INTEGRATIVE

APPROACHES Session 2

TO Pauline Elwell
pauline.elwell@canterbury.ac.uk

COUNSELLING
AND THERAPY
 o To analyse and develop a practice-based understanding of these
theories through active engagement in skills practice throughout the
module.
o To engage critically with the approaches and to explore their
suitability for different populations of clients in different contexts.
o To explore a range of challenging issues raised in counselling,

MODULE including loss, separation, bereavement, addiction, self-harm.

AIMS o To apply and evaluate the application of advanced counselling and

interpersonal skills, including challenge, immediacy and use of
silence. Critically
o To evaluate the impact of the social and cultural context in which
counselling takes place and develop appropriate understanding of
diversity and multicultural approaches within the helping professions.
 o Clearly explain an integrative approach to counselling in practice.

oAnalyse and critically evaluate Transactional Analysis to understand

communication and relationships within the helping encounter.

oAnalyse the integration and application of Transactional Analysis

MODULE (TA), Cognitive Behavioural Therapy (CBT) or Solution Focused

(Brief) Therapy (SFT or SFBT) in helping relationships, using an

OUTCOM integrative model.

ES oIdentify and apply counselling skills and approaches for working

with a range of challenging issues with due reflection upon the
issues of diversity and power within the helping interaction,
recognising developmental and learning needs.
CONTRACT
oRespect each other’s rights to their opinions/views oMobiles – on desks if necessary for dependents an/or

oAdopt a non-judgemental approach (if possible?) only use for session activities

oPunctuality – plan to arrive / start on time.

oShare if/when you feel safe to do so
oListening – giving space/not interrupting
oPositive/supportive learning environment
oTaking responsibility for the contract
oEngage fully in learning activities
oBehave assertively/positively
oConfidentiality (within the boundaries discussed at
oRespond respectfully
time of contract ) anonymity
oHow can we challenge when we feel that the
oEmbracing diversity
contract has not been adhered to?
 Congruence

CORE
CONDITIO Acceptance – Unconditional
Positive Regard
NS
Empathy
ASSIGNMENT

1. Case study- 2000 words (50%) Due: 13 th March 2pm

Analyse and critically evaluate a case study in relation to theory.

2. Reflective essay 2000 words (50%) Due: 17th April

Focussing on a particular area explaining and evaluating the most
appropriate approaches.
 THEORETICAL
APPROACHES
The majority of the mainstream approaches and
theoretical models, can be considered under one of
four primary ‘umbrella’ headings:

o Psychodynamic Approaches
o Humanistic Approaches
o Cognitive-Behavioural Approaches
o Integrative or Pluralistic Approaches.
 APPROACHES IN
PRACTICE
All main approaches outlined can be found in a variety of settings, including:
Health care settings,
Education settings and
including primary and Social care settings Independent practice
CAMHS
secondary care

The last few years has seen a particular emergence of CBT in health-care settings, partly
due to an abundance of quantitative research evidence and partly due to the commissioning
of Increasing Access to Psychological Therapies (IAPT) services for adults and latterly for
children and young people

Research evidence supports the use of all four umbrella approaches with a range of different
client presentations.
WHAT
Being pluralistic in our own philosophy – accepting that there are diverse
world views. Binary thinking sees the world in polar opposites (good/bad,
right/wrong). The integrationist adopt a broader worldview and
acknowledges, accepts and embraces diversity

DOES IT Being committed to the project, not just the approach. Accepting that there

MEAN TO
is no absolute truth, and since none of us really know, let’s commit to
working together to find out what will work in this case

BE Being expansive – insight can be found in many/varied places. All the

fields of life, literature, science, art, philosophy and so on are available to
us

INTEGRAT Being open to experience – making creative use of the their experience

IVE? through therapeutic practice. Reflection and reflexivity is central

Being able to tolerate anxiety and uncertainty – not within the counsellor’s
gift to bring harmony and order, but rather to work with the uncertainty and
anxiety without sticking relentlessly to a single approach
 INTEGRATIVE
APPROACH -
DEFINITIONS
Cognitive Person-
‘Integration covers a wide range of
perspectives, making it impossible to present a
Behavioural centred
unified set of theoretical assumptions in a way Therapy Therapy
that may be possible for purist approaches’

(Dryden and Reeves (2014)

‘the counsellor brings together elements from

different theories and models into a new theory Solution
Transactiona
or model’ (McLeod (1998) Focussed
l Analysis
Therapy
‘What is integrated is any knowledge that
helps me understand the client, her process,
myself and the therapy’ (Worsley, 2011)
 The Skilled Helper Model is grounded in the
Person Centred Approach with recognition of CBT
and other approaches (e.g. TA or solution focused)
3 stages
EGAN’S
SKILLED 1. Current scenario – where am I now?

HELPER
MODEL 2. Preferred scenario – where do I want to be?

3. Strategy: getting there – how am I going to get

to where I want to be?
NEW APPROACHES
TO INTEGRATE IN
COUNSELLING
PRACTICE

Transactional Analysis (TA)

Solution-focused Brief Therapy
(SFBT)
Cognitive Behavioural Therapy(CBT)
TRANSACTIO
NAL
ANALYSIS
oDeveloped by Eric Berne in the 1960s
oRoots in psychodynamic counselling: Id,
Ego, Super-ego and the importance of
unconscious
oFocus on raising unconscious >
conscious
oWe communicate (transact) in 2 ways:
conscious (words we use) unconscious
(how we say words and what we don’t
say!)
oEgo states Parent, Adult Child
oThe way in which we communicate will
stimulate a response.
FREUD MCLEOD PAGES 82-90
 PARENT-ADULT-CHILD
EGO STATE MODEL (PAC)
THE PARENT EGO STATE

The parent ego state contains the attitudes and behaviours that are observed
and copied from the individual’s caretakers and figures. In other words the
spoken and unspoken rules. The “shoulds’ and the ‘oughts” of life. The
individual’s early parent is formed in the child from birth to approx five
years and in Transactional Analysis terms is called the parent in the child or
the P1. The complete parent ego state or the P2 is formed between the ages
of five years to approx twenty years as a result of even more external stimuli
from their authority of caretaker figures.
When the P2 is activated in later life, the person will be acting in the ways
that their authority figures will have acted, indeed this is the model that the
individual will have incorporated into his own parent, though it must be
noted that each individual will have a different parent ego state and will act
in their own unique way.
CASE STUDIES TO DEMONSTRATE
THE APPLICATION OF THEORY TO
PRACTICE
The Parent Ego State

(Case Study One)

Bob was the leader of his group of friends and it was he who always set the time that they should
meet, where they should go and what they ‘should do’. He often shook his finger at his friends
reprovingly. People in his circle of friends eventually got fed up of him and many left the group.

(Case Study Two)

Mary and Joan were good friends and they went everywhere together. When Joan’s mother died it was
Mary who looked after her and often put her arm around Joan saying such words as ‘Don’t worry
about things. I will help you with all your work; I love you a lot you know’.

The above then, are examples of a controlling parent behaviour and a nurturing parent behaviour, of
the Parent Ego state
THE ADULT EGO STATE
The Adult Ego State emerges around six months in the child and is
concerned primarily with appraising facts, reasoning, thinking,
evaluating and responding to available data.
It is described by many Transactional Analysis writers like a computer,
concerned only with rationality and logic.
Berne’s commentary, describes an adult as coming from an integrated
stance which does not mean that when the person activates their adult
ego state he/she is coming from just a rational position, but that he/she
also has access to feelings, thinking and attitudes. Indeed the person
will be part of the ‘here and now’ and experiencing and coming from
an integrated adult stance.
CASE STUDIES TO DEMONSTRATE
THE APPLICATION OF THEORY TO
PRACTICE
Case Study 1.

James decided to go and see his aunt who lived in the next town – as
he had never left his town before, he had to get his map out to work
out how he would get there – this he did successfully and he got to
his aunt’s house at the time he said he would. Thus we can see that
James used his adult ego state to work out logically, given the facts,
how to solve a given problem.
THE CHILD EGO STATE
The Child Ego State is primarily concerned with feelings though that does not mean that
when in the ‘here and now’ experience the person does not have access to attitudes and
thinking, but it simply means that when activated feelings are usually the executive energy
force.
The child ego state is the part of the personality, which is preserved from actual childhood; it
also contains all the impulses a person was born with.

The child ego state is, as said above, primarily about spontaneous feelings, needs and wants
of the child. It is also important to note that the child ego state contains ‘recordings’ of
childhood memories and experiences.
Therefore, when the person feels and acts as they did when they were very young, they are
experiencing their child ego state.
THE CHILD EGO STATE
An example of the difference between the free and adapted child
ego state would be for example, the person who complies to
almost anything and perhaps may automatically say ‘thank you’
whilst repressing other feelings, as opposed to the free child
stance of free and spontaneous feelings, according to the situation.
The free child is naturally inquisitive, curious and often does act
without thinking of the consequences.
THE CHILD EGO STATE
Another stance of the adapted child position is one of pseudo-
rebellion. In other words, an aware adaptation to a particular situation
is the flip child of the compliant child stance.
Again, different people will respond differently to situations and thus
different ego states will be activated according to their past messages
in life. But, almost certainly, most people will have access to all parts
of their personality if they wish, and certain ego states may well
dominate their personality in may situations of their lives.
CASE STUDIES TO DEMONSTRATE THE
APPLICATION OF THEORY TO PRACTICE -
THE CHILD EGO STATE
(Case Study One)
When John’s mother died when he was three years old, he was too young to
really understand what had happened, he just felt hurt that his mother had
gone away. When he was fifteen years of age, John had a hard time trusting
women – he often complained that women left him and let him down a lot
when he most needed them. Other people felt that women were really good
to him and helped him a lot.
(Case Study Two)
Fiona when a small girl could get her father to do anything she really
wanted. Indeed as she grew up she was very good at managing to get men to
do what she wanted. Later, she was fired from several jobs by her bosses
who said they felt she was manipulating them.
 Identification of the ego state from which a client is
transacting can be made reliably through questioning and
observation

THE TA Counsellors are able to judge on an on-going basis whether

PAC clients are re-playing their childhood (Child), accessing

communication learned from parent or parental figures
(Parent) or responding directly in the here and now (Adult)
MODEL IN Counsellors who understand and can identify their own ego

PRACTICE states, are able to monitor their responses to clients

….. Counsellors with this knowledge can help themselves and

their clients to choose which response they want to make
(they are therefore in control of their communication).
CASE STUDY ROLE PLAYS
During the next few weeks we will be analysing and discussing case studies.
We will consider a framework for analysis and a range of questions we might ask.
In order to do this we will enter into a type of role play.
In this role play we will have a client, a counsellor and a supervisor as roles. The
counsellor will present the case study and the supervisor will ask questions about it.
We will do this in triads:
o 1 client 1 counsellor 1 supervisor
o Role play discussion- please make notes
o Debrief as whole group
o Reflections.
FROM:

LISTER-FORD, C. (2002). SKILLS IN TRANSACTIONAL ANALYSIS COUNSELLING & PSYCHOTHERAPY. LONDON ;

THOUSAND OAKS, CALIF.: SAGE.
FROM:

L I S T E R - F O R D , C . ( 2 0 0 2 ) . S K I L L S I N T R A N S A C T I O N A L A N A LY S I S C O U N S E L L I N G & P S Y C H O T H E R A P Y. L O N D O N ; T H O U S A N D O A K S , C A L I F. : S A G E .

This is a complementary
exchange.
Mary’s Stimulus 1 is met by
the Counsellor’s Response 1
and they complement.

Why might this be successful?

FROM:
L I S T E R - F O R D , C . ( 2 0 0 2 ) . S K I L L S I N T R A N S A C T I O N A L A N A L Y S I S C O U N S E L L I N G & P S Y C H O T H E R A P Y. L O N D O N ; T H O U S A N D O A K S , C A L I F . : S A G E .
ROLES: INITIAL MEETING

Client: Take one of the case studies and imagine the first meeting with the client-
what might you say?
Counsellor: How will you respond?
Supervisor: Can you identify the transaction that happened?

You might want to try the transaction in a number of ways- play with it a bit.
AND
FINALLY….
REFLECT
What has intrigued you from today’s session,
or raised your curiosity?
Any experiences/work with
clients/friends/family members where you
can see TA (ego states) being acted out?
KEY ACTIVITIES BEFORE THE
NEXT SESSION:
Watch part 2 Games More on the drama triangle
KEY ACTIVITIES BEFORE THE
NEXT SESSION:
Read Research

Lister-Ford, C. (2002). Skills in Continue to research an issue such as

transactional analysis counselling & •Bereavement
psychotherapy. London ; Thousand •Separation
Oaks, Calif.: Sage. •Loss
•Addiction
 Ch1
•Self harm
 Ch 2