Counseling session practices and approaches

Egan Model

Counseling and the Egan Model: A Case Study

Part A While I apply many of the techniques and tools which are common to the Egan model, I believe that my approach to counseling is somewhat of an eclectic mix of several different styles, applied as is necessary to the client that I am meeting at the time. I do not believe that there is one-size-fits all approach to counseling and that it is possible to apply the tenants of any one counseling program to every patient. This class has shown me that there is another very good tool for me in my counseling toolbox and that is the Egan model. I believe that my model of counseling is based upon several different schools of thought.

As previously stated, I plan to use the Egan model, especially in that patient who has relatively good insight and needs some help finding their way in solving their problems and finding new opportunities for themselves. This is directly in line with Egan's basic theories as noted in "The Skilled Helper." I find that Egan is very helpful, especially in those clients who have lost sight of clear goals in their lives, since the Egan model bases many of its tools on the empowerment of the individual. This model will also be very helpful in the times in which I am helping the client make difficult decisions, such as moving on from a difficult or unfruitful relationship or changing a job. I will use this tool in order to help people discover what is important to them in their lives, making sure that I am leading them and not telling them. I think the Egan model is particularly helpful in clients who are still in the early stages of personality development, especially younger people. The Egan model helps the patient work on things that are in the very recent past or in the present. It is not a tool for someone in great trauma, but instead gives the relatively psychologically intact client a map to move toward stated goals. I like the fact that it has been stated that the Egan model and the mentoring role are not synonymous, but rather the Egan model can be used in many different situations, some of which have nothing to do with mentoring at all. Again, I realize that the Egan model is generally the most effective when I comply with the core values of addressing the client with respect, empathy and of course very active listening.

The Egan model is not the only tool that I use in my counseling practice. As the Hutchens model itself describes, there is no one single style of counseling that is enough when the therapist is assisting the wide range of clients which we may expect to see in our every day practices. Hutchens' "thinking-feeling-acting" model is another good tool which I can use in my practice. I agree with Hutchens in that not only is therapy a corrective emotional experience, but that it is an educational experience for both the client and the therapist as well, and that once the counselor is able to identify what will be the best approach to the patient, he or she will be able to use every skill at his or her command to help the client meet therapy goals. The biggest problem exists when the counselor either does not have enough of a repertoire of counseling skills to have one which will apply adequately for what the patient needs, or else that the counselor tries to use a counseling style which does not fit either the client or the problem itself. Many models, to include the TFA, are based on the basic assumption that people are oriented in a particular way. In the TFA model, it is that the client is a thinker, a feeler or an actor. When there is an imbalance in all three of these orientations, the client will tend to use one response over the other two. I feel that like Egan it is useful to use the TFA model since, once the counselor has a good idea about the client and his or her part history, the counselor is then able to find out the order in which counseling issues may be most effectively dealt with in the counseling relationship. The client does not have to adapt to the counselor style, but rather the reverse is true.

I feel that in my practice, I use a faith based therapy which has been useful in the past as another modality in which I can help a wider variety of clients. The faith-based model does not always have to be used by a religious counselor but has found a place within the secular world as well. In faith based therapy, the emphasis is on choices and empowerment, somewhat in the way that the Egan model uses empowerment, and allows that people feel strongly about what they believe but generally act by what they choose to do. Faith based therapy is somewhat different in that is explains behavior in ways which explains that the client does what he or she does because of a choice, but many times those choices are based upon a faulty reality. The counseling relationship in a faith based therapy uses spirituality to allow the client to understand that the counselor is there to help the individual make better choices, but only if they can base those choices on reality. Obviously this style of counseling requires a relatively oriented and insightful individual, or at least an individual who has the facility to be so. In faith-based counseling sessions, I am able to help the client discover what it is that he or she believes, and how that applies to their feelings, thoughts and actions. Then we review what it is the client wants out of life and see if there is a schism between the thoughts and actions and the ultimate goal that the client states. It is also important in this style of therapy, as it is with the others, that the client is stating a true life goal, and not something that the client thinks the counselor or a family member would want to hear. If the stated goal in any of these modalities of therapy is not truly what the client desires, then the work toward the goal will be false, since the client will not truly desire empowerment for something they do not truly desire. Faith-based sessions are generally short interventions, but can be unusually helpful, especially in the patient who has been resistant to other elements of therapy but has a strong faith or desires a strong faith. For some reason some patients find it easier to deal with mental health issues as part of a larger spiritual problem, feeling that is more acceptable than being labeled as a "mental health" patient. Faith bases therapy requires slightly more emotional input from the counselors than some of the other modes of therapy that I use especially in the application of emotional input and the presentation to the client of belief choices that are based upon truth and the discovery of areas which can hinder recovery for this client. Still it can be very useful in a select population.

I feel that a combination of many different therapeutic styles will be helpful to me in treating my clients. The more education I have, the more skills I am able to attain, the better a counselor I will be and the greater number of patients I will be able to serve. I would be very unhappy should I only be able to tailor my practice to one type of patient simply because I only had one type of counseling strategy. That is why classes such as these are so helpful for me in that I can use every tool in my toolbox to help my patients.

Part B - Client Information and Case Study

Sara is a 21-year-old Caucasian female referred to me in my clinic by her family physician.

Sara has been attending a local four-year university with a major in business management. She will graduate from college this semester and is making her plans to move away from the local area and get on with her life. She reports that college has been hard for her, she has had to work hard to keep her grades up to a point that her parents will find acceptable. She admits that she is very excited about the prospect of starting a new life, but understands that this will require a significant amount of change and decision for her. Once she graduates, it is likely she will have to move at least a short way from her home, and this would not be in commuting distance from her home town. While her parents have been strict with her, she states that they have always been fair and that she feels that her relationship with them is close. Sara expresses significant concern regarding finding a job, leaving her family and leaving her friends. While she enjoyed her studies in business she is not exactly sure how she can apply this to her daily life. She is also somewhat ambivalent about wanting to work in the business world, and wonders if she should try to find a position that she would find more emotionally and personally fulfilling. Sara is not involved in a romantic relationship at this time but does have a small but very close circle of friends, all of whom are moving to different places. Sara expresses sadness at the thought of leaving her friends, and concern that she will be able to keep up with them after college is over. She is also concerned that she will not be able to make friends in her new setting. Sara is an intelligent woman who appears to have done well in school and has potential to get a good job. It is interesting that she is able to express several emotions such as ambivalence and sadness and concern, but appears surprised when we go through some of the signs and symptoms of anxiety and she is able to identify most of the symptoms of anxiety more days than not.

The majority of the first session with Sara was spent in active listening on the part of this counselor. I tried to compare her behaviors, key experiences and behaviors. The history she gave was congruent with her stated goals. I used the end of the first session to use the technique of empathetic highlighting, restating to Sara what I believed she had told me and asking her to verify if my perception was correct. I used probing questions to move more into the areas of feelings, which Sara did not cover in depth, and eventually was able to uncover that Sara was experiencing a significant degree of anxiety surrounding the present and the future. At the end of the first session I asked Sara if she felt capable of working with me on forming some goals on which she could work to both identify her primary concerns and areas on which she wanted to work. Applying the Egan model to Sara, we were able to identify the following issues that she wanted to work on in therapy:

Goal #1 Sara states she wants to find a good and respectable job, by her own and by her parents' standards.

Goal #2 Sara wants to maintain an active social life, somewhat like she had while she was in college.

Goal # 3 Sara wants to see reduction in the degree of anxiety she is experiencing surrounding life changes.

I asked Sara if she could contemplate these goals in the week between our next session, and see if she could come up with any useful plans which we could implement to help her reach these goals. Sara felt that she could. We wrote the goals down on a piece of paper.

In our second session Sara seemed much more relaxed in her interactions with me. She had spent a lot of time thinking about the goals we had identified at her last session. She was particularly interested in addressing her symptoms of anxiety and was able to share with me that she felt that anxiety had been a problem with her for a long time, but that she had never actually been able to identify it. She had spent a significant amount of time reviewing her feelings over the last week and had seen how so many times her anxiety had shaped her mood or actions. She had been very diligent in thinking about her goals over the week, and we discussed her plans to meet each goal.