15. 整合方法帮助个人改变

综合方法帮助个体改变

正如第13章所讨论的，目前有许多不同的咨询实践治疗模型。这些模型各自基于特定的理论基础。实践模型大致可以分为以下几类：

1. 心理分析
2. 人本主义/存在主义
3. 认知-行为
4. 建构主义（叙事和解决方案聚焦）
5. 综合方法

Feltham和Hortori（2012）详细描述了适合上述分类的各种咨询方法。我们自己更倾向于使用属于最后一组的方法，即综合方法。这种方法整合并利用了来自上述列表中第一至第四组的不同咨询方法的理论概念、技能和策略。

作为新咨询师或正在接受培训的咨询师，您可能对我们选择使用综合方法的原因感到好奇，所以我们现在来讨论这一点。

为什么使用综合方法？

我们注意到，目前在咨询行业中，许多从业者越来越倾向于使用综合或折衷的方法，而不是单一理论的方法。有大量的文献支持综合方法，包括一本专门讨论综合咨询的专业期刊（《心理治疗整合杂志》）。显然，综合咨询现在被许多执业咨询师认为是有用的。一个重要原因是，没有任何单一的咨询方法具有足够的解释力、技术力或概念力来帮助所有寻求帮助的人（Beitman, 1994）。此外，根据我们的经验，当单独使用时，这些单一方法往往不足以有效帮助某些人解决情感问题、改变思维方式并开始使用更具适应性的新行为。

Prochaska和DiClemente（2005）指出，无论是从研究文献还是临床经验来看，都已清楚地表明，没有任何单一的治疗系统能够充分解决何时、如何、与谁、针对哪个问题采取何种行动。我们同意这种情况普遍存在，并认为这些困难可以通过使用综合方法来最小化，这种方法涉及一个系统但灵活的过程，具体将在下一章中描述。这种综合方法使熟练的咨询师能够在咨询过程的每个阶段选择最适合解决个体需求的技能和策略。此外，咨询师可以更多地关注使用适合特定个体及其特定问题的方法。

在使用综合方法时，我们需要认识到我们使用的策略来自各种咨询模型，并且这些策略依赖于不同的理论框架。然而，这并不一定是一个问题。正如O'Brien和Houston（2007）所指出的，综合治疗师所做的就是调用在手头工作中看似相关的任何理论流派中发展出的实用智慧。

帮助人们改变

正如我们之前所说，咨询的一个主要目标是帮助一个人改变。通常，人们在危机和情绪困扰时期来找咨询师，那时他们不知道如何改变，以便感觉更好并能够过上更舒适、满意和适应的生活。如果我们作为咨询师要有效地帮助那些来找我们的人改变，那么我们需要对因咨询而可能发生的变化过程有所了解。

我们需要认识到，虽然一些有情绪、心理和行为问题的人能够自发地改变，感觉更好并表现得更有适应性，但其他人可能在没有咨询帮助的情况下难以改变。 考虑这个问题：“咨询的价值是什么？”Beitman（1994）建议，与其将咨询视为特定的变革代理人，我们更需要认识到咨询可以是自然发生在人们身上的自我改变过程的促进者或加速器。根据我们的经验，这是正确的。当人们来找我们作为咨询师时，我们注意到他们通常会被问题困扰和压倒，无法认识到对他们有帮助的改变方式。通过咨询，他们通常能够迅速参与一个过程，帮助他们处理情绪、改变思维并就未来的行为做出决策。咨询过程的促进性质加快了自然发生的过程，而这个过程在没有咨询的情况下可能需要很长时间。

研究表明，无论使用哪种咨询模型，积极的变化都会发生（Prochaska, 1999）。进一步的研究表明，个人与咨询师之间的关系可能是产生变化的更重要因素，而不是所使用的咨询模型（Howe, 1999）。虽然我们尊重这些结论，但在我们的经验中，如果认识到在产生情绪状态变化中最有用的技能不一定与促进思维过程变化或解决行为问题最合适的技能相同，那么咨询在产生变化方面的有效性可以最大化。此外，我们认为，将我们使用的技能与咨询过程的特定阶段相匹配是很重要的。

为了过上满意和舒适的生活，人类需要感觉良好、摆脱令人困扰的思想并从事导致积极结果的行为。许多人来找咨询是因为他们经历了令人困扰的情绪和思想，并从事对他们无益的行为。因此，为了最有用，咨询应该解决情绪、思想和行为。大多数，如果不是所有的单一理论咨询方法都有改变个人情绪、思想和行为的目标。然而，当我们检查特定咨询方法中使用的策略时，我们发现大多数方法更侧重于情绪、思想或行为中的某一方面。此外，在我们看来，大多数单一理论咨询方法不会显著调整其策略以匹配咨询过程的阶段或个体的特定需求。

在大多数单一理论方法中，假设如果在情绪感受、思维过程或行为之一发生变化，那么其他方面也会自发地发生变化。虽然我们承认这经常会发生，但在我们看来，这并不一定会发生。因此，我们认为咨询师需要熟练掌握直接解决情绪、思想和行为的不同策略。在我们看来，直接解决这些方面的最有效策略各不相同，并来自不同的咨询理论模型。

为了帮助理解变化过程，我们将讨论咨询师用于促进情绪变化、思维变化（认知变化）和行为变化的方法。虽然我们指出这三种属性的解决方式有所不同，但我们认识到，改变其中一种有时可能会自发地产生其他方面的变化。

促进情绪变化

正如我们知道的，大多数人来找咨询帮助时都在经历某种程度的情绪困扰。对一些人来说，他们的情绪明显表达出来，无论是口头还是非言语的方式。对另一些人来说，尽管他们可能表现出某种程度的情绪困扰，但他们的情绪表达更为内敛。从我们的咨询经验来看，我们认识到有些人很难清晰地识别他们正在经历的情绪。有时候，一个人的情绪被压抑得太深，以至于在咨询的早期阶段，他们可能无法触及自己的情绪。

作为人类，我们的经验是，当我们释放情绪时，往往会感觉更好，进入更平静的状态。例如，如果我们正在哀悼并且非常悲伤，我们的经验是，如果我们通过哭泣来释放情绪，之后我们会感觉更好。我们可能不会感到快乐，但很可能不再那么痛苦，更加舒适。同样地，如果一个人非常愤怒，他们可能需要以某种方式释放愤怒。这可能是通过大声喊叫、打枕头或参与象征性的仪式。显然，咨询师帮助一个人感觉更好的一种方式是通过情绪释放来达到宣泄的效果。

许多使用以人为中心咨询的咨询师非常重视情感感受的反映。因此，他们帮助的人很可能会接触到强烈的情绪。当这种情况发生时，咨询师通常会允许对方完全体验出现的情绪（在处理非常愤怒的人时注意安全）。一般来说，如果一个人开始哭泣，咨询师会允许哭泣继续，直到自然停止。因此，情绪得到释放，宣泄发生。对于其他情绪，如沮丧、愤怒和绝望，以人为中心的咨询师通常会通过反映内容和感受来鼓励对方口头表达情绪，而不是避免处理这些问题。这些咨询师使用的反思技巧在帮助人们有效应对情绪感受方面显然是非常有用的。

使用体验式咨询方法（如格式塔疗法）的咨询师有不同的方式帮助一个人释放情绪。这个人可能会被鼓励通过与某个想象中行为让他们感到不快的人进行对话的角色扮演来释放情绪。在角色扮演过程中，他们可能会被鼓励通过喊叫来表达情绪，或者被邀请通过身体动作表达情绪，例如打沙袋。使用格式塔疗法方法的咨询师直接寻求通过鼓励对方表达情绪感受来实现宣泄，进而达到情绪释放的效果。

我们已经解释了在以人为中心咨询和格式塔疗法中使用的技能在处理情绪方面是如何极其有用的。作为综合咨询师，我们在咨询时可以选择使用以人为中心的反思方法或体验式的格式塔疗法方法。我们认识到，适合一个人的方法未必适合另一个人。尽管我们都受过格式塔疗法的训练，但我们认识到有些人不喜欢参与体验式咨询策略，而另一些人则发现体验式工作非常有用。对于那些不适应体验式方法的人，我们会选择使用反思来处理情绪。此外，应该认识到，在咨询过程的早期，当与求助者建立联系至关重要时，使用较少具有挑战性的人为中心咨询技能可能比使用体验式方法更为合适。

你能看到使用灵活的综合咨询风格的优势吗？在这种风格中，技能可以有目的地选择，使其最适合特定的人和咨询过程的特定阶段。

你可能会问，“情绪释放本身是否足够？”在他们的书《心理治疗中的情绪表达》中，Pierce、Nichols 和 Du Brin（1983）明确表示，当情感完全表达时，会导致人们以新的方式看待自己和世界，换句话说，个人的思维会发生变化。作者进一步指出，新的思维方式和世界观随后会导致更令人满意的行为。然而，他们也认识到这一过程不会自动发生。不幸的是，它可能根本不会发生。虽然我们相信情绪释放是变化过程中的一个非常重要的组成部分，但我们不相信它本身是足够的。根据我们的经验，许多在咨询中释放情绪的人如果没有得到更直接的帮助来处理他们的想法和行为，就无法对其思维和行为做出重大改变。不幸的是，那些无法在思维和行为上做出改变的人在未来遇到麻烦情况时，很可能再次经历持续的问题。

促进认知变化（思维变化）

来自多种治疗方法的技能可以用来改变一个人的思维。这些技能包括关注个人的优势、挑战自我破坏性信念、外部化、重新框定、正常化、探索两极性和使用“此时此刻”的体验。这些技能将在后续章节中详细讨论。现在我们将讨论它们的起源及其在促进变化方面的有用性。

关注个人的优势

关注个人的优势将在第22章中讨论。这种方法帮助个人更积极地思考，并开始认识到他们有能力应对困难的情况。这一策略源自Macdonald（2011）讨论的解决方案聚焦咨询。

挑战自我破坏性信念

直接挑战个人的自我破坏性信念的想法来自Albert Ellis（2001）发展的理性情绪行为疗法。Ellis认为，如果他所谓的“非理性信念”被挑战并替换为更“理性”的信念，人们可以得到帮助。正如第20章将讨论的，理性情绪行为疗法理论认为，改变思维会自动导致情绪和行为的改变。虽然这有时会发生，但我们不相信这一定会发生，因为Greenberg（2002）指出，情绪、认知和行为之间的互动是复杂的，不会遵循简单的线性序列。换句话说，改变其中一个属性不一定改变其他属性。然而，理性情绪行为疗法的策略在帮助改变自我破坏性思维方面可以非常有用。

外部化

外部化是Michael White（2007）发展的故事疗法中的一种策略。外部化的价值在于，通过将问题与个人分开，可以帮助个人更好地控制问题，这一点将在第21章中详细讨论。

重新框定

这一技能源自O’Connor和Seymour（2003）讨论的神经语言程序学。这一技能特别适用于那些在狭窄和消极的世界观中思考的人。通过重新框定，咨询师可能能够帮助这些人采取更宽广和积极的观点，改变他们对自己处境的思考方式。

正常化

正如第17章将解释的，正常化涉及向个人提供信息，帮助他们理解自己的感受、反应或情况是正常的，而不是不寻常的。期望是，在正常化后，个人通常能够以不同的、更积极的方式思考情况。这不仅会影响他们的思维，还会影响他们的情绪状态，使他们能够向前迈进并做出有用的决定。虽然正常化可能影响行为，但它并不直接针对行为，因此行为变化不一定发生。

探索两极性

正如第23章将解释的，探索两极性是一种格式塔疗法的策略。虽然格式塔疗法的目的是针对个人的整体体验，但我们认为这一特定策略在改变个人对自己某些个人特质的思考、评价和管理方式方面最为有用。这一策略特别有助于那些专注于自己认为的负面方面的人改变思维方式。

使用“此时此刻”的体验

使用“此时此刻”体验的即时性是一种格式塔疗法的方法。目标是提高个人在与咨询师互动时对当前时刻正在发生的事情的意识。通过提高这种意识，他们能更全面地接触自己内部发生的事情，以及与他人关系中可能发生的事情。目标是带来个人整体体验的变化，包括情绪、思维和行为。然而，我们认为，最初关注咨询过程的即时性最有可能影响个人的思维。

使用不同策略实现不同目的

你能看到我们如何使用来自不同治疗方法的多种不同策略，以不同目的来解决个人的思维方式吗？一些单一模型咨询方法的理论家认为，改变思维会自动导致情绪和行为的改变。虽然我们同意改变思维过程可能在不同程度上影响人们的情绪和行为，但作为整合治疗师，我们认为使用特定策略来针对情绪和行为更为有用。

促进行为变化

到目前为止，在本章中我们已经讨论了通过涉及情绪释放和思维变化的方法来帮助个人的方式。对一些人来说，这可能足以产生行为变化，但对其他人来说，咨询过程需要更强烈地指向解决行为问题。

正如第25章和第26章所解释的，我们可以使用特定策略帮助个人探索未来的选项并做出关于未来行为的决定。这可以通过使用问题解决方法或格式塔疗法方法来实现。当使用问题解决方法时，可以使用第9章中描述的问题，特别是解决方案聚焦咨询中的问题。如果使用格式塔疗法体验方法，可以邀请个人参与与行为变化相关的体验性实践实验。

咨询中的变化通过探索和自我发现的过程发生

一个很好的模型来说明咨询中自我发现过程的有用性是Johari窗口。Johari窗口是由Joseph Luft和Harry Ingham在1955年的一个研讨会上设计的，如图15.1所示。根据Luft（1969），"Johari"这个名字读起来像是“Joe”和“Harry”，这就是名字的由来：Joe-Harry。然而，大多数咨询师不会这样发音。

Johari窗口分为四个窗格，每个窗格包含有关该窗口所代表的特定人的信息。左边的两个窗格包含已知的信息，而右边的两个窗格包含未知的信息。上面的两个窗格包含他人已知的信息，下面的两个窗格包含他人未知的信息。

• 左上角窗格（开放窗格）：信息被个人和他人公开认可。
• 左下角窗格（隐藏窗格）：信息只有个人自己知道，而他人不知道。
• 右上角窗格（盲点窗格）：信息被他人知道，但个人不知道。
• 右下角窗格（未知窗格）：信息完全看不见，被锁定在个人的潜意识中。

图15.1 Johari窗口

已知于他人	未知于他人
开放	盲点
隐藏	未知

来源：《群体过程：群体动力学导论》，Joseph Luft © McGraw-Hill Education

咨询对Johari窗口的影响

成功咨询对Johari窗口的可能影响如图15.2所示。当一个人来找咨询师谈话时，他们很可能会谈论开放窗格中的信息。然而，如果建立了信任关系，这个人可能会向咨询师敞开心扉，披露隐藏窗格中的信息，从而扩大开放窗格。此外，随着咨询的进行，咨询师可能会给这个人反馈或提问。由于反馈和提问，这个人可能会发现之前未知的信息，这些信息可能已被咨询师认识或未被认识。再次，开放窗格得以扩大。通过咨询过程，这个人可能会获得洞察（使用心理分析术语）、提高意识（使用格式塔疗法术语）或发现以前未知的可能性（使用解决方案聚焦或叙事疗法的描述）。如图15.2所示，在有效的咨询过程中，个人的自我知识可能会增加，从而促进个人成长，这必然会在情绪影响、思维过程或行为方面产生一定程度的变化。我们认为，当咨询师使用整合方法，特别是包括处理情绪、思维和行为的技能时，这一变化过程会得到增强，如下一章所述。

图15.2 咨询对Johari窗口的影响

已知于他人	未知于他人
开放	盲点
隐藏	未知

洞察
已知于他人
开放
反馈
-------------
未知于他人
盲点
自我披露
-------------
隐藏
未知

结论

结论

如本章开头所述，本书中描述的咨询风格是整合性的；它借鉴了多种不同的咨询模型中的策略和技能。 作为咨询师，如果我们希望有效地帮助前来寻求帮助的人，我们需要具备帮助他们进行改变的技能。如果我们帮助他们释放情绪，他们短期内会感觉更好。然而，如果我们的咨询要具有长期价值，那么在情绪释放之后，我们还需要帮助他们改变思维和行为。如果我们这样做，他们很可能能够以更加适应的方式应对未来的问题。

学习总结

许多咨询师现在更倾向于使用整合方法，从个体咨询方法中汲取理论、策略和技能，以满足寻求帮助者的即时需求。 改变情感、思维或行为中的任何一个并不一定会改变其他方面，因为情感、思维和行为之间的互动是复杂的。 整合咨询可以直接针对情感、思维和行为。 咨询促进了和加速了自然变化过程。 寻求帮助的人如果能够谈论和表达他们的情感，通常会感觉更好。 可以使用多种方法来促进思维的改变。这些方法包括重新框定、挑战自我破坏性信念、正常化、探索两极性、关注优势和使用“此时此刻”的体验。 如Johari窗口所描述的，人类自然拥有关于自己的信息，其中一些信息对他人隐藏，另一些信息对自己隐藏。 如果一个人能够接受自己隐藏的部分，他们很可能能够更好地处理这些部分，从而能够过上更加适应和满意的生活。

参考文献和进一步阅读

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• O’Brien, M, & Houston, G. 2007, Integrative Therapy: A Practitioner's Guide, 2nd edn, SAGE, London.
• O'Connor, J. & Seymour, J. 2003, Introducing NLP: Neuro-Linguistic Programming, 2nd edn, Thorsons, London.
• Pierce, R.A., Nichols, M.P. & Du Bunn, M.A. 1983, Emotional Expression in Psychotherapy, Garner, New York.
• Prochaska, J.O. 1999, 'How do people change, and how can we change to help more people?’, in M.A. Hubble, B.L. Duncan & S.D. Miller (eds), The Heart and Soul of Change: What Works in Therapy, American Psychological Association, Washington, DC.
• Prochaska, J.O. & DiClemente, C.C. 2005, 'The transtheoretical approach’, in J.C. Norcross & M.R. Goldfried, Handbook of Psychotherapy Integration, Oxford University Press, New York, pp. 147-71.
• White, M. 2007, Maps of Narrative Practice, Norton, New York.

本章知识点阐述

进一步阐述知识点

综合方法帮助个体改变

1. 不同咨询模型：

   • 心理分析：基于弗洛伊德的理论，强调潜意识和早期经历对个体行为的影响。
   • 人本主义/存在主义：强调个体的自我实现和存在意义，关注个体的主观体验。
   • 认知-行为：关注个体的认知和行为，通过改变不合理的认知来改善行为。
   • 建构主义（叙事和解决方案聚焦）：强调个体通过叙事和解决方案聚焦来重新构建自己的故事。
   • 综合方法：整合以上几种方法的理论概念、技能和策略，形成一种更为全面的咨询方法。

2. 选择综合方法的原因：

   • 多样性：综合方法结合了多种理论和方法，能够更全面地满足不同个体的需求。
   • 灵活性：综合方法允许咨询师根据具体情况灵活选择最合适的技能和策略。
   • 有效性：研究表明，综合方法在解决复杂问题时更为有效，能够更好地帮助个体实现改变。

3. 综合方法的优势：

   • 系统但灵活：综合方法涉及一个系统但灵活的过程，可以根据个体的具体情况调整咨询策略。
   • 个体化：综合方法使咨询师能够更强烈地关注使用适合特定个体及其特定问题的方法。
   • 实用性：综合治疗师调用在手头工作中看似相关的任何理论流派中发展出的实用智慧，提高了咨询的实效性。

4. 综合方法的应用：

   • 技能和策略的选择：在咨询过程的每个阶段，咨询师可以选择最适合解决个体需求的技能和策略。
   • 问题解决：综合方法能够帮助个体解决情感问题、改变思维方式并开始使用更具适应性的新行为。
   • 理论框架的整合：虽然综合方法涉及多种理论框架，但这并不一定是一个问题，因为综合治疗师能够灵活调用不同理论中的实用智慧。

通过这些内容，本书旨在帮助读者理解综合方法在咨询实践中的重要性，以及如何在实际工作中应用综合方法。这些知识不仅提高了咨询师的专业能力，还增强了他们在实际工作中的应用效果。

进一步阐述知识点

帮助人们改变

1. 咨询的目标：

   • 主要目标：咨询的一个主要目标是帮助个体改变，使他们感觉更好并能够过上更舒适、满意和适应的生活。
   • 常见情境：人们通常在危机和情绪困扰时期来找咨询师，那时他们不知道如何改变。

2. 变化过程的理解：

   • 自发改变：一些人能够自发地改变，感觉更好并表现得更有适应性。
   • 咨询的帮助：另一些人在没有咨询帮助的情况下难以改变。咨询可以作为自我改变过程的促进者或加速器。

3. 咨询的价值：

   • 促进者：咨询可以促进自然发生的自我改变过程，帮助个体更快地处理情绪、改变思维并做出决策。
   • 加速器：咨询过程的促进性质加快了自然发生的过程，使个体能够更快地实现改变。

4. 研究支持：

   • 普遍有效性：研究表明，无论使用哪种咨询模型，积极的变化都会发生（Prochaska, 1999）。
   • 关系的重要性：个人与咨询师之间的关系可能是产生变化的更重要因素，而不是所使用的咨询模型（Howe, 1999）。

5. 技能的匹配：

   • 不同技能：在产生情绪状态变化中最有用的技能不一定与促进思维过程变化或解决行为问题最合适的技能相同。
   • 阶段匹配：将技能与咨询过程的特定阶段相匹配是很重要的，以最大化咨询的有效性。

6. 综合方法：

   • 多方面解决：为了过上满意和舒适的生活，个体需要感觉良好、摆脱令人困扰的思想并从事导致积极结果的行为。
   • 单一理论的局限：大多数单一理论咨询方法更侧重于情绪、思想或行为中的某一方面，且不会显著调整策略以匹配咨询过程的阶段或个体的特定需求。
   • 综合策略：咨询师需要熟练掌握直接解决情绪、思想和行为的不同策略，这些策略来自不同的咨询理论模型。

7. 变化的相互影响：

   • 自发变化：改变情绪、思想或行为中的某一方面有时可能会自发地产生其他方面的变化。
   • 独立解决：虽然这经常会发生，但并不一定会发生，因此咨询师需要独立解决每个方面。

通过这些内容，本书旨在帮助读者理解咨询在帮助个体改变中的作用，以及如何在实际工作中应用综合方法。这些知识不仅提高了咨询师的专业能力，还增强了他们在实际工作中的应用效果。

进一步阐述知识点

促进情绪变化

1. 情绪困扰的普遍性：

   • 常见原因：大多数人在经历情绪困扰时会寻求咨询帮助。
   • 情绪表达：一些人的情绪明显表达出来，而另一些人的表达较为内敛。
   • 识别困难：有些人难以清晰地识别自己正在经历的情绪。

2. 情绪释放的效果：

   • 情绪释放：当人们释放情绪时，往往会感觉更好，进入更平静的状态。
   • 具体例子：例如，通过哭泣来释放悲伤，通过喊叫或打沙袋来释放愤怒。

3. 咨询师的作用：

   • 以人为中心咨询：许多咨询师使用反思技巧来帮助个体接触和表达强烈的情绪。
   • 格式塔疗法：使用体验式方法，如角色扮演和身体表达，帮助个体释放情绪。

4. 技能选择的重要性：

   • 个体差异：适合一个人的方法未必适合另一个人。
   • 灵活选择：作为综合咨询师，可以根据个体的需要选择合适的方法。

5. 早期阶段的策略：

   • 建立联系：在咨询的早期阶段，建立与求助者的联系至关重要。
   • 少具挑战性的方法：使用较少具有挑战性的人为中心咨询技能可能更为合适。

6. 情绪释放的局限性：

   • 必要但不充分：虽然情绪释放是变化过程中的重要组成部分，但它本身是不够的。
   • 进一步帮助：个体需要更直接的帮助来处理他们的想法和行为，以实现持久的改变。

7. 综合方法的优势：

   • 灵活性：综合方法允许咨询师根据个体的需要和咨询过程的特定阶段选择最合适的技能。
   • 有效性：综合方法能够更全面地帮助个体实现情绪、思维和行为的改变。

通过这些内容，本书旨在帮助读者理解咨询在促进情绪变化中的作用，以及如何在实际工作中应用综合方法。这些知识不仅提高了咨询师的专业能力，还增强了他们在实际工作中的应用效果。

进一步阐述知识点

促进认知变化（思维变化）

1. 多种技能的应用：

   • 技能种类：来自多种治疗方法的技能可以用来改变一个人的思维，包括关注个人的优势、挑战自我破坏性信念、外部化、重新框定、正常化、探索两极性和使用“此时此刻”的体验。
   • 具体技能：
     • 关注个人的优势：帮助个人更积极地思考，认识到自己有能力应对困难。
     • 挑战自我破坏性信念：通过理性情绪行为疗法，挑战并替换非理性信念。
     • 外部化：通过故事疗法，将问题与个人分开，帮助个人更好地控制问题。
     • 重新框定：通过神经语言程序学，帮助个人采取更宽广和积极的观点。
     • 正常化：帮助个人理解自己的感受、反应或情况是正常的，从而以更积极的方式思考。
     • 探索两极性：通过格式塔疗法，帮助个人改变对个人特质的思考、评价和管理方式。
     • 使用“此时此刻”的体验：通过格式塔疗法，提高个人对当前时刻的意识，带来整体体验的变化。

2. 技能的起源和用途：

   • 起源：每种技能都有其理论基础，如理性情绪行为疗法、故事疗法、神经语言程序学等。
   • 用途：这些技能在促进认知变化方面非常有用，帮助个人更积极地思考，改变对问题的看法，提高自我效能感。

3. 综合方法的优势：

   • 灵活性：作为整合治疗师，可以根据个体的需要选择合适的技能。
   • 全面性：这些技能不仅影响思维，还可能影响情绪和行为，带来更全面的变化。

促进行为变化

1. 情绪释放和思维变化的作用：

   • 初步效果：对一些人来说，通过情绪释放和思维变化可以产生行为变化。
   • 进一步指导：对其他人来说，咨询过程需要更强烈地指向解决行为问题。

2. 特定策略的应用：

   • 问题解决方法：通过提出具体问题，帮助个人探索未来的选项并做出决定。
   • 格式塔疗法体验方法：通过体验性实践实验，帮助个人在实践中学习和改变行为。

3. 综合方法的重要性：

   • 多方面干预：结合情绪、思维和行为的干预，可以更有效地帮助个体实现全面的改变。
   • 个体化：根据个体的具体需求选择合适的策略，提高咨询的有效性。

通过这些内容，本书旨在帮助读者理解咨询在促进认知变化和行为变化中的作用，以及如何在实际工作中应用综合方法。这些知识不仅提高了咨询师的专业能力，还增强了他们在实际工作中的应用效果。

进一步阐述知识点

咨询中的变化通过探索和自我发现的过程发生

1. Johari窗口的概念：

   • 定义：Johari窗口是一个模型，用于说明个人在咨询过程中通过自我发现而发生的改变。
   • 结构：Johari窗口分为四个窗格，分别代表：
     • 开放窗格：个人和他人都知道的信息。
     • 隐藏窗格：只有个人知道，他人不知道的信息。
     • 盲点窗格：他人知道，个人不知道的信息。
     • 未知窗格：个人和他人都不知道的信息。

2. 咨询对Johari窗口的影响：

   • 初始阶段：当一个人来找咨询师时，他们通常会谈论开放窗格中的信息。
   • 建立信任：随着信任关系的建立，个人可能会向咨询师披露隐藏窗格中的信息，从而扩大开放窗格。
   • 反馈和提问：咨询师的反馈和提问可以帮助个人发现盲点窗格中的信息，进一步扩大开放窗格。
   • 自我发现：通过咨询过程，个人可能会获得洞察、提高意识或发现以前未知的可能性，从而增加自我知识。

3. 变化过程：

   • 个人成长：有效的咨询过程可以促进个人成长，这必然会在情绪影响、思维过程或行为方面产生一定程度的变化。
   • 整合方法：当咨询师使用整合方法，特别是包括处理情绪、思维和行为的技能时，这一变化过程会得到增强。

4. 具体应用：

   • 开放窗格：通过分享和交流，个人可以更好地了解自己的优势和弱点。
   • 隐藏窗格：通过自我披露，个人可以减少内心的负担，增强自我认知。
   • 盲点窗格：通过他人的反馈，个人可以发现自己的盲点，提高自我认识。
   • 未知窗格：通过深入探索，个人可以发现潜在的能力和可能性，实现个人成长。

通过这些内容，本书旨在帮助读者理解咨询在促进个人变化中的作用，以及如何在实际工作中应用Johari窗口模型。这些知识不仅提高了咨询师的专业能力，还增强了他们在实际工作中的应用效果。

进一步阐述知识点

整合性咨询风格

1. 整合性咨询的定义：

   • 整合性咨询：这是一种综合多种咨询模型中的策略和技能的咨询风格，旨在更全面地帮助寻求帮助者。
   • 多样化的策略：整合性咨询从多种不同的咨询模型中汲取理论、策略和技能，以满足个体的即时需求。

2. 咨询的效果：

   • 短期效果：帮助个体释放情绪可以让他们在短期内感觉更好。
   • 长期效果：为了实现长期的价值，咨询师还需要帮助个体改变思维和行为，使他们能够以更加适应的方式应对未来的问题。

学习总结

1. 整合方法的优势：

   • 灵活性：整合方法可以根据个体的需求灵活选择合适的理论和技能。
   • 全面性：整合方法可以同时针对情感、思维和行为，实现更全面的改变。

2. 情感、思维和行为的复杂互动：

   • 独立性：改变情感、思维或行为中的任何一个并不一定会改变其他方面。
   • 复杂性：情感、思维和行为之间的互动是复杂的，需要综合考虑。

3. 咨询的促进作用：

   • 自然变化：咨询促进了和加速了自然变化过程。
   • 情感表达：寻求帮助的人如果能够谈论和表达他们的情感，通常会感觉更好。

4. 促进思维改变的方法：

   • 重新框定：帮助个体从新的角度看待问题。
   • 挑战自我破坏性信念：通过理性情绪行为疗法，挑战并替换非理性信念。
   • 正常化：帮助个体理解自己的感受和反应是正常的。
   • 探索两极性：通过格式塔疗法，帮助个体改变对个人特质的思考、评价和管理方式。
   • 关注优势：帮助个体认识到自己的优势，增强自信。
   • 使用“此时此刻”的体验：通过格式塔疗法，提高个体对当前时刻的意识，带来整体体验的变化。

5. Johari窗口的应用：

   • 自我发现：Johari窗口帮助个体发现关于自己的信息，包括已知的和未知的。
   • 接受隐藏部分：如果个体能够接受自己隐藏的部分，他们很可能能够更好地处理这些部分，从而过上更加适应和满意的生活。

通过这些内容，本书旨在帮助读者理解整合性咨询在促进个人变化中的作用，以及如何在实际工作中应用这些理论和方法。这些知识不仅提高了咨询师的专业能力，还增强了他们在实际工作中的应用效果。

15 An integrative approach to helping a person change As discussed in Chapter 13, there are a number of different therapeutic models of counselling practice in use today. These are each based on particular theoretical foundations. Models of practice can broadly be grouped as follows: 1 psychoanalytic 2 humanistic/existentialist 3 co gn iti ve—beha vio u ral 4 constructivist (narrative and solution-focused) 5 integrative. The various approaches to counselling which fit into the above groupings are described in some detail by Feltham and Hortori (2012). We ourselves prefer to use an approach that fits into the last group; this is an integrative approach. This approach integrates and makes use of theoretical concepts, skills and strategies taken from a number of the different counselling approaches which belong in groups one to four in the above list. As a new counsellor or counsellor in training, you may be curious about our reasons for choosing to use an integrative approach, so we will consider this now. WHY USE AN INTEGRATIVE APPROACH? We have noticed that there is currently a strong movement among many practitioners within the counselling profession towards the use of integrative or eclectic approaches in preference to single-theory approaches. There is a considerable body of literature supporting an integrative approach, including an established professional journal devoted entirely to the discussion of integrative counselling (the Journal of Psychotherapy Integration). Clearly, integrative counselling is now recognised as useful by many practising counsellors. An important reason for this is that none of the individual counselling approaches has sufficient explanatory, technical or conceptual power to help all of those Who seek help (Beitman, 1994). Further,. in our experience, the individual approaches, when used exclusively, are often insufficient to effectively help some people to address emotional issues, to make useful changes to their thinking, and to start to use new behaviours which are more adaptive. Prochaska and DiClemente (2005) point out that both in the research literature and in clinical experience it has become clear that no single system of therapy adequately addresses what to do, when to do it, with whom, in what way and with which problem. We agree that this has generally been the situation and believe that these difficulties can be minimised by using an integrative approach which involves a systematic but flexible process, as described in the next chapter. Such an integrative approach enables a skilled counsellor to choose skills and strategies that are most suitable for addressing a person’s needs at each stage in the counselling process. Additionally, the counsellor can focus more strongly on the use of the approach or approaches that suit a particular person with particular problems. When using an integrative approach we need to recognise that the strategies we use come from various models of counselling and that these depend on differing theoretical frameworks. However, this does not need to be a problem. As pointed out by O’Brien and Houston (2007), what the integrative therapist does is to call on the practical wisdom that has evolved in whatever theoretical camp seems relevant to the work at hand. I* .1. - B fa a. 4 E fa I 4 J I. I. 4.4 u k I J a ■ L 4. 4 ■ i. 1 4 4 k. I .1. 4 HELPING PEOPLE CHANGE As we have stated previously, a major goal of counselling is to help a person change. Usually people come to counsellors at times of crisis and emotional distress, when they do not know how to change so that they can feel better and be able to live more comfortable, satisfying and adaptive lives. If we are to be effective as counsellors in helping those who come to see us to change, then we need to have some understanding of the change processes that can occur as a consequence of counselling. We need to recognise that although some people with emotional, psychological and behavioural problems are able to spontaneously change so that they feel better and behave more adaptively, others may have difficulty changing without the benefit of counselling. Consider the question ’What is the value of counselling?’ Beitman (1994) suggests that, rather than seeing counselling as a specific agent of change, we need to recognise that counselling can be a facilitator or accelerator of the self-change process which occurs naturally within people. In our experience this is true. When people come to see us as counsellors, we notice that they are often confused and overwhelmed by their problems and cannot recognise ways to change which would be helpful for them. By coming to counselling they are usually able to engage in a process that relatively quickly helps them deal with their emotions, change their thinking, and make decisions regarding future behaviours. The facilitative nature of the counselling process speeds up what might occur naturally over time without counselling. Research findings show that positive change occurs regardless of the model of counselling used (Prochaska, 1999). Further, research suggests that the relationship between a person and their counsellor may be a more important factor in producing change than the model of counselling used (Howe, 1999). While respecting these conclusions, in our experience, the effectiveness of counselling in producing change can be maximised if we recognise that the skills that are most useful in producing

change to a person’s emotional state are not necessarily the same as those that are most helpful in facilitating change to thinking processes, or those that are most appropriate for addressing behaviour. Additionally, we believe that we need to recognise that it is important to match the skills we use with particular stages of the counselling process. In order to lead satisfying and comfortable lives, human beings need to feel good emotionally, to be free from troubling thoughts and to engage in behaviours which lead to positive outcomes. Many people come for counselling because they are experiencing troubling emotions and thoughts and are engaged in behaviours that are unhelpful for them. It therefore follows that to be most useful, counselling should address emotions, thoughts and behaviours. Now it is tme that most, if not all, single-theory7 counselling approaches do have the goal of bringing about change in a person's emotions, thoughts and behaviours. However, when we examine the strategies used in specific counselling approaches we find that most approaches tend to focus more heavily on either emotions, thoughts or behaviours. Additionally, in our view, most single-theory7 counselling approaches do not significantly adjust their strategies to match stages in the counselling process, or the particular needs of individual people. In most single-theory approaches there is an assumption that if change occurs in one of emotional feelings, thinking processes or behaviour, then change will spontaneously7 occur in the others. Although we recognise that this may often happen, in our opinion it will not necessarily occur. We therefore think that it is important for counsellors to be skilled in making use of the different strategies that directly address emotions, thoughts and behaviours. In our view, strategies that are most effective in directly addressing each of these are different from each other and come from different theoretical models of counselling. In order to assist the understanding of change processes, we will discuss methods counsellors use to promote emotional change, changes in thinking (cognitive change) and changes in behaviour. While pointing out differences in the ways that these three attributes can be addressed, we recognise that changing one of them may sometimes spontaneously7 produce change in the others. . .. . b a. «. 4 a. «. 4. j . hB. 4 d 1.4. 4 a i.> FACILITATING EMOTIONAL CHANGE As we know, most people come for counselling help when they are experiencing a level of emotional distress. For some people, their emotions are clearly expressed, either verbally or non-verbally. For others, although they may exhibit some level of emotional distress, their emotional expression is more contained. From our experience as counsellors, we recognise that some people have difficulty7 clearly7 identifying the emotions they are experiencing. Sometimes a person’s emotions are so repressed that in the early7 stages of counselling it may be impossible for them to get in touch with their emotions.

As human beings our experience is that when we release our emotions we tend to feel better and to enter into a calmer state. For example, if we are grieving and very sad, our experience is that if we let our emotions out by crying, afterwards we will feel better. We may not feel happy, but we are likely to be less distressed and more comfortable. In a similar way, if a person is very angry, they may need to release their anger in some way. This may be by shouting, punching a pillow or engaging in a symbolic ritual. Clearly, one way in which a counsellor may help a person to feel better is to help them to achieve catharsis through emotional release. Many counsellors who use Person-Centred Counselling place a significant emphasis on reflection of emotional feelings. As a consequence of this, the people they help are likely to get in touch with strong emotions. When this occurs usually the counsellor will allow the person to fully experience the emerging emotion (subject to safety when dealing with people who are very angry). Generally, if a person starts to cry, the counsellor will allow7 the crying to continue until it naturally abates. Consequently, emotions are released and catharsis occurs. With regard to other emotions, such as frustration, anger and despair, the Person-Centred counsellor will usually encourage the person, through reflection of content and feelings, to verbally express the emotions rather than avoid dealing with them. The reflective skills used by these counsellors are clearly very useful in helping a person to deal effectively with emotional feelings. Counsellors who use an experiential counselling approach such as Gestalt Therapy have a different way of helping a person release emotions. The person may be encouraged to release emotions in a role-play by dialoguing in an imaginary way with someone who is, in their view, behaving in ways that make them feel bad. During the role-play they may be encouraged to act out their feelings by shouting, or they may be invited to physically express their emotions, for example by punching a beanbag. Counsellors using a Gestalt Therapy approach directly seek to achieve catharsis by encouraging the person to act out emotional feelings with consequent emotional release. We have explained how skills used in both Person-Centred Counselling and Gestalt Therapy can be extremely useful in dealing with emotions. As integrative counsellors we are able to choose whether to use a reflective Person-Centred Counselling approach or an experiential Gestalt Therapy approach when counselling. We recognise that what suits one person will not necessarily suit another. Although we have all trained in the use of Gestalt Therapy we recognise that some people do not like to be involved in experiential counselling strategies, whereas others find experiential work extremely useful. For people who are not comfortable with an experiential approach, we will choose to use reflection to deal with emotions. Additionally it should be recognised that early in a counselling process, when joining with the person seeking help is paramount, use of the less confronting Person-Centred Counselling skills is likely to be more appropriate than the use of an experiential approach. Can you see the advantage of using a flexible integrative counselling style, where the skills can be deliberately selected so that they are most appropriate for the particular person and the particular stage of the counselling process? You might ask, ‘Is emotional release sufficient in itself?' In their book Emotional Expression in Psychotherapy, Pierce, Nichols and Du Brin (1983) are clear in their belief that when feelings are expressed fully they lead to new ways for people to view themselves and the world, in other words, the person’s thinking changes. 1 he authors go on to say that the new ways of thinking and viewing the world then lead to more satisfying behaviours. However, they do recognise that this process does not happen automatically. Unfortunately, it may not necessarily happen at all. Although we believe that emotional release is a very important component of the change process, we do not believe that it is sufficient in itself. In our experience many people who release emotions in counselling are unable to make significant changes to their thinking and behaviour without receiving more direct help to deal with their thoughts and behaviours. Unfortunately, those people who are unable to make changes in their thinking and behaviours are quite likely' to re-experience ongoing problems in the future as troubling situations arise. FACILITATING COGNITIVE CHANGE (CHANGES IN THINKING) Skills from a number of therapeutic approaches can be used to bring about changes to a person’s thinking. These skills include focusing on the person’s strengths, challenging self-destructive beliefs, externalising, reframing, normalising, exploring polarities and using the ‘here and now’ experience, These skills are described in subsequent chapters. We will now discuss their origins, and their usefulness in promoting change. FOCUSING ON THE PERSON'S STRENGTHS Focusing on the person’s strengths will be discussed in Chapter 22. This approach helps the person to think more positively and start to recognise that they have the ability to cope with difficult situations. This strategy has its origins in Solution- Focused Counselling as discussed by Macdonald (2011). CHALLENGING SELF-DESTRUCTIVE BELIEFS The idea of directly challenging a person’s self-destructive beliefs conies from Rational Emotive Behaviour Therapy as developed by Albert Ellis (2001). Ellis believed that people can be helped if what he called their 'irrational beliefs’ were challenged and replaced by more ‘rational’ beliefs. As will be discussed in Chapter 20, Rational Emotive Behaviour Therapy theory suggests that changing thoughts automatically results in changing emotions and behaviours. Although this may sometimes happen, we don’t believe that it will necessarily happen, because, as pointed out by Greenberg (2002), the interactions between emotions, cognitions and behaviour are complex and do not follow a simple linear sequence. In other words, changing one of these attributes will not necessarily change the others. However, strategies from Rational Emotive Behaviour Therapy can be extremely useful in helping to change self-destructive thoughts. EXTERNALISING Externalising is a strategy used in Narrative Therapy as developed by Michael White (2007). The value of externalising is that it can help a person to have more control over their problem by separating the problem from the person, as will be described in Chapter 21. REFRAMING This skill has its origins in Neuro-Linguistic Programming as discussed by O’Connor and Seymour (2003). This skill is particularly useful for those people who think within the constraints of a very narrow and negative view of their world. By using refraining, the counsellor may be able to help such people to take a wider and more positive view, changing the way they think about their situation. NORMALISING Normalising, as will be explained in Chapter 17, involves giving a person information that helps them to understand that their feelings, reactions or situation are normal and to be expected, rather than unusual. I he expectation is that after normalising their situation the person will usually be able to think about the situation differently and hopefully more positively. This is likely to affect not only their thinking but also their emotional state, enabling them to move forward and make useful decisions. Although normalising may have an effect on behaviour, it does not directly target behaviour, so behavioural change will not necessarily occur. EXPLORING POLARITIES As will be explained in Chapter 23, exploring polarities is a Gestalt Therapy strategy". While the Gestalt Therapy intention is to target a person’s experience as a whole, we believe that this particular strategy is most useful in changing the way a person thinks about, values and manages particular personal attributes. This Strategy is most useful in helping to change the thinking of those people who are focusing on what they perceive as negative aspects of themselves. USING THE 'HERE AND NOW' EXPERIENCE Using the immediacy of the 'here and now’ experience is a Gestalt Therapy approach. The aim is to raise a person’s awareness of what is happening in the present moment in the interaction between themselves and the counsellor. By raising the person’s awareness of this, they get more fully in touch with what is happening within themselves, and what may be happening in their relationships with others. The aim is to bring about change in the whole of the person’s experience including emotions,

thoughts and behaviours. However, we believe that focusing on the immediacy of the counselling process is initially most likely to impact on a person’s thoughts. USING DIFFERENT STRATEGIES FOR DIFFERENT PURPOSES Can you see how we can use a number of different strategies, taken from different therapeutic approaches, for different purposes in addressing the way a person thinks? Some theorists from single-model counselling approaches believe that changing thoughts automatically leads to emotional and behavioural change. Although we agree that changing thought processes may to varying extents influence the emotions and behaviours of people, as integrative therapists we believe that it is more useful to target emotions and behaviours by using specific strategies which address these. FACILITATING BEHAVIOUR CHANGE V / Until now in this chapter we have discussed ways of helping a person by using methods that involve emotional release and changes in thinking. For some people, this may be sufficient to produce behavioural change, but for others the counselling process needs to be more strongly directed towards addressing behaviours. As explained in Chapters 25 and 26, we can use particular strategies to help a person explore their options for the future and make decisions about their future behaviour. 1 his can be done by using either a problem-solving approach or a Gestalt Therapy approach. When using a problem-solving approach, questions as described in Chapter 9, particularly those from Solution- Focused Counselling, can be used. If a Gestalt Therapy experiential approach is used, the person can be invited to engage in experiential practical experiments related to behavioural change. CHANGE OCCURS IN COUNSELLING THROUGH A PROCESS OF EXPLORATION AND SELF-DISCOVERY A good model to illustrate the usefulness of the process of self-discovery m counselling is the Johari window. 1 he Johan window was devised by Joseph Luft and Harry Ingham at a workshop in 1955 and is shown in Figure 15.1. According to Luft (1969) the name 'Johari’ is pronounced as if it were Joe’ and 'Harryh which is where the name comes from: Joe-Harry7. However, most counsellors do not pronounce the word this way. 1 he window has four panes as shown. Each pane in the window contains information about the particular person who is represented by the window. The two panes on the left-hand side contain information that is known to the person, whereas the two panes on the right-hand side contain information that is unknown to the person. The two panes at the top contain information that is known to others and the two panes at the bottom contain information that is unknown to others. Information in the top left-hand pane (the open pane) is openly recognised by both the person and other people. For example, if David were to use his own personal window as an example, he might recognise that he gets satisfaction from writing textbooks and other people are aware of this information. Consequently this information is in his open pane. Information in the bottom left-hand pane, labelled hidden, is known, to him alone and unknown to others. He can possibly think of some characteristics and beliefs of his that would fit into this pane, but if he doesn’t tell anyone else they stay hidden. Information in the top right-hand pane labelled blind is known to others but not to David. For example, other people may know that he has some special qualities that he may not recognise, information in the bottom right-hand pane, labelled unknown, is totally unseen and is locked in David’s subconscious.

Figure 15.1 The Johari window Known to selfUnknown to self Known to othersOpenBlind Unknown to othersHiddenUnknown The Johari window from: Group Processes: An introduction to Group Dynamics, by Joseph Luft © McGraw-Hill Education

THE INFLUENCE OF COUNSELLING ON THE JOHARI WINDOW 1 he likely influence of successful counselling on the Johari window is shown in Figure 15.2. When a person comes to talk with a counsellor, it is quite likely that at first they will talk about information in the open pane. However, if a trusting relationship develops, the person may take the counsellor into their confidence and self-disclose information from the hidden pane, in turn enlarging the open pane. Additionally, as counselling proceeds the counsellor may give the person feedback or ask questions. As a result of the feedback and questioning, the person may discover information that was unknown to them but may, or may not, have been recognised by the counsellor. Once again the open pane is enlarged. As a consequence of the counselling process, the person may gain insight (to use a psychoanalytic term), or gain awareness (to use a Gestalt Therapy term), or discover previously unknown

possibilities (to use a Solution-Focused or Narrative Therapy description). As shown in Figure 15.2, the person’s self-knowledge is likely to increase during ail effective counselling process, allowing for personal growth which will inevitably result in some level of change in either emotional affect, thinking processes or behaviours. We believe that this change process is enhanced when the counsellor uses an integrative approach that specifically includes skills to address emotions, thoughts and behaviours, as explained in the next chapter.

Figure 15.2 The effect of counselling on the Johari window Insight Known to self Open feedback Known to others Unknown to self Blind Self-disclosure Unknown to others Hidden Unknown

IN CONCLUSION As discussed at the beginning of this chapter, the counselling style described in this book is integrative; it draws on strategies and skills taken from a number of differing counselling models. As counsellors, if we are to be effective in helping those who come to see us, we need to be skilled in enabling them to make changes. If we help them to .... release emotions they will feel better in the short term. However, if our counselling help is to be of long-term value, after emotions have been released we also need to help them to change their thoughts and behaviours. If we do this, it is likely that they will be able to deal with future problems in more adaptive ways.

Learning summary • • • • • • • • Many counsellors now prefer to use an integrative approach, drawing theories, strategies and skills from individual counselling approaches to suit the immediate needs of the person seeking help. Changing one of emotions, thoughts or behaviours does not necessarily change the others because the interaction between emotions, thoughts and behaviours is complex. Integrative counselling can directly address emotions, thoughts and behaviours. Counselling facilitates and accelerates the natural processes of change. A person seeking help will generally feel better if they are able to talk about and express their emotions. A number of approaches can be used to facilitate changes in thinking. These include reframing, challenging self-destructive beliefs, normalising, exploring polarities, focusing on strengths, and using the Mere and now' experience. As described by the Johari window, human beings naturally have information about themselves, some of which is hidden from others and some of which is hidden from themselves. If a person can accept the hidden parts of themselves, they are likely to be better able to deal with these parts, and consequently are able to lead more adaptive and satisfying lives. References and further reading London. Greenberg, L.S. 2002, 'Integrating an emotion-focused approach to treatment in psychotherapy integration’, Journal of Psychotherapy Integration, 12(2): 154—89. Howe, D. 1999, ‘The main change agent in psychotherapy is the relationship between therapist and client', in C. Feltham (rd*), Controversies in Psychotherapy in Counselling, SAGE, London, pp. 95—103. Luft, J. 1969, Of Human Interaction, National Press, Palo Alto, GA. Macdonald, A. 2011, Solution-Hocused Therapy: Theory, Research & Practice, 2nd edn, SAGE, London. O’Brien, M, & Houston, G. 2007, Integrative Therapy: A Practitioner's Guide, 2nd edn, SAGE, London* O'Connor,!. & S ey m o u r, J. 2003, Introducing NLIJ Ac uro-Linguistic I hogra mining, 2nd edn, Th o rso ns, London. Pierce, R.A., Nichols, M.P. & Du Bnn, M.A. 1983, Emotional Expression in Psychotherapy, Garner, New York. Prochaska, J.O. 1999, 'How do people change, and how can we change to help more people?’, in M.A. Hubble, B.L. Duncan & S.D. Miller (cds), I he Heart and Sou! of Change: What ITbrG in t herapy, American Psychological Association, Washington, DC. Prochaska, J.O. & DiClemente, C.C. 2005, 'The transtheoretical approach’, in J*C. Norcross & M.R. Goldfricd, Handbook of Psychotherapy Integration, Oxford University Press, New York, pp. 147-71. White, M. 2007, Maps of Narrative Practice, Norton, New York.