Counselling should be easy for the trained therapist.

This article proposes that the relationship skills the therapist is taught in counselling should be taught to the client in 80% of presenting cases. Up until now we have not had a framework for delivering those particular relationship skills, rather we have used them with a particular type of therapy, such as CBT.

Note: The 20% of clients excluded covers those with very complex psychological needs which could have a label attached to them under a DSM5 classification.

The 80% of clients who present for counselling normally have symptoms from the following four groups of classifications;

1. Relationship problems, with others or self: [level 4]

• Lack of trust, respect, acceptance or commitment.

2. Influencing problems [esteem] , with self of others: [level 3]

• Lack our courage, assertiveness, evaluation or self-control

 

3. Problems in dealing with negative emotions [principles]: [level 2]

• Feelings of excess fear, anger, criticalness, anxiousness, guilt or confusion.

 

4. Problems in dealing with negative concerns and escaping from them using false positive emotions: [level 1]

• Feelings of paranoid fear, rage, rejection, panic, shame or hopelessness.
• Avoidance [addictions], fantasy, greed & self-centeredness

 

The model which addresses these needs has been adapted from Malsow's Hierarchy of needs. A skilled therapist can move a client through those levels

 What attributes  does a skilled therapist need?

Condensing many hundreds of studies, psychologist Bruce Wamplold, identified 13 the key factors for a successful therapy outcome: They can be broken down into two groups, namely:

Relationship & Influencing Skills by the therapist:

1. Possession of a sophisticated set of interpersonal skills.  Effective psychotherapists are able to express themselves well. They are astute at sensing what other people are thinking and feeling. In relating to their clients, they show warmth and acceptance, empathy, and a focus on others, not themselves.
2. Ability to help you feel you can trust the therapist. According to Wampold, people determine whether or not they can trust someone within 50 milliseconds of meeting them. Clients of effective therapists believe that their therapists will be helpful because the therapist communicates both verbally and non-verbally that he or she is someone the client can trust.
3. Willingness to establish an alliance with you. One of the solidest predictors of good therapeutic outcome is the feeling that clients are in a partnership with their therapists. This is known as the therapeutic alliance. Effective therapists are able to form these alliances with many types of patients.
4. Attention to the progress of therapy and communication of this interest to the client. Good therapists are interested in finding out how their clients are responding to treatment. They show that they want their clients to improve.
5. Inspiration of hope and optimism about your chances of improvement. Hope is a terrific motivator. Feeling that something is going to work is often a large part of the equation in successful treatment. However, a good therapist isn't unrealistically hopeful.  Effective therapists know how to strike a balance between realism and hope.
6. Sensitivity toward your cultural background.  This includes showing respect for your background and being aware of attitudes within your culture or community toward, for example, family relationships, religious practices, and appropriate behavior.
7. Possession of self-insight. An effective therapist is self-aware and is able to separate his or her own issues from those of clients.
8. Involvement in continued training and education. Licensed mental health professionals must participate in continuing education to maintain their credentials. 

9. Communication of confidence about the course of therapy. An effective therapist keeps clients in therapy by communicating to clients the feeling that therapy will be worthwhile. These therapists allow their clients to feel secure in the knowledge that the therapists know what they're doing and why.

 

Technical therapeutic skills practiced by the therapist:

1. Ability to provides an explanation of your symptoms and can adapt this explanation as circumstances change. Clients want to know why they're experiencing their symptoms even if this isn't the first time they've sought therapy. Effective therapists provide explanations that clients can understand but they are also willing to shift according to the way in which treatment unfolds.

2. Commitment to developing a consistent and acceptable treatment plan. Effective therapists conduct an assessment very early in treatment. Following that assessment, they should develop a treatment plan and share that treatment plan with you.

3. Flexibility in adapting treatment to the particular client's characteristics. A good therapist doesn't follow a rigid schedule of treatment- a "one size fits all" approach (as stated by Scranton University psychotherapy researcher John Norcross.  Research into psychotherapy showed convincingly in large numbers of studies that some treatments are better than others for particular psychological disorders.  However, a therapist needs to be willing to make accommodations for the client's particular characteristics.

4. Reliance on the best research evidence. Therapists acting in accordance with APA's Evidence Based Practice Guidelines stay abreast of the latest developments in clinical psychology, particularly in their areas of expertise. Ideally, therapists alter their treatment approaches to be consistent with the latest knowledge.

John Norcross identified factors which don't work in therapy. They included negative  emotions used by the therapist and false positive emotions used by the therapist.

 

THE UNIVERSAL MODEL

 The universal model of therapy is based on the therapist teaching and modelling relationship principles, influencing principles, spiritual principles [hope] and how to overcome negative concerns. These teachings have to be based on a set of  guidelines and follow a structure so that the client can understand how to use them.

 Teaching about fear, distinguishing physical fear from emotional fear.

The counsellor teaches about fear and how to separate physical fear from emotion fear.  The purpose of fear is a warning of a threat and should never come inside yourself, past your conscious mind. It works with the five senses. If fear comes into your subconscious it can cause dysfunction. 80% of all mental illnesses [the other 20% are major ones capable of being classified under a DMS psychology code] are caused by fear coming inside the subconscious and triggering a bad habit as described below:

 Fear is the partner of trust. eg. Trust the lion without fear and you are dead.
Anger is to defend the boundary from attack. Anger is the partner of respect. Low respect for self and others will result in high levels of anger, which is rage or abuse.
Critical, anxiousness, guilt and confusion are used to fix the boundary when it is broken, these are good feelings because keep you safe by restoring your boundaries. eg. If you never felt guilty, then you wouldn't try to fix the boundary and you become vulnerable to attack.

The negative principles defined in the above chart have a purpose to protect your boundary. You can have different types of boundaries. For example, relationship boundaries protects trust, respect, acceptance and commitment. Fear entering a relationship boundary can trigger a weakened attachment from the past and cause us to take things personally. All mental illness falling within the 80% range are caused by rumination and taking things personally, which creates the following cycle:

Failure-shame-blame  [self, others or circumstances ] and either avoid or control the problem with force  or by trying harder.

This rumination cycle generates negative energy and fear then attaches to our negative principles and turns them into negative concerns and dysfunction as shown below:

Fear + anger =rage [I have to defend myself aggressively]

Fear + sadness =paranoid fear [I’m going to get hurt]

Fear + criticalness = Rejection [I’m no good]

Fear + anxiousness = Panic [I’m going to die]

Fear + guilt = Shame [I’m a failure]

Fear + confusion = Hopelessness [I give up]

It can be seen that the above process can lead to dysfunctional symptoms such as depression, anxiety and low self-esteem.

The counsellor helps the client stop the rumination and restore the correct cycle, which is:

Mistakes-Guilt-Self control-Commitment [fix the problem]

 

The counsellor teaches the 5 levels of awareness.

Level 1 -Aware that fear is controlling your behavior, but you can do nothing to prevent it, because it has entered inside your boundary, and linked onto other negative emotions such are anxiousness, anger, sadness and confusion. That is, you are being controlled by your reptilian brain [instinct] or limbic system [emotion].

Level 2-Aware that fear is controlling your behavior and that your influencing principles, such as courage, patience, persistence, assertiveness and self-control and you are trying to overcome the fear by pushing it back outside your boundary. You are trying to control your fear, but are struggling to do it. That is, your neocortex [thinking] has become involved and you are aware of what is happening, but can’t do anything to stop it.

Level 3-Aware that fear belongs outside your boundary and you have successfully used your influencing principles to keep it there, but you feel under threat due to constantly ruminating over negative events. Each time you ruminate, fear is generated. That is, your neocortex is using logic and positive thinking to control your fear, but you slip into negative thinking and return to level 2. You need to find spiritual suffering and grow influencing principles of courage, patience, assertiveness, etc.

Level 4-Aware of your spiritual principles such as humility, suffering, peace, and unconditional acceptance can support your influencing principles to keep fear outside your boundary. You have stopped ruminating, but are not at peace yet. That is, your neocortex is using logic and positive thinking to control your fear. You are aware that your spiritual principles are available to you, but you cannot yet use them to provide peace. You feel under constant stress on the inside, even though you have control on the outside.

Level 5-Aware and can use your spiritual principles of unconditional acceptance to overcome fear and use fear for its true purpose. You are now at peace with fear. That is, your neocortex has accepted that this is an emotional threat, not a physical threat and that you can give up control to your spiritual principles and unconditionally accept the situation. You now understand that this is not fear, but awareness.

 

The counsellor teaches about the three levels of control.

(i) Involuntary control by the subconscious mind, mainly resulting in bad habits.

This is where most clients with mental illness enter counselling. They are being controlled by fear and have generated bad habits. Fear, awareness and control are all at level 1 or level 2

(ii) Voluntary control using the conscious logical mind to achieve flow.

This is where we are in our default or  "normal" phase, using our conscious mind to control our fear.  Fear, awareness and control are at level 3 or level 4.

(iii) Voluntary giving up control to the subconscious mind to achieve optimum flow. Fear, awareness and control are at level 5.

The three levels of control relate to the CPM theory of emotional balance. Logical control using levels 2, 3 and 4 try to keep us in balance as shown in the green area of the chart below. We feel the negative principles of fear, anger, criticalness and guilt, but can convert those back to trust, respect, acceptance and commitment , using positive thinking and our influencing principles of courage, assertiveness, logical evaluation and self-control.

We if take things personally and trigger past bad habits we will fall into negative concerns at level 1 or flip over to false positives to escape those. CPM has defined 12 defense mechanisms to explain this process. 

Our spiritual principles are available to use to move back into balance or to rise to optimum flow. The following spiritual principles are used to achieve this:

 Level 1 to level 2-Negative concerns and negative principles.

• Forgiveness to overcome negative concerns, which are taken personally. Split the person from their behavior, and forgive the person.

• Hope when your pathway out of the problem is blocked or you don’t have a pathway. Hope is based on trusting your intuition. It is often used as a tool to promote innovation. Creating hope is one of the key elements of successful counselling.

 

     Level 2 to level 3-Overcoming negative principles and using influencing principles.

• Peace to overcome negative principles. Sit with fear, anger, anxiety and accept it with no responsibility to fix it. Peace kills both rumination and worry.

       Some other therapies use mindfulness at this level.

• Suffering to grow influencing principles. Eg. Suffer and grow assertiveness, rather than go into rage and abuse the person. Suffering is based on acceptance, if you suffer with influence. However, if you suffer with concern, you will blame the other person or yourself and go backwards to negative concerns at level 1.

            Fear            Anger              Critical           Anxiety

                 to                        to                     to                         to

           Courage      Assertiveness    Evaluation       Self control.

Level 3 to level 4 Restoring relationship principles

• Acceptance. Accepting everything that is within your rules and boundaries related to trust, respect, acceptance and commitment. Accept with courage, assertiveness, evaluation and self-control.

• Giving. Give everything within your rules and boundaries related trust, respect, acceptance and commitment.

              Courage      Assertiveness    Evaluation       Self control

                    to                     to                         to                          to

               Trust             Respect         Acceptance     Commitment.

level 4 to Level 5 Using Spiritual principles.

The three spirit principles that are activated at this level are:

• Unconditional giving works when used with strong rules, boundaries and consequences built into the subconscious mind and used automatically.  The relationship principles of love, trust, respect, commitment, etc grow much faster and reach higher levels when given unconditionally because the beneficiary intuitively knows that they are freely given with no self-centered motives.  There are no goals in unconditional giving, therefore there are no negative comparisons and no judgments. The latter factors are what slows down the growth in relationships and in innovation.
• Unconditional acceptance works when used with strong rules, boundaries and consequences built into the subconscious mind and used automatically. There is no fear of failure and complete freedom to commit and take risks.
• Hope is not the type of hope that wishes for something, rather it is the hope that knows the outcome before the journey begins. It occurs when you have knowledge, skill, experience and passion. When exercising hope you have total internal control over the process and therefore have no fear. You subconscious mind operates automatically and your creativity increases.

 

The counsellor teaches about the comparative mind and the predictive mind and how to get unstuck.

Our human nature is based on greed to achieve more goals, it is external and uses our comparative mind which provides a feedback system to follow a pathway and achieve our goal.

 

In the cognitive principle matrix the predictive mind works with two groups of principles, namely negative principles and spiritual principles. The main spiritual principle is hope.
The predictive mind is hierarchical and can predict from the bottom up, using knowledge, skill and information which is already known, and it can work from the top down to predict what is missing to achieve the goal, now called hope.
With spiritual hope the outcome is known before the journey along the pathway commences. For the outcome to be known the person with hope must have complete control over the process, even if they don’t know what the process will be.

For example, if you want to build a better relationship with your partner, then the hope is that you will try everything within your power to build that relationship, but you will always stick to your relationship principles along the way. The hope is not to end up with a better relationship, because you have limited control over your partners behavior, the hope is for you to try everything you can which is within your complete control.

Once you have this type of hope the bottom up predictive mind will know from past experience what action will achieve good results and predict further ways to build on those. While the top down predictive mind will know what the end result will look like and predict the sort of experience, knowledge, or skills you require. You will find that subconsciously you are “lead, by intuition” to find supporting situations which will feel co-incidental, but are part of the predictive mind which expects to find the answer.
The knowledge that comes from the bottom and top down predictive mind provides the understanding as you travel along the pathway, which generates more predictions.
Negative principles will still occur as you travel along the pathway, but you understand their purpose and use spiritual principles to overcome them.

The predictive mind holds all your rules, boundaries and consequences, which allows your to give up your comparative mind. Hope replaces your goal so that you do not need to use your comparative mind and go outside yourself.

 

The universal model is then enhanced by drawing on techniques from other therapies, such as CBT.

The empirical studies of over 40 years have shown that the relationship between the counsellor and the therapist is the most important factor in obtaining an effective outcome in counselling . Also, expectation and hope is another significant factor, which is included in the universal model. It is no coincidence that all counselling courses start with teaching these principles and how to model them to the client. We should be teaching the client the same thing if we want them to gave good relationships with themselves and others.