INTRODUCTION TO Rosalie Mae R.

Fajardo,
MPsy, RPm
COUNSELING
PSYHCHOANALYTIC THERAPY
Basic Philosophy. Human beings are basically determined by
psychic energy and by early experiences. Unconscious motives and
conflicts are central in present behavior. Early development is of
critical importance because later personality problems have their
roots in repressed childhood conflicts.
Theoretical Background. Normal personality development is
based on successful resolution and integration of psychosexual
stages of development. Faulty personality development is the result
of inadequate resolution of some specific stage. Anxiety is a result
of repression of basic conflicts. Unconscious processes are centrally
related to current behavior.
Goal. To make the unconscious conscious. To reconstruct the basic
personality. To assist clients in reliving earlier experiences and working
through repressed conflicts. To achieve intellectual and emotional
awareness.
Therapeutic Relationship. The classical analyst remains anonymous,
and clients develop projections toward him or her. Focus is on reducing
the resistances that develop in working with transference and on
establishing more rational control. Clients undergo long-term analysis,
engage in free association to uncover conflicts, and gain insight by
talking. The analyst makes interpretations to teach clients the meaning
of current behavior as it relates to the past. In contemporary relational
psychoanalytic therapy, the relationship is central and emphasis is
given to here-and now dimensions of this relationship.
Techniques. The key techniques are interpretation, dream
analysis, free association, analysis of resistance, analysis of
transference, and countertransference. Techniques are designed to
help clients gain access to their unconscious conflicts, which leads
to insight and eventual assimilation of new material by the ego.
Clientele. Candidates for analytic therapy include professionals
who want to become therapists, people who have had intensive
therapy and want to go further, and those who are in psychological
pain. Analytic therapy is not recommended for self-centered and
impulsive individuals or for people with psychotic disorders.
Techniques can be applied to individual and group therapy
Limitation. Requires lengthy training for therapists and much time
and expense for clients. The model stresses biological and
instinctual factors to the neglect of social, cultural, and
interpersonal ones. Its methods are less applicable for solving
specific daily life problems of clients and may not be appropriate
for some ethnic and cultural groups. Many clients lack the degree
of ego strength needed for regressive and reconstructive therapy. It
may be inappropriate for certain counseling settings.
 ADLERIAN THERAPY
Basic Philosophy. Humans are motivated by social interest, by striving
toward goals, by inferiority and superiority, and by dealing with the tasks of
life. Emphasis is on the individual’s positive capacities to live in society
cooperatively. People have the capacity to interpret, influence, and create
events. Each person at an early age creates a unique style of life, which
tends to remain relatively constant throughout life.
Theoretical Background. Key concepts include the unity of personality,
the need to view people from their subjective perspective, and the
importance of life goals that give direction to behavior. People are motivated
by social interest and by finding goals to give life meaning. Other key
concepts are striving for significance and superiority, developing a unique
lifestyle, and understanding the family constellation. Therapy is a matter of
providing encouragement and assisting clients in changing their cognitive
perspective and behavior.
Goals. To challenge clients’ basic premises and life goals. To offer
encouragement so individuals can develop socially useful goals and
increase social interest. To develop the client’s sense of belonging.
Therapeutic Relationship. The emphasis is on joint responsibility, on
mutually determining goals, on mutual trust and respect, and on equality.
Focus is on identifying, exploring, and disclosing mistaken goals and
faulty assumptions within the person’s lifestyle.
Techniques. Adlerians pay more attention to the subjective experiences
of clients than to using techniques. Some techniques include gathering
life-history data (family constellation, early recollections, personal
priorities), sharing interpretations with clients, offering encouragement,
and assisting clients in searching for new possibilities.
Clientele. Because the approach is based on a growth model, it is
applicable to such varied spheres of life as child guidance, parent–
child counseling, marital and family therapy, individual counseling
with all age groups, correctional and rehabilitation counseling,
group counseling, substance abuse programs, and brief counseling.
It is ideally suited to preventive care and alleviating a broad range
of conditions that interfere with growth.
Limitation. Weak in terms of precision, testability, and empirical
validity. Few attempts have been made to validate the basic
concepts by scientific methods. Tends to oversimplify some
complex human problems and is based heavily on common sense.
 EXISTENTIAL THERAPY
Basic Philosophy. The central focus is on the nature of the human
condition, which includes a capacity for self-awareness, freedom of
choice to decide one’s fate, responsibility, anxiety, the search for
meaning, being alone and being in relation with others, striving for
authenticity, and facing living and dying.
Theoretical Background. Essentially an experiential approach to
counseling rather than a fi rm theoretical model, it stresses core
human conditions. Interest is on the present and on what one is
becoming. The approach has a future orientation and stresses self-
awareness before action.
Goals. To help people see that they are free and to become aware
of their possibilities. To challenge them to recognize that they are
responsible for events that they formerly thought were happening
to them. To identify factors that block freedom.
Therapeutic Relationship. The therapist’s main tasks are to
accurately grasp clients’ being in the world and to establish a
personal and authentic encounter with them. The immediacy of the
client–therapist relationship and the authenticity of the here-and-
now encounter are stressed. Both client and therapist can be
changed by the encounter.
Techniques. Few techniques flow from this approach because it stresses
understanding first and technique second. The therapist can borrow
techniques from other approaches and incorporate them in an existential
framework. Diagnosis, testing, and external measurements are not deemed
important. Issues addressed are freedom and responsibility, isolation and
relationships, meaning and meaninglessness, living and dying.
Clientele. This approach is especially suited to people facing a
developmental crisis or a transition in life and for those with existential
concerns (making choices, dealing with freedom and responsibility, coping
with guilt and anxiety, making sense of life, and fi nding values) or those
seeking personal enhancement. The approach can be applied to both
individual and group counseling, and to couples and family therapy, crisis
intervention, and community mental health work.
Limitation. Many basic concepts are fuzzy and ill-defined, making
its general framework abstract at times. Lacks a systematic
statement of principles and practices of therapy. Has limited
applicability to lower functioning and nonverbal clients and to
clients in extreme crisis who need direction.
PERSON – CENTERED
THERAPY
Basic Philosophy. Positive view of people; we have an inclination
toward becoming fully functioning. In the context of the therapeutic
relationship, the client experiences feelings that were previously
denied to awareness. The client moves toward increased
awareness, spontaneity, trust in self, and inner directedness.
Theoretical Background. The client has the potential to become
aware of problems and the means to resolve them. Faith is placed
in the client’s capacity for self-direction. Mental health is a
congruence of ideal self and real self. Maladjustment is the result of
a discrepancy between what one wants to be and what one is. In
therapy attention is given to the present moment and on
experiencing and expressing feelings.
Goals. To provide a safe climate conducive to clients’ self-exploration,
so that they can recognize blocks to growth and can experience
aspects of self that were formerly denied or distorted. To enable them
to move toward openness, greater trust in self, willingness to be a
process, and increased spontaneity and aliveness. To find meaning in
life and to experience life fully. To become more self-directed.
Therapeutic Relationship. The relationship is of primary
importance. The qualities of the therapist, including genuineness,
warmth, accurate empathy, respect, and non judgmentalness— and
communication of these attitudes to clients—are stressed. Clients use
this genuine relationship with the therapist to help them transfer what
they learn to other relationships.
Techniques. This approach uses few techniques but stresses the
attitudes of the therapist and a “way of being.” Therapists strive for
active listening, reflection of feelings, clarification, “being there” for the
client, and focusing on the moment-to-moment experiencing of the
client. This model does not include diagnostic testing, interpretation,
taking a case history, or questioning or probing for information.
Clientele. Has wide applicability to individual and group counseling. It
is especially well suited for the initial phases of crisis intervention work.
Its principles have been applied to couples and family therapy,
community programs, administration and management, and human
relations training. It is a useful approach for teaching, parent–child
relations, and for working with groups of people from diverse cultural
backgrounds.
Limitation. Possible danger from the therapist who remains
passive and inactive, limiting responses to reflection. Many clients
feel a need for greater direction, more structure, and more
techniques. Clients in crisis may need more directive measures.
Applied to individual counseling, some cultural groups will expect
more counselor activity.
GESTALT THERAPY
Basic Philosophy. The person strives for wholeness and integration
of thinking, feeling, and behaving. Some key concepts include
contact with self and others, contact boundaries, and awareness. The
view is nondeterministic in that the person is viewed as having the
capacity to recognize how earlier influences are related to present
difficulties. As an experiential approach, it is grounded in the here
and now and emphasizes awareness, personal choice, and
responsibility.
Theoretical Background. Emphasis is on the “what” and “how” of
experiencing in the here and now to help clients accept all aspects of
themselves. Key concepts include holism, fi gure-formation process,
awareness, unfi nished business and avoidance, contact, and energy.
Goals. To assist clients in gaining awareness of moment-to-
moment experiencing and to expand the capacity to make choices.
To foster integration of the self.
Therapeutic Relationship. Central importance is given to the
I/Thou relationship and the quality of the therapist’s presence. The
therapist’s attitudes and behavior count more than the techniques
used. The therapist does not interpret for clients but assists them in
developing the means to make their own interpretations. Clients
identify and work on unfi nished business from the past that
interferes with current functioning.
Techniques. A wide range of experiments are designed to intensify
experiencing and to integrate conflicting feelings. Experiments are
co-created by therapist and client through an I/Thou dialogue.
Therapists have latitude to creatively invent their own experiments.
Formal diagnosis and testing are not a required part of therapy.
Clientele. Addresses a wide range of problems and populations:
crisis intervention, treatment of a range of psychosomatic disorders,
couples and family therapy, awareness training of mental health
professionals, behavior problems in children, and teaching and
learning. It is well suited to both individual and group counseling. The
methods are powerful catalysts for opening up feelings and getting
clients into contact with their present-centered experience.
Limitation. Techniques lead to intense emotional expression; if
these feelings are not explored and if cognitive work is not done,
clients are likely to be left unfinished and will not have a sense of
integration of their learning. Clients who have difficulty using
imagination may not profit from certain experiments
BEHAVIOR THERAPY
Basic Philosophy. Behavior is the product of learning. We are both
the product and the producer of the environment. Traditional
behavior therapy is based on classical and operant principles.
Contemporary behavior therapy has branched out in many
directions.
Theoretical Background. Focus is on overt behavior, precision in
specifying goals of treatment, development of specific treatment
plans, and objective evaluation of therapy outcomes. Present
behavior is given attention. Therapy is based on the principles of
learning theory. Normal behavior is learned through reinforcement
and imitation. Abnormal behavior is the result of faulty learning.
Goals. To eliminate maladaptive behaviors and learn more
effective behaviors. To identify factors that influence behavior and
find out what can be done about problematic behavior. To
encourage clients to take an active and collaborative role in clearly
setting treatment goals and evaluating how well these goals are
being met.
Therapeutic Relationship. The therapist is active and directive
and functions as a teacher or mentor in helping clients learn more
effective behavior. Clients must be active in the process and
experiment with new behaviors. Although a quality client–therapist
relationship is not viewed as sufficient to bring about change, it is
considered essential for implementing behavioral procedures.
Techniques. The main techniques are reinforcement, shaping, modeling,
systematic desensitization, relaxation methods, flooding, eye movement and
desensitization reprocessing, cognitive restructuring, assertion and social skills
training, self-management programs, mindfulness and acceptance methods,
behavioral rehearsal, coaching, and various multimodal therapy techniques.
Diagnosis or assessment is done at the outset to determine a treatment plan.
Questions concentrate on “what,” “how,” and “when” (but not “why”). Contracts
and homework assignments are also typically used.
Clientele. A pragmatic approach based on empirical validation of results. Enjoys
wide applicability to individual, group, couples, and family counseling. Some
problems to which the approach is well suited are phobic disorders, depression,
trauma, sexual disorders, children’s behavioral disorders, stuttering, and
prevention of cardiovascular disease. Beyond clinical practice, its principles are
applied in fi elds such as pediatrics, stress management, behavioral medicine,
education, and geriatrics.
Limitation. Major criticisms are that it may change behavior but
not feelings; that it ignores the relational factors in therapy; that it
does not provide insight; that it ignores historical causes of present
behavior; that it involves control by the therapist; and that it is
limited in its capacity to address certain aspects of the human
condition.
COGNITIVE BEHAVIOR
THERAPY
Basic Philosophy. Individuals tend to incorporate faulty thinking, which
leads to emotional and behavioral disturbances. Cognitions are the major
determinants of how we feel and act. Therapy is primarily oriented toward
cognition and behavior, and it stresses the role of thinking, deciding,
questioning, doing, and redeciding. This is a psychoeducational model,
which emphasizes therapy as a learning process, including acquiring and
practicing new skills, learning new ways of thinking, and acquiring more
effective ways of coping with problems.
Theoretical Background. Although psychological problems may be rooted
in childhood, they are reinforced by present ways of thinking. A person’s
belief system is the primary cause of disorders. Internal dialogue plays a
central role in one’s behavior. Clients focus on examining faulty assumptions
and misconceptions and on replacing these with effective beliefs
Goals. To teach clients to confront faulty beliefs with contradictory
evidence that they gather and evaluate. To help clients seek out their
faulty beliefs and minimize them. To become aware of automatic
thoughts and to change them.
Therapeutic Relationship. In REBT the therapist functions as a
teacher and the client as a student. The therapist is highly directive
and teaches clients an A-B-C model of changing their cognitions. In CT
the focus is on a collaborative relationship. Using a Socratic dialogue,
the therapist assists clients in identifying dysfunctional beliefs and
discovering alternative rules for living. The therapist promotes
corrective experiences that lead to learning new skills. Clients gain
insight into their problems and then must actively practice changing
self defeating thinking and acting.
Techniques. Therapists use a variety of cognitive, emotive, and behavioral
techniques; diverse methods are tailored to suit individual clients. This is an
active, directive, time-limited, present-centered, psychoeducational, structured
therapy. Some techniques include engaging in Socratic dialogue, collaborative
empiricism, debating irrational beliefs, carrying out homework assignments,
gathering data on assumptions one has made, keeping a record of activities,
forming alternative interpretations, learning new coping skills, changing one’s
language and thinking patterns, role playing, imagery, confronting faulty beliefs,
self-instructional training, and stress inoculation training.
Clientele. Has been widely applied to treatment of depression, anxiety,
relationship problems, stress management, skill training, substance abuse,
assertion training, eating disorders, panic attacks, performance anxiety, and
social phobias. CBT is especially useful for assisting people in modifying their
cognitions. Many self-help approaches utilize its principles. CBT can be applied to
a wide range of client populations with a variety of specific problems.
Limitation. Tends to play down emotions, does not focus on
exploring the unconscious or underlying conflicts, de-emphasizes
the value of insight, and sometimes does not give enough weight to
the client’s past. REBT, being a confrontational therapy, might lead
to premature termination. CBT might be too structured for some
clients.
REALITY THERAPY
Basic Philosophy. Based on choice theory, this approach assumes
that we need quality relationships to be happy. Psychological
problems are the result of our resisting the control by others or of
our attempt to control others. Choice theory is an explanation of
human nature and how to best achieve satisfying interpersonal
relationships.
Theoretical Background. The basic focus is on what clients are
doing and how to get them to evaluate whether their present
actions are working for them. People are mainly motivated to
satisfy their needs, especially the need for significant relationships.
The approach rejects the medical model, the notion of
transference, the unconscious, and dwelling on one’s past
Goals. To help people become more effective in meeting all of their
psychological needs. To enable clients to get reconnected with the
people they have chosen to put into their quality worlds and teach
clients choice theory.
Therapeutic Relationship. A fundamental task is for the therapist to
create a good relationship with the client. Therapists are then able to
engage clients in an evaluation of all their relationships with respect to
what they want and how effective they are in getting this. Therapists fi
nd out what clients want, ask what they are choosing to do, invite them
to evaluate present behavior, help them make plans for change, and
get them to make a commitment. The therapist is a client’s advocate,
as long as the client is willing to attempt to behave responsibly.
Techniques. This is an active, directive, and didactic therapy. Skillful
questioning is a central technique used for the duration of the therapy
process. Various techniques may be used to get clients to evaluate
what they are presently doing to see if they are willing to change. If
clients decide that their present behavior is not effective, they develop
a specific plan for change and make a commitment to follow through.
Clientele. Geared to teaching people ways of using choice theory in
everyday living to increase effective behaviors. It has been applied to
individual counseling with a wide range of clients, group counseling,
working with youthful law offenders, and couples and family therapy.
In some instances it is well suited to brief therapy and crisis
intervention.
Limitation. Discounts the therapeutic value of exploration of the
client’s past, dreams, the unconscious, early childhood
experiences, and transference. The approach is limited to less
complex problems. It is a problem-solving therapy that tends to
discourage exploration of deeper emotional issues.
FEMINIST THERAPY
Basic Philosophy. Feminists criticize many traditional theories to the
degree that they are based on gender-biased concepts, such as being
androcentric, gender centric, ethnocentric, heterosexist, and intrapsychic.
The constructs of feminist therapy include being gender fair, flexible,
interactionist, and life-span-oriented. Gender and power are at the heart of
feminist therapy. This is a systems approach that recognizes the cultural,
social, and political factors that contribute to an individual’s problems.
Theoretical Background. Core principles of feminist therapy are that the
personal is political, therapists have a commitment to social change,
women’s voices and ways of knowing are valued and women’s experiences
are honored, the counseling relationship is egalitarian, therapy focuses on
strengths and a reformulated defi nition of psychological distress, and all
types of oppression are recognized.
Goals. To bring about transformation both in the individual client
and in society. To assist clients in recognizing, claiming, and using
their personal power to free themselves from the limitations of
gender-role socialization. To confront all forms of institutional
policies that discriminate or oppress on any basis.
Therapeutic Relationship. The therapeutic relationship is based
on empowerment and egalitarianism. Therapists actively break
down the hierarchy of power and reduce artificial barriers by
engaging in appropriate self-disclosure and teaching clients about
the therapy process. Therapists strive to create a collaborative
relationship in which clients can become their own expert.
Techniques. Although techniques from traditional approaches are used,
feminist practitioners tend to employ consciousness raising techniques
aimed at helping clients recognize the impact of gender-role socialization on
their lives. Other techniques frequently used include gender-role analysis
and intervention, power analysis and intervention, demystifying therapy,
bibliotherapy, journal writing, therapist self-disclosure, assertiveness
training, reframing and relabeling, cognitive restructuring, identifying and
challenging untested beliefs, role playing, psychodramatic methods, group
work, and social action.
Clientele. Principles and techniques can be applied to a range of
therapeutic modalities such as individual therapy, relationship counseling,
family therapy, group counseling, and community intervention. The
approach can be applied to both women and men with the goal of bringing
about empowerment.
Limitation. A possible limitation is the potential for therapists to
impose a new set of values on clients—such as striving for equality,
power in relationships, defining oneself, freedom to pursue a career
outside the home, and the right to an education. Therapists need to
keep in mind that clients are their own best experts, which means it
is up to them to decide which values to live by
POSTMODERN APPROACHES
Basic Philosophy. Based on the premise that there are multiple realities and
multiple truths, postmodern therapies reject the idea that reality is external and
can be grasped. People create meaning in their lives through conversations with
others. The postmodern approaches avoid pathologizing clients, take a dim view
of diagnosis, avoid searching for underlying causes of problems, and place a high
value on discovering clients’ strengths and resources. Rather than talking about
problems, the focus of therapy is on creating solutions in the present and the
future.
Theoretical Background. Therapy tends to be brief and addresses the present
and the future. The person is not the problem; the problem is the problem. The
emphasis is on externalizing the problem and looking for exceptions to the
problem. Therapy consists of a collaborative dialogue in which the therapist and
the client co-create solutions. By identifying instances when the problem did not
exist, clients can create new meanings for themselves and fashion a new life story
Goal. To change the way clients view problems and what they can do about these
concerns. To collaboratively establish specific, clear, concrete, realistic, and
observable goals leading to increased positive change. To help clients create a
self-identity grounded on competence and resourcefulness so they can resolve
present and future concerns. To assist clients in viewing their lives in positive
ways, rather than being problem saturated.
Therapeutic Relationship. Therapy is a collaborative partnership. Clients are
viewed as the experts on their own life. Therapists use questioning dialogue to
help clients free themselves from their problem-saturated stories and create new
life-affirming stories. Solution-focused therapists assume an active role in guiding
the client away from problem-talk and toward solution-talk. Clients are
encouraged to explore their strengths and to create solutions that will lead to a
richer future. Narrative therapists assist clients in externalizing problems and
guide them in examining self-limiting stories and creating new and more
liberating stories
Techniques. In solution-focused therapy the main technique involves change-talk,
with emphasis on times in a client’s life when the problem was not a problem. Other
techniques include creative use of questioning, the miracle question, and scaling
questions, which assist clients in developing alternative stories. In narrative therapy,
specific techniques include listening to a client’s problem saturated story without
getting stuck, externalizing and naming the problem, externalizing conversations, and
discovering clues to competence. Narrative therapists often write letters to clients and
assist them in finding an audience that will support their changes and new stories.
Clientele. Solution-focused therapy is well suited for people with adjustment
disorders and for problems of anxiety and depression. Narrative therapy is now being
used for a broad range of human difficulties including eating disorders, family distress,
depression, and relationship concerns. These approaches can be applied to working
with children, adolescents, adults, couples, families, and the community in a wide
variety of settings. Both solution-focused and narrative approaches lend themselves to
group counseling and to school counseling.
Limitation. There is little empirical validation of the effectiveness
of therapy outcomes. Some critics contend that these approaches
endorse cheerleading and an overly positive perspective. Some are
critical of the stance taken by most postmodern therapists
regarding assessment and diagnosis, and also react negatively to
the “not-knowing” stance of the therapist. Because some of the
solution-focused techniques are relatively easy to learn,
practitioners may use these interventions in a mechanical way or
implement these techniques without a sound rationale.
FAMILY SYSTEMS THERAPY
Basic Philosophy. The family is viewed from an interactive and systemic
perspective. Clients are connected to a living system; a change in one part
of the system will result in a change in other parts. The family provides the
context for understanding how individuals function in relationship to others
and how they behave. Treatment deals with the family unit. An individual’s
dysfunctional behavior grows out of the interactional unit of the family and
out of larger systems as well.
Theoretical Background. Focus is on communication patterns within a
family, both verbal and nonverbal. Problems in relationships are likely to be
passed on from generation to generation. Key concepts vary depending on
specific orientation but include differentiation, triangles, power coalitions,
family-of-origin dynamics, functional versus dysfunctional interaction
patterns, and dealing with here-and-now interactions. The present is more
important than exploring past experiences.
Goal. To help family members gain awareness of patterns of
relationships that are not working well and to create new ways of
interacting.
Therapeutic Relationship. The family therapist functions as a
teacher, coach, model, and consultant. The family learns ways to
detect and solve problems that are keeping members stuck, and it
learns about patterns that have been transmitted from generation
to generation. Some approaches focus on the role of therapist as
expert; others concentrate on intensifying what is going on in the
here and now of the family session. All family therapists are
concerned with the process of family interaction and teaching
patterns of communication.
Techniques. A variety of techniques may be used, depending on
the particular theoretical orientation of the therapist. Techniques
include genograms, teaching, asking questions, joining the family,
tracking sequences, issuing directives, use of countertransference,
family mapping, reframing, restructuring, enactments, and setting
boundaries. Techniques may be experiential, cognitive, or
behavioral in nature. Most are designed to bring about change in a
short time.
Clientele. Useful for dealing with marital distress, problems of
communicating among family members, power struggles, crisis
situations in the family, helping individuals attain their potential,
and enhancing the overall functioning of the family.
Limitation. Limitations include problems in being able to involve
all the members of a family in the therapy. Some family members
may be resistant to changing the structure of the system.
Therapists’ self-knowledge and willingness to work on their own
family-of-origin issues is crucial, for the potential for
countertransference is high. It is essential that the therapist be well
trained, receive quality supervision, and be competent in assessing
and treating individuals in a family context.