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Introduction
Counseling and psychotherapy is a practice historically associated with theoretical frameworks that are unitary in that they stand by singular positions or procedures. However, this is rapidly changing as training, research, and practice are increasingly adopting a combined approach. A pluralistic framework is becoming a common phenomenon as it allows the practitioners to consider the multiple causes of the problem and to offer more than one therapeutic solution. According to Cooper and McLeod (2007), the concept of pluralism, as applied in counseling and psychotherapy, is founded on the notion that there is no one right therapeutic method appropriate for all situations. The literature presented here defines and discusses the theoretical concept of pluralism in counseling and psychotherapy and offers a critique of the theory.
Definition and Discussion of Pluralism
The concept of pluralism is used in counseling and psychotherapy is a relatively new model being embraced by clinicians. Pluralism was first established as a foundation for the psychological theory and practice by William James (McLeod, 2013). The general idea of pluralism is that there exist many different and valid responses or solutions to any situation or problem regarding the nature of reality. In other words, there is no single definitive truth, a notion that is often associated with postmodernism (Pendle, 2015; Finnerty, Kearns, & ORegan, 2018). Another aspect of pluralism, especially when applied in the field of counseling and psychotherapy, is that it advocates for greater collaboration with clients regarding issues such as selecting the appropriate interventions and approaches. Lastly, pluralism uses a work structure based on tasks, goals and methods. Therefore, the theoretical foundation of pluralism is the consideration of alternative approaches to practice.
A pluralistic approach deviates from the traditional unitary models that have been historically used. According to Greenbrook (2016), practicing pluralism means adhering to the ethical and philosophical commitment to appreciating multiple perspectives. However, it is important to acknowledge that different researchers used the theory of pluralism contrarily. For example, Pegado (2019) states that medical pluralism is the joint usage of complementary alternative medicine (CAM) and conventional medicine (CM). Other researchers associate pluralism with creative and integrative approaches to unlock the practitioners innovation and potential (Carlyle, 2017). Regardless of the usage of the theory, pluralistic counseling and psychotherapy embrace multiple solutions to problems and different mechanisms of identifying their root causes.
The use of the pluralism theory in counseling and psychotherapy involves two distinct concepts. Scholars have emphasized that it is critical to differentiate between the two concepts of pluralism: perspective and therapeutic practice (Cooper & McLeod, 2011; Thompson, Cooper, & Pauli, 2017). The pluralistic perspective can also be described as sensibility or viewpoint, which is used to imply that there does not exist a single best set of therapeutic methods. Additionally, it can also be seen as an assumption that different clients will most likely benefit from dissimilar therapeutic methods. This means that the practitioners deliver the greatest results when they work collaboratively with the patients to identify their specific needs (Cooper & McLeod, 2011). On the other hand, pluralistic practice is a terminology that refers to a specific form of therapeutic practice that is founded on methods and understandings from more than one therapeutic orientation (Thompson, Cooper, & Pauli, 2017). Pluralistic practice is the scenario where decision-making is a shared responsibility between the practitioners and the clients. These theoretical distinctions are critical and their use in research and practice makes them vivid.
Pillars and principles of pluralism and their usage in counseling and psychotherapy is another theoretical consideration emphasized by authors and researchers. By its definition, the concept of pluralism can be seen as the philosophical belief in multiplicity and mutually conflicting responses. The first pillars are described as pluralism across orientations implying the scenario where a clinician embraces varied means of resolving an issue (Cooper & Dryden, 2016). It means that a counselor considers the diversity of patient needs and the means to resolve them. Another pillar is pluralism across clients which emphasizes the contrasting nature of individual patients and that each responds to different therapeutic approaches. Lastly, the third pillar is called pluralism across perspectives, which asserts that decision-making is shared between practitioners and clients. With these pillars, it is apparent that both the perspectives and practice components of the theory of pluralism emerge.
One of the most important features of the pluralistic approach is metacommunication. This term is used to refer to the regular occurrence of episodes extending over several minutes comprising dialogues involving the deconstruction of meanings in goal statements, diagnosis, and determination of alternative methods (Cooper & McLeod, 2007). Metacommunication may also entail brief micro-episodes involving therapists asking questions and requesting the input of the patients. In essence, a pluralistic approach is founded on the exchange between practitioner and client.
Critique of Literature
Many researchers agree that pluralism in counseling and psychotherapy is one of the most appropriate approaches to practice. It can be argued that pluralism allows the clients to become the focal point of therapy. This argument is validated by considering the fact that historically, psychotherapy and counseling have been structured around distinct sets of models and ideas with each adhering to separate manuals, professional associations, and teaching schools (Pearson & Bruin, 2019). It has been estimated that there are over 400 types of therapy with varied techniques, practices, perspectives, and foundations (Pearson & Bruin, 2019). It would appear, therefore, that each customer is placed under one of these therapies depending on the psychological problem. From a pluralistic approach, however, it can be argued that rather than specialized practitioners, generalized ones function by borrowing from the wide range of therapeutic practices to tune the solutions to the needs of the client. This could be a major weakness as it may necessitate that each therapist is knowledgeable in all fields. While pluralism makes it more effective to handle patients, it may make practice harder for the therapists, a theme that has hardly been addressed in the literature.
Pluralism can be viewed simply as the integration of different therapeutic models by clinicians. According to Oddli and McLeod (2016), the integration of knowledge and practice has resulted in the concept of knowing-in-relation which can be seen as the implementation of specific integrative models. Pluralistic therapists are, therefore, simply viewed as those who adopt one or more integrative frameworks. There lacks a concrete definition of the term integrative as used in counseling and psychotherapy. However, it can be used to refer to practitioners borrowing from more than one model or even more than one type of therapy to accomplish a single therapeutic session. A moment-to-moment integration, as described by Oddli and McLeod (2016), is used to imply that the knowledge and practice used to change as scenarios and situations change. Therefore, pluralism is the ability of the clinicians to deliver sessions based on the needs of the clients.
As argued above, pluralism may require practitioners greatly knowledgeable in a variety of therapies and therapeutic models. Such levels of knowledge have significant implications for the training of the personnel. There is hardly any attempt by researchers to examine how pluralism affects training in counselling and psychotherapy. The only efforts to discuss this theme is made by McLeod, Smith, and Thurston (2016) who highlight that pluralism affects the styles and length of training and learning. The concept of integrative training is coined by these authors to imply the structuring of the programs and materials to suit the emerging needs of pluralistic practitioners. This is an area that researchers should pay more attention to since studies have already presented empirical evidence of the importance of adopting a pluralistic approach.
Even though criticism can be targeted at various aspects of the theory, it is important to acknowledge the major strengths and usefulness of the approach. The major goal of pluralism in counseling and psychotherapy, according to (McLeod & Cooper, 2011), is to offer therapy tailored to the preferences and needs of each customer. Such an approach can be deemed as customer-oriented where practitioners deviate from using preferred models. The efficiency and effectiveness of counseling and psychotherapy can, therefore, be improved.
The most important strength, however, is the fact that pluralism requires practitioners to adopt greater use of evidence. The deviation from medical models is a critical aspect because most of them are founded on theoretical assumptions as opposed to evidence. Such an argument is supported by Collins (2017) who argues that medical models (in the context of treating depression) assume that the causes of depression emanate from the patent and that the antidepressants will work on the serotonin and noradrenaline systems. This is despite the fact that, as the researchers note, there lacks evidence to indicate anything wrong with these systems among individuals with depression. As such, the adoption of multiple therapeutic approaches and combinations of nonpharmacological therapies can be appreciated as evidence-based practices. Such interventions can achieve greater results as opposed to medical models.
Lastly, it can be acknowledged that pluralism offers a means of integrating a wide range of ideas around psychological problems. According to McLeod (2013), the most striking aspect of practice and theory in counseling and psychotherapy is the presence of diverse ideas. These are reflected in the current literature examining major forms of therapy, including psychodynamic, narrative, cognitive-behavioral, systemic/family, and experiential/humanistic among others. This spectrum poses a major challenge to practitioners who have responded either by attempting to develop a single model, identifying common themes and factors, or integrating ideas and practice. The latter of the three approaches is the basis of pluralism and allows clinicians to adopt interventions that best suit the patient. It is a fact, as McLeod (2013) and other theorists explain, that there are different approaches to different problems. Pluralism is the theory that allows alternatives to be exploited.
Conclusion
In conclusion, pluralism theory is essential for modern practitioners because it allows them to integrate several approaches to offer patients the ultimate solution. The general opinion is that the true causes of a problem become easier to discover upon deviating from the unitary models. This is because pluralism implies that there is no single truth regarding reality meaning a patients issue could result from more than one factor. Most importantly, the theory allows for greater adoption of evidence-based practices and to tailor interventions to the patients needs. However, requiring practitioners to be knowledgeable in all forms, types, and models of therapy may pose serious concerns for training.
References
Carlyle, D. (2017). Promoting pluralism in counseling: An untapped sources of relational mapping as therapeutic processes. International Journal for the Advancement of Counselling, 39(3), 311-321. Web.
Collins, L. (2017). Therapeutic pluralism in mental health nursing practice. Mental Health Practice, 20(10), 13-18. Web.
Cooper, M., & Dryden, W. (2016). Introduction to pluralistic counseling and psychotherapy. In M. Cooper, & W. Dryden, The handbook of pluralistic counseling and psychotherapy (pp. 1-12). London: SAGE.
Cooper, M., & McLeod, J. (2007). A pluralistic framework for counseling and psychotherapy: Implications for research. Counseling and Psychotherapy Research, 7(3), 135-143. Web.
Cooper, M., & McLeod, J. (2011). Pluralistic counseling and psychotherapy. London, UK: SAGE Publications.
Finnerty, M., Kearns, C., & ORegan, D. (2018). Pluralism: An ethical commitment to dialogue and collaboration. International Journal of Clinical Practice, 18(3), 14-22.
Greenbrook, J. (2016). For the development of a pluralistic and person-centered mindset among mental health practitioners. European Journal for Person Centered Healthcare, 4(4), 579-582. Web.
McLeod, J. (2013). Developing pluralistic practice in counseling and psychotherapy: Using what the client knows. The European Journal of Counselling Psychology, 2(1), 51-64. Web.
McLeod, J., & Cooper, M. (2011). A protocol for systematic case study research in pluralistic counseling and psychotherapy. Counselling Psychology Review, 25, 47-58.
McLeod, J., Smith, K., & Thurston, M. (2016). Training in pluralistic counseling and psychotherapy. In M. D. Cooper, The handbook of pluralistic counseling and psychotherapy (pp. 326-336). London: SAGE.
Oddli, H., & McLeod, J. (2016). Knowing-in-relation: How experienced therapists integrate different sources of knowledge in actual clinical practice. Journal of Psychotherapy Integration, 27(1), 107-119. Web.
Pearson, M., & Bruin, M. (2019). Pluralism in counseling and psychotherapy: An introduction to theory and implications for practice. Psychotherapy and Counselling Journal of Australia, 7(1), 1-12.
Pegado, E. (2019). Complementary and alternative medicine and conventional medicine: Managing pluralism in therapeutic trajectories. Annals of Medicine, 51(1), 199-199. Web.
Pendle, A. (2015). Pluralistic coaching? An exploration of the potential for a pluralistic approach to coaching. International Journal of Evidence-Based Coaching and Mentoring, 1-13.
Thompson, A., Cooper, M., & Pauli, R. (2017). Development of a therapists self-report measure of pluralistic thought and practice: The therapy of pluralism inventory. British Journal of Guidance & Counselling, 45(5), 1-11. Web.
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