SECTION I
INTRODUCTION AND
SOCIAL JUSTICE–
ORIENTED THEORIES
TO THEORY AND
1 INTRODUCTION
CASE CONCEPTUALIZATION
Stephen V. Flynn and Joshua J. Castleberry
LEARNING OBJECTIVES
After reading this chapter, you will be able to:
■ Describe the core counseling theoretical groupings
■ Recognize the history of counseling theory and practice
■ Provide details regarding atheoretical and theoretical case conceptualization
■ Explain trends in telebehavioral health
■ Identify the nuances of multiculturalism, intersectionality, diversity, and context in
professional practice
■ Describe the incorporation of a unitary, integrative, eclectic, and plural approach to
counseling
■ Recognize the process of picking a theoretical approach
INTRODUCTION TO THEORY AND CASE CONCEPTUALIZATION
Within this textbook, we showcase essential counseling theoretical groupings. The word
essential is provided to inform readers that these theories have stood the test of time and
sit on a solid foundation of research and practice. The word groupings is meant to describe
an umbrella that houses many theoretical traditions. Within these theoretical groupings,
all chapters deeply explore at least three relevant theories. The presented theories provide
early-, mid-, and late-career professionals with a clinical foundation of theoretical case conceptualization, theory-driven multicultural/intersectional and social justice issues, empirically based practice, a wide range of professional and contemporary issues, and a bedrock
of research. We have deliberately combined the presentation of theoretical traditions that
have their origins in the early years of psychotherapy with contemporary theories that have
been developed relatively recently and/or have had an enormous impact on the counseling
profession as a multicultural and/or social justice school of thought. The time-honored theories included in this text include traditional and relational psychoanalytic theory, person-­
centered and related experiential theory, existential-humanistic theory, behavioral theory,
cognitive theory, and systemic theory. These theoretical groupings have been thoroughly
updated and revised over the years. Consequently, they continue to remain relevant today.
Essential counseling theoretical groupings that have been developed relatively recently
and/or symbolize a multicultural and social justice theoretical approaches include multicultural counseling theory (MCT), feminist theory, postmodern theory, integrative theory,
and brief counseling theory.
According to the SAGE Encyclopedia of Theory in Counseling and Psychotherapy, there are
well over 300 approaches to counseling (Neukrug, 2015). While this number seems vast,
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having reviewed this important resource, it is our belief that many theoretical schools of
thought are only partially completed methods or provide a small deviation to an existing
theoretical approach. Within this textbook, we assume that most counseling theories can
be grouped into one of 12 distinguishable types. While we believe the theoretical groupings in this textbook have been adequately siphoned down, Neukrug (2015) produced
evidence that suggests all approaches to counseling can be traced back to one of six major
theoretical categories: psychoanalytic, behavioral, cognitive, humanistic, constructionist,
and systemic.
Within the current edition of this textbook, we do make a point to provide readers with
clear and distinct theories of counseling (e.g., traditional psychoanalytic theory, MCT,
postmodern theory); however, it should be noted that research indicates most practicing
helping professionals consider themselves to be integrative or eclectic (Tasca et al., 2015).
While we understand and respect our present clinical reality, we see a tremendous amount
of value in presenting distinct theoretical groupings of counseling. The benefits include,
but are not limited to, (a) understanding the origins of particular theories; (b) considering
how particular groups of theories conceptualize human development, mental illness, and
well-being; (c) understanding where unique skills and interventions were initially developed and how they were intended to be used; and (d) comprehending how various theoretical movements have influenced the counseling profession. While this is a textbook
designed for counseling professionals, throughout this text, the terms counselor, helping
professional, therapist, clinician, and practitioner are frequently used for readability purposes
or to adjust the scope of dialogue. This textbook uses counseling, therapy, and psychotherapy
interchangeably to describe the act of professional therapeutic service. Lastly, when general references to gender are suggested, we deliberately apply the term they and avoid the
binary terms he and she.
In professional practice, clients often choose to work with a counselor and to enter a therapeutic relationship due to some issue or concern that is affecting their lives. Clients desire
relief from these issues and choose to engage in counseling to help reduce or eliminate their
problems. However, counselors do not enter these therapeutic relationships as blank slates
or function as behavioral software programmed to help anyone with any issues. Counselors
have their own life experiences, biases, and expectations and have been socialized within a
particular context that includes unique familial factors, cultural norms, religion/spirituality,
and other environmental factors. The key questions‌‌‌‌‌‌‌ that come up for counselors include
the following: (a) How do I present myself in a way that optimally blends my professional
and personal self? (b) How do I know what to do when entering a counseling space with a
particular client, couple, group, network, and/or family? (c) What information is relevant/
irrelevant to treatment? (d) What theoretical model should I be operating from? These questions are common areas of reflective practice (Reiter, 2014).
Questions like those previously stated are partly answered through the process of
developing a theoretical and conceptual framework, which include basic clinical competencies that serve as a linchpin to all professional practice (Betan & Binder, 2010). They
are also the foundation for (a) how counselors view what’s taking place in a counseling
session; (b) a counselor’s understanding for the personal process taking place within
every client they work with; (c) comprehending the interpersonal dynamics between client and counselor; and (d) what is needed to cocreate a sense of helping, healing, and
change. These internal processes cocreate a model that supports counselor clinical practice with various populations and presenting issues. For early-career professionals entering the counseling profession, their personal beliefs and opinions about helping often
coalesces around an established academic theoretical model. As counselors become more
advanced, they will often start to move beyond the strict confines of an established therapeutic model and begin to create their own theory of helping, healing, and change (Reiter,
2014). Whether you are an early-, mid-, or late-career professional, the development of a
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theory of professional practice is important for the well-being of clients, to the counselor’s own sense of identity, and to fully integrate one’s professional and personal self in a
meaningful and holistic manner.
The Importance of Theory and Case Conceptualization
Oxford Languages (n.d.) defines theory as “a supposition or a system of ideas intended to
explain something, especially one based on general principles independent of the thing to
be explained.” Depending on the context theory is used, it can arouse a variety of reactions. Consider your initial response to the following scientific and psychological theories:
Darwin’s theory of evolution, Einstein’s theory of relativity, Copernicus’s theory of the solar
system, and Freud’s theory of the unconscious mind. For most, these frameworks are unified and verified explanations used to describe data and findings in a particular area of
science or psychology. Now consider the following uses of theory: “If my theory is correct, I
will live to be 100 years of age” or “Theoretically speaking, you can understand everything
about a person through analyzing their dreams, age, and gender.” Instead of a verified scientific explanation, these are colloquial guesses and do not typically generate a tremendous
amount of confidence. They can also inhibit the importance of theory. Counseling professionals who question the importance of theory might suggest training programs sidestep
teaching theoretical courses all together and focus on educating counselors-in-training on
researched-based common factors (Wampold, 2015). While some counseling professionals
may suggest this course of action, theory helps counselors make meaning of every aspect
of treatment including, but not limited to, diversity and intersectionality, clients’ presenting issues, case conceptualization, assessment, diagnosis, treatment planning, treatment
method, and care coordination. Theory also impacts what information counselors find clinically relevant and irrelevant. The theoretical process of making sense of and filtering out
information allows counselors to provide effective treatment and avoid being overwhelmed
by an enormous amount of client information. Without a theoretical conceptualization of
various psychological phenomena (e.g., culture, pathology, human development, well-­
being, role of counselor/client), counselors would be lost.
Counseling theory aims to add meaning to the underpinnings of human thoughts, emotions, drives, and behaviors. It also serves as a road map for counselors to provide emotional,
cognitive, and behavioral treatments to individuals who are seeking to make fundamental changes within themselves and their lives. According to Corsini and Wedding (1989)‌‌‌‌‌‌‌,
counseling is best conceptualized as an art built on science. Counseling is not a mechanical
vocation; often, what goes on in the counseling room is a process of personal discovery,
self-expression, and processing emotions and thoughts. Counselors seek to journey with
their clients into the depths of their subjective thoughts and feelings and, through this process, a counselor’s own subjective experiences become essential to the work. In this sense,
the degree to which a counselor introspects and explores their own thoughts, emotions, and
behaviors, the more likely they are to be able to dive into the depths of their clients’ experiences, deeply empathize with their pain, and to help clients see things from multiple perspectives. Counseling theories guide therapeutic work at all levels from highly data-driven
behavioral approaches to art-based counseling methods. In some cases, empirically based
brief counseling is vital to helping a client achieve their goals in a timely manner. However,
for a major life change to occur and/or to influence client personality, traditions that offer a
combination of subjective and objective practices are often preferrable.
Counseling theories are essential to the counselor’s ability to organize client content,
make sense of complex processes, and effectively pair interventions with client goals.
When clients enter a counseling relationship, they are usually required to provide a tremendous amount of personal information during the initial phase of treatment, which is
collected through a variety of methods: (a) a thorough intake assessment, (b) psychosocial
6 | I INTRODUCTI ON A ND S OCI A L J US TIC E – O RI E N T E D T H E O RI E S
background information, (c) information related to mental status, (d) treatment plan
information and goals, (e) psychopharmacological information, (f) client conceptualization of the current problem(s), and (g) details related to past providers and experiences
in counseling. The bombardment of client information can leave the counselor overwhelmed and confused if they do not have an overarching theory to make sense of it all.
It is not enough that a counseling theory provides organization and hypothesis about
a client’s concerns; it must also provide skills and techniques designed to help clients
achieve their therapeutic goals. First, however, counselors must find a way to bridge the
gap between their client and their preferred theory of counseling. This is a function of
case conceptualization.
Case conceptualization is the method for understanding, explaining, and guiding the
treatment process (Sperry & Sperry, 2020). It is the foundation of a coherent treatment strategy that is centered on planning and focusing treatment on meeting a client’s unique goals.
A detailed case conceptualization provides counselors with a bridge between client and theory, a cognitive process to determine the usefulness of various counseling interventions, and
the organizational-level (e.g., agency, hospital) accountability for effective clinical practice
(Prieto & Scheel, 2002). Lastly, whether the counselor works in a clinical or school setting,
organizations that offer counseling services almost always have a team centered on assisting clients and students with therapeutic and educational services (e.g., treatment team,
504 plan accommodation team, individualized education program [IEP] team). These teams
depend on an accurate and thorough conceptualization of the clients/students’ presenting
issues‌‌‌‌‌‌‌ to ensure effective treatment, teamwork, and communication.
This textbook is centered on the theories and models that guide counselors in their service to clients. The theories presented are more than a set of ideas or systemic approaches
to change; they are about understanding others. Counselors come from a long line of those
attempting to understand the human condition. Spanning across continents‌‌‌‌‌‌‌ and through
centuries, this textbook reviews the works of scholars who have pursued theories and therapies that speak to people’s intrapsychic dynamics and behavioral, emotional, cognitive, and
relational needs. While we employ a vocation that is simultaneously an art and a science,
contained by ethics and values, counseling is ultimately about helping, healing, and change.
As you journey through this textbook, reflect on where you align your thoughts and feelings
about the human condition and consider which theories you connect with. In the end, we
hope your findings can provide the blueprints for how you can best serve, understand, and
collaborate with those fellow travelers you find sitting across from you in session. As Irvin
Yalom (2002) eloquently stated:
Instead, I prefer to think of my patients and myself as fellow travelers, a term that abolishes distinctions between “them” (the afflicted) and “us” (the healers) […] We are all
in this together and there is no therapist and no person immune to the inherent tragedies of existence. (p. 8)
ACCREDITATION
Accredited academic institutions are required to attain appropriate and acceptable levels
of training quality for emerging helping professionals. Graduate programs accredited
through the Council for Accreditation of Counseling and Related Educational Programs
(CACREP) emphasize theory and case conceptualization practices in the training of
counselors. CACREP accreditation is the training standard for counselors that has been
recognized by the National Academy of Medicine, the Veterans Administration, and
the Council for Higher Education Accreditation (CHEA). In most states, a CACREPapproved education meets the curriculum required for counseling licensure. Accredited
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programs engage in a continuous review process to meet and maintain counseling theory
standards, ethics, faculty identity, curriculum, and licensure expectations set by the profession (Flynn, 2023). Throughout this textbook, accreditation standards are considered
in the context of counseling theory, case conceptualization, social and cultural diversity,
and professional practice.
At the time of this writing, the two authors of this chapter serve as faculty members in
CACREP-accredited counseling programs housed within two separate state universities. At
any point in time, there is a current set of CACREP standards being implemented while a
newer version of the standards is in the process of being created. Presently, the 2016 CACREP
standards are required for all CACREP programs, while the 2024 CACREP standards are
in development. Therefore, the present textbook covers both the 2016 and 2024 CACREP
standards. Please see Table 1.1 for a breakdown of the CACREP 2024 standards and standard location within the textbook. The following theory/professional practice-based 2016
CACREP standards are frequently addressed within this textbook: 2.F.3.c. theories of normal and abnormal personality development (Chapters 1–13); 2.F.3.f. systemic and environmental factors that affect human development, functioning, and behavior (Chapters 1–13);
2.F.5.a. theories and models of counseling (Chapters 1–13); 2.F.5.b. a systems approach to
conceptualizing clients (Chapter 10); 2.F.5.f. counselor characteristics and behaviors that
influence the counseling process (Chapters 1–13); 2.F.5.g. essential interviewing, counseling,
and case conceptualization skills (Chapters 1–13); 2.F.5.j. evidence-based counseling strategies and techniques for prevention and intervention (Chapters 1–13); 5.C.1.b. theories and
models related to clinical mental health counseling (Chapters 1–13); and 5.C.3.b. techniques
and interventions for prevention and treatment of a broad range of mental health issues
(Chapters 2–13).
Although researchers have suggested that a proper understanding of theory, treatment
planning, and diagnosis can and should be achieved through education, supervision, and
training, case conceptualization has increasingly been seen as the most effective way to
teach their integration (Cline et al., 2022; Meier, 1999; Osborn et al., 2004). CACREP (2016)
currently requires case conceptualization skills (CACREP 2.F.5.g). CACREP further requires
more specified knowledge of case conceptualization within the specialty areas of addiction
counseling (CACREP 5.A.1.d); clinical mental health counseling (CACREP 5.C.1.c); clinical rehabilitation counseling (CACREP 5.D.1.d); and marriage, couple, and family counseling (CACREP 5.F.1.e). Theory congruent case conceptualization is reviewed and applied in
every chapter of this textbook.
Race, ethnicity, gender, gender identity, sexual orientation, religion, culture, racism,
homophobia, sexism, racial macro- and microaggressions, and xenophobia are just some
of the important social justice-/diversity-based discussions taking place around the
world. Within the United States, we are presently experiencing one of the largest human
rights movements in history. Due in part to the systemic and institutional racism in the
United States and the recent incidents of police brutality and shootings of Black people
including, but not limited to, Trayvon Martin (1995–2012), Michael Brown (1996–2014),
Eric Garner (1970–2014), Breonna Taylor (1993–2020), and George Floyd (1973–2020), the
#BlackLivesMatter (BLM) movement has gained enormous momentum over recent years.
The BLM movement is centered on stopping racially motivated violence against Black
people. Similarly, due to a somewhat recent escalation in anti-Asian American and Pacific
Islander (AAPI) sentiment, a rise in Asian hate crimes, and American leadership scapegoating Asian communities in the COVID-19 pandemic, there has been a dramatic increase
in race-related politics and social attention given to ensuring human rights and social
justice for all Asian Americans. Lastly, the #MeToo movement is a contemporary feminist
movement that began in 2006 and became much more culturally prominent in 2017 when
women started coming forward via news and social media with stories of harassment and
8 | I INTRODUCTI ON A ND S OCI A L J US TIC E – O RI E N T E D T H E O RI E S
Table 1.1. 2024 CACREP Accreditation Standards and Location
CACREP 2024 Standard
Where the Standards Are Met Within the
Textbook
Section 3.1.a: history and philosophy of the
counseling profession and its specialized
practice areas
Chapters 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13
Section 3.2.d: the role and process of the
professional counselor advocating on behalf
of and with individuals receiving counseling
services to address systemic, institutional,
architectural, attitudinal, disability, and
social barriers that impede access, equity,
and success
Chapters 1, 2, and 3
Section 3.1.k: self-care, self-awareness,
and self-evaluation strategies for ethical and
effective practice
Chapters 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13
Section 3.2.a: theories and models of
multicultural counseling, social justice, and
advocacy
Chapters 2 and 3
Section 3.2.b: the influence of heritage,
attitudes, values, beliefs, understandings,
within-group difference, and acculturative
experiences on individuals’ worldviews
Chapters 2 and 3
Section 3.2.e: the effects of stereotypes,
overt and covert discrimination, racism,
power, oppression, privilege, marginalization, and violence on counselors and clients
Chapters 2 and 3
Section 3.2.f: the effects of various sociocultural influences on mental and physical
health and wellness, including public policies, social movements, and cultural values
Chapters 2 and 3
Section 3.2.i: strategies for identifying and
eliminating barriers, prejudices, and intentional and unintentional oppression and
discrimination
Chapters 2 and 3
Section 3.5.a: theories and models of
counseling, including relevance to clients
from diverse cultural backgrounds
Chapters 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13
Section 3.5.c: case conceptualization skills
using a variety of models and approaches
Chapters 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13
Section 3.5.e: application of technology
related to counseling
Chapter 1
Section 3.5.g: culturally sustaining and
responsive strategies for establishing and
maintaining counseling relationships across
service delivery modalities
Chapters 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13
Section 3.5.h: counselor characteristics,
behaviors, and strategies that facilitate
effective counseling relationships
Chapters 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13
Section 3.5.i: interviewing, attending, and
listening skills in the counseling process
Chapters 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13
(continued)
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Table 1.1. 2024 CACREP Accreditation Standards and Location (continued)
CACREP 2024 Standard
Where the Standards Are Met Within the
Textbook
Section 3.5.j: counseling strategies and
techniques used to facilitate the client
change process
Chapters 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13
Section 3.5.k: strategies for adapting and
accommodating the counseling process
to client culture, context, abilities, and
preferences
Chapters 1 and 2
Section 3.5.o: evidence-based counseling
strategies and techniques for prevention
and intervention
Chapters 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13
Section 3.5.v: processes for developing a
personal model of counseling
Chapter 1
Section 3.7.h: use of assessments in academic/educational, career, personal, and
social development
Chapters 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13
Section 3.7.i: use of environmental
assessments and systematic behavioral
observations
Chapters 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, and 13
Note: All accreditation information within the table was taken from the Council for Accreditation of Counseling and Related Educational Programs (CACREP 2024) standards. https://www.cacrep.org/wp-content/­
uploads/2022/10/Draft-4-2024-CACREP-Standards.pdf
sexual assault committed by men. By saying “me too,” a survivor of harassment, sexual
assault, and/or rape stands in solidarity with other women who have experienced similar
atrocities. The #MeToo movement has made a big cultural impact around raising awareness, accountability, and empowerment regarding sexual misconduct perpetrated against
women. In addition to creating a community centered on safety, empathy, and hope, the
#MeToo movement made a very positive impact in the United States through increasing the
reporting of sex crimes by 10% in its first 6 months and increasing the number of arrests for
sexual assault crimes (Meyers, 2018‌‌‌‌‌‌‌‌‌).
This textbook deliberately focuses on theory-based multiculturalism, intersectionality,
and social justice within every chapter. While we intentionally weave these elements in,
much of the textbook content is centered on theory, case conceptualization, and professional practice. For those interested in a comprehensive review of culture, diversity, multiculturalism, intersectionality, racism, and discrimination, please consider reviewing Sue
et al.’s (2019) textbook entitled Counseling the Culturally Diverse: Theory and Practice. From
a CACREP perspective, the following 2016 social and cultural diversity standards are frequently reviewed throughout this edition of the textbook: 2.F.2.a. multicultural and pluralistic characteristics within and among diverse groups nationally and internationally (Chapter
2); 2.F.2.b. theories and models of multicultural counseling, cultural identity development,
and social justice and advocacy (Chapters 2 and 3); 2.F.2.c. multicultural counseling competencies (Chapters 1–13); 2.F.2.d. the impact of heritage, attitudes, beliefs, understandings,
and acculturative experiences on an individual’s views of others (Chapters 2–13); 2.F.2.e.
the effects of power and privilege for counselors and clients (Chapters 2 and 3); 2.F.2.f.
help-seeking behaviors of diverse clients (Chapter 1–13); and 2.F.2.h. strategies for identifying and eliminating barriers, prejudices, and processes of intentional and unintentional
oppression and discrimination (Chapters 2 and 3).
10 | I INTRODUCTION A ND S OCI A L J US TI C E – O RI E N T E D T H E O RI E S
THE THEORIES OF COUNSELING
You may be wondering, “Do most people acknowledge that empathic conversations with
a professional counselor create a sense of healing?” The answer is “yes.” Because counseling professionals use empirically validated skills and interventions that have been proven
through research to address specific mental health concerns, counseling is considered a
legitimate form of healing. Counselors are agents of helping, healing, and change; however,
they are far more effective when they are operating from a theory. Counseling theories are
intellectual models used for understanding human behavior and they are at the core of
counselor preparation. These theoretical formulations are centered on the notion that mental health concerns can be healed through the art and science of counseling.
Skills and interventions are often embedded within a theory and most theories are part
of a larger theoretical grouping. For example, the empty chair technique is an in-session
experiment originally developed in Gestalt therapy. Gestalt therapy is an experiential therapeutic approach that is often grouped under the humanistic counseling theories umbrella.
These theoretical groupings are centered on certain ways of understanding human behavior, thought, emotion, and/or interpersonal dynamics, and include multicultural counseling theories, feminist theories, traditional psychoanalytic theories, relational approaches
to psychoanalytic treatment, person-centered counseling and related experiential theories,
existential-humanistic theories, behavioral theories, cognitive theories, systemic theories,
postmodern theories, integrative theories, and brief counseling theories. While these theoretical camps are important intellectual models, they are pragmatically used as a foundation
for creating skills and interventions that help clients understand, enhance, and/or change
maladaptive behaviors, feelings, cognitions, and interpersonal challenges.
Counseling theories tend to be affected by fads, trends, and novelties that garner much
attention and enthusiasm; however, after a period of high interest, many of these fads seem
to vanish from the therapeutic world. The counseling theories with long-standing tradition
often become part of the foundation of client conceptualization and counselor skill-based
training. We believe the theories presented within this textbook have withstood the test
of time and are deeply connected to counselor preparation and research. The theoretical
groups within this textbook are truly distinct and relevant, demonstrate unique methods
for helping others, and symbolize unique pathways for understanding human behavior.
Furthermore, the distinct‌‌‌‌‌‌‌ and unique nature of each theoretical camp is bridged by similarities including, but not limited to, the importance of multiculturalism, intersectionality,
and social justice and the centrality of the therapeutic relationship, client/counselor context,
assessment, and skill acquisition, which have been the cornerstone of professional counseling for decades. Table 1.2 provides a breakdown of the chapter titles, leaders and legacies
reviewed in each chapter, and the essence of the theoretical camp being explored.
The History of Counseling
While it has been suggested that the roots of the practice‌‌‌‌‌‌‌ of counseling can be traced back
to incantations provided by the Enlightenment Era priests from Mesopotamia, Persia, and
Egypt (Hackney & Cormier, 2009‌‌‌‌‌‌‌‌‌), the origins of contemporary professional counseling theory‌‌‌‌‌‌‌ are centered on the contributions of professional pioneers Frank Parsons (1854–1908)
and Carl Rogers (1902–1987). While the impact of Parsons and Rogers were enormous, additional noteworthy influences include, but are not limited to, Sigmund Freud (1856–1939),
Alfred Adler (1870–1937), Otto Rank (1884–1939), Fritz Perls (1893–1970), Abraham Maslow
(1908–1970), Virginia Satir (1916–1988), and Carl Whitaker (1912–1995). Please note, while
Parsons and Rogers often get the nod as being the pioneers of professional counseling,
Sigmund Freud, the founder of psychoanalysis and modern psychotherapy, is the pioneer
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Table 1.2. Chapters, Leaders and Legacies, and the Essence of the
Theoretical Grouping
Chapter and Title
Leaders and
Legacies
Essence of the Theoretical Group
Chapter 2. Multicultural
Counseling Theory
Clemmont
Vontress
Derald Wing Sue
Janet Helms
Manivong J. Ratts
Paul B. Pederson
Patricia
Arredondo
Thelma Daley
The essence of multicultural counseling includes contextually understanding the nuances of counseling with
individuals who are culturally different
(race, ethnicity, socioeconomic, etc.).
Chapter 3. Feminist Approaches
Mary
Wollstonecraft
Simone de
Beauvoir
Carol Gilligan
bell hooks
Judith Butler
The essence of feminist theory
includes the notion that the personal is
political, honoring the value within the
messages of marginalized people, and
the importance of demystifying power
structures.
Chapter 4. Traditional
Psychoanalytic Approaches
Sigmund Freud
Josef Breuer
Carl G. Jung
Donald Winnicott
The essence of traditional psychoanalytic theory includes therapeutically
working with individuals so they can
develop self-understanding and insight
and resolve the unconscious conflicts
within their minds.
Chapter 5. Relational Approaches
to Psychoanalytic Treatment
Karen Horney
Heinz Kohut
Alfred Adler
The essence of the relational
approaches to psychoanalysis includes
the notion that all individuals are
embedded within social relationships,
and the counselor and client are
both participants within the analytic
process.
Chapter 6. Person-Centered and
Related Experiential Approaches
Carl Rogers
Otto Rank
Abraham Maslow
Leslie Greenberg
Sue Johnson
The essence of person-centered and
related experiential theories includes
the notion that humans are relational in
nature, behaviors and cognitions
are attempting to meet relational
needs, and emotions are healed by
emotions.
Chapter 7. Existential-Humanistic
Approaches
Irvin Yalom
Viktor Frankl
Fritz Perls
Rollo May
The essence of the existential-­
humanistic theories includes
approaching clients with a sense of
wonder, curiosity, and genuineness as
they face the mysteries of life and the
difficult realities of existence.
Chapter 8. Behavioral Approaches
Ivan Pavlov
John B. Watson
Rosalie Rayner
Edward Thorndike
Joseph Wolpe
Mary Cover Jones
B. F. Skinner
The essence of behavioral theory
includes the understanding that all
client behavior is learned, has a purpose, and is modifiable using skills and
interventions grounded in empirical
support.
(continued)
12 | I INTRODUCTION A ND S OCI A L J US TI C E – O RI E N T E D T H E O RI E S
Table 1.2. Chapters, Leaders and Legacies, and the Essence of the
Theoretical Grouping (continued)
Chapter and Title
Leaders and
Legacies
Essence of the Theoretical Group
Chapter 9. Cognitive Approaches
Albert Ellis
Aaron Beck
Albert Bandura
Martin Seligman
Donald
Meichenbaum
Steven Hayes
The essence of cognitive theories is
the understanding that client issues
result from the lack of attunement
between thoughts, feelings, and
behavior and the interplay of these factors is enhanced when more adaptive
thought patterns are adopted.
Chapter 10. Systemic Approaches
Gregory Bateson
Murray Bowen
Virginia Satir
John Weakland
Paul Watzlawick
Salvador
Minuchin
Donald Jackson
Cloe Madanes
Jay Haley
The essence of systemic theories
includes the notion that the issues
­clients bring into counseling reflect
their context and familial/relational
behavior, and counselors cocreate
­client change through understanding and influencing the circularity
of interactions, subjective nature of
experiences, relational behavior, and
communication patterns.
Chapter 11. Postmodern
Approaches
David Epston
Michael White
George Kelly
Insoo Kim Berg
Steve de Shazer
The essence of postmodern theories
includes the philosophy that issues
explored in counseling often reflect
one way of viewing multiple possible realities, during counseling the
counselor and client co-construct
knowledge, and all therapeutic results
are based on a perception of perspectives that individuals apply their own
­meaning to.
Chapter 12. Integrative
Approaches
Aaron Lazarus
John C. Norcross
James Prochaska
The essence of integrative theories
includes the understanding that c
­ lients
present with different issues, needs,
and preferences. Consequently,
counselors assimilate and draw from
a variety of therapeutic models and
­techniques to best serve their clientele.
Chapter 13. Brief Counseling
Approaches
James Bitter
William Nicoll
Berthold Gersons
Insoo Kim Berg
Steve de Shazer
The essence of brief counseling theories is for the counselor to provide
a planned and time-limited approach
to understanding the issues that
led the client to come to counseling
and d
­ elivering direct and parsimonious interventions that lead to a
sense of c
­ lient relief and clinical goal
achievement.
who ultimately set the stage for Parsons, Rogers, and all other modern approaches to counseling (Flynn & Sangganjanavanich, 2014‌‌‌‌‌‌‌‌‌).
Frank Parsons’s impact was so prominent that he has been referenced as the “Father of
Vocational Guidance” (Blocher, 2000; Limberg et al., 2022). He was passionate about fighting
for the rights and needs of individuals who were exploited by industrial monopolies. He was
very interested in how people chose their vocation (i.e., career), and his theory of vocational
development postulated the importance of harmony between a worker’s strengths, limitations,
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abilities, aptitudes, and resources in selecting a suitable job. His textbook Choosing a Vocation
provided important information on how to help people arrive at a wise career selection
through expert counsel (Parsons, 1909‌‌‌‌‌‌‌‌‌). Among his many achievements, Parsons authored 14
books and created the first counseling agency that served as an antecedent to the emergence
of vocational guidance in U.S. schools (i.e., school counseling; Limberg et al., 2022).
American psychologist Carl Rogers (1902–1987) is not only a pioneer of the counseling
profession but is also one of the founders of the entire humanistic movement. His achievements and impact in the development of counseling theory and practice are so great that
his work has become the roots of the entire counseling profession. His two groundbreaking
books include On Becoming a Person: A Therapist’s View of Psychotherapy (Rogers, 1961) and
A Way of Being (Rogers, 1980). While humanistic psychology can be traced back to the Middle
Ages when the philosophy of humanism was created, the second half of the 20th century
is the time period most relevant to present-day counseling theory. Today, humanism is still
very much evident theoretically (e.g., person-centered therapy and theory), through clinical
practice (e.g., invitational and attending counseling skills), and within the research world
(e.g., The Journal of Humanistic Counseling; Flynn, 2023).
Humanistic theoretical approaches emphasize a sense of acceptance and unconditional
positive regard, highlight the importance of everybody’s worth, embrace the holistic nature
of the human condition, demonstrate an anti-reductionistic outlook, value free will and
agency, accept emotions, uphold the importance of context and subjectivity, and still consider
the development of a safe and meaningful empathic relationship as the principle of effective
clinical practice (Bohart, 2003; Flynn, 2023; Raskin & Rogers, 1989‌‌‌‌‌‌‌‌‌). Carl Rogers’s person-­
centered approach was heavily influenced by the fundamental principle of nondirectiveness.
In fact, Rogers’s therapeutic approach was once called nondirective psychotherapy. Rogers
essentially created a therapeutic atmosphere centered on permissiveness, genuineness, nonjudgment, and not using assessments or clinical interventions. Bohart (2003) and Rogers
(1963) described the skills of acceptance and clarification as the only “interventions” used
to help individuals become fully functioning beings. This anti-interventionist framework is
key to why his approach is considered nondirective. While contemporary counselors learn a
variety of theoretical models, the influence of the person-centered approach remains evident
within counselor preparation and scholarly literature. For example, most practitioners continue to believe the overall importance of the following counseling factors and dispositions:
the therapeutic relationship, empathy, the accurate reflection of feelings, congruence, and
genuineness.
MODELS OF CASE CONCEPTUALIZATION
According to Sperry and Sperry (2020b) “…a case conceptualization is a process and cognitive map for understanding and explaining a client’s presenting issues and for guiding
the counseling process” (para. 3). Having a solid case conceptualization format is a basic
counseling proficiency and has been described as the most salient counseling competency
outside of the development of the therapeutic relationship (Sperry & Sperry, 2020b). Case
conceptualization serves as a foundation for client assessment, clinician’s use of skills and
techniques, client diagnosis, psychopharmacological referral, and treatment planning (e.g.,
goals, objectives, target behaviors, interventions). The primary purpose is to build a bridge
between counselor and client through theory, resulting in a well-developed and coherent
narrative. How does one do this? Various models can be used with almost any developed
counseling theory to help the clinician through the complex and challenging case conceptualization process. Models are organized around multiple elements of client data to create a
treatment blueprint for future sessions. Specifically, a case conceptualization narrative will
identify the precipitating causes (i.e., events) of a client’s presentation (i.e., symptoms), the
patterns that activate and maintain the client’s problems, how social and cultural factors
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impact the client presentation, and the strategies for intervention planning (John & Segal,
2015; Sperry & Sperry, 2020a).
How a case conceptualization model is chosen is influenced by a variety of factors, including, but not limited to, the counselor’s theoretical orientation, client presenting problem(s),
empirically based assessment(s), agency/hospital policies, and the treatment goal(s). The
general nature of effective case conceptualization involves (a) gathering client background
information and engaging in a thorough clinical interview to arrive at a comprehensive
diagnosis; (b) deciding what type of counseling (e.g., family counseling, crisis counseling,
individual counseling) and/or services (e.g., outpatient services, inpatient hospitalization,
substance detox, appointment with a psychiatrist) are needed; (c) collecting the history
of current symptoms and how they have been maintained (e.g., “When did your anxious
thoughts and feelings first start?”); (d) cocreating a cultural and intersectional formulation
of the presenting issue(s) (e.g., race, ethnicity, gender, socioeconomic status [SES], religion,
age, ability); and (e) developing a nuanced treatment plan (Sperry & Sperry, 2020a). Here
we will provide a brief overview of the two atheoretical models of case conceptualization.
The Biopsychosocial Model of Case Conceptualization
Arguably, the most common method of case conceptualization is the biopsychosocial
model. This model is mainly atheoretical, involving the client’s vulnerabilities and protective factors relevant to their biological, psychological, and sociocultural predispositions.
Because of its biological basis, this method has been used across many allied healthcare
professions and has considerable appeal to those practicing in medical contexts. Within
the biopsychosocial model of case conceptualization, the client’s concerns and presentation
are considered a product of hierarchically organized biological, psychological, and sociocultural factors. It is a multilevel, multisystem framework for client functioning. Biological
predispositions account for risk of and resilience to mental illness. These biological predispositions begin in prenatal development and continue through adulthood but are exhibited
primarily in early development. Their causes include genetics, pre- or post-natal trauma,
disease, or birth complications. Relevant psychological factors to consider may include
personality style, coping capacities, past mental health histories, and developmental history. Finally, sociocultural risk factors are considered as they may influence both biological
and psychological factors, further protecting from or activating the development of psychopathology. Counselors must also be mindful of client’s social history, context, external
stressors, identities, marginalization, sociopolitical power and access, relationships, and
other sociocultural variables impacting the client’s symptoms and function. In short, these
three factors (i.e., biopsychosocial) work together to activate a client’s vulnerabilities and
strengths. In this model, the counselor views the manifestation of the client’s symptoms
as an attempt to cope with stressors activated through their vulnerabilities. Ultimately,
biopsychosocial case conceptualization focuses treatment on assuaging client symptoms
and increasing functioning through an integrative treatment approach (Borrell-Carrió,
Sunchman, & Epstein, 2004).
The Eight P’s
A second popular atheoretical model of case conceptualization is Sperry and Sperry’s (2020b)
eight P’s. This model is ideal for counselors who are seeking a brief, quick to understand,
and comprehensive atheoretical client conceptualization model. The format is centered on
the nature and origin of the client’s presenting issue and treatment. The step-by-step format
includes (a) presentation (i.e., clinical symptoms, traits, and interpersonal issues), (b) predisposition (i.e., biological, social, psychological, and cultural considerations), (c) precipitants
(i.e., issues that served as an antecedent or cause or simply coincided with the onset of
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clinical symptomology), (d) protective factors and strengths (e.g., coping skills, attachment
style, and client strengths), (e) pattern (i.e., predictable maladaptive patterns of coping, feeling, thinking, and behaving), (f) perpetuants (i.e., how maladaptive patterns are reinforced
and confirmed within a client’s environment), (g) plan (i.e., treatment plan, objectives,
goals, and interventions), and (h) prognosis (i.e., prediction of client ability and readiness
to change). This model clearly describes issues related to the client’s presenting problem. In
fact, four of the P’s (i.e., predisposition, precipitants, pattern, and perpetuants) are centered
on the presenting concerns. The substantial amount of clinical information gathered will
assist counselors with writing their treatment plan and providing a well-researched diagnosis based on current mental status, family development and social history, personal mental
health and physical health history, and client resources and strengths.
THEORETICAL MODELS
Most models of case conceptualization are theoretically based. One of the most practiced
psychotherapies today is cognitive behavior therapy (CBT). While there are a variety of
forms and formats of CBT, cognitive behavioral (CB) case conceptualization unites the various iterations of the approach. As part of the integrative counseling theoretical grouping,
intricately combining cognitions and behaviors in a manner that best supports clients is
the central focus of the CBT case conceptualization model. However, in addition to cognitions and behaviors, CB case conceptualization includes factors like the client’s cultural
identification, their intersectional identity, their acculturation status (if relevant), and the
explanation of the cause of the client’s presenting issue (Easden & Kazantzis, 2018). CB
case conceptualization centers on analyzing antecedents and responses to a problem and
the client’s resulting cognitive, emotional, and behavioral experiences (Padesky & Mooney,
1990). This format of conceptualization is similar to behavioral functional analysis (Haynes
& O’Brien, 2000) and Ellis’s (1962)‌‌ A-B-C framework. You will review functional analysis in
Chapter 8, and rational emotive behavior therapy (REBT) in Chapter 9 of this text.
A case conceptualization framework is not stagnant; it is an iterative and evolving process. Prior to entering the counseling profession or graduate school, soon-to-be counselors have their own way of understanding and informally assessing people, mental health
issues, and environmental factors. This initial framework was largely developed through
life experiences, socialization, culture, family, and one’s own personal development process.
After entering graduate school, counseling students are intentionally provided academically oriented theoretical models and atheoretical models of case conceptualization, which
are fluid and evolving. When new research and information emerges in the professional
stratosphere, it is absorbed into the traditional methods, and case conceptualization models
change. The next section briefly describes the models of case conceptualization presented
within this textbook.
Multicultural Counseling Theory
MCT was developed and influenced by many individuals, including, but not limited to,
Paul B. Pederson (1936–2017), Derald Wing Sue, Manivong J. Ratts, Patricia Arredondo,
Thelma Daley, and Courtland Lee. MCT emphasizes understanding race, ethnicity, sexuality, gender, religion, SES, and any other nuances that influence a client. Central themes
in the MCT model include (a) advocating for a call to action, (b) attaining multicultural
competency, (c) using well-vetted MCT counseling interventions and techniques, (d) developing ethnic and racial identity, (e) embracing spirituality, (f) understanding sexual orientation development, (g) and engaging in social justice and advocacy. When practicing from
an MCT perspective, presenting issues are linked to understanding, coping, and attaining
resiliency despite the barriers brought forth by issues such as systemic oppression, racism,
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inequity, and marginalization. To create a strong therapeutic alliance, counselors practicing
from an MCT theoretical perspective do not shy away from conversations pertaining to
race, ethnicity, and culture, especially as it relates to differences between the counselor and
client(s) (Hughes, 2023).
Feminist Theory
Feminist theory has many leaders, legacies, and contributors. The key figures within
the feminist movement include, but are not limited to, Mary Wollstonecraft (1759–1797),
Simone de Beauvoir (1908–1986), Carol Gilligan, bell hooks (1952–2021), and Judith Butler.
The essence of feminist theory is the belief that the personal is political, there is value
within the messages of marginalized communities, and demystifying power structures is
important. Feminist case conceptualization incorporates a sense of egalitarianism, multiculturalism, social justice, advocacy, and a dedication to empathizing and collaborating
with individuals, groups, families, and couples. When conceptualizing client issues, feminists carefully balance listening and affirming the voices of clients; understanding the
various contextual issues in a client’s life; assessing the roles, groups, and relationships
impacting a client; and actively observing, challenging, and resisting the continuation
of oppression and subjugation. To lift clientele out of the grips of oppression, feminist
counselors create a therapeutic environment that supports open communication, sharing
beliefs and ideas, and ask clients to collaborate on a shared meaning-making therapeutic
experience (La Guardia, 2023).
Traditional Psychoanalytic Theory
The founder of psychoanalytic theory was Sigmund Freud (1856–1939). Three additional
key contributors to psychoanalytic theory include Josef Breuer (1842–1925), Carl G. Jung
(1875–1961), and Donald Winnicott (1896–1971). The core of traditional psychoanalytic
theoretical case conceptualization is helping individuals, couples, families, and groups
develop a sense of self-understanding, begin lifelong habits of introspection, and resolve
unconscious conflicts that interfere in their everyday life. The practice of psychoanalysis
continues to explore the nature of the unconscious mind, the salience of childhood experiences on the development of one’s personality, and the evolving nature of the collaborative and empathic therapeutic alliance. Contemporary psychoanalysis has moved away
from the counselor acting as if they were a blank slate for the use of client projection to the
counselor serving as a more relational and collaborative participant in the session within a
close therapeutic alliance. Counselors practicing from a psychoanalytic perspective engage
in active listening to uncover client conflicts through collaboration, explore the origins of
interpersonal conflict, and identify pertinent client unconscious material (Smith, McGrath,
Mangin, & Altenberg, 2023).
Relational Approaches to Psychoanalytic Treatment
Relational approaches to psychoanalytic treatment have been influenced by several psychology pioneers, including, but not limited to, Alfred Adler (1870–1937), Karen Horney (1885–
1952), and Heinz Kohut (1913–1981). The essence of case conceptualization from a relational
approach includes many aspects of traditional psychoanalysis along with the conception
that all individuals are connected through interpersonal relationships. Factors like client
countertransference disclosures are used collaboratively, instead of hierarchically, to explore
the many relational scenarios that are being enacted between the counselor and client. This
relational conceptualization is also woven into the therapeutic relationship as both the counselor and client are participants within the analytic process. This change is significant when
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compared to the traditional psychoanalytic conceptualization that describes the counselor
as a blank slate who can detach themselves and analyze aspects of the client’s psyche with
neutrality (Bruner & Williams, 2023).
Person-Centered Counseling and Related Experiential Theories
Person-centered counseling and related experiential approaches are a theoretical grouping
that is part of an even larger theoretical camp known as “humanism” or “humanistic therapeutic approaches.” This larger humanistic grouping also includes the existential counseling traditions. The key figures within this theoretical grouping include, but are not limited
to, Otto Rank (1884–1939), Carl Rogers (1902–1987), Abraham Maslow (1908–1970), Leslie
Greenberg, and Susan Johnson. Case conceptualization from this theoretical perspective is
centered on the importance of moment-to-moment personal functioning; the human actualizing tendency; creativity; the relational nature of humans; the importance of understanding diversity, multiculturalism, and intersectionality; and that belief that hurt emotions are
best healed by emotions. Lastly, all person-centered counseling and related experiential
approaches view emotions, behavior, cognition, and mental illness as being deeply influenced by context (Norris et al., 2023).
Existential-Humanistic Theories
Existential and humanistic counseling theories are a long-standing therapeutic tradition.
This theoretical group embraces existential philosophy dating back to Socratic, Renaissance,
Romantic, and Asiatic eras. The key existential counseling leaders include, but are not
limited to, Irvin Yalom, Fritz Perls (1893–1997), Viktor Frankl (1905–1997), and Rollo May
(1909–1994). From a case conceptualization perspective, existential-humanistic counselors
approach client situations with a sense of wonder, genuineness, and curiosity. Within this
conceptualization, they consider the whole client in their entirety (i.e., past, present, conscious, unconscious, environment, culture, etc.). Existential-humanistic counselors journey with clients as they struggle with attempting to create meaning from the realities of
existence. As counselors conceptualize each client’s unique struggle and meaning-making
experience, they consider a variety of factors including freedom, responsibility, reflection,
destiny, death, isolation, meaninglessness, and context (Givens et al., 2023).
Behavioral Theory
Since the late 1800s, behavioral counseling approaches have encompassed a wide array of
theories, leaders, scholars, and techniques. The key behavioral leaders include, but are not
limited to, Ivan Pavlov (1849–1936), John B. Watson (1878–1958), Rosalie Rayner (1898–1935),
Edward Thorndike (1874–1949), Joseph Wolpe (1874–1949), Mary Cover Jones (1897–1987),
and B. F. Skinner (1904–1990). Behavioral counseling is centered on the following concepts:
(a) Client behavior is the focal point of all treatment, (b) all client behavior is learned and can
be unlearned, and (c) healing comes from using empirically based skills and interventions
to modify variables in a client’s environment. Behaviorally oriented case conceptualization
pulls from many theories including classical conditioning, operant conditioning, CBT, reciprocal inhibition, applied behavior analysis, behavior modification, and dialectical behavior therapy (DBT). Conceptually speaking, behaviorists believe maladaptive behaviors can
be changed to become more adaptive. Through focusing on current observable behaviors,
instead of internal processes, personality, or the past, behaviorists are able to determine the
antecedents, behaviors, and consequences that maintain and influence both adaptive and
maladaptive behaviors. Personality is reflected in client behavior, individual learning history, and patterns of reinforcement. Through applying scientific methodology, behaviorists
18 | I INTRODUCTION A ND S OCI A L J US TI C E – O RI E N T E D T H E O RI E S
carefully conceptualize ways to modify the client’s environment to reduce or eliminate maladaptive behaviors (Guillot Miller, 2023).
Cognitive Theory
The cognitive approach to counseling has received considerable attention over the past 50
years. The key leaders/scholars that have contributed to the cognitive school of thought
include, but are not limited to, Albert Ellis (1913–2007), Aaron Beck (1921–2021), Albert
Bandura (1925–2021), Martin Seligman, Donald Meichenbaum, and Steven Hayes. The core
theoretical tenant underlying cognitive theory is the notion that client concerns often result
from a lack of attunement between thoughts, feelings, and behaviors. All cognitive theories aim to replace faulty and/or dysfunctional cognitions with more adaptive ones. Faulty
and/or dysfunctional cognitions are often conceptualized as cognitive distortions and/or
irrational beliefs. The case conceptualization process involves a thorough analysis of the
client’s immediate thoughts that frequently emerge in their mind (i.e., automatic thoughts);
intermediate beliefs that underly the automatic thoughts (i.e., assumptions); and core
beliefs about self, others, and the world (i.e., schemas). Using empirically based interventions, counselors practicing from a cognitive theoretical perspective will work with clients
to create awareness around these cognitions, help clients recognize how the maladaptive
cognitions are impacting their daily functioning, and collaborate on restructuring client cognitions with more adaptive and healthy thoughts (Flynn, 2023; Limberg et al., 2023).
Systemic Theory
Systemic theories reflect a field grounded in psychology, mathematics, anthropology, science, and hypnosis. The key systemic theorists include, but are not limited to, Gregory
Bateson (1904–1980), Murray Bowen (1913–1990), Virginia Satir (1916–1988), John Weakland
(1919–1995), Donald Jackson (1920–1968), Paul Watzlawick (1921–2007), Salvador Minuchin
(1921–2017), Cloe Madanes, and Jay Haley (1923–2007). Systemic counseling represents a
theoretical paradigm shift centered on the notion that structural, system, and rule-based
adjustments create a deeper and more sustainable change when compared with individually oriented interventions and/or theories. The core of systemic theory is centered on
the notion that the issues clients bring into counseling reflect their context and familial/
relational behavior. Counselors cocreate systemic client change through understanding and
influencing the circularity of interactions, subjective nature of experiences, relational nature
of behavior, and client communication patterns. From a case conceptualization perspective,
systemic theory is heavily influenced by cybernetics, social constructivism/constructionism,
attachment, and postmodern theories and therapies. Counselors operating in this framework do not believe clients have a stable collection of intrapersonal/interpersonal traits that
appear fixed across time and location. Instead, clients are viewed as being in relation to their
context, and individual traits are theorized as being fluid, relative, and reflecting circumstance, environment, and situation (Flynn, 2023; Nielson, 2023).
Postmodern Theory
Postmodern counseling theories are influenced by multiple theories including humanism,
systems theory, feminism, constructivism, social constructivism, and social constructionism.
Individuals who have deeply influenced postmodern approaches to counseling include, but
are not limited to, George Kelly (1905–1967), Insoo Kim Berg (1934–2007), Steve de Shazer
(1940–2005), David Epston, and Michael White (1948–2008). The emergence of the postmodern theoretical grouping is ushered in a sense of creativity and humility to the counseling
relationship as clinicians and clients began to freely view issues from multiple perspectives
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and resisted feeling restricted to one or two modern narratives. This also reduced the somewhat hierarchical nature of a counseling relationship. A central tenant of all postmodern
theories is the salience of an individual’s perception of the world. One’s view of reality is
heavily influenced by language, culture, and personhood. In addition, instead of receiving
expert-based recommendations, clients are encouraged to make personal meaning around
their experiences. The core of postmodern case conceptualization is appreciation for viewing multiple possible clinical realities, co-construction of knowledge and reality through
counseling, and participating in the clinical meaning-making process through communication (Hinkle & Perjessy, 2023).
Integrative Theory
Integrative approaches to counseling are centered on synthesizing the theoretical tenants
and clinical skills of multiple theoretical traditions. The key pioneers who have made a
significant contribution to this theoretical grouping include, but are not limited to, Arnold
Lazarus (1932–2013), John C. Norcross, and James Prochaska. Counselors assimilate and
draw from a variety of theoretical models and interventions to effectively serve the diverse
needs of their clients. The consequence of this assimilation is increased clinical effectiveness with a wider range in presenting issues and the ability to provide high-quality service
to diverse client populations. Counselors practicing from an integrative perspective never
rely on one single approach to describe mental illness, wellness, or human development. In
short, humans are unique and complex so there is no one set of skills or theories that objectively and clearly describe client issues and concerns. Lastly, almost any type of empirically
based intervention may be used when considered therapeutically appropriate (McKibben
& Gainer, 2023).
Brief Counseling Theory
Two common ingredients in all brief counseling theories are the ideas that (a) change and/
or healing can occur in the moment and (b) brief counseling is an efficient way to engage in
treatment. Notable leaders of this form of treatment include, but are not limited to, James
Bitter, William Nicoll, Berthold Gersons, Insoo Kim Berg, and Steve de Shazer. The central
feature of brief counseling is for the counselor to provide a planned, time-limited approach
to issues that led the client to enter counseling and efficient services that lead to client healing and goal achievement. In general, the brief counseling format aims to make the most
out of each session and use empirically based methods to bring about fast and predictable change. The common ingredients that cut across all brief counseling modalities are the
importance of the therapeutic alliance, measurable goals and objectives, clear descriptions
of client and counselor roles, strength-based focus, and a focus on the current issues (i.e.,
here and now). These elements are key to brief counseling case conceptualization. Clients
who tend to succeed in this form of counseling believe most change takes place after counseling, have clear treatment goals, desire efficient short-term help, and actively engage in
out-of-session work (Seward & Williams, 2023).
COMMON FACTOR MODELS AND IMPLICATIONS
It is well established that counseling can effectively treat mental health disorders and help
clients overcome barriers to their development (Cristea et al., 2017; Mohr et al., 2014). Most
of the theories presented have been subjected to scientific analysis and verification. It is
important to note that describing the tenants of a theory or the empirical evidence supporting a therapy’s effectiveness in treating a mental health disorder does not demonstrate the
nature of the theory in clinical practice (Kazdin, 2007). A theory, like counseling itself, is
20 | I INTRODUCTION A ND S OCI A L J US TI C E – O RI E N T E D T H E O RI E S
a complex activity. Our experience is that most counseling theory textbooks do not do an
adequate job of demonstrating how theories work. Common questions that go unaddressed
include the following: (a) Which processes within the theory carry the effects? (b) What
combination of mechanisms are necessary, and which can be removed? (c) How effective
are counseling interventions and skills? These are difficult questions to answer. As a result,
little is known about the processes of change among many theories and therapies (Cuijpers
et al., 2019). Despite these difficulties, all counseling theory must be built upon a scientific
foundation, which means counselors need to ensure what they are doing produces positive
therapeutic results.
While the art and science of psychotherapy looks much different today, all present-day
theory has been molded and influenced by leading psychological thinkers and scholars of
their age. In truth, the therapeutic world has a unique and interesting history. From the
ceremonious and dramatic proffering of mesmerism (i.e., internal magnetic forces affecting
mental illness; Franz Anton Mesmer [1734–1815]) and the wholly discredited pseudoscience
of phrenology (i.e., study of bumps, size, and shape of cranium as an indication of mental
functioning; Franz Joseph Gall [1758–1828]) of the 18th and 19th century, to the late 19th
and 20th century, psychological theories proffered by the likes of Josef Breuer (1842–1925),
Sigmund Freud (1856–1939), John B. Watson (1878–1958), and Carl Rogers (1902–1987;
Bankart, 1997‌). Today, our field promotes the comprehension of therapeutic common factors, empirical validation, and research-based exploration of what approach to counseling
works with a particular population and/or mental health issue. As time has progressed, so
has the nature of psychotherapy science and its standards for rigor.
In 1936, Saul Rosenzweig (1907–2004) first commented that all psychotherapies are effective due to common factors (i.e., personal characteristics of the counselor, client resources,
and therapeutic relationship). He used the analogy to the Caucus race in Lewis Caroll’s
Alice’s Adventures in Wonderland. In Caroll’s story, all the animals are soaked by the tears of
giant-sized Alice. To dry off, they all decide to have a race. The dodo bird was left behind
to officiate and decide the winner, ruling “Everybody has won, and all must have prizes”
(Carroll, 2015, p. 34). Therefore, if the effectiveness of all psychotherapies is due to common
factors present, then all have won, and all must have prizes. As such, Rosenzweig’s hypothesis was termed the dodo bird effect. Since Rosenzweig first introduced the idea of general
equivalence across all psychotherapies, the dodo bird effect has been heavily researched and
hotly debated (Budd & Hughes. 2009; Wampold & Imel, 2015).
Common factors have been defined as the “ingredients or elements that exist in all forms
of psychotherapy” (Hubble et al., 2010, p. 28). It is important to clarify that common factor
models are not theoretical models per se; they are more accurately described as a framework for understanding how theories of counseling function. In short, counseling theoretical models serve as frameworks that house common factors. Since Rosenzweig proposed
the effect of therapy was due to common factors, researchers have attempted to identify,
organize, and operationalize all aspects of counseling that were common to all theoretical
models (Castonguay, 1993; Frank & Frank, 1993; Wampold, 2015‌‌‌‌‌‌‌‌‌). In an attempt to clarify
the concepts of common factors, Castonguay (1993) provided three meanings to understand
the nonspecific and common factors of counseling. The first was the factors that are not specific to any theory (e.g., insight, corrective experiences, emotional expression, and increased
sense of mastery). The second was centered on the elements of the therapeutic relationship
(i.e., working alliance). Lastly, the third was based on influenced outcomes but were not
therapeutic activities (i.e., client expectancies and engagement in treatment). These findings provided clarity for theorists and those contributing to the integration movement of
psychotherapy.
Lambert and colleagues (1992) engaged in groundbreaking research into the common
curative factors in counseling. Their findings included (a) extratherapeutic factors (40% of
successful outcome variance); (b) counseling relationship factors (30% of successful outcome
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variance); (c) expectancy, hope, and placebo factors (15% of successful outcome variance);
and (d) model and technique factors (15% of successful outcome variance). According to
Lambert (1992), extratherapeutic factors are the most important to the client and their environment when it comes to fostering change. They affect all counseling theories because
they are salient to whether the client has resources to engage in the recommended process of change. Personal client factors could be the ability to engage in personal introspection, openness to confronting fears, or the ability to differentiate thoughts from behaviors
and feelings. Client environmental factors include the ability to make therapeutic contact
with family members or the openness of a spouse to engaging in treatment. According to
Lambert’s (1992) research, the second most influential component relating to client change is
the therapeutic relationship, which should come as no surprise to any practicing counselor.
The art and science of the therapeutic relationship is at the heart of professional counseling.
There are two key elements to this common curative factor: the client’s experience of the
counselor and the counselor’s experience of the client. If both areas are positive, the therapeutic experience will likely be fruitful. This is because all theory, skills, and interventions
are enacted within the realm of the therapeutic relationship. If one or both areas is negative,
then the impact of any therapeutic intervention will likely be diminished (Duncan et al.,
1997; Lambert, 1992).
Expectancy, hope, and placebo factors account for the third highest level of change
(Lambert, 1992). When clients have expectations or hope that counseling will provide
positive results, it often does. In short, because clients think counseling will help, it often
proves to be at least somewhat beneficial. Counselors can also enhance client positive treatment outcomes and anticipation of change through exuding a sense of confidence in their
approach, having a well-thought-out case conceptualization, and offering acknowledgment
of the struggles the client has endured. In this way, positive therapeutic outcomes certainly
favor the informed mind.
The last common curative factor according to Lambert (1992) is the power of theory-based
techniques, which stems not only from the use of the chosen techniques but also the counselor’s belief in their effectiveness. A counselor’s understanding of a therapeutic model, along
with their comfort and ability in delivering model-based techniques, is proven to impact
client change (Duncan et al., 1997; Lambert, 1992). If we reframe this a bit, it sounds very
akin to the power of suggestion (i.e., guiding the thoughts, feelings, and behaviors of others
through suggestions) and/or the placebo effect (i.e., psychological improvement centered in
believing a treatment will work).
Lambert was not the only scholar who defined common factors in effective counseling.
Frank and Frank (1993) outlined four common factors they found that collectively shape a
theoretical model highlighting mechanisms of change in therapy. Frank and Frank described
these common factors as the functioning relationship between the client and counselor, a
treatment plan rationale, procedures delivered in a structured manner, and the importance
of establishing a healing environment. These factors were organized into a psychotherapy
model known as the contextual model (Wampold, 2015), which outlined three pathways
to produce benefits in therapy: (a) the counselor–client relationship, (b) expectations set
through discussion and treatment between the counselor and client, and (c) the client enacting health-promoting behaviors. Additional information on the common factor models and
their integration into theory will be presented in Chapter 12.
The discussion of common factors and their subsequent models has continued beyond
the high-impact work of Frank and Frank, Wampold, Lambert, and others with new schools
of thought and techniques continuing to develop. For the counselor in training, be mindful
of the risks and rewards of these common factor claims. While evidence strongly suggests
the importance of common factors in counseling, these models ultimately represent an atheoretical collection of commonalities (Wampold, 2015). This is partly why the counseling
profession emphasizes use of self, personhood of the counselor, and verbal and nonverbal
22 | I INTRODUCTION A ND S OCI A L J US TI C E – O RI E N T E D T H E O RI E S
therapeutic behavior. Whatever the model or theory a counselor ascribes to, an equipped
and skillful counselor is at the center of both theory and practice.
UNITARY THEORY, INTEGRATION,
ECLECTICISM, AND PLURALISM
Developing a personal counseling theory is often a lifelong process. It is important for
‌‌‌‌‌‌‌beginning counselors to understand that at its core, counseling is a practice‌‌‌‌‌‌‌; that a counselor’s evolution is constant and lengthy; and that personal growth is also paramount to this
journey. When one is physically and psychologically well and frequently engaging others
around the trials, tribulations, and successes associated with the human condition, growth
is inevitable. Part of this professional and personal growth is the development of a theoretical orientation. The classic model for developing a counseling theoretical orientation is to
invest in a unitary theoretical model (i.e., one counseling theory). There are an enormous
number of potential theories for counselors to choose from; however, as previously stated,
most of the theories can be boiled down to six salient clusters, including (a) psychoanalytic,
(b) behavioral, (c) humanistic, (d) systemic, and (e) constructionist (Neukrug, 2015).
Integration
While a sole theory may be appealing to some, research (Tasca et al., 2015) suggests that very
few contemporary practitioners rely on a unitary theory of practice. When practitioners want
to blend two or more theories together in a manner that incorporates technical, conceptual,
and theoretical domains, they are engaging in integration (Benito, 2018). Integration is centered on synthesizing multiple approaches to develop an optimal theoretical and skill-based
framework for helping clients. To successfully integrate, clinicians may ask themselves the
following questions: “How well do these theories complement each other?” “Is there a sense
of coherence and cohesiveness involved in the integration?” “Are these theories so contradictory that they cannot integrate?” “Are these theories empirically based and validated?”
While successful integration takes careful planning, time, research, and strategy, some of the
most efficacious theories are integrative in practice (e.g., common factors, CBT, DBT, acceptance and commitment therapy [ACT], emotionally focused therapy [EFT]). Integrative theoretical camps include, but are not limited to, theoretical integration (i.e., using tenants from
various theories), common factors (i.e., therapeutic factors that jointly help clients), assimilative integration (i.e., a technique is absorbed into a theoretical orientation), and technical
eclecticism (i.e., methodically incorporating treatment and theory; Benito, 2018).
Eclecticism
Eclecticism can be described as method of technique selection. Specifically, an eclectic clinician attempts to provide the techniques, regardless of where they theoretically originated
from, that they believe best suites the client’s presenting problem
‌‌‌‌‌‌‌. Essentially, an eclectic
clinician attempts to use the most efficacious approach, method, or integration of methods
that they believe can best help their clients. While clinicians can experience a great deal of
personal freedom while using this approach, the interventions and skills used should be
based on empirical evidence (i.e., not based on the clinician’s whim). Furthermore, eclecticism is misunderstood and misused when clinicians base their technique selection on the
personal interest and comfort rather than fully understanding a technique’s procedure, the
theory that supports the technique, the rationale for selecting the technique given the clinical context, the empirical evidence supporting the use of the technique, and the compatibility of the intervention with what the counselor has been using to up to this point (Benito,
2018; Lebow, 1997).
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Pluralism
Pluralism is the most social constructivist form of theoretical integration. From a pluralistic perspective, there is no correct method, theory, or technique to use when conducting
counseling. Furthermore, the pluralistic process is centered on a mutual decision-­making
approach between the counselor and client. Specifically, pluralism encourages conjoint
decision-making regarding technique selection. The rationale for this type of counseling
theory integration is based on the notion that there are many ways to help someone, and
given the level of diversity among clientele, clinicians should be able to choose whatever
they believe fits the client’s culture, style, needs, and preferences (Cooper & McLeod, 2006;
Cooper & Dryden, 2016).
THEORETICAL MULTICULTURALISM,
INTERSECTIONALITY, AND SOCIAL JUSTICE
A main emphasis within this textbook is social justice, context, multiculturalism, and
intersectionality. When the first author envisioned this textbook, he deliberately required
an emphasis on these factors throughout every chapter. As a profession, counseling has
fully embraced this mind-set within our skills, interventions, theories, and standards
(e.g., ethical codes, accreditation standards, research, professional practice). You may be
wondering, “Why it is so important to infuse this information into a theory textbook?”
Great question. To start, according to the American Counseling Association (ACA), when
counselors use a multicultural lens while working with individuals, they gain an understanding of their client’s identity, culture, ethnicity, race, social class, religious affiliation, sexuality, and SES (Garcia & McDowell, 2010). These contextual issues influence
a client’s experience of the world, and understanding this context is central to holistically treating a client. Consequently, a central component of a student’s professional
development should be to infuse an understanding of these factors in every counseling
theory they explore. While there are various definitions, at its heart, multiculturalism
is the respectful coexistence of different cultural groups that have myriad contextual
factors that create different levels of cultural privilege, power, and oppression (Garcia &
McDowell, 2010).
You may be wondering how a counselor can fully comprehend an individual’s cultural
background with so many different and unique contextual factors. Theoretically, there are a
large number of interacting and overlapping variables at play whenever you meet a person.
The blending of these personal experiences creates an intersection of identity (Crenshaw,
1991‌‌‌‌‌‌‌‌‌). A theory-based understanding of these issues gives counselors an idea of what clients
experience within their daily lives, the dynamics involved in various relationships, and an
awareness of the unique tapestry of personal equity, privilege, and equality within a client’s
culture. Counselors adopt an intersectional framework to gain an accurate understanding
of a client’s internal world, to accurately conceptualize a client’s unique needs, and to individually tailor a client’s treatment. While theory, cultural issues, and research may help
counselors glean an understanding of the issues at play in a client’s life, there is no onesize-fits-all when it comes to conceptualizing client multiculturalism and intersectionality.
A major component of understanding an individual’s situation is through developing an
empathic therapeutic alliance where a client feels safe to disclose their own distinct situation
and experiences. Some client experiences may coincide with patterns identified in multicultural and intersectional literature, while other factors will be unique to the individual(s)
engaging in treatment (Flynn, 2023).
While awareness and care for multiculturalism and intersectionality is essential to client care, social justice fuels these levels of awareness with intentional action. According to
ACA’s Counselors for Social Justice Division,
24 | I INTRODUCTION A ND S OCI A L J US TI C E – O RI E N T E D T H E O RI E S
Social justice in counseling represents a multifaceted approach in which counselors
strive to simultaneously promote human development and the common good through
addressing challenges related to both individual and distributive justice. This approach
includes empowerment of individuals and groups as well as active confrontation of
injustice and inequality in society, both as they impact clientele and in their systemic
contexts…. (Counselors for Social Justice, 2009)
Embedded within the social justice theory and literature is an ethic toward cultural participation. It is important to comprehend, challenge, and rebuild social entities and systems
that perpetuate power imbalances, injustice, and inequity. Through meaningful advocacy
and public political participation, counselors create accessible resources for marginalized
communities (Flynn, 2023; Seedall et al., 2013).
THEORY FIT WITH TELEBEHAVIORAL INTERVENTIONS
The 2020 global pandemic (i.e., COVID-19) sparked a need to urgently increase the use of
telebehavioral health in clinical practice. COVID-19 greatly increased the need for therapeutic digital technology; however, prior to the global pandemic, most areas in the United
States had a large list of practitioners offering telebehavioral health services. While there
are many potential negative issues associated with telebehavioral health services (e.g., disruption in service, miscommunication due to visual or auditory glitches, lack of privacy,
disruptive background noise, etc.), there are also many potential benefits that help those in
need. From a positive perspective, telebehavioral health has allowed (a) individuals who
live in remote/underserved areas a chance to engage in treatment, (b) clients to work with
nonlocal clinicians who possess much-needed expertise, (c) clients to engage in treatment
while not spending additional money on traveling expenses (e.g., gas), and (d) clients to
maintain a sense of privacy due to approved providers being located outside of one’s local
community. In addition to the client benefits, counselors who serve clients through telebehavioral health can experience the following: (a) greater flexibility in where they offer
counseling, (b) an enormous reduction in overhead costs, (c) the ability to reach clients who
live at a distance, and (d) the security in not risking their personal health and safety during
counseling (e.g., contracting COVID-19; Hecker & Edward, 2014).
Telebehavioral health can be applied to every counseling modality (e.g., individual,
group, family, couple, network, etc.) and every counseling theory. Due to the gradual
increase in telebehavioral health options, mass convergence during the pandemic, and
popular demand for online therapeutic platforms, there have been a number of Health
Insurance Portability and Accountability Act (HIPAA)-compliant options for counselors to
utilize, including, but not limited to, Doxy.me, Zoom for Healthcare, GoTo Meeting, and
Webex for Healthcare (www.gethealthie.com/blog/the-5-best-hipaa-compliant-telehealthtools). While each online platform provides unique features that attempt to aid counselors
in the practice of telehealth, there are still challenges when serving particular populations
(e.g., children, elderly) or when using different modalities (e.g., couple, family, group counseling) in online sessions. Fortunately, some companies and online platforms seek to assist
counselors with their telehealth sessions. One noteworthy example is the organization
Therapist Aid (www.therapistaid.com), which provides practitioners with a website and
a number of free/inexpensive evidence-based therapeutic tools that can help engage with
children in a telehealth format: Focus Fish helps children manage symptoms of attention
deficit hyperactivity disorder (ADHD; www.therapistaid.com/interactive-­
therapy-tool/
focus-fish), The Little Lion Who Lost Someone is a tool centered on health grieving (www.
therapistaid.com/interactive-therapy-tool/lion-grief), Worry Bugs is an online tool centered
on teaching children about anxiety and worry (www.therapistaid.com/interactive-therapy-tool/worry-bugs), and Angry Monsters provides children with games and activities
1 I NTR ODUCTION TO T H E O RY AN D C ASE C O N C E PT U AL I Z AT I O N
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for understanding and handling anger (www.therapistaid.com/interactive-therapy-tool/
anger-monsters).
While the application of telebehavioral health appears to provide a tremendous amount
of innovation and potential, counseling professionals must understand the ethics, standards, and security matters related to engaging in teletherapy. In addition to understanding
the standards of care within the ACA’s Code of Ethics (see Section H Distance Counseling,
Technology, and Social Media), counselors should understand and frequently review HIPAA
and the Health Information Technology for Economic and Clinical Health Act (HITECH) to
ensure they are engaging in ethical telebehavioral health practice. While reviewing all ethical information related to telebehavioral health is beyond the scope of this chapter, understanding requirements like the use of two-way encryption, state jurisdiction and scope of
practice, and standards of protected healthcare information is key. Table 1.3 reviews the relevant ACA (2014) profession-based ethical standards and professional practice stipulations.
FITTING THE PERSON WITH THE APPROACH
When first entering the counseling profession, emerging counselors are often amazed and
overwhelmed by the wide array of counseling theories at their disposal. Given the number
of theories to choose from, you may be wondering, “What factors influence a counselor’s
choice in theoretical orientation?” or “When inundated with a number of potential theoretical orientations, how does a counselor choose a preferrable theoretical orientation?” As you
can imagine, there are many potential answers to questions like these. Specifically, many
factors could play into their decision-making process including, but not limited to, personal
belief system, religious beliefs, family influence, cognitive style, and life events (Petko et al.,
2016). Furthermore, preferences in counseling theory often evolve over the course of one’s
career (Freeman et al., 2007‌‌‌‌‌‌‌‌‌). When initially learning about the various approaches to counseling, students may find themselves more interested and attracted to a particular theory or
theoretical school of thought. A salient question they may ask themselves is, “What theory
best fits my view of human nature, development, and motivation?” Some approaches may
support one’s thoughts and preferences more than others. Consequently, counselors tend to
gravitate toward their theoretical interest and comfort area, which may land on a particular
unitary theory or morph into an integrated, eclectic, technically eclectic, or pluralistic theoretical approach.
While it is our experience that most counseling trainees gravitate toward theories that
please and interest them, researchers, instructors, and supervisors often encourage counselors to consider what approach best serves the client. For example, if a new clinician develops
a clinical specialization that helps individuals who struggle with traits associated with cluster B personality disorders (e.g., antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder), they will likely
augment their preferrable theory of choice with evidence-based treatments (e.g., DBT, CBT,
trauma-informed counseling) aimed at helping their population of interest. As counseling
students begin to absorb information from various theoretical schools, some may find a
unitary theoretical orientation preferrable, while others may feel that the strict adherence to
one theoretical framework is not sufficient enough or is too limiting. The use and integration
of multiple theoretical orientations reflects many of the common factor approaches (e.g., the
contextual model; Wampold & Imel, 2015), technical eclectic models (e.g., the multimodal
model; Lazarus, 1967), and various theoretical integration approaches (e.g., CBT, DBT).
Developing a theoretical orientation is an important aspect of professional development and identity that takes considerable time, reflection, and introspection (Skovholt
& Rønnestad, 1995). Evidence suggests it is helpful to learn basic counseling skills
prior to choosing a theoretical orientation (Corey, 2013; Young, 2016). Petko et al. (2016)
­discovered that solely reading about a theoretical orientation is not a sufficient method
26 | I INTRODUCTION A ND S OCI A L J US TI C E – O RI E N T E D T H E O RI E S
Table 1.3. Professional Counseling and Telebehavioral Health Ethical Standards
Section Code
Standard
H. Introduction
Counselors actively attempt to understand the evolving nature
of the profession with regard to distance counseling, technology,
and social media and how such resources may be used to better
serve their clients…and make every attempt to protect confidentiality and meet any legal and ethical requirements for the use of
such resources.
H.1.b. Laws and Statutes
Counselors…understand that they may be subject to laws and
regulations of both the counselor’s practicing location and the
client’s place of residence. Counselors ensure that their clients
are aware of pertinent legal rights and limitations governing
the practice of counseling across state lines or international
boundaries.
H.2.a. Informed Consent
and Disclosure
…the following issues, unique to the use of distance counseling,
technology, and/ or social media, are addressed in the informed
consent process:
• distance counseling credentials, physical location of practice,
and contact information
• risks and benefits of engaging in the use of distance counseling, technology, and/or social media
• possibility of technology failure and alternate methods of service delivery
• anticipated response time
• emergency procedures to follow when the counselor is not
available
• time zone differences
• cultural and/or language differences that may affect delivery
of services
H.2.b. Confidentiality
Maintained by the
Counselor
Counselors acknowledge the limitations of maintaining the confidentiality of electronic records and transmissions.
H.2.c. Acknowledgment of
Limitations
Counselors inform clients about the inherent limits of confidentiality when using technology.
H.2.d. Security
Counselors use current encryption standards within their websites and/or technology-based communications that meet
applicable legal requirements. Counselors take reasonable precautions to ensure the confidentiality of information transmitted
through any electronic means.
H.3. Client Verification
Counselors who engage in the use of distance counseling, technology, and/ or social media to interact with clients take steps
to verify the client’s identity at the beginning and throughout the
therapeutic process. Verification can include, but is not limited
to, using code words, numbers, graphics, or other nondescript
identifiers.
H.4.a. Benefits and
Limitations
Counselors inform clients of the benefits and limitations of using
technology applications in the provision of counseling services.
H.4.b. Professional
Boundaries in Distance
Counseling
Counselors discuss and establish professional boundaries with
clients regarding the appropriate use and/or application of technology and the limitations of its use within the counseling relationship (e.g., lack of confidentiality, times when not appropriate
to use).
(continued)
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Table 1.3. Professional Counseling and Telebehavioral Health Ethical Standards
(continued)
Section Code
Standard
H.4.c. Technology-Assisted
Services
When providing technology-assisted services, counselors make
reasonable efforts to determine that clients are intellectually,
emotionally, physically, linguistically, and functionally capable of
using the application and that the application is appropriate for
the needs of the client.
H.4.d. Effectiveness of
Services
When distance counseling services are deemed ineffective by
the counselor or client, counselors consider delivering services
face-to-face. If the counselor is not able to provide face-to-face
services (e.g., lives in another state), the counselor assists the
client in identifying appropriate services.
H.4.e. Access
Counselors provide information to clients regarding reasonable
access to pertinent applications when providing technology-­
assisted services.
H.4.f. Communication
Differences in Electronic
Media
Counselors consider the differences between face-to-face and
electronic communication (nonverbal and verbal cues) and how
these may affect the counseling process. Counselors educate
clients on how to prevent and address potential misunderstandings arising from the lack of visual cues and voice intonations
when communicating electronically.
H.5.a. Records
Counselors maintain electronic records in accordance with
relevant laws and statutes. Counselors inform clients on how
records are maintained electronically.
H.5.b. Client Rights
Counselors who offer distance counseling services and/
or m
­ aintain a professional website provide electronic links
to r­ elevant licensure and professional certification boards
to p
­ rotect consumer and client rights and address ethical
concerns.
H.5.c. Electronic Links
Counselors regularly ensure that electronic links are working and
are professionally appropriate.
H.5.d. Multicultural and
Disability Considerations
Counselors who maintain websites provide accessibility to
­persons with disabilities. They provide translation capabilities
for clients who have a different primary language, when feasible.
Counselors acknowledge the imperfect nature of such translations and accessibilities.
H.6.a. Virtual Professional
Presence
In cases where counselors wish to maintain a professional and
personal presence for social media use, separate ­professional
and personal web pages and profiles are created to clearly
­distinguish between the two kinds of virtual presence.
H.6.b. Social Media as Part
of Informed Consent
Counselors clearly explain to their clients, as part of the
informed consent procedure, the benefits, limitations, and
boundaries of the use of social media.
H.6.c. Client Virtual
Presence
Counselors respect the privacy of their clients’ presence on
social media unless given consent to view such information.
H.6.d. Use of Public Social
Media
Counselors take precautions to avoid disclosing confidential
information through public social media.
Note: All information within the table was taken from American Counseling Association’s Code of Ethics
(2014).
28 | I INTRODUCTION A ND S OCI A L J US TI C E – O RI E N T E D T H E O RI E S
to fully understanding the approach. These authors found that counseling students are more
able to fully comprehend a theoretical orientation if they view theoretical skills in action
(i.e., practice example). The review of practice examples also assists ­counselors-in-training
in understanding how a theory and the associated skills can be woven into the counselor’s
personal style of helping. A graduate counseling theories class is probably the first place a
counselor might experience a discussion of a theory and practice example. During a theories
class, counselors deeply benefit from the instructor scaffolding examples of theory-based
techniques into their discussion and relevant skills presented in a textbook. As you, the
reader, peruse through the various chapters of this textbook, you will notice that each chapter provides a significant number of clinical examples, discussion of theoretically congruent
case conceptualization, and a detailed transcript demonstrating how to use a particular theory’s techniques. This is to help bring the various theories to life and to take the ­macro-based
theoretical information down to the micro-based skill level.
DIALECTIC CENTERED ON COUNSELING
THEORY AND PRACTITIONER HUMILITY
Ambiguity is inherent in the counseling process and within the vast array of theoretical
approaches available to clinicians. Counseling students and practicing counselors alike take
into consideration a wide range of theories and approaches to therapy. The initial exposure
to this multitude of approaches often leaves them confused and overwhelmed (Fowler, 1992;
Hanna et al., 1996). It is important to be mindful about how to think about this multiverse
of theoretical options. Dialectic-centered counseling theory helps counselors see beyond the
labels and language of a theory. Dialectical thinking, as it relates to counseling, is defined
as the ability to conceptualize contradictory client and clinical issues from multiple perspectives with a goal of arriving at a clear and reasonable understanding. Through dialectic
thinking, counselors seek a deeper understanding by acknowledging how opposites interplay (Hanna et al., 1996). We believe that dialectic thinking can greatly enhance one’s use
and understanding of theory by (a) increasing counselor reflectivity, (b) decreasing unhelpful dichotomous cognitive processes, (c) encouraging a sense of acceptance and appreciation for client issues, (d) increasing counselor’s level of self-understanding and acceptance,
(d) increasing levels of genuineness and authenticity within the counseling relationship,
(e) increasing a sense of therapeutic creativity, and (f) helping counselors consider how they
can blend academic theoretical models with their personal way of helping others.
Dialectic thinking transforms clear contradictions by engaging two opposing ends of
a continuum (Todd & Abrams, 2011). Rappaport (1981) describes dialectic thinking as the
tension of needing to pay attention to two opposing views of thought. By holding or struggling with apparent contradictions, the counselor can move along a continuum of thought.
For counselors, this can manifest in many ways. For example, within their investigation
exploring White student dialectics, Todd and Abrams (2011) discovered distinct thought
processes and associated dialectic tension among White participants who reflected on their
race. Specifically, they discovered an association between a belief that one’s race should
not matter and a tendency to minimize racism. In other words, those who minimized the
importance of race also minimized the existence of racism. Todd and Abrams also discovered that participants who endorsed these beliefs and acknowledged some forms of racism
existed would experience tension resulting in anger and frustration. Participants who had
previously engaged in introspection regarding their own race demonstrated a greater sense
of openness and engaged in deeper connections in multiracial relationships. Similarly, Flynn
and Black (2011, 2013) qualitatively researched an important dialectic topic involving the
tension between altruism and self-interest within the counseling profession. Participants
described the destructive nature of this philosophical false dichotomy. Specifically, an
overadherence to altruism (i.e., selflessness) increased counselor burnout and impairment
1 I NTR ODUCTION TO T H E O RY AN D C ASE C O N C E PT U AL I Z AT I O N
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and increased unhelpful counselor thought processes and role selection (e.g., martyr, victim, enabler). They also discovered that an overadherence to self-interest (i.e., selfishness)
increased boundary violations, the use of unethical practice standards, and hurtful behavior
toward colleagues and created unhelpful processes and role selection (e.g., abuser, overly
ambitious, domineering). This dialectic-based scholarly journey concluded with identifying the importance of the interaction and interdependence of altruism and self-interest in
every human interaction. These scholarly works serve as dialectic examples that highlight
the importance of counselors engaging in reflectivity and accepting ambiguity. They also
challenged the counseling profession to develop practitioners who have a solid understanding themselves and their client’s internal/external world (Miller & Rollnick, 2004). Indeed,
building tolerance and acceptance of the tension inherent in the ambiguity of counseling is
essential to a counselor’s personal and professional development.
Counselors who tolerate or embrace ambiguity when faced with different perspectives,
approaches, or interpretations may find the pursuit of counseling theory and practice desirable and stimulating. Being able to self-reflect and think through the challenges that dialectic thoughts inspire ultimately helps counselors develop a more integrated and accurate
view of the self and others. Davis et al.‌‌‌‌‌‌‌ (2016) described the accuracy of a counselor’s view
of self and their ability to be interpersonally other-oriented and humble. Humility is an
important trait to have as a counselor and it is connected to the quality of the therapeutic relationships (Davis et al., 2013‌‌‌‌‌‌‌‌‌; Weatherford & Spokane, 2013). Clients are regularly
assessing the quality of the therapeutic relationship. If a counselor unintentionally behaves
in a way that ruptures the relationship, a lack of humility will likely cause continued deterioration in the working alliance. A counselor who is low in humility would be reluctant
to revisit decisions or introspect, which further entrenches them in their existing beliefs
and choices. This limited sense of humility and introspection has a negative effect on the
therapeutic relationship with clients as well as impedes the counseling learning process.
In short, they are ultimately leading to poorer counseling outcomes. Therefore, dialectic
thinking centered on counseling and humility is a critical concept that is deeply tied to
understanding counseling theory.
THE CASE OF MARK STOCKTON
Throughout this textbook, the case of Mark Stockton will be conceptualized through a variety of theories. Additionally, authors will showcase theory-based skills and techniques in
repeating chapter-based counseling session transcripts. The following is an overview of the
case of Mark Stockton.
Mark Stockton identifies as a 42-year-old, Black, cisgender male who works as a project
manager for a general contracting company. His immediate family consists of two daughters Elle, 12, and Carla, 10; mother, Gloria, 71; father, Dennis, 72; brother Rob, 45; and sister,
Alicia, 36. Approximately 1 year ago, Mark’s spouse, Candace (Hispanic, cisgender woman,
age 40), filed for divorce. Since that time, Candace has been somewhat estranged from the
family. She makes infrequent contact with the two daughters, and Mark reports she has a
new boyfriend who has three children of his own. Mark is seeking counseling for anxiety,
sadness, and anger that occurred following his divorce. In addition, Mark has expressed
feeling lonely and guilty for wanting to start dating again because it “takes me away from
my daughters.”
Mark describes his anxiety as a lifelong struggle that he has handled on his own. He
indicates that he has never sought counseling or taken medications for his anxiety. After
his recent divorce, he decided to engage in counseling, and he is presently reconsidering
his position on pharmacological treatment. Mark’s anxiety manifests in the following ways:
constantly feeling wound-up, difficulty concentrating, irritability, and frequently feeling
worried about a variety of issues. In the past, Mark had used regular exercise to help soothe
30 | I INTRODUCTION A ND S OCI A L J US TI C E – O RI E N T E D T H E O RI E S
his feelings of anxiety. He claims this has helped tremendously. Mark enjoys running, lifting
weights, and frequently uses a rowing machine he keeps in his garage. Mark mentions that
he finds some happiness in his work; however, he states that he feels he has hit a ceiling in
terms of his potential for professional growth in the company.
Mark says that the only meaningful thing in his life are his daughters. Elle is the older sibling and Mark identifies her as a natural-born leader, bright, and a bit of a know-it-all. Mark
describes Carla as his “heart” and describes her as caring, athletic, and very stubborn. Aside
from the occasional argument and taking each other’s clothes without permission, Elle and
Carla appear to get along well. They do not typically discuss the disappearance of their
mom (Candace). Mark states that Candace was very close with both daughters, and he has
assumed that following the divorce they would both be living full time with her. When
Candace calls or visits, they both get very excited. Mark mentions that Candace’s infrequent
visits, communication, and dedication to her new partner’s family causes him a lot of sadness and anger.
When asked about his recent divorce with Candace, Mark states that it was somewhat
surprising and is the most painful experience he has ever had to endure. Mark claims that
he is still in love with Candace and feels confused as to why she suddenly stopped loving
him. When further probed, Mark admits to a few financial mishandlings, an IRS investigation, and states that Candace felt very worried about his ability to handle financial matters.
Mark indicates that within the relationship, he did not include Candace in many of his
decisions. He shares that when his handling of the family finances went poorly, Candace
became very upset.
Gloria, Mark’s mother, frequently comes over the house to help take care of Elle and
Carla and assists Mark with household chores. While Mark states having gratitude for his
mother’s assistance, he feels very guilty about the depth of her involvement with the family. Additionally, Mark frequently witnesses his mother falling asleep on the living room
couch during the daytime hours and feels they are not on the same page when it comes to
child discipline. Specifically, he believes his mom employs an “old-fashioned” parenting
style that involves harsh comments toward the children and the occasional use of corporal punishment. While Gloria’s involvement and influence on the family has been a hard
adjustment for everyone, Mark feels uncomfortable confronting her due to his need for her
assistance and fear that if he confronts her, she will stop helping him.
SUMMARY
In this chapter, you were introduced to the core counseling theoretical groupings; the history of counseling theory and practice; the atheoretical and theoretical models of case conceptualization; the innovations and growing trends in telebehavioral health; the evolving
nature multiculturalism, intersectionality, and social justice; the key components relevant
to contemporary common factor models; the elements necessary for the incorporation of
a unitary, integrative, eclectic, and plural approach to counseling; the process of picking a
theoretical approach; and a dialectic centered on counseling theory and practitioner humility. This chapter serves as a guide for the remainder of the textbook. As you continue your
professional journey into various counseling theoretical groupings, you will notice that relevant topics are scaffolded on this initial chapter of knowledge. Specifically, theory-based
factors and tenants, case conceptualization models, and counselor skill and interventions
are repeatedly introduced and explored throughout this textbook. Additionally, the case of
Mark Stockton was introduced within this chapter. This case will be reviewed throughout
the textbook in the form of chapter-based transcripts that showcase the unique theoretical
conceptualizations and skills pertinent to each chapter. We wish you well in your future
work as professional counselors and we hope you will contribute, in your own way, to the
therapeutic world.
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STUDENT EXERCISES
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Exercise 1: Scaling Beliefs About Counseling
Directions: On a sheet of paper, draw five horizontal lines. Each of the following points provides two beliefs. On each end of your horizontal line, write the two beliefs. Next, mark how
close you are to each belief. Take a moment and reflect on your position and why you placed
yourself where you did on the continuum.
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Counseling is more art or science?
Art ‌‌‌‌‌
Science
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Do people make changes by changing their thoughts or changing their behaviors?
Thoughts Behaviors
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Are people driven by their past or motivated by the prospect of their future?
Past Future
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Is an individual’s distress a result of environmental or internal influences?
Environmental Internal
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Which is more effective, telebehavioral health counseling or in-person counseling?
Telebehavioral In-person
Note: This activity can be performed in class by having the students identify their positions
as a large group. One option is to have students move to different sides of the room indicating which beliefs they hold and then ask students to share why they chose the sides they did.
Exercise 2: Unitary Versus Eclectic Theoretical Orientation
Directions: On a sheet of paper, draw a line down the center. Take a few minutes and provide
evidence on one side of the line that would support a unitary theory of practice. Then on
the other, provide evidence that would support an eclectic theory of practice. Following this
exercise, connect with a peer and process each of your findings.
Exercise 3: Build a Counselor
Directions: Identify the characteristics that you would look for in a counselor. What characteristics would motivate you to achieve your therapeutic goals? What dispositions would
be a red flag for you? Reflect on which characteristics would be the most helpful and which
would be the most harmful. Consider the following points:
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The counseling office/space
Their grooming, demeanor, and how they dress
The physical/psychological health of the counselor
Age
Years in the profession
Type of licensure they possess
The ability to engage in occasional superficial chatty behavior
Exercise 4: Learning Plan
Directions: In groups of two or three, come up with five things you would need to become
comfortable using a theory in counseling, including but not limited to the following
mechanisms:
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Reading professional literature relative to the theory
Reading case studies and written skill demonstrations
32 | I INTRODUCTION A ND S OCI A L J US TI C E – O RI E N T E D T H E O RI E S
■
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Observing videos of counselors practicing from the theoretical orientation
Hiring and working with an experienced supervisor who uses the theory
Attending professional conferences/presentations centered on the use of the theory
After determining your criteria, discuss how you and your peer’s responses are similar and different. Lastly, write a brief action plan to pursue one of the things identified as
needed to become comfortable using a theory in counseling.
Exercise 5: Discussion and Reflection
Directions: Go to your university’s online EBSCO Database and find Academic Search
Premier. Search and find an article focused on a counseling theoretical orientation of interest. Review the article in its entirety and answer the following questions:
■
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■
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How does the article showcase the theoretical orientation?
What aspects of this theoretical orientation do you identify with?
What elements from different theories would you add to your emerging theoretical
orientation?
Reflect and discuss with a peer what theory you chose and the essence of the article.
RESOURCES
Helpful Links
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American Counseling Association: www.counseling.org/
Multicultural Counseling Development: www.multiculturalcounselingdevelopment.org/
International Integrative Psychotherapy Association: www.integrativeassociation.com
Relationship Factors in Counseling and Psychotherapy: https://johnsommersflanagan.
com/category/counseling-and-psychotherapy-theory-and-practice/
Core Counseling Courses: https://counseling.education/
Introduction to Telehealth for Behaviorial Health Care: https://telehealth.hhs.gov/
providers/telehealth-for-behavioral-health/
Telebehavioral Health Information and Counselors in Health Care: www.­counseling.org/
knowledge-center/mental-health-resources/trauma-disaster/telehealth-informationand-counselors-in-health-care
Helpful Books
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Capuzzi, D., & Stauffer, M. D. (2016). Counseling and psychotherapy: Theories and
­interventions. John Wiley & Sons.
Hart, J. (2012). Modern eclectic therapy: A functional orientation to counseling and psychotherapy: Including a twelve-month manual for therapists. Springer Science & Business Media.
Magnavita, J. J., & Anchin, J. C. (2013). Unifying psychotherapy: Principles, methods, and
­evidence from clinical science. Springer Publishing Company.
Myers, J. E., & Sweeney, T. J. (Eds.). (2005). Counseling for wellness: Theory, research, and
practice. American Counseling Association.
Ratts, M. J., & Pedersen, P. B. (2014). Counseling for multiculturalism and social justice:
Integration, theory, and application. John Wiley & Sons.
Robertson, H. C., & CASAC, C. (2020). Telemental health and distance counseling: A counselor’s guide to decisions, resources, and practice. Springer Publishing Company.
Sperry, L., & Sperry, J. (2020). Case conceptualization: Mastering this competency with ease and
confidence. Routledge.
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Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what
makes psychotherapy work. Routledge.
Helpful Videos
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Counseling and Psychotherapy Theories in Context and Practice: www.psychotherapy
.net/video/counseling-psychotherapy-theories
Bruce Wampold on What Actually Makes Us Good Therapists: www.psychotherapy.net/
interview/bruce-wampold-psychotherapy-effectiveness
Integrative Counseling: www.psychotherapy.net/video/jeffrey-kottler-integrativecounseling
Multicultural Competence in Counseling & Psychotherapy: www.psychotherapy.net/
video/multicultural-competence-psychotherapy-sue
The Future of Telebehavioral Health and Digital Mental Health Services: www.youtube
.com/watch?v=edZbQ2vKL4M
A robust set of instructor resources designed to supplement this text is located at
http://connect.springerpub.com/content/book/978-0-8261-8292-0. Qualifying instructors
may request access by emailing textbook@springerpub.com.
KEY REFERENCES
Only key references appear in the print edition. The full reference list appears in the digital product on Springer
Publishing ConnectTM: https://connect.springerpub.com/content/book/978-0-8261-8292-0/section/section01/chapter/
ch01.
Betan, E. J., & Binder, J. L. (2010). Clinical expertise in psychotherapy: How expert therapists use theory
in generating case conceptualizations and interventions. Journal of Contemporary Psychotherapy, 40,
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Bohart, A. C. (2003). Person-centered psychotherapy and related experiential approaches. In A. S. Gurman
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Budd, R., & Hughes, I. (2009). The Dodo Bird verdict—controversial, inevitable and important: A commentary on 30 years of meta‐analyses. Clinical Psychology & Psychotherapy: An International Journal of
Theory & Practice, 16(6), 510–522. https://doi.org/10.1002/cpp.648
Cline, J. L., Sturm, D. C., & Staton, A. R. (2022). Teaching case conceptualization skills to clinical mental health students to enhance clinical competency and cognitive complexity. Journal of Counselor
Preparation and Supervision, 15(3), 1. https://digitalcommons.sacredheart.edu/jcps/vol15/iss3/1
Hecker, L. L., & Edwards, A. B. (2014). The impact of HIPAA and hitech: New standards for confidentiality, security, and documentation for marriage and family therapists. The American Journal of Family
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Neukrug, E. (2015). The world of the counselor: An introduction to the counseling profession. Brooks/Cole.
Osborn, C. J., Dean, E. P., & Petruzzi, M. L. (2004). Use of simulated multidisciplinary treatment teams and
client actors to teach case conceptualization and treatment planning skills. Counselor Education and
Supervision, 44(2), 121–134. https://doi.org/10.1002/j.1556-6978.2004.tb01865.x
Rogers, C. R. (1961). On becoming a person. Houghton Mifflin.‌‌‌‌‌‌‌‌‌
Rogers, C. R. (1980). A way of being. Houghton Mifflin.‌‌‌‌‌‌‌‌‌
Skovholt, T. M., & Rønnestad, M. H. (1995). The evolving professional self: Stages and themes in therapist and
coun­selor development. Wiley.
Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy
work (2nd ed.). Routledge/Taylor & Francis Group.‌‌‌‌‌‌‌‌‌
Young, M. E. (2016). Learning the art of helping: Building blocks and techniques (6th ed.). Merrill.