As a counselor, how do you develop a theoretical orientation? Do you just wake up one morning andvoilayou have your theoretical orientation?
Your theoretical orientation will not magically come to you in a dream or vision. In fact, developing a theoretical orientation is a process that begins when you take your first counseling theories course and continues throughout your masters program, your field experience, and beyond. As you progress through your studies, you will likely find that you are continually developing a clearer picture of your theoretical orientation. Over the years following your master’s degree, your orientation will begin to solidify as you work and learn from observing other counselors. In truth, the process probably never ends because you will always learn about new theories, work with new clients, and develop a deeper understanding of yourself.
For this Discussion, you listen to the personal stories of how two distinguished counselor educators, Dr. John Marszalek and Dr. Matthew Buckley, developed their own theoretical orientations. Read your Instructors post regarding his or her theoretical orientation in this weeks Discussion Board.
Then, reflect upon the various factors that can influence the development of a counselor’s theoretical orientation. What factors might be influencing your own development process?
Next, you have the opportunity to discuss how you see that two theories may integrate into an effective strategy for you as a future counselor. You may also decide that a single theory feels like it will be the best fit for your future career at this point in your training. Whether you choose to integrate two theories or remain a purist, thoughtfully and thoroughly back up your current position.
Finally, you will consider the specifics of how what you have learned during this course will enable you to be an agent of positive social change. In what ways may your specific choice of strategy or strategies affect your role of a social change agent?
To Prepare:
Review the Corey article.
Review this weeks Learning Resources specifically focusing on the two media programs Theoretical Orientations and Course Wrap-Up.
Visit the Discussion board to review your Instructors post on his/her theoretical orientation.
Reflect on the possibility of two theories that might integrate well with your future professional practice and explain your choices.
Identify the ways that the knowledge gained in this course positions you to be an agent for positive social change in the future.
Post and include the following elements about developing a theoretical orientation:
What are your initial reactions and thoughts about your Instructors theoretical orientation?
What did you learn about theoretical orientations from Drs. Marszalek and Buckley?
Explain where you are now in the process of beginning to develop your own theoretical orientation. Include a description of the factors that are currently influencing your development process.
Describe how you see that two theories may integrate into an effective strategy for you as a future counselor. You may also decide that a single theory feels like it will be the best fit for your future career at this point in your training. Whether you choose to integrate two theories or remain a purist, thoughtfully and thoroughly back up your current position.
Finally, consider what you have learned during this course that will enable you to be an agent of positive social change. In what ways may your specific choice of strategy or strategies affect your role of a social change agent?
References
Murray, K.W., Champe, J., & Young, M. Integrating theories: Emotion-focused therapy. In D. Capuzzi & M. D. Stauffer (Eds.), Counseling and psychotherapy: Theories and interventions (7th ed., pp. 359-388). American Counseling Association.
Walden University, LLC. (Producer). (2012c). Theoretical orientations. Baltimore, MD: Author.
Dr. Matt Buckley and Dr. John Marszalek discuss their own theoretical orientations.
Walden University, LLC. (Producer). (2012a). Course wrap-up. Baltimore, MD: Author.
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271
Article 29
Designing an Integrative Approach to
Counseling Practice
Gerald Corey
This article addresses the advantages of developing an integrative
approach to counseling practice and deals briefly with some of the
potential problems. Also presented is a framework for helping readers
begin to integrate concepts and techniques from various approaches.
This article is based on Gerald Coreys (2001a) book, The Art of
Integrative Counseling.
Introduction
An integrative approach to counseling and psychotherapy is best
characterized by attempts to look beyond and across the confines of
single-school approaches in order to see what can be learned from,
and how clients can benefit from, other perspectives (Arkowitz, 1997).
Integrative counseling is the process of selecting concepts and
methods from a variety of systems. The integrative approach can
ideally be a creative synthesis of the unique contributions of diverse
theoretical orientations, dynamically integrating concepts and
techniques that fit the uniqueness of a practitioners personality and
style.
Since the early 1980s, psychotherapy has been characterized by
a rapidly developing movement toward integration. This movement
is based on combining the best of differing orientations so that more
complete theoretical models can be articulated and more efficient
treatments developed (Goldfried & Castonguay, 1992). The Society
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for the Exploration of Psychotherapy Integration is an international
organization formed in 1983. Its members are professionals who are
working toward development of therapeutic approaches that transcend
single theoretical orientations.
One reason for the trend toward psychotherapy integration is
the recognition that no single theory is comprehensive enough to
account for the complexities of human behavior, especially when the
range of client types and their specific problems are taken into
consideration. Because no one theory has a patent on the truth, and
because no single set of counseling techniques is always effective in
working with diverse client populations, some writers think that it is
sensible to cross boundaries by developing integrative approaches as
the basis for future counseling practice (Lazarus, 1996).
A large number of therapists identify themselves as eclectic,
and this category covers a broad range of practice. Perhaps at its
worst, eclectic practice consists of haphazardly picking techniques
without any overall theoretical rationale. This is known as syncretism,
wherein the practitioner, lacking in knowledge and skill in selecting
interventions, grabs for anything that seems to work, often making
no attempt to determine whether the therapeutic procedures are indeed
effective. Such a hodgepodge is no better than a narrow and dogmatic
orthodoxy. Pulling techniques from many sources without a sound
rationale can only result in syncretistic confusion (Lazarus, 1986,
1996; Lazarus, Beutler, & Norcross, 1992).
There are multiple pathways to achieving an integrative approach
to counseling practice. Three of the most common are technical
eclecticism, theoretical integration, and common factors (Arkowitz,
1997). Technical eclecticism tends to focus on differences, chooses
from many approaches, and is a collection of techniques. This path
calls for using techniques from different schools without necessarily
subscribing to the theoretical positions that spawned them. In contrast,
theoretical integration refers to a conceptual or theoretical creation
beyond a mere blending of techniques. This path has the goal of
producing a conceptual framework that synthesizes the best of two
or more theoretical approaches under the assumption that the outcome
will be richer than either of the theories alone (Norcross & Newman,
273
1992). The common factors approach attempts to look across different
theoretical systems in search of common elements. Although there
are differences among the theories, there is a recognizable core of
counseling composed of nonspecific variables common to all
therapies. This perspective on integration is based on the premise
that these common factors are at least as important in accounting for
therapeutic outcomes as the unique factors that differentiate one theory
from another.
While there are advantages to incorporating a diverse range of
techniques from many different theories, it is also possible to
incorporate some key principles and concepts from the various
theoretical orientations. There are some concepts from the
experiential approaches that can blend quite well into the cognitive-
behavioral approaches. For example, the experiential approaches
emphasize here-and-now awareness, the therapeutic relationship, and
exploration of feelingsall concepts that can be incorporated into
the action-oriented therapies. Clients can be asked to decide what
they want to do with present awareness, including making behavioral
plans for change. All the action-oriented therapies depend on a good
rapport between client and therapist (Moursund & Erskine, 2004).
Techniques will not take root if there is not a good working
relationship, and clients are more likely to cooperate with a therapists
cognitive and behavioral interventions if they feel the therapist is
genuinely interested in their welfare.
Arnold Lazarus (1997), the founder of multimodal therapy,
espouses technical (or systematic) eclecticism. Multimodal therapists
borrow techniques from many other therapy systems that have been
demonstrated to be effective in dealing with specific problems.
Lazarus raises concerns about theoretical eclecticism because he
believes that blending bits and pieces of different theories is likely to
obfuscate matters. He contends that by remaining theoretically
consistent but technically eclectic, practitioners can spell out precisely
what interventions they will employ with various clients, as well as
the means by which they select these procedures.
Technical eclecticism seems especially necessary in working with
a diverse range of cultural backgrounds. Harm can come to clients
274
who are expected to fit all the specifications of a given theory, whether
or not the values espoused by the theory are consistent with their
own cultural values. Rather than stretching the client to fit the
dimensions of a single theory, practitioners are challenged to tailor
their theory and practice to fit the unique needs of the client. This
requirement calls for counselors to possess knowledge of various
cultures, be aware of their own cultural heritage, and have skills to
assist a wide spectrum of clients in dealing with the realities of their
culture.
One study summarized the importance of taking into account
cultural diversity and future trends in the practice of psychotherapy:
A major challenge for the field of psychotherapy will be to discover
creative ways to integrate the values and worldviews of multiple
cultures within the discourse of efficiency and evidence that currently
dominate health care, (Norcross, Hedges, & Prochaska, 2002, p.
322).
Practitioners who are open to an integrative perspective will find
that several theories play a crucial role in their personal counseling
approach. Each theory has its unique contributions and its own domain
of expertise. By accepting that each theory has strengths and
weaknesses and is, by definition, different from the others,
practitioners have some basis to begin developing a theory that fits
for them. It is important to emphasize that unless counselors have an
accurate, in-depth knowledge of theories, they cannot formulate a
true synthesis. Simply put, practitioners cannot integrate what they
do not know (Norcross & Newman, 1992). The challenge is for
counselors to think and practice integratively, but critically.
Developing an integrative perspective is a lifelong endeavor that is
refined with experience.
The following section addresses the topic of viewing the various
theoretical approaches to determine what common ground exists that
allows for an integrative perspective.
Searching for Common Denominators Across Therapy Schools
The experiential approaches (such as existential therapy and
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Gestalt therapy) place a premium on exploration of feelings in the
therapeutic process. However, the concepts of working with feelings
can certainly be linked closely with the necessity of exploring the
thoughts and behaviors connected to these feelings. A systematic
eclecticism is based on looking for common denominators that cut
across therapeutic orientations, which involves identifying core
concepts that various theories share or concepts that can be usefully
combined.
However, as Lazarus (1997) has warned, the blending of
theoretical constructs is more challenging than utilizing diverse
techniques from different schools. Practitioners who attempt to blend
theoretical constructs from different orientations into their own
integrative model need to determine that these concepts are indeed
compatible. In attempting to blend different theoretical frameworks
together, it is essential that these frameworks lend themselves to a
fruitful merger.
The Benefits of Integration
Since humans are integrated beings, an integrative approach to
counseling practice focuses on thinking, feeling, and acting. Effective
counseling involves proficiency in a combination of cognitive,
affective, and behavioral techniques. Such a combination is necessary
to help clients think about their beliefs and assumptions, to experience
on a feeling level their conflicts and struggles, and to actually translate
their insights into action programs by behaving in new ways in day-
to-day living.
Preston (1998) contends that no one theoretical model can
adequately address the wide range of problems clients will present in
therapy. He says it is essential for therapists to have a basic grasp of
various therapeutic models and for them to have at their disposal a
number of intervention strategies. For him, the pivotal assessment
question is, What does this particular person most need in order to
suffer less, to heal, to grow, or to cope more effectively? Preston
recommends that a practitioners selection of interventions should
be guided by their assessment of the client. This lends weight to the
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concept of integrating assessment with treatment. Once a clinician
knows what the clients target problems and goals are, it makes sense
to design specific techniques tailor-made to the client.
The Limitations of an Integrative Approach
There are some drawbacks to encouraging the development of
an integrative model, as opposed to sticking primarily with one theory.
An undisciplined eclectic approach can be an excuse for failing to
develop a sound rationale for systematically adhering to certain
concepts and to the techniques that are extensions of them. If
counselors merely pick and choose according to whims, it is likely
that what they select will be a reflection of their biases and
preconceived ideas. It is important to avoid the trap of emerging
with a hodgepodge of unamalgamated theories thrown hastily
together.
Drawing on Techniques from Various Theoretical Models
For beginning counselor practitioners, it makes sense to select a
primary theory that is the closest to their basic beliefs. It is essential
to learn that theory as thoroughly as possible, and at the same time
be open to discovering ways of drawing on techniques from many
different theories. By beginning to work within the parameters of a
single theory, practitioners will have an anchor point from which to
construct their own counseling perspective. However, simply by
adhering to a primary theory does not imply that a practitioner can
apply the same techniques to all clients. It is essential to be flexible
in the manner in which techniques are applied to a diverse range of
clients.
On the topic of therapeutic flexibility, Pauls (1967) question is
relevant: What treatment, by whom, is the most effective for this
individual with that specific problem, and under what set of
circumstances? Regardless of what model clinicians may be working
with, they must decide what techniques, procedures, or intervention
methods to utilize, when to use them, and with which clients. It is
277
useful for clinicians to avoid becoming wedded to a favorite set of
techniques that they apply in random fashion to all clients, regardless
of their cultural background. For counseling to be effective it is
necessary to utilize techniques and procedures in a manner that is
consistent with the clients values, life experiences, and cultural
background. Although it is unwise to stereotype clients because of
their cultural heritage, it is useful to assess how the cultural context
has a bearing on their problems. Some techniques may be
contraindicated because of a clients socialization. Thus, the clients
responsiveness (or lack of it) to certain techniques is a critical
barometer in judging the effectiveness of these methods.
The Foundation of the Authors Integrative Approach
In the rest of this section the author presents some elements of
an integrative approach to counseling by describing existential therapy
as the foundation of his approach. The author illustrates how he
draws both concepts and techniques from other theoretical orientations
to flesh out his integrative approach. The theory that comes closest
to this writers worldview and serves as the foundation for
constructing his theoretical orientation is existential therapy. In
addition to the existential approach, two related theories that the author
uses extensively are Gestalt therapy and psychodrama. After briefly
describing some of the key concepts and themes from the existential,
Gestalt, and psychodrama orientations, this writer shows how he
incorporates basic concepts and techniques from a number of the
other action-oriented therapies: Adlerian therapy, reality therapy,
behavior therapy, rational emotive therapy, cognitive therapy, and
feminist therapy. For a discussion of how all these above-mentioned
approaches are applied to a single case, see Coreys (2001b) Case
Approach to Counseling and Psychotherapy.
Existential Therapy as a Philosophical Base
The authors own philosophical orientation is strongly influenced
by the existential approach, which conceives of counseling as a life
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changing process. Counseling can be seen as a journey in which the
therapist is a guide who facilitates client exploration. There are a
number of key themes from the existential approach that seem to this
writer to capture the essence of the therapeutic venture. According to
the existentialist view, humans are capable of self-awareness, which
is the distinctive capacity that allows people to reflect and to decide.
With this awareness people become free beings who are responsible
for choosing the way they live. The emphasis on freedom and
responsibility is central for practice, for this notion allows people to
redesign their lives. Making choices gives rise to existential anxiety,
which is another basic human characteristic. This anxiety is
heightened when individuals reflect on the reality that they will die.
Facing the inevitable prospect of eventual death gives the present
moment significance. The reality of death is a catalyst that can lead
to creating a life that has meaning and purpose. Humans strive toward
fashioning purposes and values that give meaning to life, which is
developed through freedom and a commitment to make choices in
the face of uncertainty.
Both existential therapy and person-centered therapy place
central prominence on the person-to-person relationship. It assumes
that client growth occurs through this genuine encounter. The
emphasis on the human quality of the therapeutic relationship lessens
the chances of making counseling a mechanical process. In thinking
about therapy from an existential perspective, techniques are always
of secondary importance. From the existential perspective, it is not
the techniques practitioners use that make a therapeutic difference;
rather, it is the quality of the relationship with the client that heals.
The therapists interests are in being as fully present for the client as
possible, establishing a trusting relationship, and moving into the
clients subjective world. If a client is able to sense a therapists
presence and his or her desire to make a real connection, then a solid
foundation is being created for the hard work that counseling entails.
Because the existential approach is basically concerned with
matters such as the goals of therapy, basic conditions of human
existence, and therapy as a shared journey, practitioners are not bound
by a specific set of techniques. Although they can incorporate a wide
279
range of techniques from other orientations, their interventions are
guided by a philosophical framework about the meaning of human
existence. An existential view provides practitioners with the
framework for understanding universal human concerns, including
facing and dealing with: the problem of personal freedom, self-
alienation and estrangement from others; the fear of death and
nonbeing; living with courage; exploring the meaning of life; and
making critical choices.
Existential therapy is not a distinct or well-organized counseling
model. In fact, the founders of existential therapy did not aim to
create a separate school of therapy, but rather that its key concepts
and themes would become integrated into all therapeutic schools (May
& Yalom, 2000). Bugental and Bracke (1992) see the possibility of a
creative integration of the conceptual propositions of existential
therapy with psychodynamic or cognitive approaches. They indicate
that experienced clinicians of contrasting orientations often accept
some existential concepts and thus operate implicitly within an
existential framework.
Gestalt Therapy: A Holistic Perspective
Gestalt therapy is truly an integrative orientation in that it
focuses on whatever is in the clients awareness. From the Gestalt
perspective, feelings, thoughts, body sensations and actions are all
used as a guide to understanding what is central for the client in each
moment. The centrality of whatever is in the clients awareness is
an ideal way to understand the world of the client. A Gestalt therapist
approaches clients without a preconceived set of biases or a set agenda.
Instead, emphasis is placed on what occurs phenomenologically with
the client. By paying attention to the obvious verbal and nonverbal
leads provided, the therapist has a starting point for exploring the
clients world.
Functioning within a Gestalt framework, this writer views his
main goal as increasing the clients awareness of what is. Change
occurs through a heightened awareness of what the client
is experiencing moment to moment. The approach stresses present
awareness and the quality of contact between the individual and
280
the environment.
The Gestalt approach is characterized by many key concepts
that can be fruitfully blended into other orientations. Gestalt therapy
(and psychodrama) techniques afford clients with ways of bringing
painful memories and feelings pertaining to both past and present
events into center stage. Through the skillful and sensitive use of
Gestalt therapy interventions, it is possible to assist clients in
heightening their present-centered awareness of what they are thinking
and feeling as well as what they are doing. The client is provided
with a wide range of tools, in the form of Gestalt experiments, for
making decisions about changing the course of living.
Gestalt therapy is a creative approach that utilizes the experiment
to move clients from talk to action and experience. This is a
perspective on growth and enhancement, not merely a system of
techniques to treat disorders. With the emphasis given to the
relationship between client and therapist, there is a creative spirit of
suggesting, inventing, and carrying out experiments aimed at
increasing awareness.
Psychodrama: An Integrative Approach
Although psychodrama is primarily used in group therapy, many
psychodrama techniques can be used fruitfully in individual
counseling. Psychodrama is an approach in which the client acts out
or dramatizes past, present, or anticipated life situations and roles.
This is done in an attempt to gain deeper understanding, explore
feelings and achieve emotional release, and develop behavioral skills.
Significant events are enacted to help the client get in contact with
unrecognized and unexpressed feelings, to provide a channel for the
full expression of these feelings and attitudes, and to broaden the
role repertoire.
Integrated into other systemssuch as psychodynamic,
experiential, and cognitive behavioral approachespsychodrama
offers a more experiential process, adding imagery, action, and direct
interpersonal encounter. In turn, psychodrama can utilize methods
derived from the other experiential approaches, and the cognitive
behavioral approaches as well, to ground clients in a meaningful
281
process.
According to Blatner (1996), a major contribution of
psychodrama is that it supports the growing trend toward technical
eclecticism in psychotherapy. Practitioners are challenged to draw
on whatever tools will be useful in a given situation. Yet psychodrama
is best viewed as an optional set of tools, rather than a single approach
for all clients (Blatner, 1996). Psychodrama uses a number of specific
techniques designed to intensify feelings, clarify implicit belief,
increase self-awareness, and practice new behaviors. One of the most
powerful tools of psychodrama is role reversal, which involves the
client taking on the part of another person. Through reversing roles
with a significant person, the client is able to formulate significant
emotional and cognitive insights into his or her part in a relationship.
This technique also creates empathy for the position of another person.
Variations of role playing and role reversal have many uses in both
individual and group counseling. A few other techniques of
psychodrama that practitioners can utilize include self-presentation,
soliloquy, coaching, modeling, role training, behavior rehearsal, and
future projection.
It is clear that many psychodramatic techniques can be adapted
to fit well within the framework of other contemporary theoretical
models, including psychoanalytic therapy, behavior therapies,
multimodal therapy, Gestalt therapy, Adlerian therapy, play therapy,
imagination therapy, Jungian therapy, family therapy, and group
therapy. According to Blatner (1997), psychodramas value lies in
the fact that its methodology can be integrated with other therapeutic
approaches rather than acting in seeming competition. [See Blatner
(1996) and Corey (2004, Chapter 8) for a discussion of psychodrama
applied to group counseling.]
Drawing on the Action-Oriented Therapies
As much as this writer values working with the emotional realm,
he finds it essential to incorporate concepts and techniques from the
action-oriented approaches as a way to bring about both cognitive
and behavioral changes. What follows are a few of the ways that the
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author utilizes the action-oriented therapies (behavior therapy,
multimodal therapy, cognitive-behavior therapy, reality therapy,
Adlerian therapy and feminist therapy) in his integrative model. For
a detailed discussion of how these action-oriented approaches are
applied to a single case, see Coreys (2001b) Case Approach to
Counseling and Psychotherapy.
Behavior Therapy
A basic assumption of the behavioral perspective is that most
problematic cognitions, emotions, and behaviors have been learned
and that new learning can modify them. Although this modification
process is often called therapy, it is more properly an educational
experience in which individuals are involved in a teaching/learning
process. There are many parallels between counseling and education.
Counseling is educational in that people develop a new perspective
on ways of learning, and they also try out more effective ways of
changing their cognitions, emotions, and behaviors. Many of the
techniques employed by other action-oriented approaches, with a
strong behavioral core (such as rational emotive behavior therapy,
cognitive therapy, reality therapy, and feminist therapy), share this
basic assumption of counseling as an educational process, and they
stress the teaching/learning aspect of the counseling process.
Techniques from the action-oriented approaches can be used to attain
humanistic goals that characterize the experiential therapies. It is
clear that bridges can connect the experiential and the behavior
therapies.
Multimodal Therapy
Multimodal therapya branch of behavior therapyis a
comprehensive, systematic, holistic approach to behavior therapy
developed by Arnold Lazarus (1989,1995, 1997). Grounding his
practice on social learning theory, Lazarus endorses drawing
techniques from just about all of the therapy models. In his integrative
model, new techniques are constantly being introduced and existing
techniques are refined, but they are never used in a shotgun manner
(Lazarus, 1992; Lazarus & Beutler, 1993).
283
By using the multimodal approach, practitioners can function
actively and directively by providing information and instruction.
This requires a constant adjustment of therapeutic techniques to
achieve the clients goals in therapy. The question of paramount
importance is, What is best for this particular person? Practitioners
need to make a careful attempt to determine precisely what
relationship and what treatment strategies will work best with each
client and under which particular circumstances. The underlying
assumption of this approach is that because individuals are troubled
by a variety of specific problems, it is appropriate that both a multitude
of treatment strategies and different therapeutic styles are used in
bringing about change. Therapeutic flexibility and versatility, along
with breadth over depth, are valued highly in the multimodal
orientation.
Cognitive-Behavior Therapy
Most of the contemporary therapies can be considered
cognitive, in a general sense, because they have the aim of changing
clients subjective views of themselves and the world. However, the
cognitive-behavioral approaches differ from both psychodynamic and
experiential therapies in that the major focus of Cognitive-Behavior
Therapy (CBT) is on both undermining faulty assumptions and beliefs
and teaching clients the coping skills needed to deal with their
problems.
In many respects, rational emotive behavior therapy (REBT)
can be considered as a comprehensive and eclectic therapeutic
practice. Numerous cognitive, emotive, and behavioral techniques
can be employed in changing ones emotions and behaviors by
changing the structure of ones cognitions. REBT is open to using
therapeutic procedures derived from other schools, especially from
behavior therapy.
Aaron Becks cognitive therapy is truly an integrative approach,
since it draws from so many different modalities of psychotherap
