Integrative Counselling Using the Skilled Helper Approach

The Skilled Helper Approach

Outline

This paper is about integrative counselling using the skilled helper approach. In this paper we will discuss the theory and application of the integrative model of the skilled helper and components of person centred counselling and solution focus therapy. We will look at this integrative model and the benefits as well as the possible downsides. A case study will then be presented using this integrative model to counsel the client.

Introduction

Integrative counselling looks at several approaches that have been combined and used within a therapeutic counselling relationship. Coming away from a single counselling approach and combining suited models of counselling, both the counsellor and client reap the benefits of the integrated model (Arkowitz, 1997). Robertson (1970) stated that his ‘radical eclecticism’ bypassed theory.

Introduction – Gerald Egan

Gerald Egan is professor of organisation studies and psychology and programme director for the centre for organisation development (CORD) at the Loyola University of Chicago. Egan developed the skill helper model and in 1975 published the first edition of his book The Skilled Helper , which demonstrateding an eclectic framework for a problem management approach to the counselling process.

The Integrative Counsellor

There are counsellors that see themselves as being eclectic in their work. It is viewed they are syncretism-using techniques from many models[RZ1]. Eclecticism – no or little theoretical rationale[RZ2]. Merely pulling techniques from many models without a sound rationale can only result in syncretistic confusion (Lazarus, 1996, 1996; Lazarus, Beutler, & Norcrossk, 1992).

Development of Therapy

The three main influences on the development are the skills training approaches to counselling, the social influence theory, and behavioural theories of learning and change. Egan sums his approach up as ‘A conceptual framework…. to organise borrowed ideas, methods and techniques systematically … and to integrate them into [ones] own theory and practice of helping[RZ3].’.

Theory

The skilled helper model is a Tran theoretical approach to integration. The client seeks counselling or assistance when they are experiencing difficulties in coping with problems in his or hertheir lifeves. The Counsellor will find and act on solutions to these problems. This is done by using a problem solving process. The process is demonstrated by using 3 three main stages which originally were titled Exploration, Understanding and Action, and which are now renamed as Present Scenario, Preferred Scenario and Getting There[RZ4].

The Three Stage Model

The three stage model consists of three steps within three stages. Egan describes this model as “A a cognitive map with practical potential, complex enough to make sense of reality and simple enough to use[RZ5]..

1 Present Scenario

The client is helped to describe and explore the present Scenario[RZ6]’,

she is going through at present

2The Preferred Scenario

Articulate a preferred scenario that includes future goals

aAnd objectives.

3Getting There

Develop and implement action strategies forrom moving

from the current to preferred scenario.

The Skilled Helper Model is integrative, going mainly through three stages:. Person centered, to establish the therapeutic relationship;, Gestalt, for intense work on awareness; and behaviour therapy to work on change. Egan states ‘do whatever is ethical and works.’ (1990:62). (Robertson (1979) stated that his ‘radical eclecticism’ bypassed theory. The writer[RZ7] argues that theory is evident within the approach as it is influenced by strong theoretical approaches integrated into the skilled helper.

Dr Carl Rogers argues that “It is the client who knows what is hurting and in the final analysis it is the client who knows how to move forewardords ... the counsellors task is to enable the client to make contact with his own inner resources rather than to guide, advise or in some other way influence the direction the client should take …. Thus thus emphasising the central importance of the client’s phenomenological world”. (Mearns & Thorne, 1988, P1).

The three stage model is a systematic way of learning to work with clients helping them to cope more effectively with their life,. tTo manage their problems in living more effectively and develop unused opportunities more fully’, and to ‘help people become better at helping themselves in their everyday lives.’ (Egan G., ‘The Skilled Helper’, 1998, pp. 7-8). Using the approach counsellors are able to explore the client’s feelings, thinking and behaviour.

In stages one and two, clients are helped to explore and understand themselves their feelings and their world better, and in a different light. In stage 3 three, clients are helped to take effective action to achieve constructive change.

Assumptions of the Model

Some counsellors see the skilled helper model as being basic counselling and a paradigm that is made more complicated than necessary. Egan is slightly contrary about human nature[RZ8] ……..

Egan and Cowan 1979[RZ9]

Egan and Cowan 1979, 1980: Egan, 1984[RZ10]

The focus of the skilled helper model is concentratesd on the client, with the aid of counsellor, in enabling the client to develop new skills of self management, interpersonal communication, and decision making. The counsellor and client wWorking together on strategies to bring about change, and they. examine Looking at what the client would like to change or manage differently.

Psychological Health

The heart of the problem solving process is the client’s action itself (Egan, (1975:227). This is achievable by enabling the client to tell his or her storey. The skilled helper model is one that sees the potential of change to take place in clients (Inskipp, 1993:92), w. Where the client shi8fts their behaviour from unhealthy to healthy to juvinate[RZ11] positive change. Change comes about through action “The heart of the problem-solving process is the clients’ action itself (Egan, 1975:2227[RZ12]). This is by way of the client letting go[RZ13].

Change begins to take place when the client is given space to tell his or her their storey. In telling of the storey, the resources for change areis identified and used. Client The client is helped to reframe by seeing the story and, situations in a different light, seeing him or heerself as a survivor rather than a victim. However, simply Just wanting change to take place is not sufficient. The cClient must be active in the process of change by way of adapting his or her behaviour through action, reflection and new learning. “Constructive change is always the bottom line.” (Egan 1990:207).

Practice and clinical issues

The counsellor has to be effective in the way the approach is used. ‘Helpers are successful to the degree that their clients – because of client – helper interactions – are in a better position to manage specific problem situations and develop specific unused resources and opportunities more effectively.” (Egan, 1998:7). The role of the counsellor is to assist the client in understanding his or hertheir storey and /problem, and assist with skills that will aid their client in being effective in the management of particular challenging situations.

The gGoals of the counsellor in the relationship are to build and empathic alliance;, to assist;, identify;, support; and to evaluate.

Counsellors use of the Model

Understand and confidence of the 3 stage model with a willingness to adjust to accommodate the clients needs[RZ14]. Counsellor works with the client in the here and now. Some of the skills used would be their natural internal supervisor and , attending skills, through awareness and use of the mnemonic SOLAR (squarely, open, learn, eye, relaxed). For non verbal communication, using the model as a template for change, the counsellor worksing therapeutically at the clients pace using assessment skills, identifying if the degree of difficulty experienced by the client gets in the way of achieving change in mood and relationships.

Making a contract with client, focusses of the work, nature and frequency of contact, confidentiality and possible limitations of it, review and evaluation[RZ15]. Evaluation is ongoing through sessions as this helps identify what is /or is not helpful during the session.

Use of skill through communication

The counsellor engages with the client attending[RZ16], active listening, establishing and conveying empathy and the use of probes and questioning, immediacy, and appropriate self disclosure to client. Brain storming is a cognitive way of helping client to look at new perspectives on situations. Brainstorming generates hope that this[RZ17] can be different – this helps client to move foreward into working creatively. The cCounsellor can engage with the client using a variety of different skills, such as . Prompting : what do you really want for yourself in this situation, miracle Miracle Ququestion – brief therapy, Blank wall – visualisation – NLP (DeShezer, 1988; O’Connor and McDermott, 1996)0.

Goal setting and reviewing helps client to see hopes as goals that are SMART[RZ18], specific, measurable, achievable, realistic and time-limited.

Change Process

Egan takes his process of change from the behavioural approach (Wopolfe et al., 1989:11). Seeing behavioural change over cognitive change[RZ19]. The counsellor uses empathy to form a strong working alliance with the client through the exploration of feelings. The exploration of feelings plays the main part in effecting for change to take place. Within an article about change showedOne source identifies three3 agents for change: stated affective experiencing, cognitive mastery and behavioural regulation (Karasu 1986:690). [RZ20] These three3 agents play a major part in the skilled helper approach for change to take place.

Nature of therapeutic relationship

Egan sees that the therapeutic relationship is instrumental in the counselling process. Working to achieve goals within specific time restrains the counsellor takes on the role of[RZ21] . ‘A relationship of service, not an end in itself’ (Egan 1990:57). Whereby Rogers argues that the therapeutic relationship is fundamental in the counselling process[RZ22].

As part of the skilled helper approach, Egan incorporated Rogers core conditions. Egan describes himself as ‘standing on Rogers shoulders[RZ23],’ owing much to him as the core conditions is a major part of the approach. Rogers, on the other hand, concentrates on the person as a whole human-being. There are many differences between the two approaches (see Table 9.1).

Format of a typical session

Each session is different as there are is no set format. Tthe process depends on where the client is with the process of change.

Indications and contraindications

This approach is similar to the cognitive and behavioural approaches. The model is only beneficial for clients with mild to moderate conditions. The approaches concentrates itself onwith the client having the motivation to change and test out feelings and perceptions in a new framework.

The model can be used with most clients and situations including depression ()Mynors-Wallis et al., 1995; Sseeley et al., 1996), and working with young people (Mabey and Sorensen, 1995).

The model is described as being eclectic (Inskipp and Johns, 1984).

Weakness of Model

The model can be iInflexible, not suitable for clients with deep roouted problems, and there is little research to verify its efficacy[RZ24]. Although the problem management programme is beneficial, it may have to be modified to fit some cultures.

Obstacles to Integration

Within Tthe development and usage of an integrative mode,l as opposed to a single model, has its drawbacks and possible pitfalls. Hastily combining counselling models on a at whim just because the models separately are pleasing does not necessarily not lend itself to necessarily be combined successful combinationly into an integrated model.

No one theory or model can testify that it ey holds athe patent off the truth. No one single model or set of techniques have or can always be effective with diverse clients. Nonetheless, tThere is a current trend, as the basis for future counselling practices; writers are developing integrative approaches (Lazarus, 1996[RZ25]).

Some models of counselling integration are The Skilled Helper Model, Cognitive Analytic Therapy (CAT) and the Conversational Model.

There are times, however (dependent on the client) when a single established integrative model may be used. For the purpose of this essay an example of the Skilled Helper model will be the main integrative model.

Case Study

Introduction

This case study looks at the use of the skilled helper model with Lisa, a 16 year old college student on a one year foundation course. Her problem is that she finds herself more and more angry. Every week there is an aggressive situation at college between Lisa and her peers or with members of the college staff. She has been officially warned twice and is in great jeopardy of being thrown off her course and out of college. Throughout many of her comprehensive school life she has been expelled from several schools because of her behaviour. It was recommended by the Student Support Manager that Lisa attend some sessions of counselling to “get herself sorted out[RZ26]”. This was an option recommended to herim as an alternative to expelling her.expulsion.

Theory

“Helping relationships are influenced by whether the helper is a trained counsellor or is using counselling skills as part of performing another role. Helping relationships takes place in the head and in the heart, as well as face to face. Ultimately all helping relationships need to become client self helping relationships.” (Nelson-Jones, 1999, P.118)

Stage one looks at the problems, issues, concerns, and undeveloped opportunities for Lisa.

Lisa agreed to attend counselling;, this was not a new experience for her. She had previously received counselling and anger management several times and stated, “Tthey don’t work..

Assessment and Contracting took place during the first session. Lisa was listened to, enabling her to tell her storey of what brought her to counselling and the lead up to it. During the session, probing was used to discover that Lisa felt alone even though it appeared she had many friends. She was the leader of her girl gang. “Not real friends, they don’t know me. They’re only with me because I fight for them. Some of them are bigger than me.. She felt unloved by her mother because there was no discipline and they only encouragement given was for her to stand up for herself. Her dad has spent years in and out of prison. Lisa felt ugly and was often told that she wasso. She dressed in boys clothes and kept her strawberry blond hair (which almost reached halfway down her back) secured with an elastic band. She had an older sister who was 20, who had changed her religion and was preparing to marry within into a Muslim family. Lisa had two younger brothers that seemed to get away with ruling the household with their demands. Lisa proudly carried a small photograph around with her of her deceased sister, the only person she really felt loved by, and the only one she loved. With more gentle probing, it became apparent that her sister died as a baby two years before Lisa was born[RZ27]. Her past time is spent hanging out with her friends and at times purposely causing trouble. She left school with no formal qualifications, and therefore was placed on a foundation course which she found did not hold her attention as she got through her work quickly. and so Aas she could move foreward, Lisa found she was helping other students in the class with their work[RZ28].

Lisa is asked “what do you really want for yourself in this situation?” Brainstorming technique is used to look at course and career options. Lisa looks into the future of how she would love to be an accountant as she is very good at maths, or even an actress[RZ29]. In the past she had thought that someone like her would not have the opportunity to do either, but she was happy to look at moving foreward.

A mental list was used for the client to come up with some of the things she would like to change. She realises that she is on the wrong course and comes to know that by accepting support from the educational guidance worker and Foundation studies manager she may be able to change her course to one that will be pitched at a higher level to do business studies and accounts. She also realises if she had toned her behaviour down at school for the last few weeks before the end of term, she would not have been expelled[RZ30] and would have done her exams at school rather than giving up her 9 GCSE’s even though an alternative school was offered for her to take her exams. Her estimated grades were mainly B’s and C’s.

3 sessions – Llisa seems agitated, feeling she has to no choice but to come. options given[RZ31].

Fears of exclusion, no qwualifications, failure[RZ32]

The counsellor gave aAssurances that given everything is confidential with the exception of disclosures to child protection agencies, or in the case of imminent harm to self and others. The counsellor also eExplained counselling is not a prescription; n, she not does not have to come, the decision will be hers, no implications with or from college staff[RZ33].

By telling her storey at the place[RZ34] she has more insight into the issues she faced. She sees herself as helpful, hardworking and a good communicator.

The model of the skilled helper is explained more fully to clients

Part of the process within the model used. Learnt basic features of model for focus, direction, guidance interactions with peears[RZ35].

Stage 1 – Step 1 Tthe storey

Client tells her storey which is facilitated by me using probes;, this encourages the client to offer detailed information about herself. This enables client to understand her situation, so as she can look at what needs to be done to manage it.

Goal setting – What do I really want?

Step 1b – Blind spot

Lisa is helped to identify signifcicant blind spots about herself so as she can develop new perspectives in moving foreward.

This is used to break through areas that prevent Llisa from seeing herself and her situation[RZ36].

Step 1c Cchoosing right problem to work onn.

Lisa has many problems, I hHelped her work on problems that will make a substantial difference in her life. The client is encouraged and supported in working on her problems.

The questions[RZ37] help Llisa to look into her future. Lisa discovers there are many things she wants; there is a , right course for her, one that she is interested in and can enjoy. She can enjoy bBetter relationships with peers and staff. She can enjoy tTime for herself and her mom.

Lisa was fFurther encouraged to look at needs and prioritise them. Overall she needs to feel she is achieving academically, making progress in relationships with family, and she would like to change her image – “be a girly girl..

Setting priorities help her to think about how she might achieve them. I then helped her to explore and clarify her priorities. Tthis is done by asking her how would she know she is achieving, what would it look like. The type of course is then explored in the areas of accountancy and performing arts and which one would be more suitable for her needs and wants, and by. looking at which one is more practicael and achievable.

Stage 3 Developing action strategies

.

At the beginning of counselling, mentoring support group work was offered to Lisa. This service was offered again to client[RZ38]. She breaks through some blind spots, getting a better understanding of and prioriitising her needs, as well as. eExploring what she needs to do to get what she wants. Lisa talks more about her hoped for ambitions prioritising accountancy, making contact with the college guidance worker to see what she would need to get onto a course. On being an actress, it was decided by the client that she would need to attend sage school or the performing arts course at college. We explored each profession, looking at pay, reliability, enjoyability, the possibility that it would possibly help form good character, as well as career endurance. Accountancy took priority, coming out on top in Lisas evaluation. This also linked into the fact that the client enjoys and excels in maths and has experienced accounts at school., Armed with this information, the client contacted her personal tutor and foundations manager. She put her case forward to them them both to be able to be transferred onto an accountancy or business studies course with administration. Giving the client space to do this contributed to her empowerment.

The mentoring group consisted of eight 8 students, 16 – 18 years of age. This gave students a safe place to explore her feelings about her relationships and her body image. She Lisa bravely asked “Ddo your moms help you with your hair and make up? Ttalk to you about boys?” The questions generated much conversing over two sessions. As a result of the group, work the hair, beauty and holistic therapy departments were approached. Client wanted to be a gfirly girl, which meant she wanted help in knowing how to style her hair, and to apply put make-up on. Sessions for a course of holistic therapy to help with stress were arranged;. these therapies helped her to physically see herself in comparison to whathow she had imagined within her own mind.

By being a valued member of the weekly group, the client found she was able to receive support as well as give it, leaving her feeling empowered. Being action[RZ39] in her therapy has allowed her to concentrate on her course, career prospects, and image, which leads to improved personal conduct, relationship with peers, members of staff and mother, thereby. rReducing the anger and sometimes hate she felt for herself and resentment towards her mother.

Client Lisa eventually moves out of the group, as she feels less angry and stressed. Although client she may have benefited from staying for one or two more sessions, the end of session evaluation was that the client felt that she had sufficiently improved and wanted to withdraw; therefore the helping process had served its purpose (. Waehler and Lenox (1994)). Therefore Hher relationships are more productive and enjoyable; she is. feeling better about herself as she knows some of the feelingss and views of her peers as they saw her . hHow she was and how she can be. by way of a connextios[RZ40] worker client is being helped to communication her needs to her mother taki

Bill Carlson