Two replies. 400 words each.
DB #1 – Timothy
Option 1
Compare and contrast Counseling approaches.
Cognitive Behavioral Therapy (CBT)
My first approach when counseling is Cognitive Behavioral Therapy (CBT). Like most effective modalities, it emphasizes an optimistic and collaborative “therapeutic alliance” as an essential component. CBT addresses “thoughts and actions” (Seligman & Reichenberg, 2019, p. 332). Homework is often assigned between sessions to help clients apply what they learned during a session. A primary goal of CBT is to identify faulty thinking which manifests itself in problem behaviors. To modify or improve one’s behavior, faulty thinking must first be addressed, challenged, and then, changed. The Bible teaches in Proverbs 23:7, that a person’s thoughts affect their behavior and the person they become (King James Bible, 1769/2023). It is therefore important to examine and change a person’s cognitions before their behavior can be modified. This would also apply if CBT is utilized in Couple or Marital treatment.
Like an individual, a couple can be looked at as one person. The Bible states in Genesis 2:24 that “they shall be one flesh” (King James Bible, 1769/2023). A couple can entertain faulty thinking and it creates negative interactions between them. This determines the nature of their relationship. Is the relationship peaceful or adversarial? This is often determined by the way the couple thinks. To change negative behavioral interactions between them, it is first important to help them correct their faulty thinking, even as it relates to intimacy.
Reality Therapy (RT)
Reality Therapy is grounded in cognitive and behavioral theory. It aims to help clients focus on the present and take responsibility for their thinking and behavior which sustains the presenting concerns they bring to therapy. This approach encourages clients to “take responsibility for their difficulties and joys. Life rewards action. RT helps clients avoid the victim mindset where they take no responsibility and only blame others or circumstances for their misfortunes. It is the difference between living with an internal or an external locus of control. Even if others or circumstances are a factor, only the client can shoulder the responsibility of doing what must be done to improve their position in life. “Helping people make choices that increase their happiness and meet their needs without harming others is the essence of reality therapy” (Seligman & Reichenberg, 2019, pp. 368-369).
Most of the difficulties experienced by humans are self-inflicted by their failure to act responsibly. RT experienced an 80% success rate once developed and implemented. Further, RT addressed the importance of relationships in addition to responsibility. Relationships are more successful when those involved conduct themselves responsibly (Seligman & Reichenberg, 2019, p. 369).
RT embraces the idea that people share two basic needs; (1) To love and be loved, and, (2) to Respect or to feel worthwhile to oneself and others. When a couple’s behavior reflects responsibility in these areas, the relationship experiences better homeostasis. Further, RT does not allow for excuse-making. Excuses are not acceptable because it is not acting responsibly (Seligman & Reichenberg, 2019, p. 370). Imagine the difference it can make in a relationship when two people act responsibly, and treat one another respectfully while making no excuses.
Motivational Interviewing (MI)
Motivational interviewing helps diminish the ambivalence that prevents a couple from taking the necessary action to reconcile their differences. Iarussi et al (2013), define Motivational Interviewing (MI) as a collaborative, person-centered counseling style that seeks to elicit and explore client motivations to change (p. 162). The counselor, largely through empathy and curiosity evidenced by utilizing open-ended questions, etc., helps the client resolve the ambivalence that interferes with change. There are four phases in MI which are; (1) Engaging, (2) Focusing, (3) Evoking, and, (4) Planning (Iarussi et al, 2013, p. 163).
MI is “goal-directed” as the counselor assists the client in exploring and resolving any ambivalence interfering with change, and enhances the client’s level of motivation to change (Iarussi et al, 2013, p. 163). MI should be included in any counselor’s toolbox.
My Application
Couple, Pre-marital, and Marriage counseling constitute approximately 80% of my private practice. I love working with couples. It is both challenging and rewarding. While I don’t like to think of myself as an eclectic counselor, I would have to admit that I am more eclectic than not eclectic.
My first session with a new client couple, the intake, is a time for collecting information about them, but in the Rogerian spirit, I love to treat it as something like a social meet-and-greet. I am usually very empathic as I ask them to describe the concerns that bring them to therapy. I demonstrate genuineness and unconditional positive regard. CBT is the backbone of my approach to any therapy session because I see this approach as being very biblical. This gives me confidence in it. Too, the human mind and its thoughts have always been the fountainhead of the problems experienced by the human family throughout history, starting with how the serpent influenced Eve’s thinking in Genesis 3 (King James Bible, 1769/2023).
I also like CBT because it embraces the concepts Carl Rogers espoused about the therapeutic alliance (Seligman & Reichenberg, 2019, pp.153-154). I work hard to create a safe feeling with my clients to build rapport with the client(s) and foster a relationship of trust early on. This has never failed to help.
I am a big believer in RT if it becomes clear to me that an absence of responsibility creates or sustains the client’s problem(s). If this is the case, I usually ask, “What are you doing or not doing that might be enabling this problem?’ Here, the client is often able to acknowledge the obvious. Then I use MI to help the client resolve any ambivalence regarding change.
As it relates to marital intimacy, there remains a cognitive-behavioral component in the relationship responsible for creating or sustaining the problem. The core issue may vary. It can be infidelity and trust. It can be an emotionally absent partner. Etc. But at the end of the day, with few exceptions, what is needed is a change in the way one or both partners think which sustains or drives the problematic concerns. Maybe it is the need to forgive. Oftentimes it is how they think about communication. One of the most successful interventions I use in couple’s counseling is what I call the “As if it were our last” hug. I assign the couple the simple task of hugging at least once daily. As they hug, I ask them to pause and think, “What if this were my last opportunity to hug my partner? How would I hug him or her?” They report back to me how it has helped them to stop taking one another for granted. It has drawn them closer. Intimacy becomes easier. Why? It changes the way people think.
References
Iarussi, M., Tyler, J., Littlebear, S., and Hinkle, M. (2013). Integrating motivational interviewing into a basic counseling skills course to enhance counseling self-efficacy. The Professional Counselor, 3(3). 161-174. doi: 10.15241/mhi.3.3.161. http://tpcjournal.nbcc.orgLinks to an external site.
King James Bible. (2023). King James Bible Online. https://www.kingjamesbibleonline.org/Links to an external site. (Original work published 1769)
Seligman, L., & Reichenberg, L. (2019). Theories of counseling and psychotherapy; Systems, strategies, and skills. 4th Ed. Pearson.
DB #2 Mary
Option 3: Countertransference is a significant variable in providing any type of counseling. What are likely or possible countertransference issues that might occur in premarital/remarital counseling?
Countertransference is evidently one of the challenges that therapists encounter in the helping field in which we are called to serve. As much as we are counselors, called to serve others in navigating the storms in their challenging times, we are equally humans who have experienced our own fair share of traumatic experiences, challenges of life, as the layperson we serve. As I always share with my colleagues, what sets us apart is the Grace of God upon us, and the purpose of the Divine Assignment he is called to us into. Many times, these storms of countertransference has become a challenge to most counselors, proving that when we are called into this ministry, we ought to work on ourselves and letting go the former things, is recorded in Isaiah 43:18, that we do not dwell on the past, and Phillipian 3:13-14 also reminds us not to focus on the past, but press on towards the goal to win the prize for which God has called us in Christ Jesus. As I mature in the things and ways of the Lord daily, I have come to realize that no battle is mine to avenge and vengeance truly belongs to God. According to Sigmuid Freud’s article that I reviewed, he suggested that due to the complexity of countertransference reactions, every individual who intends to practice psychoanalysis should undergo psychoanalysis himself and this was to ensure that our own blind spots were made aware to us. This recommendation from Freud was aimed for the therapist to be conscious of his/her own conflicts and also recognize them in working with clients without it having a negative impact with work. Countertransference could be healthy if the therapist has addressed his/her trauma and is using his/her past experience in a positive way to benefit the client and not over sharing. Freud developed this idea of countertransference in the 1900’s.
What are likely or possible countertransference issues that might occur in premarital/remarital counseling?
Countertransference could impact the ability of the therapist to work with the client objectively. Therapists who have worked on addressing their own trauma could identify and work with the countertransference effectively.
Examples issues that could arise:
The therapist could easily over identify with the client and share more than is needed to benefit the client. As a therapist who has had my fair share of marital challenges, I can identify where it could be easy for countertransference to occur. At the prime of my career, I had to identify my struggle with countertransference and its impact on myself and my clients. Taking time to address and process my own trauma was the best decision I ever made.
When countertransference is happening, the therapist turns to become an advisor which we are not, and we lose the skill of active listening, and empathetic responding.
If not cautious, therapists begin to form friendships out of therapy. Countertransference involves distorted expectations of services and outcome
Stereotyping could happen( I always had to maintain and be unbiased, thus focusing on the individual instead of applying a conclusion based on characteristics known to me.
One thing I personally observed in my own practice was pushing boundaries, and wanting patients to make certain decisions when they were not ready to do that personally
Discuss how each possible issue might impact the provision of counseling services to particular clients/couples.
a) Overly identifying with a client could impede a professional relationship, and boundaries could be easily revoked. This could mean worrying about patients after work hours, over extending support and most often therapists end up feeling they have to do everything for their client because they cannot do it themselves. This takes away from the intended purpose of the counseling. An article that I reviewed stated that clinicians’ emotional reaction to patients can affect the outcome of the treatment. This article concluded by stating that the professional developing wellbeing and dealing with unresolved inner conflicts by utilizing tools such as self-guided imagery in meditation can help manage countertransference.
b)Dual relationships could result in the therapist violating the professional code of conduct and getting involved in possible legal consequences and possibly should the outcome of the relationship impact the patient in a negative manner, and losing professional licensure.
c) Stereotyping can prevent the therapist from providing authentic care and forming a therapeutic alliance with the patient. Having a preconceived notion about a person based on information provided, certain identifiable characteristics striking your core and invoking your trauma does not make it right to provide poor services to the client, since you do not know what factors in the person’s life contributed to the challenging behavior you are identifying with. If the therapist was cheated upon by her ex and it resulted in their breakup, it doesn’t mean that every man who fell victim to cheating cannot repent and restore their marriage.
d) Boundary setting and reinforcing could impact the quality of services provided to the couple, when countertransference is not addressed. I noticed that with remarrying couples, it becomes a challenge when their previous failed marriages are explored, and the therapist identifies with any of the challenges and the causes, it becomes easy to sympathize with, rather than empathizing with, and exploring effective solutions for the couple to incorporate and become a successful couple.
Explain what ethical and legal issues might be involved with issues of countertransference.
Every counselor or therapist is bound by a set of ethics we are bound to follow, and not abiding by those standards can lead to breaking professional boundaries, not seeking consent for treatment when necessary, disclosing personal information not benefiting patients’ treatment. These are but just a few of ethical issues that can lead to legal issues. A legal issue could be a client or patient suing the therapist/counselor for a dual relationship gone bad, breaking confidentiality, and even taking sides with couples. A counselor’s license could be revoked due to violation of the code of conduct.
Countertransference could be addressed by seeking supervision and addressing unresolved emotions and distorted thoughts.
References
Aasan, O. J., Brataas, H. V., & Nordtug, B. (2022). Experience of Managing Countertransference Through Self-Guided Imagery in Meditation Among Healthcare Professionals. Frontiers in psychiatry, 13, 793784. https://doi.org/10.3389/fpsyt.2022.793784Links to an external site.
Hinshelwood, R. D. (2019). Countertransference. Key papers on countertransference, 41-79.
King James Bible. (2008). Oxford University Press. (Original work published 1769)
