This section provides a brief overview of key clinical models available to the addiction counselor.

SIGMUND FREUD’S PSYCHOANALYTIC THERAPY

Psychoanalytic Therapy (also called psychodynamic and psychoanalysis) is based on the assumption that behavior results from the conflict between the conscious and unconscious minds, and biological and social forces (H. S. Friedman & Schustack, 2003).

Every personality has three parts: id, the source of psychic energy that drives the instincts for survival and pleasure; superego, the conscience that promotes personal ideals and acts as moral judge of right and wrong; and the ego, the executive part that mediates between id and the superego, between inner strivings and reality, and tries to maintain mastery over the id’s drives (Corsini & Wedding, 2001).

Freud (1961) postulated that all human motivation derives from a biological drive to obtain pleasure and avoid pain—a dynamic he called “the pleasure principle” (Freud, 1958).

According to Freud, a client’s adult pathology can be traced to early sexual development, particularly a lack of sexual gratification during one of five psychosexual developmental stages that Freud labels oral, anal, phallic, latency, and genital.

THERAPEUTIC APPROACH

The client comes into the therapist’s office, reclines comfortably on a couch, and free associates (there is no predetermined agenda) about thoughts that come spontaneously to mind.

The counselor helps the client uncover unconscious dynamics by going with the flow of these unplanned expressions. The therapist helps the client understand how unconscious ego states and defense mechanisms can negatively impact personal development.

Although the following ego defense mechanisms may help a client manage unwanted emotions, they can also impede emotional growth: Repression (pushing a memory out of conscious memory), Regression (returning to an earlier stage of development), and Reaction Formation (reacting in the opposite way to an unacceptable impulse) (Corey, 2000).

Additional Resources

Dr. C. George Boeree provides a user-friendly introduction to the core work of Freud at www.ship.edu/∼cgboeree/freud.html.

CARL G. JUNG’S ANALYTIC PSYCHOANALYSIS

Fascinated with the importance of spiritual development for an individual’s mental health, Jung also assumed that people can find their place in the world by understanding their unconscious mind.

He believed that each person has a personal unconscious made up of repressed events, wishes, feelings, and conflicts and also shares a “collective unconscious”—memories of their ancestral and racial heritage.

These latter memories are organized around images called archetypes (Howatt, 2000).

THERAPEUTIC APPROACH

The unconscious mind, once explored, opens the door for healing mental illness ( Jung, 1954a). Dream Analysis, Jung’s method for communicating with the unconscious mind, reveals archetypes that the therapist interprets for the client ( Jung, 1954b).

Although addiction counselors may not be trained in Dream Analysis (which takes years), they can use two counseling applications—personality and spirituality. Exploring personality traits such as introversion and extroversion assists clients in understanding how they interact with others.

Jung’s seminal work on extroversion and introversion led to the development of the Myers- Briggs Type Indicator (Howatt, 2005). Clients may complete this scale and use the results to develop awareness and determine core competencies needed to support their recovery.

As the history of Alcoholics Anonymous shows, addressing and strengthening spirituality in daily living can be vital in helping clients recover from their addictive disorders and develop healthier personalities.

Additional Resources

See the Jung web site at www.cgjungpage.org.

ALFRED ADLER’S INDIVIDUAL PSYCHOLOGY

Adler taught that each client pursues fictional goals in an unhealthy quest for superiority. Unrealistic goals may be overwhelming and lead to discouragement and such self-destructive behaviors as crime, addiction, and psychosis (Adler, 1929, 1958).

THERAPEUTIC APPROACH

The first step—assessment—is to learn about the client’s family of origin, birth order, early recollections, dreams, and current life tasks. Next is helping the client develop insight about the cost of trying to fulfill unrealistic goals. With these insights, the client makes new, healthier goals.

To move the client away from feelings of discouragement and inferiority, the therapist helps the client make a realistic action plan and develop the necessary skills to achieve his new goals (Howatt, 2005).

Other Adlerian techniques, such as the Magic Wand and Confrontation, can also be used (see “Counseling Techniques” later in Part IV).

Additional Resources

See the web site of the International Association of Individual Psychology at www.iaiponline.org.

CARL ROGERS’S PERSON-CENTERED THERAPY

Rogers’s client-centered philosophy assumes that each person is, by nature, good, worthy, and valuable (1951). This person-centered therapy trusts that clients have within themselves resources to improve their life situation. If this inner potential and ability emerges, the client needs only support, not direction.

THERAPEUTIC APPROACH

This nondirective and nonconfrontational counseling method assumes clients possess innate ability to evaluate and wisely choose their behaviors.

The effective counselor adheres to what Rogers (1959) calls three core conditions of counseling: (1) empathy—responding to the client with intense interest, valuing the client’s perception of the world and the meaning they attach to it; (2) congruence—being honest and consistent in behavior and thought; and (3) warm regard—showing nonjudgmental, accepting, positive regard for the client through word and deed.

These three core conditions may appear simple, but their mastery takes a strong commitment of time and effort by the counselor.

Additional Resources

Visit the Center of Studies of the Persona at
www.centerfortheperson.org/organizations.html.

FRITZ PERLS’S GESTALT THERAPY

Awareness, the principal goal of Gestalt Therapy (Perls, 1969), comes by focusing on clients’ present situations and current behaviors, how they perceive their behaviors and how they interpret their experiences (Corey, 2000).

The therapist observes only the client’s behavior and does not attempt to determine the causes of the behavior.

THERAPEUTIC APPROACH

Awareness, the therapist’s principal tool, is achieved by exploring current behaviors, feelings, and thoughts. The therapist assigns homework and assists the client in creating life experiments that demonstrate and reinforce how maladaptive behaviors have a negative impact on health and wellness.

Experiments may include role-play to stress dysfunctional interaction patterns and to experiment with healthier ways (Perls, 1969, 1973). Getting to the core of personality, Perls states, is much the same as peeling off the layers of an onion.

These are the five layers of awareness (metaphoric onion): (1) phony—responding to others in an inauthentic and stereotypical manner; (2) phobic—avoiding the pain of realistic self-examination and taking responsibility for one’s own actions; (3) impasse—stalling in the present level of maturity; (4) implosive—starting to get in touch with true self by questioning defense mechanisms; (5) explosive—a great release of energy when one finally lets go of all phony roles and pretenses (Howatt, 2000).

Because impasse in therapy is caused by the client’s defense mechanisms (e.g., introjections—accepting others’ beliefs without testing them), the therapist designs experiments to teach the client about these layers of awareness and how defense mechanisms underlie faulty perceptions of reality.

Additional Resources

For more information about Gestalt Therapy, see www.gestaltri.com.

IRVIN YALOM’S EXISTENTIAL PSYCHOTHERAPY

Existential means pertaining to existence. Working with the conscious rather than the unconscious mind, existential counseling seeks to ask and answer fundamental questions about being a human being (e.g., finding meaning in life) and the struggles inherent in this existence.

Yalom (1981) postulates that many psychological problems are directly rooted in one of four ultimate concerns: death (there is no escape), freedom (each client is free to define his or her own world), isolation (there is a gulf between self and others and self and the world), and meaninglessness (how one defines the meaning of life and its purpose).

THERAPEUTIC APPROACH

The therapist assists the client in exploring each of the four ultimate concerns and provides examples of how addressing them can improve life. As active participants, therapists share their personal views and ask questions related to the client’s internal struggle.

For related strategies such as helper self-disclosure and paraphrasing, see Counseling Techniques and ClinicalMicroskills, later in Part IV.

Additional Resources To learn more, visit the web site at www.yalom.com.

VIKTOR FRANKL’S LOGOTHERAPY

Viktor Frankl, observing how he and his fellow prisoners coped with extraordinarily stressful circumstances in Nazi concentration camps, concluded that circumstances and events in the outer world (things outside the inner self) do not matter as much as the ultimate freedom of people to determine the meaning of their situation.

In his classic book Man’s Search for Meaning, Frankl (1963) explains that, although brutal guards may have inflicted suffering and pain on his body, they could not control his mind.

Logotherapy, the idea that clients have the ability and responsibility to make their own choices regardless of their environment, assumes that a client always has a choice; and no-choice is still a choice.

THERAPEUTIC APPROACH

The therapist teaches clients how to avoid the victim role by mentally separating from their external environment and taking responsibility for their own lives. Two of Frankl’s techniques are dereflection (turning clients’ attention from their problematic situation to the creative ways they are coping or could cope) and paradoxical intentions (encouraging an exaggerated form of the undesired behavior).

Additional Resources

To learn more, visit the web site at http://logotherapy.univie.ac.at.

ALBERT ELLIS’S RATIONAL-EMOTIVE BEHAVIOR THERAPY

Ellis postulates that most, if not all, of a client’s emotional problems result from irrational thinking, and moreover, everyone can learn how to think effectively (Ellis, 1962). Directive and didactic, this cognitive-behavioral approach works with clients at a conscious level, teaching new insights and skills in the therapist’s office to be practiced at home.

Ellis’s Rational-Emotive Behavior Therapy (REBT) shares a common thread with Glaser’s Reality Therapy and Beck’s Cognitive Behavioral Therapy, all of which use problem-solving and learning by employing new behavioral skills (discussed in the paragraphs that follow).

THERAPEUTIC APPROACH

REBT addresses the client’s irrational thinking with an ABC model: (1) Activating Event—an external event that upsets the client; (2) Belief—client’s irrational belief about A; and (3) Consequences—what clients do and feel in response to their irrational belief about the activating event (Ellis, 1994).

Next the counselor focuses on the DEF part of the ABC model: (4) Disputing— the counselor challenges the client’s irrational thinking and conclusions about A and B. Using techniques such as REBT homework sheets, the counselor teaches the client to recognize irrational thinking and to think realistically; (5) Effect— cognitive change in the client, rational thinking; and (6) Feeling—instead of anxiety or depression, client’s feelings are appropriate to the situation.

Additional Resources

To learn more about the works, training, and publications of Ellis, visit www.rebt.org.

WILLIAM GLASSER’S CHOICE THEORY AND REALITY THERAPY

Choice Theory assumes that individuals choose most of their behavior and that it is internally motivated by the need to meet one or more of the following basic needs: love and belonging (the most important), power, fun, freedom, and survival. All behavior is total, meaning that clients’ actions will affect their thinking, which in turn will control feelings and physiology.

Using a car as a metaphor, Glasser (1998) teaches that what the front wheels (behavior and thinking) do, the rear wheels (feeling and physiology) will follow. For example, a depressed, lethargic client who is sitting around the house can change his or her emotional state by doing something different.

THERAPEUTIC APPROACH

Based on choice theory, reality therapy seeks to help clients build their love and belonging relationships. Glasser (1998) names Seven Caring Habits: supporting, encouraging, listening, accepting, trusting, respecting, and negotiating differences.

He also identifies Seven Deadly Habits: criticizing, blaming, complaining, nagging, threatening, punishing, and bribing or rewarding to control. Promoting the concept of an internal locus of control (self-responsibility), reality therapy offers a frame of reference to help clients see why they do what they do and how changing any element (e.g., spending time around the house) will change other aspects of the whole (e.g., feeling depressed and having low physical energy).

Therapists ask strategic questions—What do you have now that meets your needs? What do you want? What are you doing to get what you want? Is what you are doing working? Reality therapy helps clients learn to meet their own needs.

Additional Resources

To learn about Glasser’s work, training, and writing, visit www.wglasser.com. 

AARON BECK’S COGNITIVE BEHAVIORAL THERAPY

Based on the premise that most of a client’s negative thinking derives from automatic faulty thinking, Beck (1976) suggests that the client’s present difficulties (e.g., depression) result from thinking errors and negative thinking.

The therapist’s goal is to help the client become aware of negative thought patterns and change them. Beck authored four popular clinical scales: Beck Depression, Beck Anxiety, Beck Hopelessness, and Beck Suicide (see Part III).

THERAPEUTIC APPROACH

The therapist first reduces the client’s present level of anxiety by using empathy and reframing, then uncovers and monitors the client’s faulty processing and negative schema. Using Socratic dialogue (thoughtful questioning of client), the client is taught how to think more accurately and effectively.

After this, therapist and client design a behavioral experiment to test the client’s beliefs and assumptions. Finally, behavioral strategies are implemented (e.g., journaling) to reinforce the new skills designed to prevent further faulty processing. Cognitive Behavioral Therapy (CBT) works best, Beck (1970) explains, with clients who have acceptable reality levels (no delusions).

Additional Resources

To learn more, visit the Beck Institute at www.beckinstitute.org.

ERIC BERNE’S TRANSACTIONAL ANALYSIS

Berne taught that everyone interacts from three ego states—each with its own feelings, thoughts, and ways of behaving—that make up the human personality: Parent, Adult, and Child (Berne, 1972).

THERAPEUTIC APPROACH

Helping clients develop a healthy life script—“I’m OK–You’re OK ”—is the clinical objective (Berne, 1961). All clients have the potential to make change and have a part in them that is acceptable to others.

The actual work of Transactional Analysis (TA) revolves around four constructs: (1) exploration of transactions— what people say and do to and with each other; (2) games and cons—the games people play to get what they want; (3) scripts—how feedback from early transactions in childhood affect adulthood; (4) structures—the analysis of the different ego states a client communicates from in different transactions.

“Strokes” (i.e., positive feedback) is one of the biggest motivators for behavior (Berne, 1961).

Additional Resources

To learn more, visit the International Transactional Analysis Institute at www.itaa-net.org. 

OTHER BEHAVIORAL APPROACHES

Several other key behavioral approaches are available, such as Pavlov’s classical conditioning, Skinner’s operant conditioning, and Bandura’s social learning theory. Although each stands alone as an independent therapeutic model, they all emphasize the environment’s impact on behavior.

Pavlov (1960) taught that behavior is the result of conditioned reflexes whereas B. F. Skinner (1971) states that behavior is the result of rewards (positive or negative). Bandura (1977) emphasizes that a person can learn by simply observing the environment.

THERAPEUTIC APPROACH

The counselor designs activities in five stages to help the client modify unwanted behaviors: (1) study the client’s present behaviors; (2) define the primary problems; (3) determine client’s goals; (4) select interventions and make an action plan; (5) start action plan, monitor, and follow up (Wilson, 2001).

Additional Resources

To learn more about Behavioral Therapy visit the Association for the Advancement of Behavioral Therapy, a comprehensive source of the current thinking and advancements in behavioral therapy at www.aabt.org.

See also, James, R. K., & Gilliland, B. E. (1998). Theories and strategies in counseling and psychocounseling (4th ed.). New York: Allyn & Bacon, for detailed reviews of the most commonly used counseling theories applicable to addiction counseling. Howatt, W. A. (2000).

The human services counseling toolbox. Pacific Grove, CA: Brooks/Cole, contains information on theory, techniques, and strategies for working with persons with addictive disorders; it was developed with students learning to be addiction counselors.

See also, Corsini, R. J., & Wedding, D. (Eds.). (2001). Current psychotherapist (6th ed.). Belmont, CA: Brooks/Cole (a detailed book on counseling theory).