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COUN 710

Introduction to Counseling
by

Autumn Lindberg

on 27 March 2014

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Transcript of COUN 710

Introduction to Counseling
Fall 2013
Our Issues
Being ourselves/disclosing our experience
Avoiding perfectionism
Being honest about our limitations
Understanding silence
Dealing with clients who lack commitment
Avoiding losing ourselves in our clients
Developing a sense of humor
Declining to give advice
Defining your roles as counselor
Learning to use techniques appropriately
Developing your own counseling style
Staying vital as a person/professional
Dealing with our anxieties
ETHICAL ISSUES
Helping
Empathy
Important and Accurate
Qualities & Motivations
From the beginning
Attending
To clients
Freudian Therapy
Adlerian Therapy
Family Systems Therapy
Feminist Therapy
Post Modern Approaches
Communication
Patterns in the helping process
Managing
The helping session
Cognitive
Affective
Content reflection
Content reflection
Behavioral Therapy
Reality Therapy
Cognitive Behavior Therapy
Conceptualizing
Issues and setting goals
Integrative helping
Strategies and interventions
Existential Therapy
Person
Centered

Gestalt Therapy
The Shadow Side
A light in the darkness
Explore life concerns/issues
Identify culturally relevant expectations, wishes or goals
Identify, assess and implement culturally relevant strategies for change
Identify and assess results and plan for self-directed change in their world.
Co-creating a relationship as a forum for re-learning
What's happening in the therapy room?
Guiding Principles:
Respond to feelings, thoughts, actions, social systems of clients
From a stance of basic acceptance of clients.
Includes confidentiality and privacy.
Is non-coercive.
Focus is on the needs and disclosure of the client, not the therapist.
It is a multicultural experience.

"--there is a common core of characteristics of effective helpers...self-awareness and understanding, open-minded and flexible, objective, trustworthy, interpersonal sensitivity and emotional intelligence, curiosity and caring..."
Cormier/Hackney
Virtuous


Culturally Competent


Neurally Integrated, Mindful and Aware


Resilient
Define + Discuss: Does your level of virtue outside the therapy session impact your client? How?
Is NOT DISCLOSING enough?
Define and Discuss: How can your lack of cultural competence/humility hurt your client?
Define and Discuss: How do you imagine the Holy Spirit might be involved with this process?
Define and Discuss: Choose a famous person that we all know to have a resilient career. Briefly paint a picture of this person first listing all of their faults, then list all of their strengths (based perspective).
1
2
3
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"Shame that is unacknowledged, repressed or defended against that seems to result in either an attack on others or an incredible self- loathing...so long as you are an adult speaking to another adult to whom you are telling the most intimate things, there is an undercurrent of shame in every session." (Hackney, pg. 26)
Positive regard/nonposessive warmth
To provide an "overall sense of protection, support, or acceptance no matter what is divulged" (Karasu, 1992, p. 36).
Congruence/Genuineness
A condition reflecting honesty, transparency, and openness to the client (modeled)
Imagine someone in your life with whom you have limited positive regard. Picture them as your client.

How, what, when might you use prayer help
YOU
to overcome barriers to positive regard?
"We all know the deadened, bored, or anxious feelings that occur in interactions in which people cannot risk being in their truth...
Inauthenticity takes us out of real mutuality." (Jordan, 1997,p. 350)
Pair Share 5 min
Empathy Skills Preview I.
"A's": Give a brief summary of a time in your life when you felt brave.

"B's": Repeat what "A" said in your own words in 2 -3 sentences then give a feedback statement.

"A's": Refine it.

"B's": Refine it.
3min
RESPOND: "How was that?"
Appropriate Self-Disclosure
"Whose needs am I meeting by disclosing this idea or feeling--the client's or mine?"
The therapist's own issues (normalize)
Facts about the therapist's role (manage exp.)
The therapist's reactions to the client (feedback)
The therapist's reactions to the therapeutic relationship
Balancing: Too much vs. Too little
"Selective Reflective"
FISHBOWL!

Content vs. Process
Figure/Ground
"Non-verbal communication application."
Fish bowl 3 min each:
ACTIVITY #1

"A": Share a brief concern you have
"B": Do not respond with any facial expression or animation whatsoever while the "A" is talking; maintain complete facial passivity.
Both: Take note of how this feels.
ACTIVITY #2

"B": Share a brief concern you have
"A": Only ask questions, make NO reflections or feedback statements.
Both: Take note of how this feels.
Application to Group Counseling

Group work provides a rich framework for working through transference feelings
Feelings resembling those that members have experienced toward significant people in their past may emerge
Group members may come to represent symbolic figures from a client’s past

Competition for attention of the leader provides opportunities to explore how members dealt with feelings of competition in the past and how this effects their current interactions with others.

Projections experienced in group provide valuable clues to a client’s unresolved conflicts
Theory and Practice of Counseling and Psychotherapy - Chapter 4 (9)
Resistance
Resistance
Anything that works against the progress of therapy and prevents the production of unconscious material

Analysis of Resistance
Helps the client to see that canceling appointments, fleeing from therapy prematurely, etc., are ways of defending against anxiety
These acts interfere with the ability to accept changes which could lead to a more satisfying life
Theory and Practice of Counseling and Psychotherapy - Chapter 4 (4)
Anxiety
Feeling of dread resulting from repressed feelings, memories and desires
Develops out of conflict among the id, ego and superego to control psychic energy

Reality Anxiety

Neurotic Anxiety

Moral Anxiety
Theory and Practice of Counseling and Psychotherapy - Chapter 4 (3)
The Unconscious
Clinical evidence for postulating the unconscious:
Dreams
Slips of the tongue
Posthypnotic suggestions
Material derived from free-association
Material derived from projective techniques
Symbolic content of psychotic symptoms
NOTE: consciousness is only a thin slice of the total mind
Theory and Practice of Counseling and Psychotherapy - Chapter 4 (1)
The Structure of Personality
THE ID—The Demanding Child
Ruled by the pleasure principle

THE EGO—The Traffic Cop
Ruled by the reality principle

THE SUPEREGO—The Judge
Ruled by the moral principle
by Gerald Corey
Theory and Practice of Counseling and Psychotherapy
Chapter 4
Theory and Practice of Counseling and Psychotherapy - Chapter 4 (11)
Limitations of Classical Analysis
This approach may not be appropriate for all cultures or socioeconomic groups

Deterministic focus does not emphasize current maladaptive behaviors

Minimizes role of the environment

Requires subjective interpretation

Relies heavily on client fantasy

Lengthy treatment may not be practical or affordable for many clients
Psychoanalytic Techniques
Free Association
Client reports immediately without censoring any feelings or thoughts

Interpretation
Therapist points out, explains, and teaches the meanings of whatever is revealed

Dream Analysis
Therapist uses the “royal road to the unconscious” to bring unconscious material to light
Latent content
Manifest content
Theory and Practice of Counseling and Psychotherapy - Chapter 4 (7)
Transference and Countertransference
Transference
The client reacts to the therapist as he did to an earlier significant other
This allows the client to experience feelings that would otherwise be inaccessible
ANALYSIS OF TRANSFERENCE — allows the client to achieve insight into the influence of the past
Countertransference
The reaction of the therapist toward the client that may interfere with objectivity
Not always detrimental to therapeutic goals; can provide important means of understanding your client’s world
Countertransference reactions must be monitored so that they are used to promote understanding of the client and the therapeutic process.
Theory and Practice of Counseling and Psychotherapy - Chapter 4 (6)
The Development of Personality
Theory and Practice of Counseling and Psychotherapy - Chapter 4 (5)
Ego-Defense Mechanisms
Ego-defense mechanisms:
Are normal behaviors which operate on an unconscious level and tend to deny or distort reality
Help the individual cope with anxiety and prevent the ego from being overwhelmed
Have adaptive value if they do not become a style of life to avoid facing reality
Theory and Practice of Counseling and Psychotherapy - Chapter 4 (2)
Conscious and Unconscious
Adler spent most of his time teaching his theory as opposed to systematically documenting it
Hence, some consider Adlerian theory simplistic

Many of Adler’s theoretical constructs (i.e. lifestyle) are difficult to measure and require empirical testing

Research on treatment efficacy is limited
Limitations of the Adlerian Approach
Theory and Practice of Counseling and Psychotherapy - Chapter 5 (9)
Encouragement instills self confidence by expecting clients to assume responsibility for their lives and embrace the fact that they can make changes

Encouragement is the most powerful method available for changing a person’s beliefs
Helps build self-confidence and stimulates courage
Discouragement is the basic condition that prevents people from functioning
Clients are encouraged to recognize that they have the power to choose and to act differently
Encouragement
Theory and Practice of Counseling and Psychotherapy - Chapter 5 (7)
Phase 1: Establishing the Proper Therapeutic Relationship
Supportive, collaborative, educational, encouraging process
Person-to-person contact with the client precedes identification of the problem
Help client build awareness of his or her strengths

Phase 2: Exploring the Individual’s Psychological Dynamics
Lifestyle assessment
Subjective interview
Objective interview
Family constellation
Early recollections
Basic Mistakes
Four Phases of Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 5 (5)
Inferiority Feelings
Are normal
They are the wellspring of creativity.
Develop when we are young--characterized by early feelings of hopelessness

Superiority Feelings
Promote mastery
Enable us to overcome obstacles

Related Complexes
Inferiority Complex
Superiority Complex
Inferiority and Superiority
Adler’s most significant and distinctive concept
Refers to an individual’s attitude toward and awareness of being a part of the human community
Embodies a community feeling and emphasizes the client’s positive feelings toward others in the world
Mental health is measured by the degree to which we successfully share with others and are concerned with their welfare
Happiness and success are largely related to social connectedness
Social Interest
Theory and Practice of Counseling and Psychotherapy - Chapter 5 (2)
Adlerians attempt to view the world from the client’s subjective frame of reference
How life is in reality is less important than how the individual believes life to be
It is not the childhood experiences that are crucial –
it is our present interpretation of these events

Unconscious instincts and our past do not determine our behavior
The Phenomenological Approach
by Gerald Corey
Theory and Practice of Counseling and Psychotherapy
Chapter 5
Group provides a social context in which members can develop a sense of community and social-relatedness

Sharing of early recollections increases group cohesiveness

Action-oriented strategies for behavior change are implemented to help group members work together to challenge erroneous beliefs about self, life and others.

Employs a time-limited framework
Application to Group Counseling
Theory and Practice of Counseling and Psychotherapy - Chapter 5 (8)

Phase 3: Encouraging Self-Understanding/Insight
Interpret the findings of the assessment
Hidden goals and purposes of behavior are made conscious
Therapist offers interpretations to help clients gain insight into their lifestyle

Phase 4: Reorientation and Re-education
Action-oriented
Useful vs. unhelpful
Four Phases of Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 5 (6)
A concept that assigns probability to having a certain set of experiences based on one’s position in the family

Adler’s five psychological positions:
center of attention
1) Oldest child– receives more attention, spoiled,
2) Second of only two– behaves as if in a race, often opposite to first child
3) Middle– often feels squeezed out
4) Youngest– the baby
5) Only– does not learn to share or cooperate with other children, learns to deal with adults
Birth Order
A life movement that organizes the client’s reality, giving meaning to life
“fictional finalism” or “guiding self ideal”
Psychiatric symptoms are “failed attempts” at achieving our lifestyle
Adlerian therapy helps clients to effectively navigate lifestyle tasks

Lifestyle is how we move toward our life goals
“private logic”
Values, life plan, perceptions of self and others
Unifies all of our behaviors to provide consistency
Makes all our actions “fit together”
Lifestyle
Theory and Practice of Counseling and Psychotherapy - Chapter 5 (1)
Based on the holistic concept

A phenomenological approach

Teleological explanation of human behavior

Social interest is stressed

Birth order and sibling relationships

Therapy as teaching, informing and encouraging

Basic mistakes in the client’s private logic

The therapeutic relationship—a collaborative partnership
Alfred Adler’s Individual Psychology
Individuals– are best understood through assessing the interactions within an entire family

Symptoms– are viewed as an expression of a dysfunction within
a family

Problematic behaviors–
Serve a purpose for the family
Are a function of the family’s inability to operate productively
Are symptomatic patterns handed down across generations

A family– is an interactional unit and a change in one member effects all members
The Family Systems Perspective
by Gerald Corey
Theory and Practice of Counseling and Psychotherapy
Chapter 14
An overemphasis on the system may result in the unique characteristics of the individual family members being overlooked

Concern with the well-being and function of the system may overshadow the therapist’s view of the needs and functioning of the individuals in the system

Practitioners are cautioned not to assume that Western models of family are universal and must be culturally competent

Therapists with a Westernized view of the family may inadvertently overlook the importance of extended family when working with families from other cultures
Limitations of the Family Systems Approach
Resolve presenting problems by focusing on behavioral sequences

Get people to behave differently

Shift the family organization so that the presenting problem is no longer functional

Move the family toward the appropriate stage of family development
Problems often arise during the transition from one developmental stage to the next
Strategic Family Therapy
Treatment Goals
Focuses on solving problems in the present

Presenting problems are accepted as “real” and not a symptom of system dysfunction

Therapy is brief, process-focused, and solution-oriented

The therapist designs strategies for change

Change results when the family follows the therapist’s directions & change transactions
Strategic Family Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 14 (11)
Reduce symptoms of dysfunction

Bring about structural change by:
Modifying the family’s transactional rules
Developing more appropriate boundaries
Creation of an effective hierarchical structure
It is assumed that faulty family structures have:
Boundaries that are rigid or diffuse
Subsystems that have inappropriate tasks and functions
Structural Family Therapy
Treatment Goals
Focus is on family interactions to understand the structure, or organization of the family

Symptoms are a by-product of structural failings

Structural changes must occur in a family before an individual’s symptoms can be reduced

Techniques are active, directive, and well thought-out
Structural Family Therapy
Facilitate individual autonomy and a sense of belonging in the family
Help individuals achieve more intimacy by increasing their awareness and their experiencing
Encourage members to be themselves by freely expressing what they are thinking and feeling
Support spontaneity, creativity, the ability to play, and the willingness to be “crazy”
Experiential Family Therapy
Treatment Goals
A freewheeling, intuitive, sometimes outrageous approach
aiming to:
Unmask pretense, create new meaning, and liberate family members to be themselves

Techniques are secondary to the therapeutic relationship

Pragmatic and atheoretical

Interventions create turmoil and intensify what is going on here and now in the family
Experiential Family Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 14 (7)
Open communications
Individuals are allowed to honestly report their perceptions

Enhancement of self-esteem
Family decisions are based on individual needs

Encouragement of growth
Differences are acknowledged and seen as opportunities for growth

Transform extreme rules into useful and
functional rules
Families have many spoken and unspoken rules
Human Validation Process Model Therapy Goals
Theory and Practice of Counseling and Psychotherapy - Chapter 14 (6)
Enhancement and validation of self-esteem

Family rules

Congruence and openness in communications

Sculpting

Nurturing triads

Family mapping and chronologies
Human Validation Process Model
Theory and Practice of Counseling and Psychotherapy - Chapter 14 (5)
To change the individuals within the context of the system

To end generation-to-generation transmission of problems by resolving emotional attachments

To lessen anxiety and relieve symptoms

To increase the individual member’s level
of differentiation
Multigenerational Family Therapy Treatment Goals
Theory and Practice of Counseling and Psychotherapy - Chapter 14 (4)
The application of rational thinking to emotionally saturated systems
A well-articulated theory is considered to be essential

With the proper knowledge the individual can change
Change occurs only with other family members

Differentiation of the self
A psychological separation from others

Triangulation
A third party is recruited to reduce anxiety and stabilize a couples’ relationship
Multigenerational Family Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 14 (3)
Unlock mistaken goals and interactional patterns

Engage parents in a learning experience and a collaborative assessment

Emphasis is on the family’s motivational patterns

Main aim is to initiate a reorientation of the family
Adlerian Family Therapy
Treatment Goals
Theory and Practice of Counseling and Psychotherapy - Chapter 14 (2)
Adlerians use an educational model to counsel families

Emphasis is on family atmosphere and family constellation

Therapists function as collaborators who seek to join the family

Parent interviews yield hunches about the purposes underlying children’s misbehavior
Adlerian Family Therapy
by Gerald Corey

Brooks/Cole,
A division of
Cengage Learning
Theory and Practice of Counseling and Psychotherapy
Chapter 12
Therapists do not take a value neutral stance

Therapists must be careful not to impose their cultural values on a client

Therapists may challenge societal values that subordinate certain groups without first gaining a clear understanding of the client’s culture. This may alienate clients.

The heavy environmental/sociopolitical focus may detract from exploring a client’s intrapsychic experiences

More empirical support is needed for this approach
Limitations of Feminist Psychotherapy
Theory and Practice of Counseling and Psychotherapy - Chapter 12 (13)
Postmodern feminists provide a model for critiquing both traditional and feminist approaches

Women of color feminists assert that it is essential that feminist theory be broadened and be made more inclusive

Lesbian feminists call for inclusion of an analysis of multiple identities and their relationship to oppression

Global/international feminists take a worldwide perspective in examining women’s experiences across national boundaries
Diversity in Feminist Approaches
Relabeling
Changes the label or evaluation applied to the client's behavioral characteristics
Generally, the focus is shifted from a negative to a positive evaluation

Social Action
Encourages clients to embrace social activism
Develops clients’ thorough understanding of feminism by building a link between their experiences and the sociopolitical context they live in
Intervention Techniques in Feminist Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 12 (11)
Theory and Practice of Counseling and Psychotherapy - Chapter 12 (10)
Assertiveness training
Women become aware of their interpersonal rights
Transcends stereotypical sex roles
Changes negative beliefs
Implement changes in their daily lives

Reframing
Changes the frame of reference for looking at an individual's behavior
Shifting from an intrapersonal to an interpersonal definition of a client’s problem
Intervention Techniques in Feminist Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 12 (9)
Bibliotherapy
Reading assignments that address issues such as
Coping skills • Gender inequality
Gender-role stereotypes • Ways sexism is promoted
Power differential • Society's obsession
between women and men with thinness
Sexual assault

Self-disclosure
To help equalize the therapeutic relationship and provide modeling for the client
Values, beliefs about society, and therapeutic interventions discussed
Allows the client to make an informed choice
Intervention Techniques in Feminist Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 12 (7)
To affirm diversity and strive for social change and equality

To encourage clients to act as advocates on their own behalf and on the behalf of others

To become aware of one’s gender-role socialization process

To identify internalized gender-role messages and replace them with functional beliefs

To acquire skills to bring about change in the environment

To develop a wide range of behaviors that are freely chosen

To become personally empowered
Goals of Feminist Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 12 (6)
The personal is political
Personal and social identities are interdependent
Commitment to social change
The counseling relationship is egalitarian
Women’s and girls’ experiences and ways of knowing are honored
Definitions of distress and “mental illness” are reformulated
There is an integrated analysis of oppression
Principles of Feminist Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 12 (5)
4. Socialist Feminism
Focus
Goal of societal change
Emphasis on multiple oppressions
Believe solutions to society’s problems must include consideration of:
Class
Race
Other forms of discrimination
Major goal
to transform social relationships and institutions
Four Approaches to Feminist Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 12 (4)
3. Radical Feminism
Focus
The oppression of women that is embedded in patriarchy
Seek to change society through activism
Therapy is viewed as a political enterprise with the goal of transformation of society
Major goals
Transform gender relationships
Transform societal institutions
Increase women’s sexual and procreative self-determination.
Four Approaches to Feminist Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 12 (2)
1. Liberal Feminism
Focus
Helping individual women overcome the limits and constraints of their socialization patterns
Major goals
Personal empowerment of individual women
Dignity
Self-fulfillment
Equality
Four Approaches to Feminist Therapy
Problems are viewed in a sociopolitical and cultural context

Acknowledging psychological oppression imposed through sociopolitical status of women and minorities

The client knows what is best for her life and is the expert on his/her own life

Emphasis is on educating clients about the therapy process

Traditional ways of assessing psychological health are challenged

It is assumed that individual change will best occur through
social change

Clients are encouraged to take social action
Key Concepts of Feminist Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 12 (12)
Group provides an outlet for social support and political action

Forms a diverse community where members share the goal of supporting women's’ experiences

Group setting decreases feelings of isolation and loneliness

Self-disclosure is emphasized for both the leader and members as a means of self-exploration

Provides a setting where clients learn to use power appropriately by providing support for each other and taking social/political actions
Application of Feminist Therapy to Group Work
Theory and Practice of Counseling and Psychotherapy - Chapter 12 (8)
Gender-role analysis and intervention
To help clients understand the impact of gender-role expectations in their lives
Provides clients with insight into the ways social issues affect their problems

Power analysis and power intervention
Emphasis on the power differences between men and women in society
Clients helped to recognize different kinds of power they possess and how they and others exercise power
Intervention Techniques in Feminist Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 12 (3)
2. Cultural Feminism
Focus
Oppression stems from society’s devaluation of women’s strengths
Emphasize the differences between women and men
Believe the solution to oppression lies in feminization of the culture
Society becomes more nurturing, cooperative, and relational
Major goal
the infusion of society with values based on cooperation
Four Approaches to Feminist Therapy
Customer-type relationship*: client and therapist jointly identify a problem and a solution to work toward

Complainant relationship: a client who describes a problem, but is not able or willing to take an active role in constructing a solution

Visitors: clients who come to therapy because someone else thinks they have a problem
Three Kinds of Relationships in
Solution-Focused Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 13 (2 )
The client, not the therapist, is the expert

Dialogue is used to elicit perspective, resources, and unique client experiences

Questions empower clients to speak and to express their diverse positions

The therapist supplies optimism and the process
Social Constructionism
by Gerald Corey
Theory and Practice of Counseling and Psychotherapy
Chapter 13
Therapists must be skilled in implementing brief interventions

Therapists may employ techniques in a mechanistic fashion

Reliance on techniques may detract from building a therapeutic relationship

Narrative therapists must be careful to approach client’s stories without imposing a preconceived notion of the client’s experiences

For some individuals, the therapist’s “not knowing stance” may compromise the client’s confidence in the therapist as an expert

More empirical research is needed
Limitations of Postmodern Approaches
Narrative therapy has been used for group work in school settings

Group work provides an appreciative audience with which a client can discuss the new developments of his or her life

New identities can be rehearsed in the group setting

Wide range of uses for group-based narrative therapy in schools including:
Anger management
Grief counseling
Academic management
An adventure-based program
Application of Narrative Therapy to Group Counseling
Problem-saturated stories are deconstructed (taken apart) before new stories are co-created

The assumption is that people can continually and actively re-author their lives

Unique possibility questions enable clients to focus on their future

An appreciative audience helps new stories to take root
Deconstruction and Creating
Alternative Stories
Living life means relating to problems, not being fused with them

Externalization is a process of separating the person from identifying with the problem

Externalizing conversations help people in freeing themselves from being identified with the problem

Externalizing conversations can lead clients in recognizing times when they have dealt successfully with the problem
Externalization
Questions are used as a way to generate experience rather than to gather information

Questions are always asked from a position of respect, curiosity, and openness

Therapists ask questions from a not-knowing stance

By asking questions, therapists assist clients in exploring dimensions of their life situations

Questions can lead to taking apart problem-saturated stories
The Role of Questions in
Narrative Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 13 (13)
To become active facilitators

To demonstrate care, interest, respectful curiosity, openness, empathy, contact, and fascination

To believe in the client’s abilities, talents and positive intentions

To adopt a not-knowing position that allows being guided by the client’s story

To help clients construct a preferred story line

To create a collaborative relationship-- with the client being the senior partner
The Functions of the Narrative Therapist
Theory and Practice of Counseling and Psychotherapy - Chapter 13 (12)
Collaborate with the client in identifying (naming) the problem

Separate the person from his or her problem

Investigate how the problem has been disrupting or dominating the person

Search for exceptions to the problem

Ask clients to speculate about what kind of future they could expect from the competent person that is emerging

Create an audience to support the new story
The Therapeutic Process in
Narrative Therapy
Listen to clients with an open mind

Encourage clients to share their stories

Listen to a problem-saturated story of a client without getting stuck

Therapists demonstrate respectful curiosity and persistence

The person is not the problem, but the problem is the problem
Key Concepts of Narrative Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 13 (10)
Group is focused on solutions and the members’ ability to find solutions in their own lives

Leader shifts focus from the problem by providing members the opportunity to view themselves as resourceful and competent

Group members provide a supportive audience to observe one another being confident and competent

Group members can offer input and point out exceptions to problematic situations in each others’ lives

Questioning is used to facilitate client’s establishing goals early in the group process

Goals for therapy are small, realistic and achievable
Application of SFBT to Group Counseling
Pre-therapy change
(What have you done since you made the appointment that has made a difference in your problem?)

Exception questions
(Direct clients to times in their lives when the problem did not exist)

Miracle question
(If a miracle happened and the problem you have was solved while you were asleep, what would be different in your life?)

Scaling questions
(On a scale of zero to 10, where zero is the worst you have been and 10 represents the problem being solved, where are you with respect to __________?)
Techniques Used in
Solution-Focused Brief Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 13 (7)
Skillful questions allow people to utilize their resources

Asking “how questions” that imply change can be useful

Effective questions focus attention on solutions

Questions can get clients to notice when things were better

Useful questions assist people in paying attention to what they
are doing

Questions can open up possibilities for clients to do something different
Questions in
Solution-Focused Brief Therapy
The problem itself may not be relevant to finding effective solutions

People can create their own solutions

Small changes lead to large changes

The client is the expert on his or her own life

The best therapy involves a collaborative partnership

A therapist’s not knowing afford the client an opportunity to construct a solution
Basic Assumptions of
Solution-Focused Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 13 (5)
Therapy grounded on a positive orientation-- people are healthy and competent

Past is downplayed, while present and future are highlighted

Therapy is concerned with looking for what is working

Therapists assist clients in finding exceptions to their problems

There is a shift from “problem-orientation” to “solution-focus”

Emphasis is on constructing solutions rather than problem solving
Key Concepts of
Solution-Focused Brief Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 13 (4)
Postmodernists assume there are multiple truths

Reality is subjective and is based on the use of language

Postmodernists strive for a collaborative and consultative stance

Postmodern thought has an impact on the development of many theories
Key Concepts of Social Constructionism
Theory and Practice of Counseling and Psychotherapy - Chapter 13 (3)
Generate new meaning in the lives of clients

Co-develop, with clients, solutions that are unique to the situation

Enhance awareness of the impact of various aspects of the dominant culture on the individual

Help people develop alternative ways of being, acting, knowing, and living
Social Constructionism
Therapy Goals
Theory and Practice of Counseling and Psychotherapy - Chapter 13 (1)
Focuses on the stories people tell about themselves and others about significant events in their lives

Therapeutic task:
Help clients appreciate how they construct their realities and how they author their own stories
Constructivist Narrative Perspective
(CNP)
by Gerald Corey
Theory and Practice of Counseling and Psychotherapy
Chapter 9
Heavy focus on behavioral change may detract from client’s experience of emotions

Some counselors believe the therapist’s role as a teacher deemphasizes the important relational factors in the client-therapist relationship

Behavior therapy does not place emphasis on insight

Behavior therapy tends to focus on symptoms rather than underlying causes of maladaptive behaviors

There is potential for the therapist to manipulate the client using this approach

Some clients may find the directive approach imposing or too mechanistic
Limitations of Behavior Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 9 (8)
Treatments
rely on empirical support
emphasize self-management skills and thought restructuring
Are typically brief

Leaders
use a brief, directive, psychoeducational approach
conduct behavioral assessments

Leaders and members
create collaborative, precise treatment goals
devise a specific treatment plan to help each member meet goals
objectively measure treatment outcome
Application of Behavior Therapy to Group Counseling
Theory and Practice of Counseling and Psychotherapy - Chapter 9 (7)
Multimodal Therapy – a technical eclecticism

Applied Behavior Analysis— training new behaviors
Particularly effective in working with developmentally delayed individuals

Dialectical Behavior Therapy-- learning emotional regulation and mindfulness
Designed for the treatment of Borderline Personality Disorder

Mindfulness-Based Stress Reduction Therapy – meditation and yoga

Acceptance and Commitment Therapy - learning acceptance and non-judgment of thoughts and feelings as they occur
Therapeutic Techniques
Theory and Practice of Counseling and Psychotherapy - Chapter 9 (6)
Relaxation Training – to cope with stress

Systematic Desensitization – for anxiety and avoidance reactions

Modeling – observational learning

Assertion Training– learning to express one’s self

Social Skills Training– learning to correct deficits in interpersonal skills

Self-Management Programs – taught to use coping skills to self-manage and not be dependent on experts

Great for anger management
Therapeutic Techniques
Theory and Practice of Counseling and Psychotherapy - Chapter 9 (4)
It does not emphasize catharsis, rather changing specific behaviors and developing problem-solving skills
Cross-cultural "empty box" idea focuses on concrete methods for dealing with current problems by focusing on changing the environment
Behavioral Therapy
Linehan 1993
Helps clients regulate emotions and behaviors associated with depression
be in the present moment, seeing reality "as it really is" without distortions, without judgement, without evaluation, and without trying to hang on to an experience or try to get rid of it
Dialectical Behavioral Therapy (DBT)
Theory and Practice of Counseling and Psychotherapy - Chapter 9 (2)
In Vivo Desensitization
Brief and graduated exposure to an actual fear situation or event

Flooding
Prolonged & intensive in vivo or imaginal exposure to stimuli that evoke high levels of anxiety, without the opportunity to avoid them

Eye Movement Desensitization and Reprocessing (EMDR)
An exposure-based therapy that involves imaginal flooding, cognitive restructuring, and the use of rhythmic eye movements and other bilateral stimulation to treat traumatic stress disorders and fearful memories of clients
Exposure Therapies
A set of clinical procedures relying on experimental findings of psychological research

Based on principles of learning that are systematically applied

Treatment goals are specific and measurable and set by the therapist

Focusing on the client’s current problems: all problems have solutions

To help people change maladaptive to adaptive behaviors to give the client more control over their situation: increase their response options

The therapy is largely educational - teaching clients skills of self-management and making measurable changes to their environment
(table 9.1 shows assessment pg 253)
Behavior Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 9 (5)
A-B-C model
Antecedent(s): cue or triggering event
Behavior(s): response to trigger
Consequence(s): outcome of actions
Functional Assessment of Behavior
Antecedent
by Gerald Corey
Theory and Practice of Counseling and Psychotherapy
Chapter 11
Theory and Practice of Counseling and Psychotherapy - Chapter 11 (2)
All internally motivated behavior is geared toward meeting one or more of our basic human needs (in the box)
Belonging
Power
Freedom
Fun
Survival (Physiological needs)

Our brain functions as a control system to get us what we want

Our quality world consists of our visions of specific people, activities, events, beliefs and situations that will fulfill our needs
Basic Needs
Some feel it does not adequately address important psychological concepts such as insight, the unconscious, dreams and transference

Clinicians may have trouble viewing all psychological disorders (including serious mental illness) as behavioral choices

There is a danger for the therapist of imposing his or her personal views on clients by deciding for the client what constitutes responsible behavior

Reality therapy is often construed as simple and easy to master when in fact it requires much training to implement properly.

More empirical support is needed
Limitations of Reality Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 11 (4)
---Simple - Easy to understand, specific and concrete
---Attainable - Within the capacities and motivation of the client
---Measurable - Are the changes observable and helpful?
---Immediate and Involved - What can be done today?
What can you do?
---Controlled - Can you do this by yourself or will
you be dependent on others?
---Can you do this on a continuous basis?
Planning For Change
Theory and Practice of Counseling and Psychotherapy - Chapter 11 (3)
----Wants - What do you want to be and do?
Your “picture album”
----Doing and Direction - What are you doing?
Where do you want to go?
----Evaluation - Does your present behavior have a reasonable chance of getting you what you want?
----Planning – “SAMIC3” (next slide)
Procedures That Lead to Change:
The “WDEP” System
Theory and Practice of Counseling and Psychotherapy - Chapter 11 (1)
Symptoms are the result of choices we have made in our lives
We can chose to think, feel and behave differently

Emphasis is on personal responsibility

Therapist’s function is to keep therapy focused on the present

We often mistakenly choose misery in our best attempt to meet our needs

We act responsibly when we meet our needs without keeping others from meeting their needs
Reality Therapy Basic Beliefs
No response
Distracting questions (usually content)
Clichés ("yeah, sometimes life is just that way")
Interpretations ("...what you can't see is your REAL problem...")
Advice
Parroting
Sympathy and agreement
Faking it
Sympathy denotes agreement (risks collusion), empathy denotes understanding and acceptance of the person
The Shadow Side Of
Sharing Empathic Highlights

You feel . . .
[here name the correct emotion expressed by the client] . . .

because . . .
[here indicate the correct thoughts, experiences, and behaviors that give rise to the feelings] . . .
The Basic Formula for Communicating
Empathic Understanding
Copyright 2010 ©Brooks/Cole, a division of Cengage Learning
Give yourself time to think.
Use short responses.
Gear your response to the client, but remain yourself.
Tactics for
Responding with Empathy
Copyright 2010 ©Brooks/Cole, a division of Cengage Learning
Use the right family of emotions and the right intensity.
Distinguish between expressed and discussed feelings.
Read and respond to feelings and emotions embedded in clients’ nonverbal behavior.
Be sensitive in naming emotions.
Use variety in responding to clients’ feelings and emotions.
Neither overemphasize nor underemphasize feelings, emotions, and moods.
Responding Accurately
To Feelings, Emotions, and Moods
Copyright 2010 ©Brooks/Cole, a division of Cengage Learning
Empathy Skills:
Same Elbow Partners
"A's":
Give a 2-3 sentence synopsis of a memory that has "heat" for you

"B's":
Respond with empathic understanding as accurately as possible to each part of the memory, as it is disclosed (given your new knowledge)

5min then switch
RESPOND:
"What was different?"
"What do you need to work on?"
Elbow Partners
They accept their guilt and try to placate the client.
They become impatient and hostile and manifest these feelings either verbally or nonverbally.
They do nothing in the hope that the reluctance or the resistance will disappear.
They lower their expectations of themselves and proceed with the helping process, but in a halfhearted way.
They try to become warmer and more accepting, hoping to win the client over by love.
They blame the client and end up in a power struggle with him or her.
They allow themselves to be abused by clients, playing the role of a scapegoat.
They lower their expectations of what can be achieved by counseling.
They hand the direction of the helping process over to the client.
They give up.
Ways Helpers Might Be Unhelpful with Reluctant or Resistant Clients
"Counseling is something that is being done to me, my rights are not being respected."
"I have not been invited to participate in the decisions that will affect my life."
"I may be relatively powerless, but I still have the power to resist"
"I don't like my therapist, but I am not going to tell him/her."
"I don't need to change THAT much." or "She/he doesn't really get how bad it IS."
"We are too different- he/she could never understand me."
The message of resistance
Copyright 2010 ©Brooks/Cole, a division of Cengage Learning
Fear of intensity
Lack of trust
Fear of disorganization
Shame
The cost of change
A loss of hope
Some Reasons for Reluctance
Resistance and Reluctance
So what do you do with resistance???
Copyright 2010 ©Brooks/Cole, a division of Cengage Learning
Avoid Unhelpful Responses to Reluctance and Resistance
Develop Productive Approaches to Dealing with Reluctance and Resistance
Explore your own reluctance and resistance
See some reluctance and resistance as normal
Accept and work with the client’s reluctance and resistance
See reluctance as avoidance
Examine the quality of your interventions
Be realistic and flexible
Establish a “just society” with your client
Help the client search for incentives for moving beyond resistance
Do not see yourself as the only helper in your client’s life
Employ the client as a helper
Be realistic and flexible
Engagement: Overcoming
Reluctance and Resistance
Copyright 2010 ©Brooks/Cole, a division of Cengage Learning
Reluctance refers to clients' hesitancy to engage in the work demanded by the stages and steps of the helping process.
Resistance refers to the push-back coming from clients when they feel they are being coerced.
Reluctance and Resistance
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (13)
3 Phases of Behavior Change
1. Self-observation
2. Starting a new internal dialogue
3. Learning new skills

Coping skills programs– Stress inoculation training
(3 phase model)
1. The conceptual phase
2. Skills acquisition and rehearsal phase
3. Application and follow-through phase
Behavior Change & Coping (CBM)
Self-instructional therapy focus:
Trains clients to modify the instructions they give to themselves so that they can cope
Emphasis is on acquiring practical coping skills

Cognitive structure:
The organizing aspect of thinking, which seems to monitor and direct the choice of thoughts
The “executive processor,” which “holds the blueprints of thinking” that determine when to continue, interrupt, or change thinking
Meichenbaum’s CBM
Ellis:
Therapist is highly directive, persuasive, and confrontational
Thoughts create problems when they are irrational
How Ellis compares to Beck
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (8)
Basic theory:
To understand the nature of an emotional episode or disturbance it is essential to focus on the cognitive content of an individual’s reaction to the upsetting event or stream of thoughts

Goals:
To change the way clients think by using their automatic thoughts to reach the core schemata and begin to introduce the idea of schema restructuring

Principles:
Automatic thoughts: personalized notions that are triggered by particular stimuli that lead to emotional responses
Theory, Goals & Principles of CT
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (7)
Insight-focused therapy

Emphasizes changing negative thoughts and maladaptive beliefs

Theoretical Assumptions
People’s internal communication is accessible to introspection
Clients’ beliefs have highly personal meanings
These meanings can be discovered by the client rather than being taught or interpreted by the therapist
Aaron Beck’s Cognitive Therapy (CT)
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (5)
Irrational ideas lead to self-defeating behavior


Some examples:
“I must have love or approval from all the significant people in my life.”

“I must perform important tasks competently and perfectly.”

“If I don’t get what I want, it’s terrible, and I can’t stand it.”
Irrational Ideas
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (3)
We are born with a potential for both rational and irrational thinking

We have the biological and cultural tendency to think crookedly and to needlessly disturb ourselves

We learn and invent disturbing beliefs and keep ourselves disturbed through our self-talk

We have the capacity to change our cognitive, emotive, and behavioral processes
View of Human Nature
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (2)
Therapy is seen as an educational process

Clients learn
To identify the interplay of their thoughts, feelings and behaviors
To identify and dispute irrational beliefs that are maintained by self-indoctrination
To replace ineffective ways of thinking with effective and rational cognitions
To stop absolutistic thinking, blaming, and repeating false beliefs
The Therapeutic Process
by Gerald Corey
Theory and Practice of Counseling and Psychotherapy
Chapter 10
Extensive training is required to practice CBT

Therapist may misuse power by imposing their ideas of what constitutes “rational” thinking on a client

Therapists must take special care to encourage clients to act rationally within the framework their own value system and cultural context

The strong confrontational style of Ellis’ REBT may overwhelm some clients

Some clinicians think CBT interventions overlook the value of exploring a client’s past experiences
Limitations of Cognitive Behavior Therapy
Focus:
Client’s self-verbalizations or self-statements

Premise:
As a prerequisite to behavior change, clients must notice how they think, feel, and behave, and what impact they have on others

Basic assumption:
Distressing emotions are typically the result of maladaptive thoughts
Donald Meichenbaum’s Cognitive Behavior Modification (CBM)
Arbitrary inferences: making conclusions without supporting evidence (Catastrophizing is an example)

Selective abstraction: forming conclusions based on an isolated event ("measuring oneself only by failures")

Overgeneralization: holding extreme beliefs on the basis of a single incident and then applying them inappropriately to dissimilar events/settings
("not good in one setting, not good in ANY")

Magnification and minimization: perception of a case/situation in greater or lesser light than it truly deserves

Personalization: the tendency to relate external events to themselves without a basis for making this connection (often seen with Schizophrenia)

Labeling and mislabeling: portraying one's identity on the basis of past imperfections that define one's "true" identity (in the Shame vs. Guilt video)

Polarized (or dichotomous) thinking: categorizing experiences in either/or extremes (often seen with Borderline PD)
CT’s Cognitive Distortions
Theory and Practice of Counseling and Psychotherapy - Chapter 10 (6)
Tailored for specific diagnoses such as anxiety, panic, eating disorders and phobias

Treatments are standardized and based on empirical evidence

Use of homework allows lessons learned in group to generalize to the client’s daily environment

Help members gain awareness of how their self-defeating thoughts influence what they feel and how they behave

Heavy emphasis on psychoeducation and prevention of symptoms
Application of CBT to Group Counseling
Stresses thinking, judging, deciding, analyzing, and doing

Assumes that cognitions, emotions, and behaviors interact and have a reciprocal cause-and-effect relationship

Is highly didactic, very directive, and concerned as much with thinking as with feeling

Teaches that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations

BIG on homework
Rational Emotive Behavioral Therapy (REBT)
C

consequence
F

New feeling
E

effective philosophy
D

disputing intervention
The A-B-C Theory of Personality
Theory and Practice of Counseling and Psychotherapy - Chapter 6 (9)
Provides an ideal environment for therapeutic work on responsibility
Clients are responsible for their behavior in group
Group settings provide a mirror of how clients may act in the world
Through feedback members learn to view themselves through another’s eyes
Members learn how their behavior affects others

Builds interpersonal skills
Provides members with the opportunity to be fully themselves while relating to others
Creates an opportunity to relate to others in meaningful ways

Provides an opportunity to explore the paradoxes of existence
Learning to experience anxiety as a reality of the human condition
Making choices in the face of uncertainty
Discovering there are no ultimate answers for ultimate concerns
Application to Group Counseling
Theory and Practice of Counseling and Psychotherapy - Chapter 6 (8)
Therapy is a journey taken by therapist and client
The person-to-person relationship is key
The relationship demands that therapists be in contact with their own phenomenological world

The core of the therapeutic relationship
Respect and faith in the clients’ potential to cope
Sharing reactions with genuine concern and empathy
Relationship Between Therapist and Client

Helping clients to accept their freedom and responsibility to act

Assisting people in coming to terms with the crises in their lives

Encouraging clients to recognize the ways in which they are not living fully authentic lives

Inviting clients to become more honest with themselves

Broadening clients’ awareness of their choices

Facilitating the client’s search for purpose and meaning in life

Assisting clients in developing a deep understanding of themselves and the ways they can effectively communicate with others
Goals of Existential Psychotherapy

Existential anxiety is normal - life cannot be lived, nor can death be faced, without anxiety

Existential therapists help clients develop a healthy view of anxiety
Anxiety can be a stimulus for growth as we become aware of and accept our freedom
Anxiety can be a catalyst for living authentically and fully
We can blunt our anxiety by creating the illusion that there is security in life
If we have the courage to face ourselves and life we may be frightened, but we will be able to change
Anxiety – A Condition of Living
Theory and Practice of Counseling and Psychotherapy - Chapter 6 (5)
Meaning– like pleasure, meaning must be pursued obliquely
Finding meaning in life is a by-product of a commitment to creating, loving, and working

“The will to meaning” is our primary striving
Life is not meaningful in itself; the individual must create and discover meaning
The Search for Meaning
Identity is “the courage to be”– We must trust ourselves to search within and find our own answers
Our great fear is that we will discover that there is no core, no self
Being existentially “alone” helps us to discover our authentic self


Relatedness– At their best our relationships are based on our desire for fulfillment, not our deprivation
Relationships that spring from our sense of deprivation are clinging, parasitic, and symbiotic
Clients must distinguish between neurotic dependence and the authentic need to be with others

Balancing aloneness and relatedness helps us develop a unique identity and live authentically in the moment
Identity and Relationship
Theory and Practice of Counseling and Psychotherapy - Chapter 6 (2)
BASIC DIMENSIONS OF THE HUMAN CONDITION
The capacity for self-awareness
The tension between freedom & responsibility
The creation of an identity & establishing meaningful relationships
The search for meaning
Accepting anxiety as a condition of living ("Surrogate" movie)
The awareness of death and non-being
Existential Therapy
A Philosophical/Intellectual Approach
Theory and Practice of Counseling and Psychotherapy
Chapter 6
The individualistic focus may not fit within the world views of clients from a collectivistic culture

The high focus on self-determination may not fully account for real-life limitations of those who are oppressed and have limited choices

Some clients prefer a more directive approach to counseling

The approach may prove difficult for clients who experience difficulty conceptualizing or have limited intellectual capacities

The approach does not focus on specific techniques, making treatments difficult to standardize

Limited empirical support
Limitations of Existential Psychotherapy
Theory and Practice of Counseling and Psychotherapy - Chapter 6 (3)
The greater our awareness, the greater our possibilities for freedom

Awareness is realizing that:
We are finite--time is limited
We have the potential and the choice, to act or not to act
Meaning is not automatic--we must seek it
We are subject to loneliness, meaninglessness, emptiness, guilt, and isolation
The Capacity for Self-Awareness
Theory and Practice of Counseling and Psychotherapy - Chapter 6 (1)

Born from philosophy
A phenomenological philosophy of “humanness”
Humans are in a constant state of transition, evolving and becoming
Clients are searching for meaning in their subjective worlds

Common questions/sources of existential angst for clients
“Who am I?”
“I will die.”
“What does it all mean?”
“Will I die alone?”
“How am I going to get to where I want to be in my life?”
Existential Psychotherapy
Theory and Practice of Counseling and Psychotherapy - Chapter 7 (5)
Six Conditions
(necessary and sufficient for personality changes to occur)
1. Two persons are in psychological contact
2. The first, the client, is experiencing incongruence
3. The second person, the therapist, is congruent or integrated in the relationship
4. The therapist experiences unconditional positive regard or real caring for the client
5. The therapist experiences empathy for the client’s internal frame of reference and endeavors to communicate this to the client
6. The communication to the client is, to a minimal degree, achieved
Theory and Practice of Counseling and Psychotherapy - Chapter 7 (3)
Person-Centered Therapy
Emphasizes:
Therapy as a journey shared by two fallible people
The person’s innate striving for self-actualization
The personal characteristics of the therapist and the quality of the therapeutic relationship
The counselor’s creation of a permissive, “growth-promoting” climate
People are capable of self-directed growth if involved in a therapeutic relationship
Theory and Practice of Counseling and Psychotherapy - Chapter 7 (2)
Person-Centered Therapy
(A reaction against the directive and psychoanalytic)
Challenges:
The assumption that “the counselor knows best”
The validity of advice, suggestion, persuasion, teaching, diagnosis, and interpretation
The belief that clients cannot understand and resolve their own problems without direct help
The focus on problems over persons
Theory and Practice of Counseling and Psychotherapy
Chapter 7
Limitations of the Person-Centered Approach
Cultural considerations
Some clients may prefer a more directive, structured treatment
Individuals accustomed to indirect communication may not be comfortable with direct expression of empathy or creativity
Individuals from collectivistic cultures may disagree with the emphasis on internal locus of control

Does not focus on the use of specific techniques, making this treatment difficult to standardize

Beginning therapists may find it difficult to provide both support and challenges to clients

Limits of the therapist as a person may interfere with developing a genuine therapeutic relationship
Theory and Practice of Counseling and Psychotherapy - Chapter 7 (9)
Conditions for Creativity
Acceptance of the individual

A non-judgmental setting

Empathy

Psychological freedom

Stimulating and challenging experiences

Individuals who have experienced unsafe creative environments feel “held back” and may disengage from creative processes

Safe, creative environments give clients permission to be authentic and to delve deeply into their experiences
Theory and Practice of Counseling and Psychotherapy - Chapter 7 (8)
Person-Centered Expressive Arts Therapy
Various creative art forms
promote healing and self-discovery
are inherently healing and promote self-awareness and insight

Creative expression connects us to our feelings which are a source of life energy.
Feelings must be experienced to achieve self-awareness.

Individuals explore new facets of the self and uncover insights that transform them, creating wholeness
Discovery of wholeness leads to understanding of how we relate to the outer world.

The client’s inner world and outer world become unified.
Theory and Practice of Counseling and Psychotherapy - Chapter 7 (7)
Application to Group Counseling
Therapist takes on the role of facilitator
Creates therapeutic environment
Techniques are not stressed
Exhibits deep trust of the group members
Provides support for members
Group members set the goals for the group

Group setting fosters an open and accepting community where members can work on self-acceptance

Individuals learn that they do not have to experience the process of change alone and grow from the support of group members
Theory and Practice of Counseling and Psychotherapy - Chapter 7 (6)
The Therapist
Focuses on the quality of the therapeutic relationship

Provides a supportive therapeutic environment in which the client is the agent of change and healing

Serves as a model of a human being struggling toward greater realness

Is genuine, integrated, and authentic, without a false front

Can openly express feelings and attitudes that are present in the relationship with the client

Is invested in developing his or her own life experiences to deepen self- knowledge and move toward self-actualization
Theory and Practice of Counseling and Psychotherapy - Chapter 7 (4)
Therapy is a Growth-Promoting Climate

Congruence
Genuineness or realness in the therapy session
Therapist’s behaviors match his or her words

Unconditional positive regard
Acceptance and genuine caring about the client as a valuable person
Accepting clients as they presently are
Therapist need not approve of all client behavior

Accurate empathic understanding
The ability to deeply grasp the client’s subjective world
Helper attitudes are more important than knowledge
The therapist need not experience the situation to develop an understanding of it from the client’s perspective
Person-Centered View of Human Nature

At their core, humans are trustworthy and positive

Humans are capable of making changes and living productive, effective lives

Humans innately gravitate toward self-actualization
Actualizing tendency

Given the right growth-fostering conditions, individuals strive to move forward and fulfill their creative nature
Theory and Practice of Counseling and Psychotherapy - Chapter 8 (9)
The approach has the potential for the therapist to abuse power by using powerful techniques without proper training

This approach may not be useful for clients who have difficulty abstracting and imagining

The emphasis on therapist authenticity and self-disclosure may be overpowering for some clients

The high focus on emotion may pose limitations for clients who have been culturally conditioned to be emotionally reserved
Limitations of Gestalt Therapy
Theory and Practice of Counseling and Psychotherapy - Chapter 8 (7)
The experiment in Gestalt Therapy

Internal dialogue exercise

Rehearsal exercise

Reversal technique

Exaggeration exercise

Staying with the feeling

Making the rounds (in a group- eg. "I don't trust you because..."

Dream work
Therapeutic Techniques
Theory and Practice of Counseling and Psychotherapy - Chapter 8 (6)
The continuum of experience

The here and now

The paradoxical theory of change

The experiment

The authentic encounter

Process-oriented diagnosis
Six Components of Gestalt Therapy Methodology
Theory and Practice of Counseling and Psychotherapy - Chapter 8 (3)
Our “power is in the present”
Nothing exists except the “now”
The past is gone and the future has not yet arrived

For many people the power of the present is lost
They may focus on their past mistakes or engage in endless resolutions and plans for the future
The Now
Theory and Practice of Counseling and Psychotherapy

Chapter 8
by Gerald Corey
Theory and Practice of Counseling and Psychotherapy - Chapter 8 (4)
Feelings about the past are unexpressed
These feelings are associated with distinct memories and fantasies
Feelings not fully experienced linger in the background and interfere with effective contact

Result:
Preoccupation, compulsive behavior, wariness oppressive energy and self-defeating behavior
Unfinished Business
Theory and Practice of Counseling and Psychotherapy - Chapter 8 (1)
Existential & Phenomenological – it is grounded in the client’s “here and now”

Initial goal is for clients to gain awareness of what they are experiencing and doing now
Promotes direct experiencing rather than the abstractness of talking about situations
Rather than talk about a childhood trauma the client is encouraged to become the hurt child
Gestalt Therapy
Encourages direct experience and action (encounter groups)

Here-and-now focus allows members to bring unfinished business to the present

Members try out experiments within the group setting

Leaders can use linking to include members in the exploration of a particular individual’s problem

Leaders actively design experiments for the group while focusing on awareness and contact

Group leaders actively engage with the members to form a sense of mutuality in the group
Application to Group Counseling
Theory and Practice of Counseling and Psychotherapy - Chapter 8 (5)
Contact
Interacting with nature and with other people without losing one’s individuality

Boundary Disturbances/ resistance to contact
The defenses we develop to prevent us from experiencing the present fully
Five major channels of resistance:
Introjection • Deflection
Projection • Confluence
Retroflection
Contact and Resistances to Contact
Theory and Practice of Counseling and Psychotherapy - Chapter 8 (2)
Holism:
The full range of human functioning includes thoughts, feelings, behaviors, body, language and dreams

Field theory:
The field is the client’s environment which consists of therapist and client and all that goes on between them
Client is a participant in a constantly changing field

Figure Formation Process:
How an individual organizes experiences from moment to moment
Foreground: figure
Background: ground

Organismic self-regulation:
Emergence of need sensations and interest disturb an individual’s equilibrium
Principles of Gestalt Theory

2 Corinthians 4:6 (NIV)
For God, who said, “Let light shine out of darkness,”

...made His light shine in our hearts to give us the light of the knowledge of God’s glory displayed in the face of Christ.
"It is a profoundly unique Christian perspective to believe in human dignity- in Christ, we have a reason to extend unconditional positive regard. Treat people with dignity and they will reveal the face of God"
-E.Theonnes
Get curious...don't view anyone as an end in and of itself-
but as a means to know God more...human beings declare the glory of God more than any sunset.
Obstacles to the attending process:
1. Being judgmental
2. Having biases
3. Pigeonholing clients
4. Attending to facts
5. Sympathizing
6. Interrupting
Concluding thoughts…
Be aware of value imposition
How your values influence your interventions
How your values may influence your client’s experiences in therapy

Recognize that you are not value-neutral

Your job is to assist clients in finding answers that are most congruent with their own values

Find ways to manage value conflicts between you and your clients

Begin therapy by exploring the client’s goals
The Counselor’s Values
Theory and Practice of Counseling and Psychotherapy - Chapter 2 (2)
In your experience of being a client you can:
Consider your motivation for wanting to be a counselor
Find support as you struggle to be a professional
Have help in dealing with personal issues that are opened through your interactions with clients
Be assisted in managing your countertransference

Corey believes that“...therapists cannot hope to open doors for clients that they have not opened for themselves.”

Research shows that many therapists who seek personal counseling find it:
Personally beneficial
Important for their professional development
Counseling for the Counselor
Theory and Practice of Counseling and Psychotherapy - Chapter 2 (1)
The most important instrument you have
is YOU
Your living example of who you are and how you struggle to live up to your potential is powerful

Be authentic
The stereotyped, professional role can be shed
If you hide behind your role the client will also hide

Be a therapeutic person and be clear about who you are
Be willing to grow, to risk, to care, and to be involved
The Effective Counselor
Chapt 1 pg 9-16
Count off by 4's
Theory and Practice of Counseling and Psychotherapy - Chapter 3 (6)

Assessment is an ongoing process designed to help the counselor evaluate key elements of a client’s psychological functioning
Assessment practices are influenced by the therapist's theoretical orientation
Requires cultural sensitivity
Can be helpful in treatment planning

Diagnosis is the process of identifying pattern of symptoms which fit the criteria for a specific mental disorder defined in the DSM-IV-TR
Requires cultural sensitivity
Counselors debate its utility in understanding the client’s subjective world
Can be helpful in treatment planning
Assessment and Diagnosis
Theory and Practice of Counseling and Psychotherapy - Chapter 3 (3)
Clients need enough information about the counseling process to be able to make informed choices

Educate clients about their rights and responsibilities

Provide Informed Consent
Therapy Procedures
Risks/Benefits and Alternatives
Right to withdraw from treatment
Costs of treatment
Supervision
Privileged communication
Limits of Confidentiality
Informed Consent
Theory and Practice of Counseling and Psychotherapy - Chapter 3 (1)
Ethics codes are a fundamental component of effective counseling:
Guidelines that outline professional standards of behavior and practice
Codes do not make decisions for counselors
Counselors must interpret and apply ethical codes to their decision-making

Types of ethics to consider:
Mandatory Ethics
Aspirational Ethics
Positive Ethics
Professional Ethics
ETHICS
Theory and Practice of Counseling and Psychotherapy - Chapter 3 (8)
Are not deemed inherently unethical in the ethics codes of the APA or ACA.

Multiple relationships must be managed in an ethical way to eliminate non-professional interactions and protect client well-being.

Some helpful questions:
Will my dual relationship keep me from confronting and challenging the client?
Will my needs for the relationship become more important than therapeutic activities?
Can my client manage the dual relationship?
Whose needs are being met--my client’s or my own?
Can I recognize and manage professionally my attraction to my client?
Dual Relationships
Theory and Practice of Counseling and Psychotherapy - Chapter 3 (7)
Strengths
Counselors use treatments that have been validated by empirical research
Treatments are usually brief and are standardized
Are preferred by many insurance companies
Calls for accountability among mental health professionals to provide effective treatments

Criticisms
Some counselors believe this approach is mechanistic and does not allow for individual differences in clients
Is not well-suited for helping clients with existential concerns
It is difficult to measure both relational and technical aspects of a psychological treatment
Has potential for misuse as a method of cost containment for insurance companies instead of a method of efficacious treatment for clients
Evidence-Based Practices
Theory and Practice of Counseling and Psychotherapy - Chapter 3 (5)
Biases are reflected when we:
Neglect social and community factors to focus unduly on individualism
Assess clients with instruments that have not been normed on the population they represent
Judge as psychopathological – behaviors, beliefs, or experiences that are normal for the client’s culture
Strictly adhere to Western counseling theories without considering its applicability to the client’s diverse cultural background
Multicultural Issues
Theory and Practice of Counseling and Psychotherapy - Chapter 3 (4)
Confidentiality is essential but not absolute
Exceptions:
Duty to Warn (Tarasoff Case)
The client poses a danger to self or others

A client under the age of 16 is the victim of abuse
A dependant adult or older adult is the victim of abuse
The client needs to be hospitalized
The information is made an issue in a court action
The client requests a release of record
Limits of Confidentiality
Theory and Practice of Counseling and Psychotherapy - Chapter 3 (2)
The principles that underlie our professional codes
Benefit others, do no harm, respect other’s autonomy, be just, fair and faithful

The role of ethical codes--they:
Educate us about responsibilities, are a basis for accountability, protect clients, are a basis for improving professional practice

Making ethical decisions
Identify the problem, review relevant codes, seek consultation, brainstorm, list consequences, decide and document the reasons for your actions
To the degree it is possible, include the client in your decision making process
Ethical Decision Making
10 min
Theory and Practice of Counseling and Psychotherapy - Chapter 3 (6)

Assessment is an ongoing process designed to help the counselor evaluate key elements of a client’s psychological functioning
Assessment practices are influenced by the therapist's theoretical orientation
Requires cultural sensitivity
Can be helpful in treatment planning

Diagnosis is the process of identifying pattern of symptoms which fit the criteria for a specific mental disorder defined in the DSM-IV-TR
Requires cultural sensitivity
Counselors debate its utility in understanding the client’s subjective world
Can be helpful in treatment planning
Assessment and Diagnosis
Theory and Practice of Counseling and Psychotherapy - Chapter 3 (4)
Confidentiality is essential but not absolute
Exceptions:
Duty to Warn (Tarasoff Case)
The client poses a danger to self or others

A client under the age of 18 is the victim of abuse
A dependent adult or older adult is the victim of abuse
The client needs to be hospitalized
The information is made an issue in a court action
The client requests a release of record
Limits of Confidentiality
Theory and Practice of Counseling and Psychotherapy - Chapter 3 (2)
The principles that underlie our professional codes
Benefit others, do no harm, respect other’s autonomy, be just, fair and faithful

The role of ethical codes--they:
Educate us about responsibilities, are a basis for accountability, protect clients, are a basis for improving professional practice

Making ethical decisions
Identify the problem, review relevant codes, seek consultation, brainstorm, list consequences, decide and document the reasons for your actions
To the degree it is possible, include the client in your decision making process
Ethical Decision Making
Theory and Practice of Counseling and Psychotherapy - Chapter 3 (1)
Ethics codes are a fundamental component of effective counseling:
Guidelines that outline professional standards of behavior and practice
Codes do not make decisions for counselors
Counselors must interpret and apply ethical codes to their decision-making

Types of ethics to consider:
Mandatory Ethics
Aspirational Ethics
Positive Ethics
Professional Ethics
Are not deemed inherently unethical in the ethics codes of the APA or ACA.

Multiple relationships must be managed in an ethical way to eliminate non-professional interactions and protect client well-being.

Some helpful questions:
Will my dual relationship keep me from confronting and challenging the client?
Will my needs for the relationship become more important than therapeutic activities?
Can my client manage the dual relationship?
Whose needs are being met--my client’s or my own?
Can I recognize and manage professionally my attraction to my client?
Dual Relationships
Strengths
Counselors use treatments that have been validated by empirical research
Treatments are usually brief and are standardized
Are preferred by many insurance companies
Calls for accountability among mental health professionals to provide effective treatments

Criticisms
Some counselors believe this approach is mechanistic and does not allow for individual differences in clients
Is not well-suited for helping clients with existential concerns
It is difficult to measure both relational and technical aspects of a psychological treatment
Has potential for misuse as a method of cost containment for insurance companies instead of a method of efficacious treatment for clients
Evidence-Based Practices
Theory and Practice of Counseling and Psychotherapy - Chapter 3 (5)
Biases are reflected when we:
Neglect social and community factors to focus unduly on individualism
Assess clients with instruments that have not been normed on the population they represent
Judge as psychopathological – behaviors, beliefs, or experiences that are normal for the client’s culture
Strictly adhere to Western counseling theories without considering its applicability to the client’s diverse cultural background
Multicultural Issues
Theory and Practice of Counseling and Psychotherapy - Chapter 3 (3)
Clients need enough information about the counseling process to be able to make informed choices

Educate clients about their rights and responsibilities

Provide Informed Consent
Therapy Procedures
Risks/Benefits and Alternatives
Right to withdraw from treatment
Costs of treatment
Supervision
Privileged communication
Limits of Confidentiality
Informed Consent
"We can begin wherever we choose: every expression will lead us in the same direction-toward the one motive, the one melody [one core belief], around which the personality is built."
-A. Adler
"We are motivated primarily by a desire to belong."
So what are the implications for the clients with SMI?
Does this fit for you?
The first-first session
Sticks for pairs
Tasks for the therapist:
1. Therapist greets the client
2. Therapist gives limits of confidentiality
3. Therapist gives an unstructured invitation
Client responds with a brief issue
4. Therapist summarizes and reflects
Client refines
5. Therapist refines
Cognitive messages deal with people, places, things, whereas affect messages primarily reflect feelings and emotions.

Phenomenological approaches
to counseling favor an almost exclusive emphasis on
affect
; others (
Behavioral, Cognitive Behavioral, Reality Therapy
etc.) focus on
cognitive
process.
You make choices of focus based on:
1. What you are comfortable with
2. What you find most interesting
3. Where the client needs to grow

1. Silence:
Can create a greater impact; allow things to "hang"
2. Minimal Verbal Activity:
Unobtrusive but helpful for flow
3. Paraphrase:
all/select portion of the client's comment/s but
neither adds nor detracts from the basic communication
4. Questions:
Should be open-ended
Cautions- Voyeurism/Narcissism/Sadism
5. Summary:
Is one that ties together multiple elements or key points
“Your task is to accurately
identify and respond to the part of the client’s
communication that has the greatest
bearing on the client’s concern and
is therefore most important.”
Responding to Cognitive Content can be an anxiety- reduction tool for clients (or therapists) who are easily threatened by feelings.
"Differentiation process of selective responding"
Recognizing Alternatives
Prepare a 2-part comment for the "client" to read
1. The "client" will read it aloud
2. A "therapist" will sit across and respond
3. Then, the "client" will respond.
4. Repeat
NOTICE: How you choose to respond to one alternative will shape the next remark of the client
Prepare a 2-part comment for the "client" to read
1. The "client" will read it aloud
2. A "therapist" will sit across and respond with the
assigned Cognitive Content Category
3. Then, the "client" will respond.
4. Next "therapist" will sit and respond with their assigned CCC etc.
Responding to Cognitive Content
Skinner & Bandura
A daily practice
teaches participants to relate to external and internal sources of stress in constructive ways
live in the present rather than "ruminating" on the past or being "overly concerned" about the future
Mindfulness-based Stress Reduction (MBSR)
B

belief
A

activating
event
Albert Ellis
Cognitive Behavior Modification
Beck:
Therapist uses Socratic questioning to collaborate
with client in testing
validity of their thoughts
Thoughts create problems when they interfere with normal cognitive processing, not just because they are irrational
What would Beck say about the Pharisees?

survival
physical
love and sex
status, success, and self-esteem
mental health/emotional
freedom
cognitive-clarity
Clients come to therapy with unmet needs
So we ask them/ourselves...
What concerns brought you here?
Why now?
How has this been affecting your daily functioning (ADLs)
Your role in assessing/addressing concerns:
1. Set the container: be a good listener
2. Identify and reflect needs and issues
3. Help formulate goals
4. Create action plans
5. Help them see the progress
How we do this changes with the theoretical approaches we choose
Translating vague concerns...
...into specific goals
Really seek to understand the impact the problem has on their life...how is it a problem FOR THEM (multicultural)
What would this problem look like if I were managing it better?
To reach that goal what changes would I need to make in my:
lifestyle, relationships, behaviors, accomplishments?
What have you tried so far?
What do you see as your role/my role?
Goals should be continually reassessed and "tweaked"
Pair Share
Where are you in your readiness to change?
1. Choose an issue/concern and share it with your partner
2. Identify where you are in your readiness to change
3. Explain why you think you are there and not before/after in the process
The valley of the shadow
The only way to it is through it
Lies...
Break into groups (count off by 4's)
Getting the most out of supervision
Prepare a 2-part ambivalent comment for the "client" to read
1. The "client" will read it aloud
2. A "therapist" will sit across and respond with the
assigned Affective Content Category

(simple reflection/summarization)
3. Then, the "client" will respond.
Responding to Affective Content Activity
Fishbowl tag-team
Tag-team fishbowl
1. One of the most important functions in responding to Affect is to give clients permission to feel their feelings- to allow their feelings to just be- rather than stifling, controlling, or holding them back.
2. Unexpressed emotions may have somatic implications (and cross culturally may be discussed as such)
3. Such reflections can help "clear the air"
" To live a full and connected life in the face of difficulty and even tragedy requires the capacity to feel and make use of our emotional experience."
Key points of Affective Content Reflection
Families of emotions:
Pages 107-111
1. Positive Affect- Joy
2. Anger
3. Fear
4. Sadness
Verbal responses to Affective messages:
1. Reflection of feelings
2. Summarization of feelings
Rephrases one affective part of the client's
response, and mirrors it back
Helps the client recognize and value their feelings
(vs. fear them)
Rephrases and integrates several affective components
Helps clients to wrestle with ambivalence and see themes that may point to core beliefs
(Implications for our Relationship with Christ...)
What would this therapist say about
"man-in-God's image" and original sin?
Check out: Community Genogram
Ecomap
Figure 9.1 pg 165
Figure 9.2 pg 166
Multicultural considerations

Avoidance of supervision (self-protective)
1. evaluation anxiety
2. performance anxiety
3. personal issues triggered by a client
4. deficits in the supervisory relationship
5. anticipated consequences
6. shame re: mistakes
"But I'm getting worse!"
1. The Lay Helper phase
2. The Beginning Student phase
3. The Advanced Student phase
4. The Novice Professional phase
5. The Experienced Professional phase
6. The Senior Professional phase
Basics of supervision
Be prepared for Supervision
1. Be caught up on your notes
2. Be respectful of the supervisory hour
3. Review your tapes/notes ahead of time and be
ready to talk about challenges/stuck points
4. Actually TRY what they suggest
5. Be aware of what you are NOT talking about- get curious
Tag team fishbowl
Behavior
Consequence
"Cultural Humility" Handout
"You feel
disappointed
because
this class is only 16 hours."
It
doesn't
work when you respond with...
Reflections on Shame
Discuss (5min)
Pair Share
"How was I impacted by this video

and

what does that tell me about
my relationship with shame?"
“The psychoanalysis of individual human beings, however, teaches us with quite special insistence that the god of each of them is formed in the likeness of his father, that his personal relation to God depends on his relation to his father in the flesh and oscillates and changes along with that relation, and that at bottom God is nothing other than an exalted father.”
Handout
5min, then switch
The second shot at a first session
Rock-paper-scissors Tournament of Champions!!!
Tasks for the therapist:
1. Therapist greets the client
2. Therapist gives limits of confidentiality
3. Therapist gives an unstructured invitation
Client responds with a brief issue
4. Therapist summarizes and reflects
Client refines
5. Therapist refines

"B's": Give a brief summary of a time in your life when you felt brave.

"A's": Repeat what "A" said in your own words in 2 -3 sentences then give a feedback statement. This time,
NO QUESTIONS or DISCLOSURE from the "therapist"

"B's": Refine it.

"A's": Refine it.
3min
RESPOND: "How was that?"
Elbow Partners
Empathy Skills Preview II.
5 categories of content response:
"If I don't turn my paper in on time, my life will be ruined"
"My professor didn't say hello to me this morning- I know she hates me...in fact, everyone hates me"
"I am a terrible student because I didn't turn my paper in on time."
"My intervention in the fishbowl activity was proof that I am a danger to the field of mental health"
"Did you see the way my professor was looking at me? She knows I was out partying last night."
"I am not going to make it as a grad student because I don't understand cognitive distortions"
"Truth is never revealed all at once, but petal by petal."
W

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6 major topics for clinicians to evaluate in assessing potential violence:
(1) the presence of attitudes that support violence, (2) the client’s capacity of means to carry out violence,
(3) the crossing of a threshold toward violence such as purchasing a gun or breaking a law,
(4) the presence of an intent to carry out an action, (5) the responses of others to the client’s plans, and (6) the degree of client compliance with professional recommendations to reduce risk.
Full transcript