Theories of Helping/Counseling

Theories of Helping/Counseling

Changes continue in two related areas:

• The nature of processing of counseling/therapy
• The setting and environments in which counseling/therapy occur

Likewise, counseling and therapy models continue to evolve from 1) the traditional psychodynamic model (assumes an intrapsychic perspective – conflict between Id, Ego and Superego), to 2) cognitive/behavioral approaches (emphasis on problem solving), to systems approach (emphasis on family interactions) to 4) outcome oriented brief therapies within an ecological system (includes family and larger systems in which the individual is embedded/functions, including cultural attitudes and ideologies, gender, race, class, ethnicity, religion, sexual orientation, geographical region, etc., all of which interact with each other – See Fig 1.1 of text page.  Because of these changes, the professional helper needs more skills and knowledge than ever.

The Twenty-First Century

Society continues to change with implications for professional, generalist, and nonprofessional helpers.   Before long the dominant white population will be a minority in a multicultural country.   Diversity increases (culture, ethnicity, lifestyle, disability, age, language, etc.) but not without resistance and controversy.   

Many of the population continue to benefit from the economic growth of the 90s, but for a significant portion of the population, their lives are lived below the poverty line where there is a higher level of physical and mental illness, societal discrimination, lack of training/education, homelessness, social welfare dependency, and higher levels of crime.    For others, there is the loss of high paying jobs and a loss of middle-class status.    There is particular uneasiness with the economic recovery that may not include a significant number of new jobs, a situation exacerbated by an abundance of cheap labor in Asian countries that is easily accessible through modern technology and modern transportation.

There is less confidence in business as a provider of economic security.  A large percentage of the population does not have health insurance coverage.  

As the gap between the “haves” and “have-nots” increases, there is also the changing nature of employment, where one can expect to change jobs and go through re-training many times over the life cycle.   Education in itself is no longer an assurance of good employment; under-employment (overly educated for the position leading to low job satisfaction) is now a common phenomenon.  There are different philosophies, from the very conservative (little or no government intervention) to the very liberal (high level of government intervention), which advocate different approaches to individual and social problems of our time.   From our vantage point, the changing circumstances of the 21^st century have significant implications for the counselor/helper. 

 Changing Roles of Helpers

 Core concepts of helpers that have not changed:

• A “working alliance” – an authentic, warm, empathic relationship between helper/counselor and helpee/client is essential.
• Accurate assessment, treatment formulation and planning, short-term and long-term outcomes (goals and objectives).
• Confidentiality
• Focus on client’s needs rather than on the helper’s or third party (insurance) needs
• Individualized counseling treatment

 Changes – primarily driven by economic factors

• Cost containment concerns has led to a shift toward short-term, outcome-oriented counseling and therapy, where third –party payer’s (insurance, HMOs, etc.) treat those deemed to have a “medical necessity” and exclude the “worried well”; preventive care is not emphasized and access to mental health care is severely restricted. 
• Short term approach may see greater emphasis on the use of medication or a combination of therapy and medication. 
• Focus of managed care is on directive, action-oriented approach to problems – a reduction in symptoms as opposed to underlying causes; utilization of team approach by interdisciplinary helpers (individual, group, family, organizational); focus on strengths rather than weaknesses of individual. 
• Rapport building, assessment, empowering interventions, and outcome evaluation are employed in a limited treatment package. 
• A shift in the nature/nurture understanding of symptoms (more emphasis on the biological over environmental factors) requires greater knowledge on the part of helpers.  Is medication better than psychotherapy, for instance?
• Broadening range of resources and techniques (examples of hypnosis, eye movement desensitization recovery, biofeedback, newer generation of drugs, more refined assessment tools, computerized programs, cognitive/behavioral strategies, internet, and alternative medicines. 
• Helping programs and services severely constrained by economic and political factors; leads to constrained working conditions for helpers – heavier work loads
• Because of increases in societal complexity, it makes sense to see individuals and their behaviors in their relevant social and cultural systems (family, neighborhood, job, etc.) all of which can contribute to their overall stress and symptoms.  Table 1.1 presents a useful Ecological Intake Sheet, which summarizes the information needed by a helper for an accurate assessment and treatment plan from an ecological perspective.

Communication Skills:

Ineffective or faulty communication is a t the root of most interpersonal difficulties.  It means effectively responding not just to the verbal content, but also hearing, perceiving and responding to emotional messages. 

Who is a Helper/Counselor?

The helper is anyone who assists others to understand, overcome, or deal with external or internal problems.  For our purposes, helpers are divided into three categories: Professional, Generalist Human Services Worker, and Nonprofessional Helper.  

Professional:  Specialist who undergo extensive graduate-level training in the study of human behavior, learn applied helping strategies, and experience supervised clinical training while helping individuals, families, and groups.  Included are physicians, psychiatrists, psychologists, Master’s level social workers and psychotherapists, and psychiatric nurses, etc.  Although they may provide similar services, there is often “turf wars” between these professionals as they compete for limited funding. 

Generalist Human Services Workers:They overlap the professional category and include psychiatric aides or technicians, your street workers, day-care staff, probation officers, supervisors, managers, human resources personnel, and church workers.   These workers usually receive specialized human relations training at the undergraduate college level and usually work on a with professionals or have professional supervision.

Nonprofessional Helpers: May not receive formal training, but may attend seminars or meetings on various issues in human relations.  This group includes interviewers, supervisors, teachers, volunteers, friends, relatives and colleagues. 

Successful Helpers/Counselors?

It is important to be familiar with many approaches and strategies, which are filtered through the unique personality of the helper/counselor.   Personal attributes of the helper/counselor are more important than strategic skills.  The helper’s/counselor’s personal values, what is considered “good” or “bad” play a significant part in the helping relationship.  Our beliefs underlie our values, and so should be explored and clarified.  Culture, gender, race, ethnicity, sexual orientation, class, family system, geographical region, etc shape our beliefs/values. 

The effective development of trust between the helper/counselor and helpee/client is an essential first step.  It requires empathy, an understanding of another person’s emotions and feelings from that person’s frame of reference and effectively conveying/communicating that understanding; paying attention to culture, class, race, etc.   Application of helping strategies involves the affective domain (effective relating to feelings or emotion), the cognitive domain (relating to thinking or intellectual processes), and the behavioral domain (relating actions or deeds).  Different people need help in different areas of functioning; outcomes are more likely to be successful if helpers fit the strategy to the helpee’s/client’s needs; and effective strategy can be relatively simple and can be used by someone lacking lengthy professional training.  

 Two Stages of Counseling:

Counseling is both an art (personality, values, and demeanor of counselor) and a science (human services interventions measured for their effectiveness).   Counseling can be thought as having two intertwined parts or stages

• The first stage involves building rapport and trust between helper and helpee in the pursuit of self-disclosure and problem understanding, thus opening the way to goals and objectives for problem resolution and growth.
• Stage two involves strategy planning, implementation, and evaluation, which lead to termination and follow-up.  Stage two usually involves the professional helpers, but also the concern of generalist human services workers.  Non-professional helpers are not usually involved in stage two, but they do need a rudimentary knowledge of the theory and application of helping strategies as practiced by the professional and generalist. 

Human Relations Counseling Model

Drawn from several theories, this model proposed by Okun emphasizes a client-centered, problem-solving helping relationship in the interest of behavior changes and actions.  Behavior changes and actions results from the client’s exploration and understanding of his/her feelings, thoughts and actions, and/or the client’s understanding of and decision to modify pertinent environmental and systemic variables.

Assumptions and Implications of the Model:

Based on existential, cognitive/behavioral, and systems theoretical considerations (an eclectic approach), the assumptions include:

• People are responsible for and capable of decisions witin the framework of environmental factors
• Environment is a controlling factor, but people are still capable of directing their lives more than they realize – there are choices to make even when restricted by environmental and biological factors. 
• Driven by basic physiological needs to abstract self actualization, people are goal oriented
• People want to feel good about themselves which requires positive confirmation for significant others; also want to behave congruently, and to reduce dissonance between internal and external realities. 
• People can learn and change behavior, which are subject to environmental and internal consequences of their behavior – reinforcements (cognitive behavioral therapy).
• People’s problems may arise from unfinished business, unresolved problems from past events or relationships; best resolved by focusing on the here and now (gestalt/existential approach).  Incongruency, discrepancy between a person’s actual experience and his/her picture of that experience, can also cause problems. 
• Problems can be societal or systemic rather than interpersonal or intrapersonal, for example, oppression due to gender, race, ethnicity, class or sexual orientation can cause psychological problems. People can effect choices and changes from within the system as well as from without. 

I suggest that you complete the Exercise 1.2 in the textbook that should help you clarify your values in relation to helping.

 Major implications of the human relations counseling model are:

 Defines empathic communication skills as the core of effective human relationships

• Stresses that empathic communication skills can be taught to all helpers in all types of helping relationships
• Provides room for diversity and flexibility so helpers can learn a variety of intervention strategies that can be effective if a successful helping relationship is developed and maintained
• Modifies and integrates a variety of established approaches and strategies
• Provides the versatility and flexibility necessary to meet the needs of a multicultural heterogeneous population
• Provides for dealing with feelings, thoughts, and behaviors in a short-term, practical manner relating to the helpee’s/client’s life.
• Focuses on the positive rather than the negative aspects of the helpee’s/client’s life.
• Assists the helpee/client to actively assume responsibility for living and decision making.  

 Dimensions of the Model:

The human relations counseling model can facilitate professional, generalist and nonprofessional human services workers to become more self aware in order to build their own healthy interpersonal relationships and to be effective as helpers. This model has three equally important and interdependent dimensions. The first dimension is a process with two stages: relationship building, the basic condition for the success of any helping process; and strategy planning and implementation, aimed to increase the helpee’s//client’s effectiveness in the affective, behavioral and cognitive domains. The second dimension focuses on the use of effective communication skills necessary to accomplish the tasks of the first two stages. The third dimension discusses issues affecting the helper and helping process, such as personal values (including those concerning sexism, racism, ethnocentrism or heterosexism), ethical considerations (personal, professional, regarding computers), and evolving strategies of empowerment, change agency, and advocacy.