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Confrontation
Confrontation enables the counselor or therapist to provide the client with feedback in which discrepancies are presented in an honest and matter-of-fact manner. A counselor or therapist uses this strategy to indicate their reaction to the client, to identify differences between the client’s words and behaviors, and to challenge the client to put words and ideas into action. This type of direct and honest feedback should provide the client with insight into how they are perceived as well as indicate the degree of counselor or therapist caring.
Example
1 Client: (smiling) I feel angry at myself a great deal. I want so much to find a person and develop a relationship that lasts.
Confrontation
1 Counselor/Therapist: You’ve said this several times in our sessions, but I’m not sure I believe you, based on what you do to keep it from happening. Make me believe you really want this to happen.
2 Client: What do you mean, you don’t believe me? I just told you, didn’t I? What more do you want?
Confrontation
1 Counselor/Therapist: Yes, I’ve heard your words, but you haven’t convinced me. I don’t think you’ve convinced yourself, either. Say something that will convince both of us.
Responding to Nonverbal Cues
Responding to nonverbal cues enables a counselor or therapist to go beyond a client’s words and respond to the messages that are being communicated by the client’s physical actions. Care must be taken not to overgeneralize every subtle body movement. The counselor or therapist is looking for patterns that either confirm or deny the truth in the words the client uses for self-expression. When such patterns become apparent, it is the responsibility of the counselor or therapist to share these patterns with the client. It becomes the client’s responsibility to confirm or deny the credibility of the perception.
Example Client: (turning away) Yes, you’re right. I’m not convinced this is what I want. (smiling) Maybe I was never meant to be happy.
Responding to Nonverbal Cues
1 Counselor/Therapist: What I said made you angry and, I would suspect, hurt a little. Did you notice you turned away before you began to speak? What were you telling me when you turned away?
2 Client: (smiling) What you said did hurt me. I was angry, but I’m also embarrassed not to be able to handle this part of my life. I don’t like you seeing me this way.
Responding to Nonverbal Cues
1 Counselor/Therapist: I’ve noticed that on several occasions when you talk about your feelings of anger, embarrassment, or hopelessness, you smile. What does the smile mean?
2 Client: (long pause) I guess I want you to believe that it isn’t as bad as it sounds or that I’m not as hopeless as I think I am.
3 Counselor/Therapist: It is bad, or you wouldn’t be here, and “hopeless” is your word, not mine. Our time is up for today. Between now and next week, I want you to think about what we’ve discussed. See you next week?
The strategies we have outlined in this section enable a counselor or therapist to achieve more effectively both the process and the outcome goals related to counseling or therapy. Choosing which strategy to use, when to use it, and what its impact will be in the helping relationship is based on the education, experience, and personal dynamics that a counselor or therapist brings to the helping relationship (see Sidebar 1.5).
MOVING TOWARD AN INTEGRATIVE APPROACH TO COUNSELING AND PSYCHOTHERAPY
Even though this book aims to introduce the reader to various theories of counseling and psychotherapy, it is important to realize that few counselors are purists in their practice. In other words, only a small percentage of practitioners (5% or fewer) describe themselves as maintaining allegiance to only one theoretical set to guide their work with clients (McClure et al., 2005; Norcross & Beutler, 2011). In the past, many counselors described themselves as eclectic, but the term integration is currently being used in the profession because it is a more accurate description of correct practices. In a short history of eclecticism in counseling and psychotherapy, Lazarus (2005) explained that eclecticism has been supplanted by integrationism because of the negative connotation ascribed to the term eclectic, because some counselors who called themselves eclectic never developed a theoretical underpinning or rationale for the use of techniques borrowed somewhat haphazardly from various theories. In comparison, integration suggests a merging that may be more reflective of what is happening with the skilled practitioner. Norcross and Beutler (2011) described the four most common types of integration of theories of counseling and psychotherapy: technical integration, theoretical integration, assimilative integration, and common factors integration.
Sidebar 1.5 Strategy Challenges
This section of the chapter described three sets of strategies (for building rapport, for aiding in data gathering, and for adding depth and enhancement to the relationship). Which of the three sets did you find the most challenging as you read the descriptions and examples? What were the reasons you found them challenging? What could you do to meet the challenges you think those skill sets present?
Technical integration is focused on selecting the best treatment option for the individual and the diagnosis and is, as far as possible, evidence based. This type of integrationism uses techniques connected with various theories rather than techniques connected with a single theory or conceptual frame of reference. Arnold Lazarus was one of the pioneers of technical integration, and he called his approach multimodal behavior therapy (Lazarus, 1997). Several resources available to practitioners connect diagnoses and treatment plans based on what the research shows to be the most efficacious. Barlow et al.’s (2011) The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide is an excellent example of this type of integration.
Theoretical integration is based on the idea of blending the best components of two or more theories and assuming that the outcomes of counseling or psychotherapy will be better than the result of using either theory by itself. Assimilative integration is focused on a single theoretical orientation but incorporates, on a very selective basis, techniques from other therapeutic paradigms. The advantage of working this way is that the counselor bases the case conceptualization and accompanying treatment plan on a single theory. Finally, common factors integration emphasizes common practices connected with a variety of theories of counseling and psychotherapy. Many of the core dimensions of the helping relationship discussed in this chapter (e.g., empathic understanding, stages, strategies, brief approaches) and common to many theoretical practice sets are drawn on by counselors who see themselves as adhering to a common factors integrative philosophy of counseling.
We wish to emphasize that it takes considerable time as well as years of supervised practice to become familiar with the myriad theories that could be used to guide the process of counseling and psychotherapy. We are not suggesting that by the time they finish this book, readers will be able to move toward an integrative approach, but we want them to be thinking about this as they read and study each of the chapters in this book
MULTICULTURAL AND SOCIAL/CULTURAL ORIENTATIONS
Other factors that affect the helping relationship and the understanding and use of theory are counselor cultural competence, cultural humility, and social justice imperatives. The Multicultural and Social Justice Cultural