Term Paper: Running Head: Topic Selection

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Running head: Topic Selection

Main Street Counseling Center: Topic Selection

Advanced Counseling Theories

August 7, 2011

The Main Street Counseling Center provides counseling services to individuals experiencing a variety of psychological issues. The counselors at The Center employ numerous effective approaches in treatment. The following discussion will outline some of the theoretical approaches used for counseling at The Center, as well as evaluate strengths and limitations of the approaches. Examples of these approaches in practice will be described, and suggestions for methods of evaluating the counseling approaches will be discussed.

One of the therapeutic approaches commonly used by counselors to treat various clients experiencing a diverse array of symptoms and conditions is Cognitive-Behavioral Therapy (CBT). This approach addresses the way individuals think about themselves and people around them, as well as their worldview, and also looks at how behaviors affect thoughts and feelings (Carlson & Sperry, 2000). Essentially, this therapeutic approach aims to change clients' thoughts and behaviors in order to reduce negative symptoms and improve well-being. Furthermore, CBT does not focus on the past and potential causes of distress, but rather addresses problems and difficulties as they are in the present with the aim of improving clients' experiences in the here and now (Sharf, 2012). CBT proves effective by making overwhelming difficulties more manageable by breaking them down into smaller parts that can be addressed more readily by the client (2012). Also, CBT is based around the recognition of a cycle of altered thinking; feeling and behaviors, which when observed and understood clearly can be overcome through a change in thought (2012).

Cognitive Behavior Therapy can be effectively used in the treatment of post-traumatic stress disorder (PTSD) (Kar, 2011). For example, a client presented with symptoms of PTSD recently at The Center. The client was an adolescent who witnessed a car accident in which an erratic driver hit two of his friends. Symptoms now experienced by the client include nightmares, a lack of memory for some details of the event, uncontrollable crying, numbness, lack of concentration in class, avoidance of the front of the school where the accident took place, etc. Cognitive-behavioral therapy would approach this case with an assessment of how the environment is reinforcing the client's behavior. The school environment in which the client must function on a daily basis serves as a constant reminder of the accident witnessed by the client. This reminder causes certain thoughts to emerge that put the client into distress, and the client therefore avoids the environment in order to not feel distressed. CBT would recognize this avoidance as a result of dysfunctional behavior and would aim at changing the way the client thinks when exposed to the environment causing the distress. Research has demonstrated that CBT is an effective and safe intervention for the treatment of PTSD (Kar, 2011). The use of CBT for PTSD has been effective in adolescents with significant improvements observed in regards to avoidance behavior, depressive symptoms, and psychosocial functioning after therapeutic interventions (Kar, 2011).

A second therapeutic approach employed by counselors at The Center is Reality Therapy. This approach is a counseling modality that has been in practice since the 1960s and was pioneered by Dr. William Glasser, and it has a strong foundation in Choice Theory (The William Glasser Institute, 2010). This therapy views the source of the majority of all human problems as unsatisfactory or non-existent interpersonal connections. Furthermore, the primary aim of Reality Therapy is to aid people in reconnection with people they need. There are several principles counselors adhere to in order to ensure effectiveness of reality therapy. These principles include: focusing on the present, avoiding discussion of complaints and symptoms, focusing on direct behaviors that can positively change experience, avoidance of criticism or blaming, remaining non-judgmental, an understanding that excuses are barriers to reconnection, focusing on specific disconnections and establish concrete plans for reconnection (The William Glasser Institute, 2010).

An example of reality in practice is illustrated by a client at The Center that presented with anxiety especially in regard to appearance and body-image. This client was an 18-year old girl who has perfectionist tendencies, that recently was awarded a full university scholarship and will be the first person in her family to attend college. She was experiencing tremendous pressure and expressed feelings of anxiety and a need for perfection, especially in regards to her appearance and weight. A reality therapy approach would look at how the client is experiencing a need for belonging within her family, and that she may feel she will not be accepted if she is not "perfect". This results in an experienced disconnection from her family, or feelings that she will be accepted conditionally according to what she achieves, rather than being loved unconditionally. The counselor employing a Reality Therapy approach would devise a plan for the client to reconnect to family and friends on a level that would promote healthy self-expectations and decreased anxiety. Focus would especially be placed on specific actions that the client can take to foster reconnections and improve overall well-being.

Another therapeutic approach used by some counselors at The Center is Psychoanalytic Therapy. This approach is centered on evaluating unconscious past forces that affect present emotions and behaviors of clients (Schimelpfening, 2009). Psychoanalytic therapy is based in theories established by Sigmund Freud in the late nineteenth century. These theories were primarily based in an understanding of the unconscious as a vast personal reservoir of thoughts, feelings, urges and memories that individuals cannot consciously access (Schimelpfening, 2009). Deep feelings of anxiety, pain and conflict within the unconscious affect experience and behavior, but without therapy, conscious awareness of this connection cannot be made. Furthermore, the primary aim of psychoanalytic therapy is to aid the client in gaining meaningful insights into unconscious processes so that positive change in behavior can be experienced (Schimelpfening, 2009). In regards to scientific research addressing the effectiveness of psychoanalytic therapy, it has been demonstrated that Psychoanalytic therapy is more effective than no treatment and that it is also more effective than shorter forms of Psychodynamic therapy (Leichsenring, 2005).

An example of Psychoanalytic therapy in practice could be illustrated by a client at The Center who was experiencing marital difficulties including experiences of detachment, growing apart, differences in desires regarding having children and financial priorities, and recent feelings of anger and hurt due to knowledge of an affair. This client expressed not wanting to divorce, and wanting to fix the situation. Psychoanalytic therapy would examine the client's unconscious conflicts. What experiences in the recent and distant past have contributed to the distress felt by the client in the present? How can these past unconscious experiences be understood in order to change thoughts, feelings and behaviors in the present? Psychoanalytic therapy would also assess defense mechanisms, and look at what thoughts or behaviors are being used in the present in order to avoid feelings of anxiety or discomfort. The counselor utilizing this approach would focus on ways that present thoughts and behaviors could be understood in order to illuminate underlying unconscious conflicts.

It is important that any therapeutic approaches for treatment be adequately assessed and evaluated in order to determine their effectiveness. There are currently two methods under consideration. The first method would focus on evaluating short-term effectiveness of therapeutic interventions immediately following a course of treatment. This evaluation would consist of the measurement of client's experiences before the onset of counseling, during the course of counseling, and immediately following the end of the course of treatment. The measure used for this evaluation would be a Likert Scale that would fully assess severity of symptoms experienced by clients. This would allow for a clear and concise means for comparing individual's experiences before, during and after therapeutic intervention, and would allow for statistical analysis of data regarding effectiveness of different therapeutic counseling approaches.

A second method that could be used to evaluate effectiveness of different counseling approaches is a personal structured interview conducted several months after the cessation of treatment. This method would allow for assessment of long-term effectiveness of different therapeutic approaches and would provide a more qualitative evaluation. Although statistical analysis with this method would not be as possible as with the former method, it could provide a more personal, in-depth view of clients' experiences as a result of different counseling approaches.


In order to deal with the large number of patients who exhibit various forms of psychological conditions in our clinics today, effective counseling theories must be engaged (Bernes,2005). The specific techniques that are employed are largely dependent on the nature of trauma that the patients are exposed to. In this section however, we present the main ideas about the effectiveness of counseling theories as applied to working with diverse clients and issues in our clinics. The effectiveness of counseling theories translates to effective techniques and interventions. The counseling techniques that are employed must be effective as well as consistent with the expectations of the client. Bernes (2005) pointed out the techniques employed account for between 12-15 %… [END OF PREVIEW]

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