Counseling and Psychotherapy

A Christian Perspective

• Publisher: Baker Academic
• Year: 2011
• ISBN:
  9781441233714
• Topic: Theology & Religion
• Subtopic: Religious Counseling

Combining cutting-edge expertise with deeply rooted Christian insights, this text from a leading figure in the Christian counseling community offers readers a comprehensive survey of ten major counseling and psychotherapy approaches. For each approach, Siang-Yang Tan first provides a substantial introduction, assessing the approach's effectiveness and the latest research findings or empirical evidence for it. He then critiques the approach from a Christian perspective. Tan also includes hypothetical transcripts of interventions for each major approach to help readers get a better sense of the clinical work involved. This book presents a Christian approach to counseling and psychotherapy that is Christ centered, biblically based, and Spirit filled.

Part 1

Basic Issues in the Practice of Counseling and Psychotherapy

1

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Overview of Counseling and Psychotherapy

Theory, Research, and Practice

Sigmund Freud (1856–1939), the founder of psychoanalysis, is often credited with the birth of psychotherapy, or the “talking cure.” However, the deep roots of counseling and psychotherapy go back many centuries before Freud. Today the field of counseling and psychotherapy is large and diverse. There has been a proliferation of major therapies in the past fifty years: from thirty-six systems of psychotherapy identified by R. A. Harper in 1959 to over four hundred today (Prochaska and Norcross 2010, 1). Even the definitions of counseling and psychotherapy differ from author to author and from textbook to textbook. Most people think of counseling and psychotherapy as involving a professional counselor or therapist helping clients to deal with their problems in living. Let us take a closer look at some definitions of counseling and psychotherapy in this introductory overview chapter.

Definitions of Counseling and Psychotherapy

There are many different definitions of psychotherapy, none of which is precise (Corsini and Wedding 2008). James Prochaska and John Norcross (2010) have chosen to use the following working definition of psychotherapy (from Norcross 1990, 218): “Psychotherapy is the informed and intentional application of clinical methods and interpersonal stances derived from established psychological principles for the purpose of assisting people to modify their behaviors, cognitions, emotions, and/or other personal characteristics in directions that the participants deem desirable” (3–4).

Similarly, there are also several possible definitions of counseling. Christian psychologist Gary Collins has defined counseling as “a relationship between two or more persons in which one person (the counselor) seeks to advise, encourage and/or assist another person or persons (the counselee[s]) to deal more effectively with the problems of life” (1972, 13). He further states: “Unlike psychotherapy, counseling rarely aims to radically alter or remold personality” (14). Some authors therefore try to differentiate counseling and psychotherapy on a continuum, with psychotherapy dealing with deeper problems and seeking to significantly change personality. However, most authors in the mental health field today do not differentiate between counseling and psychotherapy (see, e.g., Corey 2009; Day 2004; Fall, Holden, and Marquis 2004; Parrott 2003; J. Sommers-Flanagan and Sommers-Flanagan 2004), agreeing with Charles Truax and Robert Carkhuff (1967), who, years ago, already used the two terms interchangeably. In fact, C. H. Patterson emphatically asserts that no essential differences exist between counseling and psychotherapy (1973, xiv). This is the view I take in this textbook on counseling and psychotherapy from a Christian perspective.

John Sommers-Flanagan and Rita Sommers-Flanagan also use counseling and psychotherapy interchangeably and define it as a process that involves “a trained person who practices the artful application of scientifically derived principles of establishing professional helping relationships with persons who seek assistance in resolving large or small psychological or relational problems. This is accomplished through ethically defined means and involves, in the broadest sense, some form of learning or human development” (2004, 9, italics in original).

Psychotherapy and Psychological Treatments

More recently, David Barlow (2004, 2005, 2006) has attempted to differentiate psychotherapy from psychological treatments, which may add more confusion rather than clarity to the already diverse definitions available for counseling and psychotherapy. He suggests that “psychological treatments” should refer to those dealing primarily with pathology, while “psychotherapy” should refer to treatments that address adjustment or growth (2006, 216). Psychological treatments are therefore those that are clearly compatible with the objectives of health-care systems that address pathology. He further stresses that the two activities of psychological treatment (which is more specific) and psychotherapy (which is more generic) would not be distinguished based on theory, technique, or evidence, but only on the problems they deal with. He is aware that these are controversial recommendations. However, I believe Barlow’s (2006) recommendation is not only controversial, but it is also potentially confusing and may not really help to clarify the definition of terms. Examples of psychological treatments provided by Barlow include “assertive community treatment, cognitive-behavioral therapy, community reinforcement approaches, dialectical behavior therapy, family focused therapy, motivational interviewing, multisystemic interpersonal therapy, parent training (for externalizing disorders in children), personal therapy for schizophrenia, and stress and pain management procedures” (2004, 873, italics in original). We can see that many of these examples of psychological treatments are already part and parcel of counseling and psychotherapy.

Overview of Counseling and Psychotherapy: Theory

Although over four hundred varieties of counseling and psychotherapy presently exist, most of them can be subsumed under the major schools of counseling and psychotherapy that are usually covered in textbooks in this field of people-helping. There are ten to twelve major ones, depending on the author and the text. In this book the following ten major theoretical approaches to counseling and psychotherapy will be covered in some detail, based on the theories and techniques developed by their founders and practitioners: psychoanalytic therapy, Adlerian therapy, Jungian therapy, existential therapy, person-centered therapy, Gestalt therapy, reality therapy, behavior therapy, cognitive behavior therapy and rational emotive behavior therapy, and marital and family therapy.

Psychoanalytic Therapy. The key figure of psychoanalysis and psychoanalytic therapy is Sigmund Freud. He originated a theory of personality development focused on experiences in the first six years of life that determine the subsequent development of personality. Freudian or psychoanalytic theory emphasizes unconscious factors, especially sexual and aggressive drives in motivating human behavior. Psychoanalytic therapy employs techniques such as free association (allowing the client to say whatever comes to his or her mind without censorship); dream analysis (interpreting the latent or hidden meaning of the dream mainly through the use of symbols that have consistent significance for almost every person); and analysis of transference (when the client responds to the analyst or therapist as a significant person of authority from his or her life, thereby revealing childhood conflicts he or she has experienced). The goal of psychoanalytic therapy is to help make the unconscious conscious and strengthen the ego. Contemporary versions of psychoanalytic therapy such as object-relations theory focus more on attachment and human relationship needs rather than on sexual and aggressive drives.

Adlerian Therapy. Alfred Adler founded Adlerian therapy, which was originally called individual psychology. Another major figure in this approach is Rudolph Dreikurs, who was responsible for making it better known in the United States. Adlerian therapy is based on a growth model of the human person. It emphasizes the need for the client to take responsibility in making choices that help determine one’s own destiny, and that provide meaning and direction for one’s life. Adlerian therapy uses techniques such as investigating the client’s lifestyle or basic orientation toward life by exploring birth order, early recollections from childhood years, and dreams; asking “The Question” (“What would be different if you were well?”); and paradoxical intention (encouraging clients to do or exaggerate the very behaviors they are attempting to avoid).

Jungian Therapy. The key figure of Jungian therapy, or analytical psychology, is Carl Jung. Jung’s interest in mystical traditions led him to conclude that human beings have a significant and mysterious potential within their unconscious. He described both a personal unconscious as well as a collective unconscious. Jungian therapy encourages clients to connect the conscious and unconscious aspects of their mind in constant dialogue, with the goal of individuation or becoming one’s own person. Jungian therapy techniques include the extensive use of dream analysis and the interpretation of symbols in order to help clients recognize their archetypes (ordering or organizing patterns in the unconscious). Examples of archetypal images include major ones such as the persona, the shadow, the anima and animus, and the Self, as well as others such as the earth mother, the hero, and the wise old man.

Existential Therapy. The key figures of existential therapy include Vicktor Frankl, the founder of logotherapy; Rollo May; Ludwig Binswanger; Medard Boss; James Bugental; and Irvin Yalom. It focuses on helping clients experience their existence in an authentic, meaningful, and responsible way, encouraging them to freely choose or decide, so that they can create meaning in their lives. Existential therapy therefore emphasizes more the relationship and encounter between therapist and client rather than therapeutic techniques. Core life issues often dealt with in existential therapy include death, freedom, meaninglessness, isolation, and the need to be authentic and real in responsibly choosing one’s values and approach to life. Existential therapists can be optimistic or pessimistic to the point of being nihilistic, and they include those who are religious as well as those who are antireligious. Although techniques are not stressed in existential therapy, Frankl has developed several techniques in logotherapy, a particular approach to existential therapy. Some examples are dereflection (encouraging the client to ignore the problem and focus attention or awareness on something more pleasant or positive); paradoxical intention (asking the client to do or exaggerate the very behavior he or she fears doing); and modifying the client’s attitudes or thinking (especially about the past, which cannot be changed, so that more meaningful or hopeful ways of looking at things become the focus).

Person-Centered Therapy. Carl Rogers founded person-centered therapy, which was previously called non-directive counseling or client-centered therapy. Person-centered therapy assumes that each person has a deep capacity for significant and positive growth when provided with the right environment and relationships. The client is trusted to lead in therapy and is free to discuss whatever he or she wishes. Person-centered therapy is therefore not focused on problem solving but aims instead to help clients know who they are authentically and to become what Rogers calls “fully functioning” persons. According to Rogers, three therapeutic conditions are essential for facilitating client change and growth; these are the major person-centered therapy “relationship techniques”: congruence or genuineness; unconditional positive regard (valuing the client with respect); and accurate empathy (empathic understanding of the client’s perspective or internal frame of reference).

Gestalt Therapy. Frederick (Fritz) Perls and Laura Perls founded Gestalt therapy, an experiential therapy that emphasizes increasing the client’s awareness, especially of the here and now, and integration of body and mind. The Gestalt therapist assumes a very active role in helping clients become more aware so that they can solve their problems in their own way and time. Examples of Gestalt therapy techniques that focus on doing include dream work that is experiential; converting questions to statements; using personal nouns; assuming responsibility; the empty chair; exaggeration; and confrontation.

Reality Therapy. William Glasser founded reality therapy, which focuses on the present and emphasizes the client’s strengths. It is based on choice theory as developed by Glasser, which asserts that people are responsible for choosing their own thinking and actions, which then directly influence their emotional and physiological functioning. Choice theory also posits five basic needs of all human beings: survival, love and belonging, power, freedom, and fun. Reality therapy helps clients to become more responsible and realistic and therefore more successful in achieving their goals. Examples of reality therapy techniques include structuring; confrontation; contracts; instruction; role playing; support; skillful questioning (e.g., “Does your present behavior enable you to get what you want now, and will it take you in the direction you want to go?”); and emphasizing choice (e.g., by changing nouns and adjectives into verbs).

Behavior Therapy. The key figures of behavior therapy include Joseph Wolpe, Hans Eysenck, Arnold Lazarus, Albert Bandura, B. F. Skinner, and Donald Meichenbaum. Behavior therapy applies not only the principles of learning but also experimental findings from scientific psychology to the treatment of particular behavioral disorders. It is therefore an empirically based approach to therapy that is broadly social learning oriented in theory. Behavior therapists view human beings as products of their environments and learning histories. The behavior therapist plays an active and directive role in therapy. Behavior therapy has developed many techniques that continue to be refined through systematic empirical research. Examples of therapeutic techniques used in behavior therapy include positive reinforcement (reward for desirable behavior); assertiveness training (role-playing with ...