Case Study on "Personal"

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[EXCERPT] . . . .

Integrated Counseling

There are many ways to skin a cat; the old saying goes. But when it comes to one's own theoretical approach to counseling he/she better have a routine, a system grounded in sound theory and vetted by practical experience, that leads to positive, empirical results. That is to say, skinning a cat isn't what it once was in the old fragmented world of psychology. Those good old days of supposition and speculation are gone. No longer can therapists and counselors solely rely on their own fabrications and interpretations to administer treatment. Thanks to social media and the Internet, cutting edge research, and evidence-based treatment models, therapists and counselors have to learn to hew personal, theoretical predilections to pragmatic, results-driven tools, techniques and technologies. In essence, the public is demanding results and it is up to therapists and counselors everywhere to integrate all the available resources and information to devise a theoretical orientation to counseling and therapy that is, ideally, optimally effective. It is the purpose of this paper to discuss the integrated seedlings of my own approach to counseling.

I was born a skeptic, a contrarian of sorts. If a teacher told me a Polar Bear's fur was white, I would argue immediately with her and say, "no, it's not." It's translucent, and it's a pro-survival adaptation that allows the sunlight to absorb into the Polar Bear's black skin on subzero days. And she, the teacher, would scowl at me as though I were a criminal while the rest of the fourth grade class, bristling from disillusionment, would have furrowed brows and fidgety fingers, fretting over another protracted teacher-student dispute. My point is I never accepted things on face value. I learned that things that are ostensibly simple are usually inherently complex -- for example the amount of human brainpower it takes to differentiate between the sound of "p" and the sound of "b" is utterly jaw dropping (Gelso & Fretz, 2001, pg. 355). And as this relates to psychology, specifically counseling and therapy, I knew that something that seemed so commonsensical could not be without its own complexities and uncertainties. It turns out, I was right.

The first thing one must recognize about therapy and counseling is that it's an imperfect science. As much as one, who works in the field and who makes a living applying the theories and principles of therapy and counseling, would like to believe about the impact these disciplines have on human behavior, one must inevitably confront the fact that there is no perfect model or golden rule that works for all of the people all of the time. Humans are innately mysterious and complex, that's not to say science will never find a way to cure all ailments, diseases and disorders, rather it's to acknowledge that when one counsels a patient he/she is doing so not with clinical certitude of Dr. Frankenstein, but with the hope that methodology, directives and application of theory are going to work. Much of what one does in counseling is predicated on faith and in one's own ability and one's own understanding of the literature they've read and, of course, their preconceptions about human nature.

Obviously, the more one trains and studies, and the more one experiences, the more confidence he/she will have in his/her abilities. Yet, all of this acquired knowledge and training will not mitigate the truth that it is an imperfect science. And knowing of our tenuous status will only underscore that what one does to counsel a client is inherently subjective and hinged to a faith-based (faith as in hope, not to invoke religion) paradigm. It's an "I hope that what I am doing will work," rather than "I know what I am doing will work" type position most counselors, therapists and psychologists take toward their clients, and I am no exception.

This humble and self-aware approach is difficult for people to understand, particularly nascent counselors, as it implies a certain ambiguity toward my own self-confidence. People ask, how can someone who makes a living counseling be so unsure about the efficacy of counseling? The key is to be, as John Keats would say, comfortable in uncertainty (1970). To understand that there are gaps in what we know about human nature. Yet, that is not to say that I am not confident, because I am extremely confident about my abilities as a counselor, only that I am keenly aware of the imperfect art form that is counseling. And it is my belief that because I acknowledge the fallibility of counseling, I am a better counselor. I contend that knowing the limits is just as important as knowing the tricks of the trade.

To explicate what I mean, and what I am proposing -- to be a great counselor one must be self-aware and acknowledge the limitations of counseling and pharmaceuticals -- consider some of the uncertainty and confusion counselors and psychologists confront on a daily basis, specifically with regards to depression.

Louis Menand writes in his essay, "Head Case," about this confusion and uncertainty, "However you go about making this decision [whether to take prescription meds], do not read the psychiatric literature. Everything in it, from the science (do the meds really work?) to the metaphysics (is depression really a disease?), will confuse you. There is little agreement about what causes depression and no consensus about what cures it" (2010).

These are pretty telling words. If experts cannot agree on what causes depression and, more importantly, what cures depression, what is a psychologist supposed to do? What is a counselor supposed to do? What is a patient supposed to do? This is not biology where one has the luxury of foolproof evidence. In psychology, there is nothing like the Modern Evolution Synthesis that unifies Mendelian genetics with Darwinian evolution.

And if this is not daunting enough, consider the low self-awareness many psychologists and therapists frequently exhibit, Mick Cooper of Therapy Today writes, "The reality is, therapists do get it wrong. For instance, ninety per cent of therapists put themselves in the top 25 per cent in terms of service delivery3. So therapists' perceptions, experiences or beliefs that their therapies are effective do not necessarily make them so" (2008).

An over-inflated ego and a derelict appreciation for the complexity of the job is a recipe for - a disaster. This typically translates into poor patient care and treatment, and a lower success rate.

So, if this is the current climate of the counseling arena, how does a counselor combat these obstacles -- self-aggrandizement and a poor appreciation for complexity - and deliver high-quality, results orientated, patient care? Well, as previously posited, its really about integration. For me, this means integrating, what I refer to as my rational skepticism, and my high-tolerance for the ambiguous nature of human beings, with a sound, results-driven therapeutic model.

Before I answer the question of what therapeutic models I employ, allow me to clarify the issue of therapeutic utility, as I've cast doubt thus far on the overall efficacy of therapy and counseling, and say that for as much as we don't know about counseling and therapy, we do know that it works. As Cooper writes, "Does therapy work? Fortunately there is a simple answer to this question: yes. Studies which look at clients' behaviors, feelings or psychological functioning before and after therapy nearly always find that, on average, they are better off by the end of it" (2008).

If we know that therapy and counseling work, then the next dilemma one faces is which therapeutic model(s) should one adopt and integrate? The answer that I've found for my practice, the one that forms the fundamental basis for my work in the field, is cognitive behavioral therapy (CBT). However, like most therapists and psychologists, I also take an a la carte approach to the many other popular therapeutic models out there. I will, on occasion, borrow methodology, theory, and practices and integrate them into my standard CBT approach.

But first, what is CBT? This is a loaded question, because like many psychology terms and phrases, the answer seems to evolve over time, typically due to new developments or findings that alter, even marginally, the overall concept. But the basic concept can be traced all the way back to a stoic philosopher, Epictetus, who wrote in The Enchiridion, "Men are disturbed not by things, but by the view which they take of them" (NACBT, 2008). Or a more modern rendition, CBT is a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do (SPERRY).

That said, here is a rather comprehensive definition, "Cognitive-behavioral therapy integrates the cognitive restructuring approach of cognitive therapy with the behavioral modification techniques of behavioral therapy. The therapist works with the patient to identify both the thoughts and the behaviors that are causing distress, and to change those thoughts in order to readjust the behavior (Free Dictionary

). CBT works because it addresses the maladaptive thoughts that… READ MORE

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