Experience of system integration of basic trends in psychological counselling

We firmly believe that without a common approach to psychological counseling all work in this field will inevitably be fragmented, based on individual counsellor’s vision and employ his personal favourite “tricks”. Today the community of counsellors faces the task of summarizing uncoordinated experience, of working out a shared theoretical and methodological basis, in other words, the task of integrating various approaches and trends in psychological counselling.

We are far from trying to teach our colleagues how to work; we see our main task as sharing experience of training students of our University of practical psychology in psychological counseling. We hope it will excuse those issues in this article which can seem too simple, obvious and well-known. The ABC for a qualified professional may appear quite difficult new information for a beginning counselor.

We’d like to begin with a quotation from the book of collected articles and treatises “Psychotherapy – what is it?”[1]:

‘Let’s imagine John: he feels pain each time he turns his head. Trying to get rid of it, he can turn to a number of specialists. And he is sure to find out that every specialist he is going to consult will have his own opinion and offer his own specific measures which are closely connected with his education and life experience. For instance, John’s family doctor is most likely to diagnose “increased muscle tone” and to prescribe medicine to relax muscle tension. A spiritualist, in his turn, will discover “a breakdown of John’s spiritual harmony” and will offer special prayers and “laying on of hands” treatment. A psychotherapist will wonder who is that person who “sits on John’s neck”, and will advise him to take a training course where he will learn to hold his own and stick up for himself. A chiropractor may diagnose “dislocation of cervical vertebrae” and will start treating John by manipulation of the spine. A naturopath will probably detect “a disbalance of energy” and will recommend acupuncture. And finally, John’s neighbor, who sells furniture for bedrooms, will most probably say that the springs of John’s mattress have worn out, and will advise to buy a new mattress.”

It is pointless to discuss here who of them is right. We believe, it is much more important to agree that all these reasons could cause the problem. At least, it makes sense to consider all the options. Do we always do it in our psychological practice?

The necessity of complex approach.

Schools of psychological counseling in many respects differ from each other in what the given psychologist prefers to work with: with the unconscious in psychoanalysis, with the body in Gestalt therapy, with the behavior in behavioural science, with beliefs in the cognitive approach, or with images (problems presented in images) in the narrative approach. Is it really necessary to limit yourself in such a way? We think, no.

In Oriental countries in the past, when a sultan’s wife fell ill the doctor was allowed to see only the patient’s hand. Indeed, by only feeling the pulse wonder doctors could sometimes help the patient. Do we really need today such art of the doctor if instead we can make an overall medical examination of the patient and provide a comprehensive treatment?

A unified complex approach should take the place of isolated approaches. The counselor should have not one method (or one tool), but a whole set of various tools.

The skill of complex diagnostics.

Possessing a range of different tools, the psychologist should understand what a particular client needs.

To deal with emotions? To offer work with the body? To work with beliefs? Perhaps, dealing with behavior is more productive? What about work with images? Maybe, it is worth looking into the past with its problems? How about life values? Or something else?

The choice of methods used by the counselor is mainly determined by the client’s needs, but not only. First of all, very often there is no exact need as such, the client just names some complaints. Secondly, for example, a girl may not realize the crux of her problem and actually tells the counselor what her mum or friend thinks about it. Having listened to the client’s requirements, the counselor should consider all possible reasons of the problem. Naturally, he needs a list of such reasons.

It is the same as a visit to a doctor: If the patient complains of, say, skin trouble, it is necessary to do a big number of very different tests, well-known to the doctor. The point is that doctors have lists of necessary tests and check-ups. Counsellors must have similar lists.

How to define the real problem.

If a patient consulting a doctor complains of stomach ache, the doctor may have quite a number of assumptions. It could be some unusual food, or appendicitis, or a liver disorder, or even cancer. Maybe the patient just overate, but maybe he is infected with Yersinia or has another very rare disease. So that doctors don’t hurry to cut out the appendix where the patient has ordinary indigestion, they use a set of recommendations how to define the problem.

One should start with looking at something elementary, typical, obvious. Only if this something is not so obvious, if simple assumptions do not work, it is time to look deeper. When this general rule is broken we speak about lack of professionalism and incompetence.

One of our clients complained that when he once consulted a dermatologist, the doctor examined him very superficially and said that his problem was due to nerves, and he should see a psychotherapist. The man, however, turned to another specialist who did the necessary tests and prescribed pills to restore intestinal flora. A week later everything was OK.

Coming back to psychological work, we would like to stress this major principle:

It is not professional to look for deep reasons of any psychological problem until you check more evident assumptions.

Obvious, probable and deep psychological problems.

Psychological problems can be about very different subjects: money, love, “I don’t know what I want”, or “I don’t trust people”. Anyway, they refer to internal problems if the person sees the root of the problem inside himself, but not in somebody or something external.

Dealing with internal problems of clients it is recommended to stick to the following sequence of work.

• Obvious reasons of the problem. These are difficulties and obstacles visible to the naked eye and tackled at the level of common sense. For example, if a girl is single just because she stays at home and never goes out it is natural to advise her to expand her social sphere and try to meet more people.
• Probable reasons of the problem. They are not evident, but have symptoms recognizable to a specialist. The girl can’t get on with people around her as her style of communication is vulgar or she is too quick to take offence.
• Deep reasons of the problem. These are assumptions about what could cause the client’s problem which have no real evidence. It is possible to attribute the girl’s loneliness to psychological traumas dating from her childhood, or her family generic memory, or “celibacy crown”, or perhaps the curse of her neighbor.

If the client states a particular obvious problem, in the beginning it is necessary to work directly with it.

If a young man finds it difficult to get acquainted with girls, the first steps should be elementary – to ask him if he wants to learn it and if so, to advise him how and where to do it. If a person is afraid to fly by plane it would make more sense to work with his fears rather than question him about his difficult childhood. Basic desensitization can remove fears within half an hour.

Obvious reasons of problems can often be solved in obvious ways, for a skilled counselor – at the level of common sense. Only if this is not enough the counselor should proceed to latent reasons starting with the most probable. And only after all opportunities are exhausted he has the right to plunge deep into the problem.

According to the principle of simplicity, it is not a good idea to create extra problems. If something can be solved in a simple way, it should be solved in a simple, quick and more effective way. Besides, what can be settled fast is not fair to drag on for a long time.

If you can explain the client’s problem easily you don’t need to look for complicated explanations.

If you can tackle the client’s problem by behavioural method you shouldn’t turn to profound psychology.

If you can find the answer in the client’s present you shouldn’t rush to work with his past.

If you can find the reason of the problem in the client’s recent past you shouldn’t go deep into his childhood or into generic memory.

It is important to remember that underlying psychological problems is an area of something unprovable where there is ample room both for creativity and for charlatanism and cheating.

A psychologist who offers profound psychological counseling that has no scientific grounds must ask himself: What are the long-term consequences of such treatment? What will be the impact of such kind of psychotherapy? Will it result in believing in evil eye and ill omens? Or the habit to take chances? Or the wish to pass the buck to the unconscious? Or, perhaps, to turn to generic memory instead of thinking for yourself? In our view, a truly professional psychologist must think about such ethical issues.

The approach “All is good that works” can be often shortsighted and thus harmful. If, for instance, the husband is tired after the working day his wife can offer him 200 grams of vodka. We know, it will have effect, it will help. She can do it again the next day. What is the pitfall here? It’s clear that in the long (maybe, not very long) run this man will become an alcoholic.

Something that seems helpful now can turn out a big serious problem later. Fortunetellers and witches often work no less effectively than psychologists, but an extreme interest in mysticism and esoterica, the habit of relying on some supreme power is fraught with decline in general cultural level, with infantilism and irresponsibility.

Classification of probable problems.

In our practice we use a specific list of typical probable psychological problems. Here it’s worth remembering about the complex approach to counseling, about the fact that a human being is not only body but also mind, not only mind but also soul. We’ve already pointed out that a counselor should have not one method but a whole toolkit for productive work. So, what tools should be in this kit to put the complex approach into practice?

We propose the following list of tools for your consideration:

• Problem driving forces

Vindictiveness, struggle for power, desire to always be the centre of attention, fear of failure. It was Rudolf Dreikurs [2] who gave this remarkable tool which it would be strange to reject.

• Problem body

Body tension, clamps, nuisances, general or specific condition when the body is untrained and unfit. Here we use as the basis not only works by A.Lowen [3], but also our own original training aids and methods.

• Problem thinking

Lack of knowledge, lack of positive information, lack of responsibility. Inclination to focus on problems, to primarily see drawbacks, to state problems and worry about them without constructive actions, to start processes which waste your energy (like pity, self-accusation, constant objections, criticism, revenge). Here we actively use the ideas of many authors, to name but a few: Alfred Adler, Fritz S.Perls, Werner Erhard. At the same time it is the basic direction of our own approach.

• Problem beliefs

These are negative or rigidly limiting views, life scenarios full of problems, lack of motivating and stimulating factors. This trend was started by Aaron Beck [4], Albert Ellis [5] and Eric Berne [6] and productively continued by very many authors.

• Problem images

They include problem “I”-image, problem image of the partner, problem image of life strategies, problem life metaphor. All this leads to applying the narrative approach, to working with pictures, visuals and metaphors.

• Problem way of life

It seems to us that this aspect is often underestimated by modern practical psychology. It is all about disorganized and unhealthy lifestyle, when a young man prefers night life, a businessman takes to alcohol, a young girl smokes. It is about life that turns into loneliness or about problem surroundings.

What happens in practice.

If a client comes to see a counselor, the first thing to do, in our opinion, is to listen to his needs, if necessary, to help him formulate his requirements. Whenever possible, we look for opportunities to shift the client from the position of the Victim to the position of the Author. In this case we deal not so much with a passive suffering patient, but can start cooperating with an active, thinking, responsible person. If the client’s needs can be satisfied directly, at the level of an obvious problem – that is fine. If not, then we have a prompt, a list of probable latent problems.

Let’s have a look at some practical cases.

Marital infidelity.

Let’s imagine a woman who is in two minds about what to do in the situation when she learns about her husband’s unfaithfulness. As a result of a simple analysis it turns out that they have been together for 12 years, they have got 2 children, they love each other, and, most importantly, his love affair was actually accidental. After she calms down, the woman understands rationally that it’s not the best idea to get divorced in this situation; it would make more sense to give up resentment, settle the conflict and make good relations again.

But… She is hurt, and she really wants to punish her husband. Here comes the moment to move on to her latent problems.

Perhaps, there are some problem driving forces that rule her decisions? Do we need to work with her problem body? How constructive is her thinking and whether we can reform it and put on a more positive footing? Are there problem beliefs that prevent constructive thinking? What about the woman’s self-rating and whether it is necessary to change her “I”-image? By the way, how many sleepless nights has she had recently – perhaps, she just needs a good sleep?

A stooping person.

A girl constantly stoops though she has no health problems with her spine or back. The obvious reason is that she doesn’t keep fit. A probable explanation is that she is afraid to be bright and outstanding. In reality, the counselor doesn’t consider these reasons, but instead chooses to fish for some improbable deep reasons, like “the point is that you restrain and inhibit your emotions…”

Fear of communication.

If we deal with a sensible person his fear of communication can be removed easily with the help of a number of methods, such as desensibilization, practice of non-standard behavior, training effective communication. But all this requires teaching and learning. If a person is not ready to study, not ready to make an effort, or if no method works, then it is appropriate to consider more underlying problems.

Summary.

As you can see, when we teach psychological counseling to students of our University of Practical Psychology we try to avoid unfounded compilation as well as the unsystematic approach “All is good that works”. The approach proposed here is aimed at complex and systematic use of various tools, at the use of the best practices in psychology. We believe that our ideas and our approach could be useful not only to students, but to our colleagues as well.

Bibliography

1. Psychotherapy – what is it? Modern concepts/Edited by Zeig J.K. and Munion W.M.
2. Dreikurs, R. Psychology in the classroom
3. Lowen, A. Psychology of the body
4. Beck, A., Freeman, A. Cognitive psychotherapy of personality disorders
5. Ellis, A. Humanistic psychotherapy: Rational and emotional approach
6. Berne, E. Games which people play
7. Veselago, E.V. System constellations by Bert Hellinger: history, philosophy, technology