Choosing a Theoretical Orientation…

(((I’m starting a new internship soon.  My internship supervisor gave me an assignment that involves thinking about what my theoretical approach is.  Here are my initial thoughts…)))

As I’ve worked through this Masters Program towards LMHP licensure, I can recall several instances in which i’ve been asked to define my theoretical orientation.  My own thoughts on this matter have always been “Why must I choose now?” After all, I haven’t even gotten my first job yet….

My initial thoughts are that seems best to keep open mind and allow my therapy approach to develop naturally.  However, it couldn’t hurt to begin addressing this issue but examining what counseling approaches best “resonate” with me personally.  At first glance, my immediate impression is that all theoretical orientations have their strengths and limitations.  No counseling approach exists that can in itself be considered 100% perfect.

On the one hand, there are theories that focus inward, upon mental activities. Perspectives such as the Rogerian client-centered approach, and existentialism, offer an internal subjectivist perspective.
On the other hand, you have objective and externalized approaches that put the inner world of the individual at a place of lesser importance. For example cognitive and behavioral therapies, offer a pragmatic approach, objective assessments, and a reality-based approach.

What Is The And?

An integrative structure based on the work of a number of theorists rejects an antagonist model….(and) dualistic thinking, replacing the world versus with and. Thus they proposed a three-dimensional model, with the following structure: (a) rational and affective, (b) action and insight, and (c) directive and nondirective. (Brown, 2010, p473).

The above quote summarizes my initial reactions regarding the issue of a “theoretical orientation”.  A theory that is useful can provide a dialectical balance of change and acceptance approaches.  Change-based approaches can involve pragmatic and reality based interventions that provide opportunities for direction and confrontation. Acceptance-based approaches can provide clients the Rogerian unconditional acceptance alongside empathy and the validation Lineman speaks of in DBT.

This dialectical balance of seemingly oppositional perspectives is critical, and goes well beyond a change vs. acceptance perspective.  Human beings are not islands.  We are affect our relationships and environment and change them in turn.  A theoretical orientation I need would allow me to understand my clients in a sociocultural perspective.  I would also like an approach that can help me contextualize how people are influenced and affected by significant relationships.

Overall, these considerations remind me of a question asks me often “What is the ‘and’?”  It is a subtle encouragement to seek the other side of the coin regarding matters in which I feel“stuck”.   When I address this question honestly, I inevitably learn that my beliefs and skewed perception exist as a causal of my own stickiness.  A willingness to see what I choose to ignore allows understand the solution. This life lesson is vital for professionally as well as personally.

With this in mind, what follows is a list of counseling theories that resonate with me personally….

#1. Dialectical Behavioral Therapy

As a former therapy client, I’m personally familiar with DBT as a group therapy approach.   After reading Marsha Lineman’s work, I appreciate the Hegelian dialectic approach it utilizes.

  1. Alongside cognitive behavioral techniques that promote effective emotional regulation is a mindful awareness based on Buddhist philosophy (Linehan, 1993).
  2. In addition to action-based homework assignments and rationally-oriented chain analysis to encourage change is notion of radical acceptance of things that cannot be altered (Linehan, 1993)
  3. Finally, there are techniques taught throughout the counseling process that touch upon various points of along the process of interpersonal growth (Linehan, 1993)
Click here to read a recent post I wrote on DBT

#2. Motivational Interviewing….

Motivation, Ambivalence & Resistance.

“Motivation is defined as that which moves us to action” (Salkind, 2006, p857). Working with clients who have a low motivation to change is a key challenge in the helping professions. Ambivalence and experiential avoidance are two factors frequently encountered with clients resistant to change.  Prout & Wadkins (2006) describe ambivalence as “a contradictory mix of positive and negative feelings about change” (p232). It is a complex mindset that encompasses a need for change alongside a desire to deny the problem (Prout & Wadkins, 2006).    Resistance, on the other hand, can be thought of as anything within the client that impedes progress (King, 1992).  Evidence of resistance can include excuses, limitations on change, or feelings of ambivalence (King, 1992; Prout & Wadkins, 2014).

The Stages of Change

Underlying ambivalence, resistance and low-motivation is a preference for experiential avoidance as a coping mechanism.   This experiential avoidance can be thought of as a client’s desire to avoid memories, thoughts, sensations, and emotions that are related to painful personal experience in the past (Stroshal, et al, 2004). Interestingly, while the tactics utilized to avoid such experiences are harmful from the standpoint of personal growth they still yield short-term benefits that must be addressed (Stroshal, et al, 2004).

Prout & Wadkins (2006) discuss a “Transtheoretical Stages of Change Model” (p.233) to help conceptualize the degrees of ambivalence in clients. The stages of change included in this theory consist of five stages: (1) pre-contemplation, (2) contemplation, (3) preparation, (4) action, and (5) maintenance (Prout & Wadkins, 2006, p234).   It is a useful as a tool for assessing a client’s readiness to change.

An Overview of Motivational Interviewing

Motivational interviewing is a “collaborative person-centered conversation [utilized] to elicit and strengthen motivation” (Microtraining Associates, 2011). These techniques are useful with clients who are working through ambivalent feelings regarding the idea of change (Prout & Wadkins, 2006). The four principles of motivational interviewing include: “express[ing] empathy…develop[ing] discrepancy…roll[ing] with resistance…and support[ing] self-efficacy” (Prout & Wadkins, 2006, p245). Seeing these principles in action throughout the motivational interview video series has been quite helpful (Microtraining Associates, 2011).

In a video presented in class we are provided an example of motivational interviewing “in action” The client is coming to counseling at his girlfriend’s insistence and the therapist makes a comment about this fact (Sushi Productions, 2009). Based on his response, she is given an idea of his level of resistance.  What follows is an overview of insights from this video….

Assessment   During the assessment phase of the interview, the counselor is working to attain details of the client’s drinking. The counselor’s initial efforts reflect two key principles of motivational interviewing: (1) expressing empathy and (2) rolling with resistance (Prout & Wadkins, 2014).   Firstly, the counselor makes a point of refraining from any displays of judgment. Instead, she restates the situation in his words as a show of empathy.   Later the counselor states: “and your girlfriend got a bit of mileage out of that one” (Sushi Productions, 2009). This comment acknowledges the client’s feelings of resistance regarding his participation in therapy.

Working With Ambivalence:  In this portion of the session, the positive and negative aspects of the client’s drinking are discussed.   Several useful techniques can be seen in the counselor’s summary of positive aspects of drinking. For example, in a show of empathy the counselor states, “it’s kind of given that you’re going to be drinking, you know” (Sushi Productions, 2009). This statement acknowledges the client’s perspective, and reflects the therapist’s effort to “roll with resistance” (Prout & Wadkins, 2014, p245). Inconsistencies in the client’s thinking are then highlighted in a discussion of negative factors associated of drinking. It is at this point that the motivational interview focuses on developing discrepancy (Prout & Wadkins, 2014).

At a key point, the counselor takes time to review the client’s feelings of ambivalence. She does this by summarizing the negative consequences of drinking, while also acknowledging any resistance. After allowing the client time to reflect on this she asks him they begin discussing his options.

Problem Solving & Goal Setting  In this portion of the session, the therapist discusses the parameters of a problem solving exercise. They work together to list all possible options and set aside feasibility considerations for the time being. This causes the client to set aside his ambivalence and allows the counselor to highlight any inconsistencies in his thinking.

After developing discrepancy in this discussion, the counselor moves on to feasibility considerations.   The therapist then asks the client to image following through with these options. This allows a discussion on change talk to begin.   Specific strategies to enact these options are outlined, and a plan is worked through.

Normalizing Relapse  A follow-up session in this video shows a discussion on the degree of success in following through with plans. The client admits that he underestimated the efforts required to initiate his plans for change. Clearly frustrated, the counselor acknowledges his concerns, but reminds him of his successes as well. The therapist then normalizes his experience by discussing the difficulties all people have in attempting to make major life changes (Sushi Productions, 2009). This allows the client to develop a more realistic idea of the efforts involved in his plans for change.

#3. Multicultural Counseling…

Culture can be thought of as the knowledge, beliefs, behaviors, worldview, language, etc, of a social group or segment of society (Monk, 2008, p12). It is a framework with which we understand and create meaning from our life experiences.  From a multicultural perspectives each culture as a unique meaning systems that is internalized within us as an overall life perspective.   In an environment of increasing globalization misunderstandings can easily arise as individuals from different cultures interact.   Counselors are required ethically to “maintain [an] awareness and sensitivity regarding cultural meanings” (ACA Code of Ethics, 2005).

Developing cultural competency requires a dualistic focus. On one hand, a commitment to greater self-awareness is essential to see beyond our own myopic viewpoint. On the other hand, there needs to be a willingness to gain the education, and skill necessary to assess people from within a larger sociocultural context. Doing so is critical to prevent any unintentionally ethnocentrism in the therapeutic context (Corsini & Wedding, 2011).

What follows is a list of key insights regarding a multicultural perspective.  

Social Constructivist Philosophy

A core condition of constructivist approaches includes listening to the client’s story. This is more than displaying empathy, this is a profound listening from a self-aware and politically aware counselor. It is a listening that believes that the client’s understanding of events, and how they think feel and construe the impact of their lives, is the important meaning. (Cretar, et al, 2008, p31).

As an underlying philosophical perspective for the counseling theories within this paper, it is important to note a few of the peculiarities of this point of view. Also known as postmodernism, this philosophical movement has occurred within the social sciences over the last 30 years (Monk, 2008, p4). A few interesting observations can be made of this perspective:

  1. Theories of social constructivism argue against the idea of an objective truth, stating instead that we make our own meaning. (Monk, 2008, p4).
  2. Constructivists understand reality as constructed from the inside out, rather than as a matter of externalized objective fact imposed upon individuals. (Monk, 2008, p4).
  3. Whereas traditional approaches to counseling place the therapist at the center, constructivists are less directive, engaging in a collaborative process (Monk, 2008, p4).
  4. Finally, rather than focusing on symptomatology or trait-based analysis, clients are viewed holistically, as a person in context. (Monk, 2008, p4).

Social Justice Promotion.

One of the common threads that multicultural, feminist, and social counselors share is the view that clients exist within and are constantly affected by environmental systems and contexts. (Crethar, et al, 2008, p269)

Another key commonality of multicultural counseling theories, is an awareness of the potential for unintentional ethnocentrism within traditional monocultural perspectives. Desiring to gain an awareness of person-in-context, culturally competent practitioners, display an awareness of their own worldview, and desire to learn others, (Corsini, & Wedding, 2011).

Alongside this awareness, is a desire to move beyond an intrapsychic perspective and engage in a more comprehensive perspective (McMahon & Patton, 2006). The goal becomes not only to promote mental health, positive development, but encourage distributive justice, and equality (Crethar, 2008, 273). In an interactional context, this involves utilizing an inclusive cultural empathy that comprises an affective acceptance, intellectual understanding, and culturally appropriate interaction. (Pederson, et. al, 2008, p54).

Click here to read my post on culture & rapport

#4. Systems Theory

Systems Theory can be thought of as a lens through which to view the relational processes of individuals and the significant others with whom they interact in their attempts to derive meaning and construct an identity. (Curtis & McPherson, 2000, p50)

Systems Within Systems.

What is first notable about systems theory is its view of individuals as a subsystem within a larger subsystem (Arthur & McMahon, 2005). If one were to provide a diagrammatic picture of this theory, they would draw a series of concentric circles. With a picture that looks much like a target, each level, can be thought of as a subsystem within a subsystem. The individual is a system that exists within microsystems such as family, peers, or work environment. These microsystems, then exist within a larger ecosystem that can be thought of as society at large. How does this relate to counseling practice? Essentially it calls for an understanding of individuals holistically, people aren’t beings unto themselves, but parts of a larger whole (Curtis & McPherson, 2000, p50)

Interdependent Recursiveness       

What makes this theory unique is how it describes people as individuals in context. As an elemental part within a greater whole, the relationship of individuals within the larger subsystems is actually quite complex (Curtis & McPherson, 2000, p51). On the one hand, Individuals are defined by the larger subsystems they exist within. Whether these larger subsystems are families, or society as a hole, they determine our way of perceiving ourselves and the world at large. On the other hand, we also define our culture, in the way we participate and engage with others within it. Essentially what this means, is “the whole is greater than the sum of its parts” (Arthur & McMahon, 2000, 212). This notion that we are both influenced by and influence is known as an inderdependent recursiveness (Arthur & McMahon, 2000).   The thing to remember about this as counselors, is that cause and effect do not occur in a linear fashion, but rather as a circular process (Curtis & McPhearson, 2000, p51). Therefore it is truly impossible to understand a person independent of their own sociocultural environment.

Change as Morphostasis.

The final notion which is key in systems theory, is the notion of morphostasis (Curtis & McPhearson, 2000). Essentially this notion can be thought of as a sociocultural thermostat which functions to maintain a sense of stability. Much like the way organisms maintain a biological homeostasis, societies undergo morphostasis to maintain a similar stability. Through the process of feedback from within the many subsystems that comprise it, change occurs, so that stability within the larger ecosystem can be maintained.

Toward Practical Application.

With this theoretical overview out of the way, how might one begin to apply a series of abstract notions? What follows is just a sampling of two approaches.

Structural Family Therapy.

Conceived on the notion of the looking glass self, this therapy states the family is an integral part of an individual’s identity. From a systems theory perspective, this therapy enables people to examine their identities from this standpoint. This involves a collaborative examination of roles and perceptions, examining the system-based dynamics. From within this approach, problems are said to occur commonly from within key stages of development. With the therapists take an “inside role” attempting to lead structural changes within the family system (Curtis & McPherson, 2008, p55).

Strategic Approaches.

Rather than diagnosing a “problem” to solve, this perspective seems to take on the notion of systemic “stuckness” (Curtis & McPherson, 2008). With a desire to understanding the circular causality within the system, strategic therapists aim at understanding underlying systemic perceptions. Essentially, taking on the belief that things aren’t as they seem, the problem is a reframing of the situation, to readjusting a predominate worldview. “The therapist takes responsibility for the counseling process and the duty of manipulating the system’s worldview, (Curtis & McPherson, 2008, p57).

#5.  Vygotsky’s Developmental Theory

Lev Vygotsky is a developmental theorist whose views vary significantly from many of the westernized perspectives that predominate the field (Broderick, 2010). For example, while Piaget focused on the inherent biological limitations of an individual, Vygotsky describes development as occurring with a sociocultural context (Wertsch, 1985). Instead, Vygotsky provides a unique perspective, stating famously: “the mind is no longer to be located inside the head.” (Broderick, 2010, p102). This perspective stands in stark contrast to the westernized notions of development that predominated in his day.

In keeping with a social constructivist perspective, Vygotsky states asserted there is pre-existing structure within the psyche that exists independent of our environment. Instead, our internal cognitive processes are created as a result of sociocultural interaction (Glassman, 1994). For Vygotsky, conscious creation and development is a matter interpersonal interaction. What the author finds particularly intriguing about this assertion, is recent research on the brain’s neuroplasticity confirming this fact (Broderick, 2010). What follows is just a small sampling of concepts that help to illustrate the unique benefits of Vygotsky’s theory.

Zone of Proximal Development

Vgotsky’s notion of ‘the zone of proximal development’ helps to explain how he treats the process of freeing the world. The zone of proximal development is ‘the distance between the actual developmental level as determined by independent problems solving and the level of potential development as determined through problem solving under adult guidance. (Williams, 1989, p115)

The zone of proximal development defines the range between what the child is capable of independently, and what they can learn through attentive guidance. A parent is responsible for providing a degree of structural context within which mediated learning occurs (Broderick, 2010). With this concept, in contrast to other theorists, which examine human development as a matter of individuals mastering key tasks, Vygotsky paints a very different picture.

According to Vygotsky, the crucial element to understanding human development is to examine the interactional nature of person in context. That is the crucial point he attempts to make with this concept.   For example, it is the definitive actions of parent and child, are what help to determine the nature of this zone of proximal development. With parents providing what he calls a “scaffolding”, to enable learning to occur, children engaging in “bootstrapping” efforts in response (Broderick, 2010).

Mediated Learning

“mediated learning is the training given to the human organism by an experienced adult who frames, selects, focuses, and feeds back an environmental experience in such a way as to create appropriate learning sets…These mediated learning experiences are an essential aspect of development…..the principal means by which the child develops the cognitive operations for learning independently” (Wertsch, 1989, 278)

According to Vgytosky, the concept of mediated learning describes the mode of development from a sociocultural perspective (Broderick, 2010).   In contrast to many developmental theorists, Vygotsky didn’t conceive develop as an internal process (Williams, 1989). Instead the essential tools for language, were the means through which society influences our development (Wertsch, 1985). The communication that occurs within our primary interpersonal relationships in childhood, defines the nature of our inner world. This brings us to a final concept of Vygotsky’s theory that warrants mention.

Internalization

“Vygotsky argued that there is an inherent relationship between external and internal activity, but that it is a genetic or developmental relationship in which the major issue is how external processes are transformed to create internal processes…the process of internalization is not the transferal of an external activity to a preexisting internal ‘plane of consciousness’ it is the process in which this plane is formed. (Wertsch, 1985, p163)

As with many developmental theorists, Vygotsky didn’t discuss the adult developmental life course in great detail. Still, when examining his theory in closer he appears to indirectly discuss the issue in his concept of internalization. As this notion connotes, internalization refers to a process, in which externalized processes engaging with the world transform into an internalized plane of consciousness. This process of internalization occurs through language and it is how our culture is internalized, into an internal frame of consciousness. In other words, language defines our mode of understanding, and inner thought world.

#6. Others…

Honestly, the above post is a conglomeration of assignments I’ve completed throughout this program that ask me to state my theoretical perspective.  I’m still uncertain “where I stand”, and firmly believe an open-minded stance is critical.  However, the theories above do intrigue me.  For the sake of brevity, I’m simply listing links to other theoretical orientations that have intrigued me over the years.  They also provide great “explanatory value” therapeutically.

In this post I discuss “feeling stuck” using Berne’s Transactional Analysis.   
In this post, I discuss misunderstandings using Berne’s Transactional Analysis.
In this post I discuss Erikson’s Stages of Development.  

References

American Counseling Association (2005). ACA Code of Ethics. Alexandria, VA: Author.
Arthur N. & McMahon, M. (2005). Multicultural career counseling: Theoretical applications of systems theory framework. The Career Development Quarterly. 53(3). 208-222.
Broderick, P.C. & Blewitt, P. (2010). Life Span Development: Human Development for Helping Professionals. (3rd. Ed.) Boston, MA: Pearson.
Brown, J. (2010). Psychotherapy integration: Systems theory and self-psychology. Journal of Marital and Family Therapy. 36(4), 472-485.
Corsini, R. J. & Wedding, W. (2011). Current Psychotherapies. Belmont, CA: Brooks/Cole
Crethar, H.C., Rivera, E.D., & Nash, S. (2008). In search of common threads: Linking multicultural, feminist, and social justice counseling paradigms. Journal of Counseling and Development. 86(3). 269-278.
Curtis, D.F. & McPherson, R.H. (2000). The clinical utility of systems theory in counseling practice. Journal of Professional Counseling, Practice, Theory & Research. 28(1) 50-63.
Elrich, J.F. (2006). Vygotskian inner speech & Reading process. Australian Journal of Educational & Developmental Psychology. 6. 12-25.
Glassman, M. (1994). All things being equal: The two roads of Piaget and Vygotsky. Developmental Review. 14, 186-214
Linehan, M. M. (1993). Skills Training Manual For Treatment of Borderline Personality Disorder. New York Guilford Press.
McMahon & Patton (Eds). (2006). Career Counseling: Constructivist Approaches. New York: Routledge.
Monk, G., Winslade, J. & Sinclair, S. (2008). New Horizons in Multicultural Counseling. Thousand Oaks , CA: Sage Publications.
Microtraining Associates (2011). Introduction to Motivational Interviewing. Available from http://ctiv.alexanderstreet.com/View/1779393
Prout, T.A. & Wadkins, M.J. (2006).  Essential interviewing and counseling skills.  New York, NY: Springer Publishing Company.
Pederson, P.B., Crethar, H.C., & Carlson, J. (2008). Inclusive Cultural Empathy. Washington, D.C.: American Psychological Association.
Salkind, N. J. (2006). Encyclopedia of human development. Thousand Oaks, Calif: Sage Publications.
Wertsch, J.V. (1985). Culture, Communication, & Cognition: Vgytoskian Perspectives. New York: Cambridge University Press.
William, M. (1989) Vgytosky’s Social Theory of Mind. Harvard Educational Review, 59(1). 108-126.

 

Share This: