1. Counseling Style Presentation Integrating mind, body, & spirit through diverse techniques and existential outlook
Michael Reeder, MS, LGPC
Therapist in private practice
Brookland Pastoral Center & Hygeia Counseling Services
Washington & Baltimore Locations
Version 12/17/06
© Reeder 2006

2. Overall Assumptions Holistic Balance: Existentialism:
A balance of several factors is needed for health.
Existentialism:
Search for meaning
Fears: Meaninglessness, Isolation, Death, & Freedom
Evolution & Transcendence:
Clients seek to evolve and transcend once:
basic needs are met (Maslow)
basic needs are impossible (such as dying)
© Reeder 2006
EXISTENTIAL:
I see the existential concerns underlying all of human behavior weather or not I directly discussion existential matters or not with a client.
I also see the fight to become something greater than you now are, or at least not stagnate, as an important part of the human condition
I look for ways to weave such concerns in with treating the presenting condition

3. The Model Skills & Techniques I Often Use Who Benefits Most
Body
Skills & Techniques I Often Use
Who Benefits Most
Client Examples
My Assumptions
Make sure to look at the Notes section for more thoughts on each slide!
© Reeder 2006
Integration
Cognition
Affect
I’ll be following this simple holistic model
Concentrating on each of the 5 areas in turn
Discussing each of the headings in the text box
Lower functioning clients may be best served by concentrating in only narrow areas of the model.
Spirit

4. Client Examples
I’ll use some fictionalized examples of what I’d do for people from each of the model areas
“Max” (I’ll refer to him several times)
47-year old divorced white male
Fighting alcoholism, depression, and hopelessness
Years of moving from counselor to counselor
Mainly values medication, not counseling
Former company vice president now living in a group home on low income
© Reeder 2006

5. Cognition Skills & Techniques I Often Use:
Cognitive-Behavioral Techniques: ABC
Psychoeducation
Development of personal stories
Concrete tools:
Thought Journals
Card Sorts
© Reeder 2006
Cognitive-Behavioral Techniques:
ABC: Actuating Event, Belief, Consequences – Basically the Belief in the middle of ABC is up to you and what you choose to think or believe about an event leads to the consequence. Therefore beliefs and thoughts are critical to examine and change.
Automatic thoughts – Ritualized, repetitive thoughts just below the surface of awareness, such as “I always fail at everything” and “I’m too fat to deserve life”. You’d stop hurting yourself with these if you realized you did them!
We look at the pros/cons of each belief, and replace the irrational ones
CONCRETE TOOLS:
Structured exercises and sorting through card decks (card sorts) can help people think their way through problems.
So can structured worksheets
The “Planning on Purpose” card sort takes something very remote and obscure – deciding on life goals – and makes it easy.
PERSONAL STORIES:
It’s important to have a sense of the personal meaning of one’s life. Of a sense of continuity, of place and purpose. I look for opportunities to get people thinking about their life story, and what’s important to them.
We’ll discuss this more later in another section but its as much a cognitive technique as anything else.

6. Cognition Who Benefits Most: Client Examples
Verbal, analytical clients
Clients with negative self-talk
Clients willing to do homework
Clients needing to learn about their condition
Client Examples
Max: Assigned thought journals
© Reeder 2006
Max:
Thought Journals:
To try and catch negative self-talk like “nothing I do anymore is worthwhile”.

7. Cognition My Assumptions:
Existential Underpinnings: Finding meaning through understanding and story-making.
The client must buy into the treatment
I explain, show treatment plans, and sometimes diagnoses
The client has a brain and is an equal partner in the treatment process
Understanding is curative… but rarely enough.
© Reeder 2006
The mind needs to understand but an emotional trigger is needed as well.

8. Affect Skills & Techniques I Often Use:
Basic humanistic counseling techniques:
Reflective listening, unconditional positive regard…
Gestalt
Card sorts
Guided imagery
© Reeder 2006
MORE ON THESE TECHNIQUES:
HUMANISTIC – These are the techniques pioneered by Carl Rogers. I reflect back what I hear because lots of people don’t really listen to themselves. I give respect and positive regard to each person before me. I try to create a “holding space” – a safe, nurturing therapy place – where everyone is free to talk and explore.
GESTALT – Can’t explain it fully in a slide note. Gestalt techniques are bringing unfinished business and unknown pieces of yourself into awareness and working with them until an integration is achieved. This is often very emotional ,and so I list Gestalt here under the Affect section. Some techniques include empty chair, feed you a line, and exaggeration (of speech or body movements).
CARD SORTS & GUIDED IMAGERY:
I use cards with emotional terms and evocative pictures.
They are a great way to get people less verbally inclined clients to open up.
GUIDED IMAGERY:
Use of guided journey and meditation can involve all 5 senses. Whenever we get out of just the cognitive section of our heads, we often get emotional.

9. Affect Who Benefits Most: Client Examples
People who have trouble accessing their emotions
People needing emotional expression, support, and connection (anyone!)
Client Examples
Max: Gestalt empty chair
His drinking self versus clean self talk
More pros and cons to drinking can be generated in 5 minutes than in 20 minutes of group discussion!
Beth: Emotional card sorts
Build vocabulary, deeper precision of recognition, prompt conversation
© Reeder 2006
Max can have the two sides of himself argue it out, and so learn a lot about his situation.
Beth is not very verbal, but is emotionally sensitive and responses well to pictures. She can:
Use cards to build vocabulary, improve responses from one-word “good” and “okay”
I might have her “pick three cards that describe how you felt this week”
I might have her “pick one card that describes your relationship with each family member”

10. Affect My Assumptions: Quote:
Humanistic counseling techniques underlie everything!
Quote:
“All forms of psychotherapy, when successful, arouse the patient emotionally.” – Jerome Frank
© Reeder 2006

11. Body Skills & Techniques I Often Use:
Referral: Medical and psychiatric consultations
Relaxation & breathing
For physical stress release
Body-centric approaches
© Reeder 2006
Body-centric approaches assume that feelings, memories, and component parts of yourself (subpersonalities) can be stored in the body. Some people express emotional issues physically. By concentrating on the physical feeling, the mental situation can be address. So, for example, a rape trauma survivor might have lower back pain. Concentrating on the pain, she might feel angry and helpless. After talking about her traumatic experience (when she is ready), it’s even possible her lower back pain could diminish.

12. Body Who Benefits Most: Client Examples
Persons with medical conditions
Persons needing psychotropic medications
Anxiety & panic disorder patients
Trauma patients
Client Examples
Max takes meds for depression
Max has a family history of alcoholism © Reeder 2006

13. Body
My Assumptions:
Less psychiatric medication is best IF personal resources can be mobilized.
An agitated mind can not exist in a relaxed body.
© Reeder 2006
However, I can not overrule doctor’s medical advice. Compliance with psychiatric regiments is necessary.

14. Spirit Skills & Techniques I Often Use: Spiritual Assessment
Spiritual autobiographies, spiritual roots exercise
Highfield & Cason’s four spiritual needs (meaning & purpose, give love, receive love, hope & creativity)
Goal-Setting:
Based on Highfield & Cason, & getting back to roots
Meditation & Awareness
© Reeder 2006
ASSESSMENT:
I have occasionally given formal tools like the INSPIRIT & SHI
However, informal tools that help the client formulate his/her own structures seem to work better in therapy for me.
I like using the “Spiritual Roots Exercise” by Judy Harrow and various forms of spiritual autobiographies.
Examination of where the client’s life fits into Highfield & Cason’s four spiritual needs (meaning & purpose, give love, receive love, hope & creativity) can give insight into what to change and improve going forward.
SHI: Spiritual Health Inventory: Personal spiritual experience, spiritual “well-being”, sense of harmony, & examination of personal helplessness
INSPIRIT: Identify and process close experiences of the Divine in order to determine beliefs, become more aware of and draw on spiritual experiences.

15. Spirit Who Benefits Most: Client Examples Depressed patients
Addicted patients
Spiritually or religiously inclined patients
Clients searching for meaning
Client Examples
Max: SHI & INSPIRIT
Spirituality as boost to AA efforts
Drug Relapse group: Definitions & roots exercise
© Reeder 2006
Max:
Purpose was to increate sense of spiritual connection to higher power in order to bolster connection to AA, strengthen sobriety, and build therapeutic alliance.
RELAPSE GROUP
Roots exercise led to personal understanding of what matters
Developed personal stories and meaning

16. Spirit My Assumptions:
Existential Underpinnings: Finding meaning through understanding.
Transcending yourself is healthy
© Reeder 2006
I mean many things by “transcending” the self:
A religious person might seek a stronger connection with the Divine
An atheist might take nature walks to relax and not feel bottled-up inside. He/she might join civic organizations to transcend the self through connections to other people and the civic good.

17. Integration Skills & Techniques I Often Use:
Integrating fragments of self:
Gestalt - empty chair, feed you a line, exaggeration, etc.
Adlerian -- Acting As If
Meditation – Finding the center
Balance:
Integration of techniques from all five areas
Mindfulness
Recognizing, understanding, and releasing emotions & thoughts
© Reeder 2006
I mean integration in two different meanings:
1) Subpersonalities and fragments of self
2) Simply pulling together all the parts of the model
ADLERIAN “Acting As If”: If you act as if something is true (like feigning self-confidence), you may find there’s a bit of it inside you after all, and it becomes easier to be that way in real life.
MEDITATION “Finding the Center”: There’s a still, calm, true center inside all of us beyond the chaos and conflicts. It’s easier to act with sureness and dignity if you take time to find that center occasionally.
MINDFULNESS:
Useful to combine with cognitive therapy. (See Mindfulness-Based Cognitive Therapy by Segal, Williams, & Teasdale).
Good for the chronically depressed in remission
Stops rumination – which tacks negative assumptions to original experience
Breaks the chain, returns to task

18. Integration Who Benefits Most: PTSD and DiD clients
Trauma clients in general
Patients harboring body memories
Anyone experiencing depersonalization, derealization, and dissociation
© Reeder 2006

19. Integration Client Examples My Assumptions: Max: Trauma Symptoms?
Reports losing time, trouble following conversations due to memories intruding, and feeling numb emotionally.
Alludes vaguely to earlier trauma
My Assumptions:
People have multiple, sometimes paradoxical, separate selves/parts
Meaning can help integrate self and life
© Reeder 2006
Max:
I would need to check trauma-related diagnoses like PTSD. Trauma can lead to poor self integration.
I could use discussion of trauma to process and reintegrate dissociated memories and parts of self.
Once traumatic past accepted and reintegrated, symptoms may subside.

20. Conclusion Counseling requires a balanced approach:
Body, cognition, affect, spirit, integration
Existential influences underlie the model.
Especially meaning
Especially isolation (transcendence & centering)
© Reeder 2006