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Different Levels of Problems Anne Hays - MA, CI

Often, client’s come to therapy with a wide range of presenting issues. The presenting issue or issues (i.e. the reason for coming to counseling) may or may not be the root of the problem or the real source of the inner conflict.

Problems occur across 5 levels. I'll explain:

First, the Symptom/Situational level is a problem experienced by the client that is isolated to one problematic behavior (or at least they see it as such).  For instance, a client comes to counseling because of a problem with binge eating, excessive drinking, or fighting/aggression. The problem seems to be one behavior that needs changing.  They don't see any connection to anything else.  

The therapist/professional counselor is trained to "connect the dots" for the client.  The therapist may relate the presenting issue(s) to deeper issues; but does not treat it that way until the client is able to make that connection as well.  At this level, the therapist matches an intervention (supported by research) to lessen or lower the problematic behavior without addressing any deeper issue(s). Changes in behavior can be made without dealing with the deeper, root causes of that problem.  The client will get relief from the presenting symptoms and only later may come back to therapy because the root problem is cause other problematic behavior(s).

The next level of change is Maladaptive Cognitions. This is a fancy name for irrational or problematic thinking, which produces irrational or problematic behaving.  Irrational thinking can impact several areas of the client's life.  For example, a client's irrational thoughts or maladaptive thinking create a problem with perfectionism.  The treatment of choice is to challenge their faulty cognitions (thoughts).  

In Christian counseling, the application of the Biblical injunction in I Corinthians.10:5 tells us that, "We are destroying speculations and every lofty thing raised up against the knowledge of God, and we are taking every thought captive to the obedience of Christ.” This verse reveals that one effective tool of Satan is maladaptive thoughts, which make us question "the knowledge of God." There a specific theories which enable clients to fulfill God's command to take every thought captive and thereby allow victory over depression and anxiety.

Current Interpersonal (between people) Conflicts is a third level of change.  The conflictual or dissatisfactory relationship might be with a spouse, child, in-laws, parents, co-worker, or others.  There are various reasons for such conflicts.  One is an inability to successfully handle various role transitions.  A client comes to counseling because they feel "stuck" or unable to transition into a new role as a newlywed, new parent, newly launched young adult, parent of an adolescent, empty-nester, care-giver to an elderly parent, or a new retiree.     

The therapy of best practice for this level is individual therapy in which the counselor moves into the specific role transition problem which is affecting the individual client. Based on the specific problem and symptoms experienced; the therapist will formulate a treatment plan that encompasses what the client is thinking, feeling, and doing that targets the role transition problem.

The fourth level is called Family/Systems issues. This type of counseling involves families which are experiencing problems.  Typically, a parent brings in a child who is having problems at school or at home. The stated or sometimes unstated request of the parent is “fix my child.”  Competent therapists are trained to understand that from a systemic point of view, it is unlikely for a child to have problems that are not rooted in or extended to the family system.  

A noted family counseling textbook, “Family Therapy: Concepts and Methods,” makes the following comment that gives context to what a family system entails:

“…the family is more than a collection of separate individuals; it is a system, an organic whole whose parts function in a way that transcends their separate characteristics. But even as members of family systems, we don’t cease being individuals, with hearts and minds, and wills of our own. Although it isn’t possible to understand people without taking into account their social context, notably the family, it is misleading to limit the focus to the surface of the interactions-to social behavior divorced from inner experience. Working with the whole system means not only considering all members of the family but also the personal dimensions of their experience" (Pg. 7).

The fifth level is called Intrapersonal (within the person) Conflict. In this stage, the client has experienced a traumatic event such as sexual abuse, childhood abuse, rape, and/or other traumatic events. These events have created conflict within the client that requires a methodical approach to uncover and heal the original issue. Talk therapy about daily problems may be enough to give relief to the client.  However sometimes talk therapy alone  is not enough to help a client process early childhood trauma whereby they can begin to make productive changes.

In the five levels of change, each stage represents an increasingly deeper issues. As one moves down the list, each level will generally require a greater number of counseling sessions.  The therapist listens to the client and asks, “At what level of change is the problem?” The counselor will match where the client sees the problem versus where the therapist conceptualize the problem.

During those initial sessions, it is important for the client to discern whether the therapist has sufficiently "come alongside" them.  They need to ascertain whether the counselor has validated his or her concerns.  Then the client can accurately assess whether  the therapist is a good fit for them and their particular presenting problem.  This is significantly important because the best predictor of a good outcome is the client/counselor relationship.  If the client does not sense a good, viable connection, it is recommended that they simply find a new counselor who might be a better fit.  The goal is to find a therapist who is the best possible match for the client.