Psychotherapy and Counseling
Essentials: An Introduction
Chapter One
• This class is about the mysteries of human
distress, human growth, why people change,
and how we can help them.
• We’ll be doing an overview of 9 counseling
and psychotherapy theories and
applications—with a special emphasis on
historical context and practical contemporary
applications.
Background and Overview
• Psychotherapy theories can explain and
predict ways we treat each other, including
how we define mental health and mental
illness, our ideas about helping ,
rehabilitation, and personal responsibility.
Background and Overview
They help us answer the questions like:
 What motivates people to do what they do?
 What disturbs thinking processes, triggers
unmanageable anger, lowers individual
productivity, and destroys relationships?
 What makes or breaks an individual?
 What makes some people resilience after facing
traumatic event, while others are weakened or
deeply damaged?
Background and Overview
• There’s no single answer to these questions.
It’s common for mental health professionals to
strongly disagree with each other on just
about every topic.
Human Suffering and Hope
 Psychotherapy is an imperfect science,
because every human is unique with his/her
idiosyncratic ways of being. There is much we
don’t know about human behavior, the brain,
emotions and interpersonal relationships.
• Determining why people suffer, how they
change, and how to help them live more
satisfying and gratifying lives is a huge and
important task.
Historical Context
• Every human behavior or set of beliefs has its
own particular historical context. This is
related to psychotherapy and its close
relatives: counseling, therapy, mental health
consultation and clinical social work.
Historical Context
• Contemporary psychology originated in
Europe and the United States in the late
1800s. During that time, women and other
minorities were excluded from higher
education. Much of psychotherapy’s history is
written from the perspective of white man
advocating a particular theory.
Historical Context
• Who is the father of psychotherapy?
• Who is the mother of psychotherapy?
• What is meant by the following statement?
“In psychology, even the rats are white and male.”
Who is the father of psychotherapy?
• Sigmund Freud.
• This claim is truth. But it’s impossible to give a
single individual the credit or blame for an
enterprise as huge as psychotherapy.
Alternative Historical-Cultural Realities
Early treatments for human distress and disturbance
consisted of a combination of these four perspectives:
– The biomedical perspective (then: trephining; now:
serotonin hypothesis)
– The religious/spiritual perspective (then: evil spirits;
now: ??)
– The social-psychological-biomedical perspective (then:
??; now: ??)
– Feminist and multicultural perspectives emphasize
relationship and community over individuality. (How do
people with these perspectives define pathology and
approach the counseling process?)
The Biomedical Perspective
Trephining and lobotomies: Early archaeological
findings provide evidence of a treatment
procedure, now called trephining. This hole
opening was a treatment by a shaman or healer
to release and evil spirit from the brain. This is
biomedical perspective. About a half million
years later, a similar physical intervention ,
prefrontal lobotomy emerged as a popular
treatment for mental patients in the USA.
The Religious/Spiritual Perspective
• Human looked for clergy, shamans, mystics,
monks and other religious leaders for advice
and counsel over the ages.
• For many Native American tribes, spiritual
authorities are still important for healing.
Many Asian and African cultures also believe
spiritual practices.
• Modern pyschosocial interventions include
elements of spirituality. Dialectical Behavior
Therapy (DBT) and Acceptance and
Commitment Therapy (ACT) use Buddhist
approaches to facilitate emotional regulation.
• Most clinicians know the emotional healing
potential of spiritual practices and beliefs.
Spiritual leaders have great wisdom and
insight into the human condition.
The social-psychological-biomedical
perspective
During the trephining period, about 500,000
years ago, human have probably understood
that verbal interactions and relationship
alterations can change thinking patterns, mood
and behavior. Wise healers from different
cultures and traditions use psychological and
relational techniques. Siddhartha Gautama
(Buddha) and Epictetus are forebears to modern
cognitive theory and therapy. Avicenna seems
to have been an early strategic or constructive
theorist.
Feminist And Multicultural
Perspectives
Traditional historical voices have generally been
white and male, but mental health professionals
must be aware of minority voices. Feminist mind
set differs from traditional male mind. Last 40
years, feminist approaches have been integrated
into psychotherapy approaches. Cultural
sensitivity is important to positive therapy
outcomes with diverse client populations.
Feminist and multi-cultural perspectives
emphasize relationship and community over
individuality. These are human values. The
mental health professionals are beginning to
recognise these values as different ways of being
and not as pathological.
Definitions of Counseling
and Psychotherapy
Should I get a PhD in psychology, a master’s
degree in counseling or a master’s in social
work? This disscusion leads to the confusing
topic of the differences between counseling and
psychotherapy.
Definitions of Counseling
and Psychotherapy
• What is psychotherapy?
• What is counseling?
• What are the differences between counseling
and psychotherapy?
Counseling versus Psychotherapy I
• The Histories
– Psychotherapy: Freud + Recovery from serious
personal problems
– Counseling: Out of guidance movement, which
was/is about helping people with choosing or
decision making
What Is Psychotherapy?
Anna O., Breuer’s patient, called to the
treatment she received as the ‘’talking cure’’.
Talking, expressing, verbalizing or sharing one’s
pain is potentially healing.
How should psychotherapy be practiced? This
question is relevent to how psychotherapy is
defined.
1. ‘’A conversation with a therapeutic purpose’’
(Korchin, 1976)
2. ‘’The purchase of friendship’’ (Schofield,
1964)
3. ‘’When one person with an emotional
disorder gets help from another person who
has a little less of an emotional disorder’’
(J.Watkins, personal communication, October
13, 1983)
What Is Counseling?
Adler might claim that counseling has an
inferiority complex with respect to its older
sibling, psychotherapy. Or psychotherapy has a
superiority complex with respect to its younger
rival, counseling.
‘’Counseling is the artful application of
scientifically derived psychological knowledge
and techniques for the purpose of changing
human behavior. (Burke, 1989)
What are the differences between
counseling and psychotherapy?
Patterson (1973): ‘’There are no essential
differences between counseling and
psychotherapy’’
“Counseling and psychotherapy are the same
qualitatively; they differ only quantitatively;
there is nothing that a psychotherapist does that
a counselor does not do (Corsini & Wedding,
2000, p. 2).”
• For Corsini and Wedding’s definiton, both of
them engage in the same behaviors but may
differ.
Counseling versus Psychotherapy III
What are the differences between psychotherapy
and counseling?
– Goals?
– Shorter versus longer?
– Problem versus person?
– Guidance versus advice?
– A little more on the surface versus a little deeper?
– Cheaper versus more expensive?
• Psychotherapist: Less directive, go a little
deeper, work a little longer, charge a higher
fee.
• Counselor: Slightly more directive, work more
on developmentally normal issues, work more
briefly, charge a bit less fee.
The Goals of Counseling
and Psychotherapy
People come to therapy to alleviate their painful
symptoms (e.g., anxiety, depression, guilt) and
undesirable behaviors (e.g., compulsions,
impulsivity, etc.).
People come for assistance in decision making.
People also come to therapy to grow or improve
themselves.
Counseling
and Psychotherapy Defined
•
•
•
•
•
A process that involves
a trained professional who abides by
accepted ethical guidelines and has
skills and competencies for working with
diverse individuals who are in distress or have
life problems that have led them to
• seek help (possibly at the insistence of others)
or the individuals may be
C&P–Defined II
• choosing to seek personal growth, but either
way, these parties
• establish an explicit agreement (informed
consent) to
• work together (more or less collaboratively)
toward
• mutually agreed upon or acceptable goals
C&P–Defined III
• using theoretically based or evidence-based
procedures that, in the broadest sense, have
been shown to
• facilitate human learning or human
development or effectively reduce disturbing
symptoms.
What Is a Theory?
“A coherent group of general propositions used
as principles of explanation for a class of
phenomena” (Random House Dictionary, 1993,
p. 1967).
In psychology, theories are used to generate
hypotheses about human thinking, emotion and
behavior.
For counseling and psychotherapy, a theory
needs to accurately describe, explain, and
predict a wide range of therapist and client
behaviors.
What is a Theory? II
“A theory is not built on observation. In fact, the
opposite is true. What we observe follows from our
theory.”
“Without a guiding theory . . . , clinicians would be
vulnerable, directionless creatures.” (Prochaska,
2003)
But with a guiding theory, what sorts of things are
likely to happen?
The Scientific Context of
Counseling and Psychotherapy
• Major Historical Developments: Eysenck’s (1952)
Findings (24 studies)
– Analytic—44%
– Eclectic (Mishmash, hugger-mugger) —64%
– Custodial—72%
The Scientific Context of
Counseling and Psychotherapy II
A Psychotherapy Research Boom
Smith and Glass developed method of metaanalysis. Effect size is a statistic used to estimate
how much change is produced by a particular
intervention. Effect size represents the
difference in efficacy between interventions and
no treatment control groups.
Smith, Glass&Miller, 1977 : Average person who
gets counseling is better off than 75% of those
untreated.
What is the dodo bird effect?
The Scientific Context of
Counseling and Psychotherapy III
The Great Psychotherapy Debate
Point: Research has demonstrated the
superiority of a few select psychotherapy
techniques over other specific techniques.
Counterpoint: Research doesn’t show that some
specific techniques are better than others;
instead, research shows there are common
therapeutic factors operating across different
therapy techniques.
Weinberger’s common therapeutic factors ???
The Scientific Context of
Counseling and Psychotherapy IV
Common Therapeutic Factors—Lambert (1992)
• Extratherapeutic change (40%) : Client Factors
(motivation, severity of disturbance, ego
strengths, psychological mindedness.)
• Therapeutic relationship (30%): (Rogers:
unconditional positive regard, empathy and
congruence) (Freud: therapeutic alliances)
• Expectancy (15%) : (hope)
• Techniques (15%)
• Salvador Minuchin: «Don’t be too sure»
• No theory holds the key to all problems. No
theory entirely explains what it means to be
human.
• When we get too sure about a theory, we
close ourselves off to different perspectives.
The Zeitgeist, the Ortgeist, and the
Poltergeist
• Zeitgeist: The spirit of the time
• Ortgeist: The spirit of the place
• Poltergeist: A mischievous spirit or ghost—a
mystery
Poltergeist
As a therapist, we should be ready for surprises.
Sometimes your clients will say and do shocking
things. Or we’ll suddenly feel the urge to say or
do something inappropriate. In the therapy
room, sitting cheek by jowl with another person
for long time can make unusual experiences.
Five-Minute Discussion
• Groups of three or four.
• Up to now, according to your knowledge as a
major, come up with three or four reasons
why therapy can sometimes be harmful.
Concluding Comments and Review
• Homework: Start dating Freud this week.