Theories and therapies of counseling are the building blocks of the profession. Probably every counselor has had at least one course in theories of counseling, and the names of the leading theorists, such as Sigmund Freud, Albert Ellis, Carl Rogers, and others, are both legendary and familiar. This entry will address what constitutes a theory of counseling, why counseling theories and therapies are so important, and how these theories have evolved.
Common Characteristics of Theories of Counseling
Estimates are that more than 350 counseling theories and therapies have been advanced. Although most of these have received little attention or validation, a core group of about 10 major theories, and fewer than 50 secondary approaches or modifications of the major theories, dominate the counseling profession. Most of these theories are characterized by the following important ingredients:
• A concept of how people develop throughout the life span. Typically, this involves a sequence of stages and describes important factors that are likely to influence development.
• Criteria for mental health, with characteristics of unhealthy or disordered emotional functioning either explicitly or implicitly stated. This information is important in helping people set realistic treatment goals and in assessing progress.
• Information on how to promote healthy development and help people reduce symptoms and enhance their coping skills and satisfaction with their lives.
• A description of the role of the effective counselor and the desired relationship between client and counselor. Nearly all theories of counseling currently recognize the powerful impact of the therapeutic alliance and offer clinicians ways to collaborate effectively with their clients. A safe and healing environment and a caring, skilled, and trustworthy counselor are essential to successful treatment.
• Strategies and interventions that counselors can use to help people achieve their counseling goals. Examples include reflections of feeling, modification of cognitive distortions, and systematic desensitization.
• Information on treatment parameters such as duration and frequency of sessions; whether to use individual, group, or family treatment; and benefits of medication and other adjunct services.
• Delineation of those people who are most likely to benefit from this treatment approach.
This is most
likely to be presented in terms of symptoms and disorders that are amenable to treatment via this approach, but might also discuss such factors as gender, age, cultural background, and other factors.
Purposes of Counseling Theories and Therapies
Although, of course, counselors cannot master all the important counseling theories and therapies, most counselors have a few preferred theories that they use with confidence and competence. Their skills in those therapeutic approaches enable them to do the following:
• Decide whether they are likely to be able to help a particular person with a given set of concerns.
• Collaborate with clients in establishing goals that are realistic in terms of the treatment approach that is being use.
• Develop an overall plan for helping people achieve their goals.
• Individualize treatment by emphasizing and selecting interventions and strategies that are most likely to be helpful to a particular person.
• Assess a person’s progress against that made by other people who received similar treatment and modify treatment if it does not seem effective.
• Deepen their knowledge of and skill in their chosen theory through experience, reading, training, and supervision.
Four Categories of Counseling Theories and Therapies
Although counseling theories and therapies overlap considerably, they can be organized into four broad groups. Each group is characterized by its primary emphasis (background, behavior, emotions, thoughts), as well as its theoretical rationale.
Theories and Therapies Emphasizing Background
Freud, viewed as the father of psychotherapy, advanced the first widely studied theory of therapy. Although Freud’s work dates back to the late 19th century, well before the advent of the counseling profession, Freud’s ideas established the groundwork for all the mental health professions. Freud viewed the first 5 years of life, along with the parent-child connection and interactions during those years, as the major determinants of a person’s subsequent psychological development. Therapy sought to make the unconscious conscious and, through the transference relationship, to rectify shortcomings of the child’s early connection to the parent.
Freud’s followers, as well as those who later expanded and revised his concepts and strategies, include many of the early and seminal thinkers in mental health. In addition, current conceptions of brief psychodynamic therapy developed by Gerald Klerman, Hans Strupp, and others, also are rooted in Freudian thinking.
Although relatively few counselors today practice Freudian psychoanalysis, many view people from a psychodynamic perspective and believe that understanding of people’s early histories is essential to their personal growth. Strategies such as interpretation, analysis of repetitive patterns, free association, exploration of transference and countertransference, modification of defense mechanisms, and discussion of early recollections all reflect the influence of Freud and others who emphasized the importance of people’s history and background.
Theoáes and Therapies Emphasizing Behavior
Theories emphasizing behavior and behavioral change represent the second wave of counseling theories and therapies. Gaining attention during the 1950s and 1960s and becoming a powerful force in the mental health professions, these approaches presented both an alternative and a challenge to psychoanalysis. Behavior therapy takes the stance that behavior is learned through exposure, modeling, conditioning, experiences, rewards, and punishments. In light of this, behavior that is unhealthy, nonproductive, or harmful to the self or others can be unlearned and replaced with new and more effective behaviors.
The foundations of behavior counseling can be found in the work of Ivan Pavlov and John W. Watson. Others, including B. F. Skinner, John Dollard and Neal Miller, Joseph Wolpe, and Albert Bandura, used both research and theory to develop strategies to promote behavioral change. More recent theorists, including Arnold Lazarus, Donald Meichenbaum, Albert Ellis, Aaron Beck, and William Glasser, have further expanded on the application of behavior counseling by combining that approach with cognitive therapy. The popularity of solution-focused therapy also has promoted the importance and power of behavioral change.
Behavior counseling focuses on present manifestations of observable behaviors and targets a broad range of behaviors, including substance use, eating, interpersonal skills, self-care, study habits, executive functioning, exercise, parenting, working and playing, and many others. Behaviors are viewed in context and a collaborative alliance of counselor and client is viewed as essential. Treatment typically begins by establishing a baseline or clear picture of the nature and severity of the undesirable behavior. Goal setting promotes motivation, facilitates development of change strategies, and helps people move forward. Behavior counseling incorporates a wide range of strategies to facilitate change, such as education, skill training, reinforcement, desensitization, relaxation, behavioral rehearsal, and many others. Peer and group support, as well as relapse prevention, often help to solidify gains.
Theories and Therapies Emphasizing Emotions
Carl Rogers, through his development of what is now called person-centered counseling, deserves most of the credit for bringing the third wave of counseling theories to the fore. With his emphasis on people’s emotions and his deep respect for people’s ability to grow and change in positive ways, Rogers humanized the counseling profession. He believed that counseling would be more effective if counselors could join with their clients on an emotional level, feel appreciation and empathy for them, help them express their emotions fully, and use their own resources to enhance their self-esteem and improve their lives. Rogers work brought attention to the importance of the human potential and actualization, self-esteem, and the client counselor relationship. Most counselors now appreciate the importance of the therapeutic alliance and the facilitative conditions that enhance that relationship. In addition, Rogers deep respect for each person led to an appreciation of the importance of phenomenological approaches, those that seek to understand people’s views of the world and their unique perspectives.
Although adherence to a pure person-centered treatment approach seemed to decline after Rogers’s death, his emphasis on emotions had a profound impact on counseling theories and therapies. During his lifetime, other approaches emphasizing feelings, such as Gestalt therapy, developed by Fritz and Laura Perls, and existential therapy also garnered attention. Important current treatment approaches such as narrative therapy, constructivist therapy, feminist therapy, and motivational interviewing reflect Rogers’s emphasis on empathy, phenomenology, and the therapeutic alliance. These newer approaches have contributed to a deeper appreciation for the tenets of person-centered counseling.
Theories and Therapies Emphasizing Thoughts
Albert Ellis, who initially developed rational emotive behavior therapy in the 1950s, led the way in the development of cognitive theories and therapies of counseling. His efforts to help people identify dysfunctional thoughts or irrational beliefs and replace them with thoughts that are valid, logical, flexible, and helpful gave counselors yet a fourth perspective on the process of change. The subsequent work of Aaron Beck provided more structure, as well as additional effective tools, to counselors who emphasized cognitions in their work.
Ellis, Beck, and other cognitive therapists hold that thoughts are the most powerful and successful route to effect change. They suggest that people’s emotions and behaviors, as well as their views of the world, grow out of their thoughts and that, if they can change those thoughts in positive and healthy ways, they will be more likely to make positive changes in emotions and actions. Like behavior counseling, cognitive therapy is a structured but flexible approach that usually focuses on the present, seeks to effect fairly rapid change, and involves client-counselor collaboration. Cognitive therapy also draws heavily on a wide range of treatment strategies, such as affirmations and self-talk, thought stopping, imagery, and, most important, transformation of dysfunctional and unhealthy thoughts into healthy and helpful ones.
Integrated and Eclectic Counseling Theories and Therapies
This entry on counseling theories and therapies has focused on four broad approaches to treatment, distinguished by whether they emphasize background, emotions, behaviors, or cognitions. Counselors also should keep in mind the growing trend toward eclectic and integrated approaches. Examples include Arnold Lazarus’s multimodal therapy, developmental counseling and therapy (DCT) developed by Allen Ivey and his colleagues, and the transtheoretical model developed by James Prochaska and others. Most integrated counseling theories and therapies are still in the formative stages. However, this is a growing area of the profession, and we can anticipate expansion and refinement of integrated approaches.