THEORY APPLIED TO

PRACTICE
Theory as a Roadmap
◦ There are many theoretical approaches to understanding what makes the helping
process work.

◦ theory will provide you with a framework for making sense of the multitude of
interactions that occur within the therapeutic relationship.

◦ Some helpers focus on feelings, believing that what clients need most is to identify
and express feelings that have been repressed.

◦ Other helpers emphasize gaining insight and explore the reasons for actions and
interpret clients’ behavior. Some are not much concerned about having clients
develop insight or express their feelings
◦ Some focus on behavior and assisting clients to develop specific action plans to
change what they are doing.
◦ Other practitioners encourage clients to focus on examining their beliefs about
themselves and about their world; they believe change will result if clients can
eliminate faulty thinking and replace it with constructive thoughts and self-talk.

◦ Helpers may focus on the past, the present, or the future.

Our Theoretical Orientation
◦ we function within an integrative framework that we continue to develop and
modify as we practice. We draw on concepts and techniques from most of the
contemporary counseling models and adapt them to our own unique personalities.

◦ Our theoretical orientations and styles of practice are primarily a function of the
individuals we are. Our conceptual framework takes into account the thinking,
feeling, and behaving dimensions of human experience.
◦ We want clients to be able to make necessary revisions that enable them to be
more fully themselves.

◦ One way we do this is by asking clients to pay attention to their “self-talk.”(

THINKING DIMENSION)

Here are some questions we encourage clients to ask themselves:

◦ How are my problems caused or exacerbated by the assumptions I make about
myself, about others, and about life?
◦ How do I contribute to or intensify my problems by the thoughts and beliefs I hold?
◦ How can I begin to free myself by critically evaluating the sentences I repeat to
myself?
◦ The feeling dimension is also extremely important. We emphasize this facet of
human experience by encouraging clients to identify and express their feelings.

◦ Clients are often emotionally frozen due to unexpressed and unresolved emotional
concerns.

◦ If individuals feel listened to and understood, they are more likely to express more
of the feelings that they have kept to themselves
◦ Thinking and feeling are vital components in the helping process, but eventually
clients must express themselves in the behaving or doing dimension.

◦ Examining current behavior is the heart of the helping process. We tend to ask
questions such as these:
◦ What are you doing?
◦ What do you see for yourself now and in the future?
◦ Does your present behavior have a reasonable chance of getting you what you
want, and will it take you in the direction you want to go?
◦ Individuals cannot be understood without considering the various systems that
affect them—family, social groups, community, church, and other cultural forces.

◦ For the helping process to be effective, it is critical to understand how individuals

influence and are influenced by their social world. Effective helpers need to acquire
a holistic approach that encompasses all facets of human experience
Psychodynamic Approaches
◦ Along with Freud, Alfred Adler was a major contributor to the development of the
psychodynamic approach to therapy.

◦ Although influenced by many of Freud’s ideas, Adler developed a very different

approach to therapy.

◦ Adlerian put the focus on reeducating individuals and reshaping society

Overview and basic assumptions
◦ The psychoanalytic approach rests on the assumption that normal personality
development is based on dealing effectively with successive psychosexual and
psychosocial stages of development.

◦ Faulty personality development is the result of inadequately resolving a specific

developmental conflict.

◦ Practitioners with a psychoanalytic orientation are interested in the client’s early

history as a way of understanding how past situations contribute to a client’s
present problems.
Key concepts.

◦ The psychoanalytic approach is an in-depth and generally longer-term exploration

of personality.

◦ Some of the key concepts that form this theory include consciousness and
unconsciousness, dealing with anxiety, the functioning of ego-defense mechanisms,
and the developmental stages throughout the life span.
Therapeutic goals.
◦ A primary goal is to make the unconscious conscious.
◦ Restructuring personality rather than solving immediate problems is the main goal.

◦ Childhood experiences are reconstructed in therapy, and these experiences are

explored, interpreted, and analyzed.

◦ Successful outcomes of psychoanalytic therapy result in significant modification of

an individual’s personality and character structure.
Therapeutic relationship.
◦ Psychoanalytically oriented therapists try to relate objectively with warm
detachment.
◦ Both transference and countertransference are central aspects in the relationship.

◦ The focus is on resistances that occur in the therapeutic process, on interpretation

of these resistances, and on working through transference feelings.

◦ Through this process, clients explore the parallels between their past and present
experience and gain new understanding that can be the basis for personality
change.
Techniques.
◦ All techniques are designed to help the client gain insight and bring repressed
material to the surface so that it can be attended to in a conscious way.

◦ Major techniques include maintaining the analytic framework, free association,

interpretation, dream analysis, analysis of resistance, and analysis of transference.

◦ These techniques are geared to increasing awareness, acquiring insight, and

beginning a working-through process that will lead to a reorganization of the
personality
Multicultural applications
◦ The psychosocial approach that emphasizes turning points at various stages of life
has relevance for understanding diverse client populations.

◦ Therapists can assist clients in identifying and dealing with the influence of
environmental situations on their personality development.

◦ The goals of brief psychodynamic therapy are to provide a new understanding for
current problems. With this briefer form of psychoanalytically oriented therapy,
clients can relinquish old patterns and establish new patterns in their present
behavior.
The Adlerian Approach
◦ Overview and basic assumptions. According to the Adlerian approach, people are
primarily social beings, influenced and motivated by societal forces.
◦ We are primarily motivated by a desire to belong.
◦ Human nature is viewed as creative, active, and decisional.
◦ The approach focuses on the unity of the person and on understanding the
individual’s subjective perspective. The subjective decisions each person makes
regarding the specific direction of this striving form the basis of the individual’s
lifestyle (or personality style).

◦ The lifestyle consists of our beliefs and assumptions about others, the world, and
ourselves; these views lead to distinctive behaviors that we adopt in pursuit of our
life goals.
Key concepts
◦ Consciousness, not the unconscious, is the center of personality. The Adlerian
approach is based on a growth model and stresses the individual’s positive
capacities to live fully in society.

◦ Adler saw humans as creative beings who possess strengths and abilities to
effectively meet the problems of living. The theory is characterized by seeing unity
in the personality, understanding a person’s world from a subjective vantage point,
and stressing life goals that give direction to behavior.
◦ Social interest, the heart of this theory, involves a sense of identification with
humanity, a feeling of belonging, and a concern with bettering society.

◦ Inferiority feelings often serve as the wellspring of creativity, motivating people to

strive for mastery, superiority, and perfection. People attempt to compensate for
both imagined and real inferiorities, which helps them overcome handicaps.
Therapeutic goals
◦ Counseling is a collaborative effort, with client and therapist working on mutually
accepted goals.

◦ Change is aimed at both the cognitive and behavioral levels.

◦ Adlerians are mainly concerned with challenging clients’ mistaken notions and
faulty assumptions.

◦ Some specific goals include fostering social interest, helping clients overcome
feelings of discouragement, changing faulty motivation, restructuring mistaken
assumptions, and assisting clients to feel a sense of equality with others
Therapeutic relationship.
◦ The client–therapist relationship is based on mutual respect, and both client and
counselor are active parties in a relationship between equals.

◦ Through this collaborative partnership, clients recognize that they are responsible
for their behavior.

◦ The emphasis is on examining the client’s lifestyle, which is expressed in everything

the client does. Therapists frequently interpret this lifestyle by demonstrating
connections between the past, the present, and the client’s future strivings.
Techniques.
◦ Adlerian therapists have developed a variety of cognitive, behavioral, and
experiential techniques that can be applied to a diverse range of clients in a variety
of settings and formats.

◦ Some specific techniques they often employ are attending, encouragement,

confrontation, summarizing, interpreting experiences within the family, early
recollections, acting as if, catching oneself, suggestion, and homework assignments.
Multicultural applications.
◦ The interpersonal emphasis of the Adlerian approach is most appropriate for
counseling people from diverse backgrounds. The approach offers a range of
cognitive and action-oriented techniques to help people explore their concerns in a
cultural context.
The Existential Approach
◦ The existential perspective holds that we define ourselves by our choices.
◦ Although outside factors restrict the range of our choices, we have some freedom
because we control our attitudes and behavior.
◦ Because we have the capacity for awareness, we have freedom, yet with this
freedom comes responsibility for the choices we make.
Key concepts
◦ There are six key propositions of existential therapy:
◦ (1) We have the capacity for self-awareness.
◦ (2) Because we are basically free beings, we must accept the responsibility that
accompanies our freedom.
◦ (3) We have a concern to preserve our uniqueness and identity; we come to know
ourselves in relation to knowing and interacting with others.
◦ (4) The significance of our existence and the meaning of our life are never fixed
once and for all; instead, we re-create ourselves through our projects.
◦ (5) Anxiety is part of the human condition.
◦ (6) Death is also a basic human condition, and awareness of it gives significance to
living
Therapeutic goals
◦ The principal goal is to work with clients in recognizing their role in creating the
kind of life they presently have.
◦ The existential approach places primary emphasis on understanding clients’ current
experience, not on using therapeutic techniques.
◦ Existential therapists believe that we are capable of self-awareness, which is the
distinctive capacity that allows us to reflect and to decide. With this awareness, we
become free beings who are responsible for choosing the way we live, and thus we
create our own destiny.
◦ Making choices gives rise to existential anxiety, another basic human characteristic,
which is heightened when we reflect on the reality of death.

◦ Facing the inevitable prospect of eventual death gives the present moment
significance as we become aware that we do not have forever to accomplish our
goals. The reality of death is a catalyst that can challenge us to create a life that has
meaning and purpose.
Therapeutic relationship.
◦ The client–therapist relationship is of paramount importance because the quality of
the I-Thou encounter offers a context for change.

◦ Instead of prizing therapeutic objectivity and professional distance, existential

therapists value being fully present, and they strive to create caring relationships
with clients.

◦ Therapy is a collaborative relationship in which both client and therapist are

involved in a journey into self-discovery.
Techniques
◦ Therapists are not bound by any prescribed procedures and can use techniques
from other therapeutic models. Interventions are used in the service of broadening
the ways in which clients live in their world.

◦ Techniques are tools to help clients become aware of their choices and their
potential for action
Multicultural applications
◦ Clients in existential therapy are encouraged to examine the ways their present
existence is being influenced by social and cultural factors.

◦ From a social justice perspective, the freedom to choose needs to be viewed within
the context of environmental realities such as discrimination and oppression.
The Person-Centered Approach
◦ Person-centered therapy was originally developed by Carl Rogers in the 1940s as a
reaction against psychoanalytic therapy.

◦ Based on a subjective view of human experience, the person-centered approach

emphasizes the client’s resources for becoming self-aware and for resolving blocks
to personal growth.

◦ It puts the client, not the therapist, at the center of the therapeutic process. It is the
client who primarily brings about change. By participating in the therapeutic
relationship, clients actualize their potential for growth, wholeness, spontaneity, and
inner-directedness.
Key concepts
◦ A key concept is that clients have the capacity for resolving life’s problems
effectively without interpretation and direction from an expert therapist.

◦ Clients are able to change without a high degree of structure and direction from
the therapist.

◦ This approach emphasizes fully experiencing the present moment, learning to

accept oneself, and deciding on ways to change.
Therapeutic goals
◦ A major goal is to provide a climate of safety and trust in the therapeutic setting so
that the client, by using the therapeutic relationship for self-exploration, can
become aware of obstacles to growth.

◦ The client tends to move toward more openness, greater self-trust, and more
willingness to evolve as opposed to being a static entity.

◦ The client learns to live by internal standards as opposed to taking external cues for
what he or she should become. The aim of therapy is not merely to solve problems
but to assist a client’s growth process to enable him or her to better cope with
present and future problems.
Therapeutic relationship
The qualities of the therapist that determine the relationship include genuineness,
non-possessive warmth, accurate empathy, unconditional acceptance of and respect
for the client, permissiveness, caring, and the ability to communicate those attitudes
to the client.

Effective therapy is based on the quality of the relationship between therapist and
client. The client is able to translate his or her learning in therapy to outside
relationships with others.
Techniques
◦ Techniques are always secondary to the therapist’s attitudes. The approach
minimizes directive techniques, interpretation, questioning, diagnosis, and
collecting history.

◦ It maximizes active listening and hearing, expressing empathy, reflection of

feelings, and clarification.
Multicultural applications.
◦ The emphasis on universal, core conditions provides the person-centered approach
with a framework for understanding diverse worldviews.

◦ Empathy, being present, and respecting the values of clients are essential attitudes
and skills in counseling culturally diverse clients. Person-centered counselors
convey a deep respect for all forms of diversity and value understanding the client’s
subjective world in an accepting and open way.
Gestalt Therapy
◦ Gestalt therapy is an experiential and existential approach based on the assumption
that individuals and their behavior must be understood in the context of their
present environment.

◦ The therapist’s task is to facilitate clients’ exploration of their present experience.

Awareness, choice, and responsibility are cornerstones of practice.

◦ Clients carry on their own therapy as much as possible by doing experiments

designed to heighten awareness and to engage in contact. Change occurs naturally
as awareness of “what is” increases.
◦ This approach is phenomenological because it focuses on the client’s perceptions
of reality and is existential because it is grounded in the notion that people are
always in the process of becoming, remaking, and rediscovering themselves.
Key concepts.
◦ This approach focuses on the here-and-now, direct experiencing, awareness,
bringing unfinished business from the past into the present, and dealing with
unfinished business.

◦ Other concepts include energy and blocks to energy, contact and resistance to
contact, and paying attention to nonverbal cues.

◦ Clients identify their own unfinished business from the past that is interfering with
their present functioning by reexperiencing past situations as though they were
happening in the present moment.
Therapeutic goals.
◦ The goal is attaining awareness and greater choice. Awareness includes knowing
the environment and knowing oneself, accepting oneself, and being able to make
contact.

◦ Clients are helped to note their own awareness process so that they can be
responsible and can selectively and discriminatingly make choices. With awareness
the client is able to recognize denied aspects of the self and proceed toward
reintegration of all its parts.
Therapeutic relationship.
◦ This approach stresses the I-Thou relationship. The focus is not on the techniques
employed by the therapist but on who the therapist is as a person and the quality of
the relationship.
◦ Factors emphasized include the therapist’s presence, authentic dialogue,
gentleness, direct self-expression, and a greater trust in the client’s experiencing.
There is a creative spirit of suggesting, inventing, and carrying out experiments
aimed at increasing awareness.

◦ The counselor assists clients in experiencing all feelings more fully and letting them
make their own interpretations.
Techniques
◦ Gestalt experiments take many forms: setting up a symbolic dialogue between a
client and a significant person in his or her life; assuming the identity of a key figure
through role playing; reliving a painful event; exaggerating a gesture, posture, or
some nonverbal mannerism; or carrying on a dialogue between two conflicting
aspects within an individual
Multicultural application
◦ Gestalt therapy can be used creatively and sensitively with culturally diverse
populations if interventions are used flexibly and in a timely manner.

◦ Gestalt practitioners focus on understanding the person and not on the use of
techniques. Experiments are done with the collaboration of the client and with an
attempt to understand the background of the client’s culture.
Cognitive Behavioral Approaches
◦ Cognitive behavioral approaches, which include behavior therapy, rational emotive
behavior therapy, cognitive therapy, and reality therapy.

◦ It also includes an introduction to the third wave of behavior therapy approaches

known as mindfulness and acceptance therapies.
Key concepts
◦ Behavior therapy emphasizes current behavior as opposed to historical
antecedents, precise treatment goals, diverse therapeutic strategies tailored to
these goals, and objective evaluation of therapeutic outcomes. Therapy focuses on
behavior change in the present and on action programs.

◦ Concepts and procedures are stated explicitly, tested empirically, and revised
continually. There is an emphasis on measuring a specific behavior before and after
an intervention to determine if, and to what degree, behaviors change as a result of
a procedure.
Therapeutic goals
◦ The general goals are to increase personal choice and to create new conditions for
learning.
◦ An aim is to eliminate maladaptive behaviors and to replace them with more
constructive patterns.

◦ Generally, client and therapist collaboratively specify treatment goals in concrete,

measurable, and objective terms. In helping clients achieve their goals, behavior
therapists typically assume an active and directive role.

◦ Although the client generally determines what behavior will be changed, the
therapist typically determines how this behavior can best be modified.
Therapeutic relationship
◦ Although the approach does not place primary emphasis on the client–therapist
relationship, a good working relationship is an essential precondition for effective
therapy.

◦ The therapist’s role is to teach concrete skills through the provision of instructions,
modeling, and performance feedback. Therapists tend to be active and directive
and to function as consultants and problem solvers.

◦ Clients must also be actively involved in the therapeutic process from beginning to
end, and they are expected to cooperate in carrying out therapeutic activities, both
in the sessions and outside of therapy
Techniques
◦ Behavior therapy differs from other therapies in that it is brief, active, directive,
collaborative, and focused on factors maintaining problem behaviors rather than on
factors that may have triggered a problem initially.

◦ Assessment and diagnosis are done at the outset to determine a treatment plan.

◦ Behavioral treatment interventions are individually tailored to specific problems

experienced by clients.

◦ relaxation methods, systematic desensitization, in vivo desensitization,

flooding, assertion training, and self-management programs.
Multicultural applications
◦ Behavioral approaches can be appropriately integrated into counseling with
culturally diverse client populations when culture-specific procedures are
developed.

◦ By developing their problem-solving skills, clients learn concrete methods for

dealing with practical problems within their cultural framework
Rational Emotive Behavior Therapy
◦ Albert Ellis is considered the father of rational emotive behavior therapy (REBT) and
the grandfather of cognitive behavior therapy.

◦ Rational emotive behavior therapy rests on the premise that thinking, evaluating,
analyzing, questioning, doing, practicing, and redeciding are the basics of behavior
change.
Key concepts
◦ REBT holds that although emotional disturbance is rooted in childhood, people
keep repeating irrational and illogical beliefs.

◦ Emotional problems are the result of one’s beliefs, not events, and these beliefs
need to be challenged. Clients are taught that the events of life themselves do not
disturb us; rather, our interpretation of events is what is critical.
 Therapeutic goals
◦ The goal of REBT is to eliminate a self-defeating outlook on life, to reduce unhealthy
emotional responses, and to acquire a more rational and tolerant philosophy.

◦ Two main goals of REBT are to assist clients in the process of achieving
unconditional self-acceptance and to learn unconditional acceptance of others.

◦ To accomplish these goals, REBT offers clients practical ways to identify their
underlying faulty beliefs, to critically evaluate these beliefs, and to replace them with
constructive beliefs.
Therapeutic relationship
◦ Therapy is a process of reeducation, and the therapist functions largely as a teacher
in active and directive ways.

◦ As clients begin to understand how they continue to contribute to their problems,

they need to actively practice changing their self-defeating behavior and converting
it to rational behavior.
Techniques
◦ REBT utilizes a wide range of cognitive, emotive, and behavioral methods with most
clients. This approach blends techniques to change clients’ patterns of thinking,
feeling, and acting.

◦ Techniques are designed to induce clients to critically examine their present beliefs
and behavior.

◦ REBT focuses on specific techniques for changing a client’s self-defeating thoughts

in concrete situations. In addition to modifying beliefs, REBT helps clients see how
their beliefs influence what they feel and what they do.
Multicultural applications
◦ Some factors that make REBT effective in working with diverse client populations
include tailoring treatment to each individual, addressing the role of the external
environment, the active and directive role of the therapist, the emphasis on
education, relying on empirical evidence, the focus on present behavior, and the
brevity of the approach.
Cognitive Therapy
Overview and basic assumptions

◦ Aaron Beck is a pioneer of cognitive therapy who made important contributions in

understanding and treating disorders such as depression and anxiety.

◦ Cognitive therapy (CT) rests on the premise that cognitions are the major
determinants of how we feel and act. CT assumes that the internal dialogue of
clients plays a major role in their behavior.

◦ The ways in which individuals monitor and instruct themselves and interpret events
shed light on the dynamics of disorders such as depression and anxiety.
Key concepts
◦ According to CT, psychological problems stem from commonplace processes such
as faulty thinking, making incorrect inferences on the basis of inadequate or
incorrect information, and failing to distinguish between fantasy and reality.

◦ Cognitive therapy consists of changing dysfunctional emotions and behaviors by

modifying inaccurate and dysfunctional thinking.
Therapeutic goals
◦ The goal of CT is to change the way clients think by using their automatic thoughts
to reach the core schemata and begin to introduce the idea of schema
restructuring.
◦ Changes in beliefs and thought processes tend to result in changes in the way
people feel and how they behave.

◦ Clients in CT are encouraged to gather and weigh the evidence in support of their
beliefs. Through the collaborative therapeutic effort, they learn to discriminate
between their own thoughts and the events that occur in reality.
Therapeutic relationship
◦ CT emphasizes a collaborative effort by both therapist and client to frame the
client’s conclusions in the form of a testable hypothesis.

◦ Cognitive therapists are continuously active and deliberately interactive with the
client; they also strive to engage the client’s active participation and collaboration
throughout all phases of therapy
Techniques
◦ CT emphasizes a Socratic dialogue to help clients discover their misconceptions for
themselves.

◦ Through a process of guided discovery, the therapist functions as a catalyst and

guide who helps clients understand the connection between their thinking and the
ways they feel and act.
◦ Cognitive therapists teach clients how to be their own therapist. This includes
educating clients about the nature and course of their problems, about how CT
works, and how their thinking influences their emotions and behaviors.

◦ Techniques in CT are designed to identify and test the client’s misconceptions and
faulty assumptions.

◦ Homework is often used, which is tailored to the client’s specific problems and
arises out of the collaborative therapeutic relationship. Homework is generally
presented as an experiment, and clients are encouraged to create their own self
help assignments as a way to keep working on issues addressed in their therapy
sessions.
Choice Theory/Reality Therapy
◦ Choice theory rests on the assumption that humans are internally motivated and
behave to control the world around them according to some purpose within them.

◦ Choice theory, which is the underlying philosophy of the practice of reality therapy,
provides a framework that explains the why and how of human behavior.

◦ Founded and developed by William Glasser in the 1960s, reality therapy posits that
people are responsible for what they do. Based on existential principles, reality
therapy holds that we choose our own destiny.
◦ Reality therapy is based on the assumption that human beings are motivated to
change (1) when they determine that their current behavior is not getting them what
they want and (2) when they believe they can choose other behaviors that will get
them closer to what they want. Clients are expected to make an assessment of their
current behavior to determine specific ways they may want to change.
Key concepts
◦ The core concept of this approach is that behavior is our best attempt to control our
perceptions of the external world so they fit our internal world. Total behavior
includes four inseparable but distinct components—acting, thinking, feeling, and the
physiology that accompanies our actions.

◦ A key concept of reality therapy and choice theory is that no matter how dire our
circumstances may be, we always have a choice. The key to changing a total
behavior is through acting and thinking, for these aspects of total behavior are
easier to change than are the feeling and physiology components. An emphasis of
reality therapy is on assuming personal responsibility and on dealing with the
present.
Therapeutic goals.
◦ The overall goal of this approach is to help people find better ways to meet their
needs for survival, love and belonging, power, freedom, and fun. Changes in
behavior should result in the satisfaction of basic needs.

◦ Clients are expected to make a self-evaluation of what they are doing, thinking,
and feeling to assess whether this is getting them what they want and to assist them
in finding a better way to function.
Therapeutic relationship
◦ The therapist initiates the therapeutic process by becoming involved with the client
and creating a supportive and challenging relationship. Practitioners teach clients
how to make significant connections with others.

◦ Throughout therapy the counselor avoids criticism, refuses to accept clients’

excuses for not following through with agreed-upon plans, and does not easily give
up on clients. Instead, counselors continue to ask clients to evaluate the
effectiveness of what they are choosing to determine if better choices may be
possible.
Techniques
◦ The practice of reality therapy can best be conceptualized as the cycle of
counseling, which consists of two major components: (1) the counseling
environment and (2) specific procedures that lead to change in behavior. Reality
therapy is active, directive, and didactic.
◦ Skillful questioning and various behavioral techniques are employed to help clients
make a comprehensive self-evaluation. Some of the specific procedures in the
practice of reality therapy have been developed by Robert Wubbolding (2011,
2017).

◦ These procedures are summarized in the WDEP model, which refers to the
following clusters of strategies:
◦ W = wants: exploring wants, needs, and perceptions
◦ D = direction and doing: focusing on what clients are doing and the direction that
this is taking them
◦ E = evaluation: challenging clients to make an evaluation of their total behavior
◦ P = planning and commitment: assisting clients in formulating realistic plans and
making a commitment to carry them out
END