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COUC 715: Applied Counseling Theories

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Lisa Sosin

on 14 September 2014

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Transcript of COUC 715: Applied Counseling Theories

Interview and Introduction Guide (Write these questions down):

1. Tell me something about you in each of these areas: bio-psycho-social-spiritual.
2. What do you do in the counseling field?
3. What do you hope to gain from this class?
4. Come up with a mutually agreed upon definition for the term Grace and the term Truth. How do these relate to human functioning?
The Way the Week Will Go

Intermittent Teaching
Intermittent Experientials/Application
Intermittent Presentations (Student and Video)
Intermittent Processing
Intermittent Seeking God's Wisdom and Presence (albeit it is appreciated if you seek this continually)
Try not to get overwhelmed, it will all come together in the end. PRESENTATION GUIDELINES:

1.Hand-outs: (a). Outline of presentation; (b.) Up to date references and web-sites so your audience can learn more (APA style; error free).

2.Topics to cover in your Hand-out: (a). Clear, concise, and thorough description of the most relevant and important details related to this model and techniques; (b). Discussion of how a Christian worldview and spiritual integration relate to your topic; (c) An example of an intervention (role play, assessment, intervention, etc.) related to your topic (something we can do,learn, and put in our toolbox).

3.MOST OF YOUR PRESENTATION MUST BE DEVOTED TO THE EXPERIENTIAL ACTIVITY; everything else should be on your hand-out (in other words, briefly review the highlights from your hand-out (no more than 5-10 minutes) and reserve the rest of the time to teaching us (experientially: let us do it or see you demonstrate it) how to do something important and helpful from this model (20 minutes).

4.No more than thirty minutes for the entire presentation
Theories and Their Primary Focus

Cognitive: Thoughts
Behavioral: Actions
Experiential: Feelings
Biopsychosocial: Biology
Psychodynamic: Interpersonal Patterns
Systemic: Social Systems
Multicultural: Cultural Contexts
(Brooks-Harris, 2007)

In your treatment plan with your partner, when you choose treatments to meet goals, clarify the model they orginate from. The research is clear. Good psychotherapy works and the emerging paradigm is integrative therapy with an emphasis on common factors.

"... and the tools we use are continually being refined to constantly improve effectiveness. In reality, however, not all counselors are good helpers, and not all use the best and most efficient methods. Although helping can and does work, there is plenty of evidence that ineffective helping also abounds. Helping is a powerful process that is all too easy to mismanaged…"
(Clinton & Ohlschalger, 2002) The new paradigm: Research based/common factors/ effectiveness model

Providing a healing relationship
Instilling hope
Goal consensus
Imparting needed knowledge
Facilitating emotional arousal leading to greater insight and increased motivation to change
Facilitating constructive behavioral change
Adapting the therapeutic relationship to the individual client
Consideration of client expectations, preferences, and motivation
Effective after care planning Goals of this course:

Gain a thorough understanding of counseling theories and their relevance for guiding the therapeutic process.

Appreciate contributions from various theoretical approaches to the actual practice of counseling.

Heighten effectiveness in formulating treatment strategies and in aiding in the delivery of powerful interventions in an efficient and timely manner.

Develop a personal bio-psycho-social-spiritual model that includes ethical and effective assessment, treatment planning, and treatment.

Ethical and Effective Treatment includes:
Collaborative bio-psycho-social-spiritual comprehensive asssessment
Collaborative formulation of case conceptualization(including written evaluation & multi-axial DSM diagnosis)
Collaborative formulation of counselee goals in simple, measurable format
Collaborative establishment of treatment plan based on best practices
Collaborative and continual evaluation of plan until goals are met
Collaborative formulation of aftercare plan
Strategies of Cognitive Therapy

•Impact of Thoughts
•Modifying Beliefs
•Self Talk
•Reinforcing Adaptive Cognitions
•Irrational Thoughts
•Realistic Constraints
•Core beliefs
•Brainstorming Solutions
•Evaluating Evidence
•Testing Hypotheses
(Brooks-Harris, 2007) Strategies of Behavioral Therapy

•Impact of Actions
•Reinforcement & Conditioning
•Behavioral Baseline
•Target Actions
•Active Choices
•Motivation for Change
•Schedules of Reinforcement
•Assigning Homework
•Constructing a Hierarchy
•Skills Training & Rehearsal
•Systemic Patterns
•Intervening Strategically
•Focus on Solutions
(Brooks-Harris, 2007)


CBT for Anxiety in Adolescents


Adult ADHD Strategies of Experiential Therapy

•Identifying Feelings
•Impact of Feelings
•Expressing Feelings
•Irrational Thoughts
•Realistic Constraints
•Core beliefs
•Brainstorming Solutions
•Evaluating Evidence
•Testing Hypotheses
(Brooks-Harris, 2007):

Psychodrama an example of affective expression (clips):


Les Greenberg: Emotion Focused Therapy:

http://www.youtube.com/watch?v=QpbmxHBWJqM&feature=related Strategies of Psychodynamic Therapy

•Listening to Narratives
•Free Association
•Relationships Themes
•Interpersonal Interpretations
•Honoring Resistance
•Childhood Experiences
•Working Through Past
•Attachment Styles
•Therapeutic Relationship
•Subjective Responses
•Resolving Conflicts
•Modifying Interactions
•Interpreting Dreams
•Interpersonal Losses/Disputes
•New Relationships
(Brooks-Harris, 2007) Multicultural Therapy

•Viewing Clients Culturally
•Clarifying the Impact of Culture
•Creating Culturally-Appropriate Relationships
•Celebrating Diversity
•Illuminating Similarities and Differences
•Recognizing the Impact of Identity
•Facilitating Identity Development
•Appreciating Multiple Identities
•Highlighting Oppression and Privilege
•Exploring Societal Expectations
•Supporting Social Action
•Integrating Spiritual Awareness
•Becoming Aware of the Therapist's Worldview
•Reducing Cultural Biases "Accountability is now a primary principle of professional practice--a principle more important than theory congruence or philosophical allegiance" (Sexton, Schofield, & Whiston, 1997)

No best theoretical approach
Common factors (30%): relationship factors, learning (affective experiences/corrective emotional experiences and skill acquisition), action, and counselor factors (competence, cognitive complexity, relational attunement, case conceptualization skills, competently applying protocols that increase succcess)
Factors outside of counseling (40%)
Client expectations (15%)
Specific techniques (15%) (Sexton, 1999) APPLIED COUNSELING THEORIES: Grace and Truth for Therapeutic Journeys Basic Principles

Strong therapeutic relationship most important (high levels of attending, listening, empathy, and respect; continual outcome assessment throughout treatment)
Brief for about 50-60%; longer term for 20-30% (acute symptoms: approx. 5 sessions; chronic: 14 sessions; personality disordered: 31 sessions)
Effective self and client monitoring
Relapse plans
Client variables and motivation
Use of practice guidelines and research based protocols Integrative Theoretical Stance

Knowing each theory well
Sifting each theory through a biblical grid
Bio-psycho-social-spiritual assessment, written evaluation, treatment plan, assessment, follow-up. Partner Project

1. Partners/Guys in group of three
2. Select a DSM Diagnosis you are interested in gaining more mastery treating
3.Components of the Project:
Sample Psycho-Social Evaluation
Written evaluation
Multi-axial diagnosis (all five)
Evidenced-based treatment plan
5. Due Thursday: One hard copy (You will have some classtime for this project)
6. Thursday: Collaborative discussion Process of Effective Work: COLLABORATIVE Assessment, case-conceptualization, comprehensive, written evaluation culminating in multi-axis DSM diagnosis, written treatment plan, ongoing assessment, aftercare plan.

Practice Guidelines for the Psychiatric Evaluation of Adults:
American Psychiatric Association Practice Guidelines for Effective Interviewing.

Patient interview
Use of collateral sources
Use of structured interviews and rating scales, including functional assessments
Use of diagnostic tests, including psychological and neuropsychological tests
Physical examination
Working with multidisciplinary teams
Clinical formulation
Cultural formulation (inlcuding spiritual/ethnic/cultural assessment)
Risk assessment
Differential diagnosis based on evaluation
Formulating an initial treatment plan BASED ON CLIENT GOALS
Making decisions regarding treatment-related legal and administrative issues
Consideration of systems issues
Special considerations regarding privacy and confidentiality, interactions with third-party payers and their agents, legal and administrative issues in institutions, special populations

American Psychiatric Association (APA). (2006). Practice guideline for the psychiatric evaluation of adults. 2nd ed. Washington (DC): American Psychiatric Association. Two Ingredients for healthy development from the cradle to the grave

Grace (in the form of unconditional, consistent love)
Truth (security: authority, structure, rules, limits)
Healthy brain development is dependent on the steady input of these two factors.
Our primary needs as human beings are for (unconditional) love and (eternal) security. This is the fuel we need for flourishing, the ingredients of “secure attachment.” The Developmental Ladder: Six Core Social-Emotional Processes

Regulation and Shared Attention (FELT SECURITY)
Engagement with warmth, trust, intimacy (ATTACHMENT)
Interactive problem-solving/use of gestures in continuous flow
Functional use of ideas (REPRESENTATION)
MATURITY= The ability to LOVE (including the ability to speak the truth in love) AND WORK (individuated yet interdependent, authentic expression of God-made self)richly and authentically. From an “autistic” state to human connection
From dis-regulation (biological processes) to regulation (wake, eat, interest, sleep)
Waking becomes interest and connection (attachment)
Gestural unrepresented communication (the self emerges). These stages are pre-representational and often key to the experience of intolerable emotional states.
Representation of the self via explicit communication. Continual maturation of attachment and individuation (the ability to work and love)

It is not just what the caregiver brings that creates the internal working models. It is far more complex than that! Special Needs Require Sensitive Environments

Individual differences exist in:
Sensory processing: organize sensory input from the body and the environment
Environmental Cues: Sights, Sounds, Taste, Smell,
Internal Senses: Touch, Balance (vestibular), Body Posture, Body Awareness (proprioception)
Sensory modulation: modulate/regulate the sensations
Over-reactivity or under-reactivity
Motor planning: execute plan and ideas into action
Sequencing: sequence one behavior (or thought) to another
Development can be hugely impacted by these individual differences: attachment and parenting, school experiences, relationships with peers. Unaddressed, the developmental trajectory can be very unfortunate (e.g., untreated ADHD) Healthy Development Requires Interactive Relationship:
physical, language, cognitive, emotional and social relationship

This relationship needs to be characterized by

Warm & Secure
Back and forth emotional signaling & gesturing
Shared problem solving
Using ideas in a meaningful & functional way
Requiring thinking & reasoning

As we provide these conditions within the therapeutic relationship, development has the potential to get back on a normal trajectory It (development) is a natural, God ordained process.
Imprinting and the brain, the experience of outside is what comes inside.
Internalization of the affective experience
Internalization of voices with increasing representation
Secure and sensitive relationship facilitates the falling away of distortion (when I was a child I thought as a child…); “disciple-ing”
Moving up the developmental ladder depends on experiencing the right balance of grace and truth during every stage of development
After about 18 years of receiving the right balance of grace and truth in the family oven a person should be fairly well baked and ready to love and work in the larger adult world.For a variety of reasons, it doesn’t always happen that way…
What we do as therapists is one way developmental psychopathology can be addressed Summary: Growth up the developmental ladder is natural and dependent on the felt experience of secure attachment (the provision of the right balance of grace and truth) beginning in infancy and continuing through-out development (from the cradle to the grave).

Psychopathology occurs when normal bio-psycho-social-spiritual (any or all) development goes awry, for a variety of reasons that are complex and complexly related.

The following realms are complex and complexly related as well.

Individual Sensory Processing Style
Unresolved Grief and Trauma (the experience of being terrified and alone; never "unpacked")
Unique God-made personhood
The Fall (including influences from the world, the flesh, and Satan on biological functioning)
Attachment System
Internal Working Models
Unresolved Grief and Trauma
Unique God-made personhood
The Fall (including influences from the world, the flesh, and Satan on psychological functioning)
Interpersonal history and internal working models
Present interpersonal attachment system
Social Matrices (including ethnicity, race, and culture)
Unresolved Grief and Trauma
Unique God-made personhood
The Fall (including influences from the world, the flesh, and Satan on social functioning)
God Construct
God Image
History of God Attachment
Present God Attachment
The Fall (including influences from the world, the flesh, and Satan on spiritual functioning)

Safe place, prayer, inward focus, notes on these areas, class discussion... What about you and your personal development? ...since maintaining the consistency of the emotional relationship is critical to effective work in counseling (especially the traumatized and AXIS II conditions) we have an ethical responsibility to know ourselves, that is our triggers and that which causes us to move away emotionally, leaving our counselee alone in their feelings (retraumatized) Exploring Personal Developmental Experiences

Turning points and significant experiences: Lessons
Significant Formative relationships: Lessons
Identity variables: gift mix, your calling, your personality, your temprement, interests and passions in life; the things that make you, you.
Painful experiences: Lessons
Positive, life giving people: Lessons
The Opposite of positive people: Lessons
Traumas; wounds: Lessons
Future aspirations and goals: Lessons
Scripture Life Verse Supporting Others Up the Developmental Ladder: Characteristics of Attachment

In her dissertation entitled “Evaluation of Adjustment Based Upon the Concept of Security,” Mary (Salter) Ainsworth (1940) states:

Familial security in the early states is of a dependent type and forms a basis from which the individual can work out gradually, forming new skills and interests in other fields. Where familial security is lacking, the individual is handicapped by the lack of what might be called a secure basefrom which to work (p.45).

Early parent-infant interactions (attachments) are thought to create a foundation for future interactions and behaviors (Grych & Fincham, 2001). There is substantial evidence that children with secure attachments in childhood develop more positive social-emotionalcompetence, cognitive functioning, physical health and mental health, whereas children with insecure attachments are more at risk for negative outcomes in these domains (Fonagy, Steele & Steele, 1991; Grossman & Grossman 1991; Grossman, Grossman, Main, Kaplan & Cassidy, 1985; Grossman, Grossman & Waters, 2005; Ranson & Urichuk, 2008; Steele & Steele, 2008 Waters, Hamilton, Weinfield, 2000; van IJzendoorn, 1995; Waters, 2001; Winter & Zimmerman, 2002). (Gillies, 2012, unpublished manuscript) ...AND...
Create a plan to access security in your inner most parts
so that you can remain fully emotionally connected, present, and in relationship (not reactionship) if/when YOU get triggered during a session. Good to practice this with family members and close friends too.

When triggered we move AWAY from intolerable emotional states (e.g., anxiety, guilt, shame). When we do that with counselees we potentially retraumatize because they are once again in terror (or the coping affect: anger, depression, disassociation, acting out) and ALONE. Biblical Adaption of Allen's (2001) Trauma Model Much of the symptoms folks come into therapy with are these coping behaviors. Our relationship becomes the context in which they learn that they can tolerate these emotions when not alone with them, put them into words, and then choose how to manage them from their cortical regions not their amygdala (fight, flight, or freeze and their hippocampal/limbic regions (visceral flashback states) Brain to Brain... Deeper Assessment Attachment and God Image "Research in the areas of attachment, affective neurobiology, and emotional information processing indicates that the infant’s experience of patterns of infant-caregiver emotional communication are internalized by infants and serve as templates for interpreting subsequent interpersonal interactions and organizing their characteristic approaches of relating to self, others, and God."
(Noffke & Hall, 2007)

"The perceptions of the self and others and the interactional patterns that infants develop to maintain felt security are represented in self-perpetuating neural networks that are automatically and non-consciously elicited by attachment related stimuli with God."
(Noffke & Hall, 2007)

How does this neurobiological fact relate to spiritual integration in counseling? "The psychological processes and mechanisms that automatically and unconsciously mediate how individuals process emotional information with humans also influence the form and quality of their relationships with God (“the psycho-spiritual unity of personality”). " (Benner, 1998) "Individuals with insecure attachment histories tend to perceive God as controlling, less nurturing, or distant.
Internalized forms of non-contingent emotional communication not only produce negative images of God but also result in an impaired sense of security, prompting the insecure to rely on maladaptive , compensatory strategies to re-establish homeostasis.
Often these painful experiences of God remain unconscious."
(Noffke & Hall, 2007) I AM SAFE AND LOVED (experience): from brain stem to frontal lobes…Explicit interventions will often not make an impact on core schemas related to God, self, and others. In order for individuals to develop more positive images of and relational patterns with God it is necessary to create new neural networks that correspond to experiences of others as available and responsive and of the self as loved. I keep asking that the God of our Lord Jesus Christ, the glorious Father, may give you the Spirit of wisdom and revelation, so that you may know him better. I pray also that the eyes of your heart may be enlightened in order that you may know the hope to which he has called you, the riches of his glorious inheritance in the saints, and his incomparably great power for us who believe. That power is like the working of his mighty strength, which he exerted in Christ when he raised him from the dead and seated him at his right hand in the heavenly realms, far above all rule and authority, power and dominion, and every title that can be given, not only in the present age but also in the one to come.
(Eph 1:17-21) God Construct and God Image: What you know about God and what you FEEL or experience with God.

Relaxation and internal focus
Depict what you know about God regarding being wanted, chosen, safe and loved.
Now focus inward and remember a time when you felt intensely ashamed, angry, or frightened.

Share. Concentric Circles Assessment Does Psychotherapy Really Work? Yes, the research evidence is in that
GOOD psychotherapy really works... Applied Theory= The Skilled Application of Empirically Supported Psychotherapeutic Treatments
Synaptic connections can be permanently altered and strengthened through the regulation of gene expression when psychotherapy is well-conducted (Kandal, 1998). The brain and medication: (bottom up). The brain and psychotherapy: (top down).Discerning best treatment: medication, psychotherapy, or both? (Developmental trauma responds best to psychotherapy).The therapeutic relationship is the cornerstone of all effective treatment . Promoting Growth in Therapy:
Becoming an anchor for the undeveloped and/or traumatized, and/or grieving soul...
Abiding in Christ and allowing God to do great and wonderful things that we could not ask for or even imagine.
Assisting the counselee in climbing up the developmental ladder
Increasing mentalization across all affective themes
Excellence in bio-psycho-social-spiritual assessment, treatment planning, and treatment provision. Mentalization is the ability to understand feelings, cognitions, intentions and meaning in oneself and in others. The capacity to understand oneself and others is a key determinant of self-organization and affect regulation, and is acquired in early attachment relationships. Development is God spoken and pre-ordained. Given the right circumstances, it will happen naturally. “Not by might nor by power, but by my Spirit, ”says the LORD Almighty…
(Zech 4:6) Syllabus Review: Post Course Assigment Guidelines The Importance of Ethical and Effective Assessment: Before we can "apply theories" we must have a full bio-psycho-social-spiritual understanding of the person(s) coming into treatment.

Before looking at components of ethical and effective assessment, let us ground ourselves in the biblical narrative. We will also expand on this in COUN 720, when we look at systemic foundations for clinical work.

Consider these terms:
1. Creation/Life
2. Fall/Death
3. Reconciliation/New Life
4. Resurrection/Glorified Life

Using the hand-out and working in a small group or with a partner relate each of these aspects of His Story to the terms listed. How do these biblical concepts relate to goal work with the folks He brings our way?
Hanna Levenson

Time-Limited Dynamic Psychotherapy Making Every Session Count Donald Meichenbaum
Mixed Anxiety and
Depression: A
Cognitive-Behavioral Approach

http://ctiv.alexanderstreet.com.ezproxy.liberty.edu:2048/view/536314 Experiential Spiritual Assessment
1. Accessing God the experience of God's unfailing love and presence
when untriggered.
2. ...when triggered
3. Draw
4. Share Order of Presentations

1.Model and Techniques of Psychodynamic and Brief Psychodynamic Psychotherapy:
2.Theory and Techniques of Cognitive-Behavioral Therapy: LUIS
3.Theory and Techniques of Interpersonal Psychotherapy GRACE
4.Theory and Techniques of Supportive Psychotherapy MIK
6.Theory and Techniques of Emotionally Focused Couples Therapy: An Attachment-Based Treatment RYAN
7.Theory and Techniques of Psychodynamic Couples Therapy: An Object Relations Approach SHANNA
8.Theory and Techniques of Behavioral Couples Therapy
9.Theory and Techniques Psychodynamic Group Therapy: Suzette
10.Family Interventions for Psychotic and Mood Disorders TIFFANY
11.Group Cognitive-Behavioral Therapy for Chronic Pain HEATHER
12.Theory and Practice of Psychotherapy Integration NANCY

15.Brain Processes Informing Psychotherapy SALLY (third)

Biopsychosocial Psychotherapy

Biopsychosocial Psychotherapy focuses on biology, connecting body and brain.
Biological approaches include health psychology, psychiatry, and body therapies.
Biopsychosocial strategies encourage adaptive health practices that result in biological health, holistic wellness, and mind-body awareness (Brooks-Harris, 2007) Become a Developmental Expert Systemic Therapy

Systemic-Constructivist Psychotherapy focuses on family systems, social groups, and personal narratives.
Systemic strategies encourage adaptive social practices that allow individual growth and individuation without threatening the stability of the family system.
Constructivist strategies encourage adaptive personal narratives that construct meaning in a way that matches a person’s experience and supports positive action (Brooks-Harris, 2007)

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