I was given an assignment in a theories class during the last semester of my undergraduate studies. The assignment was to choose a counseling approach on the basis of agreeing with its theories and assumptions and then defend my rationale for using that approach in counseling. At the time, I was torn between Alfred Adler’s individual psychology and Aaron Beck’s cognitive therapy, ultimately choosing the latter.

I have remained in touch with the teacher who gave me that assignment and recently asked him which theorist or therapy his students write about most frequently. He told me that more students turn in papers on Adlerian psychotherapy “by far” than any other therapy. He went on to explain that most of his students can relate to Adler more than any other of the theorists to whom they are exposed (which is a limited number in most bachelor’s programs).

We both speculated about why so many students might write about Adler and then later become primarily cognitive behavior therapists once they get into practice. For example, I have seen this occurrence among interns at my current place of employment. My former teacher and I concluded that the high demand for evidence-based practice was likely the primary reason for this theoretical “migration,” with limited exposure to alternative therapeutic approaches being a secondary reason.

Evidence-based practices, eclecticism and integration

The rise of evidence-based practices has shifted demand in their favor, while parity laws have turned demand into requirement. Most evidence-based practices come from cognitive- and behavior-based therapies.

Jonathan Shedler’s 2010 article, “The Efficacy of Psychodynamic Psychotherapy,” published in American Psychologist, offered techniques from psychodynamics that are evidence-based. In his 2005 article, “Positive Psychology Progress: Empirical Validation of Interventions,” also published in American Psychologist, Martin Seligman and colleagues reported on the effectiveness of relationships in psychotherapy through his humanistic approach, positive psychology.

But many other approaches favorable to counselors still lack this evidence-based foundation. So what are counselors to do when the theoretical assumptions with which they agree from a specific therapeutic approach cannot meet the demands of evidence-based practice?

The most common solution is eclecticism and integration. These words are sometimes used to describe different approaches, but they are also used interchangeably in many circles, scholarly or otherwise, to describe essentially the same process: combining bits and pieces of various theories and techniques based on the risks and needs of each client. Although this approach has shown promise, authors such as Brent Slife, Frank Richardson, Robert Fancher, John Norcross, Larry Beutler and Arnold Lazarus, to name only a few, have pinpointed a series of difficulties yet to be overcome in the eclectic/integrative movement. There are several obstacles, but the two most common are the lack of a guiding theory to direct and inform interventions and, on the other end, too much theory to be practical.

A manageable alternative

A viable alternative for bridging the gaps between various theories and evidence-based practices comes from a phenomenological theory known as ontological hermeneutics, which is an interpretive approach that seeks to understand what it means to be a human and to have experiences. It emerged as a viable theory long before Sigmund Freud conducted his first psychoanalytic session. As context, ontological hermeneutics was in its germinal stages before the first shots on Fort Sumter were fired to open up the Civil War. Since then, many psychotherapists, as far back as the revered philosopher and psychologist William James, have utilized elements of this theory in their practice.

But what does a 160-plus-year-old theory have to offer counselors operating under the banner of evidence-based practice in the 21st century? In a single statement: a comprehensive yet manageable theory of human nature that is advantageous to therapist conceptualization and intervention.

Unlike many mainstream psychotherapeutic approaches that maintain an individual perspective when working with clients, ontological hermeneutics conceptualizes from a relational perspective. Relationships present endless possibilities for relating to others (e.g., nonchalantly, compassionately, sarcastically) and being in the world (e.g., happy, depressed, engaged, aloof). This informs therapists that clients’ psychological ills are not occurring solely within, or because of, the individual. Rather, they emerge from clients’ relationships with, and patterns of relating to, others. In other words, a client may not be depressed because of faulty information processing and distorted thinking, but rather because the client has developed various patterns of relating to others that are not conducive to healthy relationships, therefore affecting the client in adverse ways.

The difference here, according to ontological hermeneutics, is that the client did not develop these maladaptive patterns of relating on his or her own, or as the sole result of internal cognitive or affective processes. These patterns were cocreated simultaneously by the client and the other people with whom the client is in relationship. There are endless possibilities for relating to others, however, and choosing to relate to others differently can improve well-being. And because all parties equally coconstitute a relationship, its very nature begins to change as soon as one participant (i.e., the client) chooses a different possible pattern of relating. It follows, then, that the crux of what hermeneutic theory is saying is that relationships heal, especially ones characterized by compassion.

Although there is no research supporting the efficacy of ontological hermeneutics, there are anecdotal experiences from counselors who have seen therapeutic gains through its application with clients. I am one of those counselors. Additionally, Seligman’s famous study from 1995, “The Effectiveness of Psychotherapy,” determined that psychotherapy in general, regardless of modality, is very effective. With that said, counselors attracted to theories such as existentialism, Adlerian, Gordon Allport’s trait theory or ontological hermeneutics can still maintain an overall evidence-based therapeutic practice because of eclecticism/integration.

A theory by another name

The greatest strength of ontological hermeneutic theory is its conceptualization prowess without being too theoretically laden. Much of what draws counselors to Adlerian, existential, logotherapy, humanistic and client-centered approaches, and even to a certain degree cognitive- and behavior-based therapies, can be found within ontological hermeneutics. Its theoretically sound tenets of what causes and ameliorates human suffering make it ideally situated to serve as a grounding theory in an eclectic/integrative approach.

Using ontological hermeneutics as a guiding theory that informs counselors how to incorporate and utilize evidence-based interventions can become a very specific eclectic approach. Some of us hermeneuts have started referring to this kind of approach as relational and compassionate psychotherapy (RCP).

If someone asked me what RCP is, I would respond by saying: “It is an eclectic approach that uses a well-accepted, comprehensive theory of human nature to inform how I intervene with evidence-based interventions. It greatly resembles relational and dialogical counseling and is characterized by compassion and empathy. Additionally, it is a continuation of previous efforts to utilize hermeneutic theory in psychotherapy.”

Knowing that healing takes place within relationships characterized by compassion is what guides the counselor’s selection of interventions. For example, it is common for the clients I work with to believe that other people do not like them. Instead of challenging their cognitive distortion from an individual perspective, I probe for more information about the nature of their relationships. Typically, these clients and I discover together that they spend a far-too-significant amount of time talking about themselves in their conversations. This opens me up to challenge their cognitive distortion from a relational perspective.

In cases such as these, I challenge the clients to stop personalizing their conversations with others too much. I then encourage them to utilize the GIVE skill, an interpersonal skill from dialectical behavior therapy that helps clients improve relationships by showing interest in and validating others (GIVE stands for gentle, interested, validate and easy manner). The assumption is that by devoting some attention and interest to others, clients learn to be more compassionate, leading to improved relationships and, in turn, a healthy support system. This ultimately creates new possibilities for being in the world, which is what ameliorates symptoms.

A three-step intervention

Hermeneutic counseling, or what some of us are referring to as RCP, is a very simple process that many seasoned counselors will find familiar. In its most basic form, the process has three steps.

1) Focus on the interrelatedness between the counselor and the client.

2) Maintain an attitude of openness.

3) Find ways to offer suggestions and new possibilities for the client to heal.

Although extremely similar to our basic core counseling skills, there are some subtle differences that enhance RCP. When counselors focus on their interrelatedness with clients, they are focusing on their relationship and rapport. However, there are some variations. Mainstream approaches therapeutically utilize rapport as a foot in the door, or a hook, with the client when intervening. With RCP, that rapport is not a means to an end; it is the end in and of itself. It is meant to be meaningful to both the client and the counselor.

The rationale for this is that relationships characterized by compassion are the healing factor (what we refer to in the clinical literature as the curative factor) for human suffering. As the counselor models compassion, the client emulates that model in his or her own life. In turn, this will improve the client’s relationships with family members and friends, enhancing the client’s support system.

All counselors already maintain an attitude of openness to their clients. RCP tenets attempt to develop this notion further by taking it from a level of understanding and empathy to a level of meaning and mattering. In other words, a counselor following this three-step model allows what the client says to matter and even change what the counselor thinks and believes when it is appropriate.

For example, I recently worked with a client who believed that her peers at our day-school program were making fun of her. However, her teacher was not observing any bullying, and the client wouldn’t give me any specific examples. She simply alluded to the way her peers were looking at her while laughing.

Instead of resorting to reframing her cognitive distortions, I allowed what she was saying to matter to me and took it to be true. Although this may sound like distorted logic, RCP posits that the client’s perspective, and the meaning that the client draws from that perspective, is equally important to my own. By demonstrating that degree of humility and providing this client’s perspective equal say in her therapy, I sent the message that I trusted and validated her. In doing so, I also reinforced for her that therapy offered a safe environment to be who she truly is and to continue exploring her experiences so that the possibility for transformation would increase. About three weeks later, staff uncovered some notes my client had been passing over the course of a month and a half, the contents of which contained ample bullying from her classmates.

The step of uncovering ways to intervene and offering suggestions that might lead the client to heal also carries similarities to basic counseling skills. However, RCP has its own variations.

The biggest difference is that RCP counselors offer suggestions and interventions from a place of deeper humility. RCP counselors accept that the suggestions and interventions we offer may not work for particular clients. We also accept that our understanding of what is going on with the client may not be complete (unlike what mainstream conceptualizations may suggest).

When counselors following this three-step model offer suggestions, they understand that they are merely providing counsel, and they respect that the client may opt to disregard that counsel of legitimate accord, not necessarily because the client is resistant. In such cases, the RCP counselor reverts back to Steps 1 and 2 to continue dialoguing with the client until greater understanding of the issues can be achieved and a more applicable intervention realized.

Relationships heal

Counseling does not have to be a complicated, mechanized process that risks confusing clients and building the kind of resistance that shuts clients down. Instead, counseling can be very concrete, simple and compassionate. It is not necessary for counselors to subscribe to ontological hermeneutics and RCP to implement the three steps discussed above or the tenets that accompany them. Clients will appreciate any counselor, utilizing any therapy, who adheres to this model.

In a 2007 article, “Taking Relationships Seriously in Psychotherapy: Radical Relationality,” Brent Slife and Bradford Wiggins reminded us that there is “nothing radical about the notion that ‘relationships heal.’” Terms such as rapport and therapeutic alliance have been bedrock principles of the field for decades now. It only makes sense that a relational theory whose interventions are based on ideals such as relationships, compassion and healing would come to the forefront of the minds of counselors who agree with these notions of how to relate
to clients.

 

****

 

Kevin Glenn is a licensed clinical mental health counselor and a theoretical counselor. Contact him at klg65@gmx.com.

Letters to the editor: ct@counseling.org