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Article Excerpt
Training counselors to work effectively with complex client presentations requires a variety of methods. These methods not only need to be aimed at developing conceptual understanding but also must assist counselors in managing their own emotional reactivity when working with such clients. The author describes the curriculum and experiential training processes of a course in a transtheoretical program, which draws on psychodynamic concepts to help counselor trainees develop competencies with more disturbed clients. These competencies include alliance building and repair, understanding and working with transference and countertransference, and using an understanding of personality structure in case conceptualization.
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Training counselors to deal with the emotional roller coaster of both their clients' feelings and their own feelings while engaging effectively in therapy is a multifaceted educational task. Although this is true for all client work, it becomes particularly salient when the client presents with a higher degree of disturbance. This issue is significant because the client population seen by counselors has become increasingly complex and difficult; many clients present with multiple problems, comorbid conditions, and increasingly chaotic family structures. Cases supervised by university staff have also become more difficult, with psychiatric histories, suicidal intention, personality disorders, and trauma now frequently appearing in community-based counseling agencies.
This article presents the curriculum model and innovative experiential training methods used in a course titled Advanced Psychotherapy Process and Psychopathology, which prepares students to work more productively with such clients. The course is a compulsory part of the master's/PhD program in counseling psychology at Curtin University of Technology, Perth, Western Australia. Overall, the program is transtheoretical, covering individual therapy from humanistic-existential, cognitive-behavioral, psychodynamic, and interpersonal process models; the program also includes courses in couples therapy, family therapy, and group therapy. Specifically, this article demonstrates how the richness of the psychodynamic tradition can be drawn on to develop students' competencies in working with challenging clients, whether or not the therapist is working from a psychodynamic model. These competencies include alliance building and repair, understanding and working with transference and countertransference, and using an understanding of personality structure in case conceptualization.
Counselor Training Research
Training counselors to work effectively with complex client presentations is a formidable task. In spite of the importance of good training and supervision in this area, remarkably little research attention has been devoted to documenting processes that are effective or ineffective in training the more complex capacities in therapists. Indeed, one landmark study--the Vanderbilt II study--indicated that therapists failed to improve their capacity to deal with maladaptive interpersonal patterns after a year of specific training that used a manual devoted to improving skills in this area. Some even deteriorated after training, intervening in a more mechanical manner and behaving in a more confronting, hostile fashion (Henry, Strupp, Butler, Schacht, & Binder, 1993; Strupp & Anderson, 1997). These authors concluded that manuals can only guide therapy and that learning is a complex process that includes factors such as internalization, identification, role modeling, and socialization.
What needs to be modeled so that new counselors can identify with and internalize effective therapeutic practice? There are two core areas that are particularly important in terms of experiencing positive modeling. The first is the establishment of a strong therapeutic alliance, which research has repeatedly shown to be the best predictor of therapeutic outcome (Horvath & Symonds, 1991; Wampold, 2001). For example, there is far greater variance between practitioners delivering the same intervention than there is between different interventions (Wampold, 2001). The second core area related to therapist variables is the capacity to manage countertransference reactions. According to Gelso and Hayes (1998), five attributes contribute to countertransference management--therapist self-insight, self-integration, anxiety management, empathy, and conceptualizing skills. Research has indicated that the capacity to manage countertransference effectively is positively related to therapeutic outcome (Gelso, Latts, Gomez, & Fassinger, 2002; Hayes, Riker, & Ingram, 1997).
In training, educators need to consider not only how to help trainees establish such a relationship but also how to repair it when it is ruptured and how to sustain such a relationship when the client provokes strong feelings and reactions in the therapist. In order to do this, training needs to move beyond the didactic to include procedural knowledge, reflexivity, and substantial experiential components (Andrews, 2001; Safran & Muran, 2000).
When therapists are asked what the most significant influences are in terms of their development as a psychotherapist, the responses are remarkably consistent. The most salient factors are experiential and interpersonal learning, direct practice, supervision, and personal therapy (O'Donovan, Dyck, & Bain, 2001; Orlinsky, Botermans, & Ronnestad, 2001; Rachelson & Clance, 1980; Skovholt & Ronnestad, 1995). As Orlinsky et al. concluded in their large-scale survey of 4,000 therapists from 14 different countries, "the overall impression is clearly that practical/experiential learning clearly takes precedence over academic learning as far as therapists are concerned" (p. 143).
In situations that involve high levels of emotional arousal for the client and anxiety for the trainee, counselor training provides for the integration of theoretical understanding with the application of advanced therapeutic skills. White and Russell (1995) found that maintaining a consistent link between theory and intervention was one of the most significant variables identified by experts who trained counselors and that maintaining this link was a major difficulty in counselor education. In addition, the use of live expert models has been shown to be the most effective method for developing the clinician (Avis & Sprenkle, 1990).
As Holloway and Neufeldt...
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