Counseling and therapy: concepts and practices

Counseling Models REVISED

CHART OF TYPES OF THERAPY

TYPE / / GOAL / / THERAPEUTIC RELATIONSHIP / / TECHNIQUES

Psychoanalytic. / / "To Turn Neurosis into Ordinary Unhappiness" / / Silent, occasionally venturing an interpretation, therapist as "one who knows" / / Dream analysis, attention paid to early childhood development and relations with parents

Adlerian. / / Encourage client's premises and goals / / Collaborative relationship / / Focuses on feelings of self that arise from relationships and conflicts

Existential Therapy / / Self-mastery, self-examination, creativity, client accepting responsibility for self / / Therapist as person, emphasis on quality of therapist-client relationship / / Not a technique-oriented therapy but instead a philosophical approach

Person-Centered Therapy / / Increased self-esteem and greater openness to experience / / Neutral and non-hierarchical and empathetic / / Restatement of client's statements in neutral language, unconditional positive regard, empathy

Gestalt Therapy / / Client awareness of self, environment, relation to others / / sharing client experience, giving feedback, a dialogue relationship without manipulation / / Internal dialogue exercises, guided fantasies

Cognitive-Behavior Therapy / / Goal and problem oriented, objective is for client to gain control of reaction to things by changing thoughts patterns / / Collaborative / / Homework, workbooks, self-observation of personal behavior and thoughts

Reality Therapy / / Learn better ways to fulfill basic needs and connect with people the client wants in his/her world / / Gets client to be specific about desired changes in life / / emphasis on choices made by client and how client can attain positive goals

Family Systems Therapy / / Understand client within context of larger family system / / will often treat client as part of larger system, focused on understanding the "homeostasis" of the system / / Reframing or redescribing problems, recognition that any change will necessitate a change in the entire system

Of the different therapeutic models presented by Corey in Table 1.1, the three that most intrigue and appeal to me are the traditional Psychoanalytic model, the Existential (or Reality Therapy) model, and Family Systems Therapy (9-10).

Traditional Psychoanalysis still exerts a strong fascination upon us, and certainly for those who are my age it represents -- for better or worse -- the first experience many of us had of an intellectual "theory of mind" in the form of Sigmund Freud's various obsessions. It is, of course, important in the twenty-first century to separate out Psychoanalysis as a model for therapeutic procedure from wholesale Freudian theory. There are not many people who would still defend some of Freud's more bizarre ideas, like "penis envy." But the simple fact is that the emphasis placed by psychoanalysis on "unconscious motives" (in Corey's words) as a means to understanding the self is something that still holds a large appeal for the imaginations of many of those seeking help (455). There is a lot about traditional Freudian psychoanalysis that has now proven itself to be dubious science at best and downright dangerous at worst: for instance, Freud's bizarre emphasis on the incestuous attraction of the Oedipus Complex as being the central fact of the male psyche. It is possible to assume a man's early relationship with his parents is an important determinant without dragging the idea of incest into the discussion. But the chief reason for my own lasting interest in the psychoanalytic model lies in its early description as "the talking cure." This is a model of therapy which proposes that the conversation between client and analyst -- particularly when the analyst withholds comment and interpretation -- can in and of itself be therapeutic. I think that basic notion is correct, and I'm fascinated with the history of psychoanalysis as a means of achieving cures for hysterical illnesses, for example.

The Reality Therapy or Existential model for therapy also interests me because it is more proactive. Also Corey notes the influence of Irving Yalom on this school, and I am already familiar with Yalom's name as a proponent of group therapy and also as the author of popular case histories of clients achieving success in therapy (10). However the basic description of Existential analysis also fits most closely with the sort of therapeutic work that I envision doing as a life coach. To place an emphasis on choices and actions made by a client -- and to tease out the deeper unconscious motivations behind those choices and actions -- seems to me a pretty obvious way to help people who are struggling with the ordinary forms of discomfort and distress in contemporary society. The simple fact is that most people who are anticipating a career change are not going to want to engage in elaborate Freudian examination of their reactions to maternal abandonment in pre-school, or the like. This seems to be a form of rigorous accounting for the client's own involvement in what he or she is seeking help for. The emphasis on "choice" made in Reality Therapy -- typical of Existentialism as a school of thought -- seems to offer a clear and distinct way for therapy to make a difference in the client's future life after therapy (456).