The Skilled Helper Approach
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.
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)
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 demonstrat
ing 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 own theory and practice of helping[RZ3]
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
their li ves. 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 main stages which originally were titled Exploration, Understanding and Action and 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 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
Develop and implement action strategies f
from the current to preferred scenario.
The Skilled Helper Model is integrative going mainly through three stages
. Person , 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 forew
ords ….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 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
. To 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, p 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 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
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 concentrate d on the client with the aid of counsellor in enabling client to develop new skills of self management, interpersonal communication, and decision making. Work ing together on strategies to bring about change . Looking at what client would like to change or manage differently.
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 stor ey. The skilled helper model is one that sees the potential of change to take place in clients (Inskipp, 1993:92) . Where the client shi 8fts t heir 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
their stor ey. In telling of the stor ey the resources for change is identified and used. Client is helped to reframe by seeing the story , situation in a different light seeing h erself as a survivor rather than a victim. Just wanting change to take place is not sufficient. Client must be active in the process of change by way of adapting 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 understand th eir stor ey /problem and assist with skills that will aid their client in being effective in the management of particular situations. Goals of the counsellor in the relationship are to build an d empathic alliance , to assist , identify , support and to evaluate.
Counsellor’s 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
, 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 work ing therapeutically at the clients pace using assessment skills, identifying if the degree of difficulty experienced by client get in the way of achieving change in mood and relationships.
Making a contract with client, focu
ses 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, appropriate self
Counsellor can engage with client using different skills . Prompting : what do you really want for yourself in this situation, miracle question – 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.
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 forma strong working alliance with the client through the exploration of feelings. The exploration of feelings plays the main part
for change to take place. Within an article about change showed 3 agents for change stated affective experiencing, cognitive mastery and behavioural regulation (Karasu 1986:690). [RZ20] These 3 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 Table9.1
Format of a typical session
Each session is different as there are is no set format.
the 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 approach
es concentrate itself with the client having the motivation to change and test out feelings and perception in a new framework.
The model can be used with most clients and situations including depression (
)Mynors-Wallis et al., 1995; seeley 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
Inflexible, no suitable for clients with deep ro uted problems, little research [RZ24]. Although the problem management programme is beneficial, may have to be modified to fit some cultures.
Obstacles to Integration
Within the development and usage of an integrative model as oppose to a single model has its drawbacks and possible pitfalls. Hastily combining counselling models at whim just because the models separately are pleasing does not lend itself to necessarily be combined successful ly into an integrated model.
No one theory or model can testify th
ey hold the patent o f the truth. No one single model or set of techniques have or can always be effective with diverse clients. There 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 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.
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 h
im as an alternative to expelling her.
“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 take place in the head and in the heart as well as face to face. Ultimately all helping relationships need to become client self
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, “ they don’t work” .
Assessment and Contracting took place during the first session. Lisa was listened to enabling her to tell her stor
ey 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 the y 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 often told that she was. 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, had changed her religion and was preparing to marry within 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 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, therefore was placed on a foundation course which she found did not hold her attention as she got through her work quickly and so as she could move for eward 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
A mental list was used for 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 –
lisa seems agitated, feeling she has to come – options given[RZ31] .
Fears of exlusion, no q
wualifications, failure[RZ32] Assurance given everything confidential with the exception to child protection , harm to self and others. Explained counselling not prescriptio n, not not have to come, the decision will be hers, no implications with or from college staff[RZ33].
By telling her stor
ey 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 pe
Stage 1 – Step 1
the stor ey
Client tells her stor
ey which is facilitated by me using probes , this encourages the client to offer detailed information . 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 signi
cicant blind spots so as she can develop new perspectives in moving for eward.
This is used to break through areas that prevent
lisa from seeing herself and her situation[RZ36].
choosing right problem to work o n .
Lisa has many problems,
Helped 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
lisa to look into her future. Lisa discovers there are many things she wants , Better reltionships with peers and staff. Time for herself and mom. Further encouraged to look at needs and prioritise them. Overall she needs to feel she is achieving .
Setting priorities help her to think about how she might achieve them. I then helped her to explore and clarify her priorities.
this is done by asking her hw 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 . el and achievable.
Stage 3 Developing action strategies
At the beginning of counselling, mentoring support group work was offered . This service was offered again to client[RZ38]. She breaks through some blind spots, getting a better understanding of prioriitising her needs
. Exploring what she needs to do to get what she wants. Lisa talks more about her hoped p o s s i b l y help form good character, career endurance. Accountancy took priority coming out ontop . This also linked into the fact that the client enjoys and excels in maths and has experienced accounts at school , Armed with this information client contacted her personal tutor and foundations manager. She put her case forward to 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
8 students 16 – 18 years of age. This gave student a safe place to explore her feelings about her relationships and her body image. She bravely asked “ do your moms help you with your hair and make –up? talk 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 firly p u t o n. Sessions for a course of holistic therapy to help with stress . h o w she had imagined within her own mind.
By being a valued member of the weekly group
. Reducing the anger and sometimes hate she felt for herself and resentment towards her mother. Client moves out of the group as she feels less angry and stressed. Although client may have benefited from staying for one or two more sessions, the end of session evaluation was that client felt that she had sufficiently improved and wanted to withdraw therefore the helping process had served its purpose . T herefore her relationships are more productive and enjoyable . s and views of her peers as they saw her . How 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