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From either/or to both/and: Developing a pluralistic approach to counselling and psychotherapy

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The pluralistic approach to therapy that we have articulated is grounded in ethics, and strives to develop therapists' abilities to engage with clients in deeply respectful and valuing ways. In this article, we argue that a principle obstacle to such engagements can be a tendency in the psychological therapies to hold either/or, polarised positions, such that we are not fully open to the complexity and diversity of the actual clients that we encounter. This article focuses on three particular polarisations: between advocates of different orientations, between integrative/eclectic versus single orientation practices and between client-led versus therapist-led practices. The article argues that a pluralistic approach may be able to overcome such schisms, and discusses the implications and limits of this perspective for therapeutic thinking and practice.
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... multiple approaches) discourses over an expected single discourse of counselling (e.g. Cooper and McLeod 2012;House and Musgrave 2013). There are considerable institutional benefits to operating from a single discourse of practice, and DSM-III was seen as helping psychiatry move from using inconsistent professional and research clinical language to a more consensual (by psychiatry at least) diagnostic language . ...
Chapter
The final chapter reviews previous chapters and presents a perspective on counselling as a discursively aware and resourceful conversational practice. Counselling is clearly a conversational practice occurring through how clients and counsellors talk and listen, yet seldom is it approached as a discursively meaningful activity. Counsellors and clients navigate and negotiate multiple discourses when making sense of and addressing human concerns, and that includes mental health or medicalizing discourse. The chapter revisits the importance of discursively informed counselling for helping people critically and resourcefully cope with everyday difficulties.
... multiple approaches) discourses over an expected single discourse of counselling (e.g. Cooper and McLeod 2012;House and Musgrave 2013). There are considerable institutional benefits to operating from a single discourse of practice, and DSM-III was seen as helping psychiatry move from using inconsistent professional and research clinical language to a more consensual (by psychiatry at least) diagnostic language . ...
Chapter
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This chapter presents human concerns and responses to them as cultural constructions that vie for plausibility and dominance. After defining discourse (as ideology in a critical theory sense), common approaches (psychodynamic, cognitive, poststructural, systemic, feminist) developed and taken up within counselling are reviewed as discourses. These “insider” discourses (to counsellors) are contrasted with other discourses for human concerns (spiritual, social justice), and then with medicalizing discourse. I consider how these discourses feature in everyday as well as counselling interactions, underscoring differences in such interactions and the later actions taken from them in addressing human concerns. Counselling is presented in pluralist terms, as potential discourses used in making sense of and addressing human concerns.
... multiple approaches) discourses over an expected single discourse of counselling (e.g. Cooper and McLeod 2012;House and Musgrave 2013). There are considerable institutional benefits to operating from a single discourse of practice, and DSM-III was seen as helping psychiatry move from using inconsistent professional and research clinical language to a more consensual (by psychiatry at least) diagnostic language . ...
Chapter
This chapter traces a critical, theoretical, and historical view of contemporary mental health “culture” as it is articulated and practiced in terms of diagnosable mental disorders and evidence-based practices (EBPs). Psychiatry’s pursuit of scientific legitimacy is examined through development of DSM-III–DSM-5 and corresponding evidence-based treatments (cf. Cochrane Collaboration for Evidence-Based Medicine). Clinical psychology is examined for championing this legitimizing direction for psychology (counselling psychology included), with attention given to neuroscience as a new form of evidence. Counselling’s discourses and approaches are reviewed as conversational practices focused on meaning and behavior change, and, drawing on “common factors” of change, Chapter 4 aims to make evident the grounds for a mental health “monoculture.”
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This chapter discusses: *The philosophical and theoretical underpinnings to goal articulation within therapy. * Research issues related to working with therapeutic goals * Specific practices that therapists might use whilst working with goals in therapy * Some of the challenges that therapists might encounter when working with goals in therapy * The move from articulating therapeutic goals to identifying specific therapeutic tasks and deciding upon therapeutic methods
Article
The role of a practicing psychologist often involves uncertainty and ambiguity, and individuals differ in their ability to manage or “tolerate” this uncertainty. This study investigated the relationship between tolerance of uncertainty, pluralism and confidence in case formulation in a sample of Australian psychologists. The sample consisted of 190 Australian psychologists, aged between 22 and 69 years (M = 30.48, SD = 8.04) and comprising mostly females (77.9%). This study had a cross-sectional survey design in which participants completed measures of uncertainty tolerance, pluralism and confidence in case formulation. Hierarchical multiple regression was used to predict tolerance to uncertainty. The final regression model was significant and explained 39.1% of the variance in tolerance of uncertainty. The predictor variables that contributed significantly to the model were therapeutic orientation, age, pluralistic practice and confidence in case formulation. Stage of career and pluralistic philosophy did not contribute significantly to the model. Higher pluralistic practice and confidence in case formulation skills are related to higher tolerance of uncertainty. Training in pluralistic models of therapy and the hypothesis generation approach to case formulation may offer the potential to increase uncertainty tolerance in practicing psychologists.
Article
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Whilst much research has been conducted into the efficacy of and guidelines for technical interventions in the treatment of abuse, it is argued that a relational or process approach to therapeutic work should become more integrated into the use of technical interventions to aid therapeutic outcome. The study aims to explore counselling psychologists’ experiences when working with clients who have experienced abuse. Semi-structured interviews were conducted and analysed using Interpretative Phenomenological Analysis (IPA). Six participants were recruited and asked to share their experiences of their therapeutic work with the client group. The research was given ethical approval by the ethics committee of the university. Three superordinate themes emerged from the data: ‘The Holding Environment’, ‘The Personal versus The Professional’ and ‘Internal Responses, External Communications’. These were supported by various subthemes within the accounts and were generated as a result of a double hermeneutic engagement with each interview transcript. This research contributes towards a deeper understanding of the processes involved in creating a therapeutic space for the work and the relational dynamics involved in providing therapy to clients who have experienced abuse. The dynamic process between empathising and ‘detaching’ in session, as well as counselling psychologists’ use of supervision, are highlighted as areas for further study.
Article
This study aimed to develop a self-report measure of pluralistic thought and practice. Following pilot development, a 23-item inventory was placed on an online survey site, and 474 participants satisfactorily completed the measure. Respondents were trainee or qualified therapists, predominantly female, based in the UK, and of a humanistic or integrative/eclectic orientation. A principal components analysis resulted in two scales, Pluralistic Philosophy and Pluralistic Practice, which had good internal consistency (Cronbach’s α = .72 and .80, respectively). Confirmatory factor analysis showed good model fit for this two factor solution. The Therapy Pluralism Inventory (TPI) has potential for use in training and research, although additional validity and normative data are needed.
Chapter
This chapter focuses on what counsellors have had to say about the influence of medicalization on their recent practice as counsellors. Drawing from prior survey and interview research with counsellors, it uses Adele Clarke’ssituationalanalysis method to approach the issues counsellors in macro (zooming out) and micro (zooming in) ways they associated with their ways of practice. It also reviews the professional counselling literature for responses to medicalization. Specifically, broad issues of professional practice are juxtaposed with details regarding how counsellors manage tensions associated with medicalization in conversations with clients, colleagues, and administrators. The aim of this chapter is to present a front-line perspective on medicalizing influences as experienced by practicing counsellors.
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The purpose of the study was to investigate the nature of metatherapeutic communication (MTC), defined as dialogue between therapists and clients on the nature of the therapeutic work and the means by which it can be of greatest help to clients. Twelve counselling psychologists, working pluralistically with 35 clients experiencing depression, described on post-session forms moments of negotiation and collaboration around the therapeutic work. Two main dimensions of MTC were identified: the subject matter of the MTC and the temporal focus of the MTC. In addition, MTC varied by the time at which it took place. These findings provide a framework for understanding the nature of MTC in counselling and psychotherapy, and the opportunities for implementing it in practice.
Book
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Hailed by one reviewer as "the bible of the integration movement," the inaugural edition of Handbook of Psychotherapy Integration was the first compilation of the early integrative approaches to therapy. Since its publication psychotherapy integration has grown into a mature, empirically supported, and international movement, and the current edition provides a comprehensive review of what has been done. Reflecting the considerable advances in the field since the previous edition's release in 2005, this third edition of Handbook of Psychotherapy Integration continues to be the state-of-the-art description of psychotherapy integration and its clinical practices by some of its most distinguished proponents. Six chapters new to this edition describe growing areas of psychotherapy research and practice: common factors therapy, principle-based integration, integrative psychotherapy with children, mixing psychotherapy and self-help, integrating research and practice, and international themes. The latter two of these constitute contemporary thrusts in the integration movement: blending research and practice, and recognizing its international nature. Also closely examined are the concepts, history, training, research, global themes, and future of psychotherapy integration. Each chapter includes a new section on cultural considerations, and an emphasis is placed throughout the volume on outcome research. Charting the remarkable evolution of psychotherapy integration itself, the third edition of this Handbook will continue to prove invaluable to practitioners, researchers, and students alike.
A qualitative study was conducted of therapists' experiences of using two clinical tools that have been designed to stimulate dialogue with clients about their preferences for style of therapeutic working: the Therapy Personalisation Form (TPF) and the Therapy Personalisation Form - Assessment (TPF-A). Ten therapists who had used the tools in clinical practice were interviewed about their experiences, with data analysed thematically. Therapists were generally positive about the clinical utility of the tools: they felt that they were helpful means of finding out what clients wanted from therapy such that it could be tailored accordingly, and could also serve as valuable sources of reflection and learning about their own practices. In addition, they believed that the forms were empowering for clients and helped to move the therapeutic relationship forward. In terms of limitations, the participants felt that the forms could lead to increased therapist self-criticism and over-moulding to the clients' wishes, and may be too complex or bureaucratic for some clients. The results suggest that the TPF and TPF-A may be of value to therapist and clients, though more research is needed on clients' experiences of using this measure.
Article
Luborsky et al.'s conclusion that there are no meaningful differences in the efficacy of various psychotherapies should be reconsidered for the following reasons: (a) errors in data analysis, (b) exclusion of research on many types of clients (e.g., children and adolescents), (c) faulty generalization to comparisons between therapies that have never been made, and (d) erroneous assumption that the average difference between all sorts of treatments for all sorts of problems can be assumed to represent the difference between any two types of treatment for a given problem. Concern for clients' welfare demands that psychologists be very wary of accepting the Dodo bird verdict.