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Theory and practice of counseling and psychotherapy student manual pdf

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Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

Theories at-a-Glance The tables in this book compare theories over a range of topics, thereby providing you with the ability to easily compare, contrast, and grasp the practical aspects of each theory. These tables also serve as invaluable resources that can be used to review the key concepts, philoso- phies, limitations, contributions to multicultural counseling, applications, techniques, and goals of all theories in this text.

The following chart provides a convenient guide to the tables in this text.

Pages

6–7 Table 1.1 Overview of Contemporary Counseling Models

62–63 Table 4.1 Ego-Defense Mechanisms

65–66 Table 4.2 Comparison of Freud’s Psychosexual Stages and Erikson’s Psychosocial Stages

432 Table 15.1 The Basic Philosophies

433–434 Table 15.2 Key Concepts

438 Table 15.3 Goals of Therapy

441–442 Table 15.4 The Therapeutic Relationship

443–444 Table 15.5 Techniques of Therapy

444–445 Table 15.6 Applications of the Approaches

446 Table 15.7 Contributions to Multicultural Counseling

447 Table 15.8 Limitations in Multicultural Counseling

448–449 Table 15.9 Contributions of the Approaches

449–450 Table 15.10 Limitations of the Approaches

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Overview of Focus Questions for the Theories For the chapters dealing with the different theories, you will have a basic understand- ing of this book if you can answer the following questions as they apply to each of the eleven theories:

Who are the key figures (founder or founders) associated with the approach?

What are some of the basic assumptions underlying this approach?

What are a few of the key concepts that are essential to this theory?

What do you consider to be the most important goals of this therapy?

What is the role the therapeutic relationship plays in terms of therapy outcomes?

What are a few of the techniques from this therapy model that you would want to incorporate into your counseling practice?

What are some of the ways that this theory is applied to client populations, settings, and treat- ment of problems?

What do you see as the major strength of this theory from a diversity perspective?

What do you see as the major shortcoming of this theory from a diversity perspective?

What do you consider to be the most significant contribution of this approach?

What do you consider to be the most significant limitation of this approach?

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Australia • Brazil • Mexico • Singapore • United Kingdom • United States

Gerald Corey California State University, Fullerton Diplomate in Counseling Psychology,

American Board of Professional Psychology

Theory and PracTice of counseling and

PsychoTheraPy Tenth Edition

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This is an electronic version of the print textbook. Due to electronic rights restrictions, some third party content may be suppressed. Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. The publisher reserves the right to remove content from this title at any time if subsequent rights restrictions require it. For valuable information on pricing, previous editions, changes to current editions, and alternate formats, please visit www.cengage.com/highered to search by ISBN#, author, title, or keyword for materials in your areas of interest.

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Theory and Practice of Counseling and Psychotherapy, Tenth Edition Gerald Corey

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WCN: 02-200-203

To the founders and key figures of the theories presented

in this book—with appreciation for their contributions

to contemporary counseling practice.

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abouT The auThor

gerald corey is Professor Emeritus of Human Services and Counseling at California State University at Fullerton. He received his doctorate in counseling from the University of Southern California. He is a Diplomate in Counseling Psy- chology, American Board of Professional Psychology; a licensed psychologist; and a National Certified Counselor. He is a Fellow of the American Psychological Associa- tion (Division 17, Counseling Psychology; and Division 49, Group Psychotherapy); a Fellow of the American Counseling Association; and a Fellow of the Association for Specialists in Group Work. He also holds memberships in the American Group Psychotherapy Association; the American Mental Health Counselors Association; the Association for Spiritual, Ethical, and Religious Values in Counseling; the Asso- ciation for Counselor Education and Supervision; and the Western Association of Counselor Education and Supervision. Both Jerry and Marianne Corey received the Lifetime Achievement Award from the American Mental Health Counselors Associ- ation in 2011, and both of them received the Eminent Career Award from ASGW in 2001. Jerry was given the Outstanding Professor of the Year Award from California State University at Fullerton in 1991. He regularly teaches both undergraduate and graduate courses in group counseling and ethics in counseling. He is the author or coauthor of 15 textbooks in counseling currently in print, along with more than 60 journal articles and book chapters. Several of his books have been translated into other languages. Theory and Practice of Counseling and Psychotherapy has been trans- lated into Arabic, Indonesian, Portuguese, Turkish, Korean, and Chinese. Theory and Practice of Group Counseling has been translated into Korean, Chinese, Spanish, and Russian. Issues and Ethics in the Helping Professions has been translated into Korean, Japanese, and Chinese.

In the past 40 years Jerry and Marianne Corey have conducted group counsel- ing training workshops for mental health professionals at many universities in the United States as well as in Canada, Mexico, China, Hong Kong, Korea, Germany, Belgium, Scotland, England, and Ireland. In his leisure time, Jerry likes to travel, hike and bicycle in the mountains, and drive his 1931 Model A Ford. Marianne and Jerry have been married since 1964. They have two adult daughters, Heidi and Cindy, two granddaughters (Kyla and Keegan), and one grandson (Corey).

Recent publications by Jerry Corey, all with Cengage Learning, include:

ŠŠ Theory and Practice of Group Counseling, Ninth Edition (and Student Manual) (2016)

ŠŠ Becoming a Helper, Seventh Edition (2016, with Marianne Schneider Corey)

ŠŠ Issues and Ethics in the Helping Professions, Ninth Edition (2015, with Mari- anne Schneider Corey, Cindy Corey, and Patrick Callanan)

ŠŠ Group Techniques, Fourth Edition (2015, with Marianne Schneider Corey, Patrick Callanan, and J. Michael Russell)

ŠŠ Groups: Process and Practice, Ninth Edition (2014, with Marianne Schnei- der Corey and Cindy Corey)

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ŠŠ I Never Knew I Had a Choice, Tenth Edition (2014, with Marianne Schneider Corey)

ŠŠ Case Approach to Counseling and Psychotherapy, Eighth Edition (2013) ŠŠ The Art of Integrative Counseling, Third Edition (2013)

Jerry Corey is coauthor (with Barbara Herlihy) of Boundary Issues in Counseling: Multiple Roles and Responsibilities, Third Edition (2015) and ACA Ethical Standards Case- book, Seventh Edition (2015); he is coauthor (with Robert Haynes, Patrice Moulton, and Michelle Muratori) of Clinical Supervision in the Helping Professions: A Practical Guide, Second Edition (2010); he is the author of Creating Your Professional Path: Les- sons From My Journey (2010). All four of these books are published by the American Counseling Association.

He has also made several educational DVD programs on various aspects of counseling practice: (1) Ethics in Action: DVD and Workbook (2015, with Marianne Schneider Corey and Robert Haynes); (2) Groups in Action: Evolution and Challenges DVD and Workbook (2014, with Marianne Schneider Corey and Robert Haynes); (3) DVD for Theory and Practice of Counseling and Psychotherapy: The Case of Stan and Lecturettes (2013); (4) DVD for Integrative Counseling: The Case of Ruth and Lecturettes (2013, with Robert Haynes); and (5) DVD for Theory and Practice of Group Counseling (2012). All of these programs are available through Cengage Learning.

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Preface xi

PART 1

BASIC ISSUES IN COUNSELING PRACTICE

1 Introduction and Overview 1 introduction 2 Where I Stand 3 Suggestions for Using the Book 5 Overview of the Theory Chapters 6 Introduction to the Case of Stan 9 Introduction to the Case of Gwen 13

2 The Counselor: Person and Professional 17

introduction 18 The Counselor as a Therapeutic Person 18 Personal Therapy for the Counselor 20 The Counselor’s Values and the Therapeutic Process 22 Becoming an Effective Multicultural Counselor 25 Issues Faced by Beginning Therapists 28 Summary 35

3 Ethical Issues in Counseling Practice 37

introduction 38 Putting Clients’ Needs Before Your Own 38 Ethical Decision Making 39 The Right of Informed Consent 41 Dimensions of Confidentiality 42 Ethical Issues From a Multicultural Perspective 43 Ethical Issues in the Assessment Process 45 Ethical Aspects of Evidence-Based Practice 48 Managing Multiple Relationships in Counseling Practice 49 Becoming an Ethical Counselor 52 Summary 53

Where to Go From Here 53 Recommended Supplementary Readings for Part 1 54

PART 2

THEORIES AND TECHNIQUES OF COUNSELING

4 Psychoanalytic Therapy 57 introduction 58 Key Concepts 59 The Therapeutic Process 66 Application: Therapeutic Techniques and Procedures 72 Jung’s Perspective on the Development of Personality 77 Contemporary Trends: Object-Relations Theory, Self Psychology, and Relational Psychoanalysis 79 Psychoanalytic Therapy From a Multicultural Perspective 84 Psychoanalytic Therapy applied to the case of stan 85 Psychoanalytic Therapy applied to the case of gwen 87 Summary and Evaluation 89 Self-Reflection and Discussion Questions 92 Where to Go From Here 92 Recommended Supplementary Readings 93

5 Adlerian Therapy 95 introduction 98 Key Concepts 98 The Therapeutic Process 104 Application: Therapeutic Techniques and Procedures 108 Adlerian Therapy From a Multicultural Perspective 119 adlerian Therapy applied to the case of stan 121 adlerian Therapy applied to the case of gwen 122

Contents

vii

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viii Contents

Summary and Evaluation 124 Self-Reflection and Discussion Questions 126 Where to Go From Here 127 Recommended Supplementary Readings 128

6 Existential Therapy 129 introduction 132 Key Concepts 137 The Therapeutic Process 146 Application: Therapeutic Techniques and Procedures 149 Existential Therapy From a Multicultural Perspective 153 existential Therapy applied to the case of stan 155 existential Therapy applied to the case of gwen 156 Summary and Evaluation 157 Self-Reflection and Discussion Questions 160 Where to Go From Here 160 Recommended Supplementary Readings 162

7 Person-Centered Therapy 163 introduction 165 Key Concepts 170 The Therapeutic Process 171 Application: Therapeutic Techniques and Procedures 176 Person-Centered Expressive Arts Therapy 180 Motivational Interviewing 182 Person-Centered Therapy From a Multicultural Perspective 184 Person-centered Therapy applied to the case of stan 186 Person-centered Therapy applied to the case of gwen 187 Summary and Evaluation 190 Self-Reflection and Discussion Questions 193 Where to Go From Here 193 Recommended Supplementary Readings 195

8 Gestalt Therapy 197 introduction 199 Key Concepts 200 The Therapeutic Process 206

Application: Therapeutic Techniques and Procedures 211 Gestalt Therapy From a Multicultural Perspective 220 gestalt Therapy applied to the case of stan 221 gestalt Therapy applied to the case of gwen 223 Summary and Evaluation 224 Self-Reflection and Discussion Questions 227 Where to Go From Here 227 Recommended Supplementary Readings 229

9 Behavior Therapy 231 introduction 233 Key Concepts 236 The Therapeutic Process 238 Application: Therapeutic Techniques and Procedures 240 Behavior Therapy From a Multicultural Perspective 258 behavior Therapy applied to the case of stan 259 behavior Therapy applied to the case of gwen 260 Summary and Evaluation 262 Self-Reflection and Discussion Questions 265 Where to Go From Here 266 Recommended Supplementary Readings 267

10 Cognitive Behavior Therapy 269 introduction 270 Albert Ellis’s Rational Emotive Behavior Therapy 270 Key Concepts 272 The Therapeutic Process 273 Application: Therapeutic Techniques and Procedures 275 Aaron Beck’s Cognitive Therapy 281 Christine Padesky and Kathleen Mooney’s Strengths-Based Cognitive Behavioral Therapy 289 Donald Meichenbaum’s Cognitive Behavior Modification 293 Cognitive Behavior Therapy From a Multicultural Perspective 298 cognitive behavior Therapy applied to the case of stan 300 cognitive behavior Therapy applied to the case of gwen 302 Summary and Evaluation 303

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Contents ix

Self-Reflection and Discussion Questions 307 Where to Go From Here 308 Recommended Supplementary Readings 310

11 Choice Theory/Reality Therapy 311

introduction 313 Key Concepts 314 The Therapeutic Process 318 Application: Therapeutic Techniques and Procedures 320 Choice Theory/Reality Therapy From a Multicultural Perspective 327 reality Therapy applied to the case of stan 329 reality Therapy applied to the case of gwen 331 Summary and Evaluation 332 Self-Reflection and Discussion Questions 334 Where to Go From Here 334 Recommended Supplementary Readings 336

12 Feminist Therapy 337 introduction 339 Key Concepts 341 The Therapeutic Process 345 Application: Therapeutic Techniques and Procedures 348 Feminist Therapy From a Multicultural and Social Justice Perspective 354 feminist Therapy applied to the case of stan 355 feminist Therapy applied to the case of gwen 357 Summary and Evaluation 360 Self-Reflection and Discussion Questions 364 Where to Go From Here 364 Recommended Supplementary Readings 366

13 Postmodern Approaches 367 Some Contemporary Founders of Postmodern Therapies 368 Introduction to Social Constructionism 368 Solution-Focused Brief Therapy 371 Narrative Therapy 382 Postmodern Approaches From a Multicultural Perspective 390 Postmodern approaches applied to the case of stan 392

Postmodern approaches applied to the case of gwen 394 Summary and Evaluation 396 Self-Reflection and Discussion Questions 398 Where to Go From Here 399 Recommended Supplementary Readings 400

14 Family Systems Therapy 403 introduction 404 Development of Family Systems Therapy 406 A Multilayered Process of Family Therapy 409 Family Systems Therapy From a Multicultural Perspective 415 family Therapy applied to the case of stan 417 family Therapy applied to the case of gwen 420 Summary and Evaluation 422 Self-Reflection and Discussion Questions 424 Where to Go From Here 424 Recommended Supplementary Readings 425

PART 3

INTEGRATION AND APPLICATION

15 An Integrative Perspective 427 introduction 428 The Movement Toward Psychotherapy Integration 428 Issues Related to the Therapeutic Process 437 The Place of Techniques and Evaluation in Counseling 443 an integrative approach applied to the case of stan 452 an integrative approach applied to the case of gwen 455 Summary 456 Concluding Comments 457 Self-Reflection and Discussion Questions 458 Where to Go From Here 458 Recommended Supplementary Readings 459

references and suggested readings 461

name index 481

subject index 485

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Preface to Tenth Edition

T his book is intended for counseling courses for undergraduate and graduate students in psychology, counselor education, human services, and the mental health professions. It surveys the major concepts and practices of the contemporary therapeutic systems and addresses some ethical and professional issues in counsel- ing practice. The book aims to teach students to select wisely from various theories and techniques and to begin to develop a personal style of counseling.

I have found that students appreciate an overview of the divergent contempo- rary approaches to counseling and psychotherapy. They also consistently say that the first course in counseling means more to them when it deals with them person- ally. Therefore, I stress the practical applications of the material and encourage per- sonal reflection. Using this book can be both a personal and an academic learning experience.

In this tenth edition, every effort has been made to retain the major qualities that students and professors have found useful in the previous editions: the succinct overview of the key concepts of each theory and their implications for practice, the straightforward and personal style, and the book’s comprehensive scope. Care has been taken to present the theories in an accurate and fair way. I have attempted to be simple, clear, and concise. Because many students want suggestions for supple- mentary reading as they study each therapy approach, I have included an updated reading list at the end of each chapter and a list of references for each chapter at the end of the book.

This tenth edition updates the material and refines existing discussions. Part 1 deals with issues that are basic to the practice of counseling and psychotherapy. Chapter 1 puts the book into perspective, then students are introduced to the counselor—as a person and a professional—in Chapter 2. This chapter addresses a number of topics pertaining to the role of the counselor as a person and the ther- apeutic relationship. Chapter 3 introduces students to some key ethical issues in counseling practice, and several of the topics in this chapter have been updated and expanded. Expanded coverage is given to the ACA’s 2014 Code of Ethics.

Part 2 is devoted to a consideration of 11 theories of counseling. Each of the theory chapters follows a common organizational pattern, and students can easily compare and contrast the various models. This pattern includes core topics such as key concepts, the therapeutic process, therapeutic techniques and procedures, mul- ticultural perspectives, the theory applied to the case of Stan and new to this edition to the case of Gwen, and summary and evaluation. In this tenth edition, each of the chapters in Part 2 has been revised, updated, and expanded to reflect recent trends, and references have been updated as well. Revisions were based on the recommenda- tions of experts in each theory, all of whom are listed in the Acknowledgments sec- tion. Attention was given to current trends and recent developments in the practice of each theoretical approach.

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xii PrefaCe to tenth edition

Each of the 11 theory chapters summarizes key points and evaluates the con- tributions, strengths, limitations, and applications of these theories. Special atten- tion is given to evaluating each theory from a multicultural perspective as well, with a commentary on the strengths and shortcomings of the theory in working with diverse client populations. The consistent organization of the summary and evalu- ation sections makes comparing theories easier. Students are given recommenda- tions regarding where to look for further training for all of the approaches in the Where To Go From Here sections at the end of the chapter. Updated annotated lists of reading suggestions along with DVD resources are offered to stimulate students to expand on the material and broaden their learning.

In Part 3, Chapter 15 develops the notion that an integrative approach to coun- seling practice is in keeping with meeting the needs of diverse client populations in many different settings. Numerous tables and other integrating material help stu- dents compare and contrast the 11 approaches.

What’s new in This Tenth edition Features of the tenth edition include Learning Objectives for all the theory chapters; Self-Reflection and Discussion Questions at the end of each theory chapter to facilitate thinking and interaction in class; and a new Case of Gwen, who is a composite of many clients, to complement the Case of Stan feature. Guest contributor Dr. Kel- lie Kirksey describes her way of working with Gwen from each of the theoretical perspectives.

Significant changes for the tenth edition for each of the theory chapters are out- lined below:

chapter 4 Psychoanalytic Therapy ŠŠ New material on countertransference, its role in psychoanalytic therapy,

and guidelines for effectively dealing with countertransference ŠŠ Expanded discussion of brief psychodynamic therapy and its application

chapter 5 adlerian Therapy ŠŠ Revised material on the life tasks ŠŠ More emphasis on goals for the educational process of therapy ŠŠ More on the role of assessment and diagnosis ŠŠ New material on early recollections with concrete examples ŠŠ Many new examples to bring Adlerian concepts to life ŠŠ Revised discussion of reorientation and encouragement process ŠŠ Expanded discussion of Adlerian techniques

chapter 6 existential Therapy ŠŠ Revised material on existential anxiety and its implications for therapy ŠŠ Revised section on the client–therapist relationship ŠŠ Expanded discussion of tasks of the existential therapist

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PrefaCe to tenth edition xiii

chapter 7 Person-centered Therapy ŠŠ Expanded discussion of clients as active self-healers ŠŠ Updated coverage of the core conditions of congruence, unconditional

positive regard, and empathy ŠŠ More attention to the diversity of styles of therapists practicing person-

centered therapy ŠŠ More emphasis on how the basic philosophy of the person-centered

approach is appropriate for working with diverse client populations ŠŠ A new section on emotion-focused therapy, stressing the role of emotions

as a route to change ŠŠ Revised section on motivational interviewing (person-centered approach

with a twist)

chapter 8 gestalt Therapy ŠŠ Revised discussion of the role of experiments in Gestalt therapy and

how they differ from techniques and structured exercises ŠŠ New emphasis on therapist presence, the role of dialogue in therapy,

and the therapeutic relationship ŠŠ Expanded discussion of therapist authenticity and self-disclosure ŠŠ More attention to the contemporary relational approach to Gestalt

practice

chapter 9 behavior Therapy ŠŠ Increased attention to the “third-generation” or “new wave” behavior

therapies ŠŠ Updating of section on EMDR ŠŠ Expanded and updated discussion of the role of mindfulness and

acceptance strategies in contemporary behavior therapy ŠŠ New and expanded material on mindfulness-based cognitive therapy

and stress reduction ŠŠ Expanded and revised treatment of dialectical behavior therapy

chapter 10 cognitive behavior Therapy ŠŠ Major reorganization and updating of the entire chapter ŠŠ Streamlining and updating of Albert Ellis’s rational emotive behavior

therapy ŠŠ Revised and expanded coverage of Aaron Beck’s cognitive therapy ŠŠ Increased coverage of Judith Beck’s role in the development of cognitive

therapy ŠŠ New section on Christine Padesky’s strength-based cognitive behavior

therapy ŠŠ Increased attention on Donald Meichenbaum’s influence in the devel-

opment of CBT ŠŠ More clinical examples to illustrate key CBT techniques and concepts ŠŠ Expanded coverage of a comparison among the various CBT approaches

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xiv PrefaCe to tenth edition

chapter 11 choice Theory/reality Therapy ŠŠ Revision of the relationship of choice theory to reality therapy ŠŠ More practical examples of reality therapy practice

chapter 12 feminist Therapy ŠŠ Updated and expanded treatment of the principles of feminist therapy ŠŠ Increased attention given to cultural and social justice perspectives ŠŠ More emphasis on concepts of power, privilege, discrimination, and

empowerment ŠŠ Expansion of relational-cultural theory and implications for practice ŠŠ Revised and expanded discussion on therapeutic techniques and

strategies ŠŠ Revised material on strengths from a diversity perspective

chapter 13 Postmodern approaches ŠŠ Updated coverage on parallels between solution-focused brief therapy

(SFBT) and positive psychology ŠŠ Broadened discussion of the key concepts of SFBT ŠŠ More emphasis on the client-as-expert in the therapy relationship in

postmodern approaches ŠŠ More clinical examples to illustrate the use of SFBT techniques ŠŠ New material on the defining characteristics of brief therapy ŠŠ Increased emphasis on the collaborative nature of narrative therapy and

SFBT ŠŠ Revision of narrative therapy section

chapter 14 family systems Therapy ŠŠ Streamlined to focus mainly on an integrative approach to family

therapy ŠŠ More on recent developments in family systems therapy ŠŠ More attention given to feminism, multiculturalism, and postmodern

constructionism as applied to family therapy

Chapter 15 (“An Integrative Perspective”) pulls together themes from all 11 theo- retical orientations. This chapter represents a major revision of the discussion of the psychotherapy integration movement; updates of the various integrative approaches; revision of the section on integration of spirituality in counseling; added material on research demonstrating the therapeutic alliance; expanded discussion on the central role of the client in determining therapy outcomes; new section on feedback-informed treatment; and updated coverage of the conclusions from the research literature on the effectiveness of psychotherapy. New to this chapter are two cases (Stan and Gwen) that illustrate integrative approaches. Chapter 15 develops the notion that an integrative approach to counseling practice is in keeping with meeting the needs of diverse client populations in many different settings. Numerous tables and other integrating mate- rial help students compare and contrast the 11 approaches.

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PrefaCe to tenth edition xv

This text can be used in a flexible way. Some instructors will follow the sequenc- ing of chapters in the book. Others will prefer to begin with the theory chapters (Part 2) and then deal later with the student’s personal characteristics and ethical issues. The topics can be covered in whatever order makes the most sense. Readers are offered some suggestions for using this book in Chapter 1.

In this edition I have made every effort to incorporate those aspects that have worked best in the courses on counseling theory and practice that I teach. To help readers apply theory to practice, I have also revised the Student Manual, which is designed for experiential work. The Student Manual for Theory and Practice of Counseling and Psychotherapy still contains open-ended questions, many new cases for explora- tion and discussion, structured exercises, self-inventories, and a variety of activities that can be done both in class and out of class. The tenth edition features a struc- tured overview, as well as a glossary, for each of the theories, and chapter quizzes for assessing the level of student mastery of basic concepts. New to this tenth edition of the Student Manual are experiential exercises for the Case of Gwen and questions raised by experts in each of the theory chapters. Each expert addresses the same six ques- tions as applied to each of the given theories.

MindTap™ is a new online resource available to accompany this textbook. It contains the video program for Theory and Practice of Counseling and Psychotherapy: The Case of Stan and Lecturettes, a glossary of key terms, interviews with experts (questions and answers by experts in the various theories), and case examples for each of the theories illustrating ways of applying these concepts and techniques to a counseling case. A concise version of working with Stan from an integrative perspective now appears in Chapter 15. Chapter 16, “Case Illustration: An Integrative Approach in Working With Stan,” has been deleted from this edition but is available on Mind- Tap™. A chapter covering Transactional Analysis is also available on MindTap™.

Case Approach to Counseling and Psychotherapy (Eighth Edition) features experts working with the case of Ruth from the various therapeutic approaches. The case- book, which is now available online, can supplement this book or stand alone.

Accompanying this tenth edition of the text and Student Manual are lecturettes on how I draw from key concepts and techniques from the various theories pre- sented in the book. This DVD program has been developed for student purchase and use as a self-study program, and it completes an ideal learning package. The Art of Integrative Counseling (Third Edition), which expands on the material in Chapter 15 of the textbook, also complements this book.

Some professors have found the textbook and the Student Manual or MindTap™ to be ideal companions and realistic resources for a single course. Others like to use the textbook and the casebook as companions. With this revision it is now possible to have a unique learning package of several books, along with the DVD for Integra- tive Counseling: The Case of Ruth and Lecturettes. The Case Approach to Counseling and Psy- chotherapy and the Art of Integrative Counseling can also be used in a various classes, a few of which include case-management practicum, fieldwork courses, or counseling techniques courses.

Also available is a revised and updated Instructor’s Resource Manual, which includes suggestions for teaching the course, class activities to stimulate interest, PowerPoint presentations for all chapters, and a variety of test questions and a final examina- tion. This instructor’s manual is now geared for the following learning package:

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xvi PrefaCe to tenth edition

Theory and Practice of Counseling and Psychotherapy, Student Manual for Theory and Practice of Counseling and Psychotherapy, Case Approach to Counseling and Psychotherapy, The Art of Integrative Counseling, and two video programs: DVD for Integrative Counseling: The Case of Ruth and Lecturettes, and DVD for Theory and Practice of Counseling and Psychotherapy: The Case of Stan and Lecturettes.

Acknowledgments The suggestions I received from the many readers of prior editions who took the time to complete the surveys have been most helpful in the revision process. Many other people have contributed ideas that have found their way into this tenth edi- tion. I especially appreciate the time and efforts of those who participated in a pre- revision review and offered constructive criticism and supportive commentaries, as well as those professors who have used this book and provided me with feedback that has been most useful in these revisions. Those who reviewed selected parts of the manuscript of the tenth edition are:

Jude Austin, doctoral student, University of Wyoming Julius Austin, doctoral student, University of Wyoming Mark E. Young, University of Central Florida Robert Haynes, Borderline Productions Beverly Palmer, California State University at Dominguez Hills James Robert Bitter, East Tennessee State University Patricia Robertson, East Tennessee State University Jamie Bludworth, Arizona State University Michelle Muratori, Johns Hopkins University Jake Morris, Lipscomb University

Special thanks are extended to the chapter reviewers, who provided consultation and detailed critiques. Their insightful and valuable comments have generally been incorporated into this edition:

ŠŠ Chapter 4 (Psychoanalytic Therapy): William Blau, Copper Mountain College, Joshua Tree, California

ŠŠ Chapter 5 (Adlerian Therapy): Matt Englar-Carlson, California State University, Fullerton; Jon Carlson, Governors State University; Jon Sperry, Lynn University, Boca Raton. James Robert Bitter, East Tennessee State University, and I coau- thored Chapter 5.

ŠŠ Chapter 6 (Existential Therapy): Emmy van Deurzen, New School of Psy- chotherapy and Counselling, London, England, and University of Sheffield; J. Michael Russell of California State University, Fullerton; David N. Elkins, Graduate School of Education and Psychology, Pepperdine University; Bryan Farha, Oklahoma City College

ŠŠ Chapter 7 (Person-Centered Therapy): Natalie Rogers, Person-Centered Expres- sive Arts Associates, Cotati, California; David N. Elkins, Graduate School of Education and Psychology, Pepperdine University; David Cain, California

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School of Professional Psychology at Alliant International University, San Diego

ŠŠ Chapter 8 (Gestalt Therapy): Jon Frew, Private Practice, Vancouver, Washing- ton, and Pacific University, Oregon; Lynne Jacobs, Pacific Gestalt Institute in Los Angeles; Gary Yontef, Pacific Gestalt Institute in Los Angeles; Jude Austin, doctoral student, University of Wyoming; Julius Austin, doctoral student, Uni- versity of Wyoming

ŠŠ Chapter 9 (Behavior Therapy): Sherry Cormier, West Virginia University; Frank M. Dattilio, Harvard Medical School, and the University of Pennsylvania School of Medicine; Ronald D. Siegel, Harvard Medical School

ŠŠ Chapter 10 (Cognitive Behavior Therapy): Sherry Cormier, West Virginia University; Christine A. Padesky, Center for Cognitive Therapy at Huntington Beach, California; Frank M. Dattilio, Harvard Medical School, and the University of Pennsylvania School of Medicine; Beverly Palmer, California State University at Dominguez Hills; Jamie Bludworth, Arizona State University; Jude Austin, doctoral student, University of Wyoming; Julius Austin, doctoral student, University of Wyoming; Jon Sperry, Lynn University, Boca Raton; Debbie Joffe Ellis

ŠŠ Chapter 11 (Choice Theory/Reality Therapy): Robert Wubbolding, Center for Reality Therapy, Cincinnati, Ohio

ŠŠ Chapter 12 (Feminist Therapy): Carolyn Zerbe Enns, Cornell College; James Robert Bitter, East Tennessee State University; Patricia Robertson, East Ten- nessee State University; Elizabeth Kincade, Indiana University of Pennsylvania; Susan Rachael Seem, The College at Brockport, State University of New York; Kellie Kirksey, Cleveland Institute of Wellness; Amanda La Guardia of Sam Houston State University. Barbara Herlihy, University of New Orleans, and I coauthored Chapter 12.

ŠŠ Chapter 13 (Postmodern Approaches): John Winslade, California State University, San Bernardino; John Murphy, University of Central Arkansas

ŠŠ Chapter 14 (Family Systems Therapy): James Robert Bitter, East Tennessee State University, and I co-authored Chapter 14.

ŠŠ Chapter 15 (An Integrative Perspective): Scott D. Miller, The International Center for Clinical Excellence; Beverly Palmer, California State University at Dominguez Hills; Jude Austin, doctoral student, University of Wyoming; Julius Austin, doctoral student, University of Wyoming

ŠŠ The Case of Gwen (all theory chapters) was written by Kellie Kirksey, Cleveland Clinic Center for Integrative Medicine

This book is the result of a team effort, which includes the combined efforts of a number of people at Cengage Learning. These people include Jon-David Hague, Product Director; Julie Martinez, Product Manager, Counseling, Human Services, and Social Work; Vernon Boes, Art Director, for his work on the interior design and cover of this book; Kyra Kane, Associate Content Developer, who coordinates the

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xviii PrefaCe to tenth edition

MindTap™ program and other supplementary materials for the book; Michelle Muratori, Johns Hopkins University, for her work on updating the Instructor’s Resource Manual and assisting in developing other supplements; and Rita Jaramillo, Content Project Manager. Thanks to Ben Kolstad of Cenveo® Publisher Services, who coordinated the production of this book. Special recognition goes to Kay Mikel, the manuscript editor of this edition, whose exceptional editorial talents continue to keep this book reader friendly. I appreciate Susan Cunningham’s work in creat- ing and revising test items to accompany this text and in preparing the index. The efforts and dedication of all of these people certainly contribute to the high quality of this edition.

Gerald Corey

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1Introduction and Overview

1. Understand the author’s philosophical stance.

2. Identify suggested ways to use this book.

3. Differentiate between each contemporary counseling model discussed in this book.

4. Identify key issues within the case of Stan.

5. Identify key issues within the case of Gwen.

L e a r n i n g O b j e c t i v e s

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Introduction Counseling students can begin to acquire a counseling style tailored to their own personality by familiarizing themselves with the major approaches to therapeu- tic practice. This book surveys 11 approaches to counseling and psychotherapy, presenting the key concepts of each approach and discussing features such as the therapeutic process (including goals), the client–therapist relationship, and spe- cific procedures used in the practice of counseling. This information will help you develop a balanced view of the major ideas of each of the theories and acquaint you with the practical techniques commonly employed by counselors who adhere to each approach. I encourage you to keep an open mind and to seriously consider both the unique contributions and the particular limitations of each therapeutic system presented in Part 2.

You cannot gain the knowledge and experience you need to synthesize various approaches by merely completing an introductory course in counseling theory. This process will take many years of study, training, and practical counseling experience. Nevertheless, I recommend a personal integration as a framework for the profes- sional education of counselors. When students are presented with a single model and are expected to subscribe to it alone, their effectiveness will be limited when working with a diverse range of future clients.

An undisciplined mixture of approaches, however, can be an excuse for failing to develop a sound rationale for systematically adhering to certain concepts and to the techniques that are extensions of them. It is easy to pick and choose fragments from the various therapies because they support our biases and preconceptions. By studying the models presented in this book, you will have a better sense of how to integrate concepts and techniques from different approaches when defining your own personal synthesis and framework for counseling.

Each therapeutic approach has useful dimensions. It is not a matter of a theory being “right” or “wrong,” as every theory offers a unique contribution to understand- ing human behavior and has unique implications for counseling practice. Accepting the validity of one model does not necessarily imply rejecting other models. There is a clear place for theoretical pluralism, especially in a society that is becoming increasingly diverse.

Although I suggest that you remain open to incorporating diverse approaches into your own personal synthesis—or integrative approach to counseling—let me caution that you can become overwhelmed and confused if you attempt to learn everything at once, especially if this is your introductory course in counseling theories. A case can be made for initially getting an overview of the major theoreti- cal orientations, and then learning a particular approach by becoming steeped in that approach for some time, rather than superficially grasping many theoretical approaches. An integrative perspective is not developed in a random fashion; rather, it is an ongoing process that is well thought out. Successfully integrating concepts and techniques from diverse models requires years of reflective practice and a great deal of reading about the various theories. In Chapter 15 I discuss in more depth some ways to begin designing your integrative approach to counseling practice.

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visit CengageBrain.com or watch the dvd for the video program on Chapter 1, Theory and Practice of Counseling and Psychotherapy: The Case of Stan and Lecturettes. I suggest that you view the brief lecturette for each chapter in this book prior to reading the chapter.

Where I Stand My philosophical orientation is strongly influenced by the existential approach. Because this approach does not prescribe a set of techniques and pro- cedures, I draw techniques from the other models of therapy that are presented in this book. I particularly like to use role-playing techniques. When people reenact scenes from their lives, they tend to become more psychologically engaged than when they merely report anecdotes about themselves. I also incorporate many tech- niques derived from cognitive behavior therapy.

The psychoanalytic emphasis on early psychosexual and psychosocial develop- ment is useful. Our past plays a crucial role in shaping our current personality and behavior. I challenge the deterministic notion that humans are the product of their early conditioning and, thus, are victims of their past. But I believe that an explora- tion of the past is often useful, particularly to the degree that the past continues to influence present-day emotional or behavioral difficulties.

I value the cognitive behavioral focus on how our thinking affects the way we feel and behave. These therapies also emphasize current behavior. Thinking and feeling are important dimensions, but it can be a mistake to overemphasize them and not explore how clients are behaving. What people are doing often provides a good clue to what they really want. I also like the emphasis on specific goals and on encourag- ing clients to formulate concrete aims for their own therapy sessions and in life.

More approaches have been developing methods that involve collaboration between therapist and client, making the therapeutic venture a shared responsibil- ity. This collaborative relationship, coupled with teaching clients ways to use what they learn in therapy in their everyday lives, empowers clients to take an active stance in their world. It is imperative that clients be active, not only in their counseling sessions but in daily life as well. Homework, collaboratively designed by clients and therapists, can be a vehicle for assisting clients in putting into action what they are learning in therapy.

A related assumption of mine is that we can exercise increasing freedom to cre- ate our own future. Accepting personal responsibility does not imply that we can be anything we want to be. Social, environmental, cultural, and biological realities oftentimes limit our freedom of choice. Being able to choose must be considered in the sociopolitical contexts that exert pressure or create constraints; oppression is a reality that can restrict our ability to choose our future. We are also influenced by our social environment, and much of our behavior is a product of learning and conditioning. That being said, I believe an increased awareness of these contextual forces enables us to address these realities. It is crucial to learn how to cope with the external and internal forces that influence our decisions and behavior.

Feminist therapy has contributed an awareness of how environmental and social conditions contribute to the problems of women and men and how gender-role

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socialization leads to a lack of gender equality. Family therapy teaches us that it is not possible to understand the individual apart from the context of the system. Both family therapy and feminist therapy are based on the premise that to understand the individual it is essential to take into consideration the interpersonal dimensions and the sociocultural context rather than focusing primarily on the intrapsychic domain. This comprehensive approach to counseling goes beyond understanding our internal dynamics and addresses the environmental and systemic realities that influence us.

My philosophy of counseling challenges the assumption that therapy is exclu- sively aimed at “curing” psychological “ailments.” Such a focus on the medical model restricts therapeutic practice because it stresses deficits rather than strengths. Instead, I agree with the postmodern approaches (see Chapter 13), which are grounded on the assumption that people have both internal and external resources to draw upon when constructing solutions to their problems. Therapists will view these individuals quite differently if they acknowledge that their clients possess competencies rather than pathologies. I view each individual as having resources and competencies that can be discovered and built upon in therapy.

Psychotherapy is a process of engagement between two people, both of whom are bound to change through the therapeutic venture. At its best, this is a collabora- tive process that involves both the therapist and the client in co-constructing solu- tions regarding life’s tasks. Most of the theories described in this book emphasize the collaborative nature of the practice of psychotherapy.

Therapists are not in business to change clients, to give them quick advice, or to solve their problems for them. Instead, counselors facilitate healing through a pro- cess of genuine dialogue with their clients. The kind of person a therapist is remains the most critical factor affecting the client and promoting change. If practitioners possess wide knowledge, both theoretical and practical, yet lack human qualities of compassion, caring, good faith, honesty, presence, realness, and sensitivity, they are more like technicians. I believe that those who function exclusively as technicians do not make a significant difference in the lives of their clients. It is essential that coun- selors explore their own values, attitudes, and beliefs in depth and work to increase their own awareness. Throughout the book I encourage you to find ways to apply what you are reading to your personal life. Doing so will take you beyond a mere academic understanding of these theories.

With respect to mastering the techniques of counseling and applying them appropriately and effectively, it is my belief that you are your own very best tech- nique. Your engagement with your clients is useful in moving the therapeutic pro- cess along. It is impossible to separate the techniques you use from your personality and the relationship you have with your clients.

Administering techniques to clients without regard for the relationship vari- ables is ineffective. Techniques cannot substitute for the hard work it takes to develop a constructive client–therapist relationship. Although you can learn atti- tudes and skills and acquire certain knowledge about personality dynamics and the therapeutic process, much of effective therapy is the product of artistry. Counseling entails far more than becoming a skilled technician. It implies that you are able to establish and maintain a good working relationship with your clients, that you can draw on your own experiences and reactions, and that you can identify techniques suited to the needs of your clients.

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As a counselor, you need to remain open to your own personal development and to address your personal problems. The most powerful ways for you to teach your clients is by the behavior you model and by the ways you connect with them. I sug- gest you experience a wide variety of techniques yourself as a client. Reading about a technique in a book is one thing; actually experiencing it from the vantage point of a client is quite another. If you have practiced mindfulness exercises, for example, you will have a much better sense for guiding clients in the practice of becoming increas- ingly mindful in daily life. If you have carried out real-life homework assignments as part of your own self-change program, you can increase your empathy for clients and their potential problems. Your own anxiety over self-disclosing and addressing personal concerns can be a most useful anchoring point as you work with the anxiet- ies of your clients. The courage you display in your own personal therapy will help you appreciate how essential courage is for your clients.

Your personal characteristics are of primary importance in becoming a counselor, but it is not sufficient to be merely a good person with good intentions. To be effective, you also must have supervised experiences in counseling and sound knowledge of counseling theory and techniques. Further, it is essential to be well grounded in the various theories of personality and to learn how they are related to theories of counseling. Your conception of the person and the individual characteristics of your client affect the interventions you will make. Differences between you and your client may require modification of certain aspects of the theories. Some practitioners make the mistake of relying on one type of intervention (supportive, confrontational, information giv- ing) for most clients with whom they work. In reality, different clients may respond better to one type of intervention than to another. Even during the course of an individual’s therapy, different interventions may be needed at different times. Prac- titioners should acquire a broad base of counseling techniques that are suitable for individual clients rather than forcing clients to fit one approach to counseling.

Suggestions for Using the Book Here are some specific recommendations on how to get the fullest value from this book. The personal tone of the book invites you to relate what you are reading to your own experiences. As you read Chapter 2, “The Counselor: Person and Profes- sional,” begin the process of reflecting on your needs, motivations, values, and life experiences. Consider how you are likely to bring the person you are becoming into your professional work. You will assimilate much more knowledge about the vari- ous therapies if you make a conscious attempt to apply the key concepts and tech- niques of these theories to your own personal life. Chapter 2 helps you think about how to use yourself as your single most important therapeutic instrument, and it addresses a number of significant ethical issues in counseling practice.

Before you study each of the theories chapters, I suggest that you at least briefly read Chapter 15, which provides a comprehensive review of the key concepts from all 11 theories presented in this textbook. I try to show how an integration of these perspectives can form the basis for creating your own personal synthesis to coun- seling. In developing an integrative perspective, it is essential to think holistically. To understand human functioning, it is imperative to account for the physical,

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emotional, mental, social, cultural, political, and spiritual dimensions. If any one of these facets of human experience is neglected, a theory is limited in explaining how we think, feel, and act.

To provide you with a consistent framework for comparing and contrasting the various therapies, the 11 theory chapters share a common format. This format includes a few notes on the personal history of the founder or another key figure; a brief historical sketch showing how and why each theory developed at the time it did; a discussion of the approach’s key concepts; an overview of the therapeutic process, including the therapist’s role and client’s work; therapeutic techniques and procedures; applications of the theory from a multicultural perspective; application of the theory to the cases of Stan and Gwen; a summary; a critique of the theory with emphasis on contributions and limitations; suggestions of how to continue your learning about each approach; and suggestions for further reading.

Refer to the Preface for a complete description of other resources that fit as a package and complement this textbook, including Student Manual for Theory and Practice of Counseling and Psychotherapy and DVD for Integrative Counseling: The Case of Ruth and Lecturettes. In addition, in DVD for Theory and Practice of Counseling and Psycho- therapy: The Case of Stan and Lecturettes I demonstrate my way of counseling Stan from the various theoretical approaches in 13 sessions and present my perspective on the key concepts of each theory in a brief lecture, with emphasis on the practical applica- tion of the theory.

Overview of the Theory Chapters I have selected 11 therapeutic approaches for this book. Table 1.1 presents an overview of these approaches, which are explored in depth in Chapters 4 through 14. I have grouped these approaches into four general categories.

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TabLe 1.1 Overview of Contemporary Counseling Models

Psychodynamic Approaches

Psychoanalytic therapy Founder: Sigmund Freud. A theory of personality development, a philosophy of human nature, and a method of psychotherapy that focuses on unconscious factors that motivate behavior. Attention is given to the events of the first six years of life as determinants of the later development of personality.

Adlerian therapy Founder: Alfred Adler. Key Figure: Following Adler, Rudolf Dreikurs is credited with popularizing this approach in the United States. This is a growth model that stresses assuming responsibility, creating one’s own destiny, and finding meaning and goals to create a purposeful life. Key concepts are used in most other current therapies.

Experiential and Relationship-Oriented Therapies

Existential therapy Key figures: Viktor Frankl, Rollo May, and Irvin Yalom. Reacting against the tendency to view therapy as a system of well-defined techniques, this model stresses building therapy on the basic conditions of human existence, such as choice, the freedom and responsibility to shape one’s life, and self-determination. It focuses on the quality of the person-to-person therapeutic relationship.

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Person-centered therapy Founder: Carl Rogers; Key figure: Natalie Rogers. This approach was developed during the 1940s as a nondirective reaction against psychoanalysis. Based on a subjective view of human experiencing, it places faith in and gives responsibility to the client in dealing with problems and concerns.

Gestalt therapy Founders: Fritz and Laura Perls; Key figures: Miriam and Erving Polster. An experiential therapy stressing awareness and integration; it grew as a reaction against analytic therapy. It integrates the functioning of body and mind and places emphasis on the therapeutic relationship.

Cognitive Behavioral Approaches

Behavior therapy Key figures: B. F. Skinner, and Albert Bandura. This approach applies the principles of learning to the resolution of specific behavioral problems. Results are subject to continual experimentation. The methods of this approach are always in the process of refinement. The mindfulness and acceptance-based approaches are rapidly gaining popularity.

Cognitive behavior therapy Founders: Albert Ellis and A. T. Beck. Albert Ellis founded rational emotive behavior therapy, a highly didactic, cognitive, action-oriented model of therapy, and A. T. Beck founded cognitive therapy, which gives a primary role to thinking as it influences behavior. Judith Beck continues to develop CBT; Christine Padesky has developed strengths-based CBT; and Donald Meichenbaum, who helped develop cognitive behavior therapy, has made significant contributions to resilience as a factor in coping with trauma.

Choice theory/Reality therapy

Founder: William Glasser. Key figure: Robert Wubbolding. This short-term approach is based on choice theory and focuses on the client assuming responsibility in the present. Through the therapeutic process, the client is able to learn more effective ways of meeting her or his needs.

Systems and Postmodern Approaches

Feminist therapy This approach grew out of the efforts of many women, a few of whom are Jean Baker Miller, Carolyn Zerbe Enns, Oliva Espin, and Laura Brown. A central concept is the concern for the psychological oppression of women. Focusing on the constraints imposed by the sociopolitical status to which women have been relegated, this approach explores women’s identity development, self-concept, goals and aspirations, and emotional well-being.

Postmodern approaches A number of key figures are associated with the development of these various approaches to therapy. Steve de Shazer and Insoo Kim Berg are the cofounders of solution-focused brief therapy. Michael White and David Epston are the major figures associated with narrative therapy. Social constructionism, solution-focused brief therapy, and narrative therapy all assume that there is no single truth; rather, it is believed that reality is socially constructed through human interaction. These approaches maintain that the client is an expert in his or her own life.

Family systems therapy A number of significant figures have been pioneers of the family systems approach, two of whom include Murray Bowen and Virginia Satir. This systemic approach is based on the assumption that the key to changing the individual is understanding and working with the family.

First are the psychodynamic approaches. Psychoanalytic therapy is based largely on insight, unconscious motivation, and reconstruction of the personality. The psy- choanalytic model appears first because it has had a major influence on all of the formal systems of psychotherapy. Some of the therapeutic models are extensions of

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8 CHAPTER ONE

psychoanalysis, others are modifications of analytic concepts and procedures, and still others emerged as a reaction against psychoanalysis. Many theories of psycho- therapy have borrowed and integrated principles and techniques from psychoana- lytic approaches.

Adlerian therapy differs from psychoanalytic theory in many respects, but it can broadly be considered an analytic perspective. Adlerians focus on meaning, goals, purposeful behavior, conscious action, belonging, and social interest. Although Adlerian theory accounts for present behavior by studying childhood experiences, it does not focus on unconscious dynamics.

The second category comprises the experiential and relationship-oriented therapies: the existential approach, the person-centered approach, and Gestalt therapy. The existential approach stresses a concern for what it means to be fully human. It suggests certain themes that are part of the human condition, such as freedom and respon- sibility, anxiety, guilt, awareness of being finite, creating meaning in the world, and shaping one’s future by making active choices. This approach is not a unified school of therapy with a clear theory and a systematic set of techniques. Rather, it is a philos- ophy of counseling that stresses the divergent methods of understanding the subjec- tive world of the person. The person-centered approach, which is rooted in a humanistic philosophy, places emphasis on the basic attitudes of the therapist. It maintains that the quality of the client–therapist relationship is the prime determinant of the outcomes of the therapeutic process. Philosophically, this approach assumes that clients have the capacity for self-direction without active intervention and direction on the therapist’s part. Another experiential approach is Gestalt therapy, which offers a range of experiments to help clients gain awareness of what they are experiencing in the here and now—that is, the present. In contrast to person-centered therapists, Gestalt therapists tend to take an active role, yet they follow the leads provided by their clients. These approaches tend to emphasize emotion as a route to bringing about change, and in a sense, they can be considered emotion-focused therapies.

Third are the cognitive behavioral approaches, sometimes known as the action- oriented therapies because they all emphasize translating insights into behavioral action. These approaches include choice theory/reality therapy, behavior therapy, rational emotive behavior therapy, and cognitive therapy. Reality therapy focuses on clients’ current behavior and stresses developing clear plans for new behaviors. Like reality therapy, behavior therapy puts a premium on doing and on taking steps to make concrete changes. A current trend in behavior therapy is toward paying increased attention to cognitive factors as an important determinant of behavior. Rational emo- tive behavior therapy and cognitive therapy highlight the necessity of learning how to challenge inaccurate beliefs and automatic thoughts that lead to behavioral prob- lems. These cognitive behavioral approaches are used to help people modify their inaccurate and self-defeating assumptions and to develop new patterns of acting.

The fourth general approach encompasses the systems and postmodern perspectives. Feminist therapy and family therapy are systems approaches, but they also share postmodern notions. The systems orientation stresses the importance of under- standing individuals in the context of the surroundings that influence their devel- opment. To bring about individual change, it is essential to pay attention to how the individual’s personality has been affected by his or her gender-role socialization, culture, family, and other systems.

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The postmodern approaches include social constructionism, solution-focused brief therapy, and narrative therapy. These newer approaches challenge the basic assump- tions of most of the traditional approaches by assuming that there is no single truth and that reality is socially constructed through human interaction. Both the post- modern and the systemic theories focus on how people produce their own lives in the context of systems, interactions, social conditioning, and discourse.

In my view, practitioners need to pay attention to what their clients are thinking, feeling, and doing, and a complete therapy system must address all three of these fac- ets. Some of the therapies included here highlight the role that cognitive factors play in counseling. Others place emphasis on the experiential aspects of counseling and the role of feelings. Still others emphasize putting plans into action and learning by doing. Combining all of these dimensions provides the basis for a comprehensive therapy.

Introduction to the Case of Stan You will learn a great deal by seeing a theory in action, preferably in a live demonstration or as part of experiential activities in which you function in the alter- nating roles of client and counselor. An online program (available in DVD format as well) demonstrates one or two techniques from each of the theories. As Stan’s coun- selor, I show how I would apply some of the principles of each of the theories you are studying to Stan. Many of my students find this case history of the hypothetical cli- ent (Stan) helpful in understanding how various techniques are applied to the same person. Stan’s case, which describes his life and struggles, is presented here to give you significant background material to draw from as you study the applications of the theories. Each of the 11 theory chapters in Part 2 includes a discussion of how a therapist with the orientation under discussion is likely to proceed with Stan. We examine the answers to questions such as these:

ŠŠ What themes in Stan’s life merit special attention in therapy? ŠŠ What concepts would be useful to you in working with Stan on his

problems? ŠŠ What are the general goals of Stan’s therapy? ŠŠ What possible techniques and methods would best meet these goals? ŠŠ What are some characteristics of the relationship between Stan and his

therapist? ŠŠ How might the therapist proceed? ŠŠ How might the therapist evaluate the process and treatment outcomes

of therapy?

In Chapter 15 (which I recommend you read early) I explain how I would work with Stan, suggesting concepts and techniques I would draw on from many of the mod- els (forming an integrative approach).

A single case illustrates both contrasts and parallels among the approaches. It also will help you understand the practical applications of the 11 models and provide a basis for integrating them. A summary of the intake interview with Stan, his autobiography, and some key themes in his life are presented next to provide a context for making sense of the way therapists with various theoretical orientations

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might work with Stan. Try to find attributes of each approach that you can incorpo- rate into a personalized style of counseling.

Intake Interview and Stan’s Autobiography The setting is a community mental health agency where both individual and group counseling are available. Stan comes to counseling because of his drinking. He was convicted of driving under the influence, and the judge determined that he needed professional help. Stan recognizes that he does have problems, but he is not con- vinced that he is addicted to alcohol. Stan arrives for an intake interview and pro- vides the counselor with this information:

At the present time I work in construction. I like building houses, but probably won’t stay in construction for the rest of my life. When it comes to my personal life, I’ve always had difficulty in getting along with people. I could be called a “loner.” I like people in my life, but I don’t seem to know how to stay close to people. It probably has a lot to do with why I drink. I’m not very good at making friends or getting close to people. Probably the reason I sometimes drink a bit too much is because I’m so scared when it comes to socializing. Even though I hate to admit it, when I drink, things are not quite so overwhelming. When I look at others, they seem to know the right things to say. Next to them I feel dumb. I’m afraid that people don’t find me very interesting. I’d like to turn my life around, but I just don’t know where to begin. That’s why I went back to school. I’m a part- time college student majoring in psychology. I want to better myself. In one of my classes, Psychology of Personal Adjustment, we talked about ourselves and how people change. We also had to write an autobiographical paper.

That is the essence of Stan’s introduction. The counselor says that she would like to read his autobiography. Stan hopes it will give her a better understanding of where he has been and where he would like to go. He brings her the autobiography, which reads as follows:

Where am I currently in my life? At 35 I feel that I’ve wasted most of my life. I should be finished with college and into a career by now, but instead I’m only a junior. I can’t afford to really commit myself to pursuing college full time because I need to work to support myself. Even though construction work is hard, I like the satisfaction I get when I look at what I have done.

I want to get into a profession where I could work with people. Someday, I’m hoping to get a master’s degree in counseling or in social work and eventually work as a counselor with kids who are in trouble. I know I was helped by someone who cared about me, and I would like to do the same for someone else.

I have few friends and feel scared around most people. I feel good with kids. But I wonder if I’m smart enough to get through all the classes I’ll need to become a counselor. One of my problems is that I frequently get drunk. This happens when I feel alone and when I’m scared of the intensity of my feelings. At first drinking seemed to help, but later on I felt awful. I have abused drugs in the past also.

I feel overwhelmed and intimidated when I’m around attractive women. I feel cold, sweaty, and terribly nervous. I think they may be judging me and see me as not

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much of a man. I’m afraid I just don’t measure up to being a real man. When I am sexually intimate with a woman, I am anxious and preoccupied with what she is thinking about me.

I feel anxiety much of the time. I often feel as if I’m dying inside. I think about committing suicide, and I wonder who would care. I can see my family coming to my funeral feeling sorry for me. I feel guilty that I haven’t worked up to my poten- tial, that I’ve been a failure, that I’ve wasted much of my time, and that I let people down a lot. I get down on myself and wallow in guilt and feel very depressed. At times like this I feel hopeless and that I’d be better off dead. For all these reasons, I find it difficult to get close to anyone.

There are a few bright spots. I did put a lot of my shady past behind me, and did get into college. I like this determination in me—I want to change. I’m tired of feeling the way I do. I know that nobody is going to change my life for me. It’s up to me to get what I want. Even though I feel scared at times, I like that I’m willing to take risks.

What was my past like? A major turning point for me was the confidence my supervisor had in me at the youth camp where I worked the past few summers. He helped me get my job, and he also encouraged me to go to college. He said he saw a lot of potential in me for being able to work well with young people. That was hard for me to believe, but his faith inspired me to begin to believe in myself. Another turning point was my marriage and divorce. This marriage didn’t last long. It made me wonder about what kind of man I was! Joyce was a strong and dominant woman who kept repeating how worthless I was and how she did not want to be around me. We had sex only a few times, and most of the time I was not very good at it. That was hard to take. It made me afraid to get close to a woman. My parents should have divorced. They fought most of the time. My mother (Angie) constantly criticized my father (Frank Sr.). I saw him as weak and passive. He would never stand up to her. There were four of us kids. My parents compared me unfavorably with my older sister (Judy) and older brother (Frank Jr.). They were “perfect” children, successful honors’ students. My younger brother (Karl) and I fought a lot. They spoiled him. It was all very hard for me.

In high school I started using drugs. I was thrown into a youth rehabilita- tion facility for stealing. Later I was expelled from regular school for fighting, and I landed in a continuation high school, where I went to school in the morn- ings and had afternoons for on-the-job training. I got into auto mechanics, was fairly successful, and even managed to keep myself employed for three years as a mechanic.

I can still remember my father asking me: “Why can’t you be like your sister and brother? Why can’t you do anything right?” And my mother treated me much the way she treated my father. She would say: “Why do you do so many things to hurt me? Why can’t you grow up and be a man? Things are so much better around here when you’re gone.” I recall crying myself to sleep many nights, feeling terribly alone. There was no talk of religion in my house, nor was there any talk of sex. In fact, I find it hard to imagine my folks ever having sex.

Where would I like to be five years from now? What kind of person do I want to become? Most of all, I would like to start feeling better about myself. I would like to be able to stop drinking altogether and still feel good. I want to like myself much more than I do now. I hope I can learn to love at least a few other people,

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most of all, a woman. I want to lose my fear of women. I would like to feel equal with others and not always have to feel apologetic for my existence. I want to let go of my anxiety and guilt. I want to become a good counselor for kids. I’m not certain how I’ll change or even what all the changes are I hope for. I do know that I want to be free of my self-destructive tendencies and learn how to trust people more. Perhaps when I begin to like myself more, I’ll be able to trust that others will find something about me to like.

Effective therapists, regardless of their theoretical orientation, would pay attention to suicidal thoughts. In his autobiography Stan says, “I think about committing suicide.” At times he doubts that he will ever change and wonders if he’d be “better off dead.” Before embarking on the therapeutic journey, the thera- pist would need to make an assessment of Stan’s current ego strength (or his abil- ity to manage life realistically), which would include a discussion of his suicidal thoughts.

Overview of Some Key Themes in Stan’s Life A number of themes appear to represent core struggles in Stan’s life. Here are some of the statements we can assume that he may make at various points in his therapy and themes that will be addressed from the theoretical perspectives in Chapters 4 through 15:

ŠŠ Although I’d like to have people in my life, I just don’t seem to know how to go about making friends or getting close to people.

ŠŠ I’d like to turn my life around, but I have no sense of direction. ŠŠ I want to make a difference. ŠŠ I am afraid of failure. ŠŠ I know when I feel alone, scared, and overwhelmed, I drink heavily to

feel better. ŠŠ I am afraid of women. ŠŠ Sometimes at night I feel a terrible anxiety and feel as if I’m dying. ŠŠ I often feel guilty that I’ve wasted my life, that I’ve failed, and that I’ve

let people down. At times like this, I get depressed. ŠŠ I like it that I have determination and that I really want to change. ŠŠ I’ve never really felt loved or wanted by my parents. ŠŠ I’d like to get rid of my self-destructive tendencies and learn to trust

people more. ŠŠ I put myself down a lot, but I’d like to feel better about myself.

In the chapters in Part 2, I write about how I would apply selected concepts and techniques of the particular theory in counseling Stan. In addition, in these chapters you are asked to think about how you would continue counseling Stan from each of these different perspectives. In doing so, refer to the introductory material given here and to Stan’s autobiography as well. To make the case of Stan come alive for each theory, I highly recommend that you view and study the video program, DVD for Theory and Practice of Counseling and Psychotherapy: The Case of Stan and Lecturettes. In this video program I counsel Stan from each of the various theories and provide brief lectures that highlight each theory.

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Introduction to the Case of Gwen Meet Dr. Kellie Kirksey

Background on the Case of Gwen Gwen is a 56-year-old, married African American woman presenting with fibromyalgia, difficulty sleeping, and a history of anxiety and depression. She reports feeling stress and isolation on her job and is having a difficult time manag- ing her multiple roles. Gwen is the oldest of five children, and after her parents’ divorce, she took on the responsibility of caring for her younger siblings. Gwen has been married to Ron for 31 years and states they have ups and downs but basically their relationship is supportive. Ron is employed as a high school teacher and has always made the family a priority. They have three adult children, Brittany age 29, Lisa age 26, and Kevin age 23. Gwen has a master’s degree in accounting and is employed at a large firm as a CPA. She reports being the only woman of color at her job. Because she is the only one speaking up for issues of diversity and racial equal- ity at her workplace, she often feels isolated and tired. She does not have enough time to spend with friends or to do the things she once enjoyed because of her long work hours. Gwen also helps her adult children with their bills when needed and

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I invited Dr. Kellie Kirksey to create a case (“Gwen”) based on a composite of her clients over her many years of practice. Gwen’s concerns are discussed as they relate to the theory featured in each chapter, and Dr. Kirksey demonstrates how she would work with Gwen using techniques that illustrate key concepts from the theory.

Kellie n. Kirksey, PhD, received her doctorate in Counselor Education and Psychology at The Ohio State University. She is a licensed clinical counselor, a certified rehabilitation counselor, and an approved clinical super- visor. She has practiced and taught in the counseling field for more than 25 years and has focused her work in the area of multicultural counseling, social justice, integrative counseling, and well- ness. She was previously Associate Professor of Counselor Education at Malone University in Ohio where she taught practicum, internship, group counseling, theories, and cultural diversity. She is currently a Holistic Psychotherapist at the Cleveland Clinic Center for Integrative Medicine and focuses primarily on using holistic integrative methods such as hypnotherapy and meditation for health and wellness. She also has a part-time clinical practice in Ohio.

Dr. Kirksey is a contributor to Gerald Corey’s Case Approach to Counseling and Psychotherapy text in which she works with Ruth from a spiritually focused integrative perspective. She enjoys exploring how wellness is achieved in other cultures and has given numerous workshops and presentations on wellness and self-care in North America, South Africa, Botswana, Hawaii, and Italy.

Kellie N. Kirksey

Ke lli

e Ki

rk se

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is the primary caretaker of her mother, who resides with her and is in the advanced stages of dementia.

This is Gwen’s first time in formal counseling. She reports having gone to her pastor when she was feeling “down” in the past. Gwen also reports times of being sexually molested by an older cousin. She seeks counseling because she is having dif- ficulty staying focused at work and is generally feeling sad and overwhelmed. Gwen also reports experiencing a great deal of anxiety. She states she is not suicidal but is “sick and tired of feeling sick and tired.” Gwen summarizes her current situation by saying, “I realized the other day that I am tired of just existing and surviving. So here I am.” Gwen was referred to Dr. Kirksey by the pastor of her church. Despite the many challenges in her life, Gwen says that her faith in God is strong and church has always been her place of refuge.

Intake Session Gwen begins by saying she is ready to unload the stressors she has been holding inside. She states that she has held everything together for everyone far too long. During this initial session, I also address the relevant aspects of informed consent and begin an ongoing process of educating Gwen on how the therapeutic process works.

Gwen says she feels a heaviness in her heart, which is associated with all that is expected of her at work and with her family, what she has not accomplished, and where she is heading. I acknowledge this heaviness and ask her to start wherever she wants. Gwen states that she has not felt carefree since she was a young child before her parents’ divorce. Her parents moved to the North from Georgia for work when she was 8 years old. Both of her parents were teachers and valued education. Her neighborhood and school were predominantly African American, and the commu- nity was close. In high school she was bussed across town to a predominately white school, and Gwen states she began to encounter what she felt were racist attitudes at this school. She reports:

I felt different and excluded and this was reinforced by occasional name calling and subtle slights. That was one of the first times I remember feeling like I had to work twice as hard to get ahead and to be accepted in life. Throughout college I worked hard to be successful by pushing myself to achieve what people said I couldn’t, but it seems that all my hard work has just worn me down.

A number of life concerns bring Gwen into counseling. A few of her concerns relate to her work. She experiences mounting tension on the job and, when she asserts her opinions, she is labeled as emotional and angry. The more tension she experiences at work, the less she engages at home. An additional concern is that her mother is slowly fading into another world due to dementia. Gwen states she is feeling terrible about herself and not even wanting to be around people anymore. Everything irritates her and she prefers to spend time by herself.

Gwen reports the following:

I feel like a shell of a person. I am not depressed where I am wanting to kill myself. I just feel numb. There is no real point to doing this daily routine of waking, suffering through the day, and going to bed just to get up and do it all

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over again. My life is like a flat note with little joy. I don’t go out; I don’t have sex; and I am too tired to do anything. Nothing I do is good enough. I start projects, and then it’s like they disappear. Nothing ever gets finished, and then I feel worse about myself. Sometimes I feel like I want to go into a cave and never come out. I feel like I will lose everything if I don’t make some changes in my life. Everything looks good on the outside, but inside of me, I am on edge and need to do some- thing different. My pastor and mentor tell me I am sabotaging myself. Usually, I get defensive and withdrawn, but this time, I want to get better and I am ready to do what it takes. I am done with feeling tired all the time and hiding from people. My goal is to live a more balanced life and to learn how to reduce my stress level.

The first step of our journey is to build a working alliance based on mutual respect. I let Gwen know that this is her time to use as she pleases, and that it is a safe and confidential space.

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2The Counselor: Person and Professional

1. Identify the characteristics of the counselor as a therapeutic person.

2. Understand the benefits of seeking personal counseling as a counselor.

3. Explain the concept of bracketing and what is involved in managing a counselor’s personal values.

4. Explain how values relate to identifying goals in counseling.

5. Understand the role of diversity issues in the therapeutic relationship.

6. Describe what is involved in acquiring competency as a multicultural counselor.

7. Identify issues faced by beginning therapists.

L e a r n i n g O b j e c t i v e s

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Introduction One of the most important instruments you have to work with as a counselor is yourself as a person. In preparing for counseling, you will acquire knowledge about the theories of personality and psychotherapy, learn assessment and intervention techniques, and discover the dynamics of human behavior. Such knowledge and skills are essential, but by themselves they are not sufficient for establishing and maintaining effective therapeutic relationships. To every therapy session we bring our human qualities and the experiences that have influenced us. In my judgment, this human dimension is one of the most powerful influences on the therapeutic process.

A good way to begin your study of contemporary counseling theories is by reflecting on the personal issues raised in this chapter. By remaining open to self- evaluation, you not only expand your awareness of self but also build the foundation for developing your abilities and skills as a professional. The theme of this chapter is that the person and the professional are intertwined facets that cannot be separated in reality. We know, clinically and scientifically, that the person of the therapist and the therapeutic relationship contribute to therapy outcome at least as much as the par- ticular treatment method used (Duncan, Miller, Wampold, & Hubble, 2010; Elkins, 2016; Norcross, 2011).

Visit CengageBrain.com or watch the DVD for the video program on Chapter 2, Theory and Practice of Counseling and Psychotherapy: The Case of Stan and Lecturettes. I suggest that you view the brief lecture for each chapter prior to reading the chapter.

The Counselor as a Therapeutic Person Counseling is an intimate form of learning, and it demands a practitio- ner who is willing to be an authentic person in the therapeutic relationship. It is within the context of such a person-to-person connection that the client experi- ences growth. If we hide behind the safety of our professional role, our clients will likely keep themselves hidden from us. If we strive for technical expertise alone, and leave our own reactions and self out of our work, the result is likely to be ineffective counseling. Our own genuineness can have a significant effect on our relationship with our clients. If we are willing to look at our lives and make the changes we want, we can model that process by the way we reveal ourselves and respond to our clients. If we are inauthentic, we will have difficulty establishing a working alliance with our clients. If we model authenticity by engaging in appropriate self-disclosure, our clients will tend to be honest with us as well.

I believe that who the psychotherapist is directly relates to his or her ability to establish and maintain effective therapy relationships with clients. But what does the research reveal about the role of the counselor as a person and the therapeutic relationship on psychotherapy outcome? Abundant research indicates the centrality of the person of the therapist as a primary factor in successful therapy. The person of the psychotherapist is inextricably intertwined with the outcome of psychotherapy (see Elkins, 2016; Lambert, 2011; Norcross & Lambert, 2011; Norcross & Wampold, 2011). Clients place more value on the personality of the therapist than on the

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specific techniques used. Indeed, evidence-based psychotherapy relationships are critical to the psychotherapy endeavor.

Techniques themselves have limited importance in the therapeutic process. Wampold (2001) conducted a meta-analysis of many research studies on therapeu- tic effectiveness and found that the personal and interpersonal components are essential to effective psychotherapy, whereas techniques have relatively little effect on therapeutic outcome. The contextual factors—the alliance, the relationship, the per- sonal and interpersonal skills of the therapist, client agency, and extra-therapeutic factors—are the primary determinants of therapeutic outcome. This research sup- ports what humanistic psychologists have maintained for years: “It is not theories and techniques that heal the suffering client but the human dimension of therapy and the ‘meetings’ that occur between therapist and client as they work together” (Elkins, 2009, p. 82). In short, both the therapy relationship and the therapy methods used influence the outcomes of treatment, but it essential that the methods used support the therapeutic relationship being formed with the client.

Personal Characteristics of Effective Counselors Particular personal qualities and characteristics of counselors are significant in creating a therapeutic alliance with clients. My views regarding these personal characteristics are supported by research on this topic (Norcross, 2011; Skovholt & Jennings, 2004; Sperry & Carlson, 2011). I do not expect any therapist to fully exemplify all the traits described in the list that follows. Rather, the willingness to struggle to become a more therapeutic person is the crucial variable. This list is intended to stimulate you to examine your own ideas about what kind of person can make a significant difference in the lives of others.

ŠŠ Effective therapists have an identity. They know who they are, what they are capable of becoming, what they want out of life, and what is essential.

ŠŠ Effective therapists respect and appreciate themselves. They can give and receive help and love out of their own sense of self-worth and strength. They feel adequate with others and allow others to feel powerful with them.

ŠŠ Effective therapists are open to change. They exhibit a willingness and cour- age to leave the security of the known if they are not satisfied with the way they are. They make decisions about how they would like to change, and they work toward becoming the person they want to become.

ŠŠ Effective therapists make choices that are life oriented. They are aware of early decisions they made about themselves, others, and the world. They are not the victims of these early decisions, and they are willing to revise them if necessary. They are committed to living fully rather than set- tling for mere existence.

ŠŠ Effective therapists are authentic, sincere, and honest. They do not hide behind rigid roles or facades. Who they are in their personal life and in their professional work is congruent.

ŠŠ Effective therapists have a sense of humor. They are able to put the events of life in perspective. They have not forgotten how to laugh, especially at their own foibles and contradictions.

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ŠŠ Effective therapists make mistakes and are willing to admit them. They do not dismiss their errors lightly, yet they do not choose to dwell on misery.

ŠŠ Effective therapists generally live in the present. They are not riveted to the past, nor are they fixated on the future. They are able to experience and be present with others in the “now.”

ŠŠ Effective therapists appreciate the influence of culture. They are aware of the ways in which their own culture affects them, and they respect the diver- sity of values espoused by other cultures. They are sensitive to the unique differences arising out of social class, race, sexual orientation, and gender.

ŠŠ Effective therapists have a sincere interest in the welfare of others. This concern is based on respect, care, trust, and a real valuing of others.

ŠŠ Effective therapists possess effective interpersonal skills. They are capable of entering the world of others without getting lost in this world, and they strive to create collaborative relationships with others. They readily entertain another person’s perspective and can work together toward consensual goals.

ŠŠ Effective therapists become deeply involved in their work and derive meaning from it. They can accept the rewards flowing from their work, yet they are not slaves to their work.

ŠŠ Effective therapists are passionate. They have the courage to pursue their dreams and passions, and they radiate a sense of energy.

ŠŠ Effective therapists are able to maintain healthy boundaries. Although they strive to be fully present for their clients, they don’t carry the problems of their clients around with them during leisure hours. They know how to say no, which enables them to maintain balance in their lives.

This picture of the characteristics of effective therapists might appear unrealistic. Who could be all those things? Certainly I do not fit this bill! Do not think of these personal characteristics from an all-or-nothing perspective; rather, consider them on a continuum. A given trait may be highly characteristic of you, at one extreme, or it may be very uncharacteristic of you, at the other extreme. I have presented this pic- ture of the therapeutic person with the hope that you will examine it and develop your own concept of what personality traits you think are essential to strive for to promote your own personal growth. For a more detailed discussion of the person of the counselor and the role of the therapeutic relationship in outcomes of treatments, see Psychotherapy Relationships That Work (Norcross, 2011), How Master Therapists Work: Exploring Change From the First Through the Last Session and Beyond (Sperry & Carlson, 2011), and Master Therapists: Exploring Expertise in Therapy and Counseling (Skovholt & Jennings, 2004).

Personal Therapy for the Counselor Discussion of the counselor as a therapeutic person raises another issue debated in counselor education: Should people be required to participate in coun- seling or therapy before they become practitioners? My view is that counselors can benefit greatly from the experience of being clients at some time, a view that is sup- ported by research. This experience can be obtained before your training, during it,

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or both, but I strongly support some form of self-exploration as vital preparation in learning to counsel others.

The vast majority of mental health professionals have experienced personal therapy, typically on several occasions (Geller, Norcross, & Orlinsky, 2005b). A review of research studies on the outcomes and impacts of the psychotherapist’s own psychotherapy revealed that more than 90% of mental health professionals report satisfaction and positive outcomes from their own counseling experiences (Orlinsky, Norcross, Ronnestad, & Wiseman, 2005). Orlinsky and colleagues sug- gest that personal therapy contributes to the therapist’s professional work in the following three ways: (1) as part of the therapist’s training, personal therapy offers a model of therapeutic practice in which the trainee experiences the work of a more experienced therapist and learns experientially what is helpful or not helpful; (2) a beneficial experience in personal therapy can further enhance a therapist’s interper- sonal skills that are essential to skillfully practicing therapy; and (3) successful per- sonal therapy can contribute to a therapist’s ability to deal with the ongoing stresses associated with clinical work.

In his research on personal therapy for mental health professionals, Norcross (2005) states that lasting lessons practitioners learn from their personal therapy experiences pertain to interpersonal relationships and the dynamics of psychother- apy. Some of these lessons learned are the centrality of warmth, empathy, and the personal relationship; having a sense of what it is like to be a therapy client; valuing patience and tolerance; and appreciating the importance of learning how to deal with transference and countertransference. By participating in personal therapy, counselors can prevent their potential future countertransference from harming clients.

Through our work as therapists, we can expect to confront our own unexplored personal blocks such as loneliness, power, death, and intimate relationships. This does not mean that we need to be free of conflicts before we can counsel others, but we should be aware of what these conflicts are and how they are likely to affect us as persons and as counselors. For example, if we have great difficulty dealing with anger or conflict, we may not be able to assist clients who are dealing with anger or with relationships in conflict.

When I began counseling others, old wounds were opened and feelings I had not explored in depth came to the surface. It was difficult for me to encounter a cli- ent’s depression because I had failed to come to terms with the way I had escaped from my own depression. I did my best to cheer up depressed clients by talking them out of what they were feeling, mainly because of my own inability to deal with such feelings. In the years I worked as a counselor in a university counseling center, I frequently wondered what I could do for my clients. I often had no idea what, if anything, my clients were getting from our sessions. I couldn’t tell if they were get- ting better, staying the same, or getting worse. It was very important to me to note progress and see change in my clients. Because I did not see immediate results, I had many doubts about whether I could become an effective counselor. What I did not understand at the time was that my clients needed to struggle to find their own answers. To see my clients feel better quickly was my need, not theirs, for then I would know that I was helping them. It never occurred to me that clients often feel worse for a time as they give up their defenses and open themselves to their pain. My early

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experiences as a counselor showed me that I could benefit by participating in further personal therapy to better understand how my personal issues were affecting my professional work. I realized that periodic therapy, especially early in one’s career, can be most useful.

Personal therapy can be instrumental in healing the healer. If student counsel- ors are not actively involved in the pursuit of their own healing and growth, they will probably have considerable difficulty entering the world of a client. As counselors, can we take our clients any further than we have gone ourselves? If we are not com- mitted personally to the value of examining our own life, how can we inspire clients to examine their lives? By becoming clients ourselves, we gain an experiential frame of reference with which to view ourselves. This provides a basis for understanding and compassion for our clients, for we can draw on our own memories of reaching impasses in our therapy, of both wanting to go farther and at the same time resisting change. Our own therapy can help us develop patience with our patients! We learn what it feels like to deal with anxieties that are aroused by self-disclosure and self- exploration and how to creatively facilitate deeper levels of self-exploration in cli- ents. As we increase our self-awareness through our own therapy, we gain increased appreciation for the courage our clients display in their therapeutic journey. Gold and Hilsenroth (2009) studied graduate clinicians and found that those who had personal therapy felt more confident and were more in agreement with their clients on the goals and tasks of treatment than were those who did not experience per- sonal therapy. They further found that graduate clinicians who had experienced per- sonal therapy were able to develop strong agreement with their clients on the goals and tasks of treatment. Participating in a process of self-exploration can reduce the chances of assuming an attitude of arrogance or of being convinced that we are totally healed. Our own therapy helps us avoid assuming a stance of superiority over others and makes it less likely that we would treat people as objects to be pitied or disrespected. Indeed, experiencing counseling as a client is very different from merely reading about the counseling process.

For a comprehensive discussion of personal therapy for counselors, see The Psy- chotherapist’s Own Psychotherapy: Patient and Clinician Perspectives (Geller, Norcross, & Orlinsky, 2005a).

The Counselor’s Values and the Therapeutic Process As alluded to in the previous section, the importance of self-exploration for coun- selors carries over to the values and beliefs we hold. My experience in teaching and supervising students of counseling shows me how crucial it is that students be aware of their values, of where and how they acquired them, and of how their values can influence their interventions with clients.

The Role of Values in Counseling Our values are core beliefs that influence how we act, both in our personal and our professional lives. Personal values influence how we view counseling and the manner in which we interact with clients, including the way we conduct client assessments, our views of the goals of counseling, the interventions we choose, the

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topics we select for discussion in a counseling session, how we evaluate progress, and how we interpret clients’ life situations.

Although total objectivity cannot be achieved, we can strive to avoid being encapsulated by our own worldview. We need to guard against the tendency to use our power to influence clients to accept our values; persuading clients to accept or adopt our value system is not a legitimate outcome of counseling. From my perspec- tive, the counselor’s role is to create a climate in which clients can examine their thoughts, feelings, and actions and to empower them to arrive at their own solu- tions to problems they face. The counseling task is to assist individuals in finding answers that are most congruent with their own values. It is not beneficial to provide advice or to give clients your answers to their questions about life.

You may not agree with certain of your clients’ values, but you need to respect their right to hold divergent values from yours. This is especially true when coun- seling clients who have a different cultural background and perhaps do not share your own core cultural values. Your role is to provide a safe and inviting environ- ment in which clients can explore the congruence between their values and their behavior. If clients acknowledge that what they are doing is not getting them what they want, it is appropriate to assist them in developing new ways of thinking and behaving to help them move closer to their goals. This is done with full respect for their right to decide which values they will use as a framework for living. Individuals seeking counseling need to clarify their own values and goals, make informed deci- sions, choose a course of action, and assume responsibility and accountability for the decisions they make.

Managing your personal values so that they do not contaminate the counseling process is referred to as “bracketing.” Counselors are expected to set aside their per- sonal beliefs and values when working with a wide range of clients (Kocet & Herlihy, 2014). Your core values may differ in many ways from the core values of your clients, and they will bring you a host of problems framed by their own worldview. Some clients may have felt rejected by others or suffered from discrimination, and they should not be exposed to further discrimination by counselors who refuse to render services to them because of differing values (Herlihy, Hermann, & Greden, 2014).

Counselors must have the ability to work with a range of clients with diverse worldviews and values. Counselors may impose their values either directly or indi- rectly. value imposition refers to counselors directly attempting to define a client’s values, attitudes, beliefs, and behaviors. It is unethical for counselors to impose their values in the therapeutic relationship. The American Counseling Association’s (ACA, 2014) Code of Ethics is explicit regarding this matter:

Personal Values. Counselors are aware of—and avoid imposing—their own values, atti- tudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are incon- sistent with the client’s goals or are discriminatory in nature. (Standard A.4.b.)

Value exploration is at the heart of why many counselor education programs encourage or require personal therapy for counselors in training. Your personal therapy sessions provide an opportunity for you to examine your beliefs and values and to explore your motivations for wanting to share your belief system.

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Clients are in a vulnerable position and require understanding and support from a counselor rather than judgment. It can be burdensome for clients to be saddled with your disclosure of not being able to get beyond value differences. Cli- ents may interpret this as a personal rejection and suffer harm as a result. Coun- seling is about working with clients within the framework of their value system. If you experience difficulties over conflicting personal values with clients, the ethical course of action is to seek supervision and learn ways to effectively manage these differences. The counseling process is not about your personal values; it is about the values and needs of your clients. Your task is to help clients explore and clarify their beliefs and apply their values to solving their problems (Herlihy & Corey, 2015d).

The Role of Values in Developing Therapeutic Goals Who should establish the goals of counseling? Almost all theories are in agreement that it is largely the client’s responsibility to decide upon goals, collabo- rating with the therapist as therapy proceeds. Counselors have general goals, which are reflected in their behavior during the therapy session, in their observations of the client’s behavior, and in the interventions they make. The general goals of coun- selors must be congruent with the personal goals of the client.

Setting goals is inextricably related to values. The client and the counselor need to explore what they hope to obtain from the counseling relationship, whether they can work with each other, and whether their goals are compatible. Even more important, it is essential that the counselor be able to understand, respect, and work within the framework of the client’s world rather than forcing the client to fit into the therapist’s scheme of values.

In my view, therapy ought to begin with an exploration of the client’s expec- tations and goals. Clients initially tend to have vague ideas of what they expect from therapy. They may be seeking solutions to problems, they may want to stop hurting, they may want to change others so they can live with less anxiety, or they may seek to be different so that some significant persons in their lives will be more accepting of them. In some cases clients have no goals; they are in the therapist’s office simply because they were sent for counseling by their parents, probation officer, or teacher.

So where can a counselor begin? The initial interview can be used most pro- ductively to focus on the client’s goals or lack of them. The therapist may begin by asking any of these questions: “What do you expect from counseling? Why are you here? What do you want? What do you hope to leave with? How is what you are cur- rently doing working for you? What aspects of yourself or your life situation would you most like to change?”

When a person seeks a counseling relationship with you, it is important to coop- eratively discover what this person is expecting from the relationship. If you try to figure out in advance how to proceed with a client, you may be depriving the client of the opportunity to become an active partner in her or his own therapy. Why is this person coming in for counseling? It is the client’s place to decide on the goals of therapy. It is important to keep this focus in mind so that the client’s agenda is addressed rather than an agenda of your own.

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Becoming an Effective Multicultural Counselor Part of the process of becoming an effective counselor involves learning how to recognize diversity issues and shaping one’s counseling practice to fit the client’s worldview. It is an ethical obligation for counselors to develop sensitivity to cultural differences if they hope to make interventions that are consistent with the values of their clients. The therapist’s role is to assist clients in making decisions that are congruent with their worldview, not to live by the therapist’s values.

Diversity in the therapeutic relationship is a two-way street. As a counselor, you bring your own heritage with you to your work, so you need to recognize the ways in which cultural conditioning has influenced the directions you take with your clients. Unless the social and cultural context of clients and counselors are taken into consid- eration, it is difficult to appreciate the nature of clients’ struggles. Counseling students often hold values—such as making their own choices, expressing what they are feeling, being open and self-revealing, and striving for independence—that differ from the val- ues of clients from different cultural backgrounds. Some clients may be very slow to disclose and have expectations about counseling that differ from those of therapist. Counselors need to become aware of how clients from diverse cultures may perceive them as therapists, as well as how clients may perceive the value of formal helping. It is the task of counselors to determine whether the assumptions they have made about the nature and functioning of therapy are appropriate for culturally diverse clients.

Clearly, effective counseling must take into account the impact of culture on the client’s functioning, including the client’s degree of acculturation. culture is, quite simply, the values and behaviors shared by a group of individuals. It is important to realize that culture refers to more than ethnic or racial heritage; culture also includes factors such as age, gender, religion, sexual orientation, physical and mental ability, and socioeconomic status.

Acquiring Competencies in Multicultural Counseling Effective counselors understand their own cultural conditioning, the cultural values of their clients, and the sociopolitical system of which they are a part. Acquir- ing this understanding begins with counselors’ awareness of the cultural origins of any values, biases, and attitudes they may hold. Counselors from all cultural groups must examine their expectations, attitudes, biases, and assumptions about the counseling process and about persons from diverse groups. Recognizing our biases and prejudices takes courage because most of us do not want to acknowledge that we have cultural biases. Everyone has biases, but being unaware of the biased attitudes we hold is an obstacle to client care. It takes a concerted effort and vigi- lance to monitor our biases, attitudes, and values so that they do not interfere with establishing and maintaining successful counseling relationships.

A major part of becoming a diversity-competent counselor involves challenging the idea that the values we hold are automatically true for others. We also need to understand how our values are likely to influence our practice with diverse clients who embrace different values. Furthermore, becoming a diversity-competent practi- tioner is not a destination that we arrive at once and for all; rather, it is an ongoing process, a journey we take with our clients.

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Sue, Arredondo, and McDavis (1992) and Arredondo and her colleagues (1996) have developed a conceptual framework for competencies and standards in multi- cultural counseling. Their dimensions of competency involve three areas: (1) beliefs and attitudes, (2) knowledge, and (3) skills. For an in-depth treatment of multicul- tural counseling and therapy competence, refer to Counseling the Culturally Diverse: Theory and Practice (Sue & Sue, 2013).

Beliefs and Attitudes First, effective counselors have moved from being culturally unaware to ensuring that their personal biases, values, or problems will not interfere with their ability to work with clients who are culturally different from them. They believe cultural self-awareness and sensitivity to one’s own cultural heritage are essential for any form of helping. Counselors are aware of their positive and negative emotional reactions toward people from other racial and ethnic groups that may prove detrimental to establishing collaborative helping relationships. They seek to examine and understand the world from the vantage point of their clients. They respect clients’ religious and spiritual beliefs and values. They are comfortable with differences between themselves and others in terms of race, ethnicity, culture, and beliefs. Rather than maintaining that their cultural heritage is superior, they are able to accept and value cultural diversity. They realize that traditional theories and techniques may not be appropriate for all clients or for all problems. Culturally skilled counselors monitor their functioning through consultation, supervision, and further training or education.

Knowledge Second, culturally effective practitioners possess certain knowledge. They know specifically about their own racial and cultural heritage and how it affects them personally and professionally. Because they understand the dynamics of oppression, racism, discrimination, and stereotyping, they are in a position to detect their own racist attitudes, beliefs, and feelings. They understand the worldview of their clients, and they learn about their clients’ cultural background. They do not impose their values and expectations on their clients from differing cultural backgrounds and avoid stereotyping clients. Culturally skilled counselors understand that external sociopolitical forces influence all groups, and they know how these forces operate with respect to the treatment of minorities. These practitioners are aware of the institutional barriers that prevent minorities from utilizing the mental health services available in their communities. They possess knowledge about the historical background, traditions, and values of the client populations with whom they work. They know about minority family structures, hierarchies, values, and beliefs. Furthermore, they are knowledgeable about community characteristics and resources. Those who are culturally skilled know how to help clients make use of indigenous support systems. In areas where they are lacking in knowledge, they seek resources to assist them. The greater their depth and breadth of knowledge of culturally diverse groups, the more likely they are to be effective practitioners.

Skills and Intervention Strategies Third, effective counselors have acquired certain skills in working with culturally diverse populations. Counselors take responsibility for educating their clients about the therapeutic process, including matters such as setting goals, appropriate expectations, legal rights, and the counselor’s orientation.

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Multicultural counseling is enhanced when practitioners use methods and strategies and define goals consistent with the life experiences and cultural values of their clients. Such practitioners modify and adapt their interventions to accommodate cultural differences. They do not force their clients to fit within one counseling approach, and they recognize that counseling techniques may be culture-bound. They are able to send and receive both verbal and nonverbal messages accurately and appropriately. They become actively involved with minority individuals outside the office (community events, celebrations, and neighborhood groups). They are willing to seek out educational, consultative, and training experiences to enhance their ability to work with culturally diverse client populations. They consult regularly with other multiculturally sensitive professionals regarding issues of culture to determine whether referral may be necessary.

Incorporating Culture in Counseling Practice It is unrealistic to expect a counselor to know everything about the cultural back- ground of a client, but some understanding of the client’s cultural and ethnic back- ground is essential. There is much to be said for letting clients teach counselors about relevant aspects of their culture. It is a good idea for counselors to ask clients to provide them with the information they will need to work effectively. Incorporat- ing culture into the therapeutic process is not limited to working with clients from a certain ethnic or cultural background. It is critical that therapists take into account the worldview and background of every client. Failing to do this seriously restricts the potential impact of the therapeutic endeavor.

Counseling is by its very nature diverse in a multicultural society, so it is easy to see that there are no ideal therapeutic approaches. Instead, different theories have distinct features that have appeal for different cultural groups. Some theoretical approaches have limitations when applied to certain populations. Effective multi- cultural practice demands an open stance on the part of the practitioner, flexibility, and a willingness to modify strategies to fit the needs and the situation of the indi- vidual client. Practitioners who truly respect their clients will be aware of clients’ hesitations and will not be too quick to misinterpret this behavior. Instead, they will patiently attempt to enter the world of their clients as much as they can. Although practitioners may not have had the same experiences as their clients, the empathy shown by counselors for the feelings and struggles of their clients is essential to good therapeutic outcomes. We are more often challenged by our differences than by our similarities to look at what we are doing.

Practical Guidelines in Addressing Culture If the counseling process is to be effective, it is essential that cultural concerns be addressed with all clients. Here are some guidelines that may increase your effectiveness when working with clients from diverse backgrounds:

ŠŠ Learn more about how your own cultural background has influenced your thinking and behaving. Take steps to increase your understanding of other cultures.

ŠŠ Identify your basic assumptions, especially as they apply to diversity in culture, ethnicity, race, gender, class, spirituality, religion, and

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sexual orientation. Think about how your assumptions are likely to affect your professional practice.

ŠŠ Examine where you obtained your knowledge about culture. ŠŠ Remain open to ongoing learning of how the various dimensions of

culture may affect therapeutic work. Realize that this skill does not develop quickly or without effort.

ŠŠ Be willing to identify and examine your own personal worldview and any prejudices you may hold about other racial/ethnic groups.

ŠŠ Learn to pay attention to the common ground that exists among peo- ple of diverse backgrounds.

ŠŠ Be flexible in applying the methods you use with clients. Don’t be wed- ded to a specific technique if it is not appropriate for a given client.

ŠŠ Remember that practicing from a multicultural perspective can make your job easier and can be rewarding for both you and your clients.

It takes time, study, and experience to become an effective multicultural coun- selor. Multicultural competence cannot be reduced simply to cultural awareness and sensitivity, to a body of knowledge, or to a specific set of skills. Instead, it requires a combination of all of these factors.

Issues Faced by Beginning Therapists When you complete formal course work and begin helping clients, you will be challenged to integrate and to apply what you have learned. At that point, you are likely to have some real concerns about your adequacy as a person and as a profes- sional. Beginning therapists typically face a number of common issues as they learn how to help others. Here are some useful guidelines to assist you in your reflection on what it takes to become an effective counselor.

Dealing With Anxiety Most beginning counselors have ambivalent feelings when meeting their first cli- ents. A certain level of anxiety demonstrates that you are aware of the uncertainties of the future with your clients and of your abilities to really be there for them. A willingness to recognize and deal with these anxieties, as opposed to denying them, is a positive sign. That we have self-doubts is normal; it is how we deal with them that matters. One way is to openly discuss our self-doubts with a supervisor and peers. The possibilities are rich for meaningful exchanges and for gaining support from fellow interns who probably have many of the same concerns and anxieties.

Being Yourself and Self-Disclosure If you feel self-conscious and anxious when you begin counseling, you may have a tendency to be overly concerned with what the books say and with the mechanics of how to proceed. Inexperienced therapists too often fail to appreciate the values inherent in simply being themselves. If we are able to be ourselves in our thera- peutic work, and appropriately disclose our reactions in counseling sessions, we increase the chances of being authentic. It is this level of genuineness and presence

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that enables us to connect with our clients and to establish an effective therapeutic relationship with them.

It is possible to err by going to extremes in two different directions. At one end are counselors who lose themselves in their fixed role and hide behind a professional facade. These counselors are so caught up in maintaining stereotyped role expecta- tions that little of their personal self shows through. Counselors who adopt this behavior will likely remain anonymous to clients, and clients may perceive them as hiding behind a professional role.

At the other end of the spectrum is engaging in too much self-disclosure. Some counselors make the mistake of inappropriately burdening their clients with their spontaneous impressions about their clients. Judging the appropriate amount of self-disclosure can be a problem even for seasoned counselors, and it is often espe- cially worrisome for new counselors. In determining the appropriateness of self- disclosure, consider what to reveal, when to reveal, and how much to reveal. It may be useful to mention something about ourselves from time to time, but we must be aware of our motivations for making ourselves known in this way. Assess the readi- ness of a client to hear these disclosures as well as the impact doing so might have on the client. Remain observant during any self-disclosure to get a sense of how the client is being affected by it.

The most productive form of self-disclosure is related to what is going on between the counselor and the client within the counseling session. The skill of immediacy involves revealing what we are thinking or feeling in the here and now with the cli- ent, but be careful to avoid pronouncing judgments about the client. When done in a timely way, sharing persistent reactions can facilitate therapeutic progress and improve the quality of our relationship with the client. Even when we are talking about reactions based on the therapeutic relationship, caution is necessary, and dis- cretion and sensitivity are required in deciding what reactions we might share.

Avoiding Perfectionism Perhaps one of the most common self-defeating beliefs with which we burden our- selves is that we must never make a mistake. Although we may well know intellectu- ally that humans are not perfect, emotionally we often feel that there is little room for error. To be sure, you will make mistakes, whether you are a beginning or a seasoned therapist. If our energies are tied up presenting an image of perfection, this will affect our ability to be present for our clients. I tell students to question the notion that they should know everything and be perfectly skilled. I encourage them to share their mistakes or what they perceive as errors during their supervision meet- ings. Students willing to risk making mistakes in supervised learning situations and willing to reveal their self-doubts will find a direction that leads to growth.

Being Honest About Your Limitations You cannot realistically expect to succeed with every client. It takes honesty to admit that you cannot work successfully with every client. It is important to learn when and how to make a referral for clients when your limitations prevent you from helping them. However, there is a delicate balance between learning your realistic limits and challenging what you sometimes think of as being “limits.” Before deciding that you

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do not have the life experiences or the personal qualities to work with a given popu- lation, try working in a setting with a population you do not intend to specialize in. This can be done through diversified field placements or visits to agencies.

Understanding Silence Silent moments during a therapeutic session may seem like silent hours to a begin- ning therapist, yet this silence can have many meanings. The client may be quietly thinking about some things that were discussed earlier or evaluating some insight just acquired. The client may be waiting for the therapist to take the lead and decide what to say next, or the therapist may be waiting for the client to do this. Either the client or the therapist may be distracted or preoccupied, or neither may have any- thing to say for the moment. The client and the therapist may be communicating without words. The silence may be refreshing, or the silence may be overwhelming. Perhaps the interaction has been on a surface level, and both persons have some fear or hesitancy about getting to a deeper level. When silence occurs, acknowledge and explore with your client the meaning of the silence.

Dealing With Demands From Clients A major issue that puzzles many beginning counselors is how to deal with clients who seem to make constant demands. Because therapists feel they should extend themselves in being helpful, they often burden themselves with the unrealistic idea that they should give unselfishly, regardless of how great clients’ demands may be. These demands may manifest themselves in a variety of ways. Clients may want to see you more often or for a longer period than you can provide. They may want to see you socially. Some clients may expect you to continually demonstrate how much you care or demand that you tell them what to do and how to solve a problem. One way of heading off these demands is to make your expectations and boundaries clear during the initial counseling sessions or in the disclosure statement.

Dealing With Clients Who Lack Commitment Involuntary clients may be required by a court order to obtain therapy, and you may be challenged in your attempt to establish a working relationship with them. It is possible to do effective work with mandated clients, but practitioners must begin by openly discussing the nature of the relationship. Counselors who omit preparation and do not address clients’ thoughts and feelings about coming to counseling are likely to encounter resistance. It is critical that therapists not prom- ise what they cannot or will not deliver. It is good practice to make clear the limits of confidentiality as well as any other factors that may affect the course of therapy. In working with involuntary clients, it is especially important to prepare them for the process; doing so can go a long way toward increasing their cooperation and involvement.

Tolerating Ambiguity Many beginning therapists experience the anxiety of not seeing immediate results. They ask themselves: “Am I really doing my client any good? Is the client perhaps

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getting worse?” I hope you will learn to tolerate the ambiguity of not knowing for sure whether your client is improving, at least during the initial sessions. Realize that oftentimes clients may seemingly “get worse” before they show therapeutic gains. Also, realize that the fruitful effects of the joint efforts of the therapist and the client may manifest themselves after the conclusion of therapy.

Becoming Aware of Your Countertransference Working with clients can affect you in personal ways, and your own vulnerabilities and countertransference are bound to surface. If you are unaware of your personal dynamics, you are in danger of being overwhelmed by a client’s emotional expe- riences. Beginning counselors need to learn how to “let clients go” and not carry around their problems until the next session. The most therapeutic thing is to be as fully present as we are able to be during the therapy hour, but to let clients assume the responsibility of their living and choosing outside of the session. If we become lost in clients’ struggles and confusion, we cease being effective agents in helping them find solutions to their problems. If we accept responsibility for our clients’ decisions, we are blocking rather than fostering their growth.

countertransference, defined broadly, includes any of our projections that influence the way we perceive and react to a client. This phenomenon occurs when we are triggered into emotional reactivity, when we respond defensively, or when we lose our ability to be present in a relationship because our own issues become involved. Recognizing the manifestations of our countertransference reactions is an essential step in becoming competent counselors. Unless we are aware of our own conflicts, needs, assets, and liabilities, we can use the therapy hour more for our own purposes than for being available for our clients. Because it is not appropriate for us to use clients’ time to work through our reactions to them, it is all the more impor- tant that we be willing to work on ourselves in our own sessions with another thera- pist, supervisor, or colleague. If we do not engage in this kind of self-exploration, we increase the danger of losing ourselves in our clients and using them to meet our unfulfilled needs.

The emotionally intense relationships we develop with clients can be expected to tap into our own unresolved problem areas. Our clients’ stories and pain are bound to have an impact on us; we will be affected by their stories and can express compas- sion and empathy. However, we have to realize that it is their pain and not carry it for them lest we become overwhelmed by their life stories and thus render ourselves ineffective in working with them. Although we cannot completely free ourselves from any traces of countertransference or ever fully resolve all personal conflicts from the past, we can become aware of ways these realities influence our professional work. Our personal therapy can be instrumental in enabling us to recognize and manage our countertransference reactions. (This topic is explored in more depth in Chapter 4.)

Developing a Sense of Humor Therapy is a responsible endeavor, but it need not be deadly serious. Both clients and counselors can enrich a relationship through humor. What a welcome relief when we can admit that pain is not our exclusive domain. It is important to recognize

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that laughter or humor does not mean that clients are not respected or work is not being accomplished. There are times, of course, when laughter is used to cover up anxiety or to escape from the experience of facing threatening material. The thera- pist needs to distinguish between humor that distracts and humor that enhances the situation.

Sharing Responsibility With the Client You might struggle with finding the optimum balance in sharing responsibility with your clients. One mistake is to assume full responsibility for the direction and outcomes of therapy. This will lead to taking from your clients their rightful respon- sibility of making their own decisions. It could also increase the likelihood of your early burnout. Another mistake is for you to refuse to accept the responsibility for making accurate assessments and designing appropriate treatment plans for your clients. How responsibility will be shared should be addressed early in the course of counseling. It is your responsibility to discuss specific matters such as length and overall duration of the sessions, confidentiality, general goals, and methods used to achieve goals. (Informed consent is discussed in Chapter 3.)

It is important to be alert to your clients’ efforts to get you to assume responsi- bility for directing their lives. Many clients seek a “magic answer” as a way of escaping the anxiety of making their own decisions. It is not your role to assume responsibil- ity for directing your clients’ lives. Collaboratively designing contracts and home- work assignments with your clients can be instrumental in your clients’ increasingly finding direction within themselves. Perhaps the best measure of our effectiveness as counselors is the degree to which clients are able to say to us, “I appreciate what you have been to me, and because of your faith in me, and what you have taught me, I am confident that I can go it alone.” Eventually, if we are effective, we will be out of business!

Declining to Give Advice Quite often clients who are suffering come to a therapy session seeking and even demanding advice. They want more than direction; they want a wise counselor to make a decision or resolve a problem for them. However, counseling should not be confused with dispensing information. Therapists help clients discover their own solutions and recognize their own freedom to act. Even if we, as therapists, were able to resolve clients’ struggles for them, we would be fostering their dependence on us. They would continually need to seek our counsel for every new twist in their difficulties. Our task is to help clients make independent choices and accept the consequences of their choices. The habitual practice of giving advice does not work toward this end.

Defining Your Role as a Counselor One of your challenges as a counselor will be to define and clarify your professional role. As you read about the various theoretical orientations, you will discover the many different roles of counselors that are related to the various theories. As a coun- selor, you will likely be expected to function with a diverse range of roles.

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From my perspective, the central function of counseling is to help clients rec- ognize their own strengths, discover what is preventing them from using their resources, and clarify what kind of life they want to live. Counseling is a process by which clients are invited to look honestly at their behavior and make certain deci- sions about how they want to modify the quality of their life. In this framework counselors provide support and warmth, yet care enough to challenge clients so that they will be able to take the actions necessary to bring about significant change.

You will need to consider that the professional roles you assume are likely to be dependent on factors such as the client populations with whom you are working, the specific therapeutic services you are providing, the particular stage of counsel- ing, and the setting in which you work. Your role will not be defined once and for all. You will have to reassess the nature of your professional commitments and redefine your role at various times.

Learning to Use Techniques Appropriately When you are at an impasse with a client, you may have a tendency to look for a technique to get the sessions moving. Ideally, therapeutic techniques should evolve from the therapeutic relationship and the material presented, and they should enhance the client’s awareness or suggest possibilities for experimenting with new behavior. It is imperative that you know the theoretical rationale for each technique you use, and you need to be aware that the techniques are appropriate for the goals of therapy. This does not mean that you need to restrict yourself to drawing on pro- cedures within a single model; quite the contrary. However, it is important to avoid using techniques in a hit-or-miss fashion, to fill time, to meet your own needs, or to get things moving. Your methods need to be thoughtfully chosen as a way to help clients make therapeutic progress.

Developing Your Own Counseling Style Be aware of any tendency to copy the style of a supervisor, therapist, or some other model. There is no one way to conduct therapy, and wide variations in approach can be effective. You will inhibit your potential effectiveness in reaching others if you attempt to imitate another therapist’s style or if you fit most of your behavior dur- ing the session into the Procrustean bed of some expert’s theory. Your counseling style will be influenced by your teachers, therapists, and supervisors, but don’t blur your potential uniqueness by trying to imitate them. I advocate borrowing from others, yet, at the same time, doing it in a way that is distinctive to you.

Maintaining Your Vitality as a Person and as a Professional Ultimately, your single most important instrument is the person you are, and your most powerful technique is your ability to model aliveness and realness. It is of para- mount importance that we take care of ourselves, for how can we take care of others if we are not taking care of ourselves? We need to work at dealing with those factors that threaten to drain life from us and render us helpless. I encourage you to con- sider how you can apply the theories you will be studying to enhance your life from both a personal and a professional standpoint.

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Learn to look within yourself to determine what choices you are making (and not making) to keep yourself vital. If you are aware of the factors that sap your vital- ity as a person, you are in a better position to prevent the condition known as profes- sional burnout. You have considerable control over whether you become burned out or not. You cannot always control stressful events, but you do have a great deal of control over how you interpret and react to these events. It is important to realize that you cannot continue to give and give while getting little in return. There is a price to pay for always being available and for assuming responsibility over the lives and destinies of others. Become attuned to the subtle signs of burnout rather than waiting for a full-blown condition of emotional and physical exhaustion to set in. You would be wise to develop your own strategy for keeping yourself alive personally and professionally.

Self-monitoring is a crucial first step in self-care. If you make an honest inven- tory of how well you are taking care of yourself in specific domains, you will have a framework for deciding what you may want to change. By making periodic assess- ments of the direction of your own life, you can determine whether you are living the way you want to live. If not, decide what you are willing to actually do to make changes occur. By being in tune with yourself, by having the experience of centered- ness and solidness, and by feeling a sense of personal power, you have the founda- tion for integrating your life experiences with your professional experiences. Such an awareness can provide the basis for retaining your physical and psychological vitality and for being an effective professional.

As counseling professionals, we tend to be caring people who are good at tak- ing care of others, but often we do not treat ourselves with the same level of care. Self-care is not a luxury; it is an ethical mandate. If we neglect to care for ourselves, our clients will not be getting the best of us. If we are physically drained and psy- chologically depleted, we will not have much to give to those with whom we work. It is not possible to provide nourishment to our clients if we are not nourishing ourselves.

Mental health professionals often comment that they do not have time to take care of themselves. My question to them is, “Can you afford not to take care of your- self?” To successfully meet the demands of our professional work, we must take care of ourselves physically, psychologically, intellectually, socially, and spiritually. Ide- ally, our self-care should mirror the care we provide for others. If we hope to have the vitality and stamina required to stay focused on our professional goals, we need to incorporate a wellness perspective into our daily living. Wellness is the result of our conscious commitment to a way of life that leads to zest, peace, vitality, and happiness.

Wellness and self-care are being given increased attention in professional jour- nals and at professional conferences. When reading about self-care and wellness, reflect on what you can do to put what you know into action. If you are interested in learning more about therapist self-care, I highly recommend Leaving It at the Office: A Guide to Psychotherapist Self-Care (Norcross & Guy, 2007) and Empathy Fatigue: Healing the Mind, Body, and Spirit of Professional Counselors (Stebnicki, 2008). For more on the topic of the counselor as a person and as a professional, see Creating Your Professional Path: Lessons From My Journey (Corey, 2010).

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Summary One of the basic issues in the counseling profession concerns the significance of the counselor as a person in the therapeutic relationship. In your professional work, you are asking people to take an honest look at their lives and to make choices con- cerning how they want to change, so it is critical that you do this in your own life. Ask yourself questions such as “What do I personally have to offer others who are struggling to find their way?” and “Am I doing in my own life what I may be urging others to do?”

You can acquire an extensive theoretical and practical knowledge and can make that knowledge available to your clients. But to every therapeutic session you also bring yourself as a person. If you are to promote change in your clients, you need to be open to change in your own life. This willingness to attempt to live in accordance with what you teach and thus to be a positive model for your clients is what makes you a “therapeutic person.”

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3Ethical Issues in Counseling Practice

1. Understand mandatory, aspirational, and positive ethics.

2. Identify characteristics and procedural steps of ethical decision making.

3. Understand the right of informed consent.

4. Articulate the dimensions of confidentiality (privacy, privileged communications, and exceptions).

5. Become familiar with the ethical and legal aspects of using technology.

6. Identify the major exceptions to confidentiality.

7. Understand ethical issues from a multicultural perspective.

8. Recognize when it is necessary to modify techniques with diverse clients.

9. Identify some key ethical issues in assessment and diagnosis.

10. Understand how ethnic and cultural factors can influence assessment and diagnosis.

11. Compare arguments for and against evidence-based practice.

12. Describe ethical issues related to multiple relationships in counseling practice.

13. Understand various perspectives on multiple relationships.

14. Explain the differences between a boundary crossing and a boundary violation.

15. Understand how to manage boundaries and risks associated with using social media.

16. Explain what is involved in becoming an ethical counselor.

L e a r n i n g O b j e c t i v e s

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38 CHAPTER THREE

Introduction This chapter introduces some of the ethical principles and issues that will be a basic part of your professional practice. I hope to stimulate your thinking about the importance of ethical practice so you will have a sound foundation for making ethical decisions. Topics addressed include balancing clients’ needs against your own needs, ways of making good ethical decisions, educating clients about their rights, parameters of confidentiality, ethical concerns in counseling diverse client populations, ethical issues involving diagnosis, evidence-based practice, and dealing with multiple relationships and managing boundaries.

Students sometimes think of ethics merely as a list of rules and prohibitions that result in sanctions and malpractice actions if practitioners do not follow them. You will learn that being an ethical practitioners is far more complex than a set of rules. Mandatory ethics involves a level of ethical functioning at the minimum level of professional practice. In contrast, aspirational ethics focuses on doing what is in the best interests of clients. Functioning at the aspirational level involves the high- est standards of thinking and conduct. Aspirational practice requires counselors to do more than simply meet the letter of the ethics code. It entails understanding the spirit of the code and the principles on which the code is based. Fear-based ethics does not constitute sound ethical practice. Ethics is more than a list of things to avoid for fear of punishment. Strive to work toward concern-based ethics, and think about how you can become the best practitioner possible (Corey, Corey, Corey, & Callanan, 2015). Positive ethics is an approach taken by practitioners who want to do their best for clients rather than simply meet minimum standards to stay out of trouble (Knapp & VandeCreek, 2006).

Visit CengageBrain.com or watch the DVD for the video program on Chapter 3, Theory and Practice of Counseling and Psychotherapy: The Case of Stan and Lecturettes. I suggest that you view the brief lecture for each chapter prior to reading the chapter.

Putting Clients’ Needs Before Your Own As counselors we cannot always keep our personal needs completely separate from our relationships with clients. Ethically, it is essential that we become aware of our own needs, areas of unfinished business, potential personal problems, and espe- cially our sources of countertransference. We need to realize how such factors could interfere with effectively and ethically serving our clients.

Our professional relationships with our clients exist for their benefit. A use- ful question to frequently ask yourself is this: “Whose needs are being met in this relationship, my client’s or my own?” It takes considerable professional maturity to make an honest appraisal of how your behavior affects your clients. It is not unethi- cal for us to meet our personal needs through our professional work, but it is essen- tial that these needs be kept in perspective. An ethical problem exists when we meet our needs, in either obvious or subtle ways, at the expense of our clients’ needs. It is crucial that we avoid exploiting or harming clients.

We all have certain blind spots and distortions of reality. As helping profession- als, we must actively work toward expanding our self-awareness and learn to recognize

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our areas of prejudice and vulnerability. If we are aware of our personal problems and are willing to work through them, there is less chance that we will project them onto clients. If certain problem areas surface and old conflicts become reactivated, we have an ethical obligation to do whatever it takes to avoid harming our clients.

We must also examine other, less obviously harmful personal needs that can get in the way of creating growth-producing relationships, such as the need for con- trol and power; the inordinate need to be nurturing; the need to change others in the direction of our own values; the need for feeling adequate, particularly when it becomes overly important that the client confirm our competence; and the need to be respected and appreciated. It is crucial that we do not meet our needs at the expense of our clients. For an expanded discussion of this topic, see M. Corey and Corey (2016, chap. 1).

Ethical Decision Making The ready-made answers to ethical dilemmas provided by professional organizations typically contain only broad guidelines for responsible practice. In practice, you will have to apply the ethics codes of your profession to the many practical problems you face. Professionals are expected to exercise prudent judg- ment when it comes to interpreting and applying ethical principles to specific situ- ations. Although you are responsible for making ethical decisions, you do not have to do so alone. Learn about the resources available to you. Consult with colleagues, keep yourself informed about laws affecting your practice, keep up to date in your specialty field, stay abreast of developments in ethical practice, reflect on the impact your values have on your practice, and be willing to engage in honest self-examina- tion. You should also be aware of the consequences of practicing in ways that are not sanctioned by organizations of which you are a member or the state in which you are licensed to practice.

The Role of Ethics Codes as a Catalyst for Improving Practice Professional codes of ethics serve a number of purposes. They educate counseling practitioners and the general public about the responsibilities of the profession. They provide a basis for accountability, and protect clients from unethical practices. Perhaps most important, ethics codes provide a basis for reflecting on and improv- ing your professional practice. Self-monitoring is a better route for professionals to take than being policed by an outside agency (Herlihy & Corey, 2015a).

From my perspective, an unfortunate recent trend is for ethics codes to increas- ingly take on legalistic, rule-based dimensions. Being an ethical practitioner involves far more than following a list of rules. Practitioners anxious to avoid any litigation may gear their practices mainly toward fulfilling legal minimums. If we are too con- cerned with being sued, it is unlikely that we will be very creative or effective in our work. It makes sense to be aware of the legal aspects of practice and to know and practice risk-management strategies, but we should not lose sight of what is best for our clients. One of the best ways to prevent being sued for malpractice is to demon- strate respect for clients, keep client welfare as a central concern, and practice within the framework of professional codes.

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No code of ethics can delineate what would be the appropriate or best course of action in each problematic situation a professional will face. In my view, ethics codes are best used as guidelines to formulate sound reasoning and serve practitioners in making the best judgments possible. A number of professional organizations and their websites are listed near the end of the chapter; each has its own code of ethics, which you can access through its website. Compare your professional organization’s code of ethics to several others to understand their similarities and differences.

Some Steps in Making Ethical Decisions Most models for ethical decision making focus on the application of principles to ethical dilemmas. My colleagues and I have identified a series of procedural steps to help you think through ethical problems when using these principles (see Corey, Corey, Corey, & Callanan, 2015):

ŠŠ Identify the problem or dilemma. Gather information that will shed light on the nature of the problem. This will help you decide whether the problem is mainly ethical, legal, professional, clinical, or moral.

ŠŠ Identify the potential issues. Evaluate the rights, responsibilities, and welfare of all those who are involved in the situation.

ŠŠ Look at the relevant ethics codes for general guidance on the matter. Consider whether your own values and ethics are consistent with or in conflict with the relevant guidelines.

ŠŠ Consider the applicable laws and regulations, and determine how they may have a bearing on an ethical dilemma.

ŠŠ Seek consultation from more than one source to obtain various per- spectives on the dilemma, and document in the client’s record the suggestions you received from this consultation.

ŠŠ Brainstorm various possible courses of action. Continue discussing options with other professionals. Include the client in this process of considering options for action. Again, document the nature of this discussion with your client.

ŠŠ Enumerate the consequences of various decisions, and reflect on the implications of each course of action for your client.

ŠŠ Decide on what appears to be the best possible course of action. Once the course of action has been implemented, follow up to evalu- ate the outcomes and to determine whether further action is neces- sary. Document the reasons for the actions you took as well as your evaluation measures.

In reasoning through any ethical dilemma, there is rarely just one course of action to follow, and practitioners may make different decisions. The more subtle the ethical dilemma, the more complex and demanding the decision-making process.

Professional maturity implies that you are open to questioning and discussing your quandaries with colleagues. In seeking consultation, it is generally possible to protect the identity of your client and still get useful input that is critical to making sound ethical decisions. Because ethics codes do not make decisions for you, it is a good practice to demonstrate a willingness to explore various aspects of a problem,

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raise questions, discuss ethical concerns with others, and continually clarify your values and examine your motivations. To the degree that it is possible, include the client in all phases of the ethical decision-making process. Again, it is essential to document how you included your client as well as the steps you took to ensure ethical practice.

The Right of Informed Consent Regardless of your theoretical framework, informed consent is an ethical and legal requirement that is an integral part of the therapeutic process. It also establishes a basic foundation for creating a working alliance and a collabora- tive partnership between the client and the therapist. informed consent involves the right of clients to be informed about their therapy and to make autonomous decisions pertaining to it. Providing clients with information they need to make informed choices tends to promote the active cooperation of clients in their coun- seling plan. By educating your clients about their rights and responsibilities, you are both empowering them and building a trusting relationship with them. Seen in this light, informed consent is something far broader than simply making sure clients sign the appropriate forms. It is a positive approach that helps clients become active partners and true collaborators in their therapy.

Some aspects of the informed consent process include the general goals of coun- seling, the responsibilities of the counselor toward the client, the responsibilities of clients, limitations of and exceptions to confidentiality, legal and ethical parameters that could define the relationship, the qualifications and background of the prac- titioner, the fees involved, the services the client can expect, and the approximate length of the therapeutic process. Further areas might include the benefits of coun- seling, the risks involved, and the possibility that the client’s case will be discussed with the therapist’s colleagues or supervisors.

There are a host of ways to violate a client’s privacy through the inappropriate use of various forms of modern-day technology. Most of us have become accustomed to relying on technology, and we need to give careful thought to the subtle ways cli- ent privacy can be compromised. As a part of the informed consent process, it is wise to discuss the potential privacy problems of using a wide range of technology and to take preventive measures to protect both you and your clients. For example, clients and counselors should carefully consider privacy issues before agreeing to send e-mail messages to clients’ workplace or home. A good policy is to limit e-mail exchanges to basic information such as appointment times.

Educating the client begins with the initial counseling session, and this process will continue for the duration of counseling. The challenge of fulfilling the spirit of informed consent is to strike a balance between giving clients too much information and giving them too little. For example, it is too late to tell minors that you intend to consult with their parents after they have disclosed that they are considering an abortion. Young clients have a right to know about the limitations of confidentiality before they make such highly personal disclosures. Clients can be overwhelmed, how- ever, if counselors go into too much detail initially about the interventions they are likely to make. It takes both intuition and skill for practitioners to strike a balance.

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Informed consent in counseling can be provided in written form, orally, or some combination of both. If it is done orally, therapists must make an entry in the client’s clinical record documenting the nature and extent of informed consent (Nagy, 2011). It is a good idea to provide basic information about the therapy process in writing, as well as to discuss with clients topics that will enable them to get the maximum benefit from their counseling experience. Written information protects both clients and therapists and enables clients to think about the information and bring up ques- tions at the following session. For a more complete discussion of informed consent and client rights, see Issues and Ethics in the Helping Professions (Corey, Corey, Corey, & Callanan, 2015, chap. 5), The Counselor and the Law: A Guide to Legal and Ethical Practice (Wheeler & Bertram, 2015, chap. 2), Ethical, Legal, and Professional Issues in Counseling (Remley & Herlihy, 2016), and Essential Ethics for Psychologists (Nagy, 2011, chap. 5).

Dimensions of Confidentiality Confidentiality and privileged communication are two related but some- what different concepts. Both of these concepts are rooted in a client’s right to pri- vacy. confidentiality is an ethical concept, and in most states it is the legal duty of therapists not to disclose information about a client. Privileged communication is a legal concept that protects clients from having their confidential communications revealed in court without their permission (Herlihy & Corey, 2015a). All states have enacted into law some form of psychotherapist–client privilege, but the specifics of this privilege vary from state to state. These laws ensure that disclosures clients make in therapy will be protected from exposure by therapists in legal proceedings. Generally speaking, the legal concept of privileged communication does not apply to group counseling, couples counseling, family therapy, child and adolescent ther- apy, or whenever there are more than two people in the room.

Confidentiality is central to developing a trusting and productive client–thera- pist relationship. Because no genuine therapy can occur unless clients trust in the privacy of their revelations to their therapists, professionals have the responsibility to define the degree of confidentiality that can be promised. Counselors have an ethical and legal responsibility to discuss the nature and purpose of confidentiality with their clients early in the counseling process. In addition, clients have a right to know that their therapist may be discussing certain details of the relationship with a supervisor or a colleague.

Ethical Concerns with the Use of Technology Issues pertaining to confidentiality and privacy can become more com- plicated when technology is involved. Section H of the ACA Code of Ethics (2014) contains a new set of standards with regard to the use of technology, relationships established through computer-mediated communication, and social media as a delivery platform. Major subsections address competency to provide services and the laws associated with distance counseling, components of informed consent and security (confidentiality and its limitations), client verification, the distance coun- seling relationship (access, accessibility, and professional boundaries), maintenance of records, accessibility of websites, and the use of social media (Jencius, 2015).

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Exceptions to Confidentiality and Privileged Communication Although most counselors agree on the essential value of confidentiality, they realize that other obligations may override this pledge. There are times when confidential information must be divulged, and there are many instances in which keeping or breaking confidentiality becomes a cloudy issue. In determining when to breach confidentiality, therapists must consider the requirements of the law, the institution in which they work, and the clientele they serve. Because these circum- stances are frequently not clearly defined by accepted ethics codes, counselors must exercise professional judgment.

Whenever counselors are not clear about their obligations regarding confiden- tiality or privileged communication, it is critical to seek consultation and to docu- ment these discussions. Remley and Herlihy (2016) identify at least 15 exceptions to confidentiality and privileged communication. There is a legal requirement to break confidentiality in cases involving child abuse, abuse of the elderly, abuse of dependent adults, and danger to self or others. All mental health practitioners and interns need to be aware of their duty to report in these situations and to know the limitations of confidentiality. Here are some other circumstances in which informa- tion must legally be reported by counselors:

ŠŠ When the therapist believes a client under the age of 16 is the victim of incest, rape, child abuse, or some other crime

ŠŠ When the therapist determines that the client needs hospitalization ŠŠ When information is made an issue in a court action ŠŠ When clients request that their records be released to them or to a third

party

In general, the counselor’s primary obligation is to protect client disclosures as a vital part of the therapeutic relationship. Informing clients about the limits of con- fidentiality does not necessarily inhibit successful counseling.

For a more complete discussion of confidentiality, see Issues and Ethics in the Help- ing Professions (Corey, Corey, Corey, & Callanan, 2015, chap. 6), Essential Ethics for Psychologists (Nagy, 2011, chap. 6), The Counselor and the Law: A Guide to Legal and Ethical Practice (Wheeler & Bertram, 2015, chap. 5), and Ethical, Legal, and Professional Issues in Counseling (Remley & Herlihy, 2016, chap. 5).

Ethical Issues From a Multicultural Perspective Ethical practice requires that we take the client’s cultural context into account in counseling practice. In this section we look at how it is possible for practitioners to practice unethically if they do not address cultural differences in counseling practice.

Are Current Theories Adequate in Working With Culturally Diverse Populations?

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