By Tanya Glover

Abstract

The counselor described in this paper has chosen to put herself in the position of imagining herself working in a private practice. As a result, she has determined that she will most likely be working with a wide array of mental health issues including depression, relationship issues, eating disorders, etc. In order to be successful as a counselor in this setting, she has chosen two specific theories that she will incorporate into her practice; Adlerian theory and Behavioral theory. The theories were chosen in accordance with the counselor’s views and beliefs on therapy and its personal value in her life. Heavy focus is given to describing the main assumptions of each theory and information is given on how each theory would work on a given disorder. Adlerian theory is the focus of treating depression while Behavioral theory is the focus of treating eating disorders. The counselor shows why she feels that these two theories fit well together and how they can be incorporated into treatments for many different mental and emotional disorders.

  Counseling Theories
There are many environments in which a mental health professional can choose to work. For this paper, the venue the mental health professional will be working in is private practice. The professional’s purpose will be explored; including the role they play in the counseling process and the type of clients the professional will likely encounter. While working in this venue the counselor will choose to use two theories: Adlerian theory and Behavioral theory. Each theory will be explored, detailing the basic assumptions of each theory and how these assumptions integrate with the counselor’s personal philosophy, values, and life story. Consideration will be given to how these theories can be applied in various counseling settings and with different cultural backgrounds. Using current research on the two theories, a description and analysis will be provided of their effectiveness when working with specific populations of clients with mental and emotional disorders.
 
Private Practice
The mental health professional in the paper has chosen to work in a private practice. The private practice she is working in is a small business with one other professional. The services offered will be general counseling treatments. The clients that will likely be seen by the counselor would include people suffering from depression, people who need marriage/relationship counseling, people who are at an impasse in their lives and need help finding direction, and people who are having trouble getting through past events in their lives. In a private practice, many different types of clients are seen and that is the purpose this counselor has for having another professional on board. If she does not have the skills or experience to handle a specific issue, the other professional can be brought in to take that particular case. This counselor does have past experience working with the child population and her work in private practice will differ from that past work experience as she will not be treating children as she found that working with children was not the type of work she felt comfortable with. She will be focused on adult clients in her private practice and also be focused on using two particular theories of practice.

Adlerian Theory
One theory the counselor plans to use in her practice is Adlerian theory, developed by Alfred Adler. Adler developed the first holistic approach to therapy. “According to Adler, when we feel encouraged, we feel capable and appreciated and will generally act in a connected and cooperative way. When we are discouraged, we may act in unhealthy ways by competing, withdrawing, or giving up.”(Adler Graduate School, 2007). Encouragement is a significant aspect of the Adlerian theory. “Adler and subsequent Adlerians consider encouragement a crucial aspect of human growth and development.”(Watts and Pietrzak, 2000). Adler worked under the assumption that the human mind does not see actual facts but rather our own presumption of what we perceive as actual facts. Adler was one to look at subjective facts while Freud was one to look at objective facts. “Adler was not interested in facts per say, but the individual’s perception of the facts.” (Mosak, & Maniacci, 1999, pg 19, para 2). The word subjective means from someone’s own personal point of view. Adler believed that when it comes to human views, everything was subjective. Take for example a headache. “Naturally, you have your own personal private "subjective" experience of the headache, and nobody else can have your headache for you. So, in one of the usual (oversimplified) senses of "subjective", all headaches are subjective.”(LaFave, 2008). Adler viewed human perceptions, feelings, and ideas as subjective. The way a person views the world is the major contributor of how their behaviors are shaped. One’s reality is subjective, not factual (objective).

Another assumption made in Adlerian theory is that people are driven by the need to feel superior. “Adler stressed that striving for perfection and coping with inferiority by seeking mastery are innate.” (Corey, 2009, pg 100, para 4). Humans are constantly seeking to become what they perceive as their ideal self. This search can sometimes lead a person to take on a feeling of overwhelming inferiority thus leaving them with an inferiority complex. It is  stated that “However in some people, inferiority feelings can become excessive resulting in what is widely known today as "INFERIORITY COMPLEX" - Exaggerated feelings of weakness and inadequacy.” (Magnus, 2009).

Adler was one to look at both the past and the present. However, the main focus was on the present. Adler operated on the assumption that people develop who they are through series of events that occur during the first six years of their lives. By recalling early memories clients can see a pattern in their lives that in many cases continue throughout their adult lives. From there the focus is on what they can do to reshape their present and future. The past events serve as a starting point for understanding why they perceive themselves and their lives the way they do now. 

The counselor feels that Adlerian assumptions align well with her own personal views and life history. Having gone through her own personal therapy, she was able to see where her early recollections shaped her views on life and herself. Understanding these things have allowed her to understand how the things in her life can be changed and how she kept herself in a bad place because of her perception of what was real and what was not. The counselor was able to change her subjective views and by doing do heal herself in many ways.

Behavioral Theory 
The other practice the counselor plans to use in her practice is behavioral theory which she feels is highly complementary to the Adlerian theory. “Behavior therapy practitioners focus on observable behavior, current determinants of behavior, learning experiences that promote change, tailoring treatment strategies to individual clients, and rigorous assessment and evaluation.”(Corey, 2009, pg 234, para 1). The most basic assumption of behavior theory is that since feeling, emotions, and thoughts are immeasurable, thus the most effective way to help clients is through observing their behaviors. This can lead the counselor to being able to effectively help the client. “The ethos of behavioral approaches arose from the inability of scientists to measure and evaluate the outcomes of psychoanalytic and phenomenological approaches to helping and from a need to predict and measure outcomes of helping based on specific, observable, objective, and measurable variables.” (Okun, & Kantrowitz, 2008, pg 133, para 3).

According to the behavior theorist, behavior is a product of learning experiences and we, as humans are not only a product of our environment but the producer of our environment as well. “We learn new behaviour  [sic] through classical or operant conditioning.” (McLeod, 2007).  Another connected assumption of the behavior theory is that all behaviors, both simple and complex, can be reduced to a stimulus-response feature.  “Behavior is shaped and maintained by its consequences.” (Okun, & Kantrowitz, 2008, pg 134, para 2). A person’s behavior can be reinforced positively or negatively although typically, positive reinforcement has a more significant impact. No matter how much work is but into changing or developing a certain behavior, the behavior can disappear if the reinforcement fails to appear.

Overall, behavior theory stresses that a person is shaped by learning and environment. Heavy emphasis is put on current behaviors and treatment goals as well as how to change undesirable behaviors.” The general goals are to increase personal choice and to create new conditions for learning. An aim is to eliminate maladaptive behaviors and to replace them with more constructive patterns.”(Corey and Corey, 2011, pg169, para 4).

The counselor feels that behavior theory aligns well with her own personal views and life history. Overall, it does not differ much in from the Adlerian school of thought. Both theories are of the belief that people can change their behavior and are the controller of their destinies. For the counselor, behavior theory is a good explanation of why we behave the way we do and how motivating factors throughout our lives play an important role in behavior.

  Role of Theories with Clients
This counselor believes that blending Adlerian theory and Behavioral theory will be a successful for her clients. For example, a person who has suffered from depression their whole lives can find through Adlerian theory where her depression stems from and the behavioral theory can help the client to change her behavior patterns. For a couple who comes for counseling due to commitment issues, Adlerian theory can help them to determine why they have a fear of commitment and Behavioral theory can help them to see their situation in a different light and change the things that are not working for them. The counselor cannot see any instances where this combined practice would not be successful in helping any client she may treat in her private practice. 
 

Counseling Settings and Diverse Backgrounds

 Although the counselor plans on using these two theories in a private practice, they can also be successfully used in other counseling venues as well. In a setting that caters to addiction counseling, behavior theory can be very successful in helping clients to overcome their addictive behaviors. The Adlerian theory comes into play in indentifying the root of the addiction. This can be achieved through exploration of past family history and early recollection. Perhaps there is a life theme in the client that shows where the need for the additive substance came into play. One theory of addictive behavior deals with adaption models and shows “the way in which the addict's experience of a drug's effects fits into the person's psychological and environmental ecology. In this way drugs are seen as a way to cope, however dysfunctionaly [sic], with personal and social needs and changing situational demands.” (Peele, 1998).

Another venue that these theories can be applied is in school counseling. Many students suffer through problems at home that affect their performance in the school setting. Adlerian theory can help to draw out these family issues while the behavior theories can help in changing the students’ behaviors. This counselor feels that this is especially true for young people having family problems that affect their academic performance. While pinpointing the family issues through use of the adlerian theory may not change things at home (unless the family is willing to enter into counseling) the behavior theory can certainly play a key role in helping the student to overcome these issues and see that while they cannot change the behavior of others they can change their behavior and how they react to the situations in their lives.

Adlerian theory and Behavioral theory can be helpful for many different types of people. However, working with clients from diverse cultural backgrounds can provide a challenge in some situations. It does appear though, that Adlerian perspectives on cultural diversity are less rigid then other theories. “This approach addresses cultural issues in both the assessment and treatment process. Adlerian therapists encourage clients to define themselves within their social environments.” (Corey, 2009, pg 119, para 2). Globally speaking, this theory fully recognizes the different aspects of culture including gender, race and religion and works within the clients comfort zone when it comes to their

cultural beliefs and differences. Thought this is true of Adlerian approaches, behavioral approaches can present problems for people from different cultures. When it comes to behavior there are many factors to consider such as a person’s cultural beliefs and how the client was raised. For instance, if a Hispanic woman was seeking counseling for her marital problems it may be hard for her to embrace behavior changing techniques due to her cultures view of woman and divorce.

  Counselors Personal Bias
The counselor’s personal bias can affect the way she views a particular theory depending on her personal beliefs and values. As for the two theories discussed, the counselor is biased in that she feels that these are the most effective theories when combined. She feels that the past must be explored in order to fix situations in the present and to move effectively into the future. She also feels that learned behavior can be unlearned and changed to make the clients life the way they envision it being. There are also bias’s against certain theories. While the counselor is a woman, she feels bias against the feminist model of counseling as she

feels it to too pushy and only can cater to a certain class of people. (I.e. white woman, middle class woman, and other feminists or on the fence feminists). The counselor does not feel that any theory that cannot be somehow applied to the general population is not as effective as it should be.

  Effectiveness of Adlerian Theory on Depression
Depression can occur due to various issues in a clients life, including relationship issues, feeling little self worth due to not being able to find meaning in their life, or losing a loved one just to name a few. Other causes of depression may be “pessimistic thinking, a lack of self-esteem, trauma survived such as child abuse, crime, or natural disaster, or severe problems such as job loss, financial setback, poor health, or divorce.” ("Why does depression," 2007)

 Depression can occur due to a heavy amount of anxiety in one’s life. For example, a person who is constantly bullied may suffer high anxiety and lower self worth and therefore suffer from depression.

Adlerian therapy can be an effective means of treating clients who suffer from depression. “Adlerian therapy basically tries to assist a patient to get over the inferiority feelings, and make him or her fix realistic agendas and achieving them, which will contribute to their happiness and self importance.” ("Adlerian therapy," 2009). Adlerian therapy operates under the assumption that humans are influenced by social agendas which means that by using what motivates the client can lead to the end of depression. Once the client is able to view their environment differently and their self differently then they can work to lift the depression and find happiness. “Adlerian therapy concentrates on applications of personal psychological principals that are intended to make available the advantages of individual improvements and self-worth.” ("Adlerian therapy," 2009).By using this approach, Adlerian therapy can be quite successful in treating clients with depression.

Effectiveness of Behavioral Theory on Eating Disorders 

All types of people suffer from eating disorders. Men and women, young and old, can all be victim to this terrible mental illness. Theories found in behavior therapy can be highly effective in treating eating disorders. “Cognitive behavior therapy (CBT) and behavior therapy (BT) have been used for many years as first-line treatment, and they are the most-used types of psychotherapy for bulimia.” ("Treatments available for," 2011, pg 1). Both forms of behavior therapy have been found to be an effective means to overcoming eating disorders such as bulimia. “When used to treat bulimia nervosa, BT focuses on teaching relaxation techniques and coping strategies that individuals can use instead of binge eating and purging or excessive exercise or fasting.” ("Treatments available for," 2011, pg 1).

A new method of treating clients with eating disorders has been developed and is called CBT-E (Cognitive Behavioral Therapy Enhanced). This is the first treatment as of yet that shows high success rates on all types of eating disorders. In a study due by the American Journal of Psychiatry, a professor by the name Fairburn states that the results have shown that this new type of treatment “is not only more potent than the earlier NICE-recommended treatment, but it can also be used to treat both bulimia nervosa and the atypical eating disorders, making it suitable for over 80 percent of cases of eating disorders.” (Nauret, 2008). The final results of the study showed that “Approximately two-thirds of those who completed treatment made a complete and lasting response with many of the remainder showing substantial improvement.”(Nauret, 2008). These are impressive results; especially dealing with something as hard fought as an eating disorder and this is one reason the counselor feels that behavior therapy can be successful with eating disorders as well as other mental and emotional disorders.

Conclusion

Working in a private practice, the counselor will deal with a wide array of mental and emotional issues. For this counselor personally, Adlerian theory and Behavioral theory are the two theories that align most with her personal values and beliefs mainly due to the partial focus of the past in Adlerian theory and because of the techniques used in Behavioral theory to bring about change. Each theory can be used to treat a wide variety of mental disorders and such is shown in clients who suffer from

depression and eating disorders. These are illnesses that the counselor is likely to be confronted by in the area of private practice and understanding each theory and how to combine them effectively will bring about a higher success rate for her and her clients.

References
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Corey, G, & Corey, M.S. (2011). Becoming a helper. Belmont, CA: Brooks/Cole.

Corey, G. (2009). Theory and practice of counseling and psychotherapy. Belmont, CA: Brooks/Cole.

LaFave, S. (2008). Thinking critically about the "subjective"/"objective distinction. Unpublished raw data, Philosophy, West Valley College, Saratoga, California. Retrieved from

http://instruct.westvalley.edu/lafave/subjective_objective.html.

Magnus, U. (2009, March 4). How to manage inferiority complex with alfred adler techniques. Associated Press

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Nauret, R. (2008). Behavioral therapy for eating disorders. Psych Central, Retrieved from http://psychcentral.com/news/2008/12/16/behavioral-therapy-for-eating-disorders/3510.html.

Peele, S. (1998). The meaning of addiction [Chapter 3 ]. Retrieved from http://peele.net/lib/moa.html.

Watts, R., & Pietrzak, D. (2000). Adlerian "encouragement" and the therapeutic process of solution-focused brief therapy. Journal of Counseling and Development, 78, 1.

Why does depression happen? (2007). Alternative Health, Retrieved from http://www.alternativehealthbuzz.com/depression/why-does-depression-happen.php.

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