The profession of counseling is dynamic, adaptive, and centered on meeting the needs of individuals in their particular environment. The goals of the counseling profession are directed toward assisting individuals to become self-sufficient and capable of managing their problems in efforts to lead productive, fulfilling lives. Moreover, the counseling process provides a therapeutic context to help individuals recognize and effectively use unused or underused resources and opportunities. Hence, through the process of counseling, individuals become effective and empowered self-helpers as they learn how to manage problem situations and develop life-enhancing opportunities. Counseling is a collaborative, two-way process that involves active involvement between client and counselor. According to Gerard Eagan, the process of counseling represents an “-ing” word that illustrates active engagement and involvement in a series of therapeutic activities or interventions that will create and elicit constructive change. The art of counseling involves a process in which skilled counselors assist individuals to develop tailored programs that will encourage constructive change in efforts to live more fully. Individual counseling is driven and determined by client needs and is effective to the degree that the needs and concerns of clients are successfully met.
According to Carl Rogers (1902-1987), the counseling relationship is characterized as a relationship in which one person has the objective to promote growth, development, and maturity in another person with the goal to assist the other person to learn how to effectively cope with life. The counselor’s role is to facilitate self-growth in individuals and to make individuals aware of possible alternatives or choices available in their lives. Counselors have the responsibility to ascertain by means of conducting a thorough assessment which counseling interventions, services, and treatment modalities will most likely lead to positive outcomes. In particular, competent counselors will amalgamate research with practice in efforts to afford quality service to clients. The goals of counseling, regardless of the occupational setting, involve behavioral, cognitive, and lifestyle change; insight and self-knowledge; and amelioration of suffering and symptomatolology. Professional counselors provide an array of services that promote mental health and well-being through a variety of counseling practices that range from individual counseling, to couples and family counseling, to group counseling.
The profession of counseling is rooted in a variety of disciplines, which has led to the development of a variety of counseling specialties, in the fields of marriage and family counseling, school counseling, rehabilitation counseling, college counseling, and addiction counseling, to name a few. Hence, counselors work in a variety of occupational settings, from private practice; to community mental health agencies; to medical, educational, jail, and prison settings; to business settings, and they offer a wide range of services to a diverse population of individuals.
Historical Perspective of Counseling
The profession of counseling is considered to be a relatively new occupation. Prior to the 1900s, professional counseling took the form of advice or deliverance of information. The evolution of counseling can be traced back to important historical events of the 20th century. The counseling profession developed and emerged consequent to the convergence of societal problems that plagued the United States at the turn of the 19th century, most notably the Industrial Revolution and the urbanization of America. Other factors that contributed to the growth and advancement of counseling in America include the advent of World War I and World War II, the Great Depression, the science and development of psychology as an occupation, the mental hygiene movement in the early 1900s, the mental health movement in the mid-1940s, the vocational guidance movement in the late 19th and early 20th centuries, and continued emphasis in vocational counseling. Government involvement also influenced the course of professional counseling by means of government-sponsored counseling services.
Theories of Counseling
Psychoanalytic Theory
Psychoanalysis evolved from the work of Sigmund Freud (1856-1939), founder of psychoanalytic therapy in the late 19th century. A dedicated student, Sigmund Freud completed medical school at the University of Vienna in 1881. Freud’s initial occupational endeavors and contributions to the medical profession consisted of neurological research that focused on the brain and spinal cord. However, Freud’s research focus shifted as he became interested in the work of Josef Breuer, a famous physician who practiced in Vienna, Austria. Breuer specialized in treating individuals who suffered from emotional disorders and implemented the use of hypnosis and verbal expression as methods of treatment. During this time, Freud began to invest his professional energies into the study and treatment of neurotic disorders. As Freud began to involve himself in researching and counseling clients who suffered from psychological disorders, he eventually came to emphasize the importance of human sexuality, sexual expression, as well as dreams as key to understanding human nature.
Prior to Freud, the discipline of psychology was regarded as both a philosophy and a study of psychophysiological processes. The notion of scientific thinking as it related to the study of the human mind and human motivation began to define the practice of psychology with the commencement of psychoanalysis. The historical timeline of psychoanalysis can be divided into three periods, dating from the late 19th century and continuing into the present day. The initial period that marks the beginning of the psychoanalytic movement was dominated by Freud in the late 19th century and continued until the end of World War I. To understand the fundamental tenants of psychoanalysis that developed out of the work of the early psychoanalytic pioneers, it is first essential to recognize the social context the dominated Western Europe and Viennese society in the late 19th century. During this time, Victorian society was governed by strict adherence to defined social norms, particularly as they related to human sexuality. Above all, female expression of sexuality was strictly confined and governed, which, in turn, encouraged repression or denial of sexuality among women. At the turn of the 20th century, the first psychoanalytic society was organized in Vienna; shortly thereafter, psychoanalysis began to gain momentum and recognition, which led to the formation of the International Psychoanalytical Association.
The second historical period of psychoanalysis began shortly after World War I, from 1918 to 1939. The emergence of psychoanalytic training institutes and psychoanalytic societies worldwide mark this period. It was during this time that scientific literature and case studies that demonstrated the work of psychoanalysts began the expansion of psychoanalytic thought and study. The third period of psychoanalysis began post-World War II (1945-) and continues into the present day. The significance of this period is marked by continued international expansion of psychoanalysis, as well as an expansion of psychoanalytic thought beyond Freud’s traditional psychoanalysis. New theories of ego, object relations, and self psychology have emerged as contemporary, modern theories of psychoanalysis.
Psychoanalysis is recognized and defined as a depth psychology. The goals of psychoanalysis are aimed at resolving conflicts that reside at the unconscious level in efforts to change personality. Furthermore, psycho-analysis places emphasis on problem resolution and enhancement of coping resources in order to equip individuals to learn how to effectively manage their lives and to live in relation to others in a meaningful way. Intervention strategies that comprise the psychoanalysis process revolve around working through unresolved developmental problems. Interventions that are widely employed in psychoanalysis involve free association, analysis of dreams, analysis of transference, resistance, interpretation, and the study of the dynamic relationship between client and counselor. Other analytic techniques include interpretation, which involves bringing into conscious awareness of unconscious material, confrontation, clarification, and working through. The process of working through is a significant analytic procedure and refers to the continued analysis of resistance (form of psychological defense) once clients gain insight and awareness of their well-established unconscious conflicts. The procedure of working through helps clients to unblock and erode unconscious repressive or defensive mechanisms in efforts to create lasting change in personality and character structure.
Recent developments in the delivery of health care in the United States have had a well-defined impact on the current practice of professional counseling. Most notably, the rise of managed care has created significant changes in the funding and delivery of mental health treatment. A salient implication in how the practice of counseling has been impacted by managed care rests in the increased use of time-limited brief therapies and solution-focused interventions. Given that psychoanalysis is recognized as an extended, long-term depth psychology that requires both time and money, the practice and incorporation of psychoanalysis has lost popularity and favorability in the United States.
Cognitive-Behavioral Theories
Cognitive-behavioral theories are a set of related theories that have emerged from the clinical experiences, scholarly writings, and empirically based studies that were conducted by psychologists who studied and conceptualized human behavior from both behavioral and cognitive theoretical orientations. Cognitive-behavioral theories represent an extensive theoretical system within the profession of counseling. Theories that are cognitive-behavioral represent an amalgamation of both cognitive and behavioral oriented approaches to counseling people. Cognitive-behavioral theoretical orientations place emphasis on the mutual influence between cognitions and behaviors within individuals. These theories do not place importance on clients’ feelings, insight, or the exploration of unconscious processes. Furthermore, cognitive-behavioral theories are concerned with present issues and place little value on exploring childhood issues or on past histories of individuals. The basic philosophy that underlies the cognitive-behavioral approaches suggests that cognitions are mediators of behavior.
Since cognitive-behavioral theories represent an amalgamation of behavioral and cognitive theories, the evolution and development of cognitive-behavioral treatment modalities trace back to the 1950s, with the earlier works of behaviorists and cognitive therapists. Behavior therapy was defined, shaped, and prevailed as an approach to counseling and psychotherapy from the contributions and works of three leading behaviorsts: John B. Watson (1878-1958), an American psychologist who is also referred to as the “father of behaviorism”; B. F. Skinner (1904-1990), an experimental psychologist; and Joseph Wolpe (1915-1997), a South African psychiatrist. By the 1980s, behavior therapy had gained status and recognition among the mental health profession. Albert Ellis (1913-), an American psychoanalysis, and Aaron Beck (1921-), an American psychiatrist, are considered to be two of the most influential contributors in the development of cognitive therapy. Cognitive-behavior theories emerged as a result of the integration of both cognitive and behavioral theories.
Just like there are a wide range of cognitive-behavioral theories, there are a number of cognitive-behavioral treatment interventions. Cognitive-behavioral interventions are considered to be structured, goal directed, didactic, and time limited in nature. Cognitive-behavioral strategies may include the use of humor, homework, risk-taking exercises, systematic desensitization, bibliotherapy, and stress inoculation training. The application of cognitive-behavioral interventions incorporate both behavioral (reinforcement, positive reinforcement, negative reinforcement, extinction, shaping, and stimulus control) and cognitive interventions (identifying distortions in thinking, thought stopping, positive self-statements, cognitive restructuring) that emphasize the importance of cognitive processes and behavior mediation. In essence, cognitive-behavioral theories place emphasis on identifying cognitive and behavioral deficits and excesses.
Family Therapy Theories
According to Samuel T. Gladding, a family is defined as individuals who are bonded through historical, emotional, or economic connections and who perceive themselves as being biologically and/or psychologically related to each other. This definition of family encourages a wide conceptualization in defining who comprises a family unit as well as acknowledging the varying compositions of family life.
Family counseling is considered to be a relatively new profession in the mental health field. The evolution of family theory can be traced back to the mid-20th century. Prior to the 1940s, family theory was nonexistent within the counseling profession due to the popularity and preeminence of individual psychoanalysis and behaviorism. The fruition of family theory evolved as a result of multiple historical events that transpired in American life during and after World War II. In the advent of World War II, many families experienced considerable stress and systemic changes as family members were geographically separated from one another. World War II also challenged traditional gender-specific roles as women were expected to work outside the home in factories to support the war efforts. In addition, mass casualities, as well as physical and emotional disabilities, added further strain to family life. Post-World War II, women began to reject their roles as housewives and began to reevaluate their status in society, which marked the advent of women attending college. It was during this time that courses in family life education gained popularity. Another hallmark event that influenced the evolution of family therapy was the development and appreciation of professional marriage counseling.
The practice of family therapy began to flourish in the 1970s. Consequently, as family theory and family counseling gained momentum and professional recognition in the United States, mental health professionals began to have new ways to conceptualize human behavior and individual psychopathology. The advent of family counseling marked a shift in the way that individual pathology and symptomatic behavior were explained and understood. Family theories emphasized the etiology and maintenance of pathology as existing within a larger social system, that being within the family. Such a systemic perspective invited a shift from treating the individual family member to treating the entire family.
The practice of family therapy is based in systems theory, which conceptualizes families as living social systems who seek to maintain homeostasis through patterned and predictable transactional patterns. Systems theory contends that change in any part of a system subsequently creates deviation from the status quo and, in turn, affects the entirety of a system. When applied to family counseling, systems theory recognizes that family dysfunction is meditated by maladaptive interactions between family members that subsequently have an effect on the whole family system. Family counselors incorporate techniques throughout the course of family counseling in efforts to elicit the process of change that will accordingly transform the basic structure of the family system.
There are several family therapy theories and approaches to counseling families. The majority of family theories focus on interpersonal dysfunction and maladaptive interactional patterns, whereas individual counseling targets intrapersonal dysfunction. The primary goal of family theory is best perceived as eliciting structural change within the whole family system. This concept of systemic familial change represents a sharp deviation from that of individual counseling, in which the primary objective is intended to initiate behavioral, cognitive, and affective change of an individual. The term family theory houses a wide variation of distinct family therapy approaches, with each ascribing its own family counseling theory and approach to counseling families. In general, the application of family counseling consists of identifying dysfunctional communication and relational patterns within the family system, as well as ascertaining issues related to hierarchy, power dynamics, and problems within the family structure. Furthermore, family counseling identifies boundary problems, dysfunctional transactional patterns, and family role conflicts.
To date, there are a number of family therapy theories, such as conjoint theory, strategic theory, structural theory, transgenerational theory, and narrative theory, which all approach family counseling from different frames of reference. Each theory integrates different techniques and interventions when counseling families. It is important to note that no matter what family theory a family counselor is counseling from, the fundamental goal of family therapy is the restructuring of some part of the family system.
Brief-Therapy Theories
Toward the late 20th century, the counseling profession and practice of counseling began to shift and embrace the use of brief therapies in response to the limited mental health resources and pressures from managed care organizations to contain rising costs of mental and medical health care. The advent of managed-care systems has created substantial implications for professional counselors, most notably in the number of counseling sessions that are allotted and approved and in the selection, deliverance, and implementation of clinical duties and counseling interventions. Brief therapy can be quantified as time-limited treatment that typically consists of 8 to 12 counseling sessions.
Brief, time-limited counseling is an all-encompassing topic that incorporates many different theories. It will be illustrated through the time-limited counseling modality of brief solution-focused therapy (BSFT). The practice of BSFT is considered a time-limited, cognitive-behavioral treatment orientation that focuses on individual strengths and resources. The process of BSFT is collaborative in nature between client and counselor in efforts to assist clients in developing solutions to resolve personal difficulties. Key constructs of BSFT illustrate the creation of meaning, use of language to assess how individuals perceive and create the world around them, responsibility for self, and utilization of unused resources.
Counselors who practice from a BSFT modality believe that individuals create meaning in their lives and construct reality through the use of language. A fundamental belief of BSFT is that objective reality is nonexistent, since the construction of reality and mere act of describing experiences require interpretations that are rooted in the subjective. Brief solution-focused therapy counselors ascribe to the beliefs that individuals are the experts of their own lives, are capable of initiating change, and espouse self-corrective inclinations. The clinical practice of BSFT places emphasis on competence rather than on pathology or character deficits. Furthermore, BSFT acknowledges that focusing on problems is not beneficial nor is it helpful for individuals; rather, counselors collaborate with individuals to help them define and create solutions. In doing so, the change process pivots around solution talk rather than problem talk.
Current Trends Within the Counseling Profession
The profession of counseling is an ever-evolving occupation that is constantly changing and shifting to meet the growing demands and needs of society. Societal issues that continue to be salient to the counseling profession in the early 21st century are advancements in media and technology; issues pertinent to wellness, health promotion, spirituality, social justice, diversity, and advocacy; and issues related to managed care and health maintenance organizations. Other current trends within the counseling profession that highlight prominent concerns and shed light on complex societal and multifaceted issues include poverty, violence, and social unrest. In response to heightened incidents of school violence in the forms of school bullying and school shootings, counselors are becoming increasingly concerned with the need to develop crisis plans and methods of intervention that will stop acts of violence and bullying within school settings. Hence, issues of promoting and maintaining school safety represent pressing issues for counselors in the 21st century.
Of these noteworthy issues that have had a pervasive impact on the delivery of counseling services, one of the most defining moments that has shaped the course of the counseling profession was the terrorist attacks on September 11,2001. This momentous event has had a profound impact on the mental health community, most notably, the demand and large-scale need of crisis intervention services. Following the aftermath of September 11, 2001, when terrorists crashed commercial airliners into the World Trade Center in New York City and into the Pentagon in Washington, D.C., issues pertinent to immediate responsive actions to traumas, tragedies, and crises took on a new meaning within the mental health community. Specifically, such a defining moment highlighted the need for counselors to be trained and competent in implementing and delivering crisis services to individuals affected by large-scale trauma and tragedy.
Other noted salient issues within the counseling profession in the new millennium include dealing with poverty, family discord, workplace violence, funding of mental health services, and caring for the aging.
Wellness
Wellness is not a new concept. Dr. Halbert Dunn first coined the term wellness in 1961, and he defined it as unified functioning directed toward maximizing an individual’s potential. Dunn defined complete well-being by focusing on the interrelatedness among mind, body, family, and community. The concept of high-level wellness is conceptualized as optimal functioning of the individual.
Wellness is a basis of life quality and involves embracing health-enhancing values and lifestyle behaviors that promote health or illness-free states.
The tenant of wellness revolves around the concepts of health promotion, disease prevention, and well-being. Furthermore, the concepts of wholeness, integration, purposeful living, and good health are used to conceptualize the construct of wellness. Perhaps the most salient aspect of a wellness philosophy is that it challenges the long-established belief of repairing something only when broken. A wellness approach attempts to move beyond such a reparative conceptualization by focusing on prevention rather than on remediation. Wellness is viewed as pertaining to the total person and is conceptualized as existing on a continuum throughout the life span. Thus, wellness is a lifelong, continuous, and proactive process rather than a one-time prescription. Such a deliberate health-conscious process is construed as an ideal, dynamic, fluctuating state of being. Positive wellness is to be attained through concerted, purposeful efforts to promote optimal functioning, rather than a state that exists succeeding reparative work related to a deficit in one’s state of wellness. The notion of “well-being of the many” underscores the holistic perspective of wellness and gives emphasis to the idea of wellness of individuals, community context, and societal structures.
A wellness movement has gained momentum across the United States as a result of the pressing realities of increasing health care costs and alarming rates of premature morbidity and mortality due to unhealthy lifestyle behaviors. The wellness movement signifies a cost-effective and humane paradigm shift that is a distinct departure from a medical system that has exhausted the nation’s financial resources.
A contemporary paradigm of wellness has emerged within the last decade that has provided a refreshing approach to health and wellness. During the late 20th century, Dr. Jane Myers and Dr. Tom Sweeney considered the notions of prevention and well-being as they related to individuals’ overall total health. These two researchers and counselor educators have proposed and created several wellness models in efforts to view wellness from a holistic, multifaceted frame of reference. Most notably, their indivisible self model of wellness represents a contemporary, evidence-based model of wellness that highlights the reciprocal interactions between environmental factors and human behavior. The indivisible self model of wellness conceptualizes wellness across the life span and consists of 17 discrete dimensions of wellness; 5 second-order factors, identified as the essential self, social self, creative self, physical self, and coping self; and 1 higher-order wellness factor. The essential self consists of 4 dimensions, including spirituality, self-care, gender identity, and cultural identity. The creative consists 5 factors, including thinking, emotions, control, positive humor, and work. The social self consists of friendship and love. The physical self consists of exercise and nutrition. The last factor is the coping self, which consists of realistic beliefs, stress management, self-worth, and leisure.
Counseling and Wellness Promotion
Inherent to the role of professional counselor is the promotion of wellness and enhancement of quality of life. The American Counseling Association (ACA) in 1992 underscored the significance of wellness promotion as the foundation to the counseling profession. Counseling for wellness pivots around the salient belief that wellness constitutes purposeful choice and decision making regarding lifestyle and healthy living; individuals who make healthy lifestyle choices will experience greater happiness, life satisfaction, longevity, and overall well-being.
A primary function that counselors have in the promotion of wellness is to encourage and endorse the process of client self-awareness, self-acceptance, and responsible living in efforts to promote a healthy lifestyle. By espousing and introducing a holistic wellness approach to the counseling process, professional counselors can further perpetuate the guiding philosophy of wellness, that being an acknowledgment of the whole person. The profession of counseling is rooted in a strength-based approach when working with clients, much like the underpinnings of wellness paradigms that also focus on engendering a sense of self-empowerment and optimal functioning. The nature of the counseling profession requires that counselors create and maintain a safe and supportive therapeutic environment that will encourage positive growth and desired change. Moreover, professional counselors are committed and obligated to enhance and increase clients’ knowledge base regarding holistic health, wellness, and creative living.
The emerging paradigms of health and wellness embrace prevention, early intervention, and alternative interventions. With the growing importance on wellness and holistic health care in the 21st century, the popularity of complementary and alternative medicine has significantly increased among U.S. adults in recent years. More Americans are relying on alternative paradigms in health care in efforts to treat ailments, promote wellness, delay aging, and protect against illness.
Perhaps the first mental health professionals who embrace and adhere to a wellness approach in under-standing, designing, and implementing a preventive orientation that focuses on positive human growth, optimal functioning, holistic health, and well-being are professional counselors. Counselors are in a leading position to promote health and affect wellness among a diverse population of individuals.
References:
- Ardell, D. B., & Langdon J. G. (1989). Wellness, the body, mind, and spirit. Dubuque, IA: Kendall/Hunt.
- Capuzzi, D., & Gross D. R. (1999). Counseling and psychotherapy. Upper Saddle River, NJ: Prentice Hall.
- DeJong, P., & Berg, I. K. (1998). Interviewing for solutions. Pacific Grove, CA: Brooks/Cole.
- Eagan, G. (1989). The skilled helper. Pacific Grove, CA: Brooks/Cole.
- Ellis, A. (1995). Better, deeper, and more enduring brief therapy. New York: Brunner/Mazel. Gladding, S. (2002). Family therapy: History, theory, and practice. Upper Saddle River, NJ: Prentice Hall.
- Gladding, S. T., & Newsome, D. (2004). Community and agency counseling. Upper Saddle. River, NJ: Prentice Hall.
- Myers, J., Sweeney, T., & Witmer, J. M. (2000). The wheel of wellness counseling for wellness: A holistic model for treatment planning. Journal of Counseling and Development, 78, 251-266.
