Theoretical Orientation

My approach to counseling has evolved over time and continues to evolve.  It reflects many gifts and wisdom from all of my teachers.  In addition to my training and experience in psychology, I combine spiritual and philosophical influences.  The approaches I typically employ include cognitive behavioral, psychodynamic, Jungian and other humanistic approaches.

There is not a single counseling approach that works for everyone.  I tailor my approach to meet people where they are, honoring each person's place along life's pathway. 

There are three basic levels of work.

  1. When people are in crises, they need directives in what to do which includes resource utilization to resolve the crises.
  2. Some people feels like they are tend to repeat the same problems.  These people need a supportive cognitive behavioral approach.
  3. Others engage in therapy to find and develop their hidden potentials to enrich their lives.

Initially, much of my theoretical orientation was primarily reflective of the works of Carl Rogers, Karen Horney, William Glasser, and Alfred Adler.  Through the years my orientation has changed to more of a cognitive behavioral/solution focused approach.  This cognitive behavioral approach is reflective of the writings of Albert Ellis, Aaron Beck and David Burns.  With couples and families, I use family systems therapy for resolution of presenting problems.  I do not believe that I have discarded my past viewpoints.  I have modified them to address clinical needs of the diversity of clients I have encountered.

I view humans as beings who are that that they might enjoy life.  This statement indicates that all persons were meant to have fulfilling lives free from the emotional problems that all too often cause mental illness.  All persons have the right to intellectual, physical, emotional, and spiritual actualization, as they desire, without all of the constraints that society places upon them.  I do not advocate that society should abandon norms.  Persons are responsible for their existence, being free to choose.  They are responsible for the consequences of their actions.  Each person carves his/her destiny and essence, his/her inner being the product of his/her actions.  The way a person lives their life determines what he/she is.  Existence does not occur in isolation but in the interaction with others in the world.  The existence of persons is an active ongoing process where persons define their being.  Persons are not static but dynamic; they shape their being through actions and interactions with others in the world.

Both genetics and the sum of all life experiences since birth determine individual's behavioral dispositions.  Throughout life, we are dependent upon the environment and significant others.  As children, we need nurturing, guidance, protection, and support.  As adults, other people and daily events around us challenge us to use our mental faculties to adapt.  If we are deprived of certain types of stimulation, we lose our capacity to adapt.  A reduced capacity to adapt increases our risk of developing mental illness.  I acknowledge that persons have two basic needs:  The need to love and be loved and the need to feel that we are worthwhile to ourselves and to others.  If persons do not have these basic needs fulfilled, they will have trouble with the ongoing stream of challenging life events.

For persons to fulfill their needs they first do so in a way not to deprive others of fulfilling their needs.  Ideally persons must be emotionally involved in leisure time activities with significant others.  For optimal self-confidence, persons must maintain satisfactory standards of behavior.  To do so they must learn to correct themselves when they do wrong and to credit themselves when we do right. If people do not actively strive to improve their conduct when it is below their standards, they will experience feelings of shame and/or guilt.  With these feelings of shame and guilt can come feelings of isolation or abandonment from others.

Our present culture imposes multiple stresses, which hamper growth.  Our culture also provides false quick solutions that are appealing and deceptively simple to follow.  Following these solutions can result in an intensification of pathology.  They take the form of an abandonment of who we are now for the sake of pursuing fantasies of what we could become.  All of us have the capacity to develop our potentials, but questions remain.  Are these imagined potentials realistic?  Frequent re-assessment of self is necessary to support ongoing changes throughout the life span.

An important aspect of my theoretical position is that persons define reality based on their life experiences.  It is this personal perception of reality, which governs behavior independent of the facts as others see them.  Perceptions of reality are based upon the persons' view of themselves, the world in which they live, and the meanings events have for them.  Everything a person does is reasonable and necessary at the time the person is doing it.  People perform the best they can under a given set of circumstances, if persons knew in a moment how to behave more effectively they would do so.

It is my position that the mind and body has an interactive physiological effect.  Andrews and Karlins (1975) have succinctly summarized my viewpoint.  "Every change in the physiological state is accompanied by an appropriate change in the mental emotional state, conscious or unconscious, and every change in the conscious or unconscious state is accompanied by an appropriate change in the physiological state."  It is my opinion that the interactive physiological effective I have briefly mentioned above provides foundational support both for the effectiveness of psychotherapy and psychopharmacology.

I recognize the importance of being sensitive to both nonverbal and verbal communication.  During graduate school, various inservices, and other CEU events I have been told that over 80% of all communication is nonverbal.  The other 20% is verbal.  This has made me acutely aware of the need to listen to voice intonation.  As a therapist I note body posturing, hand positioning, subtle facial expressions, eye contact, and observable muscle tension in face, neck, arms, and hands.  In addition, when I greet clients for the first time I shake their hand and introduce myself as Dr. Thomas.  During those momentary seconds of shaking their hand, I note their hand temperature.  There have been those instances where extremely cold hands were indicative of high anxiety.  This has occurred even when these clients were attempting to present themselves as easy going and relaxed.

When a client presents for therapy their immediate, present needs are considered.  If clients are manifesting cognitive distortions, negative self-talk, they are confronted to consider their self-defeating belief structure.  Clients receive an evaluation of their cognitive distortions.  Clients are directed to consider the impact of these distortions on their daily life.  I use confrontation to enable clients realize discrepancies in their behaviors.  These discrepancies could involve a clash between the client's emotions and cognition, verbal expression and self-awareness, and point out discrepancies in clients thinking and actions.  If clients are acutely experiencing grief then those persons need supportive therapy while being directed to work through their grief.  Support groups for those experiencing bereavement issues are considered as an adjunct to therapy.  For clients with addictions, therapy needs to be confrontational and educational.  Again, support groups such as Alcoholics Anonymous, Narcotics Anonymous, and Gambling Anonymous groups are recommended.

For therapy to be effective both Long Term Goals and Short Term Goals must be defined.  These goals are included in the treatment plan.  Objectives for these goals must state the period in which the goals will be accomplished.  For example, a Long Term Goal could be:  John will reduce his overall level, intensity and frequency of anxiety so that his overall functioning is not impaired.  A Short-term goal for John could be identify one irrational thought per week.  After the irrational though is identified than the client is challenged replace that thought with a more rational thought.  Treatment plans must be reviewed and revised at least once a month to determine if objectives have been met.  Revision allows additional objectives to be added in the event that other client issues surface during the course of therapy.

Focus of therapy is on the present.  The primary objective is how to resolve current problems.  Past events are visited only in the context of how they impact the present.  If clients persist in bringing up past events, they are told that their past cannot be changed.  But they can change their present evaluations of their past.  Dr. Thomas does NOT advocate spending numerous therapy sessions dwelling on the past and old memories for the sake of recovery.

In summary, I have presented my evolving theoretical orientation in a condensed format.  A non-condensed format would be the length of a book.  I outlined my evolving theoretical orientation that I use with clients.

 

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