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Counseling theories converge: Person, client,
therapist
By Keith J. Myers
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November 19, 2013
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(https://ct.counseling.org/wpcontent/uploads/2013/11/Counselingtheories.jpg)Establishing a theoretical
orientation as a counselor is vital in
working with clients in the mental health
profession. This is common knowledge
in the field because any well-grounded
professional needs a basis by which to
operate.
As a professional counselor, one must know how to respond to various complex
individual and family issues, behaviors and emotions. If the counselor does not
know how to respond to the client, then he or she may appear incompetent to the
client. Actually, the counselor may be incompetent regarding that particular issue.
Most theories propose that counselors are competent to address most of the major
:
life issues that clients present within the therapeutic relationship, however.
Therefore, being knowledgeable and well-trained in a particular theory may
increase a counselor’s competence and confidence when working with clients in
need.
A new counseling student may wonder, “What is the process for tailoring my own
counseling theory?” Personally, I can trace my theoretical orientations back to
several factors that include but are not limited to life experiences, personal beliefs
and values, perspectives on how people change, my own work in individual therapy
and professional experiences working with diverse client populations. These
orientations include person-centered therapy, cognitive behavior therapy (CBT),
brief psychodynamic therapy and motivational interviewing.
Theoretical orientation was originally formed by my life experiences. Part of my life
experience was being raised in a home with parents who worked in a helping
profession most of their lives. My father was a pastor for more than 40 years and the
founder and headmaster of a private school for 13 years, while my mother served as
a secretary in both of those arenas.
Some of my earlier memories involve observing my father modeling interpersonal
skills among the parishioners he served. Some of those people were especially
difficult. He would tell me, “Keith, you just have to love them and accept them where
they are. Eventually, that love and acceptance will get through to them. It’s all about
the relationship.”
Similarly, Carl Rogers, founder of person-centered therapy, attested that the
necessary conditions for therapy are contained solely within the therapeutic
relationship itself. At least six specific conditions emerge out of this relationships,
including unconditional positive regard, genuineness and empathy, as referenced in
:
the popular theories text Systems of Psychotherapy: A Transtheoretical Analysis by
James Prochaska and John Norcross. I would say there is an excellent chance that if
my father were alive today, he would identify with Rogers as it relates to how people
change.
Throughout my life, I was able to test this “theory” as I connected with other people
and made observations about how people change. I observed that, in fact, people
do change within the context of how people relate to them. I originally learned my
own version of “person-centered therapy” through the modeling of relationships
from my father, but I learned later in life that the relationship is not the only
necessary ingredient for helping within the counseling profession, even though it
remains a foundational one.
Another theoretical orientation I identify with is cognitive therapy, also commonly
referred to as cognitive behavior therapy. CBT posits that one’s emotions and
behaviors are often caused or derived by one’s thoughts. In other words, if a person
is depressed or anxious, then that person has certain cognitive errors or distortions
that cause that person to be depressed or anxious. For example, a person
experiencing severe anxiety and panic attacks might have common thoughts such
as “I’m going to die” or “I can’t handle this!” By confronting the cognitive error and
replacing it with a more realistic thought (“This is uncomfortable, but it will pass on
its own” or “This is tough, but I can handle it”), the person will reduce or even
eliminate the anxiety completely.
I identify with this therapy largely because of my own psychotherapeutic work. I can
attest to CBT’s efficacy in my own life. For example, I learned that my inner thoughts
of “should” statements (“I shouldn’t be this” or “I should have done this”) exacerbate
:
my personal anxiety. I realized that by increasing my own thought awareness, I
could identify my cognitive distortions that were unrealistic or even completely
false. Once I learned to be more aware of my thoughts, it helped me to reduce my
anxiety significantly.
I have also experienced the importance of my changing beliefs through the years
and how this has affected my emotional and behavioral life. From a spiritual
perspective, my thoughts and beliefs about God, myself and others have also
shifted the way I feel about those important aspects of my life. For example, I
previously held the view that God expected a performance of good deeds in order
to receive His love and acceptance. When I confronted that “spiritual cognitive
error,” however, I was able to free myself from significant anxiety that had a spiritual
basis.
In my therapeutic work with diverse client populations, I have also found it helpful to
confront their thought and belief patterns and examine how these affect their other
emotional problems. For instance, I worked with a client who had moderate to
severe anxiety that often resulted in panic attacks and vomiting. The client stated, “I
can’t figure out why I’m having anxiety. Things in life are going well.” In other words,
he did not think he had any external or life circumstances that warranted anxiety
and was therefore perplexed. I assigned the client to keep a thought journal in
which he would regularly record his thoughts, especially during times of higher
anxiety. After journaling for two weeks, he said he realized he had the following
thoughts during times of anxiety: “I can’t handle this” and “If this happens, then I
won’t be a good husband, and that would be unbearable.” The client was
astonished that these thoughts were manifested during anxiety, and his awareness
increased. We explored some cognitive restructuring around those thoughts, and he
was able to form more realistic thoughts and beliefs given the situation. Four weeks
:
later, he reported that he had not experienced any significant anxiety or panic
attacks since our session. This was the first time he had been free of anxiety in over
a year. Thanks to personal and professional experiences such as these, today I
strongly identify with CBT.
When reading my theories textbook about psychodynamic therapies, I must admit I
was a little surprised. After almost 11 years of working in mental health, I thought I
had solidified my theoretical orientation. Then I read about the following themes
that, according to Prochaska and Norcross, characterize brief psychodynamic
therapy:
Emphasis on past experiences
Focus on client’s emotional expression
Exploration of client’s desires, fantasies and dreams
Emphasis on the therapeutic relationship
Exploration of client’s attempt to avoid issues
Focus on the interpersonal experiences of clients
Identification of client patterns in relationships
I continued to be surprised as I read about the specifics of the therapeutic working
alliance. This alliance is based on collaboration with the client about therapy goals,
consensus on treatment tasks and a connection within the professional relationship.
This alliance seems to merge well with my leanings toward person-centered therapy
and Rogers’ themes. I also connected with the principle of consensus in treatment
tasks because I have always viewed informed consent to be a living and ongoing
process with the client. For instance, when I am working through an evidence-based
treatment for PTSD with a trauma client, ongoing informed consent (specific phases
of treatment) is a necessary collaboration in order for the client to feel a continued
sense of safety and trust. Another theme from brief psychodynamic therapy is that
therapists seem to be more empathic, similar to the tradition of person-centered
:
therapy.
A final theoretical orientation I relate with is motivational interviewing (MI). MI is
considered to be in the same category as other person-centered therapies. It is
based on skills related to empathy and warmth, while focusing on working with
clients who often are resistant to treatment. It was originally developed for resistant
clients who were receiving substance abuse treatment. Four active elements of MI
are expressing empathy, developing discrepancy, rolling with resistance and
supporting self-efficacy.
Expressing empathy entails the therapist applying reflective listening skills to
express a genuine concern for the client and a basic understanding of the client’s
message. Developing discrepancy relates to identifying the difference between the
client’s current behavior and deeply held values. Rolling with resistance involves the
therapist avoiding any argument with the client because the client’s resistance is
simply his or her way of voicing ambivalence. Supporting self-efficacy involves the
therapist portraying that the client is capable of change. It is the client who is
responsible for finding his or her own solution to the issue. Four important skills of
therapists who operate from an MI orientation are open questions, affirmation,
summaries and reflective listening. From my clinical perspective gained while
working with the military population, I have discovered that MI helps veterans in
establishing their own goals for treatment. I also believe that MI is helpful as a
supervision model, and I am excited about utilizing it in my doctoral studies while
supervising graduate counseling students.
Given my orientation to various counseling theories, I ask myself whether I am an
integrative therapist who works across theoretical systems in a purposeful way, or
whether I just pick and choose as I prefer without any rationale behind my choices. I
would like to believe that I am more of an integrative therapist who chooses
commonalities among systems in a purposeful manner concerning the theories I
:
select. However, I must explore this on a deeper level to obtain an accurate answer.
When I reflect about this process, I discover common themes between the therapies
of person-centered, motivational interviewing and brief psychodynamic regarding
the important of the relationship, working alliance and assisting clients in
developing their own goals. However, my leaning toward CBT is incongruent with
the other therapies in some of these important aspects. Instead of the relationship
being the “end all, be all,” CBT is oriented toward thoughts and how they affect
behaviors and emotions.
I believe some of my incongruence is in conjunction with my own work in CBT and
how it has helped me. I have experienced firsthand the effectiveness of CBT.
Therefore, I have integrated it into my way of helping others. I have been helped, so
I choose to help others in the same way I have benefited. Consequently, my
integrative orientation is partly based on common themes between therapies and
partly based on my personal experience within my own therapeutic work. This is
how I resolve this discrepancy of sorts regarding my orientation.
What is the process of developing one’s own theory as a counselor? A counseling
theory is not something that is solidified by simply reading a theories textbook and
choosing from a plethora of options. Developing a theoretical orientation is initiated
and enhanced by personal reflection, readings, working in the mental health field
and life experience. Furthermore, it can be integrated by participating in one’s own
individual therapy. It is derived from within, particularly from the beliefs and
significant relationships of the counselor. It changes over time and is dependent
upon personal growth or working with diverse populations. Counselors should not
be surprised if they identify with a particular theory when they revisit those theories
years later. I am a person, a client and a therapist, and I attest to this process.
:
****
Keith J. Myers is a licensed professional counselor and doctoral student of
counselor education and supervision at Mercer University. He is also an intensively
trained eye movement desensitization and reprocessing therapist and serves on the
American Counseling Association’s Ethics Committee. Contact him at
[email protected] (mailto:[email protected]).
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1 7 C O M M E N TS
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OUNSELING-THEORIES-CONVERGEP E R S O N – C L I E N TT H E R A P I ST / # C O M M E N TS )
Joe papa
November 27, 2013 at 12:52 pm
(https://ct.counseling.org/2013/11/counseling-theories-converge-person-client-therapist/#comment-270740)
Hi Keith,
Just wanted to thank you for an amazing article, it reminded me so much of why I
am still in this field after 15 years. I was happy to hear once again, I am not alone
in my theraputic approaches. I was just with a client last night meeting with her
for the second time, and when reading your artice, it was like Wow, I used all
those same approaches of brief psychodynamci theory, and to tell you the truth I
:
do not remember studying up on that in my years of study, however was taught it
somewhere, or by God, lol.
Thanks again for you jnspiration!
Joe
Keith Myers
November 27, 2013 at 4:12 pm
(https://ct.counseling.org/2013/11/counseling-theories-converge-person-client-therapist/#comment-270780)
Thanks so much, Joe, for your encouraging words!!
Sean Pinto
February 26, 2015 at 1:18 pm
(https://ct.counseling.org/2013/11/counseling-theories-converge-person-client-therapist/#comment-758857)
This is an amazing article that I hope to read more fully later on in the day. I just
want to thank you for writing it and sharing it with the world.
Keith (http://www.keithmyerslpc.com)
May 1, 2015 at 10:40 pm
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(https://ct.counseling.org/2013/11/counseling-theories-converge-person-client-therapist/#comment-791596)
Thanks for your feedback, Sean!
Promise Agbaso
July 19, 2015 at 3:29 pm
(https://ct.counseling.org/2013/11/counseling-theories-converge-person-client-therapist/#comment-801256)
Hi keith myers, i must tank you alot for your wounderful article. Is a tool to my
academic enhancement. I appreciate you alot. After reading your article i gained
encouraged in my discipline ‘GUIDANCE & COUNSELING programme’. I would
want to have you as my mentor. Here is my contact:+2347035244770
(tel:+2347035244770) thanks!
Julie Creekmur
July 29, 2015 at 1:29 pm
(https://ct.counseling.org/2013/11/counseling-theories-converge-person-client-therapist/#comment-801780)
Hi Mr. Myers, I enjoyed your article and thought it was very helpful as I am
studying towards my masters in guidance counseling. It gave me a clear idea of
how important it is to have theoretical theories as a solid foundation for helping
people in need. I like what you wrote about Rogers theory on how people can
:
changes. Thank you so much.
Stacy Taylor
December 13, 2015 at 10:33 am
(https://ct.counseling.org/2013/11/counseling-theories-converge-person-client-therapist/#comment-808171)
Hello Keith
I am pursuing a Master’s level, Mental Health Counseling degree. My current
course work is on counseling theory, in particular the integrative approach. In
order to get a practical understanding of this portion of the coursework I
searched CT. Thank for your article. I have a deeper understanding.
Stacy Taylor
Keith (http://www.keithmyerslpc.com)
April 5, 2016 at 12:25 am
(https://ct.counseling.org/2013/11/counseling-theories-converge-person-client-therapist/#comment-809386)
Julie & Stacy,
Thanks for the feedback! Glad you found it helpful.
Keith
Akello Joyce
August 2, 2016 at 10:19 am
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(https://ct.counseling.org/2013/11/counseling-theories-converge-person-client-therapist/#com-
ment-809563)
Dear Keith
I want to appreciate the good article that you have published for being so
interesting since it would help me develop much more skills since I already
pursued a Diploma in counsling Psychology.
Joyce
Keith Myers (http://www.keithmyerslpc.com)
August 3, 2016 at 12:00 am
(https://ct.counseling.org/2013/11/counseling-theories-converge-person-client-therapist/#comment-809567)
Thanks for your feedback, Akello! Glad it was helpful.
Maria (http://www.mariameadcounselling.co.uk)
January 7, 2017 at 11:43 am
(https://ct.counseling.org/2013/11/counseling-theories-converge-person-client-therapist/#comment-809774)
Thanks for this interesting article. I am in the process of thinking how my theory
informs my work which is one of the criteria for meeting the BACP accreditation
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requirements and you have made me think about how I work, what I do and why.
Keith Myers (http://www.keithmyerslpc.com)
June 23, 2017 at 11:00 pm
(https://ct.counseling.org/2013/11/counseling-theories-converge-person-client-therapist/#comment-810146)
Thanks so much, Maria, for your feedback!
Jonnee Johnson
July 9, 2017 at 3:46 am
(https://ct.counseling.org/2013/11/counseling-theories-converge-person-client-therapist/#comment-810163)
Wow! Great article! You are an extremely talented writer. I enjoyed reading your
article. I also have a deeper understanding, after reading this article, of
theoretical orientations and how they can intertwine. So what is the theoretical
approach called if you take a little bit from all of the different theories?
“Individual-Customized Theory?” Maybe we can invent a new approach and call
it the “Individual-Customized Theoretical Approach.” 🙂
Thank you for writing this. I would like to read more of your work.
Thank You,
Jonnee D. Johnson
Jonnee Johnson
July 9, 2017 at 4:21 am
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(https://ct.counseling.org/2013/11/counseling-theories-converge-person-client-therapist/#comment-810164)
I guess that would just be my theoretical orientation I see.
E Alex
March 27, 2018 at 7:45 pm
(https://ct.counseling.org/2013/11/counseling-theories-converge-person-client-therapist/#comment-810495)
So happy to have run across this article. As a new clinician, I sometimes struggle
(inside) when asked this question but this article resonates with me! This article
was beautifully written and helps take some of the mystics out of identifying with
a particular approach. Honestly, this should be given at the start of any
counseling profession program. You know, I must say that after reading this
article I fell in love with why I entered this profession. Thank you!!! God Bless.
Nancy Thelusma
January 14, 2021 at 8:51 pm
(https://ct.counseling.org/2013/11/counseling-theories-converge-person-client-therapist/#comment-813078)
Keith, I enjoy this article. It is straight forward. It does not speak over my head. I
understand and get the ideas you want to get across.
Deana Russell
November 2, 2021 at 12:03 am
:
(https://ct.counseling.org/2013/11/counseling-theories-converge-person-client-therapist/#com-
ment-818740)
Thank you for this article Keith it was very informative. I am working towards my
LCSW after 25 years of being a social worker outside of mental health. I’ve
recently started my supervision and was asked to do a brief presentation on A
particular counseling theory. Not having worked in mental health much of my life
career I didn’t know where to begin. After reading your article it brought back
some deep knowledge I had gained 25 years ago and gave me a place to at
least start and feel comfortable in presenting on one of these particular theories.
Thanks again
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