Post:Respond to the following questions regarding the Case of Stan from page 454 of the textbook:

• What themes in Stan's life do you find most significant, and how might you draw on these themes during the initial phase of counseling?
• What specific concepts from the various theoretical orientations would you be most inclined to utilize in your work with Stan?
• Identify some key techniques from the various therapies that you are most likely to employ in your therapy with Stan.
• How would you develop experiments for Stan to carry out both inside and outside the therapy sessions?
• Knowing what to do with Stan, what do you imagine it would be like to be his therapist? What problems, if any, might you expect to encounter in your counseling relationship with him.

An Integrative Approach Applied to the Case of Stan

Clarifying the Therapeutic Relationship

In establishing the therapeutic relationship, I am influenced by the person-centered, existential, Gestalt, feminist, postmodern, and Adlerian approaches. I ask myself these questions: "To what degree am I able to listen to and hear Stan in a nonjudgmental way? Am I able to respect and care for him? Do I have the capacity to enter his subjective world without losing my own identity? Am I able to share with him my own thoughts and reactions as they pertain to our relationship?" I invite Stan's questions about this therapeutic relationship. One goal is to demystify the therapy process; another is to get some focus for the direction of our sessions by developing clear goals for the therapy.

Clarifying the Goals of Therapy

With respect to setting goals, precision and clarity are essential. Once we have identified some goals, Stan can begin to observe and measure his own behavior, both in the sessions and in his daily life. This self-monitoring is a vital step in any effort to bring about change. I will be asking for Stan's feedback throughout the therapeutic process and will use his feedback as a basis for making modifications in our therapeutic alliance.

Throughout our time together, I ask Stan to decide time and again what he wants from his therapy and to assess the degree to which our work together is helping him meet his goals. It is important that Stan provide the direction in which he wants to travel on his journey. Once I have a clear sense of the specific ways Stan wants to change how he is thinking, feeling, and acting, I am likely to take an active role in co-creating experiments with Stan that he can do both in the therapy sessions and on his own away from our sessions.

Working With Stan's Past, Present, and Future

Dealing With the Past

In my integrative approach, I tend to give weight to understanding, exploring, and working with Stan's early history and to connect his past with what he is doing today. My view is that themes running through our life can become evident if we come to terms with significant experiences in our childhood. I favor the Gestalt approach of asking Stan to bring into the here and now those people in his life with whom he feels unfinished. A variety of role-playing techniques in which Stan addresses significant others through symbolic work in our sessions will bring Stan's past intensely to life in the present moment of our sessions.

Dealing With the Present

Being interested in Stan's past does not mean that we get lost in history or that we dwell on reliving traumatic situations. By paying attention to what is going on in the here and now during the counseling session, I get significant clues about what is unfinished from Stan's past. He and I can direct attention to his immediate feelings as well as to his thoughts and actions. It seems essential to me that we work with all three dimensionswhat he is thinking, what he is actually doing, and how his thoughts and behaviors affect his feeling states.

Dealing With the Future

If Stan decides that his present behavior is not getting him what he wants, he is in a good position to think ahead about the changes he would like to make and what he can do now to actualize his aspirations. The present-oriented behavioral focus of reality therapy is a good reference point for getting Stan to dream about what he would like to say about his life five years hence. Connecting present behavior with future plans is an excellent way to help Stan formulate a concrete plan of action, which can give him a way to create his future.

Identifying and Exploring Feelings

The authenticity of my relationship with Stan encourages him to begin to identify and share with me a range of feelings. Our open and trusting relationship is not sufficient to change Stan's personality and behavior, however, and I continue to use my knowledge, skills, and experiences to help Stan clarify his own thoughts. Stan is the best expert on his own life, and I assist him in coming to value the ways in which he is the expert in the therapeutic endeavor as well.

I draw heavily on Gestalt experiments to help Stan express and explore his feelings. Eventually, I ask him to avoid merely talking about situations and about feelings. Rather, I encourage him to bring whatever reactions he is having into the present. For instance, if I notice tears in his eyes, I may direct him to "be his tears now." By putting words to his tears, he avoids abstract intellectualization about all the reasons he is sad or tense. Before he can change his feelings, Stan must allow himself to fully experience them. The experiential therapies provide valuable tools for guiding him to the expression of his feelings.

The Thinking Dimension in Therapy

Once Stan has experienced some intense feelings and perhaps released pent-up feelings, some cognitive work is essential. To bring in this cognitive dimension, I focus Stan's attention on messages he incorporated as a child and on the decisions he made. I get him to think about the reason he made certain early decisions. Finally, I challenge Stan to look at these decisions about life, about himself, and about others and to make necessary revisions that can lead him to creating a life of his own choosing.

The cognitive behavioral therapies have a range of cognitive techniques that can help Stan recognize connections between his cognitions and his behaviors. Over a number of sessions we work on specific beliefs. My role is to promote corrective experiences that will lead to changes in his thinking. Eventually, our goal is some cognitive restructuring work by which Stan can learn new ways to think, new things to tell himself, and new assumptions about life. I have given Stan a number of homework assignments aimed at helping him identify a range of feelings and thoughts that may be problematic for him. This provides a basis for change in his behavior.

Doing: Another Essential Component of Therapy

Feeling and thinking are not a complete therapy process. Doing is a way of bringing these feelings and thoughts together by applying them to real-life situations in various action programs. I ask Stan to think of as many ways as possible of actually bringing into his daily living the new learning he is acquiring in our sessions. Homework assignments (preferably ones that Stan gives himself) are an excellent way for Stan to become an active agent in his therapy. He must do something himself for change to occur. The degree to which he will change is directly proportional to his willingness to experiment. Thus, each week we discuss his progress toward meeting his goals, and we review how well he is completing his assignments, as well as how his action plan is working.

Moving Toward Termination of Therapy

Termination of therapy is as important as the initial phase, for now the key task is to put into practice what he has learned in the sessions by applying new skills and attitudes to daily social situations without professional assistance. When Stan brings up a desire to "go it alone," we talk about his readiness to end therapy and his reasons for thinking about termination. I also share with him my perceptions of the directions I have seen him take. This is a good time to talk about where he can go from here. We spend time developing an action plan and talking about how he can best maintain his new learning.

In a behavioral spirit, evaluating the process and outcomes of therapy seems essential. This evaluation can take the form of devoting some time to discussing Stan's specific changes in therapy. A few questions for focus are: "What stands out the most for you, Stan? What did you learn that you consider the most valuable? How did you learn these lessons? What can you do now to keep practicing new behaviors? What will you do if you experience a setback?" We explore potential difficulties he expects to face when he no longer comes to weekly counseling sessions. At this point, I introduce some relapse prevention strategies to help Stan cope constructively with future problems. By addressing potential problems and stumbling blocks that he might have to deal with, Stan is less likely to become discouraged if he experiences any setbacks. If any relapses do occur, we talk about seeing these as "learning opportunities" rather than as signs that he has failed. I let Stan know that his termination of formal therapy does not mean that he cannot return for a visit or session when he considers it appropriate.

Commentary on the Thinking, Feeling, and Doing Perspective

Although the steps I described with Stan may appear relatively structured and even simple, actually working with clients is more complex and less predictable. If you are practicing from an integrative perspective, it would be a mistake to assume that it is best to always begin working with what clients are thinking (or feeling or doing). Effective counseling begins where the client is, not where a theory indicates a client should be.

In summary, depending on what clients need at the moment, I may focus initially on what they are thinking and how this is affecting them, or I may focus on how they feel, or I may choose to direct them to pay attention to what they are doing. If Stan can change his thoughts, I believe he is likely to change some of his behaviors and his feelings. If he changes his feelings, he might well begin to think and act differently. If he changes certain behaviors, he may begin thinking and feeling differently. Because these facets of human experience are interrelated, one route generally leads to the other dimensions.