Integrative Counseling Asia Pacific Journal

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An integrative model of counseling
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DOI: 10.1080/21507686.2010.546864
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Asia Pacific Journal of Counselling and Psychotherapy

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Rainer Matthias Holm-Hadullaa; Frank-Hagen Hofmanna; Michael Spertha
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University of Heidelberg, Counseling Service for Students, Gartenstrasse 2, Heidelberg, Germany
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Asia Pacific Journal of Counselling and Psychotherapy
Vol. 2, No. 1, March 2011, 3–24

Rainer Matthias Holm-Hadulla, Frank-Hagen Hofmann∗ and Michael Sperth
University of Heidelberg, Counseling Service for Students, Gartenstrasse 2, Heidelberg, 69115

Germany
(Received 4 October 2010; in final form 7 December 2010)
There are many different approaches to counseling and an eclectic blending of dif-
Downloaded By: [Holm-Hadulla, Rainer Matthias] At: 10:59 24 February 2011
ferent techniques is ubiquitous. The present paper tries to develop a comprehensive

integrative framework of counseling that integrates different approaches into a broader
frame of human interaction and that is practically useful and open to consensual valida-
tion. Based on a systematic review of existing literature and the results of the authors’
own research as well as a critical reflection of practical work, an integrative model of
counseling is proposed. The implementation of the integrative model of counseling is
illustrated with a case study. An integrative framework of counseling is proposed that
contains principles of the helping alliance, behavioral, cognitive, (psycho-) dynamic
and existential aspects. It is based on modern psychotherapy research as well as the
hermeneutics of human communication. It corresponds to a phenomenological real-
ity, and is in itself coherent and of practical value to counselors. Some of the aspects
included in the model are open to empirical investigation, such as the outcome of
counseling or the presence of the single components during the counseling process.
The proposed model of integrative counseling combines aspects of various theoretical
approaches by means of a broader framework of human interaction. While some parts
of the proposed model can be empirically examined, there are also some aspects that
defy scientific scrutiny and can only be grasped hermeneutically. The integrative model
of counseling is useful for the counselor because it allows for a coherent mentalization
of the counseling process which helps to improve the counseling process. Implications
for training and research are outlined.
Keywords: counseling; students; integrative model; helping alliance; cognitive–
behavioral; psychodynamic; systemic; existential; hermeneutics; creativity
Introduction
Psychological and psychotherapeutic counseling are widespread and used in many different
fields, be it to treat psychic disorders or fostering vocational success and personal growth.
There are significant overlaps to short-term psychotherapy on the one hand and coaching
on the other hand. Theories are manifold and are mostly applied eclectically (Goin, 2005).
In the realm of psychotherapy, many researchers have developed frameworks that take into
account various characteristics of the psychotherapeutic process. Well-known examples
are Orlinsky and Howard’s generic model of psychotherapy (1987) or Lazarus’ multimodal
therapy model (1976). However, for the area of counseling, we are still at the beginning. So
*Corresponding author. Email: f.h.hofmann@gmail.com
ISSN 2150-7686 print/ISSN 2150-7708 online

© 2011 Taylor & Francis Ltd.
DOI: 10.1080/21507686.2010.546864
http://www.informaworld.com
4 R.M. Holm-Hadulla et al.
far, a consistent, integrative and mandatory concept of counseling is missing. This article
aims to close this gap.
In the area of application of psychological and psychotherapeutic counseling for stu-
dents, a model was developed which is theoretically coherent, viable in daily counseling
routine, and which meets with the growing numbers and diversity of counseling requests.
The integrative model of counseling presented here contains supportive (alliance), behav-
ioral (behavior), cognitive (cognitions), psychodynamic (dynamics) and existential ele-
ments (existentials) – therefore it can be called ABCDE model of counseling. It allows
consideration of the client’s current concerns and problems from different and mutually
complementary theoretical perspectives, and it provides for a comprehensive understand-
ing of human experience, thinking, feeling and acting as well as for associated restrictions.
On the basis of this understanding, the appropriate strategies to work with and overcome
the current set of problems are chosen. We propose a concept that takes into considera-
tion the fact that these different approaches do not exclude each other but that there is a
potential of mutual supplementation which could be beneficial for the counselor just as
much as for the client. Each counselor brings into the counseling process his or her ‘nat-
ural’ potential of empathy and cognitive–emotional structuring of experiences which we
call understanding. As modern neurobiology confirms (e.g. Kandel, 1999; Harris, 2007),
this capacity for emotional and cognitive understanding stems from early life experiences.
This potential is used and refined by scientifically oriented training, and applied to specific
problems and disorders.
Especially in the counseling of students, a wide variety of interventions is needed to
adjust the counseling offered to the current problems, personal living conditions and needs
of the clients. The time frame available for counseling is limited, yet the needs of the
clients are urgent so that the use of different interventions at the same time or in succession
is recommended to boost the efficacy of counseling.
Methods and techniques of the ABCDE model of integrative counseling originate
from established and theoretically well-founded, empirically evaluated and implemented
psychotherapeutic approaches. Theoretical models and practical strategies which are
relevant to counseling have been extracted from client-centered psychotherapy, cognitive–
behavioral psychotherapy, psychodynamic and existential psychotherapy. They have been
modified according to the specific characteristics of the counseling setting and are summa-
rized under solution-focussed and resource-oriented considerations into a comprehensive
psychological–psychotherapeutic model of counseling. In the daily counseling routine
this approach resembles technical eclecticism (Lazarus, 1967); yet, the ABCDE model
of integrative counseling surpasses integration on the basis of therapeutic techniques by
substantiating the efficacy of individual interventions through a meta-theoretic perspective.
Based on the consideration that each therapeutic intervention is embedded in an
interpersonal context and that counselor and client meet each other in a conversation
regardless of the theoretic/therapeutic background and psychotherapeutic approach, mod-
ern hermeneutics was chosen as a metatheoretic frame for the integrative model of
counseling outlined below. In recent years there has been a renewed interest in the interper-
sonal context of psychotherapy and counseling (Orlinsky, 2006; Wampold, 2007). Strupp
(1995) regards the quality and nature of the interpersonal context as the most important
aspects of all forms of psychotherapy – ‘My own view is that the quality of interpersonal
context is the sine qua non in all forms of psychotherapy’ (p. 70) – and demands the explo-
ration of the ‘fundamental principles of human interaction which underlie the interpersonal
conditions essential for therapeutic change’ (Butler & Strupp, 1986, p. 38).
Wampold (2007) also stresses the importance of communication between counselor
and client for psychotherapeutic change: ‘the communication between the therapist and
Asia Pacific Journal of Counselling and Psychotherapy 5
the patient [ . . . ] is not simply a necessary condition for the remediation of a dysfunction
but is the primary mechanism of change’ (Wampold, 2007, p. 861).
Modern hermeneutics can contribute to such a basic understanding of human and
psychotherapeutic communication (Holm-Hadulla, 1996, 2003, 2004). It can establish
an understanding of the conditions under which the communication between counselor
and client can be successful and of the way the strategies and interventions of the
integrative psychotherapeutic model of counseling are working. Originally a method of
interpretation and exegesis of works of literature and art, hermeneutics as the art of
understanding in its modern forms (Gadamer, 1960/1989, 1976; Ricœur, 1965/1981)
is ‘a natural ability of man’ (Gadamer, 1986, p. 301). From infancy on, understanding
is a prerequisite for the experience of meaningfulness and inner consistence. Through
the hermeneutic working principles of remembrance, narrative shaping and interactional
experience (Holm-Hadulla, 1996, 2003, 2004), it will be described later on how the pro-
cesses of development and change can unfold in the dialogue between counselor and
client. Modern hermeneutics therewith constitutes a meta-theoretical frame which connects

diverse intervention strategies in a broader theory of human communication.
In the field of psychotherapy integration (Norcross & Goldfried, 2005; Stricker & Gold,
1993), the ABCDE model of integrative counseling outlined here can be understood as a
combination of the technical–eclectic approach and a metatheoreticalintegration (Feixas &
Botella, 2004). Feixas and Botella (2004) see metatheoretical integration as a means to
overcome the difficulties which are associated with technical eclecticism or theoretical
integration. Metatheoretical integration allows for a combination of different therapeutic
theories inside a common framework. Modern hermeneutics is especially suited to be used
as such a metatheoretic framework because it facilitates the description of the basic prin-
ciples of psychotherapeutic dialogue and on which different psychotherapeutic techniques
are based (Holm-Hadulla, 1996, 2003, 2004).
All of the psychotherapeutic approaches mentioned above are important for the coun-
seling process. They are linked by a resource-oriented viewpoint in which the counselor
tries to enable the client to capitalize on his strengths. We believe that this may be helpful
in many ways. First, the client will feel more supported if he can see that the counselor
recognizes not only his deficits but also his resources and what he is good at. This could
facilitate therapeutic change, in the counseling process as well as after the end of coun-
seling, the goal being to enable the client to become his own counselor. This conception
is based on self-management strategies developed by Kanfer (e.g. 1984) and salutogenetic
reflections in the sense of Antonovsky (1987), and perspectives of positive psychology
given by Seligman and Csikszentmihalyi (2000). Therefore, in addition to the alleviation
of problems, the authors believe that counseling is an effective way to (re-)enable clients to
use their potential for creativity.
The single elements of the integrative psychological and psychotherapeutic will be
described below. Then, the hermeneutic principles of remembrance, narrative shaping
and interactional experience (Holm-Hadulla, 1996, 2003, 2004), on which the specific
strategies are based, will be outlined. The practical application of the integrative model of
counseling will then be exemplified with a casuistics.
The ABCDE model of integrative counseling

As stated above, the integrative model of counseling draws on five different psychothera-
peutic approaches: client-centered therapy, behavior therapy, cognitive therapy, psychody-
namic therapy and existential psychotherapy. It goes without saying that psychotherapeutic
techniques cannot be transferred to the counseling setting without modifications. Only
the client-centered approach (Rogers, 1957) and the existential one (Yalom, 1980) can be
adapted easily (Sharf, 2008). We would like to show that basic assumptions and procedures
of cognitive–behavioral and psychodynamic therapy can be transferred to the counseling
setting too. The integrative model of counseling outlined here can be summarized as the
ABCDE model of counseling. In this model, the alliance component is based on the key
concepts of client-centered psychotherapy and refers to the stable and helping alliance
between counselor and client. Behavioral strategies incorporated in the integrative model
originate from interventions developed in behavior therapy. Dysfunctional attitudes and
thinking styles are analyzed and modified on the level of the cognitions involved using tech-
niques from cognitive psychotherapy. The dynamics of psychological and social conflicts
are illuminated by understanding of the transference/countertransference manifestations
and rely on theories of psychodynamic psychotherapy. Existential life themes such as
personal growth and creativity are also receiving attention in the integrative model of
counseling.
These five parts of the integrative model are connected recursively and linked from a
resource-oriented and solution-focused perspective, thereby implicitly implementing ideas
from systemic family counseling into the model as well. Each approach will now be
addressed in more detail and the application in the setting of integrative counseling will be
discussed. Then, the implementation of the integrative model of counseling is illustrated
with a casuistic.
Alliance
The relationship between counselor and client plays a major role in client-centered
approaches (Rogers, 1957). Genuineness, acceptance and empathy are expressed and
take effect foremost in and through the relationship between counselor and client, which
is characterized by mutual respect and trust. Criticized because of a lack of struc-
ture and direction (see Sharf, 2008), the major concepts of client-centered counseling
are mostly regarded as a necessary but not sufficient requisite for change to hap-
pen. In opposition to Rogers, in the integrative model of counseling outlined here, a
supportive and empathic attitude alone is not regarded as sufficient for change to hap-
pen. They constitute the basis for the therapeutic process and are therefore of great
importance; nevertheless they need to be supplemented with other psychotherapeutic
techniques and strategies. According to Frank (1993), the success of the therapeutic
alliance depends on adequate hermeneutic understanding and rhetorical actualization (see
below). By now there are convincing neurobiological correlates of empathy (Harris, 2007;
Marcy, Ham, Moran, & Orr, 2007) which underline its importance for the counseling
process.
While empathic understanding, unconditional regard and genuineness are core con-
cepts in client-centered counseling, nearly every other theory of psychotherapy implicitly
or explicitly includes the establishment of a good working relationship between client and
therapist. In cognitive–behavioral therapy, a supportive attitude is shown through posi-
tive reinforcement; in psychodynamics, offering time and space for mentalization can be
regarded as a supportive element. This is an example for the different foci of the distinctive
theories of psychotherapy – single concepts may be quite similar but of different impor-
tance and labeled differently. Therefore, in this integrative model of psychotherapeutic
counseling, supportive elements are used to establish a sustainable and helpful relation-
ship, which is in turn considered a key factor for the counseling process as well as for the
effects of counseling (Orlinsky, Roennestad, & Willutzki, 2004).
The importance of the helping alliance (Luborsky, 1976) can also be explained by
another theoretical framework. Human interaction is also central concept in attachment the-
ory (Bowlby, 1988). The counselor can act as a ‘secure base’ (Bowlby, 1988), from which
the client can explore the environment in an increasingly courageous manner and get in
touch with previously frightening aspects. In order to be such a secure base, the counselor
has to be honest, attentive and reliable. Looking from an attachment theory point of view,
establishing a good working relationship through supportive techniques then is a crucial
part of integrative counseling, especially in the initial phase of the counseling process, and
a prerequisite for development and change.
Behavior
Behavior therapy states that learning experiences are the main determinants of behavior.
Hence, if dysfunctional behavior has been learned, it is possible to ‘unlearn’ this behavior
by means of specific behavioral techniques and to develop a more functional replacement.

It is especially important to modify dysfunctional behavior patterns, because behav-
ior is sometimes part of the problem and maintaining factor at the same time. The
underlying foundations of behavioral counseling techniques are developed from the the-
ories of classic and operant conditioning (Pawlow, 1927; Skinner, 1953) as well as of
social learning theory (Bandura, 1977). Through those theories, the development of
mental health problems is explained, and those theories also point out the therapeutic
possibilities.
In general, behavioral counseling in the sense of our integrative model of counseling is
‘short-term, collaborative, problem-oriented, active and directive’ (Lovell, 2006). There
is no extensive exploration of the client’s biography, although the history of the prob-
lem and its first manifestations are explored. In the integrative model of counseling,
behavioral counseling techniques are used in the treatment of test anxiety or work
difficulties. Examples are pragmatic behavioral rules that specify functional alterna-
tives to the hitherto problematic behavior. At the Counseling Service Heidelberg, for
example, a set of rules that focus on good working/learning behavior was developed
(http://www.stw.uni-heidelberg.de); those rules are also used with clients who suffer from
test anxiety. In essence, behavior rules are a means to strengthen the self-efficacy of the
client.
Operant techniques based on positive and negative reinforcement are among others
present in integrative counseling through the counselor’s verbal and nonverbal approval,
positive reinforcement and general acknowledgment. Frequently, clients are missing the
necessary information about what contributes to the maintenance of the problem. When
given that information and provided with functional alternatives in a positively reinforcing
setting, clients are enabled to become more active, they learn to reinforce themselves and
their self-efficacy is strengthened. Kanfer has developed a prominent approach that tries to
(re-)enable the client to solve his problems independently (e.g. Karoly & Kanfer, 1982).
Social learning can take place in integrative counseling as well, and the counselor can
act as a role model. Model behavior can be observed either live with the counselor per-
forming the target behavior or symbolic through movies or pictures. It can be acted out in
a little role-play (maybe a simulation of the oral examination) or covert modeling can be
used, where the counselor gives a detailed description of the target behavior and has the
client imagine it. In addition to new behavior that has explicitly been part of the counsel-
ing process, clients sometimes take with them implicit attitudes, norms and values of the
counselor.
Cognitions
Cognitive approaches to psychotherapy focus on the systematic modification and correc-
tion of dysfunctional meanings, values and beliefs. The basic assumption of the cognitive
approach is that the way you think about things influences the way you feel and act.
Accordingly, people do not react directly to the situation; rather, their reaction is to a
great extent dependent on the conscious and unconscious appraisal of this situation. The
appraisal of a situation is in turn influenced by attitudes, values and beliefs that the per-
son holds. Corresponding with this basic idea, the reason for psychic disturbance lies in
distorted cognitions. What type of cognitions are thought to be distorted varies depend-
ing on the specific cognitive approach. Rational–emotive behavior therapy (Ellis, 1962)
focuses on the correction of four types of irrational beliefs: rigid demands, awfulizing
beliefs, low frustration tolerance beliefs and depreciation beliefs (Dryden, 2006). The term
‘rational’ refers to developing efficient, flexible and logical solutions that allow the client
to reach his goals. Cognitive therapy (Beck, 1976) stresses the importance of automatic
thoughts which act as a kind of standard interpretation for events. Based on Mytton (2006),
we can extract three types of cognitions relevant for cognitive counseling: information-
processing, automatic thoughts and schemata. Cognitive schemata serve as a filter and
select what information one actually perceives, thus blocking out all unimportant informa-
tion. Because schemata influence the way we draw conclusions from what we experience,
they are important for counseling too.
Based on that, cognitive interventions ‘seek to reduce distress and enhance adap-
tive coping by changing maladaptive beliefs and providing new information-processing
skills’ (Hollon & Beck, 2004). Cognitive therapy places great emphasis on the rela-
tionship between client and therapist. Both client and therapist work together to enable
the client to get rid of distorted cognitions and dysfunctional schemata. Absolutes are
disputed in order to make nuances visible, and maladaptive beliefs are questioned, not
interpreted.
Cognitive techniques can be applied in the integrative model of counseling for the
treatment of social phobias, hopelessness, rigid thinking, decision-making problems and
low self-esteem. A complete cognitive restructuring is mostly impossible due to time con-
straints. Thus, cognitive techniques in integrative counseling have to be selective and
focused. The cognitive model often is not explicitly outlined to the client; rather, it is
done implicitly by picking up dysfunctional behaviors and uncovering underlying dis-
torted beliefs. A major cognitive technique is Socratic dialogue (e.g. Overholser, 1993).
Socratic dialogue is a way to pry open inflexible belief systems, but they have to be
replaced by more functional ones. It is of great importance that the client is not bereaved
of his belief systems without having a more functional alternative at hand. Roughly
described, the counselor questions the client’s (dysfunctional) belief system, so that the
client recognizes its inconsistencies and the dysfunctional aspects.The client develops
a new set of beliefs which is questioned again so that the client has to defend it; the
realization that there are no inconsistencies leads to the consolidation of the new belief
system.
In addition, cognitive elements used in our integrative model of counseling
are frequently combined with behavioral interventions. The set of rules concerning
good working/learning behavior mentioned above contains cognitive aspects as well.
Sometimes, the cognitive elements provide a rationale for behavioral interventions.
A change process is initiated during counseling sessions, but carried on and completed
between sessions and after counseling. Beddoes-Jones and Miller (2007) have shown on a
qualitative basis that even short-term cognitive interventions can be helpful to the client in
a way that the client feels to have gained new perspectives. This could be interpreted as a
broadening of one’s horizon and an opportunity to move on in new directions, one of the
goals of integrative counseling.
Dynamics
Around 1900, Sigmund Freud (1985) has emphasized the importance of unconscious con-
flicts for psychic well-being. Recently, neurobiological research confirmed that a major
part of human behavior is determined through unconscious information processing and
decision-making (Kandel, 1999; Damasio, 2000). Internalized experiences of the past have
a strong influence on how new situations are shaped and interpreted. In particular, they
influence what one expects from others regarding relationships. Implicitly, one assumes
that other people behave just like significant reference persons behaved in the past, thus
one expects them to behave equally frustratingly or disappointingly. At the same time, one
may unconsciously hope that these new reference persons and oneself behave contrary to
prior experience and that thus new experiences will be possible.
In integrative counseling the client can get in touch with her inner conflicts and learn to
recognize them more consciously. The therapist–client–relationship serves as a sheltered
frame in which the client can reflect her personal history and re-enact her conflicts. The
psychodynamic part of our integrative model of counseling offers the possibility to deal
with memories, feelings and conflicts in a narrative way. If this language game is useful,
experiences that have not been sufficiently represented in the client’s inner world can now
be consciously restructured into a coherent mental representation (Fonagy & Target, 2003).
The usefulness of the language game is the fundamental criterion for truth in Wittgenstein’s
epistemiology (1953), reminding of the classical statement of Schiller that ‘ Man only plays
when in the full meaning of the word he is a man, and he is only completely a man when
he plays’. By this, inhibitions are dissoluted and personal growth is initiated. In contrast
to psychodynamic psychotherapy, manifestations of transference and counter-transference
are recognized, reflected and used to facilitate understanding in integrative counseling, but
they are not explicitly worked through.
Because the individual can never be seen as independent from the surroundings, inte-
grative counseling inevitably contains a systemic aspect. The margin for individual change
is largely dependent on the extent to which dysfunctional communication patterns inside
the system can be changed. In consideration of the surrounding system, the client can be
led to recognize the differences of the perspectives of individual members and start to
slowly change her own way of thinking about things. It follows from the systems view,
that disorders and disturbances of an individual member of the system are manifestations
of a failure in the system, for example resulting from deficient communication patterns or
pathogen relationships. The theoretical background is the general system theory brought
forth by von Bertalanffy (1956). Through the interactions between the individual elements
of the system, behaviors emerge that cannot be explained by the characteristics of the sin-
gle elements. A change in one element will inevitable change the other elements as well as
they are part of a common system. Systemic counseling is influenced by constructivism,
a philosophical approach that views reality as a subjective construction that cannot be
seen independently from the subject. Other important concepts are autopoesis (Maturana &
Varela, 1991) and synergy. The goal of systemic family therapy and systemic counseling is
to initiate change on a systems level and to increase available problem solutions by means
of redefinition of implicit system rules or changing the balance of different elements of the
system.
Based on the individual perceptions and viewpoints of the members of the system,
the counselor and the members of the system try to identify patterns according to which
the members of the system communicate with each other. From these patterns, the implicit
rules of the system are extracted. Simple cause-and-effect-conclusions are avoided; instead
the counselor tries to establish a circular perspective. Hence, to blame someone simply
does not make sense anymore: each element of the system is responsible to a certain
degree.
Important systemic techniques that are also used in integrative counseling are circular
questions and reframing. By using circular questions in the form of ‘What do you think . . .
thinks of you?’, the counselor tries to form and test hypotheses regarding communication
processes in the system. The perspectives of other members of the system are made explicit,
either by symbolic representations of significant others through circular questions or by
involving them in the sessions directly. Thus, the client becomes aware of the fact that
there always is an opportunity to take an alternative point of view. Thereby, changes in
the way reality is constructed can be initiated. Reframing refers to the process of adding a
systemic frame to the hitherto exclusively individual perspective; there are always several
ways to see and interpret an event. It is achieved among other things through circular
questions. Another important aspect of systemic counseling is resource orientation. In the
conception of de Shazer (1988), the system already has the resources that are necessary to
solve the problem but is currently unable to use them. Integrative counseling becomes a
search for undiscovered or neglected resources. It is important for the counselor to show
the client what she does well, and that there are a lot of situations where the client is highly
competent.
Existential dimensions: hermeneutics and creativity

Existential psychotherapy (Yalom, 1980) does not offer distinct therapeutic interventions
as such; in fact existential psychotherapy is against applying distinct techniques ‘as these
might hamper human interaction at a deep, direct and real level’ (Van Deurzen, 2006,
p. 283). Existential philosophy is concerned with the position of an individual in relation to
the world; central existential themes are responsibility, death, freedom, isolation, creativity
or the meaning of life. Transferred to counseling and psychotherapy, ‘[t]he objective is not
to cure people of pathology, [ . . . ], but rather to assist them in coming to terms with the
contradictions, dilemmas and paradoxes of their everyday existence’ (Van Deurzen, 2006,
p. 281).
According to existential counseling and psychotherapy, mental disturbances occur
because we sometimes try to escape from reality and its philosophical meaning (Frankl,
1969). Life in itself offers many small and not-so-small problems, and sometimes they
may seem overwhelming and unsolvable. Many people then try to take a somewhat fatal-
istic attitude and attempt to accept their fate. Unfortunately, this leads to passivity. Instead,
the way to overcome obstacles and facilitate change would be to use the possibilities of
individual freedom and ‘the responsibility of making our own choices and changes in
life’ (Van Deurzen, 2006, p. 282). Life means constant change, and crisis is seen as a
moment of danger but also as an opportunity for transformation (Jaspers, 1913/1997).
Keshen (2006) proposes an interesting framework which revolves around the concept of
‘existential vacuum’. When an individual does not have an authentic purpose in life an
existential vacuum develops which can lead to an ‘existential neurosis’ that expresses itself
through feelings of worthlessness or apathy. The individual then engages in purpose sub-
stitutes as a defense against existential vacuum. Thus, the goal of existential counseling is
to detect and eliminate purpose substitutes and to help the client find an authentic purpose
in life.
In integrative counseling, existential themes often become obvious: clients are in the
process of individuation, feel isolated or experience feelings of loss. Students move to a
new town and leave their families, they have to take responsibility for their life in general
and their study in particular. They face the tasks of integrating into the crowd of students
and finding new friends. Additionally, inherent in the counseling process is the existen-
tial theme of separation and departure – just as life, integrative counseling is time-limited.
However, even when existential themes do not emerge as the focus of integrative counsel-
ing, they are inevitably a part of it. Counseling on the basis of existential psychotherapy is
more or less developing a new attitude towards life. In this sense, existential psychother-
apy and existential counseling show an interesting relatedness to cognitive approaches. In
both perspectives, the way to think about things plays a major role, and in essence, estab-
lishing new ways to think about events and situations is the key goal of both approaches.
Sometimes it is quite helpful to see that some of the obstacles one has to overcome are an
integral part of human life and have to be overcome by every other person as well. The
daily struggle will probably become more tolerable if it can be recognized as a ‘normal’
task.
What has been outlined so far illustrates that existential psychotherapy can be inte-
grated in counseling not so much through specific interventions or techniques but rather in
taking an opening stance with regard to central life themes that are of universal importance.
Integrative counseling can be effective to the extent that the counselor is able to create a
secluded space in which the client can get in touch with the existential facts of life. A
major way in which existential, hermeneutic and creative approaches are expressed and in
which they influence the counseling process is through the relationship between counselor
and client. Here the circle implied in Figure 1 closes because of the particular link to the
supportive helping alliance.
Client-
centered
Counseling
Existential Behavioral
Counseling Counseling
Integrative
Counseling
Psycho-
dynamic Cognitive
Counseling Counseling
Figure 1. An integrative model of counseling.

Hermeneutics
The different approaches that build the foundation of the integrative model of counseling
are encompassed by a broader concept of human communication, namely hermeneutics.
Hermeneutics is the art of hermeneuein, i.e. ‘heralding, interpreting, explaining and con-
struing’ (Gadamer, 1974). Classic hermeneutics had been constricted to the interpretation
of literary works and works of art and had thus been mainly domain-specific. In the nine-
teenth century, hermeneutics achieved the unfastening of the ties to theology and linguistics
and expanded into a universal theory of understanding and interpretation. Dialogue as the
rationale of understanding received more and more attention. In Dilthey’s work (1978), the
psychological turn in hermeneutics then developed into a systematic recasting of the idea of
Geisteswissenschaften (what we today usually call the ‘humanities’) on the basis of psycho-
logical understanding. The concept of (subjective) experience (Erleben) is central to this
new form of hermeneutics. Based on the works of Dilthey, Karl Jaspers (1913/1997) devel-
oped a hermeneutics–humanistic psychopathology (general psychopathology) in which the

patient is not treated like an object but awarded an individual subjective truth and efforts are
made in the process of understanding to do justice to her dignitiy as a human being. A new
expansion of the term ‘hermeneutics’ to encompass all existence comes with Gadamer
(1960/1989, 1976). He sees the totality of human existence as ‘understanding’ and the
‘basic movement of human existence’. Hermeneutic understanding is a process in which,
at a fundamental level, human beings experience, manage and shape their own individual
and social realities. In this sense, it is a living process of interpretation carried out by the
human subject in its own world (cf. Ricœur, 1965/1981; Strenger, 1991).
We believe that a hermeneutic approach to counseling can prove beneficial because in
hermeneutics the principles of how experiences are expressed in dialogue are described.
Hermeneutics stresses the importance of dialogue as an interactional experience, again
pointing out the significance of the relationship between counselor and client. Frank (1993)
sees psychotherapy as overlapping with rhetorics and hermeneutics because the use of
words forms attitudes and induces action. The active principles of hermeneutics present in
psychological and psychotherapeutic counseling are remembrance, narrative shaping and
interactional experience (Holm-Hadulla, 1996, 2003, 2004).
Remembrance
The experience of distance to the events of one’s own history is often needed to understand
past and present events adequately. Within the trusting relationship of client and counselor,
the client can achieve a more coherent feeling of self and self-efficacy. Remembering one’s
past and present leads to a completion of the personal reality, which in turn changes the
way the past is seen. For many clients counseling induces a process of gaining possession
of their personal history and their life-world and assuming the authorship of their own lives.
Narrative shaping
Past experiences and memories are expressed through language and the images conjured
in one’s mind, and the process of shaping likewise. Putting a name on previously unformed
experiences makes it easier to integrate them into a coherent concept of the self. What has
been a fragmentary and restricted dialogue with oneself and significant others can now be
resumed in a more complete way. The shaping of experiences and impressions of the world
is an important aspect of human life and is necessary in order to develop a coherent model
of the inner and outer world. As Rorty (2001) put it:
We pragmatists think that the reason people try to make their beliefs coherent is not that they
love the truth but because they cannot help doing so. Our minds can no more stand incoherence
than our brains can stand whatever neuro-chemical imbalance is the physiological correlate of
such incoherence. (p. 15).
In addition, coherence is a concept that is frequently referred to when salutogenetic factors

are discussed. Sense of coherence (Antonovsky, 1987) has repeatedly been shown to be a
protective resource and to promote mental health. Thus, counseling should include sense
of coherence as a construct that is meaningful for the client’s health and the long-term
effectiveness of counseling.
Interactional experience
Single experiences gain their significance only by interactional validation. The interaction
between client and counselor can open new perspectives. Owing to the subjective nature
of the counselor’s accounts, the client is free to decide if she wants to share the coun-
selor’s conceptions. If she decides to do so, a ‘fusion of horizons’ (Gadamer, 1960/1989)
can occur and a shared meaning, a ‘mutually satisfactory story’ (Frank, 1993, p. 72) can
emerge. A feeling of ‘being a part of it’ is formed, a ‘sense of belonging’ with regard
to the counselor–client relationship as well as with regard to the personal experiences of
the past.
Creativity
The development process imposed upon us anthropologically can be understood as a cre-
ative activity. This means first of all work, in the narrower sense, giving shape to the
external world; on the other hand it implies imposing a structure on our inner relations
with our fellow humans, our own selves and our affects (cf. Kernberg, 1980). This process
never comes to an end. Any attempt to evade the necessity of constant shaping and struc-
turing, sustained perhaps by the desire for tension-free sameness and for things to ‘stay as
they are’, will lead to a state of terminal equanimity that involves a hazardous dialectic. It
is this task of continuing development that we must accept. As Goethe (1981) says at the
end of the poem ‘Blissful Yearning’:
And as long as you don’t attain it
This ‘die and become!’
You will be a gloomy guest
On this dark earth. (cf. Holm-Hadulla, 2004)
A psychological crisis can be interpreted as a process of shaping reality and coping with
life’s difficulties that has come to a standstill. Integrative counseling can help to rediscover
the creative potential: individual obstructions that make a productive shaping of life impos-
sible can be dissolved through counseling, and competencies for the creative formation of
life and acting in creative ways can be specifically supported and developed.
Practical application of the theoretical model

Integrative counseling offers the counselor a framework which she can keep in mind and
which enables her to easily structure the client’s narrative as well as to generate possi-
ble directions and on which she can base his decisions. So while one has this framework
in mind and is therefore able to conceptualize cases more easily, one can also focus on
the dimensions that seem to be important for the treatment of a specific client. It is also
permitted by this framework that each dimension may vary in importance throughout the
process of counseling. This makes it flexible enough to respond to new developments and
the dynamics of an interactional experience that counseling is.
The initial phase of integrative counseling is essential to establish a circumscribed
and secure space in which the client can get in touch with his problems. The client is
supported by the counselor’s empathy and understanding. A good working relationship
is established and constitutes the basis for specific interventions. The technical phase of
counseling is characterized by the application of specific interventions according to the
individual presenting problems and needs. The goal is to (re-)enable the client to deal
with life and its difficulties in a constructive and creative way. The preservation of a good
work–life balance is paramount for many of the students who seek to keep up their good
performance by reducing creative and social activities in favor of learning. Personal growth
is facilitated through creative activities that offer new and unusual experiences. During the
end phase of counseling, the development of the client so far is stressed and made visible.
The creative potential of the client should be accessible again and free for use in dealing
with life.
The five dimensions of the integrative model of counseling are present and relevant
in every single counseling session. Depending on the client’s presenting problems, the
dimensions may be of different importance for the effective treatment. For some clients, a
stronger emphasis on behavioral aspects is preferable, while others might gain more from
a stronger psychodynamic focus. It is also common that the dimensions’ weight changes
over the course of counseling, e.g. the existential perspective gets more important towards
the end of a counseling process when more general themes can be adressed. Rather than
being restrictive but only on a broader basis, this model is quite flexible and allows the five
dimensions to be constantly changing in terms of relative importance for the counseling
process over the course of time. Moreover, while the model is depicted sequentially, it is
thought to be recursive. One dimension can be left now and returned to at a later time, when
new information has been acquired in the course of development and hints at the possible
benefit of returning to a previously left dimension. Besides, the therapist can start with any
dimension, although establishing a working counselor–client relationship will be the first
step most of the time and especially for crisis interventions, when a supportive attitude of
the counselor is of utter importance to stabilize the client.
At this point, it is important to point out that we do not expect a counselor to be
thoroughly trained in all of the approaches that build the theoretical foundations of the
integrative model. However, this poses the question of how to take account of the differ-
ent perspectives: While all the dimensions are present at any given point in the counseling
process, their respective importance varies – over time as well as with different clients.
The counsellor will most probably focus on one or two dimensions in a session according
to the general theme of the session, and the dimensions might or might not change over
time as new information gets available. It is helpful, if the counsellor establishes a kind of
routine and continually reflects new information with respect to the different dimensions:
if the client mentions that she is generally careful and withdrawn when meeting people,
what does it mean for establishing and maintaining the therapeutic alliance, what are pos-
sible behaviors that may interfere with change, what are typical beliefs and cognitions of
the client, what is the psychodynamic background and function of it and what does that
imply for existential questions of human existence? A good way to establish such a routine
is to frequently and regularly discuss cases with colleagues, using the five dimensions as
a kind of blueprint to structure the narrative of the client. If problems arise in the course
of the counseling process, it might be helpful to check the dimensions not currently in
focus and look for possible explanations for the problems. When solving complex prob-
lems, it is often helpful to switch perspectives and to try explaining it in different terms –
the integrative model of counseling offers those perspectives, and they bring their specific
conceptions with them.
Working with university students always includes the possibilty of working with for-
eign clients with different cultural backgrounds. Like personal likes and dislikes, strengths
and weaknesses or goals of the client, the cultural background is another aspect which
influences the possibilities of applying the ABCDE model. Some cultures focus more on
the individual while others stress the importance of the society. In some cultures, reli-
gion is of great importance and influences the way things are explained (thus also pointing
to possible solutions). As such, the client’s culture is the background that heavily influ-
ences the way she is most likely to bond with the counsellor (therapeutic alliance). It also
affects the way the client behaves (behavior) based on beliefs and attitudes (cognitions)
that have been shaped by culture and society. The client’s culture also influences early
development (psychodynamics), as the ‘do’s and don’t’s’ of a specific culture are impor-
tant guidelines in childhood and are generally taught through the parents’ behavior. Finally,
the cultural background heavily influences the opinion towards general aspects of human
nature (existentials) like the definition of freedom or the meaning of life. Thus, the cul-
tural background is an important factor which offers a specific perspective to interpret
the client’s history and problems (as is recognized in DSM-IV-TR and ICD-10). It also
influences the choice of therapeutic interventions: meditation, mindfulness-based interven-
tions or socratic dialogue will not work equally well with clients from different cultures.
Finally, the cultural background and the society from which the clients come act as a sys-
tem that effctively limits the possibilities of change. The client can only change to an
extent that is permitted by society to avoid becoming a pariah. It is helpful for the coun-
sellor to encourage the client to explain her cultural heritage and society in order to get
a better understanding of what can be possible goals for the counseling process and what
cannot.
The dimensions of the integrative model of counseling have been described in
detail above and hermeneutic principles as the combining the elements of the differ-
ent approaches to counseling have been explained. Next, the practical application of the
integrative model of counseling is exemplified by giving a detailed case report.
Case report
A 21-year-old student in her second year of biology had had a ‘black-out’ in her last verbal
test. She sensed a kind of ‘emptiness in her head’, and she no longer knew how to put her
thoughts into words. She had the impression that her phrases were not authentic and felt
increasingly helpless in the face of the professor’s questions. Finally, she failed the test and
the examiner advised her to work on her problem and to consult the counseling service.
Problem clarification (firstt session)
The middle-sized client is carefully dressed and wears heavy make-up. The interviewer has
the impression of something ‘doll-like’. She sits up holding the armrests tightly as if look-
ing for support. She talks monotonously about the failed test, her preparatory works and her
test-anxiety. The client talks about her difficulties regarding continuous preparation for tests.
Although she is constantly making big plans, she regularly fails at implementing them, giving
up her project of continuous preparation rather fast.
It becomes obvious that the client has considerable problems in taking a stand for her
point of view. She likes to be ‘nice and good-natured’ in the eyes of adults. She values
harmony and does not like to ‘attract attention in an unpleasant way’. Therefore, she is
constantly trying to guess what other people want to hear and answer accordingly. In the last
exam she felt very self-conscious because she could not guess the examiner’s opinion with
regard to the topics of the exam. The client agrees that ‘guessing-the-opinions-of-others-
in-advance-and-behaving-accordingly’ is infinitely strenuous and often leads to feelings of
‘not being my true self ’. At the same time, she has always behaved like that.
The emotionally bland atmosphere in the interview changes as she begins to talk about
her mother, who has suffered from hypochondriac fears and depressive disgruntlement. Her
mother likes to exaggerate and often complains about her daughter not taking her illness
seriously and about ‘never being there’. During the description of her mother’s situation
the client appears distinctly more mature and her understandable worries about her mother
as well as her annoyance about her mother’s escape into illness and giving her a hard time
are easily comprehensible.
Alliance – building a sustainable and helpful counselor–client relationship

The client seems to relax a little over the course of the session, perhaps because of my accept-
ing empathic and interested listening to her. She sometimes leans back in her chair, becomes
more accessible and open, her descriptions become more vivid. My initial feeling of boredom
is replaced by feelings of worry about the client; behind her ‘nice façade’ I discover needy and
lovable aspects. A level of understanding seems to originate.
After the client has left I tentatively diagnose ‘learning/working difficulties’, low self-
esteem and identity uncertainty.
In the initial session, the elements of the integrative model of counseling are already
hinted at. The alliance dimension is represented heavily, as the counselor succeeds in initi-
ating a conversation with the client and in adopting a supportive stance which is dominated
by empathy, unconditional regard and genuineness. This allows the client to feel accepted
and she is able to speak fluently about her problems.
However we can also see that there is a problem represented on the level of behavior
(working/learning difficulties) as well as on the cognitive level (low self-esteem, identity
issues). The dynamic dimension is tapped by the counselor’s description of the transference
manifestation. With respect to the existential dimension, we can assume a blockade of
creative interests.
While further establishing a positively reinforcing relationship between client and
counselor, the counseling process enters the more technical phase in which the dimensions
B, C, D and E are gaining more importance.
At the beginning of the second session, the counseling relationship with the client
is made more difficult as her (unconscious) interactional pattern also expresses itself
between us.
The client reports that – while on the way to counseling – she was thinking about an answer to
my question about how she feels. At the beginning she had wanted to reply that everything was
going rather bad. But then she realized that some things had actually been pretty good. Now
she feels confused because she is not sure what the right answer to my question is. Here I get
the impression that the client is trying to present herself to me either as a ‘charming princess’
and ‘down-to-earth, well-behaved child’ with no problems at all or as someone who has totally
lost control and is in dire need of help. I encourage the client to express her feelings the way
they are, without the need to ‘act’.
Accordingly, the dynamics dimension of integrative counseling is present as a cen-

tral theme at the beginning of the second session. Rather than focusing on the dynamic
aspects of the scene and devoting the whole session to it, the course of the session then
turns towards the problem behavior the client described in the first session: because the
client has to pass the re-sit of her failed exam to be allowed to proceed with her studies,
I make the offer of 10 counseling sessions to support and accompany her in the course
of preparation for the exam. She thankfully accepts my offer and we agree on the goal of
finding a way of preparation that saves her from having to learn until the last moment and
allows her to take the exam more confidently.
Behavior-oriented interventions
To achieve the desired goal it seemed sensible to take a first look into the client’s learning
and working behavior so far. Based on the requirements of her studies the counselor gives
behavioral advice targeting effective revision and stable work–life balance.

She says that she always prepares for exams in her room exclusively. However, she often feels
distracted there and is not able to concentrate fully on the task at hand.When friends call her
and ask to meet each other she finds it difficult to decline the suggestion. She would rather
lay aside her work, have a coffee with her friends or go out in the evening. Afterwards she
would sit at her desk deep into the night and the daytime ‘learning hours’ have not been used
efficiently. We discuss that it might be helpful if she separated her workplace from her living
area and I encourage her to go to the library and learn there. Because the client has not been
able to devise a realistic work schedule in the past, we begin with talking about the general
aspects of such a work schedule. The client finds it unusual to carefully plan for the whole time
that is at her disposal. Till now, she had merely planned from week to week and tried to fit the
subject matter into it without bearing ‘the big picture’ in mind. She finds it equally strange
to include everyday tasks like housework and the planning of her free time. We also talk
about the possibilities to configure her spare time in a useful way that allows her to replenish
her energy as well as to have fun and pleasure. The client wants to go to the gym and meet
her friends in the evening more often again. For the next session she receives the homework
task of devising a realistic work schedule. As a guideline I give her a guideline devised at
the Counseling Service Heidelberg which aims at autonomous, structured and goal-oriented
working behavior by making detailed suggestions.
The behavior-oriented interventions persist over the whole counseling process but are most
pronounced in the first few sessions. This is not to say that a one-time psychoeducative
intervention (description of better learning behaviors) is enough to produce a sufficiently
stable change in behavior. Rather, behavioral interventions require practice and repetition.
Thus, in the following session the client is constantly encouraged to keep practicing the
new behaviors. The counselor monitors the client’s development and assists in overcoming
obstacles.
Changing dysfunctional cognitions

In the description given above the client talks about her working difficulties which are
somehow connected to her uncertainty regarding the true identity and her low self-esteem.
In the third session the client proudly presents her learning schedule which has turned out
really well. She has made a plan for the whole month which covers the remaining time to the
exam in alimentary biology and has also made a plan for the current week to which she has
transferred the scheduled tasks from the whole month plan. In addition to times dedicated to
learning her schedule includes sufficient recreation breaks. She states that she is able to behave
according to the schedule better than expected but still she feels dissatisfied with herself.
In alimentary biology, she says, there are clear-cut questions with clearly defined answers
and then there are questions which leave some room for interpretation. For the last type she
thinks that she has to attune her answers to what the examiners want to hear – but she finds
it impossible to do considering that there is plenty of subject matter. Such questions lead to
despair because she lacks a clear distinction between what is right and what is not. She simply
has to pass the exam in order to go on with her studies. She needs good grades as well to have
a chance to be accepted for the master degree course later on.
The information the client shared so far allows extraction of the following dysfunctional
evaluations of the exam:
I have to know the correct answers the examiners want to hear in advance or else
• The examiner is personally disappointed with me.

• There is no way to pass the exam.
The client seems to turn the exam into an emotional evaluation of her. She believes that
she has to subject to the ambiguous and hard-to-guess demands of the examiner so as not
to lose recognition and affection. To her own notions and attitudes regarding the questions
she pays no heed. This appraisal of the exam makes the preparation very difficult and leads
to the client facing a very time-consuming and very possibly unsolvable problem.
Working on dysfunctional cognitions

Interventions on the cognitive level try to make it possible for the client to experience
that her subjective manner of evaluating a specific situation [here: the exam] is only one
amongst many and that there are alternatives which are much less emotionally harmful
in the long run (refer to Wilken, 2006). Accordingly, the appropriateness of the client’s
beliefs and demands are to be reviewed by the client herself and then changed into a more
functional appraisal of the exam. The following example of a Socratic dialogue shows how
this is done:
Client: The examiner has talked contradictorily about the question of whether diet
margarine is healthier than butter.
Counselor: Well, that makes guessing the right answer harder. What do you think about
the use of diet margarine?
Client: Diet margarine contains polyunsaturated fatty acids which lower the choles-
terol level, there are even scientific studies for that. On the other hand, it would
be wrong to believe that margarine automatically contains less fat than butter,
because it is only the composition of the fatty acids that differs between them.
Besides, butter is a much better flavor carrier and therefore the decision to use
the one or the other is at least in terms of health a matter of taste. People with
higher cholesterol levels should rather use diet margarine.
Counselor: To sum it up, it seems there is no single right answer, is there? What do you
believe? How would the examiner rate such an answer?
Client: I really don’t know; that’s exactly my problem. I don’t know what he expects
me to say.
Counselor: And if you don’t know exactly what the examiner expects you’d rather say
nothing?
Client: In case of doubt, yes.
Counselor: But when you don’t say a word the examiner has no chance to see that you
have thought about the topic
Counselor: And when the examiner then thinks I’m silly?

Counselor: He might find you silly because you don’t know his attitude towards diet mar-
garine? Do you think someone silly who doesn’t know the right answers to
each and every question, above all to questions that simply don’t have a single
right answer?
Client: You think that I should say something not that wrong instead of nothing?
Counselor: It might be worth thinking about, especially because I found your answer to
the question very good and really detailed.
In this and the following sessions there are more and more dialogues similar to the one
above. Gradually the client gains more confidence in her perspectives: she is no longer
convinced that everything she does is insufficient but that her thoughts and deeds can at
least not be totally wrong. While working on her beliefs we do not neglect the behavior-
oriented strategies targeting her work–life balance from the first two sessions. However,
the client has internalized these strategies to an extent that allows them to be relevant only
marginally.
The client’s attitude towards learning is changing. In comparison the past she doesn’t ‘get
frantic that much’ anymore. While she used to be thinking ‘oh my, only two weeks left’ two
weeks prior to the exam she now says ‘it’s a chance to learn some more’. It has been some time
since she learned throughout the whole night, she says. All in all she feels more organized
now and even allows herself some enjoyment in the last days prior to the exam to ‘clear out
the cobwebs’.
She eventually passes the exam in alimentary biology with a very good result. In the exam,
she had found it easy to talk, had felt ‘authentic and answered from within’, and had related
her point of view without thinking about what the examiner would possibly like to hear. When
in danger of losing the thread she had remained calm, had thought about it and then given an
answer. The answers had not always been correct but had led to pursuing questions from the
examiner and a good dialogue had developed. Prior to the exam she had felt surprisingly calm
and confident. She had confided in the notes she’d made, and had therefore had a good base to
refer to ‘no matter what the question’.
Now the original counseling goal we agreed upon is reached. However, the client
signals that she would like to have some more sessions to find more security.
Psychodynamic Dimension
As we have seen before, the dynamic dimension flared up at the beginning of the sec-
ond session. The client tried to figure out what the counselor would most likely want to
hear and answer accordingly. Feeling unable to find that out, the client experienced dis-
comfort and was not sure how to present herself to the counselor – either as a charming
successful princess or a child in need for help. In this dilemma, the client’s uncer-
tainty regarding her own identity and the behavioral consequences that arise out of it is
hinted at.
At a later point in the counseling process the question of identity arises again, this time
manifesting itself in the context of the relationship with her boyfriend:
In the following session she for the first time mentions her one-year long relationship with one
of her fellow students. Hustled by one of her friends she had met her friend’s younger brother
and present boyfriend. After a first physical approach she had not sought closer contact. But
then her friend had pushed and urged her to try it again and she had rather ‘stumbled into that
relationship’ with her friend’s brother, which she had done with earlier relationships. After
a short time she had realized that they are too different from each other: she’s more of the
emotional kind and he rather rational. He wasn’t giving her what she needed, wasn’t paying
her compliments, he wasn’t saying that he missed her or only after she urged him to. The client
says she misses in-depth conversations in the relationship. In his presence, she also doesn’t feel
like ‘a real woman’, her attractiveness only rarely acknowledged. Not that her boyfriend wasn’t
trying to work on the things she criticizes, but so far she can’t accept the changes he made.
As an answer to the circular question (von Schlippe & Schweitzer, 2003) of what it would
be like if her boyfriend matched her ideal, made compliments at just the right moment and
kissed her at the very moment she wants to be kissed, the client says that he would then be
like a toy, just like a puppet on a string to be taken out of the cupboard when needed. That’s
not what she would like it to be. Her boyfriend should have ‘his own personality’. With me
taking sides with her boyfriend to some extent and reasoning from his perspective, the client
and I are able to understand that between the client and her boyfriend a problematic interaction
pattern has formed: triggered by her dissatisfaction with the relationship her boyfriend is put
under considerable strain by his ongoing efforts to satisfy her and increasingly resembles a
puppet on a string which in itself is reason enough for her to criticize him for not contributing
anything personal.
Based on the way she shapes the relationship with her boyfriend it becomes clear that
the client is transferring her own feelings of being manipulated (her ‘puppet-on-a-string’-
side) to her boyfriend and is manipulating him. Out of the (unconscious) misgiving that her
boyfriend – just like significant others (e.g. her mother) have done in the past – is going to
manipulate her to achieve his own goals and satisfy his own needs, she rather manipulates
him. This defense mechanism, called ‘projective identification’, is not interpreted in the
counseling process. By indentifying in part with her boyfriend, I try to mirror what she
does with him, how one becomes a marionette and I try hint at the possibility to escape
from this situation by developing one’s own personality. More generally, I try to positively
mirror her true and authentic aspects.
In the current relation with the counselor the client should be enabled to have cor-
rective emotional experience in the sense of Alexander and French (1946), assuming
that therapeutic changes can be initiated without full awareness of fend-off contents.
From a psychodynamic perspective I seem to be an external auxiliary ego lending struc-
ture and security to the client: she notices that the validation she is receiving from
me can be very helpful. In this way she is experiencing that her notions and behav-
iors cannot be that wrong. Besides, counseling serves as a ‘potential space’ according
to Winnicott (1971), a space for development in which significant aspects of the client’s
past, present, and future can be apprehended and creatively formed (Holm-Hadulla,
2007).
Existential dimension, creativity and authenticity

In every counseling process topics emerge that are universally human: shaping rela-
tionships, occupational development, the meaning of life and creativity. In the coun-
seling process described above, the client’s struggle for authenticity is of pivotal
importance. The client is confronted with the existential question of whether she is
allowed to show her true self or has to hide significant aspects of herself to secure
affection, acceptance and putative harmony and thus not feeling authentic and like a
marionette.
According to the description in the theoretical background section of this article, the
hermeneutic principles of remembrance, narrative shaping and interactional experience
are an integral part of every dialogue; in counseling and psychotherapy, however, they are
put to use more systematically (Holm-Hadulla, 1996, 1997), albeit implicitly. The case
report described above illustrates the ‘results’ of the hermeneutic principles based on some
examples.
Broadening of horizon through interactional experience

The client has experienced a dilatation of her self-perception initiated through Socratic
dialogue and circular questioning, for example. She no longer sees herself as someone
who does everything wrong, rather she acknowledges that she is at least doing some things
the right way. She is no longer as someone without an attitude or an attitude only to secure
a superficial harmony. Instead, she now is a person who can speak her mind even in an
exam. This change of self-image goes along with behavioral changes. As well, behavioral
changes can lead to a different and maybe more complete point of view. In former times
the client orientated towards her friends out of her fear of losing or disappointing them and
postponed her learning efforts until night-time. By encouraging her to dissociate working
time and leisure time more clearly, she was able to experience that she can prepare for
the exams in a long-term and thorough manner without having to abstain from meetings
with her friends who, contradictory to her predictions, reacted quite understandingly to her
clear-cut working hours.
Creativity–authenticity
In the ‘puppet on a string’ metaphor the client found for her boyfriend, her own identity and
relationship problems are condensed. In talking about her boyfriend and the sustentative
conditions of his being a marionette, her own share in the difficult interaction patterns
could be made clear. Representative for the couple, possibilities were demonstrated of how
to ‘detach the puppet from the string’ by means of developing one’s own personality.
The client’s strive for authenticity is maybe best represented in her use of the creative
metaphor of the doll. In this picture of a puppet guided by threads which lie in the hands
of others, dynamic aspects as well as the existential dimension of the integrative model
are blended. At the heart of working difficulties, manifesting themselves on the behavioral
level, there are feelings for which the client finds the picture of a puppet-on-a-string the
most appropriate description. In this picture, there is more than meets the eye on a purely
literal level. It can also be interpreted as an expression of the hermeneutic principle of
narrative shaping.
She makes creative use of language and engages in a language game. In dialogue with
the counselor, the client is able to find metaphors to express feelings, thereby shaping them
into a more coherent representation. The interactional experience taking place throughout
the whole counseling process leads to a slow change in the self-perception of the client,
shifting from the ‘puppet on a string’ to a more confident feeling of agency.
Tapping those aspects (i.e. dynamic and existential) of the client’s problem is only
possible after a sufficiently stable therapeutic relationship has developed. Furthermore,
the stability of the setting is also supported by the behavioral and cognitive interventions
the counselor provides in the first few sessions to initiate changes ‘on the surface’. It is
necessary to provide the client with a feeling of security and alliance before one can work
on such central themes as identity.
Discussion
The ABCDE model of integrative counseling is a useful theoretical development which
provides a framework to develop a conceptualization of the client’s narrative from differ-
ent theoretical perspectives. Through the use of modern hermeneutics as a metatheory,
the ABCDE model of integrative counseling surpasses the problems and limitations asso-
ciated with mere technical eclecticism in that it allows for a metatheoretical integration
(Feixas & Botella, 2004) of different psychotherapeutic approaches. The integration of
their respective foci into daily counseling routine makes it easier to adjust the counsel-
ing process to the current problem areas, personal living conditions, cultural background
and needs of the clients. The combination of different psychotherapeutic perspectives can
enrich everyday practice and enhance the outcome of the counseling process. The ABCDE
model of integrative counseling is flexible enough to be adaptable to the specific config-
uration of the client’s personal life and experience. It recognizes that different paths may
lead to therapeutic change, not unlike the pluralistic framework of counseling proposed by
Cooper & McLeod (2007).
Taking account of the five dimensions and using them to plan and structure the counsel-
ing process is something that might seem hard to do at first. It seems like thorough training
and experience in the different psychotherapeutic approaches is needed to be up to the
task. To a certain extent, this might be true. However, the counsellor’s interest in concepts
and theories from other psychotherapeutic approaches than the one(s) she is trained in is
a valuable starting point. The counsellor’s training could help to kindle such an interest by
systematically integrating different concepts into the curriculum. Personal communication

with colleagues with different psychotherapeutic backgrounds can also be helpful to dis-
cuss the different dimensions and gain an understanding of those dimensions that are not
in one’s focus by default.
For research purposes, an examination of the differential effects of the dimensions and
their interventions would be interesting. It can be hypothesized that the relative importance
of the dimensions will depend on type and severity (including chronicity) of mental disor-
ders as well as the personality, cultural background and expectations of the client. To use
the integrative model of counseling for research purposes, a detailed operationalization of
the different dimensions is necessary to achieve an understanding of what actually works
at what point in the counseling process and for whom. Hermeneutics as the metatheoretic
link between the different dimensions might prove to be the most evasive construct, as
the operationalization has to be sufficiently different from the psychotherapeutic alliance.
Furthermore, hermeneutics is about understanding, not explaining, and as such it is hard
to quantify the extent of mutual understanding. However, to find an adequate measure for
hermenteutics in psychotherapy will be an interesting challenge – methodologically and
with regard to contents.
Acknowledgment
This research is supported by grants from the Klaus Tschira Foundation gGmbH.
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An integrative model of counseling

Article · February 2011

Rainer M Holm-Hadulla Frank Hofmann

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An integrative model of counseling

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An integrative model of counseling

University of Heidelberg, Counseling Service for Students, Gartenstrasse 2, Heidelberg, 69115

ferent techniques is ubiquitous. The present paper tries to develop a comprehensive

*Corresponding author. Email: f.h.hofmann@gmail.com

ISSN 2150-7686 print/ISSN 2150-7708 online

client. Modern hermeneutics therewith constitutes a meta-theoretical frame which connects

The ABCDE model of integrative counseling

by means of specific behavioral techniques and to develop a more functional replacement.

Existential dimensions: hermeneutics and creativity

Figure 1. An integrative model of counseling.

oped a hermeneutics–humanistic psychopathology (general psychopathology) in which the

In addition, coherence is a concept that is frequently referred to when salutogenetic factors

Practical application of the theoretical model

Problem clarification (firstt session)

are easily comprehensible.

Alliance – building a sustainable and helpful counselor–client relationship

Accordingly, the dynamics dimension of integrative counseling is present as a cen-

behavioral advice targeting effective revision and stable work–life balance.

Changing dysfunctional cognitions

• The examiner is personally disappointed with me.

Working on dysfunctional cognitions

Counselor: And when the examiner then thinks I’m silly?

Existential dimension, creativity and authenticity

Broadening of horizon through interactional experience

clear-cut working hours.

systematically integrating different concepts into the curriculum. Personal communication

Luborsky, L. (1976). Helping alliances in psychotherapy. In J.L. Cleghorn (Ed.), Successful

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