Effectiveness of Integrating Therapies in Counselling

For decades, integration of the different schools of psychotherapy had been in process (Jones-Smith, 2016). Therapists, however, remained fixated on their approach and opposed this ideology  (Corey, 2009). Tracing back to Freud’s principles on psychotherapy, there were differences between him and his colleagues over the framework for conceptualising client problems (Jones-Smith, 2016). This was a practical framework for understanding the client’s personality change (Corey, 2009). However, according to Corey (2009), it was somewhat practical to merge the most useful ideas from the various approaches than searching for one best theory (Corey, 2009). The underlying belief of psychotherapy integration is that not a single therapy has a solution to all the problems of the client (Jones-Smith, 2016). Hence, integrating therapies improves the effectiveness of counselling and can cater to the needs of the diverse client population (Corey, 2009). A counsellor should be open-minded and willing to have an integrative approach to understand the thought process, feelings and behaviour of the client.

I firmly believe that impede understanding causes dysfunctional behaviour and inability to display appropriate emotions. Individuals are not victims of their problems and should take responsibility for their state as they have choices to make meaning of their lives.  Also, there is gender inequality in the society and understanding this issue can reduce it and empower the oppressed population. In an Indian society along with diversity comes a patriarchal society, religious beliefs and values, preconceived expectation of acting in a particular way according to gender roles to be a valued member of the society. For example, most women are solely responsible for household chores and are discouraged to step out for work. It is the responsibility of the male member to be the breadwinner of the family. Thus, women are dependent on their partners for their necessities. All these aspects give rise to various problems such as power struggle, gender inequality, depression, the stigma of being different, discrimination and other problems which leads to distress. In this fast-paced world, many individuals are stuck in their thought process and lack coping skills due to their current circumstances. This leads to irrational beliefs and over expectation from society results in psychological distress. People often need help as they face mental and emotional problems in their life and need to be heard but do not know how to begin to make a change in the right direction. So, I look at therapy as a process, and I understand therapeutic and extra-therapeutic factors are responsible for the process of change in therapy. Therapeutic factors include a strong bond between the client and therapist, techniques and methods the therapist use to help the client take actions to improve themselves and their situation. Also, the client should believe in the treatment. Extra therapeutic factors include the client’s belief in themselves, inner strength, support from the family and community. According to my cultural background, I agree gender has played a significant role in shaping the life experiences of an individual and also allows them to deal with various life circumstances. Therefore, I understand not all individuals have the equal opportunity to make particular choices due to their cultural, social and political circumstances. Hence, this will help me counsel clients in a way that is appropriate to their worldview. Additionally, as an individual I believe in logical thinking and reasoning, development of self- awareness and hold an opinion that individuals are capable of making choices and respect their free will. Therefore, in my books, a counsellor is considered as a guide, teacher and facilitator to develop new ways of coping skills in a supportive surrounding.

Evolution of Theories

In the1950’s, psychoanalysis was a dominant force in understanding behaviour (Korman, 2017). Wolpe was dissatisfied with the Freudian psychodynamic approach which persuaded him in developing behavioural therapy (Westbrook, Kennerley, & Kirk, 2007). Behavioural therapy was successful especially in the treatment of anxiety disorders such as phobia and obsessive-compulsive disorders. However, most adult clients faced problems with anxiety and depression, and behavioural therapy focused only on anxiety (Westbrook et al., 2007). In the 1960’s, A.T Beck, who was a psychoanalyst, tried to test the psychoanalytic hypothesis of depression but concluded that depression was a ‘thought disorder’ rather than related to the unconscious theory. Thus, he found the psychoanalytic concept invalid (Korman, 2017). Therefore he reached out to the behavioural therapists to work with cognition (Korman, 2017). Eventually, he identified the limitation of behavioural therapy and this dissatisfaction lead to the cognitive revolution in the 1970’s (Westbrook et al., 2007). Over the years behavioural therapy and cognitive therapy evolved as cognitive behavioural therapy to included cognitive, emotional and behavioural processes (Westbrook et al., 2007). Beck together with Albert Ellis, who was working independently on Rational Emotive Behavioural therapy and Donald Meichenbaum (cognitive behavioural modification) have made a significant contribution in the demystification of the therapy process(Corey, 2009). In recent years, CBT is known as a dominant theoretical approach to psychotherapy (Jones-Smith, 2016).

Feminist Therapy developed in responses to the challenges and emerging women’s needs as women were discontent with being confined in their traditional gender role (Corey, 2009). Feminist Therapy criticised psychoanalysis as a male therapist practised it and thus had gender biased values and often misdiagnosed women. This was due to sexism in psychotherapy and counselling (Jones-Smith, 2016). Feminism can be traced down to the late 1800s, but feminist therapy grew out of the women’s rights movement during the 1960s (Corey, 2009; Jones-Smith, 2016). Amid this time, the consciousness-raising group started programs mainly intended to help women. There was a great deal of research in the 1970s, on gender biases and the formation of Association for Women in Psychology and American Psychological Association further encouraged the development and defining of the feminist therapy (Corey, 2009; Jones-Smith, 2016). By the 1980s, feminist therapist began to test and criticise the traditional theoretical system of psychotherapy. It diversified and included issues relating to eating disorders, body image, abusive relation, sexual abuse and incest (Corey, 2009; Jones-Smith, 2016). The second wave of feminism philosophy goals was based on social activism and changing society. In recent years, the third wave of feminism has included women of colour, lesbians, a post-modern and constructivist viewpoint of present-day feminist (Corey, 2009). Feminism has mutual grounds with Adlerian Therapist on social interests and social equality, and with the existential therapist who values the therapy process as a shared journey (Corey, 2009). Feminist therapists like person-centred therapists, covey their authenticity and believe in shared empathy between the therapist and the client (Corey, 2009). Both feminist and post-modern therapy, firmly believe that psychotherapy should not replicate a societal power structure and encourage dependency. Instead, therapy must have equal and active participation of the client and the therapist to work collaboratively to determine aims and goals for the client (Corey, 2009).

The underlying foundations of existential psychotherapy lie in philosophy from the 1800s, with philosophers working on the topic of human existence (Corey, 2009). The existential approach does not concur with the deterministic perspective of human nature adopted by orthodox radical behaviourism and psychoanalysis (Corey, 2009). During the 1940’s and 1950’s existential therapy emerged among various schools of psychiatry and psychology in various parts of Europe (Corey, 2009). Soren Kierkegaard, one of the first existential philosopher, theorised that human’s dissatisfaction could be overcome through self-awareness or internal wisdom (Corey, 2009). Friedrich Nietzsche focused on subjectivity and introduced the idea of free will and responsibility (Corey, 2009). Kierkegaard and Nietzsche studies of subjectivity and emerging self together are known as the originators of the existential perspective. Rollo May was an essential figure for translating critical concepts of existentialism into psychotherapeutic practice and was responsible for bringing existentialism from Europe to the United States (Corey, 2009). This simplified approach began to impact other theories, including ‘ logotherapy’ which was developed by Vicktor Frankl (Corey, 2009). Over the years, contemporaries acknowledged the importance of ‘experience’ in the context of psychological well-being (Corey, 2009). At the same time, existentialism development in Britain was brought about by Emmy van Deurzen and was now an alternative to traditional methods (Corey, 2009).

Underlying assumptions

Faulty cognition causes dysfunctional behaviour and is the primary cause of how we act and feel (Corey, 2009). Cognition serves as intervening reactions between the stimuli and behavioural responses. So basically, behaviour can influence insights however the general point is that cognitions are associated with the behavioural procedure as well as vital to it (Westbrook et al., 2007). Hence, individuals are not a victim of the problem they are facing because to some extent they are responsible for being in that situation (Corey, 2009). Social, political and cultural factors can create problems (Corey, 2009).

Key concepts

While developing an integrated theory, I will include fundamental concepts from three therapies. First, the existential therapy focuses on essential nature of human condition, including self-awareness, freedom and responsibilities, developing meaningful relationships and shaping one’s identity, understand the purpose, meaning and value of life, anxiety as a living condition and awareness of life and death (Corey, 2009). Existential therapy intents to maintain a healthy balance between identifying our limitations yet being positive about possibilities in life and making choices (Corey, 2009). It also emphasis on becoming aware of one’s self before taking action to solve problems and change one’s life (Corey, 2009). Once an individual is aware of one’s self, they have the freedom of choice, but with freedom comes the responsibility of making those choices. Also, self- awareness gives an individual meaning for their existence, and they can relate to others and develop meaningful relations. Existential therapy and cognitive behavioural therapy focus on present problem-solving. However, CBT also acknowledges that psychological problems can be caused due to past events but is reinforced by an individual’s way of thinking in the present (Corey, 2009). CBT can analyse these past problems. Also focus on the efforts to develop useful beliefs by examining and confronting faulty internal dialogue (Corey, 2009). Also, feminist therapy acknowledges all the groups of oppressed people and makes me aware of how societal condition contributes and has an impact on the issues faced by women and men. At the same time, how the society views gender role socialisation that can lead to gender inequality (Corey, 2009).

Role of the therapist and therapeutic relationship

A counsellor should be a guide, facilitator, teacher and help the clients identify automatic thoughts, understand the impact of gender and culture, confront faulty thinking and assumptions by trying to reduce them. The therapist and client should collaboratively set goals and create action plans by being authentic.  This process will enable them to lead a satisfied life. As the counsellor, my role will vary according to each client. I will have a positive approach towards my clients and show compassion and empathy, be understanding, honest and supportive. I apprehend that being truthful, modelling authentic behaviour and self-disclosing relevant information which will build trust and strengthen trust. This will be demonstrated at the initial stage. Additionally, taking responsibility and feeling empowered is vital during a counselling session.  Therefore, at a later stage, I will allow the client to make choices while I continue providing them with a structured direction in developing their coping skills. This will not only prepare the client to take responsibility during the therapeutic process but also prepare them to be responsible in real life.

The therapeutic relationship will the client is considered necessary for the client to progress (Corey, 2009). From existential therapy, I will borrow the idea of viewing the world from the client’s worldview and build an authentic relationship with the client (Corey, 2009). Further, I will adopt the principles of feminist therapy of egalitarian and empowerment in my encounter with the clients and will focus on developing a collaborative relation with the client in which the client is the “expert” (Corey, 2009). Lastly, I will keep a check and evaluate myself on my beliefs and values to be open-minded and unbiased.

Techniques

Existential therapy does not have a particular set of techniques, and therefore, I will use CBT techniques such as Socratic dialogue to give the client an understanding of his/her impede thoughts and irrational beliefs. Once the client has understood his/her faulty beliefs, I will help the client using techniques like confronting faulty beliefs, debating irrational beliefs to get a broad perspective, forming alternative interpretations, learning new coping skills to prepare for the future. Further, I will use techniques such as collaborative goal setting to make the client actively responsible, homework assignments to understand and practice coping skill outside the therapy, changing the internal language and thinking patterns, imagery and role-playing (Corey, 2009). From the feminist therapy, I will utilise consciousness-raising techniques that help clients understand the societal influence on their lives. Additional techniques include gender-role examination and intervention, therapist self-disclosure, reframing and relabelling, cognitive restructuring, social action and group work (Corey, 2009).

The client population is diverse comprising of the clients are from different background. Therefore, it is vital for me to have a variety of techniques to perform adequately. I feel that the integration of existential, cognitive-behaviour and feminist therapies will give me an opportunity to work with clients in an active, directive manner and focus on the thought process of an individual. At the same time, develop an egalitarian relationship by modelling authenticity with the client while understanding their political and social environment. I believe in solving the present problems which cause dysfunctional thinking and beliefs but also acknowledge that some negative cognitions are related to past experiences. These therapies will allow me to include techniques that will keep the diverse client population in consideration and the different problems they face in their life. Existential therapy will give me an opportunity to help clients understand the meaning of life as human existence is never fixed it continually keeps changing (Corey, 2009). Thus, helping clients find a meaning to their existence will motivate them to understand their life and relations with others and prevent distress. Existential therapy lacks techniques and structure but allows me to integrate cognitive behavioural therapy. Therefore, integrating cognitive behavioural therapy as a beginner in the counselling field will provide me with that structure and direction. Additionally, CBT techniques will be useful as it has proven to bring a change to deal with clients with transition crisis and development issues (Corey, 2009). Lastly, feminist therapy will allow me to serve clients who face inequality in society. Also, the New Zealand population is multicultural and consist of Maori and Western Europeans. According to the NZAC code of ethics, there are three principles of counselling: protection, participation and partnership. A partnership is considered a core value of counselling and therefore, the therapeutic relationship is essential (Crocket, Agee, & Cornforth, 2011). Existential and feminist therapy emphasis on equal and robust therapeutic relationship. Also, Maori people take pride in their culture and traditions. Hence, feminism and existential therapy understand the cultural background of individuals. Further existentialism explores options of change within the client context of cultural reality.  Additionally, CBT believes in active participation of clients while feminist therapy understands the world views of the client through the client’s lens.

In a nutshell, developing an integrative approach to best suit the clients need is difficult, but the therapist should aim at developing approaches according to the client’s needs. CBT is empirically proven to be effective is problem and action focused therapy. It helps deal with the client’s problems within a short frame of time and is directive. Existential therapy balances out and helps to explore the meaning of life or helps in life transition keeping in mind the spiritual and religious consideration of the client. Lastly, feminist therapy helps in issues regarding inequality. Therefore, helping clients making a choice to live a life they want to live and developing coping skills to deal with the problems they face is my duty as a therapist. This will empower my clients and make them confident to move in a positive direction to face life and life situations.

Corey, G. (2009). Theory and practice of counseling and psychotherapy (8th ed.). Belmont, CA: Thomson Brooks/Cole.

Crocket, K., Agee, M., & Cornforth, S. (2011). Ethics in practice: A guide for counsellors.

Jones-Smith, E. (2016). Theories of counseling and psychotherapy: an integrative approach (2nd ed.).

Korman, G. P. (2017). Crossing the Rubicon: from psychoanalysis to cognitive therapy. Psicologia USP, 28(2), 214.

Westbrook, D., Kennerley, H., & Kirk, J. (2007). An introduction to cognitive behaviour therapy: skills and applications. London: Sage.