Most therapists utilise an integrative approach towards counselling that combines approaches and methods from a broad range of theoretical orientations as they assist clients through the various challenges of life.

To help counsellors come to a better place of integration in being able to “pick” the right approach at the right time, we’ve overviewed four widely used therapies - and their typical application within the counselling process.

Cognitive Behaviour Therapy

Cognitive-behaviour therapy involves a specific focus on identifying and modifying faulty patterns of thinking through the use of cognitive intervention strategies. Further focus is on behavioural strategies that are designed to activate clients in the environment with a view to effect desired behaviour change.

Distinctive features of CBT:

1. Use of homework and outside-of-session activities
2. Direction of session activities
3. Teaching of skills used by clients to cope with problems
4. Emphasis on clients’ future experiences
5. Providing clients with information about the course of treatment
6. An intrapersonal/cognitive focus

CBT has its origin in behavioural theories however contemporary CBT focuses more on the individual’s cognitive (thought) processes. There are two main contributors to contemporary CBT, Albert Ellis and Aaron Beck.

Applications of CBT: Cognitive approaches have been applied as means of treatment across a variety of presenting concerns and psychological conditions. Cognitive approaches emphasise the role of thought in the development and maintenance of unhelpful or distressing patterns of emotion or behaviour.

Beck originally applied his cognitive approach to the treatment of depression. Cognitive therapy has also been successfully used to treat such conditions as anxiety disorders, obsessive disorders, substance abuse, post-traumatic stress, eating disorders, dissociative identity disorder, chronic pain and many other clinical conditions. In addition, it has been widely utilised to assist clients in enhancing their coping skills and moderating extremes in unhelpful thinking.

Behavioural Therapy

According to Seligman (2006) Behavioural Therapy focuses on the present not the past, observable behaviours rather than unconscious forces and short-term treatment, clear goals, and rapid change.

Behavioural therapy had its beginnings in the early 1900’s and became established as a psychological approach in the 1950s and 1960s. At this time, it received much resistance from the current school of thought, psychoanalysis.

The traditional behavioural approach is generally not used as it once was. It has moved towards a more collaborative treatment with other therapies and as such this has meant a more applicable approach (Seligman, 2006). Seligman (2006) has identified five models incorporating the behavioural approach. These models have some similar principles:

1. Applied behavioural analysis - Focuses on how environmental events affect behaviour.
2. Neo-behaviourism - Focuses on conditioning and learning.
3. Social Learning theory - Focuses on the interaction of cognitive, behavioural and environmental factors that affect behaviour.
4. Cognitive-behavioural theory - Focuses on how cognitions affect behaviour and implements both cognitive and behavioural techniques.
5. Multimodal therapy - Integrates strategies from a wide range of approaches including behaviour therapy.

Applications of the behavioural approach: The behavioural approach can be used in the counselling process to help “clients acquire new coping skills, improve communication, or learn to break maladaptive habits and overcome self-defeating emotional conflicts” (Corsini & Wedding, 2000).

The focus of the approach should be on setting goals in relation to target behaviours (Sharf, 2004). Target behaviours can be anything from stopping smoking, decreasing anxiety provoking situations, learning how to act in a social setting, other interpersonal and marital problems, and prevention and treatment of cardiovascular disease.
 
Dependent on your qualifications and skill level, behavioural therapy may also be used in the treatment of many psychological disorders including anxiety disorders, sexual disorders, depression, chronic mental conditions, childhood disorders as well as eating and weight disorders (Corsini & Wedding, 2000).

Person Centred Therapy

The person-centred approach was developed from the concepts of humanistic psychology. The humanistic approach “views people as capable and autonomous, with the ability to resolve their difficulties, realize their potential, and change their lives in positive ways” (Seligman, 2006). Carl Rogers (a major contributor of the client-centred approach) emphasized the humanistic perspective as well as ensuring therapeutic relationships with clients promote self-esteem, authenticity and actualisation in their life, and help them to use their strengths (Seligman, 2006).

The person-centred approach was originally focused on the client being in charge of the therapy which led to the client developing a greater understanding of self, self-exploration, and improved self-concepts. The focus then shifted to the client’s frame of reference and the core conditions required for successful therapy such as ensuring the therapist demonstrates empathic understanding in a non-judgemental way.

Currently, the person-centred approach focuses on the client being able to develop a greater understanding of self in an environment which allows the client to resolve his or her own problems without direct intervention by the therapist. The therapist should keep a questioning stance which is open to change as well as demonstrating courage to face the unknown.

Applications of the Person Centred approach: The person-centred approach can be applied to working with individuals, groups and families (Corey, 2005). The person-centred approach has been successful in treating problems including anxiety disorders, alcoholism, psychosomatic problems, agoraphobia, interpersonal difficulties, depression, and personality disorders (Bozrath, Zimring & Tausch, as cited in Corey, 2005). Person-centred therapy has been shown to be as effective as the more goal-focused therapies (Corey, 2005).

Solution Focused Therapy

Solution focused therapies are founded on the rationale that there are exceptions to every problem and through examining these exceptions and having a clear vision of a preferred future, client and counsellor, together, can generate ides for solutions. Solution focused therapists are competency and future focused. They highlight and utilise client strengths to enable a more effective future.

Historically, psychotherapeutic approaches of the early-mid 1900s focused primarily on client pathology and problems. By the late 1950s a moderate shift in practitioner direction was occurring. Therapists were shifting from a focus on the past to a ‘here and now’ approach. Nonetheless the focus on client pathology and problems remained.

By the late 1970s, practitioners, particularly family therapists, were taking note of their own biases. Contextual factors became the focus as clinicians began to challenge traditional pathologizing and power-orientated practices (Bertolino & O’Hanlon, 2002).

Solution focused practice emerged with the idea that solutions may rest within the individual and his or her social network. As postmodernism sparked questions about the superiority of the therapist’s position and the idea of a universal truth, the therapeutic relationship began to transform - the client now recognised as the expert in his or her own life. This created a more collaborative approach to counselling (Bertolino & O’Hanlon, 2002) and established a context in which solution focused practice could flourish.

Applications of the Solution Focused approach: Solution focused counsellors are more concerned with solutions than how or why a problem originated. For this reason, solution focused practice has a broad application. The solution focused approach can be brief due to its focus on ‘what works’ and its  emphasis on action as a significant factor in change. This makes it an approach that can be well integrated into the typically fast-paced lifestyle of the contemporary client.

As such, solution focused therapy has been successfully applied to a variety of client concerns, including drug and alcohol abuse, depression, relationship difficulties, relationship breakdown, eating disorders, anger management, communication difficulties and crisis intervention to name but a few.

In addition, solution focused approaches have been effectively applied to a vast array of client groups, including children, families, couples and mandated clients

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Many of us already know that stress is a double edge sword. Stress can be good for us when preparing us for a special or threatening event. Many will be familiar with the concept of the Fight and Flight Syndrome. When a threat is perceived, our brain and body prepares to do battle or to run. The chemical changes make us more alert, with heightened response in order to perform at our fastest, strongest and highest level of alertness.

Too much stress though can reduce our performance. When stress becomes anxiety or induces panic attacks, an individual can freeze. For example, some individuals when asked to make a speech in public suffer panic attacks due to their increased anxiety levels. For others sitting an exam may be so anxiety provoking that their minds become blank and they cannot recall well-revised information.

Individuals who endure severe stress over a prolonged period can suffer serious psychological and physical health problems. Dr Hans Selye found that chronic exposure to severe stressors produces a sequence of three physiological stages: (1) alarm, (2) resistance and (3) exhaustion (Carlson, et al. 2007). These three stages are collectively referred to as the general adaptation syndrome.

According to Carlson, et al. (2007) the alarm stage occurs when an individual is first confronted with a stressor. The individual may experience shock (i.e. arousal of the autonomous nervous system causing impairment of physiological functioning). If this is a reaction to a temporary event, the physiological state will return to normal within a short period.

However, with continued exposure to the stressor the individual enters the stage of resistance, causing the individual’s physiological functioning to continue at an extreme level. This stage reflects the individual’s adaptation to the stressor. Should the individual continue to be exposed to the stressor, the autonomous nervous system continues to function at the above normal level entering the exhaustion stage. During this stage the individual loses the ability to adapt, resistance decreases to below normal levels leaving the individual susceptible to illness.

Prolonged Duress Stress Disorder

Stress that is initiated by a single, sudden dramatic incident (such as a car accident) or being a witness to a traumatic event can result in posttraumatic stress disorder. However, individuals experiencing an ongoing occurrence of negative stress (such as being a constant witness to trauma as an officer in the emergency services or an individual constantly finding themselves the subject of workplace harassment) will exhibit similar symptoms to PTSD, but this is known as Prolonged Duress Stress Disorder (PDSD). The trauma is cumulative rather than sudden.

The symptoms are the same: high levels of anxiety, which can swing to deep levels of depression. Hence, individuals will often resign, withdraw from life or suffer in silence. Triggers can set off panic attacks similar to those experienced by individuals diagnosed with PTSD, but the triggers are different. They could be letters marked as “Private and Confidential”, certain words, images or phrases associated with work (such as the company logo).

Both Post Traumatic Stress Disorder and Prolonged Duress Stress Disorder need the assistance of an experienced psychiatrist to diagnose and help treat the disorder.

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There are many forms of disabilities that can affect the child’s normal developmental process. Some disabilities can be more severe than others.

A common type of disability hindering a child’s development is a learning disorder. Having such a disorder can be painful for children as they have to deal the disconnections they may be experiencing from thought, expression and creativity, books and words as well as people and feelings (Hallowell & Ratey, 1995).

The most common learning disorder is Dyslexia. Children who are suffering from Dyslexia tend to feel confused and are easily upset trying to work out the right messages. They are often very smart therefore they tend to get frustrated when they have problems with reading, spelling, listening and understanding.

According to Dr Kim, (2006, p.1) “the collecting part of the brain gets the seeing and hearing message muddled up so that the detective part of the brain can’t work things out correctly”.

There are different forms of dyslexia, including:

1. Writing letters the wrong way round
2. They find it hard to write by hand
3. They have difficulty copying things accurately off the board
4. They can’t remember or understand what they have just read
5. They can’t remember or understand what they have just heard
6. They can’t repeat what they have just been told
7. They have difficulty writing down what they think
8. They have trouble understanding and following instructions
9. They tend to get letters the wrong way round when spelling out loud.

Whiteside and Stokes (2001) describe Dyslexia as having a mental blind spot in the brain, causing them to have an inability to perceive or understand a specific subject or issue. They have suggested that people having trouble with their learning may not be dyslexic, but rather show dyslexic like traits as symptoms of stress.

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It is important to be aware of the way in which stress may be impacting on you and your counselling work. Which aspects of you are more susceptible to the influence of stress?

Relaxation strategies

“What do you find relaxing? Is it dancing, art, meditation, fishing, going for a walk with friends, reading a book, listening to music, shopping, a gym work out, talking to a friend or playing sport?” Source:  “Advice from the Mental Health Association NSW Inc.” (2002)

Relaxation exercises allow you to create a state of deep rest, which is very healing to the entire body and can contribute to self-care.The above quote highlights the diversity of activities that individuals may find relaxing. It is important to find ways to incorporate relaxing activities into your weekly routine as a means of preventing burnout.

When you are in a relaxed state, your body responds in a number of ways:

1. Metabolism slows, as do physiological functions such as heart rate and blood pressure.
2. Muscle tension decreases.
3. Brain wave patterns shift from the faster waves that occur during a normal active day to the slower waves, which appear just before falling asleep or in times of deep relaxation.

Not all relaxation exercises suit everyone. So it is important to try a number of techniques to find one which suits you. We are going to look at one particular relaxation technique. The following exercise has been selected because it takes only a few minutes of your time and can be used almost anywhere.

When a technique is practiced regularly, you will find that it becomes easier, and therefore will be more effective in reducing your stress and anxiety level and also be more able to centre your thoughts and emotions.

Relaxation Technique – Erasing Stress

Erasing stress is a visualising technique.  It allows you to visualise the thought or situation which is constantly on your mind and helps erase it from your thoughts. 

Sit or lie in a comfortable position. Breathe slowly and deeply.

Visualize a situation, a person, or even a belief (such as, “A situation at work which is confronting” or “A home renovation which is causing disruption in the household”) that causes you to feel anxious, fearful or upset.

As you do this you might see a specific person, an actual place, or simply shapes and colours. Where do you see this stressful picture? Is it below you, to the side, in front of you? How does it look? Is it big or little, dark or light, or does it have a specific colour?

Imagine that a large eraser, like the kind used to erase chalk marks, has just floated into your hand. Actually feel and see the eraser in your hand. Take the eraser and begin to rub it over the area where the stressful picture is located.

As the eraser rubs out the stressful picture it fades, shrinks, and finally disappears. When you can no longer see the stressful picture, simply continue to focus on your deep breathing for another minute, inhaling and exhaling slowly and deeply.

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Marcia, 29 years of age, came to you six weeks ago with issues of poor self-esteem and lack of self worth. She has been married for 8 years to Michael, however in session she speaks little about him and when the conversation turn towards him she quickly tries to change the subject or issue. Although you have noted this shift you have not challenged her regarding this relationship as you work on different areas and issues leading up to the relationship.

At the appointed time today Marcia shows up with an unannounced Michael for her session. He said he was there because Marcia was changing and he wanted to play a role in the process, while getting a notion about what was in Marcia’s mind at the moment.

Throughout the session you watch Michael dominate and bully Marcia into answers that she, you feel, would not normally give. At one point Michael tries to stand over you when you challenge this behaviour. Throughout the session you feel uncomfortable and have feelings of melancholy for your client.

At the end of a very strained session Michael declares that he thinks it would be better if he came to all Marcia’s sessions so he can see what going on and what you’re filling her head with. After they had gone and you have reflected on the session you discover how his behaviours and her passivity have triggered feelings of unresolved helplessness in you – similar to those that you felt when your parents displayed these behaviours.

As her counsellor, how would you react to this situation?

(click on the comments link below to view responses)

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