Integrating Social Cognition into Therapeutic Practice

Beneath and Beyond the Process of Therapy

Louis H. Falik

• Publisher: Routledge
• Year: 2021
• eBook ISBN: 9781000363692
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

This book presents a new model for conceptualizing and applying a social and cognitive perspective on therapeutic practice. Building on the micro-skills framework for training, the author adds cognitive modifiability theories to create a social cognition approach to training and practice. The material has been field tested in a graduate academic context and in consultation in mental health settings, and chapters contain didactic explications, illustrative examples, practice exercises, and graphic schemas to help readers integrate specific practices into a broader comprehensive theoretical framework. Mental health professionals and students in advanced counseling courses will find that this book broadens their perspectives beyond basic micro-skills approaches and provides an expansive and systematic framework for conceptualizing the therapeutic process.

1
Formulating the Process of Counseling

The Dynamics of Behavioral Change

The expectation of the individual who enters into a counseling relationship is that there will be change in a number of potential ways—levels of comfort, insight, self-perception, and behavior. The assumption of the counselor is that change is possible, and that the nature of the interaction will facilitate the change. Lacy Crawford, in a fictional account of helping graduating students apply to colleges, titled Early Decision (2013), adds another dynamic, that of imagination, and integrates this dimension into the mix of expectations and assumptions. Thus, for both participants in the process, the client/patient and counselor/therapist, a therapeutically effective interaction must be grounded in a mutually shared belief in the modifiability of behavior, the thought processes that underlie it, and the client’s optimistic and personally unique sense of the possibilities, bringing in the element of imagination. There are numerous theoretical and conceptual formulations regarding the potential for modifiability. But notwithstanding the differences in terminology and process expectations, the foundational belief system is that humans have the capacity to change, and to be changed by therapeutic experiences. Even in a scientific period of time when revolutionary things are being uncovered regarding the brain and neural systems, and its tremendous capacity for plasticity, the human—person to person, heart to heart—element continues to be critical. This is the important role of counseling and psychotherapy.

Ironically, as the technology and knowledge base are expanding rapidly, introducing artificial intelligence and algorithms, with the added seductive availability of devices (our cell phones, computers, tablets, and the ‘apps’ that support them) that have the potential to reduce human-to-human contacts, we must pay even more attention to the nature and potential of human interaction. The danger is that algorithms substitute for the face-to-face, eye-to-eye, soul-to-soul human connectivity. Consider the popularity of the many computer-based programs for thinking, decision-making, and self-improvement. We must ask whether sitting with a mechanical device, in isolation from personal interaction, affects the existential human condition? From the perspective of counseling practice, this implies the potential diminishing of the importance of human contact in the process of change.

This is the dilemma of our times and is relevant to the ways in which we frame the human service professions, with increased importance on understanding the nature of human interactions and interventions for change. This is of utmost importance in conceptualizing the processes of counseling and psychotherapy. Mediated learning experience (MLE), as a ‘superordinate’ framework for identifying and structuring the interactive process, can respond to the new social and interpersonal realities, and the needs that are identified. The outcome of this recognition is to orient the counselor, therapist, and other helping professionals to develop both skills and the perspective to participate in these new realities.

The Role of Interpersonal Interaction

There is a general consensus in the field of counseling and psychotherapy that it is the nature of the interpersonal relationship that is a more important predictor of positive change than the specific methodological approach of the therapist. This is not to denigrate the role of theory and methodology, but rather to highlight that human interaction is the primary vehicle for the application of a particular methodology. Theorists have long speculated regarding the foundational dynamics for personality and behavioral change. This has led to a multiplicity of formulations, some of which may appear contradictory and some of which appear to require almost a kind of blind faith in their validity. An alternative perspective is to look for generic elements that might bind together the diverse approaches. It is in this latter context that the formulation of MLE is proposed as relevant.

At this early stage of our discourse, two points must be made: (1) no matter the theoretical/methodological approach that is adopted, interpersonal interaction is the generic quality that relates to facilitating change in thinking and behavior and (2) effective interventions are produced when there is a linking theory and practice. The foundation of an effective and mutually satisfying process requires that this linkage be identified and utilized, moving from the ‘general’ to the specific. One can describe this integration by paraphrasing the philosopher Immanuel Kant: Theory without practice is blind, and Practice without theory is futile.

The approach that is taken in this book is to integrate the above through the development of a theory/practice formulation that can be learned and applied to the counseling/psychotherapeutic process. Given such an integration, any specific methodology (e.g., psychodynamic, cognitive/behavioral, narrative, and brief/strategic) can be utilized. The integrative aspect is provided by the introduction of MLE as formulated by Professor Reuven Feuerstein, and applied to a diverse range of human behaviors, both cognitively and emotionally experienced. This is, however, a ‘reframed’ view of the process issues, and an alternative pathway to the acquisition of both initial interviewing skills and treatment planning.

As the meaning and parameters of MLE are explicated throughout this book, and connected to the processes of clinical interviewing and therapeutic treatment planning, we will observe how making the initial connections to the client and developing a strategy for therapeutic change are powerfully and directionally guided by the conceptual framework of MLE. To put it simply, Feuerstein proposed that all meaningful human interaction is a consequence of mediated learning, and when applied to the process of counseling interactions, responses that are made—planned for, with the consequences observed and modified according to observations—are both systematically and intuitively formulated with the guidance of the parameters of MLE. Subsequent chapters develop this integrated process accordingly.

To enter the existential world of another human being is fraught with potential danger, or at best uncertainty. For the therapist this presages a potential dilemma. Can I know what to say? Will I say it correctly? Will I respond with too much, or too little? The answers to these questions comprise the heart of a therapeutic interpersonal interaction. The preceding discussion regarding the impact of the role of the omnipresent devices in our lives (computers, cell phones, etc.) is to point out that in spite of (or because of) their presence there is a potential increase in social distance, and with this, potential for loneliness, isolation, and diminishing social skills. Yet, to return to the bottom line, it is highly likely that human engagement is what ultimately makes the difference. Fortunately, a careful reading of the research also reinforces this.

Here is where MLE comes in. The parameters guide the selection, employment, analysis, and practicing of critical technical aspects of clinical interviewing and therapeutic treatment planning. Moreover, as the therapeutic process is initiated, MLE parameters illuminate the process issues, in sequential and interactive aspects. In the chapters that follow, these will be explicated, illustrated, with opportunities to practice the skills in observing and identifying their role in the process. There is a convergence between the structural/strategic employment of MLE and particular methodological perspectives. In other words, how a response is framed, within the context of the process issues, can come from various orientations. For example, one can conceptualize a ‘cognitive/behavioral’ orientation and respond synchronously within the MLE process framework. The methodological framework serves as sensitively applied tools in the change process.

The Nature of the Process of Change

There are two sides to the process of changing behavior, both of which are reflecting in the therapeutic process. The developmental psychologist Jean Piaget (see Flavel, 1963) identified a cognitive and an affective aspect and metaphorically described them as two sides of the same coin. Professor Feuerstein took the metaphor further and added that the sides of the coin were transparent, each affecting the other, and that the mechanism for modifiability (change) was in bringing together the cognitive and affective in an integrative and interactional relationship. Feuerstein then further expanded the metaphor, saying that our mediational interactions are represented by the edge of the coin, where the change is facilitated. In this way, MLE brings the two sides, in their transparency, together and engenders action! Behavior change is neither exclusively a cognitive nor an affective phenomenon, but a combination of both. And our counseling interventions are the ‘edge’ bringing to two sides together.

If this is true, the question arises as to what extent this is related to the counseling/therapeutic processes that are formulated in various methodological approaches, either overtly or covertly. A meta-analysis of this issue was conducted, briefly surveying a number of major approaches to counseling and psychotherapy, seeking evidence of commonality and shared values and techniques—described in the Preface (Falik & Feuerstein, 1990). The conclusion of that study was that the qualities of MLE were clearly in evidence, often explicitly but always implicitly. Thus, it is that MLE serves to explain, elucidate, and further to serve as a framework for developing therapeutic strategies for helping individuals to move toward and achieve behavioral/cognitive/emotional modifiability.

Evidence for the Shared Characteristics in the Process of Change

The process of counseling can be viewed as having several distinct domains that occur in developmental phases. While they are ultimately integrated, with a great deal of natural and needed overlapping, it is important to see the distinction and focus upon the unique characteristics of the phase and bring in elements of other phases when ‘organically’ appropriate. With this perspective the process becomes naturally integrated, with the counselor’s responses becoming more intuitive, seamless, spontaneous, and meaningful. Sometimes this is automatic, but sometimes not. Acquiring familiarity with the parameters of MLE and their potential to structure responses often helps. Beginning practitioners find this to be facilitative of the ‘what to do, how to say it, when to say it’ perspective. For experienced therapists, this approach offers retrospective potential as well as treatment planning for ongoing responding.

Finding the integration and using it in the service of effectiveness is enhanced when one identifies and understands the tasks, experiences, and goals of the phases. In a later chapter we will describe the phases of the counseling relationship and show how the MLE perspective contributes. At this point in our discourse, it can be summarized as analyzing the ways in which the counselor:

• identifies the elements of the process used in the formulation of responses,
• practices their use,
• observes the contribution of the elements, and
• adapts/calibrates responses in increasingly meaningful and purposive ways.

When this happens, an initial process objective is that both client and counselor will be aware of the effects, and this drives the relationship in positive directions. When we later explicate the parameters of MLE, this will be seen as a manifestation of the intentionality of the counseling relationship.

The counseling/psychotherapeutic process is one of learning. An initial goal, whatever one’s methodological approach, is to develop a sense of its developmental nature, and out of this understanding to acquire and use a flexible and adaptive repertoire of skills to formulate appropriate responses. This will increasingly lead to relevant interventions that help clients to access their issues and move toward relevant changes—in self-awareness and the potential for change.

It is often difficult to bridge from the acquisition of interviewing skills to the insights leading to clinical interventions. We can know or believe that there is something that needs to be addressed, in the client’s experience and/or readiness to address change. We can have faith in the process of the relationship—that there is a connective tissue that will make the experience meaningful and productive—for ourselves as therapist and our clients—but how to objectify it? It is one of the central tenants of the integrative model proposed, with elements of MLE that it is the process of the search, mutually embarked upon and mutually experienced and accepted by both parties in the relationship that is at the heart of achieving a positive therapeutic relationship. As it is a salient aspect of the early stages of the counseling relationship, it derives its intention and fulfillment from the ‘mechanics’ of interviewing, leading to a level of clinical insight, and then to planning, and subsequent ‘therapeutic’ intervention. There are many aspects to the achieving of this dynamic connection. They have been eloquently described by a number of scholars in this field, including Kottler’s On Becoming a Therapist (1993) and later Kottler and Carlson’s On Becoming a Master Therapist (2014), and Teyber’s Interpersonal Process in Psychology: An Integrative Model (1996).

Returning to the theme of the search, when one embarks into seemingly uncharted domains, as the Crusaders journeying to the mid-east seeking the Holy Grail, or the early navigators like Magellan or Captain Cook, those engaged in the search are transformed by the experience, as was Charles Darwin returning from his voyage on the Beagle. As counselors, moving into the uncharted wildernesses of the human experience of others, the search is not without risks—entering to the unknown, stressful, frightening, vague, or challenging life experiences of another risks examining our own values, and our readiness to accept and identify with our human existence. But these early risk-takers were motivated by a belief system and acted upon them. One of the corollary insights of Feuerstein as he formulated the parameters of MLE was to emphasize the crucial importance of having a belief system. In this context, one’s beliefs must include that of the positive potential for change, and the relevance of devoting energy to achieving the behavioral and emotional change that our clients possess. The elements of the belief system that Feuerstein formulates enable a positive response to the process and potential for human modifiability. It has great relevance for our discourse here.

The Mediational Belief System

• I want and know that the person can be changed (the level of need).
• I believe that change is possible (the level of general belief).
• I believe that my client can be changed (the level of personal responsibility).
• I believe that I will be changed as I mediate my client (the level of reciprocity).
• I believe that as the individual changes others will change in relation to him or her (the level of societal effect).
• I believe that as changes are recognized and accepted, responses of others will be changed (the level of systemic effect).

These elements need to be further elaborated. The formulation starts with the assumption that we need to have both a belief that change is possible and necessary and to acquire the skills that guide us on the search for the conditions that create the potential for transformation. We search for deeper meaning, the keys to understanding, the connections and themes of our client’s experience, and the best ways of accessing all of this—perhaps the Holy Grail of our process! (This metaphor loses some of its impact when we acknowledge that the Holy Grail was a mythological phenomenon, but searched for actively nonetheless—in contrast, our search for the meaning of our client’s experience is fully real and can be actualized.) For our clients, we know that there are links and bridges to deeper meaning—in an understanding and behavioral relevance—and that if we are willing to whole-heartedly undertake the journey meaningful change will occur.

The Process Elements of the Therapeutic Relationship

Here the process elements of the counseling process will be presented in a generally descriptive way. Later they are examined with regard to their specific developmental characteristics so that they can be analyzed and integrated into the generic counseling interaction. Both aspects of analysis are needed to gain full functional freedom to understand and interact in the process.

Whether one is new at the doing of therapy or an experienced practitioner, it is helpful to consider the dynamics: What is the process of counseling? We listen to the client’s story. Not only to the details of the story but the underlying affect that the client emits as it is being told. We absorb the client’s persona as we experience the face-to-face encounter. We focus in order to understand the details, themes, and sequences. We share with the client the experience of the telling. The client observes and participates in the telling and experiencing, thus—sometime...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• List of figures
• Foreword
• Preface
• 1 Formulating the Process of Counseling: The Dynamics of Behavioral Change
• 2 A Theoretical Foundation for the Therapeutic Process: Mediated Learning Experience (MLE)
• 3 Applying MLE to the Therapeutic Process
• 4 Social Cognition: A Foundation for Affective and Behavioral Change
• 5 Translating Social Cognition into Treatment Planning
• 6 Application of an Integrative Model to the Therapeutic Process
• 7 The Phases of the Therapeutic Relationship Reflected in the Integrative Model
• 8 The Focus of the Interaction: Content versus Process
• 9 The Nature of the Therapeutic Response: Implicit versus Explicit
• 10 Application of the Model
• Appendix A: Formulating Responses Reflecting the MLE Parameters
• Appendix B: Illustrative Case Studies
• Appendix C: Glossary
• References
• Index