Developmental Counseling and Therapy

Developmental counseling and therapy (DCT) is a counseling approach developed by Allen Ivey for understanding and helping people. It is based in theories of individual uniqueness, human growth and development, family and environmental systems, wellness, multicultural awareness, counseling and therapy, and change. DCT may be described as an integrative metatheory that incorporates other theories and counseling approaches in a systematic manner. As a consequence, it provides a means for counselors to assess their clients accurately and choose interventions most likely to assure successful counseling outcomes.

Human Developmental Nature

Individuals change and grow over their life span. Their unique life experiences combine to create an exclusive life story for them. That story tells how they make sense of their life experiences and transitions. How they deal with the changes and challenges of each life period becomes part of their life story. Each individual has strengths built through his or her experiences. Individuals also have some blind spots, or lack of awareness of the thoughts and feelings that keep them from living life to the fullest.

Normal Development

Basic to the DCT model is a wellness approach and a search for what is right in client development. Counselors seek to help people grow in a positive manner over the life span. Changes and transitions are normal, yet even normal changes can create difficulties. People are often confused when a transition creates conflicting emotions such as joy and sadness. This is typical because with every transition, some new and desired things are gained, and some things are lost as well. For example, the birth of a new child is a joy to parents and a cause for celebration. The birth also brings a major change in the activities of each day. “Free” time may be lost as the needs of the child require the attention of parents.

Counselors help people sort through the conflicting emotions of normal transitions and work through them successfully. Success both requires and results from one’s strengths. These strengths are defined in terms of wellness, a holistic perspective that includes aspects of physical, emotional, social, intellectual, occupational, and spiritual health. Achieving wellness in all of these areas requires that people make intentional choices on a daily basis. Healthy choices build additional strengths for responding to life challenges.

Developmental Challenges

The challenges of life create stresses. Sometimes stresses are severe, and environmental trauma or abuse is extreme. Traditional counseling approaches view these extremes as the basis of personality disorders. From a developmental perspective, responses to trauma are normal processes of trying to make sense of one’s life experiences. Trauma threatens one’s sense of safety and requires defenses that match the severity of the situation. Emotional and personality disorders are thus logical responses to extreme life circumstances. For the traumatized individual, these responses are “normal.”

Counselors need to understand how people make meaning of their world in order to help them grow and change. By viewing trauma responses as developmentally normal, counselors are able to focus on understanding the client rather than diagnosing a problem. This understanding is helpful for promoting a positive, proactive view of clients. It also frees clients to develop an awareness of their strengths, not just their limitations.

The Developmental Counseling and Therapy Model

Philosophical Foundations

DCT is grounded in multiple theories and in the philosophical writings of Plato and the research and applications of Jean Piaget. Both proposed four levels or styles of thinking that are linear and qualitatively different.

Plato

In the allegory of the cave, Plato explained the transition to enlightenment. A slave, chained in the dark with only candles for light, sees shadows on the walls. The slave creates stories to explain the shadows. After the slave emerges from the cave the true meaning of the shadows becomes clear. Upon returning to the cave, the shadows no longer have the same meaning. This constitutes a permanent change in perspectives and in ways of thinking. It is impossible to return to earlier stages of thinking. A “blind spot” has been removed.

Piaget

Piaget studied the cognitive development of children and proposed four sequential stages in the development of thought processes. These stages are linear and hierarchical. They are also qualitatively different. The sensory motor stage is seen in the infant who experiences the world through the five senses: taste, touch, hearing, smell, and vision. The preoperational child begins to develop mental images to represent things that are not physically present. Lacking life experiences, these images are often incomplete or flawed. Young children, ages 7 to 11, begin to develop a concrete understanding of the world. This allows children to think logically rather than magically to explain events. Adolescents enter the final stage of development and are able to understand abstract concepts. They can imagine future events and think about and hypothesize consequences without needing to take action.

Four Cognitive-Emotional-Developmental Styles

The DCT model is based in a metaphorical interpretation of the theories of Plato and Piaget. These theories propose different ways of thinking and the development of thought processes. In DCT, four cognitive-emotional-developmental styles (CED) are defined, the sensorimotor, concrete, formal, and dialectic systemic CED styles. These are similar to Piaget’s four styles but differ in that they are not linear, not hierarchical, and not sequential. They cycle over the life span in response to new developmental transitions and life experiences. The CED styles are similar to Plato’s concepts in that they represent both observable external behaviors and the internal world of ideas.

Each of the four styles is a different way of processing information. An individual can function in one style most of the time or in multiple styles. The styles are not mutually exclusive and an individual can function in more than one style at the same time. Each person has a preference for a particular style in response to a given issue or set of issues. Problems arise when a person overuses one style or when he or she gets stuck in one style and is unable to see other perspectives in a situation.

The four DCT styles blend in a cyclical model and flow from one to another. An early and late component of each style contributes to the transition and flow. It is also possible to move between the styles in a nonlinear manner.

The four styles each help individuals understand their world and their experience in different and important ways. All four are important and necessary ways of understanding their experiences. The inability to function in a style is referred to as a developmental block. This is what was referred to earlier as a “blind spot.” Developmental blocks can be overcome through counseling.

Sensorimotor Cognitive-Emotional-Developmental Style

Sensorimotor functioning is based in sensory experience. What one sees, hears, and feels is important. When an individual has an experience, he or she also has a feeling and feelings are based in senses. Therefore, all of one’s experiences in life have a physical component. Another way to say this is that feelings are physically embedded in one’s body. When an individual has an experience, he or she has a related body memory of that experience. That memory may be experienced as an image or thought.

Feelings are expressed in images that reflect conscious or unconscious thoughts. Physical sensations and feelings are the foundation of people’s affective responses and often the foundation of their behaviors.

People feel and then they act. Often they are not conscious of the feelings and question why they behave as they do.

Early sensorimotor functioning is defined as the experience of feelings. Being able to locate the feelings in one’s body is evidence of late sensorimotor functioning. A developmental block in this style may be either an inability to experience one’s feelings or an inability to locate feelings in one’s body. When individuals act in response to feelings without awareness of their feelings, they may have a developmental block in this style.

Concrete Cognitive-Emotional-Developmental Style

The concrete CED style is based in logic and details. Thinking concretely means thinking in terms of linear sequences of events. Often an individual can provide extensive detail about these events. In the early concrete stage, specific, linear details of events and circumstances are provided. The late concrete stage is characterized by if-then thinking. When an individual is able to give detailed sequences of events and reflect on those sequences, the next step is to logically see the relationship between antecedents and consequences.

Just because a person gives lots of details does not mean those details are correct or realistic. A person who leaves out important details in telling a story may have an early concrete block. Someone who is overly concrete may be able to provide many examples of overwhelming life circumstances yet be unable to understand why these events occur. This is also a block, but in the late concrete style. A late concrete block occurs when a person cannot understand relationships among events. The person cannot anticipate that if he or she does one thing, then he or she will experience a certain consequence. If the person cannot anticipate outcomes, then he or she is apt to keep repeating the same mistakes.

Formal Cognitive-Emotional-Developmental Style

The ability to think abstractly signifies formal operational thinking. In the DCT model, formal thinking means having the ability to be self-reflective and analytical. This allows an individual to see his or her patterns of thoughts, feelings, and behaviors. The individual may recognize the cause-and-effect nature of repeating patterns as well. Repeating patterns can be positive and healthy or negative and dysfunctional.

In the early formal CED style, people become aware of their repeating patterns but may not understand how those patterns result in the problems they experience. In the late formal style, people begin to understand the patterns and the meaning those patterns have in their lives. Developmental blocks occur when a person distorts or overgeneralizes his or her patterns, or attributes causes to external events and circumstances. Distortions may occur in the area of thoughts, feelings, or behaviors, or any combination of the three. A person may have a block in the ability to see his or her patterns (an early formal block), or to understand his or her patterns (a late formal block), or both.

Dialectic Systemic Cognitive-Emotional-Developmental Style

The first three orientations in the DCT model comprise internal aspects of functioning. The fourth style, dialectic, requires that people move beyond an egocentric view to see themselves as part of multiple interacting systems. In the dialectic mode, people “think about thinking about thinking.” Their cognitive complexity allows them to view themselves and their patterns as developmentally based in family, gender, and cultural influences. They also can recognize the views of others as separate and distinct from their own.

In the early dialectic style, people are able to understand how and when their patterns developed. Typically these patterns developed in their family of origin. This understanding helps people begin to reconsider whether they want those patterns to continue. In the late dialectic style, people are able to challenge their patterns or deconstruct the meaning of the patterns. Given a choice to continue or change, a person may experience the freedom to change. Part of this awareness is the ability to understand how others think, and to recognize that not everyone thinks the same way that he or she does.

An awareness of the influence of systems and multiple interacting systems also becomes apparent in the dialectic style. An understanding of the influence of family, gender, culture, spirituality, and other multicultural factors emerges in late dialectic thinking. This understanding allows individuals to recognize how multiple systems, individually and collectively, have affected their development and continue to affect their relationships, growth, daily functioning, and holistic wellness.

A block in the early dialectic style is reflected in an inability to understand how patterns developed. Individuals may be unable to conceptualize the factors affecting their developmental processes and how those continue to influence present functioning. They also may also be unable to understand or appreciate the views of others and consider that only their own perspectives are accurate. People who overuse the dialectic orientation may have a tendency to get caught up in an intellectual cloud. They may spend so much time thinking about alternatives, or who might be affected by what they do, that taking concrete action becomes difficult. They may be unable to understand the influence of one or more systems in their lives and may reject those systems as a consequence.

Assessing Cognitive Styles

Ivey developed the Standard Cognitive Developmental Interview (SCDI) to facilitate exploration and movement through the four cognitive styles. This is a structured, 1 hour or more, clinical assessment during which a particular issue or presenting problem is explored in considerable depth. The assessment is unique in that it is at once an assessment, an intervention, and the foundation for treatment planning.

The purpose of the developmental assessment interview is to determine how well clients function in each of the four cognitive-emotional-developmental styles and whether developmental blocks exist in relation to specific presenting issues. The interview is always situation specific and focused on one particular issue. When multiple issues arise, successful completion of the interview depends on the ability of the counselor and client to maintain a focus rather than pursue multiple possible concerns.

The assessment process begins with the creation of an image related to the presenting issue. For example, a counselor would ask the client to think of one specific time when his or her presenting issue or problem happened. The client would then be asked to describe that time as if it were happening right now. For example, if the presenting issue was arguments with the client’s spouse, the client would be asked to think of one particular argument and describe that one argument in detail. The goal in exploring the image is to help the client connect with sensorimotor experiencing in the present.

Once an affective response has occurred, movement to the concrete style is facilitated by asking the client to provide an example of another time he or she felt the same way. After exploration of a second and sometimes third example, formal operational thinking is explored by asking for reflections on similarities or patterns between the original image and the subsequent example or examples. Movement to the dialectic style is fostered by asking the client to reflect on the origins of the pattern and on how others might view and explain the client’s experiences. An important part of this process is helping clients uncover the “rule” that is guiding their behavior in the circum-stances described, and that is keeping them stuck relative to their presenting issue.

Throughout the interview, it is important that counselors “stay out of the client’s way” by focusing on the client’s constructions of meaning. This requires the use of basic microcounseling skills such as attending, listening, paraphrasing, summarizing, questioning, and encouraging. These skills are applied within four sequences of questions corresponding to the four DCT cognitive-emotional-developmental styles. The questioning sequences, given below, are applied after the client generates an image related to a presenting issue. The image is encouraged by an open-ended question that begins with “Tell me what happens for you when you focus on [whatever issue the client has presented].”

Assessing the Sensorimotor Cognitive-Emotional-Developmental Style

Once the client has generated an image, the goal of the first questioning sequence is to help the client process the issue in the sensorimotor style and experience the issue in both the early and late sensorimotor modalities. The questions are designed to make the image present and experienced or felt in the here-and-now of the session. The following four questions are asked and considerable reflection and exploration of the client’s responses is desired before moving to each new question:

What are you seeing?
What are you hearing?
What are you feeling?
Can you locate that feeling in your body?

If the client can respond positively to each of these questions, and is able to experience and explain a bodily sensation directly related to his or her feelings, an assessment of full functioning in the sensorimotor style may be made.

If the client is unable to tell what he or she is feeling in response to the image, a sensorimotor block may be present. The presence of such a block may inhibit successful completion of the remaining portions of the interview as the embedding of the feeling is of singular importance. Should this occur, further exploration of the image with a focus on developing the image in considerable depth typically results in some type of sensorimotor experience.

The emotions expressed at this point in the interview are not necessarily highly visible and negative. Images may evoke positive feelings, and feelings may run the gamut from mild to extreme. What is important is that the client be able to describe a physical sensation in relation to the image presented, not that the counselor judge the relative importance of the feeling. When the client has reported the experience of a feeling associated with an image, and has been able to locate that feeling physically, then the counselor can summarize the first part of the interview and turn attention to the next style.

Assessing the Concrete Cognitive-Emotional-Developmental Style

The goal of the concrete questioning sequence is to determine how well the client is able to process an issue in a linear and detailed manner. The transition to this questioning sequence occurs immediately after the embedding of a feeling. It begins with a summary of the sensorimotor image, a reflection of the embedded feeling, and the question “Was there another time you felt the same way?” This question stimulates the client to determine a second example of a time when the first feeling occurred. To explore this second example, the following questions are posed:

Can you tell me specifically what happened?
What happened just before that?
What did you (or others) say (or do) when that happened?
So if you do_, then what happens?

The counselor listens for details and for evidence of logical and if-then thinking. This questioning sequence moves the client away from present sensory experience in preparation for a more reflective style.

If a client is highly concrete and able to offer many details, multiple stories often emerge. It can be a challenge to keep this type of client focused on one story and one sequence of events. Reflecting back to the embedded feeling may be helpful. Once the concrete processing has been completed, two examples have been provided in which the same embedded feeling was predominant.

Assessing the Formal Cognitive-Emotional-Developmental Style

The transition to the formal questioning sequence begins with the summary of the first two examples. The goal is to assist the client in identifying patterns and repeating patterns by asking questions such as the following:

What similarities do you see in these two (or more) experiences?
Does this kind of thing (feeling, behavior, thought) happen a lot for you when (the situation happens)?
What are you saying to yourself when this happens?
How is your way of reacting to each situation similar?

Clients who enjoy being reflective are often easily able to see their patterns and talk about them. Clients who are not used to being self-reflective may struggle with this style. The goal is to help the client begin to relate the meaning behind his or her affective and behavioral responses to the presenting issue.

Assessing the Dialectic Systemic Cognitive-Emotional-Developmental Style

Once patterns have been identified and the meaning of the patterns has been explored, the dialectic questioning sequence may be initiated. The sequence begins with a summary of the first (sensorimotor image), second (concrete situation), and third (reflection on patterns) sections of the interview. The transition is somewhat more awkward than in the earlier parts of the interview. The first three sections are internally focused. The dialectic perspective requires that clients reflect on their situation from the perspective of others and from the lens of multiple interacting systems. For example, how are the client’s reactions to his or her situation different, or not different, when interacting with family members, with coworkers in a work setting, with friends and neighbors, or during interactions with members of a social club or religious institution. During this sequence, the counselor elicits the client’s perspectives on how others might view the situation and what others might say in response to the client’s concerns.

The questions are more difficult and the flow less fluid, as the client is challenged to think in new ways. Questions that may be asked in this part of the interview include:

How do you think this pattern developed (in your family or current living arrangements)?
Does this pattern happen in your family at all?
How did you learn this way of thinking and acting in your (family)?
What rule are you using when you think/act/feel this way?

The identification of a rule is perhaps the second most difficult part of the interview, after the process of embedding a feeling. Many people do not like to use the word rule, yet it succinctly encapsulates the issue.

The process of deconstructing or challenging the rule may be facilitated with this type of question:

I wonder if it is possible to identify any flaws in this rule, any way that following this rule keeps you from getting what you need or want?

Deconstruction is followed by directing attention to co-construction of a new rule, which leads into a commitment to continued exploration and counseling. The following two questions are asked:

As you think about it, is there a way to change this rule so you do get what you need or want?
Is this something you would like to work on in counseling?

This final question signifies both the end of the interview and the transition to a new working alliance between counselor and client. It commits the client to return for more sessions, and it sets the stage for the counselor to begin thinking about interventions.

Treatment Planning Using the DCT Model

The DCT assessment interview is often a therapeutic experience that begins the change process. Identification of the rule is tantamount to an “a-ha!” experience in which the client learns the reasons underlying automatic behaviors, or blind spots. Empowerment to change occurs in concert with the commitment to continue exploration in counseling. Consistent with a philosophy of wellness, clients are encouraged to make positive lifestyle choices to improve their quality of life. Such choices may occur in the physical arena, in terms of nutrition, exercise, or basic self-care activities such as tooth flossing, or in spiritual, vocational, emotional, cognitive, or intellectual areas. Personal traits such as sense of humor, sense of control, self-esteem, and rational beliefs may become the focus of wellness efforts, which are holistic and affect the total person, much as integrative counseling models address the needs of the whole person at a particular point in time.

An advantage of integrative counseling models is that they bring together assessments, interventions, and multiple theoretical approaches. What is unique about DCT is the structured manner in which the model is presented. This structure allows for virtually all counseling theories and methods to be integrated in a purposeful manner so that clinicians may use assessment results to select interventions most likely to be successful with a particular client in response to a given presenting issue. Examples of the preferred interventions based on the four styles are as follows:

Sensorimotor: bodywork (acupuncture, massage, yoga); catharsis; exercise (walking, jogging); focusing on emotions in the here-and-now; Gestalt interventions; guided imagery; medication; meditation; psychodynamic free association; relaxation training
Concrete: assertiveness training; behavioral counts and charts; brief therapy; cognitive automatic thoughts charts; crisis intervention; decision and problem solving; desensitization and establishment of anxiety hierarchies; narratives and story telling; psychoeducational skills training; reality therapy; Rational Emotive Behavior Therapy; thought stopping
Formal: Adlerian therapy; bibliotherapy; cognitive therapy; dream analysis; logotherapy; narratives and reflecting on stories; person-centered therapy; psychodynamic therapies; Rational Emotive Behavior Therapy
Dialectic Systemic: advocacy for social justice; community genograms; community or neighborhood action; consciousness raising groups; family dream analysis; family genograms; feminist therapy; multicultural counseling and therapy; self-help groups

Experienced counselors may complete the assessment within the first 100 or so words of the session as a client tells about a presenting problem. A counselor trained in DCT is usually able to determine preferred cognitive-emotional-developmental style from a short interview segment. At that point a choice may be made whether to use the assessment questions as an intervention or whether to use the information available to begin an intervention plan. As the client begins to change, intervention styles will change. An assessment of preferred style on each new issue is necessary so that optimum matching of styles and interventions may continue. Alternately, a counselor may intentionally mismatch a client’s preferred style to help a client overcome a developmental block and to promote optimum development and wellness.

DCT Applications and Research

DCT has been used successfully with children, adolescents, and adults of all ages. It is effective and appropriate for a wide range of client populations and issues, and is useful for teaching counseling skills and for supervision in the acquisition of those skills.

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