Counseling Theories for School Counselors, Research Paper Example

The practice of psychotherapy has involved a multitude of theoretical orientations that provide a framework for clinical practice. Every clinician forms his or her own style of practice, based on theory, methodologies, the nature of the setting in which he or she works, and personal traits that lend themselves to the formation of an effective therapeutic approach. Sigmund Freud is given credit for being the founder of psychoanalysis and “psychodynamic” theory, including the concepts of neurosis, conflict, attachment, object relations, the unconscious, defenses, the id, ego, and superego, and transference, all of which form the basis of Freudian psychotherapy (Strisik, 2010. ) Freud’s psychoanalytic system is a model of personality development and an approach to psychotherapy. He focused on the role of the unconscious, and developed the first therapeutic procedures for understanding and modifying the structure of one’s basic character (Corey, 2009.) Other theoretical approaches include humanistic psychotherapy, which considers the entire person, including mind, body, and spirit and focuses on this self-healing powers of the individual; Carl Rogers and Abraham Maslow are two of the leading humanistic personality theorists. Another well known modality is cognitive-behavioral therapy, which is considered to be a practical method that utilizes tangible and concrete objectives, helping the patient to utilize active methods to reach them; some of the most significant behaviorists are B. F. Skinner, Ivan Pavlov, Albert Ellis and Albert Bandura.

Self psychology, developed by Heinz Kohut, is a theory that is of particular interest to me, since its principal concept–the use of empathy in the therapeutic relationship as a vehicle for change–fits perfectly with my therapeutic persona. This paper will explore the essential aspects of self psychology theory, its role in personality development and the ways in which the environment contributes to that development as well as the manner in which self psychology complements my role as a therapist. In addition, it will include issues such as interventions and resistance and the ways that they are managed in a self psychological framework. Examples of instances in which my empathic connection with clients was disrupted, then repaired will be provided as well.

Self psychology was the first significant psychoanalytic theory in the United States that emphasized the importance of empathy in the therapeutic process, the role it plays in establishing a therapeutic relationship, and effecting change. It also differs from other psychoanalytic orientations in that it places no emphasis at all on the innate sexual drives that are characteristic of Freudian theories. The central goal for the therapist in self psychology is establishing a profound rapport with the patient based on an empathic connection, guided by the human need for healthy development of the self. Specifically, the needs that must be met are mirroring, idealizing, and twinship (Self Psychology Page.) Kohut’s theory stresses that our sense of well being, which depends on the ability to love and to work with energy, dynamism, humor and wisdom, is completely based on our sense of self. If we can manage to derive a sense of pride and happiness from our accomplishments, participate in and maintain intimate personal relationships, or grieve for the inevitable setbacks and losses we must experience while living a typical life, then the chances of developing a cohesive sense of self are maximized.

Heinz Kohut was motivated to change his thinking about the therapist’s role in the process when he realized that many of his patients felt that he didn’t truly understand them, and that they were justified in their thinking. He began to develop his theory of self psychology from one of his patients, who insisted that he be perfectly attuned to her every word (What Is Self Psychology?) The woman would become enraged when she felt that Dr. Kohut had misunderstood what she was saying, expressing that he was sabotaging the process by even slightly revising what she had intended to say. Freudian analysis would have interpreted this as resistance, or the client’s pushing back against uncomfortable feelings or anxiety because the therapist’s interpretation had touched on a sensitive area that needed to be defended against. Instead, Kohut realized that he had been unable to fully grasp the woman’s experience, and concentrated his efforts on understanding what she was saying exclusively from her point of view, or learning to empathize. He discovered that when he was able to respond to her in a way that reflected accurately what she was thinking and feeling, her sense of comfort and well-being returned.

According to Kohut, there are four distinct developmental phases of the human self:

• The nuclear self, with which all babies are born. It is a physically-based psychological identity that is a given, does not develop, but rather appears in each individual, beginning the path of the human self.
• The virtual self, or rather, the identity of the child as viewed by the parents. This self is projected onto the child by its caregivers.
• The cohesive self, or the juncture at which the interaction of the previous selves allows a child to control and organize its ego activities and
• The grandiose self, where the child sees himself as the center of the universe (Olivarez, 2011.)

Kohut viewed the therapeutic process as a continual cycle of empathic connections as well as inevitable disruptions that required working through each instance of empathic breaks in order to restore the therapeutic connection. The disruptions are considered to be a vital part of the relationship, as long as they are repaired, in order to develop a solid psychic connection and ultimately, a cure.

The therapist who practices self psychology must utilize all available tools to understand the basic needs of each individual client. Healthy narcissism is a positive feature of the vibrant and developing personality, since it is viewed as the evidence of a significant ambition with a strong drive to attain personal goals (Self Psychology.) This is in direct contrast with the usual connotation of the word “narcissism,” which is usually used as a negative term meaning self-absorption or selfishness. The therapist works with the client to determine early on in the treatment which needs have gone unmet: the need to idealize, or the need to be idealized. In working with people from a self psychological perspective, it can become fairly easy to spot early on in the treatment which of these categories a person falls into.

If someone comes into therapy and speaks about aspects of their life in a way that seeks to revoke an admiring, complementary response from the therapist, one can conclude that they have unmet needs to be admired because no one performed that function for them early on. An example of this from my own practice was when I worked with a student who had lost her part-time job. She attended all sessions dressed very glamorously, and presented herself in a flamboyant manner, drawing attention to herself, asking if I liked her outfits, if I noticed her haircuts, and other physical attributes. Her need to be admired by me was direct and constant, and I responded by providing her with the reassurance that yes, I thought her outfit was attractive, or yes, it sounded like her job interview had gone very well. After several weeks of this interaction, and receiving much affirmation of her positive behavior and attributes from me, she came in one day looking completely different: dressed almost sloppily, hair unkempt, clearly having a rough time of it. It was only then that she was able to express her depressed feelings of low self worth. Providing her with the positive regard that she had been needing for a time allowed her to drop her narcissistic presentation and reveal her innermost insecurities.

On the other hand, if someone comes to see his or her therapist and spends time commenting on the therapist’s skills, office, competence, or other issues in a highly positive manner, it would appear that they have a need to idealize, an unmet need based on the absence of a parent or caretaker who could be put on a pedestal when the client was in need of an adult to fill such a role. It is only in an atmosphere that is truly empathic that it becomes safe for a patient to openly examine his inner self and gain insight into the voids in his persona (Self Psychology.) A young man with whom I worked spent many sessions fantasizing about the glamorous high-rise apartment I must live in, my interesting life, including all types of well-known and connected people; I never corrected his perceptions, allowing him to engage in the idealization that he so needed, despite my discomfort with having his fantasies about me not being corrected by me.

Another key concept of self psychological theory is the self-object experience, which relates to the ways that a person’s sense of self develops and is sustained. According to Kohut, we are all born with an innate need to have connections with others, and to have confidence that these people can be relied on to provide us with the emotional tools that are required in order to develop fully as people. The specific needs that are required in this environment include: the validation and approval of the developing self, the pride that is reflected in a parent’s eyes when children show their achievements to them; the ability to merge with the positive features of the strong, idealized parents or caretakers; and experiences of basic similarity with other people (About Self Psychology.). These needs are never outgrown, according to Kohut. When life begins, they are met by parents or other nurturing caregivers; later on, those needs are fulfilled through other people such as peers, teachers, mentors, partners, and therapists.

When our self object environment does not meet our needs, frequently because of lack of empathic connection or understanding, the self does not develop in a cohesive way, often lacking stability or positive emotional responses to people. The result may be a feeling of alienation, identity confusion, and an inability to advocate for ourselves; in addition, depression may result as well as a lack of vitality, ambition, direction, and a sense of where one is headed. Typically, relationships, both personal and professional, are unsatisfying. These unmet needs become the focus of the self psychological treatment, an effort to establish an environment that is conducive to helping the self to develop or restore itself to a position that will strengthen the sense of self. The therapist seeks to create an environment that is empathic and utilizes insight and introspection to help the patient work through the dysfunctional adaptations that developed as a result of a deficient self object environment.

My own development as a clinician who practices self psychology has involved continually improving the process of maintaining an empathic connection with my clients through intent listening and hearing just what they are saying, and then responding in a way that mirrors them and let them know that I am right there with them in their experience. The reason that I believe this theory works so well for me in particular is that I have always been able to empathize with people rather easily. I pay attention to what people are saying both overtly and covertly, and try to respond to them in ways that are not judgmental but rather, supportive, and that convey understanding of what they have been saying. I have used my own experiences of sharing things with people and not being responded to empathically to learn just what not to say; in addition, I have learned that sometimes saying nothing is the best response as well is the most empathic one.

My role as the therapist is to provide a safe environment in which a person can feel free, although not necessarily comfortable, to share their innermost thoughts without fear of judgment. In addition, it is to convey a sense of the positive regard I hold for that client, as demonstrated by my acceptance of them, my empathic responses to them, my consistency in being welcoming to them regardless of their various moods, because I believe that ultimately it is that very positive regard and the relationship that I have formed with my client, which becomes the vehicle for change.

I have certainly had my share of empathic ruptures which have needed repairing. On one occasion, a student with whom I had been working for many months and who had always been extremely verbal as soon as she entered my office came to a session and sat in stony silence. I gently probed whether something was wrong, whether I had done something that had upset her, but she sat in silence, looking furious, for nearly the entire session. She did not say one word. We sat together, neither one speaking until about ten minutes. before the end of the session. Finally, she said, “The last time I came in, last week, you didn’t seem to be paying attention to a word I was saying.” I struggled to recall the prior week’s session, which day it was, what had possibly been happening with me that I would have been so inattentive to her. Finally I recalled that I had been having some blurry vision during that session, was alarmed, and had been blinking my eyes to try to clear up my eyesight. I told my client exactly what had been going on, “You know, there was something happening with me last week. My vision was blurry for a few minutes, and I was trying to clear it up, and obviously it was apparent to you that something was happening. But the problem was mine, and had nothing to do with you. I’m very sorry that I was so distracted, and I’m really glad that you were able to tell me so I could have the chance to clarify things. I am still as interested in what you have to say as I’ve always been.” This appeared to relieve my client, and she returned the next week, resuming the discussion of her issues. I was fortunate in this case, because the client returned the following week, giving me the opportunity to repair the therapeutic rupture that had occurred. This could just as easily have resulted in her dropping out of treatment, never showing up again because of her injured feelings, without my ever learning just what the problem had been.

Self psychology offers a different understanding of the concept of resistance from other theoretical orientations: rather than viewing resistance as something that is an obstacle to treatment, self psychology sees resistance as a set of tools that are utilized in order to protect a vulnerable self construct. They are viewed as the client’s efforts to maintain levels of organization that the patient has developed in order to cope with traumatic life situations (Rowe, 1996.) People can make progress in therapy if the therapist can understand their need to maintain their defenses for protection. This is in direct opposition to former therapeutic methods of how to respond to resistance, which was to “strip” people of their defenses. Instead, self psychology recognizes that people utilize a variety of methods to protect themselves from intolerable anxiety and other uncomfortable feelings, so that defenses are viewed more as survival tools then as defenses that need to be removed. Certainly, there is the danger of stripping people of their defenses when there is nothing formed yet that can replace those structures.

This application of resistance to my direct work with clients has been extremely productive since rather than confronting them about their resistance in a way that suggests that they are doing something wrong, I address the behavior as something completely predictable that occurs in therapy and suggest that we try to understand its meaning to the patient. If a client consistently comes late to sessions, or cancels sessions frequently, then we spend time together having the client attempt to sort out what is happening that is causing him or her to miss time in therapy. Rather than chastising the person, I explained that it is a normal part of the therapeutic process and that it is important for us to make sense of why the client needs to avoid time with me. Typically, this occurs either when we are addressing material that is extremely uncomfortable for the client, or when there has been an empathic rupture caused by something I have said or done, or not said or done.

Regarding multicultural issues, although they are certainly relevant in understanding the identity of any individual, I have found that the competent use of self psychology as a treatment modality is applicable to anyone, regardless of age, gender, ethnicity, or racial background. Empathy is empathy, and all human beings respond to being understood. Differences in ethnicity could conceivably cause the therapist to have to work a bit harder to understand where a client is coming from situationally, but for me, that only translates into asking more questions of the client so that they can clarify for me what it is that is happening for them. For example, at one point I was working with a population of inner-city pregnant teenagers, and while I had little in common with them regarding my ethnic background, there was a common humanness to their situations that we shared that involved being a teenager, dealing with issues of sexuality, and the pain and loss of having a relationship break up. These universal issues made it easy to empathize with my teenage clients, despite our vast differences in background.

While I believe strongly in the merits of self psychology and it has been the perfect theoretical orientation for me in working with people, I have found that other colleagues simply don’t understand the concept of empathy and how healing it is for human beings to feel understood and accepted. A coworker of mine remarked, “What’s the big deal about empathy? Of course everyone is nice to their clients.” I was compelled to try to explain that empathy does not equal “being nice to your clients” but rather, it means joining with the client’s subjective emotional experience and conveying that.

It is extremely challenging to focus one’s energy on trying to understand and feel exactly what a client is expressing. In trying to explain the principles behind empathic understanding, I used the explanation that when a client is having a hard time emotionally, I am not feeling sorry FOR them, I am feeling sorry WITH them. I don’t believe that everyone who practices mental health treatment is capable of joining with clients emotionally in that way. Naturally, the issue of maintaining appropriate boundaries when practicing self psychology is crucial, because many times, the attachments that clients feel for their therapist can be extremely strong; after all, in some situations, I have been the first and only person who has ever come close to paying attention to and truly understanding them. Clients’ feelings of love, or rather their perception that it is love, need to be addressed, acknowledged, and put into perspective in ways that do not injure them emotionally and make them feel rejected or embarrassed.

Although Heinz Kohut is very difficult to read in his original writings, the ideas that he espoused which formed the basis for self psychology are brilliant. In particular, they have been the most significant theoretical basis for my clinical practice, because there is a natural fit with my specific personal qualities, in particular, my ability to empathize with people and convey caring and acceptance in a way that helps them move forward. Not many of my colleagues are familiar with self psychology, but when I have taken classes and seminars about this theoretical model, it has been very gratifying to talk with other clinicians who believe in this treatment modality. I believe that my success with clients has progressed to a completely different level with the application of self psychology to our work.

Bibliography

Corey, G. (2009). Theory and Practice of Counseling and Psychotherapy. Belmont, CA: Thomson-Brooks/Cole.

Olivarez, B. (2011, January 6). Self Psychology Theory. Retrieved November 4, 2011, from Helping Psychology:http://helpingpsychology.com/self-psychology-theory

Palombo, Joseph  (2009). Guide to Psychoanalytic Developmental Theories. New York: Springer.

Rowe, C. E. (1996). The Concept of Resistance in Self Psychology. American Journal of Psychotherapy , 50(1): 66-74.

Strisik, P. (2010). Types of Psychotherapy Approaches. Retrieved November 4, 2011, from http://www.strisik.com/therapy/approaches.htm

What Is Self Psychology? (n.d.). Retrieved November 4, 2011, from Self Psychology Page: http://www.selfpsychology.com/whatis.htm