THEORIES OF COUNSELING AND PSYCHOTHERAPY
3. Psychoanalytic Theory
4. Jungian Analytical Theory
5. Adlerian Theory
6. Existential Theory
7. Person-Centered Theory
8. Gestalt Theory
9. Cognitive-Behavioral Theories
10. Dialectical Behavior Theory
11. Rational Emotive Behavior Therapy
12. Reality Therapy/Choice Theory
13. Family Theory
14. Feminist Theory
15. Transpersonal Theory
Part 2 contains 13 chapters, each of which addresses a selected theoretical system that has direct application to the counseling or therapy process. We selected the theoretical systems based on their current use in the field of counseling and therapy, and we chose the chapter authors based on their expertise and their current application of the theoretical system in their work with clients. To provide the reader with a consistent format, each chapter contains information dealing with the following areas:
• Background: This section provides historical information related to the development of the theoretical system and the individual(s) responsible for its development.
• Human Nature – A Developmental Perspective: The process of individual development over time, as defined by the theoretical system, is discussed in this section.
• Major Constructs: This section introduces the structural components that make up the theoretical system.
• Applications: This section includes the following areas:
Overview: an introduction to the six areas that follow.
Goals of Counseling and Psychotherapy: a description of desired client outcomes based on the tenets of the theory.
The Process of Change: the factors within the theory that address what brings about change in the individual.
Traditional Intervention Strategies: techniques for implementing the process of change.
Brief Intervention Strategies: techniques for implementing the process of change using a brief approach.
Clients With Serious Mental Health Issues: a discussion of how each theory can be used with clients with serious mental health issues.
Cross-Cultural Considerations: a discussion of cross-cultural considerations in using the theory.
• Evaluation: This section includes the following areas:
Overview: an introduction to the three areas that follow.
Supporting Research: current research studies that form the bases for continued use of this theoretical system.
Limitations: a description of the factors that limit the use of this theoretical system.
Summary Chart: an overview of the material presented.
• Case Study: This section provides a case analysis and discusses treatment based on the theory.
The first three chapters in Part 2 deal with the theoretical systems, often classified as analytical, which were developed by Sigmund Freud, Carl Jung, and Alfred Adler. Chapter 3, Psychoanalytic Theory, provides background information relating to counseling and therapy within a psychoanalytic framework and emphasizes current use of this framework for individual counseling and therapy. Chapter 4, Jungian Analytical Theory, takes the reader from the development and definition of the major constructs of Jungian psychology to their application in the case of Maria, the subject of our hypothetical case study. We think readers will find this journey both intriguing and enlightening. Chapter 5, Adlerian Theory, highlights the contributions of Alfred Adler and demonstrates the application of his major constructs in current approaches to counseling and psychotherapy.
The next three chapters deal with the theoretical systems often classified as humanistic. Chapter 6, Existential Theory, sets forth the philosophical underpinnings of existential counseling and psychotherapy and demonstrates how this philosophy translates into approaches that can be used by the counselor or therapist in working with clients. Chapter 7, Person-Centered Theory, deals specifically with the work of Carl Rogers and highlights the continual development of this theoretical system from Rogers's work in the early 1940s to the last years of his life, when he traveled to the most troubled places in the world and used his person-centered approach to promote peace among warring groups. Chapter 8, Gestalt Theory, emphasizes the pioneering work of Frederick Peris and his development of Gestalt counseling and psychotherapy. Major concepts and interventions are presented in combination with their current use in counseling and therapy.
The next four chapters deal with the theoretical systems, often classified as behavioral, which were developed by theorists such as Aaron Beck, Donald Meichenbaum, Marsha M. Linehan, Albert Ellis, and William Glasser. Chapter 9, Cognitive-Behavioral Theories, provides the reader with a general background about both the behavioral and cognitive-behavioral theoretical views and discusses how the cognitive-behavioral approach developed from the behavioral point of view. Emphasis is given to the work of Aaron Beck and Donald Meichenbaum. Chapter 10, Dialectical Behavior Theory, is a therapeutic methodology initially developed by Marsha M. Linehan in the late 1970s to treat individuals with borderline personality disorder. This theory combines customary cognitive-behavioral techniques for emotion regulation and reality testing with concepts of mindful awareness, distress tolerance, and acceptance predominantly derived from Buddhist meditative practice. Chapter 11, Rational Emotive Behavior Therapy, emphasizes the work of Albert Ellis with special attention directed to the A-B-C model for understanding how thoughts and behaviors are related. Contributions to counseling and therapy made by Ellis and his colleagues are stressed. Chapter 12, Reality Therapy/Choice Theory, highlights the work of William Glasser and places special emphasis on a system he developed to provide a delivery system for reality therapy in helping others remediate deficiencies, make better choices, and become more fully self-actualized.
Chapter 13, Family Theory, provides the reader with ideas for working with families, because it is important to understand that individual approaches do not adequately address the patterns of communicating and relating that connect individuals to each other in families. The purpose of the chapter is to help the reader find ways to add systems-level interventions to the individualistic approaches studied in earlier chapters. We think readers will find this chapter both interesting and informative.
Chapter 14, Feminist Theory, which has evolved gradually over time as a response to women's rejection of traditional psychotherapies, addresses some of the sexist, oppressive aspects of many of the currently used theories of counseling and psychotherapy and encourages counselors and therapists not to apply theories based on male developmental models to women.
Chapter 15, Transpersonal Theory, discusses transpersonal theories, generally known as transpersonal psychology, as they apply to diagnosis and treatment of psychological problems associated not only with normal human development but also with difficulties associated with developmental stages beyond that of the adult ego. The practices of transpersonal theory can include discussions and interventions pertaining to spiritual experiences; mystical states of consciousness; mindfulness and meditative practices; shamanic states; ritual; the overlap of spiritual experiences with disturbed mental states such as psychosis, depression, and other psychopathologies; and the transpersonal dimensions of interpersonal relationships, service, and encounters with the natural world. We think readers will appreciate the inclusion of this material in the fifth edition of the book.
The theoretical systems included in Part 2 provide the reader with a comprehensive and current review of major counseling and psychotherapy approaches to working with individuals. Our conviction is strengthened by our selection of authors, who not only have expertise in the specific theoretical systems but also practice these approaches in working with clients.
We asked each author or set of authors, in Part 2 of this text, to address the following case study information in the development of a treatment or counseling plan that is consistent with the specific theoretical system presented. This approach gives readers the opportunity to view the theoretical systems from a comparative perspective as they search for the theoretical system that is most appropriate for their future work as counselors or therapists.
THE CASE OF MARTA
The client, Maria, is a 32-year-old Hispanic female. She is the oldest of five children, raised in a culturally encapsulated Hispanic neighborhood in a large metropolitan area in the
Southwest. She attended Catholic schools, and her religion remains a very significant part of her life. She is a single parent raising two children, a 6-year-old son and an 8-year-old daughter. She is bilingual, graduated from college with honors, has a degree in education, and for the past 4 years has taught middle school math and science. She and her husband of 5 years divorced 3 years ago. She receives no financial assistance from her former husband, and the only knowledge the children have of their father is through communication with their paternal grandparents.
Maria arrived 15 minutes early for her initial appointment. She related easily, expressed herself well, but her body appeared tense and her voice was strained. She expressed appreciation for getting an early appointment because she felt that she could not have waited much longer. She had been referred to the mental health agency by her physician because of insomnia and frequent unexplained crying spells. During the intake process, she stated that she was depressed, unable to sleep because of reoccurring nightmares, not eating, losing control of her two children, and having difficulty dealing with family members. She said that she has thought about suicide but stops because of the guilt she feels about abandoning her children and the tenets of her religion. She has difficulty concentrating and this is affecting her teaching. She has been absent frequently from work, and her principal is recommending that she take a leave of absence. This decision is causing her great stress as she needs the income to support her children. If she leaves her teaching position, she would be forced to move back with her family. She is unable to maintain meaningful relationships with various men she has been dating and views her future as very negative. When asked what words she would use to describe herself, she used terms such as "insecure," "frightened," "distrustful of self and others," "lonely, and lacking hope."
On the basis of information gathered during the intake process, Maria describes her family of origin as very close-knit, held together by both cultural and religious values. She was raised to be proud of her Hispanic heritage, her language, and her culture's traditions. She has three younger brothers and one younger sister, all of whom looked to her for advice and support. Education was stressed in her home, and her academic success was the center of much family pride. She was touted as a model to her siblings and was expected to perform in an exemplary way not only in school but also in other aspects of her life.
Maria's parents were self-educated and operated a small business near their home. Due to the fact that the business demanded a large time commitment from both parents, Maria often found herself, during adolescence, taking care of both the house and her younger siblings. Most of the family activities centered on their local parish and the activities generated in the community. Maria's social life was very much tied to her immediate family and contacts she made at either the Catholic school or church youth groups. She was encouraged to bring her friends to her home and to date young men within the community. Cultural pride, religion, and the parameters of the local Hispanic community affected much of her formative development.
Early Adult Years
Maria's first true exposure to other cultures came upon her leaving home to attend a state university. She had received scholarships from two of the state's three universities and even though her parents wanted her to stay at home and attend the local university, she decided to attend the university approximately 200 miles from her home. Her decision caused conflict within her family and she reported that it placed a good deal of strain on her relationships with both parents. Her sister supported her actions but her brothers felt that she was abandoning the family.
She was very successful at the university and it was here that she met and later married the first person she had dated outside of her religion and culture. Mark was an engineering student, Caucasian, and seemed to have no specific religious affiliation. It wasn't until their graduation that Maria introduced Mark to her family and at the same time announced their plans to be married.
Maria's family, with the exception of her sister, were very opposed to the marriage and made their opposition known not only to Maria but also to Mark. Maria and Mark also received opposition from his parents. To avoid further confrontations, Maria and Mark eloped and were married by a Justice of the Peace in a nearby state.
After their marriage, they returned to their home area, secured jobs, and began to build a life together. It was not until after their first child was bom that contact with both families was renewed. By the time their second child was bom, both families were much more involved with both their children and grandchildren.
The second child put a strain on the marriage, and within 2 years, Maria and Mark separated and were later divorced. Mark left the state and has had no contact with Maria or his children in 2 years. The paternal grandparents do, however, continue to have contact with their grandchildren.
Since the divorce 3 years ago, Maria has been able to discuss the physical and psychological abuse that she received from Mark. He became physically abusive when drinking and constantly demeaned her profession, culture, and religion. He drew away from both Maria and the children and spent more and more time away from the home. Turning to her family for support, Maria was confronted with indifference and reminders of their opposition to the marriage. Her sister, once supportive, now blames Maria for a great deal of the disunity within the family. The children's paternal grandparents refuse to believe that their son was abusive and are very critical of the manner in which Maria is raising their grandchildren.
With the lack of support coming from family Maria turned to friends for help. One friend suggested that Maria needed to date and get back into "circulation." She found that she had difficulty relating to men, was afraid to trust, and felt that all they wanted was sex. She felt that when they found out she had two children, the relationships cooled down rapidly.
She turned next to her work and poured all of her energy into her students. This left very little for her own children, and the mother-child relationship grew very strained. It was at this time that she began to have disturbing dreams that kept her from sleeping. The dreams, according to Maria, generally entail the following:
I am always running and there are shadowy figures behind me. I am in a large warehouse- type structure with lots of boxes and crates. The boxes and crates are all marked with arrows reading "Exit." The only problem is that the arrows are all going in different directions. Therefore, I never find the exit, and the figures keep getting closer and closer. I wake up in a cold sweat, breathing rapidly, heart pounding, and a scream struck in my throat. I lie there trying to calm down, knowing that I am too afraid to go back to sleep. In a little while I get up and spend the rest of the long night sitting at the kitchen table drinking coffee.
The more often the dreams occurred, the more depressed Maria became. She fought sleep because of her fear of dreaming, and at times she found herself crying uncontrollably.
Her eating habits have also changed drastically, and she finds herself buying "fast foods" for the children so that she does not have to cook. She seldom eats and has lost 15 pounds, weight she really cannot afford to lose.
The depression kept her away from work and away from people. She began spending more and more time alone. In Maria's words, "I have nothing to live for. No one cares about me. I have ruined my life and the life of two families and I am currently hurting my children." Upon the advice of her priest, she sought the help of her physician, who recommended that she seek psychological help.