Counselling Theoretical Approaches

In counselling there are many aspects to consider (e.g. the relevance of the approach to the condition, the concept of counselling supervision, etc.). Counselling can be actually a dangerous occupation (Breakwell, 1989). Counsellors need to have in place structures, safeguards and procedures that ensure that, as far as possible, they are protected from abuse, exploitation, or the acting out of destructive fantasies by disturbed clients. Similarly they need to make sure that, whatever intake and assessment procedures they employ, they take on for counselling, certainly in an out-patient setting, only those individuals who give a reasonable indication that they are psychologically minded and can make appropriate use of a counselling relationship and process (Lemma, 1996; Palmer and McMahon, 1997).

In particular, counsellors need to pay attention to issues relating to the client’s boundaries and sense of self and be wary of taking on individuals who have such poor ego boundaries that a fragile sense of self may disintegrate to a point where boundaries between self and other are no longer discernible and capable of being respected. Therapists have been persecuted, stalked and even killed (Lemma, 1996) by seriously disturbed clients. Therapy for some may only be safely proffered in an environment that provides security and protection for both client and therapist, for instance within the confines of a secure psychiatric unit where the risk of the client acting out destructive fantasies against the therapist is reduced by institutional safeguards that serve to protect and preserve the physical welfare and anonymity of the therapist. The use of self is also, and crucially, about therapists knowing and respecting their own limits as well as those of their clients. This paper will present the literature review on the concept of counselling supervision and the different model that can be used for a successful counselling supervision.

For almost fifty years pass, there has been an explosion of various approaches to counselling and psychotherapy. There have been more than 400 to be listed (Dryden and Mytton, 1999). Unfortunately, many of these are rather obscure and are not widely used. Further, this array of approaches can be very confusing both to the uninitiated and also those who are directly inclined with the profession. But then again, this medley of diverse approaches to counselling simply represents the individuality of every human being and the seemingly innate search for truth and meaning of life.

This paper discusses three (3) counselling theoretical approaches namely: cognitive-behavioural therapy, reality therapy, and person-centred counselling. Further, it presents the relative merits and limitations of these different theoretical approaches to counselling, and with a particular emphasis on the circumstances under which each approach is most relevant and effective.

Cognitive Behavioural Counselling

According to Dryden and Mytton (1999), cognitive-behaviour therapy is a generic term comprising a number of approaches which all have in common the assumption that human thoughts or cognitions have a great influence on our emotions. Such cognitive approaches, as mentioned by the Association for Behavioral and Cognitive Therapies (ABCT) (no date) are often collectively referred to as cognitive behaviour therapy (CBT) since most now include behavioural components. The British Association of Behavioural and Cognitive Psychotherapies (BABCP) with Grazebrook and Garland (2005) declared that CBT is the generic name of numerous and various therapies that share some common elements. Proponents of these approaches believe that for therapy to be successful not only must a client's cognitions change but also their behaviour. Some problems seem more amenable to behavioural techniques while others respond better to cognitive techniques.

Sheldon (1995) argued that cognitive-behavioural therapy is a branch of applied psychology which seeks to change problematic behaviour by modifying the environmental contingencies that surround it; weakening previous conditioned associations which have resulted in maladaptive emotional reactions; offering clients more effective models of problem-solving and interpersonal behaviour; and which seeks to change the ways in which stimuli are recognized and interpreted in the first place-offers an objectively superior basis for the therapeutic, counselling or casework roles of the counsellor, psychologist or social worker.

The most outstanding feature of CBT is the inclusion of both cognition and behaviour (Keller et al., 2000). Cognitive-behavioural configurations appear to be effective across a wider range of problems than can be claimed for unadorned behavioural methods (Sheldon, 1995). Also, CBT is commonly utilised by experts because of it is evidence-based (through randomised controlled trials – RTCs, uncontrolled trials, case series and studies) and cost effective in the psychotherapy of many disorders. Similarly, Grazebrook, Garland and the BACBP (2005) aim problems in the ‘here and now’ with much less therapeutic time constant to experiences in early life. The therapeutic relationship is a very important ingredient but it is not considered as the main mechanism for change (as to compare with other psychotherapies) (Kendall, 2005). The main focus is the collaborative output on equally agreed problems. Meanwhile, when taken individually, cognitive and behavioural therapies are both highly structured and flexible because of the constant judgment of the result of the interventions (Grazebrook, Garland and the BACBP, 2005). Where client reactions to the therapeutic medium are gathered in studies, cognitive-behavioural approaches emerge as a 'user-friendly' approach compared to alternatives, and drop-out rates are often lower (Sheldon, 1995). CBT is a form of therapy that addresses problems in a straight and targeted means. In CBT, there is common model of understanding in reference to psycho-educational approach, democratic sharing of the formulation and teaching of self-evaluation and management skills (Reinecke et al., 2003). Lastly, there are more recommendations to be accumulated in CBT due to the evidence-based guideless at hand (Grazebrook, Garland and the BACBP, 2005; Roth & Fonagy, 2005).

In application, Grazebrook, Garland and the BACBP (2005) summarizes that various CBT models were developed to address the increasing range of mental health and health difficulties including severe and enduring mental health problems (e.g. psychosis, schizophrenia, bi-polar disorder), anger control, pain, adjustment to physical health problems, insomnia and organic syndromes, such as early stage dementia. Also, Briere and Scott (2006) involved cognitive interventions in the management of trauma, Tanner and Ball (2001) and McCullough (2003) applied it to depression, and Deblinger and Heflin (1996) used it to sexually abused children and their non-offending parents.

The most important consideration to CBT approaches when it comes to its limitation in interventions is the specific identification of problem (Albano and Kearney, 2000; Grazebrook, Garland and the BACBP, 2005; Roth & Fonagy, 2005). As cognitive-behaviour therapists likewise integrated cognitive and behavioural approaches to counselling and psychotherapy, there is a further need to study the situation as normal standard procedure.

Reality Therapy

Citing The William Glasser Institute (2006),

Reality Therapy is the method of counseling that Dr. Glasser has been teaching since 1965. It is now firmly based on Choice Theory and its successful application is dependent on the counselor's familiarity with, and knowledge of, that theory. In fact, teaching Choice Theory to counselees (whether clients or students) is now part of Reality Therapy.

Today, reality therapy is among the most popular psychotherapy approaches and widely applied in the field of education. This approach focuses on the here-and-now of the client and how to create a better future, instead of concentrating at length on the past (The William Glasser Institute, 2006). Considered as cognitive-behavioural approach to therapy, it emphasizes making decisions, and taking action and control of one's own life particularly behaviours and cognitions (Myers and Jackson, 2002). Also, Neenan and Dryden (2004) believe that RT centres on assisting clients towards awareness of, and if necessary, transformation of their thoughts and actions.

Moon and colleagues (2004) further declared that RT consists, at its most fundamental level, of four questions: What do you want? What are you doing? Is what you are doing getting you what you want? Do you want to figure out a better way? In application to education, this approach provides a conceptually simple yet effective method for working with emotionally challenged youth as it also requires those working with the student to develop a positive, friendly relationship, especially with those who do net want such a relationship (Moon et al., 2004). Unlike with some psychological models, RT encourages everyone who works with the student to enter into a counselling relationship with them, not just the psychologist (Moon et al. 2004). Thus, group participation and collaboration is patronised.

There are still further characteristics that RT approach must prove. The arguments on the ‘past versus present’ situation and the concept of disconnection are elementary stages to be dealt relative to its full identification as an effective therapeutic intervention. With the limitations of RT, critics state that this approach is not yet widely known and little tested (Neenan and Dryden, 2004). Its "one answer solves all" approach is opposed as similar to many other "one answer solves all" conventions of psychotherapy. However, with the constant development and enquiry on the execution and relevance of RT, its effectiveness will fully materialise given the proper intervention to specific kinds of circumstances particularly in education.

Person-Centred Counselling

Person-Centred Therapy (PCT), also known as Client-centred therapy revolves around the idea of empowering the client in the therapeutic relationship as the expert, rather than the therapist, went against the grain of traditional therapy (Schapira, 2000). This was developed by humanist psychologist Carl Rogers and referred as counselling rather than psychotherapy. Accordingly, the most outstanding attributes of this approach is the involvement of human relationship of the therapist and the client (Bower, 2000). This more personal relationship offered by the therapist assists the patient to reach a state of realisation particularly on the thought that they can help themselves. PCT is mainly used in order for people to achieve personal growth and solve problems or overcome situations that they are having (Bruno, 1977). The core concepts of PCT are congruence, unconditional positive regard, empathetic understanding, and self-actualisation (Levant and Shlien, 1984; Lietaer et al., 1990; Brazier, 1993).

Some of the humanistic schools, such as Gestalt or person-centred approaches, would not tackle around much in the client’s past, for example, believing that all the material that is necessary is presented in the present (Schapira, 2000). Schapira identified the most fundamental concepts of what is now known as person-centred therapy namely: trust, empathy, congruence, genuine respect for the other and unconditional regard for the client that includes a non-judgemental view of them.

In application, the person-centred counsellor’s role is to stay with whatever the client feels, and this is to let the client lead. The counsellor reflects back the client’s feelings to him/her, so that s/he can hear them from another point of view. This clarifies his/her feelings for him/her or makes them more apparent. His/Her empathy encourages him/her to express the feelings that s/he has. Furthermore, it is the therapist’s role to help individuals to discover their own potential for themselves, and resist the temptation to solve clients’ problems for them. This may be one of the difficult aspects of the training in the person-centred approach (Schapira, 2000). It is highly emphasise in person-centred counselling that clients define their own goals, and counsellors strive to deeply understand the world as their clients see and experience it (Merry, 1995).

One of the most typical criticisms to PCT is that delivering the core conditions is that what all good therapists do before moving on the specific intervention and application of their expertise to make the client feel better (Spangenberg, 2003). Also, the PCT seem to avoid addressing confrontational situations (Mearns and Thorne, 1999). To address such, Merry (1995) put it, "the differences between people are outweighed by the similarities, and ... understanding, empathy and acceptance are activities (or qualities) that transcend cultural and social differences" (p. 118). This reconciles the difficulty in applying the principles of PCT as well as its core concepts particularly in any psychotherapeutic situation.

Conclusion

These abovementioned techniques are largely activity-based. Essentially, they centre on the client doing things differently, or more or less often. It is therefore very hard to explain away either the aims or the results of cognitive-behavioural therapy, reality therapy, and person-centred therapy in difficult to understand or euphemistic terminology. Both ends and means are open to inspection – which is certainly not true of many other psychotherapeutic approaches. Because approaches and counsellors’ styles vary, it is impossible to say exactly how all counsellors practice such conventions. Thus, whether a particularly objectionable 'means' is a regularly accompanying feature of programmes directed to particular problems, or to a particular client group, is open to scrutiny and further development.

References

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