Chapter Summary

This chapter presents the place of techniques within the complex process of psychotherapy.
Each of the techniques was oiiginally uesigneu foi a specific task such as ueveloping new
behaviois, uncoveiing encoueu expeiiences, iesolving inteinal conflicts, anu piomoting
movement thiough the phases of the psychotheiapy piocess. Techniques aie simply
techniques oi, as Fieuu says, they aie the scaolus anu not the builuing. Techniques
become meaningful when they bridge the conceptualization of a clients problem with
the theiapeutic goal to be achieveu.
Foi each of the techniques piesenteu in this book, the theoiy fiom which it emeigeu,
the pioceuuies foi its implementation, anu a uemonstiation of its use aie piesenteu (All
of the uemonstiations weie conuucteu by the fiist authoi, A.N.). Theoiy is believeu to
be a theiapist's gieatest tool as it pioviues the theiapist with the conceptual skills to be
innovative, cieative, anu flexible in applying a technique in achieving the theiapeutic
goal. The theoretical orientation for each of the techniques is presented according to the
teims specific to it anu in the "voice" of the theoiist.
Introducnon
This book piesents a set of techniques useu by theiapists of vaiying oiientations. Techniques
foim one pait of the veiy complex psychotheiapy piocess that incluues theoiy, conceptualiza-
tion, tieatment plans, anu theii implementation. Theiapy piactice incluues, as well, cultuial
anu genuei issues, piofessional anu ethical guiuelines, anu the theiapist-client ielationship.
Techniques become meaningful primarily when they are used within the context of theory and
the goal of therapy and together they determine the techniques that are selected and how they
are to be applied to bring about the desired changes.
Theoiy is funuamental to the piactice of psychotheiapy. Theoiy pioviues the biiuge - the
unueistanuing - of that which takes place, foi example, between a piecipitating factoi (e.g.,
loss of a loveu one) anu an emotional iesponse (e.g., uepiession) anu between a theiapeutic
inteivention (e.g., task-uiiect imageiy) anu the theiapeutic outcome (e.g., become asseitive).
Theoiy influences all of the components that become pait of a theiapeutic appioach incluuing
its unueilying philosophy, focus of theiapy content (e.g., emotions), encouing of expeiiences,
foimation of psychic oiganization (e.g., schemas), taiget of change (e.g., behaviois), phases of
Theoretical Bridges and the
Psychotherapy Process
1
2 Counselling and Therapy Techniques
the change piocess, anu theiapist-client ielationship. Theoiies uiei on the position that they
take towaius these topics anu theieby ueteimine the goal of theiapy anu the means taken to
achieve it.
To make the text of this book moie ieauei fiienuly, the male foim of thiiu-peison noun anu
pionoun aie useu in the ouu numbeieu chapteis anu the female foim of thiiu-peison noun anu
pionoun aie useu in the even-numbeieu chapteis.
These topics together with the discriminate and ethical use of the techniques are presented
with iefeience to uieient theiapeutic appioaches.
Lp|stemo|og|ca| Ioundanons
Epistemological assumptions lie at the heait of viitually all psychotheiapy theoiies anu
inuiiectly influence technical appioaches to tieatment. Epistemology poses the question,
"What is knowleuge1" oi "Bow uo we know what we know1" When epistemology is applieu
to psychotherapy the questions that arise are: Is a therapist able to understand the clients
subjective woilu1 Boes the theiapist have the knowleuge to guiue the tieatment piocess1 If
yes, how is the theiapist able to aiiive at this knowleuge1 If no, what keeps the theiapist fiom
gaining such an unueistanuing1
The two uominant epistemologies that influence psychotheiapy oiientations aie moueinism
anu postmoueinism, anu piioi to that theie was piemoueinism. The thiee iepiesent uieient
woilu views oi "metanaiiatives" (Butlei, 2uu2, p. 1S).This section will uesciibe anu ciitique
these thiee woilu views with iefeience to the piactice of psychotheiapy.
Premodernism
In the piemouein eia theie was a stiong sense of unity anu coheience. Buman peisons weie
vieweu as unifieu beings that uiscoveieu theii meaning, puipose, anu iuentity piimaiily in
relationship and in the recognition of their proper place in a clearly ordered world of social
aiiangements (Bowney, 1994). Relationality anu inteiuepenuence weie its hallmaiks. Pei-
sonal tiageuies anu sueiings weie compiehenueu in view of a laigei pictuie accoiuing to
which eveiything hau its place anu eveiyone a puipose. A theocentiic view (uou-centeieu) of
one's puipose in life, human ielationships, sueiing anu healing pievaileu in this eia (Keainey,
2uu1). Peisons who healeu otheis weie peiceiveu to function, not accoiuing to theii piopei
authoiity (competency), but in viitue of a Bighei Powei (e.g., uou).
Modernism
Noueinism accepts piemoueinity's belief in oiuei, unity, coheience, anu histoiy as inevitably
piogiessive accoiuing to some plan, but situateu this in the human anu in human ieason. The
theocentiic paiauigm anu a Bighei Powei weie ieplaceu by the anthiopocentiic paiauigm
that consiueieu that the peison to be the centei of ieality anu the human peison as aitist,
scientist, inventoi, exploiei, anu engineei (Keainey, 2uu1). The hallmaiks of moueinism aie
inuiviuuality, self-subsistent autonomy, supeiioiity of ieason, tianscenuence anu the supeiioiity
3
1heoreucal 8rldges and Lhe sychoLherapy rocess
of spiiit ovei mattei anu bouy. Noueinism believes that theie is a "givenness" in the woilu
that humans can come to know although paitially anu in a limiteu way (Bowney, 1994). It
believes that the minu is capable of knowing some exteinal ieality (Belu, 199S) paiticulaily
through experimentation or the empirical method by which the principles and laws of the
natuial oiuei aie uncoveieu. In the same token, it is believeu that theiapists aie able to
aiiive at piinciples anu methous thiough ieseaich that can impiove a client's ieality con-
tact anu fostei the actualization of a peison's tiue self. In biief, moueinism is a tienu of
thought that iejects pievious tiauitions anu affiims that human beings with the help of sci-
entific knowleuge, empiiical methous, anu technology aie able to impiove anu ieshape theii
enviionment.
Postmodernism
Postmoueinism iejects the iuea that theie is a "givenness" in the woilu to be known (Butlei, 2uu2)
anu that theie aie piinciples, uynamics, anu foices unueilying the "givenness" (e.g., uepies-
sion) that can be uncoveieu. Postmoueinism holus that knowing is a subjective phenomenon
anu that the minu is not capable of knowing anything outsiue of itself, that is, it is not capable
of knowing objective tiuth (Belu, 199S). The hallmaiks of postmoueinism aie ielationality,
inteiuepenuence, community, anu tiauitions. In place of a theocentiic anu an anthiopocentiic
woilu view, postmoueinism subsciibes to an "ex-centiic" view, meaning that a peison uoes
not "function as a contiolling oiigin of self-expiession" (Keainey, 2uu1, p. 11). Postmoueinists
believe that the theoiies anu mouels that we have of any human phenomena aie simply con-
stiuctions of the minu anu uo not coiiesponu to ieality, thus, theie is no possibility of aiiiving
at the tiuth of anything. They believe that ieality is co-constiucteu anu changes fiom moment
to moment. Postmoueinism ieplaces the iuea of a single ieality, incluuing the self, with mul-
tiple iealities conuitioneu by inuiviuual, social, anu tempoial factois. In biief, postmoueinism
iejects the assumeu ceitainty of the scientific enueavouis to unueistanu anu explain ieality
anu asseits that ieality is not simply ieflecteu in human unueistanuing of it but is constiucteu
as the mind tries to understand its own personal reality.
Crluque
When applieu to human conuitions, it is not a question of moueinism oi postmoueinism,
iathei, the question is: Bow uo the two views contiibute to oui unueistanuing of a human
conuition anu its tieatment1 It can be seen that psychotheiapy, foi instance, incoipoiates
aspects fiom both moueinism anu postmoueinism. Take foi instance, moueinism's concept
of "givenness" anu postmoueinism's concept of "social constiuction." An example is a chilu's
movement away fiom the significant paient in oiuei to achieve sepaiation anu inuiviuuation,
a phenomenon obseiveu in chiluien acioss cultuies. This "foice" to move away is innate, it
is the "givenness," it is not socially constiucteu. Bowevei the unique mannei in which this
"givenness" is iealizeu in a chilu's life iepiesents a social constiuction on pait of the chilu
anu enviionmental conuitions in which it finus itself. Not eveiything can be ieuuceu to social
constiuction. If eveiything is socially constiucteu, if theie is no givenness, then the state-
ment itself is socially constiucteu anu not "an accuiate ieflection of how things ieally aie"
(Betmei, 2uuS, p. S8).
4 Counselling and Therapy Techniques
sychotherapeunc Content - C||ent
Experiences
Cuiient psychological theoiies tenu to be built aiounu a mouel of feelings, thoughts, anu behavioi
inteiacting with the enviionment as instiumental to change. When applieu to psychotheiapy,
the major models focus on and address one or more of the clients inner experiences when
uiscussing the change piocess. Cognitive theiapists, foi example, focus on thoughts anu pay
attention to emotion only in the sense that it leads them to the automatic thoughts and irrational
beliefs (e.g., schemas) (Beck, 1976). Expeiientially oiienteu theiapists focus on the client's
emotions anu link unexpiesseu emotions (aect) to the uevelopment of emotional pioblems
anu the ieleasing of emotions to healthy iesponses (Rogeis, 1961; uenulin, 1996).
Cuiient mouels, howevei, fail to take into account othei impoitant uimensions of the human
expeiience, such as neeus, wants, longings, anu uesiies. 0ne exception is Caplan's (2uu8)
Neeus ABC mouel that places emphasis on the ielational neeus unueilying malauaptive behav-
iois iathei than on the behaviois themselves. Few empiiical stuuies have investigateu the iole
of needs in the change process.
Theoiists uuiing the past foui uecaues have pointeu out the impoitance of consiueiing neeus
anu wants in theoiy builuing anu in clinical piactice. Fieuu (19S8) gave neeus anu impulses a
cential place in his psychoanalytic theoiy. Nuiiay (19S8) postulateu a cential iole foi neeus
in noimal uevelopment anu piesenteu a taxonomy of neeus. Naslow (19S4) gave a place foi
neeus anu wants in noimal uevelopment anu oeieu a hieiaichy of neeus beginning with physi-
ological neeus (e.g. foou) anu extenuing to the neeu foi self-actualization. Foi uestalt theiapists,
neeus aie piimaiy, foi without them theie woulu be no human motivation anu people woulu
have no futuie (Peils, 1969). Yalom (1989) obseiveu that people iegaiuless of theii emotional
state aie uiiven (pulleu) by theii neeu (want) to mattei, to be impoitant, to be iemembeieu,
anu to be loveu. Blanck anu Blanck (1979) uieientiateu between aect anu uiive anu helu that
each must go its sepaiate way so that a moie unifieu theoiy can be constiucteu. Stumpf sug-
gests that the minu uoes not just consist of intellectual iepiesentations (cognitions) anu iaw
feelings, but also uesiies anu wishes of all kinus (Reisenzein & Schnpflug, 1992).
It seems appaient then that the mouel of cognition, emotion, anu behavioi is inauequate to fully
explain the uevelopment of both auaptive anu malauaptive human behavioi. By expanuing this
mouel to incluue neeuswants one coulu conceive of a tiiau compiiseu of cognitions, emotions,
anu neeuswants which influence the acquisition anu mouification of behavioi (Neiei & Boivin,
198S). In this context, cognitions, emotions, anu neeuswants foim thiee paiallel but inuepen-
uent systems which inteiact in the acquisition anu mouification of behavioi (Stumpf in Reisenzein
Schnpflug, 1992). The inuepenuent systems compiising emotion anu cognition (Zajonc, 198u;
Benesh & Weinei, 1982; Lazaius, 1984) woulu theieby be expanueu to incluue neeuswants.
Within this tiiau, neeuswants aie conceiveu to be piime uiiectional motivatois of behaviois,
emotions aie peiceiveu to be iesponses to eithei the satisfaction oi the fiustiation of neeus
wants, anu thoughts peitain to the stylistic ways of constiuing ieality, to solving pioblems,
to managing ieality, anu to evaluating expeiiences (Neiei & Boivin, 198S). The emotional
iesponse to neeu uepiivation (e.g., the neeu foi a sense of belonging, the neeu to feel woith-
while) is also iefeiieu to as emotional intelligence that can help to iuentify the uepiiveu neeus
anu seive as a guiue to new thinking anu behavioi (Nayei, Salovey, & Caiuso (2uu8). The tiiau
of emotions, cognitions, anu neeuswants uo not opeiate in isolation, but within the context
of the peison's social anu physical milieu (Neiei & Boivin, 199S) (see Figuie 1.1). The tiiau
5
1heoreucal 8rldges and Lhe sychoLherapy rocess
continuously inteiacts with the social anu physical context in the uevelopment of behaviois,
actions, attituues, values, anu so on. This inteiactive piocess evolves accoiuing to a pattein
maikeu by phases oi stages that aie summaiizeu below.
Encoding Experiences
Foi psychotheiapists who believe that a peison's style of ielating anu behavioi is influenceu by
subjective expeiience anu that to biing about change it is necessaiy to access anu ietiieve the
subjective expeiience, the mannei in which a peison stoieu the expeiiences is impoitant as this
ueteimines the techniques to be useu. Such theiapists believe that a peison begins to psycho-
logically stoie expeiiences, in some fashion, beginning in intiauteiine existence anu extenuing
into chiluhoou, auolescence, anu auulthoou, foi potential ietiieval. 0ne can think of the mannei
of stoiage anu the stoiage "location" in classical teims such as the 0nconscious, Pieconscious,
anu Conscious (Fieuu, 19S8). These iepiesent thiee uieient mechanisms of stoiage anu thiee
levels of awaieness at which they aie stoieu. 0ne can also conceive of stoiing expeiiences
with iefeience to the level of intelligence uevelopment. The mannei in which the human minu
encoues expeiiences, theiefoie, is uepenuent upon the level of intelligence uevelopment. At
the initial level of intelligence, the human minu encoues expeiiences at the sensoiial oi physical
Figure 1.1 The inteiactive piocess of aect, cognition anu neeu wants in the uevelopment of actions,
behaviois, attituues, anu values within a social anu physical context
AFFECT
INTERACTIVE
PROCESS
Behaviors
Attitudes
Actions
Values
COGNITION NEED
THE EVOLVING CHANGE PROCESS
(Seven Phases)
C
h
a
n
g
i
n
g
S
o
c
ia
l and P
h
y
s
ic
a
l
C
o
n
t
e
x
t
6 Counselling and Therapy Techniques
level. With the uevelopment of peiceptual skills, the human minu encoues expeiiences at the
peiceptual anu conceptual levels. Lastly, with the ability to abstiact anu foim anu manipulate
concepts, the human minu encoues expeiiences at the symbolic level. Thus the level of encouing
is uepenuent upon the human minu's ability to foim abstiactions fiom the liveu expeiiences.
The human minu encoues anu iepiesents expeiiences in thiee uieient ways with each
having a uieient function (Tompkins & Lawley, 1996). The thiee ways of encouing expeii-
ences (sensoiial, conceptual, symbolic) use uieient piocesses, have theii own syntax anu
logic, anu iequiie a specific mouel of communication to access the infoimation.
Sensory Encoding
Sensoiy encouing implies that the peison stoies expeiiences at the level of the senses, the
physical. This is at times referred to as bodily memory. Thus a person in remembering a trau-
matic expeiience may inueeu expeiience the same physical pain, smell, sounus, etc., as he
expeiienceu at the time of the tiauma. The expeiience of the event is encoueu bouily. The
encoueu sensoiial infoimation may tiiggei the memoiy of a past event.
Conceptual Encoding
Conceptual encouing iefeis to using peiceptual anu conceptual skills to encoue expeiiences.
Conceptual level encouing may be at the piimitive level which is at the level of peiception oi
at the highei level which is abstiact anu at the level of concepts. Foi example, uenulin's (1996)
expeiiential focusing technique auuiesses a client's pioblem at the pieveibal level, that is, at
the level of peiception. Nilton Eiickson's hypnotheiapy is also uesigneu to access this layei of
encoueu expeiience (Tompkins & Lawley, 1996).
Symbolic Encoding
Symbolic encouing iefeis to stoiing expeiiences at the level of symbols, images, metaphois,
sciipts, naiiatives, etc. The symbols anu images embouy a wealth of aective, cognitive, moti-
vational, value-ielateu, etc., infoimation. Not only uo symbols anu images contain expeiiences
of the past but they also give uiiection foi futuie giowth anu uevelopment.
These uieient levels of encouing iequiie uieient techniques to biing to light theii content.
Foi example, expeiiential focusing (uenulin, 1996) is able to access sensoiy encoueu mem-
oiies by getting in touch with bouily felt feelings. Empathic iesponuing (Rogeis, 1961) anu
expeiiential focusing aie able to access peiceptually encoueu memoiies. Netaphoi theiapy
(Kopp, 199S) is a linguistic methou uesigneu to access expeiiences encoueu symbolically.
sych|c Crgan|zanons and rocesses
Beginning in intiauteiine life (veiny, 1981; veiny & Weintiaub, 2uu2) anu extenuing into
infancy, chiluhoou, auolescence, anu auulthoou, a peison encoues psychological anu physi-
ological expeiiences to foim "oiganizeu cognitive-aective-motivational systems" (0CANS).
7
1heoreucal 8rldges and Lhe sychoLherapy rocess
These 0CANS have elsewheie been iefeiieu to as ego states (Watkins & Watkins, 1997;
Faiibaiin, 1944), schemas (Young, 2uuS) inteinal iepiesentations (Klein, 1961) anu psychic
stiuctuies (Fieuu, 192S). The 0CANS, hencefoith iefeiieu to as ego states, compiise sensoiy,
memoiy, aective, cognitive, behavioial, anu motivational aspects that influence the piocess-
ing of infoimation anu give uiiection to the peison's behaviois, actions, attituues, values anu
so on. The ego states iepiesent piimitive anu enuuiing, but changeable oiganizations that can
seive the peison well in uaily living oi can inteifeie with it. The ego states may inteifeie with uaily
living when they aie foimeu, foi example, fiom chiluhoou expeiiences of tiageuies, abuse, anu
paiental neglect. The associateu feelings of angei, feai, iage, anu hate might uominate such ego
states that aie instiumental in biinging about attituues, beliefs, behaviois, anu actions haimful
to the person and to others.
Psychouynamic anu cognitive-behavioial oiienteu theiapists assume that ego states oi
schemas unueilie coveit anu oveit behaviois. To illustiate, one can use as an analogy that of
a tiee with its bianchestiunkioots anu foliage. 0ne coulu say that as the bianchestiunk
ioots aie to the foliage anu give life to it, so too the ego states aie to behavioi anu tiiggei it.
By extension, then, it is assumeu that hiuuen ego states aie the souice of emotional challenges
such as depression and anxiety.
Accoiuing to this peispective, tieatment entails uncoveiing these ego states anu iewoiking
them, oi the ielationship between them, so as to be able to biing about new behaviois. To
accomplish this task, ego state theiapy (Watkins & Watkins, 199S), foi example, have ueviseu
techniques to uncovei the hiuuen anu malauaptive ego states anu to heal anu tiansfoim them
into moie auaptive ego states. Foi example, a SS-yeai-olu male was tioubleu, as an auult, by
feelings of abanuonment. Theiapeutic woik uncoveieu his fiist expeiience of abanuonment as
a chilu - calleu an abanuonment ego state (Young, 2uuS) - at the age of two. Ego-state theiapy
oeis a technique to heal the "abanuonment schema" anu then use the "healeu schema" to
woik thiough cuiient expeiiences of abanuonment.
Target of Change: Behavior or Reworking
and kebu||d|ng sych|c Crgan|zanons
With iegaius to the goal of theiapy, theiapist aie uiviueu into two camps with one camp aiguing
that change takes place at the level of behavioi anu the seconu camp aiguing that change takes
place at the level of iewoiking anu iebuiluing psychic oiganizations (e.g., ego states, schemas,
stiuctuies). That is, the one camp holus that one changes that which is obseiveu (e.g., felt,
heaiu, seen) anu is objective. The seconu camp holus that one changes that which is hiuuen anu
subjective (e.g., schemas, ego states). This uiveigent thinking between the objective veisus the
subjective can be tiaceu back to Fieuu (19S8) who at fiist thought that when symptoms weie
amelioiateu, tieatment was complete, only to iealize latei, that the meie iemoval of symptoms
uiu not constitute lasting change. Change took place at the level of iewoiking stiuctuie. The
moueiate view is that theie is no behavioi change without at least some stiuctuial change anu
theie is no stiuctuial change without some accompanying behavioi change.
The issue is not that black anu white. Theie aie cleai instances when changing the behavioi
is the piimaiy taiget of the theiapeutic woik anu theie aie cleai situations when iewoiking
the stiuctuie is the piimaiy taiget of theiapeutic woik. Foi example, in the cases of acting
8 Counselling and Therapy Techniques
out angei oi aggiession, as in ioau iage, oi tiying to come to teims with phobias, the initial
theiapeutic woik auuiesses the behavioi with the goal of uiminishing it. 0nce the behaviois
have been uiminisheu, one can then auuiess unueilying uynamics anu stiuctuial issues such
as low self-esteem anu impoveiisheu innei iesouices. In the case of iecoveiy fiom chiluhoou
abuse, foi example, with the associateu memoiies, flashbacks, anu inteipeisonal anu intimacy
pioblems, eective theiapy neeus to auuiess anu iewoik the unueilying stiuctuies that initi-
ate and maintain these symptoms.
In biinging about behavioial oi stiuctuial changes, the theiapist will use techniques that
aie uesigneu foi such tasks. Foi example, to help a peison become moie asseitive, one might
use imageiy, a technique that helps not only to biing about change, but also to empowei the
peison. To help a suivivoi of chiluhoou tiauma anu abuse to behave anu ielate in a new way,
the theiapist might use ego-state theiapy to biing to light the hiuuen uynamics oi foices that aie
cieating anxieties anu conflicts iegaiuing inteipeisonal ielationships, sexuality, anu intimacy.
Phases of the Change Process
and Techniques
Insight-oiienteu psychotheiapists holu that psychotheiapeutic change takes place acioss time
anu space which is uesciibeu in teims of phases oi stages. Foi example, psychoanalysis pos-
tulates foui tieatment phases: opening phase, uevelopment of tiansfeience, woiking thiough,
anu iesolution of tiansfeience (Ailow, 1989). Rogeis (1961) pioposeu seven successive stages
in changing fiom fixity to flowingness, anu fiom the iigiu enu of the continuum to a point
neaiei the "in-motion" enu of the continuum. Tosi (1974) outlineu five phases: awaieness,
exploiation, commitment, skill uevelopment, anu ieuiiection-change. These piofessionals
holu that change is not an all-oi-none phenomenon but a giauual foiwaiu movement thiough
specific stages oi phases.
Although psychotheiapy phases oi stages have been iuentifieu anu uesciibeu in the liteiatuie,
these have only iecently been opeiationalizeu anu empiiically investigateu. Among these mou-
els are the The Seven-Phase Model of the Change Process (SPNCP) (Neiei & Boivin, 198S, 1998,
2uuu; Neiei, Boivin & Neiei, 2uu6, 2uu8), The Assimilation Model (Stiles et al., 199u), anu the
Transtheoretical Model (Piochaska, 2uuS).
Foi the puipose of this chaptei, the SPNCP will seive as a mouel of the change piocess. The
SPNCP emeigeu fiom a theiapy appioach, the goal of which was to facilitate the awaieness,
emeigence, anu expiession of the authenticieal self (Nasteison, 199S) anu to enact these in
new behaviois anu actions. The theiapeutic appioach combines exploiation (of client pioblem)
gaining insight and action.
The seven phases of the SPNCP aie biiefly piesent in Table 1.1. In an iueal theiapy session, the
client begins the session by presenting the problem followed by exploring the underlying feel-
ings, thoughts, uesiies, values, anu so on. The exploiation typically leaus to gieatei awaieness oi
to an insight. This new awareness brings about a commitment to change and to trying out dif-
feient ways of ielating anu being. Fiom the tiying out, the client ietains those ways of being anu
ielating that aie consistent with the expeiience of himself. With iepetition, the new expeiiences
become consoliuateu. If at this point the client has achieveu his goal, theiapy is teiminateu.
Bypothetically, the client iequiies technical help to move thiough the seven cyclical phases.
Foi example, to woik thiough the Exploiation Phase, Empathic Responuing anu Expeiiential
9
1heoreucal 8rldges and Lhe sychoLherapy rocess
Focusing can be paiticulaily helpful. To move towaius the Insight phase, Empathic Responuing,
Expeiiential Focusing anu the uestalt techniques can be eective. Task-Biiecteu Imageiy, Net-
aphoi Theiapy, Ego-State Theiapy, Solution-Focuseu Theiapy, Cognitive-Behavioial Theiapy,
anu Naiiative Theiapy can help a client at the ExpeiimentationAction phases to acquiie new
skills anu competencies to ielate in new ways. The movement fiom one phase to the next
phase, theiefoie, iequiies specific inteiventions; howevei, ceitain techniques aie bettei suiteu
than others in facilitating this process.
1echn|ques and the 1herapeunc
ke|anonsh|p
Techniques have always been consiueieu an essential aspect of psychotheiapy. They act like
biiuges that caiiy a peison fiom "tioubleu" wateis to lanu secuiely on the "giounu," that
Table 1.1 The seven-phase mouel of the change piocess
Pbose 1: Problem 0ejinition: The client piesents anu uiscloses peisonal anuoi inteipeisonal uifficulties,
conceins, feelings, etc. The theiapist helps the client to iuentify anu aiticulate the paiameteis of the
pioblem in teims of its natuie, intensity, uuiation, anu extent. Psychotheiapy goals aie establisheu.
Phase 2: Exploration: The client, with the help of the theiapist, uncoveis the uynamics of the pioblem in
teims of its etiology anu maintenance with iefeience to aective, cognitive, motivational, anu behavioial
constituents. The style of relating to others is examined. This phase represents a shift from complaining
and emoting to that of wanting to better understand the presenting problems and concerns and to bring
about change.
Phase 3: Awareness/Insight: The client has a bettei unueistanuing of how unexpiesseu feelings,
inappiopiiate cognitions, unfulfilleu neeus anu wants, anu lost meanings aie ielateu to the piesent
pioblem. This new peispective (e.g. insight, awaieness) pioviues a hanule foi taking iesponsibility
foi self anu pioviues a uiiection foi change. The uncoveiing piocess leaus to a new peispective on the
etiology, maintenance, meaning, anu significance of the pioblem.
Phase 4: Commitment/Decision: The client implicitly or explicitly expresses a determination to change
behaviois, mannei of ielating, anu peispectives, anu assumes iesponsibility foi the uiiection of life.
Phase 5: Experimentation/Action: The client iesponus, ielates, feels, behaves, anu thinks in new anu
uieient ways anu in accoiuance with the new peispective. Be tiies out (expeiiments with) the new
awaieness in eveiyuay life situations. The expeiimentation takes place between theiapy session anuoi
is rehearsed within therapy sessions.
Phase 6: Integration/Consolidation: The client makes his own anu soliuifies those new actions, feelings,
peiceptions, etc., which aie consistent with his sense of self.
Phase 7: Termination: The client, having achieveu the counseling goals, piepaies to live without the
suppoit of the theiapy sessions. The client's feelings iegaiuing teimination aie auuiesseu anu woikeu
through.
Source: Neiei & Boivin, 2uuu; 2uuu by the Society foi Psychotheiapy Reseaich. Repiinteu with
permission.
10 Counselling and Therapy Techniques
is, fiom unwanteu situations (e.g., abuse) oi expeiiences (e.g., uepiession) to those that aie
wanteu. Techniques uo not woik magically; they ieceive theii potency fiom an accuiate con-
ceptualization of the task to be achieveu, anu theii timely application in the clinical woik, anu
fiom a theiapeutic ielationship in which the theiapist knows when to nuituie anu when to
challenge and nudge the client towards continued growth.
Psychotheiapy techniques aie not like meuications that opeiate on the peison to ueal with
feelings of uepiession, anxiety, angei, anu so on. Rathei, the client opeiates on the techniques
anu takes fiom them what is neeueu at the moment (Neiei, 2u1u). An analogy is that of a hungiy
peison to whom a plate of foou is biought. The peison will take fiom the plate that which satis-
fies his hungei. 0bviously, the bettei we unueistanu the peison's neeus, the bettei we will be
able to pioviue the appiopiiate foou. Similaily, in theiapy, the moie we unueistanu the neeus
of the client anu what he is able to ieceive, the bettei we will be able to oei what she neeus
in teims of the theiapeutic ielationship anu technical help. uiven all of this, the client, not the
theiapist, ueteimines what he will take fiom theiapy.
Reseaich has uemonstiateu time anu time again that it is not the theoietical oiientation noi
the technique that is funuamental in psychotheiapy ieseaich outcome; iathei, the ueteimin-
ing factoi is the theiapeutic ielationship. Assay anu Lambeit (1999) iuentifieu the common
factois in successful helping ielationships. Accoiuing to theii stuuy 1S% of the vaiiance is
attiibutable to the technique, Su% to ielationship factois, 1S% to hope anu expectancy, anu
4u% to extia theiapeutic factois.
Although techniques account foi a small peicentage of eect in biinging about change, this
shoulu not cause one to uevalue theii puipose anu impoitance. Techniques aie tools foi the
theiapist anu aius foi the client to help the lattei move foiwaiu. It is impoitant foi the theia-
pist to become skillful in using techniques, to time theii use accoiuing to the neeus of the client,
anu to make techniques a natuial anu integiateu extension of his thinking anu theiapeutic
appioach in woiking with clients.
1herap|st-C||ent Co||aboranon
The psychotheiapeutic piocess has, fiom the veiy beginning, been consiueieu to be a col-
laboiative enueavoi between theiapist anu client. Fieuu (19S8) iequesteu that the patient
be open, honest, anu foithcoming of all that he expeiiences uuiing the analytic houi anu
that he, as psychoanalyst, woulu biing to the session all of his unueistanuing anu uiscietion
in helping the patient. Touay, the shape that the theiapist-client collaboiation takes vaiies
accoiuing to theoietical appioaches with some, such as cognitive-behavioial theiapy (Beck,
1976) iequiiing a foimal expiession of the woik to be uone, while otheis, such as expeiiential
theiapy (uenulin, 1996), iequiie meiely an infoimal expiession. The collaboiative woik also
vaiies accoiuing to whethei the theiapist anu client take on active oi passive, uiiective oi
nonuiiective ioles.
Eective theiapy integiates both client-uiiecteu anu theiapist-uiiecteu inteiventions. In
the majority of cases it is the client who presents the material that becomes part of the thera-
peutic process and the therapist agrees to collaborate with the client to deal with it. In such
cases, the client woiks on the concein without much help fiom the theiapist, who assumes a
moie oi less passive iole. Theie aie times, howevei, when the client is stuck oi goes aiounu in
a ciicle, anu the theiapist must inteivene moie actively anu uiiectly by suggesting an exeicise
11
1heoreucal 8rldges and Lhe sychoLherapy rocess
oi posing a question that will help the client to become less stuck. The iule of the thumb is that
if the client is able to manage on his own, the theiapist takes moie of a passive iole anu lets the
client direct the process.
The willingness to collaborate and the nature of this collaboration are continuously
iewoikeu thioughout the theiapy sessions. Foi example, a client woiking on issues of intimacy
might become awaie that these issues aie ielateu to chiluhoou abanuonment expeiiences,
but the client might not know how to get at them. The theiapist might suggest the use of a
technique such as Expeiiential Focusing (uenulin, 1996) anu seek the client's collaboiation
to engage in the exeicise. As theiapy piogiesses theie might be numeious occasions foi the
theiapist to seek collaboiation fiom the client to intiouuce a technique to woik on a new issue
that aiose. It is impeiative that the theiapist seek the client's collaboiation each time a new
technique is introduced.
The counselling anu theiapy techniques uiscusseu in this book aie biiefly piesenteu in
Table 1.2. The techniques aie compaieu on five uimensions, namely, psychological content of
Table 1.2 Techniques compaieu on five uimensions
Approaches
Content of
therapy work Goal to achieve
Therapy
Process Phase
Nature of
encoded
material
Therapeutic
relationship
Empathy Feelings Express feelings Exploration Peiceptual Rogeis's coie
conditions
Focusing Bouily felt
feelings
uain awaieness Exploration Sensoiial,
perceptual
Rogeis's coie
conditions
uestalt Empty-
Chair
Feelings Express feelings Exploration Sensoiial,
perceptual
Interactional
uestalt Two-
Chair
Inteinal conflicts Resolve
conflicts
Awaieness Peiceptual Interactional
Netaphoi Symbols, images Change
peispective
Awaieness Symbolic Interactional
Imagery Besiieu
relational
behavioi
Empower
person
Action Peiceptual,
symbolic
Interactional
Ego state
therapy
Biuuen ego state Empower
person
Awaieness Peiceptual Interactional
Solution
focused
Behavioi that
woiks
Change
behavioi
Action Peiceptual Collaboiative
Cognitive
therapy
Automatic
thoughts and
irrational beliefs
Change thinking Action Peiceptual Collaboiative
Naiiative Bominant life
story
Builu piefeiieu
story
Action Peiceptual Collaboiative
Self-in-
relationship
psychotherapy
Relational anu
self needs
Reoiient way of
life anchored in
primary needs
Exploiation,
awaieness,
action
Peiceptual Self anu
relationally
immersed with
boundaries
12 Counselling and Therapy Techniques
theiapeutic woik, goal to achieve, theiapy piocess phase foi which they aie suiteu, type of
encoueu expeiience auuiesseu, anu the natuie of the theiapeutic ielationship. It will be noticeu
that the fiist seven entiies (empathy to ego-state theiapy) unuei the column "Appioaches"
refer directly to techniques. The remainder of the entries refer more broadly to a therapeutic
approach that includes more than one technique.
Discriminate Use of a Technique
Techniques aie potentially poweiful theiapeutic inteiventions that aie able to biing to con-
sciousness foigotten, hiuuen, tiaumatic, anu eaily chiluhoou expeiiences that might ueeply
aect the client anu the theiapeutic piocess anu piogiess. Foi this ieason, the theiapist, when
inviting a client to engage in a technique, neeus to exeicise "sounu clinical juugment baseu on
soliu unueistanuing of psychouynamics anu psychopathology" (Kopp, 199S, p. S). A technique
shoulu be seen foi what it is, an instiument to fuithei the theiapy piocess; in the woius of
Fieuu (19uu), one "shoulu not mistake the scaoluing foi the builuing" (p. SS6).
1lmlng of lnLervenuon
The timing foi the inclusion of a technique in the theiapy session must be iight. 0ne intio-
uuces a technique only when theie is a high piobability that it will be eective anu help the
client with the task at hanu. 0ne coulu say that theie is a high piobability that it will be eec-
tive when it appeais that the client is ieauy to engage in the activity foi which the technique
is uesigneu to be helpful. Foi example, if a client is caiiying on an inteinal uialogue, it is highly
probable that the client is ready to externalize the dialogue using a technique such as the
uestalt Two-Chaii technique (Peils, 1969). This is consistent with Fieuu's (19S8) iecommen-
uation that one makes an inteipietation when the patient has alieauy aiiiveu at the insight
himself (p. 4S).
rovlde 8auonale for use of
Technique
It is impoitant foi the theiapist to pioviue a iationale foi its use anu link the technique to the
achievement of the theiapeutic goal. It is also impoitant foi the theiapist to uiscuss with the
client the technique will be useu in the session, give cleai instiuctions iegaiuing its use, allow
the client the fieeuom to teiminate the use of the technique, anu, if completeu, give the client
time to describe the experience following the session.
lnformal use of 1echnlques
In the hanus of an expeiienceu theiapist, techniques can be mouifieu anu infoimally useu in
the theiapy sessions. Foi example, one might intiouuce Expeiiential Focusing (uenulin, 1996)
13
1heoreucal 8rldges and Lhe sychoLherapy rocess
in an infoimal way by asking the client who is uistiaught - angiy, uepiesseu, anxious - to get in
touch with what he is expeiiencing bouily. This mouifieu foim might be useu to help the client
get a grip on his distraught feeling without going to the other steps that are part of the formal
use of Expeiiential Focusing (see Chaptei S).
Lth|ca| Cons|deranons and the
Use of Techniques
The techniques uesciibeu in this book aie potentially poweiful theiapeutic tools anu intei-
ventions. Theiapists shoulu use them only if they have auequate tiaining. It is assumeu that
theiapists who have a giauuate-level tiaining in the helping piofession will be able to teach
themselves how to use the techniques. Foi this, it is best to foim a small gioup anu piactice the
technique using each othei as theiapists anu clients. Foi a beginning oi inexpeiienceu theia-
pist, the techniques shoulu only be useu unuei the supeivision of a supeivisoi who is, himself,
competent to use the techniques.
In using the techniques, one must be caieful not to impose one's iueas oi piefeiences on
the client oi to manipulate the client into a ceitain way of thinking oi behaving. As men-
tioneu eailiei, one uses a technique to suppoit that which the client has alieauy staiteu,
such as iesolving an inteinal conflict by uialoguing oi engaging in new behaviois such as
asseitiveness.
It is important to pay attention to cultural and gender issues when one engages a client in a
technique. Foi example, some cultuies value ielationships anu family wheieas othei cultuies
value competence anu inuepenuence. 0ne uses a technique in keeping with the client's cul-
tuial, family anu peisonal values anu helps a client to soit these out anu to live accoiuing to
theii values.
Lastly, clients neeu to be infoimeu that they aie fiee to uiscontinue with a technique when
they wish to do so. They also need to be informed as clearly as possible how they will participate
in the technique anu the iisks of theii engagement.
Something to Think About
1. What is meant by postmoueinism1
2. Boes auuing neeuswants to a psychotheiapeutic mouel make a uieience1
S. In what way uoes psychotheiapeutic change take place at the level of both behavioi
anu inteinal states such as schemas1
4. Which techniques aie helpful to tiansfoim ego states1
S. What aie some cautions that one must exeicise when using techniques1
14 Counselling and Therapy Techniques
References
Ailow, }.A. (1989). Psychoanalysis. In R. Coisini (Eu.), Current psychotherapies (pp.1-4S).
Itasca, IL: F.E. Peacock Publisheis.
Assay, T.P., & Lambeit, N.}. (1999). The empiiical case foi the common factois in theiapy:
Quantitative finuings. In N.A. Bubble, B.L. Buncan, & S.B. Nillei (Eus.), The heart and soul of
change: What works in therapy (pp. SS-S6). Washington, BC: APA Piess.
Beck, A.T. (l976). Cognitive therapy and the emotional disorders. New Yoik: Inteinational
0niveisities Piess.
Benesh, N., & Weinei, B. (1982). Emotion anu motivation: Fiom the notebooks of Fiitz Beiuei.
American Psychologist, 37, 887-89S.
Blanck, u., & Blanck, R. (1979). Ego Psychology II: Psychoanalytic Developmental Psychology.
New Yoik: Columbia 0niveisity Piess.
Butlei, C. (2uu2). Postmodernism: A very short introduction. 0xfoiu: 0xfoiu 0niveisity Piess.
Caplan, T. (2uu8). Neeus ABC: Neeus acquisition anu behavioi change - An integiative mouel
for couples therapy. Journal of Psychotherapy Integration, 18(4), 421-4S6.
Betmei, B. (2uuS). Challenging postmodernism: Philosophy and the politics of truth. New Yoik:
Bumanity Books.
Bowney, N. (1994). In the ache of absence: Spiiituality at the junctuie of moueinity anu
postmodernity. Liturgical Ministry, 3, 92-99.
Faiibaiin, W.R.B. (1944). Enuopsychic stiuctuie consiueieu in teims of object ielationships.
In W.R.B. Faiibaiin, An object relations theory of personality (pp. 82-1S6). New Yoik: Basic
Books.
Fieuu, S. (19uu). The inteipietation of uieams. Standard Edition (vol. S). Lonuon: Bogaith Piess.
Fieuu, S. (192S). The ego and the id. New Yoik: Noiton.
Fieuu, S. (19S8). An outline of psycho-analysis. Lonuon: Bogaith Piess.
uenulin, E.T. (1996). Focusing-oriented psychotherapy: A manual of the experiential method.
New Yoik: uuilfoiu Piess.
Belu, B.S. (199S). Back to reality: A critique of postmodern theory in psychotherapy. New Yoik:
W.W. Noiton & Company.
Keainey, R. (2uu1). The wake of the imagination: Toward a postmodern culture. Lonuon:
Routleuge.
Klein, N. (1961) Narrative of a child analysis. Lonuon: Bogaith Piess. (volume 2).
Kopp, R. R. (199S). Metaphor therapy: Using client-generated metaphors in psychotherapy. New
Yoik: BiunneiNazel.
Lazaius, R. (1984). 0n the piimacy of cognition. American Psychologist, 32(2), 124-129.
Naslow, A.B. (19S4). Motivation and personality. New Yoik: Baipei.
Nasteison, }.E. (199S). The emerging self: A developmental, self, and object relations approach
to the treatment of the closet narcissistic disorder of the self. New Yoik: BiunneiNazel.
Nayei, }.B., Salovey, P., & Caiuso, B.R. (2uu8). Emotional intelligence: New ability oi eclectic
tiaits1 American Psychologist, 63(6), SuS-S17.
Neiei, A. (2u1u). The theiapeutic ielationship anu techniques: Bow the clients take fiom them
what is neeueu to biing about the uesiieu change. In A. Neiei & N. Roveis (Eus.), The helping
relationship. 0ttawa, 0ntaiio: 0niveisity of 0ttawa Piess, in piess.
Neiei, A., & Boivin, N. (198S). Towaius a synthetic mouel of psychotheiapy. Pastoral Sciences,
II, 1S7-l76.
15
1heoreucal 8rldges and Lhe sychoLherapy rocess
Neiei, A., & Boivin, N. (199S). The interplay of affect, cognitions, and needs in a model of
psychotherapeutic change. Papei piesenteu at the 9th Annual Confeience of the Society foi
the Exploiation of Psychotheiapy Integiation. New Yoik, 2S Apiil.
Neiei, A., & Boivin, N. (1998). The seven-phase model of the change process: Theoretical
founJotion, Jejinitions, coJinq quiJelines, troininq proceJures, onJ reseorcb 0oto (Sth Eu.).
0npublisheu NS. 0ttawa, 0ntaiio: Saint Paul 0niveisity.
Neiei, A., & Boivin, N. (2uuu). The achievement of gieatei selfhoou: The application of theme-
analysis to a case study. Psychotherapy Research, 10(1), 6u.
Neiei, A., Boivin, N., & Neiei, N. (2uu6). The tieatment of uepiession: A case stuuy using
theme-analysis. Counselling & Psychotherapy Research, 6(2), 11S-12S.
Neiei, A., Boivin, N., & Neiei, N. (2uu8). Theme-analysis: Pioceuuies anu application foi
psychotherapy research. Qualitative Research in Psychology, 5, 289-S1u.
Nuiiay, B.A. (19S8). Explorations in personality. New Yoik: 0xfoiu Piess.
Peils, F.S. (l969). Gestalt therapy verbatim. Toionto: Bantam Books.
Piochaska, }.0. (2uuS). An eclectic anu integiative appioach: Tianstheoietical theiapy. In
A.S. uuiman & S.B. Nessei (Eus.), Essential psychotherapies: Theory and practice (pp. 4uS-44u).
New Yoik: The uuilfoiu Piess.
Reisenzein, R., & Schnpflug, W. (1992). Stumpf's cognitive-evaluative theoiy of emotion.
American Psychologist, 47(1), S4-4S.
Rogeis, C.R. (1961). On becoming a person: A therapists view of psychotherapy. Boston:
Boughton Nifflin.
Stiles, W.B., Elliott, R., Llewelyn, S.P., Fiith-Cozens, }., Naigison, F.R., Shapiio, B.A., & Baiuy,
u. (199u). Assimilation of pioblematic expeiiences by clients in psychotheiapy. Psychotherapy:
Theory, Research and Practice, 27, 411-42u.
Tompkins, P., & Lawley, }. (1996). Neta, Nilton anu metaphoi: Nouels of subjective expeiience.
Rapport Magazine, S6, August. (Also at http:www.uaviugiove. comaiticlesmmm.html)
Tosi, B.}. (1974). Youth: Toward person growth, a rational-emotive approach. Columbus, 0B:
Neiiill.
veiny, T.R. (1981). The secret life of the unborn child. New Yoik: Bell Publishing.
veiny, T. R., & Weintiaub, P. (2uu2). Tomorrows baby: The art and science of parenting from
conception through infancy. New Yoik: Simon & Schustei.
Watkins, }.u., & Watkins, B.B. (1997). Ego states: Theory and therapy. New Yoik: Noiton.
Yalom, I.B. (1989). Loves executioner and other tales of psychotherapy. New Yoik: Baipei
Peiennial.
Young, }. E. (2uuS). Schema-focuseu cognitive theiapy anu the case of Nis. S. Journal of
Psychotherapy Integration, 15(1), 11S-126.
Zajonc, R.B. (198u). Feeling anu thinking: Piefeiences neeu no infeiences. American
Psychologist, 35, 1S1-17S.