Counselling and Therapy Techniques: Theory and Practice

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Augustine Meier & Micheline Boivin

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    Dedication

    We dedicate this book to our daughter, Molisa Meier

    Author Biographies

    Augustine Meier, Ph.D., Clinical Psychologist, Professor Emeritus, Saint Paul University, is the Founder and President of the Ottawa Institute for Object Relations Therapy. He trains and supervises candidates pursuing Certification as Object Relations Therapists and Supervisors. He taught graduate courses on Psychotherapy and Psychopathology and trained and supervised graduate students in counselling and research and doctoral students in psychology. Dr. Meier edited five books including The Helping Relationship: Healing and Change in Community Context (in press) and with his wife, Micheline Boivin, published over forty articles in refereed journals and as chapters in books on psychotherapy process and outcome. He has a private practice where he specializes in posttraumatic stress disorder, abuse, trauma and personality disorders.

    Micheline Boivin, M.A., is a Certified Clinical Psychologist and a Certified Object Relations Therapist working with troubled and traumatized children and their parents at the Services psychologiques du Programme Enfance Jeunesse Famille du Centre de santé et des services psychosociaux de l'Outaouais, Gatineau, Québec (Psychological Services of the Family, Youth and Children's Program at the Psychosocial and Health Center of Gatineau, Québec). She has presented workshops on child sexual abuse and play therapy and with her husband, Augustine Meier, she has presented more than a dozen workshops on psychotherapy techniques such as Experiential Focusing, Task-Directed Imagery and Gestalt Two-Chair technique.

    Acknowledgements

    For decades the authors have been interested in integrating psychotherapy theory and practice and wrote the first article on the topic over twenty five years ago. In the development of their ideas over the years, the authors are particularly grateful for the comments, questions and feedback from their graduate students who were enrolled in therapy and counselling courses, took graduate-level training and practicum in counselling, and received supervision for their clinical work. The authors also wish to acknowledge the contributions of the persons who requested professional therapy and counselling to resolve their self, relational and emotional problems. They helped us to assess when, how and which techniques are helpful to achieve their therapy goals.

    Special thanks to our cherished daughter, Molisa Meier, for having carefully reviewed each of the chapters and for posing challenging questions and providing us with helpful suggestions. Thanks for assisting us in preparing the glossary. We enjoyed our many lively, thought provoking and stimulating discussions that helped to sustain our efforts to stay with our project, to move it forward and bring it to its ultimate conclusion. We are extremely happy that we were able to share with you our joy in writing this book.

    We wish to thank Shelley Briscoe-Dimock, our dear friend and colleague, for having meticulously read and commented on each chapter and helped formulate the title of the final chapter Self-in-Relationship Psychotherapy. You were very generous in giving of your time and were prompt in providing us with your comments and suggestions. Your excitement for and belief in our book was a constant source of inspiration.

    This book would not have been possible without the professional help of the editorial staff of Sage Publications. The authors wish to express their appreciation to Alison Poyner, Senior Commissioning Editor, Susannah Trefgarne, Commissioning Editor, Alice Oven, Associate Editor, Counselling, and Emma Paterson, Editorial Assistant. Your patience, kindness, enthusiasm and guidance made the writing of our book a sheer delight and joy and a very positive experience. Thank you for your encouragement and support. The authors wish to acknowledge the meticulous work of Imogen Roome who took the book through the copyediting and proofing stage.

    Lastly, we wish to express our appreciation to our families, colleagues and friends who took particular interest in our endeavours.

  • Epilogue

    This book presents eleven commonly used therapeutic techniques together with the theory from which they emerged, the procedures for their administration, and an illustration of each technique. How can one account for such a divergent group of techniques, assuming that each is therapeutically effective? We will attempt to answer this question with reference to four of the dimensions for comparing techniques presented in the first chapter, namely, therapy as process, therapeutic content, psychic organization and target for change, and the therapeutic relationship.

    Therapy as Process

    One can make sense of the divergent techniques used in therapy if one considers therapy to be a process that sees a client move from being in a troubled situation to having resolved the situation. This process is characterized by the achievement of significant tasks, called phases. Four of these phases are exploration, awareness, action, and integration. Clients typically arrive in therapy at different places in working through their problem, that is, they arrive at differing phases regarding their troubled situation. For example, one client might be psychologically derailed by flashbacks and require help to explore and gain awareness as to the source of the flashbacks, while another client has given a lot of thought to their problem and requires help to put their awareness into action. Techniques such as experiential focusing, ego-state therapy, and self-in-relationship psychotherapy are very useful to help a client explore the underlying dynamics of the problem (e.g., flashbacks) and gain insight into the problem, whereas solution-focused therapy, cognitive-behavioural therapy, and task-directed imagery are helpful to learn new ways of acting and behaving (e.g., being assertive). Thus, one can make sense of the multitude of available techniques when therapy is viewed as a process that requires specific technical aid to help a client to move from one phase to the next.

    Therapeutic Content

    When the therapeutic approaches and their techniques are viewed as a whole, we observe that they address a wide spectrum of therapeutic (psychological) content. This ranges from a focus on emotions, bodily felt feelings, cognitions, and desires/aspirations to metaphors, narratives, and behaviours. All of these are part of every person's experiences. Specific techniques have been developed to address these differing therapeutic contents. Metaphor therapy has detailed guidelines in how to work with metaphors, and experiential focusing has guidelines how to work with bodily felt feelings. To provide a rationale for these differing contents, it is necessary to develop a theory that demonstrates how these therapeutic contents relate to each other and the order in which they need to be addressed in therapy. It is not helpful to reduce the contents to a few concepts such as hot cognitions and emotional needs. It appears that it would be helpful from both therapeutic and research perspectives to consider emotions, needs/aspirations, and cognitions as three interdependent systems that interact in the formation of behaviours, attitudes, values, and so on. It is assumed that in addressing these contents therapy will unfold according to the process referred to above. In providing a rationale for the therapeutic contents, one is at the same time providing a rationale for the divergent techniques and the role they play in the therapy process.

    Psychic Organization and Processes, and Targets for Change

    All therapeutic approaches accept, at least implicitly, that experiences form internal organizations such as schemas and ego states that influence both adaptive and maladaptive behaviours. Therapeutic approaches, however, differ in the extent to which these organizations are addressed in therapy and become the target of change. Some of the therapeutic approaches such as experiential focusing, metaphor therapy, and Gestalt Two-Chair, design techniques to bring into awareness experiences that have been encoded sensorially, perceptually, and symbolically. The target of change for these approaches is the psychic organization. Other approaches such as solution-focused therapy and narrative therapy designed techniques to address problems that the client is aware of. These are addressed at a conscious and rational level. The target of change for these approaches is the development of new and adaptive behaviour. Thus therapeutic approaches and their techniques differ according to whether they address psychic organizations and/or overt behaviours.

    The Therapeutic Relationship

    All forms of therapeutic approaches acknowledge that the therapeutic relationship is important for the technique to be effective. However, they differ on the type of relationship that needs to be offered. When viewed broadly one can identify three types of client-therapist relationship. One type is where the therapist and client work collaboratively as detectives and researchers to identify the problem and systematically determine what strategies are needed to solve the problem. This is seen in solution-focused, narrative, and cognitive-behavioural therapies. A second type of client-therapist relationship is where the therapist offers a set of interpersonal qualities that facilitate the therapeutic process. Person-centred therapies, such as empathic responding, advocate that the therapist be empathic, genuine, and congruent, and actively listen and be present to the client. The belief is that the provision of these qualities by themselves is therapeutic. A third type of relationship is where both the therapist and the client are actively engaged in a dynamic, lively, and at times emotional encounter. There is a working out of an issue at the emotional and motivational (e.g., relational needs) levels rather than at the intellectual, logical, and practical levels. This type of therapist-client relationship is seen in self-in-relationship psychotherapy and Gestalt-oriented therapies where self and relational issues (e.g., transferences and countertransferences) are worked through. Gestalt therapists maintain that all relationships, including therapy, take place at the contact boundary.

    Conclusion

    From the above descriptions, it can be seen that all techniques potentially contribute towards therapy. However, the techniques and the theory from which they emerge, tend to have a narrow focus and are keyed to specific psychotherapeutic content at a particular point in the therapy process, and work with psychic organization and/or overt behaviours. It appears necessary to define the therapist-client relationship differently. Rather than seeing the relationship, technique, and theory as separate constructs, it might be useful to view, as integral to the relationship, a therapist's grasp of a theory and the ability to use it to guide assessment and treatment, and techniques as an extension of the therapists ability to deal with day-to-day problems. The therapist-client relationship, therefore, comprises his/her personal and interpersonal qualities, grasp of theory, and ability to create and/or apply techniques. This view is akin to parenting, which comprises personal and interpersonal qualities, understanding of children, and ability to guide their growth and development. All three qualities constitute parenting, and when one or more of these qualities is absent, parenting suffers. Therapy is analogous to parenting in that the therapist also needs to possess personal and interpersonal qualities, an understanding of emotional problems (a grasp of theory), and an ability to guide the process. Therapy suffers when one or more of these attributes are absent or where one dominates the others. For example, a therapist may know theory but not be able to relate emotionally to the client and not have the skills to apply the theory to the client's problem.

    To explain the array of therapy techniques and their usefulness in the therapy process, it is important to develop a theory that integrates the psychotherapeutic contents, links psychic organization and actual behaviour, and bridges subjective experiences and objective realities. Such a theory would contribute enormously in viewing therapy as an integrated and a unified process. Theory needs to be embodied and alive. Techniques are not the therapy, they are aids to therapy. Techniques are meaningful when they bridge the conceptualization of a client's problem with the therapeutic goal to be achieved.

    Glossary

    • Acknowledgment: Affirmation or validation of the child's self-directed actions, behaviours, and thoughts.
    • Active imagination: Ability to loosen one's conscious focus, enter into a state of reverie, and allow images and sensations to emerge and become elaborated regardless of whether they are socially acceptable or unacceptable.
    • Advanced-level accurate empathy: Empathy that gets at what clients say not only explicitly but also implicitly and which is only half expressed.
    • Antilibidinal ego state: Part of self that encompasses parental, familial, and cultural demands, expectations, and prohibitions. When it dominates it is hateful, vengeful, bitter, and critical of its own libidinal needs and cravings, and controls by creating guilt feelings.
    • Automatic thoughts: Minute-to-minute, unplanned thoughts, words, images, and memories that pass through our minds throughout the day.
    • Being: Essential existence of the organism that is present from birth.
    • Boundary disturbances: Disturbances in relationships where a person may merge with another, incorporate the other, or exclude the other.
    • Central ego state: Primary psychic and unitary self present at birth.
    • Circular questions: Orient the therapist to the client's situation, seek to reveal the recurrent patterns that connect events to perceptions, feelings and so on.
    • Clearing a space: Create an internal environment that is receptive and open to fully experience the problem or feeling.
    • Client-generated metaphors: Come from within the client's experience and are coded with symbolic attributes which contain meaning and significance for the client.
    • Cognitive distortions: Systematic errors in reasoning brought about by the breakdown of the information-processing system with a consequent shift to a more primitive information-processing system.
    • Cognitive schemas: Deeply engrained and stable cognitive patterns that comprise rules or erroneous premises and assumptions that dominate how persons regard themselves, others, and the world.
    • Cognitive shift: A move away from normal cognitive processing to a predominance of processing by negative schemas.
    • Confluence: Process by which persons merge with the environment and are not able to tell what belongs to them and what belongs to the environment.
    • Contact: The meeting between two separate and independent persons at which I experience “me” in relation to whatever is “not me” and where I experience “me” as distinct from “you.”
    • Contact boundary: The point in the contact between two independent persons at which something transpires and happens.
    • Coping questions: Illicit information about client resources that will have gone unnoticed by them.
    • Deconstructing narratives: Procedures that subvert taken-for-granted realities and practices.
    • Developmental process: Entails becoming attached to the caregiver and then separating from them and embarking on the path to becoming individuated, an individual. This process comprises subphases that carry with them unique developmental tasks to be achieved.
    • Direct referent: Inward bodily feeling that a person can turn to at any time to resolve problems.
    • Dissociation: Process of disconnecting from oneself for a short period of time. Can include phenomena which range from daydreams and children's imaginary games to personality disorders.
    • Dominant narrative: Cultural, societal, and family expectations, values, demands, and behaviours that a person is expected to live by.
    • Early recollection metaphors: Association, on a bodily feeling, of a current problem situation (being noisy; snoring), with an early memory image (noisy, because of childhood pneumonia; coughing).
    • Ego states: Primitive, enduring, internalized, but mutative, organizations formed from the child's relational experiences that affect how well a person deals with the tasks and challenges of daily living.
    • Ego-state bridging: Involves amplifying a present ego state and tracing it back in time to when it was first experienced.
    • Ego-state shift: Movement from a problematic ego state (the hidden ego state) to some other ego state that can soothe or relieve the anxiety associated with the problematic ego state.
    • Empathic cycle: Process of listening to the client, observing his/her behaviours, resonating with what is said, and communicating your understanding and checking for its accuracy.
    • Empathic understanding: Moment-to-moment sensitivity in the here-and-now of the inner world of the client's private personal meanings “as if” it were the therapist's own, but without losing the “as if” quality.
    • Exceptions: Ability of the client to identify some of their own resources and strengths that they used in solving a problem and which forms the basis for them to see possible solutions towards moving forward.
    • Executive ego state: Ego state of which the person is conscious and in which the energy and identity of self reside.
    • Externalizing the problem: Problems considered as objects existing outside of oneself and experienced as being oppressive.
    • Fantasy: Mental creation which has little or no connection with reality.
    • Fluidity: Shift from one predominant ego state to another ego state, often initially hidden.
    • Focusing: Attending to a body felt sense that at first is unclear so that something new emerges.
    • Guided imageries: Pre-recorded specific imagery scripts wherein clients are asked to journey through the script and then at the end of the script to share their experience.
    • Hidden ego state: Problematic ego that is hidden in the sense that it is disowned, unaccepted, or unacknowledged by the predominant ego states.
    • Human agency: People are active agents, mediators, and negotiators of their own lives.
    • Imagery: Mental recreation of an experience that resembles in some respects the experience of actually perceiving an absent object or an event.
    • Individuation: Developing one's own interests, opinions, goals, meanings, values and becoming a separated and differentiated individual.
    • Information processing: Processing information through the application of logical rules and strategies.
    • Intentional states: Intentions and purposes according to which people live their lives in the pursuit of what matters to them.
    • Internal conflict: Self's failure to mediate the needs of being and self-image that results in a conflict between the two.
    • Landscape of action questions: Explore the events, sequences, time, and plots of a narrative.
    • Landscape of consciousness questions: Explore the desires, intentions, beliefs, meanings, characteristics, and qualities of the characters of a story.
    • Libidinal ego state: Person's biological, physiological, sexual, relational, and self needs that are inherited at the beginning of physical life and represent that part of the self that is needy, perpetually frustrated, deprived, feels attacked, and insatiably craves for the fulfillment of its relational and self needs.
    • Lineal questions: Investigative questions that orient the therapist to the client's situation.
    • Linear correspondence: Relationship of items characterized by linear, logical, cause-and-effect relationships.
    • Linguistic metaphor: Image that is used to convey meaning of the situation to which it refers.
    • Metaphor: Figure of speech in which a word or phrase literally denoting one kind of object or idea is used in place of another to suggest a likeness or analogy between them (as in drowning in money) (Merriam-Webster Dictionary).
    • Miracle question: Method of questioning that helps the client to envision how the future will be different when the problem is no longer present and to establish goals.
    • Modernism: Trend of thought that rejects previous traditions and affirms that human beings with the help of scientific knowledge, empirical methods, and technology are able to improve and reshape their environment.
    • Narrative: Forms a thread around a theme which intertwines the experiences of the past and the present with anticipation of the future.
    • Nonlinear correspondence: Pattern and organization characterized by nonlinear causal chains (e.g., A is to B as C is to D).
    • Object constancy: Positive internal representation of a significant other such as a caregiver that is formed from positive experiences with that person and provides an “emotional psychological home” to which the person can turn to comfort and soothe themselves when distraught.
    • Organismic self-regulation: Striving for tension reduction and a balance between the conflicting forces represented by an external demand and an internal need.
    • Organismic valuing process: Inherent ability to positively value experiences that a person perceives as enhancing his organism.
    • Permeability: Ability of primary ego state to access subordinate ego states.
    • Postmodernism: Rejects the assumed certainty of scientific endeavors to understand and explain reality and asserts that reality is co-created in conversations between people.
    • Preferred narrative: Personal values, expectations, and behaviours that a person wishes to live by but that are often counter to the dominant narrative.
    • Primary-level accurate empathy: Entails communicating a basic understanding of what the client is feeling together with the experiences and behaviours that underlie these feelings.
    • Reconstructing narratives: Rebuilding alternative perspectives, stories, behavioural practices, and relationship patterns that replace the old oppressive narratives.
    • Relational needs: Need to bond with a significant caregiver and the need to separate from the caregiver and to individuate.
    • Relational patterns: Patterns of relating to others that have been internalized and serve as prototypes for the infant/child's future relationships and shape the expectations about the way in which relational and self needs are to be met.
    • Retroflection: Individual turns the energy to be used for adaptation inward upon himself and treats self as he wanted to be treated by others (e.g., caresses self).
    • Scaling questions: Tools used to identify useful differences for the client, assess the client's level of motivation and confidence, help to set small identifiable goals, establish priorities for action, and measure progress.
    • Self (Gestalt): Creative process which leads the individual to actualizing behaviours. It represents that part of personality concerned with wants.
    • Self-actualization: Innate tendency that subsumes all other needs and aims to develop all capacities in ways that maintain or enhance the organism and move it towards autonomy.
    • Self-image: Part of personality that says what an individual should do and which hinders creative growth.
    • Self needs: Innate desires to be empowered, omnipotent, and master of one's life and environment and to feel good, lovable, and worthwhile.
    • Self organization: Internalized notion of self derived from child-caregiver interactions that are organized according to the two innate basic needs, to be admired for being competent and to be loved for being a good person.
    • Sensory encoding: Storing experiences at the level of the senses; this is also referred to as bodily memory.
    • Social learning: Learning that takes place within a social context where a person observes, imitates, and models the behaviours of others.
    • Solution-focused therapy: Future-focused and goal-directed approach that builds upon clients' resources and helps them to achieve their preferred outcomes by collaboratively designing solutions to their problems.
    • Solutions: Changes that clients make regarding their perceptions and patterns of interacting and the meanings they give to their experience within the context of their frame of reference.
    • Spontaneous imagery: Image that is freely evoked while the client is relaxing, listening to music, or looking at an object or a painting.
    • Structuralism: Form of postmodernism that argues that language shapes and creates reality.
    • Symbolic encoding: Storing experiences at the level of symbols, images, metaphors, scripts, and narratives that embody a wealth of affective, cognitive, motivational, and value-related information.
    • Task-Directed Imagery: Form of imagery designed to help a client to achieve a personal or relational goal by first empowering the client and then asking the client to proceed from this empowered position to confront and resolve a current personal or relational problem.
    • Therapist-suggested imagery: Imageries that have been selected, in advance, for their therapeutic value, with the client being asked to focus on the image and report what is experienced.
    • Unfinished business: Nagging, unresolved, unexpressed, or withheld feelings, memories, and events of hurt, anger, and resentment towards another person.

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