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Counseling Theory & Practice Quick Reference Guide

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Navodini Harmsen

on 6 December 2013

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Transcript of Counseling Theory & Practice Quick Reference Guide

Counseling Theory & Practice
Quick Reference Guide

• Psychosocial development throughout life span
• Ego striving
• Emphasis on identity, intimacy, integrity
• Infant learn to trust vs. mistrust

Adlerian Therapy
Alfred Adler

‘Where we are striving to go is more important than where we have come from’

Family systems therapy
Psychoanalytic Therapy (traditional)

Sigmund Freud

Key Concepts

determined by
• irrational forces
• unconscious motivations (
to current behavior
• biological & instinctual drives and
Evolve through
psychosexual stages – birth to 6 years of life

• Id (instinctual, pleasure principle),
• Ego (reality principle)
• Superego (moral codes)
• Death instinct
• life style assessment (faulty goals & assumptions)– aim to develop a sense of belonging
• Re-educate – provide information, teach, guide- facilitate exploration
• I think you can do this!


• Life history data – family constellation,
• early recollections,
• developing self-awareness
• re-orientation
• offering encouragement, new possibilities- HOPE
• personal priorities), sharing interpretations with clients,

Fall 2013
Johns Hopkins University
Montgomery County Campus

• Free Association
• Interpretation
• Dream analysis
• Analysis and interpretation of resistance
• Analysis and interpretation of transference

Diagnosis and testing

unconscious > conscious
reconstruct basic personality
work through repressed conflicts

therapist a blank slate
• Say whatever comes to mind
• Identify repressed material, hidden meaning
• Identify, clarify and translate

• Free Association
• Interpretation
• Dream analysis
• Analysis and interpretation of resistance
• Analysis and interpretation of transference

Object Relations Theory (British School)
Otto Rank
Margaret Mahler

• Object – primary caregiver
• Splitting
• Whole object relating

Borderline and narcissistic disorders
Jungian Analytic psychology
Carl G Jung

Key Concepts
• Progress beyond past events- The person whom we want to become
• Dream analysis
• Collective unconscious
• Archetypes- persona (mask, public face)
• Animus & Anima (biological & psychological aspects of masculinity & femininity)
• Shadow – we tend to disown project them out - Recognize our dark side of human nature


Dream interpretation
Word association
Active imagination
• Painting
• Drawing
• Confession of pathogenic secret
• Interpretation, explanation, elucidation
• Education of patient as social being
• Transformation
Contemporary Psychoanalytic Therapy

Ego Psychology
(American School)
• Eric Erikson
Key Concepts

• Around 6 years of age
• Unity of personality
• Perception and interpretation
of past events continue to influence
phenomenological world
• Social relatedness
• Behavior is purposeful and goal directed
• Consciousness is the meaning of life
• Choice and responsibility
• Inferiority ‘a normal’ condition- wellspring of creativity
• Approach holistic, social, goal oriented, and humanistic

• Child guidance
• Parent/child counseling
• Marital and family therapy
• Individual counseling – all age groups
• Correctional and rehabilitation counseling
• Group counseling
• Substance abuse programs
• Brief counseling

Existential Therapy
Victor Frankl
‘He who has a why to live for can bear with almost any how’
Rollo May
Irvin Yalom

Key Concepts
• Awareness
• Freedom
• Identity and relationships
• Search for meaning
• Anxiety- normal (source of vitality) & neurotic
• Awareness of death
(transform stale mode of living into an authentic one) and nonbeing

Borrow from other approaches.
• initial phase - identifying and clarifying clients assumptions about the world
• middle phase – fully examine source of authority
• final phase – new learning into practice/action.
• Challenge to find meaning and purpose
• challenge to live authentically
• intensify feelings of '
I am nothing


• Awareness is the central goal
• Do you like the direction of your life?
• Are you pleased with what you are now and what you are becoming?
• If you are confused what are you doing to get some clarity?
• help create a value system congruent with client’s way of being
• teach clients to trust their own capacity to discover
• come to terms with paradoxes of existence – life & death, success & failure, freedom & limitations
• encourage clients to deal with insecurity & anxiety
• Paradoxical intention If you are nervous, go ahead and be nervous
Acting as ‘if’ – act as if all is well
• Spitting in the client soup
• Invitation to be authentic
• Recognize and facilitate making choices
• Help client face the anxiety that freedom brings
• Address ultimate concerns
• Implementation of newly acquired values

Selective disclosure of the therapist

• Developmental crisis
• Life transitions
• Making choices
• Dealing with freedom and responsibility
• Coping with guilt and anxiety
• Making sense in life
• Finding values
• For individual & group counseling
• Assertiveness therapy
• Marital and family therapy
• Crisis intervention
• Community mental health work
Person-Centered Therapy
Carl Rogers


• Crisis intervention – initial phases
(Nursing, medicine, education, and ministry)
• Marital and family therapy
• Human relations training
• Approach for teaching
• Parent/child relations
• Groups from diverse cultures

Key Concepts

• Attention to facades and
• Attitude of the therapist-
Congruence Unconditional positive regard
Accurate empathy
• Counselor enters clien
t’s Phenomenological world
• Capacity for self-understanding and self-direction
• Self-actualizing tendency
• Internal Locus of Evaluation

• Attitude of the therapist
• Quality of the therapeutic relationship
• Active listening and hearing
• Accepting
• Respecting and understanding
• Responding
• Reflection of feelings
• Clarification
• ‘Being there’ for the client
• Paraphrasing
• Restatement

NO diagnostic testing!

Provide a warm & supportive environment to facilitate self exploration

• Empty Chair
“What is happening right NOW”
• Internal Dialogue – integrate disowned & denied parts of personality
• Making the rounds
In group setting
• Reversal Technique
To recognize & accept positive & negative sides
• The rehearsal exercise
• The exaggeration exercise
Intensify and put words
• Staying with the feeling
• Dream works – to relive and acting fully in the present
• Establishing immediacy and vitality
• Directive and confrontational
• Alertness to non-verbal and bodily cues

• Formal diagnosis and testing not required


• What & How
• What is happening right now?
• What is going on now?
• What is your awareness at the moment?
• How are you experiencing your fear/…?
• “I chose to” instead of “I had to.”
“I won't” instead of “I can't.”
“I want” instead of “I need.”
“I'd like to” instead of “I'm afraid to.”
“I'm unwilling to work hard enough to” instead of “I'm unable to.”


Wants, needs, & perceptions
Direction & Doing
Planning & Commitment
• Create a caring, non criticizing, non blaming environment

What do you want?
Quality world > < external world
Do you really want to change your life?
What are you doing now?
What stopped you from doing what you say you want to do?
Is your behavior working for you?
What are you willing to do today to begin to change your life?
Behavior therapy
Ivan Pavlov (classical conditioning)
B F Skinner
(Operant conditioning & Reinforcement)
Wolpe (systematic desensitization)
Arnold Lazarus
(Multi-Modal approach)


Examine the following issues:
1. conflicting or ambivalent feelings
2. maladaptive behaviors
3. misinformation
4. missing information
5. interpersonal pressures and demands
6. external stressors outside the immediate interpersonal network
7. severe traumatic experiences
8. biological dysfunctions
Cognitive behavior therapy
Albert Ellis
Rational Emotive Behavior Therapy REBT

• Socratic dialogue
• Debating irrational beliefs
• Learning new coping skills
• Changing one’s language and thinking patterns
• Role playing
• Imagery
• Confronting faulty beliefs

Teaches clients an ABC model of changing their cognitions
Cognitive therapy
Aaron Beck

• Socratic dialogue
• Debating irrational beliefs
• Learning new coping skills
• Changing one’s language and thinking patterns
• Role playing
• Imagery
• Confronting faulty beliefs


Focus is on a collaborative relationship
Confront faulty beliefs

What did you do about that?
How did you feel/react when…?


• Genograms (organize data over at least 3 generations)
• Teaching
• Asking questions
• Family sculpting
• Joining the family
• Typical day
Key Concepts

• Whole is better than sum of its parts
• Human personality attempts to bring all parts together
• Interdependence with the environment (external & internal) NOT independence
• Greater awareness is curative in itself
• Capacity of individuals to self-regulate
Contemporary Gestalt Therapy:
• Stresses Dialogue
Gestalt Therapy
Fritz Perls
Laura Perls


• Crisis Intervention
• Psychosomatic disorders
• Marital & Family Therapy
• Awareness training of mental health professionals
• Behavior problems in children
• Teaching & Learning
• Individual & Group counseling
• Catalyst for opening up feeling & Present-centered experience
• Nervous
• Perfectionist
• Depression
• Phobia

Key Concepts

• Quality world – keep track of what feels good (in the brain)
• All problems due to
- unsatisfying relationships
- choice (to depress
• People have genetically encoded needs
survival, love & belonging, power or achievement, freedom or independence, & fun
• love & belonging – focus of therapy
• Rejects Medical Model (DSM diagnoses, pharmacological interventions)
• People are motivated to change if convinced
• Rejects Medical Model, transference, the unconscious, and dwelling on one’s past


• Social work
• Education
• Crisis intervention
• Correction and rehabilitation
• Institutional management
• Community development
• Drug and alcohol abuse treatment
• Group counseling
• Marital & Family Therapy
Reality Therapy
(choice theory)
William Glasser

Key Concepts

• Focus on overt behavior
• precision on specifying goals of treatment
• development of specific treatment plans
• objective evaluation of therapy outcomes
• Systematic & structured approach
• Operant learning
- reinforcement & Imitation
- punishment
- shaping, chaining
- token economy
• Extinguishing
• Systematic Desensitization

Homework assignments


Diagnosis/assessment at the outset to determine treatment
• Systematic desensitization
• Relaxation training
• Exposure therapies
- In vivo desensitization
- Flooding- prolonged exposure to stimuli
• Modeling
• Cognitive restructuring
• Assertion training
• Self-management programs
• social skills training
• Multi-modal therapy
- teach, coach, train, model, & direct
- provide information, instruction, & reaction
- challenge self-defeating beliefs, offer constructive feedback
- provide reinforcement and appropriate self-disclosure
• anxiety-management training
• behavior rehearsal
• bibliotherapy
• biofeedback
• communication training
• hypnosis
• meditation
• positive imagery, reinforcement

• Individual & Group counseling
• Marital & Family
• Anxiety
• Panic
• Depression
• Grief
• Addictions
• Phobias
• Sexual Disorders
• Children’s behavioral disorders
• Stuttering
• Prevention of Cardiovascular disease
• Trauma
• Sexual abuse victims
• Combat veterans
• Victims of crime
• Rape survivors
• Accident victims
• Stress Management
• Education
• Pediatrics
• Behavioral Medicine


• anxiety
• hostility
• character disorders
• depression
• problems of sex, love, & marriage
• child rearing & adolescence
• social skills training
• self-management skills
• group therapy
• couples & family counseling

Key Concepts

• Psychological distress largely due to dysfunctional cognitive processes
• ABC theory of personality
• Human beings rational/straight and irrational/crooked thinking
• Self-preservation, self-actualization
• Self-destruction, procrastination, endless repetition of mistakes superstition, intolerance, perfectionism and self-blame
• Time-limited
• Homework assignments

Key Concepts

• focus on the cognitive content
• identify automatic thoughts to get to core schemata
• depression is anger turned inward
cognitive triad


Children and families
Parent training
Child abusers
Substance abuse recovery
Marital distress
Divorce counseling
Skill training
Stress management
Health care problems

Cognitive Behavior modification
Donald Meichenbaum

Key Concepts

• Change self statements/verbalizations
• Clients must notice how they think, feel, and behave and the impact on others.
• cognitive restructuring



• Self-observation
• Starting a new internal dialogue
• Learning new skills
• coping skills programs
• Stress inoculation training (SIT)
- information giving
- Socratic discussion
- cognitive restructuring
- problem solving
- relaxation training
- behavioral rehearsals
- self-monitoring
- self-instruction
- self-reinforcement
- Modifying environmental situations
• How can I prepare for a stressor?
• How can I confront and deal with what is stressing me?
• How can I cope with feeling…?

Feminist Therapy
Jean Baker Miller
Carol Zerbe Enns

Key Concepts

• equality
• Balancing independence & interdependence
• empowerment
• self-nurturance
• valuing diversity

Stress related to gender role
Assertiveness training
Body Image


• Gender role analysis and intervention
• Power analysis and intervention
• Bibliotherapy
• Journal writing
• Therapist self-disclosure
• Assertiveness training
• Reframing and relabeling
• Cognitive restructuring
• Identifying and challenging untested beliefs
• Role playing
Key Concepts

• The ‘whole’ is greater than the sum of its parts
• Parts can be understood only within the context of a whole system
• Circular, reciprocal dynamics of behavior/action
• A change in one part of a system affects all other part of that system.
• The tendency of ‘homeostasis’ (equilibrium)
• intervention focus relationships within the entire family system

Post-Modern Approaches
Narrative Therapy
Key Concepts

Peoples' 'self narratives' basis for interpreting subsequent experiences
Reciprocal relatoinship between stories - one influences the other
The power of language
No one right answer, solution
Future oriented


Therapeutic document
create a record for the new improved behavior
create an audience for the new behavior
Write a letter
Certificate of recognition

Family & Marital Counseling
School counseling

Deconstructing/unraveling narratives
Reconstructing narratives
Externalizing: separate the problem from the individual
Therapeutic Letter
Post-Modern Approaches
Solution Focused Brief Therapy
Key Concepts

Not necessary to know the source of the problem to find a solution (avoid diagnosis)
People have what they need to solve their own problems
Meaning lies withing social interaction and how a person constructs it
Small change leads to larger change

Miracle Question (setting of goals)
Exception question
Therapist feedback to clients (last part of session)

Cleary defined goals in collaboration with the client
increase current positive behaviors
Decrease current behavors that detract from goals
do something different
E.A.R.S. Elicit, Amplify, Reinforce, Start over again
Assess readiness for change - Visitors, Complainants, Customers

• Employer/employee issues
• Co-worker conflicts


Examine Woman's role in all spheres of her life.
Help develop skills toward specific goals

Regina Navodini Harmsen

• Personality conflict
• Depression
• Anxiety
• Panic attacks
• Obsessions
• Compulsions


• Family & Marital Counseling
• Child/parent relationship

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