Freud and His Successors

Modern psychological therapies trace their history back to the work of Sigmund Freud in Vienna in the
1880s. Trained as a neurologist, Freud entered private practice in 1886 and by 1896 had developed a method
of working with hysterical patients which he called ‘psychoanalysis’. Others such as Alfred Adler, Snador
Ferenczi, Karl Abraham and Otto Rank were also analysed by Freud and had brief apprentice-type training
from him before becoming psychoanalysts in their own right.

In the early 1900s, Ernest Jones and A.A. Brill, from the UK and US respectively, visited Freud in Vienna
and returned to their own countries to promote Freud’s methods; Freud himself began a lecture tour of North
America in 1909. Gradually many such as Ferenczi, Adler, Rank, Stekel and Reich began to develop their
own theories and approaches, which sometimes differed markedly from Freud’s. Jung in particular, a close
collaborator of Freud’s from 1907-1913 who was in some sense ‘groomed’ as Freud’s intellectual successor,
eventually split from Freud and pursued the development of his own school of analytical psychology,
drawing heavily on both Freud’s and Adler’s ideas. All these immediate descendants of Freud’s approach are
characterized by a focus on the dynamics of the relationships between different parts of the psyche and the
external world; thus the term ‘psychodynamics’.

A separate strand of psychological therapies developed later under the influence of psychology and learning
theory and leading thinkers such as B.F. Skinner. Rejecting the notion of ‘hidden’ aspects of the psyche
which cannot be examined empirically (such as Freud’s rendition of the ‘unconscious’), practitioners in the
behavioural tradition began to focus on what could actually be observed in the outside world.

Finally, under the influence of Adler and Rank, a ‘third way’ was pioneered by the US psychologist Carl
Rogers. Originally called ‘client-centred’ and later ‘person-centred’, Rogers’s approach focuses on the
experience of the person, neither adopting elaborate and empirically untestable theoretical constructs of the
type common in psychodynamic traditions, nor neglecting the internal world of the client in the way of early
behaviourists. Other approaches also developed under what came to be called the ‘humanistic’ branch of
psychotherapy, including Gestalt therapy and the psychodrama of J.L. Moreno. The figure below illustrates
some of the historical links between these three main strands which developed from Freud’s original
contributions.
The Medical vs. Non-Medical Split
Freud strongly supported the idea of lay analysts without medical training, and he analysed several lay people
who later went on to become leading psychoanalysts, including Oskar Pfister, Otto Rank and his own
daughter Anna Freud. He published two staunch defenses of lay analysis in 1926 and 1927, arguing that
medicine and the practice of analysis were two different things. When Ernest Jones brought psychoanalysis
to the UK in 1913, he followed Freud’s preferences in this area, and the tradition of lay involvement
continues to this day in the UK, where most psychoanalysts, psychotherapists and counsellors have a lay
background.

In the US, however, Freud’s analysand A.A. Brill insisted that analysts should be medically qualified — even
though there were already many lay analysts practising in the US who, like Brill, had trained with Freud in
Vienna. Brill prevailed, however: in 1926 the state of New York made lay analysis illegal, and shortly
thereafter the American Medical Association warned its members not to cooperate with lay analysts. To this
day, almost all US psychoanalysts are medically qualified, and counsellors typically study psychology as
undergraduates before becoming counsellors.

The Counselling vs. Psychotherapy Divide

It was largely in response to the US prejudice against lay therapists that Carl Rogers adopted the word
‘counseling’, originally used by social activist Frank Parsons in 1908. As a psychologist, Rogers was not
originally permitted by the psychiatry profession to call himself a ‘psychotherapist’. Ironically, Rogers
himself became renowned as one of the most influential empirical scientists in the fields of psychology and
psychiatry, introducing rigorous scientific methods to psychology and psychotherapy that psychoanalysts
themselves had long resisted (and, in the view of many, still largely resist today). He became a joint
Professor in the Departments of Psychology and Psychiatry at the University of Wisconsin as well as Head of
the Psychotherapy Research Section of the Wisconsin Psychiatric Institute.

In the field as it now stands, the argument as to whether counselling differs significantly from psychotherapy
is largely academic. Those from psychodynamic traditions sometimes equate ‘psychoanalysis’ and
‘psychotherapy’ — suggesting that only psychoanalysts are really psychotherapists — but this view is not
common anywhere else. Others use ‘psychotherapy’ to refer to longer-term work (even though some
psychotherapists offer brief therapy) and ‘counselling’ to refer to shorter term work (even though some
counsellors may work with clients for years). The two terms are commonly used interchangeably in the US,
with the obvious exception of ‘guidance counseling’, which is often provided in educational settings and
focuses on career and social issues.

Counselling and Psychotherapy Today

Modern counselling and psychotherapy have benefited tremendously from the empirical tradition which was
given such impetus by Carl Rogers, even though the research agendas of psychology and counselling have
diverged greatly over the last half century. Additional work in cognitive psychology, learning theory and
behaviour has informed many therapeutic approaches. The richness of the bodies of both empirical and
theoretical work which are now available, coupled with the raw complexity of human beings, has led to a
profusion of different approaches to the field. By some accounts, the different strands of counselling and
psychotherapy now number in the hundreds. Mainstream approaches, however, are much fewer in number,
and over time it is likely that many of the less well-grounded schools of thought will fade away, while more
new ones will emerge to take their place. While the main approaches continue to develop, and others appear
and then fade away, clients are left to choose for themselves what might be best for them. Hopefully the
information provided by this site (incomplete though it very definitely is!) will be of some help in this
process.

Overall Effectiveness vs. Individual Effectiveness

Research evidence about the effectiveness of counselling and psychotherapy overall is relatively
unambiguous: counselling does work. For a wide range of types of psychological distress, both subjective
client reports and more objective measurements indicate that counselling and psychotherapy are effective,
both in the short term and over longer time periods. For certain kinds of psychological distress, such as
depression, some evidence also suggests that the benefits of counselling can interact positively with
medications such as anti-depressants: in other words, counselling and medication together sometimes offer
better results than either counselling or medication on their own.

What is more ambiguous, however, is the research evidence on the effectiveness of specific types of
counselling or psychotherapy. Overall, no one therapeutic approach stands out as offering better results than
any other. (However, evidence from efficacy studies is gradually accumulating to indicate that some kinds of
distress are particularly well addressed by certain approaches; clients with panic disorders, for instance, often
respond particularly well to cognitive behavioural therapy.) At first glance, it might seem that this failure to
discriminate between therapeutic approaches in terms of overall effectiveness could be attributed simply to
the fact that different people will respond in their own ways to different types of counselling: if clients
choose the 'right' or 'wrong' types of therapy only by accident, this might result in particular types offering
good results in some areas and bad results in others, with the overall result that no one type of counselling
would stand out. But because studies are typically designed to detect and isolate these types of regularities,
we know that random choice about therapy type does not, by itself, provide a sufficient explanation of the
evidence.

While no one type of therapy stands out in terms of overall effectiveness, however, individual counsellors
clearly do. Within given approaches, research shows very significant variation between individual
counsellors. Indeed, the evidence suggests that the abilities of individual therapists may be a more significant
factor in determining outcome than therapeutic orientation! So there may not be a clear answer to the
question of whether there are better or worse therapeutic orientations, but there certainly are better and worse
therapists. Pinning down exactly why this is so -- exactly what kinds of factors account for the variation in
individual results -- is much more difficult. The research evidence cannot yet help the client to understand
exactly why one therapist might be better or worse for them than any other. Worse, there is no evidence that
any of the various counsellor accreditation schemes serve to pick out better therapists, and neither years of
counsellor experience nor duration of their training have any strong bearing on therapeutic outcome. (Indeed,
some research has even suggested that counsellors in training and newly-qualified counsellors are more
effective than their more experienced peers!)

What Effectiveness Research Might Mean for Clients

If the aggregate effect of all main types of counselling and psychotherapy is positive, and if the individual
therapeutic approaches do not distinguish themselves clearly in terms of overall effectiveness, does this mean
that therapeutic orientation is irrelevant from an individual client's point of view? Definitely not!

While the quality of the relationship which a client can establish with a particular counsellor probably heads
the list of factors to consider when entering counselling, the match between an individual client's preferences
and a particular style of counselling remains extremely important. This match (or mismatch) can strongly
influence how the client feels about the process and the relationship and consequently bears on how easy it is
for that client to make progress. Virtually all relevant empirical studies agree that clients benefit more when
they are committed to working within the therapeutic approach offered in their particular counselling
environment -- and some studies suggest that client variables such as this account for about 40% of
therapeutic change, more than any other factors. A client who doubts whether a cognitive model adequately
represents their experience probably will find less benefit from cognitive or cognitive behavioural therapy,
while a client who would like their counsellor to give them a great deal of advice and instruction may not get
very much from person-centred counselling. By analogy, while it is probably possible to walk 5 miles in
shoes that are either much too big or painfully small or have too much traction or not enough, the right choice
of footwear can make it much easier to do so in comfort, enjoying the scenery along the way, and having
some energy left at the end. Likewise, many different kinds of shoes will do for such a walk, but some will
be a help while others may actually be a hindrance. Some time spent considering the different types of
counselling and psychotherapy available before embarking on a therapeutic journey will be time well spent.

As for the question of individual counsellor effectiveness, perhaps the most important lesson to be drawn
from the research is that clients should make up their own minds based upon their own experience with a
counsellor, rather than relying entirely on evidence such as paper qualifications, years of experience, or
recognition via professional accreditation schemes. (The section About Counselling and Psychotherapy
includes some suggestions both on finding counsellors and on selecting one.) Remember that the quality of
the relationship which the client can establish with the counsellor probably heads the list of factors
influencing therapeutic outcome, so at the end of the day, the client's judgement of this relationship probably
carries the most weight.
What Effectiveness Research Might Mean for Counsellors
One of the more pernicious conclusions occasionally drawn from the absence of evidence favouring any one
type of counselling or psychotherapy over any other is that individual counsellors needn't concern themselves
very much with orientation. This line of thought seems to go along with a kind of 'therapeutic relativism'
which suggests that everything has its value, and no way of working with a given client is really better than
any other. Similarly, one sometimes hears the view expressed that critically evaluating the theoretical
differences between approaches is unimportant, and one can just be entirely pragmatic: do what works.
Perhaps the most defeatist approach is that there is just no point learning about various therapeutic
approaches, given that none has ever demonstrated a clear overall advantage over others.

There are good reasons for rejecting each of these responses. First among them is that there is no justification
for inferring from the evidence that a specific individual client (as opposed to the aggregate set of all clients)
will be helped just as much by one approach as by any other. We don't yet have the evidence to answer
unambiguously the question of what works for which types of clients, but that doesn't relieve the counsellor
of the responsibility to consider what will work for his or her specific clients. Moreover, the absence of
evidence about overall differences in effectiveness does not imply that there are no differences in how to be
effective. (Indeed, there patently are differences in counsellor effectiveness, but research has yet to separate
out the most relevant variables at work.) The same is true of why a given approach or counsellor is effective.
In fact, some theorists and researchers have gone to considerable effort to account for the success of a given
approach in terms of what it might accomplish in light of the theoretical model espoused by another. There
may be considerable benefits for the client (not least among them, speed and cost) if the counsellor is
effective because he or she is getting it 'right' by design, rather than by accident.

(As one example of accounting for the success of one approach in terms of another, the cognitive therapist --
and former psychoanalyst -- Aaron Beck provides convincing arguments in terms of cognitive therapy for
why the therapeutic interventions of a psychoanalyst might have a successful outcome; the cognitive
explanation is entirely consistent with the falsity of psychoanalytic theory. In other words, the psychoanalyst
might be acting on an entirely mistaken view of the client's psychology, yet these misguided interventions
might inadvertently hit right on target in terms of eventual outcome.)

The response that counsellors should just be pragmatic, doing what works, is actually very credible. But even
here, it is difficult to see how a counsellor could just do what works without some grasp of the theoretical
underpinnings of whatever overall approach or technique he or she might be inclined to employ with a given
client. It is preferable for the client if any suggestions from the counsellor that a particular approach might be
helpful are made on the basis of some informed view of why it might work: a counsellor's suggestion of a
particular way of working should not be made by default, it should be both deliberate and informed. In other
words, it may be true that one should 'do what works', but doing that requires some effort to understand and
evaluate underlying theory.

One last curious conclusion about the evidence is worth addressing. Namely, some proponents of person-
centred theory suggest that it is unsurprising that different therapeutic orientations do not differ in terms of
aggregate effectiveness. They suggest that only individual therapists who manifest the 'core conditions' of
person-centred theory will be effective, and that anyone from any orientation could do a good job of offering
the core conditions. The evidence does not support this conclusion: these conditions have been researched
along with many others, and there is no evidence to suggest that success can be picked out just by looking at
the core conditions. (It is entirely possible that the view is true, but for now it remains an item of faith, not a
conclusion correctly derived from reliable empirical evidence.) Moreover, if it were true, it would imply an
interesting conclusion which person-centred proponents would presumably find unpalatable: namely, that
counsellors who successfully manifest the core conditions are no more likely to be found in the ranks of the
person-centred tradition than within any other therapeutic tradition. In other words, it would imply than
person-centred counsellors are no more likely to be person-centred than any other type of counsellor.

Finally, all this might strike some practitioners as being entirely tangential to their own take on counselling
and psychotherapy. For some, scientific research is irrelevant anyway, and even if the particular benefits of a
given approach became empirically evident, they would still prefer to maintain the purity of their own
particular therapeutic orientation and their own ways of dealing with individual clients. (One psychologist
wrote that "one can no more argue someone out of a counselling model by advancing empirical evidence
than one could argue them out of a religious belief".) One way of getting at whether there is any tension in
this view -- and there needn't necessarily be any at all -- is by way of a question which is worth asking for
any counsellor: what would it take to convince you that you are approaching a given client in the wrong
way? The client telling you so? A scientific study? The client telling you so twenty times? Twenty scientific
studies? Alternatively: what would it take to convince you that a given client would benefit more from
something other than what you are doing?

These questions will probably be answered differently by every counsellor or psychotherapist.

Further Reading on the Effectiveness of Counselling and

Psychotherapy
The Annotated Bibliography contains pointers to additional literature in this area. Probably the single best
source of specific research data on the effectiveness of counselling and psychotherapy is Bergin and Garfield
(1994). In that volume, Lambert and Bergin (1994) include useful results on individual counsellor
effectiveness, while Beutler et al. (1994) cover cross-study correlational data indicating that levels of
experience and therapist training are almost irrelevant to therapeutic outcome. The data on client variables'
contribution to therapeutic change come from Asay and Lambert (1999). Seligman (1995) comments on the
1995 Consumer Reports survey on the effectiveness of psychotherapy and clearly explains the distinction
between controlled efficacy studies and the less-stringent effectiveness study.

UK readers especially may be interested in the Department of Health's treatment guidelines, which
summarize some of the available data about best matches between specific types of psychological distress
and specific types of therapy. See Beck (1976) for details of the comparisons mentioned above between
psychoanalysis and cognitive therapy. The psychologist quoted above on counselling models and religious
beliefs is Legg (1998), p. 4.

This section provides 'critical engagements' with different types of counselling and psychotherapy, or with
specific theoretical or practical issues on which different types of counselling disagree.

Critical engagements explore therapeutic approaches in considerably more depth than the overviews
of individual types of counselling included here separately. The first article in this series highlights the
strengths and weaknesses of each of two approaches as seen from the viewpoint of the other, as well as from
the author's own individual perspective. The hope is that by setting each of these three perspectives off
against the others, some creative synthesis will occur which -- while not necessarily representative of the
views of anyone else at all -- might at least serve to stimulate thought about the two approaches considered as
well as about other individuals' therapeutic practice or experiences as a client.
Click to read the critical engagement comparing existential and person-centred approaches.

Typically more academic in nature than other materials on this site, critical engagements assume some
familiarity with the types of counselling being considered. They are written with a slightly more formal tone,
and they dispense with the gender-neutral grammatical liberties taken elsewhere on the site, favouring
grammatical correctness instead.

Underlying Theory of Cognitive Therapy

The central insight of cognitive therapy as originally formulated over three decades ago is that thoughts
mediate between stimuli, such as external events, and emotions. As in the figure below, a stimulus elicits a
thought — which might be an evaluative judgement of some kind — which in turn gives rise to an emotion.
In other words, it is not the stimulus itself which somehow elicits an emotional response directly, but our
evaluation of or thought about that stimulus. (Some practitioners use Ellis’s ABC model, described in the
section on rational emotive behaviour therapy, to describe the role of thoughts or attitudes mediating between
events and our emotional responses.) Two ancillary assumptions underpin the approach of the cognitive
therapist: 1) the client is capable of becoming aware of his or her own thoughts and of changing them, and 2)
sometimes the thoughts elicited by stimuli distort or otherwise fail to reflect reality accurately.

A common ‘everyday example’ of alternative thoughts or beliefs about the same experience and their
resulting emotions might be the case of an individual being turned down for a job. She might believe that she
was passed over for the job because she was fundamentally incompetent. In that case, she might well become
depressed, and she might be less likely to apply for similar jobs in the future. If, on the other hand, she
believed that she was passed over because the field of candidates was exceptionally strong, she might feel
disappointed but not depressed, and the experience probably wouldn’t dissuade her from applying for other
similar jobs.

Cognitive therapy suggests that psychological distress is caused by distorted thoughts about stimuli giving
rise to distressed emotions. The theory is particularly well developed (and empirically supported) in the case
of depression, where clients frequently experience unduly negative thoughts which arise automatically even
in response to stimuli which might otherwise be experienced as positive. For instance, a depressed client
hearing "please stop talking in class" might think "everything I do is wrong; there is no point in even trying".
The same client might hear "you’ve received top marks on your essay" and think "that was a fluke; I won’t
ever get a mark like that again", or he might hear "you’ve really improved over the last term" and think "I
was really abysmal at the start of term". Any of these thoughts could lead to feelings of hopelessness or
reduced self esteem, maintaining or worsening the individual’s depression.

Usually cognitive therapeutic work is informed by an awareness of the role of the client’s behaviour as well
(thus the term ‘cognitive behavioural therapy’, or CBT). The task of cognitive therapy or CBT is partly to
understand how the three components of emotions, behaviours and thoughts interrelate, and how they may be
influenced by external stimuli — including events which may have occurred early in the client’s life.
Therapeutic Approach of Cognitive or Cognitive Behavioural
Therapy
Cognitive therapy aims to help the client to become aware of thought distortions which are causing
psychological distress, and of behavioural patterns which are reinforcing it, and to correct them. The
objective is not to correct every distortion in a client’s entire outlook — and after all, virtually everyone
distorts reality in many ways — just those which may be at the root of distress. The therapist will make every
effort to understand experiences from the client’s point of view, and the client and therapist will work
collaboratively with an empirical spirit, like scientists, exploring the client’s thoughts, assumptions and
inferences. The therapist helps the client learn to test these by checking them against reality and against other
assumptions.

Often this process will continue outside the therapeutic session. For instance, a client whose fear of
dying in a car crash is causing them great anxiety when it comes time to drive to work might record on a slip
of paper their estimate of the odds of dying in a car crash at various points in the morning — when they first
get up, when they are nearly ready to leave the house, when they are almost to the car, and when they are
actually driving. (For someone experiencing such anxiety, these odds might go something like: 1,000 to 1
against when first getting up; 20 to 1 against when nearly ready to leave the house; 2 to 1 against when
almost to the car; 5 to 1 in favour of dying in a car crash when actually driving.) This can help the client to
see that their estimated odds of actually dying in a car crash are changing just as they move about the house
and complete the morning routine. This can be the first step toward making those estimates more realistic and
reducing the anxiety which accompanies the thought that one is very likely to die in a crash while driving.

Because of the interrelationship between thoughts, feelings and behaviours, therapeutic interventions
frequently involve the client’s behaviour. For instance, a client with a strong fear that squirrels will jump
onto their head if they walk under trees may go to great lengths to avoid walking under trees. This behaviour
will prevent the client from acquiring information that contradicts their thought that "if I walk under a tree, a
squirrel will jump onto my head" or perhaps their mental image of a squirrel jumping onto their head the
moment they step under a tree. The therapist may help the client to overcome this avoidance of walking
under trees as part of the process of correcting the distorted thought that walking under trees will lead to
squirrels jumping on the client’s head.

Throughout this process of learning, exploring and testing, the client acquires coping strategies as well as
improved skills of awareness, introspection and evaluation. This enables them to manage the process on their
own in the future, reducing their reliance on the therapist and reducing the likelihood of experiencing a
relapse.
Criticisms of Cognitive Therapy and CBT
On first hearing of the basic cognitive therapeutic approach, many people will observe that simply being told
that a view doesn’t accurately reflect reality doesn’t actually make them feel any better. They might say, "I
know squirrels aren’t likely to jump on my head, but I can’t help worrying about it anyway". But to suggest
that a cognitive therapist merely tells the client something is wrong is to caricature the approach (and, in fact,
few cognitive therapists would actually tell a client some view doesn’t reflect reality anyway; they would
help the client to explore whether it reflects reality). This would be like criticising the person-centred
approach on the grounds that a therapist merely telling a client they are free to discuss anything they like,
without judgement from the therapist, doesn’t make it feel any easier to talk about difficult problems.

A more salient criticism for some clients may be that the therapist initially may fulfil something of an
authority role, in the sense that they provide problem solving experience or expertise in cognitive
psychology. Some people may also feel that the therapist can be ‘leading’ in their questioning and somewhat
directive in terms of their recommendations.

Best Fit With Clients

Clients who are comfortable with introspection, who readily adopt the scientific method for exploring their
own psychology, and who place credence in the basic theoretical approach of cognitive therapy, may find
this approach a good match. Clients who are less comfortable with any of these, or whose distress is of a
more general interpersonal nature — such that it cannot easily be framed in terms of an interplay between
thoughts, emotions and behaviours within a given environment — may be less well served by cognitive
therapy. Cognitive and cognitive-behavioural therapies have often proved especially helpful to clients
suffering from depression, anxiety, panic and obsessive-compulsive disorder.

Further Reading on Cognitive Therapy

Our Annotated Bibliography includes pointers to additional reading on this and other therapeutic approaches.
The basic cognitive therapy framework is explained well by Beck (1976), and Trower, et al (1988) offer a
good introduction to the modern cognitive behavioural approach.

Underlying Theory of Rational Emotive Behaviour Therapy

Rational emotive behaviour therapy (‘REBT’) views human beings as ‘responsibly hedonistic’ in the sense
that they strive to remain alive and to achieve some degree of happiness. However, it also holds that humans
are prone to adopting irrational beliefs and behaviours which stand in the way of their achieving their goals
and purposes. Often, these irrational attitudes or philosophies take the form of extreme or dogmatic ‘musts’,
‘shoulds’, or ‘oughts’; they contrast with rational and flexible desires, wishes, preferences and wants. The
presence of extreme philosophies can make all the difference between healthy negative emotions (such as
sadness or regret or concern) and unhealthy negative emotions (such as depression or guilt or anxiety). For
example, one person’s philosophy after experiencing a loss might take the form: "It is unfortunate that this
loss has occurred, although there is no actual reason why it should not have occurred. It is sad that it has
happened, but it is not awful, and I can continue to function." Another’s might take the form: "This
absolutely should not have happened, and it is horrific that it did. These circumstances are now intolerable,
and I cannot continue to function." The first person’s response is apt to lead to sadness, while the second
person may be well on their way to depression. Most importantly of all, REBT maintains that individuals
have it within their power to change their beliefs and philosophies profoundly, and thereby to change
radically their state of psychological health.

REBT employs the ‘ABC framework’ — depicted in the figure below — to clarify the relationship between
activating events (A); our beliefs about them (B); and the cognitive, emotional or behavioural consequences
of our beliefs (C). The ABC model is also used in some renditions of cognitive therapy or cognitive
behavioural therapy, where it is also applied to clarify the role of mental activities or predispositions in
mediating between experiences and emotional responses.

The figure below shows how the framework distinguishes between the effects of rational beliefs about
negative events, which give rise to healthy negative emotions, and the effects of irrational beliefs about
negative events, which lead to unhealthy negative emotions.

In addition to the ABC framework, REBT also employs three primary insights:

1. While external events are of undoubted influence, psychological disturbance is largely a matter of
personal choice in the sense that individuals consciously or unconsciously select both rational beliefs
and irrational beliefs at (B) when negative events occur at (A)
2. Past history and present life conditions strongly affect the person, but they do not, in and of
themselves, disturb the person; rather, it is the individual’s responses which disturb them, and it is
again a matter of individual choice whether to maintain the philosophies at (B) which cause
disturbance.
3. Modifying the philosophies at (B) requires persistence and hard work, but it can be done.

Therapeutic Approach of Rational Emotive Behaviour

Therapy
The main purpose of REBT is to help clients to replace absolutist philosophies, full of ‘musts’ and ‘shoulds’,
with more flexible ones; part of this includes learning to accept that all human beings (including themselves)
are fallible and learning to increase their tolerance for frustration while aiming to achieve their goals.
Although emphasizing the same ‘core conditions’ as person-centred counselling — namely, empathy,
unconditional positive regard, and counsellor genuineness — in the counselling relationship, REBT views
these conditions as neither necessary nor sufficient for therapeutic change to occur.

The basic process of change which REBT attempts to foster begins with the client acknowledging the
existence of a problem and identifying any ‘meta-disturbances’ about that problem (i.e., problems about the
problem, such as feeling guilty about being depressed). The client then identifies the underlying irrational
belief which caused the original problem and comes to understand both why it is irrational and why a rational
alternative would be preferable. The client challenges their irrational belief and employs a variety of
cognitive, behavioural, emotive and imagery techniques to strengthen their conviction in a rational
alternative. (For example, rational emotive imagery, or REI, helps clients practice changing unhealthy
negative emotions into healthy ones at (C) while imagining the negative event at (A), as a way of changing
their underlying philosophy at (B); this is designed to help clients move from an intellectual insight about
which of their beliefs are rational and which irrational to a stronger ‘gut’ instinct about the same.) They
identify impediments to progress and overcome them, and they work continuously to consolidate their gains
and to prevent relapse.

To further this process, REBT advocates ‘selective eclecticism’, which means that REBT counsellors are
encouraged to make use of techniques from other approaches, while still working specifically within the
theoretical framework of REBT. In other words, REBT maintains theoretical coherence while pragmatically
employing techniques that work.

Throughout, the counsellor may take a very directive role, actively disputing the client’s irrational beliefs,
agreeing homework assignments which help the client to overcome their irrational beliefs, and in general
‘pushing’ the client to challenge themselves and to accept the discomfort which may accompany the change
process.

Criticisms of Rational Emotive Behaviour Therapy

As one leading proponent of REBT has indicated, REBT is easy to practise poorly, and it is from this that
one immediate criticism suggests itself from the perspective of someone who takes a philosophical approach
to life anyway: inelegant REBT could be profoundly irritating! The kind of conceptual disputing favoured by
REBT could easily meander off track into minutiae relatively far removed from the client’s central concern,
and the mental gymnastics required to keep client and therapist on the same track could easily eat up time
better spent on more productive activities. The counsellor’s and client’s estimations of relative importance
could diverge rather profoundly, particularly if the client’s outlook really does embody significant
irrationalities. Having said all that, each of the preceding sentences includes the qualifier ‘could’, and with a
great deal of skill, each pitfall undoubtedly could be avoided.

Perhaps more importantly, it would appear that the need to match therapeutic approach with client preference
is even more pressing with REBT than with many others. In other words, it seems very important to adopt the
REBT approach only with clients who truly are suitable, as it otherwise risks being strongly counter-
productive. On this point, however, it is crucial to realize that some clients specifically do appreciate exactly
this kind of approach, and counsellors who are unable or unwilling to provide the disputation required are
probably not right for those clients.

Best Fit With Clients

REBT is much less empirically supported than some other approaches: the requisite studies simply have not
been completed yet, and the relevant data points for determining the best match with clients are therefore thin
on the ground. However, one may envision clients responding particularly well who are both willing and able
to conceptualise their problems within the ABC framework, and who are committed to active participation in
the process of identifying and changing irrational beliefs (including performing homework assignments in
support of the latter). Clients will also need to be able to work collaboratively with a counsellor who will
challenge and dispute with them directly, and a scientific and at least somewhat logical outlook would seem a
pre-requisite. REBT would be less suitable for clients who do not meet one or more of the above. And as
hinted above in the section on Criticims, one might also speculate that clients who are already highly skilled
in philosophical engagement could find the approach less useful. (Perhaps REBT-style self help could be of
more benefit for such clients?)

Further Reading on Rational Emotive Behaviour Therapy

Our Annotated Bibliography includes pointers to additional reading on this and other therapeutic approaches.
The comment referenced in the section on Criticisms, on the easiness of practising REBT poorly, is due to
Dryden (2002b), p. 367; the notion of ‘selective eclecticism’ is due to Dryden (1987). Note that REBT is
closely related to cognitive therapy and is viewed by many as a subset of it.

Underlying Theory of Existential Counselling and Psychotherapy

Largely dispensing with psychological constructs and theories about personality, the existential approach
characterizes human beings as creatures of continual change and transformation, living essentially finite lives
in a context of personal strengths and weaknesses as well as opportunities and limitations created by their
environment. With attention given to this entire context of the client’s life, the existential approach is all
about exploring meaning and value and learning to live authentically — that is, in accordance with one’s own
ideals, priorities and values. Authentic living means being true to oneself and honest about one’s own
possibilities and limitations, continually creating one’s own identity even in the face of deep uncertainty
about everything in the future except for the eventual arrival of our own death. Authentic living means living
deliberately, rather than by default.

Psychological health, from an existential perspective, is characterized by an ability to navigate the

complexities of one’s own life, the world, and one’s relationships with the world. Disturbance, on the other
hand, is taken as the outcome of avoiding life’s truths and of working under the shadow of other people’s
expectations and values. Self deception about these factors provides a powerful psychological defense
mechanism. Existential counselling maintains that disturbance is an inevitable experience for virtually
everyone; the question is not so much how to avoid it as it is how to face it with openness and a willingness
to engage with life rather than a tendency to retreat, withdraw or refrain from responsibility.

Therapeutic Approach of Existential Counselling

The role of the existential therapist is really to facilitate the client’s own encounter with themselves, to work
alongside them in the job of exploring and understanding better the client’s values, assumptions and ideals.
The therapist is concerned to engage seriously with what matters most to the client, to avoid imposing their
own judgements, and to help the client to elucidate and elaborate on their own perspective, with an ultimate
view to the client’s being able to live life well and in their own way.
Great emphasis is placed on the therapist’s responsibility to be aware of — and to question — their own
biases and prejudices. The therapist must be self aware and able to set aside as much as possible their pre-
conceptions and to encounter the client’s world with an open mind. The therapist brings a sort of deliberate
naivete to the therapeutic relationship, with a goal of understanding the client’s meaning rather than their
own and recognizing the client’s assumptions and underlying life themes with a clarity which the client may
not yet be able to muster. The therapist will be sensitive to and help the client explore their weaknesses,
limitations and responsibilities as well as their strengths, opportunities and freedoms. Above all, they will
value the meaning which the client creates in their own emotions, thoughts, beliefs, and personal history.

In the course of exploring the client’s world, the therapist may appeal to a 4-part framework
encompassing the client’s existence in the physical dimension of the natural world, the body, health and
illness; the social dimension of public relationships; the psychological or personal dimension, where we
experience our relationship with ourselves as well as intimacy with others; and the spiritual dimension of
ideals, philosophy and ultimate meaning. Crucially, however, this framework of four dimensions is not
imposed on the client by the therapist; it simply informs the therapist’s understanding of the client’s world so
that, for instance, if a client never mentioned intimate relationships, the therapist would become aware of a
deficiency in their understanding of the client’s personal dimension.

The existential approach seeks clarity and meaning in all these dimensions and thus, in a sense, it begins with
a significantly broader view of human existence than those approaches which focus on specific psychological
mechanisms or which focus on the self as a meaningful entity, separable from its relations and interactions
with the surrounding world.

Criticisms of Existential Counselling

Although sometimes criticised for ‘intellectualizing’ the client’s life situation, this characterization is on
target only to the extent that reflection, self examination, and self awareness are ‘intellectual’ activities. As
one leading author puts it, "The approach is not about intellectualizing, but about verbalizing the basic
impressions, ideas, intuitions and feelings a person has about life".

Nonetheless, as discussed below, this quality of existential counselling means that it is perhaps more narrow
than some other approaches in terms of the client set whose concerns it can most successfully address. (Of
course this criticism cuts both ways, and many other approaches may be less able to help clients who
specifically approach life with something like the spirit favoured by existential counselling.)
Best Fit With Clients
Generally speaking, clients who view their problems as challenges of living, rather than symptoms of
psychopathology, and clients who are genuinely attracted to increasing self awareness and self examination,
will be well served by existential counselling. The approach will appeal to clients who are interested in the
search for meaning and in deeply personal philosophical investigations. The approach is well suited to those
who are attempting to clarify their own personal ideology and/or those who are facing significant personal
adversity or change; some existential practitioners suggest the approach is particularly appropriate for those
who feel at the very edge of existence, including those with terminal illnesses or who are contemplating
suicide, or perhaps those who are just beginning a new phase of life in some way.

Clients who are less inclined to examine and explore their personal assumptions and ideals, or who would
like to achieve immediate relief of specific psychological symptoms — as well as those who would like
advice or diagnosis from their counsellor — will probably find less value in existential counselling.

Unfortunately, a clear empirical picture of factors influencing efficacy in existential counselling has not yet
emerged in the research literature.

Further Reading on Existential Counselling

Our Annotated Bibliography contains pointers to additional reading on this and other therapeutic approaches.
One of the most accessible book-length treatments of this area is Emmy van Deurzen’s Existential
Counselling & Psychotherapy in Practice, which is reviewed here at this site. The quotation about existential
counselling and intellectualizing is from van Deurzen (2002b), p. 189.

A separate paper in the ‘Critical Engagements’ section of this site critically compares person-centred and
existential counselling.

By Substance Abuse & Mental Health Services Administration (SAMHSA)

Will You Be First? retweet

Are you interested in alternative approaches to mental health care? This guide from the US National Mental
Health Information Center may help to answer some of your questions and provides pointers to some
additional resources.

Article Contents

• Self-Help
• Diet and Nutrition
• Pastoral Counseling
• Animal Assisted Therapies
• Expressive Therapies:
o Art Therapy;
o Dance/Movement Therapy;
o Music/Sound Therapy
• Culturally Based Healing Arts:
o Acupuncture
 o Ayurveda
o Yoga/Meditation
o Native American Traditional Practices
o Cuentos
• Relaxation and Stress Reduction Techniques:
o Biofeedback
o Massage Therapy
o Guided Imagery or Visualization
• Technology-Based Applications:
o Telemedicine
o Telephone Counseling
o Electronic Communications
o Radio Psychiatry
• Where can I find more information?

What are alternative approaches to mental health care?

An alternative approach to mental health care is one that emphasizes the interrelationship between mind,
body, and spirit. Although some alternative approaches have a long history, many remain controversial. The
National Center for Complementary and Alternative Medicine at the National Institutes of Health was
created in 1992 to help evaluate alternative methods of treatment and to integrate those that are effective into
mainstream health care practice. It is crucial, however, to consult with your health care providers about the
approaches you are using to achieve mental wellness.

Self-help

Many people with mental illnesses find that self-help groups are an invaluable resource for recovery and for
empowerment. Self-help generally refers to groups or meetings that:

• Involve people who have similar needs

• Are facilitated by a consumer, survivor, or other layperson;
• Assist people to deal with a "life-disrupting" event, such as a death, abuse, serious
accident, addiction, or diagnosis of a physical, emotional, or mental disability, for
oneself or a relative;
• Are operated on an informal, free-of-charge, and nonprofit basis;
• Provide support and education; and
• Are voluntary, anonymous, and confidential.

Diet and Nutrition

Adjusting both diet and nutrition may help some people with mental illnesses manage their symptoms and
promote recovery. For example, research suggests that eliminating milk and wheat products can reduce the
severity of symptoms for some people who have schizophrenia and some children with autism. Similarly,
some holistic/natural physicians use herbal treatments, B-complex vitamins, riboflavin, magnesium, and
thiamine to treat anxiety, autism, depression, drug-induced psychoses, and hyperactivity.
Pastoral Counseling

Some people prefer to seek help for mental health problems from their pastor, rabbi, or priest, rather than
from therapists who are not affiliated with a religious community. Counselors working within traditional
faith communities increasingly are recognizing the need to incorporate psychotherapy and/or medication,
along with prayer and spirituality, to effectively help some people with mental disorders.

Animal Assisted Therapies

Working with an animal (or animals) under the guidance of a health care professional may benefit some
people with mental illness by facilitating positive changes, such as increased empathy and enhanced
socialization skills. Animals can be used as part of group therapy programs to encourage communication and
increase the ability to focus. Developing self-esteem and reducing loneliness and anxiety are just some
potential benefits of individual-animal therapy (Delta Society, 2002).

Expressive Therapies
Art Therapy:

Drawing, painting, and sculpting help many people to reconcile inner conflicts, release deeply repressed
emotions, and foster self-awareness, as well as personal growth. Some mental health providers use art
therapy as both a diagnostic tool and as a way to help treat disorders such as depression, abuse-related
trauma, and schizophrenia. You may be able to find a therapist in your area who has received special training
and certification in art therapy.

Dance/Movement Therapy

Some people find that their spirits soar when they let their feet fly. Others-particularly those who prefer more
structure or who feel they have "two left feet"-gain the same sense of release and inner peace from the
Eastern martial arts, such as Aikido and Tai Chi. Those who are recovering from physical, sexual, or
emotional abuse may find these techniques especially helpful for gaining a sense of ease with their own
bodies. The underlying premise to dance/movement therapy is that it can help a person integrate the
emotional, physical, and cognitive facets of "self."

Music/Sound Therapy

It is no coincidence that many people turn on soothing music to relax or snazzy tunes to help feel upbeat.
Research suggests that music stimulates the body's natural "feel good" chemicals (opiates and endorphins).
This stimulation results in improved blood flow, blood pressure, pulse rate, breathing, and posture changes.
Music or sound therapy has been used to treat disorders such as stress, grief, depression, schizophrenia, and
autism in children, and to diagnose mental health needs.

Culturally Based Healing Arts

Traditional Oriental medicine (such as acupuncture, shiatsu, and reiki), Indian systems of health care (such as
Ayurveda and yoga), and Native American healing practices (such as the Sweat Lodge and Talking Circles)
all incorporate the beliefs that:

• Wellness is a state of balance between the spiritual, physical, and mental/emotional

"selves."
• An imbalance of forces within the body is the cause of illness.
• Herbal/natural remedies, combined with sound nutrition, exercise, and
meditation/prayer, will correct this imbalance.

Acupuncture

The Chinese practice of inserting needles into the body at specific points manipulates the body's flow of
energy to balance the endocrine system. This manipulation regulates functions such as heart rate, body
temperature, and respiration, as well as sleep patterns and emotional changes. Acupuncture has been used in
clinics to assist people with substance abuse disorders through detoxification; to relieve stress and anxiety; to
treat attention deficit and hyperactivity disorder in children; to reduce symptoms of depression; and to help
people with physical ailments.

Ayurveda

Ayurvedic medicine is described as "knowledge of how to live." It incorporates an individualized regimen--

such as diet, meditation, herbal preparations, or other techniques--to treat a variety of conditions, including
depression, to facilitate lifestyle changes, and to teach people how to release stress and tension through yoga
or transcendental meditation.

Yoga/meditation

Practitioners of this ancient Indian system of health care use breathing exercises, posture, stretches, and
meditation to balance the body's energy centers. Yoga is used in combination with other treatment for
depression, anxiety, and stress-related disorders.

Native American traditional practices

Ceremonial dances, chants, and cleansing rituals are part of Indian Health Service programs to heal
depression, stress, trauma (including those related to physical and sexual abuse), and substance abuse.

Cuentos

Based on folktales, this form of therapy originated in Puerto Rico. The stories used contain healing themes
and models of behavior such as self-transformation and endurance through adversity. Cuentos is used
primarily to help Hispanic children recover from depression and other mental health problems related to
leaving one's homeland and living in a foreign culture.

Relaxation and Stress Reduction Techniques

Biofeedback

Learning to control muscle tension and "involuntary" body functioning, such as heart rate and skin
temperature, can be a path to mastering one's fears. It is used in combination with, or as an alternative to,
medication to treat disorders such as anxiety, panic, and phobias. For example, a person can learn to "retrain"
his or her breathing habits in stressful situations to induce relaxation and decrease hyperventilation. Some
preliminary research indicates it may offer an additional tool for treating schizophrenia and depression.

Guided Imagery or Visualization

This process involves going into a state of deep relaxation and creating a mental image of recovery and
wellness. Physicians, nurses, and mental health providers occasionally use this approach to treat alcohol and
drug addictions, depression, panic disorders, phobias, and stress.

Massage therapy

The underlying principle of this approach is that rubbing, kneading, brushing, and tapping a person's muscles
can help release tension and pent emotions. It has been used to treat trauma-related depression and stress. A
highly unregulated industry, certification for massage therapy varies widely from State to State. Some States
have strict guidelines, while others have none.

Technology-Based Applications
The boom in electronic tools at home and in the office makes access to mental health information just a
telephone call or a "mouse click" away. Technology is also making treatment more widely available in once-
isolated areas.

Telemedicine

Plugging into video and computer technology is a relatively new innovation in health care. It allows both
consumers and providers in remote or rural areas to gain access to mental health or specialty expertise.
Telemedicine can enable consulting providers to speak to and observe patients directly. It also can be used in
education and training programs for generalist clinicians.

Telephone counseling

Active listening skills are a hallmark of telephone counselors. These also provide information and referral to
interested callers. For many people telephone counseling often is a first step to receiving in-depth mental
health care. Research shows that such counseling from specially trained mental health providers reaches
many people who otherwise might not get the help they need. Before calling, be sure to check the telephone
number for service fees; a 900 area code means you will be billed for the call, an 800 or 888 area code means
the call is toll-free.
 Electronic communications

Technologies such as the Internet, bulletin boards, and electronic mail lists provide access directly to
consumers and the public on a wide range of information. On-line consumer groups can exchange
information, experiences, and views on mental health, treatment systems, alternative medicine, and other
related topics.

Radio psychiatry

Another relative newcomer to therapy, radio psychiatry was first introduced in the United States in 1976.
Radio psychiatrists and psychologists provide advice, information, and referrals in response to a variety of
mental health questions from callers. The American Psychiatric Association and the American Psychological
Association have issued ethical guidelines for the role of psychiatrists and psychologists on radio shows.

This fact sheet does not cover every alternative approach to mental health. A range of other
alternative approaches--psychodrama, hypnotherapy, recreational, and Outward Bound-type
nature programs--offer opportunities to explore mental wellness. Before jumping into any
alternative therapy, learn as much as you can about it. In addition to talking with your health
care practitioner, you may want to visit your local library, book store, health food store, or
holistic health care clinic for more information. Also, before receiving services, check to be sure
the provider is properly certified by an appropriate accrediting agency.

Why are traditional therapies used to treat mental illnesses?

Mental health professionals use a variety of approaches to give people tools to deal with ingrained,
troublesome patterns of behavior and to help them manage symptoms of mental illness. The best therapists
will work with you to design a treatment plan that will be most effective for you. This sometimes involves a
single method, or it may involve elements of several different methods, often referred to as an "eclectic
approach" to therapy.

Behavioral Therapy:

As the name implies, this approach focuses on behavior-changing unwanted behaviors through rewards,
reinforcements, and desensitization. Desensitization, or Exposure Therapy, is a process of confronting
something that arouses anxiety, discomfort, or fear and overcoming the unwanted responses. Behavioral
therapy often involves the cooperation of others, especially family and close friends, to reinforce a desired
behavior.

Biomedical Treatment:

Medication alone, or in combination with psychotherapy, has proven to be an effective treatment for a
number of emotional, behavioral, and mental disorders. The kind of medication a psychiatrist prescribes
varies with the disorder and the individual being treated.
Cognitive Therapy:

This method aims to identify and correct distorted thinking patterns that can lead to feelings and behaviors
that may be troublesome, self-defeating, or even self-destructive. The goal is to replace such thinking with a
more balanced view that, in turn, leads to more fulfilling and productive behavior.

Cognitive/Behavioral Therapy:

A combination of cognitive and behavioral therapies, this approach helps people change negative thought
patterns, beliefs, and behaviors so they can manage symptoms and enjoy more productive, less stressful lives.

Couples Counseling and Family Therapy:

These two similar approaches to therapy involve discussions and problem-solving sessions facilitated by a
therapist-sometimes with the couple or entire family group, sometimes with individuals. Such therapy can
help couples and family members improve their understanding of, and the way they respond to, one another.
This type of therapy can resolve patterns of behavior that might lead to more severe mental illness. Family
therapy can help educate the individuals about the nature of mental disorders and teach them skills to cope
better with the effects of having a family member with a mental illness-such as how to deal with feelings of
anger or guilt.

Electroconvulsive Therapy:

Also known as ECT, this highly controversial technique uses low voltage electrical stimulation of the brain to
treat some forms of major depression, acute mania, and some forms of schizophrenia. This potentially life-
saving technique is considered only when other therapies have failed, when a person is seriously medically ill
and/or unable to take medication, or when a person is very likely to commit suicide. Substantial
improvements in the equipment, dosing guidelines, and anesthesia have significantly reduced the possibility
of side effects.

Group Therapy:

This form of therapy involves groups of usually 4 to 12 people who have similar problems and who meet
regularly with a therapist. The therapist uses the emotional interactions of the group's members to help them
get relief from distress and possibly modify their behavior.

Interpersonal Psychotherapy:

Through one-on-one conversations, this approach focuses on the patient's current life and relationships within
the family, social, and work environments. The goal is to identify and resolve problems with insight, as well
as build on strengths.

Light Therapy:

Seasonal affective disorder (SAD) is a form of depression that appears related to fluctuations in the exposure
to natural light. It usually strikes during autumn and often continues through the winter when natural light is
reduced. Researchers have found that people who have SAD can be helped with the symptoms of their illness
if they spend blocks of time bathed in light from a special full-spectrum light source, called a "light box."

Play Therapy:

Geared toward young children, this technique uses a variety of activities-such as painting, puppets, and
dioramas-to establish communication with the therapist and resolve problems. Play allows the child to
express emotions and problems that would be too difficult to discuss with another person.

Psychoanalysis:

This approach focuses on past conflicts as the underpinnings to current emotional and behavioral problems.
In this long-term and intensive therapy, an individual meets with a psychoanalyst three to five times a week,
using "free association" to explore unconscious motivations and earlier, unproductive patterns of resolving
issues.

Psychodynamic Psychotherapy:

Based on the principles of psychoanalysis, this therapy is less intense, tends to occur once or twice a week,
and spans a shorter time. It is based on the premise that human behavior is determined by one's past
experiences, genetic factors, and current situation. This approach recognizes the significant influence that
emotions and unconscious motivation can have on human behavior.

Counselor or Psychotherapist?

The Difference Between Counseling and Psychotherapy

By Nancy Schimelpfening, About.com Guide

Updated April 02, 2010

"Psychotherapy" and "counseling" are terms that are often used interchangeably. Although they are very
similar, there are some subtle differences as well.

Technically speaking, "counselor" means "advisor". It involves two people working together to solve a
problem. It is a term that is used in conjunction with many types of advice giving. For example, financial
planning and spiritual guidance are both types of counseling. Just about anyone at all may claim to be a
counselor if they are in the role of giving advice. The term counseling may also properly be used to refer to
what occurs in a relationship with a psychotherapist.

In the context of mental health, "counseling" is generally used to denote a relatively brief treatment that is
focused most upon behavior. It often targets a particular symptom or problematic situation and offers
suggestions and advice for dealing with it.
"Psychotherapy" on the other hand is generally a longer term treatment which focuses more on gaining
insight into chronic physical and emotional problems. It's focus is on the patient's thought processes and way
of being in the world rather than specific problems.

In actual practice there may be quite a bit of overlap between the two. A therapist may provide counseling
with specific situations and a counselor may function in a psychotherapeutic manner. Generally speaking,
however, psychotherapy requires more skill than simple counseling. It is conducted by professionals trained
to practice psychotherapy such as a psychiatrist, a trained counselor, social worker or psychologist. While a
psychotherapist is qualified to provide counseling, a counselor may or may not possess the necessary training
and skills to provide psychotherapy.

10 Ways to Become More Resilient

Build Your Resilience and Coping Skills With These Tips

Research has shown that while some people seem to come by resilience naturally, these
behaviors can also be learned. The following are just a few of the techniques you should focus
on in order to foster your own resilience.

1. Build Positive Beliefs in Your Abilities

Research has demonstrated that self-esteem plays an important role in coping with stress and
recovering from difficult events. Remind yourself of your strengths and accomplishments.
Becoming more confident about your own ability to respond and deal with crisis is a great way
to build resilience for the future.

2. Find a Sense of Purpose in Your Life

After her 13-year-old daughter was killed by a drunk driver, Candace Lightner founded
Mother's Against Drunk Driving (MADD). Upset by the driver's light sentence, Lightner decided
to focus her energy into creating awareness of the dangers of drunk driving. "I promised
myself on the day of Cari’s death that I would fight to make this needless homicide count for
something positive in the years ahead," she later explained. In the face of crisis or tragedy,
finding a sense of purpose can play an important role in recovery. This might involve
becoming involved in your community, cultivating your spirituality or participating in activities
that are meaningful to you.

3. Develop a Strong Social Network

Having caring, supportive people around you acts as a protective factor during times of crisis
(Jones). It is important to have people you can confide in. While simply talking about a
situation with a friend or loved one will not make troubles go away, it allows you to share your
feelings, gain support, receive positive feedback and come up with possible solutions to your
problems.

4. Embrace Change
Flexibility is an essential part of resilience. By learning how to be more adaptable, you'll be
better equipped to respond when faced with a life crisis. Resilient people often utilize these
events as an opportunity to branch out in new directions. While some people may be crushed
by abrupt changes, highly resilient individuals are able to adapt and thrive.

5. Be Optimistic
Staying positive during dark periods can be difficult, but maintaining a hopeful outlook is an
important part of resiliency. Being an optimist does not mean ignoring the problem in order to
focus on positive outcomes. It means understanding that setbacks are transient and that you
have the skills and abilities to combat the challenges you face. What you are dealing with may
be difficult, but it is important to remain hopeful and positive about a brighter future.

6. Nurture Yourself
When you're stressed, it can be all too easy to neglect your own needs. Losing your appetite,
ignoring exercising and not getting enough sleep are all common reactions to a crisis situation.
Focus on building your self-nurturance skills, even when you are troubled. Make time for
activities that you enjoy. By taking care of your own needs, you can boost your overall health
and resilience and be fully ready to face life's challenges.

7. Develop Your Problem-Solving Skills

Research suggests that people who are able come up with solutions to a problem are better
able to cope with problems than those who cannot (Jones). Whenever you encounter a new
challenge, make a quick list of some of the potential ways you could solve the problem.
Experiment with different strategies and focus on developing a logical way to work through
common problems. By practicing your problem-solving skills on a regular basis, you will be
better prepared to cope when a serious challenge emerges.

8. Establish Goals
Crisis situations are daunting. They may even seem insurmountable. Resilient people are able
to view these situations in a realistic way, and then set reasonable goals to deal with the
problem. When you find yourself becoming overwhelmed by a situation, take a step back to
simply assess what is before you. Brainstorm possible solutions, and then break them down
into manageable steps.

9. Take Steps to Solve Problems

Simply waiting for a problem to go away on its own only prolongs the crisis. Instead, start
working on resolving the issue immediately. While there may not be any fast or simple
solution, you can take steps toward making your situation better and less stressful. Focus on
the progress that you have made thus far and planning your next steps, rather than becoming
discouraged by the amount of work that still needs to be accomplished.

10. Keep Working on Your Skills

Resilience may take time to build, so do not become discouraged if you still struggle to cope
with problematic events. According to Dr. Russ Newman, "research has shown that resilience
is not an extraordinary thing but is rather ordinary and can be learned by most anyone"
(2002). Psychological resilience does not involve any specific set of behaviors or actions, but
can vary dramatically from one person to the next. Focus on practicing some of the common
characteristics of resilient people, but also remember to build upon your existing strengths.

Characteristics of Resilience
While people vary dramatically in the coping skills they use when confronting crisis, there are some key
characteristics of resilience that have been identified. Many of these skills can be developed and
strengthened, which can improve your ability to deal with life's setbacks.

Awareness:

Resilient people are aware of the situation, their own emotional reactions and the behavior of those around
them. In order to manage feelings, it is essential to understand what is causing them and why. By remaining
aware, resilient people can maintain their control of the situation and think of new ways to tackle problems.

An Understanding that Setbacks are Part of Life:

Another characteristic of resilience is the understanding that life is full of challenges. While we cannot avoid
many of these problems, we can remain open, flexible and willing to adapt to change.

An Internal Locus of Control:

Do you perceive yourself as having control over your own life? Or do you blame outside sources for failures
and problems? Generally, resilient people tend to have what psychologists call an internal locus of control.
They believe that the action they take will affect the outcome of an event. Of course, some factors are simply
outside of our personal control, such as natural disasters. While we may be able to put some blame on
external causes, it is important to feel as if we have the power to make choices that will affect our situation,
our ability to cope and our future.

Strong Problem-Solving Skills:

When a crisis emerges, will you be able to spot the solution that will lead to a safe outcome. In danger
situations, people sometimes develop tunnel vision. They fail to note important details or take advantages of
opportunities. Resilient individuals, on the other hand, are able to calming and rationally look and the
problem and envision a successful solution.

Having Strong Social Connections:

Whenever you're dealing with a problem, it is important to have people who can offer support. Talking about
the challenges you are facing can be an excellent way to gain perspective, look for new solutions or simply
express your emotions.
Identifying as a Survivor, Not a Victim:

When dealing with any potential crisis, it is essential to view yourself as a survivor. Avoid thinking like a
victim of circumstance, and instead look for ways to resolve the problem. While the situation may be
unavoidable, you can still stay focused on a positive outcome.

Being Able to Ask for Help:

While being resourceful is an important part of resilience, it is also essential to know when to ask for help.
During a crisis, people can benefit from the help of psychologists and counselors specially trained to deal
with crisis situations. Other potential sources of assistance include:

• Books – Reading about people who have experienced and overcome a similar problem
can be both motivating and good for ideas on how to cope.

• Online Message Boards – Online communities can provide continual support and a
place to talk about issues with people who have been in a similar situation.

• Support Groups – Attending support group meetings is a great way to talk about the
challenges you're facing and find a network of people who can provide compassion and
support.

• Psychotherapy – If you are having trouble coping with a crisis situation, consulting a
qualified mental health professional can help you confront the problem, identify your
strengths and develop new coping skills.

How Resilient Are You?

A Resilience Quiz

How would you fare in a crisis situation? Would you be able to stay calm, look for solutions and manage
your emotions? Test your coping skills by answering the following questions. By identifying your strengths
and weaknesses, you will be able to develop a plan to further develop your crisis coping abilities and increase
your overall resilience.
Question: Do you have strong social connections?

Somewhat

Yes

No

Question: Do you find it easy to adapt to changing situations?

 Somewhat

Yes

No

Question: Are you generally optimistic, even when things are difficult?

No

Yes

Most of the time

Question: Are you usually calm in high stress situations?

Yes

Somewhat

No

Question: When something terrible happens, which of the following statements best reflects your feelings?

"Things are bad, but hopefully I'll be able to learn from the experience."

"Why does this always happen to me!"

"Things will never get better and I'll never recover from this."

Question: During a crisis, do you:

Blame external events or other people for creating the situation.

Try to solve the problem, but become overwhelmed.

Focus on steps you can take to resolve the problem.

Question: Do you feel confident in your ability to tackle problems?

No

Somewhat

Yes

Question: Are you able to laugh at yourself or find humor in a situation, even during difficult events?

Occasionally

Yes, most of the time.

No

Question: Do you often feel like you have become a stronger person due to your life's experiences?

Yes

Somewhat

No

Question: Do you take the time to take care of yourself, such as eating a healthy diet, exercising and getting plenty of sleep?

No

Somewhat

Yes

Question: Are you confident in yourself and your ability to accomplish goals?
 Yes

No

Somewhat

Question: Are you able to identify the emotions you are feeling and understand what caused these feelings?

Yes, most of the time

Sometimes

Rarely

Question: Are you able to deal with situations that are ambiguous or unclear?

Sometimes

Yes, most of the time

Rarely

What Is Crisis Counseling?

In mental health terms, a crisis refers not to a traumatic event or experience, but to how an individual
responds to the situation. The events that trigger this crisis can run the gamut of life experience, from
developmental hurdles (such as going through puberty) to natural disasters to the death of a loved one. Crisis
counseling can help individuals deal with the crisis by offering assistance and support.

The roots of modern day crisis counseling date back to World War I and World War II. Prior to this time,
soldiers who exhibited significant psychological reactions to the experiences they had at war were frequently
seen as weak or even disloyal. 1 However, it soon became apparent that soldier who were immediately
offered treatment fared much better than their untreated counterparts.

Elements of Crisis Counseling

Crisis counseling is intended to be quite brief, generally lasting for a period of no longer than a few weeks. It
is important to note that crisis counseling is not psychotherapy. Crisis intervention is focused on minimizing
the stress of the event, providing emotional support and improving the individual’s coping strategies in the
here and now.2

Like psychotherapy, crisis counseling involves assessment, planning and treatment, but the scope of is
generally much more specific. While psychotherapy focuses on a wide range of information and history,
crisis assessment and treatment focuses on the client’s immediate situation including factors such as safety
and immediate needs.3

While there are a number of different treatment models, there are a number of common elements consistent
among the various theories of crisis counseling.

1. Assessing the Situation

The first element of crisis counseling involves assessing the client’s current situation.
This involves listening to the client, asking questions and determining what the
individual needs to effectively cope with the crisis. During this time, the crisis
counseling provider needs to define the problem while at the same time acting as a
 source of empathy, acceptance and support. It is also essential to ensure client safety,
both physically and psychologically.

2. Education
People who are experiencing a crisis need information about their current condition and
the steps they can take to minimize the damage. During crisis counseling, mental health
workers often help the client understand that their reactions are normal, but temporary.
While the situation may seem both dire and endless to the person experiencing the
crisis, the goal is to help the client see that he or she will eventually return to normal
functioning.

3. Offering Support
One of the most important elements of crisis counseling involves offering support,
stabilization and resources. Active listening is critical, as well as offering unconditional
acceptance and reassurance. Offering this kind of nonjudgmental support during a crisis
can help reduce stress improve coping. During the crisis, it can be very beneficial for
individuals to develop a brief dependency on supportive people. Unlike unhealthy
dependencies, these relationships help the individual become stronger and more
independent.

4. Developing Coping Skills

In addition to providing support, crisis counselors also help clients develop coping skills
to deal with the immediate crisis. This might involve helping the client explore different
solutions to the problem, practicing stress reduction techniques and encouraging
positive thinking. This process is not just about teaching these skills to the client, it is
also about encouraging the client to make a commitment to continue utilizing these
skills in the future.

References

1
Hill, J.R. (1985). Predicting suicide. Psychiatric Services, 46, 223-225.

2
Parad, H.J. & Parad, L.G. (1999). Crisis Intervention: Book 2. Ontario, Canada: Manticore Publishers.

3
Wiger, D.E. & Harowski, K.J. (2003). Essentials of Crisis Counseling and Intervention. Hoboken, New Jersey: John Wiley & Sons.

Common Reactions to a Crisis

Reactions to a crisis or traumatic events vary considerably from person to person. Symptoms and reaction
times are different for each individual. According to SAMHSA's National Health Information Center, people
undergoing a crisis or dealing with the aftermath of a disaster are "...normal, well-functioning people who are
struggling with the disruption and loss caused by the disaster. They do not see themselves as needing mental
health services and are unlikely to request them."
Because of this, it is important that those treating individuals undergoing a crisis learn to recognize the
common reactions to a traumatic event. Reactions can include changes in behavior, physical well-being,
psychological health, thinking patterns, and social interactions. According to Wainrib and Bloch (1998), the
following signs, symptoms, and reactions are common psychological responses to a crisis or traumatic event.

• Disbelief
• Emotional numbing
• Nightmares and other sleep disturbances
• Anger, moodiness, and irritability
• Forgetfulness
• Flashbacks
• Survivor guilt
• Hypervigilance
• Loss of hope
• Social withdrawal
• Increased use of alcohol and drugs
• Isolation from others

Roberts (2000) described several characteristics of individuals currently going through a crisis or traumatic
event:

• People first begin to recognize that there is a threat.

• Next, these individuals discover that the stress and trauma of the event cannot be dealt with using
existing coping skills.
• People then begin to experience fear, confusion, and stress.
• Those facing a crisis begin to exhibit symptoms of distress and discomfort.
• Finally, people enter a state of imbalance where the crisis situation seems insurmountable.

Crisis counseling can be very beneficial to help people cope with the negative effects of a crisis situation.
While most crisis events are time-limited, long term exposure to stressors and traumas can lead to post
traumatic stress disorder (PTSD) and other anxiety disorders. Individuals suffering from PTST experience
flashbacks, nightmares, sleep disturbances, and other symptoms, which often become so severe that they
interfere with daily life. While PTSD is a serious disorder, psychotherapy and medication are often effective
treatments.

Post-traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder is a psychiatric illness that can occur after experiencing or
witnessing a traumatic event, including natural disasters, rape, violent crime, or war. Symtoms
include hypervigilance, reliving the trauma, anxiety, and avoidance. Learn more about the
causes, symptoms, and treatments for PTSD.

The Irritable Heart - Effects of Trauma in Civil War Veterans

K. Kris Hirst, About Guide to Archaeology, explores a recent study of the effects of trauma and
war on soldiers in the American Civil War. The study reveals that many soldiers suffered
symptoms similar to what is today known as PTSD. Learn more about this study and the
implications it has for the long-term effects of combat and other traumatic events.

PTSD Simplified
A great article that explains some of the symtoms, causes, and treatments of PTSD, from the
About Mental Health Guidesite.

How an Intern Counselor or Psychotherapist Can Help

With Extreme Stress
By Elizabeth Scott, M.S., About.com Guide

Updated December 17, 2005

Degrees :
They usually have a master’s degree in counseling, social work or a related field, but don’t have a
professional license yet and are accruing hours of experience working under the supervision of a licensed
therapist, which means they conduct therapy with you, but consult a more experienced, licensed therapist for
input and backup.
Experience :
Typically, they have less than 3000 hours of professional experience.
What They Can Provide :
They can provide psychotherapy, group counseling, marital or couples counseling or sometimes family
therapy. They can address deeper emotional issues and relationship dynamics that may underlie the stress
you’re experiencing and help you better understand, process and resolve these issues. Some will also provide
you with some of the same resources a coach would.
What They Can’t Provide :
They may not provide as many insights or techniques as would a more experienced therapist, although this
isn’t always the case, as individuals vary and supervision from professionals can sometimes more than
compensate for a lack of experience. They also can’t prescribe medications.
How They Compare To Other Professionals:
They provide help with more in-depth emotional, psychological and relationship issues than would a life
coach. They generally cost less than a licensed professional, but don’t have as much experience.
Types of
Psychological Treatment

Page Contents: What is Psychotherapy? / Psychological

Change / Psychoanalysis / Psychodynamic Psychotherapy /
Some Common Elements (General description; Psychotherapist
Distance/neutrality; Therapeutic Relationship/alliance;
Transference and Counter-transference; Free Association;
Resistance) / Cognitive-Behavioral Therapy (General description;
Biofeedback; Relaxation Techniques; Systematic
Desensitization; Hypnosis; Prayer)
 S USED throughout this website, psychotherapy can be defined as follows:

An interaction between a professional and a client that leads to changes—from a

less adaptive state to a more adaptive state—in the client’s thoughts, feelings, and
behaviors.

On this website, the “professional” in the above definition will be assumed to be a

psychologist, although other mental health practitioners may be licensed to conduct
psychotherapy.

Psychotherapy, as defined here, has ethics which can be distinguished from the ethics of
counseling that focus on helping a person solve “normal” problems.

Although medications may be used in conjunction with psychotherapy, for present

purposes medication will not be considered the essence of psychotherapy, because
psychotherapy really depends on the use of the client’s own mental experiences to bring
about the desired changes.

Clearly, in the above definition, “adaptive” is a very subjective concept. My attitude

toward the matter is this:

1. As long as you generally adhere to the law of the culture in which you live,
and if you are satisfied with your life, then there is no problem and no need for
psychotherapy. At this point, the science of psychology reaches a limit and
must stop.
2. There are many things, however, that are legal and socially acceptable and
that nevertheless pose a grave danger not only to one’s mental health but also
to one’s spiritual life. Thus there is a further spiritual dimension to adaptive
life, but I won’t make this an issue in general psychotherapy unless a client
has a specific desire to discuss it.

In general, if you get too far out of line, life will let you know it: first, by whispering in
your ear (i.e., through dreams); next, by kicking you in the butt (i.e., through the
repetition of unpleasant, unconscious conflicts); and finally, by pulling the rug out from
under you (i.e., you end up in prison or hospital).

As you will learn from what follows, there are many theoretical approaches to the
practice of psychotherapy.
Psychological Evaluations

What is the Purpose of a Psychological Evaluation?

A comprehensive assessment by a trained professional is a crucial first step in understanding and addressing
the difficulties which an individual is experiencing. At Manning Psychological Services the purpose of our
evaluations is not simply to assign a diagnostic label to you or your child. Rather, our assessments are seen as
means for developing a deeper understanding of why someone is behaving and feeling the way they are, so
that appropriate treatments can be structured and implemented.

What Treatments or Interventions Might Be Recommended Following An Evaluation?

Every individual who participates in an evaluation at Manning Psychological Services will ultimately receive
a unique service plan, based on their own specific assessment results. Some of the more frequently
recommended treatment strategies include:

• Individual or Family Counseling

• Positive Behavioral Interventions
• IEP’s or 504 plans
• Medication Therapy
• Instructional Strategies
• FBA’s & BSP’s
• Gifted Instruction
• Testing Accommodations (SAT, GRE, etc)
• Referrals to Local Agencies for Additional Support

When is a Psychological Assessment Appropriate?

When it is suspected that an individual’s functioning is being affected by a developmental, emotional, or
learning disability, a professional evaluation is an essential first step for developing appropriate interventions,
and for identifying educational and/or mental health services for which that person may be eligible. It is also
recommended that a psychological assessment be conducted when an individual is considering counseling, or
medication therapy, for themselves or their child. A comprehensive evaluation can lead to more efficient and
effective treatment, by determining the most appropriate diagnosis, and recommending a course for
treatment.

What is involved in a Psychological Evaluation?

Psychological evaluations are conducted in a one-to-one setting with Dr. Manning, and are generally
completed in three testing sessions. The first step in any evaluation is meeting with the individual or parent to
develop an understanding of the current concern, as well as a clear goal for having an assessment conducted.
Following an appropriate number of testing sessions, the evaluation is concluded with a discussion of the
assessment findings and recommendations.

Will I Receive a Written Report?

Yes. All evaluations at Manning Psychological Services include a detailed written report. This document will
describe the assessment results, make a diagnosis (when appropriate), and provide thoughtful and realistic
treatment recommendations and strategies. Our written evaluations can be helpful not only to you, but to
other educational and medical professionals who are working with yourself or your child.
Therapeutic Counseling

At Manning Psychological Services the approach to therapy is one which focuses on helping individuals
better understand, and learn how to change, problematic feelings and behaviors. By providing support in
making lifestyle changes, and insights into how thoughts, feelings and behaviors are all related, Dr. Manning
helps clients to effectively address the difficulties which have led them to counseling. However, as every
individual and situation is unique, the therapeutic goal and counseling techniques utilized are specifically
tailored for each client.

Regardless of the concern which has brought an individual to counseling, at Manning Psychological Services
the therapeutic process is always conducted in a caring and supportive environment. It is within such an
atmosphere that you, or your child, can feel comfortable in working through the present concern.

Who Can Benefit from Counseling?

Many individuals can benefit from therapeutic counseling services. Research has shown that counseling can
be an effective means for helping to improve a variety of emotional, behavioral, and educational concerns. At
Manning Psychological Services individual counseling is available for older children, adolescents, and
adults.

What is the Format for Therapy Sessions?

Counseling is typically conducted during individual sessions, with meetings lasting between 45 and 50
minutes.

What is a Psychological Consultation?

In addition to providing assessments and individual therapy, Manning Psychological Services is available to
provide consultation to parents and organizations who are struggling to understand and meet the unique
needs of children and/or individuals with disabilities. Consultation is process which allows parents,
educators, and other professionals the opportunity to meet and discuss specific concerns with a psychologist.
The goal of this process is to provide a parent or professional with a better understanding of the problems
they are faced with, and to develop strategies for managing these difficulties.