Two-Stage Theory of Counseling – Parallel Not Serial

Two-Stage Theory of Counseling – Parallel Not Serial

David Bottorff

Loyola University of Chicago

18 March 2010 Abstract

This essay argues that although effective therapist leadership and client action require the product of good encouragement, listening and following, and although listening and leading require different skills, these two therapeutic energies are co-occurring and inextricable.  The therapist’s challenge is to manage the ongoing dialogue between these curative forces throughout the entire counseling relationship.

Keywords: stage counseling theory Egan Rogers Meichenbaum cognitive behavioral therapy CBT humanistic-existentialist therapy

Two-Stage Theory of Counseling – Parallel Not Serial

On the one hand, it appears axiomatic and a priori that psychotherapy cannot progress prior to investigation.  That is, so-called Stage II counseling skills designed to solve problems and elicit change in thinking and behavior requires the counselor-client dyad first work through Stage I rapport building and fact gathering.  And yet, curative vectors surely exist from the moment a client walks through the door with intention to seek help.  Deepak Chopra is credited with saying, “Love without action is meaningless and action without love is irrelevant.”  The tension expressed in this statement finds corollary in the therapeutic process:  Client problem resolution requires thought and feeling data, and yet the process of eliciting such information is in itself curative.

Stage I therapy is characterized as a process of introspection for the client and listening for the therapist.  Stage II therapy is characterized as a move toward objective understanding for the client and leadership for the therapist.  I propose these two “stages” are interdependent and synergistic processes that fit together like hypotenusally mated right-triangles, forming a complete rectangle, a whole therapeutic process.  At one end we see an almost exclusive emphasis on Stage I introspection by the client, while toward the end of therapy we see an almost exclusive emphasis on Stage II action.  Yet at every point along the way, some component of each can, and should, be accessed.  The delicate balance between the point at which the therapist should primarily follow (Stage I) or take the lead (Stage II) is intimately connected with each discrete moment in therapy. 

No where is this continuous interaction between self-exploration/following and action/leading more clear than in the person-centered therapy of Carl Rogers.  By carefully attending, encouraging and paraphrasing, Rogers elicits actionable crumb after actionable crumb from the client, eventually culminating in a patient-supplied solution to the presenting problem.  After all, “nondirective therapy” was the original name for Rogers’ method, migrating eventually to “person-centered therapy.”  Although originating from the psychoanalytic school rather than the humanistic-existentialist school, Donald Winnicott (1991, p. 116) said, “[I]f only we can wait, the patient arrives at understanding creatively and with much joy … . The principle is that it is the patient and only the patient who has the answers.”

In the now famous psychotherapeutic session with Gloria (Psychological & Educational Films, 1965), Rogers at first appears to only be listening and encouraging, but he also paraphrases in ways that lead and drive the conversation forward, e.g., “You are acting from guilt,” or, “If you’re not comfortable with yourself, how can she possibly be comfortable with you.”  At one point in the Gloria session he steps too far and too fast.  He proposes that what she wants is to “seem” perfect, but she rejects that characterization.  The challenge, and her reply, deepens her progress toward problem resolution, even though he is solidly in the middle of learning the first few things about her.  [As an aside, I was particularly taken by Roger’s statement during the post-session debriefing.  “Transference and counter-transference completely misses the point of the immediate I-thou experience,” he said (Psychological & Educational Films, 1965).]

Summarizing Gerard Egan (2009), Thomas Gorey wrote, “Self-exploration is not a goal in itself, but a means to an end – action, action that leads to more effective living on the part of the client.  … Vague solutions to vague problems never lead to effective action.”  I agree completely with this argument.  Further, “The goal of Stage II is to help the client achieve the kind of objective understanding of himself, his problems, and his world that leads to effective action.”  Again, this is a statement of essentially indisputable truth.  The dialogue between Stage I and Stage II, however, is brought to the fore when Gorey paraphrases Egan in saying, “Stage II skills represent ‘stronger medicine’ than Stage I skills.”  The operative word is “stronger.”  There is, in fact, some “medicine” in Stage I client introspection, and there is further introspection and enlightenment in the action-oriented Stage II – the two forces form an alchemy of therapy.  In the same way the analyst and the analysand merge to form the so-called analytic third, Stage I and Stage II dialogue create a therapeutic gestalt environment.

Thus, and not to sound too equivocal, although the stages are not completely separate, and although they do not completely follow one another in time, there is a gradual progression from learning to doing, from Stage I to Stage II.  In this respect, I take respectful issue with the proposition that the stages are distinct and succinctly chronological.

The skilled therapist should be able to toggle from moment to moment between following the client as she is encouraged to divulge her thoughts and feelings to leading the client as she steps back, looks more objectively at her life, and takes corrective action.  Although following and leading clearly do require different skills, it would be inappropriate to dedicate one session to one goal and a different session to the other goal.  These forces, like yin and yang, are married and intertwined.

The five-stage theory of counseling articulated by Allen Ivey et al (2007) substantiates my argument of continuity and gradual progression from introspection to action, as opposed to a quantum shift from one mode to the other.  With the exception of the introductory Stage 1 “Hello,” each step poses questions to the client.  The client’s ability to answer the questions brings her closer to her own solutions, as though gradually assembling a jigsaw puzzle.  The client may see the picture even before the puzzle is complete, allowing her to take incremental action.  Although the last step involves the most succinct leadership gesture, e.g., “Will you do it?” each step plays a crucial role in eliciting the solution from the client herself.

Cognitive Behavioral Therapy (CBT) takes a more pro-active stance on therapist leadership.  This is evident in the style of Donald Meichenbaum, who appears ready and willing to use confrontation and direct talk when he feels the enough information has been gathered and the client trusts him enough to accept his leadership. 

Yet, again, my sense is that each act of leadership leads to more honest introspection on the client’s part, and vise versa.  There is a symbiosis through the course of the session, even though CBT allows for more direct leadership of the client than do other schools, including humanistic-existentialist and psychoanalytic therapy.

Coda

In the process of educating new counselors, it may well be essential to clearly differentiate between “following” and “leading” roles during psychotherapy.  In practice, however, the line between these two modalities is fuzzy at best.  Although the skills needed to listen undoubtedly differ from those needed to guide, the clever therapist should always be ready to switch from one to the other lest an opportunity for client growth escape.

References

Egan, G. (2009). The skilled helper: A problem-management and opportunity-development approach to helping. London: Wadsworth.

Ivey, A. E., D'Andrea, M., Ivey, M. B., & Simek-Morgan, L. (2007). Theories of counseling and psythotherapy: A multicultural perspective. Boston: Pearson Education.

Psychological & Educational Films (1965). Three Approaches to Psychotherapy. Retrieved 17 March 2010 from YouTube: http://www.youtube.com/watch?v=ZBkUqcqRChg

 Winnicott, D. (1991). Playing and reality. London: Routledge.