Egan's Skilled Helper Model

Developments and Implications in Counselling

Val Wosket

• Publisher: Routledge
• Year: 2008
• eBook ISBN: 9781135453688
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

The skilled helper model of counselling is hugely influential in the helping professions. Egan's Skilled Helper Model brings a number of new and challenging perspectives to bear on Egan's work and makes a major contribution to the development of this problem-management and opportunity-development approach to helping.

Val Wosket draws on over twenty years experience of counselling, training and supervising to provide a clear exposition of the model and situate it in contemporary counselling practice. Numerous case studies are provided throughout, along with contributions from experienced practitioners, illustrating how the model can be applied in a variety of clinical settings and with a range of counselling issues. Egan's Skilled Helper Model builds on and extends the aims of Egan's original work, covering key topics, including:

• Developing a client-responsive approach that places the therapeutic relationship at the heart of the model
• Applying the skilled helper model in research, training and supervision
• Translating the model into more accessible and adaptable language

This book provides an invaluable resource for trainees, trainers, supervisors and experienced practitioners wishing to update their knowledge of the model. It will also be of great interest to anyone in the helping professions looking for a pragmatic integrative framework that is adaptable to a diverse range of client issues and contexts.

Chapter 1

Background and context to the skilled helper model

This first chapter attempts to place the skilled helper model in context, both historically and in terms of contemporary counselling practice. It includes an overview of the evolution of the model and its relationship to recent key developments in the field of counselling theory and practice. In particular there is an exploration of where the skilled helper model is situated in relation to the ‘common factors’ paradigm and developments in integrative and eclectic counselling. There then follows a discussion of the nature of process models of counselling and psychotherapy and their relationship to the skilled helper model. Consideration is also given to the key values, principles and assumptions underpinning the model. The chapter concludes with a presentation of Egan’s view of the person within a people-in-systems framework. Included at the end of the chapter and in subsequent chapters throughout the book are suggested exercises that can be used in training to raise awareness and develop skills relating to the model.

In the closing decades of the twentieth century it became possible to observe a welcome shift taking place in the field of counselling and psychotherapy as some of the more rigid territorial boundaries that have traditionally separated the various ‘pure’ schools of therapy began to dissolve and break down. This process of dis-solution started to come about largely as a result of researchers and practitioners moving away from the seemingly redundant search to find the most effective counselling approach and, instead, moving towards the more productive aim of attempting to identify those common therapeutic factors that appear to be universally effective in all mainstream counselling approaches (Aebi 1993; Connor-Greene 1993; Duncan et al. 1992; Frank 1961; Goldfried 1982a; Miller et al. 1997; Shepherd and Sartorious 1989; Strupp and Hadley 1979; Wills 1982). This endeavour has become widely known as the search for the common or nonspecific factors that appear to contribute to the effectiveness of therapy.

The observable shift in focus from favouring purist theories to valuing common factors underpins the development and increasing popularity of integrative and eclectic approaches, of which Egan’s skilled helper model is one. Before moving on to consider the skilled helper model in more detail, I will attempt to outline some of the key influences on the development of the common factors paradigm, as this will help us to consider the context in which the model is currently situated.

Common factors in therapy

The non-specific or common factors approach to integration seeks to uncover and make best use of what have been revealed as the universal, core ingredients of effective therapy across all major counselling approaches. Importantly, this paradigm attempts to take Egan's skilled helper model 2 greater account of what clients themselves consider to be the effective ingredients of therapy, rather than relying merely on what therapists and researchers think (Duncan et al. 1992).

Common factors have been selected and presented in different ways in the professional literature. Grencavage and Norcross (1990) reviewed fifty publications to identify common factors across therapies and categorised them into five groups which appeared to feature most prominently. These are:

1. Client characteristics, e.g. positive expectations; distressed client actively seeking help.
2. Therapist qualities, e.g. warmth, empathy, acceptance; a socially sanctioned healer and cultivator of hope.
3. Change processes, e.g. opportunity for catharsis; acquisition and practice of new behaviours; fostering of insight/awareness; success and mastery experiences; emotional and interpersonal learning.
4. Treatment structures, e.g. the use of techniques/rituals; a healing setting; the provision of a sound rationale for change; a focus on inner world and exploration of emotional issues.
5. Relationship elements, e.g. the development of a therapeutic alliance; engagement and transference.

From this list we can begin to see that a complex interplay of factors is at work in any effective therapeutic approach and that techniques and strategies may form only a small part of the whole change-inducing package.

The growth of eclectic and integrative approaches

The growing recognition that common factors appear in all major counselling approaches as universal change agents has contributed significantly to the observable movement towards eclecticism and integration in the counselling world. In a survey of eclecticism among counsellors in Britain undertaken in 1999, Hollanders and McLeod (1999) found that from a sample of 309 therapists, 87 per cent revealed, either explicitly or implicitly, their engagement in eclectic or integrative practice. The exponential increase in the popularity of eclectic and integrative approaches in recent years has been bolstered by a range of factors, including:

• The ever-increasing proliferation of therapies
• The inadequacy of single theories to account for therapeutic change
• The impossibility of identifying one counselling approach as more effective than the rest
• Socio-economic contingencies (in particular the requirement of service providers to be accountable and cost effective).

The integrative/eclectic movement, while taking much of its initial shape from the common factors paradigm, continues to be moulded by an increasing accumulation of research evidence, some key findings from which are summarised below. This body of research (see Wosket 1999 for a detailed discussion and full references to individual studies) includes, but also extends well beyond, those findings that support the notion of universal change agents occurring in all therapeutic approaches. Findings from this research indicate:

• that whereas counselling and psychotherapy are generally effective, they are not differentially so. This means that it has proved impossible to ascertain which approach (or approaches) are more effective than others
• the existence of what is known as the ‘equal outcomes phenomenon’—this is the notion that different therapeutic approaches can achieve similar outcomes
• that it is those common factors across approaches, as outlined above, that largely account for this equivalence of outcomes
• that therapist and client matching across a range of variables (see Chapter 4) is an important predictor of outcomes
• the ‘paradox of equivalence’, which suggests that experienced therapists (regardless of orientation) are more similar than different in the way that they practise and that the more experienced the practitioner, the more likely he or she is to work in an integrative fashion
• that experience, rather than theory, drives the practice of more seasoned therapists
• that para-professional (minimally trained) helpers using a variety of skills may be equally as effective as professionally trained therapists in some contexts
• that the major change agent of effective counselling or psychotherapy is the personality of the therapist, rather than the theory or model employed—particularly the ability to form a warm, supportive relationship
• that a number of studies may have mis-attributed therapeutic change to a therapeutic approach where the change was actually effected by the individual therapist.

A personal approach to integration

Alongside the growing popularity of integrative and eclectic models has emerged a perceptible movement towards transtheoretical and deconstructionist approaches. These are essentially ways of working that are personally shaped by the individual therapist (Duncan et al. 1992; House 1999; Karasu 1996; LeShan 1996; Miller et al. 1997; Parker 1999). From within this movement can be heard a strengthening argument that personal integration undertaken by individual counsellors and psychotherapists may be a more meaningful and effective response to the dilemmas of pluralism than the further proliferation of ‘grand’ theories and models of therapy (Horton 2000b; Lapworth et al. 2001; Lomas 1981; O’Brien and Houston 2000; Wosket 1999).

More about developing a personally integrated style of counselling within the framework of the skilled helper model is said in Chapters 5 and 6 where we will turn to considering aspects of the training and supervision of helpers. In the following section I will begin to look at the place that the skilled helper model occupies in the current world of integrative and eclectic practice.

Eclecticism, integration and the skilled helper model

Since it first appeared on the counselling scene in the mid-1970s, Egan’s skilled helper model has been continuously revised and expanded. The model evolved from Egan’s early writings on interpersonal skills within group and individual contexts (Egan 1970, 1973, 1976, 1977; Egan and Cowan 1980) and has moved through the presentation of a sequential process model for individual counselling to the development of change agent models and skills within the broader field of organisational change.

Early and enduring influences on the skilled helper model are drawn from the work of Rogers (1951, 1957, 1965) and Carkhuff (1969, 1971, 1987), which provide both its person-centred values and principles and its emphasis on the client-centred use of counselling skills. The model’s cognitive-behavioural elements are closely informed by figures such as Bandura, Beck, Ellis, Seligman and Strong.

A three-stage map of the helping process, as outlined later in Chapters 2 and 3, has remained a constant during the various editions of The Skilled Helper although Egan has made a number of significant adjustments to the model over the years to take account of emerging research and developments in integrative practice. So, for instance, the third edition, which was published in 1986, evidenced a shift from problem management to opportunity development, while in 1990 the fourth edition carried an increased emphasis on challenge and action as running through all stages of the counselling process. In 1994 the fifth edition engaged more forcefully with debates about eclecticism and integrationism. This edition also highlighted the fundamentally flexible, non-linear characteristics of the model together with the importance of addressing shadow-side elements of the helping process. In the seventh edition (2002a) Egan has noticeably adopted a positive psychology approach to helping. This is discussed at more length later in the chapter.

At the time of writing, an eighth edition of The Skilled Helper, in which the importance of therapeutic dialogue and of paying attention to the counselling relationship is emphasised, is in preparation (Egan: personal communication). This forthcoming edition also has some notable changes in terminology, as currently outlined in Egan’s newest text Essentials of Skilled Helping (2006), and these changes are incorporated in the following two chapters that describe the model.

Is the skilled helper model eclectic or integrative?

This is a question that is often asked but one that I believe is becoming less relevant as developments in integrative and eclectic practice increasingly show that making an absolute distinction between the two may be simplistic, inaccurate, outdated and based more on semantics than real differences (Lapworth et al. 2001). While agreeing with this argument to the point of acknowledging that firm distinctions between integration and eclecticism are unrealistic and unhelpful, Hollanders (2003) nonetheless considers the skilled helper model to be an essentially eclectic framework. This is based on the argument that the model enables the helper to systematically use a variety of skills and strategies matched to different stages of the counselling process. He refers to this as systematic or technical eclecticism. Jenkins (2000) prefers to see the model as integrative in so far as it provides an overarching framework for the helping process yet does not have an overreliance on theory.

The divisions between eclecticism and integration are not always clear-cut, therefore my own preference is to think of the terms as shading into one another on a continuum rather than as being distinctly different. Adopting this perspective, I would suggest that the skilled helper model sits somewhere towards the middle of the continuum between integrative and eclectic approaches. In saying this I agree in principle with Lapworth and colleagues (2001), who state that integration is now a useful umbrella term to accommodate a range of approaches that extend beyond purist forms of therapy to include pluralism, transtheoreticism, common factors, eclecticism, relational and deconstructionist approaches. A number of what might be considered to be the integrative elements of the skilled helper model are considered below.

The skilled helper model as an integrating framework

The skilled helper model is derivative in that it draws predominantly on person-centred values and principles and on cognitive-behavioural approaches. Egan himself has described the model as ‘atheoretical’ (York St John University College counselling summer school 1990)—meaning it moves beyond theory in searching for a framework or map that is built on pragmatism (what has been shown to work) rather than on theoretical constructions. In a sense, the model might be thought of as something of a nomad of the counselling world. It tends to turn up all over the place and seems not to have a fixed abode or place of origin. It has been variously described as ‘humanistic-existential’ (Franklin 2003:64) due to its focus on the present whilst being inclusive of the past and future; as ‘cognitive-behavioural’ and ‘person-centred’ (Jenkins 2000:163) and as drawing on ‘psychodynamic, humanistic and behavioural theory’ (Connor 1994:69). Coles (2003:21) has written about the capacity of the model to integrate ‘psychodynamic notions of the unconscious’ with ‘cognitive-behavioural’ and ‘humanistic’ perspectives.

My own preferred term is the one that Egan himself uses to describe the model, which is an ‘integrating framework’ (Egan 2002a:37). As such, I consider that the model can provide a consistent and coherent container for a personally integrated approach to helping (more about this is said in Chapter 5). I particularly like what Egan (1998) says on the back cover of the sixth edition of The Skilled Helper—that here is a model that will help students and practitioners ‘develop a solid foundation for forming your own counselling orientation’.

As well as providing a useful framework for personal integration, Egan’s skills-based approach has influenced the development of a number of generic integrative and eclectic models of counselling (e.g. Culley 1991; Culley and Bond 2004; Nelson-Jones 1982, 1990, 2000, 2002; O’Connell 1998; Russell 1993), of training (e.g. Connor 1994; Dainow and Bailey 1988; Frankland and Sanders 1995; Inskipp 1996) and of supervision (e.g. Dexter and Russell 1989; Jones 1998; Page and Wosket 2001; Wosket and Page 2001).

In addition to influencing models of counselling, training and supervision, the skilled helper model has been applied to specialist client populations and contexts including sexual abuse (Hall and Lloyd 1993), dream work (Hill 1996, 2004), student counselling (Stein 1999), counselling in primary health care (Hudson-Allez 1997), counselling in the voluntary sector (Tyndall 1993), counselling children and young people (Mabey and Sorensen 1995; Plummer 1999), mentoring (Dancer 2003), careers counselling (Kidd 2003) and workplace counselling (Coles 2003; Franklin 2003; Hayes 2002; Martin 1997; Reddy 1987). It has been particularly influential in the field of training nurses and other health professionals (e.g. Arnold and Boggs 1995; Burnard 1996; Freshwater 2003; Rollnick et al. 1999).

Egan himself has stated that he sees the model not as competing with other approaches but as providing a solid foundation and direction for the development of the integrative practitioner as he or she draws on a number of different approaches (Coles 1996). In offering this form of accommodation the skilled helper model has had some surprising bedfellows. Inskipp (1993), for instance, has happily married the model to the transpersonal approach and integrated it into a Diploma in Psychosynthesis, while Hill (1996, 2004) uses it as the basis for dream interpretation. Perhaps a particular facility of the skilled helper model, as Frankland and Sanders have remarked, lies in its generic process that many have found ‘would hold for any assisted change’ (1995:61, original emphasis).

Process models and the skilled helper model

Egan has defined a model both as (1) ‘a visual portrait of how things actually work or how they should work under ideal conditions’ (Egan 1984a:25); and as (2) ‘a framework or cognitive map with delivery potential’ (ibid.). Thus the skilled helper model provides both a picture of the helping process and a methodology for implementing that process. Egan has also referred to the model as giving us a ‘geography of learning’ (York St John University College, counselling summer school 1991). By this he means that the model can enable helpers to map at any point where ...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Tables and figures
• Exercises and guidelines
• Contributors to Chapter 7
• Foreword
• Acknowledgements
• Introduction
• Chapter 1: Background and context to the skilled helper model
• Chapter 2: Overview of the skilled helper model 1: stage one
• Chapter 3: Overview of the skilled helper model 2: stages two and three
• Chapter 4: Critiques and commentaries of the skilled helper model
• Chapter 5: Using the skilled helper model in training
• Chapter 6: Research, supervision and the skilled helper model
• Chapter 7: Developments and applications of the skilled helper model: a round-table of views
• References