What is a theoretical orientation in counseling

Counseling Theory- Theoretical Orientation Development Plan Paper

DEVELOPING YOUR

THEORETICAL

ORIENTATION IN

COUNSELING AND PSYCHOTHERAPY

Third Edition

DUANE A. HALBUR

Georgia Military College

Life Management Group, Inc.

KIMBERLY VESS HALBUR

Medical College of Georgia at Georgia Regents University

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Library of Congress Cataloging-in-Publication Data

Halbur, Duane.

Developing your theoretical orientation in counseling and psychotherapy/Duane A. Halbur, Kimberly Vess Halbur.—Third edition. pages cm

Includes bibliographical references and index.

ISBN 978-0-13-348893-7

ISBN 0-13-348893-4

1. Psychology—Philosophy. 2. Counseling. 3. Psychotherapy. I. Halbur, Kimberly Vess. II. Title.

BF38.H33 2015

158.3—dc23

2014011528

10 9 8 7 6 5 4 3 2 1

ISBN 10: 0-13-348893-4 ISBN 13: 978-0-13-348893-7
In memory of

Edna May Thompson and

Carol Lynn Halbur,

who gave us much love and many of our theories about life and helped us to pass them along to our children

Dominic Anthony Halbur and

Carolyn Maye Halbur

About the Authors

Dr. Duane Halbur’s research interests include the needs of school counselors, philosophical counseling, and the integration of technology in counseling. Along with teaching and writing, he works as a licensed counselor in private practice specializing in children and families in transition. Dr. Kimberly Vess Halbur’s research includes cultural competencies for the helping professions and medical fields.

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We first wrote Developing Your Theoretical Orientation in Counseling and Psychotherapy with the objective of assisting other helping professionals through finding their theoretical orientation more easily than we did. We realize that the term helping professionals may seem generic, but we use it in an effort to include helpers who work with diverse populations in a wide array of fields. Specifically, we are speaking to mental health counselors, psychologists, social workers, school counselors, substance abuse counselors, psychotherapists, and peer helpers. This third edition attempts to assist clinicians further in finding their theoretical orientation in a diverse society while enjoying the process of self-exploration. The theories are presented in a way that allows the reader to identify quickly the philosophical and cultural foundations of the theories while accessing the goals and techniques of the theories.

Because the work of helping professionals needs to be grounded in theory, we have featured in this text an innovative model for selecting a theoretical orientation and hands-on activities to assist readers in their quest for a theoretical approach to helping. Learning activities, reflection questions, and case studies are included throughout the text, with several featured prominently in Chapter 5. These activities have been updated to demonstrate traditional and contemporary theories as well as multicultural perspectives so important to the helping fields.

Preface

The Intentional Theory Selection (ITS) model is a contemporary model for selecting a theoretical orientation. This model can assist helpers in finding a theory that is congruent with their personal values. We also acknowledge that the selection of a theoretical orientation may be quite cyclical. Just as in life, change in theoretical orientation is constant and inevitable. Thus, a professional helper may revisit the model many times throughout his or her career.

This text may also serve as a reminder or overview of the foremost helping theories and their respective schools of thought. We provide readers with a reminder of the basic philosophies, goals, and techniques of the major theories of counseling. We hope this text offers just enough information to remind professional helpers of what they already know while enticing them to seek out and learn more about a presented theory.

In addition to a summary of selected counseling theories, students and counselors will be exposed to 10 applied ways to aid in the self-discovery process. This self-discovery will begin the readers’ processes of intentionally finding a theoretical orientation that is congruent with their own worldview, beliefs, and values. The Selective Theory Sorter– Revised (STS–R) is a survey that was developed to help students and counselors discover which researched theories they might endorse. This sorter, more important in self- discovery than in assessment, is one of several tools that will be offered to readers while they are in the process of finding their own theoretical orientation.

We hope that readers find the material and the ITS model refreshing and at the same time meaningful. Those in the helping professions know, through research and

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PREFACE

observation, that theory is important. Many innovators, researchers, and clinicians have dedicated their research and life work to finding techniques and philosophies that can best serve our clientele. We owe so much to these pioneers who have helped us to be effective and ethical in the work we do.

The helping professions are truly important to a developing society. Helping professionals have the opportunity to prevent and remediate when they serve in a field that makes its daily impact by improving the lives of others. As you work on your own professional identity and struggles, remember that this opportunity is both a blessing and a responsibility. In this text, as in many endeavors in your professional life, you will be asked to look inward. As professionals, we ask this of clients; as authors, we ask this of you. Take this opportunity to challenge yourself and grow.

We have presented the ITS model and the STS–R at many professional conferences and have greatly appreciated the feedback and the anticipation for this project to be in print for a third time. We still receive emails and phone calls from faculty members who have adopted the text and their students who have enjoyed using it. The interest we have received professionally has served as a muse and motivation for us to improve and update it in this third edition.

NEW TO THIS EDITION
The third edition of Developing Your Theoretical Orientation in Counseling and Psychotherapy offers the following new elements:

■ An increased focus on diversity, including commentary regarding the application of each theory in a culturally rich profession.

■ A greater review of the implications of empirically validated treatments.

■ A greater review of the implications of common-factor approaches to counseling.

■ An expansion and update of the counseling theories, which are necessary for the successful completion of national and state counselor examinations, including updated techniques.

■ Greater explanation of the application of multicultural counseling and feminism.

■ Increased focus on material that readers will find relevant to Counseling for Accreditation of Counseling and Related Educational Programs™ (CACREP) 2016 Standards.

■ Updated websites related to theories and theoretical training to allow readers quick access to more information.

■ Updated cases to assist readers through the process of choosing their theoretical orientation.

With the addition of several new topics, the references have been updated significantly since the previous editions. Readers with experience with the first and second editions will also note a more consistent voice throughout the text.

We would like to thank the reviewers of our manuscript for their insights and comments: John P. Galassi, University of North Carolina at Chapel Hill; Terence Patterson, University of San Francisco; David Shriberg, Loyola University of Chicago; and Amy M. Williams, University of Northern Colorado.

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CHAPTER ONE

Why Theoretical Orientation is Important 1
A PERSONAL EXPERIENCE 1

THE BIG PUZZLE 2

WHAT IS THEORETICAL ORIENTATION? 3

THE HELPER’S TOOL BELT 3

WHAT CAN A THEORETICAL ORIENTATION DO FOR ME? 4

HOW HAVE OTHERS PICKED A THEORETICAL ORIENTATION? 5

WHAT IF I’M ECLECTIC? 6

EMPIRICALLY VALIDATED THERAPIES: ARE THEY BETTER? 8

GUIDANCE FROM COMMON FACTORS: DO THEY ALL WORK? 9

ONCE I HAVE IT, HOW CAN I USE IT? 10

HOW ARE THEORETICAL ORIENTATION AND ETHICS RELATED? 10

THE MAIN POINTS 11

Contents

REFLECTION QUESTIONS 11

CHAPTER TWO

Incorporating Theory into Practice 13
MAKING THEORY USEFUL: A MODEL 13

THEORY DEVELOPMENT 14

IMPORTANCE OF YOUR LIFE PHILOSOPHY 15

LIFE PHILOSOPHY—IT’S PERSONAL 16

SCHOOLS OF THOUGHT 17

THEORIES 18

GOALS AND TECHNIQUES: INTERVENTIONS AT WORK 19

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CONTENTS

COUNSELORS ARE DIVERSE 20

RESISTANCE TO THEORIES: ECLECTIC, INTEGRATED, OR JUST DON’T KNOW 21

DOES IT REALLY WORK? 23

WHAT TO TAKE HOME 24

REFLECTION QUESTIONS 25

CHAPTER THREE

Top 10 Ways to Find Your Theoretical Orientation 27
FIND YOURSELF 28

ARTICULATE YOUR VALUES 29

SURVEY YOUR PREFERENCES 30

USE YOUR PERSONALITY 30 Taking the MBTI 37

CAPTURE YOURSELF 37

LET OTHERS INSPIRE YOU IN YOUR LEARNING 38

READ ORIGINAL WORKS 38

GET REAL 38

STUDY WITH A MASTER 39

BROADEN YOUR EXPERIENCES 40

TOP 10 WRAP-UP 40

REFLECTION QUESTIONS 41

SUGGESTED READINGS AND WEBPAGES 41

CHAPTER FOUR

Six Schools of Thought and Their Theories of Helping 45
PSYCHODYNAMIC SCHOOL OF THOUGHT 48

Psychoanalytic Theory 48

Analytical Theory 53

Individual Psychology 55

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CONTENTS ix

BEHAVIORAL SCHOOL OF THOUGHT 58

Behavioral Therapy 58

HUMANISTIC SCHOOL OF THOUGHT 61 Person-Centered 62

Existential 64 Gestalt 67

PRAGMATIC SCHOOL OF THOUGHT 70

Cognitive-Behavioral 70

Rational Emotive Behavioral Therapy 72 Reality Therapy 74

CONSTRUCTIVIST SCHOOL OF THOUGHT 76

Multicultural Counseling and Therapy 77

Feminist Therapy 79

Narrative Therapy 81

Solution-Focused Brief Therapy 84

FAMILY APPROACHES SCHOOL OF THOUGHT 86

Bowen Family Systems Therapy 86

Strategic Family Therapy 88

Structural Family Therapy 89

Family Therapies and Diversity 91

SUMMARY 92

REFLECTION QUESTIONS 92

CHAPTER FIVE

Case Examples for Integrating Theory into Practice 93
CLINICIAN CASE STUDIES 93 Case One: Evan 93

Case Two: Jill 95

Case Three: Garrett 97

Case Four: Lillian 99

Comment on the Cases 101

CLIENT CASE STUDIES 102

Case One: Tony 102

Case Two: Nancy 102

Case Three: Brenda 103

CONTENTS SUPERVISION CASE STUDIES 104 Case One: Grace 104 Case Two: Casey 104 Case Three: Dominic 105 Summary of Supervision Case Studies 106 PUTTING IT ALL TOGETHER 106 Importance Revisited 106 How Theory Is Found 106 Benefit of the ITS Model to the Field 107 References 109 Index 115

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A PERSONAL EXPERIENCE
Since our first years of teaching graduate counseling classes, students have often asked, “How did you decide your theoretical orientation?” This question is reasonable and understandable because students in the helping professions are frequently asked about their theoretical orientation. Thus, we began pondering the development of our own theoretical orientations, which centered inevitably around three core issues: personalities, mentors and supervisors, and clients.

Why Theoretical

Orientation is

Important

1

First, we contemplated how personality might play a role in the theories that we liked and the ways we worked with clients. For example, one of us is an outgoing, energetic person who reflects these traits in interactions with others, both personally and professionally, and who sets high standards and believes that, in general, people strive to do what they believe is right. The other tends to focus on philosophical understanding, however, and consequently practices existential questioning in everyday life. These personal tendencies greatly influence our theories. One of us focuses on social and humanistic theories, while the other works with theories that have strong philosophical foundations. Personal qualities, values, actions, and assumptions clearly have an impact on our theoretical orientations and consequently on our work with clients.

Next, we thought about our mentors and supervisors and the various theoretical orientations they espoused. For instance, one mentor was very clearly humanistic and relied on Gestalt interventions. Some faculty members were fairly diverse in their theoretical orientations and championed constructivist, client-centered, cognitivebehavioral, and ecological approaches. One clinical supervisor said that he was a “planned eclectic.” These mentors and supervisors greatly affected our choices of theoretical orientation. Their feedback, guidance, and expectations were always tinted by their theoretical orientations. As a result, we knew that they had affected our choices as well; we were just not sure how.

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Acknowledging that we had been exposed to a wealth of theoretical orientations, we began to think about past and present clients with whom we had worked. We thought about how effective our theoretical orientations were for them. We c oncluded that each client must have also affected us as we selected our theoretical orientations. Despite, or perhaps because of, our examinations of these theoretical orientation issues, we seemed to answer students by saying, “You just figure it out as you go along.

When a theory really ‘fits’ for you, you will know it.”

But we knew this answer was not satisfactory. We remembered all too well our first years as helping professionals. We had often been quizzed about our own theoretical orientations and yet we had not been given any tools other than the required survey course in major theories to guide us. As we recounted our own similar struggles, we were reminded in many ways just how important theoretical orientation is in the helping professions. Thus, we wanted to offer clinicians and our students specific strategies to use in developing their theoretical orientation.

THE BIG PUZZLE
Selecting a theoretical orientation is typically a puzzling experience for students in the helping professions. A common goal of training programs is to teach effective helping skills. Academic programs also strive to help students conduct counseling in a way that is intentional and theory based. Consequently, students are frequently asked during the course of their graduate programs to state their theoretical orientation, typically by writing a paper about it. The assignment usually goes something like this: After reading a brief overview of counseling theories, which one do you believe fits your style of counseling?

Although this assignment is valuable, it may occur too early in the education of professional helpers. Because these students do not yet have enough clinical experience to guide them, they typically respond to the theoretical orientation assignment by picking theories that sound good on paper. Students at this stage usually have little understanding of the theories they choose. Unfortunately, many students continue to support, research, and apply their chosen theory, which ultimately limits their overall understanding of counseling theories. Some students simply choose the instructor’s theoretical orientation in hope of receiving a high grade on the assignment. Others pick the theory that they understand best. It is not that students are attempting to be lazy or manipulate instructors for a higher grade; rather, they are overwhelmed by the multitude of theories and therapeutic interventions to which they are exposed. Even when students find theories that they like on paper, they often feel lost and unable to apply theory to practice. Hence, most students in the helping professions find it extremely difficult to develop and articulate in both words and practice their own theoretical orientation. This dilemma can easily be compared to the experience of holding pieces to a jigsaw puzzle without having the picture on the front of the box that contained the puzzle pieces. In this situation, the corner and the edge pieces are easily identified, but the central pieces are difficult to discern.

On the journey to finding a theoretical orientation, the role of soul searching and clinical practice cannot be emphasized enough. Although this text does not offer

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direct clinical experience, it does provide for self-evaluation and soul searching. This text does offer applied methods to assist students and clinicians as they look for their theory of counseling. Within these pages you will first be offered the Intentional Theory Selection (ITS) model, which can serve as a guide to make finding your theoretical orientation a process. Tools, such as the Selective Theory Sorter–Revised (STS–R), will also be offered to serve as pragmatic assistants. Many resources, theory summaries, reflective questions, and case studies will also be offered to help clinicians and counselors-in-training begin to complete a puzzle that culminates in forming their theoretical orientation.

WHAT IS THEORETICAL ORIENTATION?

Before students in the helping professions can begin the voyage to finding and solidifying a theoretical orientation, they must have a working definition of the term theoretical orientation. This definition enables students, counselors, and the field in general to have a similar idea of what being theoretically orientated means. Poznanski and McLennan (1995) provide an excellent definition: A theoretical orientation is “a conceptual framework used by a counselor to understand client therapeutic needs” (p. 412). More specifically, theoretical orientation provides helpers with a theory-based framework for “(a) generating hypotheses about a client’s experience and behavior, (b) formulating a rationale for specific treatment interventions, and (c) evaluating the ongoing therapeutic process” (Poznanski & McLennan, 1995, p. 412). Thus, theoretical orientation forms the foundation for helping professionals in counseling, social work, and applied psychology. Having a theoretical orientation provides helpers with goals and techniques that set the stage for translating theory into practice (Strupp, 1955).

As students in the helping professions learn skills and theories, they often struggle with ways to integrate the information. Yet theory and practical application need a balance (Drapela, 1990). In counseling classes, for example, students may learn to express empathy and to confront, but they do not yet understand how to practice those skills with the intention that follows from a specific theoretical orientation. By choosing a theoretical orientation to practice and applying it, a counselor is able to use general counseling skills in an applied and intentional way.

THE HELPER’S TOOL BELT
Once counselors learn the basic helping skills, they have the opportunity to use them in an intentional way. In many ways, a theoretical orientation serves as a tool belt. The tool belt is filled with a multitude of tools that serve different functions. Among the tools, counselors will find the basic skills of confrontation, reflection of feeling, openended questions, and empathy. Additionally, counselors who have a theoretical foundation have tools specific to their theory. For example, a Gestalt counselor has the tool of the empty-chair technique, and the behaviorist counselor has the tool of behavioral contracting. Any of these tools can be useful in the construction (helping)

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process. All of the techniques have the potential of achieving the same desired result: helping the client. The difficult part is knowing when to use each tool. Continuing with the tool belt analogy, there is an old adage that says something like this: “If you only have a hammer, everything looks like a nail.”

For example, a student enrolled in a graduate counseling program is seeing a client at his practicum site. The client, a college freshman, is very frustrated with her mother and anxious about going home over the holiday break. The student believes that the client needs to express her feelings toward her mother. Depending on the counselor’s theoretical orientation, the tool selected for the expression of the client’s feelings may vary. If the counselor prefers rational emotive behavioral therapy (REBT), he may explore with the client her beliefs about going home for the holidays. If the counselor works from an existential framework, he might encourage the client to be authentic with her mother regarding her feelings of frustration. If the counselor ascribes to Gestalt theory, however, he may decide to use the empty-chair technique, prompting the client to express her feelings during the session. In this particular case, the counselor decides to use the empty-chair technique. The intervention looks somewhat awkward, and the counselor is clearly uncomfortable with the intervention and the processing of it with his client. After the session, the counselor says to his instructor, “Wasn’t that awful? I can’t believe it didn’t work. I really thought the c lient would like it.” Unfortunately, the counselor picked an intervention that really was not in his typical tool belt because his natural theory was REBT. He used an intervention, a tool that was not congruent with his theory. Although you can use a wrench to pound a nail, it will likely not feel right and may not be as effective.

WHAT CAN A THEORETICAL ORIENTATION DO FOR ME?

A theoretical orientation provides helpers with a framework for therapy that sets the foundation for intentional counseling. For the counselor, being intentional is a prerequisite to ethical and effective helping. Theory is an important factor in structuring therapy and directing interventions (Hansen & Freimuth, 1997). Consequently, intentional counseling requires counselors to rely on their theoretical orientation to guide therapy. Thus, when counselors get lost in the therapeutic process, theory can provide a road map. Theory is also a way for counselors to organize and listen to data and information given to them by clients. A number of theories provide specific steps to treatment planning; these steps may assist counselors in being intentional and consistent in their role as a therapist. Ideally, counselors’ interventions stem from their theoretical orientation; however, human beings do not fit neatly into categories. Hackney (1992) has written eloquently about theory and process, stating that, like human nature, “client problems are typically multidimensional” (p. 2). The following is a clinical example.

Louis, a 23-year-old, Mexican-American male seeks therapy. During the initial interview, he states: “I am a loser. I have a college degree and can’t get a job. I don’t ask people out on dates because I know they’ll see immediately that I’m a loser. When I do

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go out to meet people, women seem to avoid me.” The therapist believes the client has a problem with self-esteem. While self-esteem is an important facet of the client’s experience, it needs to be viewed from a larger perspective. The client’s problem seems to encompass his thinking, feeling, behavior, and interactions with the world around him. A therapist who has a specific theoretical orientation will be able to view the client holistically, knowing that the theory will provide a road map for the therapy.

Espousing a theoretical orientation to helping has numerous benefits for both clinicians and the clients they serve. Specifically, a theoretical orientation provides ways to organize client information. An orientation can also help intentionality and consistency within the work of a professional helper. Although the helper should understand what a theoretical orientation is, why it is important, and what it can do for both the client and the counselor, this information provides little help to a counselor who must pick a theory from which to work. The ways in which others have picked a theory may help students understand where they can go to pick a working theory.

HOW HAVE OTHERS PICKED A THEORETICAL ORIENTATION?

Hackney (1992) noted that most helpers choose their theoretical orientation based on one of three considerations: (1) the theoretical orientation of the helper’s training program, (2) the helper’s life philosophy, and/or (3) the helper’s professional experience as a client. Some helpers also consider the evidence supporting the various therapies or even look at the common characteristics of effective therapies. While helpers commonly use these traditional methods to find their theoretical orientation, each has inherent pitfalls. The shortcomings of each of these methods will be discussed in order to provide a rationale for a new model of choosing a theory that is presented in Chapter 2.

First, initial training programs may or may not expose students to every theoretical orientation. For example, if faculty members at the same institution support the same theoretical orientation, they limit their students’ exposure to the myriad of available theories. Conversely, if students enroll in an academic program where every faculty member has a different theoretical orientation, the students may receive mixed messages about “effective” therapy. Another potential difficulty for students is underexposure to the process of developing a personal orientation because faculties choose not to discuss their own theoretical orientations in hopes of being unbiased in their teaching. Thus, a theoretical orientation to helping cannot be based solely on students’ training programs.

Second, some counselors base their theoretical orientation on their own personality and philosophy of life. This approach can also present difficulties. For example, counselors who are predominantly optimistic and believe the best about people may choose a humanistic approach. Other counselors may believe that people’s thoughts are the core of their problems and choose REBT as a way to help clients develop more rational thinking. Both beliefs ultimately influence how counselors perceive, interact with, and treat their clients, even if those clients have a personality and worldview

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much different from those of the counselors. Although theory provides a framework for working with most clients, counselors must remember that each client is unique. A counselor must remain both open to experience and flexible with clients.

The third way helpers determine their theoretical orientation is through clinical experience, even though helpers may realize that their theoretical orientation does not fit for all clients or clinical situations. For example, counselors who favor a humanistic orientation may have difficulty in career-counseling settings. While these counselors may be skilled at the reflection of feeling, genuineness, and rapport building that lay at the core of the humanistic approach, their clients who are seeking résumé reviews and job information may feel frustrated when they get a “listening ear” but not the results they expected, such as direct advice on finding an internship or tips on interviewing.

In such cases, counselors need to adjust their theory to fit the needs of the client.

The fourth strategy employed by counselors to determine their theoretical orientation is choosing an evidence-based theory. While this is a sound decision-making strategy, it may be difficult for counselors to find an evidence-based theory that fits their personality, values, and/or client needs. Those who choose their theory in this way limit themselves to theories that lend themselves to empirical testing and validation. For example, therapies that focus on helping clients strive toward actualization and personality change may not be easy to validate and thus may be ignored in the process of choosing a theoretical orientation.

Counselors not only must maintain their fundamental beliefs and values regarding the helping relationship but also must adapt their interventions to help the client. In the example of the humanist in the career-counseling situation, he may choose to hold onto the belief that people are basically good and striving for actualization. However, in an attempt to meet the needs of the client, the humanistic career counselor may be open to a change of perception—one that acknowledges that formal career exploration can lead to greater actualization. In another example, while attempting to be grounded in theory, a cognitive-behavioral therapist utilized cognitive techniques that were not appropriate for her client because the client had low intellectual functioning. In attempting to stay completely in harmony with her theory, the therapist was not meeting her client’s needs. Consequently, she had to adapt her style and take a more behavioral approach.

WHAT IF I’M ECLECTIC?

Most examples provided in the text thus far highlight a counselor with one specific theoretical orientation. However, many counselors do not believe that one size fits all and believe that they can best serve their clients by offering a variety of approaches to their clients. Thus, they believe there is better efficacy in applying different theories and techniques to different clients. In general, eclecticism has been found to be a practiced theoretical orientation (Norcross, 1997), with many offering it as their primary identified theory. However, some cautions about eclecticism should be noted. First, eclecticism requires extensive training and competency, which beginning counselors typically lack (Norcross, 2005). To truly be an effective, eclectic counselor, clinicians

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should be able to be intentional in their application of techniques. They should have a great understanding of what techniques to apply when specific symptoms present or specific client characteristics emerge. Often those that purport to be eclectic share that their goals include assessing their clients, identifying clients’ needs, and providing those techniques or therapies that would be most beneficial to the clients. This, however, takes a great deal of skill and knowledge. It is truly a daunting task, during the complex interchange of a therapy session, to assess a client and pull from one’s repertoire the “right” technique or the “right “therapy” that will meet a presenting client’s needs. In addition, many who identify as eclectic have not completely identified and acknowledged the differences between technique and theory. Most who identify as eclectic refer to the eclectic component of their work as the action stage where interventions are offered to clients. Thus a potentially more accurate way to describe their work is by saying that they offer a variety of techniques or interventions.

Most eclectic counselors have an overarching theory that guides their work. Although this may not be true of all eclectic counselors, in practice, most counselors have a theoretical orientation they lean toward or even consider their primary orientation. “Switching” theoretical orientations to meet client needs does indeed seem to make sense. In the field of counseling, however, theoretical orientation offers a framework for how a clinician might view development, pathology, and the counseling relationship itself. Altering one’s view, or application of, such constructs while in the middle of a therapeutic relationship would seem to be almost risky to the productivity of therapy and could even be confusing to clients. If a clinician is to choose eclectic as an approach, however, it would seem that he or she should have a vast understanding of the theories and therapies they hope to utilize with clients. Thus, the authors of this text and many others recommend that beginning counselors may be best served by developing a single theoretical orientation that works best for them and learning to be as effective as possible within that paradigm.

However, eclecticism is indeed endorsed by many counselors, so its merit should not be just thrown out. Sometimes eclecticism is titled strategic eclecticism, highlighting the intentionality and purposefulness of using a wide variety of therapies and techniques. However, the authors offer a reframe. There is a difference between being eclectic and applying a variety of techniques. A counselor who is truly eclectic in terms of theory would change fundamental beliefs about human development, psychopathology, and epistemology from situation to situation and from client to client. However, applying a variety of techniques while maintaining a firm foundation in a fundamental belief is a different process. For example, an existential therapist working with a client with a phobia may use systematic desensitization (an eclectic technique for a t raditional existentialist) while maintaining that removing such a phobia will enable the client to move toward greater actualization and live a more meaningful life (theoretically founded).

Being grounded in a theoretical orientation does not stop you from being flexible to the needs of clients. To truly serve clients, we should be fluid in the process and adaptable in the relationship. We should be willing, and competent, to be able to understand clients from a variety of perspectives. Their symptoms, characteristics, and immediate needs should affect how therapists work with clients. As a therapist

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works with diverse clients and their needs, however, flexibility and eclecticism in fundamental beliefs seems like a potential disservice not only to clients but also to therapists who strive to be congruent, ethical, and effective.

EMPIRICALLY VALIDATED THERAPIES:

ARE THEY BETTER?

Similar to those who choose eclecticism as an answer to the question of theoretical orientation are those who choose how to work with clients based on research. Some clinicians and researchers believe that the best way to decide how to work with clients is by examining the research and seeing what, through scientific inquiry, we know are effective therapies. Research in the fields of counseling, psychology, and the related helping professions has produced a variety of empirically validated therapies (EVTs), with a large number of those being “proven” (see Chamless et al., 1998) to work.

Those who promote using EVTs or empirically supported treatments (ESTs; see Parson, 2009) as the focus of their work worry less about what theory to “choose” and instead ask what technique or theory is “proven” to work with the client issue that is presented. To discover EVTs, specific techniques are typically applied to clients with an isolated or limited symptomology through the use of controlled research methods to see which therapies indeed prove to be most effective for specific clients and specific symptoms. This commonsense approach is becoming vastly popular through the helping professions; however, it does present some difficulties.

Many of these proven approaches specifically look at therapies that attempt to address one specific symptom. Most of the EVTs discovered do not promote client health and welfare or alleviate diagnosed disorders. They look instead at how specific symptoms can be reduced or eliminated. Thus, EVT techniques are predominately behavior-based because there is a propensity to measure symptoms while using these techniques.

Consequently, although the EVT argument is often presented as relevant when discussing clinicians choosing a theoretical orientation, most EVTs are not theories at all. This is partly because, for a therapy to be empirically validated, it must “be studied as a treatment for a disorder or problem, be manualized, and be validated either by two different studies done using a randomized clinical trials design, or by use of a single-subject design (traditionally of relevance primarily to behavioral therapies)” (Bohart, O’Hara, & Leitner, 1998, p. 142). Thus, they may be categorized more accurately as techniques or collections of interventions. In addition, many of these therapies do not, as a theory would, provide conceptualization of clients, perspectives of development, or frameworks for the progression of therapy. They are focused on the relief of specific symptoms and include approaches such as interactive behavioral therapy (IBT) for people with intellectual disabilities (Tomasulo & Razza, 2009), dialectical behavioral therapy (DBT) for people with borderline personality disorder (Hoffman & Steiner-Grossman, 2012) and for eating disorders (Safer, Telch, Chen, & Linhan, 2009), and cognitive behavioral therapy for panic disorder (Craske & Zunker, 2001).

Many of the studies validating these approaches analyze interventions and approaches with clients that have specific symptoms (Yalom, 2002) and not with

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clients with complicated diagnoses. Although there is scientific support for the use of empirically validated therapies, there is limited ability about generalizing findings to a diversity of clients and symptomologies. As Yalom (2002) states, however, “nonvalidated therapies are not invalidated therapies” (p. 223).

GUIDANCE FROM COMMON FACTORS:

DO THEY ALL WORK?

Theories vary greatly in their depth, complexity, and usefulness. In the counseling field, there really could be as many theories, and there likely are, as there are counselors. However, the theoretical approaches that are generally published are those proven to have some generalized effectiveness (Kottler, 1999). Some answer the question of choosing their theoretical orientation by looking at the characteristics from all theories of counseling and examining the commonalities and the effectiveness about all of them. This so-called dodo bird effect states that factors common to all the various counseling theories account for the efficacy of all of the currently practiced psychotherapy theories (Leibert, 2011; Wampold, 2001). This effect states that we can find common, curative characteristics (Grencavage & Norcross, 1990) that occur in counseling and therapeutic relationships to explain why therapy ultimately works.

Wampold sought data for differential efficacies among therapies but discovered the opposite. Wampold ascribed this to the common factors theory of uniform efficacy among all existing psychotherapies. The idea that common factors among the different counselors are what account for their efficacy was first proposed by Rosenzweig (1936). This concept received little attention until nearly 40 years later, when Luborsky, Singer, and Luborsky (1975) found empirical data to suggest that all therapies had nearly equal outcomes, thereby confirming the accuracy of the dodo bird effect. Since that time, numerous studies have been done and articles have been written that support the dodo bird effect (Assay & Lambert, 1999; Duncan, 2002; Wampold et al., 1997).

Assay and Lambert (1999) concluded from their empirical study comparing various therapies that specific factors or techniques accounted for only 15% of the variance in treatment outcome, whereas common factors accounted for the remaining 85%. Specifically, they found that client factors (what the client brings to therapy) accounted for the majority of the variance in outcome (40%), followed by relationship factors (30%) and by placebo, hope, and expectancy (15%). Wampold (2001) offered similar common factors, including alliance, allegiance, adherence, and counselor effects.

Of particular importance are Assay and Lambert’s (1999) expectancy factor and Wampold’s (2001) allegiance factor. Expectancy involves the clients’ belief in the credibility of the theory and thus their expectation that it will be helpful and produce positive change. Allegiance involves a condition similar to that of expectancy, except it is the counselor who must believe that the treatment he or she is offering is efficacious. The concepts of expectancy and allegiance parallel Frank’s (1973) assertion that counseling is most helpful when both the client and the counselor believe in its efficacy. Arthur (2001) expressed a similar sentiment regarding efficacy in his review

WHY THEORETICAL ORIENTATION IS IMPORTANT 3

WHY THEORETICAL ORIENTATION IS IMPORTANT 3

WHY THEORETICAL ORIENTATION IS IMPORTANT 3

of studies on factors contributing to counselors’ choices of theoretical orientation. These common factors lead to the first consideration for counselors-in-training when choosing a theoretical orientation: They must assess whether they believe in the theory themselves and whether they believe they can convey that conviction to clients sufficiently to gain their acceptance of the theory as well.

Finding what is common and effective in various theories of therapy has proven successful to researchers (eg., Grencavage & Norcross, 1990) and beneficial to clinicians (Halbur & Halbur, 2006) across the various counseling theories. If people accept wholeheartedly the premise of the dodo bird, then what theoretical orientation one chooses is not nearly as important as that a theoretical orientation is chosen. As stated above, research on common factors theory has suggested that, although all major theories have the potential for equally effective outcomes, counselors’ belief in their theory is critical to its actual effectiveness (Arthur, 2001; Assay & Lambert, 1999; Frank, 1973; Wampold, 2001).

ONCE I HAVE IT, HOW CAN I USE IT?

Once a counselor’s theoretical orientation is developed, it must be put into action. Counselors are often ready to jump in with one of the many techniques shown to be effective with clients (e.g., Erford, Eaves, Bryant, & Young, 2010). It is important to know first, however, how to move forward. Theoretical orientation is used as a blueprint to organize a client’s information as well as a tool to guide clinical decisions, diagnosis, intervention selection, and treatment planning. Theoretical orientation can help determine the direction of and activities used during the course of counseling. Certainly, counselors use theory to explain or conceptualize clients’ problems. According to Kottler (1999), theory is “the place to start when you are trying to sort out a complex, confusing situation” (p. 30). Similarly, Strohmer, Shivy, and Chodo (1990) suggest that counselors may also use theoretical orientation to confirm selectively their hypotheses regarding their clients. Not only does theoretical orientation help in case conceptualization, diagnosis, and treatment planning, but it may also allow for a clinician to behave ethically.

HOW ARE THEORETICAL ORIENTATION AND ETHICS RELATED?

Clinicians are ethically and often legally bound to have a theoretical foundation. Informed consent is a component of many professional ethical codes, including those of the American Counseling Association (ACA), the American Psychological Association (APA), and the National Association of Social Workers (NASW). Each of these professional ethics codes states that clients enter the helping relationship with informed consent. Implicit within the notion of informed consent is that helpers should share their theoretical orientation with clients or must at least be able to articulate their theory if asked by clients. Helpers who share their theoretical orientation

10 CHAPTER ONE

10 CHAPTER ONE

10 CHAPTER ONE

with clients allow them to make an informed choice to engage in therapy. Thus, helpers need to be able to articulate their theoretical orientation and how it affects the helping relationship and the therapeutic process. In addition, many states dictate that licensed practitioners provide their clients with a professional disclosure statement. Such a statement usually orients the client to the counseling process and typically includes information about the helper’s educational background and areas of expertise, the length of sessions, the responsibilities of each party, the hourly fee, and the helper’s theoretical orientation. Thus, helpers need to be able to articulate their theoretical orientation in order to meet these ethical and professional obligations.

THE MAIN POINTS
In summary, counselors must develop a theoretical orientation that gives them the tools to build ethical, helping relationships based on their values, personality, and intention. Choosing a theory, “a conceptual framework used by a counselor to understand client therapeutic needs” (Poznanski & McLennan, 1995, p. 412), is an ongoing process that will ultimately make counselors more confident and effective in serving the needs of their clients. Within the chapter, the processes that counselors often engage in to determine their theory range from finding their theory based on their own therapeutic experiences to examining research on empirically validated therapies.

In the following chapters, readers will be assisted in developing their theoretical orientation through many forms of self-examination. The Intentional Theory Selection (ITS) model, which is presented in Chapter 2, offers a framework for finding a theoretical orientation. Chapter 3 builds on this model by offering reflection questions, activities, value clarification, and the Selective Theory Sorter as ways to help counselors understand theories that are most likely congruent with who they are and the potential work they do and will do with clients. In the remaining chapters, theory is offered in a pragmatic way following the ITS model, and clinical and supervisory examples of the ITS model in action are discussed.

REFLECTION QUESTIONS
1. If you had to select your theoretical orientation today, what would it be? How confident are you with your current choice of theoretical orientation?

2. What experiences have you had with clients that either support or negate your current theoretical orientation?

3. What influences have faculty members and supervisors had on your theoretical orientation?

4. What do you see as advantages and disadvantages to using empirically validated therapies?

5. What steps do you need to take to increase your allegiance to the theories in which you are interested?