Theory in the Practice of Counseling Stephen Southern

THEORY DEVELOPMENT

Inductive Reasoning Observing specific cases or events Describing these “particulars” Asserting an hypothesis Conducting a test Obtaining results Generalizing from findings Building models and theories

Deductive Reasoning Understanding is a function of current state of cumulative knowledge Developing theories from one’s understanding of events Deriving an hypothesis from a relevant theory and testing it Accounting for results based on theory

Scientific Method Observation Question Hypothesis Prediction Testing Results Analysis Discussion Replication Decision-making Control

Hypotheses Simple Empirical Falsifiable

How Theories Evolve Understanding or knowledge base (e.g., review of the literature) Sound reasoning Intuition and discovery Analogizing Statistical inference Replication and generalization

Theory Defined Theory is a conceptual framework that explains existing observations and generates hypotheses about new observations

What is a Theory? (Peterson & Nisenholz, 1999, p. 159) Theory is a road map of the world, but the map is not the territory Theory provides structure from which to understand what we are doing Theory is an explanation for events that can be tested Theory helps us organize our actions

Formal Counseling Theory (Patterson, 1986) Set of assumptions regarding counseling or behavior change Set of definitions of ideas and concepts stated in behavioral or observational terms Concepts are related, some are cause and effect relationships Hypotheses constructed from the assumptions, definitions, and concepts can be tested through research

Arguments for Theory (Peterson & Nisenholz, 1999, p. 160) People have implicit theories that should be made explicit Counselors cannot function unless they are able to bring some order to events they observe Helps counselors understand the process of behavior change, enabling them to describe and make predictions

Arguments Against Theory (Peterson & Nisenholz, 1999, p. 161) Theories constrict counselors and clients, limiting behavior change Theories tend to indoctrinate or influence people Most counselors do not really use theory in the work they do There is lack of evidence that any one theory is “right” or produces better outcomes than a competing theory

THEORY IN COUNSELING & PSYCHOTHERAPY

Theory Construction Command of a relevant literature Professional practice experience Ongoing professional presentation and communication Quantitative and qualitative research Personal experience and reflection

Personal Practice Theory Population Problem Setting Self of therapist Lifespan career development

ECLECTICISM AND PSYCHOTHERAPY INTEGRATION

Proliferation of Counseling Theories With the creation of psychoanalysis, there was basically one theory; however, Freud’s students quickly began to modify the classic model The Psychotherapy Handbook (Herink, 1980) listed 250 different types of therapy Corsini & Wedding (2005) reported more than 400 approaches

Four Forces in Psychotherapy (Peterson & Nisenholz, 1999, p. 166) Psychodynamic Behavioral (Cognitive-Behavioral) Humanistic-Existential Transpersonal

Eclecticism in Psychotherapy: Is Integration Possible? Little progress has been made in developing a single comprehensive system of psychotherapy (Patterson, 1989).

Obstacles to Theory Integration Coherent theoretical structures do not exist Irreconcilable differences in theoretical constructs Practitioners perceive theory as too abstract and irrelevant

The Original Challenge “What treatment, by whom, is more effective for this individual with that specific problem and under which set of circumstances” (Paul, 1967, p. 111)

THE ONGOING CHALLENGE OF PSYCHOTHERAPY INTEGRATION

Psychotherapy Integration in the Postmodern World Various views and functions corrected by ongoing dialogue (Woolfolk & Murphy, 2004)

Divergent Views Objectivism reflects modernism; True and precise categories of mental illness and treatment can be known; Examples of objectivism include cognitive-behavior therapy and DSM-IV Normativism reflects existentialism; Cultural norms determine psychopathology and psychotherapy; Normative views expressed by Thomas Szasz and Carl Jung

Divergent Views Objectivists assert that psychopathology represents malfunction of psychological mechanisms that can be diagnosed and treated Normativists argue that any conception of mental disorder is fundamentally evaluative according to current cultural norms

How to Determine Malfunction Etiological function: the view that there are defects in the nervous system Propensity function: the view that lack of success or adjustment is related to a given environment Cummins function: the view that malfunction is practical and systemic; when a known cause cannot contribute to a specified effect

Psychotherapy and Culture Psychotherapy absorbs and reflects the culture of which it is a part while simultaneously putting its imprint on society

Psychotherapy and Modernity In the 20th century, psychotherapy has been linked to efficiency and effectiveness Implied morality in means and ends In the USA, psychotherapy is a means for pursuing American individualism A “communitarian critique” argues that therapy should take into account the collective context and the greater good of the community

Psychotherapy and Post-modernism Post-modernism is a healthy reaction against the tyranny of reason in rationalism Post-modern perspectives of contextualism and pluralism apply to the case of psychotheray Psychotherapy integration is a process characterized by dialogue and dialectics

Contextualism Psychotherapy concepts can be understood only within the linguistic, theoretical, and ideological frameworks in which they are embedded (Safran & Messer, 1997).

Pluralism There is no single theoretical or methodological approach that is pre-eminent and no one integrative system toward which psychotherapy is evolving (Safran & Messer, 1997).

Theory & “The Other” Identity emerges through construction of “the other” depriving other individuals of legitimate standing In order to appreciate other theoretical stances it is helpful to use the anthropological methods of immersion, curiosity, and astonishment

Metatheoretical Integration Psychoanalytic therapy is guided by a tragic sense of reality in which people are subject to unknown forces which can be only partially ameliorated Behavior therapy falls within the comic view where conflicts are treated as external and readily resolvable Humanistic therapy is characterized by the romantic view which prizes individuality, spontaneity, and unlimited potentials

CHARACTERISTICS OF CONTEMPORARY PSYCHOTHERAPY INTEGRATION

Factors Contributing to Psychotherapy Integration Managed care; demand for brief, empirically-supported treatment Confusion and fragmentation with the proliferation of schools of thought Realization that no given approach could handle all clinical cases Focus on practical solutions to specific clinical problems

Factors Contributing to Psychotherapy Integration Increasing experience of therapists with approaches other than their own Failure to identify any one theoretical approach that is consistently demonstrated to be more effective than others Development of interests in common factors across forms of psychotherapy Existence of professional networks for disseminating knowledge and opinion (e.g., Society for the Exploration of Psychotherapy Integration)

Phases of Therapeutic Change Unconscious incompetence Conscious incompetence Conscious competence Unconscious competence (Goldfried, 2004)

Common Change Principles Expectation that therapy can help Experience of an optimal therapeutic relationship Awareness of what is causing problems Involvement in ongoing reality testing (Goldfried, 2004)

Mechanisms of Change Integrative psychotherapies are designed to include as many relevant change factors in order to best meet the needs of particular patients (Stricker & Gold, 2003)

Modes of Psychotherapy Integration Technical Eclecticism: most common form of integration with the least investment in theory (e.g., Multimodal Therapy) Common Factors: effective ingredients in the therapeutic process that are held in common by a group of therapies Theoretical Integration: most complex and difficult process, frequently assimilating constructs from one or more theories into an extant theory

References Corsini, R.J., & Wedding, D. (2005). Current psychotherapies. (7th ed.). Belmont, CA: Brooks/Cole. Goldfried, M.R. (2004). Integrating integratively oriented brief psychotherapy. Journal of Psychotherapy Integration, 14, 93-105.

References Gurman, A.S., & Messer, S.B. (2003). Contemporary issues in the theory and practice of psychotherapy: A framework for comparative study. In A.S. Gurman & S.B. Messer (Eds.), Essential psychotherapies: Theory and practice (2nd ed.) (pp. 1-23). New York: Guilford Press. Herink, R. (Ed.). (1980). The psychotherapy handbook. New York: New American Library. Patterson, C.H. (1986). Theories of counseling and psychotherapy. (4th ed.). New York: Harper & Row.

References Patterson, C.H. (1989). Eclecticism in psychotherapy: Is integration possible? Psychotherapy, 26, 157-161. Peterson, J.V., & Nisenholz, B. (1999). Orientation to counseling. (4th ed.). Boston: Allyn and Bacon. Paul, G.L. (1967). Strategy of outcome research in psychotherapy. Journal of Consulting Psychology, 31, 109-119. Safran, J.D., & Messer, S.B. (1997). Psychotherapy integration: A postmodern critique. Clinical Psychology: Science and Practice, 4, 140-152.

References Stricker, G., & Gold, J. (2003). Integrative approaches to psychotherapy. In A.S. Gurman & S.B. Messer (Eds.), Essential psychotherapies: Theory and practice (2nd ed.) (pp. 317-349). New York: Guilford Press. Woolfolk, R.L., & Murphy, D. (2004). Axiological foundations of psychotherapy. Journal of Psychotherapy Integration, 14, 168-191.