Egan's integrative approach to counselling - Essay Example

I) Identify, describe and critically evaluate Egans integrative approach to counselling The role of counselling in the improvement of health has been extensively researched by medical practitioners and theorists. In this context, the study of Thoresen et al. (1985, 15) showed that “the crucial roles of behavioral, cognitive, and environmental factors in health and disease have been recognized, giving rise to the new fields of health psychology and behavioral medicine; the growing complexities involved yield a host of conceptual, methodological, and clinical problems; examples include narrow definitions of health and disease, abuse of statistical significance testing in research, and confusing conceptualizations of chronic stress”. Egan’s approach to counselling is based on a model constituted by three main parts. In the literature this model has been analyzed and evaluated at a high level. In accordance with a recent study Egan’s model presents “three main phases to the helping/or choice process: 1. Where am I now? (Identifying and clarifying problem situations and unused opportunities) 2. Where do I want to be? (Developing a preferred scenario) 3. How do I get there? (Formulating strategies and plans)” (The Egan model, Prospects Graduate, 2007). At a next level, the analysis of each phase is depended on the particular characteristics of the problem under examination and the circumstances in which this model will be applied. Generally, it has been supported that “phase 1 will almost certainly involve self awareness and some opportunity awareness, while phase 2 requires the relation between these to be established and some aspects of decision learning may be required in both stages 2 and 3, while phase 3 is mainly related to transition learning” (The Egan model, Prospects Graduate, 2007). In counselling the use of Egan’s model (as developed above) can be extensive, it depends though on the needs of each particular case and the environment (social, political or other) in which this model will be applied. In the organizational environment, the application of Egan’s model has to be based on specific criteria and terms. In this context, it has been supported by Smith et al. (2002, 197) that “organizations currently operate with a facade of rationality, ignoring emotional reality while the leverage for such change lies in working at team/group level meetings, changing the quality of interactions to enhance authenticity and create emotional openness” (Smith et al., 2002, 197). In other words, Egan’s model can be particularly valuable for all aspects of social activities and interactions but it has to be formulated in each particular occasion in order to meet the requirements and the needs of each specific case. When used in counselling Egan’s model can be combined with other theoretical approaches in order to achieve a more integrate result. The role of counselors in the effectiveness of the relevant procedure is significant. Regarding this issue it has been stated by Brendel et al. (2003, 327) that “the importance of counselors being able to provide help in different ways, and in particular, in ways individualized for persons who differ (i.e., are diverse) from them, is well recognized; however the effectiveness of helping in such contexts is to a large extent contingent upon the skills and attitudes of the helper”. The success of the whole effort is highly depended on the theoretical approach used for the interpretation of the circumstances of each particular case. The use of the model of Egan has to be evaluated in accordance with the circumstances of each case and the readiness (potential) of the persons involved to proceed to the required changes. For this reason, Brendel et al. (2003, 327) referred to the study of Egan (1994) in which a particular case of interaction between helpers and clients is analyzed: “Helpers differ from their clients in any number of ways-gender, sexual orientation, social status, economic status, religion, politics, ethnicity, work experience, age/life stage, type of problem, and so forth; the significant question is, how do helpers come to have the “appropriate” understandings and attitudes necessary for effective helping for persons from diverse populations?” In accordance with the above views, supported by Egan in 1994, the effectiveness of the intervention of helpers can be influenced by the differences between the helpers and the clients. If these differences will not be able to be appropriately resolved, it is very likely that the intervention of helpers will fail. From a different approach, Thompson (2003) referred to the study of Egan in 1975 in which the above author supported that there are several aspects of human behaviour that are formulated during childhood. These aspects are, in accordance with Egan, the following ones: “a) How to remain superficial, b) How to build facades, c) How to plan interpersonal games, d) How to hide from ourselves and others, e) How to downplay risk in human relating, f) How to manipulate others (or endure being manipulated) and g) How to hurt and punish others, if necessary” (Egan, 1975 in Thompson, 2003, 32). In fact there are many ways to explain Egan’s approach to counselling. Many parameters and criteria could be possibly examined as of their role to the formulation of Egan’s model in accordance with the needs of each particular era. More specifically, apart from its primary counselling model (1975) Egan proceeded in the years that followed to the presentation of a series of theoretical approaches trying to explain the role and the influence of several issues on the development of an appropriate counselling approach. In this context, it has been stated by Hoffman (2001, 472) that “consciously and unconsciously, people (particularly young people) continually assess and redefine their identities as females and males and are affected by subtle pressures to maintain gender-stereotypical attitudes and behaviours that devalue both sexes and negatively affect women, men, and society; counselors are in a key position to facilitate healthy development in this area; thus, counselors need to examine what masculinity and femininity mean, both to themselves and to their clients” (Hoffman, 2001, 472). In other words, gender can be a decisive criterion on the formulation of an appropriate psychological framework in which all particular parameters (like personal attitudes, influence of environment, social trends and so on) should be taken into account. It should also be noticed that there could be many aspects of integrative counselling in accordance with the attitudes of the particular theorist, the conditions of a particular case and the social trends that characterize a particular region or period. Towards this direction it has been supported by Lees (2004, 14) that “perhaps the most common approach to integrative counselling is to combine different theories within an integrative framework and then apply the ensuing integrative model in practice; in practice, the main strategy for achieving integration has been to find a central theoretical concept or framework within which some or all existing approaches can be subsumed”. Under these terms, it could be stated that the choice of the most appropriate theoretical approach in order to explain the human behaviour in a particular case is depended on the conditions of a particular case and the needs of the person to which psychological support is going to be provided. Moreover, it is highlighted by Lees (2004, 14) that “while the integrative theories of Egan, Andrews and Ryle are prime examples of this approach as they all ‘successfully integrate previously existing sets of ideas’ and could be referred to as ‘transtheoretical”. In other words, the views of the above theorists could be all characterized as integrative, however it depends on their use in a particular case that this characteristic will be fully evaluated and applied. In any case, the communication between the counsellor and the client has to be continuous at least for the initial period of medical psychological support. Regarding this issue it has been noticed by D’Andrea et al. (2004, 117) that the most significant issue in similar cases is “to help both the client and the counselor understand their therapeutic relationship, thus removing potential roadblocks in therapy that could impede the therapeutic process; when the issue is acknowledged, therapy may progress more quickly”. However, the effectiveness of the support offered to the client cannot be measured with accuracy. It can only be evaluated usually under a specific period during which the responses of the person to his/ her environment are going to be identified and criticized in accordance with the targets set by the counsellor and the needs of the particular client. There are also other issues that need to be considered when applying Egan’s model in practice. In accordance with Atkinson et al. (1993, 257) “the counseling profession heavy reliance on the psychotherapy role has been criticized as being unresponsive to the needs and experiences of ethnic-minority clients; the use of other counseling roles and techniques indigenous to the clients ancestral culture have been proposed as alternatives to psychotherapy; however, no schema currently exists to help counselors select an appropriate helping role or strategy”. In other words, counselor should choose the most appropriate method regarding the particular client in accordance with the conditions related with the specific case, the needs of the client and his/ her ability to apply the counselor’s proposals. On the other hand, it should be noticed that the response of the client to the counselor’s treatment cannot be precisely estimated. The level of communication between the counsellor and the client is another issue that needs to be thoroughly examined before proposing any appropriate treatment/ behaviour by the counsellor. For this reason, it is mentioned by Thompson (2003, 158) that “for example, if a client says, “Ive tried to get along with my boss, but it never works out. Shes too hard on me” an empathic response could be “You feel discouraged about your unsuccessful attempts to get along with your boss”; In contrast, if the counselor responded with “You should try harder” the counselor is responding from his or her own frame of reference; the communication formula for basic empathy, for responding verbally to the clients feelings about concern, uses a statement that identifies the clients feelings and the content of the situation: “I feel [fill in the right category of emotion and the right intensity] because [fill in the experiences, behaviors, or both that elicit the feeling or emotions]”. In accordance with the above, the counsellor’s intervention in a particular case can be easily proved to have no particular importance for the improvement of the patient’s psychology. The existence of barriers in their communication is the most common reason for this phenomenon. Moreover, it should be noticed that the application of Egan’s model in practice has been related with a series of problems. In this context, the findings of the research made by Kelly et al. (1996) were contradicted with Egan’s model in several parts. More specifically, in this study it was found that “counselors tended to provide information related to the clarity of the counseling process (e.g., "I will see you next week") and description of facts regarding client behaviours (e.g., "We have your achievement test results"; "Your mom was concerned about that"), instead of sharing information designed to help clients develop new perspectives on their problems, which may be more appropriate during later stages of counselling” (Kelly et al., 1996, 391). The above differentiation can be explained by many reasons. In accordance with Kelly et al. (1996, 391) “for the inconsistency between the present study and Egans model may be that Egans model has been used with adult-to-adult counseling; whereas in this study adult-to-child counseling was conducted”. In other words, the effectiveness of Egan’s model in particular cases can be limited especially when the conditions related with these cases have specific characteristics and aspects which cannot be thoroughly examined through Egan’s model. II) Consider which aspects of Egans model are most relevant for bereavement – comparison with Worden’s Four Tasks of Mourning Referring to the application of Egan’s model in cases of bereavement, it should be noticed that counselors should be well informed on all particular aspects of this model. The analytical examination of the conditions of the specific case is also another issue that should be considered by counselors that would be interested to intervene. In fact, it has been found by Constantine (2001, 357) that “counselors who are capable of considering others perspectives or points of view (i.e., have cognitive empathy) may be similarly proficient in conceptualizing treatment issues related to working with culturally diverse clients”. The above approach could be used in cases of bereavement. The only problem would be the fact that counselors would have experience on the particular issue as it presents many difficulties especially when it has resulted to severe problems of health. The simultaneous intervention of many practitioners (both psychologically and physically) would be then necessary. Particularly regarding the intervention in cases of bereavement there are many schemes that could be used as theoretical basis for the evaluation of human behaviour. An issue that has been considered to be very important for the development of the appropriate approach by counselor is his ability to understand the needs of the patient and to intervene appropriately in according with the conditions involved. Moreover, it has to be noticed that especially in the case of bereavement, Egan’s model can be combined with other theoretical models – especially those referring especially in bereavement – like the Worden’s Four Tasks of Mourning. In order to understand the interaction between the above two models we should primary refer to the model of Worden which includes the following four principles/ tasks: “1) Acceptance of the reality of loss; 2) Working through the pain; 3) Adjusting to the environment and 4) Moving on” [1]. It should be noticed that Worden has accepted a specific term of mourning, supporting that the above ‘human condition’ can be explained as a “process of separating from the person who has died and adapting to the loss” (Worden, 1991, 10). The development of the above phases in mourning by Worden has been extensively analyzed in the literature. In this context, Servaty-Seib (2004, 125) supported that “Wordens work was an important development in the understanding of the process of coping adaptively with bereavement as each task is clearly defined in an action-oriented manner”. It should also be noticed that Worden’s model has been used in all cases of bereavement especially in those related with children who have suffered the loss of a parent. Regarding this issue, it has been found by Carus et al. (1999, 166) that “many changes can occur after a parents death (i.e., economic changes, new residence, different school, parents remarriage), which can contribute further to the disruption generated by a parents death and may reinforce beliefs that life is unpredictable and out of personal control, beliefs that can exacerbate adjustment difficulties”. However, the application of Worden’s model in the above cases is not limited on certain aspects of bereavement but can refer to all parts of the relevant ‘process’. For this reason, Carus et al. (1999, 167) noticed that “less attention has been focused on the events surrounding the parents death and burial, although there is some evidence that childrens experiences during this period also can affect their post-death functioning; circumstances such as the extent to which the child was prepared for the funeral experience”. On the other hand, it seems that Worden’s model is bases on specific theoretical approaches like many other theorists in the particular area of knowledge taking into account the particular psychological conditions usually related with bereavement of a loved one – especially a member of the family. Under these terms, it should be noticed that “factors contributing to the idiosyncratic reactions to bereavement include personality traits, cultural background, and developmental level of the bereaved” (Servaty-Seib, 2004, 127). If compared with Egan’s model, the theory supported by Warden through his ‘Four Tasks of Mourning’ could be characterized as a ‘limitation’ of the former in sense that it refers to a specific aspect of psychological support, the one offered to a person in bereavement. Moreover, in accordance with the above the effectiveness of Egan’s model in cases of bereavement especially when combined with Worden’s Four Tasks of Mourning, cannot be considered as absolute since there is always the risk of failure in applying the principles and the terms included in both the above models. The competence of the particular counselor to identify the conditions involved in the specific case and propose the appropriate methods for psychological support of the person suffered the loss, is a basic prerequisite for the successful application of the above models in practice. The effectiveness of counselling in the cases of bereavement has been studied by Cutcliffe (1998, 754) who supported that “bereavement can be considered to have a number of phases or stages which need not occur in a linear fashion, but this does not make bereavement a mechanistic process”. Under these terms, the response of a specific person to the psychological support offered can be differentiated in accordance with his/ her personal attitudes, the effects of the loss involved in his/ her life and the prospects for the future. Generally, it could be noticed that even the methods applied in psychological support of people in bereavement can be differentiated. As for the effectiveness of the psychological support offered to people in bereavement, it has been found to be high, always in accordance with the targets set by the medical professional (counselor) and the potential of the person suffered the loss to respond to the requirements of the particular treatment. Moreover, psychological support offered to people in bereavement should be considered as a valuable tool towards the reduction of the disorders related with the particular case. The level of effectiveness of this support can be differentiated however in accordance with the conditions related with each specific case, the psychological strength of the person who suffered the loss and the role of the social environment (family, friends). In the case of bereavement, Worden’s model should be considered as most appropriate regarding the support offered to a person (no matter his/ her age) that have suffered a loss. On the other hand, Egan’s model presents a general framework of appropriate initiatives when having to cope with a case of psychological support. It is not limited in bereavement but it can refer to a series of problems/ issues that have an impact on the person’s attitude and mood. Works Cited Atkinson, D., Thompson, C., Grant, S. (1993) A Three – Dimensional Model for Counseling Racial/ Ethnic Minorities. The Counseling Psychologist, 21(2): 257-277 Benasutti, K., Clements P., Deranieri, J., Vigil, G. (2004). Life after Death: Grief Therapy after the Sudden Traumatic Death of a Family Member. Perspectives in Psychiatric Care, 40(4): 149-155 Brendel, J., Devaney, S., Vacc, N. (2003) Counseling Multicultural and Diverse Populations: Strategies for Practitioners. New York: Brunner-Routledge Constantine, M. (2001) Multicultural Training, Theoretical Orientation Empathy, and Multicultural Case Conceptualization Ability in Counselors. Journal of Mental Health Counseling, 23(4): 357-367 Cutcliffe, J. (1998) Hope, counselling and complicated bereavement reactions Journal of Advanced Nursing 28 (4): 754–761 Deminco, S. (1995). Young Adult Reactions to Death in Literature and in Life. Adolescence, 30(117): 179-183 Egan, G. (1975). The skilled helper: A model for systematic helping and interpersonal relating. Pacific Grove, CA: Brooks/Cole Egan, G., (1990) The skilled helper (4th Edition) Pacific Grove, CA: Brooks/Cole Egan, G. (1994). The skilled helper: A problem-management approach to helping (5th ed.). Pacific Grove, CA: Brooks/Cole Hoffman, R. (2001) The Measurement of Masculinity and Femininity: Historical Perspective and Implications for Counseling. Journal of Counseling and Development, 79(4): 472-492 Karus, D., Raveis, V., Siegel, K. (1999) Childrens Psychological Distress Following the Death of a Parent. Journal of Youth and Adolescence, 28(2): 165-176 Kelly, K., Lin, M., Nelson, R. (1996) A Comparative Analysis of the Interpersonal Process in School-Based Counseling and Consultation. Journal of Counseling Psychology, 43(4): 389-395 Lees, J. (2004) Eclecticism and integration within workplace counselling. Counselling at work, Autumn, 13-15 Muller E., Thompson, C. (2003). The Experience of Grief after Bereavement: A Phenomenological Study with Implications for Mental Health Counseling. Journal of Mental Health Counseling, 25(3): 183-197 Parkes, D. (1980) Bereavement counselling: does it work? British Medical Journal, 3-6 Prospects Graduate (2007) The Egan Model, available at http://www.prospects.ac.uk/nicec/distance-learning-unit/DLUnit2/Egan.html Raphael, B. (1996) The Anatomy of Bereavement: A Handbook for the Caring Professions. London: Routledge Servaty-Seib (2004) Connections between Counseling Theories and Current Theories of Grief and Mourning. Journal of Mental Health Counseling, 26(2): 125-129 Smith, P., Sharma, M. (2002) Rationalizing the promotion of non-rational behaviours in organizations. The Learning Organization, 9(5): 197-201 Thompson, R. (2003) Counseling Techniques: Improving Relationships with Others, Ourselves, Our Families, and Our Environment. New York: Brunner-Routledge Thoresen, C., Eagleston, J. (1985) Counseling for Health. The Counseling Psychologist, 13(1): 15-87 Warden’s Four Tasks of Mourning, available at http://www.sidsillinois.org/images/reading_material/wordens_4_tasks_of_mourning.pdf Worden, J. W. (1991). Grief counseling and grief therapy: A handbook for the mental health practitioner. New York: Springer Read More