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Chapter 4: Traditional and Contemporary Theories of Counseli

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Krystin Jolly

on 22 June 2015

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Transcript of Chapter 4: Traditional and Contemporary Theories of Counseli

Chapter 4: Traditional and Contemporary Theories of Counseling
Overview
Traditional Theories of Counseling and Psychotherapy
Psychoanalysis
Individual Psychology
Behavioral Therapy
Cognitive Approaches
Humanistic Therapies and Existential Theory
Narrative Therapies
Feminist Therapy
Family Therapy
Contemporary Trends in the Application of Counseling Theory
Traditional Theories of Counseling
Psychoanalysis
Individual Psychology
Behavior Therapy
Cognitive Approaches
Humanistic Therapies and Existential Theory
Feminist Therapy
Family Therapy
Spirituality in Counseling
Spirituality and clinical practice have been at odds for years
The counseling profession recognizes that spirituality and counseling has made a comeback
Spirituality is an integral aspect of the whole person
Counselors' increased appreciation of social and cultural diversity includes religion
Many counselors incorporate spiritual concepts and techniques into counseling practice
Biologicalization of Psychopathologyand Human Behavior
All aspects of human behavior are being explained in biological terms
Is criticized for overemphasizing medical intervention to treat emotional and psychological problems
Many counseling practices affected by the biologicalization of human behavior
Creation of managed care organizations force counselors to be accurate in diagnosis and treatment planning
Integration of mind-body connection into their practice
Contemporary Economic Context
Understanding the economic context in which counseling services are affected
Previously- one to one, office-based services, no restrictions on sessions
Costs for mental health services are higher than many people are willing or capable of paying
CMHC's are competing for limited mental health funding
Krystin Porter, M.A., LPC-Intern, LMFT-Associate, NCC
Supervised by Judith DeTrude, PhD, LPC-S, LMFT-S

Conceptualization
Conceptualization is an essential part of counseling. Several inferential errors can occur that that distort assessment and implementation of treatment strategies.
Single-Cause Etiologies
This error occurs when we select one cause for the client's problem while dismissing all other potential alternatives
(Stevens & Morris, 1995)
Availability of Heuristics
When a particular theory remains in our conscious and becomes the lens through which we interpret all new information (Myers, 2010). The risk is that we may use the most available model rather than the one most relevant.
(Stevens & Morris, 1995)
Fundamental Attribution Errors
We explain our own behavior in terms of situational characteristics (Myers, 2010; Ross, 1977). We explain the behaviors of others in terms of personal characteristics.
(Stevens & Morris, 1995)
Illusory Correlations
Perceiving two independent events occurring together in time as being related (Myers, 2010).
(Stevens & Morris, 1995)
Cautions
Verbal agreement does not equal validity
Due to common errors, we can be too confident in conceptualizing
Ask questions that confirm or deny your working hypothesis
Consider opposing ideas and put them to the test
Psychoanalysis
(Freud, 1856-1939)
Two Basic Assumptions
Everything we do, think, or feel has meaning and purpose. Everything we do relates to fulfillment.
Most human behavior stems from urges that are beyond our general awareness; unconscious motivation
Levels of Awareness
Conscious: sensations, thoughts, feelings, and behaviors that a person is aware of at any given moment
Preconscious: memories of past events, related facts, and associated thoughts that were not in the person's awareness at the time, but are easily accessible now
Unconscious: reservoir of urges, wishes and conflicts that threaten to overwhelm the conscious and are pushed out of awareness
Structure of Personality
Id: instinctual urges; operates according to the pleasure principle
Ego: rational problem solver
Superego: reflection of the values of society
The Role of Anxiety
Concept is central to psychoanalytic theory
Used by the ego as a symbol of impending danger and a call for action
Neurotic anxiety is the emotional response to the threat
Defense Mechanisms
Repression
Regression
Projection
Displacement
Rationalization
Reaction Formation
Denial
Sublimation
Object Relations
Only about 2% of practicing counselors embrace classical psychoanalysis
Larger population practice modified versions such as object relations
Focuses on the relationships between the self and others
We tend to represent others mentally in ways that resemble our earliest relationships; typically caregivers
The ways infants relate to primary caretakers
Individual Psychology (Adlerian Therapy)
Six Assumptions
Behavior is goal oriented, purposeful and socially motivated
Behavior is best understood from the vantage point of the client's subjective reality
Personality is an organized whole that interacts within a specific and unique social system
The core motive for behavior to strive for superiority
Each person develops a cognitive map, or lifestyle, that lends consistency to their behavior
Humans find personal fulfillment and well-being by acting for the general social interest
Goal of Treatment
The fundamental goal of Adlerian counseling is to help clients live a more complete life in ways that contribute not only to personal well-being but also to the general well-being of others
Techniques
Acting as if: suggesting a limited task in which clients act as they would wish to but feel incapable of
Spitting in the client's soup: reframing behavior as to make it undesirable
Paradoxical intention: increasing clients' awareness of their ineffective behavior by prescribing an increase in the display of the symptom
The question: "What would be different if you were well?"
Catching oneself: once aware, clients are asked to consciously monitor the behavior they wish to change
Family Therapy
Feminist Theory
Humanistic and Existential Theory
Cognitive Approaches
Behavior Therapy
Key theorists: Ivan Pavlov and B.F. Skinner
Goals of Behavior Therapy
Behaviorists view pathological behavior as being learned and see maladaptive behavior as being the problem
Targets of counseling are typically thought to be part of one or several of the following categories:
Behavioral deficits
Behavioral excesses
Inappropriate environmental stimulus control
Inappropriate reinforcement contingencies
Cognitive approaches began to develop in the mid-1960's
Main idea is that behavioral and emotional change is best accomplished through interventions that seek to alter the client's cognitive style
Albert Bandura developed a framework that has become known as the "second wave" of behavioral therapies, cognitive-behavioral revolution
Key Theorists
Albert Ellis, Aaron Beck
Key Concepts
Cognition is the target of many of the interventions
Cognition takes the form of cognitive structures or self-schemas
Schemas play a critical role in CT because they introduce bias and cognitive distortion
Cognitive distortions lead to the misinterpretation of events; ex:
Arbitrary inference- conclusions without supporting evidence
Selective abstratction- focusing on one point while ignoring or discounting other information
Overgeneralization- developing a general rule based on only a few events or facts
Magnification or minimization- exaggerating or underestimating the significance of an event
Personalization- relating events to yourself when there is no reason to do so
Dichotimous thinking- events are placed in two opposite and exclusive categories
Third Wave of CBT: Mindfulness and Acceptance-Based Therapies
Acceptance and Commitment Therapy (ACT)
Dialectical Behavioral Therapy (DBT)
Acceptance and Commitment Therapy (ACT)
Contextual cognitive behavioral therapy is designed to increase personal flexibility by helping clients to fully experience and embrace their present emotional experience while assisting them to move in self-selected, personally valued directions
Psychological pain is normal, important and everyone has it
You can't deliberately get rid of psychological pain, but you can take steps to decrease it
Pain and suffering are two different states of being
You do not have to identify with your suffering
Accepting the pain is a step toward ridding yourself of suffering
You can live a life of value, beginning right now
Dialectical Behavioral Therapy (DBT)
Originally developed to treat females with borderline personality disorder and hx of self-destructive behaviors
Assumptions of BPD clients:
They are doing the best they can
Clients want to improve
Clients need to do better, try harder, and be more motivated to change
Clients may not have caused all their own problems, but they have to solve them anyways
The lives of suicidal borderline individuals are unbearable as they are currently being lived
Clients must learn new behaviors in all relevant contexts
Clients cannot fail in therapy
Therapist of borderline clients need support
Key theorist: Carl Rogers (1902-1987)
Person-centered has been one of the most prominent theories
Rejected psychoanalytic theory and developed an approach based on the "goodness of humanity"
Approach is truly person-centered, not theory centered
Main concepts: actualizing tendency, unconditional positive regard, congruency
Goal: Increase the degree of congruence between oneself and one's experience
Process and Techniques
Rogers did not adhere to a specific set of interventions
Core conditions
Six specific characteristics for change:
Psychological closeness within the context of a meaningful relationship
Client experiences vulnerability and is in a state of incongruency; client is motivated to stay in the relationship
Counselor is congruent and genuine
Counselor has unconditional positive regard for the client
Counselor has an accurate empathic understanding of the client
The client perceives unconditional positive regard and empathic understanding from the counselor
Narrative Therapy
Shaped by the post-modern paradigm
Key theorists: Insoo Kim Berg, Steve DeShazer, Michael White, David Epstien
Clients have personal stories that they tell in present that have shaped their past
Client's story is their reality
Goal: Personal narrative construction or repair
The target is the story, not the client or the family
Technique: telling the story, reconstruction or reauthoring of the story
Key theorists: Jean Baker Miller, Carolyn Zerbe Enns, and Olivia Espin
Rooted in pluralism and the women's movement of the 1960's
Sexism, racism, classism, and monoculturalism are harmful to a person's well-being
Women learn to value their female characteristics
Goal: To empower clients while advocating for societal change; not only personal, but institutional change
Goals: Symptom removal, enhancement of self-esteem, increased quality of personal relationships, internal locus of acceptance of body and sexuality, increased value of diversity, increased political awareness and social action
Techniques: Positive self-evaluations, assertiveness training
Basic assumptions of family therapy
Family functions as a system
Circular causality provides more accurate explanations of behavior and emotional response
Persons must be viewed within the context of their family
The whole is greater than the sum of it's parts
Individual disorders are viewed as family disorders
Pathology serves a family function
Boundaries are emotional barriers that protect the integrity of individuals and subsystems; Enmeshment occurs when individuals or subsystems lose autonomy due to a blurring of boundaries
Triangles are a three person subsystem that are the smallest stable emotional unit
Bowenian Family Therapy
Main goal: Strengthen a client's intellectual functioning while decreasing emotional reactivity
Minuchin's Structural Family Therapy
Families are governed by their structure
Counselor picks up on covert family rules, alliances, patterns of behavior
Hierarchy exists and serves as structure in the family
Main goal: establish effective hierarchical structure within the family; the parents must serve as an executive coalition
Haley's Strategic Family Therapy
Referred to as brief problem-solving therapy because it is problem-focused
Cognitive approach to the assessment of family problems
Makes no attempt at promoting family insight
Goal: solve the presenting problem
Technique: assign the symptom, paradoxical intention (do not try and solve the problem)
Emotionally-Focused Therapy (EFT)
Key theorist: Sue Johnson
Integrates attachment theory, systems theory, humanistic experiential theories' emphasis on emotion in session to promote change
Main goal: understand the presenting dysfunctional pattern of interaction in terms of attachment and help families reconnect with each other; increased emotional self-regulation
Important questions to ask in regards to community mental health:
What theory and set of techniques works best and for whom?
How many sessions are required to treat this specific condition?
Is the specific client served well by the traditional 45-min hour format?
Could other formats be more effective and cost efficient?
Can you demonstrate the necessity of each session?
Are you using a form of treatment that has demonstrated efficacy for the specific presenting problem?
Full transcript