by panic attacks, I let him

know that I am more interested in what he is

doing and thinking because these are the behav-

ioral components that can be directly changed.

I help Stan understand that his depressing is

the feeling part of his choice. Although he may

think he has little control over how he feels, over

his bodily sensations, and over his thoughts, I

want him to understand that he can begin to

take different action, which is likely to change

his depressing experience. I frequently ask this

question, “Is what you are choosing to do get-

ting you what you want?” I lead Stan to begin

to recognize that he does have some, indirect

control over his feelings. This is best done after

he has made some choices about doing some-

thing different from what he has been doing. At

this point he is in a better place to see that the

choice to take action has contributed to feeling

better, which helps him realize that he has some

power to change.

Stan tells me about the pictures in his head,

a few of which are becoming a counselor, act-

ing confident in meeting people, thinking of

himself as a worthwhile person, and enjoying

life. Through therapy he makes the evaluation

that much of what he is doing is not getting

him closer to these pictures or getting him

what he wants. After he decides that he is

willing to work on himself to be different, the

majority of time in the sessions is devoted to

making plans and discussing their implementa-

tion. We both focus on the specific steps he

can take right now to begin the changes he

would like.

As Stan continues to carry out plans in the

real world, he gradually begins to experience

success. When he does backslide, I do not put

him down but help him refocus. We then de-

velop a new plan that we both feel more confi-

dent about. I am not willing to give up on Stan

even when he does not make major progress,

and Stan lets me know that my support is a

source of real inspiration for him to keep working

on himself.

I teach Stan about choice theory, and, if he

is willing to engage in some reading, I sug-

gest that he read and reflect on the ideas in

Counseling With Choice Theory: The New Reality

Therapy (Glasser, 2001) and A Set of Directions

for Putting and Keeping Yourself Together

(Wubbolding & Brickell, 2001). Stan brings

some of what he is learning from his reading

into his sessions, and eventually he is able to

achieve some of his goals. The combination of

working with a reality therapist, his reading,

and his willingness to put what he is learning

into practice by engaging in new behaviors in

the world assist him in replacing ineffective

choices with life-affirming choices. Stan comes

to accept that he is the only person who can

control his own destiny.

Follow-Up: You Continue as Stan’s

Reality Therapist

Use these questions to help you think about how

you would counsel Stan using reality therapy:

• If Stan complains of feeling depressed most

of the time and wants you to “fix” him, how

would you pr

oceed?

• If Stan persists, telling you that his mood is

getting the best of him and that he wants you

to work with his physician in getting him on

an antidepressant drug, what would you say

or do?

• What are some of Stan’s basic needs that are

not being met? What action plans can you

think of to help Stan find better ways of g

et-

ting what he wants?

• Would you be inclined to do a checklist on al-

coholism with Stan? Why or why not? If y

ou

determined that he was addicted to alcohol,

would you insist that he attend a program

such as Alcoholics Anonymous in conjunction

with therapy with you? Why or why not?

• What interventions would you make to help

Stan explore his total behavior?

See DVD f

or Theory and Practice of

Counseling and Psychotherapy: The Case

of Stan and Lecturettes (Session 9 on reality

therapy) for a demonstration of my approach

to counseling Stan from this perspective. This

session deals with assisting Stan in forming an

action plan.

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REALITY THERAPY

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354

CHAPTER ELEVEN

summary and evaluation

Summary

The reality therapist functions as a teacher, a mentor, and a model, confronting cli-

ents in ways that help them evaluate what they are doing and whether their behavior

is fulﬁ lling their basic needs without harming themselves or others. The heart of

reality therapy is learning how to make better and more effective choices and gain

more effective control. People take charge of their lives rather than being the victims

of circumstances beyond their control. Practitioners of reality therapy focus on what

clients are able and willing to do in the present to change their behavior. Practitioners

teach clients how to make signiﬁ cant connections with others. Therapists continue

to ask clients to evaluate the effectiveness of what they are choosing to do to deter-

mine if better choices are possible.

The practice of reality therapy weaves together two components, the counseling

environment and speciﬁ c procedures that lead to changes in behavior. This thera-

peutic process enables clients to move in the direction of getting what they want.

The goals of reality therapy include behavioral change, better decision making, im-

proved signiﬁ cant relationships, enhanced living, and more effective satisfaction

of all the psychological needs.

Contributions of Reality Therapy

Among the advantages of reality therapy are its relatively short-term focus and

the fact that it deals with conscious behavioral problems. Insight and awareness

are not enough; the client’s self-evaluation, a plan of action, and a commitment

to following through are the core of the therapeutic process. I like the focus

on strongly encouraging clients to engage in self-evaluation, to decide if what

they are doing is working or not, and to commit themselves to doing what is

required to make changes. The existential underpinnings of choice theory are

a major strength of this approach, which accentuates taking responsibility for

what we are doing. People are not viewed as being hopelessly and helplessly

depressed. Instead, people are viewed as doing the best they can, or making

the choices they hope will result in fulﬁ lling their needs. With the emphasis on

responsibility and choice, individuals can acquire a sense of self-direction and

empowerment.

Too often counseling fails because therapists have an agenda for clients. The

reality therapist helps clients conduct a searching inventory of what they are do-

ing. If clients determine that their present behavior is not working, they are then

much more likely to consider acquiring a new behavioral repertoire. Many clients

approach counseling with a great deal of skepticism. Reality therapy can be used

effectively with individuals who manifest reluctance and who are often highly re-

sistant. For example, in working with people with addictions, reality therapy strate-

gies can be used to help clients evaluate where their behavior is leading them and

to provide clients with options to bring about positive changes in their behavior.

Reality therapy has been effectively used in addiction treatment and recovery pro-

grams for more than 30 years (Wubbolding & Brickell, 2005). In many situations

with these populations, it would be inappropriate to embark on long-term therapy

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355

REALITY THERAPY

that delves into unconscious dynamics and an intensive exploration of one’s past.

Reality therapy focuses on making changes in the present and is an effective, short-

term approach, often in 10 sessions or less.

Limitations and Criticisms of Reality Therapy

From my perspective, one of the main limitations of reality therapy is that it does

not give adequate emphasis to the role of the following aspects of the counseling

process: the role of insight, the unconscious, the power of the past and the effect

of traumatic experiences in early childhood, the therapeutic value of dreams, and

the place of transference. Because reality therapy focuses almost exclusively on

consciousness, it does not take into account factors such as repressed conﬂ icts

and the power of the unconscious in inﬂ uencing how we think, feel, behave,

and choose.

Dealing with dreams is not part of the reality therapist’s repertoire. Accord-

ing to Glasser (2001), it is not therapeutically useful to explore dreams. For him,

spending time discussing dreams can be a defense used to avoid talking about

one’s behavior and, thus, is time wasted. From my perspective, dreams are pow-

erful tools in helping people recognize their internal conﬂ icts. I believe that

there is richness in dreams, which can be a shorthand message of clients’ central

struggles, wants, hopes, and visions of the future. Asking clients to recall, report,

share, and relive their dreams in the here and now of the therapeutic session can

help unblock them and can pave the way for clients to take a different course

of action.

Similarly, I have a difﬁ cult time accepting Glasser’s view of transference as a

misleading concept, for I ﬁ nd that clients are able to learn that signiﬁ cant people

in their lives have a present inﬂ uence on how they perceive and react to others. To

rule out an exploration of transference that distorts accurate perception of others

seems narrow in my view.

As you will recall, Glasser (2001, 2003) contends that chronic depression and pro-

found psychosis are chosen behaviors. Apart from speciﬁ c brain pathology, Glasser

argues that mental illness is the result of an individual’s unsatisfying present rela-

tionships or general unhappiness. I have trouble viewing all psychological disorders

as behavioral choices. People suffering from chronic depression or schizophrenia

are struggling to cope with a real illness. In reality therapy these people may have ad-

ditional guilt to carry if they accept the premise that they are choosing their condition.

I believe reality therapy is vulnerable to the practitioner who assumes the

role of an expert in deciding for others how life should be lived and what consti-

tutes responsible behavior. Wubbolding (2008) admits that reality therapy can

lend itself to ﬁ xing problems and imposing a therapist’s values on clients, es-

pecially by inexperienced or inadequately trained counselors. Wubbolding adds

that it is not the therapist’s role to evaluate the behavior of clients. Generally, cli-

ents need to engage in a process of courageous self-evaluation to determine how

well certain behaviors are working and what changes they may want to make.

It is critical that therapists monitor any tendency to judge clients’ behavior, but

instead to do all that is possible to get clients to make their own evaluation of

their behavior.

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356

CHAPTER ELEVEN

Finally, reality therapy makes use of concrete language and simple concepts.

This can erroneously be viewed as a simple approach that does not require a high

level of competence. Because reality therapy is easily understood, it might appear

to be easy to implement. However, the effective practice of reality therapy requires

practice, supervision, and continuous learning (Wubbolding, 2007b, 2011a). Com-

petent reality therapists have a thorough understanding of choice theory and have

mastered the art of applying reality therapy procedures to working with diverse

clients with a range of clinical problems.

where to go from here

In the DVD for Integrative Counseling: The Case of Ruth and Lecturettes, Session 8

(“Behavioral Focus in Counseling”), you will note ways that I attempt to assist Ruth

in specifying concrete behaviors that she will target for change. In this session I

am drawing heavily from principles of reality therapy in assisting Ruth to develop

an action plan to make the changes she desires.

Free Podcasts for ACA Members

You can download ACA Podcasts (prerecorded interviews) at www.counseling.org;

click on the Resource button and then the Podcast Series. For Chapter 11, Reality

Therapy, look for Podcast 18, “Reality Therapy, Choice Theory: What’s the Differ-

ence?” by Dr. Robert Wubbolding.

Other Resources

DVDs offered by the American Psychological Association that are relevant to this

chapter include the following:

Wubbolding, R. (2007). Reality Therapy

Psychotherapy.net is a comprehensive resource for students and professionals

that offers videos and interviews on demonstrating reality therapy working with

addictions, adults, and children. New video and editorial content is made available

monthly. DVDs relevant to this chapter are available at www.psychotherapy.net

and include the following:

Wubbolding, R. (2000). Reality Therapy (Psychotherapy With the Experts Series)

Wubbolding, R. (2000). Reality Therapy for Addictions (Brief Therapy for

Addictions Series)

Wubbolding, R. (2002). Reality Therapy With Children (Child Therapy With

the Experts Series)

The programs offered by the William Glasser Institute are designed to teach the

concepts of choice theory and the practice of reality therapy. More than 7,800 thera-

pists have completed the training in reality therapy and choice theory. The institute

offers a certiﬁ cation process, which starts with a 3-day introductory course known

as “basic training” in which participants are involved in discussions, demonstra-

tions, and role playing. For those wishing to pursue more extensive training, the

institute offers a ﬁ ve-part sequential course of study leading to certiﬁ cation in real-

ity therapy, which includes basic training, a basic practicum, advanced training,

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357

REALITY THERAPY

an advanced practicum, and a certiﬁ cation week. This 18-month training program

culminates in a Certiﬁ cate of Completion. Complete information on this program

can be obtained directly from the institute.

The William Glasser Institute

William Glasser, MD, President and Founder

Attention: Executive Director

22024 Lassen Street, Suite #118

Chatsworth, CA 91311-3600

Telephone: (818) 700-8000

Toll free: (800) 899-0688

Fax: (818) 818-700-0555

E-mail: wginst@wglasser.com

Website: www.wglasser.com

Center for Reality Therapy

Dr. Robert E. Wubbolding, Director

7672 Montgomery Road #383

Cincinnati, OH 45236-4204

Telephone: (513) 561-1911

Fax: (513) 561-3568

E-mail: [email protected]

Website: www.realitytherapywub.com

The International Journal of Choice Theory and Reality Therapy (online journal) fo-

cuses on concepts of internal control psychology, with particular emphasis on re-

search, development, and practical applications of choice theory and reality therapy

principles in various settings. To subscribe, contact:

Dr. Tom Parish

International Journal of Choice Theory and Reality Therapy

4606 SW Moundview Drive

Topeka, Kansas 66610

Telephone: (785) 862-1379

E-mail: P[email protected]

Recommended Supplementary Readings

Counseling With Choice Theory: The New Reality Therapy (Glasser, 2001) repre-

sents the author’s latest thinking about choice theory and develops the existen-

tial theme that we choose all of our total behaviors. Case examples demonstrate

how choice theory principles can be applied in helping people establish better

relationships.

Reality Therapy (Wubbolding, 2011a) updates and extends previous publications on

choice theory and reality therapy. As a part of the APA theories of psychotherapy se-

ries, this is a well-written and comprehensive overview of reality therapy and choice

theory.

28549_ch11_rev01.indd 357 20/09/11 3:55 PM

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

American Psychiatric Association. (2000).

Diagnostic and statistical manual of mental

disorders, text revision, (4th ed.). Washington,

DC: Author.

Corey, G. (2012). Theory and practice of group

counseling (8th ed.). Belmont, CA: Brooks/

Cole, Cengage Learning.

*Corey, G. (2013). Case approach to counseling

and psychotherapy (8th ed.). Belmont, CA:

Brooks/Cole, Cengage Learning.

Glasser, W. (1965). Reality therapy: A new

approach to psychiatry. New York: Harper & Row.

Glasser, W. (1968). Schools without failure.

New York: Harper & Row.

Glasser, W. (1992). Reality therapy. New York

State Journal for Counseling and Development,

7(l), 5–13.

*Glasser, W. (1998). Choice theory: A new psychol-

ogy of personal freedom. New York: HarperCollins.

*Glasser, W. (2001). Counseling with choice

theory: The new reality therapy. New York:

HarperCollins.

Glasser, W. (2003). Warning: Psychiatry can

be hazardous to your mental health. New York:

HarperCollins.

Glasser, W. (2005). Defining mental health as a

public health issue: A new leadership role for the

helping and teaching professions. Chatsworth,

CA: William Glasser Institute.

Glasser, W., & Glasser, C. (2000). Getting

together and staying together. New York:

HarperCollins.

Glasser, W., & Glasser, C. (2007). Eight

lessons for a happier marriage. New York:

HarperCollins.

*Wubbolding, R. E. (1988). Using reality

therapy. New York: Harper & Row

(Perennial Library).

*Wubbolding, R. E. (1991). Understanding reality

therapy. New York: Harper & Row (Perennial

Library).

*Wubbolding, R. E. (2000). Reality therapy for

the 21st century. Philadelphia, PA: Brunner-

Routledge.

Wubbolding, R. E. (2007). Reality therapy.

In A. B. Rochlen (Ed.), Applying counseling

theories: An online case-based approach

(pp. 193–207). Upper Saddle River, NJ:

Pearson Prentice-Hall.

Wubbolding, R. E. (2008). Reality therapy.

In J. Frew & M. D. Spiegler (Eds.), Contempo-

rary psychotherapies for a diverse world

(pp. 360–396). Boston: Houghton

Mifflin.

W

ubbolding, R. E. (2009). Headline or foot-

note? Mainstream or backw

ater? Cutting

edge or trailing edge? Included or excluded

from the professional world? International

Journal of Reality Therapy, 29(1), 26–29.

Wubbolding, R. E. (2010). Cycle of psycho-

therapy, counseling, coaching, managing and

supervising (chart, 17th revision). Cincinnati,

OH: Center for Reality Therapy.

*Wubbolding, R. E. (2011a). Reality therapy.

Washington, DC: American Psychological

Association.

*Wubbolding, R. E. (2011b). Reality therapy/

choice theory. In D. Capuzzi & D. R. Gross (Eds.),

Counseling and psychotherapy: Theories and inter-

ventions (5th ed., pp. 263–285). Alexandria, VA:

American Counseling Association.

358

CHAPTER ELEVEN

*Books and articles marked with an asterisk are suggested for further study.

Case Approach to Counseling and Psychotherapy (Corey, 2013) illustrates how

prominent reality therapists Drs. William Glasser and Robert Wubbolding

would counsel Ruth from their different perspectives of choice theory and real-

ity therapy.

References and Suggested Readings

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359

REALITY THERAPY

*Wubbolding, R. E., & Brickell, J. (2001). A

set of directions for putting and keeping yourself

together. Minneapolis, MN: Educational Media

Corporation.

Wubbolding, R. E., & Brickell, J. (2005).

Reality therapy in recovery. Directions in

Addiction Treatment and Prevention, 9(1),

1–10. New York: The Hatherleigh

Company.

Wubbolding, R. E., & Brickell, J. (2009).

Perception: The orphaned component of

choice theory. International Journal of Reality

Therapy, 28(2), 50–54.

Wubbolding, R. E., & Colleagues. (1998).

Multicultural awareness: Implications for

reality therapy and choice theory. International

Journal of Reality Therapy, 17(2), 4–6.

Wubbolding, R. E., Brickell, J., Imhof, L., Kim, R.,

Lojk, L., & Al-Rashidi, B. (2004). Reality therapy:

A global perspective. International Journal for the

Advancement of Counselling, 26(3), 219–228.

Wubbolding, R. E., Robey, P., & Brickell, J.

(2010). A partial and tentative look at the

future of choice theory, reality therapy and lead

management. International Journal of Choice

Theory and Reality Therapy, 19(2), 25–34.

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360

introduction

• History and Development

key concepts

• View of Human Nature

• Feminist Perspective on Personality

Development

• Principles of Feminist Therapy

the therapeutic process

• Therapeutic Goals

• Therapist’s Function and Role

• Client’s Experience in Therapy

• Relationship Between Therapist and Client

application: therapeutic

techniques and procedures

• The Role of Assessment and Diagnosis

• Techniques and Strategies

• The Role of Men in Feminist Therapy

feminist therapy from a

multicultural and social

justice perspective

• Strengths From a Diversity Perspective

• Shortcomings From a Diversity Perspective

feminist therapy applied

to the case of stan

summary and evaluation

• Summary

• Contributions of Feminist Therapy

• Limitations and Criticisms of Feminist

Therapy

where to go from here

• Recommended Supplementary Readings

• References and Suggested Readings

chapter 12

Feminist Therapy

Coauthored by Barbara Herlihy and Gerald Corey

360

of Men in Feminist T

lication: therape

techniques and proc

•

The Role of Assessment an

•

Techniques and

•

The Rol

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361

FEMINIST THERAPY

Some Contemporary Feminist Therapists

JEAN BAKER MILLER, MD

(1928–2006), was a clinical

professor of psychiatry at

Boston University School of

Medicine and director of the

Jean Baker Miller Training

Institute at the Stone Center,

Wellesley College. She wrote

Toward a New Psychology of

Women (1986) and coau-

thored The Healing Connection: How Women Form

Relationships in Therapy and in Life (Miller & Stiver,

1997) and Women’s Growth in Connection (Jordan

et al., 1991). Dr. Miller collaborated with diverse

groups of scholars and colleagues on the develop-

ment of relational-cultural theory. She made im-

portant contributions toward expanding this theory

and exploring new applications to complex issues

in psychotherapy and beyond, including issues of

diversity, social action, and workplace change.

Courtesy of Jean Baker Miller Training Institute

CAROLYN ZERBE ENNS,

PhD, is Professor of Psy-

chology and participant in

the Women’s Studies and

Ethnic Studies programs at

Cornell College in Mt.

Vernon, Iowa. Enns became

interested in feminist

therapy while she was

completing her PhD in Counseling Psychology at

the University of California, Santa Barbara. She

devotes much of her work to exploring the pro-

found impact feminist theory has on the manner in

which therapists implement therapeutic practices,

and she discusses this impact in Feminist Theories

and Feminist Psychotherapies: Origins, Themes, and

Diversity (2004). The relationship of theory to

feminist pedagogy is another major interest area

and is the topic of a co-edited book (with Ada

Sinacore) of Teaching and Social Justice: Integrating

Multicultural and Feminist Theories in the Classroom

(2005). Dr. Enns was one of three co-chairs

(with Roberta Nutt and Joy Rice) of the task force

that developed APA’s (2007) “Guidelines for

Psychological Practice with Girls and Women.” Her

most recent efforts are directed toward articu-

lating the importance of multicultural feminist

therapy, exploring the practice of feminist therapy

around the world (especially in Japan), and writing

about multicultural feminist pedagogies.

Courtesy of Carolyn Zerbe Enns

OLIVA M. ESPIN, PhD,

is Professor Emerita in the

Department of Women’s

Studies at San Diego State

University and at the

California School of Profes-

sional Psychology of Alliant

International University. A

native of Cuba, she did her

undergraduate work in psychology at the Universidad

de Costa Rica and received her PhD from the

University of Florida, specializing in counseling

and therapy with women from different cultures

and in Latin American Studies. She is a pioneer in

the theory and practice of feminist therapy with

women from different cultural backgrounds and

has done extensive research, teaching, and train-

ing on multicultural issues in psychology. Dr. Espin

has published on psychotherapy with Latinas,

women immigrants and refugees, the sexuality of

Latinas, language in therapy with fluent bilinguals,

and training clinicians to work with multicultural

Courtesy of Dr. Oliva Espin, Professor

Emerita of Women’s Studies, San Diego State

University

Feminist therapy does not have a single founder.

Rather, it has been a collective effort by many. We

have selected a few individuals who have made

significant contributions to feminist therapy for

inclusion here, recognizing full well that many other

equally influential scholar-practitioners could have

appeared in this space. Feminist therapy is truly

founded on a theory of inclusion.

Jean Baker Miller / Carol Zerbe Enns /

Oliva M. Espin / Lauara S. Brown

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362

CHAPTER TWELVE

populations. Espin co-edited Refugee Women and

Their Mental Health: Shattered Societies, Shattered

Lives (Cole, Espin, & Rothblum, 1992) and has

written Latina Healers: Lives of Power and Tradition

(1996) , Latina Realities: Essays on Healing,

Migration, and Sexuality (1997), and Women Cross-

ing Boundaries: A Psychology of Immigration and the

Transformation of Sexuality (1999), which is based

on a study of women immigrants from all over the

world.

LAURA S. BROWN, PhD,

is a founding member

of the Feminist Therapy

Institute, an organization

dedicated to the support

of advanced practice in

feminist therapy, and a

member of the theory

workgroup at the National

Conference on Education

and Training in Feminist Practice. She has writ-

ten several books considered core to feminist

practice in psychotherapy and counseling, and

Subversive Dialogues: Theory in Feminist Therapy

(1994) is considered by many to be the founda-

tion book addressing how theory informs

practice in feminist therapy. Her most recent

book is Feminist Therapy (2010). Dr. Brown has

made particular contributions to thinking about

ethics and boundaries, and the complexities of

ethical practice in small communities. Her cur-

rent interests include feminist forensic psychol-

ogy and the application of feminist principles to

treatment of trauma survivors.

Courtesy of Dr. Laura S. Brown

introduction

This chapter provides an alternative perspective to the models considered thus far

in this book.* As you will see, feminist therapy puts intersections of gender, social

location, and power at the core of the therapeutic process. Feminist therapy is

built on the premise that it is essential to consider the social, cultural, and political

context that contributes to a person’s problems in order to understand that per-

son. This perspective has signiﬁ cant implications for the development of coun-

seling theory and for how practitioners intervene with diverse client populations.

A central concept in feminist therapy is the importance of understanding and

acknowledging the psychological oppression of women and the constraints im-

posed by the sociopolitical status to which women have been relegated. The fem-

inist perspective offers a unique approach to understanding the roles that both

women and men have been socialized to accept and to bringing this understanding

into the therapeutic process. The socialization of women inevitably affects their

identity development, self-concept, goals and aspirations, and emotional well-

being (Belenky, Clinchy, Goldberger, & Tarule, 1987/1997; Gilligan, 1982; Turner &

Werner-Wilson, 2008). As Natalie Rogers (1995) has observed, socialization

patterns tend to result in women giving away their power in relationships, often

without being aware of it. Feminist therapy keeps knowledge about gender sociali-

zation in mind in the work with all clients.

The majority of clients in counseling are women, and the majority of psycho-

therapy practitioners at the master’s level are women. However, most theories that

*I invited a colleague and friend, Barbara Herlihy, a professor of counselor education at the University of

New Orleans, to coauthor this chapter. We have coauthored two books (Herlihy & Corey, 2006a, 2006b),

which seems like a natural basis for collaboration on a project that we both consider valuable.

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363

FEMINIST THERAPY

are traditionally taught—including all of the other theories in this book—were

founded by White males from Western (American or European) cultures, with

only Adler taking a pro-feminist stance in early theory development. The need for

a theory that evolves from the thinking and experiencing of women seems self-

evident. Theories are developed from the experiences of the “developer,” and femi-

nist theory is the ﬁ rst therapeutic theory from a female perspective.

Feminist therapists have challenged male-oriented assumptions regarding

what constitutes a mentally healthy individual. Early feminist therapy efforts

focused on valuing women’s experiences, political realities, and the unique issues

facing women within a patriarchal system. Current feminist practice emphasizes

a diverse approach that includes an understanding of multiple oppressions, mul-

ticultural competence, and social justice (American Psychological Association,

2007; Beardsley, Morrow, Castillo, & Weitzman, 1998; Brown & Root, 1990;

Enns & Byars-Winston, 2010). Today’s feminists believe that gender cannot be

considered apart from other identities related to race, ethnicity, socioeconomic

class, and sexual orientation. The contemporary version of feminist therapy and

the multicultural and social justice approaches to counseling practice have a

great deal in common (Crethar, Torres Rivera, & Nash, 2008). All three of these

approaches provide a systemic perspective based on understanding the social

context of clients’ lives and are aimed toward affecting social change as well as

individual change.

See the video program for Chapter 12, DVD for Theory and Practice of Counseling

and Psychotherapy: The Case of Stan and Lecturettes. I suggest that you view the

brief lecture for each chapter prior to reading the chapter.

History and Development

Feminist therapy has developed in a grassroots manner, responding to challenges

and to the emerging needs of women (Brabeck & Brown, 1997). No single indi-

vidual can be identiﬁ ed as the founder of this approach, reﬂ ecting a central theme

of feminist collaboration. Its history is relatively brief. The beginnings of feminism

can be traced to the late 1800s, but it is the women’s movement of the 1960s

that laid the foundation for the development of feminist therapy. In the 1960s

women began uniting their voices to express their dissatisfaction with the limiting

and conﬁ ning nature of traditional female roles. Consciousness-raising groups, in

which women came together to share their experiences and perceptions, helped

individual women become aware that they were not alone. A sisterhood developed,

and some of the services that evolved from women’s collective desires to improve

society included shelters for battered women, rape crisis centers, and women’s

health and reproductive health centers.

Changes in psychotherapy occurred when women therapists participated in

consciousness-raising groups and were changed by their experiences. They formed

feminist therapy groups that operated from the same norms as consciousness-

raising groups, including nonhierarchical structures, equal sharing of resources

and power, and empowerment of women. These women also realized in their

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364

CHAPTER TWELVE

sharing that they were already working with clients from a feminist lens that had

never been formally deﬁ ned.

Believing that personal counseling was a legitimate means to effect change,

they viewed therapy as a partnership between equals and built mutuality into the

therapeutic process. They took the stance that therapy needed to move away from

an intrapsychic perspective on psychopathology (in which the sources of a wom-

an’s unhappiness reside within her) to a focus on understanding the social, politi-

cal, and cultural forces in society that damage and constrain girls and women, as

well as boys and men.

A profusion of research on gender-bias emerged in the 1970s, which helped

further feminist therapy ideas, and formal organizations began to foster the devel-

opment and deﬁ nition of feminist therapy. Among them were the Association for

Women in Psychology (AWP) and various efforts by the American Psychological

Association (APA).

The 1980s were marked by efforts to deﬁ ne feminist therapy as an entity in

its own right (Enns, 1993), and individual therapy became the most frequently

practiced form of feminist therapy (Kaschak, 1981). Gilligan’s (1982) work on the

development of a morality of care in women, and the work of Miller (1986) and

the Stone Center scholars in developing the self-in-relation model (now called the

“relational-cultural” model) were inﬂ uential in the evolution of a feminist person-

ality theory. New theories emerged that honored the relational and cooperative

dimensions of women’s experiencing (Enns, 1991, 2000, 2004; Enns & Sinacore,

2001). Feminist therapists began to formally examine the relationship of feminist

theory to traditional psychotherapy systems, and integrations with various existing

systems were proposed.

By the 1980s feminist group therapy had changed dramatically, becoming more

diverse as it focused increasingly on speciﬁ c problems and issues such as body im-

age, abusive relationships, eating disorders, incest, and other forms of sexual abuse

(Enns, 1993). The feminist philosophies that guided the practice of therapy also

became more diverse. According to Enns (2004), in the ﬁ eld of feminist therapy

“there is room for diversity of practice and the opportunity for individuals to

articulate a set of beliefs which are personally meaningful and which guide trans-

formational practice” (p. 10). Brown (2010) maintains that feminist therapy is a

technically integrative approach that stresses tailoring interventions to meet clients

with their strengths. Feminist therapists also draw upon strategies from many oth-

er therapy models. There are feminists who identify themselves as person-centered,

Gestalt, Adlerian, cognitive, cognitive-behavioral, existential, and psychoanalytic,

but most feminist therapists do not feel a need to position themselves in a particu-

lar philosophical place.

Enns (1993, 2004; Enns & Sinacore, 2001) identiﬁ es four enduring feminist

philosophies, which are often described as the “second wave” of feminism: liberal,

cultural, radical, and socialist feminism. These philosophies all advocate social

activism and changing society as goals in feminist practice.

Liberal feminists focus on helping individual women overcome the limits and

constraints of traditional gender-role socialization patterns. Liberal feminists argue

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FEMINIST THERAPY

for a transformation from accepting traditional gender roles to creating equal oppor-

tunities for both women and men. These feminists tend to believe the differences

between women and men will be less problematic as work and social environments

become increasingly bias free. For liberal feminists, the major goals of therapy in-

clude personal empowerment of individual women, dignity, self-fulﬁ llment, shared

power in decision making in relationships, and equality. Another key goal is to

eliminate psychotherapy practices that have supported traditional socialization and

are based on biased views about women and men (Enns, 2004).

Cultural feminists believe oppression stems from society’s devaluation of wom-

en’s strengths, values, and roles. They emphasize the differences between women

and men and believe the solution to oppression lies in feminization of the cul-

ture so that society becomes more nurturing, intuitive, subjective, cooperative, and

relational. Cultural feminism highlights the value of interdependence over indi-

vidualism (Enns, 2004). For cultural feminists, the major goal of therapy is so-

cial transformation through the infusion of feminine values (such as cooperation,

altruism, and connectedness) into the culture.

Radical feminists focus on the oppression of women that is embedded in pa-

triarchy and seek to change society through activism and equalizing power. Radi-

cal feminists strive to identify and question the many ways in which patriarchy

dominates every area of life including household chores, paid employment, inti-

mate partnerships, violence, and parenting. They challenge the many ways that

women are denied power. The major goals are to transform gender relationships,

transform societal institutions, and increase women’s sexual and procreative self-

determination.

Socialist feminists share with radical feminists the goal of societal change. Their

emphasis differs, however, in that they focus on multiple oppressions and believe

solutions to society’s problems must include considerations of class, race, sexual

orientation, economics, nationality, and history. Socialist feminists pay close at-

tention to the ways that work, education, and family roles affect their lives. For

socialist feminists, the major goal of therapy is to transform social relationships

and institutions.

During the past 20 years feminist women of color and postmodern feminists

have found classic feminist theories wanting and have offered new theoretical

perspectives focused on issues of diversity, the complexity of sexism, and the

centrality of social context in understanding gender issues. In 1993 psychologists

who embraced a diversity of feminist perspectives met at the National Confer-

ence on Education and Training in Feminist Practice. They reached consensus

on basic themes and premises underlying feminist practice, thus taking a signiﬁ -

cant step toward integration of a number of feminist perspectives. Enns (2004)

states that this “third wave” of feminism embraces diversity with its inclusion

of women of color, lesbians, and the postmodern and constructivist viewpoints

espoused by many of the most recent generation of feminist women. New devel-

opments in feminism also include global and international perspectives. Enns

(2004) describes some of the key characteristics associated with contemporary

feminist approaches.

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CHAPTER TWELVE

Postmodern feminists provide a model for critiquing other traditional and fem-

inist approaches, addressing the issue of what constitutes reality and proposing

multiple truths as opposed to a single truth. The postmodern perspective is based

on the assumption that “reality is embedded in social relationships and histori-

cal contexts, is socially created or invented, and is reproduced through power

relationships” (Enns, 2004, p. 271). This approach calls attention to the limita-

tion of knowledge and the fallibility of “knowers.” Polarities such as masculine–

feminine are deconstructed, which involves an analysis of how such constructs

are created.

Women of color feminists believe it is essential that feminist theory be broadened

and made more inclusive. Women of color have criticized some White feminists

who overgeneralize the experiences of White women to ﬁ t the experiences of all

women. They challenge feminist theory to include an analysis of the intersections

of multiple oppressions, an assessment of access to privilege and power, to rec-

ognize the importance of the spiritual dimension of human experience, and to

emphasize activism.

Lesbian feminists share commonalities with many aspects of radical femi-

nism. Both perspectives view women’s oppression as related to heterosexism

and sexualized images of women. Lesbians who deﬁ ne themselves as feminists

sometimes feel excluded by heterosexual feminists who do not understand dis-

crimination based on sexual orientation. This perspective calls for feminist theory

to include an analysis of the intersections of a person’s multiple identities and

their relationship to oppression and to recognize the diversity that exists among

lesbians. In recent years, lesbian feminism has been enriched through interac-

tion with queer theory, which emphasizes the ﬂ uidity, ﬂ exibility, and multiple

meanings associated with sex, sexual orientation, and gender. Some individuals

identify “lesbian feminism” with 1970s and 1980s movements. Although queer

theory and lesbian theory are not identical, queer theory seems to be increasingly

integrated with lesbian feminism.

Global international feminists take a worldwide perspective and seek to under-

stand the ways in which racism, sexism, economics, and classism affect women

in different countries. Western feminists are challenged to recognize their eth-

nocentrism and stereotyping of women in different parts of the world. Global

feminists assume that each woman lives under unique systems of oppression.

They see a need to address those cultural differences that directly contribute to

women’s oppression.

The variety in feminist theories provides a range of different but overlapping

perspectives from which to work (Enns & Sinacore, 2001). Brown (2010) deﬁ nes

feminist therapy as a postmodern, technically integrative approach that emphasizes

the analysis of gender, power, and social location as strategies for facilitating

change. Feminist therapists, both male and female, believe that understanding

and confronting gender-role stereotypes and power are central to therapeutic prac-

tice and that addressing a client’s problems requires adopting a sociocultural per-

spective: namely, understanding the impact of the society and culture in which a

client lives.

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FEMINIST THERAPY

key concepts

View of Human Nature

The feminist view of human nature is fundamentally different from that of most

other therapeutic models. Many of the traditional theories grew out of a historical

period in which social arrangements were assumed to be rooted in one’s biologi-

cally based gender. Men were assumed to be the norm and were the only group

studied or understood within the normative construct. It also was assumed that

because of biological gender differences women and men would pursue differ-

ent directions in life. Worell and Remer (2003) are critical of traditional theories

for being androcentric (using male-oriented constructs to draw conclusions about

human, including female, nature), gendercentric (proposing two separate paths

of development for women and men), heterosexist (viewing a heterosexual orien-

tation as normative and desirable and devaluing lesbian, gay male, and bisexual

orientations), deterministic (assuming that personality patterns and behavior are

ﬁ xed at an early stage of development), and having an intrapsychic orientation (at-

tributing behavior to internal causes, which often results in blaming the victim and

ignoring sociocultural and political factors). To the degree that traditional theories

contain these biased elements, they have clear limitations for counseling females

and members of marginalized groups.

Worell and Remer (2003) describe the constructs of feminist theory as being gen-

der fair, ﬂ exible–multicultural, interactionist, and life-span-oriented. Gender-fair

approaches explain differences in the behavior of women and men in terms of

socialization processes rather than on the basis of our “innate” natures, thus avoid-

ing stereotypes in social roles and interpersonal behavior. A ﬂ exible–multicultural

perspective uses concepts and strategies that apply equally to individuals and

groups regardless of age, race, culture, gender, ability, class, or sexual orientation.

The interactionist view contains concepts speciﬁ c to the thinking, feeling, and

behaving dimensions of human experience and accounts for contextual and envi-

ronmental factors. A life-span perspective assumes that human development is a

lifelong process and that personality and behavioral changes can occur at any time

rather than being ﬁ xed during early childhood.

Feminist Perspective on Personality Development

Feminist therapists emphasize that societal gender-role expectations profoundly

inﬂ uence a person’s identity from the moment of birth and become deeply in-

grained in adult personality. Because gender politics are embedded in the fabric

of American society, they inﬂ uence how we see ourselves as girls and boys and

as women and men throughout the course of our lives. Prochaska and Norcross

(2010) point out that gender-role expectations tend to generate a false sense of self

and force women to accept stereotyped gender roles. “Women are expected to be a

lady, to never swear, hit, or get angry. They should strive to please men and, above

all, never offend or best a man” (p. 379).

Gilligan (1977) recognized that theories of moral development were based

almost exclusively on research with males. As a result of her studies on women’s

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CHAPTER TWELVE

moral and psychosocial development, Gilligan came to believe women’s sense of

self and morality is based in issues of responsibility and care for other people and is

embedded in a cultural context. She posited that the concepts of connectedness and

interdependence—virtually ignored in male-dominated developmental theories—

are central to women’s development.

Most models of human growth and development emphasize a struggle toward

independence and autonomy, but feminists recognize that women are searching

for a connectedness with others. In feminist therapy women’s relational qualities

are seen as strengths and as pathways for healthy growth and development instead

of being identiﬁ ed as weaknesses or defects.

The founding scholars of relational-cultural theory have elaborated on the vital

role that relationships and connectedness with others play in the lives of women

(Jordan, Kaplan, Miller, Stiver, & Surrey, 1991; Miller, 1986, 1991; Miller et al., 1999;

Miller & Stiver, 1997; Surrey, 1991; Trepal, 2010). These scholars suggest that

a woman’s sense of identity and self-concept develop in the context of relation-

ships. They describe a process of relational movement in which women move

through connections, disconnections, and enhanced transformative relationships

throughout their lives (Comstock et al., 2008). As you will see, many of the tech-

niques of feminist therapy foster mutuality, relational capacities, and growth in

connection.

Bem (1993) posits that even very young children develop gender schemas, which

are internalizations of the gender roles perpetuated in a sexist society. In a similar

vein, Kaschak (1992) used the term engendered lives to describe her belief that gen-

der is the organizing principle in people’s lives. She has studied the role gender

plays in shaping the identities of females and males and believes the masculine

deﬁ nes the feminine. For instance, because men pay great attention to women’s

bodies, women’s appearance is given tremendous importance in Western society.

It is easy to see how this perspective gets reiﬁ ed in both eating disorders and vari-

ous forms of depression. Men, as the dominant group, deﬁ ne and determine the

roles that women play. Because women occupy a subordinate position, to survive

and thrive in society they must be able to interpret the needs and behaviors of

the dominant group. To that end, women have developed “women’s intuition”

and have included in their gender schema an internalized belief that women are

less important than men. Females are raised in a culture grounded in sexism, and

they internalize the oppression. Understanding and acknowledging internalized

oppression is central in feminist work.

Feminist therapists remind us that traditional gender stereotypes of women

are still prevalent in cultures throughout the world. They teach their clients that

uncritical acceptance of traditional roles can greatly restrict their range of freedom.

Today many women and men are resisting being so narrowly deﬁ ned. Women and

men in therapy learn that, if they choose to, they can experience mutual behavioral

characteristics such as accepting themselves as being interdependent, giving to

others, being open to receiving, thinking and feeling, and being tender and tough.

Rather than being cemented to a single behavioral style, women and men who

reject traditional roles are saying that they are entitled to express the complex range

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369

FEMINIST THERAPY

of characteristics that are appropriate for different situations and that they are open

to their vulnerability as human beings.

Principles of Feminist Therapy

A number of feminist writers have articulated core principles that form the foun-

dation for the practice of feminist therapy. These principles are interrelated and

overlapping.

1. The personal is political. This principle is based on the assumption that the per-

sonal or individual problems that individuals bring to counseling originate in a

political and social context. For females this is often a context of marginalization,

oppression, subordination, and stereotyping. Acknowledgment of the political and

societal impact on an individual’s life is perhaps the most fundamental tenet that

lies at the core of feminist therapy. Although feminist therapists emphasize social

context, they also work from a biopsychosocial perspective, attending to the inter-

section of the biological, psychological, and social aspects of people’s lives (Brown,

1994).

2. Commitment to social change. Feminist therapy aims not only for individual

change but for social change. Feminists view their therapy practice as existing not

only to help individual clients in their struggles but also to advance a transforma-

tion in society. Direct action for social change is part of their responsibility as

therapists. It is important that women who engage in the therapy process—clients

and therapists alike—recognize that they have suffered from oppression as mem-

bers of a subordinate group and that they can join with other women to right these

wrongs. The goal is to advance a different vision of societal organization that frees

both women and men from the constraints imposed by gender-role expectations.

This vision of counseling, which moves away from the traditional focus on change

from within the individual out into the realm of social activism, distinguishes fem-

inist therapy from other historically accepted approaches.

3. Women’s and girl’s voices and ways of knowing are valued and their experiences

are honored. Women’s perspectives are considered central in understanding their

distress. Traditional therapies that operate on androcentric norms compare women

to the male norm and ﬁ nd them deviant. Much of psychological theory and research

tends to conceptualize women and men in a polarized way, forcing a male–female

split in most aspects of human experience (Bem, 1993). A goal of feminist ther-

apy is to replace patriarchal “objective truth” with feminist consciousness, which

acknowledges diverse ways of knowing. Women are encouraged to value their

emotions and their intuition and to use their personal experience as a touchstone

for determining what is “reality.” Their voices are acknowledged as authoritative

and invaluable sources of knowledge. The valuing and facilitation of women’s voic-

es in or out of therapy directly counteracts the often forced silence of women and

contributes to an ultimate change in the body politic of society.

4. The counseling relationship is egalitarian. Attention to power is central in femi-

nist therapy. Feminist therapists recognize that there is a power imbalance in the

therapeutic relationship, so they strive for an egalitarian relationship, keeping in

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370

CHAPTER TWELVE

mind that clients are the experts on their own lives. The intent is to shift power

and privilege to the voices and experiences of those who come to counseling

and away from those who deliver it (Brown, 2010). An open discussion of power

and role differences in the therapeutic relationship helps clients to understand

how power dynamics inﬂ uence both counseling and other relationships and also

invites a dialogue about ways to reduce power differentials (Enns, 2004). Finding

ways to share power with clients and to demystify therapy is essential because

feminist therapists believe all relationships should strive for equality, or mutuality

(a condition of authentic connection between the client and the therapist).

5. A focus on strengths and a reformulated deﬁ nition of psychological distress. Feminist

therapy has a “conﬂ icted and ambivalent relationship” with diagnostic labeling

and the “disease model” of mental illness (Brown, 2010, p. 50). Psychological dis-

tress is reframed, not as disease but as a communication about unjust systems.

When contextual variables are considered, symptoms can be reframed as survival

strategies. Feminist therapists talk about problems in the context of living and cop-

ing skills rather than pathology (Enns, 2004; Worell & Remer, 2003). If a formal

diagnosis is used, it is arrived at collaboratively with the client.

6. All types of oppression are recognized. Clients can best be understood in the context

of their sociocultural environments. Feminist therapists acknowledge that social

and political inequities have a negative effect on all people. Feminist therapists

work to help individuals make changes in their lives, but they also are commit-

ted to working toward social change that will liberate all members of society from

stereotyping, marginalization, and oppression. Diverse sources of oppression, not

simply gender, are identiﬁ ed and interactively explored as a basis for understand-

ing the concerns that clients bring to therapy. Framing clients’ issues within a

cultural context leads to empowerment, which can be fully realized only through

social change (Worell & Remer, 2003).

the therapeutic process

Therapeutic Goals

According to Enns (2004), some goals of feminist therapy include empowerment,

valuing and afﬁ rming diversity, striving for change rather than adjustment, equality,

balancing independence and interdependence, social change, and self-nurturance.

Enns adds that a key goal of feminist therapy is to assist individuals in viewing

themselves as active agents on their own behalf and on behalf of others. A goal of

feminist therapy is to empower all people to create a world of equality that is reﬂ ected

at individual, interpersonal, institutional, national, and global levels (Enns & Byars-

Winston, 2010). Perhaps the ultimate goal of this approach is to create the kind

of society where sexism and other forms of discrimination and oppression are no

longer a reality (Worell & Remer, 2003). Feminist therapy strives for transforma-

tion for both the individual client and society as a whole.

At the individual level, feminist therapists work to help females and males

recognize, claim, and embrace their personal power. Empowering the client is

at the heart of feminist therapy, which is the overarching long-term therapeutic

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371

FEMINIST THERAPY

goal (Gilbert & Rader, 2007). Through this empowerment, clients are able to free

themselves from the constraints of their gender-role socialization and to challenge

ongoing institutional oppression.

According to Worell and Remer (2003), feminist therapists help clients:

• Become aware of their own gender-role socialization process

• Identify their internalized messages and replace them with more self-enhancing

beliefs

• Understand how sexist and oppressive societal beliefs and practices inﬂ uence

them in negative ways

• Acquire skills to bring about change in the environment

• Restructure institutions to rid them of discriminatory practices

• Develop a wide range of behaviors that are freely chosen

• Evaluate the impact of social factors on their lives

• Develop a sense of personal and social power

• Recognize the power of relationships and connectedness

• Trust their own experience and their intuition

Feminist therapists also work toward reinterpreting women’s mental health.

Their aim is to depathologize women’s experiencing and to inﬂ

uence society so

that female voices are honored and relational qualities are valued. Women’s and

girls’ experiences are examined without the bias of patriarchal values, and their life

skills and accomplishments are acknowledged.

Therapist’s Function and Role

Feminist therapy rests on a set of philosophical assumptions that can be applied to var-

ious theoretical orientations. Any theory can be evaluated against the criteria of being

gender fair, ﬂ exible–multicultural, interactionist, and life-span-oriented. The therapist’s

role and functions will vary to some extent depending on the particular therapist and

client in the therapeutic relationship. In Case Approach to Counseling and Psychotherapy

(Corey, 2013, chap. 10) three feminist therapists (Drs. Evans, Kincade, and Seem) team

up to demonstrate a variety of feminist interventions in their work with Ruth. They also

conceptualize the case of Ruth from a feminist therapy perspective.

Feminist therapists have integrated feminism into their approach to therapy

and into their lives. Their actions and beliefs and their personal and professional

lives are congruent. They are committed to monitoring their own biases and distor-

tions, especially the social and cultural dimensions of women’s experiences. Femi-

nist therapists are also committed to understanding oppression in all its forms—

including but not limited to sexism, racism, heterosexism—and they consider the

impact of oppression and discrimination on psychological well-being. They value

being emotionally present for their clients, being willing to share themselves dur-

ing the therapy hour, modeling proactive behaviors, and being committed to their

own consciousness-raising process. Finally, although feminist therapists may use

techniques and strategies from other theoretical orientations, they are unique in

the feminist assumptions they hold.

Feminists share common ground with Adlerian therapists in their emphasis

on social equality and social interest, and with existential therapists who emphasize

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CHAPTER TWELVE

therapy as a shared journey, one that is life changing for both client and therapist,

and with their basic trust in the client’s ability to move forward in a positive and

constructive manner (Bitter, Robertson, Healey, & Cole, 2009). Feminist thera-

pists believe the therapeutic relationship should be a nonhierarchical, person-to-

person relationship, and they aim to empower clients to live according to their own

values and to rely on an internal (rather than external or societal) locus of control

in determining what is right for them. Like person-centered therapists, feminist

therapists convey their genuineness and strive for mutual empathy between client

and therapist. Unlike person-centered therapists, however, feminist therapists do

not see the therapeutic relationship alone as being sufﬁ cient to produce change.

Insight, introspection, and self-awareness are springboards to action.

Some feminist therapists share with postmodern therapists (see Chapter 13) an

emphasis on the politics and power relationships in the therapy process and a con-

cern about power relations in the world in general. Both feminist and postmodern

thought asserts that psychotherapists must not replicate societal power imbalances

or foster dependency in the client. Rather, therapist and client take active and equal

roles, working together to determine goals and procedures. A common denomina-

tor of both feminist and postmodern approaches is the avoidance of assuming a

therapist role of all-knowing expert.

Client’s Experience in Therapy

Clients are active participants in the therapeutic process. Feminist therapists are

committed to ensuring that this does not become another arena in which women

remain passive and dependent. It is important that clients tell their stories and give

voice to their experiencing.

Appropriate self-disclosure is afﬁ rmed within feminist therapy. The female thera-

pist may share some of her own experiences including gender-role oppression. As an

analysis of gender-role stereotyping is conducted, the client’s consciousness is raised.

Feminist therapists do not restrict their practice to female clients; they also

work with males, couples, families, and children. The therapeutic relationship is

always a partnership, and the client, male or female, will be the expert in determin-

ing what he or she needs and wants from therapy. A male client will explore ways in

which he has been limited by his gender-role socialization, becoming more aware

of how he is constrained in his ability to express a range of emotions. In the safe

environment of the therapeutic sessions, he may be able to fully experience such

feelings as sadness, tenderness, uncertainty, and empathy. As he transfers these

ideas to daily living, he may ﬁ nd that relationships change in his family, his social

world, and at work.

As mentioned earlier, a major goal of feminist therapy is empowerment, which

involves acquiring a sense of self-acceptance, self-conﬁ dence, joy, and authentic-

ity. Worell and Remer (2003) write that clients acquire a new way of looking at

and responding to their world. They add that the shared journey of empower-

ment can be both frightening and exciting—for both client and therapist. Clients

need to be prepared for major shifts in their way of viewing the world around

them, changes in the way they perceive themselves, and transformed interper-

sonal relationships.

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FEMINIST THERAPY

Relationship Between Therapist and Client

Feminist therapists view the therapeutic relationship as being based on mutuality,

equality, and empowerment (Evans, Kincade, & Seem, 2011). The very structure

of the client–therapist relationship models how to identify and use power respon-

sibly. Feminist therapists clearly state their values to reduce the chance of value

imposition. This allows clients to make a choice regarding whether or not to work

with the therapist. It also is a step in demystifying the process.

As mentioned, although there is an inherent power differential in the therapy

relationship, feminist therapists work to equalize the power base in the relation-

ship by employing a number of strategies (Thomas, 1977). First, they are acutely

sensitive to ways they might abuse their own power in the relationship, such as by

diagnosing unnecessarily, by interpreting or giving advice, by staying aloof behind

an “expert” role, or by discounting the impact the power imbalance between thera-

pist and client has on the relationship.

Second, therapists actively focus on the power their clients have in the therapeu-

tic relationship and make this part of their informed consent processes. Therapists

encourage clients to identify and express their feelings, to become aware of the

ways they relinquish power in relationships with others as a result of socialization

or as a means for survival, and to make decisions with this knowledge as the basis.

Third, feminist therapists work to demystify the counseling relationship by

sharing with the client their own perceptions about what is going on in the re-

lationship, by making the client an active partner in determining any diagnosis,

and by making use of appropriate self-disclosure. Some feminist therapists use

contracts as a way to make the goals and processes of therapy overt rather than

covert and mysterious.

A deﬁ ning theme of the client–counselor relationship is the inclusion of clients

in both the assessment and the treatment process, keeping the therapeutic rela-

tionship as egalitarian as possible. Walden (2006) emphasizes the value of edu-

cating and empowering clients. When counselors keep their clients uninformed

about the nature of the therapeutic process, they deny them the potential for active

participation in their therapy. When counselors make decisions about a client for

the client rather than with the client, they rob the client of power in the therapeutic

relationship. Collaboration with the client in all aspects of therapy leads to a genu-

ine partnership with the client.

application: therapeutic

techniques and procedures

The Role of Assessment and Diagnosis

Feminist therapists have been sharply critical of the DSM classiﬁ cation system,

and research indicates that gender, culture, and race may inﬂ uence assessment of

clients’ symptoms (Enns, 2000; Eriksen & Kress, 2005). To the degree that assess-

ment is inﬂ uenced by subtle forms of sexism, racism, ethnocentrism, heterosexism,

ageism, or classism, it is extremely difﬁ cult to arrive at a meaningful assessment

or diagnosis. For a thoughtful discussion of feminist challenges to DSM diagnosis,

see Eriksen and Kress (2005, 2008) and Evans, Kincade, and Seem (2011).

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CHAPTER TWELVE

From the perspective of feminist therapy, diagnostic criteria were established

through a system that views male gender-role traits as “normative.” Thus women’s

behaviors are more prone to becoming pathologized. Feminist therapists refer

to distress rather than psychopathology (Brown, 2010), and they use diagnostic

labels quite carefully, if at all. They believe diagnostic labels are severely limiting

for these reasons: (1) they focus on the individual’s symptoms and not the social

factors that cause dysfunctional behavior; (2) as part of a system developed main-

ly by White male psychiatrists, they may represent an instrument of oppression;

(3) they (especially the personality disorders) may reinforce gender-role stereotypes

and encourage adjustment to the norms of the status quo; (4) they may reﬂ ect

the inappropriate application of power in the therapeutic relationship; (5) they can

lead to an overemphasis on individual solutions rather than social change; and

(6) they have the potential to dehumanize the client through the label. Using diag-

nostic categories may contribute to a victim-blaming stance and dull the therapist’s

sensitivity to external factors that contribute to a client’s symptoms (Enns, 2000;

Eriksen & Kress, 2005).

The feminist approach emphasizes the importance of considering the gender-

normative context of men and women’s lives and points out that many symp-

toms can be understood as coping or survival strategies rather than as evidence of

pathology (Bitter, 2008; Worell & Remer, 2003). Due to the cultural and gender

limitations of diagnoses, Eriksen and Kress (2005) encourage therapists “to be

tentative in diagnosing those from diverse backgrounds, and to, as a part of a more

egalitarian relationship, co-construct an understanding of the problem with the

client, rather than imposing a diagnosis on the client” (p. 104). In keeping with

the focus on client empowerment, diagnosis is a shared process in which clients

are the experts on the meaning of their distress. Reframing symptoms as resist-

ance to oppression and as coping skills or strategies for survival and shifting the

etiology of the problem to the environment avoids “blaming the victim” for her

or his problems. Assessment is viewed as an ongoing process between client and

therapist and is connected to treatment interventions (Enns, 2000). In the femi-

nist therapy process, diagnosis of distress becomes secondary to identiﬁ cation and

assessment of strengths, skills, and resources (Brown, 2010). If a DSM diagnosis

is discussed, feminist therapists may ask questions aimed at deconstructing the

diagnosis: “Who beneﬁ ts from using this label?” “How might this label contribute

to disempowering the person to whom it is assigned?”

Using the DSM-IV-TR (American Psychiatric Association, 2000), depression

is diagnosed twice as often in women as in men. Feminist therapists believe

women have many more reasons to experience depression than do men, and they

often frame depression as a normative experience for women. Women are often

ﬁ nancially disadvantaged or dependent, relationally submissive, and strive to

please others by anticipating their needs. Depression may result from women’s

sense of powerlessness in their subordinate position, along with their experiences

of domestic violence, sexual abuse, poverty, or sexual harassment in the workplace.

Similarly, with eating disorders feminist therapists focus on messages given by

society, and by the mass media in particular, about women’s bodies. The therapist

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uses a gender-role analysis to help clients who suffer from anorexia or bulimia to

examine these societal injunctions and how they have come to accept them. Thera-

pist and client work together on ways to challenge and change these messages.

Perhaps the potentially most damaging diagnosis is borderline personality disor-

der (American Psychiatric Association, 2000), a diagnosis usually assigned to and

critical of women (Bitter, 2008). Since very few women who receive this diagnosis

have escaped physical abuse or sexual molestation, Herman (1992) has argued

that the more appropriate diagnosis would be complex posttraumatic stress disor-

der. The latter diagnosis would certainly generate more compassion and sympathy

in therapists than does the diagnosis of borderline personality disorder.

Feminist therapists do not refuse to use the DSM-IV-TR in this age of managed

care and the prevalence of the medical model of mental health, but therapists who

participate in the process of diagnosis have a responsibility to challenge the current

diagnostic system (Eriksen & Kress, 2008). Diagnosis, when used, results from

a shared dialogue between client and therapist. The therapist is careful to review

with the client any implications of assigning a diagnosis so the client can make an

informed choice, and discussion focuses on helping the client understand the role

of socialization and culture in the etiology of her problems.

Techniques and Strategies

Feminist therapy does not prescribe any particular set of interventions; rather, femi-

nist therapists tailor interventions to clients’ strengths with the goal of empowering

clients while evoking their feminist consciousness (Brown, 2010). Nonetheless, they

have developed several unique techniques, and have borrowed others from tradi-

tional approaches. Particularly important are consciousness-raising techniques that

help women to differentiate between what they have been taught is socially accept-

able or desirable and what is actually healthy for them. Some of the techniques

described by Worell and Remer (2003) and Enns (1993, 2004) are discussed in this

section, using the case example of Alma to illustrate how these techniques might

be applied.

Alma, age 22, comes to counseling reporting general anxiety about a new job she began a

month ago. She states that she has struggled with depression off and on throughout her life

because of bullying as a child and rejection from much of her family after coming out as a

lesbian at age 14. Alma identiﬁ es as Dominican and continues to struggle with the loss of

her place within her family of origin. She now believes coming out was a selﬁ sh mistake

and is trying to make amends by keeping her feelings regarding her sexual and affectional

orientation hidden. Due in part to past experiences, she is worried that if she comes out to

her coworkers the company might ﬁ nd a reason to ﬁ re her. Alma says, “I would like to cut

my hair short again because it is more manageable and I also prefer to wear what is con-

sidered to be more masculine clothing, but I am worried this will cause people at work to

question my femininity. I really like my job, and I worked very hard to get it. I am afraid if

I show them who I really am, they won’t want me there anymore.”

empowerment Enns and Byars-Winston (2010) point out that many of the

strategies of multicultural feminist therapy are part of the general umbrella of em-

powerment, which enables people to see themselves as active agents on behalf of

themselves and others. At the heart of feminist strategies is the goal of empowering

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CHAPTER TWELVE

the client. Feminist therapists work in an egalitarian manner and use empower-

ment strategies that are tailored to each client (Brown, 2010; Evans, Kincade, &

Seem, 2011). Alma’s therapist will pay careful attention to informed consent issues,

discussing ways Alma can get the most from the therapy session, clarifying expec-

tations, identifying goals, and working toward a contract that will guide the thera-

peutic process.

The process of feminist therapy begins with the informed consent process,

which Brown (2010) refers to as “empowerment consent.” Informed consent

offers a place to begin a relationship that is egalitarian and collaborative. By explain-

ing how therapy works and enlisting Alma as an active partner in the therapeutic

venture, the therapy process is demystiﬁ ed and Alma becomes an equal partici-

pant. Alma will learn that she is in charge of the direction, length, and procedures

of her therapy. Alma’s therapist might ask her, “What is the most powerful thing

you could do right now?” The intent of this question is to “interrupt the trance

of powerlessness” (Brown, 2010, p. 35) by inviting Alma to notice how power is

actually available to her. Given Alma’s cultural background, it may be particularly

important to address power within the therapeutic relationship because Alma may

view the therapist as an expert who holds the answers she is seeking. In addition,

Alma may view counseling as a weakness and may feel shame associated with her

need for help.

self-disclosure Feminist therapists use therapeutic self-disclosure in the

best interests of the client to equalize the client–therapist relationship, to provide

modeling, to normalize women’s collective experiences, to empower clients, and

to establish informed consent. Believing that there is no such thing as therapist

neutrality or objectivity, therapists who disown the reality of being knowable and

known to clients are at greater risk of abusing their power (Brown, 2010). For

example, Alma’s therapist may disclose her own difﬁ culties in relating to members

of her family of origin, acknowledging that at times hiding information seems im-

portant in order to keep the peace. The therapist can share how she decides when

to be open about her personal life and how to balance relating in a less open way.

The counselor could then discuss with Alma ways in which they have both experi-

enced cultural and social pressures to conform to a hetero-normative ideal. Alma

beneﬁ ts from this modeling by a woman who does not meet society’s expectations

for female behavior and appearance but is comfortable with the image she has

developed and how it has worked for her, not against her.

Self-disclosure is not just sharing information and experiences. It also involves

a certain quality of presence the therapist brings to the therapeutic sessions. Effec-

tive therapist self-disclosure is grounded in authenticity and a sense of mutuality.

The therapist considers how the disclosures may affect the client by using what

relational-cultural theorists refer to as “anticipatory empathy.” Feminist therapists,

like counselors who subscribe to other theoretical orientations, are ethically com-

mitted to using self-disclosure appropriately to enhance the therapeutic process.

The therapist also clearly states her relevant values and beliefs about society

to allow Alma to make an informed choice about whether or not to enter into a

professional relationship with this therapist. The therapist explains to Alma the

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377

FEMINIST THERAPY

therapeutic interventions that are likely to be employed. Alma, as an informed

consumer, will be involved in evaluating how well these strategies are working and

the degree to which her personal goals in therapy are being met.

gender-role analysis A hallmark of feminist therapy, gender-role analy-

sis explores the impact of gender-role expectations on the client’s psychological

well-being and draws upon this information to make decisions about future gender-

role behaviors (Enns, 2004). Some feminist therapists prefer the term “social iden-

tity analysis” because it reﬂ ects the importance of assessing all relevant aspects of

a client’s identity, including multiple memberships in both socially disempowered

and privileged groups. Hayes (2008) proposes an ADDRESSING model that in-

cludes the elements of age, disability status, religion, ethnicity, race, social class,

and sexual orientation along with gender.

Gender-role analysis begins with clients identifying the societal messages they

received about how women and men should be and act (Remer, 2008). The thera-

pist begins by asking Alma to identify messages she has received related to sexual-

ity and appearance from her culture, society, her peers, the media, and her family.

The therapist talks about how body image expectations differ between females

and males in our culture and how they may differ in other cultures. The therapist

explains how expectations related to appearance could intersect with beliefs about

what it means to be gay or straight in Alma’s culture, family, and society as it

relates to her working environment. Alma decides what messages she would pre-

fer to have in her mind and keeps an open awareness when the discounting mes-

sages play in her head.

gender-role intervention Using this technique, the therapist responds

to Alma’s concern by placing it in the context of society’s role expectations for wom-

en. The aim is to provide Alma with insight into the ways social issues are affecting

her. Alma’s therapist responds to her statement with, “Our society really focuses

on sometimes unrealistic beauty ideals with females. The media bombards girls

and women with the message that they must be thin, have long straight hair, and

wear attractive clothing. The message is so ingrained that many girls are struggling

with self-esteem issues related to their appearance as early as elementary school to

avoid being bullied or to ﬁ t in.” By placing Alma’s concern in the context of societal

expectations, the therapist gives Alma insight into how these expectations have af-

fected her psychological condition and have contributed to her feeling depressed

and anxious about judgment from others. The therapist’s statement also paves the

way for Alma to think more positively about her unity with other women and even

to think about how she might contribute as a role model for girls and young women

in the future.

power analysis Power analysis refers to the range of methods aimed at

helping clients understand how unequal access to power and resources can inﬂ u-

ence personal realities. Together therapists and clients explore how inequities or

institutional barriers often limit self-deﬁ nition and well-being (Enns, 2004). With

this technique, Alma will become aware of the power difference between men and

women as well as the power differences associated with sexual orientation in our

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378

CHAPTER TWELVE

society. Speciﬁ c issues related to Alma’s cultural perspective also are explored. In

Alma’s case the power analysis may focus on helping Alma identify alternate kinds

of power she may exercise and to challenge the gender-role messages that prohibit

the exercise of that kind of power. Interventions are aimed at helping Alma learn

to appreciate herself as she is, regain her self-conﬁ dence based on the personality

attributes she possesses, and set goals that will be fulﬁ lling to her within the con-

text of her cultural values.

bibliotherapy Nonﬁ ction books, psychology and counseling textbooks, au-

tobiographies, self-help books, educational videos, ﬁ lms, and even novels can all be

used as bibliotherapy resources. Reading about feminist perspectives on common

issues in women’s lives (incest, rape, battering, and sexual harassment) may chal-

lenge a woman’s tendency to blame herself for these problems (Remer, 2008). The

therapist describes a number of books that address issues of relevance to Alma, and

she selects one to read over the next few weeks. Providing Alma with reading ma-

terial increases knowledge and decreases the power difference between Alma and

her therapist. Reading can supplement what is learned in the therapy sessions, and

Alma can enhance her therapy by exploring her reactions to what she is reading.

assertiveness training By teaching and promoting assertive behavior,

women become aware of their interpersonal rights, transcend stereotypical gender

roles, change negative beliefs, and implement changes in their daily lives. The

therapist and client consider what is culturally appropriate, and the client makes

decisions about when and how to use the new skill of assertion.

Through learning and practicing assertive behaviors and communication,

Alma may increase her own power, which will ameliorate her depression and

anxiety. Alma learns that it is her right to ask for what she wants and needs in the

workplace. The therapist helps Alma to evaluate and anticipate the consequences

of behaving assertively, which might range from criticism to actually getting what

she wants.

reframing and relabeling Like bibliotherapy, therapist self-disclosure,

and assertiveness training, reframing is not unique to feminist therapy. However,

reframing is applied uniquely in feminist therapy. Reframing includes a shift

from “blaming the victim” to a consideration of social factors in the environ-

ment that contribute to a client’s problem. In reframing, rather than dwelling

exclusively on intrapsychic factors, the focus is on examining societal or political

dimensions. Alma may come to understand that her depression and anxiety are

linked to social pressures to behave within hetero-normative gender-role expecta-

tions and to develop an appearance that matches these culturally and societally

prescribed ideals.

Relabeling is an intervention that changes the label or evaluation applied to

some behavioral characteristic. Alma can change certain labels she has attached

to herself, such as being inadequate or socially unwanted because she does not

conform to ideals commonly associated with feminism. An example might be that

Alma is encouraged to talk about herself as a strong and healthy woman rather

than as being “selﬁ sh” or too “masculine.”

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379

FEMINIST THERAPY

social action Social action, or social activism, is an essential quality of femi-

nist therapy (Enns, 2004). As clients become more grounded in their understanding

of feminism, therapists may suggest that clients become involved in activities such

as volunteering at a rape crisis center, lobbying lawmakers, or providing commu-

nity education about gender issues. Participating in such activities can empower

clients and help them see the link between their personal experiences and the

sociopolitical context in which they live. Alma might decide to join and partici-

pate in organizations that are working to change societal stereotypes about beauty

expectations for women or social groups that afﬁ rm people who identify with a

variety of sexual and affectional orientations. Taking this kind of social action is

another way for Alma to feel more empowered.

group work Group work became popular as a way for women to discuss their

lack of voice in many aspects of society. Historically, group work has been used for

both consciousness-raising and support (Herlihy & McCollum, 2011). Conscious-

ness-raising groups initially provided an avenue for women to share their experi-

ences of oppression and powerlessness. Eventually, these groups evolved into self-

help groups that empowered women and challenged many of the social patterns

of the time (Evans, Kincade, Marbley, & Seem, 2005; Evans et al., 2011). Feminist

therapists often encourage their clients to make the transition from individual ther-

apy to a group format such as joining a support group or a political action group as

soon as this is realistic (Herlihy & McCollum, 2011). Although these groups are as

diverse as the women who comprise them, they share a common denominator em-

phasizing support for the experience of women. The literature reveals that women

who join these groups eventually realize that they are not alone and gain validation

for their experiences by participating in the group. These groups can provide wom-

en with a social network, decrease feelings of isolation, create an environment that

encourages sharing of experiences, and help women realize that they are not alone

in their experiences (Eriksen & Kress, 2005). Groups provide a supportive context

where women can share and begin to critically explore the messages they have in-

ternalized about their self-worth and their place in society. The self-disclosures of

both the members and the leader foster deeper self-exploration, a sense of univer-

sality, and increased levels of cohesion. Members learn to use power effectively by

providing support to one another, practicing behavioral skills, considering social/

political actions, and by taking interpersonal risks in a safe setting (Enns, 2004).

Through their group participation, women learn that their individual experiences

are frequently rooted in problems within the system. In conjunction with the group

members, the group facilitator’s job is to design a group that results in both indi-

vidual and systemic change (Kees & Leech, 2004). Participation in a group experi-

ence can inspire women to take up some form of social action. Indeed, a form of

homework can be to carry out what women are learning in the group to bring about

changes in their lives outside of the group.

Alma and her therapist will likely discuss the possibility of Alma joining a

women’s support group, a gay-straight alliance, or another type of group as a part

of the process of terminating individual therapy. By joining a group Alma will have

opportunities to discover that she is not alone in her struggles. Other women can

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380

CHAPTER TWELVE

provide her with nurturance and support, and Alma will have the chance to be sig-

niﬁ cant to other women as they engage in their healing process.

The Role of Men in Feminist Therapy

Men can be feminist therapists, and feminist therapy can be practiced with male

clients. It is an erroneous perception that feminist therapy is conducted only by

women and for women, or that feminist therapy is anti-men because it is pro-women

(Herlihy & McCollum, 2011). Although the original feminist therapists were exclu-

sively women, men are now included among their ranks. Male feminist therapists

are willing to understand and “own” their male privilege, confront sexist behavior

in themselves and others, redeﬁ ne masculinity and femininity according to other

than traditional values, work toward establishing egalitarian relationships, and ac-

tively support women’s efforts to create a just society.

The principles and practices of feminist psychotherapy are useful in working

with male clients, individuals from diverse racial and cultural backgrounds, and

people who are committed to addressing social justice issues in counseling practice

(Enns, 2000, 2004; Worell & Remer, 2003). Social mandates about masculinity

such as restrictive emotionality, overvaluing power and control, the sexualization

of emotion, and obsession with achievement can be limiting to males (Gilbert &

Scher, 1999; Pleck, 1995; Pollack, 1995, 1998; Real, 1998).

Some feminist therapists routinely work with men, especially with abusive

men and in batterers’ groups. According to Ganley (1988), issues that men can

deal with productively in feminist therapy include learning how to increase their

capacity for intimacy, expressing their emotions and learning self-disclosure, bal-

ancing achievement and relationship needs, accepting their vulnerabilities, and

creating collaborative relationships at work and with signiﬁ cant others that are not

based on a “power-over” model of relating. Any presenting issue can be dealt with

from a feminist perspective.

feminist therapy from a

multicultural and social

justice perspective

Strengths From a Diversity Perspective

Of all the theoretical approaches to counseling and psychotherapy in this book,

feminist therapy has the most in common with the multicultural and social justice

perspectives. Historically, multicultural approaches evolved in response to societal

oppression, discrimination, and marginalization faced by people of color. Over time,

multicultural counseling has become more inclusive, and contemporary multicul-

tural counselors work to address inequities created not only by racism but also by

other “isms” that limit full participation in society. Social justice counseling aims

to empower the individual as well as to confront injustice and inequality in society.

Although multicultural, feminist, and social justice counseling have been

viewed as disparate models, they have many common threads (Crethar, Torres

Rivera, & Nash, 2008). All three approaches emphasize the need to promote

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381

FEMINIST THERAPY

social, political, and environmental changes within the counseling context.

Practitioners of all three theories strive to create an egalitarian relationship in

which counselor and client co-construct the client’s problems from a contextual

perspective and collaborate in setting goals and choosing strategies. All three

approaches reject the “disease model” of psychopathology; they view clients’

problems as symptoms of their experiences of living in an unjust society rather

than as having an intrapsychic origin.

The “personal is political” principle is embraced equally in each of the ap-

proaches. None of the approaches rests solely on individual change; they all em-

phasize direct action for social change as a part of the role of therapists.

Culture encompasses the sociopolitical reality of people’s lives, including how

the privileged dominant group (in Western societies: White, Protestant, hetero-

sexual, rich males) treats those who are different from them. Feminist therapists

believe psychotherapy is inextricably bound to culture, and, increasingly, they are

being joined by thoughtful leaders in the ﬁ eld of counseling practice. All cultures

include feminist voices from within them today.

The women’s movement and the multicultural movement, and more recently

the social justice movement, have called to our attention the negative effects of dis-

crimination and oppression on their targets and also on those doing the discrimi-

nating and oppressing. Culturally competent feminist therapists look for ways to

work within the client’s culture by exploring consequences and alternatives. They

appreciate the complexities involved in changing within one’s culture but do not

view culture as sacrosanct (Worell & Remer, 2003). It is important to understand

and respect diverse cultures, but most cultural contexts have both positive and

toxic aspects. Feminist therapists are committed to taking a critical look at cultural

beliefs and practices that discriminate against, subordinate, and restrict the poten-

tial of groups of individuals, which can be either a strength or a shortcoming.

Shortcomings From a Diversity Perspective

Feminist therapists advocate for change in the social structure, especially in the

areas of inequality, power in relationships, the right to self-determination, freedom

to pursue a career outside or inside the home, and the right to an education. This

agenda could pose some problems when working with women who do not share

these beliefs. Remer (2008) acknowledges this practice of critically evaluating soci-

etal values and structures that subordinate certain groups as a shortcoming of the

approach. If therapists do not fully understand and respect the cultural values of

clients from diverse groups, they run the risk of imposing their own values. Remer

claims “a potential danger inherent in feminist counseling is that counselors’ val-

ues will too strongly inﬂ uence clients or will conﬂ ict with clients’ values” (p. 431).

Being aware of the cultural context is especially important when feminist ther-

apists work with women from cultures that endorse culturally prescribed roles that

keep women in a subservient place or that are grounded in patriarchy. Consider

this scenario. You are a feminist therapist working with a Vietnamese woman who

is struggling to ﬁ nd a way to be true to her culture and also to follow her own

educational and career aspirations. Your client is a student in a helping profession

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382

CHAPTER TWELVE

who is being subjected to extreme pressure from her father to return home and

take care of her family. Although she wants to complete a degree and eventually

help others in the Vietnamese community, she feels a great deal of guilt when she

considers “selﬁ shly” pursuing her education when her family at home needs her.

In this complex situation, the therapist is challenged to work together with the

client to ﬁ nd a path that enables her to consider her own individual goals without

ignoring or devaluing her collectivistic cultural values. The therapist’s job is not

to take away her pain or struggle, nor to choose for the client, but to be present in

such a way that the client will truly be empowered to make signiﬁ cant decisions.

The feminist counselor must remain aware that the price may be very high if this

woman chooses to go against what is culturally expected of her, and that the cli-

ent is the one to ultimately decide which path to follow. As can be seen from this

example, to minimize this potential shortcoming of imposing cultural values on

a client, it is essential that therapists understand how their own cultural perspec-

tives are likely to inﬂ uence their interventions, especially when they are working

with culturally diverse clients. A safeguard against value imposition is for feminist

therapists to clearly present their values to clients early in the course of the coun-

seling relationship so that clients can make an informed choice about continuing

this relationship (Remer, 2008).

Feminist Therapy Applied to the Case of Stan

Stan’s fear of women and his gender-

role socialization experiences make

him an excellent candidate to benefit

from feminist therapy. A therapeutic relationship

that is egalitarian will be a new kind of experi-

ence for Stan.

Stan has indicated that he is willing and even

eager to change. Despite his low self-esteem and

negative self-evaluations, he is able to identify

some positive attributes. These include his deter-

mination, his ability to articulate his feelings, and

his gift for working with children. Stan knows what

he wants out of therapy and has clear goals: to

stop drinking, to feel better about himself, to relate

to women on an equal basis, and to learn to love

and trust himself and others. Operating from a

feminist orientation, I will build on these strengths.

In the first session I focus on establishing an

egalitarian working relationship to help Stan begin

to regain his personal power. It is important that

the therapeutic relationship does not replicate

other relationships Stan has had with significant

figures in his life. I consciously work to demystify

the therapeutic process and equalize the relation-

ship, conveying to Stan that he is in charge of the

direction of his therapy. I spend time explaining

my view of the therapy process and how it works.

A gender-role analysis is conducted to help

Stan become aware of the influence of gender-

role expectations in the development of his

problems. First, I ask him to identify gender-role

messages he received while growing up from a

variety of societal sources including his parents,

teachers, the media, faith community, and peers.

In his autobiography Stan has written about

some of the messages his parents gave him,

and this provides a natural starting point for his

analysis. He remembers his father calling him

“dumb” and his mother saying, “Why can’t you

grow up and be a man?” Stan wrote about his

mother “continually harping at” his father and

telling Stan how she wished she hadn’t had him.

He describes his father as weak, passive, and

mousy in relating to his mother and remembers

that his father compared him unfavorably with

his siblings. Stan internalized these messages,

often crying himself to sleep and feeling very

hopeless.

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I ask Stan to identify the damaging self-

statements he makes now that are based on

these early experiences. As we review his

writings, Stan sees how societal messages he

received about what a man “should” be were

reinforced by parental messages and have

shaped his view of himself today. For example,

he wrote that he feels sexually inadequate. It

appears that he has introjected the societal

notion that men should always initiate sex, be

ready for sex, and be able to achieve and sustain

an erection. Stan also sees that he has already

identified and written about how he wants to

change those messages, as exemplified in his

statements that he wants to “feel equal with

others” and not “feel apologetic” for his existence

and develop a loving relationship with a woman.

Stan begins to feel capable and empowered as I

acknowledge the important work he has already

done, even before he entered therapy.

I follow this gender-role analysis with a

gender-role intervention to place Stan’s con-

cerns in the context of societal role expectations.

I say, “Indeed, it is a burden to try to live up to

society’s notion of what it means to be a man,

always having to be strong and tough. Those

aspects of yourself that you would like to value—

your ability to feel your feelings, being good with

children—are qualities society tends to label as

‘feminine.’” Stan replies wistfully, “Yeah, it would

be a better world if women could be strong

without being seen as domineering and if men

could be sensitive and nurturing without being

seen as weak.” I raise the question, “Are you sure

that’s not possible? Have you ever met a woman

or a man who was like that?” Stan ponders for a

minute and then with some animation describes

the college professor who taught his Psychology

of Adjustment class. Stan saw her as very

accomplished and strong but also as someone

who empowered him by encouraging him to find

his own voice through writing his autobiography.

He also remembers a male counselor at the

youth rehabilitation facility where he spent part

of his adolescence as a man who was strong as

well as sensitive and nurturing.

As the first session draws to a close, I invite

Stan to talk about what he learned from our time

together. Stan says two things stand out for him.

First, he is beginning to believe he doesn’t need

to keep blaming himself. He knows that many

of the messages he has received from his

parents and from society about what it means

to be a man have been undesirable and one-

dimensional. He acknowledges that he has

been limited and constrained by his gender-role

socialization. Second, he feels hopeful because

there are alternatives to those parental and

societal definitions—people he admires have

been able to successfully combine “masculine”

and “feminine” traits. If they can do it, so can he.

I ask Stan whether he chooses to return for

another session. When he answers in the

affirmative, I give him W. S. Pollack’s (1998)

book Real Boys to read. I explain that this book

descriptively captures the gender-role socializa-

tion that many boys experience.

Stan comes to the following session eager to

talk about his homework assignment. He tells me

that he gained some real insights into his own

attitudes and beliefs by reading Real Boys. What

Stan learned from reading this book leads to a

further exploration of his relationship with his

mother. He finds it helpful to understand his par-

ents’ behavior in the context of societal expecta-

tions and stereotypes rather than continuing to

blame them. I help Stan to see how our culture

tends to hold extreme positions about mothers—

that they are either perfect or wicked—and that

neither of these extremes is true. As Stan learns

to reframe his relationship with his mother,

he develops a more realistic picture of her. He

comes to realize, too, that his father has been

oppressed by his own socialization experiences

and by an idealistic view of masculinity that he

may have felt unable to achieve.

Stan continues to work at learning to value

the nurturing and sensitive aspects of himself.

He is learning to value the “feminine” aspects

of himself as well as the “masculine” side of

his personality. He also continues to monitor

and make changes in his self-talk about what

it means to be a man. He is involved in gaining

ongoing awareness of these messages that come

from current sources such as the media and

friends. Since a number of Stan’s sessions were

devoted to exploring his relationship with his

mother, along with his resentment toward her, I

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FEMINIST THERAPY

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suggest another reading assignment—

Caplan’s (1989) book, Don’t Blame Mother.

The aim of this assignment is to assist

Stan in exploring alternatives to blaming

his mother for his present problems.

Throughout our therapeutic relation-

ship, we discuss with immediacy how

we are communicating and relating to

each other during the sessions. I am

self-disclosing and treat Stan as an equal,

continually acknowledging that he is the

“expert” on his life.

Follow-Up: You Continue as Stan’s

Feminist Therapist

Use these questions to help you think

about how you would counsel Stan using

a feminist therapy model:

• What unique values do you see in work-

ing with Stan from a feminist perspective

as opposed to w

orking from the other

therapeutic approaches you’ve studied

thus far?

• If you were to continue working with

Stan, what self-statements regarding

his view of himself as a man might you

f

ocus on, and what alternatives might

you offer?

• In what ways could you integrate cog-

nitive behavior therapy with feminist

ther

apy in Stan’s case? What possibili-

ties do you see for integrating Gestalt

therapy methods with feminist thera-

py? What other therapies might you

combine with a feminist approach?

• I used bibliotherapy as a form of home-

work assignment. Would you suggest

books or films f

or Stan? If so, which

ones? What other homework might

you suggest to Stan? What other femi-

nist therapy strategies would you utilize

in counseling Stan?

See DVD for Theory and Practice of

Counseling and Psychotherapy: The

Case of Stan and Lecturettes (Session 10

on feminist therapy) for a demonstra-

tion of my approach to counseling Stan

from this perspective. This session deals

with Stan’s exploration of his gender-role

identity and messages he has incorpo-

rated about being a man.

summary and evaluation

Summary

The origins of feminist therapy are connected with the women’s movements of the

late 1800s and the 1960s, when women united in vocalizing their dissatisfaction

over the restrictive nature of traditional female roles. Feminist therapy largely grew

out of the recognition by women that the traditional models of therapy suffer from

basic limitations due to the inherent bias of earlier theoreticians. Feminist therapy

emphasizes these concepts:

• Viewing problems in a sociopolitical and cultural context rather than on an

individual level

• Recognizing that clients know what is best for their lives and are experts on

their own lives

• Striving to create a therapeutic relationship that is egalitarian through the proc-

ess of self-disclosure and informed consent

• Demystifying the therapeutic process by including the client as much as

possible in all phases of assessment and treatment, which increases client

empowerment

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385

FEMINIST THERAPY

• Viewing women’s experiences from a unique perspective

• Understanding and appreciating the lives and perspectives of diverse women

• Understanding that gender never exists in isolation from other aspects of identity

• Challenging traditional ways of assessing the psychological health of women

• Emphasizing the role of the therapist as advocate as well as facilitator

• Encouraging clients to get involved in social action to address oppressive

aspects of the environment

Feminist therapy is aimed at both personal and social change. The theory is not

static but is continually evolving and maturing. The major goal is to replace the

current patriarchal system with feminist consciousness and thus create a society

that values equality in relationships, values diversity, stresses interdependence

rather than dependence, and encourages both women and men to deﬁ ne

them-

selves rather than being deﬁ ned by societal demands.

Instead of being a singular and uniﬁ ed approach to psychotherapy, feminist

practice tends to be diverse. As feminist therapy has matured, it has become more

self-critical and varied. Feminist therapists share a number of basic assumptions

and roles: they engage in appropriate self-disclosure; they make their values and

beliefs explicit so that the therapy process is clearly understood; they establish egal-

itarian roles with clients; they work toward client empowerment; they emphasize

the commonalities among women while honoring their diverse life experiences;

and they all have an agenda to bring about social change.

Feminist therapists are committed to actively breaking down the hierarchy of

power in the therapeutic relationship through the use of various interventions.

Some of these strategies are unique to feminist therapy, such as gender-role analy-

sis and intervention, power analysis, assuming a stance of advocate in challenging

conventional attitudes toward appropriate roles for women, and encouraging cli-

ents to take social action. Other therapeutic strategies are borrowed from various

therapy models, including bibliotherapy, assertiveness training, cognitive restruc-

turing, reframing and relabeling, counselor self-disclosure, role playing, identify-

ing and challenging untested beliefs, and journal writing. Feminist therapy prin-

ciples and techniques can be applied to a range of therapeutic modalities such

as individual therapy, couples counseling, family therapy, group counseling, and

community intervention. Regardless of the speciﬁ c techniques used, the overrid-

ing goals are client empowerment and social transformation.

Contributions of Feminist Therapy

One of the major contributions feminists have made to the ﬁ eld of counseling and

psychotherapy is paving the way for gender-sensitive practice and an awareness of

the impact of the cultural context and multiple oppressions. By focusing attention

on our attitudes and biases pertaining to gender and culture, feminist therapists

have expanded the awareness of therapists of all theoretical orientations regarding

how social justice issues may touch clients. Feminists have had a major inﬂ uence

on therapeutic practice with women and girls; for example, feminist perspectives

are reﬂ ected throughout the American Psychological Association’s Guidelines for

Psychological Practice with Girls and Women (2007). A signiﬁ cant contribution of

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386

CHAPTER TWELVE

feminist therapy is the emphasis on social change, which can lead to a transforma-

tion in society. Therapists with a feminist orientation understand how important it

is to be fully aware of typical gender-role messages clients have grown up with, and

they are skilled in helping clients identify and examine these messages (Philpot,

Brooks, Lusterman, & Nutt, 1997).

According to Gilbert and Rader (2007), feminist therapists have brought about

signiﬁ cant theoretical and professional advances in counseling practice. Some of

these contributions include power sharing with clients, cultural critiques of both

assessment and treatment approaches, and the validation of women and their nor-

mative experiences. Feminist therapists have also made important contributions

by questioning traditional counseling theories and models of human development.

Most theories place the cause of problems within individuals rather than with

external circumstances and the environment. This has led to holding individuals

responsible for their problems and not giving full recognition to social and politi-

cal realities that create problems. A key contribution feminists continue to make

is reminding all of us that the proper focus of therapy includes addressing oppres-

sive factors in society rather than expecting individuals to merely adapt to expected

role behaviors. This emphasis on social justice issues has expanded the role of

therapists to be advocates for clients. For a discussion of adaptations to traditional

approaches to counseling women, see Enns (2003).

Another major contribution of the feminist movement is in the areas of ethics in

psychology and counseling practice (Brabeck, 2000) and ethical decision making in

therapy (Rave & Larsen, 1995). The uniﬁ ed feminist voice called attention to the extent

and implications of child abuse, incest, rape, sexual harassment, and domestic vio-

lence. Feminists pointed out the consequences of failing to recognize and take action

when children and women were victims of physical, sexual, and psychological abuse.

Feminist therapists work with male clients who are abusive, and increasing numbers

of groups composed of male batterers are led or co-led by feminist therapists.

Feminist therapists demanded action in cases of sexual misconduct at a time

when male therapists misused the trust placed in them by their female clients. Not

too long ago the codes of ethics of all the major professional organizations were

silent on the matter of therapist and client sexual liaisons. Now, virtually all of the

professional codes of ethics prohibit sexual intimacies with current clients and

with former clients for a speciﬁ ed time period. Furthermore, the professions agree

that a sexual relationship cannot later be converted into a therapeutic relationship.

Largely due to the efforts and input of women on ethics committees, the existing

codes are explicit with respect to sexual harassment and sexual relationships with

clients, students, and supervisees (Herlihy & Corey, 2006b).

Feminist therapy principles have been applied to supervision, teaching, con-

sultation, ethics, research, and theory building as well as to the practice of psycho-

therapy. Building community, providing authentic mutual empathic relationships,

creating a sense of social awareness, and addressing social injustices are all signiﬁ -

cant strengths of this approach.

The principles and techniques of feminist therapy can be incorporated in many

other contemporary therapy models and vice versa (Enns, 2003). Both feminist and

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387

FEMINIST THERAPY

Adlerian therapists view the therapeutic relationship as egalitarian. Both feminist

and person-centered therapists agree on the importance of therapist authenticity,

modeling, and self-disclosure; empowerment is the basic goal of both orientations.

When it comes to making choices about one’s destiny, existential and feminist

therapists are speaking the same language—both emphasize choosing for oneself

instead of living a life determined by societal dictates.

Although feminist therapists have been critical of psychoanalysis as a sexist

orientation, a number of feminist therapists believe psychoanalysis can be an

appropriate approach to helping women. Object-relations theory may help clients

examine internalized object representations that are based on their relationships

with their parents. Therapy might include an examination of unconscious learn-

ing about women’s roles through the mother–daughter relationship to provide in-

sights into why gender roles are so deeply ingrained and difﬁ cult to change.

Gestalt therapy and feminist therapy share the goal of increasing the client’s

awareness of personal power. Gestalt therapy also is useful for increasing a wom-

an’s sense of herself as a powerful person (Enns, 2003). In many ways the dialogic,

relational, and collaborative model of Gestalt therapy ﬁ ts well with the philosophy

of a feminist perspective (Enns, 1987, 2004).

Cognitive behavioral therapies and feminist therapy are compatible in that they

view the therapeutic relationship as a collaborative partnership, with the client

being in charge of setting goals and selecting strategies for change. These approach-

es are committed to demystifying therapy, and both aim to help clients take charge

of their own lives. Both the cognitive behavior therapist and the feminist therapist

assume a range of information-giving and teaching functions so clients can become

active partners in the therapy process. A feminist therapist could employ action-

oriented strategies such as assertiveness training and behavioral rehearsal, and sug-

gest homework assignments for clients to practice in their everyday lives. A useful

source for further discussion of feminist cognitive behavior therapy is Worell and

Remer (2003).

Limitations and Criticisms of Feminist Therapy

Feminist therapists do not take a neutral stance; they believe therapy is a value-

oriented process. They emphasize the importance of counselors clarifying their

personal and professional values and being aware of the potential impact of these

values on clients. However, there is a danger that therapists may unduly inﬂ u-

ence clients, especially those who lack a strong sense of their own values. Feminist

therapists must remain aware of their own values and explicitly share these values

with clients in an appropriate, timely, and respectful manner to reduce the risk of

value imposition.

Feminist therapists call attention to clients’ unexamined choices, but they must

honor clients’ choices as long as those choices are indeed informed. Once clients

understand the impact of gender and cultural factors on their choices, the therapist

must guard against providing speciﬁ c directions for client growth. Feminist thera-

pists are committed to helping clients weigh the costs and beneﬁ ts of their current

life choices but should not push clients too quickly toward changes they feel are

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388

CHAPTER TWELVE

beyond their reach. Lenore Walker (1994) raised this issue with regard to working

with abused women. Although Walker focuses on the importance of asking ques-

tions that enable women to think through their situations in new ways and of help-

ing women develop “safety plans,” she emphasizes how critical it is to understand

those factors in a woman’s life that often pose difﬁ culties for her in making changes.

Looking at contextual or environmental factors that contribute to a woman’s

problems and moving away from exploring the intrapsychic domain can be both a

strength and a limitation. Instead of being blamed for her depression, the client is

able to come to an understanding of external realities that are indeed oppressive.

However, viewing the source of a client’s problem as being in the environment

could contribute to the client not taking personal responsibility to act in the face

of an unfair world. A client can make some internal changes even in those cir-

cumstances where external realities may largely be contributing to her problems.

Therapists must balance an exploration of the outer and inner worlds of the client

if the client is to ﬁ nd a way to take action in her own life.

Because feminist therapists do not assume a neutral stance, they need to iden-

tify any sources of bias and work toward restructuring or eliminating biased

aspects in any theories or techniques they employ. This is indeed a demanding

endeavor, and it should be considered an ongoing process.

Factors that inhibit the growth of feminist therapy include training that is often

offered only sporadically in a nonsystematic way (Brown, 2010) and the lack of qual-

ity control. No credentialing organization confers ofﬁ cial status as a qualiﬁ ed femi-

nist therapist, so formalized training and credentialing need to be addressed in the

future. In addition, evidence-based research on the efﬁ cacy of feminist therapy is

lacking, as is an understanding of feminist therapy as an integrative approach that

can inform therapeutic practice for counselors of varied theoretical orientations.

where to go from here

The DVD for Integrative Counseling: The Case of Ruth and Lecturettes is especially

useful as a demonstration of interventions I make with Ruth that illustrate some

principles and procedures of feminist therapy. For example, in Session 1 (“Begin-

ning of Counseling”) I ask Ruth about her expectations and initiate the informed

consent process. I attempt to engage Ruth as a collaborative partner in the thera-

peutic venture, and I teach her how counseling works. Clearly, Ruth is the expert

on her own life and my job is to assist her in attaining the goals we collabora-

tively identify as a focus of therapy. In Session 4 (“Understanding and Addressing

Diversity”) Ruth brings up gender differences, and she also mentions our differ-

ences in religion, education, culture, and socialization. Ruth and I explore the

degree to which she feels comfortable with me and trusts me.

Other Resources

DVDs offered by the American Psychological Association that are relevant to this

chapter include the following:

Brown, L. S. (2009). Feminist Therapy Over Time (APA Psychotherapy Video

Series)

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389

FEMINIST THERAPY

Psychotherapy.net is a comprehensive resource for students and professionals that

offers videos and interviews on feminist therapy. New video and editorial content

is made available monthly. DVDs relevant to this chapter are available at www.

psychotherapy.net and include the following:

Walker, L.(1994). The Abused Woman: A Survivor Therapy Approach

Walker, L. (1997). Feminist Therapy (Psychotherapy With the Experts

Series)

The Jean Baker Miller Training Institute offers workshops, courses, professio-

nal training, publications, and ongoing projects that explore applications of the

relational-cultural approach and integrate research, psychological theory, and social

action. This relational-cultural model is based on the assumption that growth-

fostering relationships and disconnections are constructed within speciﬁ c cultural

contexts.

Jean Baker Miller Training Institute

Stone Center, Wellesley College

106 Central Street

Wellesley, MA 02481

Telephone: (781) 283-3800

Fax: (781) 283-3646

Website: www.wellesley.edu/JBMTI/

The American Psychological Association has two divisions devoted to special inter-

ests in women’s issues: Division 17 (Counseling Psychology’s Section on Women)

and Division 35 (Psychology of Women).

American Psychological Association

750 First Street, N.E.

Washington, DC 20002-4242

Telephone: (202) 336-5500 or (800) 374-2721

Fax: (202) 336-5568

Association Website: www.apa.org

Division 17 Website: www.div17.org

Division 35 Website: www.apa.org/divisons/div35

The Association for Women in Psychology (AWP) sponsors an annual confer-

ence dealing with feminist contributions to the understanding of life experiences

of women. AWP is a scientiﬁ c and educational feminist organization devoted

to reevaluating and reformulating the role that psychology and mental health

research generally play in women’s lives.

Association for Women in Psychology

Website: www.awpsych.org

The Psychology of Women Resource List, or POWR online, is cosponsored by APA

Division 35, Society for the Psychology of Women, and the Association for Women

in Psychology. This public electronic network facilitates discussion of current top-

ics, research, teaching strategies, and practice issues among people interested in

the discipline of psychology of women. Most people with computer access to Bitnet

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390

CHAPTER TWELVE

or the Internet can subscribe to POWR-L at no cost. To subscribe, send the com-

mand below via e-mail to:

LISTSERV@URIACC (Binet) or LISTSERV@URIACC.URI.EDU

Subscribe POWR-L Your name (Use first and last name)

The University of Kentucky offers a minor specialty area in counseling women

and feminist therapy within the Counseling Psychology graduate programs. For

information, contact:

Dr. Pam Remer

University of Kentucky

Department of Educational and Counseling Psychology

251-C Dickey Hall

Lexington, KY 40506-0017

Telephone: (859) 257-4158

E-mail: Premer@uky.edu

Website: www.uky.edu/Education/edphead.html

Texas Women’s University offers a training program with emphasis in women’s

issues, gender issues, and family psychology. For information, contact:

Dr. Roberta Nutt

Texas Women’s University

Counseling Psychology Program

P. O. Box 425470

Denton, Texas 76204-5470

Telephone: (940) 898-2313

E-mail: [email protected]wu.edu

Website: www.twu.edu/as/psyphil/Counseling_Home.htm

Recommended Supplementary Readings

Feminist Perspectives in Therapy: Empowering Diverse Women (Worell & Remer,

2003) is an outstanding text that clearly outlines the foundations of empower-

ment feminist therapy. The book covers a range of topics such as integrating

feminist and multicultural perspectives on therapy, changing roles for women,

feminist views of counseling practice, feminist transformation of counseling

theories, and a feminist approach to assessment and diagnosis. There also are

excellent chapters dealing with depression, surviving sexual assault, confronting

abuse, choosing a career path, and lesbian and ethnic minority women.

Feminist Theories and Feminist Psychotherapies: Origins, Themes, and Diversity

(Enns, 2004) describes the wide range of feminist theories that inform and inﬂ u-

ence feminist practice. The book includes short self-assessment questionnaires

designed to help readers clarify their feminist theoretical perspective.

Feminist Therapy (Brown, 2010) provides an interesting perspective on the history

of feminist therapy and speculates about future developments of the approach.

Brown clearly explains key concepts of feminist theory and the therapeutic process.

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Introduction to Feminist Therapy: Strategies for Social and Individual Change (Evans,

Kincade, & Seem, 2011) emphasizes the practical applications of feminist theory

to clinical practice. They provide useful information on social change and empow-

erment, the importance of establishing an egalitarian relationship, and interven-

tion strategies when working with people from diverse cultural backgrounds.

The Healing Connection: How Women Form Relationships in Therapy and Life

(Miller & Stiver, 1997) describes how connections are formed between people

and how this leads to strong, healthy individuals. The authors also deal with dis-

connections between people that lead to anxiety, isolation, and depression.

Women’s Growth in Diversity: More Writings From the Stone Center (Jordan, 1997)

builds on the foundations laid by Women’s Growth in Connection (Jordan et al.,

1991). This work offers insights on issues such as sexuality, shame, anger, de-

pression, power relations between women, and women’s experiences in therapy.

References and Suggested Readings

American Psychiatric Association. (2000).

Diagnostic and statistical manual of mental

disorders, text revision (4th ed.). Washington,

DC: Author.

American Psychological Association. (2007).

Guidelines for psychological practice with

girls and women. American Psychologist, 62,

949–979.

Beardsley, B., Morrow, S. L., Castillo, L., &

Weitzman, L. (1998, March). Perceptions and

behaviors of practicing feminist therapists: De-

velopment of the feminist multicultural practice

instrument. Paper presented at the 23rd annual

conference of the Association for Women in

Psychology, Baltimore.

Belenky, M., Clinchy, B., Goldberger, N., &

Tarule, J. (1997). Women’s ways of knowing:

The development of self, voice, and mind (10th

anniv. ed.). New York: HarperCollins. (Original

work published 1987)

Bem, S. L. (1993). The lenses of gender.

New Haven, CT: Yale University Press.

Bitter, J. R. (2008). Reconsidering narcis-

sism: An Adlerian-feminist response to the

articles in the special section of the Journal

of Individual Psychology. Journal of Individual

Psychology, 64(3), 270–279.

Bitter, J. R., Robertson, P. E., Healey, A., &

Cole, L. (2009). Reclaiming a profeminist

orientation in Adlerian therapy. Journal of

Individual Psychology, 65(1), 13–33.

Brabeck, M. M. (Ed.). (2000). Practicing

feminist ethics in psychology. Washington, DC:

American Psychological Association.

Brabeck, M., & Brown, L. (1997). Feminist

theory and psychological practice. In J. Worell

& N. G. Johnson (Eds.), Shaping the future of

feminist psychology: Education, research, and

practice (pp. 15–35). Washington, DC:

American Psychological Association.

*Brown, L. S. (1994). Subversive dialogues:

Theory in feminist therapy. New York: Basic

Books.

Brown, L. S. (2006). Still subversive after all

these years: The relevance of feminist therapy

in the age of evidence-based practice. Psychol-

ogy of Women Quarterly, 30, 15–24.

*Brown, L. S. (2010). Feminist therapy.

Washington, DC: American Psychological

Association.

Brown, L. S., & Root, M. (1990). Diversity

and complexity in feminist therapy. New York:

Hayworth.

*Books and articles marked with an asterisk are suggested for further study.

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392

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395

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396

CHAPTER THIRTEEN

Some Contemporary Founders of Postmodern Therapies

Insoo Kim Berg / Steve de Shazer / Michael White / David Epston

INSOO KIM BERG (1935–

2007) was a co-developer

of the solution-focused

approach. Until her death in

2007, she was the director

of the Brief Family Therapy

Center in Milwaukee,

Wisconsin. As a leader in the

practice of solution-focused brief therapy (SFBT),

she provided workshops in the United States,

Japan, South Korea, Australia, Denmark, England,

and Germany. Among her writings are Family Based

Services: A Solution-Focused Approach (1994), Work-

ing With the Problem Drinker: A Solution-Focused

Approach (Berg & Miller, 1992), and Interviewing for

Solutions (De Jong & Berg, 2008).

Courtesy of Brief Family Therapy Center

The postmodern approaches do not have a single

founder. Rather, it has been a collective effort by

many. I have highlighted two cofounders of solution-

focused brief therapy and two cofounders of nar-

rative therapy who have had a major impact on the

development of these therapeutic approaches.

STEVE de SHAZER

(1940–2005) was one of the

pioneers of solution-focused

brief therapy. For many

years he was the director of

research at the Brief Family

Therapy Center in Milwaukee,

where solution-focused

brief therapy was developed. He wrote several

books on SFBT, including Keys to Solutions in Brief

Therapy (1985), Clues: Investigating Solutions in Brief

Therapy (1988), Putting Difference to Work (1991), and

Words Were Originally Magic (1994). He presented

workshops, trained, and consulted widely in North

America, Europe, Australia, and Asia. He died in

September 2005 while on a teaching tour in Europe.

MICHAEL WHITE (1949–

2008) was the cofounder,

with David Epston, of the

narrative therapy move-

ment. He founded the

Dulwich Centre in Adelaide,

Australia, and his work with

families and communities

has attracted widespread international interest.

Among his many books are Narrative Means to

Therapeutic Ends (White & Epston, 1990), Reau-

thoring Lives: Interviews and Essays (1995), Narrative

of Therapists’ Lives (1997), and Maps of Narrative

Practice (2007). Michael White died in April 2008

while visiting San Diego for a teaching workshop.

DAVID EPSTON (b. 1944)

is one of the co-developers

of narrative therapy. He is

co-director of the Family

Therapy Centre in Auckland,

New Zealand. He is an inter-

national traveler, presenting

lectures and workshops

in Australia, Europe, and

North America. He is a coauthor of Narrative Means

to Therapeutic Ends (White & Epston, 1990) and

Playful Approaches to Serious Problems: Narrative

Therapy With Children and Their Families (Freeman,

Epston, & Lobovits, 1997). He is well known for his

work with persons affected by eating disorders and

was a coauthor of Biting the Hand That Starves You

(Maisel, Epston, & Borden, 2004).

Courtesy of Brief Family Therapy Center

Courtesy of Cheryl White, Dulwich Centre,

Adelaide, Australia

Courtesy of David Epston

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397

POSTMODERN APPROACHES

introduction to social

constructionism

Each of the models of counseling and psychotherapy we have studied so far has

its own version of “reality.” The simultaneous existence of multiple and often con-

ﬂ icting “truths” has led to increasing skepticism of the possibility that a singular,

universal theory will one day explain human beings and the systems in which they

live. We have entered a postmodern world in which truth and reality are often

understood as points of view bounded by history and context rather than as objec-

tive, immutable facts.

Modernists believe in objective reality and assume that it can be observed and

systematically known through the scientiﬁ c method. They further believe reality

exists independent of any attempt to observe it. Modernists believe people seek

therapy for a problem when they have deviated too far from some objective norm.

For example, clients may think they are abnormally depressed when they experi-

ence sadness for longer than they think is normal. They might then seek help to

return to “normal” behavior.

Postmodernists, in contrast, believe that realities do not exist independent of

observational processes. Social constructionism is a psychological expression of this

postmodern worldview; it values the client’s reality without disputing whether it is

accurate or rational (Gergen, 1991, 1999; Weishaar, 1993). To social construction-

ists, any understanding of reality is based on the use of language and is largely a

function of the situations in which people live. Our knowledge about realities is so-

cially constructed. A person is depressed when he or she adopts a deﬁ nition of self

as depressed. Once a deﬁ nition of self is adopted, it is hard to recognize behaviors

counter to that deﬁ nition; for example, it is hard for someone who is suffering from

depression to acknowledge the value of a periodic good mood in his or her life.

In postmodern thinking, forms of language and the use of language in stories

create meaning. There may be as many meanings as there are people to tell the

stories, and each of these stories expresses a truth for the person telling it. Every

person involved in a situation has a perspective on the “reality” of that situation,

but the range of truths is limited due to the effects of speciﬁ c historical events and

the language uses that dominate particular social contexts. In practice, therefore,

the range of possible meanings is not inﬁ nite. When Kenneth Gergen (1985, 1991,

1999) and others began to emphasize the ways in which people make meaning in

social relationships, the ﬁ eld of social constructionism was born. Berger and Luck-

man (1967) are reputed to be the ﬁ rst who used the term social constructionism, and

it signaled a shift in emphasis for individual and family systems psychotherapy.

In social constructionism the therapist disavows the role of expert, preferring a

more collaborative or consultative stance. Clients are viewed as experts about their

own lives. De Jong and Berg (2008) put this notion about the therapist’s task well:

We do not view ourselves as expert at scientiﬁ cally assessing client problems and then inter-

vening. Instead, we strive to be expert at exploring clients’ frames of reference and identify-

ing those perceptions that clients can use to create more satisfying lives. (p. 19)

The collaborative partnership in the therapeutic process is considered more impor-

tant than assessment or technique. Understanding narratives and deconstructing

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398

CHAPTER THIRTEEN

language processes (linguistics) are the focus for both understanding individuals

and helping them construct desired change.

Social constructionist theory is grounded on four key assumptions (Burr, 2003),

which form the basis of the difference between postmodernism and traditional psycho-

logical perspectives. First, social constructionist theory invites a critical stance toward

taken-for-granted knowledge. Social constructionists challenge conventional knowl-

edge that has historically guided our understanding of the world, and they caution us to

be suspicious of assumptions of how the world appears to be. Second, social construc-

tionists believe the language and concepts we use to generally understand the world are

historically and culturally speciﬁ c. Knowledge is time- and culture-bound, and our ways

of understanding are not necessarily better than other ways. Third, social construction-

ists assert that knowledge is constructed through social processes. What we consider to

be “truth” is a product of daily interactions between people in daily life. Thus there is

not a single or “right” way to live one’s life. Fourth, negotiated understandings (social

constructions) are considered to be practices that affect social life rather than being

abstractions from it. Therefore, knowledge and social action go together.

See the video program for Chapter 13, DVD for Theory and Practice of Counseling

and Psychotherapy: The Case of Stan and Lecturettes. I suggest that you view the

brief lecture for each chapter prior to reading the chapter.

Historical Glimpse of Social Constructionism

A mere hundred years ago, Freud, Adler, and Jung were part of a major paradigm

shift that transformed psychology as well as philosophy, science, medicine, and

even the arts. In the 21st century, postmodern constructions of alternative knowl-

edge sources seem to be one of the paradigm shifts most likely to affect the ﬁ eld

of psychotherapy. Postmodernist thought is inﬂ uencing the development of many

psychotherapy theories and contemporary psychotherapeutic practice. The creation

of the self, which so dominated the modernist search for human essence and truth,

is being replaced with the concept of socially storied lives. Diversity, multiple frame-

works, and integration—collaboration of the knower with the known—are all part

of this new social movement, which provides a wider range of perspectives in coun-

seling practice. For some social constructionists, the process of “knowing” includes

a distrust of the dominant cultural positions that permeate families and society today

(White & Epston, 1990), particularly when the dominant culture exerts a destructive

impact on the lives of those who live beyond the margins of what is generally consid-

ered normal. Change begins by deconstructing the power of cultural narratives and

then proceeds to the co-construction of a new life of meaning.

Among the best-known postmodern perspectives on therapy practice are the

collaborative language systems approach (Anderson & Goolishian, 1992), solution-

focused brief therapy (de Shazer, 1985, 1988, 1991, 1994), solution-oriented ther-

apy (Bertolino & O’Hanlon, 2002; O’Hanlon & Weiner-Davis, 2003), narrative

therapy (White & Epston, 1990), and feminist therapy (Brown, 2010). The next sec-

tion examines the collaborative language systems approach, but the heart of this

chapter addresses two of the most signiﬁ cant postmodern approaches: solution-

focused brief therapy and narrative therapy.

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399

POSTMODERN APPROACHES

The Collaborative Language Systems Approach

A relatively unstructured social constructionist dialogue has been suggested

by Harlene Anderson and the late Harold Goolishian (1992) of the Houston

Galveston Institute. Rejecting the more therapist-controlled and theory-based

interventions of other North American therapeutic approaches, Anderson

and Goolishian developed a therapy of caring and being with the client. Their

stance is similar to the person-centered way of being that originated with Carl

Rogers, but without the theory of self-actualization. Informed by and contrib-

uting to the ﬁ eld of social constructionism, they came to believe human life is

constructed in personal and family narratives that maintain both process and

meaning in people’s lives. These narratives are constructed in social interac-

tion over time. The sociocultural systems in which people live are a product

of social interaction, not the other way around. In this sense, therapy is also a

system process created in the therapeutic conversations of the client and the

listener-facilitator.

When people seek therapy, they are often “stuck” in a dialogic system that

has a unique language, meaning, and process related to “the problem.” Therapy

is another conversational system that becomes therapeutic through its “problem-

organizing, problem-dissolving” nature (Anderson & Goolishian, 1992, p. 27).

It is therapists’ willingness to enter the therapeutic conversation from a “not-

knowing” position that facilitates this caring relationship with the client. In

the not-knowing position, therapists still retain all of the knowledge and person-

al, experiential capacities they have gained over years of living, but they allow

themselves to enter the conversation with curiosity and with an intense interest

in discovery. The aim here is to enter a client’s world as fully as possible.

Clients become the experts who are informing and sharing with the therapist

the signiﬁ cant narratives of their lives. The not-knowing position is empathic

and is most often characterized by questions that “come from an honest, con-

tinuous therapeutic posture of not understanding too quickly” (Anderson, 1993,

p. 331).

Based on the referral or intake process, the therapist enters the session with

some sense of what the client may wish to address. The questions the therapist

asks are always informed by the answers the client-expert has provided. The client’s

answers provide information that stimulates the interest of the therapist, still in a

posture of inquiry, and another question proceeds from each answer given. The

process is similar to the Socratic method without any preconceived idea about

how or in which direction the development of the stories should go. The intent of

the conversation is not to confront or challenge the narrative of the client but to

facilitate the telling and retelling of the story until opportunities for new meaning

and new stories develop: “Telling one’s story is a representation of experience; it

is constructing history in the present” (Anderson & Goolishian, 1992, p. 37). By

staying with the story, the therapist–client conversation evolves into a dialogue of

new meaning, constructing new narrative possibilities. This not-knowing position

of the therapist has been infused as a key concept for both the solution-focused and

the narrative therapeutic approaches.

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CHAPTER THIRTEEN

solution-focused brief therapy

Introduction

Solution-focused brief therapy (SFBT) is a future-focused, goal-oriented therapeu-

tic approach to brief therapy developed initially by Steve de Shazer and Insoo Kim

Berg at the Brief Family Therapy Center in Milwaukee in the early 1980s. SFBT

emphasizes strengths and resiliencies of people by focusing on exceptions to their

problems and their conceptualized solutions.

Having grown dissatisﬁ ed with the constraints of the strategic model, in the

1980s de Shazer collaborated with a number of therapists, including Eve Lipchik,

John Walter, Jane Peller, Michelle Weiner-Davis, and Bill O’Hanlon, who each

wrote extensively about solution-focused therapy and started their own solution-

focused training institutes. Both O’Hanlon and Weiner-Davis were inﬂ uenced

by de Shazer and Berg’s original work, and they expanded on this foundation to

create what they called solution-oriented therapy. In this chapter when I discuss

solution-focused brief therapy, solution-focused therapy, and solution-oriented therapy,

I am focusing on what these approaches have in common rather than looking at

their differences.

Key Concepts

unique focus of sfbt Solution-focused brief therapy (SFBT) differs from

traditional therapies by eschewing the past in favor of both the present and the

future. Therapists focus on what is possible, and they have little or no interest

in gaining an understanding of how the problem emerged. Behavior change

is viewed as the most effective approach to assisting people in enhancing their

lives. De Shazer (1988, 1991) suggests that it is not necessary to know the cause

of a problem to solve it and that there is no necessary relationship between the

causes of problems and their solutions. Assessing problems is not necessary for

change to occur. If knowing and understanding problems are unimportant, so

is searching for “right” or absolute solutions. Any person might consider mul-

tiple solutions, and what is right for one person may not be right for others. In

solution-focused brief therapy, clients choose the goals they wish to accomplish;

little attention is given to diagnosis, history taking, or exploring the emergence

of the problem (Berg & Miller, 1992; Gingerich & Eisengart, 2000; O’Hanlon &

Weiner-Davis, 2003).

positive orientation Solution-focused brief therapy is grounded on the

optimistic assumption that people are healthy and competent and have the abil-

ity to construct solutions that can enhance their lives. An underlying assumption

of SFBT is that we already have the ability to resolve the challenges life brings us,

but at times we lose our sense of direction or our awareness of our competencies.

Regardless of what shape clients are in when they enter therapy, solution-focused

therapists believe clients are competent. The therapist’s role is to help clients recog-

nize the competencies they already possess and apply them toward solutions. The

essence of therapy involves building on clients’ hope and optimism by creating posi-

tive expectations that change is possible. SFBT is a nonpathologizing approach that

emphasizes competencies rather than deﬁ cits, and strengths rather than weaknesses

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401

POSTMODERN APPROACHES

(Metcalf, 2001). The solution-focused model requires a philosophical stance of ac-

cepting people where they are and assisting them in creating solutions. Solution-

focused brief therapy has parallels with positive psychology, which concentrates

on what is right and what is working for people rather than dwelling on deﬁ cits,

weaknesses, and problems (Murphy, 2008). By emphasizing positive dimensions,

clients quickly become involved in resolving their problems, which makes this a

very empowering approach.

Because clients often come to therapy in a “problem-oriented” state, even the

few solutions they have considered are wrapped in the power of the problem orien-

tation. Clients often have a story that is rooted in a deterministic view that what has

happened in their past will certainly shape their future. Solution-focused practi-

tioners counter this negative client presentation with optimistic conversations that

highlight a belief in achievable and usable goals. Therapists can be instrumental in

assisting clients in making a shift from a ﬁ xed problem state to a world with new

possibilities. One of the goals of SFBT is to shift clients’ perceptions by reframing

what White and Epston (1990) refer to as clients’ problem-saturated stories through

the counselor’s skillful use of language.

looking for what is working The emphasis of SFBT is to focus on

what is working in clients’ lives, which stands in stark contrast to the traditional

models of therapy that tend to be problem-focused. Individuals bring stories to

therapy. Some stories are used to justify the client’s belief that life can’t be changed

or, worse, that life is moving them further and further away from their goals.

Solution-focused brief therapists assist clients in paying attention to the excep-

tions to their problem patterns. They promote hope by helping clients discover-

ing exceptions, or times when the problem is less intrusive in their life (Metcalf,

2001). SFBT focuses on ﬁ nding out what people are doing that is working and then

helping them apply this knowledge to eliminate problems in the shortest amount

of time possible. Identifying what is working and encouraging clients to replicate

these patterns is extremely important (Murphy, 2008). A key concept is, “Once you

know what works, do more of it.” If something is not working, clients are encour-

aged to do something different, which typically involves drawing on their unique

strengths and successes.

There are various ways to assist clients in thinking about what has worked

for them. De Shazer (1991) prefers to engage clients in conversations that lead to

progressive narratives whereby people create situations in which they can make

steady gains toward their goals. De Shazer might say, “Tell me about times when

you felt a little better and when things were going your way.” It is in these stories

of life worth living that the power of problems is deconstructed and new solutions

are manifest and made possible.

basic assumptions guiding practice Walter and Peller (1992,

2000) think of solution-focused therapy as a model that explains how people

change and how they can reach their goals. Here are some of their basic assump-

tions about solution-focused therapy:

• Individuals who come to therapy do have the capability of behaving effectively, even

though this effectiveness may be temporarily blocked by negative cognitions. Prob-

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CHAPTER THIRTEEN

lem-focused thinking prevents people from recognizing effective ways they have

dealt with problems.

• There are advantages to a positive focus on solutions and on the future. If clients

can reorient themselves in the direction of their strengths using solution-talk,

there is a good chance therapy can be brief.

• There are exceptions to every problem, or times when the problem was absent.

By talking about these exceptions, clients can get clues to effective solutions

and can gain control over what had seemed to be an insurmountable personal

difﬁ

culty. Rapid changes are possible when clients identify exceptions to their

problems and begin to organize their thinking around these exceptions instead

of around the problem.

• Clients often present only one side of themselves. Solution-focused therapists

invite clients to examine another side of the story they are presenting.

• No problem is constant, and change is inevitable. What people need to do is

become aware of any positive changes that are happening. Small changes pave

the way for larger changes. Oftentimes, small changes are all that are needed

to resolve problems that clients bring to therapy. Like tipping the ﬁ rst

domino,

one small change leads to another, then another, and so on until the “solution

momentum” outweighs the problem momentum.

• Clients want to change, have the capacity to change, and are doing their best to

make change happen. Therapists should adopt a cooperative stance with clients

rather than devising strategies to control resistive patterns. When therapists

ﬁ

nd ways to cooperate with people, resistance does not occur.

• Clients can be trusted in their intention to solve their problems. Therapists as-

sume that clients want to change, can change, and will change under coopera-

tive and empowering therapeutic conditions. There are no “right” solutions to

speciﬁ

c problems that can be applied to all people. Each individual is unique

and so, too, is each solution.

Walter and Peller (2000) have moved away from the term therapy and refer to

what they do as personal consultation. They facilitate conversations around the pref-

erences and possibilities of their clients to help them create a positive future. By

avoiding the stance of the expert, Walter and Peller believe they can be interested,

curious, and encouraging in jointly exploring the desires of their clients.

The Therapeutic Process

Bertolino and O’Hanlon (2002) stress the importance of creating collaborative

therapeutic relationships and see doing so as necessary for successful therapy.

Acknowledging that therapists have expertise in creating a context for change, they

stress that clients are the experts on their own lives and often have a good sense

of what has or has not worked in the past and, as well, what might work in the

future. Solution-focused counseling assumes a collaborative approach with clients

in contrast to the educative stance that is typically associated with most traditional

models of therapy. If clients are involved in the therapeutic process from begin-

ning to end, the chances are increased that therapy will be successful. In short, col-

laborative and cooperative relationships tend to be more effective than hierarchical

relationships in therapy.

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403

POSTMODERN APPROACHES

Walter and Peller (1992) describe four steps that characterize the process of

SFBT: (1) Find out what clients want rather than searching for what they do not

want. (2) Do not look for pathology, and do not attempt to reduce clients by giv-

ing them a diagnostic label. Instead, look for what clients are doing that is already

working and encourage them to continue in that direction. (3) If what clients are

doing is not working, encourage them to experiment with doing something differ-

ent. (4) Keep therapy brief by approaching each session as if it were the last and

only session. Although these steps seem fairly obvious, the collaborative process of

the client and therapist constructing solutions is not merely a matter of mastering

a few techniques.

De Shazer (1991) believes clients can generally build solutions to their prob-

lems without any assessment of the nature of their problems. Given this frame-

work, the structure of solution building differs greatly from traditional approaches

to problem solving as can be seen in this brief description of the steps involved

(De Jong & Berg, 2008):

1. Clients are given an opportunity to describe their problems. The therapist lis-

tens respectfully and carefully as clients answer the therapist’s question, “How

can I be useful to you?”

2. The therapist works with clients in developing well-formed goals as soon as

possible. The question is posed, “What will be different in your life when your

problems are solved?”

3. The therapist asks clients about those times when their problems were not

present or when the problems were less severe. Clients are assisted in exploring

these exceptions, with special emphasis on what they did to make these events

happen.

4. At the end of each solution-building conversation, the therapist offers clients

summary feedback, provides encouragement, and suggests what clients might

observe or do before the next session to further solve their problem.

5. The therapist and clients evaluate the progress being made in reaching satisfac-

tory solutions by using a rating scale. Clients are asked what needs to be done

before they see their problem as being solved and also what their next step will be.

therapeutic goals SFBT reﬂ ects some basic notions about change, about

interaction, and about reaching goals. The solution-focused therapist believes peo-

ple have the ability to deﬁ ne meaningful personal goals and that they have the

resources required to solve their problems. Goals are unique to each client and are

constructed by the client to create a richer future (Prochaska & Norcross, 2010). A

lack of clarity regarding client preferences, goals, and desired outcomes can result

in a rift between therapist and client. During the early phase of therapy, it is impor-

tant that clients be given the opportunity to express what they want from therapy

and what concerns they are willing to explore. From the ﬁ rst contact with clients,

the therapist strives to create a climate that will facilitate change and encourage

clients to think in terms of a range of possibilities.

Solution-focused therapists concentrate on small, realistic, achievable changes

that can lead to additional positive outcomes. Because success tends to build

upon itself, modest goals are viewed as the beginning of change. Solution-focused

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404

CHAPTER THIRTEEN

practitioners join with the language of their clients, using similar words, pacing,

and tone. Therapists use questions such as these that presuppose change, posit

multiple answers, and remain goal-directed and future-oriented: “What did you

do, and what has changed since last time?” or “What did you notice that went bet-

ter?” (Bubenzer & West, 1993).

Walter and Peller (1992) and Murphy (2008) emphasize the importance of

assisting clients in creating well-deﬁ ned goals that are (1) stated positively in the

client’s language; (2) are process- or action-oriented; (3) are structured in the here

and now; (4) are attainable, concrete, speciﬁ c, and measurable; and (5) are control-

led by the client. Counselors should not too rigidly impose an agenda of getting

precise goals before clients have a chance to express their concerns. Clients must

feel that their concerns are heard and understood before they can formulate mean-

ingful personal goals. In a therapist’s zeal to be solution-focused, it is possible to

get lost in the mechanics of therapy and not attend sufﬁ ciently to the interpersonal

aspects.

Solution-oriented therapy offers several forms of goals: changing the viewing

of a situation or a frame of reference, changing the doing of the problematic situa-

tion, and tapping client strengths and resources (O’Hanlon & Weiner-Davis, 2003).

Therapists note the language they use, so they can increase their clients’ hope and

optimism and their openness to possibilities and change. Clients are encouraged

to engage in change- or solution-talk, rather than problem-talk, on the assumption

that what we talk about most will be what we produce. Talking about problems can

produce ongoing problems. Talk about change can produce change.

therapist’s function and role Clients are much more likely to fully

participate in the therapeutic process if they perceive themselves as determining

the direction and purpose of the conversation (Walter & Peller, 1996). Much of

what the therapeutic process is about involves clients’ thinking about their future

and what they want to be different in their lives. Consistent with the postmodern

and social constructionist perspective, solution-focused brief therapists adopt a not-

knowing position to put clients in the position of being the experts about their own

lives. Therapists do not assume that by virtue of their expert frame of reference

they know the signiﬁ cance of the client’s actions and experiences (Anderson &

Goolishian, 1992). This model casts the role and function of a therapist in quite

a different light from traditionally oriented therapists who view themselves as

experts in assessment and treatment. The therapist-as-expert is replaced by the

client-as-expert, especially when it comes to what the client wants in life and in

therapy. It is important that therapists actually believe that their clients are the

true experts on their own lives. According to Guterman (2006), therapists have

expertise in the process of change, but clients are the experts on what they want

changed. The therapist’s task is to point clients in the direction of change without

dictating what to change.

Therapists strive to create a climate of mutual respect, dialogue, and afﬁ rma-

tion in which clients experience the freedom to create, explore, and coauthor their

evolving stories. A key therapeutic task consists of helping clients imagine how they

would like life to be different and what it would take to make this transformation

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405

POSTMODERN APPROACHES

happen. One of the functions of the therapist is to ask questions and, based on the

answers, generate further questions. Examples of some useful questions are “What

do you hope to gain from coming here?” “If you were to make the changes you de-

sire, how would that make a difference in your life?” and “What steps can you take

now that will lead to these changes?”

the therapeutic relationship The quality of the relationship between

therapist and client is a determining factor in the outcomes of SFBT, so relation-

ship building or engagement is a basic step in SFBT. The attitude of the therapist

is crucial to the effectiveness of the therapeutic process. It is essential to create a

sense of trust so clients will return for further sessions and will follow through on

homework suggestions. The therapeutic process works best when clients become

actively involved, when they experience a positive relationship with the therapist,

and when counseling addresses what clients see as being important (Murphy,

2008). One way of creating an effective therapeutic partnership is for the therapist

to show clients how they can use the strengths and resources they already have to

construct solutions. Clients are encouraged to do something different and to be

creative in thinking about ways to deal with their present and future concerns.

De Shazer (1988) has described three kinds of relationships that may develop

between therapists and their clients:

1. Customer: the client and therapist jointly identify a problem and a solution to

work toward. The client realizes that to attain his or her goals, personal effort

will be required.

2. Complainant: the client describes a problem but is not able or willing to assume

a role in constructing a solution, believing that a solution is dependent on some-

one else’s actions. In this situation, the client generally expects the therapist to

change the other person to whom the client attributes the problem.

3. Visitor: the client comes to therapy because someone else (a spouse, parent,

teacher, or probation ofﬁ cer) thinks the client has a problem. This client may

not agree that he or she has a problem and may be unable to identify anything

to explore in therapy.

De Jong and Berg (2008) recommend using caution so that therapists do not box

clients into static identities. These three roles are only starting points for conversa-

tion. Rather than categorizing clients, therapists can reﬂ ect on the kinds of rela-

tionships that are developing between their clients and themselves. For example,

clients who tend to place the cause of their problems on another person or persons

in their lives (complainants) may be helped by skilled intervention to begin to see

their own role in their problems and the necessity for taking active steps in creat-

ing solutions. A visitor client may be willing to work with the therapist to create a

customer relationship by exploring what the client needs to do to satisfy the other

person or “get them off their back.” Initially, some clients will feel powerless and

overwhelmed by their problems. Even clients who are unable to articulate a prob-

lem may change as the result of developing an effective therapeutic alliance. How

the therapist responds to different behaviors of clients has a lot to do with bringing

about a shift in the relationship. In short, both complainants and visitors have the

capacity for becoming customers.

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CHAPTER THIRTEEN

Application: Therapeutic Techniques and Procedures

Some of the key techniques that solution-focused practitioners are likely to employ

include looking for differences in doing, exception questions, scaling questions,

and the miracle question. If these techniques are used in a routine way without

developing a collaborative working alliance, they will not lead to effective results.

Murphy (2008) reminds us that these solution-focused techniques should be used

ﬂ exibly and tailored to the unique circumstances of each client. Therapy is best

guided by the client’s goals, perceptions, resources, and feedback. Therapy should

not be determined by any absolutes or rigid standards outside the therapeutic rela-

tionship (namely, evidence-based treatments).

pretherapy change Simply scheduling an appointment often sets positive

change in motion. During the initial therapy session, it is common for solution-

focused therapists to ask, “What have you done since you called for the appointment

that has made a difference in your problem?” (de Shazer, 1985, 1988). By asking

about such changes, the therapist can elicit, evoke, and amplify what clients have

already done by way of making positive change. These changes cannot be attrib-

uted to the therapy process itself, so asking about them tends to encourage clients

to rely less on their therapist and more on their own resources to accomplish their

treatment goals (McKeel, 1996; Weiner-Davis, de Shazer, & Gingerich, 1987).

exception questions SFBT is based on the notion that there were times in

clients’ lives when the problems they identify were not problematic. These times are

called exceptions and represent news of difference (Bateson, 1972). Solution-focused

therapists ask exception questions to direct clients to times when the problem did

not exist, or when the problem was not as intense. Exceptions are those past experi-

ences in a client’s life when it would be reasonable to have expected the problem

to occur, but somehow it did not (de Shazer, 1985; Murphy, 2008). By helping

clients identify and examine these exceptions, the chances are increased that they

will work toward solutions (Guterman, 2006). Once identiﬁ ed by an individual,

these instances of success can be useful in making further changes. Change-focused

questions explore what clients believe to be important goals and how they can tap

their strengths and resources to reach their goals (Murphy, 2008). This exploration

reminds clients that problems are not all-powerful and have not existed forever; it

also provides a ﬁ eld of opportunity for evoking resources, engaging strengths, and

positing possible solutions. The therapist asks clients what has to happen for these

exceptions to occur more often.

the miracle question Therapy goals are developed by using what de

Shazer (1988) calls the miracle question, which is a main SFBT technique. The

therapist asks, “If a miracle happened and the problem you have was solved over-

night, how would you know it was solved, and what would be different?” Clients

are then encouraged to enact “what would be different” in spite of perceived prob-

lems. If a client asserts that she wants to feel more conﬁ dent and secure, the thera-

pist might say: “Let yourself imagine that you leave the ofﬁ ce today and that you

are on track to acting more conﬁ dently and securely. What will you be doing differ-

ently?” This process of considering hypothetical solutions reﬂ ects O’Hanlon and

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407

POSTMODERN APPROACHES

Weiner-Davis’s (2003) belief that changing the doing and viewing of the perceived

problem changes the problem.

De Jong and Berg (2008) identify several reasons the miracle question is a

useful technique. Asking clients to consider that a miracle takes place opens up a

range of future possibilities. Clients are encouraged to allow themselves to dream

as a way of identifying the kinds of changes they most want to see. This question

has a future focus in that clients can begin to consider a different kind of life that

is not dominated by a particular problem. This intervention shifts the emphasis

from both past and current problems toward a more satisfying life in the future.

scaling questions Solution-focused therapists also use scaling questions

when change in human experiences are not easily observed, such as feelings,

moods, or communication, and to assist clients in noticing that they are not com-

pletely defeated by their problem (de Shazer & Berg, 1988). For example, a woman

reporting feelings of panic or anxiety might be asked: “On a scale of zero to 10,

with zero being how you felt when you ﬁ rst came to therapy and 10 being how you

feel the day after your miracle occurs and your problem is gone, how would you

rate your anxiety right now?” Even if the client has only moved away from zero to

1, she has improved. How did she do that? What does she need to do to move an-

other number up the scale? Scaling questions enable clients to pay closer attention

to what they are doing and how they can take steps that will lead to the changes

they desire.

formula first session task The formula ﬁ rst session task (FFST) is

a form of homework a therapist might give clients to complete between their ﬁ rst

and second sessions. The therapist might say: “Between now and the next time we

meet, I would like you to observe, so that you can describe to me next time, what

happens in your (family, life, marriage, relationship) that you want to continue

to have happen” (de Shazer, 1985, p. 137). At the second session, clients can be

asked what they observed and what they would like to have happen in the future.

This kind of assignment offers clients hope that change is inevitable. It is not a

matter of if change will occur, but when it will happen. According to de Shazer,

this intervention tends to increase clients’ optimism and hope about their present

and future situation. The FFST technique emphasizes future solutions rather than

past problems (Murphy, 2008). Bertolino and O’Hanlon (2002) suggest that the

FFST intervention be used after clients have had a chance to express their present

concerns, views, and stories. It is important that clients feel understood before they

are directed to make changes.

therapist feedback to clients Solution-focused practitioners gen-

erally take a break of 5 to 10 minutes toward the end of each session to compose

a summary message for clients. During this break therapists formulate feed-

back that will be given to clients after the break. De Jong and Berg (2008) de-

scribe three basic parts to the structure of the summary feedback: compliments,

a bridge, and suggesting a task. Compliments are genuine afﬁ rmations of what

clients are already doing that is leading toward effective solutions. It is impor-

tant that complimenting is not done in a routine or mechanical way, but in an

encouraging manner that creates hope and conveys the expectation to clients

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408

CHAPTER THIRTEEN

that they can achieve their goals by drawing on their strengths and successes.

Second, a bridge links the initial compliments to the suggested tasks that will be

given. The bridge provides the rationale for the suggestions. The third aspect

of feedback consists of suggesting tasks to clients, which can be considered as

homework. Observational tasks ask clients to simply pay attention to some

aspect of their lives. This self-monitoring process helps clients note the differ-

ences when things are better, especially what was different about the way they

thought, felt, or behaved. Behavioral tasks require that clients actually do some-

thing the therapist believes would be useful to them in constructing solutions.

De Jong and Berg (2008) stress that a therapist’s feedback to clients addresses

what they need to do more of and do differently in order to increase the chances of

obtaining their goals.

terminating From the very ﬁ rst solution-focused interview, the therapist

is mindful of working toward termination. Once clients are able to construct a

satisfactory solution, the therapeutic relationship can be terminated. The initial

goal-formation question that a therapist often asks is, “What needs to be different

in your life as a result of coming here for you to say that meeting with me was

worthwhile?” Another question to get clients thinking is, “When the problem is

solved, what will you be doing differently?” Through the use of scaling questions,

therapists can assist clients in monitoring their progress so clients can determine

when they no longer need to come to therapy (De Jong & Berg, 2008). Prior to end-

ing therapy, therapists assist clients in identifying things they can do to continue

the changes they have already made into the future. Clients can also be helped to

identify hurdles or perceived barriers that could get in the way of maintaining the

changes they have made.

Guterman (2006) maintains that the ultimate goal of solution-focused coun-

seling is to end treatment. He adds, “If counselors are not proactive in making

their treatment brief by design, then in many cases counseling will be brief by

default” (p. 67). Because this model of therapy is brief, present-centered, and

addresses speciﬁ c complaints, it is very possible that clients will experience other

developmental concerns at a later time. Clients can ask for additional sessions

whenever they feel a need to get their life back on track or to update their story.

Dr. John Murphy puts many SFBT techniques into action as he illustrates assess-

ment and treatment from a solution-focused brief therapy approach in the case

of Ruth in Case Approach to Counseling and Psychotherapy (Corey, 2013, chap. 11).

application to group counseling The solution-focused group prac-

titioner believes that people are competent, and that given a climate where they

can experience their competency, they are able to solve their own problems, ena-

bling them to live a richer life. From the beginning, the group facilitator sets a

tone of focusing on solutions (Metcalf, 1998) in which group members are given

an opportunity to describe their problems brieﬂ y. A facilitator might begin a new

group by requesting, “I would like each of you to introduce yourself. As you do,

give us a brief idea as to why you are here and tell us what you would like for us

to know about you.” Facilitators help members to keep the problem external in

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POSTMODERN APPROACHES

conversations, which tends to be a relief because it gives members an opportunity

to see themselves as less problem-saturated. It is the facilitator’s role to create

opportunities for the members to view themselves as being resourceful. Because

SFBT is designed to be brief, the leader has the task of keeping group members

on a solution track rather than a problem track, which helps members to move in

a positive direction.

The group leader works with members in developing well-formed goals as

soon as possible. Leaders concentrate on small, realistic, achievable changes that

may lead to additional positive outcomes. Because success tends to build upon

itself, modest goals are viewed as the beginning of change. Questions used to as-

sist members in formulating clear goals might include “What will be different in

your life when each of your problems is solved?” and “What will be going on in

the future that will tell you and the rest of us in the group that things are better for

you?” Sometimes members talk about what others will be doing or not doing and

forget to pay attention to their own goals or behavior. At times such as this they

can be asked, “And what about yourself? What will you be doing differently in that

picture? As a result of your doing things differently, how would you imagine others

responding to you?”

The facilitator asks members about times when their problems were not present

or when the problems were less severe. The members are assisted in exploring

these exceptions, and special emphasis is placed on what they did to make these

events happen. The participants engage in identifying exceptions with each other.

This improves the group process and promotes a solution focus, which can become

quite powerful. Exceptions are real events that take place outside of the problem

context. In individual counseling, only the therapist and the client are observers of

competency. An advantage of group counseling is that the audience widens and

more input is possible (Metcalf, 1998).

The art of questioning is a main intervention used in solution-focused groups.

Questions are asked from a position of respect, genuine curiosity, sincere inter-

est, and openness. Group leaders use questions such as these that presuppose

change and remain goal-directed and future-oriented: “What did you do and what

has changed since last time?” or “What did you notice that went better?” Other

group members are encouraged to respond along with the group leader to promote

group interaction. Facilitators may pose questions like these: “Someday, when the

problems that brought you to this group are less problematic to you, what will you

be doing?” “As each of you listened to others today, is there someone in our group

who could be a source of encouragement for you to do something different?” The

leader is attempting to help the members identify exceptions and begin to recog-

nize personal resiliency and competency. Creating a group context in which the

members are able to learn more about their personal abilities is key to members

learning to resolve their own concerns.

Solution-focused group counseling offers a great deal of promise for practition-

ers who want a practical and time-effective approach to interventions in school set-

tings. As a cooperative approach, SFBT shifts the focus from what’s wrong in stu-

dents’ lives to what’s working for them (Murphy, 2008; Sklare, 2005). Rather than

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CHAPTER THIRTEEN

being a cookbook of techniques for removing students’ problems, this approach of-

fers school counselors a collaborative framework aimed at achieving small, concrete

changes that enable students to discover a more productive direction. This model has

much to offer to school counselors who are responsible for serving large caseloads

of students in a K–12 school system. For a more detailed treatment of how SFBT

can be applied to group work in the schools, see Sklare (2005) and Murphy (2008).

They give special attention to the process of goal setting and provides many concrete

examples of how counselors can assist students in identifying well-established goals.

For a more detailed discussion of SFBT in groups, see Corey (2012, chap. 16).

narrative therapy

Introduction

Of all the social constructionists, Michael White and David Epston (1990) are best

known for their use of narrative in therapy. According to White (1992), individu-

als construct the meaning of life in interpretive stories, which are then treated

as “truth.” Because of the power of dominant culture narratives, individuals tend

to internalize the messages from these dominant discourses, which often work

against the life opportunity of the individual.

Adopting a postmodern, narrative, social constructionist view sheds light on

how power, knowledge, and “truth” are negotiated in families and other social and

cultural contexts (Freedman & Combs, 1996). Therapy is, in part, a reestablish-

ment of personal agency from the oppression of external problems and the domi-

nant stories of larger systems.

Key Concepts

The key concepts and therapeutic process sections are adapted from several differ-

ent works, but primarily from these sources: Winslade and Monk (2007), Monk

(1997), Winslade, Crocket, and Monk (1997), McKenzie and Monk (1997), and

Freedman and Combs (1996).

focus of narrative therapy The narrative approach involves adopt-

ing a shift in focus from most traditional theories. Therapists are encouraged to

establish a collaborative approach with a special interest in listening respectfully

to clients’ stories; to search for times in clients’ lives when they were resourceful;

to use questions as a way to engage clients and facilitate their exploration; to avoid

diagnosing and labeling clients or accepting a totalizing description based on a

problem; to assist clients in mapping the inﬂ uence a problem has had on their

lives; and to assist clients in separating themselves from the dominant stories they

have internalized so that space can be opened for the creation of alternative life

stories (Freedman & Combs, 1996).

the role of stories We live our lives by stories we tell about ourselves

and that others tell about us. These stories actually shape reality in that they con-

struct and constitute what we see, feel, and do. The stories we live by grow out of

conversations in a social and cultural context. Therapy clients do not assume the

role of pathologized victims who are leading hopeless and pathetic lives; rather,

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POSTMODERN APPROACHES

they emerge as courageous victors who have vivid stories to recount. The stories

not only change the person telling the story, but also change the therapist who is

privileged to be a part of this unfolding process (Monk, 1997).

listening with an open mind All social constructionist theories em-

phasize listening to clients without judgment or blame, afﬁ rming and valuing

them. Narrative practice goes further in deconstructing the systems of normal-

izing judgment that are found in medical, psychological, and educational dis-

course. Normalizing judgment is any kind of judgment that locates a person on a

normal curve and is used to assess intelligence, mental health, or normal behavior.

Because these kinds of judgments claim to be objective measures, they are difﬁ cult

for individuals to resist and usually are internalized. Narrative therapists argue that

suspending personal judgment is of little value if you participate in normalizing

judgment. Deconstruction involves turning the tables and inquiring what clients

think of the judgments they have been assigned. Narrative practitioners might be

said to invite people to pass judgment on the judgments that have been working

them over.

Lindsley (1994) emphasizes that therapists can encourage their clients to

reconsider absolutist judgments by moving toward seeing both “good” and “bad”

elements in situations. Narrative therapists make efforts to enable clients to modify

painful beliefs, values, and interpretations without imposing their value systems

and interpretations. They want to create meaning and new possibilities from the

stories clients share rather than out of a preconceived and ultimately imposed

theory of importance and value.

Although narrative therapists bring to the therapy venture certain attitudes

such as optimism, respectful curiosity and persistence, and a valuing for the cli-

ent’s knowledge, they seek to listen to the problem-saturated story of the client

without getting stuck. As narrative therapists listen to the client’s story, they stay

alert for details that give evidence of the client’s competence in taking stands

against oppressive problems. Winslade and Monk (2007) maintain that the thera-

pist believes that clients have abilities, talents, positive intentions, and life experi-

ences that can be the catalysts for new possibilities for action. The counselor needs

to demonstrate faith that these strengths and competencies can be identiﬁ ed, even

when the client is having difﬁ culty seeing them.

During the narrative conversation, attention is given to avoiding totalizing lan-

guage, which reduces the complexity of the individual by assigning an all-embracing,

single description to the essence of the person. Therapists begin to separate the

person from the problem in their mind as they listen and respond (Winslade &

Monk, 2007).

The narrative perspective focuses on the capacity of humans for creative and

imaginative thought, which is often found in their resistance to dominant dis-

course. Narrative practitioners do not assume that they know more about the lives

of clients than their clients do. Clients are the primary interpreters of their own

experiences. People are viewed as active agents who are able to derive meaning

from their experiential world, and they are encouraged to join with others who

might share in the development of a counter story.

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CHAPTER THIRTEEN

The Therapeutic Process

This brief overview of the steps in the narrative therapeutic process illustrates the

structure of the narrative approach (O’Hanlon, 1994, pp. 25–26):

• Collaborate with the client to come up with a mutually acceptable name for the

problem.

• Personify the problem and attribute oppressive intentions and tactics to it.

• Investigate how the problem has been disrupting, dominating, or discouraging

to the client.

• Invite the client to see his or her story from a different perspective by offering

alternative meanings for events.

• Discover moments when the client wasn’t dominated or discouraged by the

problem by searching for exceptions to the problem.

• Find historical evidence to bolster a new view of the client as competent enough

to have stood up to, defeated, or escaped from the dominance or oppression

of the problem. (At this phase the person’s identity and life story begin to be

rewritten.)

• Ask the client to speculate about what kind of future could be expected from

the strong, competent person who is emerging. As the client becomes free of

problem-saturated stories of the past, he or she can envision and plan for a less

problematic future.

• Find or create an audience for perceiving and supporting the new story. It is

not enough to recite a new story. The client needs to live the new story outside

of therapy. Because the person’s problem initially developed in a social context,

it is essential to involve the social environment in supporting the new life story

that has emerged in the conversations with the therapist.

Winslade and Monk (2007) stress that narrative conversations do not follow the

linear progression described here; it is better to think of these steps in terms of

cyclical progression containing the following elements:

• Move problem stories toward externalized descriptions of problems

• Map the effects of a problem on the individual

• Listen to signs of strength and competence in an individual’s problem-saturated

stories

• Build a new story of competence and document these achievements

therapy goals A general goal of narrative therapy is to invite people to

describe their experience in new and fresh language. In doing this, they open up

new vistas of what is possible. This new language enables clients to develop new

meanings for problematic thoughts, feelings, and behaviors (Freedman & Combs,

1996). Narrative therapy almost always includes an awareness of the impact of

various aspects of dominant culture on human life. Narrative practitioners seek

to enlarge the perspective and focus and facilitate the discovery or creation of new

options that are unique to the people they see.

therapist’s function and role Narrative therapists are active fa-

cilitators. The concepts of care, interest, respectful curiosity, openness, empathy,

contact, and even fascination are seen as a relational necessity. The not-knowing

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413

POSTMODERN APPROACHES

position, which allows therapists to follow, afﬁ rm, and be guided by the stories of

their clients, creates participant-observer and process-facilitator roles for the thera-

pist and integrates therapy with a postmodern view of human inquiry.

A main task of the therapist is to help clients construct a preferred story line.

The narrative therapist adopts a stance characterized by respectful curiosity and

works with clients to explore both the impact of the problem on them and what

they are doing to reduce the effects of the problem (Winslade & Monk, 2007). One

of the main functions of the therapist is to ask questions of clients and, based on

the answers, to generate further questions.

White and Epston (1990) start with an exploration of the client in relation to

the presenting problem. It is not uncommon for clients to present initial stories in

which they and the problem are fused, as if one and the same. White uses questions

aimed at separating the problem from the people affected by the problem. This

shift in language begins the deconstruction of the original narrative in which the

person and the problem were fused; now the problem is objectiﬁ ed as external to

the client.

Like the solution-focused therapist, the narrative therapist assumes the client

is the expert when it comes to what he or she wants in life. The narrative therapist

tends to avoid using language that embodies diagnosis, assessment, treatment,

and intervention. Functions such as diagnosis and assessment often grant prior-

ity to the practitioner’s “truth” over clients’ knowledge about their own lives. The

narrative approach gives emphasis to understanding clients’ lived experiences and

de-emphasizes efforts to predict, interpret, and pathologize. Narrative practition-

ers are careful not to ascribe the major role of taking initiative in another per-

son’s life or usurping the agency (power) of the client in bringing about change

(Winslade et al., 1997).

When it comes to the effective practice of narrative therapy, there are no set for-

mulas or recipes to follow (Freedman & Combs, 1996; Monk, Winslade, Crocket, &

Epston, 1997; Winslade & Monk, 2007). Monk (1997) emphasizes that narrative

therapy will vary with each client because each person is unique. For Monk, narra-

tive conversations are based on a way of being, and if narrative counseling “is seen

as a formula or used as a recipe, clients will have the experience of having things

done to them and feel left out of the conversation” (p. 24).

the therapeutic relationship Narrative therapists place great im-

portance on the values and ethical commitments a therapist brings to the therapy

venture. Some of these attitudes include optimism and respect, curiosity and per-

sistence, valuing the client’s knowledge, and creating a special kind of relation-

ship characterized by a real power-sharing dialogue (Winslade & Monk, 2007).

Collaboration, compassion, reﬂ ection, and discovery characterize the therapeutic

relationship. If this relationship is to be truly collaborative, the therapist needs to

be aware of how power manifests itself in his or her professional practice. This

does not mean that the therapist does not have authority as a professional. He or

she uses this authority, however, by treating clients as experts in their own lives.

Furthermore, the therapist is interested in facilitating the articulation of the values

and ethical commitments of the client.

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CHAPTER THIRTEEN

Winslade, Crocket, and Monk (1997) describe this collaboration as coauthor-

ing or sharing authority. Clients function as authors when they have the authority

to speak on their own behalf. In the narrative approach, the therapist-as-expert

is replaced by the client-as-expert. This notion challenges the stance of the thera-

pist as being an all-wise and all-knowing expert. Winslade and Monk (2007) state:

“The integrity of the counseling relationship is thus maintained while the client

is honored as the senior author in the construction of an alternative narrative

(pp. 57–58).

Clients are often stuck in a pattern of living a problem-saturated story that

does not work. When a client has a limited perception of his or her capacities

due to being saturated in problem thinking, it is the job of the therapist to elic-

it other strength-related stories to modify the client’s perception. The therapist

assists the client in this pursuit by entering into a dialogue and asking questions in

an effort to elicit the perspectives, resources, and unique experiences of the client.

The past is history, but it sometimes provides a foundation for understanding and

discovering news of differences or unique outcomes that will make a difference.

The history of the problem often dominates understanding, but there is another

history that narrative therapists argue should not be neglected. It is the history of

the counter story to the problem story, which is constructed in conversation and

becomes the foundation for a different future. The narrative therapist supplies the

optimism and sometimes a process, but the client generates what is possible and

contributes the movement that actualizes it.

Application: Therapeutic Techniques and Procedures

The effective application of narrative therapy is more dependent on therapists’

attitudes or perspectives than on techniques. In the practice of narrative therapy,

there is no recipe, no set agenda, and no formula that the therapist can follow to

assure positive results (Drewery & Winslade, 1997). When externalizing questions

are approached mainly as a technique, the intervention will be shallow, forced, and

unlikely to produce signiﬁ cant therapeutic effects (Freedman & Combs, 1996;

O’Hanlon, 1994).

Narrative therapists are in agreement with Carl Rogers on the notion of the

therapist’s way of being as opposed to being technique driven. A narrative approach

to counseling is more than the application of skills; it is based on the therapist’s

personal characteristics that create a climate that encourages clients to see their

stories from different perspectives. However, a series of “maps” of narrative con-

versational trajectories can help give structure and direction to a therapeutic conver-

sation (White, 2007). The approach is also an expression of an ethical stance, which

is grounded in a postmodern framework. It is from this conceptual framework that

practices are applied to assist clients in ﬁ nding new meanings and new possibilities

in their lives (Winslade & Monk, 2007).

questions . . . and more questions The questions narrative thera-

pists ask may seem embedded in a unique conversation, part of a dialogue about

earlier dialogues, a discovery of unique events, or an exploration of dominant cul-

ture processes and imperatives. Whatever the purpose, the questions are often

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415

POSTMODERN APPROACHES

circular, or relational, and they seek to empower clients in new ways. To use

Gregory Bateson’s (1972) famous phrase, they are questions in search of a differ-

ence that will make a difference.

Narrative therapists use questions as a way to generate experience rather than

to gather information. The aim of questioning is to progressively discover or con-

struct the client’s experience so that the client has a sense of a preferred direction.

Questions are always asked from a position of respect, curiosity, and openness.

Therapists ask questions from a not-knowing position, meaning that they do not

pose questions that they think they already know the answers to. Monk (1997)

describes this stance as follows:

In contrast to the normative, knowing stance, a narrative way of working invites the coun-

selor to take up the investigative, exploratory, archaeological position. She demonstrates to

the client that being a counselor does not imply any privileged access to the truth. The coun-

selor is consistently in the role of seeking understanding of the client’s experience. (p. 25)

Through the process of asking questions, therapists provide clients with an op-

portunity to explore various dimensions of their life situations. This questioning

process helps bring out the unstated cultural assumptions that contribute to the

original construction of the problem. The therapist is interested in ﬁ nding out how

the problems ﬁ rst became evident, and how they have affected clients’ views of

themselves (Monk, 1997). Narrative therapists attempt to engage people in decon-

structing problem-saturated stories, identifying preferred directions, and creating

alternative stories that support these preferred directions (Freedman & Combs,

1996). For a more complete discussion of the use of questions in narrative thera-

py, see Madigan (2011).

externalization and deconstruction Narrative therapists believe

it is not the person that is the problem, but the problem that is the problem (White,

1989). These problems often are products of the cultural world or of the power

relations in which this world is located. Living life means relating to problems, not

being fused with them.. Narrative therapists help clients deconstruct these prob-

lematic stories by disassembling the taken-for-granted assumptions that are made

about an event, which then opens alternative possibilities for living (Winslade &

Monk, 2007).

Externalization is one process for deconstructing the power of a narrative. This

process separates the person from identiﬁ cation with the problem. When clients

view themselves as “being” the problem, they are limited in the ways they can effec-

tively deal with the problem. When clients experience the problem as being located

outside of themselves, they create a relationship with the problem. For example,

there is quite a difference between labeling someone an alcoholic and indicating

that alcohol has invaded his or her life. Separating the problem from the individual

facilitates hope and enables clients to take a stand against speciﬁ c story lines, such

as self-blame. By understanding the cultural invitations to blame oneself, clients

can deconstruct this story line and generate a more positive, healing story.

The method used to separate the person from the problem is referred to

as externalizing conversation, which opens up space for new stories to emerge.

This method is particularly useful when people have internalized diagnoses and

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CHAPTER THIRTEEN

labels that have not been validating or empowering of the change process

(Bertolino & O’Hanlon, 2002). Externalizing conversations counteract oppressive,

problem-saturated stories and empower clients to feel competent to handle the

problems they face. Two stages of structuring externalizing conversations are (1) to

map the inﬂ uence of the problem in the person’s life, and (2) to map the inﬂ uence

of the person’s life back on the problem (McKenzie & Monk, 1997).

Mapping the inﬂ uence of the problem on the person generates a great deal of

useful information and often results in people feeling less shamed and blamed.

People feel listened to and understood when the problem’s inﬂ uences are explored

in a systematic fashion. A common question is, “When did this problem ﬁ rst

appear in your life?” When this mapping is done carefully, it lays the foundation

for coauthoring a new story line for the client. Often clients feel outraged when

they see for the ﬁ rst time how much the problem is affecting them. The job of the

therapist is to assist clients in tracing the problem from when it originated to the

present. Therapists may put a future twist on the problem by asking, “If the prob-

lem were to continue for a month (or any time period), what would this mean

for you?” This question can motivate the client to join with the therapist in com-

bating the impact of the problem’s effects. Other useful questions are “To what

extent has this problem inﬂ uenced your life?” and “How deeply has this problem

affected you?”

It is important to identify instances when the problem did not completely dom-

inate a client’s life. This kind of mapping can help the client who is disillusioned

by the problem see some hope for a different kind of life. Therapists look for these

“sparkling moments” as they engage in externalizing conversations with clients

(White & Epston, 1990).

The case of Brandon illustrates an externalizing conversation. Brandon says

that he gets angry far too much, especially when he feels that his wife is criticizing

him unjustly: “I just ﬂ are! I pop off, get upset, ﬁ ght back. Later, I wish I hadn’t, but

it’s too late. I’ve messed up again.” Questions about how his anger occurs, com-

plete with speciﬁ c examples and events, can help chart the inﬂ uence of the prob-

lem. However, it is questions like the ones that follow that externalize the problem:

“What is the mission of the anger, and how does it recruit you into this mission?”

“How does the anger get you, and how does it trick you into letting it become so

powerful?” “What does the anger require of you, and what happens to you when

you meet its requirements?” “What cultural supports (in your family/community/

world) have shaped the role that anger plays for you?”

search for unique outcomes In the narrative approach, external-

izing questions are followed by questions searching for unique outcomes. The

therapist talks to the client about moments of choice or success regarding the

problem. This is done by selecting for attention any experience that stands apart

from the problem story, regardless of how insigniﬁ cant it might seem to the cli-

ent. The therapist may ask: “Was there ever a time in which anger wanted to take

you over, and you resisted? What was that like for you? How did you do it?” These

questions are aimed at highlighting moments when the problem has not oc-

curred or when the problem has been dealt with successfully. Unique outcomes

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POSTMODERN APPROACHES

can often be found in the past or the present, but they can also be hypothesized

for the future: “What form would standing up against your anger take?” Explor-

ing questions such as these enables clients to see that change is possible. Linking

a series of such unique outcomes together starts to form a counter story. It is

within the account of unique outcomes that a gateway is provided for alternative

versions of a person’s life (White, 1992).

Following the description of a unique outcome, White (1992) suggests posing

questions, both direct and indirect, that lead to the elaboration of preferred identity

stories:

• What do you think this tells me about what you have wanted for your life and

about what you have been trying for in your life?

• How do you think knowing this has affected my view of you as a person?

• Of all those people who have known you, who would be least surprised that

you have been able to take this step in addressing your problem’s inﬂ uence

in

your life?

• What actions might you commit yourself to if you were to more fully embrace

this knowledge of who you are? (p. 133)

The development of unique outcome stories into solution stories is facilitated by

what Epston and White (1992) call “circulation questions”:

• Now that you have reached this point in life, who else should know about it?

•

I guess there are a number of people who have an outdated view of who you are

as a person. What ideas do you have about updating these views?

• If other people seek therapy for the same reasons you did, can I share with them

any of the important discoveries you have made? (p. 23)

These questions are not asked in a barrage-like manner. Questioning is an integral

part of the context of the narrative conversation, and each question is sensitively

attuned to the responses brought out by the previous question (White, 1992).

McKenzie and Monk (1997) suggest that therapists seek permission from the

client before asking a series of questions. By letting a client know that they do not

have answers to the questions they raise, therapists are putting the client in control

of the therapeutic process. Asking permission of the client to use persistent ques-

tioning tends to minimize the risk of inadvertently pressuring the client.

alternative stories and reauthoring Constructing new stories

goes hand in hand with deconstruction, and the narrative therapist listens for open-

ings to new stories. People can continually and actively reauthor their lives, and

narrative therapists invite clients to author alternative stories through “unique out-

comes,” deﬁ ned as events that could not be predicted from listening to the domi-

nant problem-saturated story. The narrative therapist asks for openings: “Have you

ever been able to escape the inﬂ uence of the problem?” The therapist listens for

clues to competence in the midst of a problematic story and builds a story of compe-

tence around it. Madigan (2011) suggests that a person’s life story is probably much

more interesting than the story being told. He maintains a therapist’s main task

is “to help people to remember, reclaim and reinvent a richer, thicker, and more

meaningful alternative story” (p. 159).

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CHAPTER THIRTEEN

A turning point in the narrative interview comes when clients make the choice

of whether to continue to live by a problem-saturated story or create an alternative

story (Winslade & Monk, 2007). Through the use of unique possibility questions,

the therapist moves the focus into the future. For example: “Given what you have

learned about yourself, what is the next step you might take?” “When you are act-

ing from your preferred identity, what actions will it lead you to do more of?” Such

questions encourage people to reﬂ ect upon what they have presently achieved and

what their next steps might be.

The therapist works with clients collaboratively by helping them construct

more coherent and comprehensive stories (Neimeyer, 1993). Whether involved

in a free-ﬂ owing conversation or engaged in a series of questions in a relatively

consistent process, narrative therapists seek to elicit new possibilities and em-

bed them in the life narratives and processes of the people they serve. White and

Epston’s (1990) inquiry into unique outcomes is similar to the exception ques-

tions of solution-focused therapists. Both seek to build on the competence already

present in the person. The development of alternative stories, or narratives, is an

enactment of ultimate hope: Today is the ﬁ rst day of the rest of your life. Refer to

Case Approach to Counseling and Psychotherapy (Corey, 2013, chap. 11) for two con-

crete examples of a narrative approach to working with Ruth from the perspectives

of Dr. Gerald Monk and Dr. John Winslade.

documenting the evidence Narrative practitioners believe that new

stories take hold only when there is an audience to appreciate and support them.

Gaining an audience for the news that change is taking place needs to occur if

alternative stories are to stay alive (Andrews & Clark, 1996), and an appreciative

audience to new developments is consciously sought.

One technique for consolidating the gains a client makes is by writing let-

ters. Narrative therapists have pioneered the development of therapeutic letter

writing. These letters that the therapist writes provide a record of the session

and may include an externalizing description of the problem and its inﬂ uence

on the client, as well as an account of the client’s strengths and abilities that are

identiﬁ ed in a session. Letters can be read again at different times, and the story

that they are part of can be reinspired. The letter highlights the struggle the

client has had with the problem and draws distinctions between the problem-

saturated story and the developing new and preferred story (McKenzie & Monk,

1997).

Epston has developed a special facility for carrying on therapeutic dialogues

between sessions through the use of letters (White & Epston, 1990). His letters

may be long, chronicling the process of the interview and the agreements reached,

or short, highlighting a meaning or understanding reached in the session and

asking a question that has occurred to him since the end of the previous therapy

visit. These letters are used to encourage clients, noting their accomplishments in

relation to handling problems or speculating on the meaning of their accomplish-

ments for others in their community. Letters documenting the changes clients

have achieved tend to strengthen the signiﬁ cance of the changes, both for the cli-

ent and for others in the client’s life (Winslade & Monk, 2007).

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419

POSTMODERN APPROACHES

David Nylund, a clinical social worker, uses narrative letters as a basic part of

his practice. Nylund describes a conceptual framework he has found useful in

structuring letters to his clients (Nylund & Thomas, 1994):

• The introductory paragraph reconnects the client to the previous therapy session.

• Statements summarize the inﬂ

uence the problem has had and is having on the

client.

• Questions the therapist thought about after the session that pertain to the alter-

native story that is developing may be posed to the client.

• The letter documents unique outcomes or exceptions to the problematic story

that emerged during the session. Where possible, the client’s words are quoted

verbatim. Using the client’s words enhances the therapeutic relationship,

resulting in the client feeling empowered and understood. This connection

leads to a more comfortable opportunity for the client to rethink descriptions

and stories and to create new images, leading to change.

Nylund and Thomas (1994) contend that narrative letters reinforce the importance

of carrying what is being learned in the therapy ofﬁ

ce into everyday life. The mes-

sage conveyed is that participating fully in the world is more important than being

in the therapy ofﬁ ce. In an informal survey of the perceptions of the value of narra-

tive letters by past clients, the average worth of a letter was equal to more than three

individual sessions. This ﬁ nding is consistent with McKenzie and Monk’s (1997)

statement: “Some narrative counselors have suggested that a well-composed letter

following a therapy session or preceding another can be equal to about ﬁ ve regular

sessions” (p. 113).

application to group counseling Many of the techniques described

in this chapter can be applied to group counseling. Winslade and Monk (2007)

claim that the narrative emphasis on creating an appreciative audience for new

developments in an individual’s life lends itself to group counseling. They state:

“Groups provide a ready-made community of concern and many opportunities for

the kind of interaction that opens possibilities for new ways of living. New identi-

ties can be rehearsed and tried out into a wider world” (p. 135). They give several

examples of working in a narrative way with groups in schools: getting back on

track in schoolwork; an adventure-based program; an anger management group;

and a grief counseling group. For a detailed description of these narrative groups,

see Winslade and Monk (2007, chap. 5).

postmodern approaches from

a multicultural perspective

Strengths From a Diversity Perspective

Social constructionism is congruent with the philosophy of multiculturalism.

One of the problems that culturally diverse clients often experience is the expecta-

tion that they should conform their lives to the truths and reality of the dominant

society of which they are a part. With the emphasis on multiple realities and the

assumption that what is perceived to be a truth is the product of social construc-

tion, the postmodern approaches are a good ﬁ t with diverse worldviews.

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CHAPTER THIRTEEN

The social constructionist approach to therapy provides clients with a frame-

work to think about their thinking and to determine the impact stories have on

what they do. Clients are encouraged to explore how their realities are being con-

structed out of cultural discourse and the consequences that follow from such con-

structions. Within the framework of their cultural values and worldview, clients

can explore their beliefs and provide their own reinterpretations of signiﬁ cant life

events. The practitioner with a social constructionist perspective can guide clients

in a manner that respects their underlying values. This dimension is especially im-

portant in those cases where counselors are from a different cultural background

or do not share the same worldview as their clients.

Narrative therapy is grounded in a sociocultural context, which makes this

approach especially relevant for counseling culturally diverse clients. Narrative ther-

apists operate on the premise that problems are identiﬁ ed within social, cultural,

political, and relational contexts rather than existing within individuals. They are

very much concerned with considering the speciﬁ cations of gender, ethnicity, race,

disability, sexual orientation, social class, and spirituality and religion as therapeutic

issues. Furthermore, therapy becomes a place to reauthor the social constructions

and identity narratives that clients are ﬁ nding problematic.

Narrative therapy is a relational and anti-individualistic practice. Michael White

believes that to address a person’s struggles in therapy without a relational and con-

textual understanding of his or her story is entirely absurd (Madigan, 2011). Narrative

therapists concentrate on problem stories that dominate and subjugate at the personal,

social, and cultural levels. The sociopolitical conceptualization of problems sheds light

on those cultural notions and practices that produce dominant and oppressive narra-

tives. From this orientation, practitioners take apart the cultural assumptions that are

a part of a client’s problem situation. People are able to come to an understanding of

how oppressive social practices have affected them. This awareness can lead to a new

perspective on dominant themes of oppression that have been such an integral part of

a client’s story, and with this cultural awareness new stories can be generated.

In their discussion of the multicultural inﬂ uences on clients, Bertolino and O’Hanlon

(2002) make the point that they do not approach clients with a preconceived notion

about their experience. Instead, they learn from their clients about their experiential

world. Bertolino and O’Hanlon practice multicultural curiosity by listening respect-

fully to their clients, who become their best teachers. Here are some questions these

authors suggest as a way to more fully understand multicultural inﬂ uences on a client:

• Tell me more about the inﬂ

uence that [some aspect of your culture] has played

in your life.

• What can you share with me about your background that will enable me to more

fully understand you?

• What challenges have you faced growing up in your culture?

• What, if anything, about your background has been difﬁ

cult for you?

• How have you been able to draw on strengths and resources from your culture?

What resources can you draw from in times of need?

Questions such as these can shed light on speciﬁ c cultural inﬂ uences that have

been sources of support or that contributed to a client’s problem.

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421

Shortcomings From a Diversity Perspective

A potential shortcoming of the postmodern approaches pertains to the not-knowing

stance the therapist assumes, along with the assumption of the client-as-expert.

Individuals from many different cultural groups tend to elevate the professional as

the expert who will offer direction and solutions for the person seeking help. If the

therapist is telling the client, “I am not really an expert; you are the expert; I trust

in your resources for you to ﬁ nd solutions to your problems,” then this may engen-

der lack of conﬁ dence in the therapist. To avoid this situation, the therapist using

a solution-focused or a narrative orientation needs to convey to clients that he or

she has expertise in the process of therapy but clients are the experts in knowing

what they want in their lives. The postmodern approaches stress being transparent

with clients and honoring their hopes and expectations in therapy. This emphasis

creates a context for providing culturally responsive services.

I operate from an integrative perspective

by combining concepts and techniques

from the solution-focused and narrative

approaches. From this framework, I am philo-

sophically opposed to assessment and diagnosis

using the DSM-IV-TR model, and I do not begin

therapy with a formal assessment. Instead,

I engage Stan in collaborative conversations

centered on change, competence, preferences,

possibilities, and ideas for making changes in the

future.

I begin my work with Stan by inviting him

to tell me about the concerns that brought him

to therapy and what he expects to accomplish

in his sessions. I also provide Stan with a brief

orientation of some of the basic ideas that guide

my practice and describe my view of counseling

as a collaborative partnership in which he is the

senior partner. Stan is somewhat surprised by

this because he expected that I was the person

with the experience and expertise. He informs

me that he has very little confidence in knowing

how to proceed with his life, especially since he

has “messed up” so often. I am aware that he has

self-doubts when it comes to assuming the role

of senior partner. However, I work to demystify

the therapeutic process and establish a collabo-

rative relationship, conveying to Stan that he is in

charge of the direction his therapy will take.

Soon after this orientation to how therapy

works, I inquire about some specific goals that

Stan would like to reach through the therapy

sessions. Stan gives clear signs that he is will-

ing and eager to change. However, he adds that

he has become convinced that he suffers from

low self-esteem. I begin to externalize the idea

of low self-esteem and inquire into its effects in

his life. Then I start to focus Stan on looking for

exceptions to the problem of low self-esteem.

I pose an exception question (solution-focused

therapy): “What is different about the contexts

or times when you have not experienced low

self-esteem?” Stan is able to identify some

positive characteristics: his courage, deter-

mination, and willingness to try new things in

spite of his self-doubts, and his gift for working

with children. Stan knows what he wants out

of therapy and has clear goals: to achieve his

educational goals, to enhance his belief in him-

self, to relate to women without fear, and to feel

more joy instead of sadness and anxiety.

I invite Stan to talk more about how he has

managed to make the gains he has in spite of

struggling with the problem of self-doubt and

low self-esteem.

I allow Stan to share his problem-saturated

story, but I do not get stuck in this narrative. I

invite Stan to think of his problems as external

Postmodern Approaches Applied to the Case of Stan

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422

CHAPTER THIRTEEN

to the core of his selfhood. I help him to notice

the cultural forces that have recruited him into a

story of thinking less about himself. Even during

the early sessions, I encourage Stan to separate

his being from his problems by posing questions

that externalize his problem.

Although Stan presents several problem

areas that are of concern to him, I work with him

on identifying one particular problem. Stan says

he is depressed a great deal of the time, and

he worries that his depression might someday

overwhelm him. After listening to Stan’s fears

and concerns, I ask Stan the miracle question

(solution-focused technique): “Let’s suppose

that a miracle were to happen while you are

asleep tonight. When you wake up tomorrow,

the problems you are mentioning are gone.

What would be the signs to you that this miracle

actually occurred and that your problems were

solved? How would your life be different?”

With this intervention, I am shifting the focus

from talking about problems to talking about

solutions. I explain to Stan that much of his ther-

apy will deal with finding both present and future

solutions rather than dwelling on past problems.

Together we engage in a conversation that fea-

tures change-talk rather than problem-talk.

To a great extent, Stan has linked his identity

with his problems, especially depression. He

doesn’t think of his problems as being sepa-

rate from himself. I want Stan to realize that he

personally is not his problem, but instead that

the problem is the problem. When I ask Stan to

give a name to his problem, he eventually comes

up with “Disabling depression!” He then relates

how his depression has kept him from function-

ing the way he would like in many areas of his

life. I then use externalizing questions (narrative

technique) as a way to separate Stan from his

problem: “How long has depression gotten the

best of you?” “What has depression cost you?”

“Have there been times when you stood up to

depression and did not let it win?” Of course, I

briefly explain to him what I am doing by using

externalizing language, lest he think this is a

strange way to counsel. I talk more about the ad-

vantages of engaging in externalizing conversa-

tions. I also talk with Stan about the importance

of mapping the effects of the problem on his life.

This process involves exploring how long the

problem has been around, the extent to which

the problem has influenced various aspects of

his life, and how deeply the problem continues

to affect him.

As the sessions progress, there is a col-

laborative effort aimed at investigating how the

problem has been a disrupting, dominating, and

discouraging influence. Stan comes to view his

story from a different perspective. I continue

talking with Stan about those moments when

he has not been dominated or discouraged by

depression and anxiety and continue to search

for exceptions to these problematic experi-

ences. Stan and I participate in conversations

about unique outcomes, or occasions when he

has demonstrated courage and persistence in

the face of discouraging events. Some of these

“sparkling moments” include Stan’s accomplish-

ments in college, volunteer work with children,

progress in curbing his tendencies to abuse

alcohol, willingness to challenge his fears and

make new acquaintances, talking back to self-

defeating internal messages, accomplishments

in securing employment, and his willingness to

create a vision of a productive future.

With my help, Stan accumulates evidence

from his past to bolster a new view of himself

as competent enough to have escaped from the

dominance of problematic stories. At this phase

in his therapy, Stan makes a decision to create

an alternative narrative. Several sessions are

devoted to reauthoring Stan’s story in ways that

are lively, creative, and colorful. Along with the

process of creating an alternative story, I explore

with Stan the possibilities of recruiting an audi-

ence who will reinforce his positive changes. I

ask, “Who do you know who would be least sur-

prised to hear of your recent changes, and what

would this person know about you that would

lead to him or her not being so surprised?”

Stan identifies one of his early teachers who

served as a mentor to him and who believed in

him when Stan had little belief in himself. Some

therapy time is devoted to discussing how new

stories take root only when there is an audience

to appreciate them.

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After five therapy sessions, Stan brings up

the matter of termination. At the sixth and final

session, I introduce scaling questions, ask-

ing Stan to rate his degree of improvement on

a range of problems we explored in the past

weeks. On a scale of zero to 10, Stan ranks how

he saw himself prior to his first session and

how he sees himself today on various specific

dimensions. We also talked about Stan’s goals

for his future and what kinds of improvements

he will need to make to attain what he wants. I

then give Stan a letter I wrote summarizing both

the problem story and its effects and also the

counter story that we have been developing in

therapy. In my narrative letter, I describe Stan’s

determination and cooperation in his own words

and encourage him to circulate the news of the

differences he has brought about in his life. I also

ask some questions that invite him to develop

the new story of identity more fully.

Follow-Up: You Continue as Stan’s

Postmodern Therapist

Use these questions to help you think about how

to counsel Stan from a postmodernist approach:

• As Stan’s therapist, I borrowed key concepts

and techniques common to both solution-fo-

cused and narrative orientations. In your work

with Stan, what specific concepts would you

borrow from each of these approaches? What

techniques would you draw from each of the

approaches? What possible advantages do

you see, if any, in applying an integration of

solution-focused and narrative models in your

work with Stan?

• What unique values, if any, do you see in work-

ing with Stan from a postmodern perspective as

opposed to working with Stan fr

om the other

therapeutic approaches you’ve studied thus far?

• I asked many questions of Stan. List some

additional questions you would be particularly

interested in pursuing with Stan.

• In what ways could you integrate SFBT and

narrative therapy with feminist ther

apy in

Stan’s case? What other therapies might you

combine with the postmodern approaches?

What other therapies would not combine so

well with these postmodern therapies?

• At this point, you are very familiar with the

themes in Stan’s life. If you were to write a nar

-

rative letter that you would then give to Stan,

what would you most want to include? What

would you want to talk to him about regarding

his future?

See DVD for Theory and Practice of

Counseling and Psychotherapy: The Case

of Stan and Lecturettes (Session 11 on SFBT and

Session 12 on narrative therapy) for a demon-

stration of my approach to counseling Stan

from this perspective. Session 11 illustrates

techniques such as identifying exceptions,

the miracle question, and scaling. Session 12

focuses on Stan’s work in creating a new story

of his life.

summary and evaluation

Summary

In social constructionist theory the therapist-as-expert is replaced by the client-

as-expert. Although clients are viewed as experts on their own lives, they are often

stuck in patterns that are not working well for them. Both solution-focused and nar-

rative therapists enter into dialogues in an effort to elicit the perspectives, resources,

and unique experiences of their clients. The therapeutic endeavor is a highly col-

laborative relationship in which the client is the senior partner. The qualities of

the therapeutic relationship are at the heart of the effectiveness of both SFBT and

narrative therapy. This has resulted in many therapists giving increased attention

to creating a collaborative relationship with clients. Collaborative therapists adjust

423

POSTMODERN APPROACHES

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424

CHAPTER THIRTEEN

their approach to each client or group instead of requiring clients to adapt to their

approach. Thus therapy may look very different for one client than for another.

The not-knowing position of the therapist has been infused as a key concept of

both the solution-focused and narrative therapeutic approaches. The not-knowing

position, which allows therapists to be curious about, afﬁ rm, and be guided by the

stories of their clients, creates participant-observer and process-facilitator roles for the

therapist and integrates therapy with a postmodern perspective of human inquiry.

Both solution-focused brief therapy and narrative therapy are based on the

optimistic assumption that people are healthy, competent, resourceful, and pos-

sess the ability to construct solutions and alternative stories that can enhance their

lives. In SFBT the therapeutic process provides a context whereby individuals fo-

cus on creating solutions rather than talking about their problems. Some common

techniques include the use of miracle questions, exception questions, and scaling

questions. In narrative therapy the therapeutic process attends to the sociocultural

context wherein clients are assisted in separating themselves from their problems

and are afforded the opportunity of authoring new stories.

Practitioners with solution-focused or narrative orientations tend to engage cli-

ents in conversations that lead to progressive narratives that help clients make steady

gains toward their goals. Therapists often ask clients: “Tell me about times when your

life was going the way you wanted it to.” These conversations illustrate stories of life

worth living. On the basis of these conversations, the power of problems is taken apart

(deconstructed) and new directions and solutions are manifest and made possible.

Contributions of Postmodern Approaches

Social constructionism, SFBT, and narrative therapy are making many contributions

to the ﬁ eld of psychotherapy. I especially value the optimistic orientation of these post-

modern approaches that rest on the assumptions that people are competent and can

be trusted to use their resources in creating better solutions and more life-afﬁ rming

stories. Many postmodern practitioners and writers have found that clients are able

to make signiﬁ cant moves toward building more satisfying lives in a relatively short

period of time (Bertolino & O’Hanlon, 2002; De Jong & Berg, 2008; de Shazer, 1991;

Freedman & Combs, 1996; Miller, Hubble, & Duncan, 1996; O’Hanlon & Weiner-

Davis, 2003; Walter & Peller, 1992, 2000; Winslade & Monk, 2007).

To its credit, solution-focused therapy is a brief approach, of about ﬁ ve sessions,

that seems to show promising results (de Shazer, 1991). In de Shazer’s summary

of two outcome studies at the Brief Family Therapy Center, he reports that 91% of

the clients who attended four or more sessions were successful in achieving their

treatment goals. SFBT tends to be very brief, even among the time-limited thera-

pies. In one study, Rothwell (2005) reports the average number of solution-focused

sessions to be two, in comparison to ﬁ ve sessions for cognitive therapy. Brevity is

a main appeal of SFBT in an era of managed care, which places a premium on

short-term therapy. It should be noted that the brevity comes from the client being

in charge of goal setting and determining which issues are of immediate concern.

This differs from many other models in which the therapist determines the direc-

tion therapy should take. The narrative approach to counseling also tends to be

based on brief methods.

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425

POSTMODERN APPROACHES

I think the nonpathologizing stance characteristic of practitioners with a social

constructionist, solution-focused, or narrative orientation is a major contribution

to the counseling profession. Rather than dwelling on what is wrong with a per-

son, these approaches view the client as being competent and resourceful. People

cannot be reduced to a speciﬁ c problem nor accurately labeled and identiﬁ ed with

a disorder. Even practitioners who are expected to formulate a diagnosis can learn

the value of a respectful way to relate to clients.

Research from an “empirical generalizable” perspective is somewhat antithetical

to the social constructionist approach, but how effective is solution-focused brief ther-

apy? Regardless of the speciﬁ c theoretical orientation of the therapist, brief therapy

has been shown to be effective for a wide range of clinical problems. Studies that have

compared brief therapies with long-term therapies have generally found no difference

in outcomes (McKeel, 1996). In a review of research of SFBT, McKeel concludes that

when SFBT techniques have been tested, the results are generally favorable. Although

only a few studies of SFBT exist, outcome studies generally show that most clients

receiving SFBT report accomplishing their treatment goals.

One particular area where the solution-focused approach shows promise

is in group treatment with domestic violence offenders. Lee, Sebold, and Uken

(2003) describe a cutting-edge treatment approach that seems to create effective,

positive change in domestic violence offenders. This approach is dramatically dif-

ferent from traditional approaches in that there is virtually no emphasis on the

presenting problem of domestic violence. The approach focuses on holding

offenders accountable and responsible for building solutions rather than empha-

sizing their problems and deﬁ cits. The process described by Lee and colleagues

is brief when measured against traditional program standards, lasting only eight

sessions over a 10- to 12-week period. Lee, Sebold, and Uken report research that

indicates a recidivism rate of 16.7% and completion rates of 92.9%. In contrast,

more traditional approaches typically generate recidivism rates between 40 and

60% and completion rates of less than 50%.

In their review of 15 outcome studies of SFBT, Gingerich and Eisengart (2000)

found that 5 studies were well controlled, and all showed positive outcomes. The

other 10 studies, which were only moderately controlled, supported a hypothesis

of the effectiveness of SFBT. The review of these studies provided preliminary sup-

port for the idea that SFBT may be beneﬁ cial to clients, but methodological ﬂ aws

did not permit a deﬁ nitive conclusion. For a more detailed review of early research

and outcome measurement of SFBT, see De Jong and Berg (2008, chap. 11).

A major strength of both solution-focused and narrative therapies is the use of

questioning, which is the centerpiece of both approaches. Open-ended questions

about the client’s attitudes, thoughts, feeling, behaviors, and perceptions are one

of the main interventions. Especially useful are future-oriented questions that get

clients thinking about how they are likely to solve potential problems in the future.

Questions can assist clients in developing their story and discovering better ways

to deal with their concerns. Effective questioning can help individuals examine

their story and ﬁ nd new ways to present their story. Winslade and Monk (2007)

note that a therapist’s careful questioning about clients’ early experiences of their

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426

CHAPTER THIRTEEN

capabilities and resources tends to strengthen the foundation for clients in build-

ing a new sense of direction and for them to create alternative stories.

Limitation and Criticisms of Postmodern Approaches

To effectively practice solution-focused brief therapy, it is essential that therapists

are skilled in brief interventions. Although it may appear that SFBT is simple and

easy to implement, therapists practicing within this framework must be able to

make assessments, assist clients in formulating speciﬁ c goals, and effectively use

a range of appropriate interventions. Some inexperienced or untrained therapists

may be enamored by the variety of techniques: the miracle question, scaling ques-

tions, the exception question, and externalizing questions. But effective therapy

is not simply a matter of relying on any of these interventions. The attitudes of

the therapist and his or her ability to use questions that are reﬂ ective of genuine

respectful interest are crucial to the therapeutic process.

McKenzie and Monk (1997) express their concerns over those counselors who

attempt to employ narrative ideas in a mechanistic fashion. They caution that

a risk in describing a map of a narrative orientation lies in the fact that some

beginners will pay more attention to following the map than they will to following

the lead of the client. In such situations, McKenzie and Monk are convinced that

mechanically using techniques will not be effective. They add that although nar-

rative therapy is based on some simple ideas, it is a mistake to assume that the

practice is simple.

McKeel (1996) observes that recent research on the importance of the thera-

peutic relationship is consistent with the SFBT view that positive treatment out-

comes are linked to therapists developing effective and collaborative working

relationships with clients. He cautions practitioners that losing sight of the po-

tency of the therapeutic relationship “will only doom SFBT to be remembered as a

disembodied set of clever techniques” (p. 265). Some solution-focused practition-

ers now acknowledge the problem of relying too much on a few techniques, and

they are placing increased importance on the therapeutic relationship and the

overall philosophy of the approach (Lipchik, 2002; Nichols, 2013).

Despite these limitations, the postmodern approaches have much to offer prac-

titioners, regardless of their theoretical orientation. Many of the basic concepts

and techniques of both solution-focused brief therapy and narrative therapy can be

integrated into the other therapeutic orientations discussed in this book.

where to go from here

Free Podcasts for ACA Members

You can download ACA Podcasts (prerecorded interviews) at www.counseling.org;

click on the Resource button and then the Podcast Series. For Chapter 13, Post-

modern Approaches, look for the following:

Interview with Dr. John Murphy on Solution-Focused Counseling in Schools

(Podcast 5) Lorraine Hedtke, L. & Winslade, J., Remembering Lives, Conversa-

tions With the Dying and Bereaved

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

427

POSTMODERN APPROACHES

Other Resources

Psychotherapy.net is a comprehensive resource for students and professionals that

offers videos and interviews on the postmodern approaches. New video and edito-

rial content is made available monthly. DVDs relevant to this chapter are available

at www.psychotherapy.net and include the following:

Madigan, S. (2002). Narrative Therapy With Children (Child Therapy With

the Experts)

Madigan, S. (1998). Narrative Family Therapy (Family Therapy With the Experts)

If you are interested in keeping up to date with the developments in brief therapy,

the Journal of Brief Therapy is a useful resource. It is devoted to developments,

innovations, and research related to brief therapy with individuals, couples, fami-

lies, and groups. The articles deal with brief therapy related to all theoretical

approaches, but especially to social constructionism, solution-focused therapy, and

narrative therapy. For subscription information, contact:

Springer Publishing Company

11 West 42nd Street, 15th Floor

New York, NY 10036

Toll-Free Telephone: (877) 687-7476

Website: www.springerpub.com

Another useful journal is the International Journal of Narrative Therapy and Commu-

nity Work. For more information, contact:

Dulwich Centre

345 Carrington Street

Adelaide, South Australia 5000

Website: www.dulwichcentre.com.au/

Training in Solution-Focused Therapy Approaches

Center for Solution-Focused Brief Therapy

John Walter and Jane Peller

2320 Thayer Street

Evanston, IL 60201

Telephone: (847) 475-2691

E-mail: John W[email protected]

O’Hanlon and O’Hanlon Inc.

223 N. Guadalupe #278

Santa Fe, NM 87501

Telephone: (505) 983-2843

Fax: (505) 983-2761

E-mail: PossiBill@brieftherapy.com

Website: www.brief.org.uk

The Solution Focused Institute (SFI) at Texas Wesleyan University was founded in

January 2009 in Fort Worth, Texas, to provide training to mental health practition-

ers and school teachers and counselors who want to implement a solution-focused

approach in their work. The institute provides training on- and off-site in solution-

focused therapy and offers supervision to individuals and groups. For information

on SFI services, contact:

28549_ch13_rev01.indd 427 20/09/11 3:57 PM

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428

CHAPTER THIRTEEN

Linda Metcalf, PhD

Solution Focused Institute

3001 Avenue D

Fort Worth, TX 76105

Telephone: (817) 690-2229

Fax: (817) 531-4935

E-mail: lmetcalf@txwes.edu

Website:www.Solutionfocusedinstitute.com

Change-Focused Practice in Schools (CFPS) was initiated by John Murphy in 2005

to translate psychotherapy research into practical applications in schools and oth-

er settings. CFPS offers international training, supervision, and consultation on

solution-focused/outcome-informed approaches to helping young people change

in ways that honor their strengths and resources. For more information, contact:

John Murphy, PhD

Department of Psychology & Counseling

University of Central Arkansas

Conway, AR 72035-0001

Telephone: (501) 450-5450

Fax: (501) 450-5424

E-mail: [email protected]

Website: www.drjohnmurphy.com

Training in Narrative Therapy

Evanston Family Therapy Institute

Jill Freedman and Gene Combs

820 Davis Street, Suite 504

Evanston, Illinois 60201

Dulwich Centre

Cheryl White

345 Carrington Street

Adelaide, South Australia 5000

http://www.dulwichcentre.com.au/

Bay Area Family Therapy Training Associates

Jeffrey L. Zimmerman and Marie-Nathalie Beaudoin

21760 Stevens Creek Blvd., Suite 102

Cupertino, CA 95015

Telephone: (408) 257-6881

Fax: (408) 257-0689

E-mail: [email protected]

Website: www.baftta.com

The Houston-Galveston Institute

3316 Mount Vernon

Houston, TX 77006

Telephone: (713) 526-8390

Fax: (713) 528-2618

E-mail: [email protected]

Website: www.talkhgi.com

28549_ch13_rev01.indd 428 20/09/11 3:57 PM

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Recommended Supplementary Readings

Interviewing for Solutions (De Jong & Berg, 2008) is a practical text aimed at

teaching and learning solution-focused skills. It is written in a conversational and

informal style and contains many examples to solidify learning of skills.

Solution-Focused Counseling in Schools (Murphy, 2008) is a clearly written and

practical book that offers efﬁ cient strategies for addressing a range of problems

from preschool through high school. Numerous case examples illustrate the

foundations, tasks, and techniques of solution-focused counseling. The book also

describes how the principles of client-directed, outcome-informed practice can be

integrated in solution-focused counseling.

Narrative Means to Therapeutic Ends (White & Epston, 1990) is the most widely

known book on narrative therapy.

Maps of Narrative Practice (White, 2007) is Michael White’s ﬁ nal book, which

brings together much of his work over several decades in one accessible volume.

Narrative Therapy (Madigan, 2011) provides an updated discussion of the theory

and therapeutic process of narrative therapy.

Narrative Counseling in Schools (Winslade & Monk, 2007) is a basic and easy-

to-read guide to applying concepts and techniques of narrative therapy to school

settings.

Narrative Therapy: The Social Construction of Preferred Realities (Freedman & Combs,

1996) is an exceptionally clear explanation of the basic ideas of narrative therapy.

The authors emphasize key concepts and the application of speciﬁ c clinical prac-

tices. This is one of the best sources on the theory and practice of narrative therapy.

References and Suggested Readings

Anderson, H. (1993). On a roller coaster: A

collaborative language system approach to

therapy. In S. Friedman (Ed.), The new language

of change (pp. 324–344). New York: Guilford

Press.

*Anderson, H., & Goolishian, H. (1992). The

client is the expert: A not-knowing approach

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(Eds.), Therapy as social construction

(pp. 25–39). Newbury Park, CA: Sage.

Andrews, J., & Clark, D. J. (1996). In the case

of a depressed woman: Solution-focused or

narrative therapy approaches? The Family

Journal, 4(3), 243–250.

Bateson, G. (1972). Steps to an ecology of mind.

New York: Ballantine.

Berg, I. K. (1994). Family based services: A

solution-focused approach. New York: Norton.

Berg, I. K., & Miller, S. D. (1992). Working with

the problem drinker: A solution-focused approach.

New York: Norton.

Berger, P. L., & Luckman, T. (1967). The social

construction of reality: A treatise in the sociology

of knowledge. London: Penguin.

*Bertolino, B., & O’Hanlon, B. (2002). Collabo-

rative, competency-based counseling and therapy.

Boston: Allyn & Bacon.

*Books and articles marked with an asterisk are suggested for further study.

429

POSTMODERN APPROACHES

28549_ch13_rev01.indd 429 20/09/11 3:57 PM

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

*Brown, L. S. (2010). Feminist therapy. Washing-

ton, DC: American Psychological Association.

Bubenzer, D. L., & West, J. D. (1993). William

Hudson O’Hanlon: On seeking possibilities and

solutions in therapy. The Family Journal: Counseling

and Therapy for Couples and Families, 1(4), 365–379.

Burr, V. (2003). Social constructionism. London,

UK: Routledge.

Corey, G. (2012). Theory and practice of group

counseling (8th ed.). Belmont, CA: Brooks/

Cole, Cengage Learning.

Corey, G. (2013). Case approach to counseling

and psychotherapy (8th ed.). Belmont, CA:

Brooks/Cole, Cengage Learning.

*De Jong, P., & Berg, I. K. (2008). Interviewing

for solutions (3rd ed.). Belmont, CA: Brooks/

Cole, Cengage Learning.

*De Shazer, S. (1985). Keys to solutions in brief

therapy. New York: Norton.

*De Shazer, S. (1988). Clues: Investigating

solutions in brief therapy. New York: Norton.

*De Shazer, S. (1991). Putting difference to work.

New York: Norton.

*De Shazer, S. (1994). Words were originally

magic. New York: Norton.

De Shazer, S., & Berg, I. (1988). Doing

therapy: A post-structural revision. Journal of

Marital and Family Therapy, 18, 71–81.

*De Shazer, S., & Dolan, Y. M. (with Korman, H.,

Trepper, T., McCullom, E., & Berg, I. K.). (2007).

More than miracles: The state of the art of solution-

focused brief therapy. New York: Haworth Press.

Drewery, W., & Winslade, J. (1997). The theo-

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J. Winslade, K. Crocket, & D. Epston (Eds.),

Narrative therapy in practice: The archaeology of

hope (pp. 32–52). San Francisco: Jossey-Bass.

Epston, D., & White, M. (1992). Consulting your

consultants: The documentation of alternative

knowledges. In Experience, contradiction, nar-

rative and imagination: Selected papers of David

Epston and Michael White, 1989–1991 (pp. 11–26).

Adelaide, South Australia: Dulwich Centre.

*Freedman, J., & Combs, G. (1996). Narrative

therapy: The social construction of preferred

realities. New York: Norton.

Freedman, J., Epston, D., & Lobovits, D.

(1997). Playful approaches to serious problems:

Narrative therapy with children and their families.

New York: Norton.

Gergen, K. (1985). The social constructionist

movement in modern psychology. American

Psychologist, 40, 266–275.

Gergen, K. (1991). T

he saturated self. New York:

Basic Books.

Gerg

en, K. (1999). An invitation to social

construction. Thousand Oaks, CA: Sage.

Gingerich, W. J., & Eisengart, S. (2000). Solu-

tion-focused brief therapy: A review of the out-

come research. Family Process, 39(4), 477–498.

*Guterman, J. T. (2006). Mastering the art of

solution-focused counseling. Alexandria, VA:

American Counseling Association.

Lee, M. Y., Sebold, J., & Uken, A. (2003).

Solution-focused treatment of domestic violence

offenders: Accountability for change. New York:

Oxford University Press.

Lindsley, J. R. (1994). Rationalist therapy in a

constructivistic frame. The Behavior Therapist,

17(7), 160–162.

Lipchik, E. (2002). Beyond technique in solution-

focused therapy: Working with emotion and the

therapeutic relationship. New York: Guilford Press.

*Madigan, S. (2011). Narrative therapy. Washing-

ton, DC: American Psychological Association.

Maisel, R., Epston, D., & Borden, A. (2004).

Biting the hand that starves you: Inspiring resist-

ance to anorexia/bulimia. New York: Norton.

McKeel, A. J. (1996). A clinician’s guide to

research on solution-focused brief therapy. In

S. D. Miller, M. A. Hubble, & B. L. Duncan (Eds.),

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(pp. 251–271). San Francisco: Jossey-Bass.

McKenzie, W., & Monk, G. (1997). Learn-

ing and teaching narrative ideas. In G. Monk,

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*Metcalf, L. (1998). Solution-focused group

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schools, agencies and treatment programs.

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Metcalf, L. (2001). Solution focused therapy. In

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Adelaide, South Australia: Dulwich Centre.

*White, M. (2007). Maps of narrative practice.

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counseling in schools (2nd ed.). Thousand Oaks,

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431

POSTMODERN APPROACHES

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432

introduction

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Family Systems Therapy

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433

FAMILY SYSTEMS THERAPY

Alfred Adler / Murray Bowen / Virginia Satir / Carl

Whitaker / Salvador Minuchin / Jay Haley and Cloé Madanes

ALFRED ADLER (1870–

1937) was the first psy-

chologist of the modern era

to do family therapy using

a systemic approach. He

set up more than 30 child

guidance clinics in Vienna

after World War I, and later

Rudolf Dreikurs brought this

concept to the United States in the form of family

education centers. Adler and Dreikurs conducted

family counseling sessions in an open public forum,

educating parents and professionals in greater

numbers; they believed the problems of any one

family were common to all others in the commu-

nity (Christensen, 2004). As we have seen in the

chapter on Adlerian therapy, the focus of interven-

tions is on the purposes or goals of behavior—and

Adlerian family therapists extend this teleological

focus to family interactions and patterns of com-

munication.

Hulton Archive/Getty Images

MURRAY BOWEN

(1913–1990) was one

of the original develop-

ers of mainstream family

therapy. Much of his theory

and practice grew out of

his work at the National

Institute of Mental Health

(and later at Georgetown

University) with schizo-

phrenic individuals in families. He believed families

could best be understood when analyzed from a

three-generation perspective because patterns of

interpersonal relationships connect family mem-

bers across generations. Two of his objectives in

therapy were to help family members develop a

rational, nonreactive approach to living (called

a differentiation of self) and to de-tangle family

interactions that involved two people pulling a third

person into the couples’ problems and arguments

(or triangulation). Bowen’s emphasis on a multi-

generational perspective led to the development of

genograms (McGoldrick, Gerson, & Petry, 2008),

family life cycle development (McGoldrick, Carter,

& Garcia-Preto, 2011), and a comprehensive focus

on a multicultural perspective in family therapy

(McGoldrick, Giordano, & Garcia-Preto, 2005).

Courtesy of The Bowen Center for the Study of

the Family; photo by Andrea Schara

Contributors to Family Systems Theory

Family systems therapy is represented by a variety

of theories and approaches, all of which focus on

the relational aspects of human problems. Some of

the individuals most closely associated with

the origins of these systemic approaches are

featured here.

VIRGINIA SATIR

(1916–

1988) developed conjoint

family therapy, a human vali-

dation process model that

emphasizes communication

and emotional experienc-

ing. Like Bowen, she used an

intergenerational model, but

she worked to bring family

patterns to life in the present through sculpting and

family reconstructions. Claiming that techniques

were secondary to relationship, she concentrated

on the personal relationship between therapist and

family to achieve change. The core of Satir’s model

relied on the power of congruence to help family

members communicate with emotional honesty.

Her presence with people encouraged them to get in

touch with what was significant within, to become

more fully human, to share the individual’s best self

with a significant other: Satir called this experience

“making contact,” and she believed that it extended

the peace one had within to a peace between peo-

ple, and eventually, to a peace among people. From

Satir, family therapy gets it model for empathic lis-

tening, therapeutic presence, and nurturance (Satir,

Banmen, Gerber, & Gomori, 1991).

Courtesy of The Virginia Satir Global Network

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

CARL WHITAKER

(1912–1995) is the creator

of symbolic-experiential

family therapy, a freewheel-

ing, intuitive approach to

helping families open chan-

nels of interaction. His goal

was to facilitate individual

autonomy while retaining

a sense of belonging in the family. He saw the

therapist as an active participant and coach who

enters the family process with creativity, putting

enough pressure on this process to produce change

in the status quo. From Whitaker, the field of family

therapy learned to tolerate and sometimes create

anxiety in families—and then how to join families

in their struggle to become more real and more

transparent.

University of Wisconsin Madison Archives

SALVADOR MINUCHIN

(b. 1921) began to develop

structural family therapy

in the 1960s through his

work with delinquent boys

from poor families at the

Wiltwyck School in New

York. Working with col-

leagues at the Philadelphia

Child Guidance Clinic in the 1970s, Minuchin

refined the theory and practice of structural

family therapy. Focusing on the structure, or

organization, of the family, the therapist helps

the family modify its stereotyped patterns and

redefine relationships among family members.

He believes structural changes in families must

occur before individual members’ symptoms

can be reduced or eliminated. From Minuchin

and his colleagues, family therapy developed

an understanding of power, organization,

and alignments in family life, and family thera-

pists learned how to use themselves to set

boundaries and even unbalance dysfunctional

family systems.

Courtesy of The Minuchin Center for the Family

JAY HALEY (1923–2007)

and

CLOÉ MADANES

(b. 1941) founded the

Washington School of

strategic family therapy

in the 1970s, after Haley

had left the Mental

Research Institute in

Palo Alto, California, and

later the Philadelphia

Child Guidance Center, where he spent a brief

period with Salvador Minuchin and colleagues.

Haley blended structural family therapy with

the concepts of hierarchy, power, and strategic

interventions. Madanes contributed to the

development of a brief, solution-oriented ther-

apy approach. The strategic interventions most

favored by Haley and Madanes were reframing,

family directives, and paradoxical interven-

tions. Strategic family therapy became the

most popular family therapy approach in the

1980s. It is a pragmatic approach that focuses

on solving problems in the present; understand-

ing and insight are neither required nor sought.

The problem brought by the family to therapy

is treated as “real”—not a symptom of underly-

ing issues—and is solved. When the problem is

solved, therapy is finished.

Courtesy of Chloe Madanes

introduction

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434

CHAPTER FOURTEEN

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

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FAMILY SYSTEMS THERAPY

435

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

436

CHAPTER FOURTEEN

See the video program for Chapter 14, DVD for Theory and Practice of Coun-

seling and Psychotherapy: The Case of Stan and Lecturettes. I suggest that you

view the brief lecture for each chapter prior to reading the chapter.

Differences Between Systemic and Individual Approaches

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The individual therapist may: The systemic therapist may:

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Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

FAMILY SYSTEMS THERAPY

437

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JMZPSMBSHFSTZTUFNBTXFMMBTUIFJOEJWJEVBMFYQSFTTJOHQBJO

*O"OOTDBTFIFSEFQSFTTJPONBZIBWFPSHBOJDHFOFUJDPSIPSNPOBMDPNQP

OFOUT*UNBZBMTPJOWPMWFDPHOJUJWFFYQFSJFOUJBMPSCFIBWJPSBMQBUUFSOTUIBUJOUFS

GFSFXJUIFGGFDUJWFDPQJOH&WFOJGIFSEFQSFTTJPODBOCFFYQMBJOFEJOUIJTNBOOFS

IPXFWFSUIFTZTUFNJDUIFSBQJTUJTWFSZJOUFSFTUFEJOIPXIFSEFQSFTTJPOBGGFDUTPUI

FSTJOUIFGBNJMZBOEIPXJUJOnVFODFTGBNJMZQSPDFTT)FSEFQSFTTJPONBZTJHOBM

CPUIIFSPXOQBJOBOEUIFVOFYQSFTTFEQBJOPGUIFGBNJMZ*OEFFENBOZGBNJMZ

TZTUFNBQQSPBDIFTXPVMEJOWFTUJHBUFIPXUIFEFQSFTTJPOTFSWFTPUIFSGBNJMZNFN

CFSTEJTUSBDUTGSPNQSPCMFNTJOUIFJOUJNBUFSFMBUJPOTIJQTPGPUIFSTPSSFnFDUTIFS

OFFEUPBEKVTUUPGBNJMZSVMFTUPDVMUVSBMJOKVODUJPOTPSUPQSPDFTTFTJOnVFODFECZ

HFOEFSPSGBNJMZMJGFDZDMFEFWFMPQNFOU3BUIFSUIBOMPTJOHTJHIUPGUIFJOEJWJEVBM

GBNJMZUIFSBQJTUTVOEFSTUBOEUIFQFSTPOBTTQFDJmDBMMZFNCFEEFEJOMBSHFSTZTUFNT

development of family systems

therapy and personal development

of the family therapist

'BNJMZTZTUFNTUIFPSZIBTFWPMWFEUISPVHIPVUUIFQBTUZFBSTBOEUPEBZUIFSB

QJTUTDSFBUJWFMZFNQMPZWBSJPVTQFSTQFDUJWFTXIFOUBJMPSJOHUIFSBQZUPBQBSUJDVMBS

GBNJMZ5IJTTFDUJPOQSFTFOUTBCSJFGIJTUPSJDBMPWFSWJFXPGTPNFPGUIFLFZmHVSFT

BTTPDJBUFEXJUIUIFEFWFMPQNFOUPGGBNJMZTZTUFNTUIFSBQZXJUITQFDJBMBUUFOUJPO

UPUIPTFBTQFDUTPGGBNJMZUIFPSZUIBUTQFBLUPUIFEFWFMPQNFOUPGUIFGBNJMZUIFSB

QJTUBTBQFSTPOBOEBQSPGFTTJPOBM8IPPOFJTUIFQFSTPOTXBZPGCFJOHJTJOUJ

NBUFMZDPOOFDUFEUPUIFEFWFMPQNFOUPGUIFQSBDUJUJPOFSBOEUIFLJOEPGUIFSBQZ

UIBUTIFPSIFQSPWJEFT4PMFUTTUBSUCZUBLJOHBMPPLBUUIFNPTUQSPNJOFOUNPEFMT

BOEXIBUUIFZJOEJDBUFJTTJHOJmDBOUJOUIFEFWFMPQNFOUPGUIFUIFSBQJTU

Adlerian Family Therapy

"MGSFE "EMFS XBT UIF mSTU QTZDIPMPHJTU PG UIF NPEFSO FSB UP EP GBNJMZ UIFSBQZ

$ISJTUFOTFO)JTBQQSPBDIXBTTZTUFNJDMPOHCFGPSFTZTUFNTUIFPSZIBE

CFFO BQQMJFE UP QTZDIPUIFSBQZ "EMFST PSJHJOBM DPODFQUVBMJ[BUJPOT DBO TUJMM CF

GPVOEXJUIJOUIFQSJODJQMFTBOEQSBDUJDFPGPUIFSNPEFMT

"EMFSXBTUIFmSTUUPOPUJDFUIBUUIFEFWFMPQNFOUPGDIJMESFOXJUIJOUIF

GBNJMZDPOTUFMMBUJPOIJTQISBTFGPSGBNJMZTZTUFNXBTIFBWJMZJOnVFODFECZCJSUI

PSEFS"EMFSXBTBQIFOPNFOPMPHJTUBOEFWFOUIPVHICJSUIPSEFSBQQFBSFEUPIBWF

TPNFDPOTUBODZUPFBDIQPTJUJPOIFCFMJFWFEJUXBTUIFJOUFSQSFUBUJPOTDIJMESFO

BTTJHOFEUPUIFJSCJSUIQPTJUJPOTUIBUDPVOUFE"EMFSBMTPOPUFEUIBUBMMCFIBWJPS

XBTQVSQPTFGVMBOEUIBUDIJMESFOPGUFOBDUFEJOQBUUFSOTNPUJWBUFECZBEFTJSFUP

CFMPOHFWFOXIFOUIFTFQBUUFSOTXFSFVTFMFTTPSNJTUBLFO

*UXBT3VEPMG%SFJLVSTIPXFWFSXIPSFmOFE"EMFSTDPODFQUTJOUP

BUZQPMPHZPGNJTUBLFOHPBMTBOEDSFBUFEBOPSHBOJ[FEBQQSPBDIUPGBNJMZUIFSBQZ

" CBTJD BTTVNQUJPO PG NPEFSO "EMFSJBO GBNJMZ UIFSBQZ JT UIBU CPUI QBSFOUT BOE

DIJMESFOPGUFOCFDPNFMPDLFEJOSFQFUJUJWFOFHBUJWFJOUFSBDUJPOTCBTFEPONJTUBLFO

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

438

CHAPTER FOURTEEN

HPBMTUIBUNPUJWBUFBMMQBSUJFTJOWPMWFE#JUUFSB"EMFSJBOGBNJMZUIFSBQZTUBSUT

XJUIGPSNJOHBSFMBUJPOTIJQCBTFEPONVUVBMSFTQFDUKVTUBTBO"EMFSJBOUIFSBQJTU

EPFTXJUIBOJOEJWJEVBMDMJFOU"TTFTTNFOUJTCBTFEPOUIFTVCKFDUJWFEFTDSJQUJPOT

UIBUGBNJMZNFNCFSTVTFUPEFmOFUIFNTFMWFTBOEUIFJOUFSBDUJPOTUIBUPDDVSJOFWF

SZEBZMJGF*UJTXJUIJOUIFTFJOUFSBDUJPOTUIBU"EMFSJBOTTFFLUPEJTDPWFSUIFQVSQPTFT

BOEHPBMTPGCFIBWJPS#JUUFS3PCFSUT4POTUFHBSE

5BLFBNPNFOUBOEUIJOLBCPVUUXPEJGGFSFOUGBNJMZFYQFSJFODFTJOZPVSPXO

MJGF8IFOZPVXFSFMJUUMFXIBUEFTDSJQUJPOTXPVMEZPVIBWFVTFEGPSZPVSQBSFOUT 

8IBUEPUIFTFEFTDSJQUJPOTUFMMZPVBCPVUXIBUXBTJNQPSUBOUUPZPV /PXUIJOL

BCPVUZPVSDVSSFOUGBNJMZTJUVBUJPOFJUIFSXJUIZPVSGBNJMZPGPSJHJOPSXJUIB

OFXGBNJMZZPVIBWFTUBSUFE8IBUEFTDSJQUJPOTXPVMECFVTFECZGBNJMZNFNCFST

GPSZPV 8IBUEPFTUIBUUFMMZPVBCPVUZPVSQMBDFPSSPMFJOUIFGBNJMZ 'JOBMMZ

UIJOLBCPVUBSFDFOUGBNJMZJOUFSBDUJPOUIBUXBTEJGmDVMUGPSZPV8IBUHPBMTPSQVS

QPTFTEJEZPVIBWFGPSZPVSQBSUPGUIFJOUFSBDUJPO 8IBUHPBMTPSQVSQPTFTNJHIU

IBWFCFFOJOWPMWFEGPSUIPTFJOUFSBDUJOHXJUIZPV :PVDBOHFOFSBMMZEJTDPWFSUIF

HPBMPSQVSQPTFPGCFIBWJPSCZMPPLJOHBUUIFDPOTFRVFODFPGUIBUCFIBWJPSJOUIF

SFTQPOTFTPGPUIFST8IBUEPQFPQMFEPXIFO*BDUJOPOFXBZPSBOPUIFS

Multigenerational Family Therapy

.VSSBZ#PXFOXBTPOFPGUIFEFWFMPQFSTPGNBJOTUSFBNGBNJMZUIFSBQZ)JT

GBNJMZTZTUFNTUIFPSZXIJDIJTBUIFPSFUJDBMBOEDMJOJDBMNPEFMUIBUFWPMWFEGSPNQTZ

DIPBOBMZUJDQSJODJQMFTBOEQSBDUJDFTJTTPNFUJNFTSFGFSSFEUPBTNVMUJHFOFSBUJPOBM

GBNJMZUIFSBQZ#PXFOBOEIJTBTTPDJBUFTJNQMFNFOUFEBOJOOPWBUJWFBQQSPBDIUP

TDIJ[PQISFOJBBUUIF/BUJPOBM*OTUJUVUFPG.FOUBM)FBMUIXIFSF#PXFOBDUVBMMZIPT

QJUBMJ[FEFOUJSFGBNJMJFTTPUIBUUIFGBNJMZTZTUFNDPVMECFUIFGPDVTPGUIFSBQZ

#PXFOTPCTFSWBUJPOTMFEUPIJTJOUFSFTUJOQBUUFSOTBDSPTTNVMUJQMFHFOFSBUJPOT

)FDPOUFOEFEUIBUQSPCMFNTNBOJGFTUFEJOPOFTDVSSFOUGBNJMZXJMMOPUTJHOJmDBOUMZ

DIBOHF VOUJM SFMBUJPOTIJQ QBUUFSOT JO POFT GBNJMZ PG PSJHJO BSF VOEFSTUPPE BOE

EJSFDUMZDIBMMFOHFE)JTBQQSPBDIPQFSBUFTPOUIFQSFNJTFUIBUBQSFEJDUBCMFQBUUFSO

PGJOUFSQFSTPOBMSFMBUJPOTIJQTDPOOFDUTUIFGVODUJPOJOHPGGBNJMZNFNCFSTBDSPTT

HFOFSBUJPOT"DDPSEJOHUP,FSSBOE#PXFOUIFDBVTFPGBOJOEJWJEVBMTQSPC

MFNTDBOCFVOEFSTUPPEPOMZCZWJFXJOHUIFSPMFPGUIFGBNJMZBTBOFNPUJPOBMVOJU

8JUIJO UIF GBNJMZ VOJU VOSFTPMWFE FNPUJPOBM SFBDUJWJUZ UP POFT GBNJMZ NVTU CF

BEESFTTFEJGPOFIPQFTUPBDIJFWFBNBUVSFBOEVOJRVFQFSTPOBMJUZ&NPUJPOBMQSPC

MFNTXJMMCFUSBOTNJUUFEGSPNHFOFSBUJPOUPHFOFSBUJPOVOUJMVOSFTPMWFEFNPUJPOBM

BUUBDINFOUTBSFEFBMUXJUIFGGFDUJWFMZ$IBOHFNVTUPDDVSXJUIPUIFSGBNJMZNFN

CFSTBOEDBOOPUCFEPOFCZBOJOEJWJEVBMJOBDPVOTFMJOHSPPN

0OFPG#PXFOTLFZDPODFQUTJTtriangulation,BQSPDFTTJOXIJDIUSJBETSFTVMU

JO B two-against-one FYQFSJFODF #PXFO BTTVNFE UIBU USJBOHVMBUJPO DPVME FBTJMZ

IBQQFOCFUXFFOGBNJMZNFNCFSTBOEUIFUIFSBQJTUXIJDIJTXIZ#PXFOQMBDFE

TPNVDIFNQIBTJTPOIJTUSBJOFFTCFDPNJOHBXBSFPGUIFJSPXOGBNJMZPGPSJHJO

JTTVFT,FSS#PXFO-BUFSJOUIFDIBQUFSXFTIPXZPVIPXUPDPOTUSVDU

BCBTJDHFOPHSBNPGZPVSFYUFOEFEGBNJMZ5BLFTPNFUJNFUPHBUIFSUIJTJOGPSNB

UJPOBOEVTFJUBTBOPQQPSUVOJUZUPFYQMPSFUIFTUPSJFTJOZPVSGBNJMZTMJGF

"OPUIFSNBKPSDPOUSJCVUJPOPG#PXFOTUIFPSZJTUIFOPUJPOPGdifferentiation

of self, XIJDIJOWPMWFTCPUIUIFQTZDIPMPHJDBMTFQBSBUJPOPGJOUFMMFDUBOEFNPUJPO

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

439

FAMILY SYSTEMS THERAPY

BOEJOEFQFOEFODFPGUIFTFMGGSPNPUIFST*OUIFQSPDFTTPGJOEJWJEVBUJPOJOEJ

WJEVBMTBDRVJSFBTFOTFPGTFMGJEFOUJUZ5IFPQQPTJUFPGBEJGGFSFOUJBUFETFMGJTFY

QFSJFODFEBTFNPUJPOBMSFBDUJWJUZXIJDIJTXIBUIBQQFOTXIFOPUIFSTiQVTIZPVS

CVUUPOTw5IFSFTQPOTFXIBUFWFSJU NJHIUCFBOHFSIVSU QBOJDJTBVUPNBUJD

4JNJMBSUPDPHOJUJWFCFIBWJPSJTUT#PXFOGFMUUIBUQFPQMFDPVMEMFBSOUPVTFUIFJS

JOUFMMFDUUPSFTQPOESBUJPOBMMZ#PXFOBTLFEIJTUSBJOFFTUPHPUPTJHOJmDBOUGBNJMZ

FWFOUTBOEUPBEPQUBOPCTFSWFSSPMFUPQSBDUJDFOPUJOHXIBUIBQQFOTBOEUPOPU

SFBDU5IJTEJGGFSFOUJBUJPOGSPNUIFGBNJMZPGPSJHJOFOBCMFEIJTUSBJOFFTUPBDDFQU

QFSTPOBMSFTQPOTJCJMJUZGPSUIFJSUIPVHIUTGFFMJOHTQFSDFQUJPOTBOEBDUJPOT"GUFS

ZPVDPOTUSVDU ZPVS HFOPHSBN ZPV NJHIU XBOU UP OPUF POJUXIJDIQFPQMFXFSF

HPPEBUQVTIJOHZPVSCVUUPOT)PXEJEUIFZEPJU 8IBUXFSFUIFJTTVFTJOWPMWFE 

8BTUIFSFBTFRVFODFUPUIFJOUFSBDUJPOTUIBUFTDBMBUFEJOUPFNPUJPOBMSFBDUJWJUZ

*UJTBMTPJNQPSUBOUUPOPUFUIBUUXPPG#PXFOTNPTUQSPNJOFOUDPMMFBHVFT#FUUZ

$BSUFSBOE.POJDB.D(PMESJDLBMNPTUTJOHMFIBOEFEMZJOJUJBUFECPUIBEFWFMPQNFOUBM

BOEBNVMUJDVMUVSBMQFSTQFDUJWFJOGBNJMZUIFSBQZ*OEFFE.D(PMESJDLTXPSLJODMVEFT

UIFmFMETNPTUJNQPSUBOUXPSLPOHFOPHSBNT.D(PMESJDLFUBMGBNJMZMJGF

DZDMF.D(PMESJDLFUBMBOEHFOEFS.D(PMESJDL"OEFSTPO8BMTI

Human Validation Process Model

"UBCPVU UIF TBNF UJNF UIBU#PXFOXBTEFWFMPQJOHIJTBQQSPBDI7JSHJOJB4BUJS

CFHBOFNQIBTJ[JOHGBNJMZDPOOFDUJPO)FSUIFSBQFVUJDXPSLIBEBMSFBEZMFE

IFSUPCFMJFWFJOUIFWBMVFPGBTUSPOHOVSUVSJOHSFMBUJPOTIJQCBTFEPOJOUFSFTUBOE

GBTDJOBUJPOXJUIUIPTFJOIFSDBSF6OMJLF#PXFO4BUJSDPVMEFOWJTJPOBOETPVHIU

UPTVQQPSUUIFEFWFMPQNFOUPGBOVSUVSJOHUSJBEUXPQFPQMFGPSFYBNQMFQBSFOUT

XPSLJOHGPSUIFXFMMCFJOHPGBOPUIFSQFSIBQTBDIJME4BUJSUIPVHIUPGIFSTFMGBTB

EFUFDUJWFXIPTPVHIUPVUBOEMJTUFOFEGPSUIFSFnFDUJPOTPGTFMGFTUFFNJOUIFDPN

NVOJDBUJPOPGIFSDMJFOUT*OEFFETIFQMBDFEBWFSZTUSPOHFNQIBTJTPOUIFJNQPS

UBODFPGDPNNVOJDBUJPOBOENFUBDPNNVOJDBUJPOJOGBNJMZJOUFSBDUJPOTBOEUIF

WBMVFPGUIFSBQFVUJDWBMJEBUJPOJOUIFQSPDFTTPGDIBOHF4BUJS#JUUFS

4BUJSPVUMJOFEGPVSDPNNVOJDBUJPOTUBODFTUIBUQFPQMFUFOEFEUPBEPQUVO

EFSTUSFTTCMBNJOHQMBDBUJOHTVQFSSFBTPOBCMFBOEJSSFMFWBOUBlamingJTXIFOPOF

TIJGUTSFTQPOTJCJMJUZUPTPNFPOFFMTFJOBOFGGPSUUPQSFTFSWFUIFTFMGPlacatingJTKVTU

UIFPQQPTJUFUBLJOHUIFCMBNFUPQSPUFDUTPNFPOFFMTFGSPNCFJOHIFMESFTQPOTJCMF

PSUSZJOHUPNBLFFWFSZPOFIBQQZTPPUIFSTXJMMCFIBQQZXJUIUIBU QFSTPO"EPQU

JOHBsuper reasonableQPTJUJPOJTEPOFUPNBJOUBJODPOUSPMPGPOFTNFTTZPSQBJOGVM

FNPUJPOTUIJTQFSTPOXJMMSFTQPOEXJUIGBDUTBOETPVOEWFSZNVDIMJLFBDPNQVUFS

IrrelevanceJTBOZEJTUSBDUJOHDPNNVOJDBUJPOVTFEUPBWPJETUSFTTPSQBJOBMUPHFUIFS

JUJTXIBUQFPQMFTBZXIFOUIFZBSFJHOPSJOHQSPCMFNTSJHIUJOGSPOU PG UIFN 5IF

BOUJEPUFUPUIFTFTUSFTTDPNNVOJDBUJPOTJTcongruenceCZXIJDI4BUJSNFBOUFNPUJPO

BMIPOFTUZJOXIJDIPOFTQFBLTGPSPOFTFMGTUBZTHSPVOEFEPSDFOUFSFEBOEJTBCMF

UPCPUITIBSFXIBUTIFPSIFJTGFFMJOHBOEBTLGPSXIBUJTOFFEFE'BNJMJFTJOUIFSBQZ

BSFBMNPTUOFWFSDPOHSVFOUCVUJUIFMQTBHSFBUEFBMJGUIFDPVOTFMPSPSUIFSBQJTUJT

5IJOL BCPVU B UJNF XIFO QFPQMF JO ZPVS GBNJMZ XFSF VOEFS B MPU PG TUSFTT

8IBUDPNNVOJDBUJPOTUBODFEJEZPVSGBNJMZNFNCFSTVTF 0OXIJDITUBODFEJE

ZPVNPTUSFMZ 8BTUIFSFBEBODFUPUIFTUSFTTDPNNVOJDBUJPOTNBZCFmSTUTV

QFSSFBTPOBCMFUIFOCMBNJOHBOEUIFOQMBDBUJOH 8IBUJTJUMJLFUPUIJOLBCPVU

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

440

CHAPTER FOURTEEN

DPNNVOJDBUJPO BT BO JOUFSBDUJWF TUSFTT EBODF  )PX EJE QFPQMF SFTQPOE UP ZPV

XIFO ZPV XFSF VOEFS TUSFTT  %P ZPV LOPX BOZPOF NBZCF FWFO ZPVSTFMG XIP

SFTQPOETUPTUSFTTJOBDPOHSVFOUNBOOFS

Experiential Family Therapy

$BSM8IJUBLFSXBTBQJPOFFSJOTZNCPMJDFYQFSJFOUJBMGBNJMZUIFSBQZ$MFBSMZ

BOBQQMJDBUJPOPGFYJTUFOUJBMUIFSBQZUPGBNJMZTZTUFNT8IJUBLFSTUSFTTFEDIPJDF

GSFFEPN TFMGEFUFSNJOBUJPO HSPXUI BOE BDUVBMJ[BUJPO 8IJUBLFS  #VNCFSSZ

 -JLF 4BUJS BOE PUIFS FYQFSJFOUJBM BQQSPBDIFT 8IJUBLFS TUSFTTFE UIF JN

QPSUBODFPGUIFSFMBUJPOTIJQCFUXFFOUIFGBNJMZBOEUIFUIFSBQJTU8IJUBLFSXBT

DMFBSMZNPSF DPOGSPOUJWF JO IJTiSFBMOFTTw UIBO 4BUJSXIP XBT NPSF OVSUVSJOH

)JTHPBMXBTOPUUPFMJNJOBUFBOYJFUZJOUIFGBNJMZCVUUPNBJOUBJOPSFOIBODFJU

TPUIBUJUXPVMETFSWFBTBNPUJWBUJPOGPSDIBOHF8IJUBLFSTJOUFSWFOUJPOTXFSF

BMNPTUBMXBZTFOBDUFEXJUIDPUIFSBQJTUT5PXBSEUIFFOEPGIJTMJGFIFXPVMEPOMZ

TFFXIPMFGBNJMJFTOFWFSJOEJWJEVBMTPSQBSUTPGGBNJMJFTBOEIFFWFOUSJFEUPHFU

DPNNVOJUZBOEXPSLBTTPDJBUFTPGUIFGBNJMZUPDPNFJO

8IJUBLFSTGSFFXIFFMJOH JOUVJUJWFBQQSPBDITPVHIUUPVONBTL QSFUFOTF BOE

DSFBUFOFXNFBOJOHXIJMFMJCFSBUJOHGBNJMZNFNCFSTUPCFUIFNTFMWFT8IJUBLFS

EJE OPU QSPQPTF B TFU PG NFUIPET SBUIFS JU JT UIF QFSTPOBM JOWPMWFNFOU PG UIF

UIFSBQJTUXJUIBGBNJMZUIBUNBLFTBEJGGFSFODF8IFOUFDIOJRVFTBSFFNQMPZFE

UIFZBSJTFGSPNUIFUIFSBQJTUTJOUVJUJWFBOETQPOUBOFPVTSFBDUJPOTUPUIFQSFTFOU

TJUVBUJPOBOEBSFEFTJHOFEUPJODSFBTFDMJFOUTBXBSFOFTTPGUIFJSJOOFSQPUFOUJBM

BOEUPPQFODIBOOFMTPGGBNJMZJOUFSBDUJPOTFF#JUUFSC

'SPN8IJUBLFSXFMFBSOUIFJNQPSUBODFPGVTJOHZPVSTFMGJOUIFSBQZ8IBUBSF

TPNFUIJOHTZPVDPVMEJNBHJOFUIJOLJOHPSGFFMJOHBCPVUBGBNJMZCVUXIJDIZPV

XPVMEGFFMDPOTUSBJOFEOPUUPTBZ )PXXPVMEZPVHPBCPVUmOEJOHZPVSPXOXBZ

PGDPOGSPOUJOHGBNJMJFTJOBUIFSBQFVUJDXBZ 8IJUBLFSTiJOUVJUJPOwXBTJOGPSNFE

CZNPSFUIBOZFBSTPGQSBDUJDF)PXXJMMZPVHPBCPVUUSBJOJOHZPVSJOUVJUJPO

BOEEPZPVUIJOLJUXPVMECFXJTFUPIBWFBDPUIFSBQJTUXIJMFZPVEPUIBU 8IBU

XPVMEZPVFYQFDUJOZPVSSFMBUJPOTIJQXJUIBDPUIFSBQJTU

Structural-Strategic Family Therapy

5IFPSJHJOTPGstructural family therapyDBOCFUSBDFEUPUIFFBSMZTXIFO4BMWB

EPS.JOVDIJOXBTDPOEVDUJOHUIFSBQZUSBJOJOHBOESFTFBSDIXJUIEFMJORVFOUCPZT

GSPNQPPSGBNJMJFTBUUIF8JMUXZDL4DIPPMJO/FX:PSL.JOVDIJOTDFO

USBMJEFBXBTUIBUBOJOEJWJEVBMTTZNQUPNTBSFCFTUVOEFSTUPPEGSPNUIFWBOUBHF

QPJOUPGJOUFSBDUJPOBMQBUUFSOTPSTFRVFODFTXJUIJOBGBNJMZBOEGVSUIFSTUSVDUVSBM

DIBOHFTNVTUPDDVSJOBGBNJMZCFGPSFBOJOEJWJEVBMTTZNQUPNTDBOCFSFEVDFEPS

FMJNJOBUFE5IFHPBMTPGTUSVDUVSBMGBNJMZUIFSBQZBSFUXPGPMESFEVDFTZNQUPNT

PGEZTGVODUJPOBOECSJOHBCPVUTUSVDUVSBMDIBOHFXJUIJOUIFTZTUFNCZNPEJGZ

JOHUIFGBNJMZTUSBOTBDUJPOBMSVMFTBOEEFWFMPQJOHNPSFBQQSPQSJBUFCPVOEBSJFT

*OUIFMBUFT+BZ)BMFZKPJOFE.JOVDIJOBUUIF1IJMBEFMQIJB$IJME(VJEBODF

$MJOJD5IFXPSLPG)BMFZBOE.JOVDIJOTIBSFETPNBOZTJNJMBSJUJFTJOHPBMTBOE

QSPDFTTUIBUNBOZDMJOJDJBOTJOUIFTBOETCFHBOUPRVFTUJPOXIFUIFSUIF

UXPNPEFMTXFSFEJTUJODUTDIPPMTPGUIPVHIU*OEFFECZUIFMBUFTstructural-

strategic approachesXFSFUIFNPTUVTFENPEFMTJOGBNJMZTZTUFNTUIFSBQZ5IF

JOUFSWFOUJPOT HFOFSBUFE JO UIFTF NPEFMT CFDBNF TZOPOZNPVT XJUI B TZTUFNT

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

441

FAMILY SYSTEMS THERAPY

BQQSPBDIUIFZJODMVEFEKPJOJOHCPVOEBSZTFUUJOHVOCBMBODJOHSFGSBNJOHPSEFBMT

QBSBEPYJDBMJOUFSWFOUJPOTBOEFOBDUNFOUT

*GZPVEJWJEFEZPVSGBNJMZPGPSJHJOJOUPTVCTZTUFNTXIPXPVMECFJOUIFQBSFO

UBMTVCTZTUFN 5IFTQPVTBMTVCTZTUFN 5IFTJCMJOHTVCTZTUFN *OZPVSGBNJMZEJE

UIFQBSFOUBMTVCTZTUFNBOEUIFTQPVTBMTVCTZTUFNDPOUBJOUIFTBNFQFPQMFPSEJG

GFSFOUQFPQMFBUEJGGFSFOUUJNFT 8IBUSVMFTBOECPVOEBSJFTXFSFTFUBSPVOEFBDI

TVCTZTUFN 8FSF UIF CPVOEBSJFTFWFS DSPTTFE  #ZXIPN BOE XJUI XIBU SFTVMU 

8IBUXFSFDPNNPOJOUFSBDUJPOBMTFRVFODFTJOZPVSGBNJMZ 8IBUXFSFUIFSPV

UJOFTUIBUNBEFVQZPVSFBSMZMJGFBOEXIBUSVMFTHPWFSOFEUIFTFSPVUJOFT )PXBD

DPNNPEBUJOHXFSFZPVSGBNJMZNFNCFSTUPDIBOHFBOEUSBOTJUJPOTCSPVHIUPOCZ

GBNJMZEFWFMPQNFOUPSXIFOBMMPGZPVIBEUPGBDFBOFYUFSOBMDIBMMFOHFPSPSEFBM 

8IPIBEUIFQPXFSJOZPVSGBNJMZBOEIPXXBTJUFYFSDJTFE 8IPXBTBMJHOFEXJUI

XIPNBOEXIBUEJEUIFZVTFUIBUBMJHONFOUUPBDIJFWF 5IFTFBSFKVTUBGFXPG

UIFBTTFTTNFOUTUIBUTUSVDUVSBMTUSBUFHJDUIFSBQJTUTUBVHIUVTUPDPOTJEFS

.JOVDIJOBOEPUIFSTUSVDUVSBMGBNJMZUIFSBQJTUTJOJUJBUFEUIFJSXPSLXJUIUIF

QPPS5IFZIBWFBMXBZTCFFOFOHBHFEJONVMUJDVMUVSBMTFUUJOHTBOEXPSLFEXJUI

NVMUJDVMUVSBMDMJFOUT*OEFFENBOZPGUIFNPTUQSPNJOFOUTUSVDUVSBMGBNJMZUIFSB

QJTUTIBWFEFEJDBUFEUIFJSFGGPSUTUPXPSLJOHQSFEPNJOBOUMZXJUI"GSJDBO"NFSJDBO

BOE)JTQBOJDGBNJMJFT*UXBTPOMZJO)BMFZTNPTUSFDFOUXPSLUIBUIFFNQIBTJ[FE

UIFJNQPSUBODFPGDVMUVSBMFNCFEEFEOFTT)BMFZ3JDIFQPSU)BMFZ

Recent Innovations in Family Therapy

*OUIF MBTU EFDBEFfeminism, multiculturalismBOEpostmodern social construction-

ismIBWFBMMFOUFSFEUIFGBNJMZUIFSBQZmFME5IFTFNPEFMTBSFNPSFDPMMBCPSBUJWF

USFBUJOHDMJFOUTJOEJWJEVBMTDPVQMFTPSGBNJMJFTBTFYQFSUTJOUIFJSPXOMJWFT

5IFUIFSBQFVUJDDPOWFSTBUJPOTTUBSUXJUIUIFDPVOTFMPSJOBiOPULOPXJOHwQPTJ

UJPOJOXIJDIDMJFOUTBSFBQQSPBDIFEXJUIDVSJPTJUZBOEJOUFSFTU5IFUIFSBQJTUJT

TPDJBMMZBDUJWFBOEBJETDMJFOUTJOUBLJOHBQSFGFSSFETUBOEJOSFMBUJPOUPUIFEPNJ

OBOUDVMUVSFUIBUNBZCFPQQSFTTJOHUIFN5IFSBQZPGUFOJODPSQPSBUFTiSFnFDUJOH

UFBNTwBOEiEFmOJUJPOBMDFSFNPOJFTwUPCSJOHNVMUJQMFQFSTQFDUJWFTUPUIFXPSL

TFF8FTU#VCFO[FS#JUUFS

5IFTF NPSF SFDFOU BQQSPBDIFT UP GBNJMZ UIFSBQZ DIBMMFOHF XIBU #FDWBS BOE

#FDWBSDBMMmSTUPSEFSDZCFSOFUJDTBQFSTQFDUJWFUIBUIBTCFFOQBSUPGGBNJMZ

UIFSBQZTJODFUIFUJNFPG"EMFSFirst-order cyberneticsWJFXTUIFDPVOTFMPSBOEUIFSB

QJTUBTBOPCTFSWFSXIPJTPVUTJEFPGUIFTZTUFNDBOBTTFTTXIBUJTHPJOHPOBOEDBO

QSPNPUFDIBOHFBMMXJUIPVUFWFSCFDPNJOHQBSUPGUIFTZTUFN5IJTQFSTQFDUJWFJT

JOIFSFOUJOUIFNFEJDBMNPEFMBOEJTUIFXBZJOXIJDINBOZQSPGFTTJPOTGVODUJPO

'FNJOJTUBOE QPTUNPEFSONPEFMTPGGBNJMZ UIFSBQZ BSFCBTFEPOUIF QFSTQFDUJWF

PGsecond-order cybernetics;UIBUJTUIFGBNJMZQSBDUJUJPOFSCFDPNFTQBSUPGUIFGBNJMZ

TZTUFNBOEKVTUCZCFJOHQSFTFOUXJUIUIFGBNJMZDIBOHFTJU'FNJOJTUNVMUJDVMUVSBM

BOEQPTUNPEFSOUIFSBQJTUTBSFFYUSFNFMZBXBSFPGUIFQPXFSUIFZIBWFFOUFSJOHJOUP

BMSFBEZFTUBCMJTIFETZTUFNTBOEUIFZXPSLUPQSPNPUFVOEFSTUBOEJOHUISPVHIDV

SJPTJUZBOEJOUFSFTUSBUIFSUIBOUISPVHIGPSNBMBTTFTTNFOUT"EPQUJOHBEFDFOUFSFE

QPTJUJPOBMMPXTUIFNUPCFQBSUPGUIFTZTUFNXJUIPVUUBLJOHJUPWFS

postmodern perspectives in family therapy*O$IBQUFSZPV

XFSF JOUSPEVDFE UP QJPOFFST JO UIF QPTUNPEFSO BQQSPBDIFT 8F SFUVSO IFSF UP

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

442

CHAPTER FOURTEEN

CSJFnZEJTDVTTTPNFPGUIFDPOUSJCVUJPOTPGUIFTFJOEJWJEVBMTJOEFWFMPQJOHQPTU

NPEFSONPEFMTPGGBNJMZUIFSBQZ

4UFWFEF4IB[FSBOE IJT TQPVTFQBSUOFS *OTPP ,JN#FSHUVSOFETUSBUF

HJDGBNJMZUIFSBQZBTJUXBTQSBDUJDFEBUUIF.FOUBM3FTFBSDI*OTUJUVUFPOJUTIFBE

3BUIFSUIBO GPDVTJOHPOUIFQSPCMFNEF 4IB[FS EFWFMPQFENFUIPETUIBUGPDVTFE

POMZPOTPMVUJPOTDBMMJOHIJTBQQSPBDIsolution-focused therapy. *OEFFEEF4IB[FSXBT

TPTPMVUJPOGPDVTFEUIBUIFBDUVBMMZTVHHFTUFEIFEJEOPUFWFOOFFEUPLOPXXIBUUIF

QSPCMFNXBTUIBUCSPVHIUUIFGBNJMZUPUIFSBQZ6TJOHJOUFSWFOUJPOTMJLFUIFNJSBDMF

RVFTUJPOTDBMJOHRVFTUJPOTFYDFQUJPORVFTUJPOTBOEFWFODPNQMJNFOUTTPMVUJPOGP

DVTFEUIFSBQJTUTIFMQFEGBNJMJFTDSFBUFUIFJSQSFGFSSFEXBZTPGCFJOH0OFPGEF4IB[

FSBOE#FSHTGPSNFSTUVEFOUT.JDIFMF8FJOFS%BWJTKPJOFEXJUI#JMM0)BOMPOUP

NPEJGZ UIF TPMVUJPOGPDVTFE BQQSPBDI TMJHIUMZ 0)BOMPO  8FJOFS%BWJT 

5IFZDSFBUFETPMVUJPOPSJFOUFEUIFSBQZBOECFMJFWFEUIBUGBNJMZTPMVUJPOTXFSFPG

UFOFNCFEEFEXJUIJOUIFQSPCMFNTUIBUUIFJSDMJFOUTSFQPSUFE4PMVUJPOGPDVTFEBOE

TPMVUJPOPSJFOUFEUIFSBQJFTXFSFQBSUPGBOFXPSJFOUBUJPOUPGBNJMZUIFSBQZCBTFE

POBQPTUNPEFSOQFSTQFDUJWFBOEXIBU(FSHFODBMMFETPDJBMDPOTUSVDUJPOJTN

.JDIBFM8IJUFBOE%BWJE&QTUPODSFBUFEUIFNPTUJOnVFOUJBMPGUIFQPTU

NPEFSOBQQSPBDIFTnarrative therapy8IJUFBOE&QTUPOCFMJFWFEUIBUQFPQMFBOE

GBNJMJFTEJEOPUNFSFMZMJWFMJGFCVUMJWFEUIFTUPSJFTPGUIFJSMJWFT&BDINFNCFSPGUIF

GBNJMZIBEIJTPSIFSPXOQFSTPOBMOBSSBUJWFBTXFMMBTUIFGBNJMZOBSSBUJWF8IFO

UIFTFTUPSJFTCFDBNFQSPCMFNTBUVSBUFEOFJUIFSJOEJWJEVBMTOPSGBNJMJFTGVODUJPOFE

WFSZ XFMM 8IJUF BOE &QTUPO BEPQUFE B EFDFOUFSFE QPTJUJPO XJUI GBNJMJFT XIJDI

DBNF UP CF LOPXO BT B iOPULOPXJOHw QPTJUJPO "OEFSTPO  (PPMJTIJBO 

5IFZBQQSPBDIFEUIFNFNCFSTPGBGBNJMZXJUIDVSJPTJUZBOEJOUFSFTUBOEUIFZUSFBU

FEUIFTFJOEJWJEVBMTBTFYQFSUTJOUIFJSPXOMJWFT/BSSBUJWFUIFSBQJTUTTFFLUPNBQ

UIFJOnVFODFQSPCMFNTIBWFPOQFPQMFBOEUIFOFYUFSOBMJ[FUIPTFQSPCMFNTTPUIBU

JOEJWJEVBMTBOEGBNJMJFTDBOBEPQUBQSFGFSSFETUBOEJOSFMBUJPOUPUIFQSPCMFN

BT XFMM BT TFFLJOH B QSFGFSSFE PVUDPNF :PV DBO TFF JO UIJT MBUUFS FNQIBTJT UIF

SFMBUJPOTIJQPGUIFOBSSBUJWFNPEFMUPTPMVUJPOPSJFOUFE UIFSBQZ 1PTUNPEFSO BQ

QSPBDIFTUPGBNJMZUIFSBQZMJLFOBSSBUJWFUIFSBQZTFFLUPSFEVDFPSFMJNJOBUFUIF

QPXFSBOEJNQBDUPGUIFGBNJMZUIFSBQJTU5BLFOUPHFUIFSQPTUNPEFSOBQQSPBDIFT

SFQSFTFOUBSFBMQBSBEJHNTIJGUJOUIFmFMEPGGBNJMZUIFSBQZ

/PXUIBUZPVIBWFUBLFOUIJTCSJFGUPVSPGTPNFPGUIFNBKPSBQQSPBDIFTUP

GBNJMZUIFSBQZXIJDIBQQSPBDINPTUJOUFSFTUTZPVBOEXIJDIPOFXPVMEZPVXBOU

UPMFBSONPSFBCPVU 8IBUEPZPVCFMJFWFJTUIFCFTUBQQSPBDIUPGBNJMJFTJOEJG

mDVMUZ "SFZPVNPSFDPNGPSUBCMFXJUIGPSNBMBTTFTTNFOUTEJSFDUJWFTQBSBEPYJDBM

JOUFSWFOUJPOTBOEDIBMMFOHJOHUIFGBNJMZTZTUFN 0SBSFZPVNPSFJOUFSFTUFEJO

GBNJMZTUPSJFTBOEJOEJWJEVBMQFSTQFDUJWFTUIBUBSFCPUIBOJOnVFODFPOBOEIBWF

CFFOJOnVFODFECZDVMUVSFHFOEFSBOETPDJFUBMQSFSPHBUJWFT %PZPVTFFZPVSTFMG

BTBOPVUTJEFPCTFSWFSPSBQFSTPOXIPFOUFSTUIFTZTUFNBOECFDPNFTQBSUPGJUJO

TPNFXBZ /FJUIFSQFSTQFDUJWFJTSJHIUPSXSPOHHPPEPSCBEUIFZBSFKVTUEJGGFS

FOU,OPXJOHUIFQFSTQFDUJWFXJUIXIJDIZPVBSFNPTUDPNGPSUBCMFDBONBLFBMM

UIFEJGGFSFODFJOUIFEFWFMPQNFOUPGZPVSDBSFFS

5IJTCSJFGEJTDVTTJPOPGUIFWBSJPVTTZTUFNJDWJFXQPJOUTJOGBNJMZUIFSBQZQSP

WJEFTBDPOUFYUGPSVOEFSTUBOEJOHUIFEFWFMPQNFOUPGGBNJMZUIFSBQZ5BCMF

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

443

FAMILY SYSTEMS THERAPY

TABLE 14.1 A Comparison of Six Systemic Viewpoints in Family Therapy

ADLERIAN

FAMILY

THERAPY

MULTI-GENERATIONAL

FAMILY

THERAPY

HUMAN

VALIDATION

PROCESS

MODEL

EXPERIENTIAL/

SYMBOLIC

FAMILY

THERAPY

STRUCTURAL

FAMILY

THERAPY

STRATEGIC

FAMILY

THERAPY

Key figures

"GSFE"EMFS

3VEPMG

%SFJLVST0TDBS

$ISJTUFOTFO

.BOGPSE

4POTUFHBSE

.VSSBZ#PXFO 7JSHJOJB4BUJS $BSM8IJUBLFS 4BMWBEPS.JOVDIJO +BZ)BMFZ$MP±.BEBOFT

Time focus

1SFTFOUXJUI

TPNFSFGFSFODF

UPUIFQBTU

1SFTFOUBOEQBTUGBNJMZPG

PSJHJOUISFFHFOFSBUJPOT

)FSFBOEOPX 1SFTFOU 1SFTFOUBOEQBTU 1SFTFOUBOE'VUVSF

Therapy goals

&OBCMF

QBSFOUTBT

MFBEFSTVOMPDL

NJTUBLFOHPBMT

BOEJOUFS

BDUJPOBMQBUUFSOT

JOGBNJMZ

QSPNPUJPO

PGFGGFDUJWF

QBSFOUJOH

%JGGFSFOUJBUFUIFTFMGDIBOHF

UIFJOEJWJEVBMXJUIJOUIF

DPOUFYUPGUIFTZTUFN

EFDSFBTFBOYJFUZ

1SPNPUFHSPXUI

TFMGFTUFFNBOE

DPOOFDUJPO

IFMQGBNJMZ

SFBDIDPOHSVFOU

DPNNVOJDBUJPO

BOEJOUFSBDUJPO

1SPNPUFTQPOUBOFJUZ

DSFBUJWJUZBVUPOPNZ

BOEBCJMJUZUPQMBZ

3FTUSVDUVSFGBNJMZ

PSHBOJ[BUJPODIBOHF

EZTGVODUJPOBM

USBOTBDUJPOBM

QBUUFSOT

&MJNJOBUFQSFTFOUJOH

QSPCMFNDIBOHF

EZTGVODUJPOBMQBUUFSOT

JOUFSSVQUTFRVFODF

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

444

CHAPTER FOURTEEN

Role and

function of

the therapist

&EVDBUPS

NPUJWBUJPOBM

JOWFTUJHBUPS

DPMMBCPSBUPS

(VJEFPCKFDUJWFSFTFBSDIFS

UFBDIFSNPOJUPSPGPXO

SFBDUJWJUZ

"DUJWFGBDJMJUBUPS

SFTPVSDFEFUFDUJWF

NPEFMGPS

DPOHSVFODF

'BNJMZDPBDI

DIBMMFOHFSNPEFMGPS

DIBOHFUISPVHIQMBZ

i'SJFOEMZVODMFw

TUBHFNBOBHFS

QSPNPUFSPGDIBOHF

JOGBNJMZTUSVDUVSF

"DUJWFEJSFDUPSPGDIBOHF

QSPCMFNTPMWFS

Process of

change

'PSNBUJPOPG

SFMBUJPOTIJQ

CBTFEPO

NVUVBMSFTQFDU

JOWFTUJHBUJPOPG

CJSUIPSEFSBOE

NJTUBLFOHPBMT

SFFEVDBUJPO

2VFTUJPOTBOEDPHOJUJWF

QSPDFTTFTMFBEUP

EJGGFSFOUJBUJPOBOE

VOEFSTUBOEJOHPG

GBNJMZPGPSJHJO

'BNJMZJTIFMQFE

UPNPWFGSPN

TUBUVTRVPUISPVHI

DIBPTUPOFX

QPTTJCJMJUJFTBOE

OFXJOUFHSBUJPOT

"XBSFOFTTBOE

TFFETPGDIBOHFBSF

QMBOUFEJOUIFSBQZ

DPOGSPOUBUJPOT

5IFSBQJTUKPJOT

UIFGBNJMZJOB

MFBEFSTIJQFSPMF

DIBOHFTTUSVDUVSF

TFUTCPVOEBSJFT

$IBOHFPDDVSTUISPVHI

BDUJPOPSJFOUFEEJSFDUJWFT

BOEQBSBEPYJDBM

JOUFSWFOUJPOT

Techniques and

innovations

'BNJMZ

DPOTUFMMBUJPO

UZQJDBMEBZ

HPBMEJTDMPTVSF

OBUVSBMMPHJDBM

DPOTFRVFODFT

(FOPHSBNTEFBMJOH

XJUIGBNJMZPGPSJHJO

JTTVFTEFUSJBOHVMBUJOH

SFMBUJPOTIJQT

&NQBUIZUPVDI

DPNNVOJDBUJPO

TDVMQUJOHSPMF

QMBZJOHGBNJMZMJGF

DISPOPMPHZ

$PUIFSBQZ

TFMGEJTDMPTVSF

DPOGSPOUBUJPOVTFPG

TFMGBTDIBOHFBHFOU

+PJOJOH

BDDPNNPEBUJOH

VOCBMBODJOH

USBDLJOHCPVOEBSZ

NBLJOHFOBDUNFOUT

3FGSBNJOHEJSFDUJWFT

BOEQBSBEPYBNQMJGZJOH

QSFUFOEJOHFOBDUNFOUT

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

445

FAMILY SYSTEMS THERAPY

PVUMJOFT UIF EJGGFSFODFT JO UIFTF IJTUPSJDBM QFSTQFDUJWFT 'PS BO JOEFQUI USFBUNFOU

PGUIF TDIPPMT PG GBNJMZ UIFSBQZTFF#JUUFSTCTheory and Practice of Family

Therapy and Counseling4FFBMTPUIFSFDPNNFOEFESFBEJOHTBUUIFFOEPGUIFDIBQUFS

a multilayered process

of family therapy

'BNJMJFTBSFNVMUJMBZFSFETZTUFNTUIBUCPUIBGGFDUBOEBSFBGGFDUFECZUIFMBSHFS

TZTUFNTJOXIJDIUIFZBSFFNCFEEFE'BNJMJFTDBOCFEFTDSJCFEJOUFSNTPGUIFJS

JOEJWJEVBM NFNCFST BOE UIF WBSJPVT SPMFT UIFZ QMBZ UIF SFMBUJPOTIJQT CFUXFFO

UIF NFNCFST BOE UIF TFRVFOUJBM QBUUFSOT PG UIF JOUFSBDUJPOT BOE UIF QVSQPTFT

UIFTFTFRVFODFTTFSWF#PUIUIFNFNCFSTBOEUIFTZTUFNDBOCFBTTFTTFECBTFE

POQPXFSBMJHONFOUPSHBOJ[BUJPOTUSVDUVSFEFWFMPQNFOUDVMUVSFBOEHFOEFS

#SFVOMJO4DIXBSU[.BD,VOF,BSSFS&WFOJOEJWJEVBMTDBOCFDPOTJE

FSFEGSPNUIFQFSTQFDUJWFPGBOJOUFSOBMGBNJMZTZTUFN4DIXBSU[*OBEEJ

UJPOOVDMFBSGBNJMJFTJOBHMPCBMDPNNVOJUZBSFPGUFOQBSUPGFYUFOEFEJGEJTUBOU

GBNJMJFTNVMUJQMF GBNJMJFT NBLF VQ BDPNNVOJUZNVMUJQMFDPNNVOJUJFTNBLF

VQCPUISFHJPOTBOEDVMUVSFTXIJDIJOUVSODPOTUJUVUFOBUJPOTPSTPDJFUJFT5IF

QPXFSPGUIFTFNBDSPTZTUFNTUPJOnVFODFGBNJMZMJGFFTQFDJBMMZJOUIFBSFBTPG

HFOEFSBOEDVMUVSFJTTJHOJmDBOU(JWFOPVSQSFTVQQPTJUJPOTBCPVUGBNJMJFTBOE

UIFMBSHFSTZTUFNTJOXIJDIGBNJMJFTBSF FNCFEEFE B NVMUJMBZFSFE BQQSPBDI UP

GBNJMZUIFSBQZJTFTTFOUJBM

4FWFSBM GPSNT BOE TUSVDUVSFT IBWF CFFO QSPQPTFE GPS JOUFHSBUJWF NPEFMT PG

GBNJMZ DPVOTFMJOH BOE UIFSBQZ FH $BSMTPO 4QFSSZ  -FXJT  (MBEEJOH

)BOOB/JDIPMT5IFJOUFHSBUJWFNPEFMXFIBWFDIPTFO

UPQSFTFOUIFSFBMMPXTGPSBOFOMBSHFEJOUFHSBUJPOPGJEFBTGSPNNVMUJQMFNPEFMTPG

GBNJMZUIFSBQZ4JNJMBSUPBQJFDFPGDMBTTJDBMNVTJDUIFQSPDFTTPGGBNJMZUIFSBQZ

JUTFFNTUPVTIBTNPWFNFOUT5IFTFNPWFNFOUTDBOCFEFTDSJCFEBTTFQBSBUF

FYQFSJFODFTFNCFEEFEJOUIFMBSHFSnPXPGUIFSBQZ*OUIJTTFDUJPOXFEFTDSJCFGPVS

HFOFSBMNPWFNFOUTFBDIXJUIEJGGFSFOUUBTLTGPSNJOHBSFMBUJPOTIJQDPOEVDUJOH

BOBTTFTTNFOU IZQPUIFTJ[JOH BOE TIBSJOH NFBOJOHBOEGBDJMJUBUJOHDIBOHF*O

SBSFJOTUBODFTUIFTFGPVSNPWFNFOUTNJHIUPDDVSXJUIJOBTJOHMFTFTTJPOJONPTU

DBTFTIPXFWFSFBDINPWFNFOUSFRVJSFTNVMUJQMFTFTTJPOT

Forming a Relationship

0WFSUIFZFBSTGBNJMZTZTUFNTUIFSBQJTUTIBWFVTFEBXJEFSBOHFPGNFUBQIPSTUP

EFTDSJCFUIFSPMFPGUIFUIFSBQJTUBOEUIFUIFSBQFVUJDSFMBUJPOTIJQ5IFFNFSHFODF

PGGFNJOJTUBOEQPTUNPEFSONPEFMTJOUIFSBQZIBTNPWFEUIFmFMEPGGBNJMZUIFS

BQZUPXBSENPSFFHBMJUBSJBODPMMBCPSBUJWFDPPQFSBUJWFDPDPOTUSVDUJOHSFMBUJPO

TIJQTTFF5"OEFSTFO)"OEFSTPO"OEFSTPO(PPMJTIJBO

&QTUPO8IJUF-VFQOJU[

5IF EFCBUF $BSM 3PHFST  mSTU JOUSPEVDFE UP JOEJWJEVBM UIFSBQZ JO UIF

TIBTSFFNFSHFEXJUIJOGBNJMZUIFSBQZJOUIFGPSNPGUIFTFRVFTUJPOT

t 8IBUFYQFSUJTFEPFTUIFUIFSBQJTUIBWFJOSFMBUJPOUPUIFGBNJMZBOEIPXTIPVME

UIBUFYQFSUJTFCFVTFE

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

446

CHAPTER FOURTEEN

t )PXEJSFDUJWFTIPVMEUIFSBQJTUTCFJOSFMBUJPOUPGBNJMJFTBOEXIBUEPFTUIBU

TBZBCPVUUIFVTFTPGQPXFSJOUIFSBQZ

8FCFMJFWFBNVMUJMBZFSFEBQQSPBDIUPGBNJMZUIFSBQZJTCFTUTVQQPSUFECZBDPM

MBCPSBUJWFUIFSBQJTUoDMJFOUSFMBUJPOTIJQJOXIJDINVUVBMSFTQFDUDBSJOHFNQB

UIZBOEBHFOVJOFJOUFSFTUJOPUIFSTJTQSJNBSZ*OBEEJUJPOXFCFMJFWFEJSFDUFE

BDUJPOTBOEFOBDUNFOUTBSFNPTUVTFGVMXIFOUIFZBSFBKPJOUWFOUVSFPGCPUIUIF

UIFSBQJTUBOEUIFGBNJMZ

5IFSBQJTUTCFHJOUPGPSNBSFMBUJPOTIJQXJUIDMJFOUTGSPNUIFNPNFOUPGmSTU

DPOUBDU*ONPTUDBTFTXFCFMJFWFUIFSBQJTUTTIPVMENBLFUIFJSPXOBQQPJOUNFOUT

BOTXFSJOJUJBMRVFTUJPOTDMJFOUTNBZIBWFBOEHJWFDMJFOUTBTFOTFPGXIBUUPFYQFDU

XIFOUIFZDPNF5IJTJTBMTPBUJNFXIFODPVOTFMPSTDBOMFUGBNJMJFTLOPXUIFJS

QPTJUJPOPOXIFUIFSBMMNFNCFSTTIPVMECFQSFTFOU4PNFGBNJMZUIFSBQJTUTXJMM

XPSLXJUIBOZPGUIPTFNFNCFSTPGUIFGBNJMZXIPXJTIUPDPNFPUIFSTXJMMPOMZ

TFFUIFGBNJMZJGFWFSZPOFJTBQBSUPGUIFUIFSBQZTFTTJPO

'SPN UIF NPNFOU PG mSTU GBDFUPGBDF DPOUBDU HPPE UIFSBQFVUJD SFMBUJPOTIJQT

TUBSUXJUIFGGPSUTBUNBLJOHDPOUBDUXJUIFBDIQFSTPOQSFTFOU4BUJS#JUUFS

8IFUIFSJUJTDBMMFEjoiningengagementPSTJNQMFcare and concernJUJTUIFUIFSBQJTUT

SFTQPOTJCJMJUZUPNFFUFBDIQFSTPOXJUIPQFOOFTTBOEXBSNUI(FOFSBMMZBGPDVTFE

JOUFSFTUPOFBDIGBNJMZNFNCFSIFMQTUPSFEVDFUIFBOYJFUZUIFGBNJMZNBZCFGFFMJOH

5IFSBQFVUJDQSPDFTTBOETUSVDUVSFBSFQBSUPGUIFUIFSBQJTUTKPCEFTDSJQUJPO

*UJTJNQPSUBOUGPSGBNJMZNFNCFSTUPJOUSPEVDFUIFNTFMWFTBOEUPFYQSFTTUIFJS

DPODFSOTCVUUIFUIFSBQJTUTIPVMEOPUGPDVTUPPUJHIUMZPODPOUFOUJTTVFT6OEFS

TUBOEJOHGBNJMZQSPDFTTJTBMNPTUBMXBZTGBDJMJUBUFECZhowRVFTUJPOT2VFTUJPOT

UIBUCFHJOXJUIwhatwhywherePSwhenUFOEUPPWFSFNQIBTJ[FDPOUFOUEFUBJMT

(MBEEJOH

"MMDIBOHFJOIVNBOTZTUFNTTUBSUTXJUIVOEFSTUBOEJOHBOEBDDFQUJOHUIJOHT

KVTUBTUIFZBSF4BUJS#BMEXJO5IFGBNJMZQSBDUJUJPOFSTTLJMMJODPNNV

OJDBUJOHUIBUVOEFSTUBOEJOHBOEFNQBUIZUISPVHIBDUJWFMJTUFOJOHMBZTUIFGPVOEB

UJPOGPS BOFGGFDUJWFXPSLJOHSFMBUJPOTIJQ 5IPTF DPVOTFMPSTBOEUIFSBQJTUTXIP

VTFWBMJEBUJPOBOEFODPVSBHFNFOUXIPTVQQPSUGBNJMZSFTJMJFODFBOEXIPFMJDJU

DPPQFSBUJPOFYQFSJFODFUIFHSFBUFTUBNPVOUPGTVDDFTTJOUIFSBQZ

Conducting an Assessment

5IFNVMUJQMFMBZFSTXFIBWFOPUFEBCPWFQSPWJEFOVNFSPVTFOUSZQPJOUTGPSDPO

EVDUJOHGBNJMZBTTFTTNFOUT CVU CFHJOOJOH DPVOTFMPSTBOE UIFSBQJTUT XJMM PGUFO

mOEUIBU NPSF GPSNBMBTTFTTNFOU QSPDFEVSFT TVDI BT HFOPHSBNT .D(PMESJDL

FUBMXJMMBMMPXUIFGBNJMZTUSVDUVSFBOETUPSJFTUPCFQSFTFOUFEJOBDMFBSFS

NPSFPSEFSMZNBOOFS*OTPNFDBTFTGPSNBMUFTUTBOESBUJOHTDBMFTTFFGPSFYBN

QMF(PUUNBOBMTPDBOCFVTFGVM

-FUTTUBSUXJUIUIFQSPDFTTGPSDPDPOTUSVDUJOHBHFOPHSBN.PTUGBNJMZQSBDUJ

UJPOFSTTUBSUXJUIBNBQPGUIFGBNJMZUIBUDPNFTUPUIFSBQZ5IFQBSFOUTBSFMJTUFE

XJUIUIFJSOBNFBHFBOEEBUFPGCJSUIJOFJUIFSBSFDUBOHMFGPSNFOPSBDJSDMFGPS

XPNFO*G UIFSFBSFNVMUJQMFSFMBUJPOTIJQT JOWPMWFE JOUIFQBSFOUBMTVCTZTUFN

UIFZBSFHFOFSBMMZJOEJDBUFEJODISPOPMPHJDBMPSEFSXJUINFOMJTUFEPOUIFMFGUBOE

XPNFOPOUIFSJHIU

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

447

FAMILY SYSTEMS THERAPY

*OUIFBCPWFHFOPHSBN.BSZNBSSJFE3BMQIXIFOTIFXBTBOE3BMQIXBT

UIFJSNBSSJBHFMBTUFEBCPVUZFBSTBOEUIFOUIFZXFSFEJWPSDFE*O.BSZ

BOE+PIOXFSFNBSSJFE*G+PIOBOE.BSZIBEEFDJEFEUPMJWFUPHFUIFSCVUOPU

DPNNJUUPBGPSNBMNBSSJBHFUIFHFOPHSBNXPVMEVTFBCSPLFOMJOFPSEBTIFTUP

JOEJDBUFBOJOGPSNBMSFMBUJPOTIJQMJLFUIJT

Ralph

Age 30

1/17/81

John

Age 25

2/27/86

Mary

Age 24

12/22/87

m. 2006//d. 2008 m. 2010

John

Age 25

2/27/86

Mary

Age 24

12/22/87

Ralph

Age 30

1/17/81

Mary

Age 24

12/22/87

d. 2008 m. 2006

*G3BMQIIBEEJFEJOTUFBEPGEJWPSDJOH.BSZJUXPVMEMPPLMJLFUIJT

8IFO.BSZBOE+PIOIBWFDIJMESFOUIFJSHFOPHSBNNBZMPPLMJLFUIJT

John

Age 30

2/27/86

John, Jr.

Age 5

4/20/11

Mary

Age 29

12/22/87

Ann

Age 2

3/12/14

m. 2010

*OUIFBCPWFHFOPHSBNJUJTOPXBOE+PIOBOE.BSZIBWFCFFONBS

SJFEGPSZFBST8IFOUIFZIBECFFONBSSJFEGPSZFBS.BSZHBWFCJSUIUPUIFJS

mSTUDIJMEBCPZUIBUUIFZOBNFE+PIO+S"ZFBSMBUFS.BSZIBEBNJTDBSSJBHF

JOEJDBUFECZBCMBDLPWBMBUUIFFOEPGBDIJMEMJOF5XPZFBSTBHPUIFZBEPQUFE

JOEJDBUFECZBTPMJEMJOFOFYUUPBCSPLFOMJOFUIFJSEBVHIUFS"OO*GXFFYUFOE

+PIOBOE.BSZTHFOPHSBNUPUISFFHFOFSBUJPOTBOEJGXFBTTVNFUIBUCPUI+PIO

BOE.BSZXFSFPOMZDIJMESFOUIFCBTJDUISFFHFOFSBUJPOGBNJMZHFOPHSBNXPVME

MPPLMJLFUIJT

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

448

CHAPTER FOURTEEN

.BOZPUIFSTZNCPMTBSFVTFEJOBHFOPHSBNJODMVEJOHBEPVCMFTRVBSFPSBEPV

CMFDJSDMFUPJOEJDBUFUIFJOEFYQFSTPOPSQFSTPOPOXIPNUIFHFOPHSBNJTBGPDVT

"OVQTJEFEPXOUSJBOHMFJOBTRVBSFPSDJSDMFJTVTFEUPJOEJDBUFBHBZNBOPSBMFT

CJBOXPNBO8FTIBEFUIFCPUUPNIBMGPGBTRVBSFPSDJSDMFUPJOEJDBUFTVCTUBODF

BCVTF8FVTFEPVCMFQBSBMMFMMJOFTUPJOEJDBUFBTUSPOHSFMBUJPOTIJQCFUXFFOUXP

QFPQMF BOE UISFF QBSBMMFM MJOFT UP JOEJDBUF B GVTFE PS FONFTIFE SFMBUJPOTIJQ "

EPUUFEMJOFJOEJDBUFTBEJTUBOUSFMBUJPOTIJQBOEDPOnJDUJTJOEJDBUFEXJUIMJOFTUIBU

MPPLMJLFUIJT======   -BUFSJOUIFDIBQUFSXFVTFBHFOPHSBNJOPVSXPSLXJUI

4UBOCVUZPVOPXIBWFFOPVHIJOGPSNBUJPOUPDPOTUSVDUZPVSPXOHFOPHSBNBOE

XFIJHIMZSFDPNNFOEUIBUZPVHFUBMBSHFQJFDFPGQBQFSBOEHFUTUBSUFE*UXPSLT

CFTUJGUXPQFPQMFJOUFSWJFXFBDIPUIFSTPUIBUZPVBSFCPUIESBXJOHUIFHFOPHSBN

BOEUFMMJOHFBDIPUIFSUIFTUPSZPGZPVSGBNJMZ

"TUIFUIFSBQJTUMJTUFOTUPGBNJMZNFNCFSTEFTDSJCFUIFTUPSZPGUIFJSGBNJMZJU

JTPGUFOEJGmDVMUUPLOPXXIFSFUPTUBSUXJUIBGBNJMZ'BNJMZNFNCFSTBSFPGUFO

UIFCFTUQFPQMFUPDIPPTF B GPDVT 'BNJMZ QSBDUJUJPOFSTPGUFOVTFDJSDVMBSPS SFMB

UJPOBMRVFTUJPOJOHUPHFUBUUIFTZTUFNJDJTTVFTQSFTFOUFEJOUIFGBNJMZTUPSZUIBUXJMM

QSPWJEFNFBOJOHGPSUIFUIFSBQJTUBOEUIFGBNJMZ'PSFYBNQMFTVQQPTF5BNNZJT

VQTFUUJOHUIFGBNJMZTZTUFNCZJHOPSJOHUIFDVSGFXIFSQBSFOUTIBWFTFUGPSIFS5IF

UIFSBQJTUNJHIUBTLi8IBUXJMMIBQQFOJG5BNNZTUBZTPVUQBTUDVSGFXBOEJTQJDLFE

VQCZUIFQPMJDF 8IPXJMMCFNPTUVQTFUCZUIJT w)FSFJT5BNNZTGBUIFSTSFQMZ

*XJMMQSPCBCMZCFUIFNPTUVQTFUPOUIFPVUTJEF*UFOEUPHPPGGCFGPSF*UIJOLBOEUIFO*

SFHSFUJUMBUFS0OUIFPUIFSIBOEIFSNPUIFSNBZOPUTIPXJUJNNFEJBUFMZCVUIFSIVSUXJMM

TUBZXJUIIFSMPOHFSBOEUIFOTIFXJMMHFUNBEBUNFGPSiMFUUJOH5BNNZPGGUIFIPPLw4IF

XJMMTBZUIBU5BNNZJTNBOJQVMBUJOHNFCVU*KVTUEPOUTFFXIZXFTIPVMELFFQmHIUJOH

BCPVUUIJOHT*UEPFTOUEPBOZHPPE8FmHIUBOE5BNNZEJTBQQFBST4IFXBOUTUPSVO

XJUIUIFCJHLJETTPNFPGXIPNBSFJODPMMFHFPWFSBOEIBWFOPDVSGFX

'SPNUIJTGBUIFSTSFTQPOTFUIFUIFSBQJTUDBODIPPTFGSPNBOVNCFSPGQPJOUTPG

FOUSZJOUPUIFMJGFPGUIJTGBNJMZ5IFDPVOTFMPSNJHIUDIPPTFUPXPSLXJUIUIFBO

HFSPSHVJMUFYQSFTTFECZUIFNFNCFSTBOEQSFTFOUJOUIFJSJOUFSBDUJPOT4FRVFOUJBM

QBUUFSOTXFSFDMFBSMZBSUJDVMBUFECZUIFGBUIFSXIFOUIFGBNJMZNFNCFSTBSFUSZ

JOHUPSFTPMWFDPOnJDUBOEIBOEMFQSPCMFNT)JTEFTDSJQUJPOBMTPJODMVEFTJNQMJFE

John

Age 30

2/27/86

John, Jr.

Age 5

4/20/11

Mary

Age 29

12/22/87

Ann

Age 2

3/12/14

m. 2010

His Parents

Her Parents

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

449

FAMILY SYSTEMS THERAPY

QPTJUJPOTPOUIFSPMFTPGNFOXPNFOBOEGFNBMFDIJMESFOJOGBNJMJFTBTXFMMBT

EFWFMPQNFOUBMJTTVFTSFMBUFEUP5BNNZXBOUJOHUPCFPMEFSUIBOTIFJT

*OUIFBTTFTTNFOUQSPDFTTJUJTIFMQGVMUPJORVJSFBCPVUGBNJMZQFSTQFDUJWFTPO

JTTVFTJOIFSFOUJOFBDIPGUIFTFMBZFST*OBEEJUJPOUPUIFQPJOUTPGFOUSZXFIBWF

OPUFEIFSFBSFTPNFPUIFSRVFTUJPOTUIBUNJHIUCFJODMVEFEJOBNPSFEFUBJMFE

BTTFTTNFOU

t 8IBUEPFTFBDIGBNJMZNFNCFSCSJOHUPUIFTFTTJPO

t )PXEPFTFBDIQFSTPOEFTDSJCFXIPIFPSTIFJT

t 8IBUBSFUIFHPBMTPGFBDIGBNJMZNFNCFS 8IBUHPBMTEPFTFBDIGBNJMZNFN

CFSIBWFGPSUIFPUIFSQFPQMFJOUIFGBNJMZ

t 8IBUSPVUJOFTTVQQPSUUIFEBJMZMJWJOHPGFBDINFNCFSPGUIFGBNJMZ

t 8IPNBLFTEFDJTJPOT )PXBSFDPOnJDUTSFTPMWFEPSQSPCMFNTIBOEMFE

t 8IBUQBSUTBSFJOWPMWFEJOUIFNPTUDPNNPOTFRVFODFTJOUIFGBNJMZ

t 8IBUJTBUZQJDBMEBZMJLF

t "SFUIFQBSFOUTFGGFDUJWFMFBEFSTPGUIFGBNJMZBOEJTUIFQSPDFTTPGMFBEFSTIJQ

CBMBODFEPSJNCBMBODFE

t )PXEP

UIFDIJMESFOSFTQPOEUPQBSFOUBMMFBEFSTIJQ 8IBUBSFUIFDIJMESFOT

HPBMTJOSFTQPOEJOHUIFXBZUIFZEP

t 8IFSFJTFBDIQFSTPOJOUIFGBNJMZJOSFMBUJPOUPQFSTPOBMCJPMPHJDBMDPHOJUJWF

FNPUJPOBMBOETPDJBMEFWFMPQNFOU

t 8IFSFJTUIF

GBNJMZJOUIFGBNJMZMJGFDZDMFBOEIPXBSFUIFZIBOEMJOHUSBOTJUJPOT

t 8IBUDVMUVSFTBSFJOUIFGBNJMZCBDLHSPVOETPGFBDIPGUIFGBNJMZNFNCFST

t *OXIBUDVMUVSFPSSFHJPOJTUIFGBNJMZDVSSFOUMZMJWJOHBOEJTJNNJHSBUJPOPS

NJHSBUJPOBSFDFOUGBNJMZFYQFSJFODF

t )PXEP

FDPOPNJDTFEVDBUJPO FUIOJDJUZ SFMJHJPO SBDF SFHJPOBMCBDLHSPVOE

HFOEFSTFYVBMPSJFOUBUJPOBCMFOFTTBOE

BHFBGGFDUGBNJMZQSPDFTTFTBOEIPX

JTUIFmUCFUXFFOUIFGBNJMZQSBDUJUJPOFS BOE UIF GBNJMZ XJUI SFHBSE UPUIFTF

BTQFDUTPGGBNJMZMJGF

t 8IBUFGGFDUTIBTSBDJTNQBUSJBSDIZPSIFUFSPTFYJTNIBEPOUIJTGBNJMZBOEJUT

NFNCFST

t 8IBUJEFBTJOSFMBUJPOUPHFOEFSOFFEUPCFBGmSNFEPSDIBMMFOHFE

t 8IFSFJTUIJTGBNJMZJOUIFQSPDFTTPGDIBOHF

t 8IBUSFTPVSDFTJOUFSOBMPSFYUFSOBMOFFEUPCFBDDFTTFE

Hypothesizing and Sharing Meaning

5PIZQPUIFTJ[FJTUPGPSNBTFUPGJEFBTBCPVUQFPQMFTZTUFNTBOETJUVBUJPOTUIBU

GPDVTNFBOJOHJOBVTFGVMXBZ*OGBNJMZUIFSBQZIZQPUIFTJ[JOHnPXTGSPNUIF

JEFBTBOEVOEFSTUBOEJOHTHFOFSBUFEJOUIFBTTFTTNFOUQSPDFTT5XPRVFTUJPOTBSF

HFSNBOFUPUIFGPSNPGIZQPUIFTJ[JOHPOFDIPPTFTUPEP)PXNVDIGBJUIEP

UIFUIFSBQJTUBOEUIFGBNJMZIBWFJOUIFJEFBTUIFZHFOFSBUF )PXNVDIPGBO

JOnVFODFJTUIFUIFSBQJTUXJMMJOHUPCFJOUIFMJWFTPGQFPQMFBOEGBNJMJFT

'BNJMZ DPVOTFMPST MJLF JOEJWJEVBM UIFSBQJTUT DBOOPU BWPJE JOnVFODJOH UIF

GBNJMZ BOE JUT NFNCFST #VU XIBU LJOE PG JOnVFODF XJMM UIF UIFSBQJTU CSJOH UP

UIFTFTTJPO  4BUJS BOE#JUUFSTVHHFTUUIBUGBNJMZ UIFSBQJTUT DBOOPU CFJO

DIBSHFPG UIF QFPQMFCVUUIFZOFFEUPCF JO DIBSHF PGUIFQSPDFTTUIBUJTUIFZ

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

450

CHAPTER FOURTEEN

PXO UIF SFTQPOTJCJMJUZ GPS IPX UIFSBQZ JT DPOEVDUFE 'FNJOJTUT BOE TPDJBM DPO

TUSVDUJPOJTUTBSFQFSIBQTUIFNPTUFYQSFTTJWFPGUIFJSDPODFSOTBCPVUUIFNJTVTF

PGQPXFSJOUIFSBQZ5IFZBSFKPJOFECZNVMUJDVMUVSBMJTUTQFSTPODFOUFSFEUIFSB

QJTUT"EMFSJBOTBOEFYJTUFOUJBMJTUTUPOBNFBGFXXIPIBWFBMTPXJUOFTTFEUIF

PGUFOVODPOTDJPVTJNQPTJUJPOPGiEPNJOBOUDVMUVSFwJOUIFSBQZ*OUIFFBSMZEBZT

PG GBNJMZ UIFSBQZ UIF NPTUMZ NBMF UIFSBQJTUT PGUFO JHOPSFE UIF FGGFDUT PO GBN

JMZMJGFPGQBUSJBSDIZQPWFSUZSBDJTNDVMUVSBMEJTDSJNJOBUJPOBOENBSHJOBMJ[BUJPO

IPNPQSFKVEJDFBOEPUIFSTPDJFUBMQSPCMFNT"UUIFTUSBUFHJDTUSVDUVSBMFOEPGUIF

DPOUJOVVN UIFSBQJTUT XFSF NPSF MJLFMZ UP DMBJN B DFSUBJO FYQFSUJTF JO TZTUFNT

XPSLUIBUBMMPXFEUIFNUPNBLFEJSFDUJOUFSWFOUJPOTJOUIFFOBDUNFOUPGiOFFEFEw

DIBOHFTJOUIFGBNJMZ5PDPVOUFSBDUUIFSBQFVUJDBCVTFTBOEXIBUTPNFQFSDFJWFE

UPCFBOPOHPJOHNJTVTFPGQPXFSJOUIFSBQZTPNFOBSSBUJWFUIFSBQJTUTBEPQUFE

Bdecentered QPTJUJPOJOSFMBUJPOUPUIF GBNJMZ 8IJUF-JLFQFSTPO

DFOUFSFEUIFSBQJTUTCFGPSFUIFNEFDFOUFSFEUIFSBQJTUTTFFLUPLFFQGBNJMJFTBOE

GBNJMZNFNCFSTBUUIFDFOUFSPGUIFUIFSBQFVUJDQSPDFTT

*UJTJNQPSUBOUGPSGBNJMJFTUPCFJOWJUFEJOUPSFTQFDUGVMFTTFOUJBMMZDPMMBCPSBUJWF

EJBMPHVFTJOUIFSBQFVUJDXPSL5IFEJGGFSFOUQFSTQFDUJWFTEJTDPWFSFEJOUIJTXPSLUFOE

UPDPBMFTDFJOUPXPSLJOHIZQPUIFTFTBOETIBSJOHUIFTFJEFBTQSPWJEFTUIFGBNJMZXJUI

BXJOEPXJOUPUIFIFBSUBOENJOEPGUIFUIFSBQJTUBTXFMMBTUIFNTFMWFT4IBSJOHIZ

QPUIFTFTBMNPTUJNNFEJBUFMZJOWJUFTBOEJOWPLFTGFFECBDLGSPNWBSJPVTGBNJMZNFN

CFST"OEJUJTUIJTGFFECBDLUIBUBMMPXTUIFUIFSBQJTUBOEUIFGBNJMZUPEFWFMPQBHPPE

mUXJUIFBDIPUIFSXIJDIJOUVSOUFOETUPDFNFOUBXPSLJOHSFMBUJPOTIJQ

5IFUFOUBUJWF IZQPUIFTJ[JOH BOE TIBSJOH QSPDFTT UIBU %SFJLVST  

EFWFMPQFE JT XFMM EFTJHOFE GPS UIF LJOE PG DPMMBCPSBUJWF XPSL FOWJTJPOFE IFSF

%SFJLVSTXPVMEVTFBQBTTJPOBUFJOUFSFTUBOEDVSJPTJUZUPBTLRVFTUJPOTBOEHBUIFS

UPHFUIFSUIFTVCKFDUJWFQFSTQFDUJWFTPGGBNJMZNFNCFST*OEFFEIFXPVMEIPOPS

UIFJEFBTUIBUJOEJWJEVBMTCSPVHIUUPUIFJSKPJOUVOEFSTUBOEJOH8IFOIFIBEBO

JEFBUIBUIFXBOUFEUPTIBSFIFXPVMEPGUFOTFFLQFSNJTTJPOGPSIJTEJTDMPTVSF

t *IBWFBOJEFB*XPVMEMJLFUPTIBSFXJUIZPV8PVMEZPVCFXJMMJOHUPIFBSJU

t $PVMEJUCFUIBU

5IFWBMVFPGUIJTXBZPG

QSFTFOUJOHIZQPUIFTFTJTUIBUJUJOWJUFTGBNJMJFTBOEGBN

JMZNFNCFSTUPDPOTJEFSBOE UP FOHBHF XJUIPVU HJWJOHVQUIFJSSJHIUUP EJTDBSE

BOZUIJOHUIBUEPFTOPUmU8IFOBTVHHFTUFEJEFBEPFTOPUmUUIFUIFSBQJTUJTUIFO

DMFBS BCPVU MFUUJOH JU HP BOE MFUUJOH UIF GBNJMZ SFEJSFDU UIF DPOWFSTBUJPO UPXBSE

NPSFVTFGVMDPODFQUVBMJ[BUJPOT

Facilitating Change

'BDJMJUBUJOHDIBOHFJTXIBUIBQQFOTXIFOGBNJMZUIFSBQZJTWJFXFEBTBKPJOUPSDPM

MBCPSBUJWFQSPDFTT5FDIOJRVFTBSFNPSFJNQPSUBOUUPNPEFMTUIBUTFFUIFUIFSBQJTU

BTFYQFSUBOEJODIBSHFPGmaking change happen$PMMBCPSBUJWFBQQSPBDIFTSFRVJSF

planningi1MBOOJOHDBOTUJMMJODMVEFXIBUGBNJMZUIFSBQZIBTDBMMFEtechniquesPS

interventions, CVU XJUI UIF GBNJMZT QBSUJDJQBUJPOw #SFVOMJO FU BM  Q 

5XPPGUIFNPTUDPNNPOGPSNTGPSGBDJMJUBUJPOPGDIBOHFBSFFOBDUNFOUTBOEBT

TJHONFOUPGUBTLT#PUIPGUIFTFQSPDFTTFTXPSLCFTUXIFOUIFGBNJMZDPDPOTUSVDUT

UIFNXJUIUIFUIFSBQJTUPSBUMFBTUBDDFQUTUIFSBUJPOBMFGPSUIFJSVTF

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

451

FAMILY SYSTEMS THERAPY

8JUIJOUIFDIBOHFQSPDFTTUIFOVNCFSPGQPTTJCMFPVUDPNFTJTPOMZMJNJUFECZ

UIFSFTPVSDFTBWBJMBCMFJOUFSOBMMZBOEFYUFSOBMMZUPUIFGBNJMZ5IJTEPFTOPUNFBO

IPXFWFSUIBUUIFGBNJMZQSBDUJUJPOFSJTXJUIPVUBHVJEFGPSQSFGFSSFEPSEFTJSFEPVU

DPNFT*OHFOFSBMUIFJOUFSOBMQBSUTPGGBNJMZNFNCFSTGVODUJPOCFTUXIFOUIFZ

BSFCBMBODFEOPUQPMBSJ[FEBOEXIFOUIFJOEJWJEVBMFYQFSJFODFTQFSTPOBMQBSUTBT

SFTPVSDFT#FJOHBCMFUPUIJOLJTVTVBMMZNPSFVTFGVMUIBOFNPUJPOBMSFBDUJWJUZCF

JOHBCMFUPGFFMJTCFUUFSUIBOOPUGFFMJOHHPPEDPOUBDUXJUIPUIFSTJTNPSFSFXBSE

JOHUIBOJTPMBUJPOPSTFMGBCTPSQUJPOBOEUBLJOHSFBTPOBCMFSJTLTJOUIFTFSWJDFPG

HSPXUIBOEEFWFMPQNFOUJTNPSFCFOFmDJBMUIBOTUBHOBUJPOPSBSFUSFBUJOUPGFBS

'VSUIFSLOPXJOHUIFHPBMTBOEQVSQPTFTGPSPVSCFIBWJPSTGFFMJOHTBOEJOUFSBD

UJPOTUFOETUPHJWFVTDIPJDFTBCPVUUIFJSVTF"OEVOEFSTUBOEJOHUIFQBUUFSOTXFFOBDU

JOGBDFUPGBDFSFMBUJPOTIJQTUIFFCCTBOEnPXTPGMJGFPSBDSPTTHFOFSBUJPOTQSPWJEF

NVMUJQMFBWFOVFTGPSDIBMMFOHJOHQBUUFSOTBOEUIFFOBDUNFOUPGOFXQPTTJCJMJUJFT

family systems therapy from

a multicultural perspective

Strengths From a Diversity Perspective

0OFPGUIFTUSFOHUITPGUIFTZTUFNJDQFSTQFDUJWFJOXPSLJOHGSPNBNVMUJDVMUVSBM

GSBNFXPSLJTUIBUNBOZFUIOJD BOEDVMUVSBMHSPVQT QMBDFHSFBUWBMVFPOUIFFY

UFOEFEGBNJMZ*GUIFSBQJTUTBSFXPSLJOHXJUIBOJOEJWJEVBMGSPNBDVMUVSBMCBDL

HSPVOEUIBUHJWFTTQFDJBMWBMVFUPJODMVEJOHHSBOEQBSFOUTBVOUTBOEVODMFTJOUIF

USFBUNFOUJUJTFBTZUPTFFUIBUGBNJMZBQQSPBDIFTIBWFBEJTUJODUBEWBOUBHFPWFS

JOEJWJEVBMUIFSBQZ'BNJMZUIFSBQJTUTDBOEPTPNFFYDFMMFOUOFUXPSLJOHXJUINFN

CFSTPGUIFFYUFOEFEGBNJMZ

8JUIJOUIFmFMEPGGBNJMZUIFSBQZ.POJDB.D(PMESJDLIBTCFFOUIFNPTUJOnV

FOUJBMMFBEFSJOUIFEFWFMPQNFOUPGCPUIHFOEFSBOEDVMUVSBMQFSTQFDUJWFTBOEGSBNF

XPSLTJO GBNJMZ QSBDUJDF TFF .D(PMESJDL FU BM   .D(PMESJDL )BSEZ

*ONBOZXBZT.D(PMESJDLBOEIFSDPMMFBHVFTBQQSPBDIGBNJMJFTMJLFTZTUFNT

BOUISPQPMPHJTUT5IFZTFFFBDIGBNJMZBTBVOJRVFDVMUVSFXIPTFQBSUJDVMBSDIBSBDUFSJT

UJDTNVTUCFVOEFSTUPPE-JLFMBSHFSDVMUVSBMTZTUFNTGBNJMJFTIBWFBVOJRVFMBOHVBHF

UIBUHPWFSOT CFIBWJPS DPNNVOJDBUJPO BOE FWFOIPX UP GFFM BCPVU BOE FYQFSJFODF

MJGF'BNJMJFTIBWFDFMFCSBUJPOTBOESJUVBMTUIBUNBSLUSBOTJUJPOTQSPUFDUUIFNBHBJOTU

PVUTJEFJOUFSGFSFODFBOEDPOOFDUUIFNUPUIFJSQBTUBTXFMMBTUPBQSPKFDUFEGVUVSF

4JNJMBSMZGBNJMJFTDBOOPUFTDBQFUIFTFYJTNBOEQBUSJBSDIZUIBUBSFJOIFSFOU

JOBMMDVMUVSFT5IFSPMFTGPSNFOBOEXPNFOBSFQSFTDSJCFEJOEJGGFSFOUTPDJFUJFT

CVUJOFWFSZDVMUVSFXPNFOUFOEUPDPNFPVUPOUIFTIPSUFOENPSFPGUFOUIBOOPU

5IFSPMFTUIBUXPNFOBTNPUIFSTQMBZJOUIFGBNJMZJOUIFXPSMEPGXPSLBOEJO

UIFDPNNVOJUZTFUUIFNPEFMGPSGFNBMFDIJMESFOPGUFOGPSHFOFSBUJPOTUPDPNF

#FDBVTFGBNJMZMJGFJT XIFSFUIFSPMFT PGXPNFODBO CFNPTUMJNJUFE BDPOTJE

FSBUJPOPGHFOEFSJTTVFTJOGBNJMJFTJTBOFTTFOUJBMGSBNFXPSLGPSGBNJMZUIFSBQZ

.D(PMESJDLFUBM1FSIBQTUIFNPTUEJGmDVMUJOUFHSBUJPOPGBMMJTmHVSJOH

PVUIPXUPIPOPSEJGGFSFOUDVMUVSFTJOUIFSBQZXJUIPVUTVQQPSUJOHNBSHJOBMJ[BUJPO

PSPQQSFTTJPOPGXPNFO5PXBSEUIJTFOEJUJTJNQPSUBOUUPSFNFNCFSUIBUUIFSF

BSFGFNJOJTUWPJDFTJOFWFSZDVMUVSFUISPVHIPVUUIFXPSME

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

452

CHAPTER FOURTEEN

+VTUBTEJGGFSFOUJBUJPONFBOTDPNJOHUPVOEFSTUBOEPVSGBNJMZXFMMFOPVHIUP

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In our work with Stan in this modal-

ity, we include examples of forming a

relationship and joining, reading Stan’s

genogram, a multilayered assessment, refram-

ing, boundary setting in therapy, and facilitating

change. There are many useful models and ways

to work with families; this discussion represents

some possible ways to work with Stan from a

multilayered perspective.

At an intake interview, a family therapist

meets with Stan to explore his issues and con-

cerns and to learn more about him and his life

situation. As they talk, the therapist brings an

intense interest and curiosity to the interview

Family Therapy Applied to the Case of Stan

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and wonders out loud about the familial roots of

some of Stan’s problems. It does not take much

of an inquiry to learn that Stan is still very much

engaged with his parents and siblings, no matter

how difficult these relationships have been for

him. This initial conversation involves the devel-

opment of a genogram of Stan’s family of origin

(see Figure 14.1). This map will serve both Stan

and the therapist as a guide to the people and

the processes that influence Stan’s life.

Stan’s genogram is really a family picture,

or map, of his family-of-origin system. In this

genogram, we learn that Stan’s grandparents

tend to have lived fairly long lives. Stan’s maternal

grandparents are both alive. The shaded lower half

of their square and circle indicates that each had

some problem with alcohol. In the case of Tom,

Stan reports that he was an admitted alcoholic

who recommitted himself to Christ and found help

through Alcoholics Anonymous. Stan’s maternal

grandmother always drank a little socially and

with her husband, but she never considered her-

self to have a problem. In her later years, however,

she seems to secretly use alcohol more and more,

and it is a source of distress in her marriage. Stan

also knows that Margie drinks a lot, because he

has been drinking with his aunt for years. She is

the one who gave him his first drink.

453

FAMILY SYSTEMS THERAPY

'JH VS F 5ISFF(FOFSBUJPO(FOPHSBNPG4UBOT'BNJMZ

Judy

b. 1963

Mary

b. 1963

Joseph

b. 1907

Oris

b. 1938

Matthew

Stan

b. 1988

Frank Sr.

b. 1940

Matt

b. 1960

Frank Jr.

b. 1966

Stan

b. 1970

Karl

b. 1972

Seth

b. 1942

Emma

b. 1917

m. 1937

d. 1977

(Cancer)

d. 1968

(Vietnam)

Martha

b. 1921

Margie

b. 1944

Angie

b. 1942

m. 1940

m. 1962

Tom

b. 1920

= Problem with alcohol

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Angie, Stan’s mother, married Frank Sr. after

he had stopped drinking, also with the help of

AA. He still goes to meetings. Angie is suspi-

cious of all men around alcohol. She is especially

upset with Stan and with Judy’s husband, Matt,

who “also drinks too much.” The genogram

makes it easy to see the pattern of alcohol prob-

lems in this family.

The jagged lines /\/\/\/\ between Frank Sr.

and Angie indicate conflict in the relationship.

The three solid lines === between Frank Sr. and

Frank Jr., and between Angie and Karl, indicate a

very close or even fused relationship. The double

lines ==== between Karl and Stan are used to

note a close relationship only. As we will see,

Karl actually looks up to Stan in this family. The

dotted lines . . . . . between Frank Sr. and Stan

and between Frank Jr. and Stan indicate a distant

or even disengaged relationship.

Since the family therapist believes that the

whole family is involved in Stan’s use of alco-

hol, she spends a good part of the first session

exploring with Stan processes for asking his

other family members to join him in therapy.

Stan may have many difficulties, but at the mo-

ment his difficulty with alcohol is the primary

focus. Alcohol is a negative part of his life, and

as such it has systemic meaning. It may have

started out as a symptom of other problems,

but now the alcohol is a problem in itself. From

a systemic perspective, the questions are “How

does this problem affect the family?” and “Is the

family using this problem to serve some other

purpose?”

In the first therapy session with the family,

the therapist’s main focus is in forming a

relationship with each of the family members,

but even here, a variety of approaches present

themselves.

THERAPIST [to Frank sr.]: I know coming here was

an inconvenience for you, but I want you to know

how appreciative I am that you came. Can you tell

me what it’s like for you to be here? [Forming a

relationship through joining]

FRANK SR.: Well, I have to tell you that I don’t like

it much. [Pause] Things are a lot different today

than they used to be. We didn’t have counseling

20 years ago. I had a problem with drinking at

one point, but I got over it. I just quit—on my own.

That’s what Stan needs to do. He just needs to

stop.

THERAPIST: So I’m hearing that life is better for

you without alcohol, and you would like Stan’s life

to be better too. [Reframing]

FRANK SR.: Yeah. I’d like his life to be better in a lot

of different ways.

THERAPIST: Angie, what about you? What is it like

for you to be here? [Forming a relationship with each

member]

ANGIE: It’s heartbreaking. It’s always heartbreak-

ing. He [Referring to Frank Sr.] makes it sound as if

he just summoned up his own personal power and

quit drinking through his own strength of charac-

ter. That’s a laugh. I threatened to leave him. That’s

what really happened. I was ready to get a divorce!

And we’re Catholics. We don’t get divorced.

[Possible face-to-face sequence around family stress

and coping]

THERAPIST: So you’ve been through this before.

ANGIE: Oh my, yes. My father and mother drank.

Dad still does. My sister won’t admit it, but she

drinks too much. She goes crazy with it. Judy’s

husband has a problem. I’m surrounded by alco-

holics. I get so angry. I wish they would all just

die or go away. [Possible transgenerational family

sequence: an entry point for exploring values, beliefs,

and rules]

THERAPIST: So this is something the whole family

has been dealing with for a long time.

ANGIE: Not everyone. I don’t drink. Frankie and

Judy don’t drink. And Karl doesn’t seem to have a

problem.

THERAPIST: Is that how the family gets divided:

into those who drink and those who don’t?

[Possible organization perspective]

JUDY: Drinking isn’t the only problem we have. It’s

probably not even the most important.

THERAPIST: Say more about that.

JUDY: Stan has always had it hard. I feel sorry

for him. Frankie is clearly Dad’s favorite [Frank Sr.

protests, saying he doesn’t have favorites], and things

have always come easily for me. And Karl, he gets

whatever he wants. He’s Mom’s favorite. Mom and

Dad have fought a lot over the years. None of us

have been that happy, but Stan seems to have the

worst of it. [Again, possible sequence and organiza-

tion perspectives]

454

CHAPTER FOURTEEN

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FRANK JR.: As I remember it, Stan gave Dad and

Mom a lot to fight about. He was always messing

up in one way or another.

THERAPIST: Frankie, when your father was talk-

ing earlier, I sensed he had some disappointment

about Stan too, but he also wanted to see things

work out better for him. Is that true for you too?

[Reframing Frankie’s comment, maintaining a focus

on new possibilities and new relations that might be

developed]

FRANK JR.: Yes. I would like his life to be better.

The initial part of this counseling session

has been devoted to meeting family members,

listening intently to the multiple perspectives

they present, and reframing Stan’s problem into

a family desire for a positive outcome. Although

there is a long way to go, the seeds of change

have already been planted. There is evidence

in these early interactions that Stan’s problem

has a multigenerational context. If this context

is explored, family sequences that support and

maintain alcohol as a problem may be identified.

It is possible to track these interactions and to

work toward more congruent communications.

Evolving relational, organizational, developmen-

tal sequences might be explored as a means of

freeing family members for new possibilities in

their life together. Among other possibilities still

to be explored are perspectives related to gender

and culture. If the therapist were just listening

to Stan, only one point of view would be evident.

In this family session, multiple perspectives and

the entire interactive process become clear in a

very short time.

As the family interview proceeds, a number of

possibilities are presented for consideration. The

therapist considers and may structure therapy

around any or all of the following possibilities:

1. Stan’s parents have not been a well-

functioning leadership team for a long time,

and both their spousal relationship and

their parenting hav

e suffered.

2. The adult siblings need a new opportunity

to function together without the influence

and distractions continually imposed by the

par

ents.

3. Stan has been reduced to a single part (his

alcoholic part), and his description and ex-

perience of himself needs to be enlar

ged—

both for his own perspective and in the

eyes of others.

A new place for Stan in the family, a better

way of relating, and an ability to access “lost”

parts of his internal system are all critical to

winning his battle with alcohol. As therapy

continues, it becomes clear that two separate

relational–organization hypotheses must be

explored. One is that the spousal relationship

has been defined by the problem of alcohol

too, and it has not evolved or developed in any

kind of positive way over the years. Second,

the transgenerational sequences have targeted

Stan and assigned him to a fixed role that he

has been expected to play that has blocked de-

velopment past his middle to late adolescence,

which was the period in which he started

drinking.

Follow-Up: You Continue as Stan’s

Family Therapist

Use these questions to help you think about how

you would counsel Stan from a family systems

perspective:

t What unique values do you see in working with

Stan from a multilayered, sy

stemic perspective

as opposed to an individual therapy approach?

t What internal parts might Stan re-access as

he continues in therapy? What parts of him

might be polariz

ed?

t Assuming that Stan was successful in getting

at least some of his family members to an-

other session, where would you begin? Would

you get everyone involved in the sessions? If

so, how would you do that?

t What are some specific ways to explore other

perspectives with this family?

t

What hypotheses are you developing, and

how would you share them with the family?

t Are there systemic interventions that you would

find hopeful in terms of facilitating change?

455

FAMILY SYSTEMS THERAPY

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

456

CHAPTER FOURTEEN

summary and evaluation

Summary

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

457

FAMILY SYSTEMS THERAPY

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

458

CHAPTER FOURTEEN

FOPVHIPGBOJOUSPEVDUJPOUPUIFEJWFSTFmFMEPGGBNJMZUIFSBQZUIBUZPVXJMMXBOU

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Other Resources

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Approach

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ily Therapy,XIJDIJTQVCMJTIFEGPVSUJNFTBZFBSBOEBTVCTDSJQUJPOUPTJYJTTVFT

ZFBSMZPGThe Family Therapy Magazine'PSBDPQZPGUIF"".'5$PEFPG&UIJDT

NFNCFSTIJQBQQMJDBUJPOTBOEGVSUIFSJOGPSNBUJPODPOUBDU

American Association for Marriage and Family Therapy

112 South Alfred Street

Alexandria, VA 22314-3061

Telephone: (703) 838-9808

Fax: (703) 838-9805

Website: www.aamft.org

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Ethnicity and Family Therapy.D(PMESJDL(JPSEBOP(BSDJB1SFUPJTUIF

TFNJOBMXPSLPODVMUVSFJOGBNJMZUIFSBQZ5IFBVUIPSTSFWJFXUIFJNQPSUBODFPG

DVMUVSBMDPOTJEFSBUJPOTJOSFMBUJPOUPGBNJMZUIFSBQZBOEQSPWJEFDIBQUFSTPOUIF

CBDLHSPVOESFTFBSDIBOEUIFSBQZJTTVFTPGNPSFUIBODVMUVSFT

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

459

FAMILY SYSTEMS THERAPY

Theory and Practice of Family Therapy and Counseling#JUUFSCJTBDPNQSF

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GBNJMZUIFSBQZBOEDPVOTFMJOH

Family Therapy: An Overview(PMEFOCFSH(PMEFOCFSHQSPWJEFTBOFYDFM

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References and Suggested Readings

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Dialogues and dialogues about the dialogues.

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Bitter, J. R. (2009a). The mistaken notions

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*Bitter, J. R. (2009b). Theory and practice of

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*Bowen, M. (1978). Family therapy in clinical

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*Carlson, J., Sperry, L., & Lewis, J. A. (2005).

Family therapy techniques: Integrating and

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Cengage Learning.

*Christensen, O. C. (Ed.). (2004). Adlerian

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De Shazer, S. (1985). Keys to solutions in brief

therapy. New York: Norton.

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Dulwich Centre.

*Gergen, K. J. (1999). An invitation to social

construction. Thousand Oaks, CA: Sage.

*Gladding, S. T. (2010). Family therapy: History,

theory, and practice (5th ed.). Upper Saddle

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*Goldenberg, H., & Goldenberg, I. (2013). Fam-

ily therapy: An overview (8th ed.). Belmont, CA:

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Jossey-Bass.

*Haley, J., & Richeport-Haley, M. (2003). The

art of strategic therapy. New York: Brunner

Routledge.

*Hanna, S. M. (2007). The practice of family

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*Luepnitz, D. A. (1988). The family interpreted:

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(1991). Women in f

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*McGoldrick, M., & Hardy, K. V. (2008). Revision-

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*Minuchin, S., & Fishman, H. C. (1981). Family

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Prentice-Hall.

*Nichols, M. P. (with Schwartz, R. C.). (2013).

Family therapy: Concepts and methods (10th

ed.). Upper Saddle River, NJ: Prentice-Hall.

O’Hanlon, W. H., & Weiner-Davis, M. (2003).

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therapy (Rev. ed.). New York: Norton.

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460

CHAPTER FOURTEEN

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

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Alto, CA: Science and Behavior Books.

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F. G., & Prata, G. (1978). Paradox and

counterparadox. Northvale, NJ: Aronson.

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(Eds.). (1998). Social construction in couple

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IAMFC.

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*Whitaker, C. A., & Bumberry, W. M. (1988).

Dancing with the family: A symbolic-experiential

approach. New York: Brunner/Mazel.

White, M. (1997). Narratives of therapists’ lives.

Adelaide, South Australia: Dulwich Centre.

*White, M. (2007). Maps of narrative practice.

New York: Norton.

*White, M., & Epston, D. (1990). Narrative means

to therapeutic ends. New York: Norton. (Original

title Linguistic means to therapeutic ends)

Wilcoxon, S. A., Remley, T. P., & Gladding, S. T.

(2012). Ethical, legal, and professional issues in

the practice of marriage and family therapy

(5th ed.). Upper Saddle River, NJ: Merrill/

Prentice-Hall (Pearson).

461

FAMILY SYSTEMS THERAPY

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463

part 3

Integration and

Application

15 An Integrative Perspective 464

16 Case Illustration: An Integrative Approach

in Working With Stan 503

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464

introduction

the movement toward

psychotherapy integration

• Pathways Toward Psychotherapy Integration

• Advantages of Psychotherapy Integration

• Integration of Multicultural Issues in

Counseling

• Integration of Spirituality and Religion in

Counseling

• The Challenge of Developing an Integrative

Perspective

issues related to the

therapeutic process

• Therapeutic Goals

• Therapist’s Function and Role

• Client’s Experience in Therapy

• Relationship Between Therapist

and Client

the place of techniques and

evaluation in counseling

• Drawing on Techniques From Various

Approaches

• Evaluating the Effectiveness of

Counseling and Therapy

summary

where to go from here

• Recommended Supplementary

Readings

• References and Suggested Readings

chapter 15

An Integrative Perspective

464

pe

•

Therapeu

•

Therapis

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introduction

This chapter will help you think about areas of convergence and divergence among

the 11 therapeutic systems covered in this book. Although these approaches all

have some goals in common, they have many differences when it comes to the best

route to achieve these goals. Some therapies call for an active and directive stance

on the therapist’s part, and others place value on clients being the active agent.

Some therapies focus on experiencing feelings, others stress identifying cognitive

patterns, and still others concentrate on actual behavior. The key task is to ﬁ nd ways

to integrate certain features of each of these approaches so that you can work with

clients on all three levels of human experience.

The ﬁ eld of psychotherapy is characterized by a diverse range of specialized

models. With all this diversity, is there any hope that a practitioner can develop

skills in all of the existing techniques? How does a student decide which theories

are most relevant to practice? Looking for commonalities among the systems of

psychotherapy is relatively new (Norcross & Beutler, 2011). Practitioners have been

battling over the “best” way to bring about personality change dating back to the

work of Freud. For decades, counselors resisted integration, often to the point of

denying the validity of alternative theories and of ignoring effective methods from

other theoretical schools. The early history of counseling is full of theoretical wars.

Since the early 1980s, psychotherapy integration has developed into a clearly

delineated ﬁ eld. It is now an established and respected movement that is based

on combining the best of differing orientations so that more complete theoreti-

cal models can be articulated and more efﬁ cient treatments developed (Goldfried,

Pachankis, & Bell, 2005). The Society for the Exploration of Psychotherapy Inte-

gration, formed in 1983, is an international organization whose members are pro-

fessionals working toward the development of therapeutic approaches that tran-

scend single theoretical orientations. As the ﬁ eld of psychotherapy has matured,

the concept of integration has emerged as a mainstay (Norcross & Beutler, 2011).

In this chapter I consider the advantages of developing an integrative per-

spective for counseling practice. I also present a framework to help you begin to

integrate concepts and techniques from various approaches. As you read, start to

formulate your own personal perspective for counseling. Look for ways to synthe-

size diverse elements from different theoretical perspectives. As much as possible,

be alert to how these systems can function in harmony.

See the video program for Chapter 15, DVD for Theory and Practice of Counseling

and Psychotherapy: The Case of Stan and Lecturettes. I suggest that you view the

brief lecture for each chapter prior to reading the chapter.

the movement toward

psychotherapy integration

A large number of therapists identify themselves as “eclectic,” and this category

covers a broad range of practice. At its worst, eclectic practice consists of haphaz-

ardly picking techniques without any overall theoretical rationale. This is known

as syncretism, wherein the practitioner, lacking in knowledge and skill in selecting

465

AN INTEGRATIVE PERSPECTIVE

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466

CHAPTER FIFTEEN

interventions, looks for anything that seems to work, often making little attempt

to determine whether the therapeutic procedures are indeed effective. Such an un-

critical and unsystematic combination of techniques is no better than a narrow and

dogmatic orthodoxy. This pulling of techniques from many sources without a sound

rationale results in syncretistic confusion (Lazarus, 1996b; Norcross & Beutler, 2011).

Pathways Toward Psychotherapy Integration

Psychotherapy integration is best characterized by attempts to look beyond and

across the conﬁ nes of single-school approaches to see what can be learned from

other perspectives and how clients can beneﬁ t from a variety of ways of conducting

therapy. The majority of psychotherapists do not claim allegiance to a particular

therapeutic school but prefer, instead, some form of integration (Norcross, 2005;

Norcross & Beutler, 2011). In a survey conducted by the Psychotherapy Networker

(2007), only 4.2% of respondents identiﬁ ed themselves as being aligned with one

therapy model exclusively. The remaining 95.8% claimed to be integrative, mean-

ing they combined a variety of methods or approaches in their counseling practice.

The integrative approach is characterized by openness to various ways of in-

tegrating diverse theories and techniques, and there is a decided preference for

the term integrative over eclectic (Norcross, Karpiak, & Lister, 2005). Although

different terms are sometimes used—eclecticism, integration, convergence, and

rapprochement—the goals are very similar. The ultimate goal of integration is to en-

hance the efﬁ ciency and applicability of psychotherapy. Norcross and Beutler (2011)

and Stricker (2010) describe four of the most common pathways toward the inte-

gration of psychotherapies: technical integration, theoretical integration, assimilative

integration, and common factors approach. All of these approaches to integration look

beyond the restrictions of single approaches, but they do so in distinctive ways.

Technical integration aims at selecting the best treatment techniques for the

individual and the problem. It tends to focus on differences, chooses from many

approaches, and is a collection of techniques. This path calls for using techniques

from different schools without necessarily subscribing to the theoretical posi-

tions that spawned them. For those who practice from the perspective of technical

integration, there is no necessary connection between conceptual foundations and

techniques. One of the best-known forms of technical integration, which he refers

to as technical eclecticism, is Lazarus’s (1997a) multimodal therapy (see Chapter 9).

Multimodal therapists borrow from many other therapeutic models, using tech-

niques that have been demonstrated to be effective in dealing with speciﬁ c clinical

problems. Whenever feasible, multimodal therapists employ empirically support-

ed techniques (Lazarus, 2008a).

In contrast, theoretical integration refers to a conceptual or theoretical crea-

tion beyond a mere blending of techniques. This route has the goal of producing a

conceptual framework that synthesizes the best aspects of two or more theoretical

approaches under the assumption that the outcome will be richer than either theory

alone. This approach emphasizes integrating the underlying theories of therapy

along with techniques from each. Examples of this form of integration are dialecti-

cal behavior therapy (DBT) and acceptance and commitment therapy (ACT), both of

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467

AN INTEGRATIVE PERSPECTIVE

which were described in Chapter 9. Emotion-focused therapy (EFT), which is in-

formed by the role of emotion in psychotherapeutic change, also can be considered

a form of theoretical integration. Greenberg (2011), a key ﬁ gure of the development

of EFT, conceptualizes the model as an empirically supported, integrative, experi-

ential approach to treatment. EFT synthesizes concepts of person-centered thera-

py, Gestalt therapy, experiential therapy, and existential therapy, viewed through

the lens of modern cognitive and emotion theory.

The assimilative integration approach is grounded in a particular school of

psychotherapy, along with an openness to selectively incorporate practices from

other therapeutic approaches. Assimilative integration combines the advantages

of a single coherent theoretical system with the ﬂ exibility of a variety of interven-

tions from multiple systems. An example of this form of integration is mindfulness-

based cognitive therapy (MBCT), which integrates aspects of cognitive therapy and

mindfulness-based stress reduction procedures. As you may recall from Chapter 9,

MBCT is a comprehensive integration of the principles and skills of mindfulness

applied to the treatment of depression (Segal, Williams, & Teasdale, 2002).

The common factors approach searches for common elements across different

theoretical systems. Despite many differences among the theories, a recognizable

core of counseling practice is composed of nonspeciﬁ c variables common to all

therapies. Lambert (2011) concludes that common factors can be a basis for psy-

chotherapy integration:

The common factors explanation for the general equivalence of diverse therapeutic inter-

ventions has resulted in the dominance of integrative practice in routine care by implying

that the dogmatic advocacy of a particular theoretical school is not supported by research.

Research also suggests that common factors can become the focal point for integration of

seemingly diverse therapy techniques. (p. 314)

Some of these common factors include empathic listening, developing a working al-

liance, opportunity for catharsis, practicing new behaviors, positive expectations of

clients, working through one’s own conﬂ icts, understanding interpersonal and intrap-

ersonal dynamics, and learning to be self-reﬂ ective about one’s work (Norcross & Beut-

ler, 2011; Prochaska & Norcross, 2010). Other common factors that have been shown to

be curative include support, warmth, feedback, reassurance, and credibility (Lambert,

2011). These common factors are thought to be at least as important in accounting for

therapeutic outcomes as the unique factors that differentiate one theory from another.

Among the approaches to psychotherapy integration, the common factors approach

has the strongest empirical support (Duncan, Miller, Wampold, & Hubble, 2010).

Of all of the common factors investigated in psychotherapy, none has re-

ceived more attention and conﬁ rmation than a facilitative therapeutic relationship

(Lambert, 2011). The importance of the therapeutic alliance is a well-established

critical component of effective therapy, and research conﬁ rms that the client–

therapist relationship is central to therapeutic change.

Advantages of Psychotherapy Integration

One reason for the movement toward psychotherapy integration is the recognition

that no single theory is comprehensive enough to account for the complexities

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468

CHAPTER FIFTEEN

of human behavior, especially when the range of client types and their speciﬁ c

problems are taken into consideration. Because no one theory contains all the

truth, and because no single set of counseling techniques is always effective in

working with diverse client populations, integrative approaches hold promise for

counseling practice. Norcross and Wampold (2011b) maintain that effective clini-

cal practice requires a ﬂ exible and integrative perspective. Psychotherapy should

be ﬂ exibly tailored to the unique needs and contexts of the individual client. Nor-

cross and Wampold contend that using an identical therapy relationship style and

treatment method for all clients is inappropriate and can be unethical.

The 11 systems discussed in this book have evolved in the direction of broaden-

ing their theoretical and practical bases and have become less restrictive in their

focus. Many practitioners who claim allegiance to a particular system of therapy

are expanding their theoretical outlook and developing a wider range of therapeu-

tic techniques to ﬁ t a more diverse population of clients. There is a growing recog-

nition that psychotherapy can be most effective when contributions from various

approaches are integrated (Goldfried, Glass, & Arnkoff, 2011). Although to date

the bulk of psychotherapy integration has been based on theoretical and clinical

foundations, Goldfried and colleagues suggest that evidence-based practice will

increasingly become the organizing force for integration. Empirical pragmatism,

not theory, will be the integrative theme of the 21st century.

Practitioners who are open to an integrative perspective will ﬁ nd that several

theories play a crucial role in their personal counseling approach. Each theory has

its unique contributions and its own domain of expertise. By accepting that each

theory has strengths and weaknesses and is, by deﬁ nition, “different” from the oth-

ers, practitioners have some basis to begin developing a theory that ﬁ ts for them

and their clients. It takes considerable time to learn the various theories in depth. It

is not realistic for any of us to expect that we can integrate all the theories. Instead,

integration of some aspects of some of the theories is a more realistic goal. Devel-

oping an integrative perspective is a lifelong endeavor that is reﬁ ned with clinical

experience, reﬂ ection, reading, and discourse with colleagues.

Integration of Multicultural Issues in Counseling

Multiculturalism is a reality that cannot be ignored by practitioners if they hope

to meet the needs of diverse client groups. I believe current theories, to varying

degrees, can and should be expanded to incorporate a multicultural dimension.

I have consistently pointed out that if contemporary theories do not account

for the cultural dimension, they will have limited applicability in working with

diverse client populations. For some theories, this transition is easier than for

others.

Clients can be harmed if they are expected to ﬁ t all the speciﬁ cations of a given

theory, whether or not the values espoused by the theory are consistent with their

own cultural values. Rather than stretching the client to ﬁ t the dimensions of a

single theory, practitioners need to tailor their theory and practice to ﬁ t the unique

needs of the client. This calls for counselors to possess knowledge of various cul-

tures, to be aware of their own cultural heritage, and to have skills to assist a wide

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469

AN INTEGRATIVE PERSPECTIVE

spectrum of clients in dealing with the realities of their culture. Psychotherapy

integration stresses tailoring interventions to the individual client rather than to

an overarching theory, making this approach particularly well suited to consider-

ing cultural factors and the unique perspective of each client. Comas-Diaz (2011)

asserts that cultural competence enables counselors to work effectively in most

clinical settings. Practitioners demonstrate their cultural competence by becoming

aware of their own and their clients’ worldviews, and by being able to use cultur-

ally appropriate interventions to reﬂ ect their cultural beliefs, knowledge, and skills.

She adds:

Culturally competent therapists develop the capacities to value diversity and manage the

dynamics of difference. They also acquire and incorporate cultural knowledge into their

interventions, plus adapt to diversity and the cultural contexts of their clients. (p. 251)

This is a good time to review the discussion of the culturally skilled counselor in

Chapter 2 and to consult Tables 15.7 and 15.8, which appear later in this chapter.

In your role as a counselor, you need to be able to assess the special needs

of clients. Depending on the client’s ethnicity and culture and on the concerns

that bring this person to counseling, you are challenged to develop ﬂ exibility in

utilizing an array of therapeutic strategies. Some clients will need more direction,

and even advice. Others will be very hesitant in talking about themselves in per-

sonal ways, especially during the early phase of the counseling process. What you

may see as resistance could be the client’s response to years of cultural condition-

ing and respect for certain values and traditions. Basically, it comes down to your

familiarity with a variety of theoretical approaches and your ability to employ and

adapt your techniques to ﬁ t the person-in-the-environment. It is not enough to

merely assist your clients in gaining insight, expressing suppressed emotions, or

making certain behavioral changes. The challenge is to ﬁ nd practical strategies

for adapting the techniques you have developed to enable clients to examine the

impact their culture continues to have on their lives and to make decisions about

what, if anything, they want to change.

Being an effective counselor involves reﬂ ecting on how your own culture inﬂ u-

ences you and your interventions in your counseling practice. This awareness is

critical in becoming more sensitive to the cultural backgrounds of the clients who

seek your help. Using an integrative perspective, therapists can encompass social,

cultural, spiritual, and political dimensions in their work with clients.

Integration of Spirituality and Religion in Counseling

The counseling process can help clients gain insight into the ways their core be-

liefs and values are reﬂ ected in their behavior. Current interest in spiritual and

religious beliefs has implications for how such beliefs might be incorporated in

therapeutic relationships (Young & Cashwell, 2011a; Frame, 2003). Survey data

from members of both the American Psychological Association and the American

Counseling Association indicate that spiritual and religious matters are therapeuti-

cally relevant, ethically appropriate, and potentially signiﬁ cant topics for the prac-

tice of counseling in secular settings (Delaney, Miller, & Bisono, 2007; Young,

Wiggins-Frame, & Cashwell, 2007).

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470

CHAPTER FIFTEEN

Worthington (2011) asserts that the increasing openness of therapists to clients’

spiritual and religious concerns and interests has been fueled by the multicultur-

al evolution. The emphasis on multiculturalism has empowered people to deﬁ ne

themselves from a cultural perspective, which includes their spiritual, religious,

and ethnic contexts.

Clients who are experiencing a crisis situation may ﬁ nd a source of comfort,

support, and strength in drawing upon their spiritual resources. For some clients

spirituality entails embracing a religion, which can have many different meanings.

Other clients value spirituality, yet do not have any ties to a formal religion. What-

ever one’s particular view of spirituality, it is a force that can help the individual

to ﬁ nd a purpose (or purposes) for living. Spirituality or religious beliefs can be

a major sustaining power that supports clients when all else fails. Other clients

may be affected by depression and a sense of worthlessness due to guilt, anger, or

sadness created by their unexamined acceptance of spiritual or religious dogma.

Counselors must remain open and nonjudgmental in conversations about reli-

gion or spirituality. Furthermore, counselors cannot ignore a client’s spiritual and

religious perspectives if they want to practice in a culturally sensitive and ethical

manner (Young & Cashwell, 2011a; 2011b).

common goals In some ways spirituality and counseling have similar goals.

Both emphasize learning to accept oneself, forgiving others and oneself, learn-

ing to love oneself and others, admitting one’s shortcomings, accepting personal

responsibility, letting go of hurts and resentments, dealing with guilt, and learning

to let go of self-destructive patterns of thinking, feeling, and acting.

Spiritual/religious values have a major part to play in human life and strug-

gles, which means that exploring these values has a great deal to do with providing

solutions for clients’ struggles. Because spiritual and therapeutic paths converge in

some ways, integration is possible, and dealing with a client’s spirituality will often

enhance the therapy process. Themes that have healing inﬂ uences include loving,

caring, learning to listen with compassion, challenging clients’ basic life assump-

tions, accepting human imperfection, and going outside of self-oriented interests

(social interest). Both religion and counseling help people ponder questions of

“Who am I?” and “What is the meaning of my life?” At their best, both counseling

and religion can foster healing.

implications for assessment and treatment Traditionally,

when clients come to a therapist with a problem, the therapist explores all the factors

that contributed to the development of the problem. A background of involvement

in religion can be part of clients’ history, and thus it can be a part of the intake as-

sessment and can be explored in counseling sessions. Frame (2003) presents many

reasons for including spirituality in the assessment process: understanding clients’

worldviews and the contexts in which they live, assisting clients in grappling with

questions regarding the purpose of their lives and what they most value, exploring

religion and spirituality as client resources, and uncovering religious and spiritual

problems. This information will assist the therapist in choosing appropriate interven-

tions. Young and Cashwell (2011a) maintain that counselors must assess clients’ spir-

itual or religious beliefs if they may be exacerbating clients’ psychological problems.

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471

AN INTEGRATIVE PERSPECTIVE

your role as a counselor It is critical that counselors not be judgmen-

tal when it comes to their clients’ beliefs and that they create an inviting and safe

climate for clients to explore their values and beliefs. There are many paths toward

fulﬁ lling spiritual needs, and it is not your role as a counselor to prescribe any par-

ticular pathway. By conducting a thorough assessment on a client’s background,

you will obtain many clues regarding personal themes for potential exploration. If

you remain ﬁ nely tuned to clients’ stories and to the purpose for which they sought

therapy, clients’ concerns about spiritual or religious values, beliefs, and practices

will surface.

To assist clients in clarifying their values and in making their own decisions

requires that you have a clear sense of your own spiritual perspective. Spiritual

self-awareness is the basis for competence in dealing with the worldviews of your

clients (Hagedorn & Moorhead, 2011). Worthington (2011) reminds therapists of

their responsibility to provide informed and sensitive care to all clients, whether or

not they embrace a spiritual or religious worldview:

Given the social changes and openness of both clients and therapists to religion and spiritu-

ality, it is a reasonable supposition that spirituality tailored therapies will increase to meet

clients’ needs. There will also need to be continuing sensitivity to clients who do not want

to attend religiously or spiritually tailored therapy. (p. 541)

Robertson and Young (2011) stress the need to work with a client’s spiritual and

religious concerns, and state that “failure to address these issues, may, in some

cases, be incompetent or unethical practice” (p. 38).

If you are to effectively serve diverse client populations, it is essential that you

pay attention to your training and competence in addressing spiritual and religious

concerns your clients bring to therapy. Ethically, it is important to monitor yourself

for subtle ways that you might be inclined to inﬂ uence clients to embrace a spir-

itual perspective or to give up certain religious beliefs that you think are no longer

functional for them. It is important to keep in mind that clients should determine

the speciﬁ c values they want to retain, replace, or modify.

From my vantage point, the emphasis on spirituality will continue to be impor-

tant in counseling practice, which makes it imperative that you prepare yourself to

work competently with the spiritual and religious concerns that your clients bring

up. For further reading on the topic of integrating spirituality and religion into

counseling, I highly recommend Integrating Spirituality and Religion into Coun-

seling: A Guide to Competent Practice (Cashwell & Young, 2011).

The Challenge of Developing an Integrative Perspective

A survey of approaches to counseling and psychotherapy reveals that no common

philosophy uniﬁ es them. Many of the theories have different basic philosophies

and views of human nature (Table 15.1). As the postmodern therapists remind

us, our philosophical assumptions are important because they inﬂ uence which

“reality” we perceive, and they direct our attention to the variables that we are “set”

to see. A word of caution, then: Beware of subscribing exclusively to any one view

of human nature. Remain open and selectively incorporate a framework for coun-

seling that is consistent with your own personality and your belief system.

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472

CHAPTER FIFTEEN

TABLE 15.1 The Basic Philosophies

Psychoanalytic therapy

Human beings are basically determined by psychic energy and

by early experiences. Unconscious motives and conﬂ icts are

central in present behavior. Early development is of critical

importance because later personality problems have their roots

in repressed childhood conﬂ icts.

Adlerian therapy

Humans are motivated by social interest, by striving toward

goals, by inferiority and superiority, and by dealing with the

tasks of life. Emphasis is on the individual’s positive capacities

to live in society cooperatively. People have the capacity to

interpret, inﬂ uence, and create events. Each person at an

early age creates a unique style of life, which tends to remain

relatively constant throughout life.

Existential therapy

The central focus is on the nature of the human condition, which

includes a capacity for self-awareness, freedom of choice to

decide one’s fate, responsibility, anxiety, the search for meaning,

being alone and being in relation with others, striving for

authenticity, and facing living and dying.

Person-centered therapy

Positive view of people; we have an inclination toward

becoming fully functioning. In the context of the therapeutic

relationship, the client experiences feelings that were

previously denied to awareness. The client moves toward

increased awareness, spontaneity, trust in self, and inner-

directedness.

Gestalt therapy

The person strives for wholeness and integration of thinking,

feeling, and behaving. Some key concepts include contact with

self and others, contact boundaries, and awareness. The view

is nondeterministic in that the person is viewed as having the

capacity to recognize how earlier inﬂ uences are related to present

difﬁ culties. As an experiential approach, it is grounded in the

here and now and emphasizes awareness, personal choice, and

responsibility.

Behavior therapy

Behavior is the product of learning. We are both the product and

the producer of the environment. Traditional behavior therapy

is based on classical and operant principles. Contemporary

behavior therapy has branched out in many directions.

Cognitive behavior therapy

Individuals tend to incorporate faulty thinking, which leads

to emotional and behavioral disturbances. Cognitions are the

major determinants of how we feel and act. Therapy is primarily

oriented toward cognition and behavior, and it stresses the role

of thinking, deciding, questioning, doing, and redeciding. This

is a psychoeducational model, which emphasizes therapy as a

learning process, including acquiring and practicing new skills,

learning new ways of thinking, and acquiring more effective

ways of coping with problems.

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473

AN INTEGRATIVE PERSPECTIVE

Reality therapy

Based on choice theory, this approach assumes that we need

quality relationships to be happy. Psychological problems

are the result of our resisting the control by others or of our

attempt to control others. Choice theory is an explanation of

human nature and how to best achieve satisfying interpersonal

relationships.

Feminist therapy

Feminists criticize many traditional theories to the degree

that they are based on gender-biased concepts, such as being

androcentric, gendercentric, ethnocentric, heterosexist, and

intrapsychic. The constructs of feminist therapy include being

gender fair, ﬂ exible, interactionist, and life-span-oriented.

Gender and power are at the heart of feminist therapy. This

is a systems approach that recognizes the cultural, social, and

political factors that contribute to an individual’s problems.

Postmodern approaches

Based on the premise that there are multiple realities and

multiple truths, postmodern therapies reject the idea that

reality is external and can be grasped. People create meaning in

their lives through conversations with others. The postmodern

approaches avoid pathologizing clients, take a dim view of

diagnosis, avoid searching for underlying causes of problems,

and place a high value on discovering clients’ strengths and

resources. Rather than talking about problems, the focus of

therapy is on creating solutions in the present and the future.

Family systems therapy

The family is viewed from an interactive and systemic

perspective. Clients are connected to a living system; a change

in one part of the system will result in a change in other

parts. The family provides the context for understanding how

individuals function in relationship to others and how they

behave. Treatment deals with the family unit. An individual’s

dysfunctional behavior grows out of the interactional unit of the

family and out of larger systems as well.

Despite the divergences in the various theories, creative syntheses among some

models are possible. For example, an existential orientation does not necessarily

preclude using techniques drawn from behavior therapy or from some of the cog-

nitive theories. Each point of view offers a perspective for helping clients in their

search for self. I encourage you to study all the major theories and to remain open

to what you might take from the various orientations as a basis for an integrative

perspective that will guide your practice.

In developing a personal integrative perspective, it is important to be alert

to the problem of attempting to mix theories with incompatible underlying as-

sumptions. Lazarus (1995) asks, “How is it possible to blend two systems that

rest on totally different assumptions about the meaning, origins, development,

maintenance, signiﬁ cance, and management of problems?” (p. 156). An advocate

of technical eclecticism, Lazarus (2008b) has consistently emphasized that a blend

of different theories is likely to result in confusion and argued against the notion

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474

CHAPTER FIFTEEN

of theoretical integration. He adds that basic concepts that may seem compatible

often are, upon closer scrutiny, quite irreconcilable (see Table 15.2). Lazarus stress-

es that psychotherapy integration does not have to rely on a theoretical amalgama-

tion. Clinicians can be technically eclectic (or technically integrative) in that they

can select methods from any discipline without necessarily endorsing any of the

theories that spawned them.

TABLE 15.2 Key Concepts

Psychoanalytic therapy

Normal personality development is based on successful

resolution and integration of psychosexual stages of

development. Faulty personality development is the result of

inadequate resolution of some speciﬁ c stage. Anxiety is a result

of repression of basic conﬂ icts. Unconscious processes are

centrally related to current behavior.

Adlerian therapy

Key concepts include the unity of personality, the need to view

people from their subjective perspective, and the importance of

life goals that give direction to behavior. People are motivated

by social interest and by ﬁ nding goals to give life meaning.

Other key concepts are striving for signiﬁ cance and superiority,

developing a unique lifestyle, and understanding the family

constellation. Therapy is a matter of providing encouragement

and assisting clients in changing their cognitive perspective and

behavior.

Existential therapy

Essentially an experiential approach to counseling rather than

a ﬁ rm theoretical model, it stresses core human conditions.

Interest is on the present and on what one is becoming. The

approach has a future orientation and stresses self-awareness

before action.

Person-centered therapy

The client has the potential to become aware of problems

and the means to resolve them. Faith is placed in the client’s

capacity for self-direction. Mental health is a congruence of ideal

self and real self. Maladjustment is the result of a discrepancy

between what one wants to be and what one is. In therapy

attention is given to the present moment and on experiencing

and expressing feelings.

Gestalt therapy

Emphasis is on the “what” and “how” of experiencing in the

here and now to help clients accept all aspects of themselves. Key

concepts include holism, ﬁ gure-formation process, awareness,

unﬁ nished business and avoidance, contact, and energy.

Behavior therapy

Focus is on overt behavior, precision in specifying goals of

treatment, development of speciﬁ c treatment plans, and

objective evaluation of therapy outcomes. Present behavior is

given attention. Therapy is based on the principles of learning

theory. Normal behavior is learned through reinforcement and

imitation. Abnormal behavior is the result of faulty learning.

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475

AN INTEGRATIVE PERSPECTIVE

Cognitive behavior therapy

Although psychological problems may be rooted in childhood,

they are reinforced by present ways of thinking. A person’s

belief system is the primary cause of disorders. Internal

dialogue plays a central role in one’s behavior. Clients focus

on examining faulty assumptions and misconceptions and on

replacing these with effective beliefs.

Reality therapy

The basic focus is on what clients are doing and how to get

them to evaluate whether their present actions are working

for them. People are mainly motivated to satisfy their needs,

especially the need for signiﬁ cant relationships. The approach

rejects the medical model, the notion of transference, the

unconscious, and dwelling on one’s past.

Feminist therapy

Core principles of feminist therapy are that the personal is

political, therapists have a commitment to social change,

women’s voices and ways of knowing are valued and women’s

experiences are honored, the counseling relationship is

egalitarian, therapy focuses on strengths and a reformulated

deﬁ nition of psychological distress, and all types of oppression

are recognized.

Postmodern approaches

Therapy tends to be brief and addresses the present and the

future. The person is not the problem; the problem is the

problem. The emphasis is on externalizing the problem and

looking for exceptions to the problem. Therapy consists of a

collaborative dialogue in which the therapist and the client

co-create solutions. By identifying instances when the problem

did not exist, clients can create new meanings for themselves

and fashion a new life story.

Family systems therapy

Focus is on communication patterns within a family, both

verbal and nonverbal. Problems in relationships are likely to

be passed on from generation to generation. Key concepts vary

depending on speciﬁ c orientation but include differentiation,

triangles, power coalitions, family-of-origin dynamics,

functional versus dysfunctional interaction patterns, and

dealing with here-and-now interactions. The present is more

important than exploring past experiences.

By remaining theoretically consistent, but technically integrative, practi-

tioners can spell out precisely the interventions they will employ with various

clients, as well as the means by which they will select these procedures. Lazarus

(1997a, 1997b) contends that therapists who hope to be effective with a wide

range of problems and with different client populations must be flexible and

versatile. Therapists should ask these basic questions when devising a treat-

ment program: “What works for whom under which particular circumstances?”

“Why are some procedures helpful and others unhelpful?” “What can be done

to ensure long-term success and positive follow-ups?” Lazarus (1993) believes

some clients respond to warm, informal counselors but that others want more

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476

CHAPTER FIFTEEN

formal counselors. Some clients work well with therapists who are quiet and

nonforceful, whereas others work best with directive and outgoing therapists.

Furthermore, the same client may respond favorably to various therapeutic

techniques and styles at different times.

Lazarus (1996a) mentions the value of a therapist assuming an active role

in blending a ﬂ exible repertoire of relationship styles with a wide range of tech-

niques as a way to enhance therapeutic outcomes. He maintains that a skilled

therapist is able to determine when to be confrontational, when to be directive,

when to allow the client to struggle, when to be formal or informal, when to

self-disclose or remain anonymous, and when to be gentle or tough. Lazarus

(1993) asserts that relationships of choice are at least as important as techni-

ques of choice. (For a review of multimodal procedures and their rationale, see

Chapter 9.)

One of the challenges you will face as a counselor is to deliver therapeutic

services in a brief, comprehensive, effective, and ﬂ exible way. Many of the theoreti-

cal orientations addressed in this book can be applied to brief forms of therapy.

One of the driving forces of the psychotherapy integration movement has been

the increase of brief therapies and the pressures to do more for a variety of client

populations within the limitations of 6 to 20 sessions. Most forms of short-term

psychotherapy are active in nature, collaborative in relationship, and integrative in

orientation (Norcross & Beutler, 2011).

The main goal of brief therapy is to help clients resolve problems and to move

forward as quickly as possible. Some of the deﬁ ning characteristics of brief therapy

include the following (Hoyt, 2011):

• Rapid working alliance between therapist and client

• Clear speciﬁ

cation of achievable treatment goals

• Clear division of responsibilities between client and therapist, with active client

participation and a high level of therapist activity

• Emphasis on client’s strengths, competencies, and adaptive capacities

• Expectation that change is possible and realistic

• Here-and-now orientation with a primary focus on current functioning in

thinking, feeling, and behaving

• Speciﬁ

c, integrated, and eclectic techniques

• Time sensitive, including making the most of each session and ending therapy

as soon as possible

The core task is for integrative practitioners to learn how to rapidly and system-

atically identify problems, create a collaborative relationship with clients, and

intervene with a range of speciﬁ

c methods. Hoyt puts the challenge to therapists

concisely: “The simple truth is that most therapy is brief therapy and will be

increasingly so; for the sake of our patients and our profession, we should learn to

practice it well” (p. 419).

An integrative perspective at its best entails a systematic integration of underly-

ing principles and methods common to a range of therapeutic approaches. The

strengths of systematic integration are based on its ability to be taught, replicated,

and evaluated (Norcross & Beutler, 2011). To develop this kind of integration, you

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477

AN INTEGRATIVE PERSPECTIVE

will eventually need to be thoroughly conversant with a number of theories, be

open to the idea that these theories can be connected in some ways, and be will-

ing to continually test your hypotheses to determine how well they are working.

Developing a systematic integrative perspective is the product of a great deal of

study, clinical practice, research, and theorizing.

issues related to the

therapeutic process

Therapeutic Goals

The goals of counseling are almost as diverse as are the theoretical approaches.

Some goals include restructuring the personality, uncovering the unconscious,

creating social interest, ﬁ nding meaning in life, curing an emotional disturbance,

examining old decisions and making new ones, developing trust in oneself, be-

coming more self-actualizing, reducing anxiety, reducing maladaptive behavior

and learning adaptive patterns, becoming grounded in the present moment, man-

aging intense emotions, gaining more effective control of one’s life, and reauthor-

ing the story of one’s life (Table 15.3). Is there a common denominator in this range

of goals?

TABLE 15.3 Goals of Therapy

Psychoanalytic therapy

To make the unconscious conscious. To reconstruct the basic

personality. To assist clients in reliving earlier experiences and

working through repressed conﬂ icts. To achieve intellectual and

emotional awareness.

Adlerian therapy

To challenge clients’ basic premises and life goals. To offer

encouragement so individuals can develop socially useful goals

and increase social interest. To develop the client’s sense of

belonging.

Existential therapy

To help people see that they are free and to become aware of

their possibilities. To challenge them to recognize that they

are responsible for events that they formerly thought were

happening to them. To identify factors that block freedom.

Person-centered therapy

To provide a safe climate conducive to clients’ self-exploration,

so that they can recognize blocks to growth and can experience

aspects of self that were formerly denied or distorted. To enable

them to move toward openness, greater trust in self, willingness

to be a process, and increased spontaneity and aliveness. To ﬁ nd

meaning in life and to experience life fully. To become more

self-directed.

Gestalt therapy

To assist clients in gaining awareness of moment-to-moment

experiencing and to expand the capacity to make choices. To

foster integration of the self.

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478

CHAPTER FIFTEEN

Behavior therapy

To eliminate maladaptive behaviors and learn more effective

behaviors. To identify factors that inﬂ uence behavior and ﬁ nd

out what can be done about problematic behavior. To encourage

clients to take an active and collaborative role in clearly setting

treatment goals and evaluating how well these goals are

being met.

Cognitive behavior therapy

To teach clients to confront faulty beliefs with contradictory

evidence that they gather and evaluate. To help clients seek out

their faulty beliefs and minimize them. To become aware of

automatic thoughts and to change them.

Reality therapy

To help people become more effective in meeting all of their

psychological needs. To enable clients to get reconnected with

the people they have chosen to put into their quality worlds and

teach clients choice theory.

Feminist therapy

To bring about transformation both in the individual client and

in society. To assist clients in recognizing, claiming, and using

their personal power to free themselves from the limitations of

gender-role socialization. To confront all forms of institutional

policies that discriminate or oppress on any basis.

Postmodern approaches

To change the way clients view problems and what they can do

about these concerns. To collaboratively establish speciﬁ c, clear,

concrete, realistic, and observable goals leading to increased

positive change. To help clients create a self-identity grounded

on competence and resourcefulness so they can resolve present

and future concerns. To assist clients in viewing their lives in

positive ways, rather than being problem saturated.

Family systems therapy

To help family members gain awareness of patterns of

relationships that are not working well and to create new ways

of interacting.

This diversity can be simpliﬁ ed by considering the degree of generality or spe-

ciﬁ city of goals. Goals exist on a continuum from speciﬁ c, concrete, and short term

on one end, to general, global, and long term on the other. The cognitive behavioral

approaches stress the former; the relationship-oriented therapies tend to stress the

latter. The goals at opposite ends of the continuum are not necessarily contradic-

tory; it is a matter of how speciﬁ cally they are deﬁ ned.

Therapist’s Function and Role

In working toward an integrative perspective, ask yourself these questions:

• How do the counselor’s functions change depending on the stage of the coun-

seling process?

• Does the therapist maintain a basic role, or does this role vary in accordance

with the characteristics of the client?

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479

AN INTEGRATIVE PERSPECTIVE

• How does the counselor determine how active and directive to be?

• How is structuring handled as the course of therapy progresses?

• What is the optimum balance of responsibility in the client–therapist relationship?

• What is the most effective way to monitor the therapeutic alliance?

• What, when, and how much does the counselor self-disclose?

As you saw through your study of the 11 therapeutic approaches, a central issue

of each system is the degree to which the therapist exercises control over clients’

behavior both during and outside the session. Cognitive behavior therapists and

reality therapists, for example, operate within a present-centered, directive, didac-

tic, structured, and psychoeducational context. As a collaborative endeavor, they

frequently design homework assignments to assist clients in practicing new behav-

ior outside therapy sessions. In contrast, person-centered therapists operate with a

much looser and less deﬁ

ned structure. Solution-focused and narrative therapists

view the client as the expert on his or her own life; they assist clients in reﬂ ection

outside of the session that might result in self-directed change. Although they are

active questioners, they are not prescriptive in their practice.

Structuring depends on the particular client and the speciﬁ c circumstances he

or she brings to the therapy situation. From my perspective, clear structure is most

essential during the early phase of counseling because it encourages the client to

talk about the problems that led to seeking therapy. In a collaborative way, it is

useful for both counselor and client to make some initial assessment that can pro-

vide a focus for the therapy process. As soon as possible, the client should be given

a signiﬁ cant share of the responsibility for deciding on the content and agenda of

the sessions. From early in the therapy process the client can be empowered if the

counselor expects the client to become an active participant in the process.

Client’s Experience in Therapy

Most clients share some degree of suffering, pain, or at least discontent. There

is a discrepancy between how they would like to be and how they are. Some in-

dividuals initiate therapy because they hope to cure a speciﬁ c symptom or set of

symptoms. They want to get rid of migraine headaches, free themselves of chronic

anxiety attacks, lose weight, or get relief from depression. They may have conﬂ ict-

ing feelings and reactions, may struggle with low self-esteem, or may have limited

information and skills. Many seek to resolve conﬂ icts in their close relationships.

I believe people are increasingly entering therapy with existential problems. Their

complaints often relate to the these existential issues: a sense of emptiness, mean-

inglessness in life, routine ways of living, unsatisfying personal relationships,

anxiety over uncertainty, a lack of intense feelings, and a loss of their sense of self.

The initial expectation of many clients is that results will come quickly. They

often have great hope for major changes in their life and rely on direction from the

therapist. As therapy progresses, clients discover that they must be active in the

process, selecting their own goals and working toward them, both in the sessions

and in daily living. Some clients can beneﬁ t from recognizing and expressing pent-

up feelings, others will need to examine their beliefs and thoughts, others will

most need to begin behaving in different ways, and others will beneﬁ t from talking

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480

CHAPTER FIFTEEN

with you about their relationships with the signiﬁ cant people in their lives. Most

clients will need to do some work in all three dimensions—feelings, thoughts, and

behaviors—because these dimensions are interrelated.

In deciding what interventions are most likely to be helpful, it is important

to take into account the client’s cultural, ethnic, and socioeconomic background.

Moreover, the focus of counseling may change as clients enter different phas-

es in the counseling process. Although some clients initially feel a need to be

listened to and allowed to express deep feelings, they can proﬁ t later from ex-

amining the thought patterns that are contributing to their psychological pain.

Certainly at some point in therapy it is essential that clients translate what they

are learning about themselves into concrete action. The client’s given situation

in the environment provides a framework for selecting interventions that are

most appropriate.

Listening to client feedback about the therapy process is of the utmost im-

portance. One of the best ways to improve the effectiveness of psychotherapy is

through client-directed, outcome-informed therapy (Duncan, Miller, & Sparks,

2004). Therapists need to take direction from their clients. If therapists learn to

listen to clients’ feedback throughout the therapeutic process, clients can become

full and equal participants in all aspects of their therapy. In their book, The Heroic

Client, Duncan and his colleagues (2004) emphasize that “it is time to recast the

client as not only the hero or heroine of the therapy drama but also the director of

the change endeavor” (p. 12). Client strengths and perceptions are the foundation

of therapy work, and these authors advocate for systematic and consistent assess-

ment of the client’s perceptions of progress, which allows the therapist to tailor

the therapy to the individual needs and characteristics of each client. Using client

feedback, therapists can adjust and accommodate to maximize beneﬁ cial outcomes.

In essence, Duncan and colleagues are arguing for practice-based evidence rather

than evidence-based practice: “Becoming outcome informed not only ampliﬁ es the

client’s voice but offers the most viable, research-tested method to improve clinical

effectiveness” (p. 16).

Relationship Between Therapist and Client

Most approaches share common ground in accepting the importance of the thera-

peutic relationship. The existential, person-centered, Gestalt, Adlerian, and post-

modern views emphasize the personal relationship as the crucial determinant of

treatment outcomes. Rational emotive behavior therapy, reality therapy, cognitive

behavior therapy, and behavior therapy certainly do not ignore the relationship fac-

tor, yet they place less emphasis on the relationship and more on the effective use

of techniques (Table 15.4).

Counseling is a personal matter that involves a personal relationship, and evi-

dence indicates that honesty, sincerity, acceptance, understanding, and spontaneity

are basic ingredients for successful outcomes. Therapists’ degree of caring, their

interest and ability in helping their clients, and their genuineness inﬂ uence the

relationship. Norcross and Wampold (2011a) stress that psychotherapy is primarily

a human relationship. Both client and therapist bring origins, culture, expecta-

tions, biases, defenses, and strengths to this relationship. They claim that how we

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AN INTEGRATIVE PERSPECTIVE

TABLE 15.4 The Therapeutic Relationship

Psychoanalytic therapy

The classical analyst remains anonymous, and clients

develop projections toward him or her. Focus is on

reducing the resistances that develop in working with

transference and on establishing more rational control.

Clients undergo long-term analysis, engage in free

association to uncover conﬂ icts, and gain insight by

talking. The analyst makes interpretations to teach clients

the meaning of current behavior as it relates to the past.

In contemporary relational psychoanalytic therapy, the

relationship is central and emphasis is given to here-and-

now dimensions of this relationship.

Adlerian therapy

The emphasis is on joint responsibility, on mutually

determining goals, on mutual trust and respect, and

on equality. Focus is on identifying, exploring, and

disclosing mistaken goals and faulty assumptions within

the person’s lifestyle.

Existential therapy

The therapist’s main tasks are to accurately grasp

clients’ being in the world and to establish a personal

and authentic encounter with them. The immediacy

of the client–therapist relationship and the authenticity

of the here-and-now encounter are stressed. Both

client and therapist can be changed by the

encounter.

Person-centered therapy

The relationship is of primary importance. The qualities

of the therapist, including genuineness, warmth,

accurate empathy, respect, and nonjudgmentalness—

and communication of these attitudes to clients—are

stressed. Clients use this genuine relationship with the

therapist to help them transfer what they learn to other

relationships.

Gestalt therapy

Central importance is given to the I/Thou relationship

and the quality of the therapist’s presence. The therapist’s

attitudes and behavior count more than the techniques

used. The therapist does not interpret for clients but

assists them in developing the means to make their own

interpretations. Clients identify and work on unﬁ nished

business from the past that interferes with current

functioning.

Behavior therapy

The therapist is active and directive and functions

as a teacher or mentor in helping clients learn

more effective behavior. Clients must be active in the

process and experiment with new behaviors. Although

a quality client–therapist relationship is not viewed

as sufﬁ cient to bring about change, it is considered

essential for implementing behavioral procedures.

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482

CHAPTER FIFTEEN

Cognitive behavior therapy

In REBT the therapist functions as a teacher and the client

as a student. The therapist is highly directive and teaches

clients an A-B-C model of changing their cognitions. In

CT the focus is on a collaborative relationship. Using a

Socratic dialogue, the therapist assists clients in identifying

dysfunctional beliefs and discovering alternative rules for

living. The therapist promotes corrective experiences that

lead to learning new skills. Clients gain insight into their

problems and then must actively practice changing self-

defeating thinking and acting.

Reality therapy

A fundamental task is for the therapist to create a good

relationship with the client. Therapists are then able to

engage clients in an evaluation of all their relationships

with respect to what they want and how effective they

are in getting this. Therapists ﬁ nd out what clients want,

ask what they are choosing to do, invite them to evaluate

present behavior, help them make plans for change,

and get them to make a commitment. The therapist is a

client’s advocate, as long as the client is willing to attempt

to behave responsibly.

Feminist therapy

The therapeutic relationship is based on empowerment

and egalitarianism. Therapists actively break down

the hierarchy of power and reduce artiﬁ cial barriers by

engaging in appropriate self-disclosure and teaching

clients about the therapy process. Therapists strive to

create a collaborative relationship in which clients can

become their own expert.

Postmodern approaches

Therapy is a collaborative partnership. Clients are viewed

as the experts on their own life. Therapists use questioning

dialogue to help clients free themselves from their

problem-saturated stories and create new life-afﬁ rming

stories. Solution-focused therapists assume an active role

in guiding the client away from problem-talk and toward

solution-talk. Clients are encouraged to explore their

strengths and to create solutions that will lead to a richer

future. Narrative therapists assist clients in externalizing

problems and guide them in examining self-limiting

stories and creating new and more liberating stories.

Family systems therapy

The family therapist functions as a teacher, coach,

model, and consultant. The family learns ways to detect

and solve problems that are keeping members stuck,

and it learns about patterns that have been transmitted

from generation to generation. Some approaches focus

on the role of therapist as expert; others concentrate on

intensifying what is going on in the here and now of the

family session. All family therapists are concerned with

the process of family interaction and teaching patterns of

communication.

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483

AN INTEGRATIVE PERSPECTIVE

create and nurture this powerful human relationship can be guided by the fruits

of research.

As you think about developing your personal counseling perspective, give con-

sideration to the issue of the match between client and counselor. I certainly do

not advocate changing your personality to ﬁ t your perception of what each client

is expecting; it is important that you be yourself as you meet clients. You also need

to consider the reality that you will probably not be able to work effectively with

every client. Some clients will work better with counselors who have another type

of personal and therapeutic style than yours. Be sensitive in assessing what your

client needs, and use good judgment when determining the appropriateness of the

match between you and a potential client.

Although you do not have to be like your clients or have experienced the same

problems to be effective with them, it is critical that you be able to understand

their world and respect them. Ask yourself how well prepared you are to counsel

clients from a different cultural background. To what degree do you think you

can successfully establish a therapeutic relationship with a client of a different

race? Ethnic group? Gender? Age? Sexual orientation? Spiritual/religious orienta-

tion? Socioeconomic group? Do you see any potential barriers that would make it

difﬁ cult for you to form a working relationship with certain clients? It is also im-

portant to consider the client’s diagnosis, resistance level, treatment preferences,

and stages of change. Different types of clients respond better to different types of

treatments and relationship styles. Therapeutic techniques and styles should be

selected to ﬁ t the client’s personal characteristics. Norcross and Beutler (2011) sug-

gest that therapists create a new therapy for each client:

We believe that the purpose of integrative psychotherapy is not to create a single or uni-

tary treatment. Rather, we select different treatment methods according to the patient’s

response to the treatment goals, following an established set of integrative principles. The

result is a more efﬁ cient and efﬁ cacious therapy—and one that ﬁ ts both the client and the

clinician. (p. 509)

the place of techniques

and evaluation in counseling

Drawing on Techniques From Various Approaches

Effective therapists incorporate a wide range of procedures into their therapeutic

style. Much depends on the purpose of therapy, the setting, the personality and

style of the therapist, the qualities of the particular client, and the problems selected

for intervention. Regardless of the therapeutic model you may be working with,

you must decide what relationship style to adopt, what techniques, procedures, or

intervention methods to use, when to use them, and with which clients. Take time

to review Table 15.5 and Table 15.6 on therapeutic techniques and applications of

techniques. Pay careful attention to the focus of each type of therapy and how that

focus might be useful in your practice.

It is critical to be aware of how clients’ cultural backgrounds contribute to their

perceptions of their problems. Each of the 11 therapeutic approaches has both

strengths and limitations when applied to culturally diverse client populations

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484

CHAPTER FIFTEEN

TABLE 15.5 Techniques of Therapy

Psychoanalytic therapy

The key techniques are interpretation, dream analysis, free

association, analysis of resistance, analysis of transference,

and countertransference. Techniques are designed to help

clients gain access to their unconscious conﬂ icts, which

leads to insight and eventual assimilation of new material

by the ego.

Adlerian therapy

Adlerians pay more attention to the subjective

experiences of clients than to using techniques.

Some techniques include gathering life-history data

(family constellation, early recollections, personal

priorities), sharing interpretations with clients, offering

encouragement, and assisting clients in searching for

new possibilities.

Existential therapy

Few techniques ﬂ ow from this approach because it

stresses understanding ﬁ rst and technique second. The

therapist can borrow techniques from other approaches

and incorporate them in an existential framework.

Diagnosis, testing, and external measurements are not

deemed important. Issues addressed are freedom and

responsibility, isolation and relationships, meaning and

meaninglessness, living and dying.

Person-centered therapy

This approach uses few techniques but stresses the

attitudes of the therapist and a “way of being.” Therapists

strive for active listening, reﬂ ection of feelings,

clariﬁ cation, “being there” for the client, and focusing on

the moment-to-moment experiencing of the client. This

model does not include diagnostic testing, interpretation,

taking a case history, or questioning or probing for

information.

Gestalt therapy

A wide range of experiments are designed to intensify

experiencing and to integrate conﬂ icting feelings.

Experiments are co-created by therapist and client through

an I/Thou dialogue. Therapists have latitude to creatively

invent their own experiments. Formal diagnosis and

testing are not a required part of therapy.

Behavior therapy

The main techniques are reinforcement, shaping,

modeling, systematic desensitization, relaxation methods,

ﬂ ooding, eye movement and desensitization reprocessing,

cognitive restructuring, assertion and social skills training,

self-management programs, mindfulness and acceptance

methods, behavioral rehearsal, coaching, and various

multimodal therapy techniques. Diagnosis or assessment

is done at the outset to determine a treatment plan.

Questions concentrate on “what,” “how,” and “when” (but

not “why”). Contracts and homework assignments are also

typically used.

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485

AN INTEGRATIVE PERSPECTIVE

Cognitive behavior therapy

Therapists use a variety of cognitive, emotive, and

behavioral techniques; diverse methods are tailored to suit

individual clients. This is an active, directive, time-limited,

present-centered, psychoeducational, structured therapy.

Some techniques include engaging in Socratic dialogue,

collaborative empiricism, debating irrational beliefs,

carrying out homework assignments, gathering data on

assumptions one has made, keeping a record of activities,

forming alternative interpretations, learning new coping

skills, changing one’s language and thinking patterns,

role playing, imagery, confronting faulty beliefs, self-

instructional training, and stress inoculation training.

Reality therapy

This is an active, directive, and didactic therapy. Skillful

questioning is a central technique used for the duration of

the therapy process. Various techniques may be used to get

clients to evaluate what they are presently doing to see if

they are willing to change. If clients decide that their present

behavior is not effective, they develop a speciﬁ c plan for

change and make a commitment to follow through.

Feminist therapy

Although techniques from traditional approaches are

used, feminist practitioners tend to employ consciousness-

raising techniques aimed at helping clients recognize the

impact of gender-role socialization on their lives. Other

techniques frequently used include gender-role analysis

and intervention, power analysis and intervention,

demystifying therapy, bibliotherapy, journal writing,

therapist self-disclosure, assertiveness training, reframing

and relabeling, cognitive restructuring, identifying and

challenging untested beliefs, role playing, psychodramatic

methods, group work, and social action.

Postmodern approaches

In solution-focused therapy the main technique involves

change-talk, with emphasis on times in a client’s life

when the problem was not a problem. Other techniques

include creative use of questioning, the miracle

question, and scaling questions, which assist clients

in developing alternative stories. In narrative therapy,

speciﬁ c techniques include listening to a client’s problem-

saturated story without getting stuck, externalizing and

naming the problem, externalizing conversations, and

discovering clues to competence. Narrative therapists

often write letters to clients and assist them in ﬁ nding an

audience that will support their changes and new stories.

Family systems therapy

A variety of techniques may be used, depending on the

particular theoretical orientation of the therapist. Techniques

include genograms, teaching, asking questions, joining the

family, tracking sequences, issuing directives, use of

countertransference, family mapping, reframing, restructuring,

enactments, and setting boundaries. Techniques may be

experiential, cognitive, or behavioral in nature. Most are

designed to bring about change in a short time.

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486

CHAPTER FIFTEEN

TABLE 15.6 Applications of the Approaches

Psychoanalytic therapy

Candidates for analytic therapy include professionals who

want to become therapists, people who have had intensive

therapy and want to go further, and those who are in

psychological pain. Analytic therapy is not recommended for

self-centered and impulsive individuals or for people with

psychotic disorders. Techniques can be applied to individual

and group therapy.

Adlerian therapy Because the approach is based on a growth model, it is

applicable to such varied spheres of life as child guidance,

parent–child counseling, marital and family therapy,

individual counseling with all age groups, correctional and

rehabilitation counseling, group counseling, substance

abuse programs, and brief counseling. It is ideally suited to

preventive care and alleviating a broad range of conditions that

interfere with growth.

Existential therapy

This approach is especially suited to people facing a

developmental crisis or a transition in life and for those with

existential concerns (making choices, dealing with freedom

and responsibility, coping with guilt and anxiety, making

sense of life, and ﬁ nding values) or those seeking personal

enhancement. The approach can be applied to both individual

and group counseling, and to couples and family therapy,

crisis intervention, and community mental health work.

Person-centered therapy

Has wide applicability to individual and group counseling.

It is especially well suited for the initial phases of crisis

intervention work. Its principles have been applied to couples

and family therapy, community programs, administration

and management, and human relations training. It is a

useful approach for teaching, parent–child relations, and

for working with groups of people from diverse cultural

backgrounds.

Gestalt therapy

Addresses a wide range of problems and populations: crisis

intervention, treatment of a range of psychosomatic disorders,

couples and family therapy, awareness training of mental

health professionals, behavior problems in children, and

teaching and learning. It is well suited to both individual and

group counseling. The methods are powerful catalysts for

opening up feelings and getting clients into contact with their

present-centered experience.

Behavior therapy

A pragmatic approach based on empirical validation of results.

Enjoys wide applicability to individual, group, couples, and

family counseling. Some problems to which the approach is

well suited are phobic disorders, depression, trauma, sexual

disorders, children’s behavioral disorders, stuttering, and

prevention of cardiovascular disease. Beyond clinical practice,

its principles are applied in ﬁ elds such as pediatrics, stress

management, behavioral medicine, education, and geriatrics.

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487

AN INTEGRATIVE PERSPECTIVE

Cognitive behavior therapy

Has been widely applied to treatment of depression, anxiety,

relationship problems, stress management, skill training,

substance abuse, assertion training, eating disorders, panic

attacks, performance anxiety, and social phobias. CBT is

especially useful for assisting people in modifying their

cognitions. Many self-help approaches utilize its principles.

CBT can be applied to a wide range of client populations with

a variety of speciﬁ c problems.

Reality therapy

Geared to teaching people ways of using choice theory in

everyday living to increase effective behaviors. It has been

applied to individual counseling with a wide range of clients,

group counseling, working with youthful law offenders, and

couples and family therapy. In some instances it is well suited

to brief therapy and crisis intervention.

Feminist therapy

Principles and techniques can be applied to a range

of therapeutic modalities such as individual therapy,

relationship counseling, family therapy, group counseling,

and community intervention. The approach can be applied

to both women and men with the goal of bringing about

empowerment.

Postmodern approaches

Solution-focused therapy is well suited for people with

adjustment disorders and for problems of anxiety and

depression. Narrative therapy is now being used for a broad

range of human difﬁ culties including eating disorders,

family distress, depression, and relationship concerns.

These approaches can be applied to working with children,

adolescents, adults, couples, families, and the community in

a wide variety of settings. Both solution-focused and narrative

approaches lend themselves to group counseling and to

school counseling.

Family systems therapy

Useful for dealing with marital distress, problems of

communicating among family members, power struggles,

crisis situations in the family, helping individuals attain

their potential, and enhancing the overall functioning of the

family.

(Table 15.7 and Table 15.8). Although it is unwise to stereotype clients because of

their cultural heritage, it is useful to assess how the cultural context has a bearing

on their concerns. Some techniques may be contraindicated because of a client’s

socialization. The client’s responsiveness (or lack of it) to certain techniques is a

critical barometer in judging the effectiveness of these methods.

Effective counseling involves proﬁ ciency in a combination of cognitive, affec-

tive, and behavioral techniques. Such a combination is necessary to help clients

think about their beliefs and assumptions, to experience on a feeling level their

conﬂ icts and struggles, and to translate their insights into action programs by

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488

CHAPTER FIFTEEN

TABLE 15.7 Contributions to Multicultural Counseling

Psychoanalytic therapy

Its focus on family dynamics is appropriate for working

with many cultural groups. The therapist’s formality appeals

to clients who expect professional distance. Notion of ego

defense is helpful in understanding inner dynamics and

dealing with environmental stresses.

Adlerian therapy

Its focus on social interest, helping others, collectivism,

pursuing meaning in life, importance of family, goal

orientation, and belonging is congruent with the values of

many cultures. Focus on person-in-the-environment allows

for cultural factors to be explored.

Existential therapy

Focus is on understanding client’s phenomenological world,

including cultural background. This approach leads to

empowerment in an oppressive society. Existential therapy can

help clients examine their options for change within the context

of their cultural realities. The existential approach is particularly

suited to counseling diverse clients because of the philosophical

foundation that emphasizes the human condition.

Person-centered therapy

Focus is on breaking cultural barriers and facilitating open

dialogue among diverse cultural populations. Main strengths

are respect for clients’ values, active listening, welcoming

of differences, nonjudgmental attitude, understanding,

willingness to allow clients to determine what will be

explored in sessions, and prizing cultural pluralism.

Gestalt therapy

Its focus on expressing oneself nonverbally is congruent

with those cultures that look beyond words for messages.

Provides many experiments in working with clients who

have cultural injunctions against freely expressing feelings.

Can help to overcome language barrier with bilingual clients.

Focus on bodily expressions is a subtle way to help clients

recognize their conﬂ icts.

Behavior therapy

Focus on behavior, rather than on feelings, is compatible

with many cultures. Strengths include a collaborative

relationship between counselor and client in working

toward mutually agreed-upon goals, continual assessment

to determine if the techniques are suited to clients’ unique

situations, assisting clients in learning practical skills, an

educational focus, and stress on self-management strategies.

Cognitive behavior therapy

Focus is on a collaborative approach that offers clients

opportunities to express their areas of concern. The

psychoeducational dimensions are often useful in exploring

cultural conﬂ icts and teaching new behavior. The emphasis on

thinking (as opposed to identifying and expressing feelings) is

likely to be acceptable to many clients. The focus on teaching

and learning tends to avoid the stigma of mental illness. Clients

may value the active and directive stance of the therapist.

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489

AN INTEGRATIVE PERSPECTIVE

Reality therapy

Focus is on clients making their own evaluation of behavior

(including how they respond to their culture). Through

personal assessment clients can determine the degree to

which their needs and wants are being satisﬁ ed. They can

ﬁ nd a balance between retaining their own ethnic identity

and integrating some of the values and practices of the

dominant society.

Feminist therapy

Focus is on both individual change and social transformation.

A key contribution is that both the women’s movement and

the multicultural movement have called attention to the

negative impact of discrimination and oppression for both

women and men. Emphasizes the inﬂ uence of expected

cultural roles and explores client’s satisfaction with and

knowledge of these roles.

Postmodern approaches

Focus is on the social and cultural context of behavior.

Stories that are being authored in the therapy ofﬁ ce need

to be anchored in the social world in which the client lives.

Therapists do not make assumptions about people and

honor each client’s unique story and cultural background.

Therapists take an active role in challenging social and

cultural injustices that lead to oppression of certain groups.

Therapy becomes a process of liberation from oppressive

cultural values and enables clients to become active agents of

their destinies.

Family systems therapy

Focus is on the family or community system. Many ethnic

and cultural groups place value on the role of the extended

family. Many family therapies deal with extended family

members and with support systems. Networking is a part

of the process, which is congruent with the values of many

clients. There is a greater chance for individual change if

other family members are supportive. This approach offers

ways of working toward the health of the family unit and the

welfare of each member.

TABLE 15.8 Limitations in Multicultural Counseling

Psychoanalytic therapy

Its focus on insight, intrapsychic dynamics, and long-term

treatment is often not valued by clients who prefer to learn

coping skills for dealing with pressing daily concerns.

Internal focus is often in conﬂ ict with cultural values that

stress an interpersonal and environmental focus.

Adlerian therapy

This approach uses a detailed interview about one’s

family background; this can conﬂ ict with cultures that

have injunctions against disclosing family matters. Some

clients may view the counselor as an authority who will

provide answers to problems, which conﬂ icts with the

egalitarian, person-to-person spirit as a way to reduce

social distance.

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CHAPTER FIFTEEN

Existential therapy

Values of individuality, freedom, autonomy, and

self-realization often conﬂ ict with cultural values of

collectivism, respect for tradition, deference to authority,

and interdependence. Some may be deterred by the

absence of speciﬁ c techniques. Others will expect more

focus on surviving in their world.

Person-centered therapy

Some of the core values of this approach may not be

congruent with the client’s culture. Lack of counselor

direction and structure are unacceptable for clients

who are seeking help and immediate answers from a

knowledgeable professional.

Gestalt therapy

Clients who have been culturally conditioned to

be emotionally reserved may not embrace Gestalt

experiments. Some may not see how “being aware of

present experiencing” will lead to solving their problems.

Behavior therapy

Family members may not value clients’ newly acquired

assertive style, so clients must be taught how to cope

with resistance by others. Counselors need to help

clients assess the possible consequences of making

behavioral changes.

Cognitive behavior therapy

Before too quickly attempting to change the beliefs

and actions of clients, it is essential for the therapist

to understand and respect their world. Some clients

may have serious reservations about questioning their

basic cultural values and beliefs. Clients could become

dependent on the therapist for deciding what are

appropriate ways to solve problems.

Reality therapy

This approach stresses taking charge of one’s own life,

yet some clients are more interested in changing their

external environment. Counselor needs to appreciate the

role of discrimination and racism and help clients deal

with social and political realities.

Feminist therapy

This model has been criticized for its bias toward the

values of White, middle-class, heterosexual women,

which are not applicable to many other groups of women

nor to men. Therapists need to assess with their clients

the price of making signiﬁ cant personal change, which

may result in isolation from extended family as clients

assume new roles and make life changes.

Postmodern approaches

Some clients come to therapy wanting to talk about their

problems and may be put off by the insistence on talking

about exceptions to their problems. Clients may view the

therapist as an expert and be reluctant to view themselves

as experts. Certain clients may doubt the helpfulness of a

therapist who assumes a “not-knowing” position.

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491

AN INTEGRATIVE PERSPECTIVE

Family systems therapy

Family therapy rests on value assumptions that are

not congruent with the values of clients from some

cultures. Western concepts such as individuation,

self-actualization, self-determination, independence,

and self-expression may be foreign to some clients. In

some cultures, admitting problems within the family is

shameful. The value of “keeping problems within the

family” may make it difﬁ cult to explore conﬂ icts openly.

TABLE 15.9 Contributions of the Approaches

Psychoanalytic therapy

More than any other system, this approach has generated

controversy as well as exploration and has stimulated

further thinking and development of therapy. It has

provided a detailed and comprehensive description of

personality structure and functioning. It has brought

into prominence factors such as the unconscious as a

determinant of behavior and the role of trauma during the

ﬁ rst 6 years of life. It has developed several techniques for

tapping the unconscious and shed light on the dynamics

of transference and countertransference, resistance,

anxiety, and the mechanisms of ego defense.

Adlerian therapy

A key contribution is the inﬂ uence that Adlerian

concepts have had on other systems and the integration

of these concepts into various contemporary therapies.

This is one of the ﬁ rst approaches to therapy that was

humanistic, uniﬁ ed, holistic, and goal-oriented and that

put an emphasis on social and psychological factors.

Existential therapy

Its major contribution is recognition of the need for a

subjective approach based on a complete view of the human

condition. It calls attention to the need for a philosophical

statement on what it means to be a person. Stress on the I/

Thou relationship lessens the chances of dehumanizing

therapy. It provides a perspective for understanding anxiety,

guilt, freedom, death, isolation, and commitment.

behaving in new ways in day-to-day living. Table 15.9 and Table 15.10 outline the

contributions and limitations of the various therapeutic approaches. These tables

will help you identify elements from the various approaches that you may want to

incorporate in your own counseling perspective.

Evaluating the Effectiveness of Counseling and Therapy

Mental health providers must be accountable and be able to demonstrate the efﬁ cacy

of their services. In the era of managed care, it is even more essential for practitioners

to demonstrate the degree to which their interventions are both clinically sound and

cost-effective. Does therapy make a signiﬁ cant difference? Are people substantially bet-

ter after therapy than they were without it? Can therapy actually be more harmful than

helpful? A thorough discussion of these questions is beyond the scope of this book, but

I will address a few basic issues related to evaluating the effectiveness of counseling.

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492

CHAPTER FIFTEEN

Person-centered therapy

Clients take an active stance and assume responsibility

for the direction of therapy. This unique approach has

been subjected to empirical testing, and as a result

both theory and methods have been modiﬁ ed. It is an

open system. People without advanced training can

beneﬁ t by translating the therapeutic conditions to both

their personal and professional lives. Basic concepts

are straightforward and easy to grasp and apply. It

is a foundation for building a trusting relationship,

applicable to all therapies.

Gestalt therapy

The emphasis on direct experiencing and doing rather than

on merely talking about feelings provides a perspective

on growth and enhancement, not merely a treatment of

disorders. It uses clients’ behavior as the basis for making

them aware of their inner creative potential. The approach

to dreams is a unique, creative tool to help clients discover

basic conﬂ icts. Therapy is viewed as an existential

encounter; it is process-oriented, not technique-oriented. It

recognizes nonverbal behavior as a key to understanding.

Behavior therapy

Emphasis is on assessment and evaluation techniques,

thus providing a basis for accountable practice. Speciﬁ c

problems are identiﬁ ed, and clients are kept informed

about progress toward their goals. The approach has

demonstrated effectiveness in many areas of human

functioning. The roles of the therapist as reinforcer,

model, teacher, and consultant are explicit. The approach

has undergone extensive expansion, and research

literature abounds. No longer is it a mechanistic

approach, for it now makes room for cognitive factors and

encourages self-directed programs for behavioral change.

Cognitive behavior therapy

Major contributions include emphasis on a comprehensive

and eclectic therapeutic practice; numerous cognitive,

emotive, and behavioral techniques; an openness to

incorporating techniques from other approaches; and a

methodology for challenging and changing faulty thinking.

Most forms can be integrated into other mainstream

therapies. REBT makes full use of action-oriented

homework, various psychoeducational methods, and

keeping records of progress. CT is a structured therapy

that has a good track record for treating depression and

anxiety in a short time.

Reality therapy

This is a positive approach with an action orientation

that relies on simple and clear concepts that are easily

grasped in many helping professions. It can be used by

teachers, nurses, ministers, educators, social workers,

and counselors. Due to the direct methods, it appeals to

many clients who are often seen as resistant to therapy.

It is a short-term approach that can be applied to a

diverse population, and it has been a signiﬁ cant force in

challenging the medical model of therapy.

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493

AN INTEGRATIVE PERSPECTIVE

Feminist therapy

The feminist perspective is responsible for encouraging

increasing numbers of women to question gender

stereotypes and to reject limited views of what a woman

is expected to be. It is paving the way for gender-

sensitive practice and bringing attention to the gendered

uses of power in relationships. The uniﬁ ed feminist

voice brought attention to the extent and implications

of child abuse, incest, rape, sexual harassment, and

domestic violence. Feminist principles and interventions

can be incorporated in other therapy approaches.

Postmodern approaches

The brevity of these approaches ﬁ t well with the

limitations imposed by a managed care structure. The

emphasis on client strengths and competence appeals to

clients who want to create solutions and revise their life

stories in a positive direction. Clients are not blamed for

their problems but are helped to understand how they

might relate in more satisfying ways to such problems.

A strength of these approaches is the question format

that invites clients to view themselves in new and more

effective ways.

Family systems therapy

From a systemic perspective, neither the individual nor

the family is blamed for a particular dysfunction. The

family is empowered through the process of identifying

and exploring interactional patterns. Working with an

entire unit provides a new perspective on understanding

and working through both individual problems and

relationship concerns. By exploring one’s family of

origin, there are increased opportunities to resolve other

conﬂ icts in systems outside of the family

TABLE 15.10 Limitations of the Approaches

Psychoanalytic therapy

Requires lengthy training for therapists and much

time and expense for clients. The model stresses

biological and instinctual factors to the neglect of

social, cultural, and interpersonal ones. Its methods

are less applicable for solving speciﬁ c daily life

problems of clients and may not be appropriate for

some ethnic and cultural groups. Many clients lack

the degree of ego strength needed for regressive and

reconstructive therapy. It may be inappropriate for

certain counseling settings.

Adlerian therapy

Weak in terms of precision, testability, and empirical

validity. Few attempts have been made to validate

the basic concepts by scientiﬁ c methods. Tends to

oversimplify some complex human problems and is

based heavily on common sense.

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494

CHAPTER FIFTEEN

Existential therapy

Many basic concepts are fuzzy and ill-deﬁ ned, making

its general framework abstract at times. Lacks a

systematic statement of principles and practices of

therapy. Has limited applicability to lower functioning

and nonverbal clients and to clients in extreme crisis

who need direction.

Person-centered therapy

Possible danger from the therapist who remains

passive and inactive, limiting responses to reﬂ ection.

Many clients feel a need for greater direction, more

structure, and more techniques. Clients in crisis may

need more directive measures. Applied to individual

counseling, some cultural groups will expect more

counselor activity.

Gestalt therapy

Techniques lead to intense emotional expression; if

these feelings are not explored and if cognitive work is

not done, clients are likely to be left unﬁ nished and will

not have a sense of integration of their learning. Clients

who have difﬁ culty using imagination may not proﬁ t

from certain experiments.

Behavior therapy

Major criticisms are that it may change behavior but not

feelings; that it ignores the relational factors in therapy;

that it does not provide insight; that it ignores historical

causes of present behavior; that it involves control by the

therapist; and that it is limited in its capacity to address

certain aspects of the human condition.

Cognitive behavior therapy

Tends to play down emotions, does not focus on exploring

the unconscious or underlying conﬂ icts, de-emphasizes

the value of insight, and sometimes does not give enough

weight to the client’s past. REBT, being a confrontational

therapy, might lead to premature termination. CBT might

be too structured for some clients.

Reality therapy

Discounts the therapeutic value of exploration of the

client’s past, dreams, the unconscious, early childhood

experiences, and transference. The approach is limited

to less complex problems. It is a problem-solving

therapy that tends to discourage exploration of deeper

emotional issues.

Feminist therapy

A possible limitation is the potential for therapists

to impose a new set of values on clients—such as

striving for equality, power in relationships, deﬁ ning

oneself, freedom to pursue a career outside the home,

and the right to an education. Therapists need to keep

in mind that clients are their own best experts, which

means it is up to them to decide which values to

live by.

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495

AN INTEGRATIVE PERSPECTIVE

Postmodern approaches

There is little empirical validation of the effectiveness

of therapy outcomes. Some critics contend that these

approaches endorse cheerleading and an overly positive

perspective. Some are critical of the stance taken by

most postmodern therapists regarding assessment

and diagnosis, and also react negatively to the

“not-knowing” stance of the therapist. Because some

of the solution-focused techniques are relatively easy

to learn, practitioners may use these interventions

in a mechanical way or implement these techniques

without a sound rationale.

Family systems therapy

Limitations include problems in being able to involve

all the members of a family in the therapy. Some family

members may be resistant to changing the structure of

the system. Therapists’ self-knowledge and willingness

to work on their own family-of-origin issues is crucial,

for the potential for countertransference is high. It is

essential that the therapist be well trained, receive quality

supervision, and be competent in assessing and treating

individuals in a family context.

Evaluating how well psychotherapy works is far from simple. Therapeutic

systems are applied by practitioners who have unique individual characteristics,

and clients themselves have much to do with therapeutic outcomes. For example,

effects resulting from unexpected and uncontrollable events in the environment

can lessen the impact of gains made in psychotherapy. Moreover, practitioners

who adhere to the same approach are likely to use techniques in various ways and

to relate to clients in diverse fashions, functioning differently with different clients

and in different clinical settings. Norcross and Beutler (2011) note that evidence-

based practice reﬂ ects a commitment on “what works, not on what theory applies”

(p. 510).

Most of the outcome studies have been done by two divergent groups: (1) the

behavior and cognitive therapists, who have based their therapeutic practice on

empirical studies, and (2) the person-centered researchers, who have made sig-

niﬁ cant contributions to understanding both process and outcome variables. Sig-

niﬁ cant empirical research dealing with how well the therapy works has not been

produced for most of the other models covered in this book.

How effective is psychotherapy? A meta-analysis of psychotherapy outcome

literature conducted by Smith, Glass, and Miller (1980) concluded that psycho-

therapy was highly effective. Prochaska and Norcross (2010) note that controlled

outcome research consistently supports the effectiveness of psychotherapy. They

point out that more than 5,000 individual studies and 500 meta-analyses have

been conducted on the effectiveness of psychotherapy; these studies demonstrate

that well-developed therapy interventions have meaningful, positive effects on

the intended outcome variables. In short, not only does psychotherapy work, but

research demonstrates that therapy is remarkably effective.

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496

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A summary of the research data shows that the various treatment approaches

achieve roughly equivalent results (Duncan et al., 2004). Lambert’s (2011) re-

view of psychotherapy research makes it clear that the similarities rather than

the differences among models account for the effectiveness of psychothera-

py. Reviews of comparative outcome studies reveal the same general conclu-

sion: there is relative equivalence among the various therapeutic approaches.

Interpersonal, social, and affective factors common across therapeutic orienta-

tions are more critical than techniques employed when it comes to facilitat-

ing therapeutic gains. Lambert believes the future direction of theory, practice,

and training will see (1) the decline of single-theory practice and the growth

of integrative therapies, and (2) the increase in short-term, time-limited, and

group treatments that seem to be as effective as long-term individual treatments

with many client populations.

Although it is clear that therapy works, there are no simple explanations of

how it works, and it appears that we must look to factors that are common to all

therapeutic approaches. Hubble, Duncan, Miller, and Wampold (2010) summa-

rized research studies in the ﬁ eld and found that the following four factors account

for change in therapy:

• Client factors: 40%

• Alliance factors (the therapeutic relationship): 30%

• Expectancy factors (hope and allegiance): 15%

• Theoretical models and techniques: 15%

Common factors that are part of all theoretical orientations are critical to thera-

peutic outcome. Wampold (2010) concludes that “there is little evidence that the

speciﬁ

c ingredients of any treatment are responsible for the beneﬁ ts of therapy”

(p. 71). Research indicates that a variety of treatments are equally effective—when

administered by therapists who believe in them and when they are accepted by

the client.

The various therapy approaches and techniques work equally well because they

share the most important ingredient accounting for change—the client. Data point

to the conclusion that the engine of change is the client (Bohart & Tallman, 2010),

and we can most productively direct our efforts toward ways of employing the cli-

ent in the process of change (Duncan et al., 2004). Duncan and colleagues further

state that therapists can translate this research into their clinical work by purpose-

fully working to do the following:

• Enhance the common factors across all theories that account for successful

outcomes

• Focus on the client’s perspective and theory of change as a guide to selecting

techniques and integrating various therapy models

•

Obtain systematic client feedback regarding the client’s experience of the proc-

ess and outcome of therapy

Hubble, Duncan, Miller, and Wampold (2010) note that monitoring outcome

and adjusting accordingly on the basis of feedback from the client must become

routine practice. Duncan and colleagues (2004) claim that the client’s theory of

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497

AN INTEGRATIVE PERSPECTIVE

change can be used as a basis for determining which approach, by whom, can be

most effective for this person, with his or her speciﬁ c problem, under this particu-

lar set of circumstances. This approach to practicing therapy places emphasis on

continuous client input into the therapy process. Doing this increases the chances

of active client participation in therapy, which is the most important determinant

of the outcome of treatment.

summary

Creating an integrative stance is truly a challenge. Therapists cannot simply pick

bits and pieces from theories in a random and fragmented manner. In forming an

integrated perspective, it is important to ask: Which theories provide a basis for

understanding the cognitive dimensions? What about the feeling aspects? And how

about the behavioral dimension? Most of the 11 therapeutic orientations discussed

here focus on one of these dimensions of human experience. Although the other

dimensions are not necessarily ignored, they are often given short shrift.

Developing an integrated theoretical perspective requires an accurate, in-

depth knowledge of the various theories. Without such knowledge, you cannot

formulate a true synthesis. Simply put, you cannot integrate what you do not know

(Norcross & Beutler, 2011). A central message of this book has been to remain

open to each theory, to do further reading, and to reﬂ ect on how the key concepts

of each approach ﬁ t your personality. Building your personalized orientation to

counseling, which is based on what you consider to be the best features of several

theories, is a long-term venture.

Besides considering your own personality, think about what concepts and tech-

niques work best with a range of clients. It requires knowledge, skill, art, and experi-

ence to be able to determine what techniques are suitable for particular problems.

It is also an art to know when and how to use a particular therapeutic intervention.

Although reﬂ ecting on your personal preferences is important, I would hope that

you also balance your preferences with evidence from the research studies. Devel-

oping a personal approach to counseling practice does not imply that anything goes.

Indeed, in this era of managed care and evidence-based practice, your personal pref-

erences will not likely be the sole determinant of your psychotherapy practice. In

counseling clients with certain clinical problems (such as depression and gener-

alized anxiety), speciﬁ c techniques have demonstrated their effectiveness. For in-

stance, behavior therapy, cognitive behavior therapy, mindfulness-based cognitive

therapy, and short-term psychodynamic therapy have repeatedly proved successful

in treating depression. Your use of techniques must be grounded on solid theoreti-

cal constructs. Ethical practice implies that you employ efﬁ cacious procedures in

dealing with clients and their problems, and that you are able to provide a theoreti-

cal rationale for the interventions you make in your clinical work.

This is a good time to review what you have learned about counseling theory

and practice. Identify a particular theory that you might adopt as a foundation

for establishing your counseling perspective. Consider from which therapies you

would be most inclined to draw (1) underlying assumptions, (2) major concepts,

(3) therapeutic goals, (4) therapeutic relationship, and (5) techniques and procedures.

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498

CHAPTER FIFTEEN

Also, consider the major applications of each of the therapies as well as their basic

limitations and major contributions. The tables presented in this chapter are de-

signed to assist you in conceptualizing your view of the counseling process.

where to go from here

In the DVD for Integrative Counseling: The Case of Ruth and Lecturettes (Session 9,

“An Integrative Perspective”) you will view my ways of working with Ruth by draw-

ing on techniques from various theoretical models. I demonstrate how the founda-

tion of my integrative approach rests on existential therapy. In this session I am

drawing heavily from principles of the action-oriented therapies.

Other Resources

DVDs offered by the American Psychological Association that are relevant to this

chapter include the following:

Stricker, G. (2009). Psychotherapy Integration Over Time (Psychotherapy

Video Series)

A private group of clinicians and researchers is dedicated to studying “what

works” in behavioral mental health. Members and associates translate the latest

research into guidelines for clinical practice and publish the information in clini-

cally friendly terms on their website. The Institute for the Study of Therapeutic

Change has also developed an outcome management system that uses ongoing

client feedback to monitor and improve retention in therapy and improve outcome

of treatment services.

Scott D. Miller, PhD, Co-director

Institute for the Study of Therapeutic Change

P. O. Box 180147

Chicago, IL 60618-0573

Telephone: (773) 404-5130

Fax: (847) 841-4874

Mobile: (773) 454-8511

Website: www.talkingcure.com

The International Center for Clinical Excellence (ICCE) is a worldwide commu-

nity of practitioners, health care managers, educators, and researchers dedicated

to promoting excellence in behavioral health care services. This online community

facilitates sharing of best practices and innovative ideas speciﬁ cally designed to

improve behavioral health care practice and enable practitioners and managers to

achieve their personal best as helping professionals.

The International Center for Clinical Excellence

www.centerforclinicalexcellence.com

Scott D. Miller’s website has additional information on workshops on clinical

excellence:

Scott D. Miller

Website: www.scottdmiller.com

28549_ch15_rev01.indd 498 20/09/11 4:00 PM

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Recommended Supplementary Readings

Psychotherapy Integration (Stricker, 2010) is a concise presentation that deals with

the theory, therapeutic process, evaluation, and future developments of integra-

tive approaches.

A Casebook of Psychotherapy Integration (Stricker & Gold, 2006) features master

therapists who demonstrate how they successfully apply their own integrative

approaches.

Handbook of Psychotherapy Integration (Norcross & Goldfried, 2005) is an excel-

lent resource for conceptual and historical perspectives on therapy integration.

This edited volume gives a comprehensive overview of the major current

approaches, such as theoretical integration and technical eclecticism.

The Art of Integrative Counseling (Corey, 2013a) is designed to assist students in devel-

oping their own integrative approach to counseling. This book is complemented by

the DVD for Integrative Counseling: The Case of Ruth and Lecturettes (Corey, 2013c).

Case Approach to Counseling and Psychotherapy (Corey, 2013b) illustrates each of

the 11 contemporary theories by applying them to the single case of Ruth. I also

demonstrate my integrative approach in counseling Ruth in the ﬁ nal chapter.

This book also is designed to ﬁ t well with the DVD for Integrative Counseling: The

Case of Ruth and Lecturettes (Corey, 2013c).

Integrating Spirituality and Religion into Counseling: A Guide to Competent Prac-

tice (Cashwell & Young, 2011)

offers a concrete perspective on how to provide

counseling in an ethical manner, consistent with a client’s spiritual beliefs and

practices. The authors help practitioners develop a respectful stance that honors

the client’s worldview and works within this framework in a collaborative fashion

to achieve the client’s goals.

References and Suggested Readings

499

AN INTEGRATIVE PERSPECTIVE

*Bohart, A. C., & Tallman, K. (2010). Cli-

ents: The neglected common factor in

psychotherapy. In B. L. Duncan, S. D. Miller,

B. E. Wampold, & M. A. Hubble (Eds.), The

heart and soul of change: Delivering what

works in therapy (2nd ed., pp. 83–111).

Washington, DC: American Psychological

Association.

*Cashwell, C. S., & Young, J. S. (2011).

Integrating spirituality and religion into coun-

seling: A guide to competent practice (2nd ed.).

Alexandria, VA: American Counseling

Association.

Comas-Diaz, L. (2011). Multicultural approach-

es to psychotherapy. In J. C. Norcross, G. R.

Vandenbos, & D. K. Freedheim (Eds.), His-

tory of psychotherapy (2nd ed., pp. 243–268).

Washington, DC: American Psychological

Association.

*Corey, G. (2013a). The art of integrative coun-

seling (3rd ed.). Belmont, CA: Brooks/Cole,

Cengage Learning.

*Corey, G. (2013b). Case approach to counseling

and psychotherapy (8th ed). Belmont, CA:

Brooks/Cole, Cengage Learning.

*Books and articles marked with an asterisk are recommended for further study.

28549_ch15_rev01.indd 499 20/09/11 4:00 PM

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

*Corey, G. (with Haynes, R.). (2013c). DVD for

integrative counseling: The case of Ruth and lec-

turettes. Belmont, CA: Brooks/Cole, Cengage

Learning.

Delaney, H. D., Miller, W. R., & Bisono, A. M.

(2007). Religiosity and spirituality among

psychologists: A survey of clinician members

of the American Psychological Association.

Professional Psychology: Research and Practice,

38(5), 538–546.

*Duncan, B. L., Miller, S. D., & Sparks, J. A.

(2004). The heroic client: A revolutionary way

to improve effectiveness through client-directed,

outcome-informed therapy. San Francisco:

Jossey-Bass.

*Duncan, B. L., Miller, S. D., Wampold, B. E., &

Hubble, M. A. (Eds.). (2010). The heart and

soul of change: Delivering what works in therapy

(2nd ed.). Washington DC: American Psycho-

logical Association.

*Frame, M. W. (2003). Integrating religion and

spirituality into counseling: A comprehensive

approach. Belmont, CA: Brooks/Cole, Cengage

Learning.

*Goldfried, M. R., Glass, C. R., & Arnkoff, D. B.

(2011). Integrative approaches to psychother-

apy. In J. C. Norcross, G. R. Vandenbos, & D.

K. Freedheim (Eds.), History of psychotherapy

(2nd ed., pp. 269–296). Washington, DC:

American Psychological Association.

Goldfried, M. R., Pachankis, J. E., & Bell, A. C.

(2005). A history of psychotherapy integra-

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503

counseling stan: integration

of therapies

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concluding comments

chapter 16

Case Illustration: An

Integrative Approach in

Working With Stan

H

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504

CHAPTER SIXTEEN

counseling stan: integration

of therapies

The purpose of this chapter is to bring together in an integrative fashion the 11

approaches you have studied by combining thinking, feeling, and acting models

in counseling Stan. The material in Chapter 15 provides a conceptual framework

for my way of counseling from an integrative perspective. Many of the key points

made in Chapter 15 will become clearer as you read about the interventions I am

making with Stan in this chapter. At this point it would be helpful for you to review

the background material and themes in Stan’s life presented in Chapter 1. In addi-

tion, I suggest you consult the Student Manual for Theory and Practice of Counseling

and Psychotherapy (Chapter 16) for an overview and review of the major areas I

focus on for each of the theoretical approaches in my work with Stan.

In this section, I describe how I would integrate concepts and techniques from

the 11 theoretical perspectives in counseling Stan on the levels of thinking, feeling,

and doing. I use information presented in Stan’s autobiography, and I indicate

what aspects from the various theories I would draw on in working with Stan at

the various stages of his therapy. As you read, think about the interventions you

would make with Stan that would be either similar to or different from mine.

Questions in the “Follow-Up” section near the end of the chapter will guide you

as you reﬂ ect on being Stan’s counselor and working with him from your own

integrative perspective.

See the video program for Chapter 16, DVD for Theory and Practice of Counseling

and Psychotherapy: The Case of Stan and Lecturettes. I suggest that you view the

brief lecture for each chapter prior to reading the chapter.

A Place to Begin

I start by giving Stan a chance to say how he feels about coming to the initial ses-

sion. To begin to understand why Stan has sought therapy, I might explore his

thoughts regarding any of the following questions:

• What brings you here? What has been going on in your life recently that made

you want to seek professional help?

• What expectations do you have of therapy? Of me? What are your hopes, fears,

and any reservations? What goals do you have for yourself through therapy?

• Give me a picture of some signiﬁ

cant turning points in your life? Who have

been the important people in your life? What signiﬁ cant decisions have you

made? What are some of the struggles you’ve dealt with, and what are some of

these issues that are current for you?

• How would you describe your life in your family? How did you view your par-

ents? How did they react to you? What do you remember about your early

years? (It would be useful to administer the Adlerian lifestyle questionnaire.)

Clarifying the Therapeutic Relationship

I will work with Stan to develop a contract, which involves a discussion of our mu-

tual responsibilities and a clear statement of what he wants from these sessions

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505

CASE ILLUSTRATION: AN INTEGRATIVE

APPROACH IN WORKING WITH STAN

and what he is willing to do to obtain his goals. I believe it is important to discuss

any factors that might perpetuate a client’s dependency on the therapist, so I invite

Stan’s questions about this therapeutic relationship. One goal is to demystify the

therapy process; another is to get some focus for the direction of our sessions by

developing clear goals for the therapy.

In establishing the therapeutic relationship, I am inﬂ uenced by the person-

centered, existential, Gestalt, feminist, postmodern, and Adlerian approaches.

They do not view therapy as something that the therapist does to a passive client.

I will apply my knowledge of these therapies to establish a working relationship

with Stan that is characterized by mutual trust and respect. I will ask myself these

questions: “To what degree am I able to listen to and hear Stan in a nonjudgmen-

tal way? Am I able to respect and care for him? Do I have the capacity to enter his

subjective world without losing my own identity? Am I able to share with him my

own thoughts and reactions as they pertain to our relationship?” I begin by being

as honest as I can be with Stan as the basis for creating this relationship. This rela-

tionship is critical at the initial stages of therapy, but it must be maintained during

all stages if therapy is to be effective. I operate on the assumption that the quality

of our relationship will be critical to the therapeutic outcome.

Clarifying the Goals of Therapy

It is not enough to simply ask Stan what he hopes to gain by the conclusion of thera-

py. Clients are oftentimes vague, global, and unfocused about what they want. With

respect to goals, precision and clarity are essential. There is no progress when you

have directionless sessions. Thus, speciﬁ city is a must. Once we have identiﬁ ed some

goals, Stan can begin to observe and measure his own behavior, both in the sessions

and in his daily life. This self-monitoring is a vital step in any effort to bring about

change. I will be asking for Stan’s feedback throughout the therapeutic process and

will use his feedback as a basis for making modiﬁ cations in our therapeutic alliance.

Here are a few interchanges that focus on the process of deﬁ ning goals that will

give direction to Stan’s therapy:

JERRY: What would you most hope for, through our work together?

STAN: Well, I know I put myself down a lot. I’d like to feel better about myself.

JERRY: If you had what you want in your life today, what would that be like? What

would it take for you to feel good about yourself?

STAN: For one thing, I’d have people in my life, and I would be closer to people.

JERRY: Is this an area you’d be willing to explore in our sessions?

STAN: Yes.

JERRY: I’ll be glad to provide suggestions of ways to begin, if I know what you want.

STAN: For sure I’d like to get over my dumb fears of being with people.

JERRY: I like it that you’re willing to challenge your fears. Are you aware that you just

put yourself down by labeling your fears as dumb?

STAN: It’s almost a reﬂ ex response for me. But I would like to feel more comfortable

when I’m with others.

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506

CHAPTER SIXTEEN

JERRY: How is it for you to be here with me now?

STAN: It’s not like me to do something like this, but I feel good. I’m talking, and I’m

saying what’s on my mind.

JERRY: I hope you will continue to give yourself credit for being different in our con-

versation right now.

Goal setting is not accomplished in a single session. Throughout our time to-

gether, I ask Stan to decide time and again what he wants from his therapy and to

assess the degree to which our work together is resulting in his meeting his goals.

As his therapist, I expect to be active, yet it is important that Stan provide the direc-

tion in which he wants to travel on his journey. Once I have a clear sense of the

speciﬁ c ways Stan wants to change how he is thinking, feeling, and acting, I am

likely to take an active role in co-creating experiments with Stan that he can do both

in the therapy sessions and on his own away from our sessions.

Working With Stan’s Past, Present, and Future

dealing with the past Reality therapy, solution-focused brief therapy,

behavior therapy, and rational emotive behavior therapy place very little emphasis

on the client’s history. The rationale for this lack of attention to the past is that

early childhood experiences do not necessarily have much to do with the mainte-

nance of present ineffective behavior. My inclination, in contrast, is to give weight

to understanding, exploring, and working with Stan’s early history and to connect

his past with what he is doing today. My view is that themes running through our

life can become evident if we come to terms with signiﬁ cant experiences in our

childhood. The use of an Adlerian lifestyle questionnaire would indicate some of

these themes that originate from Stan’s childhood. The psychoanalytic approach,

of course, emphasizes uncovering and reexperiencing traumas in early childhood,

working through the places where we have become “stuck,” and resolving conﬂ icts

that are often out of our awareness.

Although I agree that Stan’s childhood experiences were inﬂ uential in contrib-

uting to his present personality (including his ways of thinking, feeling, and behav-

ing), it does not make sense to me to assume that these factors have determined him.

I favor the Gestalt approach of asking Stan to bring into the here and now those peo-

ple in his life with whom he feels unﬁ nished. A variety of role-playing techniques in

which Stan addresses signiﬁ cant others through symbolic work in our sessions will

bring Stan’s past intensely to life in the present moment of our sessions.

dealing with the present Being interested in Stan’s past does not

mean that we get lost in history or that we dwell on reliving traumatic situations.

By paying attention to what is going on in the here and now during the counseling

session, I get excellent clues about what is unﬁ nished from Stan’s past. He and

I can direct attention to his immediate feelings as well as to his thoughts and

actions. It seems essential to me that we work with all three dimensions—what

he is thinking, what he is actually doing, and how his thoughts and behaviors

affect his feeling states. Again, by directing Stan’s attention to what is going on

with him during our sessions, I can show him how he interacts in his world apart

from therapy.

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507

CASE ILLUSTRATION: AN INTEGRATIVE

APPROACH IN WORKING WITH STAN

dealing with the future Adlerians are especially interested in where

the client is heading. Humans are pulled by goals, strivings, and aspirations. It

would help to know what Stan’s goals in life are. What does he want for himself?

If he decides that his present behavior is not getting him what he wants, he is in

a good position to think ahead about the changes he would like to make and what

he can do now to actualize his aspirations. The present-oriented behavioral focus

of reality therapy is a good reference point for getting Stan to dream about what

he would like to say about his life 5 years hence. Connecting present behavior with

future plans is an excellent way to help Stan formulate a concrete plan of action.

He will actually create his future.

Identifying Feelings

The person-centered approach stresses the ﬁ rst stage in the therapy process, which

involves identifying, clarifying, and learning how to express feelings. Because of

the therapeutic relationship I have built with Stan, I expect him to feel increasingly

free to talk about feelings that he has kept to himself. In some cases these feelings

are out of his awareness, and I encourage Stan to talk about any feelings that are a

source of difﬁ culty.

During the early stages of our sessions, I rely on empathic listening. I need

to do more than merely reﬂ ect what I hear Stan saying; I need to share with him

my reactions as I listen to him because doing so helps to build a good therapeutic

alliance. When Stan senses that he is being understood and accepted for the feel-

ings he has, he has less need to deny or distort his feelings. His capacity for clearly

identifying what he is feeling at any moment will gradually increase.

There is a great deal of value in letting Stan tell his story in a way he chooses.

The way he walks into the ofﬁ ce, his gestures, his style of speech, the details he

chooses to go into, and what he decides to relate and not to relate—to mention just

a few elements—provide me with clues to his world. If I do too much structuring

too soon, I will interfere with his typical style of presenting himself.

Expressing and Exploring Feelings

The authenticity of my relationship with Stan encourages him to begin to identify

and share with me a range of feelings. But I do not believe an open and trusting

relationship between us is sufﬁ cient to change Stan’s personality and behavior. I

must also use my knowledge, skills, and experiences although my clinical expertise

is not the sole determinant of therapeutic change. Stan is the best expert on his

own life, and I will assist him in coming to value the ways in which he is the expert

in the therapeutic endeavor.

As a way of helping Stan express and explore his feelings, I draw heavily on

Gestalt experiments. Eventually, I ask him to avoid merely talking about situations

and about feelings. Rather, I encourage him to bring whatever reactions he is hav-

ing into the present. For instance, if Stan reports feeling tense, I ask him how he

experiences this tension right now and where it is located in his body. I encourage

him to “be that feeling.” Thus, if he has a knot in his stomach, he can intensify

his feeling of tension by “becoming the knot, giving it voice and personality.” If I

notice tears in his eyes, I may direct him to “be his tears now.” By putting words

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508

CHAPTER SIXTEEN

to his tears, he avoids abstract intellectualization about all the reasons he is sad or

tense. Before he can change his feelings, Stan must allow himself to fully experi-

ence them. The experiential therapies provide valuable tools for guiding him to the

expression of his feelings.

Here are some segments of our dialogue in a session where Stan becomes

quite aware of what he is feeling as he talks about his relationship with his

father:

JERRY: You mentioned that your father often compared you with your brother Frank

and your sister Judy. What was that like for you?

STAN: I hated it! He told me that I’d never amount to anything.

JERRY: And when he said that, how did that affect you?

STAN: It made me feel that I could never measure up to all the great things that Judy

and Frank were accomplishing. I felt like a failure. [As he says this, he begins to tear up,

and his voice changes.]

JERRY: Stan, what is going on right now?

STAN: All of a sudden a wave of sadness is coming over me. I’m getting all choked

up. This is hard!

JERRY: Stay with your feeling. What’s going on?

STAN: My chest is tight, like something wants to come out.

JERRY: Say more.

STAN: I’m feeling very sad and hurt.

JERRY: Would you be willing to try something? I’d like you to talk to me as though I

were your father. Are you willing to do that?

STAN: Well, you’re not mean the way he was, but I can try.

JERRY: How old are you feeling now?

STAN: Oh, maybe 12 years old—just like when I had to be around my father and

listen to all the stuff he told me about how useless I was.

JERRY: Let yourself be 12 again, and tell me what it’s like for you to be you—speaking

to me as your father.

STAN: There was nothing that I could ever do that was good enough for you. No mat-

ter how hard I tried, I couldn’t get you to notice me. [Crying] Why didn’t I count, and

why did you ignore me?

JERRY: Stan, I’ll just let you talk for a while, and I’ll listen. So keep on telling me all

the things you may be feeling as that 12-year-old now.

STAN: All I ever wanted was to know that I mattered to you. But no matter how

hard I tried, all you’d do was put me down. Nothing I did was worth anything. I just

wanted you to love me. Why didn’t you ever do anything with me? [Stan stops talking

and just cries for a while.]

JERRY: What’s happening with you now?

STAN: I’m feeling so sad. As if it’s hopeless. Nothing I can do will ever get his approval.

JERRY: At 12 it was important for you to get his acceptance and his love. There is still

that part in you that wants his love.

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509

CASE ILLUSTRATION: AN INTEGRATIVE

APPROACH IN WORKING WITH STAN

STAN: Yes, and I don’t think I’ll ever get it.

JERRY: Tell him more of what that’s like.

Stan continues talking to his “father” and recounts some of the ways in which

he tried to live up to his expectations. No matter what he did, there was no way to

get the acceptance that Frank and Judy got from him.

JERRY: Having said all that, what are you aware of now?

STAN: I’m feeling embarrassed.

JERRY: You say you’re embarrassed. Whom are you aware of now?

STAN: Well, right now of you. I feel like a wimp. You’re probably thinking that I’m

weak and dumb for letting this get to me.

JERRY: Tell me more about feeling weak and dumb.

Stan expresses that he should be stronger and that he is afraid I’ll think he is

hopeless. He goes into some detail in belittling himself for what he has just expe-

rienced and expressed. I avoid quickly reassuring him that he “shouldn’t feel that

way.” Instead, I let him express whatever he is feeling. After telling me many of

the ways in which he is feeling embarrassed, he wonders if I still want to work with

him. At this point I let him know that I respect his struggle and encourage him to

continue revealing aspects that he typically keeps hidden. Because this session is

coming to an end, I talk with Stan about the value of releasing feelings that he has

been carrying around for a long time, suggesting that this is a good beginning. I

am also interested in getting him to do some homework before the next session.

By focusing on his feelings both in the therapy ofﬁ ce and in daily life, I hope Stan

can eventually learn to avoid judging himself so harshly.

JERRY: Stan, I’d like to suggest that you write a letter to your father . . .

STAN: [Interrupting] Oh no! I’m not going to give that guy the satisfaction of knowing

that I need anything from him!

JERRY: Wait. I was about to say that I hope you’ll write him a letter that you don’t mail.

STAN: What’s the point of a letter that won’t be sent?

JERRY: Writing him a letter is an opportunity for further release and to gain some

new insights. I hope you’ll let yourself write about all the ways you tried to live up

to his expectations. Let him know what it felt like to be around him. Tell him more

about you, especially how it felt in not getting those things that you so much wanted.

STAN: OK, I’ll do that.

In this session I might have made many different interventions. For the mo-

ment, I chose to let him “borrow my eyes” and talk to me as his father while he was

12 years old. I asked him to stay with whatever he was experiencing, paying par-

ticular attention to his body and to the emotions that were welling up within him.

It would be premature to suggest problem-solving strategies or to attempt to ﬁ gure

everything out. My intent in offering him the homework assignment of writing a

letter is to provide an avenue for Stan to continue thinking about the impact his

father has had on him and to further promote his work during the week. Writing

the letter may trigger memories, and he may experience further emotional release.

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510

CHAPTER SIXTEEN

At our next session I will ask Stan about the letter and what it was like for him

to write it. What did he say to his father? How was it to read the letter later? Is

there anything that he wants to share with me? The direction of our next session

will depend on his response. Again, Stan will provide clues to where he needs to

go next.

The Thinking Dimension in Therapy

Once Stan has experienced some intense feelings and perhaps released pent-up

feelings, some cognitive work is essential. To bring in this cognitive dimension,

I focus Stan’s attention on messages he incorporated as a child and on the deci-

sions he made. I get him to think about the reason he made certain early decisions.

Finally, I challenge Stan to look at these decisions about life, about himself, and

about others and to make necessary revisions that can lead him to creating a life of

his own choosing.

After getting basic information about Stan’s life history (by means of the Adle-

rian lifestyle assessment form), I summarize and interpret it with Stan in a ses-

sion. For example, I ﬁ nd some connections between his present fears of developing

intimate relationships and his history of rejection by his siblings and his parents.

I am interested in his family constellation and his early recollections. Rather than

working exclusively with his feelings, I want Stan to begin to understand (cog-

nitively) how these early experiences affected him then and how they still inﬂ u-

ence him today. My emphasis is on having Stan begin to question the conclusions

he came to about himself, others, and life. What is his private logic? What are some

of his mistaken, self-defeating perceptions that grew out of his family experiences?

An Adlerian perspective provides tools for doing some productive cognitive work

both in and out of the therapy sessions.

From rational emotive behavior therapy I especially value the emphasis on

learning to think rationally and am interested in having Stan assess whether or

not his thoughts are rational. I am not imposing my views of rational thinking;

rather, I hope to help Stan examine his behavior and his beliefs about his behavior.

I look for the ways in which Stan contributes to his painful feelings by the process

of self-indoctrination with faulty beliefs that no longer serve him well. I ask him to

test the validity of the dire consequences he predicts. I value the stress put on do-

ing hard work in demolishing beliefs that have no validity and replacing them with

sound and rational beliefs. I do not think Stan can merely think his way through

life or that examining his faulty logic is enough by itself for personality change. But

I do see this process as an essential component of therapy.

The cognitive behavioral therapies have a range of cognitive techniques that

can help Stan recognize connections between his cognitions and his behaviors.

He should also learn about his inner dialogue and the impact it has on his day-to-

day behavior. Eventually, our goal is some cognitive restructuring work by which

Stan can learn new ways to think, new things to tell himself, and new assumptions

about life. This provides a basis for change in his behavior.

I have given Stan a number of homework assignments aimed at helping him

identify a range of feelings and thoughts that may be problematic for him. Follow-

ing are sample pieces of a session in which we focus on his cognitions.

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511

CASE ILLUSTRATION: AN INTEGRATIVE

APPROACH IN WORKING WITH STAN

JERRY: Several times now you’ve brought up how you’re sure you’d be judged

critically if you allowed yourself to get close to a woman. Is this a topic you want to

explore in more depth?

STAN: Yes. I’m tired of avoiding women, but I’m still scared of approaching a woman.

I’m convinced that if any woman gets to know me, she’ll eventually reject me.

JERRY: Have you checked out this assumption? How many women have you

approached, and how many of them have actually rejected you?

STAN: They never tell me these things. But in my head I keep telling myself that

if they get to know the real me they’ll be turned off by my weakness, and then they

wouldn’t want anything to do with me.

JERRY: How about telling me some of the things you tell yourself when you think of

meeting a woman? Just let yourself free associate, listing out loud some of the state-

ments you make to yourself internally. Ready?

STAN: So often I say to myself that I’m not worth knowing. [Pause]

JERRY: Just rattle off as many of these self-statements as you can. Don’t worry about

how it sounds.

STAN: What a nerd! Every time you open your mouth, you put your foot in it. Why

don’t you just shut up and hide? When you do talk to people, you freeze up. They’re

judging you, and if you say much of anything, they’ll ﬁ nd out what a complete and

utter failure you are. Anything you try, you fail in. You are not very interesting. You’re a

weak and a scared kid. Why don’t you keep to yourself so that others won’t reject you?

Stan continues with this list, and I listen. After he seems ﬁ nished, I tell him

how I’m affected by hearing his typical self-talk. I let him know that it saddens me.

Although I like Stan, I don’t have the sense that he will emotionally believe that I

care about him. I let him know that I respect the way he doesn’t run from his fears

and that I admire his willingness to talk openly about his troubles.

Stan has acquired a wide range of critical internal dialogues that he has practiced

for many years. As he begins to challenge those thoughts, he will discover that his

thinking is grossly inaccurate. Eventually I hope he will change many of the beliefs

that are resulting in problems for him. Along this line, I work with him to pinpoint

speciﬁ c beliefs and then do my best to get him to examine them. I am inﬂ uenced by

the constructivist trend in cognitive behavior therapy. Applied to Stan, constructiv-

ism holds that his subjective framework and interpretations are far more important

than the objective bases that may be at the origin of his faulty beliefs. Thus, rather

than imposing my version of what may constitute faulty, irrational, and dysfunc-

tional beliefs on his part, I pursue a line of Socratic questioning whereby I get Stan

to evaluate his own thinking processes and his conclusions.

JERRY: Let’s take one statement that you’ve made a number of times: “When I’m

with other people, I feel stupid.” What goes on within you when you say this?

STAN: I hear critical voices, like people are in my head or are sitting on my shoulder.

JERRY: Name one person who often sits on your shoulder and tells you you’re stupid.

STAN: My dad, for one. I hear his voice in my head a lot.

JERRY: Let me be Stan for a moment, and you be your dad, saying to me some of

those critical things that you hear him saying inside your head.

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512

CHAPTER SIXTEEN

STAN: Why are you going to college? Why don’t you quit and give your seat to some-

one who deserves it? You’re not a good student. You’re wasting your time and the

taxpayers’ money by pretending to be a college student. Do yourself a favor and wake

up to the fact that you are just a dumb kid.

JERRY: How much truth is there in what you just said as your dad?

STAN: You know, it sounds stupid that I let him convince me that I’m totally stupid.

JERRY: Instead of saying that you’re stupid for letting him tell you that you’re stupid,

can you give yourself credit for being smart enough to come to this realization?

STAN: OK, but he’s right that I’ve failed at most of the things I’ve tried.

JERRY: Does failing at a task mean that you’re right holding to the label of being a

failure in life? I’d like to hear you produce the evidence that supports your interpreta-

tion of being stupid and of being a failure.

STAN: How about the failure in my marriage? I couldn’t make it work, and I was

responsible for the divorce. That’s a pretty big failure.

JERRY: And were you totally responsible for the divorce? Did your wife have any part in it?

STAN: She always told me that no woman could ever live with me. She convinced me

that I couldn’t have a satisfying relationship with her or any other woman.

JERRY: Although she could speak for herself, I’m wondering what qualiﬁ es her to

determine your future with all women. What study did she conduct that proves that

Stan is utterly destined to be allergic to all women forever?

STAN: I suppose I just bought into what she told me. After all, if I couldn’t live with

her, what makes me think I could have a satisfying life with any woman?

At this point, there are many directions to go with Stan to explore the origin of his

beliefs and to assess the validity of his interpretations about life situations and his con-

clusions about his basic worth. In this and other sessions, we explore what cognitive

therapists call “cognitive distortions.” Here are some of Stan’s cognitive distortions:

• Arbitrary inferences. Stan makes conclusions without supporting and relevant evi-

dence. He often engages in “catastrophizing,” or thinking about the worst pos-

sible scenario for a given situation.

• Overgeneralization. Stan holds extreme beliefs based on a single incident and

applies them inappropriately to other dissimilar events or settings. For in-

stance, because he and his wife divorced, he is convinced he is destined to be a

failure with any woman.

• Personalization. Stan has a tendency to relate external events to himself, even

when there is no basis for making the connection. He relates an incident in

which a female classmate did not show up for a lunch date. He agonized over

this event and convinced himself that she would have been humiliated to be

seen in his presence. He did not consider any other possible explanations for

her absence.

• Labeling and mislabeling. Stan presents himself in light of his imperfections

and mistakes. He allows his past failures to deﬁ

ne his total being.

• Polarized thinking. Stan frequently engages in thinking and interpreting in all-

or-nothing terms. Through this process of dichotomous thinking, he has cre-

ated self-defeating labels that keep him restricted.

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513

CASE ILLUSTRATION: AN INTEGRATIVE

APPROACH IN WORKING WITH STAN

Over a number of sessions we work on speciﬁ c beliefs. The aim is for Stan to criti-

cally evaluate the evidence for many of his conclusions. My role is to promote cor-

rective experiences that will lead to changes in his thinking. I am striving to create

a collaborative relationship, one in which he will discover for himself how to dis-

tinguish between functional and dysfunctional beliefs. He can learn this by testing

his conclusions.

Doing: Another Essential Component of Therapy

Stan can spend countless hours gathering interesting insights about why he is the

way he is. He can learn to express feelings that he kept hidden for many years. He

can think about the things he tells himself that lead to defeat. Yet in my view feel-

ing and thinking are not a complete therapy process. Doing is a way of bringing

these feelings and thoughts together by applying them to real-life situations in vari-

ous action programs. I am indebted to Adlerian therapy, behavior therapy, reality

therapy, rational emotive behavior therapy, cognitive therapy, narrative therapy,

and solution-focused brief therapy, all of which give central emphasis to the role of

action as a prerequisite for change.

Behavior therapy offers a multitude of techniques for behavioral change. In

Stan’s case I am especially inclined to work with him in developing self-management

programs. For example, he complains of often feeling tense and anxious. Daily

relaxation procedures are one way Stan can gain more control of his physical and

psychological tension. I have been teaching him a variety of mindfulness tech-

niques, including a combination of meditation and relaxation procedures. Through

mindfulness practice, Stan can get himself centered before he goes to his classes,

meets women, or talks to friends. He can also begin to monitor his behavior in

everyday situations to gain increased awareness of what he tells himself, what he

does, and then how he feels. When he gets depressed, he tends to drink to alleviate

his symptoms. He can carry a small notebook with him and actually record events

that lead up to his feeling depressed (or anxious or hurt). He might also record

what he actually did in these situations and what he might have done differently.

By paying attention to what he is doing in daily life, he is already beginning to gain

more control of his behavior.

This behavioral monitoring can be coupled with both Adlerian and cognitive

approaches. My guess is that Stan gets depressed, engages in self-destructive be-

havior (drinking, for one), and then feels even worse. I work very much on both his

behaviors and cognitions and show him how many of his actions are inﬂ uenced

by what he is telling himself. Together we work on how he is setting himself up

for failure by his self-defeating expectations. True to the spirit of rational emotive

behavior therapy, we explore his faulty assumptions that he must be perfect and

that if he does not get the job, life will be unbearable. There are many opportunities

for Stan to see connections between his cognitive processes and his daily behavior.

I encourage him to begin to behave differently and then look for changes in his

feeling states and his thinking.

With this in mind, I ask Stan to think of as many ways as possible of actually

bringing into his daily living the new learning he is acquiring in our sessions. Prac-

tice is essential. Homework assignments (preferably ones that Stan gives himself)

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514

CHAPTER SIXTEEN

are an excellent way for Stan to become an active agent in his therapy. He must

do something himself for change to occur. The degree to which he will change is

directly proportional to his willingness to experiment. I want Stan to learn from

his new behavior in life. Thus, each week we discuss his progress toward meeting

his goals, and we review how well he is completing his assignments. If he does not

like the way he carried out an assignment, we can use this as an opportunity to talk

about how he can adjust his behavior. I hold ﬁ rm about expecting a commitment

from him to have an action plan for change and to continually look at how well his

plan is working.

In the following dialogue, our interchanges deal primarily with Stan learning a

more assertive style of behavior with one of his professors. Although this session

focuses on Stan’s behavior, we are also dealing with what he is thinking and feel-

ing. These three dimensions are interactive.

JERRY: Last week we role-played different ways you could approach a professor with

whom you were having a difﬁ culty. You learned several assertive skills that you used

quite effectively when I assumed the role of the critical professor. Before you left last

week, you agreed to set up a time to meet with your professor and let her know about

your difﬁ culty. When we did the role playing, you were very clear about what you

wanted to say and strong in staying with your feelings. Did you carry out your plan?

STAN: The next day I tried to talk to her before class. She said she didn’t have time to

talk but that we could talk after class.

JERRY: And how did that go?

STAN: After class all I wanted to do was make an appointment with her so that I

could talk in private and without feeling hurried. When I tried to make the appoint-

ment, she very brusquely said that she had to go to a meeting and that I should see

her during her ofﬁ ce hours.

JERRY: How did that affect you?

STAN: I was mad. All I wanted to do was make an appointment.

JERRY: Did you go to her ofﬁ ce hours?

STAN: I did, that very afternoon. She was 20 minutes late for her ofﬁ ce hours, and

then some students were waiting to ask her questions. All I got to do was make an

appointment with her in a couple of days.

JERRY: Did that appointment actually take place?

STAN: Yes, but she was 10 minutes late and seemed preoccupied. I had a hard time

at the beginning.

JERRY: How so? Tell me more.

STAN: I feel stupid in her class, and I wanted to talk to her about it. When I ask ques-

tions, she gets a funny look on her face—as if she’s impatient.

JERRY: Did you check out these assumptions with her?

STAN: Yes I did, and I feel proud of myself. She told me that at times she does get

a bit impatient because I seem to need a lot of her time and reassurance. Then I let

her know how much I was studying for her class and how serious I was about doing

well in my major. It was good for me to challenge my fears, instead of avoiding her

because I felt she was judgmental.

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515

CASE ILLUSTRATION: AN INTEGRATIVE

APPROACH IN WORKING WITH STAN

JERRY: It’s good to hear you give yourself credit for the steps you took. Even though

it was tough, you hung in there and said what you wanted to say. Is there anything

about this exchange with her that you wish you could have changed?

STAN: For the most part, I was pretty assertive. Generally, I blame people in author-

ity like her for making me feel stupid. I give them a lot of power in judging me. But

this time I remembered what we worked on in our session, and I stayed focused on

myself rather than telling her what she was doing or not doing.

JERRY: How did that go?

STAN: The more I talked about myself, the less defensive she became. I learned

that part of how she reacts to me is inﬂ uenced by my behavior and when I changed

she also changed. I can still feel good about myself, even if the other person doesn’t

change. That was powerful.

JERRY: Great! Did you notice any difference in how you felt in her class after you had

this talk?

STAN: For a change, I didn’t feel so self-conscious, especially when I asked questions

or took part in class discussions. I was not so concerned about what she might think

about me, and she seemed more at ease with me.

JERRY: What did your meeting with her teach you about yourself?

STAN: For one thing, I’m learning to check out my assumptions. That freed me up to

act much more spontaneously. Also, I learned that I could be clear, direct, and asser-

tive without getting nasty. It was possible for me to take care of myself without being

critical of her. Normally, I’d just swallow all my feelings and walk away feeling dumb.

This time I was assertive and was able to let her know that I needed some unhurried

time from her.

Practicing assertive behavior is associated with working with the feeling and

thinking domains. Had Stan not done as well as he did in engaging his professor,

we could have examined what had gone wrong from his vantage point. We could

have continued role-playing various approaches in our sessions, and then with

new knowledge and skills and more practice, he could have tried again. It is essen-

tial that Stan be willing to experiment with new ways of acting, especially outside of

the therapy sessions. In a sense, counseling can be like a dress rehearsal for living.

He exhibited courage and determination in carrying out a speciﬁ c action plan, and

change did take place.

Working Toward Revised Decisions

When Stan has identiﬁ ed and explored both his feelings and his faulty beliefs

and thinking processes, it does not mean that therapy is over. Becoming aware of

early decisions, including some of his basic mistakes and his self-defeating ideas,

is the starting point for change. It is essential that Stan ﬁ nd ways to translate his

emotional and cognitive insights into new ways of thinking, feeling, and behaving.

Therefore, as much as possible I structure situations in the therapy sessions that

will facilitate new decisions on his part on both the emotional and cognitive levels.

In encouraging Stan to make these new decisions, I draw on cognitive, emotive, and

behavioral techniques. A few techniques I employ are role playing, imagery work,

assertion training procedures, and behavioral rehearsals. Both reality therapy and

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516

CHAPTER SIXTEEN

Adlerian therapy have a lot to offer on getting clients to decide on a plan of action

and then make a commitment to carry out their program for change.

Here are some examples of experiments I suggest for Stan during the therapy

sessions and homework assignments.

• I engage in reverse role-playing situations in which I “become” Stan and have

Stan assume the role of his mother, father, former wife, sister, older brother, and

a professor. Through this process Stan gets a clearer picture of ways in which he

allowed others to deﬁ

ne him, and he acquires some skills in arguing back to self-

defeating voices.

• To help Stan deal with his anxiety, I teach him meditation and other mindful-

ness techniques and encourage him to practice them daily. Stan learns to employ

these relaxation strategies in anxiety-arousing situations. I also teach him a range

of coping skills, such as assertiveness and disputing faulty beliefs. Stan is able to

apply these skills in several life situations.

• Stan agrees to keep a journal in which he records impressions and experi-

ences. After encountering difﬁ

cult situations, he writes about his reactions, both

on a thinking and a feeling level. He also records how he behaved in these situa-

tions, how he felt about his actions, and how he might have behaved differently. He

also agrees to read a few self-help books in areas that are particularly problematic

for him.

• As a homework assignment that we collaboratively design, Stan agrees to

meet with people whom he would typically avoid. For instance, he is highly anxious

over his performance in a couple of his classes. He decides to make an appoint-

ment with each professor to discuss his progress. In one case, a professor took an

increased interest in him, and now he does very well in her class. In the other case,

the professor is rather abrupt and not too helpful. He is able to recognize that this

is more the professor’s problem than anything he is doing.

• Stan wants to put himself in situations where he can make new friends. To-

gether we work on a clear plan of action that involves joining a club, going to social

events, and asking a woman in his class for a date. Although he is anxious in each

of these situations, he follows through with his plans. In our sessions we explore

some of his self-talk and actions at these events.

Encouraging Stan to Work With His Family of Origin

After working with Stan for a time, I suggest that he take the initiative to invite his

entire family for a session. My assumption is that many of his problems stem from

his family-of-origin experiences and that he is still being affected by these experi-

ences. I think it will be useful to have at least one session with the family so that I

can get a better idea of the broader context. The following dialogue illustrates my

attempt to introduce this idea to Stan.

JERRY: Our sessions are certainly revealing a good deal of difﬁ culties with several

members of your family. I think it would be useful to bring in as many of them as

you can for a session.

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517

CASE ILLUSTRATION: AN INTEGRATIVE

APPROACH IN WORKING WITH STAN

STAN: No way! That’s way too much.

JERRY: Are you willing to talk with me more about this idea?

STAN: I’ll talk, but I don’t think it will change my mind.

JERRY: Why is that?

STAN: They already think I’m nutty, and if they ﬁ nd out I’m seeing a psychologist,

that will be one more thing they can throw in my face.

JERRY: Would they use this against you?

STAN: Yes. Besides, I can’t see how it would help much. My mother and father don’t

think they have any problems. I don’t see them wanting to change much.

JERRY: Changing them is not my goal. It is more to give you a chance to express

yourself respectfully to people who are still an important part of your life.

STAN: Maybe, but I’m not ready for that one yet!

JERRY: I can respect that you don’t feel ready yet. I hope you’ll remain open to the

idea, and if you change your mind, let me know.

My rationale for including at least some of Stan’s family members is to pro-

vide him with a context for understanding how his behavior is being inﬂ uenced

by what he learned as a child. He is a part of this system, and as he changes, it

is bound to inﬂ uence others in his family with whom he has contact. From what

he has told me, I am assuming that his unclear boundaries with his mother have

had an impact on his relationships with other women. If he can gain a clearer

understanding of his relationship with his mother, he may be able to apply some

of these insights with other women. In many ways Stan has allowed himself to

be intimidated by his father, and he still hears Dad’s voice in his head a lot. In

much of his present behavior, Stan compares himself unfavorably with others,

which is a pattern that was established in early childhood with his siblings. If he is

able to deal with the members of his family about some of their past and present

struggles, there is a good chance that he will be able to form the kind of intimate

relationships that he says he would like to have in his life. (For a more complete

description of working with Stan from a family systems perspective, see Stan’s

case in Chapter 14.)

The Spiritual Dimension

Although I do not have an agenda to impose religious or spiritual values on Stan, I

want to assess the role spirituality plays, if any, in his life currently—and to assess

beliefs, attitudes, and practices from his earlier years. When I ask Stan if religion

was a factor in his childhood or adolescence, he informs me that his mother was

a practicing Lutheran and his father was rather indifferent to religion. His mother

made sure that he went to church each week. He tells me what he mainly remem-

bers from his church experiences is feeling a sense of guilt. Stan recalls that his

attitudes about religion ﬁ t in with his low self-esteem. Not only was he not good

enough in the eyes of his parents, but he was also not good enough in the eyes of

God. He also adds that when he went to college he developed a new interest in

spirituality.

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518

CHAPTER SIXTEEN

Although formal religion does not seem to play a key role for Stan now, he is

struggling to ﬁ nd a spiritual core as this is missing in his life. He also lets me know

that he is pleasantly surprised that I am even mentioning religion and spirituality.

He was under the impression that counselors would not be too interested in these

areas. Upon further discussion of this area, he informs me of his intention to bring

up his concerns about his spirituality at a future session.

Working With Stan’s Drinking Problem

Although each of the 11 therapeutic approaches address drug and alcohol abuse

in different ways, all probably agree that it is imperative at some point in Stan’s

therapy to confront him on the probability that he is a chemically dependent per-

son. In this section, I describe my approach to working with his dependence as

well as giving some brief background information on the alcoholic personality and

on treatment approaches.

some basic assumptions Stan has given me a number of signiﬁ cant

clues suggesting that he is a chemically dependent person. From the information

he has provided, it is clear that Stan has many of the personality traits typically as-

sociated with addictions, including low self-concept, anxiety, underachievement,

feelings of social isolation, inability to receive love from others, hypersensitivity,

impulsivity, dependence, fear of failure, feelings of guilt, and suicidal ideation. He

has used drugs and alcohol as a way of blunting anxiety and attempting to control

what he perceives as a painful reality.

Once our therapeutic relationship is ﬁ rmly established, I confront Stan (in a

caring and concerned manner) on the self-deception that drinking is less problem-

atic than taking drugs. He needs to see that alcohol is a drug. I think it is important

that he make an honest evaluation of his behavior so that he can recognize the

degree to which his drinking is interfering in his living.

a supplementary treatment program Stan eventually recognizes

and acknowledges that he does indeed have a problem with alcoholism, and he

says he is willing to do something about this problem. Stan needs to know that

long-term recovery is based on the principle of total abstinence from all drugs

and alcohol and that such abstinence is a prerequisite to effective counseling. In

addition to his weekly individual therapy sessions with me, I provide Stan with a

referral to deal with his chemical dependence.

I encourage Stan to join Alcoholics Anonymous and attend their meetings.

The 12-step program of AA has worked very well for many alcoholics. Once Stan

understands the nature of his chemical dependence and no longer uses drugs, the

chances are greatly increased that we can focus on the other aspects of his life that

he sees as problematic and would like to change. In short, it is possible to treat his

alcoholism and at the same time carry out a program of individual therapy geared

to changing Stan’s ways of thinking, feeling, and behaving.

Moving Toward Termination of Therapy

The process I have been describing will probably take months. During this time, I

will continue to draw simultaneously on a variety of therapeutic systems in working

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519

CASE ILLUSTRATION: AN INTEGRATIVE

APPROACH IN WORKING WITH STAN

with Stan’s thoughts, feelings, and behaviors. Eventually this process will lead to a

time when Stan can continue what he has learned in therapy without my assistance.

Termination of therapy is as important as the initial phase, for now the key

task is to put into practice what he has learned in the sessions by applying new

skills and attitudes to daily social situations without professional assistance.

When Stan brings up a desire to “go it alone,” we talk about his readiness to

end therapy and his reasons for thinking about termination. I also share with

him my perceptions of the directions I have seen him take. This is a good time

to talk about where he can go from here. We spend time developing an action

plan and talking about how he can best maintain his new learning. He may

want to join a therapeutic group. He could ﬁ nd support in a variety of social

networks. In essence, he can continue to challenge himself by doing things that

are difﬁ cult for him yet at the same time broaden his range of choices. Now he

can take the risk and be his own therapist, dealing with feelings as they arise in

new situations.

In a behavioral spirit, evaluating the process and outcomes of therapy seems

essential. This evaluation can take the form of devoting some time to discussing

Stan’s speciﬁ c changes in therapy. A few questions for focus are: “What stands

out the most for you, Stan? What did you learn that you consider the most valu-

able? How did you learn these lessons? What can you do now to keep practicing

new behaviors? What will you do if you experience a setback?” We explore poten-

tial difﬁ culties he expects to face when he no longer comes to weekly counseling

sessions. At this point, I introduce some relapse prevention strategies to help Stan

cope constructively with future problems. By addressing potential problems and

stumbling blocks that he might have to deal with, Stan is less likely to become

discouraged if he experiences any setbacks. If any relapses do occur, we talk about

seeing these as “learning opportunities” rather than as signs that he has failed. I

let Stan know that his termination of formal therapy does not mean that he can-

not return for a visit or session when he considers it appropriate. Rather than

coming for weekly sessions, Stan might well decide to come in at irregular inter-

vals for follow-up sessions.

Encouraging Stan to Join a Therapy Group

As Stan and I talk about termination, he gives me clear indications that he has

learned a great deal about himself through individual counseling. Although Stan

has been doing well on his own, I believe he would beneﬁ t from a group experi-

ence. I suggest that Stan consider joining a 16-week therapy group that will begin

in 2 months.

To me, progressing from individual therapy to a group seems useful for a cli-

ent like Stan. Because many of his problems are interpersonal, a group is an ideal

place for him to deal with them. The group will give Stan a context for practicing

the very behaviors he says he wants to acquire. Stan wants to feel freer in being

himself, to be able to approach people even when he is fearful, and to be able to

trust people more fully. In addition to a group experience, I will be working with

Stan to ﬁ nd some other ways to continue his growth.

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520

CHAPTER SIXTEEN

Commentary on the Thinking, Feeling, and Doing Perspective

In applying my integrative perspective to Stan, I’ve dealt separately with the cog-

nitive, affective, and behavioral dimensions of human experience. Although the

steps I outlined may appear relatively structured and even simple, actually working

with clients is more complex and less predictable. If you are practicing from an in-

tegrative perspective, it would be a mistake to assume that it is best to always begin

working with what clients are thinking (or feeling or doing). Effective counseling

begins where the client is, not where a theory indicates a client should be.

In summary, depending on what clients need at the moment, I may focus initially

on what they are thinking and how this is affecting them, or I may focus on how they

feel, or I may choose to direct them to pay attention to what they are doing. Think-

ing and feeling are two sides of the same coin, and if Stan can change his thoughts,

I believe he is likely to change some of his behaviors and his feelings. If he changes

his feelings, he might well begin to think and act differently. If he changes certain

behaviors, he may begin thinking and feeling differently. Because these facets of hu-

man experience are interrelated, one route generally leads to the other dimensions.

A person-centered focus respects the wisdom within the client and uses it as a

lead for where to go next. My guess is that counselors often make the mistake of

getting too far ahead of their clients, thinking, “What should I do next?” By staying

with our clients and asking them what they want, they will tell us which direction

to take either directly or indirectly. We can learn to pay attention to our own reac-

tions to our clients and to our own energy. By doing so we can engage in a thera-

peutic connection that is helpful for both parties in the relationship.

Follow-Up: You Continue Working With Stan

in an Integrative Style

Think about these questions to help you decide how to counsel Stan from your

own integrative approach:

• What themes in Stan’s life do you ﬁ

nd most signiﬁ cant, and how might you

draw on these themes during the initial phase of counseling?

• What speciﬁ

c concepts from the various theoretical orientations would you be

most inclined to utilize in your work with Stan?

• Identify some key techniques from the various therapies that you are most

likely to employ in your therapy with Stan.

•

How would you develop experiments for Stan to carry out both inside and out-

side the therapy sessions?

• Knowing what you do about Stan, what do you imagine it would be like to be

his therapist? What problems, if any, might you expect to encounter in your

counseling relationship with him?

See DVD for Theory and Practice of Counseling and Psychotherapy: The Case of

Stan and Lecturettes (Session 13 on an integrative approach) for a demonstra-

tion of my approach to counseling Stan from this perspective. This session

deals with termination and takes an integrative view of Stan’s work. This is also

a good time to review the entire program of the 13 sessions with Stan as a way

to think about how you might counsel Stan from your integrative perspective.

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521

CASE ILLUSTRATION: AN INTEGRATIVE

APPROACH IN WORKING WITH STAN

concluding comments

At the beginning of the introductory course in counseling, my students typically

express two reactions: “How will I ever be able to learn all these theories?” and

“How can I make sense out of all this information?” By the end of the course, these

students are often surprised by how much work they have done and by how much

they have learned. Although an introductory survey course will not turn students

into accomplished counselors, it generally provides the basis for selecting from

among the many models to which they are exposed.

At this point you may be able to begin putting the theories together in some

meaningful way for yourself. This book will have served its central purpose if it

has encouraged you to read further and to expand your knowledge of the theories

that most caught your interest. I hope you have seen something of value that you

can use from each of the approaches described. You will not be in a position to

conceptualize a completely developed integrative perspective after your ﬁ rst course

in counseling theory, but you now have the tools to begin the process of integra-

tion. With additional study and practical experience, you will be able to expand and

reﬁ ne your emerging personal philosophy of counseling.

Finally, the book will have been put to good use if it has stimulated you to think

about the ways in which your philosophy of life, your values, your life experiences,

and the person you are becoming are vitally related to the caliber of counselor you

can become. This book and your course may have raised questions for you regard-

ing your decision to become a counselor. Seeking out at least one of your profes-

sors to explore these questions can be the next step.

Now that you have ﬁ nished this book, I would be very interested in hearing

about your experience with it and with your course. The comments readers have

sent me over the years have been helpful in revising each edition, and I welcome

your feedback. You can complete the reaction sheet at the end of the book and mail

it to Brooks/Cole, Cengage Learning, 20 Davis Drive, Belmont, California 94002.

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NAME INDEX

Adler, A., 10–11, 63, 84, 102–103,

106–108, 115, 120, 128, 143, 291,

433, 437

Ainslie, R., 75–77, 85

Alberti, R., 265

Alford, B., 322

Al-Rashidi, B., 343, 350, 352

American Counseling Association

(ACA), 23, 48–49

American Psychiatric Association,

45, 107, 340, 374–375, 436

American Psychological Association,

363, 385

American Psychological Associa-

tion Presidential Task Force on

Evidence-Based Practice, 46

Andersen, T., 445

Anderson, C., 439, 451

Anderson, H., 398–399, 404, 442,

445

Andrews, J., 418

Angel, E., 143

Ansbacher, H., 103–108, 119, 128

Ansbacher, R., 104–108, 119

Antony, M., 247, 254, 263, 269,

280

Arciniega, G., 123–124

Arkowitz, H., 191–192

Arlow, J., 73–75, 96–97

Arnkoff, D., 468

Arredondo, P., 25

Astor-Lazarus, D., 247

Atkinson, D., 91

Austin, S., 182

Axline, V., 201

Baldwin, M., 446

Bandura, A., 10, 245–247, 249–250

Banman, J., 433

Barber, P., 237

Bateson, G., 406, 415

Beardsley, B., 363

Beck, A. T., 10, 128, 250, 288–289,

291, 302–303, 305–310, 322

Beck, J., 10, 289, 303, 306–307, 324

Becvar, D., 434–435, 441

Becvar, R., 434–435, 441

Beisser, A., 214

Belenky, M., 362

Bell, A., 465

Bem, S., 368–369

Berg, I., 11, 396–397, 400, 403, 405,

407–408, 424–425

Berger, P., 397

Bertolino, B., 398, 402, 407, 416,

420, 424

Beutler, L., 47–48, 465–467, 476,

483, 495, 497

Bhati, K., 47

Binswanger, L., 140, 142

Bisono, A., 469

Bitter, J., 101, 107, 110, 113–114, 115–

119, 121–122, 128, 372, 374–375,

438–441, 445–446, 449, 456

Black, M., 89

Blanchard, L., 121

Blau, S., 293

Blau, W., 79

Bohart, A., 174, 179, 181, 185–186,

195, 201, 496

Borden, A., 396

Boscolo, L., 457

Boss, M., 140, 142

Bowen, M., 11, 433, 438, 438

Bowman, C., 211, 227

Bozarth, J., 174–175, 180, 185–186

Brabeck, M., 363, 386

Bracke, P., 165

Breshgold, E., 227, 236

Brickell, J., 341, 343, 345, 347, 350,

352–354

Brodley, B., 178

Brodsky, A., 51

Bromley, D., 46–47

Brooks, G., 386

Brooks, J., 191, 193, 195

Brown, J., 212, 214, 223

Brown, L., 11, 362–364, 366, 369–

370, 372, 374–376, 388, 398

Brown, S., 25

Brownell, P., 237

Breunlin, D., 445, 450

Bubenzer, D., 441

Buber, M., 140–141, 157, 211

Bugental, J., 140–141, 144–145, 155,

157, 159, 165

Bumberry, W., 440

Burns, A., 46

Burr, V., 398

Butler, A., 306

Byars-Winsston, A., 363, 370, 375

Cain, D., 173–174, 176, 181–186, 190,

194–196, 198–200, 212

Callaghan, G., 250, 279

Callanan, P., 39, 41–42, 44

Cannon, K., 368

Caplan, P., 384

Carlson, J. D., 123, 125, 445

Carlson, J. M., 105, 107

, 111–112, 114,

117–119, 121–125, 127–130

Carter, B., 433, 439

Cashwell, C., 469–471

Castaldo, J., 307

Castillo, L., 363

Cavasos, L., 191, 193, 195

Cecchin, F., 457

Chambless, D., 307

Chang, R., 252, 275, 280

Christensen, O., 113–114, 116, 121,

433, 437

Clark, A., 110, 116, 184

Clark, D., 418

Clarkin, J., 89

Clemmer, F., 107

Clinchy, B., 362

Name Index

523

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524

Cole, E., 362

Cole, L., 128, 372

Comas-Diaz, L., 469

Combs, A., 199, 201

Combs, G., 410, 412–415, 424

Committee on Professional Practice

and Standards, 41

Comstock, D., 368

Cooper, M., 166, 199, 232

Corey, G., 34, 38–39, 41–42, 44, 46,

49–50, 79, 83, 101, 117, 122, 128,

154, 158, 160, 186, 189, 224, 233,

254, 258, 268, 274, 297–298, 302,

310, 349, 371, 386, 408, 410, 418

Corey, M., 38–39, 41–42, 44, 154

Cormier, S., 253–254, 258–260, 266,

317

Counseling Today, 34

Craske, M., 260, 262

Crawford, T., 297

Crethar, H., 363, 380

Crocket, K., 410, 413–414

Cukrowicz, K., 46

Curtis, R., 75, 77, 79–81

Dattilio, F., 46–47, 165, 245, 249,

258, 304–307, 310, 322–323

Deegear, J., 46

De Jong, P., 396–397, 403, 405,

407–408, 424–425

Delaney, H., 469

De Shazer, S., 11, 396, 398, 400–401,

403, 405–408, 424, 442

Deurzen, E., van, 140, 145, 148, 152,

154, 156–160, 164–166

Dienes, K., 291, 306

Digiuseppe, R., 250, 279, 305

Dimidjian, S., 269, 271, 278

Dinkmeyer, D., 105, 120–121

Dinkmeyer, D., Jr., 112, 119

Di Pietro, R., 110–111, 116, 128

Disque, J., 110, 119

Dobson, K., 303

Donovan, D., 314

Doolin, E., 183

Dozois, D., 303

Dreeben, S., 271

Dreikurs, R., 10, 103, 108–109,

113–114, 120, 433, 437, 450

Drewery, W., 414

Driscoll, K., 46

Dryden, W., 291, 293–295, 297, 299

Duncan, B., 18, 48, 187, 201–202,

424, 467, 480, 496

Edwards, J., 46–47

Eifert, G., 272–273

Eisengart, S., 400, 425

Eldridge, N., 368

Elkins, D., 19, 166, 173–174, 202

Ellenberger, H., 143

Elliott, R., 201, 213

Ellis, A., 11, 128, 288, 291–300, 302,

316–317, 323

Emmons, M., 265

Englar-Carlson, M., 105, 107, 114,

117–118, 123–124, 129

Enns, C., 11, 97, 361, 363–366, 370,

373–375, 377, 379–380, 386–387

Epp, L., 160

Epstein, N., 307

Epston, D., 11, 396, 398, 401, 410,

413, 416–418, 442, 445

Eriksen, K., 373–375, 379

Erikson, E., 64, 69–70, 94

Espin, O., 11, 361–362

Evans, K., 373, 376, 379

Evans, T., 109, 118, 120

Fairhurst, I., 199

Farber, B., 183

Farha, B., 151

Feder, B., 233

Ferguson, K., 258

Fernbacher, S., 233

Fishman, D., 270, 279

Fishman, H., 457

Flynn, J., 272

Follette, V., 268, 273

Follette, W., 250, 279

Forman, E., 268, 273

Forsyth, J., 272–273

Frame, M., 469–470

Frankl, V., 10, 128, 137, 143, 148, 152

Freedman, J., 396, 410, 412–415, 424

Freeman, A., 291, 302, 304,

306–307, 323

Freiberg, H., 175

Fresco, D., 272

Freud, S., 10, 63, 70, 83–84, 94, 102

Frew, J., 215, 218, 223–224, 227,

233

Fromm, E., 103, 128

Fulton, P., 273

Gamori, M., 433

Ganley, A., 380

Garcia-Preto, N., 433, 439

Geller, J., 21–22

Gelso, C., 77–78

Gendlin, E., 201

Gerber, J., 433

Gergen, K., 397, 442

Germer, C., 269, 273

Gerson, R., 433, 439, 446

Gilbert, L., 371, 380, 386

Gilligan, C., 362, 364, 36

7–368

Gingerich, W., 400, 406, 425

Giordano, J., 433

Gladding, S., 445–446

Glass, C., 468

Glass, G., 495

Glasser, C., 338

Glasser, W., 11, 334, 336, 339–340,

343, 350, 353, 355

Goldberg, N., 362

Goldenberg, H., 435, 456

Goldenberg, I., 435, 456

Goldfried, M., 465, 468

Goldman, R., 177, 179, 198, 213, 220,

225, 237

Goldstein, K., 211

Goodman, R., 212, 220

Goolishian, H., 398–399, 404, 442,

445

Gordon, J., 296

Gottman, J., 446

Gould, W., 142

Grant, S., 91

Granvold, D., 307

Greenberg, L., 177, 179, 195, 198,

200–202, 213, 220, 467

Griffith, J., 115

Gross, A., 259–260

Guevremont, D., 247, 253, 259,

262–263, 269, 275, 280

Guterman, J., 404, 408

NAME INDEX

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

525

Gutheil, T., 51

Guy, J., 18, 34

Hagedorn, W., 471

Haigh, A., 272

Haley, J., 11, 434, 440–441, 457

Hammer, T., 368

Hanna, S., 445

Hardy, K., 451

Harper, R., 293–295

Harris, A., 85

Hawes, C., 113–114, 116, 121

Hayes, J., 77–78

Hayes, S., 268–269, 272–273

Hays, P., 316–317, 377

Hazlett-Stevens, H., 260, 262

Head, L., 259–260

Healey, A., 128, 372

Hedges, L., 87–88

Hefferline, R., 212, 220

Heidegger, M., 140–142

Heimberg, R., 278, 299–300

Herbert, J., 268, 273

Herlihy, B., 38, 41, 49–50, 379–380,

386

Herman, J., 375

Higginbotham, H., 252, 275, 280

Hirsch, I., 75, 77, 79–81

Hogan, T., 47–48, 202

Holden, J., 105

Hollon, S., 250, 279, 305

Hood, A., 116

Horney, K., 103, 128, 291

Houts, A., 269, 272

Hoyt, M., 476

Hubble, M., 18, 48, 187, 201–202,

424, 467, 496

Hummel, A., 77–78

Humphrey, K., 212

Imhof, L., 343, 350, 352

Ingram, R., 321

Jacobs, L., 212, 220, 223–224, 227,

232, 236, 238

Jacobs, N., 298, 306

Jacobson, E., 258

Jennings, L., 19–20

Johnson, J., 160

Johnson, R., 116

Joiner, T., 46

Jones, J., 25

Jordan, J., 361, 368

Josselson, R., 139, 146, 152, 154,

156–157, 160

Jung, C., 63, 83–85, 94, 102

Kabat-Zinn, J., 269, 271

Kaplan, A., 361, 368

Karpiak, C., 466

Kaschak, E., 364, 368

Kazdin, A., 250, 256–257, 280

Kees, N., 379

Kefir, N., 107

Kemper, T., 46

Kendall, P., 307

Kernberg, O., 86, 88–89

Kerr, M., 438

Kersh, B., 191, 193, 195

Keys, S., 199

Kierkegaard, S., 138, 140

Kim, R., 343, 350, 352

Kincade, E., 373, 376, 379

Kirschenbaum, H., 173, 198

Klein, M., 87, 182

Knapp, S., 37

Kohut, H., 86, 88–89

Koldon, G., 182

Koocher, G., 47–48, 202

Korman, L., 201

Kottman, T., 130

Krebs, P., 193

Kress, V., 373–375, 379

Krug, O., 145, 147, 155, 161, 165,

176

Lago, C., 199

Lambert, M., 19, 467, 496

Larsen, C., 386

Latner, J., 215

Lawson, D., 46

Lazarus, A., 10, 246–247, 250, 255,

266–268, 466, 473, 476

Lazarus, C., 247, 268

Leahy, R., 308, 321

Ledley, D., 278, 299–300

Lee, M., 425

Lee, R., 223

Leech, N., 379

Levant, R., 47–48

Levensky, E., 191, 193, 195

Levenson, H., 90–91

Levitsky, A., 228

Lewis, J., 445

Lindsley, J., 411

Linehan, M., 97, 268–269, 269–271,

273, 278

Lipckik, E., 400

Lisiecki, J., 115, 119

Lister, K., 466

Lobovits, D., 396

Locke, D., 25

Lojk, L., 343, 350, 352

Luborsky, E., 73–75, 96–97

Luckman, T., 397

Luepnitz, D., 445

Lusterman, D., 386

MacKune-Karrer, B., 445, 450

MacLaren, C., 296–297

Macy, R., 306, 324

Madanes, C., 11, 434

Madigan, S., 4

15, 417, 420

Mahler, M., 87–88

Maisel, R., 396

Maniacci, M., 106, 109–112, 114,

117–119, 121–122, 127–128

Marbley, A., 379

Marlatt, G., 314

Martell, C., 251

Marx, B., 278, 299–300

Maslow, A., 128, 177–179

Masterson, J., 89

Maurer, R., 227

May, R., 10, 128, 137–138, 143, 150,

154, 156

McCollum, V., 379–380

McDavis, R., 25

McElwain, B., 166

McGoldrick, M., 433, 439, 446,

451

McKay, G., 120

McKeel, A., 406, 425–426

McKenzie, W., 410, 416–419, 426

Mearns, D., 199, 201

Meichenbaum, D., 10, 290, 310–315,

324

NAME INDEX

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Melnick, J., 219, 223–225

Mennin, D., 272

Merry, T., 199

Messer, S., 90

Metcalf, L., 401, 408–409

Miller, J. B., 11, 361, 364, 368

Miller, S., 18, 48, 187, 201–202, 396,

400, 424, 467, 480, 496

Miller, T., 495

Miller, W., 191–192, 254, 469

Milliren, A., 107, 109, 118, 120

Miltenberger, R., 247, 253, 256–257,

264

Minuchin, S., 11, 434, 440, 457

Mitchell, S., 86, 89

Monk, G., 410–419, 424–426

Moorhead, H., 471

Morrow, S., 363

Mosak, H., 106, 109–111, 115–117, 119,

128

Mozdzierz, G., 115, 119

Muller, K., 270, 279

Murphy, J., 401, 404–407, 409

Nagy, T., 40–42, 50

Nash, S., 363, 380

Natiello, P., 199, 201

Neenan, M., 296

Neimeyer, 418

Nevis, S., 219, 223–225

Newbauer, J., 109, 118, 120

Newlon, B., 123–124

Newman, C., 307

Nichols, M., 445, 456

Nicoll, W., 113–114, 116, 117–119,

121–122, 128

Nietzsche, F., 140–141

Niles, B., 269

Norcross, J., 18–22, 34, 47–48, 90,

184, 193, 202, 263, 367, 403,

465–468, 476,480, 483, 495, 497

North American Society of Adlerian

Psychology (NASAP), 130

Nurius, P., 253–254, 258–260, 266,

317

Nutt, R., 386

Nye, R., 245

Nylund, D., 419

Nystul, M., 123

O’Hanlon, B., 398, 400, 402, 404,

406–407, 412, 414, 416, 420, 424,

442

O’Reilly-Landry, M., 73–75, 96–97

Orlinsky, D., 21–22

Osborn, C., 253–254, 258–260, 266,

317

Pachankis, J., 465

Padesky, C., 307

Paivio, S., 201

Palmer, S., 296

Panjares, F., 246

Parlett, M., 223

Parsons, J., 368

Patterson, C., 201

Paul, G., 252

Pedersen, P., 42

Peller, J., 400–404, 424

Pelonis-Peneros, P., 122

Peluso, P., 119, 121

Perls, F., 10, 211–213, 220, 222,

227–228, 230, 238

Perls, L., 10, 211–212, 222–223

Peterman, M., 307

Petrocelli, J., 302

Petry, S., 433, 439, 446

Philpot, C., 386

Pietrefesa, A., 269

Pietrzak, D., 113, 119, 123, 127, 129

Pleck, J., 380

Plummer, D., 233

Pollack, W., 380, 383

Polster, E., 10, 212, 215–217, 221–225,

227

Polster, M., 10, 212, 215–217,

222–225, 227

Popkin, M., 120

Potter, C., 269

Powers, R., 115

Prata, G., 457

Pretzer, J., 307

Prochaska, J., 90, 193, 263, 367, 403,

467, 495

Psychotherapy Networker, 466

Rader, J., 371, 386

Raskin, N., 174, 188

Rave, E., 386

Real, T., 380

Rego, S., 270, 279

Reinecke, M., 291, 306–307

Reitzel, L., 46

Remer, P., 376, 370–372, 374–375,

377–378, 380–382, 387

Remley, T., 41

Rennie, D., 201

Rice, L., 201

Richeport-Haley, M., 441

Riskind, J., 307

Roberts, A., 438

Robertson, L., 471

Robertson, P., 128, 372

Robey, P., 341

Robins, C., 270–271

Roemer, L., 247, 254, 263, 269, 280

Rogers, C., 10, 142, 173–175, 177–181,

183, 186, 188–190, 194, 200, 399,

414, 445

Rogers, N., 10, 187–191, 199–201, 362

Rollnick, S., 191–192, 254

Ronnestad, M., 21

Root, M., 363

Rosenthal, M., 270–271

Rothblum, E., 362

Russell, D., 173

Russell, J., 143, 147–148, 154–155,

158, 166

Rutan, J., 83

Salazar, G., 368

Salmon, P., 270

Sanchez, J., 25

Sartre, J., 140, 142, 147

Satir, V., 11, 433, 439, 446, 449

Sauer, A., 291, 306

Scher, C., 321

Scher, M., 380

Schmertz, S., 269

Schneider, K., 145–147, 155, 157, 159,

161, 165, 176

Schultz, D., 83–85, 103

Schultz, S., 83–85, 103

Schwartz, R., 445, 450

Sebold, J., 425

Seem, S., 373, 376, 379

Seeman, J., 174

Segal, Z., 271, 321, 467

526

NAME INDEX

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Segrin, C., 263

Selvini Palazzoli, M., 457

Sephton, S., 271

Sgambati, R., 258

Shapiro, F., 262–263

Sharf, R., 166

Sharp, J., 140–141, 159

Shay, J., 83

Sherman, R., 105

Shulman, B., 115, 119, 127, 129

Siegel, R., 273

Simpson, L., 270–271

Sinacore, A., 364, 366

Skinner, B., 10, 245

Sklare, G., 409–410

Skovholt, T., 19–20

Slavik, S., 119

Smith, B., 199

Smith, L., 92

Smith, M., 495

Sommers-Flanagan, J., 190–191

Sonstegard, M., 122, 438

Sparks, J., 480, 496

Sperry, L., 42, 112, 119, 121, 445

Spiegler, M., 247, 253, 259–260,

262–263, 269, 275, 280, 294,

316

St. Clair, M., 86–86

Stadler, H., 25

Stebnicki, M., 34

Stern, D., 87

Stiver, I., 361, 368

Stone, W., 83

Strasser, A., 159

Strasser, F., 159

Strentzsch, J., 368

Stricker, G., 466

Strosahl, K., 269, 272

Strumpfel, U., 225, 237

Strupp, H., 89, 96

Sue, D., 25, 42

Sue, D. W., 25, 42

Sullivan, H., 103

Surrey, J., 361, 368

Sweeney, T., 111

Tallman, K., 174, 181, 201, 496

Tanaka-Matsumi, J., 252, 275, 280

Tarule, J., 362

Tausch, R., 174–175, 180, 185–186

Teasdale, J., 271, 467

Tharp, R., 265–266

Thomas, J., 419

Thomas, S., 373

Thompson, C., 91

Thorne, B., 180, 182, 199, 201

Tillich, P., 138, 149–150, 211

Tompkind, M., 304, 307

Toporek, R., 25

Torres-Harding, S., 291, 306

Torres Rivera, E., 363, 380

Trepal, H., 368

Turner, L., 362

Uken, A., 425

Vaihinger, H., 105

Vandecreek, L., 37

Vernon, A., 301

Vontress, C., 149, 152, 157, 160–161,

166

Vujanovic, A., 269

Walden, S., 373

Walker, L., 388

Walker, M., 368

Walsh, F., 439, 451

Walsh, R., 166

Walter, J., 400–404, 424

Walters, R., 245, 249

Wampold, B., 18–19, 47, 165, 187,

201–202, 467–468, 480, 496

Wang, C., 182

Warren, C., 90

Watson, D., 265–266

Watson, J., 177, 179, 181, 184–186,

195, 198–199, 201, 213, 220

Watts, R., 105, 111–114, 118–119,

121–123, 127–129

Watzlawick, P., 128

Weiner-Davis, M., 398, 400, 404,

406–407, 424, 442

Weishaar, M., 250, 289, 291,

302–303, 305–308, 321, 323, 397

Weitzman, L., 363

Werner-Wilson, R., 362

West, J., 441

Westra, H., 191

Whitaker, C., 11, 434, 440

White, B., 46

White, J., 302

White, M., 11, 396, 398, 401, 410,

413, 415–418, 442, 445, 450

Wiggins-Frame, M., 469

Williams, A., 115

Williams, J., 271, 467

Wilson, G., 247, 249–250, 253, 266,

269, 273–274, 280

Wilson, K., 269, 272

Winslade, J., 410–415, 418–419,

424–425

Wiseman, H., 21

Witty, M., 188

Wolfe, J., 291, 293, 297, 299, 316,

323

Wolitzsky, D., 64, 72–77, 81–82, 89,

96

Wolpe, J., 248, 251, 258

Worell, J., 367, 370–372, 374–375,

380–381, 387

Worthington, E., 269, 470–471

Wubbolding, R., 11, 334, 336–348,

350, 352–356

Yalom, I., 10, 97, 138–140, 144, 146,

152, 154, 156–157, 160

Yeomans, F., 89

Yontef, G., 212, 214, 220, 223–225,

227, 232, 236, 238

Young, J., 469–471

Young, M., 471

Zahm, S., 236

Zimring, F., 174–175, 180, 185–186

Zinker, J., 212, 217, 219, 225, 238

Zur, O., 49, 247

527

NAME INDEX

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

SUBJECT INDEX

A-B-C framework, 293–294, 301

ABC model, 252, 482

Acceptance, 183, 188, 269, 295

Acceptance and commitment

therapy, 272–273, 466

Accommodation, 222

Accurate empathic understanding,

184–185

Action, planning and, 347–348

Actualizing tendency, 178

Adlerian brief therapy, 113

Adlerian family therapy, 437–438

Adlerian therapy, 101–135, 472

application, 120–122, 486

applied to the case of Stan,

125–126

client’s experience, 111–112

contributions, 127–129, 488, 491

key concepts, 103–109, 474

limitations and criticisms, 129,

489, 493

multicultural perspective, 123–125

relationship between therapist

and client, 112, 481

shortcomings, 124–125

strengths, 123–124

therapeutic goals, 109–110, 477

therapeutic process, 109–112

therapeutic techniques and proce-

dures, 113–122, 484

therapist’s function and role,

110–111

Adolescence, 71

Advice, 32

Affect, 267

Aloneness, 150

Alternative interpretations, 308

Ambiguity, 30

Anal stage, 69–70

Analytic framework, maintaining

the, 79

Analytic psychology, 83

Androcentric, 367

Anger management training, 263

Angst, 140

Anima, 85

Animus, 85

Antecedent events, 252

Anxiety, 28, 66, 73, 81, 140, 152–153,

176–177, 181, 230, 261, 262

Anxiety, existential, 152

Anxiety hierarchy, 259–260

Application and follow-through

phase, 314

Approaches, theoretical

Adlerian therapy, 101–135, 472,

477, 486, 488–489, 491, 493

behavior therapy, 244–286, 472,

478, 486, 488, 490, 492, 494

cognitive behavior therapy,

287–332, 472, 478, 487–488,

490, 492, 494

existential therapy, 136–171, 472,

477, 486, 488, 490–491, 494

family systems therapy, 432–461,

473, 478, 487, 489, 491, 493,

495

feminist therapy, 360–394, 473,

478, 487, 489–490, 493, 494

gestalt therapy, 210–243, 472,

477, 486, 488, 490, 492, 494

integrative perspective, 464–521

person-centered therapy,

172–209, 472, 477, 486, 488,

490, 492, 494

postmodern approaches, 395–431,

473, 478, 487, 489–490, 493,

495

psychoanalytic therapy, 62–100,

472, 477, 486, 488–489, 491,

493

reality therapy, 333–359, 473,

478, 487, 489–490, 492, 494

Arbitrary inferences, 512

Archetypes, 84

Aspirational ethics, 37

Assertion training, 264

Assertiveness, 274, 378

Assessment, 44–46, 186, 373–375,

438, 446–449, 470

Assessment process, ethical issues

in, 44–46

Assimilation, 223

Assimilative integration, 467

Authenticity, 148, 165

Automatic thoughts, 303

Autonomy, 176

Autonomy versus shame and

doubt, 70

Awareness, 66, 76, 81, 153–154,

212–213, 217, 219, 225, 232,

236, 316

Basic assumptions, 401–402,

456, 518

Basic ID, 266–268

Basic philosophies, 472–473

Behavior, 105, 267, 465

Behavior therapy, 244–286, 472

application, 255–274, 486

applied to the case of Stan,

276–

277

areas of development, 248–250

basic characteristics and assump-

tions, 250–252

client’s experience, 254

contributions, 278–279, 488, 492

historical background, 247–248

key concepts, 250–252, 474

limitations and criticisms,

279–280, 490, 494

multicultural perspective, 274–276

relationship between therapist

and client, 254–255, 481

shortcomings, 275–276

strengths, 274–275

therapeutic goals, 252, 478

Subject Index

528

9, 472, 477,

494

proaches, 395–4

489–490, 493

c therapy, 6

486, 488–4

apy, 333–35

, 489–490,

ences, 512

–100,

9, 491,

473,

92, 494

254

278–279,

cal background, 24

key concepts, 250–252,

limitations and criticism

279–280, 490, 494

mu

cultural perspective,

relationship between therapist

and client, 254–255, 481

76

252, 478

y

chetypes, 84

shortcomings, 275–2

strengths, 274–275

therapeutic goals

ence, 71

2

ations, 308

intaining

3

267

s, 150

e interpr

, 30

e, 69–70

framework,

he, 79

alytic psychology

gu

al st

Analy

A

process, 109–112

eutic techniques and proce-

dures, 113–122, 484

herapist’s function and role,

1

0

–11

1

les

post

473

49

5

psychoanal

472

Advic

Affect

Alone

Altern

Amb

An

en therapis

and client, 112, 481

shortcomings, 124–125

strengths, 123–12

4

therapeutic goals

therapeu

the

Ado

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

SUBJECT INDEX

therapeutic process, 252–255

therapeutic techniques and proce-

dures, 255–274, 484

therapist’s function and role,

252–254

Behavior, total, 337

Behavioral analysis, 251–252

Behavioral assessment

interview, 253

Beliefs and attitudes, 25–26

Beliefs, self-defeating, 29

Belonging, 107

Bibliotherapy, 298, 378

Birth order, 107–109

Blaming, 439

Blank-screen approach, 73

Blocks to energy, 218–219

Borderline personality disorder,

88–89

Boundaries, 51

Boundary crossing, 51

Boundary disturbance, 218

Boundary violation, 51

Bridge, 408

Brief psychodynamic therapy, 90

Burnout, professional, 33

Change, 119, 193–194, 343–344,

450–451

Change-focused questions, 406

Characteristics, personal, 19

Choice, 212, 264, 339

Choice theory, 336

Circulation questions, 417

Classical conditioning, 248

Classical psychoanalysis, 69, 74

Client-centered therapy, 175

Cognition, 267

Cognitive behavior modification, 310,

322, 324

Cognitive behavior therapy, 249,

287–332, 472

application, 297–302, 307–310,

487

applied to the case of Stan,

318–319

client’s experience, 296

contributions, 320–322, 488, 492

key concepts, 292–295, 475

limitations and criticisms,

322–324, 490, 494

multicultural perspective, 315–317

relationship between therapist

and client, 297, 306–307, 482

shortcomings, 316–317

strengths, 315–316

therapeutic goals, 295, 478

therapeutic process, 295–297

therapeutic techniques and proce-

dures, 297–302, 485

therapist’s function and role,

295–296

Cognitive distortions, 303

Cognitive patterns, 465

Cognitive restructuring, 294

Cognitive therapy, 302–310, 321–324

Cognitive triad, 308

Collaborative empiricism, 305

Collaborative language systems ap-

proach, 399

Collective unconscious, 84

Commitment, 273

Common factors approach, 467

Communication, privileged, 41

Community feelings, 107, 109

Compensation, 68

Complainant, 405

Compliments, 407

Conceptual-educational phase, 313

Confidentiality, 41–42

Confluence, 218

Confrontation, 227–228

Congruence (genuineness), 182–183,

439

Consciousness, 65–66, 146

Consequences, 252

Constructivist narrative perspective,

315

Contact, 217–218

Contemporary psychoanalysis, 69

Contextual factors, 19

Cooperation, 107

Countertransference, 31, 76–78, 82

Courage, 149

Crisis, 69

Crisis intervention, 187–188

Criticisms, limitations and, 489–491,

493–495

Cultural conditioning, 25

Cultural feminists, 365

Culture, 25, 27–28

Customer, 405

Cybernetics, 441

Cycle of counseling, 342

Death and nonbeing, 153–154

Death instincts, 64

Decision making, ethical, 38–40

Decisions, revised, 515–516

Deconstruction, 415–416

Defense mechanisms, 66–68, 74

Deflection, 218

Demands, 30

Denial, 6

7

Depression, treatment of,

308–310

Desensitization, 259

Despair, integrity versus, 71

Deterministic, 367

Development, summary of stages of,

87–89

Diagnosis, 44–46, 373–375

Dialectical behavior therapy,

269–271, 466

Dialogic encounter, 165

Dichotomous thinking, 304

Differentiation of self, 438

Direction and doing, 345–346

Displacement, 67

Distress tolerance, 270

Diversity, 24, 27

Doing, direction and, 345–346

Dread, 140

Dream analysis, 80–81

Dream work, 230

Drugs, 268

Dual relationships, 48

Early childhood, 70

Early recollections, 110, 115–116

Egalitarian relationship, 369

Ego, 64–66

Ego-defense mechanisms, 66–68, 82

Ego psychology, 69, 85

Electra complex, 70

EMDR. See Eye movement desensiti-

zation and reprocessing

529

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Emotion-focused therapy, 200,

213, 467

Emotional disturbance, 292–293

Emotional regulation, 270

Empathy, 185, 199–200

Empowerment, 376–377

Empty-chair technique, 228

Encouragement, 118–119

Energy, 218–219

Engendered lives, 368

Ethical decision making, 38–40

Ethical issues, 36–58

Ethical issues, assessment process,

44–46

Ethical issues, multicultural per

spective, 42–44

Ethical obligation, 24

Ethics, 37

Evidence-based practice, 46–48

Exaggeration exercise, 230

Exception questions, 406

Exceptions, 406

Exercises, 224

Existential analysis, 142

Existential anxiety, 152

Existential guilt, 147

Existential therapy, 136–171, 472

application, 157–160, 486

applied to the case of Stan,

162–163

client’s experience, 155–156

contributions, 164–165, 488, 491

key concepts, 145–154, 474

key figures, 143–145

limitations and criticisms,

165–166, 490, 494

multicultural perspective,

160–162

relationship between therapist

and client, 156–157, 481

shortcomings, 161–162

strengths, 160–161

therapeutic goals, 154–155, 477

therapeutic process, 154–157

therapeutic techniques and

procedures, 157–160, 484

therapist’s function and role, 155

Existential tradition, 145

Existential vacuum, 152

Existentialism and humanism,

176–177

Experiential family therapy, 440

Experiments, 224

Exposure therapies, 260

Expressive arts therapy, 189–191

Externalization, 415–416

Externalizing conversations, 416

Externalizing questions, 422

Extinction, 256

Extinction process, 257

Eye movement desensitization and

reprocessing (EMDR), 262–263

Factors, contextual, 19

Family constellation, 110, 115

Family systems perspective, 435

Family systems therapy, 432–461,

473

Adlerian, 437–438

application, 487

applied to the case of Stan,

452–455

contributions, 457, 489, 493

development of, 437–445

experiential, 440

goals and values, 456, 478

human validation process model,

439–440

key concepts, 475

limitations and criticisms,

457–458, 491, 495

multicultural perspective, 451–452

multigenerational, 438–439

multilayered process, 445–451

postmodern perspectives,

442–445

shortcomings, 452

strengths, 451–452

structural-strategic, 440–441

systemic viewpoints in, 443–444

techniques, 456–457, 485

therapeutic relationship, 482

Faulty assumptions, 109

Feeling, 230, 465, 507–510

Feminist therapy, 360–394, 473

application, 373–380, 487

applied to the case of Stan,

382–384

client’s experience, 372

contributions, 385–387, 489, 493

history and development,

363–366

key concepts, 367–370, 475

limitations and criticisms,

387–388, 490, 494

multicultural and social justice

perspective, 380–382

principles of, 369–370

relationship between therapist

and client, 373, 482

shortcomings, 381–382

strengths, 380–381

techniques and strategies,

375–380

therapeutic goals, 370–371, 478

therapeutic process, 370–373

therapeutic techniques and proce-

dures, 373–380, 485

therapist’s function and role,

371–372

Fictional finalism, 105

Field, 213

Field theory, 215

Figure, 214

Figure-formation proc

ess, 215,

225, 237

Flexible-multicultural perspective,

367

Flooding, 261–262

Formula first session task, 407

Free association, 73, 79, 292

Freedom, 147–149, 176–177, 336

Friendship, 107

Functional assessment, 251–252

Fundamental rule, 73

Future, 507

Gender-fair approaches, 367

Gender-role analysis, 377

Gender-role intervention, 377

Gender schemas, 368

Gendercentric, 367

Generativity versus stagnation, 71

Genital stage, 71

Genogram, 446–448

Genuineness (congruence), 182–183

Gestalt therapy, 210–243, 472

530

SUBJECT INDEX

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

531

application, 224–233, 486

applied to the case of Stan,

234–236

client’s experience, 222–223

contributions, 236–237, 488, 492

interventions, 228–231

key concepts, 213–219, 474

limitations and criticisms,

237–239, 490, 494

multicultural perspective,

233–234

relational, 212

relationship between therapist

and client, 223–224, 481

shortcomings, 234

strengths, 233–234

therapeutic goals, 219–220, 477

therapeutic process, 219–224

therapeutic techniques and proce-

dures, 224–233, 484

therapist’s function and role,

220–222

Global international feminists, 366

Goal oriented, 105

Goals, 23–24, 470, 476, 505–506

Adlerian therapy, 109–110, 477

behavior therapy, 252, 478

cognitive behavior therapy,

295, 478

existential therapy, 154–155, 477

family systems therapy, 456, 478

feminist therapy, 370–371, 478

gestalt therapy, 219–220, 477

integrative perspective, 477–478

person-centered therapy, 179, 477

postmodern approaches,

403–404, 412, 478

psychoanalytic therapy, 72, 477

reality therapy, 340, 478

Goals, mistaken, 109

Ground, 214

Group work, 379–380

Guilt, existential, 147

Guilt, initiative versus, 70

Here-and-now, 145, 216, 219–

220, 231

Heterosexist, 367

Hierarchy of needs, 177

Holism, 214

Holistic concept, 105

Homework, 260, 263, 296, 298,

300, 307, 479, 510

Honesty, 73, 177

Human behavior, 105

Human nature, view of

Adlerian therapy, 103–104

behavior therapy, 250

cognitive behavior therapy, 292

existential therapy, 145–146

feminist therapy, 367

gestalt therapy, 213–214

person-centered therapy,

178–179

psychoanalytic therapy, 64

reality therapy, 336–337

Human personality, 104–106

Human validation process model,

439–440

Humanism, existentialism and,

176–177

Humanistic psychology, 177–178

Humor, 31, 299–300

Hypothesizing, 449–450

Id, 64–66

Id psychology, 69

Ideal self-concept, 180

Identification, 68

Identity, 149–151

Identity versus role confusion, 71

Imagery, 267

Immediacy, 185

Impasse, 216

Inauthenticity, 147

Individual psychology, 104, 107

Individual therapy, 436

Individuation, 84

Industry versus inferiority, 71

Infancy, 70

Inferiority feelings, 104

Inferiority, industry versus, 71

Informed consent, 40–41, 376

Initiative versus guilt, 70

Insight, 117–118

Integrative perspective, 464–521

advantages of psychotherapy

integration, 467–468

applied to the case of Stan,

503–521

challenge of developing, 471–477

client’s experience, 479–480

integration of multicultural issues,

468–469

integration of spirituality and

religion, 469–471

movement toward psychotherapy

integration, 465–477

relationship between therapist

and client, 480–483

techniques and evaluation,

483–497

therapeutic goals, 477–478

therapeutic process, 477–483

ther

apist’s function and role,

478–479

Integrity versus despair, 71

Internal dialogue, 228–229, 311–312

Interpersonal effectiveness, 270

Interpersonal empathy, 184

Interpersonal relationships, 268

Interpretation, 80, 117

Interruptions in contact, 218

Intervention strategies, skills and, 26

Interventions, gestalt therapy,

228–231

Intimacy versus isolation, 71

Intrapsychic orientation, 367

Introjection, 68, 217

In vivo exposure, 260–261

In vivo flooding, 261

Involuntary clients, 30

Irrational beliefs, 297–298

Isolation, intimacy versus, 71

It talk, 221

Judgment, normalizing, 411

Key concepts

Adlerian therapy, 103–109, 474

behavior therapy, 250–252, 474

cognitive behavior therapy,

292–295, 475

existential therapy, 145–154, 474

family systems therapy, 475

feminist therapy, 367–370, 475

gestalt therapy, 213–219, 474

SUBJECT INDEX

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

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532

SUBJECT INDEX

Key concepts (continued)

person-centered therapy,

178–179, 474

postmodern approaches,

400–402, 410–411, 475

psychoanalytic therapy,

64–72, 474

reality therapy, 336–340, 475

Labeling and mislabeling, 304, 512

Language, 221

Latency stage, 71

Latent content, 80

Later life, 71

Lesbian feminists, 366

Liberal feminists, 364

Libido, 64

Life instincts, 64

Life-span perspective, 367

Lifestyle, 106

Lifestyle assessment, 111, 115

Limitations, 29

Limitations and criticisms, 489–491,

493–495

Listening, 411

Logotherapy, 143, 152

Magnification and minimization, 304

Maintaining the analytic

framework, 79

Making the rounds, 229

Mandatory ethics, 37

Manifest content, 80

Mapping, 416

Meaning, 176

Meaning, search for, 151–152

Meaninglessness, 152

Metaphors, 221

Middle age, 71

Middle child, 108

Mindfulness, 269–270

Mindfulness-based cognitive

therapy, 271–272, 467

Mindfulness-based stress reduction,

269, 271

Minimization, magnification and, 304

Minor psychotherapy, 113

Miracle question, 406–407

Mislabeling, labeling and, 304, 512

Mistaken goals, 109

Mistrust, trust versus, 70

Moral anxiety, 66

Motivational interviewing, 191–194

Multicultural counseling, 25–26

Multicultural issues, integration of,

468–469

Multicultural perspective, ethical

issues in, 42–44

Multigenerational family therapy,

438–439

Multilayered process of family

therapy, 445–451

Multimodal therapy, 266

Multiple relationships, 48–50

Muscle relaxation, progressive,

257–258

Narcissistic personality, 88–89

Narrative therapy, 410–419, 442

Negative punishment, 257

Negative reinforcement, 256

Negative self-talk, 294

Neurotic anxiety, 66, 153

Nonbeing, death and, 153–154

Nondirective counseling, 174

Nonprofessional relationships, 48

Normal anxiety, 153

Normal infantile autism, 87

Normalizing judgment, 411

Not-knowing position, 399,

404, 412–413, 415, 424,

441–442

Now, the, 215–216

Object-relations theory, 86

Objective empathy, 184

Objective interview, 115

Oedipus complex, 70

Oldest child, 108

Only child, 109

Operant conditioning, 249, 300

Operationally defined, 251

Oral stage, 69–70

Organismic self-regulation, 215

Overgeneralization, 304, 512

Paradoxical theory of change, 214, 219

Past, 506

Perfectionism, 29

Person-centered approach, 175

Person-centered therapy,

172–209, 472

application, 184–189, 486

applied to the case of Stan,

196–197

client’s experience, 180–181

contributions, 177–178, 198–202,

488, 492

development of the approach,

174–176

key concepts, 178–179, 474

limitations and criticisms,

202–203, 490

, 494

multicultural perspective, 194–196

relationship between therapist

and client, 181–184, 481

shortcomings, 195–196

strengths, 194–195

therapeutic goals, 179, 477

therapeutic process, 179–184

therapeutic techniques and proce-

dures, 184–189, 484

therapist’s function and role,

180–181

Persona, 85

Personal characteristics, 19

Personal consultation, 402

Personal therapy, 20–22

Personality, 64–65

Personality, development of, 68–71,

83–85

Personality, human, 104–106

Personalization, 304, 512

Phallic stage, 69–70

Phenomenological, 104

Phenomenological awareness, 213

Phenomenological inquiry, 215

Philosophical approach, 139

Philosophical restructuring, 294

Picture album, 337

Placating, 439

Planning and action, 347–348

Pleasure principle, 65

Polarized thinking, 512

Positive ethics, 37

Positive orientation, 400–401

Positive psychology, 177, 401

Positive punishment, 257

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

533

SUBJECT INDEX

Positive reinforcement, 256

Postmodern approaches, 395–431,

473

application, 406–410, 414–419, 487

applied to the case of Stan,

421–423

contributions, 424–426, 489, 493

key concepts, 400–402,

410–411, 475

limitations and criticisms, 426,

490, 495

multicultural perspective, 419–421

narrative therapy, 410–419

shortcomings, 421

social constructionism, 397–399

solution-focused brief therapy,

400–410

strengths, 419–420

therapeutic goals, 403–404,

412, 478

therapeutic process, 402–405,

412–414

therapeutic relationship, 405,

413–414, 482

therapeutic techniques and proce-

dures, 406–410, 414–419, 485

therapist’s function and role,

404–405, 412–413

Postmodern feminists, 366

Postmodern perspectives, 442–445

Power analysis, 377

Practice-based evidence, 480

Preschool age, 70

Presence, 185

Present, 339, 506

Pretherapy change, 406

Private logic, 111

Privileged communication, 41

Problem-saturated stories, 401

Professional burnout, 33

Professional role, 32–33

Progressive muscle relaxation,

257–259

Projection, 67, 73, 217

Psychoanalytic therapy,

62–100, 472

application, 82–83, 486

applied to the case of Stan, 92–93

client’s experience, 73–75

contributions, 94–96, 488, 491

counseling implications, 72

key concepts, 64–72, 474

limitations and criticisms, 96–97,

489, 493

multicultural perspective, 91–92

relationship between therapist

and client, 75–78, 481

shortcomings, 91–92

strengths, 91

therapeutic goals, 72, 477

therapeutic process, 72–78

therapeutic techniques and

procedures, 78–83, 484

therapist’s function and role,

72–73

Psychological dynamics, 114–117

Psychological investigation, 109

Psychosexual stages, 68, 70–71

Psychosocial stages, 69–71

Psychotherapy integration, 465–477

Punishment, 257

Purpose, 176

Quality world, 337, 344

Questioning, art of, 409

Questions, 221, 406–407, 409–410,

414–417, 420, 422, 425

Radical feminists, 365

Rational emotive behavior therapy

(REBT), 291–292, 297–302,

321–323

Rational emotive imagery, 299

Rationalization, 67

Reaction formation, 67

Reality, 104, 397

Reality anxiety, 66

Reality principle, 65

Reality therapy, 333–359, 472

application, 342–349, 487

applied to the case of Stan,

352–353

client’s experience, 341

contributions, 354–355,

489, 492

key concepts, 336–340, 475

limitations and criticisms,

355–356, 490, 494

multicultural perspective,

349–352

relationship between therapist

and client, 341–342, 482

shortcomings, 351–352

strengths, 349–351

therapeutic goals, 340, 478

therapeutic process, 340–342

therapeutic techniques and

procedures, 342–349, 485

therapist’s function and role, 341

REBT. See Rational emotive behavior

therapy

Reframing, 378

Regression, 68, 74

Rehearsal e

xercise, 230–231

Relabeling, 378

Relapse prevention, 314

Relatedness, 150–151

Relational-cultural theory, 368

Relational Gestalt therapy, 212

Relational model, 86–87

Relationship, 113–114, 445–446

Relationship therapy, 435

Relationships, dual, 48

Relationships, multiple, 48–50

Relationships, nonprofessional, 48

Relaxation, 260, 300

Religion, integration of spirituality

and, 469–471

Reorientation, 118

Repression, 67

Research, 199

Resistance, 81–82, 144, 227,

218–219, 227

Responsibility, 32, 176, 212, 339

Restructuring, 294

Retroflection, 218

Reversal exercise, 229

Revised decisions, 515–516

Role confusion, identity

versus, 71

Role playing, 300

Scaling questions, 407

Schema, 310

School age, 71

Search for meaning, 151–152

Second child, 108

Copyright 2011 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).

Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

534

SUBJECT INDEX

Self- acceptance, 213

Self-actualization, 165, 177, 179

Self-awareness, 38, 73, 109,

146–147, 177

Self-care, 34

Self-concept, 180

Self-consciousness, 164

Self-defeating behavior, 216

Self-defeating beliefs, 29

Self-disclosure, 28–29, 158, 376, 385

Self-efficacy, 249

Self-evaluation, 346–347, 354

Self-exploration, 22, 177

Self-instructional training, 311

Self-management, 265

Self-monitoring, 34, 265

Self-observation, 311

Self-psychology, 86

Self-understanding, 117–118

Self-worth, 107

Sensation, 267

Separation-individuation, 88

Shadow, 85

Shame and doubt, autonomy

versus, 70

Shame-attacking exercises, 300

Sibling relationships, 107–109

Significance, 105–106

Silence, 30

Skills acquisition and consolidation

phase, 313

Skills and intervention strategies, 26

Social action, 379

Social constructionism, 397–399

Social interest, 106, 109

Social learning approach, 249

Social skills training, 263–265

Socialist feminists, 365

Socialization, 179

Solution-focused brief therapy,

400–410, 442

Spirituality and religion, integration

of, 469–471

Spiritual dimension, 517–518

Stages of development, 87–89

Stagnation, generativity versus, 71

Stan, case of

Adlerian therapy, 125–126

behavior therapy, 276–277

cognitive behavior therapy,

318–319

existential therapy, 162–163

family systems therapy, 452–455

feminist therapy, 382–384

gestalt therapy, 234–236

integrative approach, 503–521

person-centered therapy, 196–197

postmodern approaches, 421–423

psychoanalytic therapy, 92–93

reality therapy, 352–353

Storied lives, 398

Stories, role of, 410–411

Stress inoculation training, 312–314

Structural-strategic family therapy,

440–441

Student-centered teaching, 175

Subjective empathy, 184

Subjective interview, 114

Sublimation, 68

Suggesting tasks, 408

Superego, 65–66

Superiority, 105–106

Symbiosis, 87

Systematic desensitization,

258–260, 300

Systematic integration, 476

Systemic therapy, 436

Systemic viewpoints in family

systems therapy, 443–444

Technical eclecticism, 266

Technical integration, 466

Techniques, therapeutic, 33

Terminating, 408

Termination, 518–519

Theoretical approaches

Adlerian therapy, 101–135, 472,

477, 486, 488–489, 491, 493

behavior therapy, 244–286,

472, 478, 486, 488, 490,

492, 494

cognitive behavior therapy,

287–332, 472, 478, 487–488,

490, 492, 494

existential therapy, 136–171, 472,

477, 486, 488, 490–491, 494

family systems therapy, 432–461,

473, 478, 487, 489, 491, 493,

495

feminist therapy, 360–394,

473, 478, 487, 489–490,

493, 494

gestalt therapy, 210–243, 472,

477, 486, 488, 490, 492, 494

integrative perspective, 464–502

person-centered therapy,

172–209, 472, 477, 486, 488,

490, 492, 494

postmodern approaches,

395–431, 473, 478, 487,

489–490, 493, 495

psychoanalytic therapy, 62–100,

472, 477, 486, 488–489,

491, 493

reality therapy, 333–359,

473, 478, 487, 489–490,

492, 494

Theoretical integration, 466

Therapeutic core conditions, 182

Therapeutic relationship, 34, 226,

405, 413–414, 481–482,

504–505

Therapeutic techniques, 33

Therapist feedback, 407–408

Therapy, personal, 20–22

Total behavior, 337

Transference, 73, 75–76, 82,

339, 355

Triangulation, 438

Trust versus mistrust, 7

0

Unconditional other acceptance, 295

Unconditional positive regard,

182–183

Unconditional self-acceptance, 295

Unconscious, 65–66, 79, 231

Unconscious, collective, 84

Unfinished business, 216–217

Value imposition, 23

Values, 22–24, 43, 151, 176, 272

Visitor, 405

Wants, 344–345

WDEP system, 344–348

Wellness, 34

Working-through, 75

You talk, 221

Young adulthood, 71

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

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