New Series on Understand Counseling Theories: Part One - Understanding Theoretical Orientation

We are all unique individuals with certain needs in therapy. I hear very often people say, "I only went to therapy a few times, I didn't like my therapist."  This concerns me because not all therapists are meant for every client. Taking the time to interview your therapist about their approach to counseling is advisable. Any good therapist will give you some time on the phone to discuss their theoretical framework and approach to your specific concerns and issues.

Each therapist is going to have their unique theoretical orientation. This simply means they follow certain schools of thought in the way they interact with clients. What this means is that counselor uses certain techniques to engage clients in meaning for processing of their issues. In this series, I will do my best to explain what a therapist's theoretical orientation is and how you can choose a good fit for your reason for therapy.

There are several central figures in the history of psychology. Sigmund Freud is quite possibly the most renown psychotherapist and the "Father of Psychotherapy." As the field of psychology grew, so did the theories of great thinkers and researchers alike. Freud's psychoanalytical theory provides a set of terms, guidelines, therapy techniques, ways of thinking etc. The picture comes to mind of a person on a couch exploring their experience through talk therapy. Consideration to what you seek therapy for may often dictate which orientations suit your needs. If you like the "talk it out" process and believe that a listening ear and thoughtful insight are good counseling, a psychoanalysis may be the way to go. However, most therapists' are going to use talk therapy and psychoanalysis to an extent, and their actual theoretical orientation is something they call "eclectic," which maybe a combination of many schools of thought.

Often times, our issues maybe central to the relationships in our lives.  Our family structure or relationships may post strains on our ability to cope with difficult problems or emotions. If you are seeking counseling for your marriage and family issues, a marriage and family therapist would engage you in the Family systems theory and process your issues with you through this theoretical framework. A session would look very different than an individual counseling session where the therapist practice existential counseling theories (but more on that later.)  Family systems theories are often performed as an ancillary function of their role as a leader in the community, such a priest or reverend, chief of a tribe or head of a spiritual group.  This approach can be useful with interventions for drug and alcohol abuse if the person holds those in high regard and it fits within that person's belief system. Generally, this spiritual framework will only work if the person accepts the intervention and is willing to do the work to repair broken relationships.

Generally, counselors employ the techniques of more than one theoretical framework.  You will often her them say they are "existential therapists" which means that person employs the use of more than one theoretical approach.  A counselor can practice more than one type of therapeutic intervention and even take into consideration the beliefs of their client in order to meet their needs. An individualistic approach tailored to that client's needs is the best approach by any counselor. However, some therapists choose to work within their framework and don't adapt to client's needs. A counselor who offers you a person centered cognitive behavioral therapy combination may favor may be guided by the behavioralist in their interventions but uses a person centered approach to their session style. You have a right to know, understand, and be educated on the theoretical orientation that your treatment is derived from.

Some types of theoretical orientations simply do not mesh well with Christian beliefs. Aspects of the theory might be used but be weary of a counselor who uses one of these theories for their main practice. Psychoanalysis provides a good example of the foundation of unconsciousness, this is not necessarily
against Christian beliefs but a psychoanalyst explains the unconscious through repressed sexual feelings. The family system, relationships, your overall experience with the world outside of yourself is largely determined by unconscious sexual urges in psychoanalysis. Consideration of this factor determines that Christian morality might not mesh with this framework.

While most of psychology is based on Freudian thought, it possible to counsel a Christian even though psychology is considered an analysis of abnormal behavior. The process of thinking, conceptualizing and formatting your ideas into your moral code and analyzing your cognitive dissonance may allow a person to match the inconsistency of their thoughts, words, beliefs and actions. Recognizing how your beliefs relate to your actions can change a person to live a more morally congruent life.

I know, this has nothing to do with bariatrics, weight loss surgery or weight loss--- yet.  I'll get to that part in the next post.  Next up, your personality and how it relates to your therapist.

Ethics and Professionality in Bariatric Counseling

In the counseling profession, the code of ethics and responsibilities we have to keep confidentiality is a crucial element of our practice.  It's not an option, if we have a client who comes to see us, initially, we must explain to them what our code of ethics and our responsibility to them as a client is in the scope of confidentiality. 

What does all of that mean?

Simply put, if you are my client and I am seeing you in a therapeutic role and thereafter, I will always have an ethical obligation to you to minimize our contact outside of the counseling session, not disclose personal information about you as a client to anyone who you have not given me permission to discuss your case, and to always explain to you my position and role in and outside of the counseling session. Basically, if I see you at the grocery store, gym, church, school, etc, I will purposely avoid you.  If you say hello to me, I will say hello back and go about my business as I would had you not seen me.  I care about you enough to pretend to not know you to protect your privacy and not have any of your private issues potentially be discussed outside of the protected counseling environment.

I will always be upfront with my clients about my personal experience with bariatric surgery.  I cannot ethically, work in this field without telling my clients that I am a bariatric surgery patient.  My experience is not the same as other weight loss surgery patients' experiences.  I recognize and acknowledge that we all have our own reasons as to why we choose weight loss surgery as an assistive tool for us to lose weight. 

Some have major medical issues, others are preemptively electing to have surgery to prevent potential medical issues in the future.  I consider myself as part of the latter group that was anticipating that my health would decline in the long run due to excess weight.  I know that many clients are already suffering from painful, major medical issues and their reasoning behind their choice to undergo surgery maybe different from my own.

I will never use my role as a counselor to seek out my needs as a weight loss surgery patient.  I am in this field because I see a dire need for bariatric counseling in the process of long term after care.  Losing weight will not solve all of life's problems.  More often than not, the new issues are going to be challenging, changing and identifying of underlying problems that may not have been observed by "the cloak."  The cloak is all of the things we've hidden from addressing throughout our lives about what's bothering us on the inside.  What was it that made us turn to food in the first place.  How did we ignore or fail to understand our body's needs and limits?  Our internal ability to find satiation was skewed in some way.  Again, we are all different, each person is an individual and gaining this insight and understanding is crucial for adopting permanent healthy habits. 

Understanding the weight loss surgery community, online communications, and confidentiality, I will never identify in discuss a single person's experience or relay information regarding that person that could impact their life.  First and foremost, I do no harm.  I will never engage in, take sides with or include myself in the conversations that occur regarding a person's situation and/or the choices they make.  Quite frankly, I will acknowledge that talking amongst each other occurs, but as a counselor, I respect the privacy of others.  If someone seeks out help from me, they can be assured that I will take their trust in me seriously and apply my ethical standards to their confidence in me, no matter they be a paying client or an online contact asking for my help.  The only time I would ever breach confidentiality is if the person made me aware of their intention to harm themselves or someone else.  In taking any action, I will make that person aware of my duties prior to doing so and specifically know what that action is I must ethically take.

Also, as a counselor intern in the State of Louisiana, I cannot treat people who reside out of my state.  The practice of counseling must occur in the state, therefore unless I have established a face to face relationship with a client in the State of Louisiana, I will not work with a client through video conferencing mediums.  In email, I am limited in my ability to help and assist clients with their problems.  I will not offer advice but rather ask you how you can change your current situation or what it is you could do to move toward the progress you seek that you are not currently finding.  If I have the resources for professional mental health practitioners in your area, I will refer you to those resources.

This post is meant to be a documentation and clarification for everyone who I have met, become friends with, and come to know in the bariatric community.  It takes a long time to build confidence and rapport in a community. As a counselor intern in the mental health field, I want to establish clear and concise guidelines that show my clients and colleagues that I am aware of my role and responsibility to this community.   I may be seen as a newbie, but counseling is nothing new to me.  We are always learning, and we learn by doing.