Counseling is not a profession that has a knowledge ceiling. We are always working diligently to grow our knowledge so that we can be more efficacious for our clients. All too often, however, counselors may find themselves studying the same general areas: their chosen theoretical orientations, research studies on their favorite evidence-based practices, literature handed out by supervisors and so on. As a result, a vast array of topics that could greatly enhance counseling in profoundly meaningful ways often gets overlooked.

No doubt most counselors are aware of this, but many may be unsure of where to start. The purpose of this article is to identify three areas of study that counselors can explore to widen the scope of their self-education: eclecticism, theoretical counseling and neuroscience.

An alternative form of eclecticism

Many counselors use eclectic practices. This can be advantageous to therapy because it enables counselors to implement a variety of evidence-based practices under the umbrella of science.

Regardless of how beneficial this approach is to counseling, however, it still comes with limitations of which many counselors, and even supervisors, are unaware. Does this mean that eclecticism is bad or ought to be avoided altogether? Absolutely not, but counselors can be engaged in efforts to improve their eclectic practices in much the same way that clients work to improve their lives.

In their chapter on eclecticism in the book Critical Issues in Psychotherapy: Translating New Ideas Into Practice (2001) Brent D. Slife and Jeffrey S. Reber point out some key limitations to eclecticism. For starters, eclecticism actually does not fully accomplish what it originally set out to achieve: escaping single theories. All too often, what occurs is a mashing of evidence-based practices into a single therapeutic brief case. This brief case creates a single theory, much like psychodynamics, cognitive behavior therapy (CBT) or existentialism. This is important for counselors to understand so that they do not become too comfortable with their carefully crafted eclectic brief case. Otherwise, they run the risk of not branching out and, instead, unintentionally maintaining a narrow practice.

The most common eclectic practice is a collection of evidence-based practices administered under the umbrella of CBT. Many counselors refer to this as “eclectic CBT.” Arnold Lazarus is most responsible for the advent of this approach with his BASIC ID model (behavior, affect, sensation, imagery, cognition, interpersonal factors and drug/biological considerations), which he referred to as technical eclecticism underpinned by a basic social cognitive theory.

This epitomizes the single theory of eclecticism referred to by Slife and Reber. That in and of itself is not a problem. What is important is that counselors continually remain mindful of not closing themselves off to other potential avenues for helping clients achieve healing transformations. After all, that kind of narrowness, or tunnel vision, is precisely what led counselors to escape from operating under only one chosen therapy.

Counselors who become aware of this do not need to feel that their eclectic practice is wrong or inadequate. Simply being mindful of the need to look for ways to continually improve their practice is all that counselors need to do. For example, counselors looking to grow their eclectic practice might encounter the solutions put forth by John Norcross and Larry Beutler in their chapter on eclecticism and integration in the book Current Psychotherapies (2013).

One alternative they explored was a form of eclectic-like practice known as assimilative integration, which could be thought of as technical eclecticism version 2.0 because it operates very similarly. The key difference is that counselors using this form of eclecticism first identify a comprehensive theory of therapy rather than a basic minimalistic one (as advocated for by Lazarus). From there, evidence-based techniques can be incorporated for use with a stronger philosophy of care. Assimilative integration gives counselors a more detailed instruction manual for evidence-based practice than does technical eclecticism.

The theoretical side of counseling

Many counselors may be hesitant to explore assimilative integration because it requires a grasp of theory and theoretical concepts of psychotherapy. I can sympathize with that hesitation because I have felt it myself. There is no doubt that our clients experience similar hesitations when we expose them to unfamiliar interventions and encourage them to explore uncomfortable aspects of who they are when working on goals and objectives. As counselors, we can set the example for them by exploring theoretical aspects that will improve our knowledge of psychotherapy, our use of interventions and how we meaningfully relate to our clients.

So, start simple. A significant amount of literature is available that critically examines what we do in psychotherapy. Identify one or two subareas of this critical thinking and explore it at your own pace. Critical thinking about eclecticism is an ideal place to start. Critical Issues in Psychotherapy by Slife, Richard N. Williams and Sally H. Barlow is one of the most comprehensive yet reader-friendly resources I have found. Counselors looking for more of a challenge could explore Re-Envisioning Psychology: Moral Dimensions of Theory and Practice (1999) by Frank C. Richardson, Blaine J. Fowers and Charles B. Guignon. Articles in the Journal of Theoretical and Philosophical Psychology would likewise provide some excellent starting points.

Counselors who explore the theoretical aspects of counseling will gain knowledge about how to overcome the disadvantages of psychotherapy’s extant nooks and crannies. In turn, this will aid counselors, especially new ones, in dealing with those all-too-familiar crossroads in therapy. Additionally, counselors will gain the tools they need to develop a more comprehensive theory of care, greatly enhancing their use of the interventions they have selected for their brief case. Of course, this is also advantageous to clients because it promotes new avenues for growth.

There is much to learn from the theoretical side of counseling that can help counselors enrich their therapeutic relationships while maintaining professionalism. Recall that evidence-based practices are not the primary curative factor in counseling. That honor belongs to the therapeutic relationship that the client has with the counselor. Interestingly, evidence-based practices, as valuable as they are, do not inform counselors on how to relate meaningfully to clients. Theoretical and philosophical concepts of relationships do (which is why I find it extremely peculiar that the American Counseling Association does not yet have a theoretical division).

Regardless, as counselors discover and learn about theoretical modalities of relating to clients, they will instinctively formulate their own comprehensive theories of healing that can be incorporated into an assimilative integration approach. Counselors will quickly appreciate the meaningful value that a philosophy of care based on relationships can bring to their eclectic practices. They will also enjoy the flexibility to incorporate other knowledge and techniques not afforded by other modalities.

Neuroscience

Many counseling theories reject the psychodynamics concept of the unconscious, whereas affective neuroscience has been gathering evidence of the existence of an unconscious. Counselors who staunchly adhere to one of these other models may not find out about this evidence if they remain focused solely on cognitive-based avenues of practice. However, a theory based on how to relate to clients would be more open to all evidence of causes and amelioration of human suffering. Whether the cause revolves around faulty cognitions, wayward processing in the unconscious resulting from maladaptive past parent-child relationships, or emotionally minded impulses (see dialectical behavior therapy), it can be integrated into a comprehensive relationship-based approach to therapy because each of those elements can be explored within the therapeutic relationship.

The affective neurosciences have much to offer counselors about how to help clients process their emotions. In his book What Is Emotion? History, Measures and Meanings (2009), Jerome Kagan draws on neuroscience (affective and cognitive) to demonstrate that emotions promote a form of awareness in humans that comes before cognitive awareness. Kagan cites Antonio Damasio, most famous for his books The Feeling of What Happens: Body and Emotion in the Making of Consciousness (2000) and Self Comes to Mind: Constructing the Conscious Brain (2010), who uses patients with injuries to key areas of their brains, including cognitive regions, to demonstrate how emotion leads to consciousness and then thoughts.

Instead of cogito ergo sum (I think, therefore I am), Damasio is suggesting the truth is closer to I feel, therefore I am. It is our thoughts that actually make sense of the emotions we feel. Without cognition, our emotions would still exist but would be unintelligible to us. This is the case with children who suffer from hydranencephaly. These children are born without a neocortex for cognition but still feel emotions because their limbic systems remain intact.

Whether a counselor actually agrees with any of this is not the point here. The point is that the affective neurosciences offer key information that can aid clinical practice, provided that counselors are a) willing to widen their scope of self-education and b) use a philosophy of care that is amenable to synthesizing other scientific truths and knowledge that might be equally vital to therapy, even if they challenge our own worldviews.

When clients bring up unfamiliar material 

Another reason it is vitally important for counselors to widen their scope of self-education is so they will be prepared for clients who bring new and challenging information to the therapeutic setting. This applies equally, if not more so, to counselor supervisors so that they can aid budding clinicians in these experiences. Consider the following vignette.

An eye movement desensitization and reprocessing (EMDR) therapist attempted bilateral stimulation with a minor client (I’ll call her “Rose”) in a treatment placement. Rose, who had been asking the treatment facility’s group clinician questions about how emotions and memories work in the brain, told the therapist she no longer wanted to do EMDR or CBT. The eclectic therapist — who used Adlerian therapy, CBT, dialectical behavior therapy, trauma-focused CBT and EMDR — inquired about the refusal. Rose revealed information she had learned in the group clinician’s group therapy sessions. This information, which came from the affective neurosciences, challenged Rose’s prior understanding of how the brain worked. In light of this new information, Rose had become disillusioned with EMDR. When Rose’s mother learned of this, she became equally concerned and approached the treatment facility’s clinical manager.

Previously unaware of the information from the affective neurosciences, the EMDR therapist determined that Rose was being resistant to therapy and also accused the group clinician of undermining the EMDR therapist to Rose and her mother. Although the ACA Code of Ethics say counselors of differing theoretical views are to collaborate, the EMDR therapist was confused by the affective neurosciences information and sought the help of the treatment facility’s clinical manager and clinical director instead of approaching the group clinician.

The group clinician was called into the clinical manager’s office to discuss the situation. The clinical manager, a licensed therapist, asked if affective neuroscience was a therapy and, if so, did it conflict with other therapies. The group clinician attempted to explain that affective neuroscience is not a therapy but rather a scientific discipline that sheds light on how emotions work in the brain via brain scans.

Because neither the clinical manager nor the clinical director was aware of the knowledge from the affective neurosciences, they immediately issued a supervisory directive that neuroscience was not permitted as a therapy or topic of conversation at the treatment facility. Both deemed the discipline too advanced for the facility’s clientele. This bewildered the group clinician because Rose had demonstrated an accurate understanding of what she had been taught from the affective neurosciences in the group therapy sessions.

Meanwhile, the EMDR therapist worked ardently and drudgingly to rebuild Rose’s buy-in to EMDR, never collaborating with the group clinician or working from where Rose was at now. The therapist’s session notes reflected an ardent stance that the group clinician had been unethical and Rose’s treatment had been sabotaged. The therapist also noted that she was employing various interventions from her eclectic approach to break through this new “resistance.” Ultimately, the therapist was never successful in restoring Rose’s buy-in.

Turning challenges into opportunities

The foregoing vignette is an example of what can happen when counselors remain unaware of knowledge and science outside of their chosen worldview and philosophy of care, and also refuse to educate themselves. The same could be said of the clinical manager and clinical director who, in their ignorance of the discipline, chose to shoo the topic away instead of embracing it for the benefit of the client. As informed consent experts teach us, this can create a slippery slope with federal law, which mandates that it is illegal for medical or behavioral health professionals to knowingly withhold scientific information that can have a bearing on a client’s choice to start or continue with therapeutic services.

Instead, we can embrace opportunities such as the one presented above by widening the scope of our own self-education. Deepening the practice of eclecticism with a comprehensive philosophy of care that does not close the door to other scientific knowledge is an excellent place to start. Yes, this might include stepping a little outside of our comfort zones into theoretical aspects of counseling, but this wider scope of knowledge and the understanding that comes with it will better enable counselors to dialogue with clients who bring challenging knowledge and questions to therapy.

These opportunities for dialogue hold the potential to strengthen the relationship between counselor and client, set an example for the client of humility and willingness to change, and deepen the overall therapeutic experience for both client and counselor. Supervisors who remain unaware of many other aspects of scientific knowledge and theoretical understanding risk stunting their supervisees’ professional growth when they are unable to help these supervisees navigate challenging situations with clients.

If all else fails, counselors ought to have the humility to say to clients, “I was not aware of this information. Can you tell me more about it? I will look into it moving forward.” What a brilliant example of humility we can offer to our clients by validating them in this way while simultaneously opening up new pathways for therapeutic conversations and rapport building. Any counselor looking to widen the scope of his or her own self-education should wholeheartedly embrace these opportunities to learn new information from clients while enriching their therapeutic experiences.

 

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

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