There are many different types of counseling treatments. Counselors often decide what treatment to use based on the theory they adhere to. A counseling theory is the framework through which counselor’s understand a client’s thoughts, behaviors and feelings. Counselors choose interventions, or treatments, that fit the theory they have chosen.
Some counselors chose one theory, which they use with all their clients. Other counselors have an eclectic approach to counseling. Eclectic counseling is when a counselor uses several different theories and a variety of treatments based on what is the most effective treatment for the client. An eclectic counselor might use a different theory or different treatments based on a client’s disorder or other factors such as the client’s culture, beliefs or age.
My Treatment Theory
I take an eclectic approach to counseling. I will use any theory or treatment that I am trained to use and I believe will help a particular client. While I will use any theory or treatment, the main theory I understand clients through is Cognitive Behavioral Therapy (CBT).
One reason I don’t use CBT for all clients because it does not focus on a client’s past. CBT is a useful theory for most clients. However, some clients have deeply ingrained mental health issues and need to explore their history to gain insight into their thoughts and behaviors.
Another limitation of CBT is that the client has to “buy in” to the theory for it to work. Some clients don’t believe changing their thoughts will have much effect. If a client doesn’t believe the treatment will work, then he or she won’t use it. CBT can only work if the client uses it regularly and consistently.
I also use The Gottman Method, instead of CBT, with couples because it was specifically designed for couples counseling.
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy, or CBT is an evidence based treatment. Evidenced based treatments are treatments that research has shown to be effective. In fact, CBT is one of the most researched counseling theories. CBT is effective with many disorders such as depression, anxiety and addiction.
CBT is a counseling approach which maintains that thoughts, behaviors and feelings interact in a way that they affect each other. For example, you might have a thought that no one likes you. This thought affects how you feel. It makes you feel sad and lonely. It also affects your behavior. You don’t socialize because you think no one likes you.
The example above showed how thoughts can affect feelings and behaviors. In the same way, behaviors can affect thoughts and feelings. An example of this is meditation. Meditation is a behavior that has a positive affect on feelings and thoughts.
Feelings can also affect thoughts and behaviors. Sometimes, people feel anxious without an awareness of any triggering event. When a person feels anxious, they often try to make sense of the anxiety by thinking of things that could be causing the anxiety. An example is a person who has a panic attack and starts to think he is having a heart attack. This could affect his behavior by leading him to go to the ER.
Since we can’t directly change our feelings, CBT focuses on changing thoughts and behaviors. Changes to cognition and behavior improve mood and decrease symptoms of mental health issues.
Cognitive changes involve changing thoughts to be more neutral or positive and less negative. An example is instead of thinking, “I messed up,” a person might change that thought to “I’m human and I made a mistake.”
Changes in behavior might involve using tools like deep breathing, meditation or mindfulness. It can also mean making changes in diet like eliminating caffeine use.
Exposure Response Prevention
Exposure Response Prevention, or ERP is a form of CBT that is used with people who have OCD. OCD is short for Obsessive Compulsive Disorder. OCD is a disorder that often runs in families. The person has intrusive thoughts that often tell them they have to do certain things or something bad will happen. The things they feel they have to do are called compulsions or rituals.
Compulsions can take many forms. Some examples of compulsions are washing their hands repeatedly, checking that the stove is off, checking doors are locked, etc. The compulsions often have some basis in reality, which makes them harder to ignore. In the examples I gave, it is important to wash your hands, turn off the stove and lock the door. However, these tasks only need to be done once. A person with OCD might do them 10, 20 or 100 times a day.
ERP works by teaching the person with OCD to ignore OCD thoughts and stop doing their compulsions. They are taught tools to reduce the anxiety they feel when they ignore their OCD thoughts and stop doing their compulsions.
The Gottman Method
The Gottman Method was created by Drs. John and Julie Gottman. The Gottmans researched thousands of couples to see what people in happy, healthy relationships were doing different. One thing they discovered is that happy couples pay attention to what they call bids for attention from their partner. Happy couples are more likely to give their partner the attention they’re seeking.
The Gottmans also found that unhappy couples were more likely to use what they call the Four Horsemen when arguing. The Four Horsemen are criticism, contempt, defensiveness and stonewalling. Criticism means verbally attacking your partners personality or character. Contempt means attacking your partner’s sense of self with intent to insult or abuse. Defensiveness is victimizing yourself in order to fend off a perceived attack from your partner and deflect the blame back to your partner. Stonewalling is withdrawing to avoid conflict and convey disapproval, distance and separation.
The best part of using The Gottman Method is the assessment. The assessment is called The Gottman Relationship Check-up. It’s a questionnaire that each partner completes online. It takes between 1 to 2 hours to complete but you can save your progress so you don’t have to do it all in one sitting. After both partners complete the assessment, I get a very detailed report of what the couple needs to work on. It’s like a 60 to 80 page report. I’ve seen how much it helps couples. I can’t express how valuable this tool is.