Counseling Philosophy.
I believe that professional counseling is the mutual exploration of the client’s phenomenological world. The client, as primary agent of change (Wampold, 2001), guides this journey. The counselor listens, empathizes, and validates the client’s experience (Echterling, Presbury, and McKee, 2005). Clients learn via accommodating or assimilating their new experiences into their existing schema. Any education or instruction by the counselor must proceed only once the client has been allowed to discuss their areas of current knowledge and competence. Learning occurs through direct experience, and thus traditional talk therapy is not typically sufficient for clients to fully prepare themselves for change. Useful tools to facilitate client learning include experiential activities such as roleplaying, modeling and communication exercises, in addition to applied tasks such as homework and self-monitoring. In addition, clients can benefit from understanding how their brain functions. For example, how implicit, unconscious, right-hemisphere responses to events can impact thoughts, feelings, decisions, and behaviors.
Counseling Theory
My theoretical approach to counseling is grounded in the transcultural model of healing practices. Counseling is considered to be a form of healing procedure that is mainly practiced in Western countries. According to Frank and Frank (1991), there are four elements of any healing procedure. These four elements can be found in healing procedures across different cultures. First, the client must have a direct and emotionally charged relationship with the healer. Second, the healer must provide a believable and acceptable explanation (“myth”) for the client’s problems. Third, the healer must provide a ritual that is posited to heal the client’s problems. Fourth, both the healer (allegiance) and the client (expectancy) must believe fully in the effectiveness of the healing procedure. When these four elements are present, successful healing can occur. Counseling, as a form of healing originating in Western culture, requires all of these elements for successful healing to take place. Any intervention must fit with the client’s characteristics, culture, value, and preferences (Institute of Medicine, 2001). Other forms of healing procedures besides counseling should therefore be considered if they are more compatible with the client’s socio-cultural background and preference.
Case Conceptualization
I believe that a systems perspective is most helpful when conceptualizing client problems. Behaviors, emotions, and thoughts are understood to be influenced by the client’s environment; most actions make sense in context. Several meso and macro systems must be considered when conceptualizing client problems. These systems include immediate family, broader family, friends and neighbors, local communities, wider communities, country of origin, and nation. Within this systemic context, I believe that the client’s emotions and behavior are considered to be forms of communication. Since humans are highly sociable creatures, client distress often occurs when communication to others is avoided, blocked, ignored, or misunderstood. Interpersonal communication is a common problem within relationships. For example, couples and families may try to immediately problem-solve instead of listening, understanding, and validating prior to the problem-solving stage. Thus, attention must be given to the client’s systemic context and the interactions of the client with others in their environment.
The genesis of client problems. Client problems can develop from a number of factors. I have found it helpful to group these into endogenous (internal) and exogenous (external) factors. Endogenous factors include biological/ medical problems, neuro-psychiatric symptomology, emotional dysregulation stemming from past trauma or unresolved loss, cognitive distortions, behavioral problems, addiction, dissatisfaction with self-image, and not resolving developmental challenges. Exogenous factors include experiencing oppression, prejudice, and discrimination on the basis of minority group membership, language barriers and/or disabilities, victimization and traumatization, abuse and neglect, relationship problems such as abandonment and grief or loss from losing important relationships in one’s life, unemployment, underemployment, homelessness, and high levels of stress. In short, I believe that client problems are individualized because every person is a unique human being with their own unique set of circumstances and problems.
Cross-cultural competence. During intake interviews and subsequent sessions, it is vital for the counselor to consider the client’s contextual background. Since clients exist within a systemic context, the counselor must seek to understand how the client’s contextual background has influenced and shaped them. These cross-cultural variables include race/ethnicity, gender, sexual/affective orientation and identity, age and ageism, social class, ability/disability status, spirituality/religious practice, and immigrant/national status. Questions about oppression and discrimination experiences, stereotyping, and identity should proceed cautiously, with mindful thought given to how the client may respond to each question. Cultural sensitivity therefore includes gentleness and patience in discussing potentially painful topics.
Counselor’s Tasks
I believe that the counselor’s central tasks are to adhere to legal and ethical codes (e.g., American Counseling Association, 2014) form a collaborative alliance with the client, assess the client’s expectancy of change occurring, support the client’s goals and beliefs about change, provide the client with choices and options about treatment, foster the client’s autonomous decision-making, seek out areas of competence and strength, demonstrate allegiance and belief in the chosen myth and ritual of intervention, assist the client and their support systems (e.g., parents, spouse) to practice and utilize successful methods of communication, and recruit client feedback to evaluate treatment progress/outcomes and address any alliance ruptures. Finally, unlike most relationships, the counseling relationship fosters discussion about the interpersonal process between counselor and client. This process is given as much attention and importance as the content that the client brings to the therapy session.
Counselor self-awareness. I believe that in order for counselors to be fully attuned to cross-cultural interactions, the counselor must reflect on their own cultural background, including privilege and oppression experiences. For example, I acknowledge that I have benefitted from the privilege of being a white Euro-American male of heterosexual orientation without significant disabilities at the time of writing and with a British accent. Such acknowledgement of privilege and power differential is important during the therapeutic process in establishing rapport, and is the first step toward realization of similarities and differences with clients in regards to cross-cultural background. I believe that activities such as personal counseling, journaling, discussions with people of different cultural backgrounds, and deep reflection are a few of the ways in which counselors can enhance their self-understanding and consideration of macro factors that affect the client’s well-being and the counseling process as a whole.
Treatment Planning
I believe that the counselor must consider several factors when planning interventions. First, the quality of the therapeutic relationship must be assessed. This is crucial to the client’s willingness to discuss painful issues and accept feedback. Scientific research has consistently reported that the therapeutic relationship is a critical ingredient of positive outcome (Norcross & Lambert, 2005; Horvath & Bedi, 2002; Wampold, 2001). Rapport is often established as the counselor assists the client to achieve mutually agreed upon goals. After therapeutic gains have been made, the counselor must consider how changes can be generalized and sustained. Second, studies on placebo effects indicate that the expectation of positive outcome must be held by both the counselor and client in order for counseling to be effective (Anderson, Lunnen & Ogles, 2010). To this end, the counselor should ask the client about their expectations for treatment, and attend to the maintenance of the alliance. Third, consideration must be given to incorporating the client’s support systems into therapy. For example, the problematic behaviors of child and adolescent clients are often perpetuated by family dynamics. Changing patterns of behavior may also require addressing broader patterns of behavior within the client’s macro-system, such as discrimination and prejudice toward individuals who are from disadvantaged or under-resourced minority groups. Thus, sustained change often requires advocating on behalf of the client.
As the course of counseling progresses, I believe that the counselor must regularly invite the client to provide feedback on the process. Giving clients a voice in their own recovery and wellness is vital to successful outcomes, since clients represent 87% of the variance for outcomes according to meta-analytic studies (Wampold, 2001). Feedback enables the client to inform the counselor about their own experience with counseling, which is often incongruent with the counselor’s perception. By recruiting feedback, the counselor can address these blind spots, enhancing the likelihood of a successful counseling experience for the client.
References:
American Counseling Association. (2014). ACA Code of Ethics. Author.
American Psychological Association. (2006). Evidence-based practice in psychology: APA presidential task force on evidence-based practice. American Psychologist, 61, 271-285.
Anderson, T., Lunnen, K. M., & Ogles, B. M. (2010). Putting models and techniques in context. In B. L. Duncan, S. D. Miller, B. E. Wampold, & M. A. Hubble (Eds.), The heart & soul of change: Delivering what works in therapy (2nd ed.; pp. 143-166). American Psychological Association.
Echterling, L. G., Presbury, J. H., & McKee, J. E. (2005). Crisis intervention: Promoting resilience and resolution in troubled times. Pearson.
Frank, J. D., & Frank, J. B. (1991). Persuasion and healing: A comparative study of psychotherapy. Johns Hopkins Press.
Horvath, A. O., & Bedi, R. P. (2002). The alliance. In J. C. Norcross (Ed.), Psychotherapy relationships that work (pp. 255-265). Oxford University Press.
Norcross, J. C., & Lambert, M. J. (2005). The therapy relationship. In J. C. Norcross, L. E., Beutler, & R. F. Levant (Eds.), Evidence-based practices in mental health: Debate and dialogue on the fundamental questions. American Psychological Association.
Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings. Erlbaum.
I believe that professional counseling is the mutual exploration of the client’s phenomenological world. The client, as primary agent of change (Wampold, 2001), guides this journey. The counselor listens, empathizes, and validates the client’s experience (Echterling, Presbury, and McKee, 2005). Clients learn via accommodating or assimilating their new experiences into their existing schema. Any education or instruction by the counselor must proceed only once the client has been allowed to discuss their areas of current knowledge and competence. Learning occurs through direct experience, and thus traditional talk therapy is not typically sufficient for clients to fully prepare themselves for change. Useful tools to facilitate client learning include experiential activities such as roleplaying, modeling and communication exercises, in addition to applied tasks such as homework and self-monitoring. In addition, clients can benefit from understanding how their brain functions. For example, how implicit, unconscious, right-hemisphere responses to events can impact thoughts, feelings, decisions, and behaviors.
Counseling Theory
My theoretical approach to counseling is grounded in the transcultural model of healing practices. Counseling is considered to be a form of healing procedure that is mainly practiced in Western countries. According to Frank and Frank (1991), there are four elements of any healing procedure. These four elements can be found in healing procedures across different cultures. First, the client must have a direct and emotionally charged relationship with the healer. Second, the healer must provide a believable and acceptable explanation (“myth”) for the client’s problems. Third, the healer must provide a ritual that is posited to heal the client’s problems. Fourth, both the healer (allegiance) and the client (expectancy) must believe fully in the effectiveness of the healing procedure. When these four elements are present, successful healing can occur. Counseling, as a form of healing originating in Western culture, requires all of these elements for successful healing to take place. Any intervention must fit with the client’s characteristics, culture, value, and preferences (Institute of Medicine, 2001). Other forms of healing procedures besides counseling should therefore be considered if they are more compatible with the client’s socio-cultural background and preference.
Case Conceptualization
I believe that a systems perspective is most helpful when conceptualizing client problems. Behaviors, emotions, and thoughts are understood to be influenced by the client’s environment; most actions make sense in context. Several meso and macro systems must be considered when conceptualizing client problems. These systems include immediate family, broader family, friends and neighbors, local communities, wider communities, country of origin, and nation. Within this systemic context, I believe that the client’s emotions and behavior are considered to be forms of communication. Since humans are highly sociable creatures, client distress often occurs when communication to others is avoided, blocked, ignored, or misunderstood. Interpersonal communication is a common problem within relationships. For example, couples and families may try to immediately problem-solve instead of listening, understanding, and validating prior to the problem-solving stage. Thus, attention must be given to the client’s systemic context and the interactions of the client with others in their environment.
The genesis of client problems. Client problems can develop from a number of factors. I have found it helpful to group these into endogenous (internal) and exogenous (external) factors. Endogenous factors include biological/ medical problems, neuro-psychiatric symptomology, emotional dysregulation stemming from past trauma or unresolved loss, cognitive distortions, behavioral problems, addiction, dissatisfaction with self-image, and not resolving developmental challenges. Exogenous factors include experiencing oppression, prejudice, and discrimination on the basis of minority group membership, language barriers and/or disabilities, victimization and traumatization, abuse and neglect, relationship problems such as abandonment and grief or loss from losing important relationships in one’s life, unemployment, underemployment, homelessness, and high levels of stress. In short, I believe that client problems are individualized because every person is a unique human being with their own unique set of circumstances and problems.
Cross-cultural competence. During intake interviews and subsequent sessions, it is vital for the counselor to consider the client’s contextual background. Since clients exist within a systemic context, the counselor must seek to understand how the client’s contextual background has influenced and shaped them. These cross-cultural variables include race/ethnicity, gender, sexual/affective orientation and identity, age and ageism, social class, ability/disability status, spirituality/religious practice, and immigrant/national status. Questions about oppression and discrimination experiences, stereotyping, and identity should proceed cautiously, with mindful thought given to how the client may respond to each question. Cultural sensitivity therefore includes gentleness and patience in discussing potentially painful topics.
Counselor’s Tasks
I believe that the counselor’s central tasks are to adhere to legal and ethical codes (e.g., American Counseling Association, 2014) form a collaborative alliance with the client, assess the client’s expectancy of change occurring, support the client’s goals and beliefs about change, provide the client with choices and options about treatment, foster the client’s autonomous decision-making, seek out areas of competence and strength, demonstrate allegiance and belief in the chosen myth and ritual of intervention, assist the client and their support systems (e.g., parents, spouse) to practice and utilize successful methods of communication, and recruit client feedback to evaluate treatment progress/outcomes and address any alliance ruptures. Finally, unlike most relationships, the counseling relationship fosters discussion about the interpersonal process between counselor and client. This process is given as much attention and importance as the content that the client brings to the therapy session.
Counselor self-awareness. I believe that in order for counselors to be fully attuned to cross-cultural interactions, the counselor must reflect on their own cultural background, including privilege and oppression experiences. For example, I acknowledge that I have benefitted from the privilege of being a white Euro-American male of heterosexual orientation without significant disabilities at the time of writing and with a British accent. Such acknowledgement of privilege and power differential is important during the therapeutic process in establishing rapport, and is the first step toward realization of similarities and differences with clients in regards to cross-cultural background. I believe that activities such as personal counseling, journaling, discussions with people of different cultural backgrounds, and deep reflection are a few of the ways in which counselors can enhance their self-understanding and consideration of macro factors that affect the client’s well-being and the counseling process as a whole.
Treatment Planning
I believe that the counselor must consider several factors when planning interventions. First, the quality of the therapeutic relationship must be assessed. This is crucial to the client’s willingness to discuss painful issues and accept feedback. Scientific research has consistently reported that the therapeutic relationship is a critical ingredient of positive outcome (Norcross & Lambert, 2005; Horvath & Bedi, 2002; Wampold, 2001). Rapport is often established as the counselor assists the client to achieve mutually agreed upon goals. After therapeutic gains have been made, the counselor must consider how changes can be generalized and sustained. Second, studies on placebo effects indicate that the expectation of positive outcome must be held by both the counselor and client in order for counseling to be effective (Anderson, Lunnen & Ogles, 2010). To this end, the counselor should ask the client about their expectations for treatment, and attend to the maintenance of the alliance. Third, consideration must be given to incorporating the client’s support systems into therapy. For example, the problematic behaviors of child and adolescent clients are often perpetuated by family dynamics. Changing patterns of behavior may also require addressing broader patterns of behavior within the client’s macro-system, such as discrimination and prejudice toward individuals who are from disadvantaged or under-resourced minority groups. Thus, sustained change often requires advocating on behalf of the client.
As the course of counseling progresses, I believe that the counselor must regularly invite the client to provide feedback on the process. Giving clients a voice in their own recovery and wellness is vital to successful outcomes, since clients represent 87% of the variance for outcomes according to meta-analytic studies (Wampold, 2001). Feedback enables the client to inform the counselor about their own experience with counseling, which is often incongruent with the counselor’s perception. By recruiting feedback, the counselor can address these blind spots, enhancing the likelihood of a successful counseling experience for the client.
References:
American Counseling Association. (2014). ACA Code of Ethics. Author.
American Psychological Association. (2006). Evidence-based practice in psychology: APA presidential task force on evidence-based practice. American Psychologist, 61, 271-285.
Anderson, T., Lunnen, K. M., & Ogles, B. M. (2010). Putting models and techniques in context. In B. L. Duncan, S. D. Miller, B. E. Wampold, & M. A. Hubble (Eds.), The heart & soul of change: Delivering what works in therapy (2nd ed.; pp. 143-166). American Psychological Association.
Echterling, L. G., Presbury, J. H., & McKee, J. E. (2005). Crisis intervention: Promoting resilience and resolution in troubled times. Pearson.
Frank, J. D., & Frank, J. B. (1991). Persuasion and healing: A comparative study of psychotherapy. Johns Hopkins Press.
Horvath, A. O., & Bedi, R. P. (2002). The alliance. In J. C. Norcross (Ed.), Psychotherapy relationships that work (pp. 255-265). Oxford University Press.
Norcross, J. C., & Lambert, M. J. (2005). The therapy relationship. In J. C. Norcross, L. E., Beutler, & R. F. Levant (Eds.), Evidence-based practices in mental health: Debate and dialogue on the fundamental questions. American Psychological Association.
Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings. Erlbaum.
