Respond Holistically to Client
Issues
CHCCS402A Session 2
Underpinning theories of
helping/assisting people
Why do we need theories?
• Theories help to provide a framework or
scaffolding on which we base our
interventions.
• They mean that what we do in assisting others
is more than ‘common sense’ and is based on
an understanding of human behaviour and
personality
Evidence from therapy outcome research, factors that
influence successful outcome in therapy
15%
Placebo Factors
40%
15%
Technique/Model
Factors
Relationship Factors
Client Factors
30%
Data from Lambert, 1992
The major theoretical models
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Psychoanalytic theory
Existentialist/Humanistic theories
Person centred therapy
Gestalt
Cognitive behavioural interventions
Narrative therapy
Solution focussed therapy
Strengths based approaches
Psychoanalytic theory
• Not frequently used today (too slow and
expensive, some ideas outdated)
• Remains very influential in current thinking
and practice
• Beginning of the ‘talking cure’ for psychiatric
problems
Sigmund Freud 1856 to 1939
• German Psychiatrist, known as the father of
psychiatry
Freud’s Ideas
• Regarded his work as a psychiatrist as
psychotherapy, that is, a process that assisted
his patients to resolve previously unresolved
issues.
• Recognised that talking about issues through
counselling and psychotherapy were a valid
way of helping people.
The unconscious mind
• Disturbed human behaviour has its origins in
the unconscious processes of the individual.
• An individual’s beliefs, attitudes, thoughts
and emotions have their origins in the
unconscious.
• Freud was interested in the interpretation of
dreams as a way of understanding the
unconscious mind.
Free association
• The patient talks freely about their life and
one idea triggers another, then another.
• Because the patient was able to talk freely;
free association would occur and inevitably
reveal ideas that were suppressed into the
unconscious.
• This is a helpful concept in allowing clients to
freely discuss their thoughts and feelings
without interruption.
The importance of the past
• Freud emphasised the past, especially
childhood experiences.
• One of his major contributions to the study of
human behaviour is the concept that “the past
influences the present.”
Defence mechanisms
• Those ways of behaving which protect the
person from dealing with current painful
issues eg repression, avoidance, resistance
etc.
• Understanding an individual’s defence
mechanisms can be helpful in assisting clients
to identify and deal with painful issues.
The Id, Ego and Super-ego
• The Id (the primitive, basic part of us), the
only part present at birth. It is demanding and
operates on the ‘pleasure principle”
• The ego begins to develop in the first 12
months, when the baby learns that demands
are not automatically met. This is the rational
part that can delay gratification.
• The ego uses memory and reason
The super-ego
• The super-ego is the conscious or moral self
which is concerned with meeting the
demands of society.
• The super-ego demands perfection
• Develops around 2 to 3 years of age at the
stage of toilet training and when children
learn about ‘good’ and ‘bad’ behaviour
A joke about personality
• The id says “I want it and I want it now”
• The superego says, ‘you can’t have it, it’s bad
for you.”
• The ego says, “Well maybe you can have some
of it-later’
Freud’s view of the healthy personality
• All three aspects are kept in balance
• If you are controlled by the id-impulsive and
selfish
• If you are controlled by the superego-rigid,
moralistic and bossy
• Those with a weak ego cannot balance
personal needs and wishes with social duties
and realistic expectations
Freud’s view of psycho-sexual development
• The oral stage (sucking, pleasure from nursing)
• Anal stage (focussed on toileting)
• Phallic stage (boys are focussed on their penis,
girls on their lack of one)
• Latent stage
• Genital stage (adolescence & sexual maturity)
A few final points
• The ego is like the referee between the id and
the superego.
• A healthy personality is able to love, work and
play.
• Many of Freud’s terms and ideas are now part
of our language and culture.
Criticisms of psychoanalysis
• It is a very long and slow process, often taking
several years. The use of free association
provides the client with little feedback.
• The psychoanalyst is the “expert” who would
help the client gain insight by interpreting the
information the client has disclosed.
• Many of the ideas are now seen as outdated
So why study psychoanalysis
Key concepts remain important in
understanding human behaviour
• The importance of clients being able to talk
freely
• The unconscious and how it influences
behaviour (defence mechanisms)
• The influence of past experience on present
behaviour and emotions.
Humanistic/existentialist theories
• The basic premise of this model of counselling
is that the individual has within themselves
the capacity for personal growth.
• Humanism is a non-religious philosophy
which highly values human beings.
Client centered therapy
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Carl Rogers
1902 to 1987
American psychologist
The client is a person
seeking help who is
respected and valued
Person centred therapy
• Developed by Carl Rogers
• It is particularly useful in the early stages of
the client-counsellor relationship as it assists
greatly in the establishment of rapport and
building of trust
• Works well with clients who have good verbal
skills, but may take longer than some other
methods of counselling.
Gestalt therapy
• German psychiatrist
1893 to 1970
• Trained in
psychoanalysis but later
developed Gestalt
therapy.
• Focussed on ‘here and
now’ rather than the
past.
• Encourages clients to
take responsibility
rather than blame
others for past issues
Key elements of Gestalt
• Perls concentrated on raising the client’s
awareness of present bodily sensations,
feelings and related thoughts. By becoming
more aware of the present, his clients were
able to sort through “unfinished business”
from the past and sort through their
emotional confusion, therefore having a
“Gestalt” or “aha” experience.
• Perls used a more challenging or confronting
style of counselling in order to move people
forward.
• It can be useful to use Gestalt techniques at
various times during the counselling process.
However, they need to be used within the
context of a Rogerian style counsellor-client
relationship
Gestalt techniques
• Giving the client immediate feedback about nonverbal behaviour as it is observed in the counselling
process (useful in drawing the client’s attention to
feelings that are suppressed)
• Inviting clients to get in touch with and describe
bodily sensations and relate these to emotional
feelings and thoughts
• Encouraging clients to make “I” statements and to
take responsibility for their actions
• Challenging and confronting what the client
sees as “neurotic” behaviour, for example
confronting clients when they deflect away
from talking about troubling issues
 Encouraging clients to role play parts of
themselves and create a dialogue between
those parts
Double chair work
 Encouraging clients to role play themselves
and someone else with whom they have a
problem and create a dialogue between
themselves and another person.
Limitations/risks with gestalt
• Gestalt techniques may be too threatening for
some clients and need to be used only in
those situations where clients feel
comfortable and have the skills to manage any
negative emotions which may arise.
• Gestalt techniques need to be used by
experienced therapists.
Cognitive behavioural therapy
• Albert Ellis
• American
psychotherapist
• 1913 to 1997
• Studied psychoanalysis
but later developed
cognitive therapies
Albert Ellis’ contribution
• Pioneering approach to psychotherapy
• In 1953 began developing REBT (Rational
emotive behavioural therapy) as way of
making emotional and behavioural change
through challenging self defeating thoughts.
• Second most influential psychologist of 20th
century (American Psychological Association)
What is CBT?
• Cognitive Behavioural Therapy is a cost
effective way of assisting clients change their
behaviour.
• It is less emotionally draining for the
counsellor and client, as strong emotions are
not expressed as often during counselling.
• Research indicates that CBT works for many
clients experiencing anxiety and depression
The basic concept of CBT is that
negative thoughts about a particular
situation or event lead to negative
feelings and behaviour.
Activating Event
leads to
Beliefs and thoughts
leads to
Consequences (feelings and behaviour)
• By helping a client understand that their
thoughts and patterns of thinking can lead to
negative feelings and behaviour, they can
begin to challenge their negative thought
patterns.
• CBT assists clients to understand, manage and
change thoughts and behaviours.
• As an example the concept of helpful and
unhelpful thoughts is very useful in assisting
clients recognise their negative thought
patterns. Some unhelpful thought patterns or
“thinking errors” include exaggerating, black
and white thinking, making assumptions,
questions with no answers, catastrophising.
Narrative therapy
• Michael White, the guiding
genius of narrative family
therapy, began his
professional life as a
mechanical draftsman. But
he soon realized that he
preferred people to
machines and went into
social work where he
gravitated to family therapy.
The concept of narrative therapy
• In developing the notion that people's lives
are organized by their life narratives, White
came to believe that stories don't mirror life,
they shape it.
• That's why people have the interesting habit
of becoming the stories they tell about their
experience.
• Narrative therapists break the grip of
unhelpful stories by externalizing problems
• By challenging fixed and pessimistic versions
of events, therapists make room for flexibility
and change, allowing new and more optimistic
stories to be developed.
Key Concepts
• The client tells the story of how a problem has
affected their life (the dominant story) and re-telling
the story as a new and preferred story (alternative
story).
• Narrative therapists recognise that the problem is
the problem not the person. They acknowledge that
people retain only part of the huge amount of
information and experience and that the things we
notice and remember tend to reinforce our “story”
or world view.
As an example
• People can become stuck in a story that affects their
happiness and perhaps the happiness of others.
• A negative story may be “I am worthless and
unlovable, I am no use to anyone”. New experiences
are interpreted through this story.
• Narrative therapy assists clients to identify
exceptions to this dominant, negative story. This is
similar to a previous concept of life scripts which
people were given and were difficult to change.
Solution focussed therapy
• Steve de Shazer 1940 to
2005
• Started career as a
musician
• Developed brief
solution focussed
therapy in 1988
Key principles
• Externalizes problems from people
• Looks at solutions rather than focussing on
the problem
• Acknowledges strengths and resources
• Solution-focussed therapy focuses on what
the client is doing that is already working
• Looks for times when the client has been
successful in the past and when they used
coping skills successfully.
• Looks for an exception that is when the client
has used successful and adaptive behaviours.
Class exercise
• Watch the video segment and discuss how the
worker externalised the problem and the
effect that this had.
Strengths Based Approaches
• This popular approach simply focuses on
strengths rather than deficits. It draws on
earlier models especially humanistic
approaches, solution focused therapy and
narrative therapy.
How do we define strengths
• A “person’s physical, intellectual and
interpersonal skills, capacities, interests and
motivation” (Mallucio, 1981 in McCashen,
2005: p.7, St Lukes Publications, Victoria).
• Other resources such as neighbours, friends,
family, material resources can also be seen as
strengths. Often overlooked strengths include
dreams, hopes and aspirations.
Values underpinning the strengths
approach
• All people have strengths and capabilities
• People can change
• People can change and grow through their strengths and
capacities
• People are experts on their own situation
• The problem is the problem; the person is not the problem
• Problems can blind people from noticing and appreciating
their strengths and their capacity to find their own solutions
• People have good intentions
• People are doing the best they can
• The power for change is within us
So which model will I use?
• Many counsellors draw from a number of
theories or models to develop their own
framework for practice.
• This serves as a “psychological rudder” which
guides the counsellor in their practice.
• Our approach will depend on our own style as
a counsellor and the personality and needs of
our clients.
The integrative or eclectic approach
• An eclectic approach may incorporate the
Rogerian approach to build a relationship
with the client and establish trust,
psychoanalysis gives us an understanding of
the unconscious and how it influences
behaviour, while Gestalt, CBT, REBT, narrative
and solution focussed therapy provide us with
a range of techniques and strategies to assist
clients move forward.
Individual reflection
• Which style of counselling/intervention do
you think you would like to use in the future?
• Why have you chosen this approach?
• Discuss your ideas in groups of 3 to 4.
Values exercise
• From the cards you have been given which 5
cards best reflect your values as a community
services worker.
• Trade or swap your cards to get the hand that
best reflects your values.
• Share your cards with the group, explaining
why you have chosen those values.