The Master of Arts in Counseling is finalized through a comprehensive examination. The counselor identifies two preferred theoretical perspectives and then applies theoretically appropriate techniques to a specific therapy session. This exam was successfully passed by Wood in 2012. The following is an excerpt from that exam which was heavily edited for publication.
An Integrative Analysis of Narrative and Existential Counseling
The tenets of narrative and existential theory form a complementary structure and a symbiotic relationship during therapeutic practice. Both theoretical foundations suggest that healthy human beings will engage in a constant state of adaptation and willingness to change. Narrative theory proposes that individuals experience life as a linear story that the individual can rewrite or alter direction at any time. Existential theory proposes that individuals can experience life as nonlinear, and that the individual can explore new identities because any potential identities are already a part of their all-encompassing sense of self. Both therapies “include that we are meaning-making individuals who create our own reality, that change rather than stasis is the norm, that dysfunction occurs through an inability to choose and that the therapeutic relationship is based on equality (McNulty, 2013).” This essay recommends a combination of narrative and existential theories for understanding the counseling process and techniques for engaging clients in therapeutic counseling sessions.
Narrative therapists suggest that a client is the main character of the client’s life story. The client’s story “is a first-person narrative in which the person defines himself or herself based on memories of his or her past life, present life, roles in social and personal settings, and relationships with important others (Payne, 2006).” According to narrative therapists, a client seeks therapy when they experience confusion within their narrative; either the story is inadequately representing reality or reality is contradicting the person’s life story. The therapist facilitates the counseling process by assisting the client in objectively viewing their own life story, which allows the client to adapt or rewrite their story into a retelling that is more appropriate to their current position in life. Clients involved in narrative therapy may benefit from expressive arts techniques such as phototherapy, art, music, scripting, and drafting memoirs (Ricks, 2014).
Existential therapists propose that a client’s corporeal existence is only a starting point from which that individual person can develop a sense of their true essence throughout their lifetime. The client’s essence is a combination of who the client was in the past, who the client is now, and who the client will be in the future. According to existentialist theory, a client seeks therapy when they are resistant to the natural process of change in their life; this is a tension between “constancy – the desire for reliability” and “change – the desire for challenge (Adams, 2014).” The therapist facilitates the counseling process by helping the client embrace autonomy and personal responsibility, which allows the client to claim a more active role in establishing and reestablishing their essence. Clients involved in existential therapy may benefit from techniques such as self-assurance, autobiography, and responding to the question "why now?" to stimulate a need for immediate action (Adams, 2014).
Within a narrative and existential framework, a client’s presenting problem originates with a present life experience that is somehow out of flux with the client’s sense of self. The client has reached a stuck-point and is unsure how to proceed. The real problem for the client is the inability to make the desired change and break through this stuck-point; they may not be fully aware of the issue, lack clarity of will, have difficulty ending defense mechanisms, or be prone to relapsing into old patterns. The client is seeking therapy in order to view the problem objectively and to figure out the next steps to take in order to make a change. The problem of where the client is in their life and how they are stuck presents in the beginning of the first session. As the counselor listens to the client’s story, the story’s framework and problem maintenance become clear to the therapist. First, the counselor would assist the client in identifying characteristics of themselves in the story and important arcs using narrative therapy; this would lead to the client distancing their self from the story to generate an objective understanding of their narrative. Then, the counselor would use existential therapy to assist the client in removing their self from linear order and establishing self-authority of their identity; this would lead the client to accepting responsibility in consistently deconstructing and reconstructing their sense of self whenever necessary.
Mental Health and Pathology
Personality disorders involving a person's attempts to behave appropriately and successfully within society – wherein their thoughts, perceptions, or behaviors have become problematic – be treated through therapeutic methods without the necessity of pharmaceuticals. The labels of each personality disorder are a way for practitioners to communicate with one another the symptoms a client is experiencing; the label is not necessarily diagnosis of a genuine physiological pathology. Personality disorders are part of the wellness model, a holistic and affirming approach which encourages “a conscious, self-directed and evolving process of achieving full potential (Hettler, 1976).” The wellness model pairs well with narrative and existential therapy in that all three encourage deconstructing and reconstructing interconnected dimensions of the self and would be particularly effective in treating personality disorders.
Severe mental health issues that involve a chemical imbalance or other bio-psychological component such as schizophrenia are genuine pathologies. These issues have been ingrained in a human being's physiology and are part of the medical model. The treatment for such pathologies would involve pharmaceutical medicines to intervene in the individual’s physiology. Narrative and existential therapy can still assist clients experiencing genuine pathologies because of the comorbid prevalence of personality disorders with severe mental health illness, however, therapy should be conducted under joint care with a psychiatrist.
Existential theory proposes that human beings develop their true essence over the course of a lifetime; humans are therefore not innately born with a natural identity. Environmental factors and their interaction with bio-psychological components in the brain are largely responsible for creating a person's essence, or personal reflection of being. An individual's initial temperament and personality are presented within the first few years of life, however life experiences will affect this developing sense of self and cause the individual to adapt their essence over time. A person's sense of self consistently experiences disruption and manipulation throughout the lifetime, and a common experience in life is losing touch with the self. A narrative and existential counselor would present a therapeutic relationship where the client feels safe and not manipulated and can therefore feel comfortable in being themselves; empathizing and understanding a client's life experiences that have manipulated the client away from their perceived essence can allow the client to become aware of those experiences and move toward change. Change is therefore a deconstruction of narrative manipulation in order to identify the elements the client perceives as their true sense of self, while existentially encouraging the client to take personal responsibility for redefining their present and future self in a way that is congruent with their current essence.
The therapeutic relationship between counselor and client is that these are two individual human beings coming together to address one person's problem, or current stuck-point within the story of their life or sense of self. The counselor presents as an empathic person on equal standing with the client and will normalize the process of therapy. The counselor promotes a safe environment in which to explore the client’s essential self during the therapy session; therapy should comfort the client to participate as any version of their self without fear of negativity or manipulation. The counseling relationship forms through the psychological contact between these two persons and the shared reality that exists in the session. A counselor must demonstrate understanding of the client by using empathy and must also maintain and present the idea that the client's self is unconditionally positive and the counselor will treat them appropriately. Once rapport is established, the counselor can use learned techniques in the therapeutic relationship that may benefit the client in understanding the problem and bringing about change. The counselor should never take a stance of power over a client and assume they, as the expert, know what is best or appropriate for the client, but rather help the client to take personality responsibility and decide for their self the best course of action. The relationship is two individuals finding a shared reality where the client's essence can be nourished, then working together how best to proceed in encouraging the self toward a positive life change.
A successful counseling session would establish the shared reality between counselor and client, accomplish detailing the problem and its effects, highlight the influences perpetuating the problem, explore options and alternatives together, and agree on a loose plan to move toward effective change. The counselor would establish the counselor-client relationship as a shared agreement to work together and a dedication to make some small step toward change. As the client expresses their presenting issue, the counselor would identify the client’s narrative; the session would lead to the client being made aware of the scripted narrative they are enacting as well as exploring existential opportunities to adapt their narrative or invoke new identities. The session would end with an established commitment toward a specific change in the client.
Adams, M. (2014). Human development and existential counselling psychology. Counselling Psychology Review, 29(2), 34-42.
Hettler, B. (1976). The six dimensions of wellness. National Wellness Institute, Inc., http://www.nationalwellness.org/?page=Six_Dimensions.
McNulty, J. (2013). Integrating existential and narrative therapy: A theoretical base for eclectic practice. Existential Analysis, (1), 170.
Payne, M. (2006). Narrative therapy (2nd ed.). London, England: Sage.
Ricks, L., Kitchens, S., Goodrich, T., & Hancock, E. (2014). My story: The use of narrative therapy in individual and group counseling. Journal of Creativity in Mental Health, 9(1), 99-110.