Theoretical Orientation
My personal orientation lies in Gestalt (Fritz Perls), Person Centered (Carl Rogers) and Reality Therapy (William Glasser) psychotherapy.
What do you see as the time frame of counseling? Are you more oriented to the past, present, or future?
I am oriented to present; however, I believe that many problems can come from the past. Therefore, the past must be discussed at some point.
To take this a step further, do you believe counseling is intended to work on current issues and feelings or to help people with issues and feelings from the past? Or, do you believe that people need to focus on their future feelings, thoughts and behaviors.
I believe people should focus on their current issues first. However, every individual are different. Therefore, therapy should be aim at individuals’ need.
B.
What is your view of people? Do you believe people are essentially good, bad, or neutral? I believe people can be essentially good
Do you believe clients are good people with issues to work out? Generally yes.
Conversely, are your clients bad people with an inherent defect that requires counseling? Are people somewhere in between, such as good people that do bad things?
Clients are all sorts of people with many different problems that requires counseling
C.
Who is in charge? Is the counselor in charge of the therapy or is the role shared equally with the client? Counselor can be in charge first, then the role can be shared equally
If the role is shared, how much of it belongs to the client and how much belongs to the counselor? If the counselor is in charge, how is that established? How do you view your role as a counselor? Are you an expert, consultant, or friend? Gestalt therapists wear a number of different “hats” in a therapeutic relationship, varying from time to time and over time as the needs of the client change.
D.
What do you want the client to learn? Is the emphasis of counseling to gain insight, action, or both? Both.
Are you comfortable with clients leaving counseling with insight about their behaviors and feelings? Yes
Do you pay attention to thoughts, feelings, behaviors, or all of them? All of them
Next, students will describe their emerging theoretical orientation and describe:
a)
The rationale for choosing the theory including key points of the theory as applied to a hypothetical client of your choosing.
The selection of gestalt theory as conceptualized by Fritz Perls, person-centered therapy as articulated by Carl Rogers and William Glasser’s Reality Therapy was based on their respective strengths (as discussed further below) as well as their basis in forming my personal counseling orientation. The respective theoretical concepts and ideas that are unique to these theories are applied to a hypothetical client below.
b)
Theoretical concepts / ideas unique to the theory. The hypothetical client of interest for this case paper is a 61-year-old Vietnam combat veteran named “Brad” (not his real name), a medically retired staff sergeant with several physical disabilities as well as posttraumatic stress disorder (PTSD). Brad’s physical disabilities include a severe traumatic brain injury, fused right ankle and fractured right femur (which shortened his right left 1-1/2 inches), and a shortened left femur (performed to even his leg lengths to treat his back pain) and several associated orthopedic comorbidities that adversely affect his quality of life.
Over the years, Brad has experienced many of the events that characterize the lives of returning combat veterans, including problems with substance abuse, maintaining relationships (he has been married three times), some encounters with the law enforcement and criminal justice communities (two DUIs when he was younger after his divorces) and suicide ideations from time to time. Although he is still employed full time as an accountant, Brad reports increasing difficulties remaining at his desk for lengthy periods of time because of back problems and a stiff neck. At this point in his life, Brad is seeking help with his physical limitations as well as in maintaining his current relationship with his wife, children and grandchildren. In addition, Brad is concerned about his periodic suicidal thoughts. Taken together, Brad presents with a complex set of circumstances that requires a specialized approach to therapy as described further below.
Gestalt (Fritz Perls). According to Shane (2005), Fritz Perls developed gestalt therapy I collaboration with his wife, Laura, and Paul Goodman. The gestalt therapy conceptualized by Perls and his colleagues involves the interactions that take place between different levels of conscious and unconscious. For therapeutic interventions, these interactions optimally assume the form of recalling and recording nocturnal dreaming and nightmare episodes in various ways, including describing the events narratively, writing, drawing, or painting them or otherwise making their content known in the conscious waking world (Flagg, 2004). According to Flagg, “This engaging in dialogue between conscious and unconscious can be taken to another level, by inquiring of a dream symbol, in conversation in a dream, fantasy or re-dream, to understand their potential meaning” (2004, p. 64).
This is one of the fundamental theoretical concepts that underpin current gestalt therapy. For instance, in “Gestalt Therapy Verbatim,” Perls “assumes that every dream symbol represents some aspect of the dreamer, and asks a participant to ‘become’ the dream tree, or dog, or person, and communicate what it means to be that dream symbol” (Flagg, 2004, p. 63). This theoretical approach is congruent with the gestalt perspective that perceptual experiences are intrinsically holistic and organized events (Wagermans, Feldman, Gepshtein, Kimchi, Pomerantz & van der Helm, 2012).
Person Centered (Carl Rogers). According to Uebel (2007), “The humanist and Gestalt psychologists Carl Rogers and Fritz Perls provided the intellectual as well as practical ground from which such important developments as ‘confluent education’ and the ‘live classroom’ sprang” (p. 326). Like Perls, Rogers’ theoretical foundation is also based on a holistic perspective of the individual. In this regard, Uebel advises that, “This ‘live classroom’ is predicated on the understanding of the whole (or Gestalt), on integrating emotion with cognition, on awareness (of self and other or object), and on experiencing through contact” (2007, p. 327). There were there conditions proposed as “necessary and sufficient” for therapeutic change in Rogers’ theory of client-centered counseling: (a) empathy, (b) genuinenes and (c) unconditional positive regard (Wickman & Campbell, 2010). According to Wickman and Campbell, “This theoretical framework provides the instructional foundation for many counselor education programs” (2010, p. 179).
Reality Therapy (William Glasser). Similar to drawing a map of where a client wants to go, Reality Therapy developed by William Glasser provides a framework in which clients can map out their goals and collaborate with their Reality Therapy counselor to identify what steps will lead them there. For instance, according to Mauzey (2008), Reality Therapy is a problem-solving counseling model that helps people to identify what they want and build a plan which will help them get what they want” (p. 62). According to Peterson (2009), Glasser’s Reality Therapy is similar to Maslow’s hierarchy of needs framework in that people have certain basic needs that must be satisfied in order for them to survive and prosper. For this purpose, Glasser identifies four needs:
1. Love and Belonging: Glasser states that “in practice, the most important need is love and belonging”);
2. Power: “Power is the need to feel important and be recognized. It is not power or control over other people”);
3. Freedom: The freedom need refers to that sense of having control over things that affect peoples’ lives — the freedom to make choices, to have options, and not to feel trapped or stuck is essential to one’s psychological well-being;
4. Fun: The pleasure received from doing a job does not satisfy the need for fun need — fun has to be a division from work and resemble childlike play (Peterson, 2009, p. 42).
By assessing deficiencies in these needs, Reality Therapy counselors can help patients identify opportunities and build on their strengths to overcome these constraints in their lives. In this regard, Peterson advises that, “Reality Therapy counselors consider needs as pathways that contribute to psychological strength” (p. 42). The basic process used in Reality Therapy is fairly straightforward: “Counselors look for and assist their clients in identifying voids in their lives that are the result of unmet needs. Counselors question clients to determine how they satisfy each of the psychological needs” (Peterson, 2009, p. 42). For this purpose, Glasser recommends patients ask themselves the following questions and take the following advice as points of departure for further analysis:
1. Always ask yourself what you want. Then ask yourself if you really want it, and are you ready to do whatever it takes to get it.
2. Always ask yourself if what you want is achievable (Parish & Mahoney, 2009, p. 367).
It is important to note that the Reality Therapy approach is not necessarily a scheduled set of treatments for a defined duration, but is rather an iterative process that could conceivably be followed for a lifetime of self-improvement (Parish & Mahoney, 2009). For example, Glasser emphasizes that, “Once you have attained what you want set new goals. After all, life is thought to be a journey more than a destination, so never think that you ‘have arrived.’ Instead, just ‘enjoy the trip’” (cited in Parish & Mahoney, 2009, p. 367).
Finally, in sharp contrast to many other psychological theorists who subscribe to organic mental illness factors, Glasser argues that understanding how the interrelationship between these four needs can help patients overcome their problems which he insists are not caused by mental illness, but rather this incongruence between needs and reality. For instance, Sandhu (2009) reports that, “After 40 years, Glasser still stands adamant that there is no such thing as mental illness. Psychological problems are caused by lack of responsibility, the choice of behaviors, and toxic relationships” (p. 296).
c)
Effectiveness through a literature review.
Gestalt (Fritz Perls). Since its introduction, gestalt therapy has been used in a wide range of clinical settings to good effect, and a generation of therapists has been influenced by the seminal work of Fritz Perls because it was effective — for its time. According to Madewell and Shaughnessy (2009), “Fritz was very effective. Fritz could get by with what he did and was very effective if anyone was willing to stay with him” (p. 429). Evaluating the precise effectiveness of one treatment regimen over another is challenging if not impossible for a number of reasons, including the highly individualized nature of the therapeutic relationship as well as the fact that each client and therapist is unique. Indeed, Jones and Lyddon (2008) emphasize that, “Not only was it difficult to demonstrate the effectiveness of psychotherapy as a whole, but it was equally difficult to demonstrate that one therapeutic approach was necessarily superior to another.” (p. 337). In fact, each of the therapeutic approaches proposed for use with Brad have been evaluated for their relative effectiveness with no discernible differences identified. In this regard, Jones and Lyddon add that, “[Researchers] found no significant differences among Gestalt therapy, rational-emotive therapy, behavioral therapy, transactional analysis, psychodynamic therapies, and humanistic approaches” (p. 338).
Person Centered (Carl Rogers). The effectiveness of Rogers’ person-center approach is typically confirmed by references to his work with Gloria, a 30-year-old woman who recently divorced (Wickman & Campbell, 2010). According to Wickman and Campbell (2010), “Carl Rogers’s session with Gloria in the training film titled Three Approaches to Psychotherapy is among the most written about in the history of counseling and continues to be used as an instructional model for the helping professions” (p. 178). For instance, Wickman and Campbell note that, “In this session, Gloria, presented an initial problem about ‘having men to the house,’ wondering ‘how it affects the children.’ Specifically, Gloria wanted to know if she should be truthful with her daughter about having sex since the divorce or if such honesty would cause her daughter emotional harm” (2010, p. 178).
The efficacy of the gestalt approach to psychotherapy is also evinced in this training film. In this regard, Wickman and Campbell add that, “Through the course of their 30-minute conversation, this issue evolved into Gloria accepting herself and feeling ‘whole’” (2010, p. 178). Notwithstanding the relatively short duration of the treatment, there were a number of significant indicators that this approach was effective in changing the client’s life for the better (Wickman & Campbell, 2010).
Reality Therapy (William Glasser). A number of practitioners maintain that Reality Therapy is a highly effective treatment modality that can produce significantly improved clinical outcomes (Sandhu, 2009). According to one authority, “Glasser adroitly conceptualizes his clients’ problems and brilliantly illustrates how professionals improvise treatment plans using loving relationships as the key to address psychological problems” (Sandhu, 2009, p. 296). Despite the aforementioned constraints to evaluating the effectiveness of a given treatment modality for an individual client or a population of clients, Mauzey (2008) suggests that “the best way to evaluate the validity of Reality Therapy, and any therapy, by determining whether or not the behavior of the presenting problem continues” (p. 63).
d)
Strengths/weaknesses of the theory.
Gestalt (Fritz Perls). The effectiveness of gestalt therapy as practiced by Perls has been attributed to the peer pressure and innovative nature of his approach. For instance, Madewell and Shaughnessy point out that, “Fritz did most of his work in groups. And being group members people were not likely to bolt. Nowadays, people would not stand for such treatment – in a group or a private session. Times are different” (2009, p. 429). Moreover, psychotherapy in general was a relatively new field of practice and clients apparently accepted Perls’ practices because they had nothing to compare them to. As Madewell and Shaughnessy note, “Therapy professionals were nowhere as common as they are now and people are prepared to make judgments, correctly or incorrectly, about the person they have hired to enter into this rare relationship with them” (2009, p. 429). Likewise, Cortright (2008) advises that, “Therapies such as Fritz Perls’ gestalt therapy . . . have faded from the scene and exist mainly in small pockets around the globe with occasional conferences” (p. 128).
Person Centered (Carl Rogers). Accolades and criticisms (including some from Rogers himself) alike abound with respect to Rogers’ person-centered theory. With respect to the former, Nystul and Zurich (2007) note that, “The Rogers and Gloria session is perhaps the most widely known in the history of counseling … And underutilized in counselor education” (p. 369). Conversely, Wickman and Campbell report that, “Rogers expressed considerable frustration at how his theory was taught, stating that ‘such training has very little to do with an effective therapeutic relationship’ and that he had ‘become more and more allergic’ to terms like ‘reflection of feeling’” (p. 179).
Furthermore, even Rogers subsequently criticized the manner in which his concept of person-centered therapy was being taught. In fact, when asked by a student he did not consistently apply the strictures of so-called “Rogerian” therapy, Rogers responded, “I’m in the fortunate position of not having to be a Rogerian” (cited in Wickman & Campbell, 2010, p. 179). In sum, Rogers was making the point that his original conceptualization of person-centered therapy had been transformed to the point where it had become something else, reflecting a gap in the existing body of literature concerning current approaches to using this modality in . In this regard, Wickman and Campbell conclude that, “Clearly, there is a discrepancy between how Rogers conceptualized what he did and how his theory was being taught. For that reason, a greater understanding of Rogers’s enacted therapeutic style is needed to increase counselor effectiveness” (2010, p. 180).
Reality Therapy (William Glasser). Notwithstanding the constraints to evaluating the effectiveness of any psychotherapeutic modality, Mauzey (2009) reports that, “Reality Therapy is the least empirically-supported psychology” (p. 68). Moreover, Reality Therapy counselors must possess a high degree of cross-cultural competency in order to be effective with a diverse clientele. As Peterson points out, “Identifying needs is often related to culture” (2009, p. 43). Despite these considerations, some psychologists maintain that Reality Therapy is the treatment of choice for many patients with a set of complex needs that requires understanding and thoughtful action. In this regard, Sandhu (2009) emphasizes that, “The remarkable simplicity, the stunning eloquence, and the are the hallmarks of this icon in the counseling field” (p. 296).
References
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Jons, J.V. & Lyddon, W.J. (2008, January 1). Cognitive therapy and empirically validated treatments. Journal of Cognitive Psychotherapy, 14(3), 337-339.
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