Approaches to counseling

Ed Marie T. Cruz M.D., DFM

Range of ways of making sense of human
being and a range of ways of allowing
theory to form our practice
How best to help them in a counseling
session
The Psychodynamic Approach Freud and Erickson

The unconscious level of the mind is

developed out of experiences that happened to
us in earlier parts of our lives that we were
unable to deal with at that time.
When we encounter an experience in the
present that in anyway similar to that past
event, we experience anxiety- we are
unconsciously reminded of that situation
The key to understanding a person’s behavior
is through a thorough exploration of the past
To explore the clients pasts history and help him/her identify, relive various painful, past
events in order to make the person less anxious and more able to make rational decisions
about the present
 determinism- is the notion that every event has a cause, every aspect of a person’s behavior
has a cause buried in the person’s past history.
Like a jigsaw puzzle once the pieces fit in then it becomes understandable
8 stages of life cycle by Erickson

Stage 1: birth to 18 months ( trust vs. mistrust)

Stage 2: autonomy vs. shame and doubt (18-3
years)
Stage 3: initiative vs. guilt (3-5 years)
Stage 4: Industry vs. Inferiority ( 5-13 years)
Stage 5: Identity vs. role confusion (13-21years)
Stage 6: Intimacy vs. Isolation (21-40 years)
Stage 7: Generativity vs. stagnation (40-60years)
Stage 8: Integrity vs. Despair(60-death)
 The eight stages represent points along a continuum of
development in which physical, cognitive, instinctual
and sexual changes combine to trigger an internal
crisis,
 the resolution of which results in either psychosocial
regression or growth and the development of specific
virtues- ( inherent strengths)
 crisis- refers not to a threat or catastrophe, but to a
turning point, a crucial period of increased
vulnerability and heightened potential and therefore the
ontogenetic source of generational strength and mal
adjustment
Stage 1
The infant is taking the world in through
the mouth, eyes, ears, and sense of touch
◦ Stage “to get” – received what is offered and
elicit what is desired
◦ Stage of “taking and holding”- reaches out for
sensation and grasps its surroundings
◦ The basic trust in the world stems from its
earliest experiences with its mother or primary
caregiver- the quality of maternal relationship
A baby whose mother can anticipate and
respond to its needs in a consistent and timely
manner- will learn to tolerate inevitable
moments of frustration and deprivation
Trust will predominate vs. mistrust and hope
will crystallize
Disturbance in this stage- distrust or the
virtue of hope
Being empty and no good
Stage 2 autonomy vs. shame and doubt
Social modalities of holding on to and
letting go,
 development of the will- depends on the
amount and type of control exercised to
the child
Too rigid control or too early defeats the
childs own internal controls-
regression/false progression
This stage becomes decisive for the ratio
between loving goodwill and hateful self
insistence, between cooperation and
willfulness, between self expresion and
compulsive self restraint and meek compliance
When the ratio is favorable- the child develops
a sense of autonomy and the capacity “to have
and to hold”
where it is unfavorable, doubt and shame will
undermine free will
The sense of autonomy fostered in the child and
modified as life progresses serves the preservation
in economic and political life of a sense of justice
If derailed in this stage- perfectionism, inflexibility
and stinginess of the person with an obsessive
compulsive personality may stem from conflicting
tendencies to hold on and let go
Fixation at the transition between hope and
autonomous will-with its residue of mistrust and
doubt- develop paranoiac fears of persecution
Stage 3
Jealousy and rivalry now come to a climax in
the final contest of favoured position of one
of the parents; the inevitable and necessary
failure leads to guilt and anxiety
Inadequate resolution of the conflict between
initiative and guilt--- development of
conversiondisorder, inhibition and phobia
Ovecompensation – drive themselves to hard
to stress and deveop psychosomatic
symptoms
 Stage 4.
The child discovers the pleasures of production,
learning new skill s and taking pride in them
Unprepared for this stge – inferiority and inadequacy
Teachers and role models society becomes crucially
important in the childs ability to overcome that sense
of inferiority and achieve the virtue known as
competence
Pathology- the emergence of a conformist immersion
into a world of production in which creativity is stifled
and identity is subsumed under the workers role
Stage 5
The question of identity- primairly concerned
with what they appear in he eyes of others as
compared to what they feel they are and with the
questio how to connect with the roles and skills
cultivated earlier with occupational prototypes of
the day
Failure to negotiate in this stage leaves the
adolescent without solid identity, they suffer from
role diffusion or role confusion charactrized by
not having a sense of self and by confusion about
their place in theworld
Role confusion manifestation:
Running away, criminality and overt psychosis, problems in
gender identity and sexual role may manifest at this time,
joining cliques or cults or identifying with folk heroes
Projecting self image into a partner Overidentification of
idealized figure are means of seaking self definition
More sharply focused idenity leads to fedility not only to
self definition but to the ideology that provide version of
self in the world
Role confusion ensues when he is unable to develop a sense
of identity and belonging. Erickson- delinquency, gender
related identity disorders, and borderline psycholtic
episodes can result from such confusion
Stage 6: intimacy versus isolation
Intimacy in young adult is tied to fidelity (honor and
commitment)- even when that requires sacrifice and
compromise
The person cannot tolerate the fear of ego loss arising out
of the experiences of self abandonment is apt to become
isolated and self absorbed
Distandation- the readiness to repudiate to isolate , to
destroy those forces and persons whose essence seems
dangerous to one’s own- the pathological outcome of
conflicts surrounding intimacy and in the absence of
ethical sense where intimate, competitive, and combative
relationships are differentiated forms the basis for various
forms of prdudice, persecution and psychopathology
Stage 7: Generativity vs.stagnation
Generativity- protective concern for all
generations and for social institutions,
encompasses productivity and creativity as
well
Care is the virtue that coalesces at this age
When persons cannotdevelop tru genrativity,
they may settle for pseudoengagement in
occupation- they restrict their focus to the
technical aspects of roles- greater
responsibility for the organization or profession
Failure of generativity lead to profound personal
stagnation, masked by period of escapism, such as
alcohol and drug abuse and sexual and other
infidelities
Midlife crisis can occur or premature invalidism
can occur
Pathology not only in the person but on the
organizations that depend on their leadership
Failure lo develop can lead to: sick, withered, or
destructive organizations that spread the effect of
failed generativity throughout society
Integrity vs. despair
Integrity- the acceptance of once body and one’s life
cycle and of the persons who have become significant
to it as something that had to be and that, by necessity
permitted nos substitutions
He relingueshes the the wish that different persons in
his life had been different and is able to love in amore
meneaning way- one that reflects accepting
responsibility for one’s own life
The individual in possession of virtue of wisdom and a
sense of integrity has room to tolerate proximity of
death and to achieve “ detached yet active concern
with life”
According to Erikson: the style of integrity
developed by his culture thus becomes the
patrimony of his soul… in such final
consolidation death losses its sting”
When the attempt to attain integrity has failed,
the individual may become deeply disgusted
with the external world and contemptuous of
persons as well as institutions– such disgust
masks a fear of death and a sense of despair that
time is now short, too short for the attempt to
start another life and try out alternate roads to
integrity
The psychodynamic approach in practice
The health professional who adopts the
psychodynamic approach to counseling will
tend to
1. Highlight the relationship between past
and present life events
2. Acknowledge that unconscious forces are
at work that affect the client’s behavior;
3. Encourage the expression of pent up
emotion
Ex. Of applications of psychodynamic
approach in health care
1. Helping with long-term emotional
problems
2. Coping with anxiety
3. Helping the client who talks of having
had an unhappy childhood
The Behavioural approach Watson

Watson- all human behavior are learned and can

therefore be unlearned
Such learning develop through the process he
called positive reinforcement
We learn behavior that we are encouraged to learn
and forget those behaviors, for which no
encouragement is forthcoming
Once identified, next step is to develop a scheme
whereby more positive behaviors are encourage
The key is learning and relearning, and unlearning
The Behavioural Approach
The health professional who adopts the
behavioural approach to counseling will tend to:
1. Set practical aims and objectives in
counseling
2. Discuss behaviour rather than reasons for
patterns of behaviour
3. Identify a practical programme of small
changes that the client will be able to achieve
in order to cope with problems of living
Ex. Of applications of Behavioural
Approach
1. Dealing with long-term behaviour
problems
2. Helping with behaviour problems in
children
3. Enabling clients to cope with
bereavement
The Humanistic Approach
Drawing from existential philosophy, humanistic
psychology argued that people were essentially
free and responsible for their own condition.
They are neither driven by unconscious mind nor
were the a product of what they learned
There is no grand plan of how people s mind
works or how their behaviour could be
manipulated
Stresses individuality and individual differences
in human condition
Humanistic approach
Roger’s client centered counseling developed
Trusting the individual’s ability to find his or
her own way through the problems
He believed that people were essentially life
asserting and “good” by nature
Its accepting them and help them to progress
through the difficulties by their own route
Counselors simply accompany people to find
their own meaning
Humanistic Approach Carl Rogers

The health professional who adopts the

humanistic approach to counselling will
tend to:
1. Avoid interpreting the client’s behaviour
2. Seek to encourage the client to identify
their own solutions to their problems
3. Acknowledge that every individual is to
some degree responsible for his her own
behaviour
Examples of humanistic approach
1. Dealing with spiritual distress and
problems of meaning:
2. Helping with problems of self image
3. Helping to free the client who believes
that they are somehow controlled by their
circumstances
The Cognitive Approach Albert Ellis

What we think about ourselves affects the way we

feel about ourselves.
 If we change our way of thinking we can modify
feelings
The argument is that many people hold
exaggerated or incorrect beliefs about themselves
that affect their self image
The aim is to challenge these inaccurate and
negative statements in order to modify the way a
person thinks about themselves and how they feel
about themselves
Examples of these beliefs:
‘No one like me’
‘Everyone thinks I’m stupid’
‘I can’t cope with anything’
Anyone who holds this beliefs experience distress,
since they affect the way the people acts on those
beliefs
The style of counseling is that is that of challenging
and confronting the belief system
Used effectively with people who suffer from
depression and debilitating problems in living
Cognitive approach
The health professional who adopts the
cognitive approach to counselling will tend to:
1. Rely less on personal warmth and more on
confrontation in the counseling
relationship:
2. Use a logical and rational approach to
problem solving
3. Encourage the patient to develop a realistic
and pragmatic outlook on life
Example of cognitive approach
1. helping the person who is depressed
2. Helping the person who has multiple
problems
3. Encouraging rational thinking in
someone who is highly emotional
Transactional-Analysis Approach Eric Berne
Describing and discussing the people’s relationships
with one another we all relate to other people and the
world from 3 distinct ‘ego states’- parent, adult, child
Parent –( which developed through early absorption of
parental and judgmental attitudes) we tend to talk down
to others
Child-(developed through our experiences of being a
child) we tend adopt subservient relationships with
other people, we become dependent or submit readily
to their demands and feel uncomfortable as a result
Berne argues – the most appropriate method of
relating to others is through Adult- we meet
others as mature, equal beings

Cross transactions happen when the usual parent

child transaction shifts into Adult – Adult basis

The aim of transactional analysis is to enable

clients to identify the sorts of relationship
‘games’ with one another via this ego states and
learn more readily on an ADULT –ADULT basis
The transactional analysis approach
1. notice the interpersonal games that
people play
2. Encourage he client to remain adult in
his or her relationships
3. encourage the client to try new
strategies in his or her relationships
Examples of transactional approach
1. Marital and relationship difficulties
2. Encouraging the client to become more
assertive
3. Identifying more adult ways of dealing
with problems
 Personal-construct approach George Kelly

Uses the metaphor of a scientist to describe how a

person progresses through life.
Thus what we do is we predict things will be in the
future( we develop a hypothesis). Then we test out that
hypothesis in terms of what actually happens- we
therefore then either confirm or discard that hypothesis
Life therefore is a series of personal predictions and
confirmations or reconstructions
Our view of the world and of ourselves changes to
what happens to us and what sense we make of what
happens to us
We view the world through a series of constructs
or ways of viewing
Likened to a series of a pair of goggles that we put
on at various times to make sense of what we
perceive
No right or wrong goggles but they may merely
represent different aspects of the world that stand
out or are important to us
Personal construct-view this person as an evolving
dynamic subject who is continuously modifying
their view of the world in the light of what
happens to them
exercise
1. Think of the people you know, choose people from
different aspects of your life.
2. Now consider a way in which two of those people
are similar and different to the third.
3. ( you have created a construct)
4. Now consider what you take to be the opposite of
that quality, behaviour or characteristic
5. This other characteristic represents another aspect of
the person’s construct system
6. Now consider to what degree you tend to view
people in terms of those qualities, behaviours or
characteristics
Try this activity again to different sets of
people and see what constructs you elicit
in this case

For Kelly this represent something of

your particular and idiosyncratic way of
viewing the world
Personal construct approach
1. Acknowledge that people differ from one
another in fundamental ways
2. Look at the clients belief and value
system as clue to problem solving
3. Avoid interpreting the clients problem
Ex. Of personal construct approach
Helping the client to enhance self
awareness
Coping with marital and relationship
difficulties
“Unpacking” complex and multifaceted
problems
 Gestalt-therapy approach Fritz Perls 1969

gestalt-corresponds to the notion of completeness or

wholeness
Emphasizes the interplay between psychological mental state
and the state of the body- thus pointing to the totality of the
whole experience
It concentrates on the changing and fluctuating nature of
mental and physical states and concentrates specifically to the
person now.
Emphasize on the client interpreting or making sense of what is
happening to them
The gestalt approach encourages the client to become aware of
what they are thinking, feeling and sensing, physically
Gestalt therapy approach
1. Treat each counseling situation as unique
2. Deal with issues as they arise and in the
here and now
3. Notice small, non-verbal behaviours
exhibited by the patient
Ex. Of gestalt applications
1. Helping the client who bottles up
emotion;
2. Helping the person who has difficulty in
verbalizing his or her problems
3. Coping with problems of self image and
self confidence
Eclectic approach
Incorporates the approaches that most suit
the person into a personal repertoire
This personal style offers the most flexible
approach to counseling
Skilled in a wide range of possible
counseling interventions in order to help a
wide variety of people
The counselling relationship belongs to the
client , its finding out what they really want
Eclectic approach
1. Believe that no one approach to
counselling suits each situation
2. Read widely and learn a variety of
different sorts of counseling skills;
3. Run the risk of being “ jack of all
counseling skills and master of none’!
Examples of eclectic approach
1. Everyday counseling practice
2. Working with a client who does not
respond to a particular counseling
approach
3. Helping the person who has varied
problems of living
Thank you