There are many different psychotherapies today, each able to help a certain percentage of cases, but none appears to be any more effective than another. Most are based on the medical model, which includes diagnosis, prognosis, and treatment of the ego. Their inherent assumption is that something is wrong, that all clients are sick patients who need to be healed. There are many models available for helping, and virtually all are geared to providing necessary changes in behavior. The overall effectiveness of these schools and models is debatable, although most would agree that they are better than doing nothing at all.
Transpersonal psychology does not use the medical model. The transpersonal model is one in which the ego can be transcended, and the emphasis is not on "curing" so much as giving guidance and encouragement to grow. Transpersonal psychology encourages the growth of the imagination, the will, and the intuition.
Definitions.
Intervention. "A generic term used for any procedure or technique that is designed to interrupt, interfere with and/or modify an ongoing process." (Reber, 1995, p. 386).
Counseling. "Counseling is a profession and a process that involves a relationship between persons and demands a special set of skills and knowledge that can be communicated to influence a client to change" Kottler and Brown, 1985, p. 6).
Strategy. "A plan of conduct or action, a consciously arrived-at set of operations for solving some problem or achieving some goal" (Reber, 1995, p. 760).
Intervention Strategies. Specific techniques or procedures used by a therapist to bring about a desired change in the thinking or behavior of a client.
Major Traditional Intervention Strategies
Therapeutic counseling began with Freud's "talking cure" and today has branched into many different areas and includes a wide range of intervention strategies. It is generally accepted today that the goal of the counselor is to help clients make constructive changes in their lives through the use of suitable intervention techniques. Kottler and Brown (1985) suggest that all counselors begin by asking three basic questions:
a. Exactly what appears to be happening?
b. What do I wish to accomplish?
c. How will this intervention meet the desired goal? (p. 32)
The question of which intervention strategy to use is "thorny" because:
Everyone claims validity for his or her favored approach--and to some extent each is right! Everything is valid. All techniques, approaches, and styles (even the most bizarre) work--with some clients at some times. The debate as to whether or not something works can often be better replaced with an exploration of when it works. (Kottler and Brown, 1985, p. 33).
Perhaps even more important than the technique, is the capability of the therapist. It is generally agreed that an effective therapist must have developed a set of skills which include, but are not limited to: self-disclosure, confrontation, active listening, goal setting, interpretation, questioning, reassurance, modeling, reinforcing, empathy, immediacy, respect, and genuineness (Kottler and Brown, 1985).
How effective is counseling today? Recent studies have indicted that it is, at least, better than nothing. "For most people, therapy is more effective at ameliorating emotional disorders than is no treatment" (Seligman, 1990, p. 6).
Both individuals and groups, including families, can require counseling, and special techniques have been developed for both (Corey and Corey, 1987; Goldenberg and Goldenberg, 1991).
The Helping Model
The traditional helping model is discussed by Egan (1990) and shown above. This model has three basic stages linked together, with three steps in each stage. The first stage is the present scenario. It begins with the client telling her story to the therapist. As the therapist listens to the story, she tries to determine the blind spots in the story. These areas will be used for confrontation and challenging at a later time in order to stimulate the client into developing new perspectives. The third step is finding leverage. Leverage is used by the therapist to help convince the client that a change would be beneficial. These three steps concern the client at present. The therapist then suggests that the client do some kind of action that will lead into the second stage, the desired outcome.
The first step of the second stage is helping the client develop a list of possibilities for a better future. This is the stage of goal setting, where the therapist helps the client to form specific goals that they will work toward. Sometimes these are written in the form of a contract. The second step is to help the client translate her possibilities into viable agendas. This usually narrows the possibilities down to one or two, with specific means for achieving them. The third step is commitment. Unless the client is committed to achieving the goals that have been established, chances are slim that they will ever be accomplished.
The first step of the third stage looks at specific strategies. "Strategies tend to be more effective when chosen from among a number of possibilities" (Egan, 1990, p. 45). Basically, a strategy is a set of actions designed to meet a set of goals. It represents the client's possible plan of action for change. When a number of strategies have been formulated, a best-fit is selected. The best-fit strategy is the one that is most likely to be followed. Then, a step-by-step plan is developed for accomplishing each goal of the preferred strategy. In order for this model to be effective, "goals must be the client's goals, strategies must be the client's strategies, and action plans must be the client's plans" (Egan, 1990, p. 49).
The Client Map
The following major elements of a traditional treatment plan were organized into a mnemonic device by Seligman (1990):
DO A CLIENT MAP
Diagnosis
Objectives of treatment
Assessments needed (for example, neurological or
personality tests)
Clinician characteristics viewed as therapeutic
Location of treatment (for example, hospital or outpatient
setting)
Interventions to be used
Emphasis of treatment (level of directiveness; level of
supportiveness; cognitive, behavioral, or affective emphasis)
Nature of treatment (individual, couple, family, or group)
Timing (frequency, pacing, duration)
Medications needed
Adjunct services (for example, support groups, legal advice,
or education)
Prognosis
Probably the foremost goal of the counseling process is to evoke specific behavioral changes in the client. But often a client will resist changing behaviors. In counseling, resistance is generally defined as the client's subtle overt opposition to changing their behavior. There are several causes of resistance, including the fact that it is sometimes an unconscious defense mechanism that clients employ against repressed material. Recently it has been seen as a natural and healthy action that the counselor should expect and work with, rather than oppose.
Verhulst and Vijver (1990) present an interesting description and history of resistance. They begin with Freud, who considered resistance to be one of the "cornerstones" of his psychoanalytic theory, stemming from the mind of the client. Many behavioralists have disputed this, arguing that resistance is induced by the counselor through either faulty methodology or using the right method at the wrong time. Today, there is by no means a consensus on the definition of resistance. However, in a recent attempt to define and measure resistance, a "client resistance code" or CRC has been proposed to measure various non-cooperative behaviors of clients. The CRC has gained moderate support, but is not yet embraced by a majority of counselors.
Verhulst and Vijver developed a "resistance questionnaire" which they used to generate 57 verbs that address typical resistant behaviors. These verbs were analytically reduced to six general behavioral areas which they call "clusters" as follows: positive attitudes, negative attitudes, rational activities, emotionalities, action initiators, and evasive actions. A total of 170 Dutch psychotherapists (85 behavioral and 85 analytical) were used in a study from which 44 questionnaires were returned - 22 from behavioral therapists and 22 from analysts. All of the subjects considered resistance to be a normal phenomenon that occurs with virtually every client. However, the two groups significantly differed in the degree to which they regarded the resistance of their clients. Analysts were more likely to regard some behaviors as an indication of resistance than the behaviorists. Another finding was that certain actions by the therapist could trigger resistance more than other actions. High on the list of triggers was "asking questions," while low was "being friendly and nice." The authors' analyses suggest that problem-oriented rather than emotion-oriented interventions of the therapist will trigger resistance in a client. Not unexpectedly, the cluster most likely to cause resistance was "negative attitudes" (shouting, yelling, quarreling, and so on) while the cluster most likely not to cause resistance was "positive attitudes" (agreeing, making compliments, admiring, and so on). The study indicates that resistance depends on the client, the therapist, the situation that gave rise to the resistance, and the interactions between these factors. They also found that resistance is most likely to occur when the therapist is asking for information about the client, usually at the beginning of therapy.
Dowd and Seibel (1990) looked at resistance as compared with reactance. They considered psychological reactance to be a motivational force that a client uses to restore lost or threatened freedoms. When a client expects to be able to control an event only to find that the event is uncontrollable, a reactance is generated. The client will strive harder for control, even to the point of engaging in prohibited behaviors. Only after repeated failure to control the event will the client give way to hopelessness and a decrease in control motivation. Obviously, a certain amount of reactance is healthy. The authors suggest that reactance is instrumental in achieving a sense of identity and separate autonomy. However, persistence reactance can precipitate into what Erik Erikson (1981) called "negative identity" where an individual defines himself or herself by opposing primary attachment figures.
The counselor should gauge the client's reactance early in the counseling process. Clients with a weak sense of identity or who have trouble separating from primary attachment figures should be given interventions designed to increase their autonomy and decision-making ability. Such clients will be very compliant during the counseling process and the counselor should strive to increase their reactance potential. The authors suggest that clients with high reactance will miss or be late to sessions, while clients with low reactance will always be prompt.
As a counselor, these two articles are especially useful. They describe resistance and reactance as two naturally occurring phenomena that every counselor must face and deal with.
Hutchins and Lazarus
Dave Hutchins and Arnold Lazarus both agree that one single therapy style or behavioral mode is not sufficient to help a wide range of clients. Writing on ways to improve the counseling relationship, Hutchins (1984) states that "counselors should base their choice of theories and techniques on each client's behavior" (p. 572). He strongly recommends that counselors adapt their counseling style to their individual clients because "no single theory to date seems adequate for all people" (p. 572). To counter this problem, Hutchins proposes his thinking-feeling-acting (TFA) model. Lazarus (1976) echoes this idea and says, "the more a patient learns in therapy, the less likely he is to relapse afterward" (p. 11). He also notes that "faulty problem identification (inadequate assessment) is probably the greatest impediment to successful therapy" (p. 14). To counter these problems, he proposes his "multimodal" approach to the counseling process.
Hutchins' (1984) TFA model assumes that people tend to have either a thinking orientation, or a feeling orientation, or an acting orientation. While the ideal is a balance of the three orientations, the behavior of every human being tends to emphasize one of these orientations over the other two. We tend to use one orientation most of the time, use a second only occasionally, and the third seldom if ever. Hutchins proposes that the "firing order" of each client be established quickly during the counseling process, and then the counselor adjust his or her own counseling style (i.e., firing order) to accommodate that of the client. An acting client can best be helped by an acting counselor, a thinking client is best counseled by a thinking counselor, and so on. He points out that the counselor's natural tendency must give way to adaptation in order to help a broad range of clients. He says, "Throughout the counseling process, the counselor adapts behavior in light of each client's orientation" (p. 575). This, he concludes, will assure that the client will make the necessary changes in behavior and thereby be helped by the counseling process. Otherwise, he warns, each counselor will be able to help only a limited number of clients.
Lazarus states that "Multimodal behavior therapy encompasses: (1) specification of goals and problems; (2) specification of treatment techniques to achieve these goals and remedy these problems; and (3) systematic measurement of the relative success of these techniques" (p. 10). He accomplishes these three objectives by using his famous seven-point system: behavior, affect, sensation, imagery, cognition, interpersonal relationships, and drugs or medication. The first letter of each of these seven modes gives the acronym BASIC-ID.
Lazarus suggests that the seven modalities are interdependent and interactive. Each client should be initially approached to determine salient behaviors, affective responses, sensations, images, cognitions, interpersonal relationships, and the need for drugs or medication. He then points out that "durable results are in direct proportion to the number of specific modalities deliberately invoked by any therapeutic system" (p. 12). To the extent that the counselor systematically explores each of these modalities and offers appropriate therapeutic remedies, treatment outcomes will tend to be positive and long-lasting. Relapse, he points out, is an all-too-common problem that the counselor must ultimately deal with. He concludes that a relapse, or a failure to progress beyond a certain point in the counseling process, is often a result of ignoring one or more of the seven basic modalities of his BASIC-ID Model.
Although the theories of Hutchins and Lazarus at first may appear to be quite different, it is easy to see that the BASIC-ID Model and the TFA Model are very similar. If we consider that behavior, interpersonal relationships, and drugs are all acting oriented, that affect and sensation are both feeling oriented, and that imagery and cognition are both thinking oriented, then the similarity becomes obvious. Both models direct the counselor to adapt his or her counseling style to fit the client and not to ignore the body, the emotions, or the mind of the client but rather to focus on all three areas.
Although my personal approach to counseling is non-directive, I agree that some adaptation is necessary in order to help a broader range of clients. I find the TFA Model easier to use than the BASIC-ID, which is a little more complex. However, the A in TFA must imply more than simply how the client acts - it must take into account all physical symptoms and salient actions as well as interactions with others.
Transpersonal Intervention Strategies
Jung (1971, 1985, 1990, 1991) was a pioneer in transpersonal psychology. His two main intervention strategies are dream analysis and free association.
a. Dream analysis. Dreams are the most common manifestation of unconscious activity. They usually compensate one-sided distortions of the waking ego. Analytical psychology teaches that "the dream is a symbolic representation of the state of the psyche" (Hall, 1986, p. 92).
The five main points in dream interpretation are:
(1) Remembering the dream.
(2) Recording the dream.
(3) Amplifying the dream through personal, cultural, and archetypal associations.
(4) Determining the dramatic structure of the dream.
(5) Determining the purpose of the dream.
b. Active Imagination. This is a technique to confront the unconscious while awake. It is a form of meditation using controlled imagery, and resembles self-hypnosis. There are two rules: (1) The ego must act as if the imagined images were real (one's moral, ethical, and personal rules must apply), and (2) the ego must not resist or interfere with any images confronted (Hall, 1986).
Transpersonal psychology sees the established medical model of therapy as being confining and restrictive (Boorstein, 1996; Grof, 1985; Scotton, Chinen, and Battista, 1996). Hall (1986) describes the medical model as having three stages: "diagnosis (what is wrong), prognosis (what is the likely outcome), and treatment (what can be done to make things better)" (p. 45). The medical model, and the DSM IV (1994) are the hallmarks of modern psychotherapy. However, the medical model is not applicable to most transpersonal problems (e.g., Grof and Grof's (1989) spiritual emergency).
Transpersonal psychotherapy suggests that the technique to use must fit the client. In addition to the more obvious techniques such as imagination, meditation, and prayer (Firman and Vargiu, 1996) transpersonal psychologists have developed a wide range of innovative therapies. Yensen (1993) for example, has developed a perceptual affective therapy using audio-visual environments. Other techniques include biofeedback, multi-modality therapy, relationship psychotherapy, beathwork, guided-imagery therapy, psychedelic psychotherapy, and past-life therapy to name only a few. Another important therapy has to do with disidentification:
Disidentifying from the personality means recognizing experimentally that our personality is not what we are but what we have--not the source of our identity but the means by which we express that identity in the world. By disidentifying from it, we do not destroy or abandon it, rather, we transcend its limitations and the self-centered and separative tendencies these limitations can bring. (Firman and Vargiu, 1996, p. 127)
A simple technique reported by Enright (1996) is renaming the symptom. By renaming the problem (saying "persistent" instead of "stubborn" for example) the client realizes that she has control over the meaning and value of the problem, and it sometimes offers humor which can defuse a potential crisis.
Hoffman (1996) suggests that the therapist must try to understand and appreciate the client's life, teach the client to meditate, have the client pay attention to dreams, and encourage the client to read sacred texts.
Knowledge of the ancient Eastern doctrine of the chakras has led to special techniques associated with premature or spontaneous chakra activation. Nelson (1994) says that "the chakras are archetypes" (p. 162) and an understanding of them is crucial for psychology. As archetypes, their activation or functioning can cause altered states of consciousness and can serve as guides to spiritual development. "Because we tend to deny levels of awareness above our present focus, breakthroughs of higher consciousness are usually mis-diagnosed and treated with methods that negate their potential for spiritual growth" (p. 167).
The following is a list of psychological problems that Grof and Grof (1989) place under the umbrella of spiritual emergencies:
1. The shamanic crisis
2. The awakening of Kundalini
3. Episodes of unitive consciousness (the "peak experiences" of Maslow (1968, 1971).
4. Psychological renewal through return to the center (the "renewal process" of Perry (1953).
5. The crisis of psychic opening
6. Past-life experiences
7. Communications with spirit guides and "channeling"
8. Near-death experiences
9. Experiences of close encounters with UFOs
10. Possession states
To date, the medical model has been unhelpful in treating these ten major problems, and only transpersonal psychology is equipt with constructive helping techniques.
Assagioli's (1965) psychosynthesis includes a wide range of techniques for personal psychosynthesis such as catharsis, critical analysis, self-identification, exercises in dis-identification, exercises in developing and training the will, exercises to train the imagination, visualization, auditory evocation, imaginative evocation, modeling, symbol utilization, as well as specific exercises aimed at spiritual psychosynthesis.
He also advocated music as a healing agent (today, this is an accepted method for the alleviation of stress and burnout).
There are many schools of psychotherapy today, each able to help a certain percentage of cases, but none appears to be any more effective than any other. Most psychotherapies are based on the medical model, which includes diagnosis, prognosis, and treatment of the ego. Their inherent assumption is that something is wrong, that all clients are sick patients who need to be healed. There are many models available for helping, and virtually all are geared to providing necessary changes in behavior. The overall effectiveness of these schools and models is debatable, although most would agree that they are better than doing nothing at all.
Transpersonal psychology does not use the medical model. The transpersonal model is one in which the ego can be transcended, and the emphasis is not on "curing" so much as giving guidance and encouragement to grow. Transpersonal psychology encourages the growth of the imagination, the will, and the intuition and it recognizes states of consciousness other than our normal waking egoic state. Its goal is psychic maturity, usually in the sense of Jung's individuation or Maslow's self-actualization. Grof (1985), who coined the term transpersonal, points out that "nonordinary states of consciousness, with few exceptions, are generally considered to be symptomatic of mental disorders" (p. 25). He laments that in today's society, if a person had a genuine spiritual experience and tried to tell his pastor about it, his pastor would probably recommend that s/he see a therapist.
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