A response to the proposed paradigm: freedom runs through it.
Hanna (2011) should be lauded for putting forward a paradigm intended to integrate the numerous counseling specializations, various change processes, and disparate theories of counseling and psychotherapy under the general purpose of setting people free. Moreover, give Hanna much credit for presenting this paradigm in such a way as to encourage discussion, research, and reflection.
Compared with Hanna's (2011) breadth of scholarship and far-ranging integrative conceptualizations, I fear that my meager commentary will sound breezy or appear inchoate. However, that is the risk whenever there is plentiful grist for the discussion mill and only so much space to accommodate it.
Freedom: The Business of Counseling?
The paradigm appears to have its roots in the work of philosopher and psychologist William James, who conceived of freedom as selfdetermination--the innate power to initiate acts of will--as opposed to freedom as self-realization or self-perfection (Boiler, 1964). As such, James, the pragmatist, urged people to take control of their own destiny--to seize the day, as it were (Bankart, 1997). Self-determination and agency are prominent themes in Hanna's excursion into the realm of applying ancient Asian practices to directly change mental contents. The concept of helping clients to break free of obsessions, unwanted images, and other mental shackles finds practical expression in James's seminal work of charting the structure of consciousness (Bjork, 1997).
In my take on Hanna's assertive stand on freedom as the integrative concept, it appears that other grand purposes of counseling and psychotherapy such as assisting clients to "let go," discover hope, achieve potential, acquire deep insight, self-actualize, or find balance are various means by which freedom is enhanced. It struck me that perhaps more than anything else, Hanna was posing the question, "What business are we counselors in?" and making a cogent argument that the answer is freedom. Using purpose ("setting people free") as opposed to practice specialty or organizational membership may help us find some way to negotiate the always knotty issue of counselor identity. Obviously, there has been perpetual debate around that issue, such as whether a unified identity is preferable to one based on area of specialization (e.g., Sweeney, 1995). Coming at the identity impasse from a teleological angle might help, as Hanna intimated, to cause counselors of all stripes to pull oars in the same direction.
Thus, in following Hanna's line of reasoning, it seems possible to show that freeing clients is fundamental to, and may be the bridge between, the two major systems--the developmental approach and the medical model--that dominate counseling practice and that appear frustratingly incompatible. The goal of developmental counseling as set forth by Blocher (2000), which is to help clients become aware of forces and factors impinging on their lives and to exert some control over them, certainly appears commensurate with facilitating agency, hence freedom. Examples of the work of the developmental counselor are enhancing person-environment interactions, helping clients handle basic social roles, addressing inequalities in social institutions and organizations, and assisting clients to negotiate challenges attendant to life transitions (Blocher, 2000); these reflect the freedoms from, to, and with.
The medical model's influence is on the rise--and not only among clinical counselors--what with the headlong pursuit of evidence-based practices and empirically supported treatments. Professional school counselors are among those who have heartily embraced this movement, which is rooted in the medical field. Dimmitt, Carey, and Hatch (2007) have argued that making decisions based on hard data from evidence-based interventions is the soundest way of helping school children and thus, presumably, enhancing their freedom. Dimmitt et al. also made the case that collecting good outcome data may be what saves school counselors' necks from the budgetary ax. Ironically, the same evidence-based interventions that free the students may provide school counselors with freedom to continue in their profession.
As much as the medical model may be anathema to some, there are clients who work well within a "diagnose-it-and-fix-it" scheme. Our culture understands the medical model of healing, and it has a great deal of social acceptance (Wampold, 2001a). Here Hanna would no doubt agree that the needs or worldview of the client take precedence. Clients' freedom is not enhanced when the preferred operating system of the counselor intrudes.
Clarification Needed on Several Points
Hanna speaks apparently interchangeably about the paradigm unifying the profession and the field. I am not wholly sure if Hanna is referring to counseling as the "profession" and the practice of counseling and psychotherapy as engaged in by variously trained family therapists, social workers, counselors, and psychologists as the field. If Hanna envisions freedom as the unifying purpose of the counseling profession, then I wonder how counseling is different from other helping professions in this regard. Freedom cannot be proprietary to counselors. Are not psychologists, social workers, and all the other therapists in the field endeavoring to free clients too?
Of course, there has been the long-standing question of how counseling is different from other helping professions, and the answer to that question has remained elusive (Mellin, Hunt, & Nichols, 2009). Hanna's paradigm does not seem to resolve that issue and perhaps was not intended to. On the other hand, it may be time to stop harping on what makes the helping professions different. I tire of hearing how counselors work developmentally, whereas social workers are administrators or case managers and psychologists cling to a medical model that dictates they do testing and relate aloofly to patients. As Mellin et al. (2009) pointed out, these are inaccurate global representations of both professions. I argue that given the aggressive conservative political efforts to achieve fiscal restraint, the time is ripe for interprofessional discussion and collaboration. Perhaps a shared goal of freedom and shared methods for achieving client freedom can unify and strengthen the larger field. Such an outcome appears consistent with Hanna's intent to use the paradigm to collaborate and innovate.
Finally, there is the question about how freeing counseling interventions, even when applied responsibly, can have potentially conflicting outcomes. How does one reconcile such conflict? Smith, Reynolds, and Rovnak (2009) raised a number of valid points regarding counselors' roles as social advocates. Social advocacy involves "interventions aimed at the individual client as well as sociopolitical attempts to foster systemic change in society" (Smith et al., 2009, p. 483). As these authors pointed out, a potential pitfall of playing the social advocate is the "psychological dichotomizing" (p. 489) that can occur. Borrowing an example from Smith et al., my question is: Does a counselor who advocates for a strong publicly supported K-12 education system abrogate the freedom, if you will, of those who want more parental choice and school vouchers? When freedom cuts both ways, will the freedom paradigm change the manner in which these values dilemmas might get resolved? I welcome the remarks of Hanna on this point.
The Work of the Counselor: It Is All About Freedom
Hanna has provided a very broad overview of how counselors in various specialty areas work to enhance clients' freedoms. We are shown how, for example, restoring clients to precrisis functionality, achieving a drug-free lifestyle, having multiple career options, or cultivating tolerance in the workplace all reflect more, rather than fewer, degrees of freedom. This appears to follow without question from Hanna's premise that positive therapeutic outcomes result in clients or systems being set free to some degree. It also appears related to the idea advanced by Hanna "that clients are aided by the counselor shifting the focus from the mind-set of a particular technique or theory toward increasing degrees of freedom for the client" (Hanna, 2011, p. 365). If correct, I think Hanna is saying here, "Keep your eyes focused on the goal of what will increase clients' four modes of freedom as defined." I agree with Hanna that the overarching purpose of freedom--conceptualizing freedom as the business counselors are in--can serve as a connecting
link between colleagues and could bring specialties together. On the other hand, I am not sure how operating with the purpose of freedom in mind changes what counselors basically do.
This is where I ask Hanna to set me straight regarding the paradigm. If enhancing freedom is at the basis of each and every counseling endeavor and, indeed, is the sine qua non of counseling--and there are countless ways to enhance freedom--is it a too-generic purpose to give focus to my therapeutic efforts? At the level of the individual practitioner, is freedom too diffuse a purpose around which to marshal one's clinical armamentarium? I suppose that somewhere in the recesses of my mind, when I encounter a client, I may have freedom as an unarticulated goal. But more likely I am hoping to help the client to greater cognitive complexity, less manifest anxiety, a higher level of career maturity, or a more optimistic view of self, world, and future--to give several examples. Moreover, my mind-set in each instance is on how a pertinent technique or theory might be applied, as opposed to the concept of freedom, per se. Yet, if the client and I have performed our therapeutic jobs, the freedom will follow.
What Gets Set Free?
Hanna tackled the thorny question of what actually gets set free. Hanna made a case that the answer can be found in the concept of agency, which includes the concepts of self-determination and control. That answer might have led us into the vast realm of literature pertaining to self-efficacy, a topic that has been around for a long while and that is embedded in philosophical debates over determinism, free will, and human agency (Gecas, 1989). Advances in this arena have generally followed along two branches. One branch concerns itself with conceptualizing self-efficacy in motivational terms, which emphasizes causal agency, mastering challenges, and producing effect on the environment. The other branch emphasizes beliefs and perceptions of agency and the self-attributions people make regarding their control over events (Gecas, 1989). Thus, given the centrality of agency and control in self-efficacy theory, it seems curious that Hanna does not refer to it. Perhaps the omission was intentional and for a good reason. Future elucidation of the freedom paradigm might include its relationship to self-efficacy, especially because it has been touted as a unifying theory of behavioral change (Bandura, 1977). I would welcome hearing Hanna's perspective: Is self-efficacy only one indicator among many of a client's personal freedoms or is it the possible source of agency?
Theories and Techniques and Freedom
Hanna pointed out that the freedom paradigm may be more inclusive or robust than the various routes to psychotherapy integration. I tend to agree with Hanna's argument that often something gets left out in attempts to integrate theories. Yet, I also argue that the "common factors" adherents have made great contributions by teasing out the ingredients that are likely to make significant therapeutic (i.e., freeing) differences. Hanna has made the point that a paradigm grounded in freedom may be the truly integrative key--one that is hidden in plain sight. This author has elsewhere argued that the common factors represent the soul of counseling and psychotherapy, healing ingredients that, likewise, can be found "right under our noses" (Ottens & Klein, 2005).
For historically inclined readers, I (Ottens, 2010) have recently shown how Frank's four-factor contextual model (Frank & Frank, 1991) can be applied to understanding the singular case of Senator Charles Sumner. After delivering a vitriolic address in 1856 against slavery on the Senate floor, Sumner was set upon by a South Carolina congressman who savagely beat him with a cane. The attack left Sumner suffering from a malaise marked by an equivocal symptom pattern that stumped his physicians but is now known as posttraumatic stress disorder. After many trying months and fruitless treatments, Sumner placed himself under the care (the emotionally charged relationship) of an eminent French neurologist, Dr. Charles Brown-Sequard. Using the most sophisticated technology of the day (the "healing setting"), the neurologist confidently diagnosed Sumner's problem, but he could recommend only one exceedingly painful procedure powerful enough to heal. Today we know that Brown-Sequard's explanation (the "myth") was anatomically absurd, and his recommendation to apply the ancient Far Eastern treatment of moxabustion (the ritual) made no medical sense. Sumner, however, bought into the plan wholeheartedly and responded very well, becoming mostly free from pain and free to again take up the cudgel against slavery.
Hanna emphasized that each theory of counseling and psychotherapy has something unique to contribute to the purpose of freeing clients. Hence, counselors should have solid working knowledge of more than a few. It is hoped that the freedom paradigm will influence researchers and clinicians to rethink the movement to privilege only a few therapies as being efficacious (Wampold, 2001b).
Hanna went into some detail about the paradigm's potential for folding Asian techniques more into the psychotherapeutic mainstream. Certainly there is a burgeoning interest in meditative and consciousness-expanding treatments. Jon Kabat-Zinn's work at the University of Massachusetts Medical School with pain and stress management is merely one outstanding example (e.g., Kabat-Zinn, 2005). Hanna seemed highly enthusiastic regarding his belief in the potential for these centuries-old techniques to help clients cast off their depressions and obsessive thoughts. Indeed, it appears that a slogan for the paradigm could be "back to the future!"
The emphasis here on techniques might raise some eyebrows. In Wampold's (2001b) meta-analysis, for example, he attributed at least 70% of psychotherapeutic effects to general or common factors, whereas only 8% is due to specific effects. As he summarized, "Clearly the preponderance of the benefits of psychotherapy are due to factors incidental to the particular theoretical approach administered and dwarf the effects due to theoretically derived techniques [emphasis added] (p. 209). Do the yogic techniques referred to by Hanna wield extraordinary power that go far beyond the tools that are available to Western practitioners? The freedom paradigm should galvanize researchers into uncovering whether, how, or why this may be so.
Counselors and psychotherapists can benefit from Buddhist or yogic techniques to undo or deconstruct the dysfunctional mental content that fetters our clients. At the same time, it may be useful to compare, contrast, and investigate how they differ from the more familiar approach of Milton Erickson, the legendary hypnotherapist. Erickson left students marveling at his skill for freeing clients from seemingly intractable psychological snares and trying to figure out the mechanisms underlying his canny approach. Havens (1985) described how Erickson assisted clients to create internal realities via vivification:
Erickson referred to this bringing to life of memories, ideas, emotions, and previously hidden capacities as vivification. A memory, an imagined event, or a mere notion about what is happening can be experienced so vividly that it seems real.... The carefully nurtured increases in responsiveness or suggestibility described earlier make it possible for the hypnotist to guide awareness in specific ways or to create internal events which can be vivified into "real" hypnotic experiences for the subject. Past events may be relived, current events may be perceived and thought about in a totally new manner, and all sensations or perceptions may be amplified, distorted, reduced, eliminated, or replaced by an awareness of those derived entirely from internal events. (p. 232)
It would have been illuminating if Hanna had provided readers with examples of how these exotic techniques are applied to help clients get free of unwanted thoughts or relationships.
We have been presented with a model based on a broad-based concept of freedom that Hanna maintained undergird the various counseling specialties, has the potential to integrate the many theories of counseling and psychotherapy, and can usher in a new wave of powerful Eastern therapeutic techniques. Although this may be so, I think we need to await further explication of the model and more particulars as to how it might influence what counselor educators teach, how they supervise, or how they facilitate change in clients. As I indicated, the model does appear to offer another way for the counseling profession to build bridges between the two most influential systems.
I think that aligning the many counseling theories under the freedom umbrella will give us more appreciation for how each, in its unique fashion, can contribute to clients' degrees of freedom. We may also, as a profession, be more able to appreciate the notion that treatments are beneficial when intended to be therapeutic (Wampold, 200 ib), as opposed to operating from a narrower range of validated therapies.
Hanna hoped that the model would generate discussion and research, and I think those aims will be realized. For example, will more emphasis be placed on investigating what contributes to some counselors as being more effective in liberating their clients? How much education or preparation will be needed to introduce clients to exotic techniques mentioned by Hanna? With what client worldviews will they best mesh? How will they complement (or prove similar to) techniques in current practice?
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Allen J. Ottens. Department of Counseling, Adult and Higher Education, Northern Illinois University. Correspondence concerning this article should be addressed to Allen J. Ottens, Department of Counseling, Adult and Higher Education, Northern Illinois University, 200 Gabel Hall, DeKalb, IL 60115 (e-mail: aottens@comcast, net).
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|Author:||Ottens, Allen J.|
|Publication:||Counselor Education and Supervision|
|Date:||Dec 1, 2011|
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