Running head: PERSONAL COUNSELLING FRAMEWORK

A Personal Counselling Framework Rhonda D. Williams University of Calgary

Personal Counselling Framework

A Personal Counselling Framework As an emerging school psychologist, it is important that I develop a strong understanding of my own ideas and beliefs around a cohesive personal theory about counselling. Having a clear conceptual approach to describe the human condition and the process of change provides a solid foundation for a robust counselling framework. My personal counselling framework is largely based on the concepts and interventions identified within integrative psychology. I have also incorporated neuropsychology, cognitive therapy, mindfulness-based cognitive therapy, and client-centered therapy to support the descriptive theoretical aspects of my theory. This paper will describe my personal counselling theory regarding philosophical

assumptions, description of the counselling experience, and personal reflections. Within the philosophical assumptions section, the nature of humans, healthy and unhealthy functioning, and the nature of the change process will be discussed. Next, in the description of the counselling experience portion of the paper, I will articulate a definition of counselling, counselling process beliefs, the counsellor-client therapeutic relationship, roles for both the therapist and client, counselling session qualities, and my emphasis on the past, present, and future. In addition, the counselling experience section also discusses my emphasis on beliefs, emotions, and behaviours, the change process and therapeutic resistance, interventions, success, and contextual factors of counselling. Finally, in the reflection section of the paper, I will discuss the weaknesses of my personal theory and why I am drawn to my theory of counselling. Philosophical Assumptions In general, a good theoretical approach has the ability to generate hypotheses or predictions regarding psychopathology and client functioning. Currently there is no best theory that fits all circumstances of the human experience. A good theory must be able to operationalize constructs to help clients change. There should also be a level of

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generalizability that can be applied to a variety of individuals, contextual settings, and

during various times (Nature of Theory, n.d.). Within the integrative approach, because it does not adhere to any one specific school of psychology, therapists are able to select specific techniques that have been proven to work within particular contexts with individuals presenting with similar concerns. In addition to being drawn to the integrative approach to psychotherapy, I have also incorporated concepts from cognitive therapy, mindfulness-based cognitive therapy, neurodevelopmental psychology, and clientcentered therapy. Throughout this paper I have integrated concepts from each of these therapeutic approaches to best reflect my emerging personal theory of counselling. This section of the paper will further explore what I believe about the nature of humans, healthy functioning, major causes of problems, and the nature of change. Nature of Humans The view of human nature held by a therapist has a significant influence over how they explain human behaviour and the types of interventions they employ to support clients in making positive changes (Nature of Theory, n.d.). In forming my own perspective on the nature of humans, I have incorporated concepts from neurodevelopmental psychology, cognitive and client-centered approaches, and the integrative approach. I belief that core nature of humans are good when they are born and there is a balance between the influence of both biological and environmental factors that help determine aspects of an individuals innate disposition (Beck & Weishaar, 2011; Hope, Burns, Hayes, Herbert, & Warner, 2010). The human brain is continually sensing, processing, storing and responding to information from both internal and external environments. I also believe that the majority of brain organization takes place in the first five years of life. Because of this, the brain makes the majority of its primary associations from early experiences and an individuals personality begins developing in infancy (Beck & Weishaar, 2011; Perry & Hambrick, 2008; Raskin, Rogers,

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& Witty, 2011). As an infant interacts with the world around them, I think that early childhood emotional states that are consistently stimulated gradually become traits that are hard-wired neurologically. Neural pathways develop in a use-dependent manner, therefore experiences, emotions, and thoughts that are repeatedly experienced are reinforced and become stronger (Perry, 2009; Perry & Hambrick, 2008). The brain also

organizes from the bottom to the top with the lower parts of the brain developing earliest, while the cortical regions continue developing in adolescents and early adulthood. (Perry, 2009; Perry & Hambrick, 2008). Although I believe that brain plasticity plays a part in neurodevelopment throughout a lifetime, life experiences within early childhood shape many of the ways a person will interact with their environment and in relationships. I am also drawn to the integrative approach because although the approach to personality is broad and inclusive, there is a gravitation to the life-span approaches of developmental psychology. Humans are the products of a complex interplay of our genetic endowment, learning history, sociocultural context, and physical environment regardless of the clients functional or dysfunctional nature (p. 511; Norcross & Beutler, 2011). While I tend to be very developmental in my beliefs around human nature, I also believe in the growth-orientated views of the client-centered approach and the innate drive towards self-actualization (Raskin et al., 2011). Nature of Healthy Individuals Understanding the nature of healthy individuals provides guidance for therapists during the therapeutic process of change. I believe that a healthy fully functioning individual is able to interact with their environment, in relationships, and in specific situations in adaptive ways. Healthy individuals are also able to learn from previous experiences and integrate this information into future interactions. I agree with the clientcentered approach that well-functioning individuals have positive self-concepts and are able to respond to environmental experiences congruently and efficiently (Raskin et al.,

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2011). I also support the notion that healthy individuals are able to integrate cognitive, affective, motivational and behavioural systems to act together as a mode (network for various schemas) to interpret experiences in a healthy manner (Beck, 2005; Beck &

Weishaar, 2011). Because of my strong foundations in neurodevelopmental psychology, I believe that positive childhood experiences have a huge impact on healthy developmental patterns. Children exposed to consistent, predictable, nurturing, and enriching experiences develop neurobiological capabilities that increase their chance for healthy, creative, productive lives (Perry, 2009; Perry & Hambrick, 2008). Nature of Unhealthy Individuals As therapists, are first exposure to individuals in a therapeutic setting is often because they are experiencing problems and difficulties they are not able to resolve on their own. Many times an individual has been functioning in an unhealthy manner for an extended period of time or their psychological distress has become more acute, impacting their daily lives. I believe that unhealthy functioning can be impacted by multiple factors such as biological, developmental, and environmental interactions. I agree with cognitive theory in that although people may have biochemical predispositions to illness, they respond to specific stressors because of their learning history (p. 284; Beck & Weishaar, 2011). People may have a genetic predisposition for some forms of psychopathology, but it is also the individuals life experiences and interactions with their environment that can sometimes activate specific genetic factors (Perry, 2009). I also believe that if a child is exposed to abuse, chaos, and neglect during their formative years, they will have an increased risk of significant problems in all domains of functioning because healthy developmental milestones will be interrupted and distorted (Perry, 2009; Perry & Hambrick, 2008). When individuals function is a state of psychological distress for an extended period of time, I believe the way they function can become compromised. The individual

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may become more rigid, reflexive, and egocentric, further impairing the ability to engage in normal cognitive function. Reasoning, concentration and memory recall can also be impacted when in this more primal state, further impairing corrective functions such as reality testing and global conceptualization (Beck, 2005; Beck & Weishaar, 2011). Cognitive theorists also have identified that an individual may create cognitive distortions during times of psychological distress by having a biased view of themself, solutions to problems, and resources that prevent them from responding to thoughts and situations in productive and adaptive ways. These systematic errors include arbitrary inference, selective abstraction, overgeneralization, magnification and minimization, personalization, and dichotomous thinking (Beck, 2005; Beck & Weishaar, 2011; Hope et al., 2010). Nature of Change The process of change occurs in the present but also focuses on future client goals (Theory of Change, n.d.). It is important for therapists to have a clear understanding of the nature of change so they can best support therapeutic progress for their clients. I believe that the more an individual understands the change process, the more willing they will be to endure and be more resilient through more challenging times. The change process is difficult and often things tend to get worse before they feel better. It is difficult work for an individual to attain a level of healthy functioning after a period of dysfunction in life. I also think that the intensity and severity of unhealthy functioning has a large impact on the level of change that needs to take place in order to experience or return to a healthy level of functioning. When learning about the integrative psychotherapy approach, I connected with its focus on change. I was drawn to the fact that the integrative approach emphasizes multiple pathways for change. The approach focuses on the process of how clients change rather than placing emphasis on what clients need to change. As a result, the integrative approach focuses on the selection of

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therapeutic interventions and relationships that will bring about change rather than theoretical constructs of personality and psychopathology (Norcross & Beutler, 2011; Petrocelli, 2002). In addition to the importance of understanding the nature of change, I also am a strong believer in using a strength-based approach. It is important for clients to build on previous successes and feel that they are making some progress towards healthy functioning in order to stay motivated towards change. For this reason, I am drawn to aspects of the client-centered approach. As an individual begins to increase their sense of self-regard, this also strengthens the individuals self-concept, fostering greater autonomy, relatedness, and competence. As a positive self-concept continues to

develop, the client begins to move along a locus of evaluation continuum. This facilitates a shifting of his or her standards and values based on their own thoughts rather than the external opinions of others. In turn, this tends to foster more positive perspectives towards themselves and others. In the final concept, experiencing, the client shifts awareness to a more open and flexible way of experiencing self (Raskin et al., 2011). I try to facilitate change by being positive and solution-focused when counselling students at my school. I attempt to foster therapeutic growth and change in a nonjudgmental way through the use of positive regard and congruence. I also really try to understand where they are coming from and listen to what they have to say without jumping into giving advice. The Counselling Experience Definition of Counselling I view the concept of counselling as a process that could be implemented in both a proactive and reactive way. Personally, I think that attending counselling as a proactive and preventative measure is a great way to support individuals before dysfunctional and unhealthy psychopathology occurs. Preventative counselling could also support

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individuals in learning new, more adaptive coping strategies to navigate through life events or situations that could be perceived as difficult or novel. However, most counselling tends to be more of a reactive tool after the person has experienced

unhealthy functioning for a period of time where they are not able to resolve the problem on their own. Conceptually, the therapeutic relationship, process, and techniques used in counselling are designed to support the client and move them closer to an ideal standard or norm of overall psychological functioning (Petrocelli, 2002). Again, I view counselling as a way to capitalize on an individuals strengths and utilize their available resources to support positive change and growth. Counselling should also enhance the clients ability to adapt to existing realities, facilitating the development of greater competencies and satisfaction within his or her environment (Petrocelli, 2002). As growth occurs, clients should ultimately move towards and experience an increase in self-esteem, competence, logical and accurate thinking abilities, positive coping strategies and positive relationships with others. Counselling Process Beliefs My beliefs around the counselling process have evolved since the beginning of this course. Initially, I would have said that I identified strongly with cognitive-behavioural therapy with a focus on cognition. However, after exposure to several different types of counselling approaches, I feel I identify most with integrative psychotherapy while still leaning towards cognitive therapy and a client-centered approach. What all of these approaches have in common is the concept of promoting positive client change by examining and learning about the inner thoughts of the client and making changes to ways of thinking and being (Beck & Weishaar, 2011; Raskin et al, 2011). I gravitate to the process of counselling promoted by the client-centered approach in which the therapist communicates empathy and unconditional positive regard through a genuine

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relationship with the client helping to facilitate positive change (Josefowitz & Myran, 2005; Osatuke et al., 2005; Kensit, 2000). In addition to various counselling processes, one concept I am always conscious of is the developmental level of the client and their ability to access higher order thinking skills. As I have learned more about the

neurosequential model of therapeutics, I am conscious about working with students who have experienced complex trauma and their ability to engage in higher functioning cortical tasks before lower level brain functions are functionally organized and developed (Perry & Hambrick, 2008). Decreasing overall arousal levels and teaching self-regulation skills become the focus until the child is able to engage in more cognitive forms of therapy such as dyadic talk therapy. I am also drawn to that the fact that instead of adhering to a specific theoretical perspective, integrative psychotherapy places great emphasis on clinical assessment to guide effective treatment. I feel the integrative approach is advantageous because it is based on empirical evidence, it is flexible and tailored to the client rather than a one size fits all approach, and is focused on the mechanisms of change rather than descriptions of psychopathology and theories of personality (Norcross & Beutler, 2011). The assessment process is completed throughout therapy on a continuous basis and completed in collaboration with the client. The emphasis on the assessment process is very important to me given my Masters program is focused on assessment. I have found that people love to learn about themselves and gain insight about their strengths and areas for growth. Sometimes when information is collected in a standardized way, an individual is apt to take it more seriously. I am not saying that assessments are infallible, but they do provide insight and a baseline for the current levels of functioning in many areas for a client. The integrative approach emphasizes that the information gathered from various types of assessment is invaluable to the therapist and allows for more

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effective interventions and therapeutic relationship styles to be adopted to best meet the clients individual strengths and needs (Norcross & Beutler, 2011). The idea taken from the integrative approach that the counselling process is characterized by the desire to increase therapeutic effectiveness and applicability within treatment plans for clients is something I strongly believe in (Norcross & Beutler, 2011). I also agree that the integrative counselling process requires both technical eclecticism and theoretical integration in order to create an effective treatment plan. Technical eclecticism within the integrative approach focuses on selecting the best techniques and procedures to effectively meet the needs of the clients identified goals of change. This is guided by research on specific methods from various theoretical perspectives that have proven efficacy for individuals with similar problems. However, theoretical integration must also be considered as each intervention is based on some theoretical assumptions. By being able to integrate constructs from a variety of theoretical backgrounds, this allows the therapist to synthesize the best elements of each practice to best address the individual needs of each client (Norcross & Beutler, 2011). Counsellor Client Therapeutic Relationship The therapeutic relationship established between the therapist and the client is very important to the process of making positive changes. For me, aspects of the therapeutic relationship emphasized in the client-centered approach are the gold standard within the counselling process. The client-centered therapist expresses attitudes of unconditional positive regard, congruence, and empathy within an authentic relationship with the client. Foundationally, the therapeutic relationship is based on the belief that each person has the inner resources to identify and pursue their own goals and growth regardless of any personal or environmental limitations or barriers (Kensit, 2000; Raskin et al., 2011). However, there are times within the therapeutic relationship when a client may require a more coaching or consultative approach from the therapist

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to help guide the change process (Josefowitz & Myran, 2005). Because of the unique nature of each client, I believe that a therapist must be able to adapt the type of

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therapeutic relationship style to meet the needs. The integrative approach supports my beliefs by stressing therapists need to be able to individualize relational approaches according to each client. Qualities such as empathy, unconditional positive regard, goal consensus, collaboration, collecting feedback from clients, moderate self-disclosure, and management of countertransference have all been found to contribute to a positive working alliance with clients (Norcross & Beutler, 2011). The integrative approach incorporates aspects I value within the client-centered and cognitive approaches, making it the approach that again fits closest to my beliefs about the therapeutic relationship. Aspects that I would add to the list of qualities for therapists to exhibit within the therapeutic relationship would include being attentive, attuned, present, and responsive during the session. A great example of these qualities exists within the practice of mindfulness-based cognitive therapy (MBCT). The therapist enhances a sense of mutuality and connectedness with clients by simultaneously participating and guiding each mindfulness practice, further maximizing the effectiveness of the therapeutic relationship (Felder, Dimidjian, & Segal, 2012; Semple, Lee, Rosa, & Miller, 2010; Sipe & Eisendrath, 2012). Roles of the Clients and Counsellors Within the process of therapy, both the client and the therapist are responsible for various roles and responsibilities to foster positive client change. I believe that collaboration is essential and that the expertise of both the client and the therapist must be recognized and respected. The client is the expert regarding their own lived experiences and their role is to be open, honest, and forthcoming with their thoughts and emotions. The role of the therapist is to create an environment in which the client feels comfortable and safe to share details about their life in order to bring about positive

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growth and solve identified problems. The role of the counsellor is also to collaborate with the client to define techniques and tasks required to achieve desired therapeutic goals. The therapist also attempts to shape the clients approach in dealing with the identified problem to promote movement towards the next stage of change through a successive process, resulting in a new set of presenting challenges (Petrocelli, 2002). Ultimately, as identified within the integrative approach, I believe that it is the therapists role to gather information from the client and identify relational approaches that will be the most supportive and effective in reaching treatment goals. What I really like about the integrative approach is that it acknowledges that varying relational

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approaches may need to be employed due to the reactance level of the client (Norcross & Beutler, 2011). I love having the flexibility of meeting clients where they are currently functioning and utilize the best approach rather than trying to fit the client within a theoretical perspective. Until I was exposed to the integrative approach, adhering to one school of psychology often left me with more questions than answers. I like that the integrative approach allows me, as a therapist, to utilize strategies from different theoretical backgrounds to best meet the needs of my clients. For example, a cognitive psychotherapy approach could be used for clients who require a more directive approach, while a client-centered therapeutic approach could be used to support more resistant clients who require a non-directive approach. In cognitive psychotherapy, the counsellor takes on the directive role of the expert by specifying and clarifying problems and teaching cognitive and behavioural techniques to clients that foster changes in cognition and skill development (Beck, 2005; Beck & Weishaar, 2011; Josefowitz & Myran, 2005). The cognitive therapist also guides the client in their understanding of how beliefs and attitudes interact with emotions and behaviour and collaboratively uses hypothesis testing to determine if current beliefs are maladaptive. In this relationship, the client is involved in setting the agenda for the sessions and is

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responsible for the completion of homework and new skill practicing between sessions (Beck, 2005; Beck & Weishaar, 2011). In contrast, therapists could utilize a more nondirective approach with resistant or oppositional clients. The client takes a more active

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role as the architect of the therapy. Because the client is the architect of the therapy, the therapist listens to what the client wishes to share in a nondirective and nonjudgmental manner. This differs from many approaches in that the client has the right to selfdetermination of the therapeutic content and process (Raskin et al., 2011). Counselling Session Qualities length, duration and frequency I believe that there are various types of therapeutic approaches that can be used depending on the needs and severity of difficulties the client is experiencing. As a result, there can be a wide range of session qualities depending on the type of relationship and interventions selected. I would have a tendency to keep counselling sessions to approximately one hour, once a week for as long as the client required to ensure the client has developed new skills and resolved identified problems while engaging in the change process. However, in the case of MBCT, sessions for adults can last for a longer period of time because of the integration of meditation practices in addition to cognitive and behavioural tasks. I think integrative approaches such as MBCT would be something I am interested in incorporating into my practice because I like the specific teaching aspect within the session and that the treatment plan is an overall short intervention. MBCT generally consists of 8 consecutive weekly sessions, approximately 2 hours in length (Sipe & Eisendrath, 2012). In addition to individual MBCT, group-based treatment intervention programs can also be utilized to promote mindfulness practices and engage in inquiry in a supportive, nonjudgmental environment (Felder et al., 2012). It has also been used with parents and has been effective in the mitigation of stress, the cultivation of empathy, objectivity, presence, cognitive flexibility and enhancement of parent-child relationships (Davis, 2012). Likewise, mindfulness-based approaches have

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been effective in the collaboration process between school psychologists and teachers by further developing integrative decision-making skills, cognitive flexibility and metacognition (Davis, 2012). Integrative therapy embraces both short and long term treatment plans and takes into account the setting, format and intensity when creating a unique treatment plan for each client. The treatment can take place in a variety of settings depending on the need for restricting and supporting the client (e.g. therapists office, residential treatment, outpatient clinic, etc.). In addition, the format of the therapy can be varied to include individual, group, couples, or families depending on the identified treatment goals. Depending on the complexity and severity of the presenting issues and client resources, the length, frequency, and duration of the therapeutic treatment plan will vary (Norcross & Beutler, 2011). Emphasis on the Past, Present, and Future Within my own life, I tend to be more present and future orientated. I have found that a solution-focused orientation within our therapeutic school setting allows me to work with students in the moment and not ruminate in past events. This creates opportunities for students to move forward and make adjustments to their behaviour, affect, and thoughts without feeling like they need to continue to talk about things that are very upsetting and may not be within their ability to change (e.g. dysfunctional home situation). I am also drawn to the present-oriented approach of MBCT because it fosters a sense of being rather than doing. It allows individuals to recognize and accept negative emotions rather than focusing on avoiding and analysing. This in itself is anxietyreducing and stress-reducing even without the employment of meditative practices (Sipe & Eisendrath, 2012). That being said, I also believe that it is important to gain an understanding of relevant information about a clients developmental history to get an idea of potential influences

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on coping strategies and the formation of relational interactions and preferences. The collection of developmental history can also be used to gain an understanding of any developmental insults, stressors, and challenges experiences both in early childhood

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and throughout their life. It is also important to know when these experiences have taken place and the severity of the developmental challenges (Perry, 2009; Perry & Hambrick, 2008). Within the integrative approach, client histories are discussed initially if they are relevant to the current areas of concern. Information is gathered throughout the assessment process to understand the clients current level of functioning and to inform the selection of effective treatment interventions. The initial interview is an opportunity to also collect information about the clients presenting concerns, treatment expectations and goals, and personal preferences around a working alliance (Norcross & Beutler, 2011). Beliefs, Emotions, and Behaviours The connections between thoughts, beliefs, emotions, physiological sensations, and behaviours are very complex. Depending on the situation, any combination of these aspects of human experiences can be the focal point. I often think of the structural functioning of the brain and try to think about what part of the brain is being accessed and activated the most depending on the situation. For example, when a person is engaged in a problem solving task, they are primarily using the frontal cortex and engaged in thought. However, if that same individual began to struggle with the task and became very anxious, the limbic region of the brain would be primarily activated because of the emotion attached to the situation. By having this knowledge, it guides my immediate interventions based on what part of the brain is activated. Although I like how the cognitive therapy approach recognizes the interconnectedness between cognition, feelings, beliefs, and behaviour, I find myself more drawn to MBCT. MBCT differs from cognitive therapy in that it places little evidence on changing or altering thought content.

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Rather, there is a shift in focus towards increasing metacognitive skills for the client by raising their awareness of their relationship with their own thoughts and feelings. By learning that thoughts are not a fixed reality, the client is able to acknowledge that thoughts are just thoughts rather than statements of facts. This process is known as decentering (Semple et al., 2010; Sipe & Eisendrath, 2012). While cognitive therapy focuses on distinguishing, testing and challenging dysfunctional beliefs and negative thoughts, MBCT differs by promoting new ways of being with painful and challenging

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circumstances while being present and noticing/allowing negative thoughts and feelings. MBCT results in a more affirming approach to client change without placing blame on clients for creating negative and dysfunctional thoughts and feelings (Sipe & Eisendrath, 2012). When I gained some more clarity around the differences between MBCT and cognitive therapy, it was reinforcing to find an approach that fit with my own tendency to be present and future focused. Of course, with my neuropsychology lens I also found it interesting that functional magnetic resonance imaging studies have shown that individuals using nonjudgmental, present-moment awareness of ones experience (being mode) show a distinct neural response in the activation the right lateralized networks in the brain that are involved in somatic and visceral sensations rather than in the prefrontal cortex related to discrepancy-based problem solving (doing mode). When depressed clients were compared between the being and doing modes of treatment, those using mindfulness training reported fewer depressive symptoms (Sipe & Eisendrath, 2012). The Change Process and Resistance One of the main reasons why I was drawn to the integrative approach was the emphasis on the change process as a mechanism for change. Both personally and professionally I often refer to the process of change and talk about how a situation may

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appear to get worse before it will get better and more success can be experienced. I think that the process of change is uncomfortable and fear-provoking for most people.

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Naturally people are resistant to change and gravitate to more routine, predictable, and consistent ways of being. As stated earlier, the integrative approach focuses more on the process of change rather than on what the client needs to change. As a result, integrative therapists commonly use five client characteristics (diagnosis, stages of change, coping style, reactance level, and patient preferences) to guide decisions regarding individualized treatment plans. As an emerging therapist, I would like to integrate this approach into my practice to bring some structure to the change process that has been empirically proven. The first characteristic, the diagnosis of the client, is a consideration when designing a treatment plan because they are utilized by insurance companies, the effectiveness of intervention techniques are often categorized according to diagnosis in research, and specialized and manualized treatments have been designed for specific disorders (Norcross & Beutler, 2011). This would allow me as a therapist to select intervention techniques that have been effective with individuals with similar symptom and problem presentations. Another major client characteristic taken into consideration when formulating a treatment plan are the five stages of change (Norcross & Beutler, 2011). These stages gauge the clients readiness for the change process as well as specific tasks to help the client move on to the next stage. In the first stage, precontemplation, the client has no intention to make behavioural changes in the foreseeable future and is unaware or under-aware of their existing problems. Clients in this stage of change are resistant to recognizing or modifying a problem. Contemplation is the next stage of change in which the client is aware that a problem exists and is thinking of making changes but has not taken any steps towards making a commitment of action. In the third stage, preparation,

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the individual is taking small mental and behavioural actions necessary for change. Often these clients have unsuccessfully taken action towards resolving their problem within the last year. Action is the fourth stage of change where an individual make changes to their behaviour in order to overcome their problems. This stage often

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requires a considerable commitment of time and effort to make meaningful changes. In the final stage, maintenance, consolidation of newly learned information takes place to continue necessary changes and prevent relapse back into old, maladaptive patterns of behaviours and emotions (Norcross & Beutler, 2011). In addition to the diagnosis and stage within the change process, the clients coping style should also be considered when making treatment decisions. The clients coping style is a reflection of how he or she habitually responds when presented with new or problematic situations (Norcross & Beutler, 2011). An individual with an externalizing coping style tends to be extroverted, sensation-seeking, and impulsive. These clients are inclined to be more responsive to interventions focused on symptom-reduction strategies and skill building therapies. An individual with an internalizing coping style often are introverted, self-critical, and inhibited, responding better to insight and awarenessenhancing therapies (Norcross & Beutler, 2011). The fourth client characteristic important in an integrative approach is the understanding of the clients reactance level. If the client is reactive and oppositional a nondirective, self-directive, or paradoxical approach to treatment is most effective. When a client has low reactivity, more directive approaches can be employed. Finally, when clinically and ethically appropriate, the clients preferences should be accommodated for within psychotherapy to reduce misunderstandings, foster a stronger working alliance, and increase collaboration (Norcross & Beutler, 2011). In addition to the five stages of change, integrative psychotherapists have identified nine change processes that can be used to expand client consciousness and the

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therapeutic relationship. These processes include consciousness raising, selfevaluation, emotional arousal, social liberation, counterconditioning, environmental

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control, contingency management and helping relationships. Each change process has specific representative therapy methods that can be implemented in specific situations (Norcross & Beutler, 2011). Interventions I view myself as an eclectic practitioner interested in supporting the needs of each client regardless of a specific school of psychology. As I have made clear on several occasions throughout this paper, I identify most with the integrative approach while gravitating to concepts and interventions founded in neuropsychology, MBCT, cognitive psychotherapy and client-centered therapy. Empirically validated treatment interventions will be integrated within my practice as much as possible but I also understand that there are some aspects of therapeutic work and relationships that is difficult to assess within the medical model, despite fostering significant client gains. Within this section, I will focus on interventions I feel will impact my practice the most, however I would be willing to learn various other techniques to make sure I can adequately support clients throughout the entire change process. The integrative approach is committed to the synthesis of practically all effective, ethical change methods and uses a variety of empirically validated techniques that best match the client according to the five client characteristics and assessment procedures. The integrative approach also addresses the current move towards the use of more short-term intervention techniques to support client change and growth (Lazarus & Beutler, 1993). Various techniques are borrowed from a variety of sources without subscribing to the theoretical approach. Procedures and specific techniques are selected based on their empirically proven worth and how they fit the needs of the client. Specific

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techniques such as relaxation training, guided imagery, self-monitoring, role playing, interpersonal exploration, assertiveness training, sexual counselling, cognitive restructuring have been effectively implemented for clients within the integrative framework (Lazarus & Beutler, 1993). In addition to specific techniques, an effective treatment plan within the

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integrated approach should be based on a systematic process for selecting therapeutic procedures. This decision-making process should take into account contextual, environmental, therapists skill set, specific client concerns, and empirically effective procedures and techniques specific to the problems being addressed (Lazarus & Beutler, 1993). As part of the decision-making process, once a clients stage of change is identified, the therapist is able to select specific treatment psychotherapies and relationship styles that best supports the client in making meaningful changes. Clients in the precontemplative stage typically benefit most by motivational interviewing, strategic family therapy or psychoanalysis. The contemplate stage finds analytical and Adlerian approaches to be most effective in supporting clients. Existential therapy, rational emotive behaviour therapy, cognitive therapy, interpersonal therapy, and gestalt therapy are well-suited for specific client tasks in both the preparation and action phases of the change process. Finally, behaviour therapy, exposure, eye movement desensitization and reprocessing (EMDR), and structural family therapy are most effective in the action and maintenance stages of change. Relapse prevention is an important part of the final stages of a treatment plan. This supports clients by identifying and preparing for potential triggers and higher risk activities and environments by creating links to alternative adaptive responses (Norcross & Beutler, 2011; Petrocelli, 2002). While the different stages of change help therapists make decisions around treatment plans, change processes are a foundational element within the integrative approach. Change processes are empirically proven ways in which individuals attempt to

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change with or without therapy (Petrocelli, 2002). The most commonly used change processes by integrative psychotherapists are consciousness raising and helping

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relationships. In consciousness raising, the therapist facilitates an increase in the clients awareness of self and the problem through observations, confrontations, reflections, interpretations and bibliotherapy. Helping relationships become a change process when a client feels heard, understood, validated, and supported by a significant other in their life. Qualities such as empathy, moderate self-disclosure, feedback, positive regard, and collaboration as also aspects a therapist can integrate into the helping relationship (Norcross & Beutler, 2011). Over the last three years, I have learned about the neuropsychological approach to interventions and have integrated it into my practice and the way I conceptualize cognition, emotions, somatosensory information, and behaviour. I believe that without understanding the basic principles of how the brain develops and changes, one cannot expect to design and implement effective interventions (p. 39; Perry & Hambrick, 2008). Well-intended treatment plans that are not developmentally informed will not be effective. The more the therapeutic process can replicate the normal sequential developmental process, the more effective the intervention treatment plan. Therefore, therapists should start with the lowest functions within the brain that are showing impairment and move sequentially up the brain as improvements in functioning are observed (Perry, 2009; Perry & Hambrick, 2008). For example, within our therapeutic school setting, the therapeutic process could progress from self-regulatory activities that stimulate lower regions of the brain with patterned, repetitive activation (e.g. drumming, yoga, music), to relationally-enriching activities ( e.g. traditional therapy, art therapy), to finally activities that utilize more verbal and insight-oriented interventions (e.g. cognitivebehavioural or psychodynamic therapy).

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The integrative and present-focused orientation of MBCT interventions fits well with my own personal beliefs around holistic approaches to psychotherapy. I am more interested in MBCT over cognitive therapy because it does not place blame or be overly critical of the client for having dysfunctional thoughts. MBCT integrates components of meditation practice, homework, cognitive therapy, behavioural elements, and psychoeducation to facilitate positive client growth. I like how many of the treatment tasks are completed with the therapist in parallel with the client. This reinforces my beliefs around the need for the therapist to be attentive, attuned, present, and responsive within the client-counsellor therapeutic relationship. MBCT consists of a variety of formal and informal meditation practices including sitting and walking meditations, mindful movements (yoga), guided body scans, 3 minute breathing spaces, and focused awareness on daily routine activities (Felder et al., 2012; Sipe & Eisendrath, 2012). Early therapy sessions focus on breathing or body sensations and guided meditation activities. Later therapy sessions transition to more independent practice of mindful awareness of thoughts and emotions that may have been previously avoided (Sipe & Eisendrath, 2012). Homework is an essential element within the MBCT approach and clients are encouraged to engage in daily 45 minute practice sessions of mindfulness activities, often utilizing guided mediation recordings to add in this process (Sipe & Eisendrath, 2012). In addition to mindfulness activities, MBCT also integrates cognitive therapy and psychoeducation within the treatment approach. The client is taught that resisting or avoiding unwanted thoughts or feeling may actually intensify psychological distress and exacerbate identified problems. In addition, behavioural elements are also included to enhance other client well-being activities such as going for a walk, taking a bath or listening to enjoyable music. Clients also identify triggers and early warning thoughts and feelings that often lead to experiencing increased negative symptoms and develop

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action plans to implement in order to avoid or reduce adverse reactions when they occur (Sipe & Eisendrath, 2012). A core skill learned in MBCT is how to recognize and disengage from self-perpetuating patterns of ruminative, negative thought through sustained attention, and attention-switching exercises (Young, 2011). Additionally, MBCT focuses part of the treatment plan on educating clients on the potential for relapse by teaching the client to be more aware of thought and feelings as they begin and implementing mindfulness techniques early in the experience (Sipe & Eisendrath, 2012). I was interested to learn that MBCT has also been adapted to support children in increasing social-emotional resiliency through the enhancement of mindful attention. MBCT for children (MBCT-C) differs from adult programming by adapting the structure, type of mindfulness activities employed, and involved parents in the program to account for developmental attention and memory capabilities. The need for children to have more movement and varied activities to meet their sensory needs and preference for games was also incorporated into MBCT-C (Semple et al., 2010). MBCT-C is effective in reducing attention-related problems and shows promise in managing anxiety and behaviour problems in children (ages 9-13) with clinically elevated levels of anxiety (Semple et al., 2010). MBCT-C is an approach that I feel I could integrate into my intervention toolbox when I am a school psychologist to support a variety of students. Success Therapeutic success occurs when the client is able to adaptively cope with their environment, relationships, and ongoing problems that arise during daily life. The client has established and is able to effectively utilize coping strategies and no longer feels their functioning is impaired. The client will feel that they have more resources for support in their life. Ultimately, the client must feel that they have been successful within the therapeutic process. Many times client growth results in and increase in executive functioning skills, behavioural regulation, and metacognition. Successful treatment plans

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also result in a reduction in anxiety, depression, and somatic distress with a significant increase in self-esteem and sleep quality (Davis, 2012). Contextual Factors

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As a psychologist, it is very important to take into account various contextual factors when designing and implementing treatment plans. It is also critical that I am aware of any of my own biases and take into consideration the biases the client may also be carrying. I feel that it is important to be open and honest if there is something that I do not understand. It is very difficult to gain an in-depth understanding of various contextual factors, but being open and honest about what I know and expressing my desire to gain a better understanding of the clients perspective will be supportive. Within the integrative approach, a variety of contextual factors can be incorporated into a treatment plan. These factors could include ethnicity, gender, age, generational influences, sexual orientation, socio-economic status, disability status, and religion. Any of these factors or a combination of multiple factors can be infused into a flexible treatment intervention (Norcross & Beutler, 2011). Each person, regardless of cultural and contextual factors, is unique and should be treated as such through the creation of individually constructed psychotherapy. In addition to incorporating diverse backgrounds, integrative therapy also takes into account different contexts and demonstrates flexibility in the types of formats and settings taken into consideration when treatment planning (Norcross & Beutler, 2011). Reflection Weaknesses of my Personal Theory One of the major weaknesses of my personal theory is the use of the integrative approach as a foundation. The integrative approach lacks descriptive elements to explain theoretical concepts and understanding the why behind various patterns of cognition, emotions and behaviour. I have attempted to buffer this lack of descriptive

Personal Counselling Framework

qualities through the theoretical integration of MBCT, neuropsychology, cognitive therapy, and client-centered therapy. I feel this fits with the overall eclectic nature of

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integrative psychotherapy but at times my personal theory is not as cohesive as I would like. It is difficult to articulate and assimilate so many ideas into one theoretical approach. Another huge downfall to the integrative approach is that there are so many techniques to understand and be proficient at in order to truly meet the individual needs of each client. The available material is extremely vast and I think there would be a tendency to default back to what you feel competent in as a therapist rather than what is best for the client. It would also be an extensive task to remain current on effective interventions as new findings are discovered frequently within the field. Personal and Professional Connection For the last 14 years I have been working with traumatized, at-risk youth both in the residential and school setting. I have been trained in various behavioural and cognitive approaches while based within the foundation of a therapeutic milieu. While these concepts and techniques I learned and incorporated into my practice were effective with most children and youth, there were still some that were difficult to connect with and did not seem responsive to interventions. Over the years I learned skills from my colleagues, continuing to integrate them into my practice. I was able to experience firsthand some of the tremendous gains and examples of resiliency accomplished by the children and youth. I am drawn to integrative approaches, neuropsychology, MBCT, cognitive therapy, and client-centered therapy because pieces of each of these theoretical approaches explains and makes sense of my lived experience within the field of child youth care and education. Over the last few years the integration of trauma-informed practice and neuropsychology has hugely impacted how I conceptualize, plan for, and work with students. Understanding how the brain works and develops has helped me be

Personal Counselling Framework

more intentional around what types of tasks I ask students to complete. Knowledge of the impact of trauma on early development and the implications for self-regulation, attachment, and response patterns has transformed how I view the behaviours and intentionality /motivation behind them. I am drawn to the integrative approach because it does not get caught up in the theoretical debates around various constructs. Instead, there is a strong focus on the change process and the utilization of evidence-based practices from various philosophical perspectives. I connect with the flexibility of the approach to select interventions that would best meet the needs of the client. Working within special education for so long, individualized approaches become second nature. Although two

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students may present with very similar behaviour, most times the reasons why they are engaging in the behaviour are so unique. It is part of my job to guide the practice of teachers and counsellors to gain a deep understanding of each student to help them growth and see themselves as productive learners. Within the integrative approach, I really like the decision-making processes that help therapists identify specific stages of change and what interventions would best support growth within a particular stage. Conclusion While I have been introduced to many different psychotherapy orientations, I have been able to integrate my personal experiences with theory to formulate my own personal theory of counselling that amalgamated the integrative approach, MBCT, neuropsychology, cognitive and client-centered therapies. Although, still developing, my personal theory reflects my beliefs and ideas around philosophical assumptions, human nature, the counselling experience, the change process, and interventions that are effective for a variety of unique clients. This will continue to be an ongoing process as I gain more experience and exposure to various theoretical approaches in search of the most effective ways to meet the needs and facilitate growth for each of my future clients.

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References Beck, A. T. (2005). The current state of cognitive therapy: A 40-year retrospection.

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Archives of General Psychiatry, 62(9), 953-959. doi: 10.1001/archpsyc.62.9.953 Beck, A. T., & Weishaar, M. E. (2011). Cognitive therapy. In Corsini, R. J., & Wedding, D. (Eds.) Current psychotherapies (9th ed.) (pp. 276-309). Belmont, CA: Brooks/Cole. Davis, T. S. (2012). Mindfulness-based approaches and their potential for educational psychology practice. Educational Psychology in Practice: Theory, Research and Practice in Educational Psychology, 28(1), 31-46. doi: 10.1080/02667363. 2011.639348 Felder, J. N., Dimidjian, S., & Segal, Z. (2012). Collaboration in mindfulness-based cognitive therapy. Journal of Clinical Psychology: In Session, 68(2), 179-186. doi: 10.1002/jclp.21832 Hope, D. A., Burns, J. A., Hayes, S. A., Herbert, J. D., & Warner, M. D. (2010). Automatic thoughts and cognitive restructuring in cognitive behavioral group therapy for social anxiety disorder. Cognitive Therapy and Research, 34, 1-12. doi: 10.1007/s10608-007-9147-9 Josefowitz, N., & Myran, D. (2005). Towards a person-centred cognitive behaviour therapy. Counselling Psychology Quarterly, 18(5), 329-336. doi:10.1080 /09515070500473600 Kensit, D. A. (2000). Rogerian theory: A critique of the effectiveness of pure clientcentred therapy. Counselling Psychology Quarterly, 13(4), 345-351. doi: 10.1080/09515070110046551 Lazarus, A. A., & Beutler, L. E. (1993). On technical eclecticism. Journal of Counselling & Development, 71, 381-385. Retrieved from http://web.ebscohost.com.ezproxy.lib.ucalgary.ca/ehost/detail?sid=8495a608-

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Norcross, J. C., & Beutler, L. E. (2011). Integrative Psychotherapies. In Corsini, R. J., & Wedding, D. (Eds.) Current psychotherapies (9th ed.) (pp. 502-535). Belmont, CA: Brooks/Cole. Osatuke, K., Glick, M. J., Stiles, W. B., Greenberg, L. S., Shapiro, D. A., & Barkham, M. (2005). Temporal patterns of improvement in client-centered therapy and cognitive-behaviour therapy. Counselling Psychology Quarterly, 18(2), 95-108. doi: 10.1080/09515070500136900 Perry, B. D. (2009). Examining child maltreatment through a neurodevelopmental lens: Clinical applications of the neurosequential model of therapeutics. Journal of Loss and Trauma, 14, 240-255. doi: 10.1080/15325020903004350 Perry, B. D., & Hambrick, E. P. (2008). The neurosequential model of therapeutics. Reclaiming Children and Youth, 17(3), 38-43. Retrieved from http://scholar.google.ca.ezproxy.lib.ucalgary.ca/scholar?cluster=6550931649783 752420&hl=en&as_sdt=0,5 Petrocelli, J. V. (2002). Processes and stages of change: Counseling with the transtheoretical model of change. Journal of Counseling & Development, 80(1), 22-30. doi: 10.1002/j.1556-6678.2002.tb00162.x Raskin, N. J., Rogers, C. R., & Witty, M. C. (2011). Cleint-centered therapy. In Corsini, R. J., & Wedding, D. (Eds.) Current psychotherapies (9th ed.) (pp. 148-195). Belmont, CA: Brooks/Cole. Semple, R. J., Lee, J., Rosa, D. & Miller, L. F. (2010). A randomized trail of mindfulness-based cognitive therapy for children: Promoting mindful attention to enhance social-emotional resiliency in children. Journal of Child and Family

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Studies, 19, 218-229. doi: 10.007/s10826-009-9301-y

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Sipe, W. E. B., & Eisendrath, S. J. (2012). Mindfulness-based cognitive therapy: Theory and practice. The Canadian Journal of Psychiatry, 57(2), 63-69. Retrieved from http://web.ebscohost.com.ezproxy.lib.ucalgary.ca/ehost/detail?vid=3&hid=13&sid =b5e54db3-9144-4e2f-8dda-9e316e15379f%40sessionmgr14&bdata= JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=pbh&AN=73791897 The Nature of Theory (n.d.). Unpublished manuscript, Graduate Programs in Education, University of Calgary, Calgary, Canada. Retrieved from https://blackboard.ucalgary.ca/webapps/portal/frameset.jsp?tab_id=_2_1&url=%2 fwebapps%2fblackboard%2fexecute%2flauncher%3ftype%3dCourse%26id%3d_ 133498_1%26url%3d Young, S. N. (2011). Biologic effects of mindfulness meditation: Growing insights into neurobiologic aspects of the prevention of depression. Journal of Psychiatry and Neuroscience, 36 (2), 75-77. doi: 10.1503/jpn.11010