The Strength Based Approach

Working with strengths.  Collaborating on goals

            Among the fundamentals of social work practice is to approach each client from the perspective of his/her strengths as opposed to perceived deficits.  This is to say that instead of looking for what’s wrong with the client (as does the medical model) we look for the strengths that already exist and then build on those.  We go to where the client is, and walk back with him, not require him to come to us.  Social work ethics require us to give each client dignity and respect their right to self-determination.  Thus we collaborate with our clients on both the setting of goals and the means to obtain them.

THERAPEUTIC GOALS

The goals of counseling are almost as diverse as are the theoretical approaches.  Goals include: restructuring the personality, uncovering the unconscious, creating social interest, finding meaning in life, healing an emotional disturbance, examining old decisions and making new ones, developing trust in oneself, becoming more self-actualizing, reducing anxiety, shedding maladaptive behavior and learning adaptive patterns, gaining more effective control of one's life, becoming aware of and reducing the influence of gender-role socialization, acquiring personal empowerment, and creating new patterns of relationships within a family system. 

In my Eclectic approach there is room to incorporate just about all of these goals.  At different stages in therapy, different goals become important.  Clients can work on all levels of human experience by helping them identify a range of specific goals that will provide a framework for the sessions.  The main goal of most theoretical orientations is to bring about changes within an individual in the realms of thinking, feeling, and behaving. 

I find the Adlerian approach particularly valuable in establishing therapeutic goals.  Several key Adlerian concepts have special relevance for the process of establishing goals, both for therapy and for life: the goal-directedness of behavior, struggling with feelings of inferiority, striving for superiority, and social interest.  Alfred Adler's system emphasizes the social determinants of behavior.  This "socio-teleological" approach implies that we are primarily motivated by social forces and strive to achieve certain goals.  Adler's view is that we create both short and long-term goals that motivate our behavior and influence our personality development.  It is our long-term goals in particular that guide our movement toward an envisioned completion and sometimes even toward perfection. 

Another key concept from the Adlerian approach that is directly related to the process of forming goals is the notion of social interest.  This concept embodies the feeling of being connected to all of humanity-past, present, and future-and to being involved in making the world a better place.  Social interest is the individual's positive attitude toward other people in the world that involves a sense of identification and empathy with others.  As an antidote to social isolation and self-absorption, social interest leads to courage, optimism, and a true sense of belonging.  Our happiness and success are largely related to social connectedness.  As social beings we have a need to be of use to others and to establish meaningful relationships in a community.  We cannot be understood in isolation from our social context.  We are primarily motivated by a desire to belong.  Only within the group can we actualize our potential. 

I like the Adlerian notion of goal alignment, which means that goal setting involves a mutual, collaborative process.  I see it as the client's responsibility to define the target areas for us to explore in our sessions, yet it is my responsibility to guide the client in narrowing down the client's goals in such a fashion that we will both have a clear picture of how to proceed.  Developing goals is not something that the client can do at once-simply and quickly.  Establishing and refining goals takes time and continued effort, yet doing so will give direction to the counseling process. 

Cognitive Behavior/Rational Emotive therapy provides very useful concepts for identifying specific goals at the outset of the therapeutic process.  In helping the client to achieve the client's goals, I assume an active and directive role.  Although the client generally determines what behavior will be changed, I might suggest how this behavior could best be modified.  In selecting these strategies, I have a wide range of options.  The multi-modal approach, which is a form of behavior therapy, provides a context that allows me to borrow techniques from a variety of therapeutic systems and apply them to the client's unique situation.  This approach provides for the therapeutic flexibility and versatility required to effectively achieve a diverse range of goals. 

Within the restriction of time I can spend with the client, I let the client know that determining goals is a joint project.  Certainly, I won't be making the client's decisions about what we'll be exploring during the client's sessions.  Drawing on the behavioral approaches, the client and I identify goals that can be measured or monitored.  Sometimes because of the inability to spend enough time with the client, I get a sense of where a client is heading and as a client to try on an issue, to see if it fits.  I do not think this is best practice, but given the resources available at times, the choice comes down to whether it is better to suggest a goal or not come up with any at all.

I also ask the client to consider long-range goals.  What would the client most like to be able to say about the client's self or the client's life situation one year from now? Five years from now? The art of developing goals consists of breaking these long-term goals into relatively short-term objectives that lead the client in the direction the client wants to move.  The category of goals we might discuss would encompass the full spectrum of the client's thinking, feeling, and behaving. 

COGNITIVE GOALS. 

First, I would challenge the client to examine some possible goals in the cognitive realm that the client would be interested in exploring.  My aim is to listen for some of the client's underlying beliefs, especially thought patterns that seem to present difficulty for the client.  Thinking which Albert Ellis calls musterbating, shoulding on yourself, calamatizing, overgeneralizing, and perfectionism are seen in the light of mistaken conclusions coming from misinterpretations of the environment.  In listening to self-statements such as these, I strive to zero in on core beliefs that potentially result in problematic emotional and behavioral consequences.

AFFECTIVE GOALS. 

I ask the client about the realm of emotions the client is experiencing, especially feelings that the client views as problematic.  I tend to notice any bodily changes that may indicate emergent feelings.  Rather than interpret what the client is feeling, I would ask, “What did you just become aware of?”  I may notice that the client just teared up.  Was the client aware of that? What is the client experiencing right now?  I find that it is most useful to begin work with the affective realm and then move to an exploration of thoughts and behaviors.  I would draw heavily from Gestalt therapy as an effective way to assist the client in getting closer to the client's moment-by-moment experiencing.  By asking the client to notice what the client is aware of in the present moment, be it awareness of a thought, a bodily state, or feelings.  If it is appropriate, I might use a range of experiential techniques to deal with affective goals that are important to the client. 

BEHAVIORAL GOALS. 

In addition to setting cognitive and affective goals, it is essential that we identify behavioral goals.  We might explore the client's self-defeating thinking patterns and the client might express a range of feelings in sessions, yet therapy can hardly be complete without establishing concrete behavioral goals.  One of my clients complained that the client never has time to enjoy herself.  The client realized that too often she felt she was being driven, rather than doing the driving.  The client contributed to this sense of constant pressure by telling herself that the client doesn't have time to take care of herself.  Using elements of rational emotive behavior therapy, I would invite the client to examine the choices the client is making about the client's priorities and the client's overall wellness.  I asked the client to examine the client's present level of physical and psychological well-being.  From there the client restructured her thinking to give “down time” a higher priority, because if she got sick or burnt out, then surely her other priorities would not get tended to.  Although this may have been still somewhat co-dependent, to the client it was a satisfactory outcome.  I may address the co-dependency later, when some ego building has been achieved.

SPIRITUAL GOALS

There is growing empirical evidence that our spiritual values and behaviors can promote physical and psychological well-being.  I believe that spiritual and religious matters are therapeutically relevant, ethically appropriate, and potentially significant topics for the practice of counseling in secular settings, The client's own value system influences every facet of the client's counseling practice, including the client's assessment strategies, the client's views of goals of treatment, the interventions used, the topics explored during the sessions, and evaluations of therapy outcomes.  Indeed, no therapy is value-free.  I have an ethical responsibility to be aware of how the client's beliefs affect the client's work and make sure that I do not unduly influence the client.  Questions that should be considered are:

·         What role does spirituality or religion play in the client's life?

·         Does religion or spirituality provide the client with a source of meaning?

·         What connection, if any, does the client see between spirituality and religion?

·         What are the client's views concerning established organized religions?

·         Has religion been a positive, negative, or neutral force in the client's life?

·         How does the client think the client's views on spirituality and religion influence his perspective on the counseling process?

Spirituality and religion are critical sources of strength for many clients and are the bedrock for finding meaning in life.  Some clients cannot be understood without appreciating the central role of religious or spiritual beliefs and practices.  Spirituality is a significant aspect of well-being and can be instrumental in promoting healing.  To ignore the spiritual side of individuals could be a serious mistake. 

Counselors ask just about every imaginable question about a client's life, yet they sometimes do not inquire about the meaning of spirituality and religion.  An Eclectic   perspective allows for the assessment of spiritual values and practices.  If counselors do not raise the issue of how spirituality is viewed by their clients, clients might well assume that counseling ought to be divorced from any discussion of religion and spirituality. 

THE THERAPEUTIC RELATIONSHIP

In my approach to counseling, I place central prominence on the client-counselor relationship.  The quality of the person-to-person encounter in the therapeutic situation actually creates the stimulus for positive change.  My basic attitudes toward the client and my personal characteristics of honesty, integrity, and courage are what I have to offer.  Therapy is a journey taken by counselor and client, a journey that delves deeply into the world as perceived and experienced by the client.  But this type of quest demands that the therapist also be in contact with his or her own phenomenological world, especially since it may be essential to one client to be able to safely cathect and transference may occur with another

The value of the client-therapist relationship is a common denominator among all approaches, yet some approaches place more emphasis than others do on the role of the relationship.  This is especially true of the Existential, Humanistic, and Gestalt approaches.  These relationship-oriented approaches (sometimes known as experiential) are all based on the premise that the quality of the client-therapist relationship is primary, with techniques being secondary.  An effective therapeutic relationship fosters a creative spirit of inventing techniques aimed at increasing awareness, which allows clients to change their thinking, feeling, and behaving.

There are some key notions I find to be essential to effective therapy outcomes:

·         .  The quality of the person-to-person encounter in the therapeutic situation is the catalyst for positive change.

·         The counselor's chief role is to be present with clients during the therapeutic hour.

·         The therapist can best invite clients to grow by modeling authentic behavior. 

·         The therapist s role is rooted in his or her way of being and attitudes more than in the techniques employed. 

·         The therapist's attitudes and values are at least as critical as his or her knowledge, theory, or techniques.

·         To function optimally, the therapist must have good contact with clients and be centered within him or herself. 

·         A therapist who is not sensitively tuned in to his or her own reactions to a client runs the risk of becoming a technician more than an artist.

·         Through engagement with clients, the therapist assists clients in developing increased awareness of what they are experiencing in the present. 

·         Awareness emerges within the context of a genuine meeting between therapist and client.  . 

·         The basic work of therapy is done by the client; the therapist's job is to create a climate in which the client is likely to try out new ways of being. 

I have a sense of the paramount importance of the therapeutic relationship.  When I operate in the framework of the relationship-oriented therapies, I am much less anxious about using the right technique or about stimulating clients to think, feel or act in a specific manner.  Of course, I still do use a wide range of techniques designed to enhance aspects of the client's experiencing. 

Therapist functions and the role of the therapist

As a therapist, I conceive of my role as a consultant.  My clients tell me what they want and I serve as a resource person in helping them explore ways in which they have a better chance of getting what they want.  As a consultant, I teach clients specific strategies they can use in a variety of situations in everyday life.  I invite clients to grow by modeling authentic behavior.

Self-disclosure is one avenue for letting clients know me and of being real in my work.  If I keep yourself hidden during the therapeutic session or if I engage in inauthentic behavior, clients remain guarded and persist in their inauthentic ways.  Thus, I can help clients become more trusting and open by selectively disclosing my own responses at appropriate times.  Of course, this disclosure does not mean an uncensored sharing of every fleeting feeling or thought.  Rather, it entails a willingness to share persistent reactions with clients, especially when this sharing is likely to be facultative.  Therapist self-disclosure is a value shared by a number of theoretical orientations including existential therapy, the Humanistic approach, Gestalt therapy, Reality therapy, and Feminist therapy. 

The Humanistic approach has contributed greatly to an understanding of the central role of the therapeutic relationship in the healing process.  Three personal characteristics, or attitudes, of the therapist form the essence of the therapeutic relationship:

1.      Congruence or genuineness,

2.      Unconditional positive regard and acceptance

3.      Accurate empathic understanding. 

Congruence implies that as a therapist you are real; that is, you are genuine, integrated, and authentic during the therapy hour.  You are without a false front; your inner experience and outer expression of that experience match, and you can openly express feelings, thoughts, reactions, and attitudes that are present in the relationship with your client. 

In my therapeutic work, a key attitude I communicate to my clients is a deep and genuine caring for them personally.  This caring is unconditional in that I do not judge their feelings, thoughts, and behavior as good or bad, valuing and accepting clients without placing stipulations on this acceptance.  Acceptance recognizes clients' rights to have their own beliefs and feelings.  I often model acceptance by using the quote from Shakespeare: “Things are neither good nor bad, but thinking makes them so.”  Occasionally this provides a transition to a discussion of the use of Cognitive behavioral interventions.

One of a counselor's main tasks is to understand the client's experience and feelings sensitively and accurately as they are revealed in the moment-to-moment interaction during the therapy session.  Empathy requires a deep and subjective understanding of the internal world of the client and a sense of personal identification with the client's experience.  This empathy deepens the client's self-understanding and helps the client clarify his or her beliefs and worldviews. 

I stress the therapeutic alliance, rapport, and a collaborative working relationship.  Unlike a person-centered therapist who is not particularly concerned about techniques, cognitive-behavioral therapists view a good working relationship as necessary, but not sufficient, to produce change.  Action-oriented therapists use a range of specific interventions to assess and treat clients.  Beyond a working relationship, which is monitored throughout the duration of counseling, the Cognitive behavioral/Rational Emotive practitioner is expected to be skilled in tailor making interventions that will help clients change in the direction they choose. 

From my perspective, therapy is a deeply personal relationship.  I am influenced by the Humanistic approaches, which emphasize the personal characteristics and attitudes of the therapist.  I think the person I am is just as important as my knowledge of counseling theory and the level of my skills.  Although it is essential to use techniques effectively-and to have a practical base from which to draw a range of techniques-this ability becomes meaningless in the absence of a therapeutic relationship that is characterized by mutual respect and trust. 

Therefore my role would include:

·         Actively listening to and understanding clients

·         Suspending critical judgment

·         Expressing appropriate warmth and acceptance

·         Communicating that I understand their world as they experience it

·         Providing a combination of support and challenge

·         Assisting clients in cultivating their inner resources for change

·         Helping clients take the specific steps needed to bring about change

·         Helping clients evolve a usable sense of their spirituality

·         Helping clients make sense of their environment

·         Helping clients discriminate information, instinctual responses and faulty thinking 8 Providing a safe place to express powerful emotions 8 Problem solving 8 Teaching

·         Modeling

·         Holding clients accountable

Drawing on Adlerian theory I would develop a picture of the past, including family constellations, early recollections and beliefs that that may contribute to false logic, but I would add to the picture those issues raised in Discrimination Theory (see discussion of construct).

            Once a relationship founded on the core Rogerian principles is established, there comes the work of untangling the knots and freeing up the places where our clients are stuck.  As a working model I use a modified Cognitive behavioral/Rational Emotive   approach that I share with my client, in a much more simplified explanation than the following:  when something happens, the first thing that occurs is that we have a thought.  This thought comes up automatically, and the particular thought that comes up is determined by our existing database.  The thought comes up automatically, can be there and gone in a flash, and is accepted by us as the absolute, gospel truth.

Based on what this thought is we will have an emotional reaction.  Based on that reaction, we will do something.  Based on what we do, the other will have a thought, based on his/her database.  That thought will determine his/her emotional reaction.  That emotional reaction will lead to their doing something.  That something will cause us to have a thought, and around and around it goes.

Out of all of this comes a story about what happened.  That story then is added to our database, to determine our future, automatic thoughts.  All of this may or may not have anything to do with reality.  Our stories may be accurate, and sometimes not, mostly not.  Let’s look at some examples from my practice.

A client named Joe (named will be changed to insure confidentiality) is recovering from alcohol dependency.  He is divorced and his ex-wife lives in the Northeast.  She moved there because of a job offer.  My client believes that she did so to sabotage his ability to see his children.  My client stopped paying child support.  The ex-wife hangs up on him when he tries to telephone his children, confirming his initial suspicions.

Another client’s son committed suicide.  Her thought response was “I didn’t do enough.” This thinking leads to intense feelings of guilt, which she medicates with alcohol.  Her grief remains unresolved after 2 years.  Her family begins chiding her that she does not do enough.  This confirms her story about her son.

Yet another client relapses after several months of sobriety. His relapses occur just when things seem to go right.  After several sessions my client becomes aware that whenever an employer compliments him he thinks, “Now he’s going to expect more and more of me.”  The emotional response to the thought is that he becomes afraid of not being able to meet the higher expectations, confirming the client’s story (Transactional Analysis would call it a life script) that he’s not responsible.

            I suggest to my client’s that there are several interpretations for any event.  Reality Therapy counsels that some interpretations lead to actions which have negative consequences and others lead to actions that have positive consequences.  The work of this therapy is to first become mindful so that the thoughts that give rise to the emotions can be observed, then to watch how they manifest and what results arise.  This creates learning and wisdom.

The Meaning of Meaning, Existential considerations

As human beings we are meaning machines.  As soon as something happens, we put a meaning on it.  So what is meaning?  What is the meaning of that?  What do you mean?  What does that mean?  What does this mean for me, for our family, for our country?  What is the meaning of life?

We make the most important decisions in our life over meaning.  We think we do things because other things happen, but we don’t.  We do things because of the meaning that we ascribe to other things that happen.  We don’t go to war because Iraqi soldiers marched into Kuwait.  We go to war because that means that Iraq is dangerous, that they threaten our access to Middle Eastern oil, and that they “threaten our national interest”.  We change jobs not because the other job pays more, but because that means we will have a better life (which may or may not be true).

Meaning does not exist outside of the word “meaning.”  What I mean by that is: A tree can exist without the word tree, or árbol or amber.  If those words did not exist that thing we call a tree would still bear fruit.  But if the word meaning did not exist, where would we find it—can you hold it in your hand, send it to a friend or keep it in your drawer?  So, meaning is just something we make up in our heads, something brain made, something not existing in the world.  Once we understand that meaning is not something real, since it is something that we create, why not create it so that it means something that serves us, that brings happiness, peace and contentment into our lives.

So, what is the meaning of life?  It is whatever you create it to be

Change The Data Base, Change The Thought

Since we already figured out that we can create whatever meaning we want for whatever happens, how do we do it.  We do it by watching for the little thought that automatically comes up when something happens and asking ourselves if that’s the thought we want to use to create our meaning.  If not, then create another thought, accept it and then act on that and watch what happens.  Did it make you happier?  Did it make life easier, or harder?  Are you more loving or more bitter as a result? 

From these lessons we gain wisdom.  And we should also keep in mind that it is just when it is the hardest to do this that we learn the greatest lesson.  When a person cuts in front of you in line at the grocery store or on the road, one thought that might automatically come up is “That guy has some nerve, how inconsiderate, he has disrespected me and everyone else, what a jerk!”  But if you catch that thought and choose a different thought, one that sounds like “Gee, he’s in a hurry, maybe he has a sick child at home,” you will feel differently.  Which way would you rather feel?  Practice on the guy cutting in line enough and you will be able to do this during a bankruptcy, or divorce or even on being told you have a terminal illness.

After a while you will reprogram your database and the automatic thoughts that come up will be thoughts that bring you peace